Maternity part 3 Flashcards
1
Q
the initiation of uterine contractions by artificial means before spontaneous labor
A
induction of labor
2
Q
name some indications for induction of labor
A
abruptio placentae, choriamnioitis, fetal demise, hx of precipitous delivery, HTn disorder, PROM, post term pregnancy, Fetal compromise (IUGR, oligohydramnios)
3
Q
5 component tool for predicting inducibility
A
Bishop score (the higher the # the more inducible), objective measurements
4
Q
what are the 5 components of the Bishop score
A
position of cervix, consitency, effacement, dilation, baby’s station
5
Q
the higher the score the ______ inducible the women
A
more
6
Q
what happens during the pathophysiology of induction (maternal and fetal factors)
A
- Uterine muscles- strecth, prostoglandin released
- cervical pressure- oxytocin is released
- inhibition of Ca binding- oxytocin & prostoglandin which causes contractions
7
Q
what methods are used for induction
A
stimulate prostaglandin release, admin of prostaglandin, or admin of oxytocin
8
Q
what alternative methods are used for induction
A
herbals (red rasberry tea, accupuncture, castor oil, nipple stimulation, intercourse
9
Q
more then 5 contractions in 10 minutes when averaged over a 30 minute window
A
tachysystole (major risk factor when induce labor)
10
Q
what is used to ripen/open the cervix and/or stimulate labor
A
dilators, prepidil, amniotomy, cervidil, misoprostol
11
Q
amniotomy is also known as
A
rupture of membranes
12
Q
ROM release what
A
prostoglandins
13
Q
ROM that release prostoglandins which speed up contractions, done anytime before or during labor, but when done before labor it is considered an induction procedure
A
amniotomy
14
Q
what are the risks with amniotomy
A
infection, prolapsed cord, compression of cord
15
Q
when is amniotomy contraindicated
A
HIV (risk of trasmisison to NB), disengaged fetal head
16
Q
what needs to be documented with amniotomy
A
FHR, temperature, fluid (amt., color, odor), time
17
Q
examiner digitally frees membranes of amniotic sac from the lower segment of uterus around cervical os
A
membrane stripping
18
Q
when is membrane stripping done
A
at term, prenatal appt
19
Q
what does membrane stripping cause
A
prostaglandin release from sac/cervix, and labor within 48 hours
20
Q
what are the risks of membrane stripping
A
accidental ROM, vaginal placenta
21
Q
mechanical dilation with weighted balloon pressing on internal os
A
foley bulb dilator
22
Q
what does the foley bulb dilator lead to the release of
A
prostaglandin release, cervical ripening, and uterine contractions
23
Q
what are the advantages of the foley bulb dilator
A
low cost, small risk of tachysystole, decrease duration of labor, decrease risk of C/S
24
Q
what are the risks of using foley bulb dilator
A
vaginal bleeding, ROM, infection
25
absorbs fluid from surrounding tissue causing a dilator effect on the cervical os,
hygroscopic dilators
26
what is laminaria made of
stem of seaweed, remove after 12-24 hours, repeat prn, risks are infection
27
PGE2 preparation in a vaginal insert placed in posterior vagina which releases prostaglandins at a slow rate (0.3mg/hr)
cervidil (slow release)
28
cervidil
remove prior to ROM, increases success of delivery within 24 hours, doesn't decrease risk of C/S, looks like shoe string (allows for easy removal)
29
risks with cervidil
tachysystole with FHR changes, PPH, uterine rupture, need to continue fetal/maternal monitoring for @ least 2 hours after removal
30
administration guidelines with cervidil
store in fridge, need to remain in bed 30 minutes after placement, if have too many ctx it must be removed, monitor uterine activity and FHR for minimum of 2 hours, if tachysystole occurs remove immediately, remove at onset of active labor or 12 hours after insertion, MUST remove before start of pitocin
31
who don't you want to give cervidil to
pts with asthma, can result in broncho restriction
32
placement of cervidil
posterior fornix of vagina
33
intracervical PGE2 gel, releases prostaglandins at a faster rate than intravaginal insert, can repeat dose in 6-12 hours, coats cervix (doesn't go in os)
prepidil
34
what does prepidil cause
cervical ripening and uterine ctx, increases vaginal delivery, doesn't decrease risk for C/S
35
risks of prepidil
tachysystole with FHR changes, PPH, uterine rupture
