maternity Flashcards
hormone that induces amenorrhea
progesterone
presumptive signs of pregnancy
amenorrhea
n/v
urine frequency
breast tenderness
probable s/s of pregnancy
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
positive signs of pregnancy
fetal heartbeat:
doppler (10-12wk)
fetoscope (17-20wk)
fetal movement
ultrasound
gravidity
number of times someone has been pregnant
parity
number of pregnancies in which fetus reaches 20wks
viabililty
24 wks gestation
infant can live outside uterus
TPAL
T: term
P: preterm
A: abortion (includes spontaneous and elective)
L: living children
spontaneous abortion
AKA miscarriage:
bleeding, cramping, backache– think miscarriage
hCG levels will drop
Naegele’s rule for EDD
first day of LMP
add 7 days
subtract 3 months
add 1 year
first trimester nutrition & supplements
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
first trimester exercise
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)
danger signs and potential complications of maternity
sudden gush of vaginal fluid bleeding ***persistent vomiting severe headache abdominal pain increased temp edema *** no fetal movement
common discomforts
constipation ankle edema n/v breast tenderness urinary frequency tender gums fatigue heartburn increased vaginal secretions nasal congestion varicose veins hemorrhoids backache leg cramps
1st trimester meds, smoking, HCP visits, ultrasounds
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
2nd trimester nutrition
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
quickening
fetal movement (16-20wks)
fetal HR
110-160
less than 110=panic!!!
kegel exercise
strengthen pubococcygeal muscles
help stop urine flow
keep uterus from falling out
3rd trimester assessment
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
signs of labor
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
non stress test
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
biophysical profile test
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)
contraction stress test
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
types of decelerations
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
true vs false labor
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
premature/preterm labor
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)
epidural anesthesia
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
client receiving oxytocin
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
emergency delivery/precipitous delivery
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
normal post partal period assessment
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
perineal care post delivery
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
bonding post delivery
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
breastfeeding mothers
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
non-breastfeeding moms
ice packs
breast binders
chilled cabbage leaves (decrease inflammation and decrease engorgement)
no stimulation of breast
postpartum infection
within 10days E. Coli/Beta hemolytic strep proper hygiene (front to back) hand wash cultures antibiotics
postpartum hemorrhage
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
mastitis
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)
immediate newborn care
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
cord care
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)
hypoglycemia in newborn
not getting enough glucose from mom greatest risk: large small diabetic moms
pathologic jaundice
occurs first 24 hours
usually means Rh/ABO incompatibility
physiological jaundice
occurs after 24 hours
due to both normal hemolysis of excess RBCs releasing bilirubin and immaturity of the liver
Rh sensitization or Rh factor
*** 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)
diagnosis of Rh
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
