OB Final Flashcards
What increases the effectiveness of a diaphragm? How should it be applied?
spermicidal cream
place 15 min before intercourse, remove 6 hours after (though only effective for 1 hour)
What is client education for diaphragm use? What is the timeframe of use? What are the contraindication for use?
Be properly fitted
Replace q2yrs and/or with 15-20% weight fluctuation
Empty bladder prior to insertion
Wash with mild soap and warm water
Can be inserted up to 6 hrs before intercourse
Stays in place 6-24 hrs after intercourse
Hx of TSS
cystocele (prolapsed bladder)
uterine prolapse
frequent UTIs
What is the nature of combined oral contraceptives? What is some client education? What are other therapeutic effects?
combines hormones estrogen and progestin to suppress ovulation and thicken cervical mucus
Routine pap smears and breast exams
Must be consistent to be effective
Take at bedtime if nausea occurs
decreased iron def. anemia
regulates cycles
reduces dysmenorrhea
improves acne
protects against some cancers
inhibits ovarian cyst growth
What are increased risks with use of COCs? What are the contraindications for the use of COCs? When can a COCs resume postpartum?
DVT
stroke
heart attack
HTN
gallbladder disease
liver tumor
exacerbates migraines, epilepsy, asthma, kidney and heart disease
Hx of DVTs, HAs, stroke, CAD, gallbladder disease, cirrhosis, migraines, HTN, DM, breast or estrogen-related cancers
Smoking
>35 yrs
Pregnancy, lactating
6+ weeks
When is ovulation? What are the physiological identifiers of ovulation? What is the spinnbarkeit sign? How is the fertile period then identified?
generally 14 days prior to menstration
Following ovulation mucus becomes thin and flexible (like egg whites) because of estrogen and progesterone
This allows for sperm to be more mobile in the canal
Mucus is stretchiest during ovulation
begins when mucus thins and lasts 4 days after the last day of thin mucus
What is the physiology of the placenta? When does circulation from the placenta begin? In what way does the exchange occur? What are the functions of the placenta?
Begins as a few trophoblastic cells and grows into a “pancake” organ
12th day of pregnancy, by 3rd week transporting O2 and nurtrients
osmosis
fascilitates the transpirt of O2 and nutrients
Filters waste
Acts a a barrier for some toxins and insulin
What are the hormones produced by the uterus and their functions?
hCG (human chorionic gonadotropin)
ensures corpus luteum continues to produce E and P to maintain the endometrium and to protect the placenta
progesterone
maintains pregnancy with the endometrial lining, reduce contractility of uterus to prevent preterm labor
estrogen
stimulates uterine growth, facilitates lactation in the mammary gland
hPL (human chorionic somatomammotropin)
promotes growth and lactation, regulates mom’s glucose, protein and fat supply to the fetus
oxytocin and prostaglandin
fascilitates labor
What is the purpose of a nonstress test? When the fetus moves what should be the effect on the FHR? What is the concern if there is no change in FHR with movement? How long does the test take? what constitutes a non reactive nonstress test? What can lessen the variability?
measure the response of the FHR to fetal movement
should increase approximately 15 beats for about 15 seconds
low perfusion
20 minutes/2 movements
no acceleration (or less than 6 beat acceleration) with movent or no movement
fetus sleeping
smoking
drug use
hypoglycemia
What is a biophysical profile? What is used to determine the assessment? What do the scores mean?
assesses
fetal reactivity
fetal breathing movements
fetal body movments
fetal tone
amniotic fluid volume
sonogram and nonstress test
8-10 doing well
6 suspicious
4 fetus is at risk
How is the variability of the FHR rated on the rhythm strip?
Absent: no peak or trough detected
Minimal: amplitude detected, rate is 5 beats/minute or less
Moderate/normal: range detected with rate of 6-25 beats/min
Marked: amplitude detected with rate 25< beats/min
What are reproductive changes with pregnancy? What are some examples of presumptive changes within these areas?
