Maternity Part 2 Flashcards
TRUE LABOR
How are contractions?
Where is discomfort?
What happens to pain when we change activity?
Contractions: Regular and increasing in duration
Discomfort: Back and radiating to the abdomen
Pain increases
FALSE LABOR
How are contractions?
Where is discomfort?
What happens to pain when we change activity?
Contraction: Irregular
Discomfort: Abdomen
Pain goes away
Epidural anesthesia
Position?
What if there is a headache?
Given in what stage?
Major complication?
Lie on left side, leg’s flexed, could be indian style (not too much because we don’t want to get into the CSF)
*HEADACHE = CSF, there usually is no headache
Given in stage 1 @ 3-4 cm dilation
*Major complication: HYPOTENSION
What to do after an Epidural
Fluids?
Position? What does this position prevent?
How often do we alternate the position from side to side?
BOLUS 1000ml of NS or LR to fight the hypotension
Position: Semi-fowlers on their side to prevent vena cava compression
HOURLY
What happens if the vena cava is compressed?
It will decrease venous return, decreased CO, decrease BP, and decreased placental perfusion
Stages of labor
1st stage: Beginning of dilation to 10cm
2nd stage: Delivery of baby
3rd stage: Delivery of placenta
Phases of labor
Early/latent: Onset of labor to 3 cm
Active: 3 cm - 7 cm
Transition: 7 cm - 10 cm
Patient on oxytocin needs what?
ONE-on-ONE care
Complications of Oxytocin
Hypertonic labor (Too much contraction)
Fetal distress
Uterine rupture
Complete Uterine Rupture
Tear where?
S/S? What if the placenta separates?
What might stop the pain?
Tear through uterine wall AND peritoneal cavity
Sudden sharp/shooting pain
Hypovolemic shock d/t hemorrhage
Absent fetal heart tones if placenta separates
Pain may stop when contractions stop
Incomplete Uterine Rupture
Tear where?
S/S
Tear through uterine wall
Internal bleeding
Hypertonic contractions, lack of progress
May have pain, late decels, faint, vomit
May lose fetal heart tones
What patients are at high risk for uterine rupture?
Highest risk?
Vaginal birth after C-section d/t c-section scar opening under stress
Highest risk: When taking oxytocin
What kind of contractions do we want?
1 every 2-3 minutes, each lasting 60 seconds
Pauses allow more oxygen in
When would we need to DC the oxytocin?
What if late decals occur?
Contractions are too often
Contractions last too long
Fetal distress
TURN IT OFF
How is oxytocin hung?
Piggy back to main IV fluid
How should the oxytocin patient be positioned?
What if the fetus has unreassuring heart tones like bradycardia?
Any position BUT FLAT
Place on left side to enhance uterine perfusion
Emergency Delivery
Only push when? Minimize touching what? Head crowns, what might you have to do? How to prevent coming out too fast? What to do when the head is out? Do you pull at all? Keep baby's head where? Why do we have to dry baby?
Only push during CONTRACTIONS Minimize touching vaginal area Head crowns, might have to tear the sac Place gentle pressure on the head Head is out - feel for cord around neck NO PULLING, ease each shoulder out Keep baby's head DOWN Baby can't regulate T yet
Emergency delivery
Keep baby at what level?
Place baby on what?
We need to keep baby warm!
PLACENTA
What are we waiting for??
What if it all doesn’t come out? - Need to assess!!!
Can mom push to deliver it?
Keep baby at uterus level to prevent a bolus of blood from the placenta
Place on mom’s abdomen
Cover baby
PLACENTA
Wait for it to separate and deliver
THINK HEMORRHAGE! Need to inspect that thing to make sure it’s all there!
Mom can push it out
Emergency delivery
How to deal with the cord?
Will it bleed?
Final thing to assess of the uterus?
Tie cord of with a piece of cloth or shoe string
Place 1 knot about 4 inches from baby’s belly button and 2nd knot 8 inches
Cord will bleed
Check for firmness: might need fundal massage to prevent a hemorrhage
POST-PARTUM
T during first 4 hours might be what?
BP?
HR?
Breasts?
Abdomen?
GI?
T might increase to 100.4
BP - stable
HR- 50-70 common for 6-10 days
Breasts soft for 2-3 days, then engorged
Abdomen soft/loose; diastasic recti
HUNGRY
TACHYCARDIA POSTPARTUM, THINK WHAT?!?!
HEMORRHAGE
Uterus after birth
Position–
Immediately:
Few hours:
Want it to be what?
What to do if it’s boggy?
Immediately: midline 2-3 fingers below umbilicus
Few hours: umbilicus or 1 finger above
Want uterus to be FIRM
Boggy: massage until firm, then check for bladder distention
When is bladder distention suspected?
Complication of this?
When the uterus is above the expected level or is not midline
Complication: Won’t allow the uterus to contract normally, increasing the risk of hemorrhage
How should the fundal height be?
Descending 1 FB/day
What is involution?
When the funds descends and the uterus goes back to it’s normal size
What is common for the first 2-3 days and will keep occurring if mom breastfeeds?
