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NUR 318 > module 3 > Flashcards

module 3 Flashcards

1
Q

nurses role in nutrition during pregnancy

A
  1. nutritional assessment 2. identification of nutritional related problems or risk factors 3. interventions based on dietary goals and plan for appropriate weight gain. 4. it is ideal for a woman to receive information about nutrition before the start of pregnancy
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2
Q

factors that contribute to the increase in nutrient needs during the first trimester

A
  1. development of uterine placental fetus unit
  2. increased maternal blood volume and constituents
  3. maternal mammary development
  4. increased metabolic rate
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3
Q

nutritional energy needs during trimesters

A

energy needs: weight gain is determined by pre-pregnancy BMI. want to avoid excessive weight gain

  1. protein: developing placenta and amniotic fluid
  2. omega 3 fatty acids: the fetal brain needs this present in salmon and walnuts
  3. fluids: want to avoid caffeine.
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4
Q

minerals and vitamins for pregnant women

A

iron: because of the increase in plasma, there is hemodilution so try to prevent anemia
calcium: pregnancy will remove the mom’s calcium stores so intake and supplementation are important.
vitamins: prenatal vitamins are given to pregnant women. folate or folic acid, vitamin A, Bs, C D,E and K.

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5
Q

nutritional issues in pregnancy

A
  • alcohol
  • caffeine: can increase bp and cause constriction on the blood vessels in the placenta. keep It to 200 mg a day
  • artificial sweeteners: not much information regarding artificial sweetners
  • avoid mercury but can have shrimp, salmon catfish about 6 oz a week
  • lookout for PICA: ingesting non-food items
  • nausea and vomiting can make it difficult to eat healthy
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6
Q

exercise

A

moderate exercise yields many benefits, including improving muscle tone, shortening the course of labor, and a sense of well-being. water intake should be adequate and caloric intake must be adjusted to account for exercise.

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7
Q

iron supplementation

A

iron should be taken with vitamin c for better absorption. bran, tea, coffee, milk decrease iron absorption. best absorption when taken on an empty stomach but take into account the mother’s case. does it make her nauseous? supplement could help. iron can make stool black or dark green. constipation can also ensue

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8
Q

foods rich in folate

A

leafy greens, asparagus, broccoli, papaya, avocado, seeds and nuts, Brussel sprouts, beans. folic acid helps prevent neural tube defects

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9
Q

nutrient needs during lactation

A

similar to those during pregnancy. about 330 calls more than non pregnant intake. increase maternal weight loss during lactation. smoking, alcohol, and excessive caffeine intake should be avoided

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10
Q

nutrition care and teaching

A
  1. what an adequate diet looks like.
  2. use nutrition supplements appropriately like iron.
  3. a woman must understand what adequate weight gain is.
  4. after birth, the goal is to lose weight gained during pregnancy. must ensure nutrients are maintained and that there are increased caloric needs for lactation. those who gain more weight than recommended have lower breastfeeding rates.
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11
Q

labor

A

the onset of regular uterine contractions that cause cervical change. term labor onset is usually between 37 and 42 weeks. during labor, estrogen rises and progesterone drops but after labor, estrogen drops and progesterone increases. oxytocin stimulates mymetrial contraction

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12
Q

true labor

A

true labor begins with contractions that cause progressive cervical changes of dilation and effacement. ends with the placental delivery. contractions increase in frequency, duration and intensity. patient may feel back pain that gradually sweeps around to the lower abdomen. follows a specific sequence of events called cardinal movements of labor. activity will sometimes increase labor pains.

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13
Q

false labor

A

contractions that do not cause cervical dilation or effacement. it can mimic true labor but contractions are inconsistent and will decrease with activity. there is discomfort felt in the abdomen and groin.

