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YEAR 3 > NURS 330 (OBS) > Flashcards

NURS 330 (OBS) Flashcards

1
Q

When does Preconception Start?

A

At least 3 months before conception

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2
Q

How many pregnancies are planned vs unplanned

A

50-75% = unplanned
25-50% = planned

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3
Q

Folic Acid and Iron Preconception

A

0.4mg/day of folic acid (400mcg) and 16-20mg iron/day

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4
Q

How much weight should a woman gain during pregnancy?

A

1st trimester: 6lb
2nd Trimester: 12lb
3rd Trimester: 12lb
About 30 lbs

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5
Q

Screening Pregnant Client: Blood Group and Rh

A

If fetus is Rh+, moms body may react and attack fetus. If both parents are Rh-, there is no risk.

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6
Q

Screening Pregnant Client: Infectious Diseases

A

STI, HIV, Hepatitis B&C, Rubella

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7
Q

Screening Pregnant Client: Gestational Diabetes

A

Glucose Tolerance Test 24-28wk

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8
Q

Screening Pregnant Client: Perinatal Serum Screening

A

15-20wks

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9
Q

Screening Pregnant Client: Group B Strep

A

35-37wks
Common bacteria which are often found in vagina, rectum or urinary bladder of 15-40% of women
- Treated by antibiotics IN LABOUR

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10
Q

Screening Pregnant Client: Asymptomatic bacteria

A

UTI can cause pre-term labour

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11
Q

Screening Pregnant Client: For Fetus

A

Fetal movement
Fetal HR
Ultrasounds

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12
Q

Ultrasounds in pregnancy

A

between 8-12wks (age/ due date) and between 18-22wks (anatomy)

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13
Q

Purpose of Ultrasounds in Pregnancy

A
  • Confirmation and EDC dates
  • # of fetuses
  • Size for gestational age
  • How baby’s internal organs are growing
  • Placental position and size
  • Women’s uterus, fallopian tubes, ovaries
  • Check for signs of possible genetic problem
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14
Q

F = RP

A

< 6 movements in 2hr = RED FLAG
F - Fetal movement
R - Reduction in fetal movement
P - Potential for distress/fetus already in trouble

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15
Q

Amniotic Fluid Measurement

A

1L at birth
Adequate volume needed for proper G&D:
- protection of fetus
- temp control
- infection control
- lung and GI development
- Muscle and bone development
- umbilical cord support

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16
Q

Oligohydramnios

A

Less amniotic fluid

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17
Q

Polyhydramnios/Hydramnios

A

Too much amniotic fluid

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18
Q

Nuchal Scan for Translucency

A

Collection of fluid under skin at the back of fetus neck
- From measuring this + maternal age, RISK of chromosomal abnormality can be calculated.

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19
Q

Non-Invasive Prenatal Testing (NIPT) or Cell Free DNA Testing (cfDNA)

A
  • blood sample: analyze abnormalities of chromosomes
  • not publicly funded
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20
Q

Amniocentesis

A

Done between 15–16wks, very invasive

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21
Q

5 P’s of Labour and Delivery

A

Passage
Passenger
Powers
Position
Psychology

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22
Q

Stages of Labour

A

1st (Cervical): Early, active, transition
2nd (Pushing)
3rd (Placental)
4th (Postpartum)

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23
Q

Four Classic Pelvis Types and which is best?

A

Gynecoid
Android
Anthropoid
Platypelloid

GYNECOID & ANTHROPOID = BEST

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24
Q

Passage (way)

A

Ability of pelvis & cervix to accommodate passage of fetus

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25
Q

Passenger

A

The ability of fetus to complete the birth process

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26
Q

Suboccipitobregmatic

A

Smallest diameter of fetus’ head

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27
Q

Molding

A

Cranial bones overlap under pressure of the powers of labour and demands of unyielding pelvis

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28
Q

Passenger components

A

Fetal:
- attitude
- lie
- presentation
- position
- station

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29
Q

Fetal Attitude

A

Relationship of fetal parts to one another
- Head can be Extended, brow or flexed

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30
Q

Optimal Fetal Attitude

A

FLEXED

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31
Q

Fetal Lie

A

Relationship of fetal spine (cephalocaudal axis) to maternal spine (cephalocaudal axis)
- Longitudinal, transverse, oblique

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32
Q

Optimal Fetal Lie

A

Longitudinal

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33
Q

Fetal Presentation

A

Determined by fetal lie and body part of fetus that enters pelvic passage first (presenting part)

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34
Q

Cephalic Presentation

A

HEAD (vertex, brow, face, chin)

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35
Q

Breech Presentation

A

Buttocks (Complete, frank, incomplete)

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36
Q

Shoulder presentation

A

Oblique or transverse lie - CANNOT deliver vaginally

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37
Q

Compound Presentation

A

> 1 part of body coming out (ex. hand on head)

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38
Q

Fetal Position

A

Position of Fetus in relation to the pelvis (R=right, L=left, O=occiput, S=sacral, M=mentum)

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39
Q

Optimal Fetal Position

A

ROA and LOA

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40
Q

Fetal Station

A

Relationship of presenting part to imaginary line drawn between ischial spines of maternal pelvis
Head at “0” = engaged

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41
Q

Engagement

A

Presenting part at “0” = engaged
Largest diameter of presenting part reaches or passes through pelvic inlet

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42
Q

Powers

A

Characteristics of contractions & effectiveness of expulsion methods
PRIMARY AND SECONDARY

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43
Q

Primary Powers

A

Uterine Muscular Contraction

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44
Q

Secondary Powers

A

Use of abdominal muscles to push during second stage of labour

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45
Q

How to Assess Contractions?

