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Nurs 144- Maternity > Week 2 Content > Flashcards

Week 2 Content Flashcards

1
Q
  • Intrauterine development ⚬ 3 Stages:

￭ Ovum/preembryonic
* Conception to day 14
* Cellular replication, blastocyst formation, initial development of embryonic membranes, primary germ layers

￭ Embryo
* Day ___ to 8 weeks after conception
* Development of orang systems (organogenesis) and external features
* Most susceptible to environmental teratogens

￭ Fetus

A

15

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2
Q

Membranes
⚬ Chorion - covering of fetal side of placenta
⚬ Amnion - amniotic cavity

A

⚬ Chorion - covering of fetal side of placenta
⚬ Amnion - amniotic cavity

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3
Q
  • _________ fluid
    ⚬ Initially diffusion from maternal blood
    ⚬ Fluid secreted by fetal respiratory and GI tract
    ⚬ 700-1,000 mL at term
    ⚬ < 300 mL oligohydramnios
    ⚬ > 2,000 mL (poly)hydramnios
A

Amniotic

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4
Q
  • Umbilical cord
    ⚬ Supplies the embryo with maternal ___________ & __________
    ⚬ vessels : ________
    ⚬ Wharton’s jelly
    ⚬ Nuchal cord
A

⚬ Supplies the embryo with maternal nutrients and oxygen
⚬ 2 arteries, 1 vein
⚬ Wharton’s jelly
⚬ Nuchal cord

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5
Q

Placenta

Function
⚬ Endocrine gland
￭ Produces ____________ to maintain pregnancy
⚬ Metabolic function
￭ ____________, nutrition, excretion, and storage
* Has a finite life - the placenta ages

A

⚬ Endocrine gland
￭ Produces hormones to maintain pregnancy
⚬ Metabolic function
￭ Respiration, nutrition, excretion, and storage
* Has a finite life - the placenta ages

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6
Q

Non-genetic Factors Influencing Development

  • ______________
    ⚬ Drugs
    ⚬ Chemicals
    ⚬ Infection
    ⚬ Exposure to radiation
    ⚬ Maternal conditions
  • Maternal nutrition
    ⚬ ____________
A
  • Teratogens
    ⚬ Drugs
    ⚬ Chemicals
    ⚬ Infection
    ⚬ Exposure to radiation
    ⚬ Maternal conditions
  • Maternal nutrition
    ⚬ Malnutrition
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7
Q

Reproductive System Changes - Uterus

⚬ Palpation
￭ Palpated at level of the umbilicus at 20 weeks gestation
￭ Reaches the level of the xiphoid process by 36 weeks
⚬ Helps to confirm ____________________________

  • Uteroplacental blood flow
  • Changes related to presence of fetus
    ⚬ Ballottement
    ⚬ Quickening
A

the estimated date of delivery (EDD or EDB)

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8
Q

Reproductive System Changes - Cervix

signs of pregnanct

  • _________ sign - softening of cervix
  • ___________ sign - blue vagina/cervix
  • _________ fills the cervical canal and protects the fetus from infection - operculum
A
  • Goodell sign - softening of cervix
  • Chadwick’s sign - blue vagina/cervix
  • Mucous fills the cervical canal and protects the fetus from infection - operculum
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9
Q

Reproductive System Changes - Breasts

  • Breasts change in size and appearance.
  • _________ stimulates growth of mammary tissue.
  • ____________ stimulates growth of lobes, lobules, and alveoli.
  • __________ present at 12-16 weeks
A
  • Breasts change in size and appearance.
  • Estrogen stimulates growth of mammary tissue.
  • Progesterone stimulates growth of lobes, lobules, and alveoli.
  • Colostrum present at 12-16 weeks
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10
Q

Cardiovascular System

  • Blood volume
    ⚬ _________
    ￭ Plasma volume expansion results in physiologic anemia.
  • Cardiac output
  • Blood pressure
    ⚬ Expanded blood volume increases _____________ but not blood pressure
    ⚬ Venous pressure
    ⚬ Supine hypotensive syndrome
    ￭ Gravid uterus partially occludes the vena cava and aorta when mother is supine.
  • Structural adaptations
    ⚬ Changes related to ___________ workload of the heart and size of the uterus
    ⚬ S1, S2, and potential S3 present
  • Increase in ________ factors and fibrinogen
A
  • Blood volume
    ⚬ Increases
    ￭ Plasma volume expansion results in physiologic anemia.
  • Cardiac output
  • Blood pressure
    ⚬ Expanded blood volume increases cardiac output but not blood pressure
    ⚬ Venous pressure
    ⚬ Supine hypotensive syndrome
    ￭ Gravid uterus partially occludes the vena cava and aorta when mother is supine.
  • Structural adaptations
    ⚬ Changes related to increased workload of the heart and size of the uterus
    ⚬ S1, S2, and potential S3 present
  • Increase in clotting factors and fibrinogen
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11
Q

Respiratory System

  • Diaphragm changes
  • Slight hyperventilation and decreased airway resistance allow oxygen needs to be met.
  • Oxygen consumption increases by about ____%
    ⚬ ______ of this oxygen is used by the uterus, fetus, and placenta.
    ⚬ The remainder is consumed by breast tissue and increased cardiac, renal, and respiratory
    maternal demands.
  • Maternal symptoms
    ⚬ _______ congestion - Rhinitis of pregnancy
    ￭ Cause of pregnancy-induced nasal symptoms is not entirely understood
    ￭ Thought to be caused by changing hormone levels: estrogen and progesterone.
A
  • Diaphragm changes
  • Slight hyperventilation and decreased airway resistance allow oxygen needs to be met.
  • Oxygen consumption increases by about 20%
    ⚬ Half of this oxygen is used by the uterus, fetus, and placenta.
    ⚬ The remainder is consumed by breast tissue and increased cardiac, renal, and respiratory
    maternal demands.
  • Maternal symptoms
    ⚬ Nasal congestion - Rhinitis of pregnancy
    ￭ Cause of pregnancy-induced nasal symptoms is not entirely understood
    ￭ Thought to be caused by changing hormone levels: estrogen and progesterone.
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12
Q

GI System

  • Mouth - hyperemia of ______
  • Effects of prenangy hormones
    ⚬ _________
    ⚬ Relaxation of esophageal sphincter
    ⚬ Nausea/vomiting
  • Stomach displacement
  • Hypotonic gallbladder
A
  • Mouth - hyperemia of gums
  • Effects of prenangy hormones
    ⚬ Pyrosis
    ⚬ Relaxation of esophageal sphincter
    ⚬ Nausea/vomiting
  • Stomach displacement
  • Hypotonic gallbladder
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13
Q

Urinary System

  • ________ workload
  • Physical changes
    ⚬ __________ on the ureters and bladder due to the growing fetus
  • Risk factors
    ⚬ Increased risk for ________________
    ￭ UTI and kidney infections are one of the most common reasons for non-OB hospitalizations
  • Increased glomerular filtration rate may result in spilling of glucose and other nutrients into the urine.
A
  • Heavier workload
  • Physical changes
    ⚬ Pressure on the ureters and bladder due to the growing fetus
  • Risk factors
    ⚬ Increased risk for urinary tract infections
    ￭ UTI and kidney infections are one of the most common reasons for non-OB hospitalizations
  • Increased glomerular filtration rate may result in spilling of glucose and other nutrients into the urine.
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14
Q

Integumentary, Musculoskeletal, & Neurologic System

  • ______________ during pregnancy - melasma, striae gravidarum, and linea nigra.
  • Ribs flare, substernal angle widens, and chest circumference increases.
  • Muscle strain and __________ may occur during the last trimester.
  • Changes in the maternal body may result in a negative body image.
  • Maternal symptoms
    ⚬ Increased sense of ________
    ⚬ ________ in hands and feet
A
  • Hyperpigmentation during pregnancy - melasma, striae gravidarum, and linea nigra.
  • Ribs flare, substernal angle widens, and chest circumference increases.
  • Muscle strain and backache may occur during the last trimester.
  • Changes in the maternal body may result in a negative body image.
  • Maternal symptoms
    ⚬ Increased sense of smell
    ⚬ Edema in hands and feet
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15
Q

Endocrine System

  • Thyroid
  • Pituitary
    ⚬ Anterior
    ￭ Prolactin - prepares breasts for ___________
    ⚬ Posterior
    ￭ Oxytocin
  • Stimulates uterine __________
  • Stimulates ______ ________ from breasts after birth
  • Stimulates let-down reflex
  • Pancreas
A
  • Thyroid
  • Pituitary
    ⚬ Anterior
    ￭ Prolactin - prepares breasts for lactation
    ⚬ Posterior
    ￭ Oxytocin
  • Stimulates uterine contractions
  • Stimulates milk ejection from breasts after birth
  • Stimulates let-down reflex
  • Pancreas
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16
Q
  • 4 hormones necessary to maintain pregnancy & support embryo/fetus

⚬ Human chorionic gonadotropin (hCG)
￭ Preserves the function of the ovarian corpus luteum
￭ Ensures a continued supply of estrogen and progesterone needed to maintain pregnancy
- up to 8th week.
￭ Hormone identified in pregnancy tests

⚬ Human chorionic somatomammotropin (hCS) or human placental lactogen (hPL)
￭ Stimulates maternal metabolism to supply needed nutrients for fetal growth.
￭ Increases the resistance to insulin
* Facilitates glucose transport across the placental membrane
￭ Stimulates breast development
* Prepares for lactation - 2nd trimester

⚬ Progesterone
￭ Maintains the endometrium, decreases the contractility of the uterus, and stimulates
maternal metabolism and development of breast alveoli

⚬ Estrogen
￭ Stimulates uterine growth and uteroplacental blood flow, causes proliferation of the breast
glandular tissue, stimulates myometrial contractility.