36
administration guidelines for prepidil
given by MD or midwife, stored in fridge (room temp before application), stop if have too many ctx if need to stop administer tocolytic, 30 minute rest after given, monitor fetal and ctx for 4 hours after administration, delay oxytocin administration 6-12 hours
37
tablet prostaglandin, more effective but not FDA approved, synthetic PGE1 agent, safe use 1--mcg tablet (use 1/4 of tablet) vaginal or oral, low cost
Misiprostol (Cytotec)
38
risks of Misiprostol (Cytotec)
increased incidence of significant tachysystole with or without FHR changes
39
administration guidelines of Misiprostol (Cytotec)
continuous monitoring of uterine activity and FHR, can be repeated Q 3-6 hours, delay oxytocin for 4 hours after last dose
40
when is Misiprostol (Cytotec) contraindicated
previous C/S, or uterine surgery bc of possible uterine rupture
41
common for induction/augmentation, oxytocic, stimulates uterine contractons bc the myometrial cells more excitable and increase strength of ctx
oxytocin (Pitocin)
42
what is oxytocin used for
control PPH, induction
43
oxytocin is naturally released from maternal pituitary gland in response to what
cervical pressure, dilation, effacement
44
what is the goal of oxytocin
to stimulate ctx that produce cervical changes and fetal descent while avoiding tachysystole and fetal distress (Q2-3 minutes, last 60-90 seconds)
45
standard Pitocin dose
20 units/1000ml LR
ALWAYS administer with pump!!!
then titrated to the ctx pattern we want
46
what has to be assessed prior to increasing pitocin
fetal status (FHR), ctx pattern (duration, intensity, frequency), uterine tone (soften, frequency, intensity, duration)
47
Pitocin calculation
| *what changes
1000 ml. X. 60 min. X. 1mu. X. 1 unit
----------------------------------------------------
20 units x 1 hr. x. min x. 1000 mu
*the mu of Pitocin ordered/minute
48
risks with Pitocin
uterine tachysystole, fetal distress, HTN, hypotension, uterine rupture, water intoxication (exess fluid in kidneys, dilution, hyponatremia, which all increase risk for seizures)
49
Administration guidelines for Pitocin
monitor VS, FHR, I&O, uterine exam, ALWAYS piggyback Pitocin NEVER main line (always placed on lowest port), resting tone (soft btwn ctx to allow fetal perfusion), baseline resting tone 0-10mmHg
50
if you have a pt who is in tachysystole what would you do
STOP Pitocin, give Tocolytic
51
stimulating of a spontaneous occurring labor, but not progressing the way we want
augmentation, continually monitor, MD must be on unit @ all times
52
during an emergency delievery, what position do you want to keep mother prior to delivery and why
left side to decrease hypotension syndrome
53
when the babies head is out what do you have mom do
stop pushing, check umbilical cord, suction or wipe the mouth and nose, place hands on each side of babies head, apply gentle pressure to head and guide downward, after delivery of placenta massage uterus until firm
54
dystocia
difficulty delivering shoulders
55
McRoberts
hyperflex moms legs backwards, which opens pelvis to aid in delivery, apply suprapubic pressure to push shoulder down
56
once the baby is out, prior to cutting umbilical cord where do you place baby
keep baby at uterine level to aid blood flow to baby
57
umbilical cord has ? arteries and veins
2 arteries 1 vein
58
if you have a baby with a heart rate less than 100 with no respiratory effort what do you do w
CPR
59
placental separation
lengthening of cord, increase gush of blood, check for placenta for missing fragments, assess vagina
60
what can be done to decrease risk of hemorrhage
breast feeding, massage of uterus
61
the most common type of cesarean incision is
low transverse
62
which type of anesthesia is most commonly used for cesarean
regional
63
which of the following is contraindicated with an external cephalic version
polyhydramnios
64
an episiotomy is routinely performed because of its ability to speed delivery and heal faster than a laceration ? T OR F
false
65
forceps and vacuum extractors are not used in a cesarean birth? T OR F
false
66
what is not an automatic reason for a C/S
fetal distress (POPI)
67
brestfeeding after a cesarean, can it be done
yes, with help and support
68
a vaginal birth after c/s
contraindicated after a classical incision
