Midterm 1 Material Flashcards
1
Q
What are the 4 main hormones produced by the placenta?
A
- hCG
- hPL
- Estrogen
- Progesterone
hCG (drops after the first trimester),
hPL (human placental lactose) - helps regulate sugar for baby,
Estrogen & progesterone (sustains endometrial lining to nourish blood supply to baby, prepares mammary glands for production)
2
Q
When does increased urinary frequency occur to mom, what drives this change? Provide Nursing Interventions
A
1st trimester, d/t vascular engorgement and pressure on the bladder.
Nursing: empty bladder frequently, Kegel exercises, report painful urination
3
Q
When does N&V typically occur in pregnancy and what drives it?
Provide Nursing interventions
A
1st trimester d/t increased HcG levels.
Nursing: small frequent meals, low fat content, crackers at the bedside & citrus scents
4
Q
Which trimester does Heartburn start and what drives it?
A
Heartburn: typically second trimester and d/t increased progesterone and reduced intestinal mobility
5
Q
What are Montgomery’s tubercules?
A
Found around the nipples as a result of increased hormones; lead to increased lubrication for the nipples while breastfeeding
6
Q
What is the corpus luteum (C.L)? What hormones does it produce?
A
Remnants of the follicle after ovulation.
hCG produced by the inital cells of fetus signal for the CL to remain viable.
CL produces estrogen and progesterone to sustain endometrial lining and produce a habitable enviro for implantation and growth.
CL also produced relaxin ( to relax joints of the symphysis pubis) & inhibin to limit contractions
C.L will produce hormones for about 3-4 months until the placenta can take over
7
Q
What drives nasal stuffiness & epistaxis in pregnant mom?
A
estrogen levels, occurs in 1st trimester resolves after delivery
Nursing: humidifier, NS nasal drops
8
Q
What changes occur to BP during pregnancy?
A
diastolic: decreases 1st trimester until 24-32 weeks»_space; increases to pre-pregnancy levels
systolic: remains the same or slowly lower as pre-pregnancy levels
9
Q
What are the physiological changes that occur to the body during pregnancy?
A
- Fatigue»_space; d/t hormone changes
- Urinary frequency»_space; vascular engorgement & fluid changes
- N&V»_space; increased hCG
- Heartburn»_space; progesterone & decreased intestinal motility
- Breast Tenderness»_space; Hypertrophy of tissue
- Montgomery’s tubercles»_space; hormone driven
- Back pain»_space; Relaxin and changes in center of gravity
- Faintness»_space; Postural hypotension
- Epistaxis»_space; Estrogen levels
- Ankle edema»_space; increased fluid, decreased circulation
- Varicose veins»_space; heredity, enlarging uterus, relaxed smooth muscle walls in veins
- Hemorrhoids»_space; smoot muscle walls relax in veins & congestion in pelvis
- Constipation» low GI motility
- Difficulty sleeping»_space; discomforts, baby moving
- round ligament pain»_space; stretching of ligaments
- BP»_space; diastolic: increase 1st trimester until 24-32wks / systolic: remains the same, may lower slightly
- Respirations» change in respiratory center results in lowered threshold of Co2. increased tidal volume and increased O2 consumption by 20-40%
10
Q
When does the fetal heart beat at a regular rhythm
when is the fetal heart fully developed
when can the fetal heart be detected by doppler
A
4weeks
8weeks
10-12 weeks
11
Q
When do the neural tubes begin to develop?
When does ultrasound verification of the embryo occur
A
3 - 8 weeks
between the 6 - 8 weeks
12
Q
when do maternal antibodies begin transferring to the baby?
A
8- 10weeks
13
Q
Timeline of key fetal developments in the first trimester:
- Neural tubes begin developing between weeks ____ to _____
- Fetal Heart beats at a regular rhythm @ _____weeks
- Heart of the fetus is fully developed by _____ weeks
- The embryo becomes a fetus at the end of the _____ week
- Maternal antibodies begin to transfer to the baby at about ___to ____ weeks
- The first trimester last from ____________ to _________
- Fetal heart rate can be detected on doppler @ ___ to ___ weeks
- sex of the baby is determined at ____ weeks
- Urine begins to be produced and excreted at ____ weeks
- by the end of the _____ trimester all organs are formed
- by the end of 12 weeks the fetus
- resembles a ______
- ______ is secreted
- kidneys are _____________
- _________ is present
- earliest _______ _______ are present
- ______ recognizable
A
- 3 - 8weeks
- 4 weeks
- 8 weeks
- 8 week
- 8 -10 weeks
- 1st day of last period to 12 weeks
- 10-12 weeks
- 12 weeks
- 12 weeks
- 1st trimester
- human, bile, able to secrete urine, suckling, taste buds, sex is recognizable
14
Q
Timeline of key fetal developments in 2nd trimester:
- 2nd trimester last from _____ week to ______ week
- Fetal movements are felt by the mom (quickening) at ____ to ____ wks
- Lanugo begins to grow on the fetus and Vernix begins to protect the baby at about _____ weeks
- Alveolar ducts and sacs are present at _____ weeks
- Brown fat deposits are developed beneath the skin @ ____ to ___ weeks
- Lecithin begins to appear in amniotic fluid at about ____ weeks
A
- 13 week to 28th week
- 14 to 18 weeks
- 20 weeks
- 24 weeks
- 26 - 30 weeks
- 21 weeks
15
Q
Why are some fish and shellfish detrimental to the developing NS of the fetus?
How many servings of and what types of fish are recommended while pregnant?
A
high levels of mercury
2-3 servings per week of salmon, sardines and trout. Canned light tuna. All of these are low in mercury
16
Q
Foods such as hot dogs, lunch meats, bologna, deli meats, soft cheeses, raw and unpasteurized dairy products are recommended to be avoiding by pregnant women because they pose a risk of:
A
listeriosis
rare serious infection caused by consuming listeria monocytogenes bacterium
if infection developed in 1st trimester: risk of miscarriage
if infection developed later in pregnancy»_space; infection can be passed to the fetus: risk of premature or still birth
17
Q
What is a safe dose of daily caffeine while pregnant?
A
300 mg/day (equivalent to 2 8oz cups of coffee a day)
* fetal growth restriction can occur with high caffeine intake
18
Q
Pregnant women handling cat feces and eating undercooked meat can lead to infection of
A
toxoplasma gondis»_space; protozoan parasite»_space; toxoplasmosis
19
Q
Pregnant women with periodontal disease may have increased risk of:
A
delivering preterm or having a low birth weight
20
Q
It is best to seek dental care between the _____ & _____ month of pregnancy
A
4th - 6th month
during the 2nd trimester
21
Q
Risk associated with hot tubs and pregnancy
A
Breeding ground for bacterial infections
* can cause fetal tachycardia
* high temps can cause discomfort to the fetus
avoid temps above 38.9C
* hypotension»_space; dizzy and faint. do not enter hot tub alone
22
Q
Risks of smoking while pregnant
A
- single greatest modifiable cause of poor pregnancy outcomes
- low birth weight
- preterm birth
- premature rupture of the membranes
- SIDS (higher incidence of babies who are born to mothers who smoke)
- Smoking is associated with IUGD
23
Q
What is IUGR, what modifiable actions increase the risks o IUGR
A
Intrauterine growth restriction
smoking / chronic exposure to secondhand smoke
24
Q
Multiparous
gravid
para
primiparous
A
- two or more births
- state of being pregnant
- having given birth (live or stillborn) after 20weeks gestation
- 1 birth at more than 20weeks gestation (live or stillborn)
25
```
G
T
P
A
L
```
G: total # of pregnancies, including the current one
T: total number of term infants; (>37weeks) twins count as 2
P: total # of children born prematurely ( 20 - 37 weeks) twins count as 2
A: total # of pregnancies that ended in either therapeutic abortion or spontaneous abortion before 20 weeks gestation
L: Total # of children currently alive
26
Nageles rule
determine the ____ day of the last menstrual period
Subtract ______ months, and 7 days
Add ___ year
FIRST
3 months
1 year
*** this rule is an estimate assuming the woman has a regular 28 day cycle & and that pregnancy occurred on the 14th day of the cycle
27
What are the primary components of an antenatal assessment?
```
Interview
Health history
Physical exam
Lab tests
Fetal wellbeing >> fundal height, gest age, health status
```
28
Importance of the RH protein lab evaluation ?
Rh factor protein found on RBC
If it is present >> Rh positive / if not Rh negative
If the mother is Rh negative and baby is Rh positive >> Rh incompatibility.
if fetal blood (from Rh +'ve baby) transfers to mom (Rh -'ve) the mothers body will begin producing antibodies. This will become an problem for the second baby, where the mothers blood (which now has antibodies for Rh) will attack fetal RBC
29
What is Win Rho?
| When and why is it given?
Injection given at 28 weeks gestation for ALL Rh mothers and then within 72 hours of delivery. IM or IV injection
Designed to prevent Rh antibodies from developing.
30
What are the increased caloric demands on the pregnant mom at each trimester?
1st trimester: synthesis of fetal tissue few demands for maternal nutrition
31
What is the average total weight gain of the baby at 40 weeks?
13kg (29 lbs)
32
What assessments should be conducted at the first prenatal visit?
```
Vitals
Height & weight
H2T
Head and Neck inspection
chest inspection
abdomen inspection
Extremities
Pelvic exam
```
33
What is fundal height and what does it measure
fundal height is the measurement of the uterus above the pubis symphysis >> used as an indicator of fetal growth
fundal height>> provides a rough estimate of the duration of pregnancy.
use measurement of fundal height (+/- 2cm) to estimate gestational weeks
ie. fundal height of a women @ 28 weeks gestation w/ empty bladder should measure around (26 - 30 cm)
34
What is the fundus
Top of the uterus
35
Fundus is slightly above the pubis symphysis: _____to _______ weeks
Fundus is halfway between the pubis symphysis and the umbilicus: _______ weeks
Fundus is at the umbilicus: ____ to____ weeks ** think halfway
Fundus is three fingerbreadths above the umbilics _____ weeks
Fundus is at the xiphoid process: ______ weeks
```
12- 14 weeks
16 weeks
20 weeks
28 weeks
28 weeks
```
36
What is a normal fetal heart rate
110 - 160bpm
37
We want baby's HR to ________ moms contractions
mirror. This is called early deceleration
The fetal HR should decelerate with moms contractions. Not substantial decrease still within normal (120-160bpm) but slight dip
Compression of baby's head on pelvis/soft tissue of cervix
this is normal no interventions necessary
38
When fetal HR deceleration follows the contraction it is known as
late deceleration
Appears as a "u" pattern when compared with contractions
Causes: uteroplacental insufficiency >> not enough nutrients and oxygen when mom is having a contraction. uterus and placenta aren't meeting their nutrient / requirements
Needs intervention
39
The cause of variable fetal HR deceleration is
```
cord compression (prolapsed, wrapped around the baby)
Needs intervention
```
40
What are Leopold's Maneuvers
| what is their purpose
4 maneuvers of palpating the maternal abdomen to determine:
1. the number of fetuses
2. fetal presentation, lie and attitude
3. Determine the degree of decent into the pelvis
4. Determine the point of maximal intensity of the FHR on maternal abdomen
41
When can Leopold's Maneuvers be done
as early as 20-24 weeks. At this point the uterine wall has become thin enough to palpate.
