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Nursing 250-255 > OB test 1 > Flashcards

OB test 1 Flashcards

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1
Q

3 periods occur when baby is born

A
  • 1st period of activity- couple hours after birth- baby is awake, bond with baby, feed, skin to skn
  • 2nd period- rest- baby sleeps for about two hours
  • 3rd period of activity- awake and bonding
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2
Q

Newborns senses are tested before sent home

A

KNOW: hearing test on every baby before they go home*

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3
Q

What is formed in the lungs when the fetus is developing and what is its function?

A

The fetus produces surfactant at 24-25 weeks- this keeps alveoli open.

This is why premature babies born at this time have a chance of survival

-Babies do breath inutero but no gas exchange-

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4
Q

Vessels in the umbilical cord

A

There are 3: 2 arteries, 1 vein

Oxygen comes from the vein.

AVA

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5
Q

Ductus Venosus

A

bypasses the LIVER to get to the heart faster

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6
Q

Ductus Arteriosus

A

bypasses the LUNGS

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7
Q

Foramen Ovale

A

-shunts blood from RIGHT to LEFT atrium

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8
Q

Types of heat loss

A

Conduction- prevented by holding, touching

Convection- (air) protect from drafts of air

Radiation- sunlight

Evaporation- dry the baby off

**PRETERM BABIES HAVE A HARD TIME STAYING WARM

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9
Q

Heat loss in a newborn can cause 3 things. What are they?

A
  1. Respiratory distress
  2. Hypoglycemia
  3. increases oxygen demand
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10
Q

What is brown fat?

A

-area of skin that has lots of blood vessels, help keep baby warm because babies are unable to shiver. (found in back of neck)

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11
Q

Normal Respiration Rates for Newborn

A

-30-60 bpm

*periods of APNEA less than 20 seconds is NORMAL!

-See-saw resps are abnormal

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12
Q

Normal Temp for newborn

A

-97.7-99.1

Anything less than 97.7, you need to intervene.

NO rectal temps, temps are taken axillary

low temp coud be a sign of infection

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13
Q

S/S of respiratory distress

A
  • nasal flaring, GRUNTS, tachypnea, retractions
  • Ambu bag should be in every delivery room
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14
Q

What vitamin is given at birth and why?

A

Vitamin K is given at birth because the gut is sterile, cannot synthesize vitamin K which is needed for clotting.

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15
Q

First feeding

A

-start with 15mL and increase with next feeding

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16
Q

Babies first stool

A

*MECONIUM- black and tarry within 12-24 hours

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17
Q

3 causes of bowel movements that occur inside.

A
  1. post due dates
  2. fetal distress
  3. Breech positioning
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18
Q

When is jaundice normal? When is it not normal?

A

Jaundice within the first 24 hours is ABNORMAL (pathological)

Jaundice after 24 hours is normal (physiological)

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19
Q

Normal Blood Glucose in a Newborn

A

40-60mg for the first day

(Babies with diabetic mom are prone to hypoglycemia)

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20
Q

What are the different types of immunty and how does the baby get them?

A

IGG- diseae is gone- baby gets immunity from mother/placenta.

IGM- disease process is going on. Baby must have infection to get immunity.

IGA- passed only to breast fed babies

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21
Q

What is the Moro Reflex?

A

Startle reflex- make loud noise and baby becomes startled. (clap hands, raise arms and drop)

Babies hands will be in a C position

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22
Q

Babinski reflex

A

run finger upwards on sole of foot, toes expand and big toe dorsiflex.

(this is healthy for babies, not for adults)

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23
Q

How to tell the difference between seizure and hypoglycemia?

A

If baby shakes, hold them close to you. If they stop it is hypoglycemia, if they dont its a seizure

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24
Q

Normal heart rate in newborn

A

120-160 for newborn- apical for one min

110-160 for fetal heartbeat

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25
Q

APGAR score

A

2 numbers: taken at 1 MINUTE and 5 MINUTE

A-appearance

P-pulse

G-grimace

A-activity

R-Respiratory effort

(2 points for each; 10 total…. 8-10 baby is well, 4-7 some kind of intervention needed, 0-3 baby is not well.)

