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NUR 209 - Maternaty > Test 1 B > Flashcards

Test 1 B Flashcards

1
Q

Hemoglobin (Pregnant)

A

atleast 10.5 g/dl

(normal = 12-16 g/dl)

-If low do not give transfusion first—> iron supplements / food

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2
Q

Hematocrit (Pregnant)

A

atleast 32%

normal = 32%-47%

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3
Q

White Blood Cells (Pregnant)

A

5,000 - 15,000

normal = 5,000 - 10,000

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4
Q

Platelets (Pregnant)

A

150,000 - 400,000

same as normal

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5
Q

The 4 P’s

A
  • Passage* = Pelvis
  • Cartilage –stretches b/w pelvic bones
  • Passenger* = Fetus / Baby
  • Powers* =

—>Primary - Uterine Contractions

—>Secondary - Maternal pushing efforts

  • Psyche*
  • Therapeutic communication - “Build Trust”
  • Anxiety can halt dilation
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6
Q

Cephalopelvic Disproportion (CPD)

A
  • Fetal head = larger than maternal pelvis
  • Slows doen labor progression
  • Inhibits fetal descent

(possible c-section)

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7
Q

Passanger molding

A

-Suture & Fontanels allow fetal skull to reshape & fit thru pelvis

(Normal shape resumes after 24hrs)

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8
Q

Vertex presentation

A

Delivery = head comes out first.

normal

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9
Q

Breech presentation

A

birth position = butt / feet come down 1st

Variations—-

  • Frank = Legs up by shoulders
  • Full = Normal except butt first
  • Footlong = one/both feet 1st
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10
Q

Transverse lie

A

Fetus laying sideways

cannot descend

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11
Q

Fetal attitude

A
  • Relationship of fetal body parts to one another
  • Vertex = most ideal (Flexed)

BAD ATTITUDES

  • Sinciput = military
  • Brow
  • Face
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12
Q

What are primary and secondary powers?

A
  • Primary* = uterine contractions
  • Secondary* = Maternal pushing efforts

(Every contraction OPENS & THINS the cervix)–stretch

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13
Q

Contraction duration

A
  • Beginning to end of one contraction
  • Use range
  • Assess in seconds

APEX = peak of contraction

60-90 seconds = normal

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14
Q

Contraction Intensity

A
  • External monitor (assess by palpation)
  • Internal monitor (peak - baseline = intensity)

—->Risk = hemorrhage // puncture uterus

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15
Q

Contraction Frequency

A

-Beginning to Beginning of each contraction

2-3 min = ideal

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16
Q

Which part of uterus actively contracts?

A

Upper 2/3rd

Fundus

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17
Q

What part of uterus is passive?

A

Lower 3rd & cervix

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18
Q

During labor which segment of the uterus becomes thicker/thinner?

A
  • Thicker = upper segment (Fundus)
  • Thinner = Cervix

—-> Gets pulled upward too

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19
Q

What does the psyche consist of?

A
  • Preparation
  • Anxiety
  • Energy
  • Support system
  • Culture
  • Beliefs
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20
Q

Measurements

Dilation, Effacement, Fetal Station

A
  • Dilation = cm
  • Effacement (thinning of cervix) = % —– (0% , 50% , 100%)
  • Fetal Station = + or -

—–> ( -3, -2, -1, 0, +1, +2, +3)

positive means baby is on way out

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21
Q

True Labor

A
  • Regular contraction frequency
  • Low back pain moves to front or just back pain
  • Walking / Activity will increase intensity
  • Increase in duration & frequency
  • CERVICAL CHANGE
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22
Q

False Labor

A
  • Irregular contraction frequency
  • Menstrual like cramps
  • Walking / Activity gives relief
  • Duration & frequency (stays same / goes away)
  • NO CERVICAL CHANGE

(after 2-3 hrs)

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23
Q

Rupture of membranes (ROM)

what does mom assess for?

A

(water breaks)

  • T* - time (approx)
  • A* - Amount
  • C* - Color (cloudy / clear)
  • —> Green = meconium / yellow = urine
  • O* - odor (earthy / semen like)
  • —-> stinky (infection) // Ammonia (urine)
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24
Q

SROM

A

spontaneous rupture of membranes

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25
Q

AROM

A

artificial rupture of membranes (Finger / amniohook)

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26
Q

What is the 1st thing the nurse assesses for with ROM?

A

Fetal Heart Rate (FHR)

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27
Q

Normal baseline fetal heart rate?

