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OB nur104

mott ob peds 104

functions of amniotic fluid Allows free movement _ Prevent adherence _ Cushions _ Maintains temperature _ Provides homeostasis _ Prevents cord compression
ductus arteriosus diverts blood from pulmonary artery to aorta. closes functionally 15h completely 3weeks
Foramen ovale window left atrium to right, closes temp 2h completely 3months
ductus venosus diverts blood away from liver as it returns from placenta, closes functionally when cord is cut and completely in one week
3 categories of pregnancy signs *presumptive:signs and symptoms that may resemble pregnancy *probable:indicate pregnancy the majority of the time *positive:medically proven
presumptive amenorrhea, N&V, breast tenderness, urinary frequency, fatigue, quickening(tummy movement)
Probable Uterine enlargement _ Pigmentation changes _ Positive pregnancy test _ Chadwick’s sign _ Ballottement _ Braxton Hick’s _ Goodell’s sign _ Hegar’s sign
positive fetal heart sounds palpating active fetal movments visualizing fetus by U/S
changes in endocrine system during pregnancy first produced in luteum and then by placenta, maintain pregnancy ESTROGEN, AND PROGESTERONE
HPL affects the metabolic system of the maternal organism. HPL decreases maternal insulin sensitivity, and, therefore, raises maternal blood glucose levels, whilst decreasing maternal glucose utilization
human chorionic gonadotropin or simply (hCG). This hormone is produced by fetal trophoblast cells. It binds to the luteinizing hormone receptor on cells of the corpus luteum, which prevents luteal regression. Thus, hCG serves as the signal for maternal recognition of pregnancy.
changes of the reproductive system during pregnancy. (continued) breast preped to lactate by hpl, estrogen, progesterone,prolactin. rapidly increase in size first 8weeks from vascular engorgment
changes of the cardiovascular system during pregnancy. orthostatic hypertension, venacava compression by uterus+baby(supine hypotensive syndrome)cardiac output doubles, 40% increase in volume. clotting factors increase
when is the placenta fully functional at 3 months the placenta is fully operational, begins to function 4th week
scheduled prenatal visits every month for first 7months. every 2 weeks during the 8th month. weekly during the 9th month
discomforts of the first trimester N&V, frequency, breast tenderness vaginal discharge
interventions for first trimester discomforts N&V (eat dry crackers in am)supportive bra for tenderness. vaginal discharge=hygiene cotton panties contact dr for change in color odor character
interventions for second trimester heart burn(pyrosis)maalox or gelusil no sodium bicarb or alka seltzer.gas and constipation=water 8glasses,exercise roughage. hemorrhoids= cool witch hazel, sitz bath, up dietary fiber leg cramps= eval calcium intake. round lig pain= heat pack, pillow abd
vaccinations for pregnancy tetnus during second trimester. Tdap given after delivery. in short viruses can cross placenta.!!!!!MMR 28 days later
danger signs of pregnancy headaches visual disturbances. increase in systolic 30+ diastolic pressure of 15+,or over 140/80. pain,s/s of UTI, decreased fetal movement, fever 100.4+, bleeding fluid loss(wt loss) seizures
normal wt gain 25-35 lbs
biophysical profile (BPP) assess fetal oxygenation done after 26 weeks.1 breathing movements,2 gross fetal movements, 3 FHR variability and reactivity (NST),4 fetal heart tones 5 amniotic volume
percutaneous umbilical blood sampling obtain fetal blood sample from umbilicus detects anemia,Rh isoimmunizaton, chromosomal disorders and acid base balance done after 16 weeks
chorionic villus sampling Small amount of placenta is obtained _ Vaginally or abdominally _ To analyze fetal cells for genetic abnormalities(sickle cell, downs duchanes)risk of abortion higher than amniocentesis potential limb reduction defect in fetus _ Done at 10-12 weeks
amniocentesis Sample of amniotic fluid _ To detect chromosomal abnormalities, fetal lung maturity, and AFP level _ Done at 16-20 weeks
fetal lung maturity _ Lecithin/ sphingomyelin ratio (2:1) _ Phosphatidylglycerol PG=good, no PG=bad test for surfactant(foam stability index)or shake test 15 min bubble stability= surfactant is present
alpha fetoprotein produced by baby _ Glycoprotein excreted by fetus _ Via amniocentesis or maternal blood sample _ Assess for genetic disorders/ neural tube defects _ Done at 15-20 weeks higher with multibirths
daily fetal movement count KICK COUNT Kick count” _ Mother counts number of fetal movements for 30-60 minutes TID _ To assess fetal well-being _ Done after 28 weeks (7months)
fetal activity study (NST) Non stress test _ Fetal monitor to mother’s abdomen _ Assess acceleration of FHR in association with movementTo assess fetal well being _ Normal = reactive _ Done after 28 weeks
oxytocin challenge test (Stress test) Stress Test _ Induce contractions _ Oxytocin or nipple stimulation _ Evaluate FHR in response to contractions _ Assess fetal well-being during labor _ Normal = negative _ Done at 30 weeks FHR deceleration in response is bad news for baby!
