NUR 113 Test 1 FC's Flashcards
1
Q
antipartum
A
the time between conception and the onset of labor or birth. Is used interchangable with prenatal.
2
Q
gestation
A
the number of weeks since the first day of the LMP
3
Q
abortion
A
delivery that occurs prior to 20 weeks gestation. Miscariage is a spontanous abortion
4
Q
term
A
normal duration of pregnancy, beginning of 38th week to the end of 41st week
5
Q
preterm
A
delivery that occurs after 20 weeks but before 38th week. Before is an abortion, after is a full term baby
6
Q
postterm
A
delivery that occurs after the 41st week of gestation
7
Q
intrapartum
A
time from the onset of labor until the delivery of the products of conception (infant and placenta)
8
Q
postpartum
A
time from birth until the wonan’s body returns to an essentially prepregnancy state, the first 6 weeks following delivery
9
Q
gravida
A
any pregnancy, regardless of duration, including present preg
10
Q
nulligravida
A
a woman who has never been preg
11
Q
multigravida
A
woman who has been preg more than once (multiv)
12
Q
primigravida
A
a woman who is preg for first time (primiv) most dangerous type
13
Q
stillborn
A
a fetus born dead after 20 weeks
14
Q
perinatal
A
the period of time from the point of viability through the neonatal period
15
Q
viability
A
22-24 wks, the capacity to live outside the uterus, fetal weight greater than 500gm
16
Q
neonate
A
the first 28 days of life
17
Q
5-Digit System
A
GTPAL (Great to play and laugh) Gravida, Term, Preterm, Abortions, Living children
18
Q
first change that usually occurs in preg
A
enlargement of breasts
19
Q
what is the biological marker for preg
A
Hcg
20
Q
ways to tell if your preg (types)
A
subjective (presumptive), objective (probable signs), diagnostic (positive)
21
Q
size of uterus
A
prepreg-golf ball, 10wks-orange, 12wks-grapefruit, rises up out of pelvis at 12 weeks
22
Q
what happens to uterus during preg
A
grows in size d/t inc estrogen and progesterone, inc in vascularity and dilation of blood vessels, hyperplasia-prod of new fibers, hypertrophy-enlargement of existing fibers, thinning caused by growing fetus, development of decidua (endometrium)
23
Q
subjective signs/presumptive signs woman is preg
A
amenorrhea, N/V, urinary freq, breast tenderness, quickening
24
Q
objective/probable signs woman is preg
A
Hegar’s sign, Chadwick’s Sign, Goodell’s sign (6-8 weeks), uterine enlargement, Braxton Hicks contractions, enlargement of abdomen (HCG UBE)
25
Diagnostic/positive changes that confirm pregnancy
fetal heartbeat, visualization of fetus by ultrasound, fetal movement palpated by examiner
26
heights of fundus
at half way point (20wks) it will be at belly button
27
Hegar's sign
practitioner puts 2 fingers into vag past cervix and feels for softening of lower uterine segment. This allows it to fall forward to carry baby in front, if not preg it will be very hard. Will cause woman to pee a lot since uterus sits on bladder. "Hey girl what are you doing"
28
dextorated uterus
uterus tilts to the right since on L side is the colon, so they will tilt to the right
29
lightening
when uterus drops back down into pelvis, this signals baby is coming out soon (within 2 weeks), allows them to breath easy again, but they will start peeing a lot again
30
round ligament pain
lower back pain d/t uterus pushing on things
31
how do you relieve round ligament pain***
pelvic rocking, getting onto all fours and rocking pelvis
32
Braxton Hicks
aka false labor-practice shocks for uterus, they do not change cervix, they do not get stronger, they usually stop with walking, occur after 28wks, they facilitate blood flow and oxygen delivery to fetus
33
what predicts health of baby?
the placenta, healthy placenta=healthy baby
34
what restricts blood flow to placenta
smoking, HTN, type 1 DM, drugs, sickle cell, hemorrhage, BP too high or low, contractions of the uterus, supine position, multiple gestations
35
what causes inc in uterine blood flow
estrogen
36
what dilates vessels in uterus
progesterone. When it drops it starts your period (when not preg)
37
Niphedipine (procardia)
Ca Channel blocker-dec BP, dec contractions to uterus since it is smooth musc.
