Maternity Flashcards
What weeks are first trimester
Week 1-13
What are the 3 signs of pregnancy
- Presumptive
- Probable Signs
- Positive Signs of pregnancy
What are the S/S of Presumptive signs of pregnancy
Amenorrhea
N/V
Frequency- very 1st signs
Breast tenderness r/t excess hormones
What is the name of the hormone that causes amenorrhea
Progesterone
Trying to get pregnant when should you have sex
Keep a temperature chart and anticipate when temperature is going up
Every other day
What are other conditions that can increase hcG
hydatidiform mole, drugs
What sign of pregnancy does a hcg presence indicate
probable signs
What sign of pregnancy does a goodell’s sign indicate
Probable sign and gooodell is the softening of cervix
What sign of pregnancy does a Chadwick’s sign indicate
Probable sign and it is when there is bluish color of vaginal mucosa and cervix; 4 weeks
What sign of pregnancy does a Hegar’s sign occur
Probable sign, it is when there is softening of the lower uterine segment; 2nd 3rd month
What sign of pregnancy does a uterine contraction occur
Probable sign
When does Braxton contractions occur
Through out pregnancy-good helps move blood through the placenta
What sign of pregnancy does pigmentation/changes of skin occur
Probable sign of pregnancy
What are common pigmentation/changes of skin
Linea Nigra
Abdominal striae-stretch marks
Facial chloasma (mask of pregnancy)
Darkening of areloar (around nipple)
the positive signs of pregnancy -Fetal heart beat Fetoscope Fetal movement Ultrasound
the positive signs of pregnancy
What week do you hear the doppler heartbeat
3-12 weeks
What week do you use a fetoscope
17-20 weeks
The # of times someone has been pregnant is called what?
Gravidity
The # of pregnancies someone has had and fetus has reached 20 weeks is called what?
Parity
What is viability
It’s when the baby has reached 24 and beyond weeks and the infant has the ability to live outside the uterus
Is a 20 week baby considered to be viable
No
Parity TPAL
T=Term
P=Preterm
A=Abortion
L=Living children
Naegele’s rule
1st day of the lmp, add 7 days, minus 3 months and one year
What are some client teachings regarding nutrition when pregnant
- talk about the 4 food groups
- Tell them to increase calories by 300 per day after first trimester
- Adolescents should increase calories to 500 per day after first trimester
- Increase protein to 60 grams per day
What about weight gain in the first trimester, what do you tell your patient to expect with pregnancy
You will expect to gain 4 pounds in the first trimester
What do you explain to your patient regarding prenatal vitamins
take iron even though it causes constipation
take iron with vit c
folic acid prevents neural tube defects- spinabifida
Prenatal vitamins take 400mcg/day
What do you explain to your patients regarding exercise
No high impact, only swimming and walking
No heavy or unaccustomed exercise program
No overheating
Don’t let your heart rate go above 140
With heart rate over 140 what are you worried about
Cardiac output and uterine perfusion
Should you worry about: Sudden gush of vaginal fluid Bleeding Persistent vomitting Severe headache Abdominal pain increased temp edema no fetal movement
Yes worry, its danger sign
Should you worry about: varicose veins ankle edema hemorrhoids constipation backache Leg cramps
No, it’s common
Should you worry about N/V breast tenderness frequency tender gums fatigue heartburn increased vaginal secretions nasal stuffiness
No, it’s common
What are you telling your patient about medications while pregnant
Talk to your doctor first
In the first 28 weeks how often should a client visit a physician
Once a month
In 28-36 weeks how often should a client visit a physician
Every 2 weeks
In 36 weeks how often should a client visit a physician
Weekly until delivery
Before an ultrasound what should you tell them to do, why
Drink water to distend bladder, it pushes uterus to abdominal surface
For a transvergenal u/s or prior to procedure what do you tell them to do
Void
Second trimester- what weeks
14-26
Weight gain expected, how much
Yes, 4 pounds/ month
Should your client be expecting
N/V, frequency and breast tenderness in 2 trimester
No to N/V and frequency but yes to breast tenderness
What is quickening
Fetal Movement
What is the normal fetal heart rate at 2nd trimester
120-160
Worry about fetal heart rate if?
110-120 worried and watching
Less than 110-panic
What do you teach about kegel exercise
it strengthens pubococcygeal muscles, stop urine flow and help prevent uterine prolapse
When is pregnancy considered term
37-40 weeks
What weeks are the 3 trimester in
27-40 weeks
What do you expect to assess in the 3rd trimester
- weight gain-no more than a pound a week
- monitor and report increased in BP- PIH
- Fetal heart rate-120-160
- Fetal Presentation/position
What do you use to determine fetal position/presentation and ask client to do what before doing this
Leopold Manuevers, void
If the client is having contractions when should you do leopold manuevers at?
