Midterm: wk 2, 3, 4 Flashcards
Probable causes of health disparities (4)
*Race: shorter life expectancy, higher infant/maternal mortality, more birth defects, more STDs
*Environment
*socioeconomic factors
*health behaviors
Family systems theory
Views family as a complex system of interconnected and interdependent individuals
Types of families
Traditional, non-traditional
Traditional and legal family definition
Family mems are related by legal ties or genetic relationships
Non-traditional fam def
2 people who say they are “family” and are bound by emotional ties
Family DEVELOPMENT theory (3 points) (think development stages)
*Family is a developing group which goes through stages
*fam mems must perform certain time specific tasks
*disequilibrium is common when entering a new stage w/goal of hemostasis w/i stages
Family SYSTEMS theory (3 points) (the system IIB)
*Inter-related: a change in one member affects the whole family
*Interaction: “who am I” and “who I have become” depends on fam relations and interactions
*Boundaries: Lines between fam mems and between the fam and the outside world
family STRESS theory (3 points)
*stress is a definite part of fam life
*one fam’s crisis is another fam’s challenge
*ability to handle depends on fam’s stability/attributes, resources/support, perception, and learned coping strategies
Family ROLE theory (5 points): roles are/have…
*defined by culture
*Most people serve several roles
*have expectations
*have stress or strain
*have transitions
Moral distress strategy: 4 Rs
*Recognize: be aware of complexities
*Release: what you can and can’t change
*Reconsider: reframe issues/view
*Restart: move forward in a positive way
Menstrual cycle: Endometrial development (4 points)
- Menstruation: surface of endometrium sheds resulting in menses
- Proliferative phase (follicular phase): endometrial cells proliferate and lining thickens
- Secretory phase (Luteal phase): egg is expelled from ovary (ovulation) into the pelvic cavity
- Premenstrual phase: Endometrium continues to mature until a sudden drop in hormone levels triggers menstruation (Week b4 period typically)
Ovarian cycle (3 points)
- follicular phase
- ovulation
- luteal phase
Follicular phase: Where, when, hormones
*Hormones: FSH stims graafian follicles (up to 20) which prepares egg for ovulation
*Where: Nerve cells in hypothalamus release GnRH into blood -> this stims the pituitary gland to make/release FSH and LH
*When: From start of period until ovulation
Ovulation: What
*Egg released into pelvic cavity -> fimbriae of fallopian tubes bring egg into tube
Luteal phase: Hormone, Where, Job (Lut the pro, the pre-placenta)
*Hormone: Progesterone
*Where: corpus luteum produces progesterone
*Job: if preg occurs, corpus luteum maintains pregnancy until placenta is mature enough to take over at 12 wks
Cephalocaudal direction
*Travel from head to toe in the 1st yr of life in increments of 3 mon
*2nd year of life in increments of 6 mon
*after 2 yrs, in increments on a year
Developmental milestones: 3 mon
maintains head upright (head)
Developmental milestones: 6 mon
Sits upright (trunk)
Developmental milestones: 9 mon
crawling (legs)
Developmental milestones: 12 mon
walking/taking 2-3 steps (feet)
Developmental milestones: 18 mon
running (legs)
Developmental milestone: 2 yrs
jumping (2 feet leave the ground)
Developmental milestone: 3 yrs
Can ride a tricycle (tri = 3)
Developmental milestone: 4 yrs
Hop on one foot
Average growth rate from 6-9 yrs
Piaget: cognitive development theory
A progressive reorganization of mental process as a result of biological maturation and environment experiences
Piaget: sensorimotor stage (age, definition, development)
(0-2 years)
*Infant explores world through direct sensory & motor contact.