A

Frequency (interval)
Duration (length)
Intensity (strength)
Resting tone

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46
Q

Assessing Frequency of Contractions

A

From start of one to start of next, reported in minutes or # of contractions/10 mins

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47
Q

What is normal frequency of contractions

A

2-3mins = as close as they should be (5 in 10 mins)

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48
Q

Assessing duration of contractions

A

From start to end (reported in seconds)

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49
Q

Assessing intensity of contractions

A

Weak, Moderate and Strong
- non-invasive: palpate (subjective)
- invasive: IUPC (objective)

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50
Q

Why assess resting tone between contractions?

A

Need to know if it FULLY relaxes due to decreased fetal perfusion during contractions

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51
Q

Position (materal)

A

Certain maternal positions can promote comfort and enhance progress
Repeated position change is often helpful

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52
Q

Premonitory Signs of Labour

A

Lightening
Braxton Hicks
Vaginal Mucous increase
Cervical Changes
Bloody Show
Rupture of membranes
Sudden energy burst
Loss of 0.5-1kg
Diarrhea, indigestion, N/V

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53
Q

Lightening

A

Fetus engaged, descended into pelvic inlet

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54
Q

Braxton Hicks

A

“tighten”, intermittent, irregular.
Increase closer to term, painless, no cervical change

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55
Q

“False Labour”

A

Prodromal labour (irregular, does not progress, felt at the FRONT of abdomen)

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56
Q

Cervical Changes

A

Cervix begins to soften and weaken

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57
Q

Bloody Show

A

Loss of cervical mucous plug

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58
Q

Rupture of membranes

A

Usually, labour starts within 24hours after this.

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59
Q

First Stage of Labour

A

Early/Latent
Active
Transition

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60
Q

Early/Latent Phase

A

Cervix dilates 0-3cm
Regular, mild contractions begin and increase intensity and frequency

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61
Q

Active Phase

A

cervix dilates 4-7cm
Contractions increase intensity, frequency and duration
Fetus descends into pelvis

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62
Q

Transition Phase

A

Cervix dilates 8-10cm
Contractions increase intensity, duration and frequency
Fetus descends rapidly into birth passafe
N/V, diaphoretic, increased bloody show

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63
Q

Second Stage

A

“PUSHING”
Cervix fully dilated to delivery of infant
use of intra-abdominal pressure to push
Perineum bulge, flatten, move anteriorly
Crowning - head visible, does not retract between contractions

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64
Q

Third Stage

A

Delivery of infant to delivery of placenta
Strong uterine contractions
lengthening of cord
Slight blood loss
Uterus smaller, rounder, firmer, fundus rises in abdomen, harder and increased mobile
Pressure to bear down
Placental separation and delivery

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65
Q

Fourth Stage

A

1-4hrs after delivery of placenta
Increased pulse, decreased BP due to redistribution of blood
Uterus contracted between umbilicus and symphysis pubis
Shaking chill
Urinary retention r/t decreased bladder tone and possible trauma

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66
Q

CV changes of Labour

A

Decreased BP in each contraction, may increase with further pushing

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67
Q

Resp changes in Labour

A

Increase oxygen demand and consumption
Mild resp acidosis can occur

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68
Q

GI/GU Changes in Labour

A

Edema in bladder due to pressure from fetal head
Delayed gastric motility and gastric emptying

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69
Q

Hematological and Immune

A

WBC increases, blood glucose decreases

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70
Q

Initial Assessment of Labouring Client

A

Due date? # of pregnancies? Contractions? Baby activity? ROM or bleeding? Complications? Allergies?

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71
Q

Baseline Assessment of Labouring Client

A

FHR
BP, TPR
Contractions
Cervix
Membranes
Bleeding
Edema
Other Anomolies
Weight change
Assess urine (glucose, ketones, proteins, UTI)

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72
Q

Laboratory Assessment of labouring client

A

CBC, infection, blood dyscrasia or coags, serologic testing, blood type, Rh and antibodies, HIV, Hep B&C, Ultrasounds, GBS, diabetes

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73
Q

Characteristics of NORMAL labour

A

Frequency: no more than q2mins
Duration: less than 90 seconds
Intensity: IUPC - 25-75/80mmHg above baseline
Resting Tone: uterus soft between contractions for min 30 sec or 7-25mmHg with IUPC

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74
Q

Tachysystole

A

Frequency: >5 in 10 mins
Duration: > 90sec
Resting tone: resting period of < 30 seconds or remains firm on palpation b/w contractions

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75
Q

Assessing dilation and effacement

A

Sterile Vaginal Examination (SVE)
- Membrane status
- amniotic fluid
- fetal position
- station

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76
Q

Dilation

A

Opening of cervix
Complete dilation - 10cm

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77
Q

Effacement

A

Thinning of cervix (0-100%)
Muscles of upper uterine segment shorten, causes cervix to thin & flatten
Can occur before labour (primiparous/multiparous) or during labour (multiparous)

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78
Q

ROM

A

Rupture of Membrane

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79
Q

SROM

A

Spontaneous rupture of membrane

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80
Q

AROM

A

Artificial rupture of membrane (amniotomy)

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81
Q

PROM

A

Premature rupture of membrane (pre-term)

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82
Q

PPROM

A

Preterm Premature rupture of membrane

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83
Q

Goal of comfort measures and labour support

A

Promote relaxation

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84
Q

Doula

A

Not medically trained, provides emotional support and comfort in labour and delivery

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85
Q

Indigenous birth support worker

A

Trained midwives, reserved for Indigenous patients but can help out with others. Always 1 available on shift.