Between Contractions
What are some signs of labor
Lightening
Engangement
Fetal stations
What is lightening
Usually occurs 2 weeks before term, when presenting part descends to pelivs- frequency is seen
What is engagement
When the largest part of the fetus is in the pelvic inlet– hopefully head
When membranes rupture we have to think what
Prolapse cord, if head is not engaged
What is fetal station
It is a measurement; measured in cm, and it measures the relationship of the presenting part of the fetus to the ischial spine of mom
What are some other signs of labor
Braxton hicks contraction Softening of cervix bloody show (Not heavy bleeding) Sudden burst of energy called nesting diarrhea rupture of membranes and sudden burst of energy
When should the client go to the hospital
When contractions are 5 minutes apart or when the membranes rupture
What are we worried about when membranes rupture
Prolapse cord
What are some of the diagnostic tests involved in pregnancy
Non-Stress Test
Biophysical Profile Test
Contraction Stress test
What are some important things to remember with Non-stress test
- want to see 2 or more accelerations of 15 b/min with fetal movement
- Each increase should last 15 seconds and recorded over 20 minus
- This test should be reactive
What are some important things to remember with a BPP
- Done in the last trimester or 32-34 weeks if high risk (maybe weekly or bi-weekly)
- Measurements are done by ultrasound
- Each one counts for 2 points
What are the BPP measurements
1) Heart rate (NST) Reactive?
2) Muscle Tone: 1 Flexion/extension
3) Movement 3 times in 30 minutes
4) Breathing at least once
5) Amniotic Fluid- enough around the baby
In 30 minues,
CST: what are some of the important things to remember
-DO this when NST was negative and with high risk pregancy: Preeclampsia, maternal diabetes,, and any condition where placental insufficiency is suspected
Why do we do a CST?
To determine if the baby can handle stress with uterine contractions
What is decelaration
It’s when the baby’s heart rate decreases due to decrease blood flow to the baby causing hypoxia
What is uteroplacental insufficiency
Late decelarations- placenta is wearing off
DO you want a positive or negative test with CST
Negative test, no late decelerations
This test is done when
28 weeks, because it can induce contraction, and this can put them in labor
With true labor we see what to contractions
Regular and increase
With true labor we see
Discomfort to back and radiates to abdomen, and pain it increases with activity
In a false labor what do you see
Irregular contractions
Discomfort to abdomen only
pain decreases with activity
How do you position a patient when receiving an epidural
Lie on Left side, legs flexed
When should an epidural be given
In stage 1 at 3-4 cm dilation
Should the client experience headache or hypotension
usually no headache but hypotention is a complication
What should we be monitoring with an epidural
BP
What do you give prior to epidural
Bolus with 1000ml of NS or LR to fight hypotention
Nursing considerations for Pitocin
- one to one care
- Be alert for complications
- Want a contraction rate of 1 every 2-3 minutes lasting 60 seconds
- it is piggy backed with main IV fluid
What are the complications related to Pitocin
Hypertonic labor
Fetal Distress
Uterine Rupture
What are the 2 types of uterine ruputre
Complete and incomplete
What are the s/s of complete rupture
The rupture goes through uterine wall into peritoneal cavity;
- Sudden sharp shooting pain(something gave way)
- s/s of hypovolemic shock due to hemorrhate
- if placenta separates, fetal heart tone will be absent
What are the s/s of incomplete rupture
tear through peritoneal wall, but not through the cavity
- internal bleeding
- pain may or may not be present
- fetus may or may not have late decels
- client may vomit
- faint
- have hypotonic uterine contractions and lack progress
- fetal heart tones may be lost
Which clients are at high risk for uterine rupture
VBAC- vaginal births after c-section
How long do you want a contraction to last when on oxytocin
1 every 2-3 minutes lasting 60 seconds
If a client is having:
- contractions too often
- they last too long
- and fetal is in distress what do you do with oxytocin
- decelerations
Discontinue it
What position should the client be in when receiving oxytocin
Any position except flat on back, but best on the side; LEFT
Do you want to pause between contractions
YES, baby is getting oxygen
With an emergency delivery what should you make sure when the baby first comes out
Keep head of baby down Dry baby Keep baby at level of uterus place on mothers abdomen cover baby
Where do you want tie the cord
one knot about 4 inches from baby’s navel and one 8 inches from baby’s navel
What should you check for in the uterus
Firmness, not boggy
In the post partal period what do you expect with vital signs
T may increase to 100.4 during 1st 4 hours
BP stable
HR- 50-70 for 6-10 days
If a person has tachycardia in postpartum what should you be thinking
Hemorrhage
What happens to the breast post-partum
They would be soft for the first 2-3 days and then engorgement occurs
What happens to the abdomen post-partum
It is soft/loose; the abdomen muscles separate- diastasis recti(Line down the abdomen) Vigourous exercise to make it go away
Is hunger common postpartum
Yes
What does the uterus do right after delivery