A

______________________
￭ Preserves the function of the ovarian corpus luteum
￭ Ensures a continued supply of estrogen and progesterone needed to maintain pregnancy
- up to 8th week.
￭ Hormone identified in pregnancy tests

______________________
￭ Stimulates maternal metabolism to supply needed nutrients for fetal growth.
￭ Increases the resistance to insulin
* Facilitates glucose transport across the placental membrane
￭ Stimulates breast development
* Prepares for lactation - 2nd trimester

______________________
￭ Maintains the endometrium, decreases the contractility of the uterus, and stimulates
maternal metabolism and development of breast alveoli

______________________
￭ Stimulates uterine growth and uteroplacental blood flow, causes proliferation of the breast
glandular tissue, stimulates myometrial contractility.

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17
Q
  • Increased human chorionic gonadotropin (hCG) and estrogen levels may cause nausea in early pregnancy.
  • Increased progesterone causes relaxation of smooth muscle, resulting in stasis of urine and constipation.
  • ___________ maintains the uterine lining, prevents contractions, and helps prepare breasts for lactation.
A

Progesterone

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18
Q
  • Diagnosis of Pregnancy
    ⚬ ___________________________ - earliest biochemical marker of pregnancy
    ￭ Pregnancy tests based on recognition of hCG or β subunit of hCG
    ￭ Can be detected in serum or urine as early as 7 to 8 days after ovulation
A

Human chorionic gonadotropin (hCG)

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19
Q

Estimating date of birth (EDB)
⚬ Formulas for calculating EDB but none infallible
⚬ _________ rule
￭ Determine first day of last menstrual period (LMP), subtract 3 months, add 7 days plus 1 year
￭ Alternatively add 7 days to LMP and count forward 9 months

A

⚬ Formulas for calculating EDB but none infallible
⚬ Nägele’s rule
￭ Determine first day of last menstrual period (LMP), subtract 3 months, add 7 days plus 1 year
￭ Alternatively add 7 days to LMP and count forward 9 months

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20
Q

Patient 1: LMP is reported to be February 14, 2024.
What is the EDB?

Patient 2: LMP is reported to be October 1, 2023.
What is the EDB?

Patient 3: LMP is reported to be June 28, 2024.
What is the EDB?

A
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21
Q

________

G = Gravida: the number of pregnancies, including this one

T = Term: the number of pregnancies that ended in term births (37 weeks 0 days and beyond; including early, full, late term, or postterm births)

P = Preterm: the number of pregnancies that ended in preterm birth (between 20 weeks 0 days and 36 weeks 6 days gestation)

A = Abortion: the number of pregnancies that ended in miscarriage (spontaneous abortion), elective termination (therapeutic abortion) before 20 weeks or less than 500 g at birth

L = Living: the number of children currently living

A

GTPAL

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22
Q
  • ___________ – may be pregnant
    ⚬ Subjective changes felt by the woman (patient)
    ⚬ Amenorrhea
    ⚬ Nausea and vomiting
    ⚬ Fatigue
    ⚬ Urinary frequency
    ⚬ Breast and skin changes
    ⚬ Vaginal and cervical color changes
    ⚬ Fetal movement/Quickening
A

Presumptive

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23
Q
  • ________ - very likely pregnant

⚬ Changes observed by an __________ (MD, Midwife, Nurse)
⚬ Goodell/Chackwick/Hegar’s sign
⚬ Positive pregnancy tests
⚬ Braxton Hicks
⚬ Ballottement

A

Probable - very likely pregnant

⚬ Changes observed by an examiner (MD, Midwife, Nurse)
⚬ Goodell/Chackwick/Hegar’s sign
⚬ Positive pregnancy tests
⚬ Braxton Hicks
⚬ Ballottement

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24
Q
  • ________ - surely pregnant
    ⚬ Attributed to presence of the _______
    ⚬ Auscultation of fetal ______ sounds
    ⚬ Fetal ___________ felt by examiner
    ⚬ Visualization of fetus (__________)
A
  • Positive - surely pregnant
    ⚬ Attributed to presence of the fetus
    ⚬ Auscultation of fetal heart sounds
    ⚬ Fetal movements felt by examiner
    ⚬ Visualization of fetus (ultrasound)
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25
Q
  • Maternal adaptation
    ⚬ Accepting the pregnancy
    ⚬ Identifying with the mother role
    ⚬ Reordering personal relationships
    ⚬ Establishing a relationship with fetus
    ￭ Emotional attachment
    ⚬ Preparing for childbirth
A

⚬ Accepting the pregnancy
⚬ Identifying with the mother role
⚬ Reordering personal relationships
⚬ Establishing a relationship with fetus
￭ Emotional attachment
⚬ Preparing for childbirth

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26
Q
  • Partner adaptation
    ⚬ Accepting the pregnancy
    ￭ Three phases – announcement, moratorium, focusing
    ⚬ Identifying with parental role
    ⚬ Reordering personal relationships
    ⚬ Establishing relationship with fetus
    ⚬ Preparing for childbirth
    ￭ Couvade syndrome
  • Siblings: Toddlers, Older Children, Adolescents
A

⚬ Accepting the pregnancy
￭ Three phases – announcement, moratorium, focusing
⚬ Identifying with parental role
⚬ Reordering personal relationships
⚬ Establishing relationship with fetus
⚬ Preparing for childbirth
￭ Couvade syndrome
* Siblings: Toddlers, Older Children, Adolescents

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27
Q
  • Initial prenatal visit: interview
    ⚬ Current pregnancy
    ⚬ Childbearing and reproductive history
    ⚬ Health history
    ⚬ Nutrition history
    ⚬ History of drug use and herbal preparations
    ⚬ Family history
    ⚬ Social, experiential, and occupational history
    ⚬ Mental health history
    ⚬ History of physical abuse/risk
    ⚬ Review of systems
    ⚬ Physical exam
    ⚬ Laboratory tests
A

⚬ Current pregnancy
⚬ Childbearing and reproductive history
⚬ Health history
⚬ Nutrition history
⚬ History of drug use and herbal preparations
⚬ Family history
⚬ Social, experiential, and occupational history
⚬ Mental health history
⚬ History of physical abuse/risk
⚬ Review of systems
⚬ Physical exam
⚬ Laboratory tests

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28
Q
  • Goal of prenatal care is to promote the health and wellbeing of the pregnant woman, the fetus, the newborn, and family
  • Emphasis on ____________ care and optimal self-care
  • _________ care is sought routinely by women of middle or high socioeconomic status
A
  • Goal of prenatal care is to promote the health and wellbeing of the pregnant woman, the fetus, the newborn, and family
  • Emphasis on preventive care and optimal self-care
  • Prenatal care is sought routinely by women of middle or high socioeconomic status
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29
Q
  • Women in poverty or lacking health insurance may not have ________ to public or private care
    ⚬ Lack of ___________ sensitive care and communication interferes with access to care
    ⚬ __________ women may not seek prenatal care
    ⚬ Birth outcomes are less positive with higher rates of maternal and newborn complications
    ⚬ Problems with low birth rate and infant mortality associated with inadequate prenatal care
A
  • Women in poverty or lacking health insurance may not have access to public or private care
    ⚬ Lack of culturally sensitive care and communication interferes with access to care
    ⚬ Immigrant women may not seek prenatal care
    ⚬ Birth outcomes are less positive with higher rates of maternal and newborn complications
    ⚬ Problems with low birth rate and infant mortality associated with inadequate prenatal care
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30
Q
  • Barriers to obtaining prenatal care include:
    ⚬ Lack of motivation to seek care
    ⚬ Inadequate finances
    ⚬ Lack of transportation
    ⚬ Unpleasant clinic personnel
    ⚬ Unpleasant facilities or procedures
    ⚬ Inconvenient clinic hours
    ⚬ Problems with child care
    ⚬ Personal and cultural attitudes
A