38
positioning in preg women*****
don't lay supine-dec perf to placenta b/c they are laying on the aorta/vena cava. They should lay on their left side. NEVER lay on their back in 2&3 trimester
39
Ballottement
occurs after 16-18th wks, when practitioner takes finger and tap on tip of cervix and fetus will move up and them come back down and tap their finger. This tests for content of fluid in uterus
40
Quickening
feeling of life, occurs in 16-20wks, can base gestational age on this. Multivs are more accurate and can feel them sooner. It bonds mom to child. It inc in intensity as preg goes on
41
Goodell's Sign
practitioner puts finger into vag and feels the cervix. If positive they will have a softening of cervix. If not preg it will be firm like a nose. Press the doorbell, goodday
42
changes to cervix during preg
inc vascularity, hypertrophy, hyperplasia, softening (Goodell's sign), bluish color, friability (bleeds easy, esp after sex), ballottement, quickening
43
Vaginal changes during preg
mucosa thickens (strengthens musc for delivery), conn tess loosens (allows for joints to stretch), SM hypertrophy, Vag vault lengthens, formation of the operculum (mucus plug), secretions are more acidic d/t inc lactic acid prod, inc risk for yeast inf (itiching), leukorrhea-whiteish discharge clensing of vag and washing of epithelial cells, inc sensitivity of genitalia, inc sexual interest, enlargement of genitalia
44
Chadwick's Sign
bluish coloring of labia manora and inside vag. Chad choked and turned blue. Well estrogenized women have bluish tint to vag normally
45
Breast changes during preg
fullness, sensitivity, tingling, heaviness, inc pigmentation of nipples and areola-so baby can see it, more erect nipples, hypertrophy of sebaceous glands, venous congestion-more veins present on breasts, proliferation of lactiferous ducts and lobule alveolar tiss, colostrum appears in acini cells of the breast (3rd month of preg)
46
cardiac changes during preg
hypertrophy, inc CO, inc blood volume, displacement up and to the left, pulse inc by 10-15beats, possible cardiac rhythm changes-fluttering
47
BP changes during preg
affected by anxiety, positioning, size of cuff. During first tri BP same, 2nd dec, 3rd inc back to pre preg level. Watch for ORTHOSTATIC HYPOTENSION
48
what causes BP to dec
vasodilation d/t progesterone
49
trimesters
1-weeks 1-13 2-weeks 14-26 3-weeks 27-40
50
what trimester are tertogenic agents most harmful
first
51
Leukorrhea
is norm as long as it doesn't have a fowl odor or itch
52
changes in blood vol during preg
increases 40-45% or 1500ml, starts at wks 10-12, peaks at 32-34wks (important for moms on cardiac meds) max workload of heart is after 32-34wks. Perif vasodilation occurs d/t progesterone.
53
blood contents change during preg
inc RBC, dec Iron, inc WBC, inc Chol, hemodilution-hgb 11, hct 35.
54
true anemia
hgb 10 or less, Hct 33 or less. Norm is 12-16 and 37-47
55
most at risk for anemia
teens, b/c their diet sucks
56
why do WBCs inc in preg
to inc defenses during birth 18-20 is ok. Norm is 5-10
57
clotting changes during preg
inc clotting, inc in factors 7-10, dec in fibrinolytic activity (breaking up of clots), inc risk for dvt. This is so mom doesn't beed out during birth. After birth they will shed clots fot a while
58
coagualtion changes during preg
inc clotting, inc in factors 7-10
59
respiratory changes during preg
nasal congestion-d/t inc blood vol, may get epistaxis (nose bleeds), inc in BMR d/t inc need for oxygen, resp alk, relaxation of ribcage d/t estrogen, expansion of thoracic chage, thoracic breathing occurs, inc in tidal vol, inc in RR, inc in inspiratory capacity, asthma will be worsened
60
renal/urinary system during preg
inc press on kidneys, ureters dilate and lengthen, urine flow rate slows, inc vascularity-will have blood in pee from small accidents, nocturia, freq and urgency, dec in bladder tone-holds more, inc GFR, inc risk for UTI
61
why is inf bad for preg woman
b/c it causes inflam response, which may start preterm labor or try and attack fetus.
62
if having renal problems what should woman do?
bedrest, lie lateral recumbent-best for renal function
63
Fluid and Electrolyte changes during preg
Na and water reabsorption. Estrogen conserves Na, progesterone excretes Na. Do NOT give lasix to them, glucosuria-small amounts are ok, if BG is 160+ spilling will occur, proteinuria-trace or +1 are ok as long as mom doesn't have HTN
64
Integumentary changes during preg
hyperpigmentation is stimulated by the anterior pituitary releasing melanotropin (can get a better tan), inc in hair and nail growth, sebaceous gland growth-sweat more, inc circulation causes rosy cheeks, striae gravidarum-stretch marks d/t inc in adrenocorticoisteriods stretching conn tiss, chlosoma-mask of pregnancy (across nose and cheeks), darkening of nipples and underarms, palmar erythema, linea nigra
65
what type of swelling should preg women not have?
periorbital edema
66
what things in preg do not go away afterwards
striae gravidarum, and expansion of rib cage
67
Musculoskeletal system changes during preg
lordosis, waddling gait, inc mobility of joints (can cause falls), seperation of rectus abdominis musc.
68
neurological system changes during preg
compression of pelvic nerves, lordosis, carpal tunnel syn, traction of brachial plexus (due to weight of belly pulling down on shoulder nerves), lightheadedness d/t vasomotor hypotension, hypoCa
69
gastrointestinal system changes during preg
appetite-dec in 1st tri d/t N/V, inc in 2nd tri, PICA, ptyalism, gingivitis, herniation of stom, pyrosis, constipation, gallstones, Ab discomfort, pelvic heaviness, flatulence and distention
70
what makes preg woman naseous
high levels of Hcg
71
PICA
cravings for non food items like starch, dirt or ice. More common in teen moms b/c their diet sucks
72
ptyalism
excess saliva during preg, may inc N/V, can accelerate gingivitis
73
what causes constipation in preg women
inc progesterone results in inc water resorption from colon (dries out poop), and being on Iron pills
74
endocrine changes in preg women
inc estrogen, progesterone, hCG,hCS serum prolactin, oxytocin, suppression of FSH and LH, thyroid gland gets bigger d/t to estrogen, parathyroid can't keep up, pancreas-fetus steals glucose and AAs
75
why can't you get preg on top of a preg
suppression of FSH by progesterone stops the release of eggs
76
what does oxytocin do?
produced in post pituitary. Infant sucking releases oxytocin which causes contractions that shrink the uterus. It also causes labor to begin.