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26
Q

Is it normal for a newborn to have 10% weight loss within the first couple days?

A

YES

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27
Q

For full term babies, how much of theyre feet should have creases?

A

2/3 is normal - plantar creases.

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28
Q

Flex position

A

this is normal for a full term baby

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29
Q

Anterior suture

A

Diamond shaped 4-5cm

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30
Q

Posterior suture

A

Triangle shaped 0.5-1 cm (closes first)

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31
Q

Caput

A
  • crosses the suture line and is fluid filled. this usually goes away fast
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32
Q

Cephalhematoma

A

does not cross suture line (one sided) and is usually blood filled

lasts for a while.

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33
Q

Erythema Toxicum

A

Newborn Rash. this is NORMA. it goes away on its own

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34
Q

Breast is best!! why?

A
  • babies stop when theyre full; less chance of overfeeding
  • immunity- IGA
  • helps uterus contract and body get back to norm
  • its convenient- no formula, no warming bottle
  • decrease upset stomach, diarrhea and colic
  • stimulates growth of + bacteria in the gut
  • promotes bonding, proper temp
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35
Q

How do you tell if a baby is being fed adequately?

A

6-10 wet diapers a day indicate adequate nutrition

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36
Q

Cord care

A

falls off within 7-10 days.

**its okay to bathe and get the cord wet!

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37
Q

When can newborn be tested for PKU

A

after eating for 24 hours before test

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38
Q

Small Gestational Age (SGA)

A

-below 10th percentile (5lbs 8oz)

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39
Q

Large Gestational Age

A
  • 90th percentile- above 8 lbs

at risk for hypoglycemia, and birth trauma

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40
Q

Amnioinfusion

A
  • done during labor to prevent meconium aspiration.

LR in placenta to dilute meconium.

Tracheal suction used if baby is not crying

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41
Q

Post partum is when

A

the time they deliver till 6 weeks after

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42
Q

pregnancy is a state of?

A

WELLNESS NOT ILLNESS

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43
Q

Erythromicin is given how? and why

A

in eyes put in on like toothpaste give to protect from Viruses, STDs

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44
Q

Cephalopelvic disproportion (Baby >8 lbs) can cause probems what are they?

A

hypoglycemia, polycythemia, jaundice

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45
Q

pre-embyonic period

A

conception to day 14 of preg. ALL or NOTHING if exposed to tetragens SERIOUS

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46
Q

Embryonic period

A

day 15-last day of 8 week (56) MOST important time for exposure to tetragens

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47
Q

Fetal period

A

end of 8th week untill birth of babe

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48
Q

in week 3 of gestation what is developing

A

CNS, brain, spinal cord, heart

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49
Q

when does the fetus’ face begin to look human?

A

13th week

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50
Q

When is C-shaped tail formed, face, upper respiratory and when does the neural tube close? (what is vital for this neural tube to close?

A

4th week gestation, FOLIC ACID very important to NTD

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51
Q

when in utero does the heart beat @ reg rythym and paddel shaped limbs form?

A

5th week

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52
Q

when does the face fully dev in utero?

A

6th week

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53
Q

at what time is the fetus at or about the symphis pubis? (pubic bone)

A

12 weeks

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54
Q

T/F In pregnancy the blood volume increases 40-50%

A

TRUE

BP 1st trimester: stays same

BP 2nd Trimester: decreases

BP 3rd trimester: Goes back to normal

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55
Q

Pregnant moms are hypercoaguable and have increased leukocytes, this puts momma at risk for?

A

DVT!

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56
Q

N&V aka Morning sickness is very common @ 6-12 weeks due to what?

A

increased HCG levels

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57
Q

Progesterone (progestin) levels

A

supports endometreal lining, keeps baby inside

Levels increase during pregnancy and decrease in labor

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58
Q

Healthy people 2000, 2010, 2020 etc. lol

A

Increase proportion of pregnant women who receive early prenatal care

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59
Q

Neagels Rule

A

last period, subtract 3 months, add 7 days

ex. my last period was Jan 29th, subtract 3 months = October, add 7 days = NOVEMBER 5th
- Anonymus

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60
Q

GTPAL?

