maternity and its meds Flashcards
explain labor dystocia and meds for it
labor dystocia means prolong labor or difficult birth. fetal macrostomia (big baby) is a reason, maternal fatigue or uterine abnormality, epidural, etc..
oxytocin is a med that can help labor dystocia b/c it promotes uterine contraction. but we can also get mom to move position (depend on the epidural)
shoulder dystocia
what Is it, appropriate interventions?
contraindications?
baby’s shoulder is stuck, this is an emergency.
rn can push down on symphibis (mcroberts maneuver, suprapubic**). don’t push down anywhere else (fundal pressure can worsen things.
ask for help immediately**
can administer oxytocin as ordered
knees, trendelunburg
contraindications: fundal pressure, forceps associated births
prolapsed umbilical cord
cord is protruding in the cervix. can lead to cord compression. cord is how baby is getting oxygen
interventions: call for help (stay in room), requires emergency most of the time. get finger in to try to lift presenting part off of the cord
safest and quickest route is c-section, most of the times its c-section
c-section anesthetics
spinal anesthesia:
epidural anesthesia:
general anesthesia: can be given in emergency situations, no time to do a spinal or epidural
complication for c-section
top 2: hemorrhage and infections
provide antibiotics, IV fluid
which medication is given to delay labor (when the baby try to comes out too soon, ex: 27 weeks), to prevent/supressant preterm labor
terbutaline
you gotta wait in LINE for the baby.
given to calm and steady the uterus
as well as nifedipine, indomethacin
when should you administer Rho(D) globulin
at 28 weeks of pregnancy and within 72hrs after delivery
only if the mom is negative, if mom is positive, no need to give rhogam
bethametasone and dexamethasone
steroids that helps lungs mature
a steroid administered to mothers during preterm labor
exercise during pregnancy
swimming, walking,
too strong: aerel yoga
dizziness, blurred vision, persistent headache, edema are signs of
pre-eclampsia.
persistent headache means BP is high and is a sign of preeclampsia, as well as blurred vision.
scotoma as well (spots before eyes)
gush of fluid
signs that the person is in labor, water break
but if it happens 1st or 2nd trimester of pregnancy, go to hospital immediately
amt of folic acid
400 mcg/day to prevent neural tube defect
38 weeks pt has dark red vaginal bleeding, what to do first and what to avoid
could be placental previa so avoid vaginal examinations. and could be placenta abruptio or previa, so strict bed rest.
do fetal monitoring, maternal vital signs first then depend on c-section or abdominal surgery, but most common is c-section, but mom still has a say since it can still be possible
1 - 4.4 lbs during first trimester
1lbs a week during last 2 semesters
foods to minimize/avoid during pregnancy
fishes (tilefish, mackerel, tuna, shark, swordfish), raw fish
, undercooked meats, soft and unpasteurized cheese, risk of listeria, salmonella, so on
nuchal transluency or cell free dna
can detect trisomy 21
cell free dna can be done early as 10 weeks
cvs (samples of placenta) done after 10 weeks,
amniocentesis after 15-17 weeks
nonstress test should be
reactive
if it nonreactive, further testing will be done
transverse lie or shoulder presentation
a type of breech position (there are 4). when the baby is sideways (horizontal) instead of vertical.
good cervix to deliver baby?
gynecoid
android
anthropoid
platypelloid
AP is favorable b/c college credits
AnthroPoid
android (male shaped, not favorable, platepelloid not favorable.
apple is better than android.
GA (Georgia is nice b/c housing are afordable)
gynecoid (favorable), anthropoid
What determines the fetal position, engagement and presententation of the fetus in the uterus during the 3rd trimester
leopold’s maneuver
presentive part moves from
negative to positive.
positive means i’m out
primary force means contraction, what is 2ndary force?
maternal pushing during 2nd stage of labor
apgar score
which requires medical attention
when do we do them and what does it indicate?
when counting, its best to start with 10 and subtracting, rather than adding.
A: appearance
P: pulse
G: grimace
A: activity
R: respiratory effort
do apgar at 1mn then 5mn after birth, if its 7 or above, baby is considered in good health. if its lower than 7(requires medical attention) you can redo a 3rd one at 10mn if its lower than 7
best position for baby during giving birth
occipito anterior position
worst is breech
which is 1st stage latent phase of labor vs 1st active phase of labor
6 - 10cm
0 - 6cm
what is full dilation and effacement
0 - 6cm is the latent (early) phase
contractions last 30 - 45sec and every 15-20mn
while 6 - 10cm is the 1st stage in active stage
contraction 45 - 60sec and every 5mn, - 10mn more frequent
0.5cm - 1cm dilation per hr so 1st stage may last up to 19hrs
separation and delivery of placenta
3rd sstage
talk about 2nd stage of labor
2nd stage begins w/ full dilation 10cm and effacement (baby is at +4 - +5 station), pushing or expulsion and it ends with the birth of the baby
contraction every 2-5mn and last 60 - 90 sec.
last mn to 2+hrs
3rd stage
placental separation
uterus rises.
it changes shape to globular
cord lengthens
fourth stage of labor
1-4hrs after birth
shaking, hungry, thirsty
uterus remains contracted midline and midway b/w symphysis and umbilucus
give oxytocin to prevent bleeding or hemorrhage
how often to do maternal fetal assessment in 2nd stage of labor
every 5-15mn for 2nd stage
fetal hr
110 - 160
variability normal value
beat to beat fluctuations,
normal variability, 6 - 25bpm
indicates fetal oxygen
feed 3-4hrs for the first 24hrs
administer antibiotic to eyes 1-2hrs after birth
administer vitamin K shortly after birth
discharge
lochia rubra, serosa, alba
rubra 3-4 days of blood
serosa: mostly leukocytes, old blood, serum and debris. last up to 2 weeks
alba: leukocytes, epithelial cells, bacteria, last 2-6 weeks postpartum
infants who have blood type A or B and who are born to type O mothers have an inc. risk of?
