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OB Exam 1

OB nursing

antepartum period Period from conception through start of labor
Perinatal period Period from shortly before to shortly after birth about 28 weeks gestation to about 1-4 weeks postpartum
intrapartum period Period from the start of labor until delivery
Postpartum period Period after delivery to 6 weeks
puerperium period Birth to 6 weeks
Neonatal period Birth to 28 days
LMP Last menstrual period
Development from oocyte to birth Oocyte -> ovum -> *fertilization -> zygote -> morula -> blastocyst -> embryo -> fetus
Pre-embryonic period 0-20 days (2 & 6/7 weeks)
Embryonic period 3 weeks - 8 & 6/7 weeks
Fetal period 9 weeks - birth
How many chromosomes does a human have 46 chromosomes per cell
How many chromosomes does a human ovum contain 23 chromosomes per ovum
How often does the female menstrual cycle occur Every 28 days on average
How long is a ovum fertile for once it is released from the follicle 6-24 hours
How many meiotic divisions does the male gametogenesis have 2 meiotic divisions = 4 sperm
Describe gametogenesis in the female 2 meiotic divisions; the 2nd one only occurs if fertilization occurs = 1 ovum and 3 polar bodies
What are the 2 phases of the ovarian cycle Follicular stage and luteal phase
Describe the time and events in the follicular phase of the ovarian cycle Days 1-14 of the cycle; the oocyte is maturing in the follicle. Phase ends when the mature ovum is released into the ampulla space.
Describe the time and events in the luteal phase of the ovarian cycle Days 15-20 of the cycle; the ovum is released from the follicle; the corpus luteum develops from the ruptured follicle and produces progesterone and estrogen if the ovum is fertilized.
Purpose of estrogen fluid retention (increased cardiac output and tissue perfusion)& (thins cervical mucus)
Purpose of progesterone inhibit uterine contractions & make the endometrium of the uterus "thick & luscious"
How do contraceptive drugs work Inhibits ovulation by mimicking pregnancy with the release of gonadotropin
Uses of contraceptive drugs besides family planning PMDD, ovarian cysts, acne, and ENDOMETROSIS (uterine cells in other areas of the body swell and slough during the menstrual cycle causing bleeding and scar tissue is strange areas of the body)
Endometriosis Uterine cells in other areas of the body outside the uterus swell and slough during the menstrual cycle causing bleeding and scarring in strange areas of the body (mainly the fallopian tubes)
What are some adverse effects or risks with oral contraceptive drugs HTN, weight gain (carb cravings), risk for strokes (blood clots), breast changes (risk for breast cancer)
How long can a sperm survive in female reproductive system Up to 24-72 hours
Ampulla Space where the fallopian tubes and ovaries meet
Where does fertilization usually occur ampulla
What is the advantage of estrogen in the body during conception Increased fluid retention increases tissue perfusion and makes cervical mucus thin which makes sperm faster and ovum move through the fallopian tubes easily
What is the difference between a sperm carrying an X versus a Y sex chromosome Y-sperm are faster; but X-sperm tend to last longer
What is the event that creates a zygote fertilization
What is the event that makes a morula >16 cells; traveling down the fallopian tubes
What are the layers of a blastocyst and what do they become Trophoblast = fetal placenta and chorion Blastocyst = embryo and amnion
At what stage in development does implantation occur Embryonic (about 3 weeks)
Where do we like the embryo to implant in the uterus Upper posterior wall of the decidua
Decidua capularis Protective layer over the embryo that grows with the amniotic sac
Decidua basalis The layer of the decidua that the embryo implants in; will become the material placenta
Decidua Vera The remaining muscle layer of the uterus
When does cell differentiation occur At implantation (about 3 weeks)
What two structures join to develop the amniotic sac Amnion and chorion
Polyhydramnios (and potential causes) Excess amniotic fluid (could be a kidney problem or hydrocephalus)
Olighydramnios (and potential causes) Too little amniotic fluid (could be a problem with the placenta [infarction/ischemic = dead tissue] or maternal dehydration)
When does the placenta form Week 3 with growth through week 20
What are the cotyledons of the placenta for Excess surface area
What does the maternal side of the placenta look like and what is it called "raw and beefy" looking & a "Dirty Duncan"
What does the fetal side of the placenta look like and what is it called Smooth, grayish, and shiny looking & a "Shiny Schultz"
What is given to rh neg. Moms and why Rogam for rh incompatibility
Where does fetal gas exchange occur In the umbilical cord
What is the umbilical cord made up of 2 arteries (de-oxygenated) and 1 vein (oxygenated)
What are the functions of the placenta Gas exchange, nourishment, excretion, protection, and hormone production
Function of hCG Tells body you are pregnant and stops future menstrual cycles; causes nausea
Function of estrogen Fluid retention and increased cardiac output
