Ob Final Flashcards
Factors that affect the labor process: 5 P’s?
~Passenger (fetus, baby)
~Passageway (birth canal)
~Powers (mother contractions, pushing/effort)
~Position (of mother)
~Psychologic response
Induction of labor criteria
~39 weeks or older
~elective induction
~stimulates contraction naturally
Late deceleration cause?
uteroplacental insufficiency
On examination, it is noted that a laboring patient’s fetus is in the right occiput anterior position (ROA). Where should the nurse place the ultrasound transducer to obtain a fetal heart tone tracing?
Right lower quadrant (fetus back is facing right upper quadrant of mother’s abdomen); RLQ
What is the priority assessment of a newborn?
Establishing effective respirations
APGAR scoring: what does APGAR stand for?
Appearance
Pulse
Grimace
Activity
Respiration
APGAR score 2
Pink,
>100 bpm,
cries and pulls away,
active movement,
strong cry
APGAR score 1
Extremities blue,
<100bpm,
grimaces or weak cry,
arms/ legs flexed,
slow/ irregular respirations
APGAR score 0
pale or blue,
no pulse,
no response to stimulation,
no movement,
no breathing
Naegele’s rule
LMP -3 months + 7 days
Signs and symptoms of pregnancy: Presumptive
presumptive (means unconfirmed/speculation):
P: (period absent/no period)
R: really tired
E: enlarged breasts
S: sore breasts
U: ^ urine
M: movement in the abdomen
E: emesis/nausea
Signs and symptoms: Probable
Think of signs, preg tests and
B+B: “Braxton hicks and Ballotement”
Signs and symptoms: Positive
(evidence/objective signs):
ultrasound, radiography, stethoscope, baby kicking, visible/palpating
GTPAL
G- gravidity (#of pregnancies)
T- Term (# of pregnancies carried to 37wks+)
P- Preterm (# of pregnancies 20-36)
A- Abortions (# of losses before 20wks)
L- Living (# of children living)
Mastitis signs
fever/chills,
pain/tenderness and tenderness to touch,
inflammation,
redness, pink area on affected breast,
warmth,
generalized aches/fatigue/malaise,
nipples with cracks/fissures/sores,
axillary adenopathy,
purulent drainage from nipple
Ortolani maneuver: what’s the purpose of this assessment on the baby?
To assess for developmental dysplasia of the hips
What is cold stress?
Extreme loss of heat that results in increased respirations and nonshivering
What are some factors associated with a high risk for cold stress
Limited subcutaneous fat
Limited body area in relation to body mass
Limited amount of brown fat
Limited ability to shiver
Thin skin and blood vessels that are closer to the body’s surface
Normal vital signs for newborn?
B/P: 60-80 systolic; 40-50 diastolic
HR: 120-160
R: 30-60
Temp: 97.7-99.3 F
Hyperbilirubinemia/jaundice: how do we screen for it?
Most common: tcb (transcutaneous bilirubin technique, noninvasive)
Tsb (total serum bilirubin, vasive)
Primary signs of hyperbilirubinemia
Jaundice
Poor feeding
Sclera of eyes (yellow)
Lethargy
Do we bathe the baby after delivery?
No
Signs of hypoglycemia in newborn?
Jitteriness
Apnea
Seizures
Lethargy
Hypothermia
How is hypoglycemia usually resolved in newborns?
Resolved with feeding
Circumcised care: how to take care of baby postop/interventions?
Check for signs of bleeding on circumcised area and on diaper
Check for signs of infecti
Pain management
Teach parents to wash hands before touching circumcised area
If bleeding, may apply gentle pressure and sterile gauze onto site
Check if baby is urinating after circumcision
Keep diaper clean and dry and use sponge bathing until healed
Bulb suctioning: why do we use it?
To clear secretions from oral and nasal passages
Neonatal pain: pharmacological management of pain
Local anesthesia (circumcision)
Topical anesthesia (after circumcision)
Non-pharmacological management of pain
Swaddling
Cuddling
Holding baby skin to skin
breastfeeding
tucking
pacifier use
oral sucrose
Signs of pain in babies
Eyes squeezed
Grimacing
quivering tongue
High pitched/shill cries
Changes in vital (^HR, ^BP or decreased BP, shallow respirations)
Groaning
Mouth opened
Flaccid/ rigidity
Fists tightening
fetal stations: what is it?
Where the babys presenting part is located in the pelvis
What is a babys presenting part?
Can be the head, foot, etc. Whichever part is closet to the exit of the uterus (cervix/internal os of cervix)
How to measure fetal station?