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86
Q

Registered Midwife

A

Specialist in normal births, medically trained. Only 12 in SK

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87
Q

5 Categories of labour support

A
  1. Physical
  2. Emotional
  3. Instructional/Informational
  4. Advocacy
  5. Partner/Coach care
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88
Q

PAIN

A

Physical sensation

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89
Q

SUFFERING

A

Emotional reaction, should be NONE in childbirth

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90
Q

3 R’s of Labour

A

Relaxation
Rhythm
Ritual

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91
Q

Mental Activities in Labour

A

distraction, meditation, imagery, non-focused awareness, hypnosis

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92
Q

Basic Needs in Labour

A

Hygiene, eat/drink, clean up bed, mouth care, peri-care, lip balm

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93
Q

Heat and Cold in Labour

A

Preference of the client - water at temp they life, magic bag/hot water bottle, ice pack, bath

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94
Q

Simkin Breathing

A
  • Slow (Slow paced)
  • Light (modified paced)
    CLEANSING BREATH = most important
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95
Q

Massage Techniques in Labour

A
  • Double hip squeeze
  • criss-cross - back massage
  • break popsicle stick - hand massage
  • head, back, neck, feet - preference of client
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96
Q

Hydrotherapy in Labour

A

shower or tub/whirlpool during labour

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97
Q

Benefits of Hydrotherapy

A

Decreased pain and anxiety, warmth, buoyancy, decreased perineal trauma, recommended by research

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98
Q

Risks of Hydrotherapy

A

Hypo/hyperthermia, HR changes, fetal tachy, unplanned water birth

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99
Q

Why is position change important during labour?

A
  • Promote circulation and relaxation
  • Promote contraction
  • changes pelvic shape
  • relieve discomfort
  • provide distraction
  • increase fetal oxygenation
  • COMFORT
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100
Q

Benefits of birthing/peanut ball

A

Increased balance
Counter pressure on perineum
- ease back pain
- widens pelvic outlet

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101
Q

Other comfort measures in labour

A

acupuncture
acupressure
aromatherapy
TENS (transcutaneous electrical nerve stimulation)
Sterile water injection (for back pain)

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102
Q

Environment for labour

A
  • dim lights
  • peaceful surroundings, talk quietly
  • privacy, avoid interruptions
  • temp - adjust to pt preference
  • music
  • encourage personalization
  • safety
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103
Q

Nitrazine Swab

A

To confirm rupture of membranes (blue = pos, yellow = neg)

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104
Q

Intermittent Auscultation (IA)

A

for low-risk women, findings classified as normal or abnormal. Allow mom to move around, use doppler to assess FHR

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105
Q

Electronic Fetal Monitoring (EFM)

A

For women at risk of adverse outcomes, findings classified as normal, atypical, and abnormal.

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106
Q

Normal FHR

A

Rate: 110-160
Regular Rhythm
Accelerations

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107
Q

Steps of starting EFM

A

Leopold’s first
Palpate radial pulse (compare MHR to FHR)
Put baby monitor on back of baby
Put contraction monitor on top

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108
Q

FHR - Tachycardia

A

Rate above 160bpm for longer than 10 mins

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109
Q

FHR - Bradycardia

A

Rate below 110 for longer than 10 mins

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110
Q

FHR Variability

A

Fluctuations in baseline FHR/minute (not accels or decels) - amplitude of peak to trough in bpm

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111
Q

Absent variability

A

A = undetectable

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112
Q

Minimal Variability

A

MN = < 5 bpm

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113
Q

Moderate Variability

A

NORMAL
MD = 6-25bpm

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114
Q

Marked Variability

A

MK = >25 bpm

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115
Q

Sinusoidal

A

FHR pattern that is smooth, repetitive sine wave-like pattern that persists for > 20 mins, amplitude of 5-15 bpm, and frequency of 3-5 cycles/min

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116
Q

Accelerations

A

Abrupt (<30sec) increase in FHR at least 15 bpm above baseline for at least 15 seconds and < 2 mins
NORMAL, but not necessary

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117
Q

Accelerations in < 32 wks

A

10 bpm above baseline for 10 seconds

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118
Q

Decelerations

A

Decrease in FHR that is abrupt or gradual and termed early, late, or variable (categorized by abruptness and relationship to contractions)

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119
Q

Variable Decelerations

A

CORD COMPRESSION
visually apparent ABRUPT FHR < 15 bpm below baseline for > 15 seconds
Can be periodic or episodic
Can be complicated or uncomplicated

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120
Q

Early Decelerations

A

HEAD COMPRESSION
gradual decrease in FHR associated with uterine contraction (mirror)

121
Q

Late Decelerations

A

UTEROPLACENTAL INSUFFICIENCY
gradual decrease in FHR AFTER the contraction
Fetal acidemia
ATYPICAL (intermittent) or ABNORMAL (recurrent)

122
Q

Prolonged Decels

A

Profound changes
Visually apparent decrease in FHR below baseline > 2 mins but <10
Profound change in fetal environment, increased chance of fetal hypoxia

123
Q

Full Normal EFM Features

A

Normal Contraction Pattern
110-160BPM
Moderate variability (<5 for < 40min)
Accelerations present (not required)
Decelerations (absent, early or variable if non-repetitive and uncomplicated)