Those that involve the uterus, ovaries, vagina and breasts
breast tenderness
ammenorrhea
What are the presumptive/probable signs of Hegar’s, Chadwick’s and Goodell’s assessing?
Hegar’s sign – softening and compressibility of lower uterus
Chadwick’s sign – deepened violet-bluish color of cervix and vaginal mucosa.
Goodell’s sign – softening of cervical tip.
What changes occur to the cardiovascular system during pregnancy? Why are these changes important? What occurs with impaired blood return? How can the effects be manages? What is supine hypotension syndrome?
Cardiac output increases 25 to 50%
blood volume increases by 25 to 30%
increased heart rate
clotting factor increase
ensures adequate placental and fetal circulation for oxygenation and nutrition
Impaired blood return from the lower extremities can lead to edema.
increased periods of rest, elevation of legs to facilitate circulation and reduce edema, limiting dietary sodium, increase fluid intake to 12 cups of water a day
laying supine compresses the vena cava and causes decreased return to the heart
What is the purpose of prenatal care? What is the nursing assessment?
assess and educate on pregnancy and birth
establish baseline of health
determine influence on patient’s health
determine gestational age
monitor fetal development
monitor pregnancy well-being
identify complications
minimize risk
educate
What is the GTPAL staus and interpretation?
G (Gravida) = number of pregnancies, including current pregnancy
T (Term) = 37 + weeks gestation
P (Preterm) = 20 weeks gestation to 36 weeks and 6 days gestation
A (Abortions) = less than 20 weeks gestation
L (Living) = Living children
What is para, gravida, primigravida, primipara, multigravida, grand multipara, multipara, nulligravida?
Para: The number of pregnancies that have reached viability, regardless of whether the infants were born alive
Gravida: A person who is or has been pregnant
Primigravida: A person who is pregnant for the first time
Primipara: pregnant for the first time
Multigravida: A person who has given birth past the age of viability previously
Grand multipara: A person who has carried five or more pregnancies to viability
Multipara: A person who has carried two or more pregnancies to viability
Nulligravida: A person who has never been and is not currently pregnant
What are regular calorie needs for a normal weight woman? What are the needs when pregnant?
2200 cal/day
300 additional/2500 cal/day
What is the recommened weight gain for a normal BMI of 18.5-24.9? Overweight (BMI 25-29.9)? Obese (BMI 30+)?
25-35 lbs
15-25 lbs (10 lbs less)
11-20 lbs.
What foods should be avoided during pregnancy?
Raw fish/Predatory fish
Lunch meats/hot dogs
Soft cheeses
Caffeine/alcoholic beverages
Undercooked red meat
What are the 4 Ps of labor?
The passage (pelvis) is of adequate size and contour.
The passenger (the fetus) is of appropriate size and in an advantageous position and presentation.
The powers of labor (uterine factors) are adequate.
The psyche, or psychological state, which may either encourage or inhibit labor. This can be based on the pregnant person’s past life experiences as well as present psychological state.
How is fetal presentation (position of baby) determined? How can the baby present? What is the fetal attitude? What are the 4 general fetal attitudes?
by the quadrant of mom: right, left, anterior, posterior
cephalic/vertex
breech
face
shoulder
degree of flexion in fetus’s head (how much does he chin tuck to the chest)
vertex/full flexion
sinciput/moderate flexion/military
brow/partial extension
face/poor flexion/complete extension
How is the fetal presentation documented and what do the letters mean?
First letter indicates:
R = right plane
L = left plane
Second letter indicates the presenting part of the fetus.
O = occiput (head)
S = sacrum (breech)
SC = Scapula (shoulder)
M = mentum/face
Third letter indicates the position of the fetal backbone/back of head in relation to the maternal pelvis.
A = Anterior- towards the maternal abdomen
P = Posterior- towards the maternal backbone
T = Transverse- turned at a 90-degree angle to maternal backbone
What is the initial, most general description of fetal lie?
