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SAC Exam #1

Module 1,2, & IV

Gestational Age Calculated from 1st day of woman's last period
Term Gestation 37-40wks
Late preterm 35-37wks
Pre-term gestation 35wks & below
Post term gestation 42wks and above
Gravida # of times woman has been pregnant INCLUDING PRESENT ONE
Para # of woman's pregnancies that ENDED after 20wks, dead or alive
Stillbirth vs Abortion stillborn- fetus born dead after 20wks abortion- pregnancy that ends before 20wks; SAB or TAB
Primip vs Multip Primip- 1st time mom Multip- mom w/ multiple children
which part of uterus contracts upper 2/3's
Physiologic retraction ring the division between the upper/lower segments of uterus
4 components of birthing process Powers, Passageway, Passenger, Psyche
What are the Powers of birthing process? Uterine contractions and Cervical changes
True components of labor Dilation (0-10cm) and Effacement (0-100%)
What are the different ways a fetus can lie? Longitudinal and Transverse
What are the different attitudes of a fetus? Flexion and Extension
Fetal presentation? Different types? Part of fetus that enters the pelvis first; Cephalic (vertex), Breech, Transverse
Fetal Postition Relationship of reference point of fetal presenting part to one of the 4 quadrants of mom's pelvis: L/R & anterior/posterior
Fetal station relationship of presenting part of fetus to imaginary line drawn between ischial spines of maternal pelvis
Types of Cephalic presentation Vertex presentation (complete flexion), Military presentation (moderate flexion), Brow presentation (poor flexion [extension]), Face presentation (full extension)
Describe anterior & posterior fontanels Anterior in front and diamond shaped; posterior above occipital bone and triangular
Types of breech presentations Frank, Full, Footling
What is Lightening? Descent of fetus into pelvis
Conditions of fetal compromise FHR outside norm, little/no variability, persistent bradycardia, mec in amniotic fluid, foul odor to amniotic fluid, contractions >90sec, contractions <60sec apart, maternal HYPO/HYPERtension, maternal fever
4 stages of labor? !st- Dilating phase; 2nd- C/C to delivery of fetus; 3rd- delivery of fetus to delivery of placenta; 4th- 1-4hrs post-delivery of placenta
3 phases of 1st stage of labor? Latent- 0-3cm; Active- 4-7cm; Transition- 8-10cm
EBL (estimated blood loss) of delivery Vag del= 300-500mL; C/S= 700-1000mL
What does Supine Hypotension lead to in fetus? Late decelerations
What do Late Decelerations indicate in the mother? Utero-placental insufficiency
What happens to mom's H&H post-delivery? H&H decreases (norm: Hgb 12-16, Hct 36-46)
When do you suggest mom no longer sleeps on back? Why After 20wks, because of Supine Hypotension; need to promote circulation
Uteroplacental insufficiency Not enough O2 getting to uterus, through placenta, to oxygenate baby well
What s/s could indicate hemorrhaging mom? Not wanting to hold baby, nausea, vomiting, drop in BP, rise in HR --> STAT emergency hysterectomy
Should obese patients have vag del or c/s? Why? Vag del because more likely to bleed out w/ c/s
What is GBS and what meds for GBS(+)? Group beta streptococcus; ampicillin (2g 1st dose & 1g q4hrs after; 3 doses to consider treated); or clindamycin if allergic to amp
IV fluid should run at what rate? 125mL/hr
Why monitor I&O? Bladder distention
Different pain relief measures? IV, Regional anesthesia, non-pharm
What is best way to measure strength of Uterine Contractions? Internal fetal monitor
Tool to break bag of water? Amniohook
When is foley d/c'd in vag del? In c/s? vag del- at 2nd stage; c/s- 1 day after delivery
Why is pitocin given after delivery? at what rate? how long after? to control postpartum bleeding; wide-open, 999mL/hr; 2-8hrs for vagdel, 24hrs for c/s
Why does bladder become distended throughout labor process? because of increased amount of IV fluid infused
What are you noting about fundus post delivery? Location and tone
What med is given to control bleeding post delivery? Methergine (0.2mg IM if BP <130/90) and/or Hemadate OR Cytotek
How often do you monitor resp effort post delivery? what else do you monitor? q 15min for 1hr; longer for c/s; v/s, fundus, lochia, LOC
What is Duramorph? morphine-like med in epidural; leads to complete loss of sensory/motor function; generally used for c/s
What can be used for swelling of perineum? Ice packs, 24hrs post delivery; heat/sitz bath after 24hrs
How often can mom breastfeed? Start at 10min, then 15 min on each breast
Taking "in" phase vs Taking "hold" phase Taking in= mom taking care of self, no newborn teaching yet; Taking hold= mom can hold/process info to take care of baby (4-6wks)
Where does pain from cervical dilation enter spinal cord? Pain from vag/perineal distention? Cervix= T10-T12, L1; Vag/perineum= S2-S4
Pudendal block? Why given? Local anesthetic that goes into pudendal nerve, done by midwives; simplest/safest method of perineal anesthesia, doesn't alter mom's oxygenation, circulation, and GI, doesn't affect UCs, doesn't suppress newborn
Where is epidural placed? Between 2nd, 3rd, or 4th lumbar vertebra
When is Duramorph usually given? during active phase (4-7cm) of 1st stage
What is a major effect of Duramorph? Decrease in BP r/t vasodilation from local anesthetic agents; monitor resp function
What happens if maternal hypotension not corrected? Bradycardia
Examples of opiods? Duramorph, Fentanyl, Sufentanil
What is used to ease post-op pain for 1st 24hrs? Duramorph
What do narcotics cause in newborn? Resp depression
Examples of narcotics Nubain, Stadol, Demerol
Nubain Nubain (nalbuphine HCL) 10mg IM, SQ, or IV; onset 2-3min, peak 15-20min, duration 3-6hrs.