69
what factors affect labor pain
fear, culture, support, previous experience, physical causes (stretching of perineum, pressure ctx of uterine muscles)
70
what is a good question to ask a pt about their pain
what is your plan for pain management
71
will sedatives have the same effect on mom as fetus
yes, they are used in early phase of labor and false labor
72
what sedatives are used for relaxation
seconal, ambien, Phenergan, vistaril, benadryl
73
systemic (IV/IM Rx)
all cross the placenta, fetus is greatly affected, if given too early cause prolonged labor, if given too late can cause fetal problems after delivery
74
common systemic Rx
nubain, stadol, Demerol, fentanyl*
| doesn't cross the placenta as well so has limited affects on NB
75
Side effects of systemic Rx
mom & fetus: resp depression, urinary retention, N/V, drosey, dizziness, itching
fetus: decrease variability, decrease baseline, wont see accelerations
76
nursing care when giving pt systemic rx for pain
viod prior to giving, admin at peak of ctx (decrease the blood flow to fetus), precipitate withdrawal, assess VS (can decrease sucking in NB)
77
what can reverse pain rx effects
Narcan
| watch for withdraw on baby and possibility of seizure
78
local anesthetic into tissue which blocks pain transmission, remain awake
regional anesthesia
79
placed in pudendal nerve, relief of perineal stretching, has no SE
pudendal
| forceps, vacuum, episiotomy repair
80
medication placed into the epidural space via lumbar spine, doesn't reach fetus circulation
epidural anestesia
81
toxic reaction to epidural
LOC convulsions, cardiovascular collapse
82
major maternal side effect of epidural
maternal hypotension
| fetus: late decels (decrease of O2 to fetus)
83
nursing care after placement of epidural
lateral tilt 10-15 minutes after, void prior, monitor hypotension, monitor pain
84
what do you do if you have hypotension after placement of epidural
administer O2, IV bolus, trendelenburg, elevate legs, notifiy anesthesia, administer ephedrine if needed
85
what is a common side effect of epidural
itching
86
injected into spinal fluid in the subarachnoid space, prevents windows
spinal anesthesia
87
risks and complications of spinal
high spinal (RR issues), intubation, hypotension, spinal HA
88
Tx for spinal HA
fluids, caffeine, encourage lay flat, blood patch will remove maternal blood and relieve HA instantly
89
emergency C/S or difficult spinal/epidural, mother is not awake
general anesthesia
90
complications with general
fetal depression: Rx will reach the fetus in 2 minutes, anticipate resuscitation
91
alteration in the progress of labor
dystocia
92
delivery of malpresented fetus (complete, frank, incomplete)
breech extraction
93
risks with breech extraction
head trauma, entrapment, meconium aspiration, fetal asphyxia
94
procedure to change fetal presentation
version
95
external maternal abdominal manipulation to change fetus from breech, oblique or transverse lie to vertex presentation
external cephalic version
96
criteria for external cephalic version
single fetus, 36 weeks gestation, not engaged, adequate fluid, NST reactive, US, if have previous uterine surgery or malformed uterus cant do version
97
what has to be done intra op for external cephalic version
NPO, IV, NST, tocolytic (soften uterus to aid with movement)
98
when do you have to stop the external cephalic version
repeat failures, too much pain, abnormal FH pattern
99
nursing care after external cephalic version
VS, fetal status, RhoGam (fetal/maternal bleeding)
100
what would be a sign of revision of the external cephalic version
excess movement
101
multiple gestation to deliver 2nd twin after vaginal delivery of 1st, (not common procedure)
internal/podalic version
102
unplanned tear in perineum, uterus, vaginal wall or supporting tissues during delivery, more common with nulliparas, rapid head expulsion, LGA
laceration
103
1st degree laceration
skin & mucous membranes
104
2nd degree laceration
skin & mucous membranes & muscle
105
3rd degree laceration
skin & mucous membranes & muscle & anal sphincter
106
4th degree laceration
skin & mucous membranes & muscle & through anal sphincter & rectal mucosa
107
incision to enlarge the vaginal outlet
episiotomy
108
what are disadvantages of an episiotomy