Can also be performed antenatally in labor and during contractions
42
When thinking about Leopold's maneuvers the fetus is referred to as the ____________, while the maternal pelvis is referred to as the _____________
passenger
| passageway
43
4 sutures in the fetuses skull
Frontal
Lambdoid
Coronal
sagittal
44
Fetal attitude refers to
the fetal body parts in relation to one another
deviations from normal fetal attitude can cause issues for labor and birth process
Normal: general flexion, head and chin tucked in
45
Fetal lie refers to:
| name the 3 types
position of the baby's spine in relation to moms
longitudinal (99% fall in this category) - lines up with moms spine
Oblique
transverse
46
Fetal presentation refers to:
| name the 3 types:
presentation or presenting part indicates the portion of the fetus that overlies the pelvic inlet.
47
the passageway refers to the mothers pelvis.
| name the 3 bones that make up the pelvis
Ilium
ischium
Pubis
48
When discussing the fetus in the womb and how it sits we consider these 3 terms
```
Fetal attitude ( how its body parts are arranged; normal >> general flexion. head and chin tucked)
Fetal lie ( baby's spine in relation to moms)
Fetal presentation (cephalic, breech, shoulder)
```
49
The true pelvis is divided into 3 sections
inlet
midpelvis
pelvic outlet
50
Three notations to describe fetal position:
_____ _______ _______
the middle notation is viewed first. It refers to:
the first notation is viewed next and refers to:
the third notation refers to:
Look at the middle blank first. This refers to the landmark. What is the landmark of the
presenting part? Occiput (O)? Mentum (M)? Sacrum (S)? Scapula (Sc)?
Middle notation refers to left or right in relation to the mothers pelvis (L) or (R).
Third notation refers to whether the landmark is in the front, back or side of maternal pelvis. Anterior (A), Posterior (P) or transverse (T).
_________________________________________
1. Is the landmark towards the left or the right
L - left
R - right
```
Determine middle blank first!
2. Determine Landmark: Position of fetus in mother
O - occiput (flexed head)
M - mentum (un flexed head, straight up)
S - sacrum (sacrum first)
```
3. Is the landmark facing anterior, posterior or transverse (in regard to mom)
A - anterior
P - posterior
T - transverse
Ex. LOA = left, occiput, anterior
51
How many extra calories should mom intake at each stage to maintain proper nutrition?
1st trimester: Synthesis of fetal tissue occurs, there are few demands on maternal nutrition.
2nd trimester: 340 extra calories a day, (for women with normal bodyweight before pregnancy).
3rd trimester: 452 extra calories per day (for women with normal bodyweight before pregnancy).
52
What is the total weight gain for a 40 week pregnancy?
13 kg (25 - 30lbs)
53
In the 1st & 2nd trimester growth primarily takes place in _________ __________
In the 3rd trimester growth primarily occurs in the ________ _________
Maternal Tissues
Fetal tissues
54
Fetal __________ condition where the baby is born larger than 8lbs 13 ounces
What are the primary drivers of this conditon
fetal macrosomia
| diabetes & obesity of the mother during pregnancy
55
Mom reports "I've gained SOOOO much weight" during the pregnancy and has visible fluid retention.
What are your thoughts upon assessment, what causes large babies? is it an underlying condition?
modifiable factors: is she eating more than necessary, are her dietary choices nutrient dense, is she a diabetic, is she experiencing gestational diabetes.
Does she have hypertension or HF that could be causing fluid retention?
56
These nutrients play an important role in growth and development of the infant
Omega-3 fatty acids
* * remember safe sources of fish to avoid listeria
* * no sushi or uncooked fish.
57
Mom requires additional ______ to permit expansion of maternal RBC mass
iron
| red meats, eggs, poultry, whole grains, enriched breads & cereals
58
The practice of consuming nonfood substances or excessive amounts of food stuffs low in nutritional values.
Related to iron deficiency anemia
Pica
59
What are the primary nutrients that require daily increases in pregnancu
Iodine [150>>220mcg] ( iodized salt, seafood & milk products)
Iron [18mg >> 27mg]( red meats, wholegrains)
Magnesium[360>> 400mg] (nuts legumes cocoas meats whole grains)
Zinc [ 9 >> 12mg] (shellfish, meats, whole grains)
Vit A [700 >> 750mcg] (deep green leafy and dark yellow veg)
Vit B6 [1.2 >> 1.9mg](meats, deep green veg)
Vit C[65mg >> 80] (citrus fruits, strawberries, tomatoes peppers).
60
Family is ____ or ____ individuals who depend on each other for ______, ________, and ______ support
2 or more
| physical, emotional, financial
61
Family as _______ refers to family-centered or family focused. Individual as the foreground. traditional nursing approach.
Family as CONTEXT
62
Family as _________ refers to family as foreground . All members of the family are assessed. Assessing how the family is affected by illness/wellness of the individual
Family as CLIENT
63
Family as ________, believes that the whole is more than the sum of it's parts. Interactions are the targets for interactions
Family as SYSTEM
64
Family as _________ of _______ is used in community health nursing. and believes the family is an institution within ________
component of society
| institution within society
65
Three primary concepts essential to understanding family:
1. _______ : individuals that comprise the family.
2. ________: large purposes or roles of families. The way families serve of benefit each other.
3. _________: Family coping skills, roles
Structure
Function
Process
66
An individuals health affects the entire _________ functioning
family's
67
A theory is ways of thinking about and explaining _________
phenomena
68
name the 3 primary family theory's
family systems theory
Family development & life cycle theory
biological system theory
69
4 major concepts of family systems theory:
1. All parts of the system are ________
2. The ______ is more than the sum of its ______
3. All systems have ______ & _____ between the system and the enviro
4. ______ can be further organized into _________
* Subsystems consider 3 dimensions of families:
1. interconnected
2. whole, parts
3. borders and boundaries
4. systems, subsystems
structure, function and processes.
70
What is the goal of nursing in the family systems thoery
To help maintain/restore stability of family to help members achieve highest level of functioning they can.
71
Assessment questions in the family systems theory relate to interaction between _________ & __________. And interaction between ________ & _________ in which they live
individual & family
| Family & community
72
What are some strengths and weaknesses of family systems theory
Strengths:
- It focuses on family as a whole, its subsystems or both
- it is generally understood and accepted theory in society
Weaknesses:
- too broad and general
- Does not give definitive and prescriptive interventions
73
The following questions support which assessment theory?
- How does the event impact various family members
- who is affected most by this event?
- what kind of boundaries exist between the family and the enviro?
- Has there been a similar event in the past? what helped?
Family systems theory
74
This assessment theory believes:
- the family is a system
- family has a life cycle
- the family follow common and predictable stages & changes
Family development & life cycle theory
75
name strengths and weaknesses of family development & life cycle theory
strengths:
- focuses on the family as a whole
- provides a framework for predicting family events at any given stage in the family life cycle
- can offer anticipatory guidance
weaknesses:
- traditional, linear family life cycle is NOT the norm
- modern families vary widely in structure & roles
- developmental milestones shift with shifting structure of modern families
76
The following assessment questions belong to which family theory?
- what stage of the family life cycle is the family at?
- What are the typical stressors at this stage?
- is the family experiencing normative or non-normative events?
Family development & life cycle theory
77
This assessment theory believes:
| - combines children's biological deposition & environmental forces
biological systems theory
78
You would evaluate these 5 systems when using the biological systems theory
```
microsystem
mesosystem
exosystem
macrosystem
chronosystem
```
79
Provide some strengths and weaknesses of the biological systems theory
strengths
- holistic
- bio/psycho/social/cultural/spiritual approach
weaknesses:
- not specific enough to define contextual changes over time
- time consuming
- larger context in which the family is embedded can't be controlled
80
The following assessment questions support which systems theory?
- Which social structure does the family interact with?
- assessment consists of looking at all levels of the system
biological systems theory
81
________ is a pictorial display of a persons family relationship and medical history
genogram
82
________ is a graphical representation that shows all the systems at play in an individuals life
ecomap
83
What are the primary principles of family centered care
- respect and dignity
- information sharing
- participation
- Collaboration
84
Family as structure
- Individuals that comprise the family
- Interactions with other social systems
- Ordered set of relationships within the family
- Does not include roles or functions
- Does not indicate health of family or how it function
85
Family as system
-Interactions in a system
-Whole is more than the sum of its
Parts, more than each individual alone
86
Family Function
```
-The way families serve or benefit each other
Reproductive
Socialization
Affective
Economic
Health care
```
87
Family process
Family coping skills, roles, communication, decision making, rituals and routines
Interactions between members of a family including :
-relationships
-communication patterns
-time spent together
-satisfaction with family life.
88
Family process
Family coping skills, roles, communication, decision making, rituals and routines
Interactions between members of a family including :
-relationships
-communication patterns
-time spent together
-satisfaction with family life.
What are the three concepts essential to understanding family interactions that affect health, illness and well-being?
Structure
function
process
89
family structure: who is the family?
Who is in family:
- Relationships between family members
- Interactions between family members
90
Family nursing process
- Assessment
- Analysis
- Design
- Intervention
- Evaluation
- Analysis
91
Nurses role to engaging families in care
- Background and first contact
- Making Community-Based appointments
- Family assessments in Acute Care settings
- Using interpreters with families
92
Genograms include at least ______ generations
3
93
How are children organized in a genogram
oldest to youngest
94
What is the purpose of a genogram
highlights disease and conditions the family might be at risk for
maps out all family members in an organized 'tree-like' fashion
95
What will the nurse assess in biological systems theory
Assess: social structures (environmental systems) this family interacts with.