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14
Q

nursing management of false labor

A
  • relax in a warm tub with warm drink and follow with a back rub.
  • rest and sleep
  • supportive care with understanding and patience
  • activities for diversion
  • have her walk for 1-2 hours and if no cervical change then evaluate
  • education for woman and partner
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15
Q

preceding signs of labor

A
  • lightening: when the baby drops and there is less pressure on the diaphragm making it easier to breathe
  • bloody show or increase in vaginal discharge: means the cervix is changing (ripening)
  • backache
  • urinary frequency
  • stronger braxton hicks
  • surge of energy and nesting
  • slight weight loss
  • possible rupture of membrane
  • N,V,D, indigestion
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16
Q

the 5 p’s that affect the process of labor and birth

A
  • passenger (fetus and placenta)
  • passageway (birth canal)
  • powers (contraindication)
  • position of the mother
  • psychologic response
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17
Q

passenger: fetal head

A

-fetal head: anterior (diamond shape) and posterior (triangular shape) fontanelles

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18
Q

passenger: fetal presentation

A

the part of the fetus that enters the pelvic inlet first. the internal os and leads through the birth canal during labor. for a vaginal delivery cephalic presentation is necessary but there are three categories cephalic, breech, and shoulder each with sub categories.

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19
Q

cephalic

A

the fetal head is the first to come into contact with the maternal cervix. it is the most common and most favorable

vertex: chin tucked flexion
millitary: moderate flection, neurtal position
brow: slight extension
face: full extension of the neck

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20
Q

breech

A

fetal buttocks enter the maternal pelvis first. it is more common with preterm births, fetal abnormalities such as hydrocephalus, abnormalities of the uterus, pelvis, and placenta previa
could be frank: with the body in a v shape
full: the child is almost in criss-cross applesauce
footling: one or both of the feet is coming out first

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21
Q

shoulder

A

associated with a transverse lie and almost always requires a c-section. maternal abdomen appears large from side to side and fundal height is smaller than expected

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22
Q

passenger: fetal lie

A

the relation of the fetal spine (long axis) to the mother’s spine (long axis).

longitudinal: cephalic or breech
transverse: fetus long axis is perpendicular to mother” sideways”
oblique: an angle between longitudinal and transverse

23
Q

passenger: fetal attitude

A

the relation of the fetal body parts to one another in utero

24
Q

passenger: fetal position

A

the relationship of the reference point on the presenting point or the portion of the fetus to the 4 quadrants of the mother’s pelvis
Occiput, sacrum, mentem(chin) sinciput (deflexed vertex)
the first letter is R or L for right or left, the second letter is occiput, mentem, or scapula, the third letter is anterior, posterior, transverse.

25
Q

passageway: bony pelvis

A

composed of: a rigid bony pelvis, the soft tissue of the cervix, pelvic floor, vagina, introitus.
the coccyx is moveable in late pregnancy

26
Q

the powers

A

physiologic forces of labor and delivery

27
Q

primary powers

A

three parameters of contractions
1. frequency: time from the beginning of one contraction to the beginning of the next
2. duration: length of contraction
3. intensity: strength at the peak
Ferguson reflex: stretch receptors in the posterior vagina cause the release of endogenous oxytocin which triggers the urge to push. it is usually too early in labor to push so it must be held off
effacement: thinning and shortening of the cervic is a %
dilation: stretching of the cervical os from being closed to being 10 cm

28
Q

contractions and pushing

A

contractions are a primary force but pushing is a secondary force.

29
Q

how do contractions work and feel?

A

contractions are the rhythmic tightening of the uterus. fibers contract in different directions. the goal is down and out. at first contractions feel like tightening but as labor progresses they become longer, closer and stronger.