A

110-160 bpm

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28
Q

What would cause the FHR to be bradycardic?

A

(below 110 bpm)

  • Maternal drugs (depressants)
  • Prolonged fetal hypoxia (low O2)
29
Q

What would cause the FHR to be tachycardic?

A

(above 160 bpm)

  • Maternal fever / drugs (stimulants)
  • Prolonged fetal hypoxia (low O2)
30
Q

Absent Variability (FHR)

A
  • No detectable variation
  • placental insufficiency
  • meds from mom
  • baby sleeping

(GET MOM TO MOVE FOR ALL)

20 min limit or C-Section

31
Q

Minimal variability (FHR)

A

(2-5 bpm)

  • Baby sleeping
  • Sedation for mom
32
Q

Moderate Variability (FHR)

A

(6-25 bpm)

-Normal / Good

33
Q

Marked Variability (FHR)

A

(over 25 bpm)

  • O2 PROBLEM
  • Baby struggling to survive

(Like drowning)

-Jerking movements, then nothing

34
Q

What do Acels and decels tell us?

A

V- Variable decels C - Cord compression

E- Early decels H - Head (yay)

A- Accellerations O - Oxygenation (OK)

L- Late Decels (Bad) P- Placental insufficiency

35
Q

VEAL

A

V- Variable decels

E- Early decels

A- Accellerations

L- Late Decels (Bad)

36
Q

CHOP

A

C- Cord compression

H- Head compressions

O- Ok

P- Placental insuf. (reposition)

37
Q

What would an acel look like?

A
  • Atleast 15 bpm & last atleast 15 seconds

- BABY = well oxygenated

38
Q

What would a variable decel look like?

A
  • Abrupt / sudden dips
  • Baby did something to cut off circulation
  • Reposition mom
  • Start O2
  • If continuous, TOONDA
39
Q

Nursing Interventions for variable and late decels?

A

T - urn pt

O- xygenate

O- pen IV main line —> Bolus (18 gauge)

N- otify DR

D- ocument

A- ssess –>warm water delivered to bby 4 cushion

—> amnioinfusion (water broke / thick meconium)

40
Q

What is a late decel?

A
  • Gradual decrease in FHR, reutrns to baseline after contraction
  • Placental insufficiency—> inadequate perfusion
  • Not resolved with TOONDA, & remains consistent = c-section
41
Q

Nurse intervention specific for late decel?

A

-Turn off pitocin, then TOONDA

42
Q

postpartum assessment

A

I-B-U-B-B-L-E H-E-R

I: ID / IV / Introduce

B: Breasts

U: Uterine fundus

B: Bladder function

B: Bowel function

L: Lochia

E: Episiotomy (Perineum)

H: Homan’s sign (legs) / Hemorrhoids

E: Emotions

R: Rhogam / Rubella

43
Q

Breasts

A
  • Assess–> Inspect, Palpation, Nipples, Discomfort
  • Self exam
  • Engorgement relief (warm- breast-feeding/cold- non -breast feeding)
  • Milk production
  • Breast feeding —How do I know baby is getting enough milk? —-> How many pees/poops does baby have?

(7-8 wet diapers w/i 24 hrs)

44
Q

Uterus

A

-Firm vs. Boggy

(if boggy massage)

-s/s of infection (Painful, foul discharge, fever)

45
Q

Bladder

A
  • kegals
  • no tubs, jacuzzis, pools (Infection)
  • wipe front to back
  • void every few hours
46
Q

lochia

A

-postpartum vaginal bleeding

(4-6 weeks after childbirth)

  • Scant, light, moderate, heavy
  • Rubra, Serosa, Alba
  • odor = infection
  • Retained placenta = clots/ continuous bleeding

DO NOT WANT TO FILL A PAD IN AN HOUR

47
Q

What is REEDA?

A

Assessment of perineum area

R=redness

E=edema or swelling

E=echimosis or bruising

D=discharge / drainage

A=approximation - how well the incision is healing

(SIMS / side lying)

48
Q

Post partum blues

A
  • lasts 2-3 weeks
  • immediate postpartum period
  • emotional, irritable, mood swings
  • Teach support person to monitor for signs & progression into depression
49
Q

Rhogam

A
  • (+) - = Good
  • (+) + = Bad —-> Need rhogam

(mom - & baby +)

Protects mom from future miscarriages

Give @ 26 wks, accident occurs, or if baby = +

50
Q

Rubella

A

German measles

  • live vaccine
  • No sex—> can transmit to fetus
51
Q

stages of labor

A
  • Stage 1*
  • Latent (0-3 cm cervical dilation)