*Object permanence and separation anxiety develop
Piaget: Preoperational stage (age, definition, development)
(2-7 yrs)
*Symbolic thinking, able to use proper syntax and grammar to express concepts, imagination and intuition strong but complex/abstract thinking weak
*Conservation developed
Piaget: Concrete operational stage (age, definition, development)
(7-11 yrs)
*Child moves from prelogical thought to solving concrete problems through logic. Able to see problems from other’s point of view
*Abstract thinking developed
Piaget: Formal operational (age, definition)
(11 yrs to adulthood)
*Able to think abstractly and logically
Erickson’s psychosocial development theory
personality develops in a predetermined order through eight stages of psychosocial development where the person experiences a crisis w/ pos and neg outcomes for personality development
Erickson’s crisis: Infancy (age/crisis/task)
(birth to 18 mon)
*trust vs. mistrust
*attachment to primary caregiver
Erickson’s crisis: Early childhood/preschool (age/crisis/task) (“i do it stage”)
(18 mon to 3 yrs)
*autonomy vs. shame & doubt
*gaining some basic control over self and environment
Erickson’s crisis: Late childhood (age/crisis/task)
(3-6 yrs)
*initiative vs. guilt
*becoming purposeful and directive
Erickson’s crisis: School age (age/crisis/task)
(6-12 yrs)
*industry vs inferiority
*developing social, physical, and learning skills
Erickson’s crisis: Adolescence (age/crisis/task)
(12-20 yrs)
*identity vs. role confusion
*developing some sense of identity
Erickson’s crisis: Early adulthood (age/crisis/task)
(20-35 yrs)
*intimacy vs. isolation, love, and friendship
*establishing intimate bonds of family, assist w/ return to work
Erickson’s crisis: Middle adulthood (age/crisis/task)
(35-65 yrs)
*generativity vs. stagnation
*fulfilling life goals, family, career, society
Erickson’s crisis: Late adulthood (age/crisis/task)
(65 yrs to death)
*integrity vs. despair
*looking back over life, accept it’s meaning
Kohlberg’s moral development theory
*moral development is sequential
*Stages cannot be skipped but someone may not make it to certain stages
Kohlberg’s stages: Pre conventional level
*stage 1: Avoiding punishment
*stage 2: Aiming at a reward
Kohlberg’s stages: Conventional level
*stage 3: Good boy & good girl attitude
*stage 4: Loyalty to law and order
Kohlberg’s stages: Post conventional level
*stage 5: Justice and spirit of the law
*stage 6: Universal principles of ethics
Overview of each Kohlberg level
*Pre conventional level: No internalization of right and wrong
*Conventional level: Intermediate internalization of right and wrong
*Post conventional level: Full internalization of right and wrong
Sigmund Freud’s Psychosexual development theory
personality developed through a series of childhood stages in which pleasure seeking energies from the child became focused on certain erogenous areas.
Freud’s stages, ages, and order
- Oral stage (birth to 1yr): mouth
- Anal stage (1-3 yrs): bowel and bladder
- Phallic stage (3-6 yrs): genitals
- Latent stage (6 yrs to puberty): libido inactive
- Genital stage: (puberty to death): maturing sexual interest
Separation anxiety stages
- protest: loud inconsolable crying, clinging (variable lengths of time)
- Despair: physical s/s mimic depression
- Denial/Detachment: no protest, happy w/strangers, development delays (prolonged separation >6mon
Stress reactions: infant s/s (3 points)
*searching w/ eyes for parent
*clinging to parent and rejecting strangers
*crying/screaming
Stress reactions: toddlers s/s (4 points)
*verbally attack strangers (“go away!”)
*physical resistance/run away
*continuous crying
*pleading parent to stay
Stress reactions: Pre-schoolers s/s (6 points)
*refusing to comply w/routine
*Bed wetting
*Difficulty sleeping (nightmares)
*indirectly expressing anger (breaking toys)
*Continually asking for parental return
*crying quietly
Stress reactions: School age kids s/s (3 points)
*act more stoic
*withdraw/show emotional coldness
*need to express anger (find alternative outlets)
Stress reactions: Adolescents s/s (6 points)
*Self-assertion/aggression
*Anger/frustration
*Uncooperativeness
*Withdrawal
*Questioning care
*lack concern for their privacy
Self reporting pain scale: age/resources
(>4 yrs)
*Faces pain scale
*VAS (visual analog scale)
FLACC scale
*Face, Legs, Activity, Cry, Consolability
*infants to 7yrs (those unable to communicate pain)
FACES (Wong-Baker) scale
*For children >3 yrs
*Allows child to rate their pain from 0 = no hurt/happy to 10 = worst pain/sad
OUCHER scale
*Features non-white ethnic groups
*For ages 3-13 yrs
Standard numerical rating scale NRS (0-10)
For ages >5yrs
Visual analog scale
- Horizontal line scale with worst pain on left end to worst on right end of the line
- For 4 ½ to 5 years
APPT pain scale
*Adolescent pediatric pain tool
*coloring areas of pain and intensity with dark or lighter red color on a body outline/graph
*(if child has sickle cell or other chronic disease with chronic pain)
*Preferred over NRS, Oucher, and FPS-R
Nonpharm pain management (8)
*Distraction: radio, cartoons, being silly, blowing bubbles, etc.