internal monitoring Rupture membranes • Cervical dilation +2 • Spiral electrode (head or butt) • Uterine catheter (intensity measured from within)
Fetal Heart patterns Rate: 110-160, variability:6-25/min Decells are bad accells good= reassuring
accelerations 15BPM with fetal activity (exercise) also with vaginal exams, contractions, fundal pressure, and breach presentations.
early Decelerations _ Decrease in FHR _ Starts and ends with contraction (V-shape) _ Head compression (vagal response) intervention: monitor and reasure mother.
late deceleration _ Decrease in FHR _ Starts at peak of contraction and ends after contraction ends _ Uteroplacental insufficiency
late deceleration cont. intervention!!!!!LIONPIT (drop of 30/min or change in base line variability less than 3-5 beats/min****significant indicator of fetal distress) _ Intervene!!!: repositioning admin 8-10L PIT stop, increase IV fluids evaluate vitals(ID hypotension)
LION PIT Left side, IV, O2, Notify, stop the PITocin
VEAL CHOP V-C, E-H, A-O, L-P Varibility---cordcompression Early--------headcompression aceleration--Ok Late---------placenta
variable deceleration _ Sudden decrease in FHR _ “U” or “V” or “W” shape _ Before, during, or after contractions _ Cord compression (may be nucal cord) BPM down by 15, in 15 sec-2min _ Intervene change moms position give O2, call doc, prob C-section
normal oxygenation of fetus DURING LABOR 40-70%
NITROZINE PAPER BLUE OR BLUE-GREEN indicates that fluid is alkaline and most likely amniotic fluid
signs of onset labor lightening(fetal drop), bloody show,plug, energy spurt, false labor (braxton hicks),SROM,cervical changes
Engagement vs crowning engagement is 0 station. crowning is +2 or +3
duration no longer than 90 sec
intervals no shorter than 60 seconds
mechanisms of labor Engagement & descent _ Flexion _ Internal rotation _ Extension _ External rotation _ Expulsion
engagement& decent presenting part at 0 station
flexion the fetal head flexes so that the chin rest of the chest
internal rotation fetal head rotates from transverse to anterior position assisted by the pelvic inlet pressure.
extension begins when fetal head is at the pelvic floor, and it pivots under the pubic symphysis and advances upward. extension is complete when head is born.