A

G- Gravida (# of times pregnant)

T- Babies carried 38+ weeks (TERM)

P- Preterm (20-37 and 6/7 weeks)

A- Abortions (any baby lost miscarried aborted etc) before 20 weeks

L- Living kids

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61
Q

In most hospitals we just use G/P

A

Gravida = Pregnancies

P- number or preg that ended at 20+ weeks (para)

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62
Q

AFP or quad screening

A

not a diagnostic test! they all SCREEN for NTD and genetics, follow with an amniocentesis

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63
Q

Chronic Villus sampling (CVS)

A

after 10 weeks , genetic counseling (ex. 42 year old pregnant girl), never do before 10 weeks can cause limb defects in unborn fetus

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64
Q

Non-stress test (NST) is to see if baby can react under non-stress we put 2 monitors on momma to monitor HR what do we want?

A

we want it to be reactive!!! so if baby is moving their HR increases this means the CNS of babe is intact

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65
Q

Biophysical profile what are levels

A

8-10 good! 4-7 BAD <4 Horrible outcome

(same as APGAR)

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66
Q

Normal Hematological dilution w/ pregnancy

A

H&H decreases

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67
Q

Rubella (Measels) if mom gets the vaccine after she delivers?

A

tell her wait 1 month to get pregnant again (KEEP EM CLOSED OR USE PROTECTION)

-Anonymus

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68
Q

A couple things to tell mom to aviod when pregnant

A

no douching (Ew) no skiing (DUH) they can excersice light no body building

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69
Q

Urinary Freq.

A

Comes @ beginning and end of preg!

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70
Q

lower abdominal pain accompanied by shoulder pain may be indicative of what?

A

ECTOPIC PREGNANCY :(

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71
Q

Pain in calf can be indicative of what?

A

DVT

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72
Q

Preeclampsia may occur in 3rd trimester what are some s/s

A

sudden weight gain, periorbital or facial edema

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73
Q

4 stages of labor

A

1st stage- 3 parts (onset of labor till fully (10 cm) dilated

  • LATENT phase 0-3 sonometers dilated (calm mood)
  • Active: 4-7 cm dilated
  • TRANSITION 8-10 cm dilated (they dont think here) WATCH OUT

2nd stage- 10 cm dilated to birth of baby (Actively pushin)

3rd stage- after birth of baby———>delivery of placenta

4th stage- from delivery of placenta till 1-4 hrs after (post partum)

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74
Q

the four p’s for how the baby gets thru

A

passage (pelvis)

passenger (Baby)

Powers (Contractions=Primary) Secondary=Pushing)

Psyche (attitude)

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75
Q

Most common positions of baby (also most preferred)

A

LOA and ROA, (when baby is born, head is down)

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76
Q

most favorable pelvis shape and best outcome for baby if mom has?

A

Gynecoid (true pelvis) perfect for fitting baby thru, its wide and round

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77
Q

if the head comes out first this is called what?

If the butt comes out first this is what?

another way the baby can come out?

A

head out 1st (best) VERTEX

butt out first (Breech)

also shoulder presentation when shoulder comes 1st

we want the baby to be vertical (Longitudinal lie)

78
Q

Engaged means?

A

the widest part of the baby’s head is at 0 station (at the isheal spine) now the baby is ready to deliver

79
Q

True labor means

A

contractions are longer, stronger, and closer together

FALSE labor= irregular

80
Q

we can not (not the guys just us girls) push till when

A

10 cm or 0 station

81
Q

importance of contractions

A
  1. Freq (from the beginning of 1 to the next one)
  2. Duration (ho long)
  3. Intensity
82
Q

Labor relationships to estrogen and progesterone

A

increased ratio of estrogen to progesterone, increased cortisol also

83
Q

when do you take a BP in labor?

A

in between contractions, and have mom on her side

84
Q

what is the cut off temp for fever or infection and when do we have to intervene

A

>100.4!

85
Q

Leopolds maneuver

A

checking position of baby

86
Q

the 3 tests that determine if moms water broke

A

pooling

Ferning

Nitrazine paper- fluid will turn blue if water ruptured or be clear if it didnt

87
Q

fetal HR (in utero) should be?