jaundice
do cooms test to determine inc. risk of jaundice
might require treatments w/ phototherapy if severe
rh positive mom does not have to worry whether baby is positive or negative, but why does rh negative mom worry?
if rh negative mom has a rh positive baby, they need to receive rhogam within 72hrs after delivery to prevent antibodies dvpt
chloasma disapear after pregnancy, but stretch marks and linea nigra might not disappear fully
increase production of urine (diuresis) also occur after childbirth, within 12hrs. for first 3 days
uterine atony
hemorrhage, uterus don’t contract.
low BP, high hr
give oxytocin
4 diseases of placenta: previa, abruptio, vasa previa, accreta.
explain placenta previa and nursing interventions
is previa painful, what’s the blood color?
placenta previa
placenta grow out of womb. low lying can clear on its own. overlying, usually later in pregnancy (c-section will be recommended)
may cause painless, bright red bleeding.
bed rest, IV fluids, bethamethasone
No vaginal examinations
risk: age, smoking, prior c-section
placental abruption
placental accretia
vasa previa
placenta abruptio nursing interventions
bed rest
give oxygen
vital signs, support, cbc
risk for materal mortality is inc. w/ placental abruptio b/c it causes hemorrhage, also post op. patient might be in ICU receiving blood tranfusion
placenta doesn’t stop growing, continues grow in the uterus, grabs on to the uterus (attaches to the uterus), bladder, once the placenta is remove, it can cause lots of bleeding, associated w/ lots of bleeding (hemorrhage). and inc. risk of maternal mortality and morbidity
placenta accreta
c-section may be recommended
risk factors: placenta previa
ultrasound to diagnose.
blood transfusion during or after c-section/delivery. needing to be admitted to the ICU after delivery
unprotected blood umbilical cord travels to the cervical os: vasal previa, what are nursing interventions
may have scant dark red bleeding
planned c-section
gestational diabetes is tested
24-28 weeks
preeclampsia management
activity restriction, quiet
mag sulfate iv
IV and electrolyte fluid
steroids
anti-htn as needed
magnesium sulfate interventions for iv and toxicity signs
check deep tendons reflexes ever 2hr
listen to lung sounds
give a bedpan or urinary output min 30ml/hr, assess for skeletal muscle weakness and hypotonia
toxicity signs: Dec. urine ouput and Dec. deep tendons reflexes
may result in resp depression
contraindications to breastfeeding
cancer therapy, HIV, herpes, cytomegalovirus, galactosemia
colostrum
starts during 3rd trimester. last 3-5 days after delivery. colostrum is more concentrated, has more nutrition
then develops into mature human milk, which starts 3-5 days after delivery
umbilical cord care
natural healing, soap & water, alcohol or providone-iodine. remove clamp once the stump is dry, before discharge from hospital. the cord falls off by itself, approx after 10 days.
abortion, how to and meds
misoprostol + mifepristone (until 12 weeks)
surgical ways: vacuum aspiration, for the 1st trimester
dilation and evacuation, >16 weeks
contraceptive risks
stroke, breast cancer, vte
contraindications: >35yrs & >15 cigs a day, CVD risk
birth control pills prevents ovulation
primary vs 2ndary amenorrhea
primary: no period by age 15-16
2ndary: absence of period for 3 cycles
candidadis
yeast infection: thick white discharge, itching, no bad odor
bv: bad odor
vaginitis: bv, trichomnioasis: sti caused by parasite, painful, odor, often no symptom
candida vulvovaginitis (yeast infection)
how to calculate due date?
if I get pregnant June 7 2024, when will I give birth?
how about april 29 2024
LMP- 3 months + 7 days and adjust the year
June 7th
June - 3 months = March 7+7 = March 14th, 2025
April 29 - 3 months = Jan 29+7 = Jan 5th, 2025
for games
lmp = May 29th 2024
may - 3 = Feb 29+7 = March 7th, 2025, Feb was 29 days this week, but this was a tough one.
missed abortion: nonviable pregnancy but no other symptoms
complete: everything comes out
incomplete abortion
inevitable pregnancy: will not be saved b/c cervix is open
ectopic pregnancy med
methotrexate
this meth is epic
lots of vomiting, possible dehydration, weight loss, nausea
hyperemesis gravidum
2+ edema normal in late pregnancy?
no, 1+ edema is common.
A fetal scalp electrode (FSE) is a common, internally applied, electronic monitoring device used to closely evaluate fetal heart rate (FHR). Indications for FSE placement may include high-risk maternal conditions such as (eg, obesity, diabetes, hypertension) and/or nonreassuring FHR patterns (eg, late decelerations, minimal variability).
what are the contraindications?
HIV infection, blood borne infection such as hepatitis. since the risk of infection increase with site puncture
whenever there is a problem with the fetal heart monitor (ex: late decels, variable decels, high or low fetal hr), YOU ALWAYS TURN OFF THE OXYTOCIN IF IT’S RUNNING (FIRST RESPONSE)
low fetal hr: under 110
LATE DECEL
turn off oxytocin
turn pt on left side
apply o2
notify obstetrician
low hr variability, late DECEL, low fetal hr, all these L’S are really bad