immediately after birth the fundus is midlne 2-3 finger breaths below umbilicus
What happens to the uterus hours after birth
It should rise to the level of the umbilicus or one FB above
What do we want the fundus to feel like post-partal
Firm
What happens if the fundas is boggy
massage until firm and check for bladder distention
How much should the fundus height descent to
one figerbreath/day
What is the proper term used when fundus descends to uterus and returns to pre-pregnancy sixe
Involution
When are afterpains seen
for 2-3 days and if mom breastfeeds
If uterus is not involuting what are we worried about
Hemorrhage
When do you see dark red color what are you thinking
RUBRA the days should be 3-4 day’s and it’s red
When do you see pinkish brown color what are you thinking
Serousa 4-10 days
When do you see whitish yellow color what are you thinking
Alba 10-28 days can be as long as 6 weeks
What size are clots ok to be
Nickel size
What should urine output be
diuresing, monitor for dvt’s and dehydration
What can you do for perineal care
- ice packs to decrease edema
- warm water rinzes
- sitz baths 2-4 times a day
- anesthetic sprays
- change pads frequently
- teach to report foul smell
- report lochia changes
What is the Peripad rule
NOT TO HAVE MORE THAN 1 PERIPAD/HOUR
Why is bonding important between baby, and parents
it develops trust. not only an emotional need but a physiological need:
stabalizes hr
improves o2 sats
regulates infant temp
conserves calories
breast changes from warm to cool to comfort infant
What do we do for breast care with breast feeding mum
- Cleanse with warm water after each feed-let air dry
- support bra
- Ointment for soreness or express some colostrum and let it dry
- Breast pads-absorb moisture after milk come in
- mother need to initiate breast feeding asap after birth
- mum can pump
- increase calories intake by 500 calories
- 8-10 8 ouncesglasses of fluid a day
What do we care for non-breast feeding mom’s breasts
- Ice packs, breast bonders, chilled cabbage leaves
- chilled leaves decrease inflammation and decrease engorgement
- no stimulation of breast
What are some complications related to post-partal period
- Postpartum infection
- postpartum hemorrhage
- mastitis
With early hemorrhage what 2 things must be true
more than 500cc of blood lost in the first 24 hours and 10percent drop from admission hematocrit
What is considred late postpartum hemorrhage
after 24 hours up to 6 weeks postpartum
What does uterine atony, laceration, retained fragments and forcep delivery cause
postpartum hemorrhage
What does oxytocin, methylergonovine laeate and carboprost Tromethamine used for
halt excessive postpartum hemorrhage
What bacteria causes mastitis and when does it occur
Staphylococcus and occurs 2-4 weeks
Is Penicillin okay to use when breastfeeding
Yes
Which breast should the mom offer to baby first if mastitis
Affected breast first
What do you need to do right away for newborn care
Suction Clamp and cut the cor maintain body temp Apgar score 1-5 mins from delivery (Hr, R, muscle tone, reflex irritability, color) Erythromycin Phytonadione
What is erythromycin used for
Prophylaxis for Neisseria gonococcus, will also kill growing STD chlamydia
What does Phytonadione aquamephyton used for and given where
Promotes formation of clotting factors, vastus lateralis
Cord care
Dries and falls off 10-14 days
cleanse with each diaper change and use alcohol or normal saline
Fold diaper below cord
no immersions until cord falls off, watch for infection
What are some complications related to newborns
1) Hypoglycemia
2) Pathologic Jaundice
3) Physiological Jaundice
4) Rh Sensitization
Which babies are at risk for hypoglycemia
-Larger for gestatiional age
-smaller for gestational age
-preterm
-diabetic mum babies
Not getting glucose from mom
When does pathological jaundice occur and what does it mean
in the first 24 hours, usually means Rh/ABO incompatibility
When does physiological jaundice occur and what does this mean
After 24 hours, and it is due to normal hemolysis of RBC releasing bilirubin, or liver immaturity
What must occur to have an RH sensitization
- Rh- mum and Rh+ fetus
- mums blood comes in contact with baby’s blood when placenta separates
- occurs at miscarriage, amniocentesis or when trauma to mom’s abodmen
- mom produces antibodies agains baby’s RH
Is the first offspring affected by Rh factor
No
What happends in the second pregnancy
The antibodies enters baby through placenta- and hemolysis occurs
Baby tries to compensate
What is it called when baby is trying to compensate for hemolysis
Erythroblastosis fetalis (immature RBC production in fetal circulation)
What can erythroblastosis fetalis result in
- hyperbilirubinemia
- anemia
- hypoxia
- hf
- neuro damage
- hydrops fetalis
What can you do diagnose Rh factor
Indirect combs
Direct combs
What is Indirect coombs
it is measuring number of antibodies in blood of mum
What is direct coombs
It is measuring antibodies stuck on RBC done on baby
What do you do if you have an Rhpositive fetus and a sensitized mum
frequent u/s and monitor growth
early birth when growing stops
When do you give Rhogam
some give it at 28 weeks incase of any mixing of blood and again Within 72 hours after birth
and with any bleeding episodes
How does Rhogam work
It destroys fetal cells that go into mum’s blood and it does this before any antibiodies can be formed