⚬ Lack of motivation to seek care
⚬ Inadequate finances
⚬ Lack of transportation
⚬ Unpleasant clinic personnel
⚬ Unpleasant facilities or procedures
⚬ Inconvenient clinic hours
⚬ Problems with child care
⚬ Personal and cultural attitudes

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31
Q
  • Follow-up visits ⚬ Interview
    ⚬ Physical examination
    ￭ Vital signs, height/weight
    ⚬ Fetal assessment
    ￭ Fundal height
    ￭ Fetal heart tones
    ￭ Gestational age
    ￭ Health status
    ￭ Laboratory tests
  • Clean catch urine
  • Multiple-marker or triple-screen blood test
  • Other blood tests (RPR/VDRL, CBC, anti-Rh)
    ￭ Other tests * Ultrasonography * Amniocentesis
  • Group B streptococcus between 35 - 37 weeks gestation
A

⚬ Physical examination
￭ Vital signs, height/weight
⚬ Fetal assessment
￭ Fundal height
￭ Fetal heart tones
￭ Gestational age
￭ Health status
￭ Laboratory tests
* Clean catch urine
* Multiple-marker or triple-screen blood test
* Other blood tests (RPR/VDRL, CBC, anti-Rh)
￭ Other tests * Ultrasonography * Amniocentesis
* Group B streptococcus between 35 - 37 weeks gestation

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32
Q

⚬ Frequency of follow-up visits
￭ 0-28 wks q 4, 29-35 q 2-3, 36+ weekly
￭ Centering Pregnancy – start 12-18 wks q month x 4 months then weekly

A

￭ 0-28 wks q 4, 29-35 q 2-3, 36+ weekly
￭ Centering Pregnancy – start 12-18 wks q month x 4 months then weekly

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33
Q
  • Nursing interventions
    ⚬ Education about maternal and fetal changes
    ⚬ Education for self-management
    ￭ Nutrition
    ￭ Personal hygiene
    ￭ Prevention of urinary tract infections
    ￭ Kegel exercises
    ￭ Preparation for breastfeeding newborn
    ￭ Dental health
A

⚬ Education about maternal and fetal changes
⚬ Education for self-management
￭ Nutrition
￭ Personal hygiene
￭ Prevention of urinary tract infections
￭ Kegel exercises
￭ Preparation for breastfeeding newborn
￭ Dental health

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34
Q
  • Nursing interventions (Cont.)
    ⚬ Education for self-management
    ￭ Physical activity
    ￭ Posture and body mechanics
    ￭ Rest and relaxation
    ￭ Employment
    ￭ Clothing
    ￭ Travel
    ￭ Medications and herbal preparations
A

⚬ Education for self-management
￭ Physical activity
￭ Posture and body mechanics
￭ Rest and relaxation
￭ Employment
￭ Clothing
￭ Travel
￭ Medications and herbal preparations

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35
Q
  • Nursing interventions (Cont.)
    ⚬ Education for selfmanagement
    ￭ Immunizations
    ￭ Rh immune globulin
    ￭ Substance abuse
  • Alcohol
  • Tobacco
  • Caffeine
  • Marijuana
  • Cocaine
  • Opioids
A

⚬ Education for selfmanagement
￭ Immunizations
￭ Rh immune globulin
￭ Substance abuse
* Alcohol
* Tobacco
* Caffeine
* Marijuana
* Cocaine
* Opioids

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36
Q
  • Nursing interventions (Cont.)
    ⚬ Education for self-management
    ￭ Normal discomforts
    ￭ Recognizing potential complications
    ￭ Sexual counseling
    ￭ Sexual history
    ￭ Countering misinformation
    ￭ Safety and comfort during sexual activity
    ￭ Psychosocial support
A

￭ Normal discomforts
￭ Recognizing potential complications
￭ Sexual counseling
￭ Sexual history
￭ Countering misinformation
￭ Safety and comfort during sexual activity
￭ Psychosocial support

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37
Q

Common Discomforts of Pregnancy

  • Nausea and vomiting
  • Heartburn
  • Backache
  • Round ligament pain
  • Urinary ___________
  • Varicosities
  • Hemorrhoids
  • Constipation
  • Leg cramps
A
  • Nausea and vomiting
  • Heartburn
  • Backache
  • Round ligament pain
  • Urinary frequency
  • Varicosities
  • Hemorrhoids
  • Constipation
  • Leg cramps
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38
Q

Danger Signs During Pregnancy

  • Vaginal ___________, with or without discomfort
  • Rupture of membranes
  • Swelling of fingers, puffiness of face or around eyes
  • Continuous, pounding ___________
  • ________ disturbances
    ⚬ Blurred vision, dimness, spots
  • Persistent or severe ___________ pain
  • Chills or fever
  • Painful urination
  • Persistent vomiting
  • Changes in frequency or strength of fetal movements
  • Signs of preterm labor:
    ⚬ Uterine ___________, cramps, constant or irregular low backache, pelvic pressure
A
  • Vaginal bleeding, with or without discomfort
  • Rupture of membranes
  • Swelling of fingers, puffiness of face or around eyes
  • Continuous, pounding headache
  • Visual disturbances
    ⚬ Blurred vision, dimness, spots
  • Persistent or severe abdominal pain
  • Chills or fever
  • Painful urination
  • Persistent vomiting
  • Changes in frequency or strength of fetal movements
  • Signs of preterm labor:
    ⚬ Uterine contractions, cramps, constant or irregular low backache, pelvic pressure
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39
Q

Variations in Prenatal Care

  • Cultural influences
    ⚬ Emotional response
    ⚬ Clothing
    ⚬ Physical activity and rest
    ⚬ Sexual activity
    ⚬ Diet
A
  • Cultural influences
    ⚬ Emotional response
    ⚬ Clothing
    ⚬ Physical activity and rest
    ⚬ Sexual activity
    ⚬ Diet
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40
Q

Variations in Prenatal Care

  • Age differences
    ⚬ _____________
    ￭ Much less likely than older women to receive adequate prenatal care
    ⚬ Women older than 35 years old
    ￭ Multiparous women
    ￭ Nulliparous women
A

⚬ Adolescents
￭ Much less likely than older women to receive adequate prenatal care
⚬ Women older than 35 years old
￭ Multiparous women
￭ Nulliparous women

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41
Q
  • Multifetal pregnancy
    ⚬ Increased risk of adverse outcomes for both mother and fetuses
    ⚬ Twin pregnancies often end in __________
    ⚬ Rupture of membranes before term common
    ⚬ Congenital malformations twice as common in monozygotic twins as in singletons
    ⚬ No increase in incidence of congenital anomalies in dizygotic twins
A
  • Multifetal pregnancy
    ⚬ Increased risk of adverse outcomes for both mother and fetuses
    ⚬ Twin pregnancies often end in prematurity
    ⚬ Rupture of membranes before term common
    ⚬ Congenital malformations twice as common in monozygotic twins as in singletons
    ⚬ No increase in incidence of congenital anomalies in dizygotic twins
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42
Q

⚬ Multifetal pregnancy likelihood increased when one or more of the following factors are noted in the assessment:

￭ History of dizygous twins in _________ lineage
￭ Use of ________ drugs
￭ Rapid uterine growth for weeks of gestation
￭ Polyhydramnios

A

⚬ Multifetal pregnancy likelihood increased when one or more of the following factors are noted in the assessment:

￭ History of dizygous twins in female lineage
￭ Use of fertility drugs
￭ Rapid uterine growth for weeks of gestation
￭ Polyhydramnios

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43
Q
  • Multifetal pregnancy (Cont.)
    ⚬ Multifetal pregnancy likelihood increased when one or more of the following factors are noted in assessment:

￭ Palpation of _______ small or large parts than expected
￭ ____________ fetal heartbeats or more than one fetal
electrocardiographic tracing
￭ Ultrasound evidence of more than one fetus

A

￭ Palpation of more small or large parts than expected
￭ Asynchronous fetal heartbeats or more than one fetal
electrocardiographic tracing
￭ Ultrasound evidence of more than one fetus

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44
Q
  • Multifetal pregnancy (Cont.)
    ⚬ Prenatal care given women with multifetal pregnancies include changes in:
    ￭ more frequent ________.
    ￭ amount of ________ gained.
    ￭ ___________ intake observed.
    ⚬ Uterine distention can cause severe backache
A