77
what does parathyroid do?
regulates Ca and Mg, this is why people may lose a tooth while preg from not enough Ca.
78
does glucose cross placenta?
yes
79
does insulin cross placenta?
no, placenta creates it also
80
where is insulin created in mom
beta cells of pancreas
81
how does glucose work with fetus
baby steals glucose and dec mothers ability to produce glucose by stealing amino acids (AA) from mom also, this dec mom's BG. When too much insulin is produced and cells can't reuptake it all you get gestational DM?
82
RBC
inc
83
Blood vol
inc
84
muscle tone
dec
85
WBC
inc
86
BP in 1st tri
same
87
BP in 2nd tri
dec (d/t vasodilation from progesterone)
88
BP in 3rd tri
inc bac to first tri level
89
HR
inc
90
CO
inc
91
fibrolytic activity (ability to break up clots)
dec
92
why do we have inc blood vol during preg
to inc perfusion to placenta
93
where does uterus shift to during preg
up and to the right
94
what is the expected reaction from a woman when she finds out she is preg
ambivilance- b/c that is the point of no return. Is a norm reaction for first few weeks
95
Rubin's Psychological changes of preg
Safe Passage- 1st tri-mom seeks out medical care. 2nd tri-concerned for baby. 3rd tri-worried about labor and delivery
96
most important tri for fetal well being
first
97
father's role during preg
support
98
Nagele's rule or EDC (estimated date of confinement)
take first day of LMP and subtract 3 months and add 7 days
99
first MD appointment
pelvic exam, intense health Hx, Chadwicks, Goodell's, Hegars, drug use, menstrual Hx, preg Hx, violence, STIs, get prepreg weight
100
MD appointments
first at 8-10 weeks, then monthly till 26weeks, bimonthly till 36weeks, then every week till delivery
101
best indicator of how preg is going
weight gain
102
can you drug test preg woman?
only if they give permission, you can however test baby when it is born (through their diaper)
103
what drug causes preterm labor
cocaine, it vasoconstricts vessels and can cause detachmenet from uterine wall, preterm
104
what drug can we give addicts to help them during preg
methadone, to maintain their levels so they don't go through withdrawls
105
fetal alcohol syn
causes low birth weight, microcephaly, MR, unusual facial features, cardiac defects
106
greatest preventalbe cause of MR
alcohol
107
cigarettes
dec perf to baby, preterm, small babies
108
caffeine
limit to 3 cups per day, inc risk for miscariage
109
babies with withdrawls are
irritable, diarrhea, need quiet envt, skin is very sensitive, are given morphine for withdrawls b/c once cord is cut they stop getting drugs
110
when do we screen mom for DM
24-28 wks
111
SGA
small for gestitaional age
112
IUGR
intrauterine growth restriction, 10th percentile baby, very small, little musc, very wrinkly, leathery skin, due to dec perfusion
113
*** 1 hour glucose test (O'Sullivan's or 1ogt)
no fasting, maybe carb load prior. Have mom drink 50gm of glucola wait an hr and then draw blood, if 140+ she fails. Then we need to follow up and do 3hr test
114
***3Hr Oral Glucose Challenge Test **
NPO after midnight prior to test (or carb load), draw fasting BG, then drink 100gm glucola, then draw blood at 1,2,3hrs. 4 blood draws total. 2 or more abnormal results = gestational diabetic
115
GBS screening
group B strep, normal flora in many people, can cause death in newborns they become septic, and can cause preterm labor, penicilin G is given either to cure mom or to prep baby so it can fight it, try to get 3 doses into mom prior to birth. If unsure of mom's GBS we keep baby 48hrs
116
Diabetes I vs II
type one can cause birth defects, gest DM doesn't affect baby till late-it affects size of baby and possible hypoglycemia when born
117
relationship of gest DM vs type II
women what have gest DM are 70% more likely to get Type II DM in the future, usually several years later
118
S/S of infection in neonate
dec in temp, don't eat
119
toxoplasmosis
bacterial inf found in litter boxes, can cause birth defects
120
blood type and match
group- A,B,AB,O, types -,+
121
why is Rh factor important in preg
if baby is + and mom is -, mom will try and attack baby, or will build antibodies and attack next baby. You will be given Rhogam-is a type of blood product. IM inj given profalactically. When baby is born we check blood if baby is born - then mom will not need more Rhogam, if + she will get another shot within 72hrs, also given for abortions or anytime fetal and maternal blood mixes. MUST GIVE before they go HOME.