increases PP pain, infection, blood loss, painful intercourse, flatal incontinence
109
what are the 2 locations of an episitomy
*midline
less blood loss but can extend to 4th degree laceration
*mediolateral
perineum cut at 45 degree angle, advantage is no 4th degree laceration
110
after repiar of laceration/episiotomy you want to assess
site, bleeding, drainage, edema, odor, tenderness, hardened areas, approximated
111
what patient teaching can you do for an laceration/episiotomy repair
clean front to back, peri bottle, apply ice, ibuprofen, Colace, dermaplast, sitz bath, change pads frequently
112
instrument (2 curved blades) that are used during delivery for holding, repositioning or extracting the fetal head
forceps
| *used during the second stage of labor (pushing)
113
3 types of forceps
outlet (head is visible on perineum)
low (fetal skull is at station +2 not yet on pelvic floor)
midforceps ( fetal skull above station 2
114
when using forceps what do you document
procedure, placed, type used, # of applications, amt of time used
115
maternal risks of using forceps
infection, hemorrhage, trauma, laceration
116
fetal risks of using forceps
facial trauma, cephalahematoma, capet (increase risk of jaundice later)
117
vacuum applied to fetal head to assist with birth (negative pressure), d/c after a maximum of 3 pop offs, cant be applied longer than 30 minutes
vacuum assisted birth
118
contraindications for vacuum assisted birth
true CPD, non vertex presentation, extreme premature, macrosomia, fetal scalp trauma
119
chignon
artificial capet, it will go away on its own (hours to 3 days)
120
delivery through an abdominal and uterine incision
c/s
121
postoperative complications of C/S
infection, dehiscence, hemorrhage, DVT, longer recovery, bladder laceration, urethral injury, reaction to anesthesia, increase length of stay
122
pfannenstiel
incision made just below the pubic hairline
| aka low transverse
123
infraumbilical
between naval and symphysis pubis
124
classical incision
rarely used, except in emergencies
increase risk of uterine rupture
*cant have vaginal delivery after this
125
POST OP from C/S
bowel sounds, output, early ambulation, pain, VS, want to have foot ball hold when breastfeeding
126
normal resting tone
1015 mmHg
127
if mom has fibroids that puts her at a higher risk of
dysfunctional labor, PPH, fetal mal position
128
ineffective uterine contractions
uterine dysfunction
129
hypertonic uterine dysfunction
too much, uncoordinated = ineffective, discomfort
no dilation
increase risk nullipara, exhaustion, UPI (uterine placental insufficiency)
130
Tx for hypertonic uterine dysfunction
hydration, rest, pain rx, sleep pill
131
hypotonic uterine dysfunction
weak ctx,
| increase risk of multipara, UPI, exhaustion, over use of analgesia
132
tx for hypotonic uterine dysfunction
Pitocin, ambulation (increase strength of ctx)
133
precipitous labor
fast labor within 3 hours, risk of birth trauma, uterine rupture
134
tx for precipitous labor
tocolytic
135
prolonged labor
lasts longer than 24 hours, extended 1st stage of labor, caused by unfavorable cervix
136
tx for prolonged labor
Pitocin, hydration
137
dystocia
difficult labor
138
CPD
cephalopelvic disproportion
139
anterior shoulder wedged behind pubic symphysis
shoulder dystocia
140
Tx for dystocia
suprapubic pressure, downward traction
141
what would cause a soft tissue obstruction
full bladder, fibroids, bicornate uterus
142
fetal head doesn't turn, may need forceps or C/S, causes prolonged labor, exhaustion, back labor, very uncomfortable
persistent OP (occiput-posterior)
143
risks due to breech presentation
difficult delivery
144
risk with transverse lie presentation
uterine rupture
145
macrosomia
weighs over 4000 grams
146
hydrocyphalus
excess of fluid in brain
147
if you have an absent umbilical artery what other issues might you have
kidney, ear
| develop at the same time
148
velamentous insertion
cord is distal to placenta
| increase risk of cord compression, separation = hemorrhage
149
what risk do you have with a short cord
more compression as baby descends in birth canal
150
what risk do you have with a long cord
increase risk nucal cord or knots (stricture)
151
prolapsed cord
cord is delivered first, happens when have breech, SROM before head is tightly at cervix
152
Tx for prolapsed cord
emergency!