30
Q

effacement

A

0%: no changes to the cervix
50%: cervix is half of the normal thickness
100%: cervix is completely thinned out

31
Q

dilation

A

the opening of the cervix 0cm-10 cm
caused by strong contractions, pressure exerted by anmiotic fluid, increased uterine pressure during 1st and 2 nd stages of labor, descending head on cervix and stretch receptors of the posterior vagina

32
Q

intesity of contraction

A

is usually determined by palpation. mild is as hard as the nose, moderate is as hard as the chin and strong is as hard as the forehead

33
Q

oxytocin

A

stimulates ht calm and connection. is released in response to touch, security, pleasant sounds, and is good for positive thoughts

34
Q

endorphins

A

morphine-like painkillers reduce brain perception and help give focus. released in response to tough, deep breathing, rhythmic movement, and visualization. increase in pregnancy and rise in labor and birth

35
Q

catecholamine

A

stress hormone, pupils dilate, pulse and breathing quicken, muscles increase in the second stage of labor

36
Q

prolactin

A

the milk producing hormone. thouht to be important along with catecholamines in fetal drug development

37
Q

engagement

A

wides diameter of the fetal presenting part has passed through and the pelvic inlet presenting part is at station 0

38
Q

station

A

level of the presenting part in relation to maternal ischial spines.
maternal ischial spines: 0
above ischial spines: (-)
below ischial spines (+)
+4 means the fetal head is at the pelvic outlet

39
Q

postion

A

describes the relationship of the site of the presenting fetal part to the four quadrants of the matheral pelvis. ,,_ 1 R or L, 2 O,M,S,A. 3 A, P. T

40
Q

cardinal moves of labor

A

turns and adjustments necessary for the birth process. include engagement, descent, flexion, internal rotation, extension, restitution, and external rotation, expulsion

41
Q

five additional factors affecting labor

A

1, philosophy (low tech, high tech)

  1. partners (supportive caregivers)
  2. patience (natural timing of labor)
  3. patient preparation
  4. pain control
42
Q

first stage of labor

A
  1. early
  2. active
  3. transition
43
Q

early labor

A

dilation from 0-6 cm, effacement from 0-100%.

contraction pattern is 30-40 seconds every 50-30 mins

44
Q

active labor

A

6 cms- 8cms. the cervix is thinned and opening. the baby’s head is facing the mother’s side. in this position, the widest part of the baby head is in the widest part of the pelvis. contractions are 45-60 seconds every 2-5 minutes

45
Q

transition

A

8cm-10cm. the cervix completes dilation. the baby begins to rotate toward the mothers backbone with the baby’s chin tucked to its chest. contractions for 60-90 seconds every 2-3 mins

46
Q

amniotic membrane rupture

A

high leaks will trick slow, but low breaks will gush

47
Q

second stage of labor

A
  1. if circumstnaces allow, women should be able to push when they have the urge to.
  2. directing should be on a needs basis and should not be directed to push for more than 8 seconds. onpen glottis pushing is best
  3. push in an upright position. squatting increases pelvic diameter.
  4. being upright decreases duration of the labor due to gravity.
  5. being upright can also decrease pain intensity and incidence of perineal trauma
48
Q

stage 3 of labor

A

delivery of the placenta

49
Q

mothers feelings and reactions to the 3rd stage of labor

A
  1. she may be screaming with delignt or may be overwhelmed and want to sleep more
  2. involved with how baby is doing. she may be asking how the baby is doing
50
Q

physical changes of the mother

A
  1. slowing of contractions after birth of the baby

2. shrinking of uterus to grapefruit size and it is found at the level. of the umbilicus

51
Q

fetal adaptation to labor

A
  1. HR: accelerations and slight decelerations
  2. Circu: uterine contractions may decrease circulations so watch for cord compression
  3. Resp:lung fluid is cleared from the air passages during passage through the birth canal.
  4. PO2 decr, PCO2 incr, arterial pH decr, bicarb decr
52
Q

maternal adaptations to labor

A
  1. increase caardiac output during contractions (51%)
  2. incr BP during contractions but baseline between
  3. incr WBC bc of physical and emotional stress
  4. incr RR and O2 consumption
  5. proteinuria
  6. perineal stretching
  7. neuro: euphoria, inward, amnesia due to endorphins
    8: GI stomach emptying slower: nausea
53
Q

factors influencing a positive birth exp

A
  1. clear info and support
  2. sense of mastery and self confidence. personal control over breathing
  3. trust
  4. positive reaction to pregnancy
  5. preparation

NUR 318 (10 decks)

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