external rotation (restitution) the head immediatly rotates back to the transverse position in alignment with the shoulders, and the shoulders align themselves with the AP diameter of the pelvic outlet
expulsion anterior shoulder rotates forward under pub symph and delivered,the rest of the body delivered quickly. this ends the second stage of labor
stages of labor _ Stage of dilatation & effacement _ Stage of expulsion _ Placental separation stage _ Recovery stage
STAGE ONE:dilatation and effacement LATENT:0-3cm,15-20min (longest in primapara) ACTIVE:4-7cm,30-60sec TRANSITION:8-10cm,60-90sec. Begins with contractions _ Ends with cervix fully dilated & effaced _ Lasts 5-20 hours
STAGE TWO: expulsion _ Begins when cervix fully dilated & effaced _ Ends with birth of baby _ Lasts minutes to hours
STAGE THREE:Placenta _ Begins with !!BIRTH!!! of baby _ Ends with expulsion of placenta _ Lasts 5-30 minutes
STAGE FOUR: recovery _ Starts with delivery of placenta _ Ends 1-4 hours after placenta delivered _ Lasts up to four hours
intervention for stage one phases LATENT answer questions and teach
intervention for stage one phases ACTIVE assist in breathing techniques, she may walk until she is uncomfertable or ROM, at this point anxiety may kick in
intervention for stage one phases TRANSITION stay with mom as support,remind how to relax and focus on contractions. she may not want to be touched
vaginal exam labor process _ Assess progress of labor _ Dilatation & effacement _ Membranes _ Position of fetus _ Station _ After ROM, sterile gloves _ Not if bleeding
vital signs labor process every hour latent phase every 30 min active phase
ROM amniotic fluid _ Rupture of membranes: sterility _ Color, amount, & odor=infection, green is maconium, yellow is acidic from urin,wine is blood stained _ Nitrazine paper will be blue. _ Ferning conferms amniotic fluid and not other
interventions during labor rapport,comfort,coach during stage one, monitor check for hemorage, encourage bonding, privacy
bladder care during labor every 2h
vitals during labor latent Q1hr, active Q30min, transition Q15min
non pharm pain relief effleurage, sacral pressure(cutainous),(thermal)shower, hot or cold pack nipple stimulation cause contractions by releasing Oxytocin(pituitary origination ). mental diversion focal point , immagery, music. breathing
neuromuscular dissociation contraction of all muscle groups and slowly releasing tension, helps focus of the relese of tension where needed. best if practiced before labor.
breathing techniques woman to decide what type is most comfortable. S/S of hyperventilation:dizzy,tingles in hands or feet.numbness of nose and mouth. Measure to correct:hold breath before exhale, cupped hand breathing or into a moist washcloth
pharmacological pain relief at increased risk for hypoxia, due to uterus against diaphragm,decreased GI motility leads to risk of aspirating emesis,consider effect on fetus
advantages of pharmacological pain relief reduce "stress response" which decreases platlet perfusion,place mother and fetus at risk for metabolic acidosis. good for fat and hypertensive moms
limits of pharmacological pain relief cardiodysfunction may limit the amount of IV fluids needed by some drugs,dosage and time titration prevent baby from respratory distress, fetal drug metabolism slower than moms,
limits of pharmacological pain relief labor should be well established, dialatation of 4cm, and active phase. vitals and FHR considered.
Demerol most common IV opoid.rapid onset and 50 min peek. birth should be estimated to occur more than 2hours after admin to prevent CNS depression of newborn(resusatation prevention)*hypotension*sedation *nausea *pruritis(itching)*decrease FHR and variablility
sublimaze (fentanyl) rapid onset,short acting OPOID AGONIST,last 1-2 hr *respiratory depression, may be used in combo with regional anesthesia.
Butorphanol(stadol) nalbuphine (Nubian) combo opioid agonist antagonist,relief pain and Nausea with out respiratory depression. not to be given to **drug addicted moms cause withdraw in mother and baby**
labor: analgesia given as early as one hour before delivery, must be 4cm dilated (ACTIVE LABOR)
NARCAN (naloxone) used to relieve pruritis(itching)common side effect of epidural anesthesia. also used in conjunct with newborn O2,venting and gentle stimulation, in new born experiencing respiratory depression.
fun opioid fact five opioids remain in newborn system for 7days, narcan caused withdraw in mother and baby addicted to drugs
anesthesia during labor REGIONAL:pudendal, epidural, sub arachnoid. GENERAL: bad situations, crosses placenta, increases risk of mom hemorrhage
anesthesia during labor monitor (Q5min-VS, FHR). monitor ability to push, urin output freq
blood patch for subarachnoid(spinal block) 10-15 ml inj into epidural space to prevent leaking of CSF
pudendal block local anesthetic inj trans vag into pudental nerve. late second stage of labor 10-20 before delivery, assess for broad ligamint hematoma
epidural block local anesthetic inj into epidural space at 5th lumbar vertebrae. umbilical down affected. given at active labor 4cm. assess for maternal hypotension, fetal bradycardia.loss of Bering down reflex passably causing URINARY RETENTION.
spinal block (subarachnoid) local anesthetic injected into subarachnoid space. blood patch to keep CSF from leeking,affects all sensations from the level of the nipple down,given for vaginal and Csection.