Stadol Stadol (butorphanol tartrate)1-2mg IV or IM; rapid onset, peak 30-60min, duration 3-4hrs;
Demerol Demerol 50-100mg IV/IM; immeidiate onset, peak 5-7min, duration 2-4hrs
If a Postpartum mom delivers 1-4hrs prior to you receiving report, what is the first thing you assess? Bladder, fundus, lochia, vital signs
Postpartum c/s mom in recovery room. First action? Attach O2sat and BP cuff (because she just came from major abd surgery)
Local complications of IV therapy? Hematoma, infiltration, phlebitis, thrombophlebitis, extravasation
Systemic complications of IV therapy? Septicemia, fluid overload, air embolism, speed shock, catheter embolism, erratic flow rate
Nursing action for Extravasation? Stop infusion, call MD, take picture
What does narcotic do to fetal heart rate tracing? Flattens out, less variability
What to expect after epidural? drop in mom's BP (freq asses for 1st 20min) distended bladder (assess q 2hrs)
What med do you give if mom's BP drops? ephedrine IVP (by anesthesia)
Meds to prevent hemorrhage in postpartum mom? Pitocin, Methergine (not w/ high BP)
Advantage of Pudendal block? Up to void ad lib
what do you do for late decelerations? Inc. O2 by mask, reposition, inc. IV rate
early decels,late decels, and variable decels indicate what? Baby's head being compressed while entering birth canal, uteroplacental insufficiency, and cord compression
when do you get info from patient? between contractions
why do we try to discourage IV narcotics, especially in transition phase? baby might have resp depression
why do we encourage skin-to-skin and breastfeeding immediately after birth? promotes attachment and breastfeeding stimulates oxytocin release, contracting fundus, reducing postpartum hemorrhage
What to teach if mom does NOT want to breastfeed (Lactation Supression)? don't breastfeed/pump at all (stimulates production), tight bra/clothes
2 hormones from pituitary r/t breastfeeding? Prolactin (milk production) and Oxytocin (let down reflex)
how often should she be breastfeeding? 1 1/2 to 3hrs
How does she keep engorgement under control? Must empty each breast w/ each feeding
What do you suggest for c/s postpartum mom on bedrest? leg exercises and SEQs
How often do we do fundal assessments in the 4th stage of labor? Every 15min for 1st hr, then q 30min
Indications for C/S Previous c/s, failure to progress, cephalopelvic/disproportion, abnormal presentation, multiple gestation, fetal intolerance to labor (FITL), placenta previa/abruption, prolapsed cord
Primary focus of c/s procedure? Types? Uterine incision; Vertical or Pfannenstiel
Lower uterine segment vertical incision is preferable for what? multiple gestation, abnormal presentation, placenta previa, fetal distress, pre-term or macrosomic newborns,
Risks w/ lower uterine segment vertical incision? Risk of bladder trauma and uterine rupture w/ next pregnancy
Describe classical incision c/s? Upper segment of uterus is vertically cut for quick delivery of preterm baby or one w/ fetal distress. Risk for inc. blood loss and uterine rupture on repeat c/s
Pre-op actions for c/s? Informed signed consent, choice of anesthesia, hang LR, place foley, skin prep, antacids 30min prior, collect CBCs and have 2 units of blood on hold, teach postop expectations, support
Nursing actions after c/s? Prompt pt to turn, cough & deep breathe, prompt incentive spirometer use, encourage early ambulation, H&H labs, monitor I&O, monitor temp, advance diet as tolerated, active/passive ROM, fundal/lochia assessment, pericare
When are staples removed? 3rd post op day
Created by: cobedad
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