Maternity ND Flashcards
What is antepartum?
- Prenatal
- Starts with dx of pregnancy
- Ends just before baby is delivered
What is postpartum?
• Period shortly after childbirth
What are intercostal retractions?
• Unequal movements of chest &
abdomen during breathing efforts
• A sign that the new born is in distress
What is involved in the head to toe assessment of the newborn?
- Evaluate overall appearance first
- VS, weight and length
- Assess skin, hair, nails
- Neurologic reflexes-Babinski reflex
- Gestational age assessment
- Behavior assessment
What is gestational age assessment?
- Assessment of infants physical maturity
* Helpful if the dates of pregnancy is uncertain
What are the normal VS for term babies?
- HR: 110-160 BPM
- During sleep HR: 100
- Crying HR: 180
- R: 30-60 breaths per min
- Axillary temp: 97.7-98.6
- BP: 60-80/40-45
What are the normal physical measurements of newborns?
- Dependent on ethnicity, gender, genetics, maternal nutrition and smoking behaviors
- Normal weight: bt 5lbs 8 ozs-8lbs 13 ozs
- Average length: 20 ins (bt 19-21 ins)
What are the general appearances of the newborn?
- Symmetrical and well nourished
- Head large in proportion to bdy
- Bulging and prominent abdomen
- Have lanugo- fine hairs on shoulders, arms and back
- Vernix caseosa present- white cheese-like subs that covers and protects skin of fetus and still over skin of newborn
What is vernix caseosa composed of?
• Sebum (oil of the skin) and cells that have sloughed off fetus’ skin
What is the difference btw full term and pre term?
- Full term- 37 or more weeks of pregnancy
* Pre term- less than 37 weeks of pregnancy
What is molding?
- An elongated head shape
* Caused by overlapping of cranial bones as fetus moves thru birth canal
What is caput?
- Swelling of the soft tissues of the scalp
- Caused by pressure of presenting part on a partially dilated cervix
- Also by trauma by vacuum assisted delivery
- Usually disappears in a few days
What is cephalhematoma?
- Swelling from bleeding under the skull caused by birth trauma
- Resolves
- Assess newborn for S&S of anemia and shock from acute bld loss
What is Epstein Pearls?
- Small, white cysts found on mid hard palate in some newborns
- Harmless
- Disappears after a few days
What is smegma?
- A cheesy, white sebaceous gland secretion
- Found in folds of the labia of female
- Also found under foreskin of penis
- Do not remove
- Usually disappears in a few days
What is pseudomenstruation?
- Bld tinged mucus discharge from vagina
- Results from sudden withdrawal of maternal hormones
- Disappears after a few days
What is epispadias?
• When the urinary meatus is located abnormally on the dorsal (upper) surface of the penis
What is hypospadias?
• When the urinary meatus is located abnormally on the ventral (under) side of the penis
What is phimosis?
- Tightly adherent foreskin
* Normal in the term newborn
What is cryptochordism?
- Testis do not descend into scrotal sac
- Happens during fetal life
- Requires medical evaluation
What is simean crease?
- Abnormal finding
* Associated with down’s syndrome
What is Ortalani Maneuver?
• To evaluate the hip for signs of dislocation or subluxation (partial dislocation)
What is meconium?
- First stool of the newborn
- Thick, black, tarry
- Occurs within 1-2 days after birth
- Confirms patent anus
What are neural tube defects?
- Birth defects of brain and spinal cord
- Two most common: spina bifida and anencephaly
- Nerve damage that causes some paralysis of the legs
What occurs in anencephaly?
- Much of the brain does not develop
- Most babies are still born or die shortly after birth
- It is a neural tube defect
What is Spina Bifida?
- A congenital disorder
- Backbone and spinal column do not close before birth
- In severe cases-the spinal cord and covering membranes protrude out decreased
What is meningocele?