124
Q

Atypical or abnormal EFM features

A

Bradycardia (<110)
Tachycardia (>160)
Absent, minimal, or marked variability
Reccurent LATE decels
Complicated or repetitive variable decels

125
Q

Intrauterine Resuscitation nursing interventions

A

Reposition, decrease oxytocin, maternal VS, correct hypotension, admin IV fluids, pause/modify pushing efforts, vaginal exam, tocolysis (to relax uterus), initiate EFM, oxygen

126
Q

Main Physiologic changes in post-partum

A

uterus involutes, lochia, breasts begin milk production, intestines sluggish for a few dats, ovarian function and menstruation retun in 6-12wks in non-lactating mother

127
Q

BUBBLEES

A

Breasts
Uterus
Bladder
Bowels
Locia
Epistiotomy/Laceration/Perineum
Emotions
Signs (vitals, pain)

128
Q

Bubblees (B)

A

Breasts:
assess nipples for soreness, comfort, bruising, blisters, inversion
assess breasts for softness, filling, engorged
assess signs of mastitis (red streak/spot, soreness, warm/tender spot, malaise)

129
Q

How to avoid stimulation of nipples

A

Wear a tight bra, cabbage leaves in bra, ice packs

130
Q

bUbblees (U)

A

Uterus:
Involution - rapid decrease in size of uterus to non-pregnant state

131
Q

What impedes involution?

A

Overdistension (large baby, polyhydramnios, multiples, # pregnancy)
Exhaustion (long labour, induction)
Retained placental fragments/membrane shreds

132
Q

What enhances involution?

A

Oxytocin (from breastfeeding), fundal massage, complete expulsion of placenta, early ambulation

133
Q

Fundal Position PP

A

At level of umbilicus PPD1, gradually moves down

134
Q

Afterpains

A

Involution contractions (increase with number of labours)
pain in breastfeeding (due to oxytocin release)
fundus should not be painful to palpate

135
Q

Diastasis Recti Abdominus

A

Stretching/space in abdominal muscles

136
Q

Assessing Fundus in C section or tubal ligation

A

Palpate abdomen (gently)
Should be some non-operative pain (generalized)

137
Q

Uterus/Abdomen Documentation

A

Height, firmness, position, incision, musculature, interventions

138
Q

buBblees (B2)

A

Increased bladder capacity, decreased sensation, effect of anesthetic, increased swelling/bruising, PP diuresis = Risk of UTI

139
Q

bubBlees (B3)

A

Bowels: bowel sounds for c/s
BM might now happen for 2-3 days
Elimination pattern returns in 1 wk
SE: constipation, hemorrhoids, flatulence

140
Q

bubbLees (L)

A

Lochia (vaginal flow)
Normal: heavy flow expected immediately after and then heavy is 1pad/hr, moderate is <6”/hour, light is < 4”/hr, scant is < 1”/hr

141
Q

What increases Lochia flow?

A

Ambulation
Fundal Massage

142
Q

Abnormal Lochia

A

Foul smell, large clots, heavy flow, reappearance of red lochia, lasts more than 4wks

143
Q

Rubra

A

PP days 1-3
- dark red blood
- fleshy, musty, stale odor
- clots < loonie
- persistance of rubra indicates sub-involution

144
Q

Serosa

A

PP days 3-10 days
- pinkish brownish (serous)

145
Q

Alba

A

PP days 10-24 days
- yellow to white
- may last up to 6 wks

146
Q

Lochia Documentation

A

Type, quantity, odor, clots, hygiene, intervention

147
Q

bubblEes (E1)

A

Episiotomy: surgical incision to prevent soft tissue damage during delivery
Vaginal/Perineal Lacterations

148
Q

first degree tear

A

skin torn just below vaginal opening

149
Q

second degree tear

A

muscle torn below vaginal opening

150
Q

third degree tear

A

anal sphincter torn

151
Q

fourth degree tear

A

rectum torn

152
Q

Hemorrhoids

A

present in pregnancy or develop with labour and/or pushing
ice/frozen pad, tucks, analgesics

153
Q

Hematoma

A

Perineum as soft tissue offers little resistance (250-500mls of blood) relentless pain = cardinal sign
ice can prevent

154
Q

Perineal Care PP

A

Peri wash bottle, wipe front to back, change pads frequently, sitz bath, ice packs/pads, pain meds

155
Q

Perineal Tone - Kegel exercises

A

strengthen pubococcygeus muscle
- improves support to pelvis organs
- compare to elevator (1-4 floors)
- stop the flow of urine (uses that muscle)

156
Q

Perineum Documentation

A

Intact, episiotomy, laceration, hemorrhoids/hematoma, hygiene, interventions

157
Q

bubbleEs (E2)

A

Emotional
Taking-in: PPD 1-2 (pre-occupied with own needs, tells story, explores infant)
Taking-Hold: PPD 2-3 (ready to resume control, eager to learn, rapid mood swings)
Letting go: (infant as unique person, allows others to care)

158
Q

Bonding

A

Process by which parents form emotional relationship with infant

159
Q

Postpartum/Baby Blues

A

“normal” transient response in up to 75% of women (PPD 3-5) and resolves spontaneously in a few weeks
due to decrease estrogen and progesterone

160
Q

Care for PP blues

A

recognition, reassurance, education, awareness of blues as a risk factor for PP depression

161
Q

Pinks of PP

A

Mild elation/euphoria hours/days after birth
normal - but may be a warning sign

162
Q

Postpartum depression

A

Up to 20% of people with PP blues goes on to develop postpartum depression
Use edinburgh postnasal depression scale

163
Q

Postpartum psychosis

A

rare - 1/1000 live births, emergency!