*Relaxation:
-Infant = well-supported rocking, repeat words
-Children = deep breaths, comfortable positioning, progressive relaxation
*Guided imagery: have child describe a pleasurable image/event
*Positive self talk
*Cutaneous stimulation: stimulate nerves via skin contact
*Containment swaddling: tight swaddling to mimic uterus
*Nonnutritive sucking: pacifier
*Kangaroo care: skin-to-skin contact with baby
DNA
Deoxyribonucleic acid
*Carrier of genetic info
*Main constituent of chromosomes
Genes
*Segments of DNA
*give physical characteristics that make you unique
Traits
*A gene is a segment of DNA that determines a trait
*traits are determined by genes on the chromosomes
Haploid
*Only sex chromosomes (gametes, eggs, sperm)
*Having a single set of unpaired chromosomes
Diploid
The presence of 2 complete sets of chromosomes in an organism’s cells, w/ each parent contributing a chromosome to each pair
*23 pairs, 46 chromosomes in all after fertilization
*As a result of this union, the offspring are formed with a mix of inherited genes
Homozygous
*term used to refer to an organism that has two identical alleles for a particular trait (TT or tt)
Heterozygous
Term used to refer to an organism that has two different alleles for the same trait (Tt)
Down’s syndrome (which chromosome and what)
Trisomy 21
*Extra chromosome at pair #21, resulting in total of 47 chromosomes
Chromosome that determines sex
*23rd pair of chromosomes are two special chromosomes X and Y
Autosomal Recessive inheritance
*autosomal genes are all but the 23rd (non-sex chromosomes)
* a way a genetic trait or condition can be passed down from parent to child.
*A genetic condition can occur when the child inherits one copy of a mutated (changed) gene from each parent.
*The parents of a child with an autosomal recessive condition usually do not have the condition.
Examples of autosomal recessive disorders
*PKU (metabolic disorders)
*Cystic fibrosis (metabolic disorder)
*Sickle cell anemia
Define autosomal dominant inheritance paterns
Only ONE abnormal gene from one parent is necessary for disease/disorder manifestation
*50% chance if there is an affected parent
% chance a child will have a autosomal recessive disorder/disease
- 25% chance child will have the disorder
- 50% chance of child being a carrier
- 25% chance of child being neither a carrier or having the
disorder/disease
Autosomal Dominant diseases/disorders
▪ Huntington disease
▪ Polycystic kidney disease
▪ Polydactyly (extra fingers/toes)
▪ Achondroplasia (short-limbed dwarfism)
▪ Neurofibromatosis
5 structures involved in URI
*Nasal cavity
*Vocal cords in the larynx
*Sinuses
*Middle ear
*Pharynx
3 structures involved in LRI
*Trachea
*Primary bronchi
*Lungs
(alveoli)
Cues of resp difficulty in children (4)
*Tachypnea
*Retractions
*Nasal flaring
*Leaning forward/tilting head back to breathe
4 cues of increased airway resistance
*Increased resp rate
*Retractions
*Nasal flaring
*Use of accessory muscles
Nursing implications for use of metered dose inhalers (p. 1151
Treatment guidelines for URI (5)
*Analgesics
*Maintain hydration
*NO ANTIBIOTICS
*RTC is symptoms persist beyond 7 days or worsens
*Prevention of spread
Acute Otitis Media
- Most commonly diagnosed illness in childhood
- Inflammation of middle ear with rapid onset of symptoms/clinical signs
Acute Otitis Media: who is most at risk and why
- children between ages 6 months and 3 years—uncommon after age 8.
- Breast-fed infants lower incidence than formula-fed infants because breast milk provides increase immunity that protects the eustachian tube and middle ear mucosa from pathogens.
- Infants more predisposed because they have: Short, horizontally positioned eustachian tubes and Enlarged lymphoid tissue, which obstructs the eustachian tube opening
- Bottle feeding infant in the supine position increases risk as position promotes pooling of milk in the pharyngeal cavity=infection.