- A type of spina bifida
- Spinal cord develops normally
- Menings (protective covering around brain and spinal cord) protrude from a spinal opening
What is myelomeningocele?
- Most common type of spina bifida
- Neural tube defect
- Bones of the spine do not completely form
- Spinal cord and meninges stick out child’s back
What is hypotonus?
• Decreased muscle tone
What is hypertonus?
• Increased muscle tone
What is a high pitched shrill cry?
- Associated with neurologic disorders
* Abnormal cry
What are some newborn reflexes?
- Sneezing
- Coughing
- Blinking
- Withdrawal from painful stimuli
- Rooting
- Sucking
- Swallowing
- Moro (startling)
- Tonic neck
- Plantar
- Stepping
- Babinski
What is hyperemesis gravidarum?
- Persistent nausea and vomiting during pregnancy
* Interferes with nutrition and fluid balance to mother and fetus
What is the treatment for hyperemesis gravidarum?
- Oral or IV fluids for dehydration and electrolyte imbalance
- Antiemetic meds
- Severe cases-may need to be hospitalized and be given TPN (total parenteral nutrition)
What is TPN?
- Total parenteral nutrition
- Bypasses GI tract
- Fluids given in a vein
- Provides nutrients the baby needs
What is the nursing care for pts with hyperemesis gravidarum?
- Pt teaching
- Reduce factors that trigger N/V
- No food odors
- I&O to assess fluid balance
- Frequent sm amts of food and fluids
- Easily digested CHO- crackers, baked potatoes
- Sitting upright after eating
What is GPA gravida?
- Gravida/para/abortus
- Or gravida/para
- Short hand for a woman’s obstetric hx
What is gravida?
- Number of times the mother has been pregnant
- Regardless of whether they carried to term
- Current pregnany is counted in it
What is para?
- Number of > 20 wks births (including viable and non viable)
- Pregnancies with multiples ie twins count as one birth
What is abortus?
- Number of pregnancies lost for any reason
- Including abortions and miscarriages
- Stillbirths not included
What is newborn jaundice?
- Common
- Temporary
- Usually harmless
- Affects both full-term and pre-term babies
- Appears during first week of babies life
- If it is within first hrs after birth it is pathologic
How does jaundice occur?
- With build up of bilirubin
* Bilirubin deposits on the fatty tissue under the skin
What is bilirubin?
- Orange/red pigment in bld
- Produced by normal breakdown of RBC’s
- Low levels in bld is normal
- High levels deposits in fatty tissue under skin
- Causes skin and whites of eyes to appear yellow
What is phototherapy?
- Use of lights to tx jaundice
- If lights are too far they are not effective
- If too close there is a risk for burns
- Infant nude (can have diaper)
What are the nursing care for jaundice?
- Infant turned q 3-4 hrs to rotate area of exposure
- Do not turn off lights except to feed and change diaper
- Shield newborns eyes from ultraviolet rays
- Remove shield q 4 hrs to clean and asses eyes for irritation
- Increase fluid intake by 25% more to prevent dehydration
- Monitor serum bilirubin levels routinely
What is preeclampsia?
- Toxemia
- Condition in pregnant women marked by high BP and high level of protein in the urine
- Edema in feet, legs and hands occur
- Usually in 2nd or 3rd trimester of pregnancy
What are the manifestations of preeclampsia?
- Decreased bld flow and edema of organs involved
- Headache
- Visual disturbances
- Reduced urine production
- Pulmonary edema
- Epigastric pain
- Nausea
- Ischemia
- Necrosis
- Hemolysis, elevated liver enzymes, low platelets (HELP syndrome)
- No seizures!
What is eclampsia?
• When a woman has one or more generalized tonic-clonic seizures
What is tonic-clonic seizures?
- Contraction, relaxation
- Facial muscle twitch
- Then generalized contractions of all muscles (tonic phase)
- Followed by alternate contraction and relaxation of the muscles (clonic phase)
What are the tx for eclampsia?