164
Q

bubbleeS (S)

A

Signs: vital signs, pain, signs of DVT (pain, pallor, paralysis, pulse, paresthesia, perfusion, polar)

165
Q

C/S Monitoring

A

Foley: observe flow and urine output
IV: monitor
DB&C
Early ambulation
Sedation score
Analgesia

166
Q

Rh neg PP assessment

A

Mom may get WinRho ONLY if baby positive

167
Q

Rubella assessment

A

If non-immune offer vaccine, advise not to get pregnant for 3 months

168
Q

Hgb PP

A

1st day PP
anemia

169
Q

Nutrition assessment PP

A

at least 200 calories more if breastfeeding

170
Q

Recurrence of ovulation & menstruation

A

non-lactating: 6-8wks, delayed but not reliable birth control
exclusive breast feeding: longer than this

171
Q

Progestin only BC

A

recommended as safe for BF and less risk of VTE

172
Q

Combination estrogen-progestin

A

not recommended until after 6 wks (increase risk of VTE)

173
Q

Common PP complications

A

Hemorrhage, infection, depression, thrombophlebitis/DVT

174
Q

PP symptoms to report

A

vaginal flow (foul smelling, heavy, clots), chills or fever, constant lower abdomen pain, pain/burning/insufficient urination, redness/swelling/pain in leg, SOB or CP, headache or problems seeing, tender red area in breast, CS incision hot, red, painful, draining

175
Q

Priority needs of the newborn

A

Respirations, extrauterine circulation, control of body temp, nutrition, waste elimination, prevent infection, parent-infant relationship, developmental care

176
Q

Adaptation of Newborn: Respiration

A

Production of lung fluid decreases before labour

177
Q

Epidural Complications

A

HYPOTENSION, fetal bradycardia, headaches, bladder dysfunction, decreased ambulation, decreased ability to push, pruritis/tremors, N/V, neuro problems, failed block

178
Q

Contraindications for Epidural

A

Pt refusal, bleeding, sepsis, spinal injury, sensitivity to local anesthetics, unavailable personnel/equipment

179
Q

Epidural

A

Anesthetic and/or analgesic (morphine or fentanyl), injected into the epidural space

180
Q

Nursing care for epidural

A

VS & FHR baselines, IV access & bolus (500-1000mls), BP/P q5mins x 20 mins, sensory level (30-60mins), motor function q1h, bladder function

181
Q

Spinal Block

A

Local, quick onset, longer duration

182
Q

Pudenal Block

A

Local into pedunal nerve (local to vagina, vulva, and perineum)

183
Q

Local infiltration

A

local into perineum pain relief

184
Q

General Anesthesia

A

Quickest for emergency (increased risk)

185
Q

General Anesthesia Complications

A

fetal depression, uterine relaxation, vomiting, aspiration, difficult/failed intubation

186
Q

Neonatal Resuscitation Pre-Delivery

A

gestational age, clear amniotic fluid, risk factors, umbilical cord management/pain

187
Q

Neonatal resuscitation Time of Birth

A

Term gestational age, good tone, breathing/crying

188
Q

APGAR

A

Appearance
Pulse
Grimace
Activity
Respirations

189
Q

Apgar (A1)

A

Appearance/color: 2= completely pink, 1= acrocyanosis, 0=pale/blue.

190
Q

aPgar (P)

A

Pulse/HR: 2= >100, 1= <100, 0= absent

191
Q

apGar (G)

A

Grimace/irritability: 2= vigorous cry, 1=. grimace, 0= none

192
Q

apgAr (A2)

A

Activity/muscle tone: 2= well flexed/active movement, 1= some flexion, 0= flaccid

193
Q

apgaR (R)

A

Respirations: 2= good crying, 1 = slow-irregular, 0= absent

194
Q

Arterial Cord Blood

A

Deoxygenated

195
Q

Venous Cord Blood

A

Oxygenated

196
Q

Metabolic Acidosis Characteristics

A

pH < 7.0, base excess >12mEq/L & APGAR < 3 for 5 mins = increased risk of anoxia brain damage

197
Q

Normal Venous & Arterial pH

A

V: 7.30-7.35, A: 7.24-7.29

198
Q

Normal pO2

A

V: 28-32mmHg A: 12-20mmHg

199
Q

Normal pCO2

A

V: 38-42mmHg A: 45-50mmHg

200
Q

Normal Base deficit

A

V: 5mEq/L A: 10mEq/L

201
Q

Normal Newborn Temp

A

36.5-37.5

202
Q

Normal Newborn HR

A

110-160

203
Q

Normal Newborn resp rate

A

30-60

204
Q

Normal Newborn BP

A

50-75/30-45

205
Q

How to open up a newborns airways

A

Tick them off to make them cry to open alveoli

206
Q

Signs of Resp distress in newborns

A

tachypnea, cyanosis, grunting/cooing, nasal flaring, retractions/indrawing, accessory muscle use, poor feeding, apnea

207
Q

Why are infants at greater risk for heat loss?