check FHR and give mom O2, place mom in knee chest position, and with sterile glove lift presenting part off the cord, STAT C/S
153
succenturiate placenta
accessory lobe, attached to placenta by small vessels
| risk for PPH
154
circumvallate placenta
double infolding of chorion, decreases perfused area of placenta
risks for bleeding, shearing of membranes
155
battledorf placenta
cord is inserted next to margin, can interfere with perfusion of placenta
risk for cord compression
156
risks of placental infarcts/calcification
hypoxia to fetus, will see late decels
157
placenta is implanted low in uterus
placenta previa
158
3 types of placenta previa
low placental implantation-near margin of cervical os
partial previa-over top of cervical os
complete previa-completely covers cervical os
159
S.sx of placenta previa
painless vaginal bleeding (bright red blood), uterus will have normal tone, non tender
160
what is contraindicated in placental previa
vaginal exam
161
management of placenta previa
if less 37 weeks- bed rest, IV fluids, observe, if still not doing well then C/S
if greater than 37 weeks- induction, C/S
if have signs of shock- tx shock & C/S
162
complications of placenta previa
shock, anemia, coagulopathy, risk for PPH, infection
163
implanted corrected placenta but has separated from wall of uterus
abruptio placenta
164
cause of abruptio placenta
degradation of arterioles of endometrium leads to necrosis
| HTN, cocaine use, smoking, trauma
165
Types of abruptio placenta
marginal- margin of placenta has separated, may see bleeding
central- center of placenta has separated
massive- complete placenta has seperated
166
S.Sx of abruptio placenta
may or may not have bleeding, pain, tender uterus, late decels, uterus is board like (hard)
167
Tx for abruptio placenta
C/S STAT
168
complications of abruptio placenta
DIC (disseminated intravascular coagulation)
| overstimulation of the coagulation process
169
DIC
have bleeding from every orifice, have clotting and bleeding at the same time
170
Labs that you would see in DIC
```
fibrinogen decreases (normal for pregnancy is 450)
platelets decreases
fibrin increases (normal is 10-20)
PT/PTT prolonged
```
171
Tx for DIC
remove trigger factor, replacement (clotting factors, blood products), give anticoagulants (heparin), supportive care (O2, ventilator, vasopressor
172
couvelaise uterus
so much bleeding into wall of uterus that it doesn't contract
173
sudden respiratory distress, circulatory collapse, EMERGENCY
embolism (anaphylactoid syndrome)
174
Excessive amniotic fluid around fetus, increase risk SOB, dependent edema
hydramnios
| greater than 2000 ml fluid
175
oligohydramnios
check fetus kidney function, compression of cord, club foot
176
what can hinder coagulation
hypothermia
177
what effects can progesterone have on PPH
slows gastric motility, constipation, heart burn
178
normal labs in pregnancy
pH 7.4-7.5
| creatinine 0.4-0.8
179
what is the most common reason for PPH
failure of uterus to contract after delivery
180
what is the #1 risk factor for PPH
hx of PPH
181
retained placenta
prevents uterus from contracting after delivery, bleeding persists from placental site
182
placenta accreta
placenta grows into uterine wall, rare, does not separate, high risk for hysterectomy
183
methylergonovine
contracts smooth muscle, 0.2 mg IM, contraindicated in HTN pts, SE: hypotension
184
carboprost (hemabate)
produces uterine contraction, 250mcg IM
| cause N/V, diarrhea, use with caution in asthma pts
185
misoprostol (cytotec)
induces uterine contractions, PO, buccal, sublingual, rectal
| causes fever, N/V diarrhea, shivering
186
minimum output
30ml/hour
187
what is used as last resort tx
hysterectomy
188
when will you start to have VS changes with EBL
1500-2000ml
189
what labs would you monitor
CBC, DIC, electrolytes, BUN, creatinine
190
what do you need to look for when you have increase of IV fluids going in
S.sx of fluid overload, watch electrolytes
191
EBL for vag and C/s
500 Vag
| 1000 C/S
192