-Assessment includes looking at all levels of the system: micro, meso, macro and chronosystems.
96
Define preconception health
Preconception care is the promotion of the health and well-being of a woman and her partner before pregnancy
Preconception health refers to the positive health practices that youths/adults of reproductive age can make to improve their health before pregnancy
97
What is the role of estrogen produced by the placenta
increases prostaglandin production when labour to start; increases blood flow to baby; increases secretion of prolactin
98
What is the role of progesterone produced by the placenta
decreases uterine contractions; decreases immunologic response preventing rejection of fetus; gradually rises to term then drops and labour starts
99
When is side-lying a more appropriate position over supine in those who are pregnant
side-lying takes pressure off the vena cava
100
Why is preconception health important?
The health of parents, their lifestyle choices, and the environment in which they live before and during pregnancy have lifelong implications for their children’s health, learning, and behaviour.
101
Definition of preterm births
The preterm birth rate is defined as the
number of live births with a gestational age at birth of less than 37 completed weeks (<259 days),
expressed as a proportion of all live births
102
Definition of SGA birth rate
The number of live births for which birth weight is below the 10th percentile of the sex and gestation-specific birth weight, expressed as a proportion of all singleton live births.
103
The period of greatest sensitivity of the developing fetus to maternal conditions and environmental exposures is between _____ days and ____ weeks after conception.
** the sensitive period occurs between the woman's ___ and ____ periods.
15 days & 8 weeks
| between the 1st & 2nd periods
104
Organogenesis begins ____days after conception
17 days
105
What are the 4 Components of Preconception Health
1. safe guarding fertility
2. preparing for pregnancy
3. modifying risk factors
4. optimizing the early fetal environment
106
Why is FA recommended during preconception care
Taking FA before you get pregnant substantially reduces the risk of occurrence of neural tube defects (NTDs)
107
What is preconception care?
Provides health promotion, screening, and interventions for women of reproductive age to reduce risk factors that might affect future pregnancies
108
Primary factors that influence preconception health
individual factors
environmental factors
SDOH
109
______are associated with mortality in the immediate perinatal period
NDTs
110
Dietary sources of FA
Leafy greens
Citrus fruits
Enriched breads and cereals
Beans
111
If a mother has NO known NTDs/ no risk factors prior to pregnancy, how much folic acid is recommended daily
0.4 mg/day folic acid 3 months prior to pregnancy and continuing throughout pregnancy is recommended
112
If a mother is at risk for NTDs OR had a prior pregnancy affected with folate sensitive anomalies: what is the recommended daily dose
4 mg/day folic acid 3 months prior to pregnancy and through the first trimester,
Then 0.4 mg/day folic acid for the remainder of pregnancy.
OR 5mg per day
113
Individual factors affects preconception health
```
Folic acid consumption
Alcohol use
Obesity
Smoking
Underlying infections;
Hepatitis B vaccination
HIV/Aids screening and treatment
Rubella vaccination
Varicella vaccination
Sexually Transmitted Infections (STIs) screening and treatment
```
114
T or F
Obesity is an individual risk factor for preconception health. Once pregnant weight loss of 10lbs is recommended
False
| weight loss once pregnant is not recommended
115
AVOID CONCEPTION FOR ___ ______ AFTER RECEIVING LIVE-ATTENUATED VACCINES
4 Weeks
116
Advanced maternal age is a risk factor for:
trisomy 21 , Down syndrome
117
____________ Canadians have higher risks of adverse pregnancy and infant health outcomes independent of socio-economic status and neighbourhoods
Indigenous
118
Pregnancy last for _____ lunar months
10 lunar months (28 days in 1 lunar month)
| So... 280 days/ 40 weeks
119
How many weeks is the first trimester
The first trimester begins on the first day of your last period and lasts until the end of week 12.
0-13 weeks
120
How many weeks is the second trimester
14-26 weeks
121
How many weeks is the third trimester
27-40 weeks
122
T or F
A couple has decided to start trying to get pregnant. The first visit to the physician should be scheduled as soon as the woman suspects she is pregnant.
False
ideally she would visit prior to conception
** taking FA 3 months before conception has proven to be effective for reducing the risk of NTD
123
T or F
All baby’s organs and body systems have fully
formed by 8 weeks from conception.
False not fully
124
```
T or F
Women with diabetes
are more likely to have
a baby born heavier
than normal at birth.
```
True
| macrosomia
125
T or F
| Obese, pregnant women are more likely to have a baby born with a birth defect than a pregnant woman of normal weight
True
126
T or F
| Women of normal weight prior to becoming pregnant are advised to gain 11.5 - 16 kg (25-35 lbs) during pregnancy.
False weight gain is dependent on BMI
127
T or F
| Women who smoke in pregnancy are more likely to deliver an infant with a low birth weight.
True
| SGA
128
T or F
Women could transmit sexually transmitted
infections, like syphilis, to their baby
Women could transmit sexually transmitted
| infections, like syphilis, to their baby
129
T or F
During the last 3 months of pregnancy, the developing baby is at greatest risk from exposure to harmful substances or environmental toxins
False: it is the first 3 months of pregnancy. Between the first and second missed periods
130
High levels of ______ and _______ stimulate uterine growth in the first trimester.
Progesterone & estrogen
131
Kelsey is pregnant for the third time. She gave birth to a single baby at 42 weeks and twins at 35 weeks gestation, all of whom are currently alive.
What is here GTPAL?
What will the GTPAL be after
her baby is born at 39 weeks?
Gravidity – 3 number of all pregnancies
Term birth – 1 single baby at 42 weeks
Preterm births –2 twins at 35 weeks (preterm is after 20 weeks to 37 weeks)
Abortions and miscarriages – 0
Living children – 3
____________________
G3 – 3 pregnancies
T2 - 2 single babies at 37 weeks or more gestation
P2 - 2 babies at 35 weeks gestation (Textbook says to count twins as 2 here)
A0 – no abortions or miscarriages
L4 – twins plus 2 single birth babies
132
Kelly reports her menstrual cycle is 28 days long and periods have been regular prior to pregnancy.
the first day of kelly's last menstrual period (LMP) was September 19, 2018 and lasted 5 days, ending on September 24, 2018.
When is Kelly's baby due?
Using Nagele's rule:
September 19 2018
Subtract 3 months – June
Add 7 days - 26
Adjust year - 2019
133
What are the components of an antenatal assessment?
```
Interview>> health hx
Physical examination
Lab tests
Fetal well being (beginning end of 1st trimester)
Fundal height
gest age
health status
```
134
When is the woman screened for Group B streptococci? GBS
35 -37 weeks
135
How can fetal blood impact the mother, at which points can fetal blood interact with mom?
amniocentesis
chorionic villi sampling
bleeding during pregnancy
trauma to the abdomen during pregnancy
136
___________ is the earliest biological marker for pregnancy.
Human chorionic gonadotropin (HCG)
Production of HCG begins as early as the day of implantation and can be detected as early as 7-10 days after conception.
137
Main action of progesterone during pregnancy
Effects smooth muscles = relaxes
| Ex. relaxed veins in legs → varicose veins
138
Main action of estrogen during pregnancy
Increases vascularity of the breasts and uterus (hypertrophy of cells)
139
In which trimester does frequent urination tend to stop? When is frequent urination most commonly going to occur?
Frequent urination stops during 2nd trimester, as the uterus rises higher into the abdomen, relieving the pressure. Then at the end of the term, there is more pressure in the 3rd trimester due to the immense growth
1st trim: increased pressure and voiding
2nd trim: back to normal
3rd trim: increased pressure and voiding
140
What hormone relaxes the esophageal sphincter, causing acid reflux
progesterone
141
In the first 12 weeks of pregnancy where do the pregnancy hormones secrete from?
corpus luteum creates hormones for the first 12 weeks, after which the placenta takes over
142
Define primigravida
first pregnancy
143
Define antepartum
Time between conception and the onset of labour; often used to describe the period during which a woman is pregnant; used interchangeably with prenatal
144
Define intrapartum
Time from the onset of regular contractions until the birth of the baby and placenta
145
Define multiparous
has gone through labour more than once
146
What are 3 methods to determine an estimated date of birth
EDB wheel
Ultrasound
Nagele's rule
147
Define Rh incompatibility
When mom is Rh - and Dad is Rh +
148
What is hemolytic disease of the newborn?
AKA erythroblastosis fetalis
If the fetus is Rh positive, antibodies from the mother cross the placenta, attach to fetal RBCs and begin to hemolyze them. This breaks down the RBC way too fast.
149
Indirect vs Direct Coombs test
indirect coombs test: checking for sensitization, more of a screening out of precaution (indirectly checking sensitization through mom)
direct coombs test: it is done on the infant's blood to detect antibody-coated Rh-positive red blood cells. (directly checking sensitization on baby)
150
What is the role of iron supplementation in pregnancy
allows transfer of iron to the fetus. Permits expansion of maternal hemoglobin (important for brain development too)
151
pica is often related to
iron deficiency anemia
152
Why may systolic murmurs occur during pregnancy
due to increased blood volumes
153
Do resps increase or decrease during pregnancy
Increased demands on the body causes INCREASED respirations
154
A slight dip in BP is most noticeable in which trimester
2nd
Peripheral vasodilation can cause a drop in BP
155
What 4 physical changes happen to the uterus over the course of pregnancy
Hyperplasia
Increased vascularity
Hypertrophy
Change in shape and position (pear shaped) due to pressure exerted by growing fetus
156
Fundal height correlates with gestational weeks around ______ weeks
Starting around 22-24 weeks
Ex. At 22 weeks, fundal height will be 22 cm
157
At what week, does fundal height NOT correlate with gestational weeks?
why?
34 weeks
| at this point the baby has usually dropped down into the pelvis
158
Why would fundal height be measuring larger than expected?
Polyhydramnios → Too much amniotic fluid
Macrosomia → excessive tissue growth (big baby)
Twins?! Maybe it is not a singleton pregnancy: more than one child
159
Define polyhydramnios
too much amniotic fluid
160
Fundal height may be measuring smaller than expected due to ??
Intrauterine growth restriction (IUGR) → fetus isn't growing at the rate it should be.