￭ more frequent visits.
￭ amount of weight gained.
￭ nutritional intake observed.
⚬ Uterine distention can cause severe backache

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45
Q
  • Multifetal pregnancy (Cont.)
    ⚬ Multiple newborns may place strain on:
    ￭ finances
    ￭ space
    ￭ workload
    ￭ woman’s and family’s ability to cope
    ⚬ Lifestyle changes may be necessary
    ⚬ National organizations available for support
A

￭ finances
￭ space
￭ workload
￭ woman’s and family’s ability to cope
⚬ Lifestyle changes may be necessary
⚬ National organizations available for support

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46
Q
  • Perinatal education goals
    ⚬ Assist individuals and their families to make informed, safe decisions about childbirth
    ⚬ Assist to sort out reliable information from online sources
    ⚬ Assist to comprehend the long-lasting effects an empowering birth experience can have
    ⚬ Ideally this begins in the preconception period
A

⚬ Assist individuals and their families to make informed, safe decisions about childbirth
⚬ Assist to sort out reliable information from online sources
⚬ Assist to comprehend the long-lasting effects an empowering birth experience can have
⚬ Ideally this begins in the preconception period

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47
Q

Healthy Weight Gain

Energy Needs - assessment of weight gain assess whether kcal intake is adequate. This is important determinant of fetal growth!
* Poor weight gain associated with low birth weight infants and preterm birth.
* Excessive weight gain may lead to macrosomia and other complications.
If starting at a normal weight: Should gain 11.5 to 16 kg (25 to 35 lbs)
* First trimester: 1-2 kg/2-4 pounds total
* Second and third trimester: 0.4 kg per week/1 pound per week

A

Energy Needs - assessment of weight gain assess whether kcal intake is adequate. This is important determinant of fetal growth!
* Poor weight gain associated with low birth weight infants and preterm birth.
* Excessive weight gain may lead to macrosomia and other complications.
If starting at a normal weight: Should gain 11.5 to 16 kg (25 to 35 lbs)
* First trimester: 1-2 kg/2-4 pounds total
* Second and third trimester: 0.4 kg per week/1 pound per week

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48
Q

Supplements during Pregnancy

  • Folate –______ mcg
    *Women with history of baby with __________________ 4 mg (4,000 mcg) folic acid daily
A
  • Folate –600 mcg
    *Women with history of baby with Neural tube defect 4 mg (4,000 mcg) folic acid daily
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49
Q

Supplements during Pregnancy

  • Iron – ___ mg
    –Pregnant women are at-risk for physiologic anemia of pregnancy
    –The nurse should educate the patient about iron supplementation (dark stools, take with vitamin C, avoid dairy or taking with Ca, etc)
A
  • Iron –27 mg
    –Pregnant women are at-risk for physiologic anemia of pregnancy
    –The nurse should educate the patient about iron supplementation (dark stools, take with vitamin C, avoid dairy or taking with Ca, etc)
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50
Q

–______
*The practice of consuming nonfood substances (i.e. ice chips, soil)
*May be influenced by the woman’s cultural background
*Check for anemia and ask about diet

A

Pica

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51
Q

Other Nutritional Issues During Pregnancy

Vegetarian Diets
*Strict vegan vegetarians should supplement vitamin _____
*Important to consider whether proteins are “__________”
*Those that avoid dairy should ensure adequate __________ intake
*Fe and zinc may be less well-absorbed from plant sources

A

*Strict vegan vegetarians should supplement vitamin B12
*Important to consider whether proteins are “complete”
*Those that avoid dairy should ensure adequate calcium intake
*Fe and zinc may be less well-absorbed from plant sources

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52
Q

Labor & birth

The Five P’s:
* __________ - fetus and placenta
* __________ - birth canal
* __________ - primary and secondary
* __________ of the laboring woman
* __________ response

A
  • Passenger - fetus and placenta
  • Passageway - birth canal
  • Powers - primary and secondary
  • Position of the laboring woman
  • Psychologic response
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53
Q

Passenger

  • Fetus
    ⚬ Head
    ￭ Size, bones, sutures, fontanels
    ⚬ ____________
    ￭ The part of the fetus that enters the pelvin inlet first and leads through the birth canal during labor
    ⚬ Lie
    ￭ Relation of the long axis (spine) of fetus to the long axis of mother
    ⚬ Attitude
    ￭ Relation of the fetal body parts to one another
    ⚬ Position
    ▪ The relationship of a reference point on the presenting part to the four quadrants of the mother’s pelvis
A
  • Fetus
    ⚬ Head
    ￭ Size, bones, sutures, fontanels
    ⚬ Presentation
    ￭ The part of the fetus that enters the pelvin inlet first and leads through the birth canal during labor
    ⚬ Lie
    ￭ Relation of the long axis (spine) of fetus to the long axis of mother
    ⚬ Attitude
    ￭ Relation of the fetal body parts to one another
    ⚬ Position
    ▪ The relationship of a reference point on the presenting part to the four quadrants of the mother’s pelvis
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54
Q

Passenger: Presentation

  1. _______ (head down)
  2. _______ (buttocks down)
  3. _________ (transverse)
A
  1. Vertex (head down)
  2. Breech (buttocks down)
  3. Shoulder (transverse)
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55
Q

Passenger: Position

  • ___________ - relationship of presenting part to maternal ischial spine and degree of descent of presenting part of fetus
  • ___________ - indicates the largest transverse diameter of the presenting part has passed through the maternal pelvic brim or inlet, into the true pelvis
A
  • Station - relationship of presenting part to maternal ischial spine and degree of descent of presenting part of fetus
  • Engagement - indicates the largest transverse diameter of the presenting part has passed through the maternal pelvic brim or inlet, into the true pelvis
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56
Q

Passageway

  • The passageway consists of the maternal ______ and its soft tissues.
    ⚬ The bony pelvis is more important to the outcome of labor, because the bones and joints do not readily yield to the forces of labor.
    ⚬ Softening of the cartilage linking the pelvic bones increases as term approaches and the hormone relaxin increases.
A
  • The passageway consists of the maternal pelvis and its soft tissues.
    ⚬ The bony pelvis is more important to the outcome of labor, because the bones and joints do not readily yield to the forces of labor.
    ⚬ Softening of the cartilage linking the pelvic bones increases as term approaches and the hormone relaxin increases.
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57
Q

Powers

  • Primary
    ⚬ Uterine ____________ (effacement and dilation)
  • Effacement - shortening and thinning of cervix
  • Dilation - enlargement or widening of the cervical opening and the cervical canal
    ￭ First stage of labor - through dilation
    ￭ Uterine contractions are the primary forces moving the fetus through the maternal pelvis
  • Secondary
    ⚬ ____________ efforts (after full dilation)
    ￭ Second stage of labor - dilation through birth
    ￭ Voluntary pushing efforts propel the fetus through the pelvis.
    ￭ Ferguson reflex - stretch receptors cause release of oxytocin, triggers urge to bear down
A
  • Primary
    ⚬ Uterine contractions (effacement and dilation)
  • Effacement - shortening and thinning of cervix
  • Dilation - enlargement or widening of the cervical opening and the cervical canal
    ￭ First stage of labor - through dilation
    ￭ Uterine contractions are the primary forces moving the fetus through the maternal pelvis
  • Secondary
    ⚬ Bearing down efforts (after full dilation)
    ￭ Second stage of labor - dilation through birth
    ￭ Voluntary pushing efforts propel the fetus through the pelvis.
    ￭ Ferguson reflex - stretch receptors cause release of oxytocin, triggers urge to bear down
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58
Q

Position of the Laboring Woman

⚬ Position affects woman’s anatomic and physiologic adaptations to labor
⚬ Frequent changes in position
￭ Relieve fatigue
￭ Increase comfort
￭ Improve circulation
⚬ Laboring women should be encouraged to find positions most comfortable to them
￭ Upright: often most helpful for descent
￭ “All fours”
￭ Lithotomy
￭ Semirecumbent
￭ Lateral

A

⚬ Position affects woman’s anatomic and physiologic adaptations to labor
⚬ Frequent changes in position
￭ Relieve fatigue
￭ Increase comfort
￭ Improve circulation
⚬ Laboring women should be encouraged to find positions most comfortable to them
￭ Upright: often most helpful for descent
￭ “All fours”
￭ Lithotomy
￭ Semirecumbent
￭ Lateral