122
Rhubella titer
drawn on mom, if immune they don't need anything, if not give her vaccine right after birth. Do NOT give during preg, not supposed to get preg within 1 month of getting rhubella vaccine. If baby gets it causes-Hearing, cardiac, MR
123
fundal height measurements
should be within +- 2cm of gestation age charts
124
each visit
always assess for violence, calculate EDC, learning needs, assess knowledge level
125
weight gain in preg
for average women 25-35lbs, if malnurished may be more, if obese may be less. Wt gain indicates health of baby, adequate weight gain reduces risk of small baby, inadeq wt gain may inc risk for IUGR. Too much wt gain (macrosomia) or too little
126
weekly weight gain
first Tri (1-13) 2-4lbs total, then 1lb per week for second and third. First and 2nd Tri increases are in mother-blood vol, breast tiss,etc. 3rd Tri-baby grows. This is why preterm babys are little-they don't grow much till 3rd tri. Ex 16 week fetus should be 2-4 +3 lbs = 5-7lbs. ex. 26week fetus = 2-4 +13 = 15-17lb. ex 40week fetus = 2-4+27 = 29-31lbs. +- 2 lbs either way is ok
127
macrosomia
large baby
128
where does all the weight go?
amniotic fluid 2, breast tiss 1-2, blood4-5, fat storage 4-6, extra tiss3-5, fetus 6-9, placenta 2, total 25-35
129
preterm labor
cervical changes and uterine contractions occuring between 20-38wks. CERVICAL CHANGES, mostly in 2nd Tri. Preterm labor also causes milk dev, fetal lung surfactant prod
130
preterm birth
birth that occurs before 38th week
131
low birth weight
a newborn that falls within the 10th percentile, usually d/t preterm birth, have more health problems
132
what helps iron to be absorbed
vit C, orange juice. Also may give stool softener to prevent constipation
133
number one cost associated with preg
preterm labor
134
risk factors for preterm labor
35, noncaucasian, poor, unmarried, low education, long car rides (d/t sitting up and not peeing), women who took DES or short cervix, multigravita, PREVIOUS PRETERM LABOR-history repeats itself
135
goal with preterm labor
to stop it and extend preg to a term preg
136
what is point of no return
once dilated 4cm, we can't stop it, but if we catch it before we can stop it
137
diabetes in lung dev
diabetic babies don't get the fetal lung maturity till late, so delivering early is risky
138
S/S of preterm labor
uterine activity or contractions (may be painless), discomfort, vaginal discharge-has it changed? If cervix is opening discharge will change, cramps that don't go away, pelvic pressure like baby is pushing down, dull backaches, may have diarrhea
139
what happens to baby during contraction
it balls up b/c it is getting squeezed
140
PROM
premature rupture of membranes-woman's water breaking prior to 38wks, once this happens and they are preterm they must go to hosp b/c its no longer a closed envt for fetus. This does not mean we will take baby out right away-may leave it in longer to become full term as long as they don't have S/S of inf
141
if woman suspects preterm labor what should they do? Short term
dring lots of water, lie on L side for an hr. If it does not stop or if fluid begins to leak from vag, then come to hosp. May be from dehyd or over exertion
142
if woman suspects preterm labor what should they do? Long term
no sexual activity (sperm has prostiglandins that will stimulate cervix, also orgasms stimulate contractions-it releases oxytocin, breast stim-releases oxytocin), avoid long trips, no heavy lifting, no hard physical work. May be put on bedrest
143
bedrest
necessary if woman has incompetent cervix-where they require surgery to fix cervix. Negative affects of bedrest-dec in Ca in bones, musc wasting, wt gain.
144
home uterine activity monitoring
ext monitor placed on uterus to monitor FHR, put toco on top of uterus to monitor contractions
145
Betamethasone (dexamethasone)
steroid that inc prod of surfactant in fetal lungs for preterm babies, given IM in buttocks, then exactly 24hrs later get second shot.
146
Terbutaline (brethine)
asthma med, beta 2 adrenergic agonist-can be used for imeadiate pause of contractions (till we get them to OR) or longer term prevention of contractions (at home with a drip). relaxes SM, dilates uterus, bronchodil, vasodilation of vessels, can cause jitters, tremors, inc HR. Can be given IV,oral,orSC
147
Magnesium Sulfate
CNS depressant- depresses uterine activity prevents contractions, relaxes SM. Used for preterm labor and preeclamsia. S/E resp dep, hypotension, cardiac arrest. Monitor Resp, LOC, HR, BP. Calcium Gluconate is antidote
148
Prostaglandin Synthetase Inhibitors
Naproxen, Motrin-are used only short term under MD direction. Prostaglandins cause the uterus to contract so these work against that to stop contractions. S/E N/V, HA, GIB, and lots of others use with caution
149
Nifedipine (procardia)
relaxes SM and dec uterine contractions, dec in BP, watch for orthostatic hypotension, flushing, monitor HR, BP
150
tocolytics
meds that break up contractions. Betamethasone, terbutaline, Mg Sulfate
151
where do contractions start
top of uterus and work their way down, to push baby out
152
most important thing to know about pregnant woman before giving turp?