Late PPH
24 hours after delivery, usually within 1st 1-2 weeks
193
failure of uterus to involve normally
subinvolution
194
what is the most common reason for subinvolution
infection, retained placental fragments
| manual removal increases risk
195
S/Sx of late PPH
uterus is enlarged, soft
lochia is excessive, rubra
back pain, ill feeling
196
Tx for late PPH
methergine-po for 24-48 hours
D & C if fragments on US
Abx if infection
educate about change in lochia
197
blood collects in soft tissue of vagina or perineum, caused by vessel injury, the tissue has little resistance so easily expanded
hematomas
198
what can make you at higher risk for hematoma
operative delivery, precipitous delivery, macrosomia
199
Tx for hematoma
ice and analgesia, sitz bath and heat, I &D, Abx
200
wound infection S.sx
temperature, cultures, CODA
201
infection of the reproductive tract until6 weeks PP, risk because of bacterial presence
puerperal infection
| bc: ROM, uterus (warm, dark, moist, nutrient rich)
202
when you have a PP with a temperature what should you expect first
endometritis
| usually at placental site
203
risk factors for endometritis
ROM, hands, laceration/episiotomy, operative delivery, foley, PROM, mult. vaginal exams, DM
204
what is not a reliable lab for PP infection
WBC (bc already elevated due to pregnancy)
205
PP what do you want to increase in your diet
protein (promote healing)
206
vascular occlusive process with impeded blood flow
thromboembolic disease
207
what PP factors contribute to thromboembolic disease risk
increase of platelets, thromboplastin (released from tissue after delivery), fibrinolysis inhibitors (increase amount)
208
what anticoagulants are given
heparin through pregnancy
| Coumadin in PP period
209
S/Sx of thromboembolic disease
6 P's, edema, low grade fever, chills, palpable cord
210
prevention of thromboembolic disease
elevate legs, don't cross, ambulate, knee position, support hose, hydrate
211
clogged mild duct without infection
plugged duct
| breast milk pools behind a duct and blocks milk from exiting
212
S.sx of plugged duct
massage towards nipple, warm compress, nursing, pumping
213
unilateral inflammation of breast tissue
mastitis, inflammation due to plugged duct
214
S.sx of mastitis
sudden onset, pain, febrile, flulike sx
215
Tx of mastitis
warm compress before, cold after BF, rest, NSAIDS, Abx, continue to BF
216
Prevention of mastitis
hand washing, supportive bra, good technique, regular nursing, air dry milk on nipple
217
infection of the bladder/urethra
cystitis
increased risk due to PP diuresis, decrease of bladder sensitivity
overdistension or incomplete emptying = stasis + bacterial growth
218
S.Sx of cystitis
frequency, dribbling, urgency, hematuria, dysuria, suprapubic pain
systemic S.sx: increase fever, chills, flank pain, N/V
219
Tx of cystitis
UA, Abx, antispasmodics (peridion), void schedule, monitor output, badder US, cranberry juice
220
decrease of size of an organ due to a decrease in cell
involution
221
delay or absence of uterine involution
subinvolution
222
time following childbirth
puerperium (4th trimester)
223
changes with uterus PP
seals off where placental insertion site was, organ decreases in size can take 5-6 weeks, @24 hours 1 FB below U, @10days-2 weeks wont be able to palpate the fundus
224
are afterpains normal
yes, they are part of involution process, happens bc uterus has relaxation and contractions, breast feeding also increases after birth pains
225
self destruction of excess hypertrophy tissue
autolysis
226
heals from underneath superficial layer is necrotic and sloughs off and layer underneath is brought to surface, no scar tissue forms
exfoliation
227
what can cause retard involution
retained placenta, full bladder, infection, LGA, multipara women, prolonged labor, anesthesia
228
changes with cervix PP
slit like, soft thin fragile cervix, takes about 1-2 weeks to regain shape
229
changes with vagina PP
edematous, bruised, few wrinkles, smooth @3 weeks PP Rugae will reappear