Function of progesterone Decrease uterine contractions and make uterine lining thick and luscious
Function of HPL (human placental lactogen) Insulin resistance
What keeps the umbilical cord from linking in utero Wharton's jelly
What would an accessory lobe on the placenta indicate Possible past twins
What is a velamentous attachment Weak attachment of umbilical cord to placenta = risk for hemorrhage if broken
pre-embryonic stage Days 1-14; maturation of oocyte to ovum, fertilization, cell differentiation, and multiplication
Embryonic stage 3-8 and 6/7 weeks
Formation of heart 3 weeks
Formation of brain and cranial nerves 4-5 weeks
When does the heart start pumping blood in fetal development 6 weeks
When do arm and leg buds develop in the utero 5 weeks
renal system function 8 weeks
When does urine production start in fetal development 12 weeks
9 week milestone Fetal stage, decreased risk of damage
13 week milestone Decreased risk of miscarriage
When is the time of greatest risk in pregnancy to the baby embryonic
When can fetal heart be heard on doppler 10-12 weeks
When do eyelids fuse closed 10 weeks
When do eyes re-open in utero 28 weeks
16-20 week milestones Quickening, lanugo, brown fat, and alveoli
When is quickening felt 16-20 weeks
When is brown fat formed 16-20 weeks
When are alveoli formed 16-20 weeks
When is lanugo formed 16-20 weeks
When is vernix formed 24 weeks
When is viability 24 weeks
24 week milestones Viability, thermoregulation, respiratory control, grasp and startle reflex, surfactant
When does grasp and startle reflex develop 24 weeks
When is surfactant produced 24 weeks
When do the testes descend 28 weeks
When is coordinated suck and swallow evident 32 weeks
Will a 34 week baby need nicu Yes
Will a 36 week baby need nicu No
What is full term 38-42 weeks
What is post-date >42 weeks
What is dizygotic pregnancy Non-identical; separate placentas
what is monozygotic pregnancy Identical twins; usually shared placenta
When does most monozygotic division occur 4-8 days
What is a complication of monozygotic late division Siamese twins with incomplete division and shared organs
How long is human gestation 280 days
G & P gravida= # pregnancies; parity = # births past 20 weeks
What is pre-term 20-37 and 6/7 weeks
What is abortion End of pregnancy before 20 weeks
GTPAL gravida= # pregnancies; Term=# births past 38 weeks; Pre-term= # births between 20-37 weeks; Abortions= # ended pregnancies before 20 weeks; Living= # living children
What is the formula for calculating EDD 1st day of LMP - 3 months and + 7 days
Fungal height of a 10 week pregnant mom 10cm; right above the pubis symphysis
Fungal height of a 20 week pregnant mom 20 cm; at umbilicus
Presumptive signs of pregnancy are Subjective: something the patient tells you about
What are some presumptive signs of pregnancy Amenorrhea, nausea, breast changes, urinary changes, pigment hangers, fatigue, and quickening
Is quickening presumptive or probable sign Presumptive
Is nausea presumptive or probable sign Presumptive
What is cholasma Mask of pregnancy
Probable signs of pregnancy are Objective: something you physically observe
Goodell's sign Supple cervix (probable sign)
Chadwick's sign Bluish discoloration of vagina and cervix due to vascular congestion (probable sign)
When is uterine enlargement evident above the pubis symphysis 10-12 weeks (probable sign)
Hegar's sign Softening of the lower uterine segment (probable sign)
McDonald's sign Body of uterus is easily flexed against the cervix (probable sign)
Braxton Hicks Irregular contractions that occur throughout pregnancy and do not cause cervical changes (probable sign)
Ballottement "bouncing" fetus against cervix with exam (probable sign)
When can the fetal outline be palpated 24 weeks
Leopold maneuver Fetal outline is palpated at 24 weeks (probable sign)
Examples of probable signs of pregnancy Pregnancy test and striae development
Positive signs of pregnancy Signs that are absolute indicators of pregnancy
What are some positive signs of pregnancy Fetal heart tones, uterine souffle, funic souffle, fetal movement, ultrasound
What is uterine souffle Audible sounds of the placenta (positive sign)
What is funic souffle Audible sounds of the umbilical cord (positive sign)
What is normal fetal heart rate 110-160 bpm
What is normal neonate respiratory rate 30-60 bpm
Follicular phase of meiosis Oocyte maturing into ovum in the follicle on the ovary
Luteal phase of meiosis Ovum released from follicle on ovary and corpus luteum forms
When is the first prenatal exam scheduled for 8-12 weeks
What is the "false pelvis" The iliac crest of the hips do not indicate if the pelvis is narrow/wide enough for a baby to fit
What is the "true pelvis" The opening of the pelvis where the baby has to fit through; ischial spine
What is the risk to a baby when the mother has chlamydia blindness
What are the 3 functions of the amniotic fluid Shock absorption, thermoregulation, and provides free environment for growth and development
If a baby in utero does not have enough amniotic fluid to move freely in the uterus what is the risk Development of contractures
What is Gramatotrophin The first hormone released with each ovarian cycle. Triggers the production of FSH and LH.