A

110-160

88
Q

Pain Control (Pharmacological) during labor

A

Analgesia: Morphine, Nubane, Stadol, Fentanyl-

**causes resp. depression in newborn when born**** make sure to have recessitation in room, o2, ambu bag, etc.

89
Q

When to give an epidural? where? and some special considerations

A

like a spinal goes into epidural space usually injected in L3 L4, give it in active labor (4-7 sonometers) *****ACTIVE LABOR***** or maybe before. It can prolong the labor, or make baby not come down right. BEFORE epidural we have to make sure that mom is hydrated b/s S/E is HYPOTENSION! Give at lease 1000 mL or 1 L fluid.If you have this, the baby will have

<hr.>
</hr.>

90
Q

C-section, what type of meds are given?

A

usually a spinal as first line but in an emergency, General Anesthesia is given

91
Q

when is internal electric fetal monitoring done?

A

scalp lead and IUPC (membranes must be ruptured so water has to be broken 1st) Needed because of decelerations, when we don’t know whats going on with baby

92
Q

3 responses that make BP of baby go down

A 
Umbilical cord compression(Variable Deceleration)
 Head compression(Early Deceleration)
 Placental insufficiency(LATE deceleration) WORST\*
93
Q

NSG interventions for Non-reassuring Fetal Heart tones

A

P-Maternal position change****
O-O²*** 10 L of 02 per mask
I-IV fluids***
S-Sterile Vaginal Exam*** see how much dilation
O-D/C Oxytocin if running***
N-Notify Provider, prepare for possible emergency delivery****
Reassure/support patient and family
POISON

94
Q
A
95
Q

What is the best position to facilitate the 2nd stage of labor?

A

Squatting!

96
Q

What to teach pt about breathing techniques?

A

Open Glottis Pushing

97
Q

When clearing mucus what order do you use?

A

Clear mucus from mouth, then nose!

98
Q

Episiotomy is done when and why

A

To enlarge vaginal opening is the *only reason and not unless an emergency****
IT IS A 2nd DEGREE LACERATION THAT GOES THRU MUSCLE!*****

99
Q

What medication would you administer to a baby with respiratory depression if you suspect maternal drug use or the mom was given a narcotic very close to the time of delivery?

A

Narcan

100
Q

Concerning the placenta what are the types

A

DIRTY DUNCAN= MATERNAL,

Shiny Shultz- fetal (baby)*

101
Q

A 4th degree Perineal laceration contains what

A

Vaginal mucosa, posterior fourchette and perineal skin, perineal muscles, anal sphincter, RECTAL WALL!

*** 1st deg= The first 3

2nd deg= The first 3 + perineal muscle

3rd deg=The first 4 +anal sphincter

102
Q

The first bleeding that moms have will be what

A

Lochia Rubra (RED)

103
Q

Pharmacologial pain management post partum

A

Ibuprofen works really well or Motrin

104
Q

What causes a fundus to be deviated to the right or left of the midline?

A

A Full Bladder;

Encourage them to void often, check to see that she empties bladder often

105
Q

Rubin’s 3 Post-partum phases

A
  1. Taking in (Dependent)
  2. Taking hold (Both dep/indep)
  3. Letting go (Independent)
106
Q

Ductus venosus

A

oxygenated blood enters through umbilical vein. 1/3 of blood is directed away from liver to inferior vena cava.

107
Q

Foramen ovale

A

between R and L atria. 50-60 % goes to left atria, the rest goes to right atria, flow to lungs is restricted by the narrow pulomary artery and pulmonary blood vessels, causing a high pressure in R side of

108
Q

Ductus arteriosus

A

connects pulmonary artery and the descending aorta during fetal life. perfusion only.

109
Q

Fetal Lungs

A

Contain no air, O2 is delievered through placenta - umbilical vein to ductus venosus.

alveoli secrete fluid to keep them partically open, before delivery start to close so when they take 1st brath dont take much fluid in.

110
Q

newborn GI

A

Immature shincter, thats why they spit up a lot.

