maternity

Question 1

hormone that induces amenorrhea

Answer 1

progesterone

Question 2

presumptive signs of pregnancy

Answer 2

amenorrhea
n/v
urine frequency
breast tenderness

Question 3

probable s/s of pregnancy

Answer 3

positive test (based on hCG levels)
Goodell’s sign (softening of cervix)
chadwick’s sign (bluish color of vaginal mucosa and cervix)
Hegar’s sign (softening of lower uterine segment)
uterine enlargement
braxton hicks contractions throughout pregnancy

pigmentation changes:
linea nigra (dark line down the center of the abdomen)
facial chloasma (mask of pregnancy)
abdomen striae (stretch marks)
darkening of the areola

Question 4

positive signs of pregnancy

Answer 4

fetal heartbeat:
doppler (10-12wk)
fetoscope (17-20wk)

fetal movement
ultrasound

Question 5

gravidity

Answer 5

number of times someone has been pregnant

Question 6

parity

Answer 6

number of pregnancies in which fetus reaches 20wks

Question 7

viabililty

Answer 7

24 wks gestation

infant can live outside uterus

Question 8

TPAL

Answer 8

T: term
P: preterm
A: abortion (includes spontaneous and elective)
L: living children

Question 9

spontaneous abortion

Answer 9

AKA miscarriage:
bleeding, cramping, backache– think miscarriage
hCG levels will drop

Question 10

Naegele’s rule for EDD

Answer 10

first day of LMP
add 7 days
subtract 3 months
add 1 year

Question 11

first trimester nutrition & supplements

Answer 11

increase protein to 60g/day
weight gain of 1-4pounds

biggest complaint of iron (constipation and GI upset)
always take iron with vitamin C (enhances absorption)
folic acid prevents neural tube defects

Question 12

first trimester exercise

Answer 12

no high impact
walking
swimming
no heavy exercise program
dont let HR get above 140 (can decrease CO/perfusion to baby)
don’t overheat (no hot tubs or heating blankets–increase body temp and cause birth defects)

Question 13

danger signs and potential complications of maternity

Answer 13

sudden gush of vaginal fluid
bleeding
***persistent vomiting
severe headache
abdominal pain
increased temp
edema
*** no fetal movement

Question 14

common discomforts

Answer 14

constipation
ankle edema
n/v
breast tenderness
urinary frequency 
tender gums
fatigue
heartburn
increased vaginal secretions
nasal congestion
varicose veins
hemorrhoids
backache
leg cramps

Question 15

1st trimester meds, smoking, HCP visits, ultrasounds

Answer 15

no meds unless approved by HCP

stop smoking
can have small gestational age, low birth weight babies, cleft lip or palate, placental abruption

first 28wks = once a month
28-36wks = every 2 wks/twice a month
after 36wks = weekly

drink water before ultrasound to distend the bladder and push uterus up closer to abdominal surface so it’s easier to get a picture
ultrasound before procedure (amniocentesis): void

Question 16

2nd trimester nutrition

Answer 16

wk 14-26

increase 300cals
adolescent can increase 500cal

1 pound weight gain/wk

should not experience n/v and urinary frequency
can still have breast tenderness

Question 17

quickening

Answer 17

fetal movement (16-20wks)

Question 18

fetal HR

Answer 18

110-160

less than 110=panic!!!

Question 19

kegel exercise

Answer 19

strengthen pubococcygeal muscles
help stop urine flow
keep uterus from falling out

Question 20

3rd trimester assessment

Answer 20

wk 27-40

term if advances to 40 weeks

no more than 1lb weight per week

monitor BP:
pre-eclampsia develops after 20wks: 
they will have high BP
proteinuria
edema
BP 160/110 or greater documented 6 hours apart

***two or more pounds of weight gain in a week, watch close and worry about possible pre-eclampsia:
can have a seizure
magnesium sulfate is drug of choice:
given IV
close supervision
anticonvulsant
sedates
vasodilator
***it is called eclampsia when they have a seizure

FHR: 110-160

fetal position determined by leopold maneuvers:
have them void
if having contractions, do it between contractions