- Mother is a smoker: interferes with oxygen to fetus
- Lack of nutrition
Oligohydramnios → Too little amniotic fluid
161
pulsations under the fontanelles could indicate_______
dehydration
162
longitudinal fetal lie looks like.....
Baby is in line with mom's spine; HEAD FIRST pointing towards the vagina
163
Transverse fetal lie looks like
Baby is horizontally sideways; head pointing left or right
164
Oblique fetal lie looks like...
Baby is transverse but at an angle
165
Define fetal presentation. what are the 3 fetal presentations
The part of the fetus that enters the pelvic inlet first
Three presentations are:
1. cephalic (head first)
2. breech (butt/feet first)
3. shoulder presentation
166
Explain: cephalic vertex presentation. is this an ideal positon?
Head first
Chin tucked into chest
BEST for labour. The most common presentation and associated with the fewest complications
167
What are the 4 cephalic presentations?
- Vertex - complete flexion
- Military- moderate flexion
- Brow - poor flexion
- Face - full extension (literally face first out the birth canal)
168
What are SOGC Recommendations for fetal movement?
Count 6 distinctive fetal movements; if less than 6 movements in 2 hours, further assessment is indicated.
Tell her to contact primary caregiver OR go to the hospital
169
What factors affect fetal activity?
Decreased fetal movement:
- Due to decreased placental perfusion (lack of O2)
- Mother's BG levels
- Smoking and drug use
170
the ________ stage of labour begins with onset of regular contractions and ends with complete cervical effacement and dilation
first stage of labour
171
what are the 2 phases of the 1st stage of labour
Latent (early) phase: 0-3 cm dilated in primiparous and
cervical length < 1 cm or
75% effaced
Active (about 3-6 hours): Beginning at 4 cm dilated in a nulliparous woman; 4-5 cm in multiparous woman
172
What are the 5 P's that affect the process of labour
1. Passenger (fetus and placenta)
- fetal head
- fetal attitude
- fetal lie
- fetal presentation
- fetal position
engagement
station
2. Passageway (birth canal)
3.Powers (contractions)
4. Position of the mother
5.Psychological Response
173
What is amniocentesis
A procedure used to obtain amniotic fluid (which contains fetal cells) for genetic testing for fetal abnormalities OR to determine fetal lung maturity in the 3rd trimester
174
What is Chorionic Villi testing (CVS)
A procedure that involves obtaining a sample of chorionic villi from the developing placenta for genetic studies
175
T or F: Having GDM increases your risk for getting DM2 later in life?
True. Increased risk for developing DM2, after having gestational diabetes
176
When does Gestational Diabetes mellitus develop
develops during the last half of pregnancy
177
Explain: Pathology behind GDM
Maternal nutrient ingestion causes higher blood glucose levels and...
Placental hormones cause an increased maternal resistance to insulin
While... Most women are capable of increasing insulin production to compensate for insulin resistance = NO PROB, EVERYTHING IS FINE
When the pancreas is unable to produce sufficient insulin (or the insulin is not used effectively) → GDM DEVELOPS
178
What does station refer to in labour
Station: relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines
a measure of the descent of the presenting part of the fetus through the birth canal.
Station is measured in cm
minus or plus, depending on its location above or below the ischial spines
179
What does engagement refer to in labour
“The term used to indicate that the largest transverse diameter of the presenting part (usually the biparietal diameter) has passed through the maternal pelvic brim or inlet into the true pelvis and usually corresponds to station 0.
```
The true pelvis, the part involved in birth, is divided into 3 planes:
the inlet (or brim)
the midpelvis (or cavity)
the outlet
```
180
What are the 'POWERS' or physiological forces that drive contractions during labour
Frequency
Duration
Intensity
Resting Tone
181
the purpose of uterine contractions is to drive effacement; what is effacement
Effacement is the softening, thinning and shortening of the cervical canal from a structure of 1-2 cm long to one in which no canal exists at all
182
How is the effacement of the cervix in labour measured
The degree of effacement is expressed in percentages, from 0 to 100% (e.g., a cervix is 50% effaced) or in length in centimetres
183
The purpose of uterine contractions is cervical dilation. describe this process
Dilation of the cervix:… cervical canal or “os” enlarges from an orifice a few millimetres in diameter to an opening large enough (approximately 10 cm) to permit the passage of the fetus”
184
As labour progress cervical __________ & ______ occurs
effacement (thinning) and dilation (enlargement)
185
What are the maternal cardiovascular adaptions that occur in labour
Cardiac output increases 10-5-%
BP increases: systolic increases more than diastolic d/t peripheral resistance.
Increase in WBC
Contractions constricting blood flow to the uterus >> increase is BP to peripheral tissue >> increase in peripheral resistance >> slight increase in BP
186
What are the maternal respiratory adaptions that occur in labour
If you had a woman who was hyperventilating what would you do?
Increased respiratory rate
Hyperventilation can cause respiratory alkalosis (increased pH leading to hypoxia and hypocapnia
Have them breath into a paper bag
187
What are the maternal GI adaptions that occur in labour
Decreased GI motility
Decreased absorption of food
N&V is common
women can eat/drink during labour, but remember decreased GI motility >> light easily digestible foods
188
What are the maternal renal adaptions that occur in labour
Pressure on bladder from presenting part
Difficulty voiding spontaneously
Proteinuria up 1+ due to breakdown in tissues from labour
Difficulty voiding spontaneously d/t pressure on bladder.
Analgesics can limit voiding
189
What are the maternal neurological adaptations that occurs in labour
Emotional
Euphoria🡪 serious🡪 amnesia—> elation &/fatigue
Endorphins
Physiological anesthesia
endogenous endorphins can increase their pain
190
What are the maternal integumentary adaptations that occurs in labour
Stretching of birth canal and introitus
Tears can happen
hematomas and abrasions
hemorrhoids
191
What are the MSK adaptations that occur in labour
Marked increase in muscle activity
Leads to diaphoresis, exhaustion, proteinuria
Mother has backache and joint aches
May get leg cramps if pointing toes
192
What are the Endocrine adaptations that occur in labour
```
Hormones trigger onset of labour
Decreased progesterone
increased estrogen
Increased prostaglandins
Increased oxytocin
Increased metabolism
Decreased blood glucose levels
```
193
How do you assess the force/intensity of contraction of the uterus?
Place one hand on the fundus of the uterus.
During the peak of the contraction, evaluate intensity by estimating indentability of the fundus.
Soft contraction, feels like the tip of your nose
Moderate contraction feels like your chin
High contraction feels like your forehead
194
What Fetal Heart rate adaptations occur during labour?
| What are these changes in response to?
Temporary accelerations and slight early decelerations of the FHR can be expected in response to:
1. spontaneous fetal movement,
2. vaginal examination,
3. fundal pressure,
4. uterine contractions,
5. abdominal palpation and
6. fetal head compression ( when the uterus contracts it cuts off oxygen to the fetus).
195
Fetal heartbeat is heard best through the _______ _______
fetal back
196
Hand held Doppler US can detect fetal heartbeat as early as: ______ ______
12 weeks
197
two common US methods:
Transabdominal
| Transvaginal
198
Why does the women's bladder need to be full during US
Because a full bladder will push the fetus up, enabling the transducer to see the images of the fetus
199
We ask that women have an awareness of fetal movements beginning at _____ to _____ weeks.
They should count _____ distinct fetal movements within _____ _______.
26 - 32 weeks
6 fetal movements within 2 hours
200
2 primary risk factors for decreased fetal movements:
decreased placental perfusion: insufficient oxygenation
| fetal acidemia
201
Describe an NST
non-stress test: electronic fetal monitor that provides tracing of the FHR
tracing should last a minimum of 20 minutes
baseline FHR 110-160bpm
2 accelerations (15bmp) want it it last 15sec. in a period of 40 minutes of testing
results are
- normal
- atypical
- abnormal
202
What are common causes of fetal tachycardia?
maternal fever and dehydration
203
```
When examining FHR variability we are counting the beat to beat fluctuations from baseline
absent: 0 bmp
minimal: 1-5bpm
Moderate: ______ bpm
Marked : 26+ bpm
```
Which variability is "normal"
Moderate is 6-25bpm and is Normal
204
FHR accelerations must be >___ bpm and last for ____seconds
>15bpm
| last 15 seconds
205
When evaluating the Fetal well-being we would look at the BPP ________ ________ ________
Biophysical profile
206
What 4 components make up the BPP?
1. fetal breathing movement
2. Fetal movements body & limbs
3. Fetal tone extremities
4. Amniotic fluid volume
207
what is oligohydramnious
low amniotic fluid
208
What is an NTT (Nuchal translucency test)?
measures the amount of fluid at the back of the fetal neck.
11-14 weeks of pregnancy
assess for trisomy 12, 18, 21
2.5 mm > less = normal
This test is affected by amount of amniotic fluid
if the fetus is very active
if the woman is unable to stay still
209
What is an Amniocentesis
Needle inserted transabdominally for collection of amniotic fluid.
30ml of fluid collected
15-20weeks of pregnancy
- used to test for genetic abnormalities
-tests for fetal lung maturity in the 3rd trimester
Risk factors: bleeding, miscarriage, cramping, no tampons, and no sex directly following procedure
can return to normal activity within 24 hours
** unpleasant experience
210
CVS chorionic villus testing
10-13 weeks gestation
genetic testing
remove some of the chorionic villi tissue
transcervically>> contraindicated if infection is present b/c we can introduce infection to fetus.
transabdominally >> 18 gauge spinal needle.
This is generally very safe.
211
First stage of labour begins with onset of _________ __________ and ends with complete __________ __________ and __________
onset of regular contractions
| ends with complete cervical effacement (thinning) and dilation
212
Typically length of the first stage of labour:
latent phase:
Active phase:
latent: 6-8 hours0-3cm dilation
active: 3-6 hours beginning at:
- 4cm dilation in nulliparous woman.
- 5-6cm dilation in a multiparous woman
213
What does lightening a premonitory sign of labour refer to?
| At what point in pregnancy does this occur
Uterus sinks down and the baby moves into the true pelvis.
occurs about 2-4 weeks before term.
- less pressure on the lungs, but more pressure on the bladder >> return of urinary frequency.
214
What are some of the prominent premonitory signs of labour?