1st stool - dark and tarry, 2nd stool - green-brown, loose.

Breast milk stool- seedy, mustard type, can stool up to 10x/day = natural laxative

formula stool- yellow-brown, only go 1-2 x/day.

babies stomach only the size of a walnut, commonly are overfed.

111
Q

newborn urinary system

A

most newborns void immediatley after birth, indicationg adeqaute renal function.

Full kindey function doesnt happen until 3-4 months.

6-10 wet diapers a day.

112
Q

newborn immune system

A

Immature WBC- trabel slow.

Look out for cahnges in activity, color, tone and/or feelings. wont generally see a fever like in adults.

IgG- cross placenta
IgM - after babys born-exposed to environment
IgA- found in colstrum (breast feeding)

113
Q

thermoregulation

A

important to keep babies warm, have think skin and little sub-q fat.

Dry babies off completely, warm stethoscope beforing touching the baby, keep a hat on them, they loose heat through head.

Do not over heat the baby either, dangerous as well.

114
Q

Newborn hepatic system

A

BS should not be less then 40.

Bilirubin- too much can be toxic to the baby.

Iron is stored in liver/spleen. have enough if breat feed for 3-6 months, supp if not.

Two types of jaundice:

patho- happens within 1st 24 hrs.
physiological- happens after 1st 24 hrs
to test: push finger on skin, when life, if yellow means jaundice.

115
Q

Newborn hematologic system

A

Risk for clotting deficiency due to having a Vit K deficiency, they can not produce Vit K until about a week after birth, they get an IM of it at birth.

116
Q

Range for normal

A

120-160

take apical

can be higher if baby crying.

117
Q

range for normal respirations

A

30-60

periods of apnea

118
Q

Range for normal temp

A

36.5-37.3 C or 97.7-99.1 F

NO rectal temps ! only axillary !

119
Q

range for normal weight

A

2500-3999 grams or 5#8oz - 8#13oz)

120
Q

Small for gestational age (SGA)

A

infants that are below the 10th percentile in size on growth chart.

Problems: perinatal asphyzia (unable to tolerate stress of labor), hypo/hyperthermia, polycythemia, meconium aspiration

Appearance: head disproportionally large, thin skin, wasted appearance of extermities, thin cord, decreased sub-q fat and breat tissue.

121
Q

Large for gestational age (LGA)

A

Infants who are about the 90% on intrauterine growth charts.

Problems: bith trauma, hypoglycemia, polycythemia, jaundice secondary to hyperbilirubinemia

risk factors: maternal diabetes, genetics, mutiparity, hx of macrosomic infant, post date gestation, maternal obesity, male fetus

122
Q

Stork bites

A

reddish pink areas on eyelids of around neck, that blanch when pressed on, go away by 2 years.

Vernix Caseosa- thick white substance that provides a protective covering for baby in utero, sometimes born with some still on them, more term thy are , the less there is.

123
Q

Lanugo

A

fine har that covers fetus intrauterine, some are born with it still on them, found on shoulders, forehead, sides of face, upper back,

124
Q

Vernix Caseosa

A

thick white substance that provides a protective covering for baby in utero, sometimes born with some still on them, more term thy are , the less there is.

125
Q

Mongolian spots

A

bluish-black marks that look like bruises - found on darker skin tones around sacral areas, sometimes found on shoulders, arms and buttocks.

Document these at birth so they arent mistake as bruises.

126
Q

Erythema toxicum

A

newborn rash- common- goes away.

127
Q

Milia

A

White cysts, 1-2 mm in size, they disappear without treatment.

Occur on face over forhead, nose, cheeks, and chin

128
Q

Harlequin sign

A

half pale. half red- usually fixes it self

129
Q

Nevux flammeus/vasculosus

A

Flammeus (port-wine stain) permanent, flat, pink to dark reddish-purple mark that varies in size.

Vasculosus (strawberry hemangioma) enlarged capillaries in the outer layers of the skin. dark red and rasied with a rough surface. can get larger for 5-6 months but usually goes away by early school years.

130
Q

Molding is important why?

A

to help the babys head get into a shape that it can move through the birth canal.

babies head should move bakc into shape.

