Seminar day 1 Flashcards
intrapartal
labor and birth
gravida
how many times the woman has been pregnant; whether completed or not
para
number of pregnancies lasting more than or equal to 20 weeks
GTPAL
gravida term pregnancies pre-term pregnancies abortions (spontaneous or forced) living children
SVD/NSVD
spontaneous vaginal delivery/normal SVD
C/S
c-section
VBAC
vaginal delivery after cesarean
Fundus
The upper rounded extremity of the uterus above the openings of the uterine (fallopian) tubes.
lochia
vaginal discharge after birth:
rubra, serosa, alba
scant, small, moderate, heavy
can last up to 6 weeks
peuperium
the period of about six weeks after childbirth during which the mother’s reproductive organs return to their original nonpregnant condition.
4th stage of labor assessment - vag delivery
1st 1-2hours after birth: q15min x 4 q30min x 2 q1hour x3 q4hour to complete first 24 hours
include: BP pulse fundus lochia perineum
temp q4 for 24
postpartum ongoing (routine) assessment - shift
head to toe OB focal: breasts fundus lochia perineum
PP maternal temp guideline
less than or equal to 100.4 degree F (24hours) normal
considerations when pt has had duramorph
count RR q1hour x 24 hours
NO narcs in 1st 24 hours unless approved by anesthesia
have narcan bedside - reverse resp depression
most common SE = pruitis - itching
use nubain or benadryl - if not work, give narcan
epidural site
ice is best for pain
extremities assessment
look for edema - 3rd spacing
varicose veins are common
Homan’s sign - checking for DVT’s - dorsiflex foot and assess for pain - must be relaxed - don’t check if known DVT
perineum assess
lochia
lacerations
hemorrhoids - common
bladder assess
a full bladder will displace the uterus
encourage voiding q 2 hours
usually concentrated
lots of urine made - getting rid of excess from pregnancy
lacerations
1st degree = skin
2nd degree = muscle
3rd degree = capsule of anus but not through
4th degree = through anus
ICE!!
breastfeeding nutrition
need 500 calories extra - in form of protein
maternal role adjustment
taking in
taking hold
letting go
taking in
can be up to 48 hours concerned about self pain food thirst difficult to make decisions
taking hold
around d/c showered own clothes hair/make up feeling better, starts asking questions participate in baby care best time to teach
letting go
can take up to 1-2 weeks
incorporates NB into family system
lochia
scant, small, moderate, heavy - in relationship to time
pad completely saturate is about 100 ml’s
diastasis of rectus abdominus muscle
separates for the uterus to grow
surgical mesh may be used for large ones
when turns on side, stomach feels weird
touch chin to chest - makes muscle contract and can palpate edges
immediate assessment and care of NB
establish respirations
prevent heat loss - dry baby, skin to skin
APGAR at 1 min and 5 min
safety - ID bands
promote parental attachment - skin to skin for 2 hours or until first feeding
meds - vit K, erythromycin ointment
establishment of respirations
most critcial adjustment for NB right after birth
result of pressure change, chilling, noise, light, etc..
normal = 30-60/minute, irregular, count 60 seconds
signs of respiratory distress
grunting (early sign)
nasal flaring (early sign)
retractions (later sign)
cyanosis (even later sign)
brown fat
source of heat unique to NB’s
greater thermogenic activity than regular fat
prematures have less than term - increased risk heat loss
don’t want them to have to use this
KEEP WARM!
types of heat loss
evaporation
conduction
convection
radiation
evaporation
occurs when liquid is converted to vapor
vaporization of moisture from skin after birth
dry baby after birth/bath
conduction
the loss of heat from warm body surface to cooler surfaces in direct contact - placing infants on cold scale, blankets, wet linens, x-ray plates
place infant on pre-warmed warmer/scale
skin to skin with mom/dad
place barrier
convection
flow of heat from the body surface to cooler ambient air, contact with cold air
cold drafts, O2 admin
wrap infant in blankets, hats
increase room temp
look at placement of baby in terms of air system
radiation
the loss of heat from the body surface to a cooler solid surface NOT in direct contact, but in relative proximity, a vacuum
infant near cold object
keep infant away from cold windows or walls
normal NB temp ranges
97.6-99 axillary
if less, radiant warmer
normal NB HR ranges
(100 - APGAR) 110-160
count full minute
apical
APGAR
activity - muscle tone pulse grimace - reflex irritability appearance - skin color respirations
activity muscle tone APGAR scoring
absent - 0
arms and legs flexed - 1
active movement - 2
pulse APGAR scoring
absent - 0
below 100 - 1
above 100 - 2
grimace - reflex irritability APGAR scoring
no response - 0
grimace - 1
sneeze, cough, pull away - 2
appearance - color APGAR scoring
blue-gray, pale all over - 0
normal, except for extremities - 1
normal over entire body - 2
respirations APGAR scoring
absent - 0
slow, irregular - 1
good, crying - 2
assessment of the NB at time of birth
resp apical pulse temp weight, length, head circumference head to toe
vernix caseosa
A white cheesy substance that covers and protects the skin of the fetus and is still all over the skin of a baby at birth
lanugo
fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn.
milia
tiny white bumps that appear across a baby’s nose, chin or cheeks. Milia are common in newborns but can occur at any age. You can’t prevent milia. And no treatment is needed because they usually disappear on their own in a few weeks or months.
mongolian spots
very common in any part of the body of dark-skinned babies. They are flat, gray-blue in color (almost looking like a bruise), and can be small or large. They are caused by some pigment that didn’t make it to the top layer when baby’s skin was being formed.
flammeus nevus (port wine stain, stork bite)
a large congenital vascular malformation nevus having a purplish color; it is usually found on the head and neck and persists throughout life
erythema toxicum
a common harmless rash that appears in at least half of all infants who are carried to term
head assessment
molding
caput succedaneum
cephalhematoma
caput succedaneum
fluid acculumation pressure from vaginal birth will reabsorb in a few days crosses suture line appears at birth
cephalhematoma
blood accumulation torn blood vessels doesn't cross suture line if growing = active bleeding few weeks for reabsorption at risk jaundice appears few hours PP
NB bath
delay until stable temps - 2 above 98 degrees
wash head last
dry!
NB labs
TCB - transcutaneous bilirubin-based hours age
glucose per protocol - above 40mg/dL
CBC - not routine
blood cultures - no routine
NB glucose indicated if
mother with diabetes LGA SGA preterm s/sx
breastfeeding positions
football
cradle - hardest
cross cradle - best to teach
side lying
breastfeeding latch
nose to nipple
baby’s mouth open wide
help baby to breast
breastfeeding times
8-12 times in 24 hours
q2-3 hours(beginning of feed to beginning of next feed)
about 15-20 minutes per breast
don’t skip feedings
