Maternity Flashcards
what are the 4 presumptive signs of pregnancy
ammenorrhea
N/V
Urinary frequency
breast tenderness (excess tenderness)
what homrone causes ammenorrhea
progesterone
what are pregnancy tests based on
presence of hCG levels
can other conditions cause increased hCG levels?
yes; hydatidiform mole; drugs
What is Goodell’s sign and when does it happen
softening of cervix
second month
What is Chadwick’s sign and when does it occur
bluish color of vaginal mucosa and cervix
week 4
What is Hegar’s sign and when does it happen
softening of the lower uterine segment
2nd/3rd month
what are braxton hick’s contractions
occur throughout pregnancy; move blood through the placenta
what is linea nigra
dark line down center of abdomen during pregnancy
what is facial chloasama
pregnancy mask
do the nipples darken during pregnancy
yes
at what point can the fetal heartbeat be heard with a doppler
fetal 10-12 weeks
when can a fetoscope be used
17-20 weeks - can hear the baby heartbeat
what does gravidity mean
of times women has been pregnant
what is parity
of pregnancies where the baby reached 20 weeks
what is viability and how many weeks
at 24 weeks the infant has the ability to live outside the uterus
Is a 20 week old baby considered viable
no
what is TPAL
acronym that gives further information on parity T - term P - preterm A - abortion L - living children
what is NAegele’s rule for the due date estimation and how accurate is it
add 7 days and 9 months
accurate to +/- 2 weeks
what is the daily caloric intake increase for moms after their first trimester? what about pregnant adolescents? how much protein?
100
500
60 g protein a day
what is the expected weigh gain in the first trimester
4 lbs
why do women not like taking iron during pregnancy
causes constipation and GI upset
what should iron be taken with to enhance absorption
vitamin C
what does taking folic acid prevent
neural tube defects such as spina bifida
how much folic acid should be taken per day
400 mcg/day
waht are the best exercises for pregnant women
swimming and walking
true or false; high impact exercise is necessary during pregnancy
false
should hot tubs and heating blankets be used during pregnancy? why or why not?
no, increases body temp and can lead to birth defects
what is the exercise rule for pregnancy
dont let your hear rate get above 140
what happens if your HR goes over 140 in pregnancy
CO and uterine perfusion will drop
What are 8 danger signs during pregnancy
sudden gush of vaginal fluid bleeding persisten vomiting severe HA abdominal pain increased temp edema no fetal movement
what should you tell the pregnant person about taking medicatons
don’t take unless approved by dr
how often should a pregnant client visit the primary HCP during the first 28 weeks
once a month
how often should a pregnant client visit the primary HCP during the first 28-36 weeks
twice a month
how often should a pregnant client visit the primary HCP after 36 weeks
once a week till delivery
what should a pregnant person do prior to an U/S
drink water to distend the bladder
why do you want to distend bladder prior to U/S
pushes uterus to abdominal surface
what should a pregnant person do about an U/S prior to a procedure
void
what is the second trimester
weeks 14-26
how much weight gain is expected per week druing the second trimester
1 pound a week 4 pounds a month
in the second trimester is N/V still occuring
no
does a pregnatn woman still have breast tenderness in the second semester
yes
is there urinary frequency in the secondary trimester? why?
no, uterus is low in first trimester but rises and enlarges in 2nd
what is quciening and when does it start
fetal movement 2nd trimester
what should the fetal heart rate be during the second trimester
120-160
what is normal fetal heart rate, when are we worried and watching and when are we panicing
120-160 normal
110-120 worried and watching
< 110 panic
when is a pregnancy considered term
37-40 weeks
what is considered third trimester
27-40
what is the expected weight gain in the third trimester
pound a week
when are we worried about pregnancy induced HTN
third trimester
what are leopold manuevuers
used to determine fetal position and presentation
what nursing intervention should be done prior to leopold manuevuers
put in foley
where is the best place to hear the babys HR
over the babys back
what are the 3 signs of labor
lightening
engagement
fetal stations
what is lightening
first stage of labor - usually occurs two weeks before term
head descends into pelvis
how will the pergnant person feel during lightening
less congested and breathe easier but urinary frequency is a problem again
what is engagement
second stage of labor - largest presenting part is in the pelvic inlet (hopefully the head)
what are fetal stations
stage of labor
measured in cm; measures the relationship of the presenting part of the fetus to the ischial spines of the mother
what are braxton hick’s contractions
true labor more frequent and stronger
what is ripening
softening of cervix
what is bloody show
mucousy blood in labor
what is the sudden burst of energy called in labor
nesting
is diarrhea a sign of labor
yes
when should a client go to the hospital
when contractison are 5 mins apart or hwne ht emembranes ruptuer
what are we worried about when membranes rupture
prolapsed cord
what is the non-stress test
what to see two or more accelerations of 15 beats/minute or more with fetal movement
each increase should last for at least 51s and be recorded for 20 minutes
what is acceleration
when the fetal heart rate has an abrupt increase from the baseline
an increase of greater than 15 beats/minute above the baseline that lasts at least 15s but should return to bseline within 2 minutes
do you want the non stress test to be reactive or non reactive
reactive
what is the biophysical profile test BPP?