Transvese or longitudinal
What is the most favorable presentation? What kind of labor can be predicted with a posterior presentation?
anterior
longer labor and delivery (more rotations required for fetus)
back pain w/contractions
What are the cardinal movements of labor? why does the fetus naturally move this way?
descent
flexion
internal rotation
extension
external rotation
expulsion
to keep the parts that are the smallest diameter of the baby always presenting to the smallest diameter of the pelvis
What is stage one of labor? How is it broken down? What are nursing interventions?
Stage 1 – is cervical dilation from 0 to 10 cms. Separated into three phases.
Early or Latent phase. Usually the longest phase, especially for primipara clients.
Active phase – considered to begin once the cervix reaches 6 cm dilation
Transition phase – 8 to 10 cm dilation. Contractions more intense and more frequent.
monitor contraction time, change positions, support, and encourage client, pain management
What occurs in stage 2 of labor? Nursing interventions? Stage 3? What are the 2 phases of stage 3? Why is oxytocin often given right after the birth of the placenta?
Stage 2 – time span from full dilatation and cervical effacement to crowning of the head and birth of the baby.
Preparing for birth, positioning for birth, pushing, perineal cleaning, episiotomy, birth, cutting and clamping cord.
Stage 3 – begins immediately after delivery of the baby through delivery of placenta. Separated into 2 phases.
Placental separation phase includes lengthening of the cord, a sudden gush of blood, and placenta visible at vaginal opening.
Placental expulsion phase is accomplished by natural bearing down of the client or gentle pressure on the contracted uterus by the healthcare provider
facilitate uterine contractions and prevent hemorrhage.
What is stage 4 of labor? Why is this time important?
Recovery/first few hours after delivery
Mom is most at risk for hemorrhage and infection
Baby most at risk for cold stress, hypoglycemia and respiratory distress
What are the interpretations of the FHR patterns and periodic changes (VEAL)? What are the possible causes for the 4 changes in FHR pattern (CHOP)? What are nursing interventions with each reason for the pattern changes (MINE)?
V = variable decelerations
E = early decelerations
A = accelerations
L = late decelerations
C = cord compression can cause variable decels, think sharp descending V pattern
H = head compression with progression of labor
O = OK
P = placental insufficiency, indicate fetal distress and must be investigated
M = move mom, possible amnioinfusion to add fluid to prevent cord compression
I = It’s normal progression of labor
N = Non
E = Emergent: move mom to left, apply O2, stop oxytocin, VS/IV bolus, notify HCP, prepare for delivery
What is the common maneuver to determine fetal presentation and position? How is it administered?
Leopold maneuver
explain procedure
empty bladder
position supine with knees slightly flexed
place towel roll under their left side
observe abd. for longest diameter and fetal movement
palpate through the maneuvers to determine the presentation
What is the station/engagement of the fetus? How is it measured?
fetal descent, relationship of the presenting part (preferably head) to the level of the ischial spines
0 is presenting at the spines
negative numbers (-1 to -4) are before the head reaches the spines, meaning just entering engagement. -4 is the furthest away from the ischial spines
positive numbers are after ischial spines and in the birth canal, +4 being at the outlet
What are examples of effective nonpharmacological methods of pain mangt.?
Reflexology is the practice of stimulating nerve endings on the hand, feet, and ears.
Effleurage: Light, gentle circular stroking of abdomen in rhythm with breathing during contractions. Can be on thighs and arms and back.
Sacral counterpressure: Consistent pressure is applied with heel of the hand or fist against the client’s sacral area to counteract pain in the lower back.
What is the difference between analgesia and anesthesia? What is the chief concern with anesthesia medications?
analgesia decreases awareness of pain
anesthesia causes a partial or complete loss of pain sensation
causes hypotension which can decrease O2 to the fetus and can result in hypoxia
What is a pudendal block?
local anesthesia administered through the vagina for perineal anesthesia just before birth
What is the benefit of morphine or other opioids? Down side? When is it not used? If a narcotic is being administer what must be readily available for the fetus to counteract RD?