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59
Q

Psyche

  • Crucial aspect of childbirth.
  • Marked anxiety, fear, or fatigue decreases a woman’s ability to cope with labor pain.
  • Maternal catecholamine secreted in response to anxiety or fear.
    ⚬ Inhibit uterine contractility and placental blood flow.
  • Relaxation augments the natural process of labor.
A
  • Crucial aspect of childbirth.
  • Marked anxiety, fear, or fatigue decreases a woman’s ability to cope with labor pain.
  • Maternal catecholamine secreted in response to anxiety or fear.
    ⚬ Inhibit uterine contractility and placental blood flow.
  • Relaxation augments the natural process of labor.
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60
Q
  • Signs preceding labor
    ￭ Braxton Hicks contractions
  • watch out for dismissing contractions that may truly be causing cervical change
    ￭ Lightening or ___________
    ￭ _________ in clear and nonirritating vaginal secretions
    ￭ “_______ show”
    ￭ Energy spurt
    ￭ Small weight loss - 0.5-1.5 kg
  • Onset of labor
    ⚬ Onset of true labor cannot be ascribed to single cause
    ￭ Factors include changes in maternal uterus, cervix, and pituitary gland
    ￭ Typically determined by cervical change
A
  • Signs preceding labor
    ￭ Braxton Hicks contractions
  • watch out for dismissing contractions that may truly be causing cervical change
    ￭ Lightening or dropping
    ￭ Increase in clear and nonirritating vaginal secretions
    ￭ “Bloody show”
    ￭ Energy spurt
    ￭ Small weight loss - 0.5-1.5 kg
  • Onset of labor
    ⚬ Onset of true labor cannot be ascribed to single cause
    ￭ Factors include changes in maternal uterus, cervix, and pituitary gland
    ￭ Typically determined by cervical change
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61
Q

Process of Labor: Four Stages and Phases of labor

  • First stage
    ⚬ Latent Phase
    ⚬ Active Phase
  • Second stage
    ⚬ Latent Phase
    ⚬ Active Phase
  • Third stage
  • Fourth Stage
A
  • First stage
    ⚬ Latent Phase
    ⚬ Active Phase
  • Second stage
    ⚬ Latent Phase
    ⚬ Active Phase
  • Third stage
  • Fourth Stage
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62
Q

Process of Labor - Stages and Phases of labor

  • First stage
    ⚬ Onset of contractions to full dilation of the cervix
    ⚬ Latent Phase
    ￭ Onset of labor, characterized by regular, painful uterine contractions that cause cervical change to the beginning of the active phase
    ￭ More progress in effacement of cervix and little increase in descent.
    ⚬ Active phase
    ￭ Period during which the greatest rate of cervical dilation occurs, begins at 6 cm and ends with complete cervical dilation at 10 cm
    ￭ More rapid dilation of cervix, increase rate of descent on presenting part
A
63
Q

Process of Labor - Stages and Phases of labor

  • Second stage
    ⚬ Full dilation to birth
    ⚬ Latent Phase
    ￭ Passive fetal descent
    ⚬ Active Phase
    ￭ Pushing phase - laboring down/bear down
    ⚬ Mechanism of birth: vertex presentation
    ￭ Birth of head
    ￭ Birth of shoulders
    ￭ Birth of body and extremities
    ⚬ Nurse must be alert for signs of impending birth
    ￭ “The baby’s coming”
    ￭ Grunting sounds
    ￭ Bearing down
    ￭ Check the perineum
A
64
Q

Process of Labor - Stages and Phases of labor

  • Third stage
    ⚬ Birth of the fetus until delivery of the placenta
    ⚬ Placental separation and expulsion
    ￭ Firmly contracting fundus
    ￭ Change in shape of uterus from a discoid to globular
    ￭ Sudden gush of dark blood from introitus
    ￭ Apparent lengthening of umbilical cord
    ￭ Vaginal fullness
A
65
Q

Process of Labor - Stages and Phases of labor

  • Fourth stage
    ⚬ Delivery of the placenta and until the woman’s condition is stable
    ￭ Typically 2 hours after giving birth
    ⚬ Assessment
    ⚬ Post anesthesia recovery
    ⚬ Care of the new mother
    ⚬ Care of the family
A
66
Q

Mechanism of Labor: Cardinal Movements

⚬ Turns and adjustments necessary in human birth process
⚬ Seven cardinal movements of mechanism of labor
- occur in vertex presentation
￭ Engagement
￭ Descent
￭ Flexion
￭ Internal rotation
￭ Extension
￭ Restitution and external rotation
￭ Expulsion (birth)

A
67
Q

Pelvic figures - position of fetal head as seen by birth attendant.
* A: Engagement and descent
* B: Flexion
* C: Internal rotation to occipitoanterior (OA) position
* D: Extension
* E: External rotation beginning (restitution)
* F: External rotation (Perry 352)

A
68
Q

Pain During Labor and Birth

  • Neurologic origins
    ⚬ Visceral pain: from cervical changes, distention of lower uterine segment, and uterine ischemia
    ￭ Located over lower portion of abdomen
  • Referred pain: originates in uterus, radiates to abdominal wall, lumbosacral area of back, iliac
    crests, gluteal area, down thighs, lower back
    ￭ First stage of Labor
    ⚬ Somatic pain: pain described as intense, sharp, burning, and localized
    ￭ Stretching and distention of perineal tissues and pelvic floor to allow passage of fetus from distention and traction on peritoneum and uterocervical supports during contractions and lacerations of soft tissue
A
69
Q
  • Factors influencing pain response
    ⚬ Physiologic factors
    ⚬ Culture
    ⚬ Anxiety
    ⚬ Previous experience
    ￭ Early labor may be more painful for nullips
    ⚬ Gate-control theory of pain
    ￭ Hypnosis, childbirth prep
    ⚬ Comfort and support
    ⚬ Environment
    ￭ People and tone in the room
A
70
Q

Nonpharmacologic Pain Management

  • Nonpharmacologic measures often simple, safe, few adverse reactions, and inexpensive
  • Provide sense of control over childbirth
  • Methods require practice for best results (classes)
  • Try variety of methods and seek alternatives, including pharmacologic methods, if measure used is not effective
    ⚬ See Box 14.2 in textbook - Maternal Child Nursing Care 7th Edition
A
71
Q

Nonpharmacologic Pain Management

  • Alternative therapies
    ⚬ Relaxation
    ⚬ Imagery and visualization
    ⚬ Breathing techniques
    ⚬ Effleurage and counterpressure
    ⚬ Touch and massage
    ⚬ Applications of heat and cold
    ⚬ Acupressure and acupuncture

⚬ Transcutaneous electrical nerve stimulation
⚬ Water therapy (hydrotherapy)
⚬ Intradermal water block
⚬ Aromatherapy
⚬ Hypnosis
⚬ Biofeedback
⚬ Music

A
72
Q

Pharmacologic Pain Management

  • Should be implemented before pain becomes so severe that catecholamines increase and labor is prolonged
  • Combinations of pharmacologic and nonpharmacologic measures increased pain relief and create a more positive birth experience
  • Sedatives
    ⚬ Relieves anxiety and induce sleep
  • Analgesia and anesthesia
    ⚬ Anesthesia
    ￭ Rids pain perception by interrupting nerve impulse to the brain
    ⚬ Systemic analgesia
    ￭ Alleviates sensation of pain or raises threshold for pain perception without LOC
A
73
Q

Systemic Analgesia

  • Opioid (narcotic) agonist analgesics
    ⚬ Stimulate major opioid receptors - create a feeling of euphoria
    ￭ meperidine (Demerol) (rare now)
  • Crosses placenta, can cause prolonged neonatal sedation/respiratory depression and neurobehavioral changes
  • Metabolite related effects not reversible with naloxone
    ￭ fentanyl (Sublimaze) (common)
  • Rapid onset, short half life, short duration
  • Commonly given by PCA, epidural
A
74
Q

Systemic analgesia (cont.)