- low back ache, from baby dropping into true pelvis
- "bloody show" mucus plug dissipates and bloody mucus is present
- ROM rupture of membranes; 'water breaking' > amniotic fluid
- sudden burst of energy >> within week or two before birth
- "nesting instinct"
- "nature's diarrhea", caused by hormones and pressure on bowels
- Braxtons Hicks contractions, can start a month or two prior to labour. Can dissipate when she changes positions
- Slight weight loss: water loss d/t fluid shifts from changing levels of estrogen and progesterone.
215
Birth is imminent once the fetus has of a station of + ___ or +____
+4 / +5
station is measured in cm and refers to the presenting part of the fetus and its location in relation to the ischial spines (which is a station of 0)
216
The station will tell us a lot about the _____ of _____
rate of descent of the baby/fetus
217
The true pelvis is divided into 3 parts:
- inlet (brim)
- midpelvis (cavity)
- outlet
218
primary powers in labour have to do with: ________ ________
uterine contractions
219
When discussing the POWERs of contractions describe the following:
- Duration
- Frequency
- Intensity
- Resting Tone
Duration: beginning to end of one contraction
Frequency: beginning of one contraction to the beginning of the next contraction, including the resting phase
220
Purpose of contractions:
1. ________ of cervix noted in %.
2. ______ of the cervix
effacement: shortening, thinning of cervical canal. beginning as 1-2cm canal and it becomes no canal at all.
Dilation of the cervix a few mm to 10 cms.
221
On the labour chart you read: 50% effaced, 6cm, -1
What is the correct interpretation of the data?
A. The fetal presenting part is 1 cm above the ischial spines
B. Effacement is 4 cm from completion
C. Dilation is 50% completed
D. The fetus has achieved passage through the ischial spines
50% effaced >> thinning and shortening of cervical canal
6cm >> dilation (total dilation of 10cm)
-1 >> indicates station. Passing the ischial spines = station of 0. Station of +4/+5 means birth is imminent.
A
222
Contractions start at the ____ of the uterus.
pain during the first phase of labour is _____
Intensity of contraction is determined by ______
top
mild
placing hand on the uterine fundus
223
A primigravida asks the nurse about signs she can look for that would indicate the onset of labour is getting closer. The nurse should describe:
A. Weight gain of 500 to 1500 g
B. Quickening
C. Fatigue and lethargy
D. Bloody show
D
| mucus plug has disappeared
224
Spontaneous rupture of membranes (ROM) is associated with the "water breaking" we use the acronym COAT to describe the amniotic fluid.
Roughly 90% of women with go into labour within ____ hours with spontaneous ROM
Why is the time of membrane rupture so important to note?
C: color
O: odour
A: amount
T: time
24 hours
Time, starts the clock on when possible infection can set in>> there is an opening to the baby
225
When the amniotic fluid flushes out the _______ _____ can also flush out.
this is an emergency b/c contractions could compress the ______ decreasing oxygen to the baby.
Why are you checking maternal temp every 1-2 hours after ROM
ambilical cord
cord
introduction of infection
226
Green colored amniotic fluid indicates what?
fetus has had a bowel movement in utero >> this is a sign of stress to the fetus
227
A woman is in the active phase of the first stage of labour. The physician artificially ruptures the membranes (AROM). A nurse assisting explains to the woman that after the procedure, she will most likely have:
A. Less pressure on her cervix
B. Decreased number of contractions
C. Increased efficiency of contractions
D. The need for increased monitoring of BP
C
228
Fetal adaptations to labour:
1. _____ to monitor oxygen supply
2. Fetal ________
3. Fetal _________
FHR
Fetal circulation
Fetal Respirations
229
Fetal circulation can be impacted by
fetal position
strength of contractions
BP of the mother
umbilical blood flow
230
What changes occur to stimulate fetal breathing mechanisms after birth
- chemoreceptors in aorta & carotid bodies in the fetus >> helps prepare fetus for initiating respirations right after birth
- As fetus moves through the birth canal, fluid is squeezed out of the lungs.
- oxygen pressure decreases and arterial pH decreases,
bicarb level decreases, and resp movements decreases
** The only thing that increases is arterial CO2 pressure
231
What techniques instruments do we use to monitor fetal responses to labour
Fetal HR monitor
intermittent auscultation
Check maternal distal pulse to differentiate it from the fetus.
232
External Fetal monitor has 2 transducers, what do they monitor
1. monitors fetal HR
| 2. monitors uterine activity
233
To use an internal fetal monitor, certain conditions need to be met:
1.
2. cervix dilated at least ________cm
ROM or AROM
| Cervix dilated at least 2-3 cm
234
EMR has been shown to increases rates of __________
C-sections b/c it medicalizes birth
235
What are some causes of fetal bradycardia
```
FHR < 110bpm
fetal cardiac problem
viral infection
Maternal hypoglycemia
maternal hypothermia
```
236
What are some causes of fetal tachycardia
```
FHR < 160 bpm
maternal fever
maternal infection
maternal hyperthyroidism
is the fetus has anemia
** meds and illicit drugs
```
237
a moderate amplitude range of ____ to _____ bpm in fetal heart rate variability is considered normal
6-25 bpm
238
fetal HR acceleration is defined as ___ bpm above the baseline and lasts for ____ seconds
Has to return to baseline in less than ____ minutes
15 x 15
2 minutes
239
early decelerations in FHR are a sign that the baby's _____ is being compressed by contractions
head
240
Late deceleration is an indication of __________ _________
uteroplacental insufficiency >> there is an issue with oxygenation of the uterus/placenta
241
variable decelerations require _______
| prolonged decelerations require _______
monitoring
| medical emergency
242
What is the nursing care role in the first stage of labour?
- FHR (frequent monitoring)
- Pain management, what is the birth plan
- Labour status; is she progressing, is she coping
- lab eval, WBC, anemia
- comfort, positioning, food and drink
- psychosocial assessment
- cultural assessment
- documentation
243
Which stage of labour is walking most effective for the labour process and pain management?
first stage
allows the fetus to sink down into the pelvis, and allows the mother to remain upright.
Also increases the effectiveness of each contraction
244
_______ pressure can be used during a contraction to help lessen the pain
Counter pressure. gently pushing on the base of the spine with your palm or fist
245
rocking you pelvis is a helpful tool to help rotate the _______ _______ into positon
baby's head
246
Childbirth is considered _______ pain
productive
247
Primary causes of pain in the first stage of labour include:
1. _________ of cervix
2. _________ on adjacent structures
3. __________ of uterine muscles during contractions
4. _________ of lower uterine segment
1. dilation
2. pressure
3. hypoxia
4. stretching
248
Pain during labour comes from 3 places:
1. _______pain; from the organs
2. _______ pain; from skin, muscles
3. ________ pain; originates in uterus and moves to abdo muscles, iliosacral, back, glutes, thighs, breasts
1. visceral
2. somatic
3. referred
249
in the first stage of labour the woman typically experiences pain during a contractions and then subsides.
unless they are in ______ labour
back labour. where the babys spine is adjacent to moms. spinous processes are pushing against moms spine
250
pain in labour needs to be presented as _______ and _______
normal and productive
251
FActors affecting pain in labour include
affective: emotional state
behavioral: muscle tension, breathing
cognitive: how much information and education is provided to the mom and support person
cultural: beliefs around pain and labour
supportive care: doula
252
Sensory pain is greater for _________ women during EARLY (latent) labour
sensory pain is greater for _______ women in the active phase (first stage) and second stage of labour
nulliparous
| multiparous
253
________ Dutch word, describes how the enviro impacts women's perceptions of and management of pain
Gezellig
254
CLS has been shown to support the woman through labour
Continuous labour support
255
What are some of the benefits of CLS
```
increased likelihood of vaginal delivery
decreased risk of C section
reduced risk of epidural analgesia
increased Apgar score
Increased maternal satisfaction
```
256
What are the Cardiac physiological responses to pain in labour?
CO increases with pain from contractions & anxiety
| maternal position affects CO, turn to side to increase CO.
257
What changes occur to BP in pain during labour
BP increases during contractions and may increase with pain
258
What changes occur to respiratory system in response to pain during labour
O2 demand and consumption increases
| respirations and pulse increase with pain
259
What MSK changes happen in labour as a response to pain
Decreased O2 to muscles with increased pain and during contractions
260
What changes occur to immune system and blood values in response to pain and labour
WBC increase
maternal blood glucose levels decrease >> b/c glucose is used as energy source during contractions. So insulin requirements decrease
261
Endogenous endorphins are secreted by the _______ _______
acts on the PNS and CNS
Pain thresholds could ______ in response to endogenous endorphins
pituitary gland
rise
262
```
Non pharmacologic comfort measures in early labour include:
________ & _______ enhancing positions
_________ motions, to rock hips
- _______therapy
- ________ pressure
-________ ball
```
```
upright and gravity
rhythmic
aromatherapy
counter pressure
birthing ball
```
263
Position that help rotation of the body into the Occiput-posterior fetal position include:
```
squatting
hands & knees - helps when mom is in back-labour
counter pressure
birthing ball
hands-and knees or side lying
```
264
Pharmacological comfort measures include:
1. _______ analgesia
2. _______ ______ analgesia & anaesthesia
systemic analgesic >> opioid agonist
| nerve block >> epidural block
265
Epidural block can ______ labour
slow
266
Opioid (narcotic) agonist analgesics include:
- _________
- _________
These do cross the _______.
They have a rapid onset and short duration.
Can only administer once labour is ______ established.
Side effects include:
Fentanyl, sufentanyl, morphine
placenta
well established
Decreases in uterine contractions, N&V, Respiratory depression, maternal & neonatal CNS depression
267
NO is administered via ________.
enters the system within _____ seconds
must be ____administered
inhalation
15 seconds
self-administered
very effective for some, no effect for others.
Can cause dizziness in a small % of cases.
268
Goal of epidural block is to provide sufficient _________ with as little blockage to sensory and motor nerves as possible
administered into the 4th-5th _____ vertebrae
vaginal birth must numb from: the thoracic ____ to sacral ___ vertebrae
C-Section: needs to block from thoracic _____ to Sacral _____ vertebrae
anesthesia
lumbar vertebrae
T10 - S5
C-section T8 - S1
269
Which province has the highest rates of epidural admin
Quebec
270
DYSTOCIA stands for
delayed or arrested progresses in labour, irrespective of causes who require augmentation
271
maternal complications with epidural include:
epidural effects on fetus during labour
```
HYPOTENSION>> BP monitoring is a major Nursing intervention
N&V
fever
pruritis
intravascular injection
respiratory depression
```
Fetal distress secondary to maternal hypotension
272
bleeding disorder
infection to back
and back disorder (scoliosis)
are contraindications for
epidural
273
Nurses role prior to epidural admin
```
VS
pain assessment
education
contraction timing
coping skills
positioning
labs , hematocrit
fetal HR
empty bladder before hand (catheter admin)
IV access
assist her into the position
```
274
post epidural insertion the woman is positioned into_______ _________ or ________ _________ position.