measures HR muscle tone movmement breathing amniotic fluid
when is the BPP test done
last trimester but can be done at 32-34 weeks in a high risk pregnancy
how often will a high risk pregnancy have the BPP done
every week or twice a week in 3rd trimester
in the BPP what is done regarding hr
nonstress test want it reactive i.e. it increases when baby moves
in the bpp what is looked at to assess msucle tone
does baby have at least 1 flexion-extension movement in 30 mins
what is observed for regarding breathing in the BPP
does the baby have breathing movements at lesat 3x in 30 mins
what is obserrved for regarding movement in the biophysical profile test
does the baby move at least 3 times in 30 minutes
what is the observation time for BPP
30 minutes
what are good worrisome and ominous results in the BPP
10 good
6 worrisome
4 omnious
what is the contraction stress test: oxytocin challenge test
determines if a baby can handle a contraction since contractions decrease blood flow to the uterus and placenta
when is contraction stress test or oxytocin challente test done
if the NST is non-reavtive and it is a high risk pregnancy
what will be seen if the fetus becomes hypoxic during the contraction stress test or oxytocin challenge
fetal heart reate will decrese from the baseline HR (deceleration)
What do you not want to see in the contraction stress test
late decelerations –> means urteroplacental insufficienty
do you want a positive or negaitve contraction stress test
negative –> means no decelerations were seen
the contraction stress test is rarely seen befeore how many weeks
28
what are the 3 types of decelerations
early - benign not bad - casued by phsyiological hypoxia from fetal head compressionl late decelerations (bad) - caused by uteroplacental insufficenty (UPI) what is variable decelerations (bad) - caused by umbilical cord compressin
in true labor are contractions regular or irregular
regualr
do contractions increase or decrease in true labor
increase
where does discomfort in back radiate to in true labor
back
does pain decrease with change in activity in true labor
no; increases
what do contractions do in false labor
irregular
where is discomfort in false labor
just in abdomen
what happens to pain in false labor when you cahnge activities
it decrease or goes away
when is epidural anesthesia done for a pregnant lady6
stage 1 of labor at 3-4 cm dilation
what is a major complication for epidural anesthesia
hypotension
what should be done to combat hypotension forepidural anesthesia
bolus 1000mL NS or LR
what posistion should a pregger lady be put in for epidural anesthesia to prevent hypotension
semi-fowler on side to prevet vena cav compression
how often should a pregger lady alternate position from side to side when getting an epidural
hourly
what are the 3 complicatiosn we are worried about for a pt receiving oxytocin
hypertonic labor
fetal distress
uterine rupture
what is uterine rupture
can be partial or complete –>uterus rips open
complete = through the uterine wall into the peritoneal cavity
what are S & S of complete uterine rupture
sudden sharp shooting pain
“feels liek something gave way”
pain relieved
what is partial or incomplete uterine rupture
through the uterine wall but doesn’t tear the peritoneum peritoneal cavity is still intact
what are the signbs and symptoms of incomplete uterine rupture
internal bleeding
pain may or may not be present
client may vomit
what is ideal contraction rate
1 every 2-3 minutes, with each lasting 60 seconds
when should ixytocin be discontinued
if contractions are too often or too long
if there is fetal distress
do you ever straight line oxytocin
no piggy back so when you discontinue oxy be sure to discontinue fluid
what posistion should the pt receiving oxytocin be in
any posistion but on her back
what posistion do we put a preggers lady if there are any unreassuring heart tones
left side to enhance uterine perfusion
what should be done with the oxytocin infusion if late decelerations are seen
turn it off
should a client push btwn contractions
hellz no
what cna a pt. do to decrease the urge to push
pant or blow
what can be done to prevent the baby from coming out to fast
push on head
following birth what temperature might the babys temp increase to during the first 4 horus
38 degrees celsius
what heart rate for a baby is common during the first 6-10 days following birth
50-70 bpm
when you see tachycardia in a postpartum women what should you immediately think
hemorrhage
how long are breasts soft before they engorge following birth
2-3 days
what is diastasis recti
abdominal muscles separate–> dent down abdome
where is the fundus found immediately following birth
midline 2-3 finger breadths below umbilicus
whwere should the fundus be a few hours after birth
rises to level of umbilicus or one FB above
what is the first thing you do if the fundus is boggy
massage the fundus until its firm and then check for bladder distension
when is bladder distension suspected
when the uterus is above the suspected level or is not in the midline
what problem does a distended bladder cause following brith
not allow the uterus to contract normally which increases the chance of hemorrhage
how much should fundal heigh decend per day following birth
one finger breadth/day
what is the proper term used when the fundus descends and the uterus returns to its pre-pregnancy size
involution
how long are afterpains common following birth? whta will cause them to continue to be common
2-3 days
breastfeed
what color should the lochia be the first 3-4 days following birth
rubra - dark red
what color should the lochia be the first 4-10 days following birth
serosa - pinkish brown
what color should the lochia be the first 10-28 (as long as 6 weeks) days following birth
alba - whitish yellow
are clots ok to pass following birht?
