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OB Level 4


Expectations of the LVN in Obstretric situations Manage complications, give intensive support, facilitate the laboring process
What is important in immediate assessment? Birth imminence, fetal and maternal status, factors leading up to hospital visit( i.e. trauma)
What is important in non-emergent assessment? Health history, status of labor ( vaginal exam), birth preferences, labor preferences
Labs that are important to OB? CBC, Blood type and RH, VDRL or RPR, Rubella, ELISA, vaginal culture, and UA.
What are you palpating for on the fundus? Mild contraction- tip of nose Moderate Contraction - chin Strong contraction- forehead
What is TOCO? Device used to measure the contraction frequency and duration. This is to be placed on the hardest spot of stomach.
Baseline FHR Normal 110 - 160 bpm *Tachycardia >160 *Bradycardia <110 Must continue for 2 minutes. NEED VARIABLES
Accelerations -15 X 15 minute window
You have a mom in active dilation, what needs to be done by the nurse? Monitor FHR every hour, maternal status, fetal membranes, and mom's psychi.
What is the nurses primary concern during laboring process? Maternal and fetal safety.
The possible signs of pregnacy Early breast changes, amenorrhea, morning sickness
The probable signs of pregnancy bladder irritability, presence of HCG in blood , and uterine growth.
What could the presence of HCG in blood also be due to? Hydatiform mole
Describe Chadwicks sign. A bluish -purple color of the cervix , vagina, and perineum
Describe Goodell's sign. The softening of the cervix
What is the best indication of pregnancy? Visualization of fetus by ultrasound at 6 weeks
Fetal circulation uses three shunts, what are they? Ductus venosus, foramen ovale, ductus arteriosus. Exchange happens in the intervillus spaces.
How does one determine the severity of a defect in a fetus? Depends upon when during developmenty the conceptus is exposed to the teratogen and the agent to which the fetus was exposed.
What infectious agents are considered dangerous to a fetus? Varicella , cytomegalovirus (CMV), abd Rubella
Where do ectopic pregnacies occur? WHY? 95% occur in the fallopian tubes Caused by blockage or scarring of the fallopian tubes
Risk factors for twins Family history Recent cessation of birth control Tall or large stature of mother African - American Use of fertility medications
What four main functions does the amniotic fluid serve? Physical protection Temperature regulation Provides unrestricted movement Symmetrical growth
Where does the baby get its nourishment in utero? The placenta
What are the main functions of the placenta Exchange of substances Acts as a barrier Producing hormones
Umbilical cord TWO-2 arteries bring deoxygenated blood from the fetus to the placenta. ONE-1 vein carries oxygenated blood and nourished blood from the placenta to the fetus Whartons Jelly surrounds these three.
Describe the pre-embryonic period Cleavage begins 3 Days- morula forms 5 Days- blastocyst form 10th day- blastocyst buries itself in uterine wall.
Tell when the embryonic stages begin and end Lasts from the end of the (2) second week after fertilization until the end of the 8th week
Name the three germ layers Ectoderm-skin, hair Mesoderm- Bones, muscles Endoderm-glands , lungs
Describe the fetal stage. From the beginning of the 9th week after fertilization and continues until birth. Growth and maturation of the organs and bodys systems
List menstrual disturbances Amenorrhea- Absence Menorhagia- heavy bleeding Metrorrhagia- occurs at irregular intervals Dysmenorrhea- painful
How much water do newborns require? 80 - 100 ml/kg/day
Advantages of breastfeeding Rapid uterine involution Less bleeding Weight loss Provides protection against infection
Contraindications of breastfeeding Illegal drug use Active TB HIV Chemo Herpes on the breast
What is Galactosemia? An error of metabolism. Lacks enzymes to break down sugar. Baby requires special formula.
When the newborn sucks on the breast what happens? The pituitary gland releases prolactin and oxytocin. Prolactin stimulates milk production and oxytocin pushes the milk down.
What can inhibit the let down reflex? Alcohol
Teaching for infant sleep - wake cycle. Baby sleeps 16 out of 24 hours.
4 ways to hold the baby Cradle Colic Football Upright
What to watch for in formula fed babies on iron? Constipation
Teaching for mom and dad after circumcision. Do not clean with alcohol Do not remove the yellow mucus from penis
S / S of infant respiratory distress Nasal flaring Chest retractions Grunting
Initial care of newborn Maintain airway- Keep bulb syringe handy V/S 30 min. x 2, then every hour Thermo regulation- prevent heat loss Prevent infection
How to check sucking reflex Few sips of sterile water Offer the breast
What is not present at birth , that must be given at birth? Vit K - clotting factors 0.5 to 1 mg ( Do not give with Hep B , alternate sites.)
Bulging fontanels are signs of ICP, infection, hemorrhage
Moro reflex Startle, clap hands near baby
APGAR HR 100- 160 RR 30 - 60 Muscle Tone well flexed Reflex Good cry Color completely Pink 0 to 2
Glucose for infant 40- 60
Bilirubin greater than 6= jaundice
Signs that the baby is not feeding well Dry mouth Not enough wet diapers Cant wake baby up
Assessment of proper breastfeeding Audible swallowing( clicking) Rhythmic Jaw gliding Mom has uterine contractions
Mastitis Flu-like symptoms, low grade fever But mom can still breastfeed
Fore milk Watery,thin,blue
Hind milk Thick, white, Full of fat
Adequate signs of oxygenation Moist and pink mucus membranes
____________ heat loss is when the babys skin touches a cooler surface causing a heat transfer. Conduction
This refers to the swelling from bleeding under the skull of the neonate resulting from birth trauma. Cephalhematoma
Simian crease A single straight crease on the palm that is associated with Down syndrome
In a postpartum female, ______________ could be a sign of developing pre-eclampsia. A falling ______________ , is suggestive of a hemorrhage. Elevated blood pressure Falling Blood pressure
This occurs the first few days after birth, when the body rids itself of excess fluid. Particularly at night. Diaphoresis
A delay in passing the first meconium may indicate what? Hirschsprung's disease or Cystic Fibrosis
Proper way to reheat breast milk Place bottle in a sauce pan of hot water.
How long should a mother brestfeed exclusively before introducing a bottle of her milk? 6 weeks
What complications come with poorly controlled DM during pregnancy? Birth defects Still birth HTN Polyhydramnios - excess amniotic fluid Preterm delivery Shoulder dystocia
What is macrosomia? Huge baby
What do we not give DM mommies? Oral insulins, they are teratogenic
S/S of hypoglycemia Anxiety Cold and Clammy Skin Shaky Increased pulse Confusion Headache Hunger
S/S of cardiac problems in mom Tachycardia Dizziness Light headed
This is the earliest sign of cardiac decompensation Persistent rales in the base of lungs and nocturnal cough
Common signs of iron-deficiency anemia Tachycardia tachypnea dyspnea pale low blood pressure fatigue weakness
The pregnant woman in status asthmaticus recieves aggressive treatment with ________________ and mechanical ventilation in ICU Early intubation
TORCH Toxoplasmosis Other- HepB, Syphilis, Varicella,Herpes Rubella Cytomegalovirus
S/S of acute HIV Swollen lymph nodes, feeling tired, weight loss, night sweats, fever, persistant infections, short term memory loss
MAin goals of treatment in pregnant HIV Prevent progression and transmission to fetus
What are typical child bearing years? Ages 15 to 44 yrs
Why are pregnant teens at high risk for poor prenatal care? Body image, no support, and deficient knowledge.
Created by: shanda.brown