number of weeks gestation
153
what determines fetal lung maturity
L/S ratio, greater than 2=mature lungs
154
FHR
can be heard at 10wks by doppler, detects live fetus and promotes maternal/fetal bonding
155
Kick test or daily fetal movement count (DFMC)
24-28wks, mom reports how many movements in 1hr, 3 or more is +. A healthy baby moves
156
**Non Stress test (NST)**
after 27th week, mom is placed on ext monitor, when baby moves we want to see their FHR inc. Toco is placed at fundus, transducer is placed on baby's back, use leopold's manuvers to feel baby. When mom feels baby move she pushes button so we can look at monitor FHR for inc, should accelerate 15beats, this is called REACTIVE. non-reactive is BAD, if non-reactive do CST or skip to BPP
157
Contraction Stress Test (CST)
done if NST is non-reactive, done same day, this puts the baby under stress by giving Ptosin (nipple stim can also be used) to cause small contractions so it can test its reaction. When mom has contraction FHR should inc, if it dec or has a late decelleration then placental perf is compromised. you want this test to be negative for decelerations
158
Biophysical profile (BPP)
done after 24wks if NST is non-reactive, assess to see if fetus is compromised. It measures 5 things with a 2 or a 0. Fetal Breathing movement, Gross body movement, Fetal tone, Reactive FHR (NST), Qualitative amniotic fluid vol. 10 is highest score, 0 is lowest-below 6 indicates asphyxia or oligohydramnios (low amniotic fluid) of fetus and may have to deliver.
159
Ultrasound
can be done at any point in preg, usually at first visit, determines fetal age/due date, measures size of fetus, fluid, and placenta, checks for abnormalities, used in biophysical profile eval also. Is NOT done just to check sex
160
Maternal serum Alpha fetoprotein (AFP or MSAFP)
done between 15-22wks, blood test that screens for neural tube defects, not done often, has false positives and doesn't work in multiple gestations
161
Amniocentesis
possible after 14wks, dx of genetic disorder or abnormalities, assessment of pulm maturity and fetal hemolytic disease. Is done before C section to make sure baby can breath
162
nursing care post amniocentesis
instruct pt to call md if leaking, fever, cramping. May indicate PTL. Or if inc or dec in fetal movement afterwards.
163
L/S ratio (lecithin/sphingomyelin) or PG ratio
35week and beyond, determines fetal lung maturity and if baby is safe to be delivered. Greater than 2 indicates fetal lung maturity. Betamethasone will inc this.
164
Chorionic Villi sampling (CVS)
removal of small piece of tiss is removed from placenta, detects fetal chromosomal abnormalities
165
danger signs of pregnancy
Call a CCAABBBSS Chills and fever, Cerebral disturbances, Ab pain, Alteration of fetal movement, Blurred vision, Blood press, Bleeding-early on, Swelling, Sudden escape of fluid
166
nursing care for N/V
small meals, eat dry meals with fluid in between, avoid greasy/potent foods
167
nursing care of pyrosis
small meals, avoid overeating, don't lie down after meals,
168
nursing care for ptyalism
mouthwashes, chew gum, hard candy
169
nursing care for varicose veins
elevate, wear supportive hose, avoid crossing legs at knee
170
nursing care for hemorrhoids
avoid constipation, ice packs, topical ointments, anesthetics, warm soaks, sitz baths, reinsert into rectum
171
nursing care for backache
practice dorsiflexion of feet, heat, arise slowly
172
what defines labor?
a change in cervix. Without that they are just contractions
173
where is FHR best heard
in their back
174
What has to happen for internal fetal monitoring?
the water has to break, either naturally or MD can do it. Then monitor is placed next to baby's head
175
FHR
should accelerate and decelerate according to the baby's movement. A steady HR is worrysome unless baby is sleeping.
176
how does cord compression affect FHR
it decreases it
177
stomach sizes of babies
day 1 - size of a marble (7ml) Day 3- ping pong ball (22ml) Day 10- egg size (80ml)
178
what are cabbage leafs used for?
they are put on breasts to reduce swelling, sometimes with ice too
179
If mom is NOT breast feeding what should she do with her breasts?
wear tight fitting bra, and avoid heat on breasts, don't want to stimulate breast milk
180
Stool colors in newborns
starts out black (meconium), then will become greenish if breast feeding, if formula it will become brown. May get constipated if using formula
181
urinary output in newborns
may only pee 1 time in first 24hrs, then 2 times day 2, then up to 6-8 times per day within first week
182
why is vit K given to newborns
because they cannot clot, especially before circumcision
183
why is erythromycin given to babies
to protect them from getting STI that mother may have had and exposed them to during birth. Ghonorrhea and chlamidia.