She is repositioned every _____ to _____ minutes
semi reclined, side lying
| 20-30 minutes
275
Second stage of labour begins with _____cm cervical dilation and complete __________ of the cervix.
Second stage labour ends with the _______ of ______
10cm dilation and complete effacement (100%)
birth of the baby
276
Second stage of labour
average duration of
___ to ____ min in nulliparous
___ to ___ minutes in multiparous
50- 60
20-30
277
What factors influence duration of 2nd stage labour?
What happens to contraction frequency, duration & intensity at this stage?
```
maternal size
size of the fetus (weight)
position of fetus
How quickly the fetus is descending
epidural can increase the length of this phase
```
Contractions are typically every 2-3 minutes >> progress to every 1-2 minutes.
Duration: 90secs
Intensity: passive phase lull, active phase they become extremely strong
278
What are some signs indicating the onset of 2nd stage labour?
```
Ferguson's reflex
Shaking of extremities
Vomiting
increased bloody show
restlessness (verbalization)
sweat on the upper lip
involuntary bearing down efforts
```
279
What is Ferguson's Reflex
Feeling the urge to push or feeling the need to have a bowel movement
280
What are the cardinal movements
| ** do not need to know each individual movement >. just know that these movements exist.
Descent: presenting part moving through the pelvis
Flexion: when the presenting part meets resistance from the cervix. Fetus may flex so the chin comes to the chest.
Internal Rotation: in order for the head to exit the fetus has to rotate. begins at level of ischial spines and is completed when presenting part reaches the lower pelvis.
Extension:
Restitution:
External Rotation:
Expulsion:
281
What factors influence the cardinal movement of descent ?
Depends on the pressure of amniotic fluid and fundus on the fetus. As well as the strength of contractions. Descent is measured by the station of the fetal body.
Descent speeds up in the active phase
Assessed through abdominal palpation and pelvic exams
282
_______ is when the top of the head no longer regresses between contractions.
Crowning
283
What are common maternal sensations when crowning occurs?
Ring of fire.
| Episiotomy may be necessary at this part.
284
2nd stage of labour results in perineal trauma which is divided into classifications:
______ degree: extends through _____
______ degree: extends through the _______ of the perineal body
______ degree: continues through the ______ ______ _______
_____ degree: also involves the ______ _______ _______
first: skin
Second: muscles
Third: anal sphincter muscle
Fourth: anterior rectal wall
285
What are the 2 types of episiotomy?
midline: most common, heal the easiest. However there is a higher incidence of 3rd and 4th degree lacerations
medio-lateral: operative birth, 4th degree tears can be prevented (b/c it is off center from the anal sphincter) however blood loss is greater and recovery is longer and more painful.
286
What is an operative birth?
When they use forceps or vacuum
287
How do we prevent episiotomy's during birth?
```
manually supporting the perineum
Use of warm compresses
encourage Kegel exercises >> tightening of the pelvic floor muscles (prenatally and post partum).
Water births
upright position, squatting
```
288
1st & 2nd degree tears to the perineum can be sutured using ______ stitches
3rd degree tears require _______ ________
4th degree tears require an _______ layer of sutures and would be done in the recovery room with epidural
dissolvable
local anesthetic
additional
289
Women with 4th degree perineal tears would require ______ _______ and pain meds to ensure the sutures hold and recover
stool softeners
290
What are the risk factors associated with perineal trauma?
```
parity - number of births
heredity
maternal position in L&B
size of baby
speed of birth
```
291
What are the primary sources of pain during the 2nd stage of labour?
hypoxia of contracting uterine muscles
distension of vagina and perineum
pressure on adjacent structure
** somatic pain
At this stage stretch receptors of the pelvic floor stimulate the release of OXYTOCIN from posterior pituitary >> more intense contractions
292
What are some pain options during the 2nd stage of labour?
local infiltration of anesthesia to the skin >>
5-15mL of lidocaine is injected, epinephrine is added to reduce bleeding as it acts as a vasoconstrictor
pudendal nerve block >> can be administered late in 2nd stage and would be used for episiotomy or operative birth
293
What are the Nursing interventions for the 2nd stage of labour?
- Assess for the maternal signs of 2nd stage
- monitor maternal BP, pulse, and resps
- ongoing assessment of contractions, fetal response (FHR q5mins when pushing)
- ongoing assessment of maternal coping
- Assessing progress of labour q10-15 mins
- Assisting w/ positioning
- Assisting w/ breathing while pushing
294
We want open-glottis pushing, where air is released while pushing..... why?
prevents hemorrhoids
| closed-glottis push increases pressure on the cardiovascular system >> which decreases CO to the placenta.
295
Third stgae of labour starts w/ ______of baby and ends with ________ of placenta
birth of baby
| expulsion of placenta
296
How long post baby birth does it take for the placenta to come out?
15-20 minutes
297
Skin to skin contact post birth helps release _______ in the mom
oxytocin
298
When the shoulders of the baby are coming out we need to give the mom a dose of ________
why?
oxytocin
| It helps prevent post-partum hemorrhage
299
2 steps that are taken to prevent post-partum hemorrhage?
oxytocin injection to mom
| cutting the cord within 3 minutes after birth
300
When the placenta detaches there is a gush of _______ from the vagina.
While the mom is holding baby, awaiting 'birth' of the placenta what helps reduce risks of PP hemorrhage?
blood
| breast feeding >> will release oxytocin
301
Cord blood is collected on the umbilical cord to perform what tests?
Blood gases
blood type * especially if the mother is Rh negative
bilirubin levels if the baby is thought to have an infection
assess a complete blood count (especially in preme baby)
assess if there are any drugs in the baby's system
302
Need to assess the placenta post delivery to ensure what?
that it is intact, if any parts are missing it means they are still in the moms uterus.
If any placental tissue remains the uterus cannot contract and there is bleeding >> PPH
303
Fourth stage of labour involves what?
it is 1-2 hours after birth,
| involves immediate care of the mother and newborn.
304
Maternal VS are assessed every ____ minutes for the first _____ after delivery in the fourth stage of labour to assess for?
15 minutes
1 hour
PPH, bladder distention, and venous thrombosis
305
What changes occur to maternal VS in the 4th stage of labour ?
BP : monitoring to ensure it returns to prelabour level
Pulse: lower than in labour
Temperature: may increase minimally in the 1st 24 hours as a result of dehydration
**temp is usually taken every 4 hours
306
What are some changes to VS if maternal hemorrhage is present?
BP will increase and then plummet
Pulse: increase
Temp: increase if infection is present
307
We assess the uterus in the 4th stage of labour, what are normal findings?
uterus is hard and firm (felt through abdominal palpation of fundus)
We want to determine 'normal' positioning of uterus >> midline.
308
If the uterus doesn't feel like a hard globe but rather is soft /boggy in the 4th stage of labour what are the nursing interventions?
if the uterus does not firm up, what needs to be assessed?
we massage it in attempts to express retained clots and to firm it up
** this is painful for the woman
is the bladder full? if so that would prevent the uterus from firming up >> may need to be catheterized
309
measuring the position of the fundus relative to the woman's umbilicus in 4th stage of labour, how is it measured and documented?
fundus above umbilicus >> plus cm, if below measured as minus cm
one fingerbreadth equals 1cm.
310
If the uterus does not firm up despite massage and draining of bladder what is this called?
Uterine atony >> lack of tone
311
bleeding from the vagina post delivery is called _______.
Some bleeding is to be expected. How much?
what are the various colors
If you find a clot you need to be able to pull it apart, if you can't the clot is likley?
lochia
like a heavy menstrual period
dark red >> lochia rubra directly post birth
will progress to serosa >> light pink/ brownish day 3-7
into alba >> more white colored 8 weeks after birth
Tissue from the placenta
312
What are the steps to perineum care post delivery?
- Wash with warm water, dry well and apply sanitary pad
- if pain present >> place ice pack against perineum to promote comfort and decrease swelling
** suggest once home, soak perineal pad in water and freeze.
- Assess perineum while woman is lying on side
REEDA
Redness
Edema
Ecchymosis
Discharge
Approximation (how many stitches).
Hemorrhoids post labour is common
Hematoma >> common if the woman is complaining of a lot of pain inside the vagina.
May need to be taken to the OR to have surgically removed (drained)
313
inter vaginal hematomas are a serious concern b/c the woman can go into ________ if not dealt with
shock
she is essentially bleeding internally.
S&S of shock: weak thready pulse
skin cool and clammy
314
Nursing assessment for mother immediately after birth?
```
post perineum assessment
- assess bladder for distention
-Assess pain level
_ assess lower extremities
assess emotional state
_encourage attachment behaviors
```
315
The new born period lasts from birth to ____ days old
28
316
complications that could arise to the newborn would include:
baby's who are born to C-section struggle to ______ their ________.
why?
Baby may also be ______thermic
clear their secretions. During vaginal childbirth chemoreceptors are activated to stimulate the lungs and the contractions help squeeze fluid out of the lungs, this is lost in a C-section.
h
hypo-thermic. struggle with temp regulation.
317
We need to assess the umbilical cord after it is cut because it needs to have
____ arteries & ____ vein
It can be cut between ___ to ____ minutes after birth
we need to assess _____ of the cord and ensure there are no ____ in the cord
clamp about ___ inch from the baby's abdomen
we cleanse the area and if needed can add an _________ ointment
Cutting the umbilical cord helps the baby to kick start their own___________.
2 arteries
1 vein
1-3 minutes after birth
length
free of cysts
clamp about an inch away from the baby's abdomen
antimicrobial
Circulation
318
infants who are born vaginally don't typically have issues getting their respiratory system going, and require little suction. Why do C-section babies typically have more issues with their resp system?
no squeezing and clearing of the resp system.
319
if the infant is struggling with breathing, chocking on secretions what are our nursing interventions?
first steps of CPR, infant on stomach and 2-finger taps to back.
nasal suction, careful to avoid center of the mouth b/c of the gag reflex.
nasal passages can be suctioned gently one nostril at a time.