Good for pain mangt during latent phase
possibly slows contraction progression
can cause respiratory depression, including in the fetus
During active labor because the RD in the fetus while entering birth canal can be detrimental
naloxone
What is done to conteract the concern of hypotension/pseudohypovolemia from epidural anesthesia? What are nursing interventions if hypotension occurs? When are epidurals adventageous?
IV bolus of 500-1000 mL NS or LR before anesthetic is administered
do not lie supine
remain side lying
raise legs
administer O2
IV fluids
monitor BP frequently
to preserve energy and for clients with…
heart disease
pulmonary disease
DM
severe gestational HTN
What is lochia? What are the 3 stages lochia progresses and why?
post-birth bleeding and discharge. Contains blood, mucus, leukocytes and tissue
Lochia rubra – dark red color, bloody consistency, fleshy odor, can contain small clots, transient flow increases during breastfeeding and upon rising. Lasts 1 to 3 days after delivery
Lochia serosa – Pinkish brown color and serosanguineous consistency. Can contain small clots and leukocytes. Lasts day 4 to day 10 after delivery
.
Lochia alba – Yellowish white creamy color, fleshy odor. Can consist of mucus and leukocytes. Lasts from day 10 up to 8 weeks postpartum.
If the client has a firm uterus with a bright red bleeding what should be assessed?
any laceration present, both surface and cervical
What are some postpartum perineal care instructions?
Instruct client to use peri-bottle with every void and change perineal pads.
Apply ice to perineum for 24hrs to reduce swelling, numb lacerations/episiotomy/hemorrhoids.
Sitz baths should be used after 24hrs.
Perform REDDA assessment on dissolvable sutures.
Encourage high fiber diet, fluids, tucks pads and stool softeners.
What are the changes of the fundal height postpartum?
Day of delivery: level with umbilicus
Decreases 1cm per day postpartum
What is uterine atony? If the uterus is boggy and shofted to the side, what is the 1st nursing intervention?
boggy, soft uterus
void
What are 4 common changes to the integumentary system during pregnancy?
striae gravidarum: stretch marks
linea nigra: dark line along the umbilicua
diastasis recti: separation of abdominal muscles
chloasma: excessive pigment on face and neck
What are 4 modes of concern for infant heat loss? Examples?
Convection – Is the flow of heat from the newborn’s body surface to cooler surrounding air. Eliminating drafts, such as from air conditioners, is an important way to reduce convection heat loss.
Radiation – Is the transfer of body heat to a cooler solid object not in contact with the baby, such as a cold window or air conditioner.
Conduction – Is the transfer of body heat to a cooler solid object in contact with a baby. For example, a baby is placed on a cold base of a warming unit quickly loses heat to the colder metal surface.
Evaporation – A loss of heat through conversion of a liquid to a vapor. Babies are wet at birth, so they can lose a great deal of heat as the amniotic fluid on their skin evaporates.
What are normal newborn heart rate and respiratory rate? What normal process can account for heart murmurs detected in the first hours of birth?
HR: 100-160
RR: 30-60
Closing of the foramen ovale and/or ductus arteriosis
What should you never do when palpating the uterus postpartum? Why?
never palpate without supporting the lower segment
could possibly invert and cause a massive hemorrhage
What immunizations are recommended for pregnant women?
Tdap at 27-36 weeks
influenza
rubella postpartum
Wha is the difference beween RBCs in newborns and adults? What is normal Hgb values for newborns?
