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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
AROM
artificial rupture of membranes (Finger / amniohook)
26
What is the 1st thing the nurse assesses for with ROM?
Fetal Heart Rate (FHR)
27
Normal baseline fetal heart rate?
110-160 bpm
28
What would cause the FHR to be bradycardic?
(below 110 bpm) - Maternal drugs (depressants) - Prolonged fetal hypoxia (low O2)
29
What would cause the FHR to be tachycardic?
(above 160 bpm) - Maternal fever / drugs (stimulants) - Prolonged fetal hypoxia (low O2)
30
Absent Variability (FHR)
- No detectable variation - placental insufficiency - meds from mom - baby sleeping (GET MOM TO MOVE FOR ALL) *20 min limit or C-Section*
31
Minimal variability (FHR)
(2-5 bpm) - Baby sleeping - Sedation for mom
32
Moderate Variability (FHR)
(6-25 bpm) -Normal / Good
33
Marked Variability (FHR)
(over 25 bpm) - O2 PROBLEM - Baby struggling to survive (Like drowning) -Jerking movements, then nothing
34
What do Acels and decels tell us?
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
VEAL
V- Variable decels E- Early decels A- Accellerations L- Late Decels (Bad)
36
CHOP
C- Cord compression H- Head compressions O- Ok P- Placental insuf. (reposition)
37
What would an acel look like?
- Atleast 15 bpm & last atleast 15 seconds | - BABY = well oxygenated
38
What would a variable decel look like?
- Abrupt / sudden dips - Baby did something to cut off circulation - Reposition mom - Start O2 - If continuous, TOONDA
39
Nursing Interventions for variable and late decels?
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
What is a late decel?
- Gradual decrease in FHR, reutrns to baseline after contraction - *Placental insufficiency*---> inadequate perfusion - Not resolved with TOONDA, & remains consistent = c-section
41
Nurse intervention specific for late decel?
-Turn off pitocin, then TOONDA
42
postpartum assessment
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
Breasts
- 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
Uterus
-Firm vs. Boggy (if boggy massage) -s/s of infection (Painful, foul discharge, fever)
45
Bladder
- kegals - no tubs, jacuzzis, pools (Infection) - wipe front to back - void every few hours
46
lochia
-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
What is REEDA?
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
Post partum blues
- lasts 2-3 weeks - immediate postpartum period - emotional, irritable, mood swings - Teach support person to monitor for signs & progression into depression
49
Rhogam
- (+) - = Good - (+) + = Bad ----> Need rhogam (mom - & baby +) Protects mom from future miscarriages Give @ 26 wks, accident occurs, or if baby = +
50
Rubella
German measles - live vaccine - No sex---> can transmit to fetus
51
*stages of labor*
* 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
Pain Medications for mom
- 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
estimated blood loss (EBL)
- Over 500 mL = vaginal hemorrhage | - Over 1,000 mL = c-Section hemorrhage
54
What does nurse assess for w/ a normal newborn post-partum?
- Match bands = tightness - Vitals = not while crying - Color = pink - Skin = integrity - Cord= clamped - Circumcision = (Vitamin k, consent form, already peed, ID BABY!) - Reflexes
55
Normal Newborn Vitals
HR = 120-160 Respiration = 30-60 Temperature = 97.7 - 99.5 (low put baby skin 2 skin) *Feet / hands = blue = accrocyonisis*
56
Apgar scale
appearance pulse grimace activity respiration highest = 10
57
When do we cut umbilical cord?
30 sec - 1 min
58
newborn reflexes (7)
- 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
Baby must pee & poop before going home
-Pee = 1st 24 hrs (Save and weigh) ------> before and after circumcision -Poop= before go home
60
Mandatory Newborn Screening
- PKU - Hearing test - CCHD----> Coronary heart disease (pulse ox on hand and foot) - Bilirubin test - Hepatitis vaccine
61
Bilirubin Baby interventions
* Yellow skin, eyes, lips, tongue // won't eat, pee // lethargic** - Feed often (What goes in must come out) - Monitor feces output - Phototherapy (UV)
62
Mastitis
Breast infection---> infected milk duct - flu like symptoms - Not nursing enough!
63
Nutrition and newborn
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
What is PID?
(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
GTPAL
G ravida T erm P reterm A bortions L iving
66
What are the 3 Psychological changes during the postpartum period?
1. taking in-- about mom 2. taking hold-- about baby 3. letting go-- home/reality
67
Signs before labor
- Fetal lightening (baby descends-mom can breathe) - Loss of mucous plug (bloody mucous) - Nesting - Lose 1/2 pounds - Braxton hicks / false contractions
68
Breathing at Birth- Physiological Processes
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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