yes; as long as they are no larger than a nickel
what happens to UO in the first 24 hours following brith? what are we worried about
diurese
dehydration
why should the legs be closely inspected following birth
DVT
how long should ice packs be used for perineal edema following birth
6-12 hours
what are 3 things important in perineal care post-partum for patients who have an an epiosotmy, laceration or hemorrhoisd
warm water rinses
sitz baths 2-4 times a day
anaestheic sprays
what is the peripad rule following birth
do not want the client to saturate more than 1 peripad an hour
what is bonding also called? how often should it be done
kangaroo care; skin to skin
baby should be held for 1 hour at least 4 times a week
how should breastfeeding mothers cleanse their breasts
with warm water after each feeding and let air dry
what should be done for sore breasts in breastfeeding mothers
ointment or express some colostrum and let it airdry
how soon should breastfeeding be initated following birth
ASAP
what can be done if breastfeeding is interrupted
can pump
how much should caloric intake be increased by when breastfeeding
500 calories
how mcuh fluid/milk should a mother intake that is breastfeeding
8-10 8oz glasses a day
what breast care should be done for non-breastfeeding mothers
ice packs
breast binders
chilled cabbage leaves
no stimulation of brest
why do chilled cabbage leaves help for breast care in non breast feeding mothers
decreases inflammation and decrease engorgement
what are 3 complications postpartum
infection
hemorrhage
mastitis
how many days post birth are we worried about postpartum infection
10 days
what are the two things you must have to define early postpartum hemorrhage
more than 500 cc blood lost in the first 24 hours and 10% drop from admission hematocrit
when does late postpartum haemorrhage occur
after 24 hours up to 6 weeks
when does mastitis usually occur following birth
2-4 weeks
what causes mastitis
breasts not emptying properly
if mom is going to continue to breastfeed after a mastitis infection what does she need to do
initate breastfeeding frequently or pump
is penicillin ok with breastfeeding
yes
can a baby be fed during mastitis? should you use the affected breast
yes baby should be fed frequently
affected breast should be used first –> empties breast milk
what 3 things should be done immediately for newborn care
suction
clamp and cut cord
maintain body temperateure
when should apgar be done following birth
1 and 5 minutes
waht does apgar look at? what score do we want
looks at HR, R, muscle tone, refelc irritability, color
want at least 8-10
what is given for eye prophylaxix for babies? what else does it kill
erythromycin —> kills clamidyia too
what should be given to promote formation of clotting factors in new babies
IM vitamin K given IV vastus lateralis
how long does it take for a babies umbilical cord to dry and fall off
10-14 days
what should the cord be cleansed with and when should it always be cleasened
alcohol or NS and with each diaper changing
how should a diaper be folded when the umbilical cord has not yet fallen off
fold diaper below cord
why do some babies experience hypogycemia following birth
because they are not getting glucose from mo
what risks put a baby more at risk for hypoglycemia
large or small babies
preterm babies
babies of diabetic moms
when does pathological jaundice occur in newborns? why does this occur
1st 24 hours
Rh/ABO incompatibiulity
when does physiological jaundice occur in newborns? why
after 24 hours
due to normal hemolysis of excess RBCs releasing bilirubin or liver immaturity
how is Rh incompatibility diagnosed
indirect coombs - measures # of ab in MOMs blood
direct coombs - measures if there are any ab stuck to RBCs for baby
what are the 2 things done if you have a Rh+ fetus and a sensitized mother
frequent U/S to watch baby growth early birth (when baby stops growing)
when is Rho(D) given
w/in 72 hours following birth
true or false Rho(d) is given with any bleeding episode
true - prophylaxis
how does rhogam work
destroys fetal cells that got into mothers blood so mom does not make anitbiods