What is FSH (follicle stimulating hormone) Triggers the start of maturation of the oocyte to an ovum in the follicular phase
What is LH (lutinizing hormone) Triggers the release of a mature ovum from the follicle space
What is the purpose of Hcg Inhibits the production of gramatoptrophin, FSH, and LH. Stops further ovarian cycles, tells the body you are pregnant, and causes nausea.
What is HPL (human placental lactate) Causes insulin resistance to provide for extra glucose to the developing baby
What is prolactin Stimulates lactation
What is relaxin Works to relax cartilage and ligaments to allow or growth of the baby and passage.
What is a side effect of relaxin Causes heart burn because it relaxes the sphincter of the stomach
What the purpose of testosterone in pregnancy Development of bones and muscles for the baby
What is oxytocin Stimulates uterine contractions and let down of the milk
What is the concern for a mom with O blood type ABO incompatibility
What are the TORCH infection Toxoplasmosis; Other (gonorrhea, Chlamydia, HIV, Hep B, varicella), Rubella (resp infection), cytomegalovirus, herpes simplex
How frequently are prenatal visits scheduled for the first 28 weeks Once a month
How frequently are prenatal visits from 28 to 36 weeks Once every 2 weeks
When do fundal height measures begin 16-20 weeks
Why should pregnant women not lay completely flat Increased pressure on the INFERIOR VENA CAVA decreases blood flow to the brain
When does lightening typically happen 38 weeks
What is IUGR (intrauterine growth restriction) A SGA baby (small for gestational age)
When is glucose challenge test done 28 weeks
When is the group B strep test done 34-37 weeks
How will a mom who is positive for group b strep be treated Antibiotics during labor and delivery
What are persistent headaches with visual changes indicative of Pregnancy induced HTN or pre-ecclampsia
What is hyperemesis gravidarum Severe morning sickness with pregnancy
What is the cause of breast tenderness during the first trimester Increased fluid retention and breast changes due to estrogen and progesterone; teach to wear supportive bras
Why would a women experience bleeding gums and nasal stuffiness during the first trimester Increased tissue perfusion and blood volume due to fluid retention from estrogen and progesterone
Vaginal discharge that has a cottage cheese consistency and smells fishy is indicative of what Bacterial vaginosis (BV)
A pregnant women presents with heart burn pain this could be from The hormone relaxin relaxes the sphincter of the stomach and causes reflux; treat with tums
A pregnant women presents with epigastric pain (RUQ) this could be from pre-ecclampsia; this could be severe liver damage and needs attention
A women has been experiencing leg cramps during pregnancy, what are some ideas to alleviate the pain Repositioning, increase calcium and potassium intake, flex feet. *no massage because we don't watch to dislodge potential blood clots
What lab tests will be done during the first prenatal first (usually 8-12 weeks) UA, pregnancy test, pap smear, blood typing, H&H, STD screening (syphilis, gonorrhea, Chlamydia, HIV, HPV, Hep B, Herpes), Ct-met (metabolic panel, rubella titer
What labs will be done at the 20 week prenatal appointment UA, ultrasound
What labs will be done at the 28 week prenatal appointment UA, glucose challenge test, repeat H&H
What labs will be done at the 34-37 week prenatal appointment Group B strep, UA
What labs will be done on admission to the hospital for labor and delivery UA, repeat blood typing, repeat H&H, CBC
During labor what is the ideal frequency, duration, intensity, and tone of contractions Contractions every 2-3 minutes, lasting 60-90 seconds, strong per pulsation, with positive resting tone
What is the major difference between Braxton hicks contractions and contractions during true labor Braxton hicks contractions do not cause cervical changes
What are the 5 P's of labor and delivery Power, Passenger, Passage, Placenta, Psyche
What hormone starts contractions in labor oxytocin
What are the components to Power in the 5 P's of L&D Strength of contractions and maternal pushing
What is the maximum amount of time that a woman in labor should be actively pushing the baby out for 3 hours
What does Passenger in the 5 P's of L&D represent The fetus
What is fetal LIE in L&D; what are the 3 lie positions How the fetus is oriented to the mothers spine; longitudinal (up and down), transverse (sideways), oblique (diagonal)
A fetus in the transverse lie during labor will be delivered via C-section
What is attitude of the fetus during L&D The flexion of the baby's head during delivery; flexed neck= good; extended neck = bad
What is the presentation of the fetus during L&D; and what are the different presentations What part of the fetus is entering the pelvis first vertex (head first), breech (bottom first), transverse (shoulder first)
What are the 3 types of breech positioning and the delivery type associated with each Frank breech (C-section), Complete breech (vaginal or C-section), Footling breech (C-section)
What is position of the fetus during L&D refer to The relation of the baby's presenting part to the mothers pelvis