spinal block (subarachnoid) Disadvantages:limited duration of action,maternal hypotension, fetal bradycardia, potential spinal headache, URINARY RETENTION risk. monitor vitals 5-10min,contractions FHR, safety when mom moves.recognise signs of impending birth
Newborns respiratory function surfactant made by mature set of lungs, is a phospholipid.holds open aveoli by reducing surface tension.
functional residual capacity small amount of air that ramains in aveoli. causing each breath to get easier.
thermoregulation prevent cold stress keep enviroment 89-93 degrees, normal temp (97.7)
NB GI system glycogen stors are low, will begin to use brown fat(thermogenic)for energy needs, can feed immediately after birth. burping reduces air pocketing(air obstruction)erly feeding reduces biliruben lvls. glucose levels should be around 60-70 by day 3,
COLD STRESS COMPLICATIONS increase of O2 consumption hypoxia then leads to acidosis,glucose increase relese of lactic acid hypoglycemia, reduced surfactant production collapse of alveoli reopening of shunts(foramen ovale, ductus arteriosus)
brown fat(thermogenic) BAT(brown adapose tissue) nonshivering thermogenesis or called chemical thermogenesis, demerol may interfere with utilization causing hypothermia
molding resolves when 2-3 days, not seen in c section or breech babies
caput succedaneum soft flactuaant mass that may cross the suture lines. ABSORBED IN A FEW DAYS AND REQUIRES NO INTERVENTION
cephalhematoma swelling with in the bone of the skull, subperiosteal, (WILL NOT CROSS THE SUTURE LINE)but may be bilateral.emerges in one to two days, gone in 3 weeks, common with prolonged or difficult labor(dystocia)head circomference altered.
NB GI iron stores last baby for 5months.
kirnicterus newborn Kernicterus is a rare neurological condition that occurs in some newborns with very high levels of bilirubin jaundice.results from cold stress atributing to metabolic acidosis
microcephaly newborn (small head)detected by measureding head circumference. caused by toxoplasmosis, rubella during fetal development
desquamation newborn peeling of the skin at birth (postmaturity)instruct parents to avoid harsh soaps(also seen in vigorously removing the vernix)
mongolian spots newborn dark blue or slate grey lumbosacral region, no medical significance.fades in time(up to 2 years)
nevi(stork bites) gradual fade no medical significance,
port-wine stain newborn darkens with age,will not blanch on pressure. can be associated with genetic disorders. pg169 (laser surgery for self image elective)
craniosynostosis newborn small or early closure of ANTERIOR FONTENELLE. associated with abnormal brain development.can be caused by FAS,fetal hypoxia, chromosomal abnormality
eyes of the newborn color is established 3-6months may be longer. can see 7-10 inc away. tracking 10sec.tears not normal until 2months of age(conjunctiveitis or glaucoma)
newborn sleep deep sleep aprox 3hr. (quiet alert 30 min-1hr. active alert 23hr
chest of newborn nipples that are abnormaly wide may indicate defect.-----{nipples may secreat substance caused from mothers hormones (witches milk)gone in about a week.
hearing test of newborn ALGO screener, sends a tone to babies ear, reads a brain wave that indicates acknowledgement of sound and compares to data base, of other babies responses
newborn bowel sounds can be heard 15 min -2hr after birth
genitalia of new born hymen tags(few weeks) and psudomenstruation (maternal hormones) males: phimosis is foreskin that covers urethra. check for descent of testes
anus of newborn poo in first 24, assess patent anus. 3 stools a day for breast feed and one every other day for bottle fed
simian crease linear crease running across the palm indicates downs syndrome
clubfoot inward downward
unilateral moros reflex broken clavical,
APGAR (activity):flacid to flexed, (pulse): absent to 100+, (grimace): none to vigorus cry, (appearance): blue to compleatly pink, (respiration):absent to good cry
SGA, LGA, AGA small for gestational age is less the 10th percentile, large for gestational age is over 90th percentile. BALLARD SCORE to differentiate from premature
maple syrup urine disease disorder passed down through families in which the body cannot break down certain parts of proteins. Urine in persons with this condition can smell like maple syrup.