131
Q

The soft spot should close after how long?

A

14-18 months, allows for brain to develop

132
Q

Caput succedaneum

A

often appears over vertex of newborns head as a result fo pressure againts mothers cervix.

the edematous area crosses suture lines, is soft, and varies in size.

resolves quickly and generally disappears within 12-48 hrs after birth.

133
Q

Cephal hematoma

A

Bleeding between the periosteum and the skull, as the result of pressure during birth.

occurs on one or both sides of head over parietal bones or sometimes occipital bone. swelling may not present at birth but may develop within first 24-48 hours.

does not cross sutures lines.

134
Q

preterm labor (PTL) risk factors

A

maternal medical conditions, present and past OB conditions, fetal conditions, social and enviornmental factors,

Diabetes, drugs, lupus, infections, STDS, can cause an unsuccessful pregnancy

135
Q

pre-term characteristics

A

birth weight chest, poor tone, minimal sub-q fat, undescended testes, lots of lanugo, soft ear pinna, fused eyelids, spongy skull bones, absent to few sole and palm creases, minimal rugae or prominent labia and clitoris, think skin, visible veins, lots of vernix

136
Q

problems with premature babies

A

problems with: respirations, thermoregulation, fluid and electrolyte balance, infections, and pain.

they should be be prone, laying on side to decrease secretions.

137
Q

Post-term problems

A

if placenta function decreased, the amniotic sluid will decrease, could lead to a compressed umbilical cord.

If not getting enough 02 and nutrients the baby can become hypoxic or malnurished.

Fetus may pass meconium which is bad if the baby aspirates it.

138
Q

Post-term characteristics

A

dry, cracked wrinkled skin, long thin extermities, creases cover entire soles of feet, wide-eyed, alert expression, abundant hair on scalp, thin umbilical cord, limited vernix and lanugo, meconium stained skin, long nails

139
Q

Transient-tachypnea of the newborn (TTN)

A

liquid in lungs removed slowly or incompletely, will see grunting, nasal flaring, tachypnea and retractions, usually resolves in 24-48 hours.

Seen commonly in c-section babies, sent to nicu.

Treatment: supportive, NPO, 02, neutral thermal environment, assessment.

140
Q

Meconium aspiration

A

happens when the baby has its first bowel movement when he has not delivered yet, and then the baby aspirates some of it.

10-15% of babies have meconium before delievery of those 5% get meconium aspiration

Usually happens to hypoxic babies that dont handle labor well.

Get put on ECMO (

141
Q

hyperbilirubinemia: Pathological jaundice

A

Happens with first 24 hours, starts in face,moves down.

Put them by light (phototherapy), breast feed to help excrete through urine and stool.

Can result in kernicterus = staining of brain - learning disabilites, mental disorders, could cause death.

Usually happens with RH incompatibility or ABO incompatibilty.

142
Q

Zygote

A

The developing baby from conception through the first week of prenatal life.

Increases in size as it travels towards the uterus

143
Q

Fertilization and conception

A

Usually takes place in the ampulla (outer most 1/3 of the fallopian tube). sperm enters the egg (conception)

The union of the sperm and egg (fertilization)

144
Q

Blastocyte has two parts..

A

trophoblast - placenta and membranes

embryoblast - embryo

145
Q

pre-embryonic stage of development

A

conception through week 2.

Around the 4th day after conception, the fertilized ovum, now called a zygote, enters the uterus.

In this stage teratogens either kill the baby or nothing happens.

146
Q

Embryonic stage of development

A

day 1 of week 3 thru last day of week 8.

Basic structures of all major organs are completed during this time.

In this stage teratogens exert the greatest affect on fetal development.

147
Q

Fetal stage of development

A

week 9 through delivery

Dramatic growth and refinement occur during this stage. Teratogens may damage already formed structures but less likely to cause major stuctural alterations.

148
Q

Amniotic fluid (AF)

A

about 450-750 ml @ 40 wks

it should be transparent and odorless.

Functions: temp regulation, cushion againts trauma, allows for movement and development.

baby will swallow fluid and then void it back into the fluid, some most of the end AF is urine.

low fluid could mean kidney issues for baby.