184
how is erythromycin given
it is a cream that is placed across their conjunctival sac
185
when is Hep B given to babies?
when baby is stable-up to 1 month, can be done in hosp or at MD office. If mother is + then baby is also given IGG
186
Sweet-ease
pain med given to infants (sugar water) for distraction
187
hypospadias
an abnormal opening of the urethra on the penis, usually below the head
188
epispadias
an opening of the urethra on top of the penis
189
Nursing care for circumcised child
should check for bleeding q15min for a while, if bleeding apply pressure till it stops. Most types vasoline is applied so it doesn't stick to the diaper. Yellow crust around head is normal, don't try to peel it off
190
Nursing care for umbilicial stump
should be clamped for first 24hrs, keep it dry, clean 4 times a day with alcohol, wipe whole stump with alcohol, this helps disinfect and dry it out, check for 2 arteries (carry waste and deoxygenated blood away from baby) and 1 vein (carries nutrients to baby). Should fall off within 2 weeks
191
IM injection in newborns
done in Vastus lateralis, mid third between hip and knee, use 25g 5/8th inch.
192
PIH
pregnancy induced HTN
193
PNV
prenatal vitamins
194
4 P's of intrapartum
passenger-fetus and placenta, passageway-birth canal, Powers-primary contractions (involuntary) and secondary contractions (voluntary), Psyche-mental state
195
pelvis anatomy
false pelvis-outer rim or iliac crest, true pelvis-inner canal or birth canal, ischial spines-protruding knobs on inner part of pelvis, pubic symphasis-cartalige that holds pelvis together-can expand
196
factors determining how baby moves through canal
size of head, presentation, lie, attitude, and fetal position
197
fetal skull anatomy
bones-2 parietal 2 temporal, 1 frontal, 1 occipital. Sutures-sagittal seperates parietal, lambdoidal seperates occipital and parietal, coronal seperates frotnal and parietal. 2 fontanels-ant (diamond), post (triangle)
198
purpose of fontanels
allow for head to mold and move in pelvis. Also used to help determine fetal presentation, position, and attitude after ROM
199
biparietal diameter
measurement across the top of head. Largest transverse measurement 9.25cm
200
suboccipitobregmatic
smallest diameter of fetal head, is in complete flexion (chin to chest) 9.5cm
201
if chin is to chest what fontanel will you feel upon exam?
posterior or occipital
202
the more the chin is off the chest the more___
space the head will need
203
Lie
the relationship of the spine of the fetus to the spine of the mother. If both lined up it is longitudinal/vertical (can be head down or breach), if perpindicular we call this transverse/horizontal/oblique (can't have baby like this)
204
attitude
relationship of fetal body parts to each other in utero. Normal or General Flexion- is rounded back, chin to chest, arms crossed and cord lies b/w arms and legs
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Wharton's Jelly
slime that covers cord, is very slippery and makes cord float up, so it doesn't choke baby
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presentation
the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor at term. Cephalic (O), Breech or sacrum (S), Shoulder/Scapula (SC). The part first felt during exam
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** Position **
the relationship of the presenting part to the 4 quadrants of mom's pelvis. L/R, O/S/SC, A/P/T. Where presenting part faces. Ex baby facing to the left front with head to chin = ROP because occiputant is facing
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station
how far down the birth canal the baby is, whatever part is going down first. 0 is even with with ischial spines, +1 is below (coming out is good). -1 is above ischial spines. Is used when labor begins to measure progress. Determined by vaginal exam
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VSE
speculum or sterile vaginal exam, using hands to measure and check fetus
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engagement
indicates that the largest transverse diameter has passed through the pelvic brim into the true pelvis to station 0. This is the point of no return (once you get engaged you can't back out) Is good b/c it_s a tight fit so cord can't prolapse
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LOP description
baby is chin to chest facing forward and slightly to the right (according to David)
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what part of pelvis do we sit on
ischial tuberosity
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CPD
cephalopelvic disproportionation-babys head is too big for pelvis. d/t procreating with big headed man
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types of pelvis
Gynecoid-cicrular, most women Android-heart shaped, men Anthropoid-oval Platypelloid-really flat oval
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efacement
the thinning and shortening out of uterus, happens naturally, but can also be done artificially. If it doesn't completely thin it may have a lip
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when should women push
when dilated 10cm, fully efaced, and at acme of contraction
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amniotomy
artificial ROM. RN should monitor FHR before and after to rule out cord prolapse
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ferguson reflex
when baby's head touches pelvic floor, it causes urge to push, wait for this for most effective pushing. It stimulates the inc in prod of oxytocin, which inc intensity of cont
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which position of baby causes lots of back pain?
occipitoposterior, b/c baby's head is pushing against spine.
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duration of contractions
time between the onset and end of contraction, should be 90 sec or less
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frequency (timing)
start of the cont to the start of next cont, want it to be 2min or more. When about 5 min apart come into hosp
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resting tone
time between the end of one cont and the beginning of the next, important for perf. Towards end this is dec due to inc contractions
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intensity of cont
the strength of cont at its peak, mild, mod, and frim. Can be felt on mom as well. If rock hard it is a strong cont.