  • Opioid (narcotic) agonist-antagonist analgesics
    ⚬ Agonist activates/stimulates receptor to react
    ⚬ Agonist block a receptor/medication designed to activate a receptor
    ⚬ Ceiling effect for respiratory depression, increased dose doesn’t cause additional resp. depression
    ￭ butorphanol (Stadol)
    ￭ nalbuphine (Nubain)
    ￭ IM, IV, SubQ
    ⚬ Contraindicated for women with opioid dependence –> can cause withdrawal in mother and baby
  • Rapid onset, short half life, short duration
A
75
Q

Pharmacologic Pain Management

  • Don’t forget to consider:
    ⚬ Consent
    ⚬ Timing of administration
    ⚬ Preparation for procedures
    ⚬ Administration fine skills: IV, IM, Regional
  • IV medication administration
    ⚬ Given slowly
    ⚬ Small amounts
    ⚬ During a contraction or over a period of three to five consecutive contractions
    ⚬ Naloxone (Narcan) is your antidote
    ￭ Can reverse most CNS depressant effects (opioid induced resp. depression)
    ￭ IV, IM, intranasal
A
76
Q

Pharmacologic Pain Management Nerve block analgesia and anesthesia

⚬ Local perineal infiltration anesthesia
⚬ Pudendal block (rare now)
⚬ Regional analgesia (Epidural) - some pain relief and motor block
⚬ Regional anesthesia (Spinal) - complete pain relief and motor block

A
77
Q

Pharmacologic Pain Management Nerve block analgesia and anesthesia (cont.)

o Disadvantages/Side Effects:
￭ Hypotension
￭ Itching
￭ Headache
￭ Inadequate pain relief
￭ Ineffective pushing

⚬ Contraindications:
￭ Hemorrhage
￭ Hypotension
￭ Coagulopathy
￭ Infection at injection site
￭ Allergy to anesthetic drug
￭ Maternal refusal or inability to cooperate

A
78
Q
  • Nitrous oxide
    ￭ “Laughing gas”
    ￭ Used extensively in other countries
    ￭ Increasing popularity in the United States as an alternative
    ￭ Safe for mother and fetus
    ￭ Self-administered
    ￭ Side effects: nausea and dizziness
A
79
Q
  • General anesthesia
    ⚬ Infrequently used for elective cesarean section
    ⚬ May be necessary if indications necessitate a rapid cesarean birth
A
80
Q

Fetal Assessment during Labor

  • Fetal response
    ⚬ Labor is a period of physiologic stress for fetus
    ⚬ Frequent monitoring of fetal status is part of nursing care during labor
    ⚬ Fetal oxygen supply must be maintained during labor to prevent fetal compromise and promote newborn health after birth
  • Electronic fetal monitoring EFM)
    ⚬ Visualizing fetal heart rate (FHR) patterns on monitor screen or printed tracing
A
81
Q

Basis for Monitoring

Fetal Response
* Fetal oxygen supply can decrease:
⚬ Reduction of blood flow through maternal vessels
￭ Maternal hypertension: chronic or pregnancy-induced
￭ Hypotension
￭ Hypovolemia
⚬ Reduction of oxygen content in maternal blood as result of hemorrhage or severe anemia
⚬ Alterations in fetal circulation with compression of umbilical cord
⚬ Reduction in blood flow to intervillous space in placenta

A
82
Q

Basis for Monitoring

  • Fetal heart rate and response
    ⚬ Fetal well-being during labor measured by response of FHR to uterine contractions (UCs)
    ￭ Baseline FHR = 110-160 beats/min
    ￭ Accelerations with fetal movement
    ￭ Decelerations in relation to the contractions
  • Uterine contractions
    ⚬ Frequency - number of contractions in a 10 min window, averaged over 30 min
    ￭ Normal: <5 contractions in 10 min
    ￭ Tachysystole: >5 contractions in 10 min
    ￭ Frequency - number of contractions in a 10 min window, averaged over 30 min
    ⚬ Duration
    ⚬ Intensity
    ⚬ Relaxation between contractions
    ￭ Resting tone
A
83
Q

Basis for Monitoring (cont.)

  • Fetal compromise
    ⚬ Goals of intrapartum FHR monitoring are to identify nonreassuring patterns indicative of fetal compromise
    ⚬ Nonreassuring FHR patterns are associated with fetal hypoxemia
    ⚬ If uncorrected can progress to fetal hypoxia
  • Hypoxemia - deficiency of oxygen in the blood
  • Hypoxia - inadequate supply of oxygen at cellular level – > metabolic acidosis
A
84
Q

Monitoring Techniques

  • Intermittent auscultation (IA)
    ⚬ Listening to fetal heart sounds at periodic intervals to assess FHR
    ⚬ IA can be performed with:
    ￭ DeLee-Hillis fetoscope
    ￭ Pinard stethoscope
    ￭ Doppler ultrasound device
A
85
Q

Monitoring Techniques

  • Electronic fetal monitoring
    ⚬ Assess the adequacy of fetal oxygenation during labor
    ⚬ First used in 1970s
    ⚬ Anticipated effect - decrease cerebral palsy; however rate was not declined
    ⚬ Primary mode of intrapartum assessment in the U.S.
  • External monitoring
    ⚬ FHR: ultrasound transducer
    ⚬ UCs: tocotransducer
    ⚬ Wireless monitoring
  • Internal monitoring (invasive, membranes must be ruptured first!)
    ⚬ FHR: Spiral electrode
    ⚬ UCs: intrauterine pressure catheter - IUPC (transducer)
A
86
Q

Fetal Heart Rate Patterns

  • Baseline fetal heart rate
    ￭ Normal is 110-160
    ￭ Average rate during 10-minute segment
    ￭ Excludes: periodic or episodic changes, periods of marked variability, and segments of the baseline that differ by more than 25 beats/min
    ⚬ Baseline FHR variability
    ￭ Irregular waves or fluctuations in baseline FHR during two cycles per min or greater
    ⚬ Tachycardia
    ￭ Baseline FHR >160 beats/min for 10 min or longer
    ⚬ Bradycardia
    ￭ Baseline FHR <110 beats/min for 10 min or longer
A
87
Q

Fetal Heart Rate Patterns

  • Periodic and episodic changes in FHR
    ￭ Periodic changes - occurs with UCs
    ￭ Episodic changes - not with UCs
    ⚬ Accelerations
    ￭ Visually apparent, abrupt increase in FHR above the baseline rate
    ￭ Onset to peak <30 seconds
    ⚬ Decelerations
    ￭ Early decelerations - in response to fetal head compression
    ￭ Late decelerations - uteroplacental insufficiency
    ￭ Variable decelerations - umbilical cord compression
    ￭ Prolonged decelerations
A
88
Q

Prolonged Decelerations

  • Decrease in FHR at least 15 BPM below baseline
  • Lasts more than 2 minutes but less than 10 minutes
A
89
Q
  • Electronic fetal monitoring pattern recognition and interpretation
    ⚬ Categorizing FHR tracings
    ⚬ Standards set by ACOG and AWHONN
    ⚬ Nursing management of abnormal patterns
    ⚬ RNs must be certified every 2 years
  • Other methods of assessment and intervention
    ⚬ Assessment techniques
    ￭ Fetal scalp stimulation
    ￭ Vibroacoustic stimulation
    ￭ Umbilical cord acid-base determination
    ￭ Fetal scalp blood sampling
A
90
Q
  • Other methods of assessment and intervention (Cont.)
    ⚬ Interventions
    ￭ Amnioinfusion
    ￭ Tocolytic therapy
  • Patient and family teaching
  • Documentation
A
91
Q

First Stage of Labor

  • True vs False labor
  • Begins with onset of regular uterine contractions
    ⚬ Ends with full cervical effacement and dilation
    ⚬ Three phases:
    ￭ Latent phase: up to 3 cm dilation
    ￭ Active phase: 4-7 cm dilation
    ￭ Transition phase: 8-10 cm dilation
  • Care Management
    ⚬ Nulliparous women seek admission during latent phase
    ⚬ Multiparous women do not usually come to hospital or birth center until active phase
    ⚬ Care givers can strongly influence lingering impressions of childbirth experience
  • EMTALA - Emergency Medical Treatment and Active Labor Act
    ⚬ Federal regulation enacted to ensure that women receives emergency treatment/ labor care
    ⚬ Nurses must be familiar with their responsibilities
    ⚬ Agencies must have policies and procedures in place to ensure compliance
A
92
Q

First Stage of Labor (Cont.)

  • Assessment
    ⚬ Physical examination
    ￭ General systems assessment
    ￭ Vital signs
    ￭ Leopold maneuvers
    ￭ Assessment of fetal heart rate (FHR) and pattern
    ￭ Assessment of uterine contractions
    ￭ Vaginal examination
    ⚬ Laboratory and diagnostic tests
    ￭ Analysis of urine specimen
    ￭ Blood tests
    ￭ Other tests
    ￭ Assessment of amniotic membranes and fluid
    ￭ Infection
A
93
Q

First Stage of Labor (Cont.)