maple syrup urine disease treatment life long diet free of amino acids
vitamin K 0.5-1mg aquamephyton, phytonadione. normal flora not present to make K,
circumcision petrolium jelly, sterile gauze. assess bleeding q15min first hour,q30 min 2-3hours. change gauze and ointment with each diaper change. heals 3-5 days.
circumcision home care change gauze and ointment with each diaper change.wash warm water only. no debridment of any type. prevent pressure on site. report less than 6 wets a day.report redness bleeding drainage to HCP
feeding time at the zoo! galactogogues:breast mild stimulators include beer and brewers yeast or sesame tea. breast feeding speeds uterin return. 500+kcals needed.8-10glasses of non cafinated.estrogen,progesterone and human placental lactogen. feeds should be 15-20mins
let down reflex of breast feeding suckling stimulates posterior pituitary to secreat oxytocin. causes cramping (involution)and breast tingles
breast milk types colostum, 3-4 days immunity,transitional milk 5 days to 2 weeks has a little more calories and fat and lactose. mature milk is 22.5 kcals per oz and is plenty sufficient to meet infants needs.
dont feed if HIV, HBV with out vaccine.HepC if liver failure. herps and vericella zoster are contraindicated until leasions are on the breast. small pox vaccination is contra. you been drinking,
wash your hands and knockers hands are primary source of infection. careful what u wash the boobies with,some soaps may cause drying cracking and can lead to mastitis.
late sign of hunger crying, rooting and hand to mouth sucking and alertness are early signs of hunger (trust vs mistrust)
storage of breast milk room temp: 4hours max. fridge at39.2 for 24hrs. freezer 20 deg for 3months. polypropylene not suggested for freezing. microwaves not suggested for warming
breast engorgment cold between feedings and warm before feeds help. massage helps express milk. wear a suportive bra
puerperium postpartum up to 6 weeks (return to normalcy)
first 1-2 hours of postpartum risks are hemmorage and hyypovolemic shock. subsaquent danger is infection
the primary cause of involution is the sudden withdraw of estrogen and progesterone. releases proteolytic enzymes to endometrium
factors that neg impact involution prolonged labor, incomplete expultion of placenta, distended bladder,anesthesia, prevoius labors
factors that pos impact involution breastfeeding, uncomplicated labor, ambulation
after pains 2-3 days postpartum, oxytocin and uterine contractions
what is lochia blood, mucus and particles of necrotic decidua, heaviest 1-2hrs postpartum. count pads assess amt, color smell, clots ect
lochia rubra 1-3days may contain SMALL CLOTS.
lochia serosa 4-10days), pinkish brown,serosang
lochia alba 10days to 6 weeks,yellow white
episiotomy assessment REEDA redness, edema, ecchymosis, approximation
hemorrhiods assess for size, number and discomfert, and relieving factors. witch hazzel, cortico suppository, local anesthestics
temp and wbc post postpartum wbc 15000 first 10days. temp due to dehydration in first 24 hrs, hbg and hct elevated as well as fibrinogens
postpartum urinary increased volume decreased muscle tone, local swelling and anesthesia make it difficult to pee. RISK for infection. diuresis U/O 3000. protein but not glucose in urine
postpartum GI woman has worked up a hunger. constipation has multipal factors. fear of pain progesterone,decreased tone in abdominal muscles
postpartum Neuro carpaltunel resolves as edema decreases, hypertension still a concern
postpartum endocrine lactation and menstration starts as a result of declining hormones. menstration may return later if lactating up to 6mo, nonlactating 1-3 months
phases of maternal adaptation taking in, taking hold, letting go
taking in phase concerned for her self and newborn, passive dependent behavior
taking hold phase ready to assert her independence, ready to initiate newborn care
letting go phase assumes her position in the home (aka the kitchen or ass up face down)which makes her sad
postpartum BLUES not depression is up to 10 days. tearfulness, insomnia, lack of appetite, and a feeling of being disappointed. multifaceted: hormones, anesthesia, fear, pain, new adjustments and grief over freedoms lost. rest empathy and support to manage
abortion before 20 weeks,complications: hemorrhage infection.treatment bed rest, D&C, fluids,monitor for inf and bleeding
threatened abortion vaginal bleeding and cramping
inevitable abortion ROM and Cervical changes
incomplete abortion part of product of conception retained in uterus
complete abortion all product of conception is expelled
missed abortion products of conception retained in uterus less than 2 mo. mommy dident know
methotrexate and tubal pregnancy chemotherapy agent,avoid alcohol and folic acid to prevent toxic response to the drug. prevent sun exposure(photosensitivity)
gestational trophoblastic disease hydatidiform mole, invasive mole, and choriocarcinoma.trophoblast poliferate, chorion becomes fluid filld grape sacs.