149
Q

Fetal veins do what..

A

pick up 02 and nutrients and give them to baby.

150
Q

fetal arteries do what..

A

retuen waste and carbon dioxide, whic is diffused, transported to maternal veins.

151
Q

Metabolic placental function

A

Synthesizes substances needed by fetus and placenta

152
Q

Transfer functions of placenta

A

Gas exchange, nutrient transfer, waste removal, antibody transfer, hormone transfer.

IGg- can cross placenta

153
Q

Endocrine placental functions

A

produce 5 hormones:

hcG - early on in preg can test blood/or urine to see if its a viable preg. If it goes down during preg then could be miscarrying.
HPL, estrogen, progestrone - relazes smooth muscles, and relaxin.

154
Q

placenta perfusion

A

blood in the intervillous space is changed about 3-4 times per min, requiring circulation of 450-750 ml/min

155
Q

maternal vasoconstriction causes

A

hypertension

156
Q

maternal vasodilation causes

A

hypotension

157
Q

s/s of decreased CO

A

decreased HR

158
Q

Surfactant

A

is produced around 24-34 weeks, most is produced by 33 weeks.

diabetics have slow production of it.

hyperinsulinemia babies will have decreased surfactant production

159
Q

Fetal Cardio

A

by 5th wk

160
Q

Viability

A

That ability of the fetus to survive outside the uterus

MI state law says 20 wks

clinically its 24 wks

161
Q

presumtive signs of pregnancy

A

amenorrhea
fatigue
N/V
urinary frequency
skin changes
breast changes(color, size, tenderness)
vaginal and cerivcal color changes(chadwicks sign-darkish purple color)
fetal movement (quickening)

162
Q

probable signs of pregnancy

A

abd enlargement
cervical softening (Goodell’s sign)
thining of uterine lining (hegar’s sign)
ballottement - can palpate on uterus and fetus will rise and fall and doc will feel this
braxton hicks contractions
palpation of fetal outline
uterine souffle- sound that can be heard that is made from the exchange of fluids from mom to baby
positive pregnancy test

163
Q

positive signs of pregnancy

A

Fetal
fetal movement felt by examiner
ultrasound verification of fetus

164
Q

Fundal height

A

less than 12 wks - in pelvis

12 wks = at symphsis pubis

20 wks - at umbilicus

36 wks - at zyphoid

165
Q

Cardio changes in pregnancy

A

Total volume- increase overall, plasma increased about 1000, RBCs increase about 500, hgb does down.

Cardiac output is increase 50-60%

progestrone increase- relaxes smooth muscles so the BP does not go up
can get supine hypotension due to presure on vena cava when lying flat.

166
Q

hemodilution (physiological anemia pregnancy)

A

result of there being more plasma in the mom then there is RBCs.

Normal about or RBCs they are just diluted by the plasma

167
Q

Dick-read childbirth education method

A

His theory was that fear of childbith results in tension and pain. To prevent the fear-tension-pain cycle, he developed a method of slow breathing in early labor and rapid chest breathing in advanced labor.

168
Q

Bradley childbirth education method

A

First to include father as a support person. Abd breathing to increase relaxation and breath control is taught in classes that last baout 12 wks. emphasizes avoidance of all medication and other interventions.

169
Q

Lamaze childbirth education method

A

Involves concentration and conditiong to help the woman respond to contractions with relaxation and various techniques to decrease pain.

170
Q

Nagele’s rule

A

take the 1st day of LMP minus 3 months and add 7 days.. that gives you and estimated due date

171
Q

comprehensive hx done on inital visit to OB/GYN

A

current pregnancy -LMP, EDD
OB/GYN hx - GTPAL
medical hx
surgical hx
nutritional status
review of systems
tertogen exposure
psychosocial hx
hx of abuse
medications (OTC & Rx)
allergies
family hx
Overal risk assess- risk for complications

172
Q

inital visit PE

A

VS
Heat to toe
Additional OB assess
-funfal height
-fetal
-speculum exam-cervix
-bimanual exam: ovaries size and shape, uterine size, contour, tenderness, and position.
-pelvic exam: pelvic measurements/adequacy

173
Q

inital lab tests done on preggers

A

CBC, blood type and RH, antibody screen, rubella titer, TB skin test, HIV, HBSag, U/A & C&S, pap, GC/chlamydia, RPR/VDRL, triple/quad screen (MSAFP), GCT (glucola) - not always done, Ultrasound (not always done), GBS (not always done)

174
Q

follow up visits done when?