320
What are the newborn advantages of skin-to-skin contact with mom immediately after birth?
cold-stress can occur with infants>> if they get cold they can use up their glucose stores to try and warm. similarly they have brown fat that used when they are cold and shivering.
best way to get them warm
best way to get them to bond; can smell their mom.
-breastfeed as soon as possible
-reduces their crying
* for the mother: this increases the oxytocin and prolactin levels when she is holding her infant like this.
321
What are the 5 signs indicative of physiological status that are measured with the APGAR score
APGAR score is measured ___ minute after birth and ____ minutes after birth
```
HR
Respiratory Effort
Muscle tone
Reflex irritability
color
```
APGAR measured at 1 & 5 mins after birth
322
If a newborns body is pink but their extremities are pale/blueish this referred to as
acrocyanosis
| peripheral cyanosis
323
Newborn VS
HR _______bpm, assessed via the _____ pulse.
Respirations _______, assessed ideally when the newborn is ___ _____.
Periods of ______ is common for newborn resps.
Temperature________
HR: 120-160bpm, apical pulse
Resps: 30-60/min
assess when newborn is at rest. periods of apnea are common directly after birth. As are crackles (from fluid being expelled from the lungs.
Temp: 36.5 - 37.5
BP is only measured if cardiac issues are present
Goal is to prevent heat loss, we postpone the first bath for this reason.
324
Warming of a hypothermic newborn needs to happen _______.
| Over ____ to ____ hours
slowly
| 2-4 hours
325
_______ temp is the best way to measure newborn temp
axillary
326
Fluctuations in newborn temps could be a result of
heat loss
infection already present
too much clothing
327
pulse is normally around ____ to ____ bmp when the newborn is sleeping.
But when they are crying vigorously it can go up to _____ bpm
80-100bpm at rest
| 180bpm
328
signs of infant respiratory distress
nasal flaring
grunting
retractions of the chest, ribs
329
the length of the baby is measured from ____ of the head to the _____
top of the head to the heel
330
barriers are placed on the machine measuring height and weight prior to placing the baby down to prevent what?
heat loss
331
baby's lose ___% of their body weight in the first 3-5 days. They then regain it withing ___ weeks
10%
| 2weeks
332
1. ___________ – born before 37 completed weeks, regardless of birth weight
2. ____________ – born between 34 0/7 and 36 6/7 weeks
3. ____________– born between 37 and 38+6 weeks gestation
4. ____________ – born between the beginning of 39 and the end of week 40+6
5. _____________ – born in the 41st week
6. ____________ – born after completion of week 42
7. ____________- born after completion of week 42 and showing signs of placental aging (insufficiency)
1. Preterm(premature)
2. Late preterm
3. Early term
4. Full term
5. Late term
6. Postterm (postdate)
7. Postmature
333
Preterm
late term(preterm)
& early term
all share these common neonatal deficits
breast feeding issues
ADHD
Respiratory issues
prenatal morbidity and mortality rates
334
_______score is used to score gestational age.
| It assesses ____ external physical signs & ____ neuromuscular signs
Ballard Score
6
6
335
Eye Prophylaxis is given a few hours after birth to prevent ________ in the eyes
infections
** controversial
was started in the 1800s b/c 10% of baby's were going blind d/t chlamydia and gonorrhea infections.
* parents can refuse this
336
Vitamin K prophylaxis
| IM injection in thigh to prevent _________ ________
hemorrhagic disease of the newborn
* baby's are not born with vitamin K, this is produced in the intestine later.
* parents can refuse but we encourage them not to.
they can choose the oral vit K dose but it is less effective and they require multiple doses
337
Newborns go through multiple phases of reactivity
1. first phase includes the following physiological changes:
this period lasts for ___ mins, tends to resolve within the first ____ after birth
2. 60 -100 minutes
period of _________ responsiveness
3. Second period of ________
occurs ___ to ___ hours after birth.
brief periods of ____cardia & _____pnea.
______ muscle tone
1. HR will increase to 160-180bpm then settle. They will have fine crackles in lungs, grunting and nasal flares, try to get breathing under control. Will have their first meconium.
lasts about 30 minutes, resolves within the first hour.
2. decreased responsiveness. sleepy and subdued
3. reactivity occurs 2-8 hours after birth.
tachycardia & tachypnea, increased muscle tone.
338
what is myconium
newborns first BM, might be a weird color, made up of shed skin cells, and fluids
339
*Localized edema on the scalp often after a prolonged labour or use of vacuum extraction. Dissipates in about 3-4 days. Crosses suture lines.
capput succedaneum
340
A collection of blood beneath the periosteum of the skull. Swelling does not cross suture lines. Appears on day 2 or 3 and disappears in weeks or months. Jaundice may result. _____________
cephalhematoma
341
*Elongated shape of the skull as a result of overlapping of cranial bones during birth
_______________
molding
342
*Diamond-shaped “soft spot”. Remains open up to 18 months to allow the brain to grow. _____________________
anterior fontanelle
343
*Tightness of the sternocleidomastoid muscle, resulting in the newborn’s head tilting to one side. _________________
torticollis
| would need to do physio for the baby
344
*Distended, small white sebaceous glands on the nose, chin, and forehead.
Disappear on their own. _________
milia
345
Reddened, demarcated area over cheeks and jaws due to an
| instrument used to assist in delivery. _______________
forceps mark
346
*Also called port wine stain. Most often on face or neck. Flat. Pink to purple red. Permanent. May be associated with a syndrome or certain cancers. _________
nervus flammeus
347
*Also called strawberry mark. Benign. Raised, rough, dark red and sharply demarcated. ____________
nevus vasculosis
348
Lacy patterns of blood vessels under the skin. __________________
mottling
349
*Also known as “newborn rash”. Very common in 1st week. Small white or yellow papules or vesicles on the skin. No clinical significance. No treatment. _______________
erytheum toxicum
350
*Superficial vascular areas (flat, pink, capillary hemangiomas)on nape of neck, eyelids, nose, upper lip, and lower occiput. More visible when crying. Fade in first and second years of life ________
telangiectatic nevi /“storkbites”
351
A thick, white substance that protects the skin of the fetus. Common in body creases. Don’t wash it off – it has positive benefits for neonatal skin __________
vernix caseosa
352
*Soft, downy hair on the body, particularly on the face, shoulders and back. Disappears over the first few weeks of life. __________________
lanugo
353
Bluish black areas of pigmentation commonly noted on the back and buttocks. Tend to occur more frequently in newborns whose ethnic origins are in Asia or Africa. Fade gradually over months or years. ______________
mongolian spots
354
Pink body, or colour appropriate for ethnicity, and blue extremities. Normal. Appears intermittently over the first 7-10 days ___________________
acrocynosis
355
*Yellowish discolouration of the skin. ____________
jaundice
356
lower set ears are characteristic of many syndromes and internal organ abnormalities involving the ______ system
renal
357
*A ridge of frenulum tissue attached to the underside of the tongue, causing a heart-shape at the
tip of the tongue. ____________
tongue tie
358
Small, glistening white specks (keratin-containing cysts) on the
hard palate and gum margins. Disappear in weeks. __________________
epstein's pearls
359
*White patches that adhere to mucous membranes of the mouth (cheeks, lips) caused by exposure to Candida albicans during birth. _______________
thrush
if a baby has thrush they got it from their mom, need to treat the baby with drops and treat the mothers nipples.
Sometimes the baby can get thrush in their diaper as well
360
*Appears on the upper lip from feeding. _________________
sucking blister
361
1.*The urethral opening is on the underside (ventral aspect) of the penis. ____________
2.*A collection of fluid surrounding the testes in the scrotum; usually resolves
without intervention. _________________
3. *The urinary meatus is on the dorsal surface (top side) of the glans. _____________
1. hypospadius
2. hyrocele
3. epispadius
362
* A turning inward position of the feet. May be due to intrauterine
positioning. ___________
tailpes equinovarus
363
*Two or more digits fused. __________
syndactyly
364
Extra digits on either hands or feet. ___________
polydactyly
365
what is pseudomenstration in a female newborn
vaginal discharge composed of mucus mixed w/ blood may be present during first few weeks of life.
Requires no intervention
366
What are the newborn reflexes
```
tonic neck
rooting
suckling
moro (startle)
palmar grasp
plantar grasp
babinski
steppng
galant
```
367
ortolani and barlow movements are used to determine
detect developmental dysplasia of the hip DDH
368
```
When do these reflexes dissapear
Sucking & rooting
Palmar grasp
Plantar grasp
Tonic neck
Moro (or startle)
Stepping (or walking)
Babinski
Galant
```
```
Should disappear after 1 year of age
Disappears by 3-4 months
Lessens by 3-4 months
Disappears after 3-4 months
Disappears `by 4th week
Present for 3-4 wks.
Complete response seen until 8th week
Lessens by 8 months
```
369
when are the most infant-feeding decision made?
Well before the infant is born, including before conception
370
What factors influence parents feeding decisions?
how much they know about breast feeding
culture/hx
what their partner thinks about it
371
Women who are overweight and obese tend to breastfeed ______ than the general population
less
372
where is milk synthesized?
alveoli are the milk producing cells surrounded by contractile cells.
Milk ducts carry milk from the alveoli to the nipples
373
Size and shape of breast are ____ indicators of milk production.
______ are a big indicator of milk production
not
| hormones
374
Breast feeding influencing hormones include:
| 4
Progesterone
Estrogen
Prolactin
Oxytocin
375
After birth there is a decrease in __________ which stimulates release of _________from the ______ pituitary
progesterone
prolactin
anterior
* *during pregnancy prolactin prepares the breasts to produce milk
* * During lactation prolactin helps the breast synthesize milk
376
When are prolactin levels the highest?
First 10 days after birth
377
Breast feeding actually works on a ________ and _________
Supply and Demand
prolactin is stimulated by the infants suckling
* the more suckling or pumping the more milk that will be produced.
378
oxytocin is produced in the_________ __________
| and is responsible for the ________ reflex
posterior pituitary
| ejection
379
if the woman is breast feeding she is less at risk for _______, why?
PPH
| b/c oxytocin is stimulating during breastfeeding and it is also responsible for uterine contractions.