Acute Otitis Media: Treatment
*Analgesics
*Wait and see: 48-72 hrs, 6-23 mon old, non severe infection
*Antibiotics: < 6 mon, fever > 102.2F, ages > 2 w/ severe s/s
*Encourage prevention by breastfeeding, eliminate second-hand smoke exposure
*Myringotomy (incision of tympanic membrane)
*Tympanoplasty
*Severe (prophylactic antibiotics, assess hearing loss)
Influenza: treatment
*Supportive therapy
*Antiviral prophylaxis like Tamiflu
*Immunization
Croup: s/s
*BARKY COUGH
*inspiratory strider
*hoarseness
*fever
*URI symptoms
Coup treatment: mild
*Hydration
*Humidified air
*Family education about worsening respiratory distress
*Most causes are self limiting for 3-5 days
Bronchitis: def
- Acute: transient inflammation of the larger lower airways
- Chronic: poorly defined in children- rarely an isolated entity in children
Bronchitis: tx
-Supportive if viral
-Avoidance of respiratory irritants
-Increase fluid intake and rest
-Bronchodilators??
-Inhaled steroids
-ANTIBIOTICS: if bacterial
-Pain meds for chest pain
-Humidification of air promotes comfort
-Cough medications??
-No antihistamines
Bronchiolitis: def
- Acute viral infection
- Seasonal: most common in midwinter to early spring
Bronchiolitis: tx
Supportive
-Hospitalization for some
infants
Bronchiolitis: nrsg guidelines
*Don’t use bronchodilators, corticosteroids, or chest physiotherapy
*Use nebulized hypertonic saline, oxygen depending on sat
*DONT USE PULSE OX
*DONT USE ANTIBIOTICS UNLESS ANNOTHER INFECTION IS PRESENT
RSV: most at risk (3)
*infants with…(congenital heart defects, underlying pulmonary disease, weak immune system)
RSV: tx
*fluids, rest, 1-2 wks
*if not working Palivizumab IM, or Ribavirin
RSV: Prevention
highly contagious
*wash hands, social distance, cover mouth when coughing
difference between RSV and bronchiolitis
*RSV = pathogen
*Bronchiolitis = disease caused by RSV
Pneumonia: def
*infection that inflames air sacs of one or both lungs
*fluid/pus fills air sacs
bacterial pneumonia: clinical s/s (7)
-Varies greatly in age of child
-High fever
-Tachypnea
-Cough
-Crackles in the lungs
-Decreased breath sounds
-Abdominal pain
bacterial pneumonia: usual tx
-Children < 5 years old with +CXR generally receive Rx for Amoxicillin
-Follow up within 12 hours to 5 days
*hospitalize if s/s of resp distress, apnea, hypoxemia, poor feeding
bacterial pneumonia: prevention
*wash hands, social distance, cover mouth when coughing
Tonsillectomy: post-op care (10)
*position to facilitate drainage
*cautious suctioning
*sit child up when awake
*no coughing frequently, clearing throat, blowing nose
*inspect secretions & vomitus for fresh blood
*tell parents about dry blood (brown) is fine
*Ice collar
*analgesics (iv or rectal)
*foods and fluids restricted when not fully awake then soft foods
*watch for shock: dropped BP and restlessness, continuous swallowing
Tonsillectomy: pre-op care
*minimize activities
*soft liquid diet
*warm salt water gurgles
*warm fluids
*throat lozengers
*NSAIDS and Tylenol
asthma: def
inflam of air passageway to lungs affecting sensitivity of the nerve endings in the airway making them irritated/narrowed and reducing air flow
Asthma: possible triggers
animal dander, dust mites, pollen, molds, smoke
3 phases of pregnancy
*antepartum: conception to onset of labor
*intrapartum: onset of labor to delivery of placenta
*postpartum: 6wks post delivery
3 timeframes of antepartum
*First trimester: 0-12 wks
*Second trimester: 13-26 wks
*third trimester: 27-40 wks
Naegele’s rule
first day of LMP - 3mon + 7 day
cues: complete cell blood count
o Low H&H could indicate anemia and nutrition education is important
o Low platelets could indicate clotting disorder
o Unusually elevated WBC could indicate recent or ongoing infection
cues: blood types
o ABO incompatibility – Mother type O, baby type A or B or AB – risk of newborn jaundice
o Rh incompatibility – Mother Rh negative, baby Rh positive – Rhogam indicated
cues: rubella titer
*Education about risk for rubella infection
*Need for rubella immunization after delivery
*1-8 = immune status
*<1-8 = need shot for mom
fundal height: wks
*distance in centimeters from the pubic bone to the top of the uterus