A

Large head, increased SA, less adipose tissue, brown fat, decreased ability to shiver

208
Q

Non-Shivering thermogenesis (BAT)

A

Primary source of heat in hypothermic newborns

209
Q

Heat loss in Newborns

A

evaporation: wet with amniotic fluid
convection: body heat into cooler air
radiation: cold objects near incubator
conduction: cold stethoscope

210
Q

Risks of insufficient thermo regulation in newborns

A

fist 8-12hrs of life, premature, SGA, CNS problems, increased resuscitation efforts, sepsis

211
Q

Cold Stress

A

Acrocyanosis, pallor, tachypnea, tachycardia, fussiness/irritability, no shivering

212
Q

Prevention of Cold Stress

A

23-25 degrees in labor room, dry quickly, hat, warm blankets, STS, warmer, keep away from drafts, warm scale/stethoscope, guard against hyperthermia

213
Q

Normal Newborn Glucose

A

2.2-6.0mmol/L

214
Q

Infants at risk for Hypoglycemia

A

SGA, LGA, diabetic parent, premature, stressed/sick/cold

215
Q

Symptoms of Hypothermia in newborns

A

jittery/tremors, apathy, cyanosis, convulsions, apneic spells or tachypnea, weak/high-pitched cry, limpness, lethargy, difficulty feeding, eye rolling, sweating/sudden pallor, cardiac arrest

216
Q

Treatment for asymptomatic hypoglycemia

A

feeding interventions (increased breastfeeding frequency and supplement with formula)

217
Q

Treatment for symptomatic hypoglycemia

A

<2mmol/L - IV infusion of glucose, target CPS > 2.6mmol/L

218
Q

Vitamin K

A

To prevent hemorrhagic disease
- 1mg IM within 6hrs of birth
- newborn lacks intestinal flora needed for vitamin K production
- Prothrombin low during 1st few days of life
- risk of hemorrhage

219
Q

Erythromycin ointment

A

prevent opthalmia
- apply inner to outer conjunctival sac
- 2hr delay or within 1hr of birth
- both eyes, single application tube

220
Q

Newborn Behavior patterns (1st period)

A

REACTIVITY
- 30-120mins of life
- awake & active
- appears hungry (strong reflex)
- start breastfeeding
- encourage en-face
- VS evaluated

221
Q

Newborn Behavior patterns (2nd period)

A

DECREASED RESPONSIVENESS (sleep)
- after 30-120mins, activity decreased
- HR & RR decrease as baby sleeps
- difficult to wake, decreased sucking

222
Q

Newborn Behavior patterns (3rd period)

A

REACTIVITY
- last 2-8hrs
- HR & RR increase, alert for apneic periods
- passes meconium, voids, sucks, roots, swallows

223
Q

General Newborn Care Order

A
  • VS q1h for first 4 hrs, q4h for 24-48hrs, then BID
  • head to toe BID
  • wt at birth and before discharge
  • I&O - feeds and diapers
  • cord care: air dry, falls off 5-15 days, r/o infection
  • bilirubin screen at 24 hrs (TCB first)
  • facilitate family’s effort to care NB
224
Q

Overall Assessment of newborn

A
  • color: pink, acrocyanosis, pale, jaundice
  • skin: dry, anomalies
  • tone: flexed, limp, free movement, # of digits, palm creases
  • cord: clamped (moist, drying), care, DRY
  • Fontanelles: open/sunken/bulging
225
Q

Anterior Fontanelles

A

Diamond shape, ossified at 9-18months

226
Q

Posterior Fontanelles

A

Triangle shape, ossified at 8wks

227
Q

Cephalohematoma

A

Collection of blood between cranial bone and periosteal membrane
cause = hemorrhage, does not cross suture lines

228
Q

Caput succadaneum

A

Collection of fluid and edema on scalp
cause = pressure or truama, crosses suture lines

229
Q

Newborn Eyes (visual)

A

placement relative to ears, subconjunctival hemorrhage (10%), tearless x2 months, follow stimuli for short periods, immature muscular control x 3months

230
Q

Newborn Mouth (Taste)

A

palate, tongue (frenulum - ankyloglossia, TOT), precocious teeth, epstien’s pearls, selective response to tastes

231
Q

Newborn Ears (auditory)

A

Ear cartilage recoil, pre-auricular skin tags, alert and react to stimuli, habituation, hearing screening

232
Q

Newborn Nose (olfactory)

A

preferential nose breathers, patency of nares, can identify people by smell

233
Q

Newborn Reflexes

A

sucking, rooting, grasping (palmar & plantar), moro (startle), tonic neck (fencing), babinski, stepping, galant

234
Q

Newborn Bath

A

Basin, low water level, test temp with elbow
Have all supplies ready to go
2 consecutive temps of 37
work from clean to dirty
DRY WELL, STS right after

235
Q

Stools in Newborns

A

1) meconium (48hrs)
2) transitional stools (thin, brown to green)
3) breastfed infant (yellow gold, soft, seedy, mushy, after 2-3 days)
4) Formula fed infant (pale yellow, formed and pasty)

236
Q

Newborn Voiding

A

Bladder capacity = 6-44mls
6 per day for 6 days

237
Q

Brick Urine

A

NORMAL in first week

238
Q

Induction

A

The initiation of contractions in the pregnant patient NOT in labor

239
Q

Augmentation

A

Enhancement of contractions in the pregnant patient already in labor

240
Q

Cervical Ripening

A

Use of pharmacological other means to soften, efface, and/or dilate the cervix to increase likelihood of vaginal delivery when induction is indicated