380
high levels of ________ during pregnancy prevent the mother from breastfeeding. This drops once the baby is born, allowing for lactation
estrogen
381
The following steps are part of the _________ _______ ________
1. Infant latches at the breast
2. Nerve endings in the areola and nipple are stimulated
3. A message is sent to the posterior pituitary gland to release oxytocin into the bloodstream
4. Oxytocin stimulates the cells around the alveoli to contract, squeezing milk into the ducts and towards the nipple
milk ejection reflex
382
CPS recommends exclusive breastfeeding for the first ______ months of life
6
| Can go on for up tp 2 years.
383
True or False
| Protein requirements per body weight is greater in newborns than any other time in life
True
384
Milk proteins are high which make it readily digestible
whey protein: _____%
casein protein: ____%
70%
30%
They is different from cows milk which is 80% casein and 20% whey
385
Whey protein has many amino acids that with _________ properties
Similarly it has ______ binding properties
bacteriostatic
| iron
386
what are the 2 mjor components of breast milk:
1. ______ proteins
2. Long chain ______________ fatty acids
what are the benefits of #2
milk proteins
long chain polyunsaturated fatty acids
**helps with mylenation of the SC
enhances visual acuity
387
All baby's require a supplement of:
1. Vitamin D _____IU
2. _____ supplements. Baby's draw on natural stores for the first 6 months then require supplement
Baby's don't require any additional _______, b/c breast milk is 87% of this.
1. 400
2. iron
water. they get enough from breast milk and if you give them more it takes up too much room in their stomachs
388
breast fed infants need to be fed every ___ to _____ hours.
| Alternatively ________ _______ is where they eat every hour for 5 hours
2-3
| cluster feeding
389
main way you tell if a baby is hydrated is by the amount and color of ______.
urine
| they should have 6 sufficiently wet diapers in a 24 hour period by day 5
390
little 'seeds' in the breast fed infants poop is actually:
| for the first month they will have _____ stools per day
fat globules from the milk
| 3
391
infants lose ___% of their weight in the first 3-4 days.
| they should regain birth weight by ___ _____ of age
10%
| 2 weeks
392
formula fed baby's should be receiving roughly ___ to ____mL of formula per feeding in the first 24-48 hours
By the end of week 1 they are having ___ to ___ mL
10-30mL
60-90mL
We then continue to feed them based on their hunger.
generally they will have 6-8 feedings in a 24 hour period.
393
In formula fed infants their poop is a darker ______ color and is _________
yellow
| smellier
394
initially in the first 2-3 days after birth the women will produce ________________,
it is rich in antibodies, high protein and low in fat
colostrum
395
colostrum helps with the binding of _________.
________ that has not been conjugated will cause jaundice
bilirubin
bilirubin
396
it takes about _____ days for the woman to produce mature milk
10 days
397
when a baby first starts suckling they will get _________ which is thinner and is designed to quench their thirst.
Once they have been suckling for 10 mins or so they will get to the ______ _______ which is richer in nutrients and is rich in fat.
foremilk
| hind milk
398
Baby's need to stay breastfeeding long enough to get to the ______ ______.
This could take roughly ____ to ____ mins
hind milk
| 20-30mins
399
LATCH
Latch on
Audible Swallowing
Type of nipple (are there issues with the nipples)
Comfort of the mother
Holding skills (there are a # of different positions)
400
Can the mother breastfeed while on methadone
yes
401
If the mother has had alcohol she should wait __ hours before breastfeeding
2
402
How does smoking effect breastfeeding?
it impairs production, should not BF for 2 hours after smoking
403
Does nicotine pass into the breastmilk of a nursing mother?
yes.
| NTR can be used as an alternative to smoking but it still does pass to the baby through the breastmilk
404
What are the primary things we need to evaluate during a breastfeeding assessment?
- Condition of breast (soft, filling, firm)
- Condition of nipples (intact, bleeding, blistered)
- Scars, piercing or implants
- Positioning
- Latching on
- Maternal response (comfort in handling infant, level of confidence, signs of discomfort or pain, recognition of infant hunger cues and signs of satiety)
- Infant response (suck, swallow, and gag reflexes, regurgitation, signs of correct latch)
- Partner response
405
Considerations for breast feeding after a C-section:
- Is a surgical patient - needs pain control– (analgesics can make baby sleepy - through breastmilk)
- Needs someone to be with her if still drowsy and trying to breastfeed
- Needs assistance with breastfeeding – breastfeed early
- Side-lying hold or football hold are the best positions for breastfeeding
- Can use pillows to help with support of the newborn
- Need to breastfeed early and often as milk may come in late - feeding often helps stimulate milk production
- Breast milk comes in late with C-section moms, need assistance getting milk production started
406
What are some early infant feeding cues?
What are some strategies to wake the baby and get them to feed?
- sucking on fingers and hands
- waking and stretching
- Mouth opening
- Turning head, seeking/rooting
- Place infant skin-to-skin
- Change infants diaper
- tickling their toes
- Removing clothing so they are cooler ( if they are very warm they will continue to sleep).
Remember if the baby is very sleepy , and only feeds for 10 mins then falls back asleep ( they haven't gotten to the hind milk >> need to continue feeding)
407
What are proper hygiene techniques for a breast feeding mother?
no soap on the nipples >> can dry out
No need for special oils as they can block the production of natural oils from Montgomery's glands.
* may need special nipple cream >> lancelin (sp)
408
Underwire bras can contribute to clogged ____ ______
milk ducts
409
Name some of the different positions available for breastfeeding?
Cross-cradle hold
Football hold (clutch)
Side lying
Laid Back
410
What are signs of effective milk transfer?
nipple to nose, we want to nose to be in line with the nipple and the areola.
That their chin and nose are pushed into the breast and cheeks are lightly touching
Mother reports there is tugging but no pain
we want the baby to suck with well-rounded cheeks
Breasts should be less full and softer after feeding.
411
What are signs the infant is getting enough milk.
Their weight should be increasing by day 4 they should have gained 20-35g per days.
412
From day 1 to 4 the number of wet diapers should match the day, what does this mean.
After day 5 they should have how many wet diapers per day
Day 1 baby should have 1 wet diaper
day 2 baby should have 2 wet diapers
and so on
After day 5 they should have 6 wet diapers per day
413
what is the progression of bowel movements for a baby during the first week?
days 1-2 ( should have 1 or 2 dark green meconium stools per day)
Days 3-4 ( should be 2-3 greenish yellow BM per day)
Day 5 onward should have 3 yellowish BM per day.
414
What are some of the infant satiety cues?
Falls asleep
Appear to be content
hands and limbs relax >> become more extended
May activity push away from the breast
415
As baby's get older the length of their feedings decreases, why?
They get better and more efficient at feeding. getting more milk out in a shorter period of time
416
Day 1 baby's can take in ___ to ___ mL
Day 3 __ to ___ mL
Day to ___ to ___mL
of breast milk
5-7mL
22 - 27mL
60 - 80mL ( size of an egg)
417
What are the primary complications of breastfeedings
Cracked-sore nipples: this can happen with poor latch. You want the nipple to be at the back of the baby's mouth. Thrush can also cause cracked nipples.
* * Need to have proper suction / connection.
* * bring baby to breast.
* * if mom needs to break the connection do not pull baby off breast need to break suction by sticking a finger in the baby's mouth.
Engorgement: usually happens day 3-5. Need to express the milk and soften the breasts before the baby latches.
Plugged ducts: area of the breast is sore and red (no fever). Need to feed often on this side.
Yeast infection: candida albicans.
Both mother and infant need to be treated at the same time>> educate mom about good hand hygiene.
Mastitis: infection of the breast (will have fever and inflammation >> need to breast feed frequently and pump).
418
1.Mild ________________ is due to the sudden change in hormones and the increased volume of milk. It occurs ___ to ___ days after birth and usually last about ___ hours. Intense engorgement can result from accumulation of milk and increasing blood supply to the breasts. Breasts become _____________, tender, swollen, and hot and appear shiny and red.
mild engorgement
2-5 days after birth usually lasts about 24 hours
firm
419
2.At this time, the newborn may have difficulty latching onto the breast. To help soften the breasts, a small amount of milk may be _____________. Prior to a feeding, women can stand in a warm shower or breasts may be massaged and _______ compresses applied. After feedings, treatment includes _______ compresses and chilled cabbage leaves.
manually expressed
warm
cold
Warmed before feedings
cold after feedings
420
When the mother’s breasts are engorged, the newborn should also feed frequently, every ___ to ___ hours.
2-3 hours
421
The most common cause of sore nipples is improper _________ and _________. To prevent sore nipples, break _______before removing the newborn from the breast.
latching and positioning
latch
422
To maintain integrity of the nipples, only use _______, no soap, when washing the breasts and allow a slight amount of breast milk to dry on the nipples after feedings. In addition, allow nipples to air dry after feedings.
water
423
Change breast ______ frequently, and avoid those with plastic backing.
pads
424
Allow infants to feed on the ___________ side first, so that more vigorous feeding, common at the onset of the feeding, will occur first on this side.
least full
425
A _________ infection may also cause sore nipples. When this occurs, oral thrush may be evident in the infant. Mother and infant require simultaneous treatment.
yeast infection
426
__________ is an inflammation of the breast tissue caused by plugged ________ and ____________ invasion. This is most likely to develop in the first several weeks postpartum. Signs include the appearance of a painful, hot, and _______ area on the breast. The infection is usually unilateral. The mother may also experience _________, ___________, and _________________________.
mastitis
milk ducts
bacterial invasion
red area
fever, chills, body aches & headaches
427
A blocked or plugged _________ may predispose a woman to mastitis. This can occur from a bra that is too tight.
The most common infecting organism is S. Aureus which comes from _______________________________.
If untreated, this may progress to a breast ____________
Treatment consists of ______________________________ and treating the infection with antibiotics. In addition, ice or warm packs and analgesics may be needed.
duct
sore cracked bleeding nipples as entry point and milk stasis.
if mastitis is not treated can progress to breast abscess
breast feeding frequently
428
Family forms:
Family as __________ focuses on the client/patient with the family as background to the individual
Family as __________ focuses on assessing all the family members
Family as __________ states that the whole family is more than the sum of its parts
Family as Component of Society states that the family is an _____________ that interacts with other ____________
Context
Client
System
Institutions
Other Institutions
429
Family members depend on each other for ______________, emotional and financial support
physical
430
The three concepts essential to understanding family interactions that affect health are ________, ____________ and ______________.
Structure
Function
Processes