gestational trophoblastic disease avascular, no ICM. vaginal bleeding(prune juice),hypertension and hyperemesis gravidarum(elevated hCG)treatment is D&C and follow up hCG lvls
placenta previa painless bleeding, observe, bed rest tocolytics MAG SULFATE(stop labor) no vag exams, c section
abrupto placenta placental detatchment, PAINFUL BLEEDING. FHR changes. shock and DIC!!!! monitor transfusion csection
Rh sensitization affects second child, erythroblastosis fetalis Rhogam 28 weeks and 72hr of PP
ABO incompatibility mother -O, fetus is -A,B,or AB. affects first child, causes patho jaundice
antidote for mag sulfate calcium gluconate, to prevent pre eclampsia
gestational hypertension eclampsia pre-eclampsia, treatment MgSo4 mag sulfate, assess deep tendon reflex to titrate MgSo4.needs more if she kicks you through the fucking wall
pre-eclampsia proteinemia, edema/wt gain. renal involvement leads to proteinuria
eclampsia results in seizures,HELLP, CNS involvement
HELLP H:hemolysis, EL:elevated liver enzymes, LP:low platlets
preterm labor poor preterm care, infection,over distention of uterus, nutritional status. SES, tocolytics slow labor process, other measures (stop infection,restrict activity ensuring hydration)
tocolytics before 3 cm(point of no return) not effective in 5cm or more Yutopar,brethine procardia indocin vasodilation, (assess for hemorrhage) headache is common
methods of induction and augmentation prostaglandin, AROM, Oxytocin
preterm delivery (promoting fetal lung maturity) steroids given to mother 24-48 hours before delivery, betamethazone or dexamethasone
posterm delivery after 42 weeks,fetal hypoxia due to an aging placenta 42weeks exp date, birth trauma due to size of baby, CPD
precipitate labor less than 3hr from first true contraction,:fetal hypoxia from little time between contractions (fetal respiration)
hydraminos associated with fetal swallowing and voiding, removal of excess hydraminos can result in placenta abrupto, prolapsed cord is also concern. amniocentesis is done to prevent overdistention of uterus and preterm labor
factors that increase the incidence of prolapsed cord hydraminos, long cord, small fetus, ROM before engagment of fetus,multi fetal birth, breech or transverse lie
PKU build up of keytones, unable to break down phenylalanine. life long diet, detection using guthrie test 48-72 hr after birth
low birth wt. under 2500g(5.5lbs)(2.5kg)
ballard scoring posture,and physcial atrabutes -10=20gestational weeks, 50=44gestational weeks
ECMO heart and lung machine, used for meconium aspiration as well as other reasons
immature livers of newborns hypoglycemia(30 or less), and hypocalcemia,symptoms are twitching convulsions and high pitched cry
atony (sloppy soft bleeding uterus) MgSo4 can impair calcium that is needed to tighten that shit up bro.as well as calcium channel blockers such as the mother fuckin nifedipine used in da preterm bitchs. and you know that bitchs be trippin bro!you need to tighten that shit up hoe
atony managment shock (tach and low BP)boggy high uteruses. get base line labs and anticipate dextran/albumin, and blood products, high doses of oxytocin/pitocin. admin of vit K. factor 7 can reverse symptoms DIC
blood vs lochia lochia darker red, blood brighter red and continuous.
oxytotics expell retained placenta frags, if not effecient enough a D&C is in order
DIC is suspected when usual means of contraction the uterus fails to stop bleeding. signs of DIC are horrific, she will bleed out of every little interuption in skin integraty, IV, SHOCK IS LATE SIGN, blood volume delays signs of blood loss.
DIC blocker(treatment) factor 7(VIIa)
how does DIC happen infection, abrupto,GTD
Created by: medicalminded