-Assess/measure above and below ischial spine
If the babys presenting part is above the ischial spine line what numbers may it be?
minus numbers (-)
-5
-4
-3
-2
-1
If the babys presenting part is below the ischial spine line what numbers may it be?
plus numbers (+)
+1
+2
+3
+4
+5
Rationale for fetal station 0
refer to baby being “engaged” is it ischial spine line
-happens at 38 wks for first time mothers and as late as time of labor for mothers who have already had babies
PMS physical symptoms
“PERIOD SYMPTOMS”
-swollen/tender breasts
-constipation/diarrhea
-bloating
-fluid retention
-cramping
-head+backache
-clumsiness
-low tolerance for light
-aches/pains
-extremity swelling
-weight gain
-change in appetite
-Dizziness
-nausea/vomiting
-fatigue
PMS mental symptoms
-irritability/hostile
-mild psychological discomfort
-sleeping too much/too little
-feeling tired
-trouble with concentration/memory
-appetite changes/cravings
-tension/anxiety
-mood swings
-depression
-less interest in sex
-confusion
-social withdrawal
role of nurses in genetics
-identify families in need of genetic counseling
-collaborate to make referrals
-emotional support
Nurses need
- working knowledge
-awareness of recent advances
-understanding possible effects on families
Hormones during pregnancy: what are they?
hCG
hCS
Insulin
Cortisol
Progesterone
Estrogen
Prolactin
Oxytocin
Hormones during pregnancy: human chorionic gonadotropin (hCG) function
stimulates luteum to produce progesterone and estrogen
Progesterone function
-prepares the endometrium for implantation. If there is no pregnancy, progesterone levels drop & bleeding occurs. Maintains pregnancy.
■ Suppresses secretion of FSH & LH
Estrogen function
induces the shedding of the endometrium which causes bleeding.
Prolactin function
prepares breast for lactation/milkproduction
Oxytocin function
stimulates contractions and milk ejection from breasts
Human chorionic somatomammotropin hCS function
Growth hormone
-breast development
insulin function
-^production of insulin due to insulin antagonists in placental hormones
-decrease tissue sensitivity to insulin
cortisol function
-^production of insulin
-^peripheral resistance to insulin
Pathologic Jaundice of the neonate is best defined as?
clinical disorder appearing 24 hrs of age associated with anemia, RBC enzyme defects and RBC membrane disorders
What is hyperbilirubinemia assocated with?
High levels of bilirubin
Physiologic vs pathologic jaundice: which one requires intervention and why?
Pathologic jaundice requires intervention (phototherapy) to help treat bc these are even higher levels of unconjugated bilirubin
Phototherapy function
phototherapy converts bilirubin to a form that can be excreted via urine and poop
Would should baby wear during phototherapy
diaper and something to cover eyes
When phototherapy isnt effective, what may be needed?
exchange transfusion (infant blood replacement with donor blood)
When does PMS occur?
2-3 days before period starts
Morning sickness: nursing care/intervention
-eat dry, starchy foods like toast/crackers on awakening in the morning
-avoid drinking too many fluids in the morning when nauseated
-eat small amounts frequently like every 2-3 hours
-avoid skipping meals
- get out of bed slowly
-decrease intake of fried foods/fatty foods
-avoid brushing teeth immediately after eating
A pregnant woman who is in 3rd trimester, asks the nurse how to know “labor is
getting closer to starting?” Which is an appropriate response?
surge of energy
As pregnancy advances, weight of the uterus presses on abdominal vessels like vena cava therefore causing low BP. Whats an intervention for this?
lay them on their side
when planning care for a laboring woman whose membranes have ruptured,
nurse recognized that woman is at increase risk for
intrauterine infection
fetal tachycardia is most common during which of the following conditions?
maternal fever
Formula feeding instructions
Teach parent:
-15-30mL each feed for first 48hrs
-feed on demand 6-8 feeds per 24hrs
-hold bottle semi-upright while supporting head of baby
-never prop bottle because baby can choke
-burp baby several times to avoid spitting up
breastfeeding mom develops engorged breasts 3 days after birth. What action
would help this woman achieve her goal of reducing the engorgement?
Breastfeeds infant every 2 hrs!
Mastitis: Mother states they should stop breastfeeding due to use of antibiotics and NSAIDS for mastitis. Is this a sign of adequate education or further education needed?
Further education needed. Mother should continue to breastfeed depsite antibiotic use
Breastfeeding positions?
-Football clutch (underarm): recommended for mom to see babys mouth
-Across lap: works for smaller babies
-Cradling: most common for fast latching babies
-Side lying: baby and mom lying down: allows mom to rest
Feeding cues: instead of waiting until baby cries, mothers should learn these cues
-hand to mouth
-hand to hand movements
-sucking motions
-rooting reflex (if you touch next to their mouth and they turn their head and open their mouth)
Uniqueness of human milk:
It contains so many beneficial things+ fatty acids for promote brain growth and development
Are human milk and formula the same?
NO
Human milk and digestion
Human milk is more easily digested and improves infant response to infection
Breast milk is specific to the needs of each infant. Example of this
-Milk produced by
moms of preterm infants differs in composition from that of mothers who
gave birth at term.
