Test 1 B Flashcards
Hemoglobin (Pregnant)
atleast 10.5 g/dl
(normal = 12-16 g/dl)
-If low do not give transfusion first—> iron supplements / food
Hematocrit (Pregnant)
atleast 32%
normal = 32%-47%
White Blood Cells (Pregnant)
5,000 - 15,000
normal = 5,000 - 10,000
Platelets (Pregnant)
150,000 - 400,000
same as normal
The 4 P’s
- 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
Cephalopelvic Disproportion (CPD)
- Fetal head = larger than maternal pelvis
- Slows doen labor progression
- Inhibits fetal descent
(possible c-section)
Passanger molding
-Suture & Fontanels allow fetal skull to reshape & fit thru pelvis
(Normal shape resumes after 24hrs)
Vertex presentation
Delivery = head comes out first.
normal
Breech presentation
birth position = butt / feet come down 1st
Variations—-
- Frank = Legs up by shoulders
- Full = Normal except butt first
- Footlong = one/both feet 1st
Transverse lie
Fetus laying sideways
cannot descend
Fetal attitude
- Relationship of fetal body parts to one another
- Vertex = most ideal (Flexed)
BAD ATTITUDES
- Sinciput = military
- Brow
- Face
What are primary and secondary powers?
- Primary* = uterine contractions
- Secondary* = Maternal pushing efforts
(Every contraction OPENS & THINS the cervix)–stretch
Contraction duration
- Beginning to end of one contraction
- Use range
- Assess in seconds
APEX = peak of contraction
60-90 seconds = normal
Contraction Intensity
- External monitor (assess by palpation)
- Internal monitor (peak - baseline = intensity)
—->Risk = hemorrhage // puncture uterus
Contraction Frequency
-Beginning to Beginning of each contraction
2-3 min = ideal
Which part of uterus actively contracts?
Upper 2/3rd
Fundus
What part of uterus is passive?
Lower 3rd & cervix
During labor which segment of the uterus becomes thicker/thinner?
- Thicker = upper segment (Fundus)
- Thinner = Cervix
—-> Gets pulled upward too
What does the psyche consist of?
- Preparation
- Anxiety
- Energy
- Support system
- Culture
- Beliefs
Measurements
Dilation, Effacement, Fetal Station
- 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
True Labor
- Regular contraction frequency
- Low back pain moves to front or just back pain
- Walking / Activity will increase intensity
- Increase in duration & frequency
- CERVICAL CHANGE
False Labor
- Irregular contraction frequency
- Menstrual like cramps
- Walking / Activity gives relief
- Duration & frequency (stays same / goes away)
- NO CERVICAL CHANGE
(after 2-3 hrs)
Rupture of membranes (ROM)
what does mom assess for?
(water breaks)
- T* - time (approx)
- A* - Amount
- C* - Color (cloudy / clear)
- —> Green = meconium / yellow = urine
- O* - odor (earthy / semen like)
- —-> stinky (infection) // Ammonia (urine)
SROM
spontaneous rupture of membranes
AROM
artificial rupture of membranes (Finger / amniohook)
What is the 1st thing the nurse assesses for with ROM?
Fetal Heart Rate (FHR)
Normal baseline fetal heart rate?
110-160 bpm
What would cause the FHR to be bradycardic?
(below 110 bpm)
- Maternal drugs (depressants)
- Prolonged fetal hypoxia (low O2)
What would cause the FHR to be tachycardic?
(above 160 bpm)
- Maternal fever / drugs (stimulants)
- Prolonged fetal hypoxia (low O2)
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
Minimal variability (FHR)
(2-5 bpm)
- Baby sleeping
- Sedation for mom
Moderate Variability (FHR)
(6-25 bpm)
-Normal / Good
Marked Variability (FHR)
(over 25 bpm)
- O2 PROBLEM
- Baby struggling to survive
(Like drowning)
-Jerking movements, then nothing
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
VEAL
V- Variable decels
E- Early decels
A- Accellerations
L- Late Decels (Bad)
CHOP
C- Cord compression
H- Head compressions
O- Ok
P- Placental insuf. (reposition)
What would an acel look like?
- Atleast 15 bpm & last atleast 15 seconds
- BABY = well oxygenated
What would a variable decel look like?
- Abrupt / sudden dips
- Baby did something to cut off circulation
- Reposition mom
- Start O2
- If continuous, TOONDA
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)
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
Nurse intervention specific for late decel?
-Turn off pitocin, then TOONDA
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
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)
Uterus
-Firm vs. Boggy
(if boggy massage)
-s/s of infection (Painful, foul discharge, fever)
Bladder
- kegals
- no tubs, jacuzzis, pools (Infection)
- wipe front to back
- void every few hours
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
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)
Post partum blues
- lasts 2-3 weeks
- immediate postpartum period
- emotional, irritable, mood swings
- Teach support person to monitor for signs & progression into depression
Rhogam
- (+) - = Good
- (+) + = Bad —-> Need rhogam
(mom - & baby +)
Protects mom from future miscarriages
Give @ 26 wks, accident occurs, or if baby = +
Rubella
German measles
- live vaccine
- No sex—> can transmit to fetus
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
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).
estimated blood loss (EBL)
- Over 500 mL = vaginal hemorrhage
- Over 1,000 mL = c-Section hemorrhage
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
Normal Newborn Vitals
HR = 120-160
Respiration = 30-60
Temperature = 97.7 - 99.5
(low put baby skin 2 skin)
Feet / hands = blue = accrocyonisis
Apgar scale
appearance
pulse
grimace
activity
respiration
highest = 10
When do we cut umbilical cord?
30 sec - 1 min
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
Baby must pee & poop before going home
-Pee = 1st 24 hrs (Save and weigh)
——> before and after circumcision
-Poop= before go home
Mandatory Newborn Screening
- PKU
- Hearing test
- CCHD—-> Coronary heart disease (pulse ox on hand and foot)
- Bilirubin test
- Hepatitis vaccine
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)
Mastitis
Breast infection—> infected milk duct
- flu like symptoms
- Not nursing enough!
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)
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
GTPAL
G ravida
T erm
P reterm
A bortions
L iving
What are the 3 Psychological changes during the postpartum period?
- taking in– about mom
- taking hold– about baby
- letting go– home/reality
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
Breathing at Birth- Physiological Processes
- Mechanical
- birth canal compresses (air in)
- Lungs recoil (air out) - Chemical
- Thermal
- Temp. (cold) sudden change at birth stimulates crying (breathing)
- Flexion generates warmth - Sensory
- Tactile (skin 2 skin)
- cold
- sound
- light