230
if the hymine is torn what will happen
heal irregularly & leave small tags called caruncalae myrtioform
231
changes with perineum PP
edema, tenderness
232
changes with lochia PP
lasts 2-6 weeks, Lochia rubra (2-3 days), lochia serosa (3-10 days), lochia alba (2-3 weeks)
233
when should you have an increase in lochia discharge
heaviest in morning, exertion, breast stimulation
234
prolactin
promotes milk production by stimulating aveolar cells in breast
235
oxytocin
posterior pituitary (secretes oxytocin), in response to infant sucking stimulates let down, causes release of milk
236
when will menses start again PP
3-4 months after delivery or stop lactation
237
changes in cardiovascular system
stroke volume/cardiac output will return to normal in 2 weeks, HR & BP will quickly return to normal
238
changes in Respiratory system
RR increase, 6-8 weeks to return to normal
239
changes in urinary system
have edema in bladder, urethra, decrease of tone and sensitivity
kidney function returns to normal about 1 month
240
changes in gastrointestinal system
constipation bc decrease peristalsis
| hemorrhoids common
241
changes in musculoskeletal system
abdominal wall decrease muscle tone, Diastasis recti-abdominal separation resolves without intervention
242
changes in integumentary system
striae gravideium- stretch marks, cloasmia- pregnancy mask, straie negri-dark line in abdomen
243
VS changes PP
temperature slight increase, (slight increase when milk comes in), pulse decreases bc of increase blood volume, blood pressure slight increase, respirations slight increase
244
changes in endocrine system
estrogen, progesterone, human placental lactogen all decrease after placental separation
lowest levels are @ 1 week PP
prolactin levels increase & remain increase while beast feeding
245
Bromage scale
flex knees, lift legs off bed, raise butt
| used for recovery from regional anesthesia
246
breast care for bottle feeding moms
tight well fitted bra, ice analgesics, no hot showers, no partner play, apply cabbage leaves
247
breast care for breast feeding moms
bra, no soap on nipples, no stimulation other than baby sucking, shields, assess S/Sx engorgement, Lanolin (nipple cream), milk on nipples
248
when is Rhogam indicated
if mom is Rh negative and newborn is Rh+
249
what test is done for NB for antibodies
Coombs test
250
what PP exercise tips can you give a new mom
begin with low reps & gradually increase
avoid fatigue
stop if bleeding increases or changes
maintain hydration
251
mom should not get Rubella vaccine if what
is getting Rhogam bc it suppresses the immune system
252
caput succedaneum
localized scalp swelling, edema that crosses the suture line, caused by the presentingpart on undilated cervix
253
Dx & Tx for caput succedaneum
Dx; visual
| Tx: none
254
cephalhematoma
subperiosteal hemorrhage, edema that doesn't cross the suture line, no color change, caused by head hitting the pelvis
255
Dx & Tx for cephalhematoma
Dx: visual
Tx: none, resolves in 2-6 weeks
*SE can have jaundice occur when healing begins
256
diffuse scalp hemorrhage
edema of scalp & possible forehead, decrease in H&H, caused by traumatic delivery or vacuum use
257
Dx & Tx for diffuse scalp hemorrhage
Dx: visual CT scan
Tx: neuro assessment, possible transfusion
can cause hypovolemic shock and death
RARE
258
Subcutaneous fat necrosis
lesion, stays 2-6 weeks, overlying skin is intact, usually on face or cheeks, caused by pressure against bony pelvis, vigorous maneuvering of fetal body, RARE
259
Dx & Tx of Subcutaneous fat necrosis
Dx: S/Sx
Tx: watch, will disappear in 4-6 weeks
260
cause of petechaie/ecchymosis
nuchal cord, mechanical device, Dx visually, Tx observe, test if needed for coagulation deficit
261
subconjunctival hemorrhage
red spot on sclera, caused by pressure during birth
262
retinal hemorrhage
due to venous congestion from compression of head
263
injury to liver
due to manilpulation of body during delivery (breech), also during CPR