Afterpains - camping of uterus as it goes back to normal; breastfeeding = more oxytocin
Normal days for each Lochia
Rubra
Serosa
Alba
Are clots ok?
Rubra: 3-4 days; dark red
Serosa: 4-10 days; pinkish brown
Alba: 10-28 days ; white or yellow
Yes as long as they aren’t bigger than a nickel
When does mom start peeing again?
Can mom be dehydrated?
Within 24 hours
YES: Watch for s/s of DVT`
Perineal care
What is best especially for mom with an episiotomy, laceration, or hemorrhoids?
Warm water rinses
Sit bath 2-4 times a day
Anesthetic sprays
Perineal Care
Ice?
Change pads how often?
What to report?
Ice intermittently for the first 6-12 hours to decrease edema
Change pads frequently
Report foul smell
Report loch changes –> MAY NEED 911!!
Peripad rule
NO MORE THAN 1 saturates pad/hour
Bonding is what kind of need?
What does it do?
How often to do kangaroo care?
Emotional and physiological
Stabilizes HR
Improves O2
Regulates T
Conserves calories
At least 1 hr 4 times a week
Breast feeding
How to cleanse after feeding? What kind of bra? How to handle soreness? What if you leak? Need to start doing this how soon? Increase calories by how much? How much milk/fluid intake? unless what?
Cleanse with warm water (no soap); air dry
Support bra
Ointment or express colostrum; let air dry
Breast pads
Need to start ASAP after birth
Increased calories 500
8-10 fluid/milk, unless ducts will clog
NON-Breastfeeding engorgement
Ice?
Put on what?
What plant? What does it do?
Avoid what?
Ice
Breast binders
Chilled cabbage leaves cause vasodilation and decrease inflammation
Avoid STIMULATION
Post-partum infections
Develops when? - What kind?
Teaching
Infection within 10 days - E.Coli, Strep
Proper hygiene; front to back
Post-Partum hemorrhage
Early: 2 things!!!!!
Late:
Causes?
Early: More that 500mL blood lost in first 24 hours AND 10% from from admission Hct
Late: after 24 hours up to 6 weeks
causes: Uterine atony, lacerations, retained fragments, forceps used
Meds given to stop postpartum hemorrhage
Oxytocin
Methylergonovine Maleate
Carboprost Thromethamine
Mastitis
Causes?
Bacteria?
Occurs when?
Caused by not emptying completely, leading to clogged ducts and inflammation
Staphylococcus
Occurs around 2-4 weeks
How to treat mastitis
Activity?
Bra?
What if they DC breastfeeding?
What if they keep breast feeding?
Can mom take penicillin?
Pain?
Heat or cold?
How to feed baby?
Bedrest
Support bra
DC: cabbage, binding
BF: frequently or pump
YES - feed baby then take it
Pain meds
Heat to soften the breast
Feed baby frequently, giving the hurt booby first because baby will suck harder initially
NEWBORN - Immediate care
Suction
Clamp/cut cord
Cover baby
Do APGAR
When is APGAR done?
What does it look at?
Good score?
Done at 1 and 5 minutes
HR, R, muscle tone, reflex irritability, color
Want at least 8-10
What meds are given to newborn?
Erythromycin - in eyes for Neisseria gonococcus, kills chlamydia
Phytonadione - Promotes clotting factors
Cord
When does it fall off? Clean with what? Fold diaper where? When can you immerse baby? Watch for what?
10-14 days Alcohol or NS Below the cord Until it falls off Infection
What babies are at highest risk for hypoglycemia?
LGA, SGA, preterm, DM babies
When does PATHOLOGIC jaundice occur?
What does it usually indicate?
1st 24 hours
Rh/ABO incompatibility
When does PHYSIOLOGIC jaundice occur?
What is it due to?
After 24 hours
Normal hemolysis of excess RBC releasing bili
OR liver immaturity
What combo occurs with Rh sensitization?
what causes this?
Rh NEGATIVE mom with Rh POSITIVE baby
Blood mixes somehow (placenta, amniocentesis, miscarriage)
What is happen with Rh stage?
When does this affect baby?
Mom’s body looks at baby’s Rh+ as an antigen so mom produces antibodies against baby’s blood
Affects LATER pregnancies: increased antibodies with each delivery
In other pregnancies, the baby will stop growing
What is Erythroblastosis Fettles?
Increase of immature RBC in the fetal circulation resulting in
^bili
Anemia, hypoxia
HF, neuro damage
Hydrous fetalis - severe form
How to diagnose Rh
Indirect Coombs: # antibodies mom has
Direct Coombs: # RBC with antibodies attach in baby
What do you do if mom has an Rh+ baby?
Frequent US to watch fetal growth
Early birth
What is RhoGAM given?
Who do we urge to give this to?
Within 72 hours after birth - this protects the NEXT pregnancy
*May also give at 28 weeks just in case
Mom’s with abortion, amniocentesis, trauma, ectopic pregnancy (any bleeding episode)
How does RhoGAM work?
It destroys fetal cells that got into mom’s blood - but it needs to do this before antibodies form
ONCE ANTIBODIES FORM: MOM HAS THEM FOR LIE
MUST GIVE RHOGAM BEFORE THEY FORM