—->Excited, ambulate, menstural cramps

  • Active (4-7 cm cervical dilation)

—–> pain, bloody show, baby’s head moves down

  • Transitional (8cm - to complete)

—–> PRESSURE, feel urge to push, water therapy,

  • (NO MEDS AFTER 7CM)*
  • Stage 2*
  • Complete dilation - birth

—–>Breathing, undeniable urge to push

  • Stage 3*
  • Placenta delivery (cord = 1V, 2A)
  • Stage 4*
  • Recovery (2 hours)—- vitals Q15min, assess bleeding, mom/baby bonding
52
Q

Pain Medications for mom

A
  • Watch baby’s variability
  • Baby comes out floppy (don’t know if its bc meds or not)
  • always want non-pharm first!

(tub, breathing, ambulating, walking, aromatheray)

Epidural Give full liter bolus 1 hr before (Drops BP).

53
Q

estimated blood loss (EBL)

A
  • Over 500 mL = vaginal hemorrhage

- Over 1,000 mL = c-Section hemorrhage

54
Q

What does nurse assess for w/ a normal newborn post-partum?

A
  • Match bands = tightness
  • Vitals = not while crying
  • Color = pink
  • Skin = integrity
  • Cord= clamped
  • Circumcision = (Vitamin k, consent form, already peed, ID BABY!)
  • Reflexes
55
Q

Normal Newborn Vitals

A

HR = 120-160

Respiration = 30-60

Temperature = 97.7 - 99.5

(low put baby skin 2 skin)

Feet / hands = blue = accrocyonisis

56
Q

Apgar scale

A

appearance

pulse

grimace

activity

respiration

highest = 10

57
Q

When do we cut umbilical cord?

A

30 sec - 1 min

58
Q

newborn reflexes (7)

A
  • Sucking (rooting)
  • Swallowing
  • Grasp (Palmar / Plantar)
  • Extrusion (tongue sticks out)
  • Tonic neck (fencing)
  • Moro Reflex (falling -arms out)
  • Babinski (Toes fan with #7 on foot)
  • Indicates*= if neuro functioning properly
59
Q

Baby must pee & poop before going home

A

-Pee = 1st 24 hrs (Save and weigh)

——> before and after circumcision

-Poop= before go home

60
Q

Mandatory Newborn Screening

A
  • PKU
  • Hearing test
  • CCHD—-> Coronary heart disease (pulse ox on hand and foot)
  • Bilirubin test
  • Hepatitis vaccine
61
Q

Bilirubin Baby interventions

A
  • Yellow skin, eyes, lips, tongue // won’t eat, pee // lethargic**
  • Feed often (What goes in must come out)
  • Monitor feces output
  • Phototherapy (UV)
62
Q

Mastitis

A

Breast infection—> infected milk duct

  • flu like symptoms
  • Not nursing enough!
63
Q

Nutrition and newborn

A

Alignment = Nose to Nipple/Breast

  • Nipple ends up at soft back pallet
  • crying = last sign of hunger (rooting, searching)
  • Count dirty/wet diapers to know if baby is getting enough

(7-8 wet diapers in 24 hrs)

64
Q

What is PID?

A

(Pelvic Inflammatory Disease)

  • Scaring of falopian tubes / ovaries
  • Causes = STDS (G & C), Staphlococcal, Streptococcal
  • S/S= silent; dull steady pain, chills, fever, dysuria (pain), foul smell w/ discharge, dysparenuria (painful intercourse)
  • Complications = ectopic PG, Chronic discomfort, infertility, systemic shock
65
Q

GTPAL

A

G ravida

T erm

P reterm

A bortions

L iving

66
Q

What are the 3 Psychological changes during the postpartum period?

A
  1. taking in– about mom
  2. taking hold– about baby
  3. letting go– home/reality
67
Q

Signs before labor

A
  • Fetal lightening (baby descends-mom can breathe)
  • Loss of mucous plug (bloody mucous)
  • Nesting
  • Lose 1/2 pounds
  • Braxton hicks / false contractions
68
Q

Breathing at Birth- Physiological Processes

A
  1. Mechanical
    - birth canal compresses (air in)
    - Lungs recoil (air out)
  2. Chemical
  3. Thermal
    - Temp. (cold) sudden change at birth stimulates crying (breathing)
    - Flexion generates warmth
  4. Sensory
    - Tactile (skin 2 skin)
    - cold
    - sound
    - light

NUR 209 - Maternaty (7 decks)

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