S/Sx:poor feeding, increase HR, listlessness, palpate a mass in RUQ
264
Dx & Tx for injury to liver
Dx: parasentesis
Tx: evacuate hematoma
if not tx= death
265
erbs palsy
waiters tip
| trauma to C5-C6, arm hangs limply @ side and is rotated internally, elbow is extended but fingers and wrist is flexed
266
Dx & Tx of erbs palsy
Dx: check moro reflex, Xray
Tx: none specific, immobility arm to decrease inflammation
267
Klumpke
trauma to C8-T1, involvement of hand and forearm, weak wrist
268
Dx & Tx for Klumpke
Dx: check moro (no movement in hand)
Tx: splint hand, claw hand deformity
269
phrenic nerve paralysis
diaphragm, have labored respirations, cyanosis, decrease breath sounds on effected side
270
Dx & Tx for phrenic nerve paralysis
Dx: x-ray show elevating diaphragm
Tx: postion on effective side, assist with resp efforts, recovery within 6 weeks
271
facial nerve injuries
have paralysis on effected side, caused by pressure over facial nerves, forceps or position in utero
272
Dx & Tx for facial nerve injuries
Dx: visual
Tx: careful feedings, parent support, tape effected eye shut, use of artifical tears, function return in 2-3 weeks, gone in 2-3 months
273
fractures
clavical most common, have decrease movement on effected side
274
Dx & Tx of fractures
Dx: moro intact with pain, xray
Tx: immobolization not required, heal rapidly, minimize movement
275
torticollis
"wry neck", sternocleidomastoid muscle injury, painless swelling in neck
276
Tx for torticollis
ROM, take 5-6 months to disappear
277
spinal cord injury
usually from breech delivery, have paralysiss at level of defect. rare
278
women who develop carbohydrate intolerance of variable severity during pregnancy
gestational DM
279
birth anomalies are most common in women with hyperglycemia when
in the 1st trimester,
| ketoacidosis is associated with interuterine death
280
if a type 2 DM pregnant women is taking ACE inhibitors prior to pregnancy, what medication will she be put on during pregnancy
beta blocker
281
what do most gestational DM women have
chronic beta cell dysfunction
282
what are factors for gestational DM
family hx, obesity (BMI greater 30), increase age, Hx abnormal glucose metabolism, previous LGA, Hx of polycystic ovary disease
283
when is screening done for gestational DM
week 24-28
| a value of greater 140mg/dl requires further evaluation with a 3 hour OGTT
284
3 hour OGTT
fasting less than 95
1 hour less than 180
2 hour less than 155
3 hour less than 140
285
what are the normal metabolic changes during pregnancy
fetus depends on mother for fuel to meet growth needs, glucose crosses placenta, incrase insulin levels in late pregnancy
286
normal changes in pregnancy
normal growth of placenta releases increase of glucose hormones, maternal need for insulin is increased each trimester
287
in a previous DM what must they be taught about the 3rd trimester
moms pancreas must release 3-4 times the amt of insulin, so this will require significant changes in insluin need
288
when does gestational DM go away
once baby and placenta are removed from moms body
289
what risks do mothers have with hyperglycemia in pregnancy
retinal changes, hydyramnious (extra amniotic fluid), pre-eclampsia, HTN, fluid retention
290
what risks to babies have when mom is hyperglycemic during pregnancy
macrosomic, preterm, difficult delivery, still birth, neonatal death
291
goal for one hour post meal glucose
130 mg/dl or less
292
glyburide
outcomes similar to insulin use
293
metformin
crosses placenta
294
short acting insulin
Regular, Humalog
295
long acting insulin
humulin N
296
at delivery what is the risk for the baby
low blood sugar, since the baby lived in a higher sugar enviornment in moms placenta, the babys pancreas may release extra insulin and cause the sugar to go too low after delivery
297
what can be done if the babys blood sugar is too low
formula or breast milk, if unable to suck IV glucose is given
298
the child carried during this pregnancy has a risk of
obesity, insulin resistance, dyslipidemia, type 2 DM