Infants have more RBCs
14-20 g/dL
Hct 45-60%
What are the reflexes present at birth?
rooting
sucking
blinking
swallowing
palmar
step
plantar
tonic neck: head turns and arm and leg on that side extend, opposite contract
moro: startle
babinski: foot stroked in inverted J toes fan
landau: some muscle tone with arched head when in prone
How should the fontanels appear? If depressed or bulging what can they indicate? When do the fontanels close? What is molding?
soft and flat
dehydration
intracranial pressure
posterior: 8 mos
anterior: 12 mos
parts of the head that overlap during delivery, can create a cone head and can take a few days to realign
What is a cephalohematoma? What is commonly the cause?
collection of blood between the periosteum and skull bone
does not cross the suture line
vacuum delivery
What is caput succedaneum? Cause?
localized swelling of the soft tissue of the scalp
soft and edenamous
can cross suture lines
resolves within days
pressure during delivery
What newborn serum glucose reading indicates 40 mg/dL? What are s/s? What is the result if not treated quickly?
hypoglycemia
jitteriness
lethargy
seizure
brain cells can become depleted of glucose causing brain damage
When is APGAR assessed? What 5 things are assessed? What are the criteria?
1 minute and 5 minutes after birth
HR
Respiratory effort
muscle tone
reflex irritability
color
HR: >100, <100, no HR
Resp effort: Strong cry, weak cry, no effort
Muscle tone: maintains flexion, minimal flexion, limp and flaccid
Reflex: cries or sneezes, grimaces, no response
Color: pink, pink w/blue extremities, cyanosis or pallor
Why is vitamin K administered?
help to prevent hemorrhage by contributing to the coagulation factors
Why is it necessary to treat hyperbilirubinemia?
elevated bilirubin can cause acute bilirubin encephalopathy/kernicterus, can cause brain damage, vision and hearing problems
What is the nature of breastmilk?
Colostrum: Secreted from the mother’s breasts during postpartum days 1-3. It is a watery, yellow fluid composed of protein, sugar, fat, water, minerals, vitamins, and maternal antibodies. It contains the IgA immunoglobulin providing passive immunity to the newborn.
Breast milk comes in on day 4.
Mature breast milk is produced by day 10
What are the advantages of breastfeeding for the mother? What are the advantages for baby?
releases oxytocin which aids in uterine involution
helps with weight loss
opportunity to bond
can help with osteoporosis in menopause
can help decrease risk of breast and ovarian cancer
Lactoferrin is an iron-binding protein that interferes with the growth of pathogenic bacteria, lysozyme actively destroys bacteria by dissolving their cell membranes, possibly increasing the effectiveness of antibodies
interferon helps to interfere with viral growth
ideal electrolyte and mineral composition for human infant growth
high in lactose which provides ready glucose for rapid brain growth
more linoleic acid for skin integrity.
reduced childhood obesity
How can adequate nutrition be assesed?
sleeps between feedings
loses no more than 10% birth weight
good skin turgor
voids 6-8 times/day
2-3 BMs
How is LATCH breastfeeding charted? How is it rated?
L = Latch
A = Audible swallowing
T = Type of nipple
C = comfort of breast/nipple
H = hold/positioning
L: able to latch, needs help, no latch/too sleepy
A: spontaneous, only a few swallows, none
T: everted, flat, inverted
C: soft/non tender, filing/moderate discomfort, engorged/severe discomfort
H: need no assistance, minimal assistance, full assistance by staff
What is gestational diabetes? How is it managed? What is the risk to baby? To mom?
impaired tolerance to glucose with the first onset or recognition during pregnancy.
Diet controlled, oral glycemic agents (glyburide/metformin). Insulin needs will increase as the pregnancy progresses. Insulin does not cross the placenta to the baby.
An exercise routine should be followed to improve glucose regulation.
Carbohydrate intake needs to be limited to 50% of caloric intake.
Risk to baby – Hypoglycemia (jitteriness, diaphoresis, lethargy when glucose is below 40), macrosomia, electrolyte imbalance, birth trauma, spontaneous abortion, and congenital anomalies.
Risk to mom – Infections, hydramnios, ketoacidosis, hypoglycemia, hyperglycemia (which can cause excessive fetal growth), increased risk of developing type 2 diabetes later in life.