241
Q

Indications for induction

A

Post term pregnancy (41+weeks), HTN, DM, maternal disease not responding to treatment, stable antepartum bleeding, chorioamnionitis (infection), oligohydramnios, fetal compromise, Rh isoimmunization, IUGR, PROM (esp is GBS+), intrauterine fetal death, advanced age, logistical concerns

242
Q

Maternal Risk of Post Term

A

Placental “expiry date”, starts to shrivel/die

243
Q

Fetal risk of post term

A

large babe, complicated labor

244
Q

Cautions for Induction

A

Grand multiparity (faster labor), vertex not fixed in pelvis (worried about cord & head position), brow or face presentation, over distension of uterus, lower segment uterine scar, pre-existing hypertonus, prior difficulty in delivery, availability of C-section delivery

245
Q

Contraindications to Induction: Placental

A

Complete placenta previa

246
Q

Contraindications to Induction: Cord

A

Presentation/Prolapse

247
Q

Contraindications to Induction: Fetal malpresentation

A

Transverse lie, breech

248
Q

Contraindications to Induction: History

A

Previous uterine surgery/C-section
Pelvic abnormalities/absolute CPD
Active genital Herpes
Gyne/Obs/Medical Conditions

249
Q

Contraindications to Induction: Convenience

A

Lack of consent from patient

250
Q

Bishop’s Scoring System

A

A cervix that is soft & effaced is the MOST important factor for successful induction
- Dilation (cm)
- Position of Cervix
- Effacement (%)
- Station (-3 to +3)
- Cervical Consistency
Unfavourable = <6

251
Q

Preventing Induction of Labor

A

Nipple stimulation, Sexual intercourse, acupuncture, enema, herbal supplements, stripping/sweeping membranes

252
Q

Methods of Inducing Labor

A

Amniotomy (ARM/AROM), mechanical dilation (foley, ripening balloon, laminaria/seaweed), pharmacological, stripping/sweeping of membranes

253
Q

Stripping/Sweeping of Membranes

A

Mechanical separation of membranes from cervix or uterus, NO monitoring or other assessments, not used for induction when there are high priority indications

254
Q

Amniotomy - AROM

A

Augment or induce labor, committed to delivery, apply internal fetal or contraction monitors, or to obtain fetal scalp blood sample for pH monitoring

255
Q

Prostaglandin

A

Prostin: into posterior fornix of vagina
Cervidil: into posterior fornix - continuous slow release
Misoprostol/Cytotec: 50mcg orally or 25mcg vaginally

256
Q

Advantages of Prostaglandin

A

Less invasive, more physiologically similar to labor, simple administration
CAN go home on cervidil
INDUCTION use, not augmentation

257
Q

Oxytocin Infusion

A

Syntocinon/Pitocin
For INDUCTION and AUGMENTATION
half life 1-6mins
Protocol: gradual increase > 30min increments

258
Q

Oxytocin Induction - Nursing care

A

Continuous observation by an RN as per facility protocol
Contractions and FHR q15min/maternal VS q15-30min

259
Q

Tachysystole

A

Excessive uterine activity often with atypical or abnormal FHR tracing
- >5 contractions in 10 mins
- resting periods b/w contractions < 30 sec
- high resting tone
- contraction lasting more than 90 seconds

260
Q

Tachysystole (uterine hyperstimulation)

A

Can cause placental abruption, fetal hypoxia, precipitous delivery, PP hemorrhage/uterine atony

261
Q

Tachysystole (uterine hyperstimulation): Nursing care

A

Re-position to left lateral, side to side, or knees to chest
Reduce uterine stimulation (decrease or stop oxytocin, remove cervadil, swab prostin)
monitor, administer tocolytic if needed
O2 and IV bolus if needed

262
Q

Complications of Induction and Augmentation

A

INCREASED RISK FOR MOM AND FETUS
failure to establish labor
tachysystole
chorioamnionitis
Uterine rupture
PPH/blood transfusion/hysterectomy
Placenta implantation abnormalities in future pregnancies
Longer hospital stay
Increase r/o assisted vaginal birth or C/S
adverse neonatal outcomes associated with iatrogenic preterm or early term birth

263
Q

After Delivery of induction or augmentation

A

risk of PPH/PP atony is increased with induction
Watch for signs of PPH
Consider continuous infusion of oxytocin titrated to fundus/flow

264
Q

4 Causes of Dystocia

A

Problems with Powers
Problems with Passenger
Problems with the Passageway
Problems with Psyche

265
Q

Problems with Powers (dystocia)

A

Hypertonic uterine dysfunction
Hypotonic uterine dysfunction
Precipitate Labor

266
Q

Problems with the Passageway (Dystocia)

A

Pelvic contraction
Obstructions in maternal birth canal

267
Q

Problems with Passenger (dystocia)

A

Breech/shoulder dystocia, cord prolapse
Persistent occiput posterior position
Face or brow presentation
Macrosomnia

268
Q

Problems with Psyche (dystocia)

A

Psychological distress

269
Q

Labor Dystocia interventions

A

Non-progression in active labor
amniotomy and pharmacologically (oxytocin)

270
Q

Hypertensive Disorders of Pregnancy

A

Pregnancy Induced Hypertension (PIH)
Gestational Hypertension (GH)
Pre-Eclampsia
Toxemia
Incidence = 10%

271
Q

Risk Factors of gestational HTN

A

Nullipara or first pregnancy
hx of pregnancy with HTN/preeclampsia, hx of chronic HTN/CKD/SLE, poor nutrition, obesity, advanced maternal age, multiple gestation, pre-gestational diabetes, previous stillbirth/IUGR/abruption