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terms for monitor strip of contractions
increment-beginning of cont, have mom breath, Acme-peak, mom should push, Decrement-downside of cont, have mom exhale. Resting tone-in between cont, mom relax
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what happens if resting tone is too low
can cause titanic contractions
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what should RN do if cont are too freq or too long
stop Pit first. Then give 02 and turn to side
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Signs of preceding labor
lightneing, bachache, stronger Braxton Hicks, bloody show (cervical mucus from plug), cervical ripening, inc urinary freq, dec in SOB, spontaneous ROM, wt loss (small amount d/t water shift), burst of energy
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what can you do if cervix doesn't ripen?
can put cervadil on it to soften it
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fetal fibronectin
test for detecting premature labor. Is a vaginal swab
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ROM
rupture of membranes-water breaking, can be spontaneous or artificial (done by MD called amniotomy)
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Stages of labor
4 stages, each with phases.
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Stage 1: Phase1
Latent or Early- 0-3cm, cont 30min-5min mild to moderate 30-45sec, lasts 6-8hrs, longest phase, station 0 to -2, brownish discharge, mucus plug or pale pink scant, mom is excited, follows directions, good time for teaching.
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Stage 1: Phase2
Active- 4-7cm, 3-6hrs, moderate to strong 40-70sec, 3-5min apart, station +1 to +2, pink to bloody mucus scant to moderate, mom becomes more serious, pain control, desires companionship and encouragement
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Stage 1: Phase 3
Transition- 8-10cm, 20-60min, strong to very strong 45-90sec, 2-3min apart, station +2 to +3, copious bloody mucus, mom irritable, lots of pain, sweaty, shaking, feels the need to defecate, man should be quiet and no touching
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Stage 2: Phase 1
Latent phase- period of peace and rest, 10-30min, station 0 to +2, no urges to bear down yet, mom quiet, Feels like the worst is over, waiting for ferguson's reflex
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Stage 2: Phase 2
Decent phase- time varies, cont 2-2.5min apart, last 90sec, dark red blood, inc urge to bear down, grunting, very vocal, altered breathing pattern
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Stage 2: Phase 3
Transition- 5-15min, overwhelmingly strong cont, 1-2min apart, last 90sec, station +4 to birth, fetus present, inc reflex to push, may scream or swear, extreme pain, RING of FIRE, train can't be stopped
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Stage 3
birth of fetus until placenta
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Stage 4
1hr after delivery of placenta
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engagement
when the biparietal diameter of the fetal head passes the pelvic inlet
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descent
progress of fetal head through the pelvis. Is measured by the station
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flexion
how stretched out the baby is.
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extension
emerging of the fetal head under the symphysis pubis
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restitution
after head pops out it realigns itself with the shoulders
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expulsion
delivery of the rdmainder of the fetus by lifting up toward the symphysis pubis
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Early deceleration
is a good sign, it occurs during active phasewhen head is compressed during cont. FHR goes down when mom has cont then goes back to norm
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Late deceleration
indicates a perf problem, baby can's sustain during labor, can happen d/t positioning, DM, HTN, preeclamsia, placental abruption. FHR dec after cont and takes a while to recover. Have mom lay on L side, give LR & 02, if it continues call MD
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variable deceleration
occurs d/t cord compression, can happen after AROM, FHR isn't affected by contractions its affected by compression of cord. If deep drop it can be cord prolapse, low fluid may affect this
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amnio infusion
inserting cath into uterus to run NS into uterus. May be done if mom is having variable decelerations d/t oligohydramious
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meconium
first baby poop-is very sticky so must be careful if it happens during birth so it doesn't go in baby's lungs, take to neonatal if this happens.
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if RN suspects cord compression what should they do?
feel inside mom for the cord, if it can be felt, lift the presenting part off the cord to restore perf. Leave hand in there until they get to OR to get baby out. Can give 02 after.
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APGAR
newborn assessment tool-done at 1 and 5min after birth. 5 categories 0,1,2 for each best score is 10, 8-10=healthy baby, 6-7needs 02, 4 or less may need CPR. Activity (flexion/musc tone) Pulse (100-160 can get from umb stump), Grimace (reflex response does baby cry when we pull away), Apperance (color), Respiratory effort
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S/S of hypoventilation
dizziness, sweating, tingling of lips and fingers, inc HR, lightheaded, give nonrebreather, or breath into hands
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what causes baby to take first breath
inc in arterial CO2 pressure and dec in arterial pH
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nitrazine test
test to see if ROM has occurred-swab in cervix and put on pH paper if it turns blue or alkaline then ROM has occurred since vagina will be acidic
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ferns test
if you swab amniotic fluid onto a slide it will dry in the shape of a fern
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how can you test for clonus beats?