What are some points for client care specific to heart disease?
a. As a rule, those with cardiac disease need two rest periods a day and a full night’s sleep.
b. Rest should be in the left lateral recumbent position to prevent supine hypotension syndrome and increased heart effort.
c. Keeping the head of bed elevated will also help to decrease stress on a compromised heart.
What is placenta previa? How is it detected? What must be done during delivery? What are the risks of this occuring? What is nursing care?
placenta implants abnormally causing painless, bright-red bleeding in 3rd trimester
generally in ultrasound
closely monitor
cesearean birth
Risks – previous placenta previa, uterine scarring, maternal age greater than 35, multifetal gestation, smoking, closely spaced pregnancies.
Nursing care – no vaginal exam, IV fluids, assess fundal height, assess for bleeding and contractions.
What is betamethasone? Nursing actions?
corticosteroids that hastens fetal lung maturity under 34 weeks
Monitor for hyperglycemia and pulmonary edema
What is abruptio placentae? Is it an emergency? Risks? Assessment findings? Nursing actions?
premature separation of the placenta, occuring after 20 weeks and usually in the 3rd trimester
yes, high maternal and fetal morbidity
Risks – maternal hypertension, cocaine use, smoking, premature rupture of membranes, blunt trauma, polyhydraminos, and multifetal pregnancy.
Assessment – sudden onset of intense localized uterine pain with dark red vaginal bleeding, contractions with hypertonicity, fetal distress, signs of hypovolemic shock.
Nursing actions – palpate the uterus for tenderness and tone, fetal distress -perform C/S, IV fluids, blood products, oxygen
What is disseminated intravascular coagulation? What conditions can hasten this condition?
acquired blood clotting disorder when fibrinogen levels fall
abruption
HTN
amniotic fluid embolism
placental retention
septic abortion
retention of dead fetus
what is a tocolytic agent? Drug of choice? SE? What is the caution?
stops labor by relaxing smooth muscles inhibiting uterine activity
terbutaline
tachycardia (hold is HR >120), nervousness, pulmonary edema and hypotension
not for long-term because it can cause heart problems and death
What is a hydatiform mole/gestational throphoblastic disease? Finndings? What is the maternal risk? How does it appear on ultrasound? How is it treated? Education?
Proliferation and degeneration of trophoblastic villi in the placenta that becomes swollen, fluid-filled, and takes on the appearance of grape-like clusters. The embryo fails to develop beyond a primitive state.
- Excessive vomiting
- Larger than expected uterine growth
- Vaginal bleeding
- Symptoms of hypertension
choriocarcinoma
snowstorm appearance
suction curettage, methotrexate
do not get pregnant again for a year
What is preeclampsia? Findings? Pharm. treatment? What are s/s of mag toxicity? antidote?
HTN with the presence of proteinuria and edema
Severe continuous headache (possible maternal hemorrhage)
Nausea
Blurring of vision (due to cerebral edema)
Epigastric pain (liver)
Hyperactive DTRs
HELLP
dilantin
magnesium sulfate
decreased DTR
decreased resirations <12
decreased UOP
altered LOC
calcium gluconate
What is an ectoptic pregnancy? Findings? Treatment?
abnormal implantation of fertilized ovum, usually in the fallopian tube but can be on the ovary, intestine and cervix too
unilaterial stabbing pain
if ruptures, referred shoulder pain d/t peritoneal cavity
deep lower quadrant pain
ecchymosis around umbliicus
if unruptured: methotrexate
ruptured: emergency surgery to repair damaged tub and stop internal bleeding
What is a bishop’s score? What is evaluated?
Determine maternal readiness for labor
cervical dilation
effacement
consistency of cervix (firm, medium or soft)
cervical position
station
What is oxytocin used for? How is it titrated?
uterine stimulant, synthetic form of naturally occurring hormone
depends on adequate stimulation and prevention of hyperstimulation by reducing medication
Is forceps deliver considered operative? Indications? Complications? Nursing considerations?
yes
prolonged second stage of labor, fetal distress, abnormal presentation, and arrest of rotation.
lacerations of the cervix, lacerations of the vagina and perineum, injury to bladder, facial nerve palsy of the neonate, facial bruising on the neonate, and subdural hematoma in the neonate.
make sure bladder is empty, membranes should be ruptured, and fetal presenting part engaged.