- Also for twins vs one baby
Breastfeeding benefits for mom
prevents breast cancer, heart disease, MI, diabetes, and BP
Breastfeeding benefits for baby
reduced mortality, reduced risk for infections, obesity,
diabetes, & increases intelligence.
National recommendations for breastfeeding
-Infants should be breastfed for first 6months and should continue for 12 months and thereafter if needed
-complementary foods can be given after 6 months
-According to WHO, infants should be exclusively breastfed for 6mo, receive
complementary foods at 6mo, & continue breastfeeding until 2yo
If a baby is being ______,
they need ________
Breastfed
Vitamin D
Normal vision findings for newborns
-pupils react to light
-they can see objects as far as 2.5ft
-clear visual distance is 8-12 inches (distance between mom and baby during breastfeeding)/ baby can have blurry vision until a foot away
-newborn prefer moms face
Normal hearing findings for newborns
-prefer hearing mom and rhythmic sounds
-they recognize sounds and attempt to find source
-They are used to hearing moms heartbeat so a rhythmic noise is soothing for them (you can place a heartbeat stimulator nearby to help fussy baby)
Normal smell findings for newborns
-Highly developed sense of smell and can react to odors
-can smell their moms milk
Normal taste and touch findings for newborns
-Prefer sweet stuff
-Responds to touch
-early skin to skin promotes tactile interaction and stimulation
the nurse knows that thermoregulation presents a problem for newborns because
the thin layer of subQ fat provides poor insulation
Who can perform the Ortolani maneuver?
Only doctors and NPs
How is the ortolani maneuver performed? What is considered a positive ortolani test?
Flex the infant’s hips & knees to 90 degrees & apply pressure over the leg & gently adduct the leg with your thumbs. If the hip was dislocated a clunk will be felt as the hip relocates. This would be considered a positive ortolani test.
Normal findings for newborn skin?
-Skin is very thin at birth
-Desquamation (skin peeling at few days old, happens more commonly with post term babies)
-vernix caseosa (cheesy white covering on baby serving as protective covering) ; removal of this is followed by desquamation
-Milia (tiny white bumps on nose/forehead; sweat glands)
-Congenital dermal melanocytosis: aka mongolian spots (blue/black areas of hyperpigmentation)
-Nevi/stork bites: common pink areas on baby and require NO INTERVENTION
-Erythema toxicum/newborn rash: looks alarming but requires NO INTERVENTION
How to prevent heat loss in babies/interventions:
Dont place them on cold surfaces or under air conditioner to prevent cold stress
Its important to keep baby warm to prevent cold stress: TRUE or FALSE
True
Vital signs: newborn baby HR during sleep
80-100 BPM (drops)
Vital signs: newborn baby HR while crying
Can go up to 180 BPM
Are murmurs a concern in neonatal period?
NO; this is common
Placental hormones: what happens with the expulsion of the placenta?
Hormones decrease
Placental hormones: Action of hormones after expulsion (delivery) of placenta
-hCS decreases
-Estrogen and Progesterone decreases ALOT
-estrogen, cortisol and placental enzyme insulinase reverse effects of pregnancy
the 2 most common causes of subinvolution in the pp client are
retained placental fragments & infection
VEAL CHOP MINE: What does veal stand for?
Variable decels
Early decels
Acelerations
Late decels
VEAL CHOP MINE: What does CHOP stand for?
Cord compression
Head compression
Okay✅
Placental insufficiency
VEAL CHOP MINE: What does MINE stand for?
Move mother
Intervention not necessary
No intervention needed
Evaluate for why: ( stop pitocin, give 02, give fluid, reposition mom, possible c-section)
Intervention for late decels:
REPOSITION MOM
Decelerations criteria
has to last at least 15 secs for it to be considered a decel
HELLP syndrome: what is it?
lab diagnosis for preeclampsia that involves hepatic dysfunction
What does HELLP syndrome stand for?
Hemolysis
Elevated Liver enzymes
Low Platelets
How is HELLP syndrome diagnosed?
with Labs
What does HELLP syndrome put mom at risk for?
Becoming super sick and big risk for maternal death
Preeclampsia : what is it?
HTN in pregnancy (most common medical condition reported during pregnancy)
Preeclampsia criteria?
-Hypertension and proteinuria after 20wks gestation in mom with previous normotension
-have to have HTN and proteinuria
-Reflexes increased +3 or +4
-seizures (eclampsia)
Does preeclampsia resolve?
Yes, usually after placenta is delivered (expelled)
Care management for preeclampsia?
Admin magnesium sulfate (have calcium carbonate nearby)
Gestational vs Pregestational diabetes mellitus: what’s the diff
Gestational DM: occurs during pregnancy
Pregestational DM: diabetes before pregnancy
Pregestational DM: criteria
6-6.5 A1c before pregnancy
Diabetes Mellitus: high risk for moms or not?