if doing ankle fexion if ankle pulses and kind of twitches it can signal you may have a seizure (too much stimulation)
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placenta previa
placenta that is covering the bottom of the cervix, can be completely covering it, partial, or just low lying. Low lying ones can move up during preg. Can have SUDDEN PAINLESS bleeding
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what test do we NOT do with a previa
vag exam-can cause bleeding or abruption. Also must have C-section
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what can cause previa
previous previa or C/S, cocaine, cigarettes, many pregnancies
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Abruptio placenta
where the placenta pulls away from uterus, can be marginal, partial, or complete. Complete is very bad and usually results in death of fetus
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causes of abrution
ELEVATED BP, cocaine, uterine trauma
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S/S of abruption
intense pain in AB, like pulling off a scab, AB will be rock hard d/t hematoma
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pushing
stage 2
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0-3cm dilated
stage 1, latent phase
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birth of fetus
stage 3
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moderate to strong contractions
stage 1, active phase
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ring of fire
stage 2, transition phase
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removal of placenta
stage 3
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cont 40-70sec
stage 1, active phase
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cont 1-2min apart
stage 2, transition phase
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1st hr after delivery
stage 4
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cont 30-45 sec
stage 1, latent phase
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when does mom start to get irritable
stage 1, transition phase
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best time for teaching
stage 1, latent stage
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mom thinks worst is over
stage 2, latent phase
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ferguson reflex begins
stage 2, decent phase
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10cm dilated
end of stage 1, transition phase
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grunting begins
stage 2, decent phase
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4-7cm dilated
stage 1, active phase
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swearing and screaming
stage 2, transition phase
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bloody show
stage 2, decent phase
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mom wants companionship and encouragement
stage 1, active phase
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N,V, perspiration, tremor, need to defecate
stage 1, transition phase
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why are we concerned if placenta doesn't come out by itself?
can cause bleeding/hemorrage
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what is the body's natural pain killers
endorphins (not as good as morphine though)
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what is the major cause of pain in labor?
fear and tension
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non pharm ways to relieve pain
effleurage, counter press, water therapy, wet washcloth, TENS, acupressure, ice/heat, hypnosis, biofeedback, aromatherapy
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highest priority during labor
fetal response to labor, it determines what actions are taken
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do meds from epidural get to baby?
NO, it is not systemic so it does NOT cross placenta
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best time to give epidural
4-6cm dilated, too early may slow labor, too late will not relive pain
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systemic analgesics
demerol, Stadol, Nubain. These do affect baby and may require narcan after birth. If mom received this 1-4hrs before birth baby will have them it their system
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Demerol
narcotic CNS depressant, crosses placenta, causes N/V, hypotension, bradycardia, resp dep, can be given IM, SC,or IV. Dec FHR and variability
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Stadol
analgesic at CNS level, crosses placenta, causes sedation, floating feeling, lightheaded, confusion, nausea, hypotension, resp dep. Dec FHR and variability, and musc tone
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Nubain
Same as Stadol: analgesic at CNS level, crosses placenta, causes sedation, floating feeling, lightheaded, confusion, nausea, hypotension, resp dep. Dec FHR and variability, and musc tone
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Narcan
narcotic reversal agent, combats resp dep associated narcotics, IV/SC/IM, give ever 2-3min. Can give into umbilical vein or endotrachael for baby, may have to repeat in few hrs too
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what does nurse do before calling MD for epidural
bolus mom with 500-1000 of LR, it_s a volume expander and will prevent mom's BP from dropping too low. Also, take vitals of mom and baby first
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why can epidural slow down labor?
b/c bolus hydrates and relaxes uterus, and epidural can cause numbness and dec mom's pushing sensation
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what is blood patch and why would it be used?
if MD sticks epidural too far and goes into spinal cord, it will leak. This leaking will cause severe spinal headache. Blood is drawn and injected into spinal cord location of leak and it will clot and close the leak
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why does epidural dec mom's BP
it causes pooling of blood in extremities
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positions for mom to be in for epidural insertion
laying on side with knees to chest, or sitting upright hunched over. MD needs to see and count vertabrae
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if hypotension occurs d/t epidural what should RN do?
have pt lay Left Lateral, inc IV fluids that do NOT have pit, give 02 (6-10L) by face mask, vasopressors if ordered, keep supine for a few min to let meds circulate body
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when should RN discontinue Pit
fetal distress, bradycardia, late or variable decel, meconium staining, too frequent cont or sustained cont. Then turn client to L side and give 02.
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BTL
bilateral tubal ligation
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pudenal block
is injections of local anesthesia injected right near ischeal spines, huge needle, usually used for episiotomy and real bad tears. Not used often
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vaginal tears
can be 1-4th degree. 4th is the worst. 3-4 prob need stitches
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Bishop scoring
a scale that ranks indicates if induction will be successful. 8 or higher means that you can induce. If cervix is hard-pit will not work.
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reasons for inducing labor
HTN, complications, inf, low fluid, way past due date, epidural slowed labor too much
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Pitocin
causes uterine contractions, or enhances existing cont, is started low and increased. RN must monitor pt 1:1. Always run in secondary bag, too much can rupture uterus, has very short half life
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baby extraction devices
forceps and vacuum. Neither can be used if baby is CPD (cephlopelvic disproportianate or big head). Both are used when baby is becoming distressed
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forceps
big tongs that are inserted into vag and pull on baby's head. S/E tearing of perineal area, facial palsy (usually temp)
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vacuum
sucks on baby's head to help pull it out. Can leave red circle on head, hematoma, or scalpal lacerations
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Depo-Provera
contraception injection given every 3 months
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Cesarean births
Classical- cut from bellybutton down-easy, quick, if you ever had this one you will always have C/S next time. Lower uterine segment incisions (LUS)-cutting across bikini line, takes more time and skill, risky can hit bladder, less scarring, can have vaginal birth after this type (VBAC) with trial of labor (TOL) where they see if it works