- Magnesium sulfate-anticonvulsant to prevent seizures
- Usually IV
- Monitor urinary output for toxixity
- Toxicity causes loss of deep tendon reflexes followed by respiratory depression
- Calcium gluconate to reverse
What is surfactant?
- Made of proteins and lipids
- Secreted by the alveolar cells of the lung
- Prevents alveoli from sticking together when baby exhales
- Stimulates the lungs in the newborn to fxn
- Low amts lead to poor lung fxn
- Low amts results in stiff collapsible lungs and increased fluid in lungs
What is DIC?
- Disseminated intravascular coagulation
- Causes post partum hemorrhage
- Proteins that control ld clotting becomes over active
- Caused from placenta that has been left behind after delivery
- Tx is D&C
What is gestational diabetes?
- The effects of pregnancy on a woman’s metabolism
- Affects the production of glucose available to the growing fetus
- The hormones causes 2 things to happen: 1) increased resistance of maternal cells to insulin 2) increased speed of insulin breakdown
- Pregnancy increases the insulin needs for tissue growth
- Common
- Resolves quickly after birth
- If woman cannot increase insulin production she has periods of hyperglycemia-glucose accumulates in her bld
- Maternal hypoglycemia can occur bc fetus continually draws glucose from the mother
- Usually in 2nd and 3rd trimesters-increased resistance to maternal insulin occurs
What type of baby is born to a mother with gestational diabetes?
- Macrosomic- large for gestational birth weight
- Baby may be 11 lbs
- Baby may have respiratory problems
What is the tx for gestational diabetes?
- Identify GD
- Diet
- Monitoring bld glucose levels
- Ketone monitoring
- Insulin
- Exercise
- Fetal assessments
- Care during labor
- Care of neonate
What is the importance of baby lying on back in crib?
• For prevention of SIDS (sudden infant death syndrome)
What is herpes?
- Virus
- Transmitted thru sex and direct contact
- Type 1 causes fever blisters or cold sores
- Type 2 causes genital herpes
- After primary infection, the virus becomes dormant in the nerves
- May be reactivated later as a recurrent (secondary infection)
How does herpes affect the infant?
- Abortions
* IUGR (intrauterine growth retardation)
What type of delivery is indicated for a mother with active genital herpes?
• Cesarean birth
Who is considered an adolescent mother?
• Under the age of 15 yrs
What are common in adolescent pregnancies?
- High rates of Premature birth-leading cause of neonatal mortality
- Bc uterus of the young female is not structurally and functionally optimum
- Uterus of pregnant adolescent reacts unfavorably to ovarian hormones
- Has twice risk of premature or low birth weight (LBW)
- Less likely to have full term babies
- More SIDS
How is premature labor and LBW prevented in adolescent mothers?
- Prenatal care
* Appropriate nutritional counseling
What is an ectopic pregnancy?
- When fertilized ovum is implanted outside the uterine cavity
- 95% occurs in the fallopian tube (tubal pregnancy)
What are the signs of ectopic pregnancy?
- Lower abdominal pain
- Light vaginal pain
- If tube ruptures: severe abdominal bleeding and vaginal bleeding, hypovolemic shock, shoulder pain (referred pain)
What does loss of fallopian tube threaten?
• Future fertility
What are the S&S of hypovolemic shock?
- FHR (fetal heart rate) changes-increases and decreases
- Tachycardia
- Tachypnea (shallow resp rate)
- Orthostatic Hypotension
- Decreased urine output (less than 30ml/hr)
- Pale skin or mucus membranes
- Cold clammy skin
- Faintness/dizziness
- Loss of consciousness
- Agitation and anxiety
- Confusion
- Rapid breathing
- Increased sweating
- Thirst
What is the tx for hypovolemic shock?