  • Nursing interventions
    ⚬ General hygiene
    ⚬ Nutrient and fluid intake
    ￭ Oral intake
    ￭ IV intake
    ⚬ Elimination
    ￭ Voiding
    ￭ Catheterization
    ￭ Bowel elimination
    ⚬ Ambulation and positioning
A
94
Q
  • Supportive care during labor and birth

⚬ Labor support by the:
￭ Nurse
￭ Father or partner
￭ Doulas
￭ Grandparents
￭ Siblings during labor and birth
⚬ Emergency interventions
￭ Change position to left or right lateral
￭ Administer IV bolus (usually 250 ml)
￭ Turn off Pitocin (oxytocin)
￭ Consider O2 10L non-breather mask
￭ And then…call the MD/midwife (if not already there)

A
95
Q

Second Stage of Labor

  • Care Management
    ⚬ Begins with full cervical dilation (10 cm) and complete effacement (100%)
    ￭ Ends with baby’s birth
    ⚬ Median duration is 50 min in nulliparous
    ￭ 30 min in multiparas
  • Two phases:
    ⚬ Latent phase: period of rest and relative calm
    ￭ “Delayed pushing, laboring down or passive descent”
    ⚬ Active pushing phase: strong urge to bear down as presenting part presses on the stretch receptors of pelvic floor
A
96
Q

Second Stage of Labor (Cont.)

  • Preparing for birth
    ⚬ Maternal position
    ⚬ Bearing-down efforts
    ⚬ FHR and pattern
    ⚬ Support of father or partner
    ⚬ Supplies, instruments, and equipment
  • Birth in delivery or birthing room
  • Mechanism of birth: Vertex presentation
    ⚬ Management of Nuchal cord
A
97
Q

Second Stage of Labor (Cont.)

  • Immediate assessments and care of the newborn
  • Perineal trauma related to childbirth
    ⚬ Perineal lacerations
    ￭ First degree tear - laceration confined to the skin
    ￭ Second degree tear - laceration extends into perineal body
    ￭ Third degree tear - involves injury to the external anal sphincter
    ￭ Fourth degree tear - extends completely through the anal sphincter and rectal mucosa
    ⚬ Vaginal and urethral lacerations
    ⚬ Cervical injuries
    ⚬ Episiotomy
  • Emergency childbirth
A
98
Q

Third Stage of Labor

  • Care management
  • Placental separation and expulsion
    ⚬ Firmly contracting fundus
    ⚬ Change in shape of uterus
    ⚬ Sudden gush of dark blood from introitus
    ⚬ Apparent lengthening of umbilical cord
    ⚬ Vaginal fullness
  • Provider examines the placenta and membranes for intactness
A
99
Q

Obstetric Emergency

  • Retained placenta is an obstetric emergency!! Can be caused by:
    ⚬ Uterine anomalies
    ⚬ Trapped by the cervix
    ⚬ Hormonal - adrenaline is released into the blood (a hormone released into the blood during “fight or flight” response), oxytocin release can be inhibited and therefore prevent the uterus from contracting.
  • Nurse needs to observant and responsive
A
100
Q

Fourth Stage of Labor

  • Begins with the expulsion of the placenta and lasts until the woman is stable in the immediate postpartum period
    ⚬ Usually 1-2 hours after birth
  • Care management
  • Assessment
    ⚬ Postanesthesia recovery
  • Nursing interventions
    ⚬ Care of the new mother
    ⚬ Care of the family
    ⚬ Family—Newborn relationships
A
101
Q

Cesarean Birth

  • Birth of fetus through a transabdominal incision of uterus
    ⚬ Most commonly performed surgical procedure
  • Preserve life or health of mother and her fetus
  • Indications
    ￭ Maternal - specific cardiac disease
    ￭ Fetal - nonreassuring fetal status, malpresentation, active maternal herpes infection
    ￭ Maternal-fetal - failure to progress, placental abruption, placenta previa, history of previous c/sec, c/s per maternal request
  • Elective cesarean birth (“forced” C/Sec)
  • Planned or unplanned
  • Surgical techniques (skin incision may not “match” uterine incision)
    ⚬ Vertical
    ⚬ Transverse
A
102
Q

Cesarean Birth (cont.)

  • Anesthesia
    ⚬ Spinal, epidural or general anesthetics
  • Prenatal preparation
  • Preoperative care
    ⚬ NPO 8 hours prior (if planned)
    ￭ Clear liquids up to 2 hours prior to surgery
    ⚬ Blood test 1-2 days prior
  • Intraoperative care
    ⚬ Allowing the woman and/or partner chose the music during procedure
    ⚬ Implementing skin-to-skin care and breastfeeding in operating room (if able to)
  • Immediate postoperative care
    ⚬ BP and pulse every 15 min for 2 hours or longer if complications arise
  • Postoperative or postpartum care
A
103
Q

Cesarean Birth (cont.)

  • Nursing Care
    ⚬ Be alert to a woman’s physiologic needs, managingcare to ensure adequate rest and pain relief.
    ⚬ Daily care:
    ￭ Perineal
    ￭ Breast
    ￭ Routine hygienic
  • Discharge teaching
A
104
Q

at ___ weeks you can feel the fundus at the umbilicus

A

20

105
Q

⚬ Human chorionic gonadotropin (hCG)
￭ Preserves the function of the ovarian corpus luteum
￭ Ensures a continued supply of estrogen and progesterone needed to maintain pregnancy
- up to 8th week.
￭ Hormone identified in _____________

A

pregnancy tests

106
Q

⚬ Human chorionic somatomammotropin (hCS) or human placental lactogen (hPL)
￭ Stimulates maternal metabolism to supply needed nutrients for fetal growth.
￭ Increases the resistance to insulin
* Facilitates glucose transport across the placental membrane
￭ Stimulates breast development
* Prepares for _______ - 2nd trimester

A
107
Q

⚬ Progesterone
￭ Maintains the ___________, decreases the contractility of the uterus, and stimulates maternal metabolism and development of breast alveoli

A

endometrium

108
Q

⚬ Estrogen
￭ Stimulates ________ growth and uteroplacental blood flow, causes proliferation of the breast
glandular tissue, stimulates myometrial contractility.

A

uterine

109
Q

Most women should gain somewhere between__________ pounds during pregnancy

1st trimester- 2-4 lbs
after, 1 lb weekly

A

25 and 35

110
Q

Primagravida means

A

first pregnancy

111
Q

Multigravida means

A

pregnant more than once

112
Q

Nulliparous means

A

never given birth

113
Q

primiparous means

A

given birth once

114
Q

Multiparous means

A

Given birth more than once

115
Q

what is GTPAL?

A

Gravidity: # of pregnancies ever​

Term: Births 37 weeks – 41 weeks and 6 days​

Preterm: Births 20 – 37 weeks​

Abortion: Loss of pregnancy < 20 weeks​

Living: # of living children​

116
Q

Human Chorionic Gonadotropin (hCG)​

-Stimulates production of estrogen and progesterone (up to 8 weeks)​

-Hormone identified on pregnancy test (detected 7-8 days after conception)

A
117
Q

Estrogen

-Increases vascularity & vasodilation (blood & nutrients for placenta)​

  • Causes relaxation of pelvic ligaments and joints
A
118
Q

Progesterone

-Maintains pregnancy​

​-Prevents uterine contractions

A
119
Q

Prolactin

-Production of milk​

-Lactation is inhibited during pregnancy d/t high levels of estrogen and progesterone

A
120
Q

Oxytocin

-Initiation of labor​

-Stimulates uterine contractions​

-Stimulates let-down reflex

A
121
Q

Changes to Body Systems r/t Pregnancy​ [cardiovascular]

HR may increase (10-15 bpm)​
Know pre-pregnancy BP​
BP usually drops until week 22-24​
Supine hypotensive syndrome​
Increased venous pressure: edema, varicosities, hemorrhoids ​
Increased thromboembolic risk​

A
122
Q

Changes to Body Systems r/t Pregnancy​ [Resp]

O2 consumption increases​
Nasal congestion & epistaxis possible r/t increased estrogen

A
123
Q

Changes to Body Systems r/t Pregnancy​ [Renal]

Heavier kidney workload​
Increased risk of bladder infection
Proteinuria: preeclampsia​
Glucosuria: diabetes​
Ketones: inadequate fluid/food, strenuous exercise

A
124
Q

Changes to Body Systems r/t Pregnancy​ [GI]

Alteration is taste and smell​
Constipation: increasing uterus puts pressure and decrease GI motility OR poor appetite
Hemorrhoids

A
125
Q

Changes to Body Systems r/t Pregnancy​ [Genitals/breasts]

Vagina & Vulva become more sensitive​​
Vaginal discharge (leukorrhea): provides lubrication and prevents infection​
Breasts enlarge, areola darkens, increase blood supply

A
126
Q

Changes to Body Systems r/t Pregnancy​ [uterus]

Rises very high in abdomen​
Palpable by 12 weeks​

A
127
Q

Changes to Body Systems r/t Pregnancy​ [cervix]