272
Q

Chronic HTN

A

HTN that develops either before pregnancy or at <20 weeks

273
Q

Gestational HTN

A

Systolic >140mmHg and/or Diastolic > 90mmHg
>20 weeks and up to 12 weeks PP

274
Q

Severe HTN

A

Systolic > 160mmHg and/or dialstolic > 110mmHg

275
Q

Preeclampsia

A

Systolic > 140mmHg and/or diastolic > 90mmHg
Proteinuria (2+ or greater) or 1 or more adverse conditions or severe complications

276
Q

Eclampsia

A

Seizure

277
Q

Adverse conditions of HTN

A

Headache, visual disturbances, abdominal/epigastric/RUQ pain, N/V, chest pain/SOB, abnormal maternal lab values, fetal morbidity, edema/wt gain, hyperreflexia

278
Q

Severe Complications of Preeclampsia: Maternal

A

Stroke, pulmonary edema, hepatic failure, jaundice, seizures, placental abruption, acute renal failure, HELLP syndrome and DIC

279
Q

Fetal Consequences of Preeclampsia

A

IUGR, oligohydramnios, absent or reversed end diastolic umbilical artery flow by doppler, prematurity (iatrogenic), fetal compromise (metabolic acidosis), intrauterine death

280
Q

Preeclampsia Etiology - Multi-organ involvement

A

Abnormal placentation OR excessive fetal demands
Mismatch b/w uteroplacental supply and fetal demands (decreased plasma volume/vasospasm)
Maternal & fetal manifestations of Preeclampsia

281
Q

Prevention of vasospasm and hypoperfusion

A

Low dose aspirin starting pre-pregnancy or before 16wks for increased risk patients
Calcium supplementation for all clients with low dietary intake of calcium (,900mg/day), oral calcium supplementation of at least 500mg/day is suggested
Lifestyle change (exercise and dietary)

282
Q

Initial mgmt of vasospasm and hypoperfusion

A

assessment of pregnancy client and fetus, stress/activity reduction, treat BP with antihypertensives, treat symptoms (N/V, epigastric pain), consider seizure prophylaxis

283
Q

Home-Care mgmt if non-severe HTN

A

Client monitors own BP
Measures weight and tests urine protein daily
NST’s performed daily or bi-weekly
Advised to report signs of adverse conditions

284
Q

mgmt if severe HTN/preeclampsia

A

Fetal eval (movement counting, NST, biophysical profile, ultrasound, measurement of AFI, serial U/S to assess growth, umbilical artery doppler flow)
Hourly I&O
Frequent BP, pulse and resps
Blood work (liver enzymes, plateletes, Hct)
Monitor adverse conditions

285
Q

HTN medications

A

Labetalol
Nifedipine (adlat) - Ca channel blocker
Hydralazine (apresoline) - arteriolar dilators
Aldomet (methyldopa) - centrally-acting syympatholytic

286
Q

What Medications for HTN cannot be used in pregnancy

A

ACE inhibitors

287
Q

Magnesium Sulfate MgSO4

A

Tachycardia, NB to test reflex, monitor urine output, can slow labor, muscle weakness, lack of energy/drowsiness, resp depression, lower BP

288
Q

Magnesium Toxicity

A

CNS depression (resp rate < 12, Oliguria <30mls/hr, diminished or absent DTR, serum magnesium 4.8-9.6mEq
Antagonist: vitamin A

289
Q

Eclampsia Treatment: Medications

A

Anticonvulsants (bolus of magnesium sulfate)
Sedation and other anticonvulsants (dilantin)
Diuretics to treat pulmonary edema (furosemide/lasix)
Digitalis (for circulatory failure)

290
Q

HELLP Syndrome

A

Hemolysis
Elevated Liver enzymes
Low Platelets

291
Q

HELLP syndrome patho

A

thrombocytopenia
- platelets aggregate at sites of vascular damage (need to admin platelets if < 20)
Epidural anethesia may not be an option

292
Q

Disseminated Intravascular Coagulation (DIC) Causes

A

Can be cause be preeclampsia, hemorrhage, intrauterine fetal demise, emniotic fluid embolism, sepsis, HELLP

293
Q

Disseminated Intravascular Coagulation (DIC)

A

Over-activation of normal clotting mechanism - mini clots develop and platelets and clotting factors deplete
= EXCESSIVE BLEEDING

294
Q

Gestational Diabetes Incidence

A

Incidence b/w 3-20%, 3.5% of non-aboriginal women and up to 18% of aboriginal women

295
Q

How does pregnancy alter carbohydrate metabolism 2 ways in

A
  1. fetus continually takes glucose from mother
  2. placenta creates hormones, which alter effects of and resistance to insulin and glucose tolerance
296
Q

Carbohydrate metabolism: first trimester

A

rise in hormones stimulate insulin production & increase tissue response to insulin (insulin sensitivity)

297
Q

Carbohydrate metabolism: second and third trimester

A

Placental secretion of hPL begins
increased resistance to insulin to facilitate transfer to fetus for growth
Insulin needs increase (double or triple)
More insulin required to maintain normal concentration

298
Q

Gestational Diabetes: Pregnancy/Maternal effects

A

Preeclampsia/eclampsia increase due to vascular damage
Polyhydramnios, PROM
Preterm labor
r/o shoulder dystocia
r/o C/C
Worsening myp

YEAR 3 (14 decks)

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