A

monthly until 28 wks; q 2 wks 28-36 & q wk 36 wks to delivery.

175
Q

CVS ( chorionic villus sampling)

A

done at 10-12 wks for genetic testing.

176
Q

nonstress test (NST)

A

the mother is asked to void, and VS are take, she lies down with head slightly elevated and on her side to avoid supine hypotension.

reactive (reassuring) - the babies HR goes up at least 15 bpm for at least 15 secs after fetal movement or w/o FM

nonreactive (non reassuring)

177
Q

Contraction stress test

A

done if a NST findings are non reactive.

Records the FHR in response to uterine contractions

negative (reassuring) - no late decelerations (decreases in the FHR persisting after the contractions ends) although the fetus was stressed by 3 contractions of at least 40 secs

positive (abnormal) - late decelerations accompanying at least 50% of contractions even when fewer than 3 contractions occur in 10 min.

178
Q

healthy people 2010 prenatal care goals..

A

at least 90% of US women to begin antepartum care in 1st trimester.

179
Q

Stages of labor

A

1st- onsent of labor to complete dilation and effacement

2nd- complete dilation to delivery of baby

3rd- delivery of baby to the delivery of placenta

4th - 1st 4 hours after delivery of placenta

180
Q

3 phases of 1st stage of labor

A

LATENT - 1 - 3 cm

ACTIVE - 4 - 7 cm

TRANSITION - 8 - 10 cm

181
Q

Fetal station

A

measurement of the fetal head to maternal ischial spines

At ischial spine = 0

above ischial spinea = negative numbers (-1, -2, -3, -4, -5)

below ischial spine = positive numbers (+1, +2, +3, +4, +5)

182
Q

Depo-provera side effects

A

amenorrhea, weight gain, headaches,depression, hair loss, nervousness, decreased libido, breat discomfort, and spotting.

183
Q

oral contraceptive side effects

A

breakthrough bleeding, weight gain or loss, fluid retention, amenorrhea, melasma.

risk for developing DVTs is higher when taking these especially in women who are smokers and/or over the age 35

184
Q

Rubin’s stages

A
  1. Taking-in = 1 -2 days, this stage is all about the mom, she is mainly concerned about herself
  2. Taking-hold = this is the best time to teach the mom
  3. letting- go = this is when moms expectations are let go and she accepts reality. wanted a girl but got a boy
185
Q

when is RhoGAM given and why?

A

If the mom is RH- and baby is RH+ she needs rhogam.

usually given around 20-28 wks gestation.

will be given if any trauma happends during preg.

given 72 hours after birth to help with next pregnancy

186
Q

Hormones after delievery

A

estrogen, progestrin, relaxin go down right away

hcg hangs aruond for a while.

oxytocin is responsible for let down reflex, when baby sucks- the milk comes down

187
Q

GI after delivery

A

motility is decreased may take a while to get back ti normal.

may not have a BM for a few days, resist urge to defecate, constipation common. Don’t force down. use stool softeners.

Hungry and thirsty after labor, small portions are best.

188
Q

Urinary system after delivery

A

Kidneys return to normal after 2 -3 months

urinary output 3000 ml/day

make sure they are voiding after delivery and have the urge to go.

overdistention of bladder can cause UTI or hemorrhage, bladder causes uterus to rise, which releases pressure, causing hemorrhage.

189
Q

VS post partum

A

temp can increase 24hrs r/t dehydration

pulse will decrease.. watch for tachycardia.. shouldnt have this

resp - normal within 6-8 wks

BP- small tranisent rise for 4 days because of the high volume

190
Q

risk for DVTs

A

promote getting up asap, check homans sign

Nursing 250-255 (6 decks)

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