*after week 24 of pregnancy the fundal height for a normally growing baby will match the number of weeks of pregnancy — plus or minus 2 centimeters
*12 wks just above pubic bone
*20 wks at umbilicus
*36-38 wks: under sternum
*40 wks: drops down into pelvis
typical wt gain in preg
25-35 lbs
Which maternal nutrients cross the placenta
*Do: Water
inorganic salts/electrolytes
Carbohydrates
Proteins
Fats
Vitamins
Glucose
Amino acids
Albumin/gamma globulins
Bad things that can cross the placental membrane
Viruses and some bacteria and protozoa
Caffeine
Alcohol
Nicotine
Carbon monoxide
Prescription and recreational drugs
intrauterine growth restriction: symmetrical
*entire body is proportionally small
intrauterine growth restriction: symmetrical/nutrients
intrauterine growth restriction: asymmetrical
*normal head, small abd
intrauterine growth restriction: asymmetrical/nutrients
indicates undernourishment: majority goes to brain and heart at expense of liver/other organs
VS changes in pregnancy (what goes up and down)
*HR (higher) 10-20 +
*BP (lower in 2nd tri) systolic: 5-10, diastolic: 10-15
hematologic changes
*plasma: increased by 50%
*RBC mass: increased by 33%
*WBC: increase 25000-30000 during labor and early postpartum
* H&H: lower
*coagulability: increased
internal tasks of pregnancy
*Binding in: taking in
*Giving of herself: taking hold
external tasks of pregnancy
*Seeking safe passage
*Acceptance of child by self and others
nutrient intake during pregnancy (4)
*folic acid: greens
*calcium: dairy, leafy greens
*iron: veggies, eggs, greens
*Vit D: veggies, fruits
cues of concern regarding wt gain/loss
*gain: sudden wt gain (preeclampsia)
*loss: hyperemesis
recommended # of cal per day for normal wt per trimester
*Non preg per day: 1800-2000 cal/per day
*1sy tri: no change
*2nd tri: add 340 cal/day
*3rd tri: add 462 cal/day
foods to avoid during pregnancy
*No alcohol obvi
*Raw seafood (can eat cooked salmon)
*Unpasteurized juice, cider, and milk
*Soft cheese and cheese made from unpasteurized milk
*Undercooked eggs
*Premade deli salads (egg, pasta, chicken etc…may contain Listeria)
*Raw sprouts (E. Coli or salmonella)
*Cold hot dogs and luncheon meats
*Undercooked meat and poultry
pica in pregnancy: ex
Baking soda
Cotton balls
Laundry starch
Ice cubes
Generally inanimate objects
adolescent preg: dietary recommendations
- Her own body is still growing
- Same caloric recommendations as other women
- Needs adequate CALCIUM AND IRON
G and TPAL
*(G)ravida: # of pregs
*Term births
*Preterm births
*Abortions
*Living children
cues for preg risk (6)
◼ High BP
◼ Hx of previous postpartum hemorrhage
◼ Hx of previous shoulder dystocia
◼ Rh negative
◼ Gestational diabetes
◼ More than 5 previous births
risk factors/risks for GBS infection in preg/labor (5)
◼ Gestation < 37 weeks gestation
◼ Ruptured membranes > 18 hours
◼ Maternal temperature > 100.4° F
◼ GBS bacteriuria this pregnancy
◼ History of infant with GBS disease
risks for infant of DM moms (38)
◼ Macrosomia
◼ Birth trauma
◼ Congenital anomalies
◼ Respiratory distress syndrome
◼ Hypoglycemia
◼ Hyperbilirubinemia
◼ Fetal Malformations
◼ Fetal demise
teratogens in preg
*smoking
*alcohol
*drugs
*occupational hazards
*viruses
*nutritional deficits
TORCH
◼ T Toxoplasmosis
◼ O Other
◼ R Rubella
◼ C Cytomegalovirus
◼ H Herpes
◼ S Syphilis
TORCH: mode of transmission
Infections may be acquired trans placentally, may ascend in the birth canal, or be acquired during passage through the vagina at birth
*T: cat feces, raw meat
*O: blood/body fluids
TORCH: prevention
cook meats, wash hands and food prep surfaces, avoid cat feces, avoid infected blood/body fluids
TORCH: tx
*Rubella: mom immunized b4 preg or b4 discharge postpartum
*Herpes: oral antiviral therapy
TORCH: breastfeeding?
Hep B: breastfeeding is not contraindicated unless nipples are cracked and bleeding
HIV: breastfeeding IS contraindicated
Leoplod’s maneuver : feeling for…
- determine fetal head: up, down, across
- presentation: head, butt, face, brow coming down first
- position: engaged in pelvis or nah
- assist in best site for FHR monitoring
fetal station: what do + and - indicate
Relationship of presenting part to the ischial spines.