- Identify shock
- Take temp to identify if there is infection
- Assess bowel and lung sounds
- Antibiotics
- Pain meds
- NPO in prep for surgery
- Indwelling catheter to monitor urine output
- Bedrest before surgery
- Progressive ambulation post op
- Emotional support
What is placenta previa?
- Abnormal implantation of placenta in the lower part of the uterus
- Marginal- reaches within 2-3 cm of cervical opening
- Partial- placenta partly covers cervical opening
- Total- placenta completely covers the cervical opening
- The placenta detaches from uterus wall when cervix dilates causing bleeding
What are the S&S of placenta previa?
• Painless vaginal bleeding usually bright red
What can occur as a result of placenta previa?
- Increased risk of infection
* Hemorrhage after birth
What is abruptio placentae?
• Premature separation of placenta that is normally implanted
What are some causes abruptio placentae?
- HTN
- Drug use
- Smoking
- Trauma
- Alcohol use
- Prior hx of abruption placentae
- Folate deficiency
What are the S&S of abruptio placentae?
- Bleeding accompanied by abdominal or low back pain
- Most or all bleeding may be concealed behind the placenta
- Obvious dark red vaginal bleeding occurs when bld leaks past edges of placenta
- Uterus tender and very firm-board like
What are the txs for abruptio placentae?
• Immediate C-section
What is ABO and RH incompatibility?
- Occurs when sm leaks allow fetal blood to enter mother’s circulation during pregnancy or when placenta detaches at birth
- When maternal and fetal bld factors are different
- Mother’s bdy produces antibodies to destroy foreign fetal cells
- No problems with first pregnancy
- Problems occurs with successive pregnancies
- The antibodies passes thru placenta to the fetus and destroy the RH positive bld cells in the fetus
What are common cause of jaundice and anemia in newborns?
• ABO (when mother and baby have diff bld types)
What is premature rapture of membranes?
- PROM
* Rapture of membranes before labor begins
What are complications of PROM?
- Early delivery
- Rare cases-fetal death
- Respiratory distress syndrome
- Cord compression
- Chorioamnionitis
- Abruptio placentae
What is dystocia?
- Rapid contractions with no presentation
- Abnormal or difficult childbirth or labor
- May arise from insufficient quality and quantity of uterine contraction, abnormal fetal position, sm pelvis, hydrocephalus
- High risk of maternal and fetal death
What is postpartum blues?
- Perception of reality is intact
* A&O x 3
What is postpartum depression?
- Perception of reality is intact but mother is clinically depressed
- Cannot perform ADL’s
- Feeling of hopelessness etc
What is postpartum psychosis?
- Distorted view of reality
- Hallucinations-seeing and hearing things not there
- Delusions-false beliefs
What causes these postpartum disorders?
- Stress from pregnancy and childbearing responsibilities
- Sudden decrease in endorphins with labor
- Abrupt changes in hormonal levels-estrogen and progesterone
- Low serum levels of free tryptophan
- Possible thyroid dysfunction
What is toxoplasmosis?
- Non viral
- Caused by parasite
- Transmitted by cat feces-hand to mouth route or undercooked meat
- Causes blindness in newborns
How does toxoplasmosis affect infant?
- Low birth weight
- Blindness
- Enlarged liver
- Enlarged spleen
- Jaundice
- Anemia
- Inflammation of the eye structures
- Neurological damage-retardation
- Can be fatal
What is the tx for herpes and toxoplasmosis?
- Herpes- either daily suppressive therapy or occasional therapy under physicians guide
- Toxoplasmosis- Medications to treat the infection include an antimalarial drug and antibiotics
- Spiramycin can treat infection in the pregnant mother.
- Pyrimethamine and sulfadiazine can treat fetal infection (diagnosed during the pregnancy).
- Treatment of infants with congenital toxoplasmosis typically includes pyrimethamine, sulfadiazine, and leucovorin for one year. Infants are also sometimes given steroids if their vision is threatened or if the protein level in the spinal fluid is high