Question 21

signs of labor

Answer 21

lightening:
2wk before term
presenting part (head) descends into the pelvis
abe to breath easier
urinary frequency

engagement:
largest presenting part in pelvic inlet (head)

fetal station:
measured in cm

braxtion hicks (more frequent and stronger than before)
softening of cervix
bloody show
sudden burst of energy called nesting
diarrhea
ruptured membranes

when should they go to the hospital:
contractions are 5minutes apart
membranes rupture
worried about prolapsed cord when membranes rupture

Question 22

non stress test

Answer 22

two or more accelerations of 15beats/min or move with or without fetal movement

acceleration:
FHR has an abrupt increase 
increase is greater than 15beat/min 
lasts for 15 seconds
should come back to baseline within 2minutes

each increase should last for 15 seconds and recorded for 20minutes

***want it to be reactive

Question 23

biophysical profile test

Answer 23

commonly done in last trimester
measured by ultrasounds and each of the parameters count 2 points
10/10 = perfect score

parameters:
HR
muscle tone
movement
breathing
amount of amniotic fluid

BPP test:
observation time is 30minutes by sonogram
8-10 = good
6 = worrisome
less than 4 = ominous (deliver)

Question 24

contraction stress test

Answer 24

oxytocin challenge test
for high risk pregnancies
determines if baby can handle the stress of contractions

deceleration:
blood flow decreases & causes hypoxia then FHR will decrease

*** do not want to see late decelerations (uteroplaental insufficiency = placenta is wearing out)

** want a negative test

Question 25

types of decelerations

Answer 25

early: not bad benign caused by physiological hypoxia from fetal head compression late: bad caused by uteroplacental insuffiency variable: bad caused by umbilical cord compression

Question 26

true vs false labor

Answer 26

``` true: regular contractions increase in frequency and duration discomfort in back and radiates to abdomen pain increases with activity ``` false: irregular contractions discomfort in abdomen (front) pain decreases/goes away with activity

Question 27

premature/preterm labor

Answer 27

contractions occur with dilation between 20-37 weeks stop the labor treat any existing vaginal/UTI hydrate the mom will often stop preterm labor bedrest ``` Meds: magnesium sulfate (IV relaxes uterus) betamethasone (IM, steroid helps fetal lungs mature) terbutaline (SQ) indomethacin (PO) nifedipine (PO) ```

Question 28

epidural anesthesia

Answer 28

lie on L side legs flexed prop up over the bedside table given at 3-4cm dilation usually no headache major complication (hypotension) IVFs (bolus with 1000ml of NS/LR to fight hypotension) monitor BP close semi-fowlers tilt on side to prevent vena cava compression vena cava compression will decrease venous return (reduces CO and BP) if BP decreases perfusion to baby goes down alternate position from side to side hourly check urine output and assess bladder

Question 29

client receiving oxytocin

Answer 29

considerations: one-on-one care ``` complications: hypertonic labor fetal distress uterine rupture contraction rate of 1 every 2-3 minutes with each lasting 60seconds ``` discontinue oxytocin when: contractions are too often contractions last too long fetal distress oxytocin is piggly backed into a main IV fluid so when you turn off turn off IV fluids too any position except flat put on L side with any fetal distress turn it off with any late decelerations

Question 30

emergency delivery/precipitous delivery

Answer 30

``` pant/blow to decrease the urge to push only during contractions wash hands elevate HOB place something under butt decrease touching vaginal area tear amniotic sac as head crowns place hand on fetal head and apply gentle pressure when head is out, feel for the cord around he neck (nuchal cord) ease each shoulder out keep baby's head down ****dry baby (cannot regulate temp) place on mom's abdomen cover baby (skin to skin) wait for placenta to separate/deliver can push to deliver placenta ****want placenta out wihtin 30minutes check firmness of uterus ```