* “Minus 1” or “Minus 2, 3, 4, 5” means: Presenting part is above zero station and
higher than the ischial spines.
* “Plus 1” or “Plus 2, 3, 4, 5” means: Presenting part has descended lower than the ischial spines.
where is the fetal head when at station zero
at the spines: engaged
stages of labor
◼ 1st Stage
◼ Pre-Labor
◼ Phase 1 – Latent Labor
◼ Phase 2 - Active Labor
◼ Phase 3 – Transition
◼ 2nd Stage- Pushing
◼ 3rd Stage- Birth
3 phases of stage 1 of labor
◼ Phase 1 – Latent Labor
◼ Phase 2 - Active Labor
◼ Phase 3 – Transition
false labor/true labor: difference
*false: irregular intervals of pain w/ no cervical dilation
*Ture: reg intervals w/ cervical change. Bloody mucous in the cervical canal and tight, hot pain w/ contractions and back pain increases when walking
factors that influence labor: 5 P’s
◼ Power: contractions
◼ Passenger: fetus
◼ Passageway
◼ Positions
◼ Psychology
fetal lie: def and examples
*def: Relationship of long axis (spine) of the fetus to long axis of the mother
*longitudinal or oblique
fetal presentations: cephalic
face
fetal presentations: breech
buttocks
fetal presentations: shoulder
shoulder dystocia
fetal presentations: posterior
Back of the baby’s head is toward the bed.
“Sunny side up.” (severe back pain and slow progression)
fetal presentations: anterior
head toward ceiling
SROM: def and dangers
Spontaneous rupture of membranes
*increased risk of infection
AROM: def and dangers
Artificial rupture of membranes
*risk of prolapse (monitor 30 min after)
engagment
*Largest diameter of presenting part reaches or passes through pelvic inlet.
LOA
Left Occipital Anterior: left side, head presenting, back of head toward ceiling
LOP
Left occipital posterior: left side, head presenting, back of head toward the bed
ROA
Right Occipital Anterior: Right side, head presenting, back of head toward ceiling (face down)
ROP
Right Occipital Posterior: Right side, head presenting, back of head toward bed (face up)
cardinal movements of labor
*engagement
*Descent: continuous
*Flexion: fetal head flexed against the chest
*Internal rotation: fetal head rotates from transverse to anterior
*Extension: head extends w/ crowning
*External rotation (aka Restitution): head turns transverse
*Expulsion: shoulders and torso of baby are delivered
pain control options during labor: risks/benefits
*Iv analgesics
*Local/reginal anesthetics
*Epidural
SE of epideral
*Hypotension
*Itching → Narcan to tx
*N/V
*Urinary retention
*Shivering
*Impaired motor ability
contraindications for epidural
*Maternal refusal (duh)
*Local/systemic infection
*Coagulation disorders
*Low platelet count (less than 100,000)
*Hypovolemia
*Allergy to specific agents (again…duh)
*Suspicion of neurological disease
2nd stage labor cues
*FHR variables
*Increase in vaginal show
*Suprapubic pain if epidural present
*“I’m going to 💩!”
2nd stage labor interventions
*SVE to confirm 10 cm and station
*notify dr
*set up warmer/on
*delivery table
*document head and body delivery
*Prep pit bag
*warm hat and blanket
*APGAR
cues for 3rd stage of labor
*pt uncomfy
*gush of blood
*umbilical cord protrudes
*mom may feel relief
*usually focused on baby
risk for prolapsed cord
*Preterm labor
*Low birth weight
*Breech presentation
*Transverse lie
*Ruptured membranes with unengaged fetal head
shoulder dystocia: risks
*Excessive maternal weight
*Short stature
*Hx of previous shoulder dystocia
*Hx of previous large baby
*Post dates
shoulder dystocia: nrsg care
*lower mom’s head
*mcrobert’s maneuver: knees to chest
c-section reasons
Multiples
Breech presentation
Previous uterine surgery (not c/s)
Vertical uterine incision w/prior c/s
Placenta previa
Placental abruption
No progress w/pushing after several hours
Fetal intolerance of labor
frank breech
legs folded up towards head
complete breech
both of the baby’s knees are bent and his feet and bottom
footling breech
feet below bottom
TOLAC
trial of Labor After Cesarean
VBAC
Vaginal Birth After C-sec