Shorter, more elastic, larger diameter​
Thick mucous plug expelled when dilation begins​
Chadwick’s sign: violet discoloration (@ 6 weeks)​
Goodell sign: softening of the cervix

A
128
Q

Changes to Body Systems r/t Pregnancy​ [skin]

Increased ____________​
Linea Nigra​
Chloasma (melasma)​
Striae Gravidarum​
Vascular Spider Nevi

A

Increased pigmentation​
Linea Nigra​
Chloasma (melasma)​
Striae Gravidarum​
Vascular Spider Nevi

129
Q

Presumptive​ (may be pregnancy)

___________– absence of period​
N/V​
Breast Fullness​
Increase urinary frequency​
_________ – mom feels the baby move​
Fatigue​
*felt by _______

A

Amenorrhea – absence of period​
N/V​
Breast Fullness​
Increase urinary frequency​
Quickening – mom feels the baby move​
Fatigue​
*felt by patient

130
Q

Probable​ (pregnancy likely)​

__________ pregnancy test (hCG - blood or urine)​​
Uterine enlargement​
Chadwick’s/Goodell/Hegar sign​
Braxton Hicks​
*observed by practitioner or patient (_____ pregnancy test)

A

Positive pregnancy test (hCG - blood or urine)​​
Uterine enlargement​
Chadwick’s/Goodell/Hegar sign​
Braxton Hicks​
*observed by practitioner or patient (home pregnancy test)

131
Q

Positive​ preg. (diagnostic)​

Fetal heart rate (doppler __________)​
________ of fetus on US​
Active fetal movements​
* Observed by practitioner

A

Fetal heart rate (doppler transducer)​
Outline of fetus on US​
Active fetal movements​
* Observed by practitioner

132
Q

Naegeles’ Rule – ______________ ***​

A

Due Dates

133
Q

Naegeles’ Rule – Due Dates ***

​First Day of Last Period - ___________________

A

– 3 months + 7 days + 1 year​

134
Q

Preconception & Pregnancy Health Considerations​

Glycemic Control: helps decrease incidents of congenital _____________

A

malformations

135
Q

Preconception & Pregnancy Health Considerations

Folic Acid Supplementation: decrease _________________

Green leafy vegetables​
Whole grains​
Fruits​
Liver​
Beans​
Fortified cereals/breads/pastas

A

Folic Acid Supplementation: decrease neural tube defects​

Green leafy vegetables​
Whole grains​
Fruits​
Liver​
Beans​
Fortified cereals/breads/pastas

136
Q

Preconception & Pregnancy Health Considerations​

Expected weight gain: ______ lb​
Additional ______ cal/day during pregnancy​
Additional _____ cal/day during breastfeeding​
8-10 (8oz) glasses fluid (preferably more that 50% water)​
Protein: helps with fetal growth​
Calcium: dairy, legumes, sardines​

A

Expected weight gain: 25-35 lb​
Additional 300 cal/day during pregnancy​
Additional 500 cal/day during breastfeeding​
8-10 (8oz) glasses fluid (preferably more that 50% water)​
Protein: helps with fetal growth​
Calcium: dairy, legumes, sardines​

137
Q

Nutrition During Pregnancy Overview​

Protein: 70 g​
__________ of tissue | meats, eggs, cheese, yogurt​

Fiber: 28 g​
Healthy ____ | whole grains, vegetables, fruits​

Water: 3 L​
__________ volume, excretion | water, milk, juice​

A

Protein: 70 g​
Growth of tissue | meats, eggs, cheese, yogurt​

Fiber: 28 g​
Healthy GI | whole grains, vegetables, fruits​

Water: 3 L​
Blood volume, excretion | water, milk, juice​

138
Q

Iron: 30 mg ​
Hemoglobin | meats, enriched grains, breads, dark leafy greens​

Folate: 600 mcg​
____________ Defects | fortified cereal/grains, dark leafy greens, oranges​

Calcium: 1000 mg​
Fetal and maternal ____________ | dairy, sardines, dark leafy greens

A

Iron: 30 mg ​
Hemoglobin | meats, enriched grains, breads, dark leafy greens​

Folate: 600 mcg​
Neural Tube Defects | fortified cereal/grains, dark leafy greens, oranges​

Calcium: 1000 mg​
Fetal and maternal skeleton | dairy, sardines, dark leafy greens

139
Q

The 5 P’s of Labor​

Passenger*: ________​

Passageway: ________

Powers: ________(primary) & bearing down (secondary)​

Position: of the laboring ________ (all fours, upright etc.)​

Psychological Response: ________ of the woman

A

Passenger*: fetus​

Passageway: birth canal​

Powers: contractions (primary) & bearing down (secondary)​

Position: of the laboring mother (all fours, upright etc.)​

Psychological Response: state of the woman

140
Q

Stage 1 of Labor - _________ Stage​

A

Longest

141
Q

In stage 1 of labor, during the active phase, the cervix dilates?​

​
1-3 cm​

7-10 cm​

4-7 cm​

8-10 cm

A

4-7 cm​

142
Q

Stage 2 of Labor

​________________ is complete > Delivery of _______​
Increase in bloody show​
Urge to push​
Latent phase: laboring down​
Active phase: pushing​
Transition: presenting part is on the perineum​
Assess fetal HR throughout contraction​

A

​Cervical dilation is complete > Delivery of fetus​
Increase in bloody show​
Urge to push​
Latent phase: laboring down​
Active phase: pushing​
Transition: presenting part is on the perineum​
Assess fetal HR throughout contraction​

143
Q

Stage 3 of Labor​:

A

Separation of placenta > Expulsion of placenta​

144
Q

Stage 4 of Labor​

_________________

HESI: 1-4 hours​
Kramer: 2 hours​
Doing your checks every 15 min for at least 2 hours

A

Physical recovery​

145
Q

L&D Pain Management​

________________ can relieve back pain​
Massage as tolerated​
Narcotics: not the go to but may be used, when is best?​
Support System: Doula ​
Nerve Blocks

A

Counterpressure can relieve back pain​
Massage as tolerated​
Narcotics: not the go to but may be used, when is best?​
Support System: Doula ​
Nerve Blocks

146
Q

Fetal Monitoring​

_____________: contraction​
_____________ : FHR​

FHR: 110-160 bpm​

A

Tocotransducer: contraction​
Ultrasound transducer: FHR​

147
Q

VEAL CHOP MINE mnemonic

A

Variable deceleration
Early deceleration
Acceleration
Late acceleration

Cord compression
Head compression
Okay!
Placental insufficiency

Maternal repositioning
Identify labor progress
None
Execute interventions

148
Q

A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will​ have:​
​
a. amenorrhea.​
b. positive pregnancy test.​
c. Chadwick’s sign.​
d. Hegar’s sign.

A

a. amenorrhea.​

Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are felt by the woman. A positive pregnancy test, the presence of Chadwick’s sign, and the presence of Hegar’s sign are all probable signs of pregnancy.​

149
Q

A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level?​
​
a. Not palpable above the symphysis at this time​
b. Slightly above the symphysis pubis​
c. At the level of the umbilicus​
d. Slightly above the umbilicus

A

b. Slightly above the symphysis pubis​

In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. As the uterus grows, it may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. The uterus rises gradually to the level of the umbilicus at 22 to 24 weeks of gestation.​

150
Q

Numerous changes in the integumentary system occur during pregnancy. Which change persists after birth?​
​
a. Epulis​
b. Chloasma​
c. Telangiectasia​
d. Striae gravidarum

A

d. Striae gravidarum

151
Q

​​When assessing a woman in labor, the nurse is aware that the relationship of the fetal body parts to one another is called fetal:​
​
a. lie.​
b. presentation.​
c. attitude.​
d. position.

A

attitude

Attitude is the relation of the fetal body parts to one another. Lie is the relation of the long axis (spine) of the fetus to the long axis (spine) of the mother. Presentation refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor at term. Position is the relation of the presenting part to the four quadrants of the mother’s pelvis.​

152
Q

The nurse has received report regarding her patient in labor. The woman’s last vaginal examination was recorded as 3 cm, 30%,​ and -2. The nurse’s interpretation of this assessment is that:​
​
a. the cervix is effaced 3 cm, it is dilated 30%, and the presenting part is 2 cm above the ischial spines.​
b. the cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines.​
c. the cervix is effaced 3 cm, it is dilated 30%, and the presenting part is 2 cm below the ischial spines.​
d. the cervix is dilated 3 cm, it is effaced 30%, and the presenting part is 2 cm below the ischial spines.

A

b. the cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines.​

153
Q
A

Nurs 144- Maternity (8 decks)

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