IS HIGH RISK
Optimal outcome for gestational and diabetes mellitus in moms
strict maternal glucose level of 5-6%
When to screen moms for DM?
Screen at 24-28 wks with glucose drink
if blood glucose is too high, you have to do a 3hr test and get blood drawn every hour
Antepartum care for GDM
Diet, exercise
insulin therapy
monitor blood glucose levels
fetal surveillance
Intrapartum care for GDM
Avoid dextrose solutions
Monitor glucose hourly
Postpartum care for GDM
encourage breastfeeding to decrease risk of type 2 DM after GDM
Screening process for hyperbilinrubinemia
Measure total serum bilirubin by getting blood from babies heel of foot (side of heel)
Umbilical cord care: why is it done?
To prevent infection and hemorrhage because it is at risk for bacterial growth
Umbilical cord care: what to clean it with
clean with water, no antiseptic solution
Umbilical cord care cont: stump care
-Plastic cord clamp is removed after the stump is dried after 24-48hrs
-Stump should be assessed for edema, redness, drainage (infection)
-Should be kept clean, dry, open to air and loosely covered
Immediate interventions for newborn baby
airway maintenance, maintain O2 supply, maintain body
temp, eye prophylaxis (prophylactic eye drops/erythromycin 0.5%), vitamin K prophylaxis, promote parent-infant interaction, & skin to skin contact.
Why is erythromycin given?
to prevent inflammation of eye aka conjunctivitis caused by STI bacteria via passage through birth canal
Newborn screenings: screen for genetic, endocrine, metabolic disorder (why?) and how to screen for this?
for early detection of diseases that may result in severe health probs
-screen using heelstick
Newborn hearing screening: how is it done?
Rubber earpiece is placed in babies ear & in a healthy ear
you can hear an “echo”
Newborn critical congential heart disease: how to screen for this?
Pulse ox is used to detect hypoxemia; if its at 90% you
need to assess the baby!
Physical assessment of newborn: Baby has to be completely unclothed to be weighed; scale has pad or cloth
to prevent heat loss via conduction. TRUE or FALSE
True
What is assessed/measured during physical assessment of baby
general appearance, vitals, weight, head circumference, & neuro assessment
Normal head circumference of baby
32-36 cm
What does the neuro assessment of newborn baby focus on
reflexes
Newborn should remain skin to skin w mom for at least the first
30 min after birth. TRUE or FALSE
FALSE; Newborn should remain skin to skin w mom for at least the first
1-2 hrs after birth.
Signs of prolapsed umbilical cord
Woman feels cord after membrane rupture
Rupture of membranes can lead to…
Rupture of membranes can lead to infection & prolapsed cord!!!
○ This can lead to chorioamnionitis so limit vaginal exams
Antepartum: 1st, 2nd, 3rd trimester
1st:0-13 wks
2nd:14-26 wks
3rd: 27-40 wks
Antepartum: when are appts needed
○ Appt once a month between weeks 12-28
○ Appt every 2 weeks between weeks 29-36
○ Appt every week between weeks 36-delivery
Maternal adaptation hormones
○ Progesterone is LOWER than estrogen levels & this allows for uterine muscles to relax
○ Chorion (outer) membrane secrete prostaglandins which stimulate secretion of oxytocin which stimulates contractions
○ Babys adrenal glands secrete large amounts of cortisol during labor & this stimulates uterus & labor processes & contractions
cervical ripening methods: promote cervical softening, dilation, & effacement.
■ Chemical agents like prostaglandins can soften & thin the cervix
■ Mechanical & physical methods help stimulate release of prostaglandins
● Inserting a balloon catheter can thin out the cervix
● Physical methods like sex bc semen has prostaglandins, nipple
stimulation causes oxytocin release, & walking.
■ Amniotomy which is artificial rupture of membranes; make sure fetus is at
0 station
■ Oxytocin (low dose)
First period of reactivity after birth
-Lasts up to 30 min
-HR increases to 160-180
then HR decreases after 30 min to baseline 100-120
-Respirations are irregular (60-80)
-Fine crackles can be heard, retractions of the chest can be present but these
cease within the first hour.
-Infant is alert & has spontaneous startles, crying, & head movement.
Period of decreased responsiveness: when does it occur? what does this look like
occurs after first stage
-lasts from 60-100 mins
-baby is pink
-rapid respirations+shallow (60bpm)
-baby is sleep, relaxed, content
Second period of reactivity: when does it occur? what does it look like?
follows period of decreased responsiveness
-lasts from 10 min to several hours
-occurs between 2-8hrs after birth
-tachycardia + tachypnea occurs
-meconium passes
-increased muscle tone, changes in skin color and mucus production