What are possible anomalies of the placenta?
succenturiata: has an accessory lobe
circumvallata: chorion folds back on itself
battledore: marginally place cord
velamentous: vessels spread across the amnion fold, usually causes spontaneous abortion
accreta: deep attachment to uterine wall
What are monitoring procedures for high-risk pregnancies?
a. Internal electronic monitoring – this is the most precise method for assessing FHR and uterine contractions.
- Fetal Scalp Electrode- Provides monitoring for fetal heart rate via electronic scalp device. Can be useful when fetus is difficult to monitor, or healthcare provider wants more accurate monitoring.
- Intrauterine Pressure Catheter (IUPC)- Provides continuous contraction monitoring with more accuracy of intensity, duration, and frequency.
When is cesarean brith indicated?
alleviate problems such as CPD, breech/transverse position, active STI, multiple fetus births, or failure to progress in labor, emergencies.
What is the nature of postpartum depression?
onset can occur 2 weeks-6mos of delivery
What is subinvolution? Risk factors? Findings?
When the uterus remains enlarged with continued lochia discharge. Can result in postpartum hemorrhage.
a. Risk factors – multipara, macrosomia, pelvic infection, and endometritis, retained placental fragments not completely expelled from the uterus.
Prolonged vaginal bleeding, fundal height greater than expected for the postpartum day.
What can cause matitis?
a. Milk stasis, which can be caused by a blocked duct, engorgement, or a bra with an underwire.
b. Nipple trauma and cracked or fissured nipples.
c. Poor breastfeeding technique with improper latching of the infant onto the breast, which can lead to sore and cracked nipples.
d. Decrease in breastfeeding frequency due to supplementation with bottle feeding.
e. Contamination of breasts due to poor hygiene.
What blood loss is considered postpartum hemorrhage? Complications? How is flow determined with peri pads? How is bleeding assessed and managed?
loses more than 1000 mL following a vaginal or cesarean
hypovolemic shock, anemia, and disseminating intravascular coagulation (DIC).
- Scant = less than 2.5 cm on the peri-pad
- Light = 2.5 cm to 10 cm on the peri-pad
- Moderate = more than 10 cm on the peri-pad
- Heavy = one pad saturated within 1-2 hours
Weigh blood saturated items
Always subtract the dry weight of the pad or chux
1 gram = 1 mL
bPerform more frequent fundal checks/VS
Draw labs and administer blood products if indicated
Encourage intake of protein and iron for RBC production/tissue healing
What can cause uterine atony?
Urine retention/bladder distention,
retained placental fragments
prolonged or precipitous labor
magnesium sulfate
anesthesia and analgesia administration,
trauma during labor
birth from an operative delivery
What is meconium aspiration syndrome? Findings?
if hypoxia occurs in utero, a vagal reflex is stimulated which relaxes the rectal sphincter. This releases meconium into the amniotic fluid. An infant can aspirate meconium either in utero or with the first breath at birth.
Assessment: tachypnea, retractions, grunting, and cyanosis
What is surfactant? Who is at risk for RDS from lack of surfactant? What are the complications? How can lung status be assessed?
phospholipid that assists in alveoli expansion. Surfactant keeps alveoli from collapsing and allows gas exchange to occur.
Premature newborns
hyaline membrane disease, pneumothorax, and pneumonia
amniocentesis
What are possible contributing factors to SIDS?
Prematurity and low birth weight
Viral respiratory or botulism infection
Exposure to secondary smoke
Pulmonary edema
Possible lack of surfactant in alveoli
What are s/s for hypoglycemia?
jittery
lethargy
not eating
diaphoresis
low tone
