Test 2 Flashcards
Episiotomy / Laceration
Posterolateral-more painful, longer to heal, less chance of tearing to rectum.
Median-less painful, risk of tearing to rectum
Amniotomy
artificial rupture of membranes-document time, color of fluid, odor, amount; monitor FHR (cord prolapse)
pH of amniotic fluid = alkaline - (pH paper yellow to blue) **- **ferning is definitive
IOL
(induction of labor)
- assess BP and pulse frequently
- record I&O
- H/A, blurred vision, behavior change, increased BP, respirations
- assess for uterine atony post-partum, jaundice of NB
Operative/Assisted Birth
-forceps, vacuum extractor
–increased risk of injury for both mother and NB
- Mom: lacerations, hematomas of vagina
- Baby: ecchymosis, facial/scalp lacerations/abrasions, cephalohematomas, intracranial or subgaleal bleed
C-Section
- catheter
- type & cross
- baby out STAT bf anesthesia affects it
- pre-op meds: anti-emetics, bicitra (antacid), atropine (post-op N/V), antibiotics
- Low, transverse-heals better, less likely to rip, can have VBAC
- Low, vertical-can be extended upward to make larger incision if needed, more likely to rupture during subsequent birth
- Classical (verticla, up higher)-most likely of incisions to rupture during subsequent births, elimnates VBAC.
Post-C-Section
- assess: fundus, lochia, dressing, urine output, consciousness, gag reflex, pain, airway
- SCD’s for DVT (more clotting factors, immobile)
- promote bonding with infant
Leopold’s Maneuvers
- empty bladder
1. palpate fundus (moving the baby’s bottom moves it’s entire trunk, conversely, if the head is at the fundus-moving it will not move trunk)
2. palpate sides-determine posiiton of back
3. palpate suprapubic area-attempt to grasp presenting part (possible only if it is not engaged)
4. determine whether head is flexed (vertex, normal) or extended (face)
Passenger Presentation
- Right or Left
- presenting part (Occiput or Sacrum)
- Anterior or Posterior (refering to mother)
ROA or LOA is easer
RSA or LSA is breech (no fetal scalp electrode possible)
if ROP or LOP, mother complains of back pain, labor takes longer.
First Stage of Labor
Latent: reg contractions 3 cm (woman is usually sociable)
Active: 4-7 cm
Transitional-8-10 cm
Second Stage of Labor
Pushing!!!
10 cm until delivery
2 hours
perineal cleansing
document: time of ROM, baby, placenta, Apgar, Oxytocin, repairs, bleeding, pain, bonding, newborn resuscitation.
Third Stage of Labor
birth until placenta is delivered
administer oxytocin
care of infant: Apgar at 1 & 5 minutes, sucition as needed, thermoregulation, identification
watch for signs of placental separation (lengthening of cord, gush of blood, change in uterine shape)
document time and method of placental delivery (spontaneous, assisted, shiny/dirty)
Fourth Stage of Labor
1-4 hours post-delivery
VS of mother, fundus, lochia, bladder, perineum, pain (return of sensation)
promote bonding
promote comfort
Station
-5 (highest) to +5 (lowest)
references postion above or below ischial spine
Involution of Uterus
- return to pre-pregnancy state
- just after delivery, fundus should be at level of umbilicus
- normal size is fist
- risk of infection-no sex, baths; watch for fever, foul odor, increased bleeding
- excessive bleeding-massage fundus
- normal blood loss (vaginal) is 500 mL; ceseraian is 1000 mL
- cervical os will be slit and will never return to pre-preg
Lochia
- Rubra
- Serosa (second week)
- Alba (3 weeks)
REEDA
Episiotomy/Laceration:
- Redness
- Edema
- Ecchymosis
- Discharge, Drainage
- Approximation
Post-Partum Endocrine
- ovulation/menstruation return 7-9 weeks (delayed if breastfeeding-maks ovulation)
- Lactation: prolactin and oxytocin
- weight loss-10-12 lbs (from birth), additional 5-8 lb early post-partum
- WBCs will be elevated by labor
- 50-80% have post-partum blues, if lasts more than 2 wks-concern (neglecting baby or self)
Post-Partum Assessment
B-Breast
U-Uterus
B-Bladder
B-Bowel
L-Locia
E-Episiotomy/incision
H-Homan’s Sign (DVTs-pain, edema, redness)
E-Emotional support-PP blues
C-Section: add bowel sounds before food, breath sounds
APGAR
1 minute and 5 minutes
A-Activity (arms/legs flexed =1) (active=2)
P-Pulse (below 100=1, above 100=2)
G-Grimace (grimace=1, reflex irritability=2)
A-Appearance (skin color-acrocyanosis=1, normal=2)
R-Respirations (slow, irregular=1, spontaneous with strong, lusty cry=2) (30-60)
Vital Signs-Newborn
- Q6-8hr
- Heart Rate = 120-160
-Respirations = 30-60 (may be 60-70 initially)
-Glucose 40-60 first day, 50-90 afer that (signs of hypoglycemia-jittery, tremors, hypotonia, low temp)
-Temperature 36.5-37.5 (97.7-99.4)
-Bilirubin <12 mg; treat for 15-20; concern (Kernicterus-neurological condition) >20 for term baby, >12 for pre-term. Breastfeeding jaundice-late onset (3-5 days lasts 3 wks) levels 20-25 (Kernicterus not noted)
-BP 65-95/30-60 (crying increases by 20 mmHg)
Heat Loss
- conduction=loss to object touching baby
- convection=loss to surrounding air
- radiation=loss to object at greater distance (window nearby)
- evaporation
Heat production-nonshivering thermogenesis; metabolism of brown fat (sympathetic nervous system); increased metabolic rate.
Cold stress leads to: hypoglycemia, weight loss, respiratory distress, hyperbilirubinemia
Mandatated Metabolic Screenings
- PKU
- Galactosemia-unable to metabolize galactose
- Hypothyroidism
- Sickle Cell
Infant Lung Maturity
- Increased by: intrauterine growth restriction, maternal HTN, prolonged ROM, maternal administration of steroids
- Decreased by: maternal diabetes
Hypoglycemia-Infant
Risk factors: pre-maturity, post-maturity, cold stress, maternal diabets, maternal intake of terbutaline (causes hypergylcemia in the mother).