Question 31

normal post partal period assessment

Answer 31

VS: temp may increase BP stable HR 50-70 common for 6-10days after ****tachy + partum = hemorrhage breast soft for 2-3 days then the engorgement occurs soft/loose abdomen hunger is common fundus is midline 2-3 finger breaths below umbilicus fundus rises a few hours after birth want fundus to be firm if uterus is boggy: massage the fundus check for bladder distention (increases hemorrhage) fundus height will descend one finger breath/day ``` lochia: rubra 3-4 days (dark red) serosa 4-10days (pink/brown) alba 10-18 days (white, yellow) can have alba up to 6wks clots are okay as long as no bigger than a nickel ``` urine output: diurese the excess fluid around 24 hours after deliver dehydration is possible inspect close for DVT

Question 32

perineal care post delivery

Answer 32

intermittent ice packs for the first 24hours to decrease edema warm water sitz bath 2-4x/day anesthetic sprays change pads frequently *** we don't want the client to saturate more than 1 pad/hour report any foul smell and any lochia changes

Question 33

bonding post delivery

Answer 33

``` develops trust emotional and physiological need physiological impact: stabilizes HR improves O2 regulates temp conserves cals breasts can change in temp skin to skin = kangaroo care ```

Question 34

breastfeeding mothers

Answer 34

``` cleanse with warm water after each feeding let air dry support bra ointment for soreness express some colostrum and let it dry breast pads absorb moisture mother needs to initiate breastfeeding asap after birth mom can pump increase cals by 500/day fluid/milk intake" 8-10oz/day ```

Question 35

non-breastfeeding moms

Answer 35

ice packs breast binders chilled cabbage leaves (decrease inflammation and decrease engorgement) no stimulation of breast

Question 36

postpartum infection

Answer 36

``` within 10days E. Coli/Beta hemolytic strep proper hygiene (front to back) hand wash cultures antibiotics ```

Question 37

postpartum hemorrhage

Answer 37

early: more than 500ml blood lost in first 24hours accompanied by a 10% drop from admission hematocrit ***must have both to be true Late: after 24hs and up to 6wks postpartum causes: uterine atony lacerations retained fragments and forceps delivery ``` Meds used to halt excessive postpartum hemorrhage: oxytocin methylergonovine maleate carboprost tromethamine misoprostol ```

Question 38

mastitis

Answer 38

major bacteria is staphylococcus 2-4wks ``` s/s fever chills swollen breast hard/tender breast malaise ``` ``` treatment: bedrest support bra binding/chilled cabbage leaves penicillin pain meds heat feed baby frequently (offer affected breast first) ```

Question 39

immediate newborn care

Answer 39

body temp ``` apgar: 1 & 5 minutes looks at HR respiration muscle tone reflex irritability color want at least 8-10 ``` erythromycine (eye ointment) can be used because it will kill Chlamydia phytonadione promotes formation of clotting factors

Question 40

cord care

Answer 40

dries and falls off in 10-14 days cleanse with each diaper change using alcohol/NS fold diaper below the cord no immersion until cord falls off (infection)

Question 41

hypoglycemia in newborn

Answer 41

``` not getting enough glucose from mom greatest risk: large small diabetic moms ```

Question 42

pathologic jaundice

Answer 42

occurs first 24 hours | usually means Rh/ABO incompatibility

Question 43

physiological jaundice

Answer 43

occurs after 24 hours | due to both normal hemolysis of excess RBCs releasing bilirubin and immaturity of the liver

Question 44

Rh sensitization or Rh factor

Answer 44

*** Rh- mom and Rh+ baby 1st pregnancy: Rh+ blood from baby comes in contact with mom's blood when placenta separates at birth mom's body thinks of it as foreign mom produces antibodies first offspring is not affected by antibodies 2nd pregnancy: increases because with every pregnancy there is a risk of mom and baby's blood coming in contact if Rh- sensitized mom gets pregnant: antibodies enter baby's bloodstream though the placenta, baby's RBC breakdown (hemolysis), releases immature RBCs (erythroblastosis fetalis)

Question 45

diagnosis of Rh

Answer 45

indirect coombs: done in mom measures number of antibodies direct coombs: done on bbay tells if there are any antibodies stuck to RBCs done on cord treatment: frequent ultrasounds ``` prevention: Rhogam to mom 72hours after birth once at 28wk gestation also with any bleeding episode destroys positive fetal blood cells that get into the mothers negative blood ```