A fetal position described as LOA means what, and has what implications The fetal occipital bone of the head is in the left anterior quadrant of the pelvis; this is an ideal fetal position
A fetal position described as OP means what, and has what implications The fetal occipital bone of the head is posterior and pushing up against the maternal scrum bone; this can cause a more difficult passage and painful birth; if possible get the mom into a hands and knees position for pushing to relieve sacral pressure
A fetal position described as RSA means what, and has what implications The fetal sacrum is presenting in the right anterior part of the pelvis; this baby is in a reach position and may require a c-section
During a vaginal exam during labor you find the fetal occiput is the presenting part, midline, and anterior this would be described as OA positioning
During late pregnancy and labor the perineal area is very friable, what does this mean Fragile; easily torn or bleeds
Passage in the 5 P's of L&D refers to Maternal pelvic shape (gynecoid versus anthropoid)
A mother in labor struggling with POWER in L&D can receive what interventions? Pitocin (increase contractions); coaching or labor rest (increase maternal pushing)
What interventions care for the PASSANGER in L&D Fetal heart tones, progression of labor, O2 delivery to mom, prenatal visits
What interventions help with PASSAGE in L&D Maternal repositioning, pelvic assessment, cervical assessment, C-section if necessary
What interventions help with PSYCHE during L&D Relaxing mileu, providing support, education
What does Placenta in the 5 P's represent Age of the placenta, positioning of the placenta, presenting side of the placenta during delivery (Shiny Schultz versus Dirty Duncan)
Interventions for a baby with a prolapsed umbilical cord Maternal position (bottom up, face down); counter-pressure (nurses hand on the baby's head), emergency C-section delivery
When can the "bloody show" present Up to 2 weeks before true labor
What MUST be present for a women to be in true labor Dilation and effacement must be present and progressive
Women are most likely to experience emesis at what times during L&D 4cm dilation and 7cm dilation
What is SROM Spontaneous rupture of membranes
A women has experienced SROM 12 hours ago still with no signs of contraction, what should she do Call her doctor, go to the hospital, if no contractions at 24 hours, start antibiotics to prevent infection
What are the risks associated with SROM chorioamnitis (infection of the amniotic fluid and chorion) and prolapsed umbilical cord
What is internal rotation of the fetus Rotation of the fetal head out of alignment with the fetal shoulders during passage through the birth canal
What is external rotation of the fetus Rotation of the fetal head back into alignment with the fetal shoulders after the head of the baby has been birthed
When is flexion during L&D Flexed position of the fetus as it passes through the birth canal
When is extension during L&D The baby extends its neck as the head is birthed
What is expulsion When the baby is wholly birthed
What are some maternal signs of lightening and when does it happen 38 weeks; easier breathing, increased frequency of urination
What is the first stage of labor and the phases (expected times) Stage of dilation: latent phase= 0-3cm dilation: 0-10 cm dilated and 100% effaced; active phase= 4-7cm dilation; transition= 8-10cm dilation (lasts 6-10 hours)
What is the second stage of labor (expected times) Stage of expulsion: 10cm dilated and 100% efface to the birth of the baby (lasts 20 minutes-3 hours)
What is the third stage of labor (expected times) Birth of the placenta: goes from expulsion of the baby to birth of the placenta (lasts 5-30 minutes)
What is the fourth stage of labor (expected times) Period of stabilization and recovery from birth (lasts 1-4 hours)
During the third stage of labor if the placenta has not been birthed by 30 minutes, what are potential interventions and risks Manual "scoop" of the placenta, risk for infection, risk for hemorrhage, risk for placental fragmentation
What are interventions for a mother in the fourth stage of labor that is having trouble clamping down her uterus Pitocin, fungal massage, and breastfeeding
What is the #1 cause of uterine atony Full bladder
How often should a mom's vitals be checked during the fourth stage of labor and delivery q 15 mins for the 1st hour; q 30 mins for the 2nd hour; then every hour
A mom is experience chills, shaking, and perineal discomfort during the fourth stage of labor and delivery; what should you do Explain that these are normal findings due to the release of adrenaline and body changes during the delivery process
When is a new mom at greatest risk for hemorrhage About 1 hour after delivery
What is normal fetal heart rate 110-160
What is normal fetal respiratory rate 30-60
A mother is in labor when the fetal heart rate begins to slow to less than 100 bpm. What interventions should you implement immediately Administer O2 to the mom, reposition to left lateral, IV bolus fluids, stop Pitocin (if running), and notify the provider
During labor a mom's blood pressure increases by 20 mmHg above her baseline, what are the risks pre-ecclampsia, and risk of seizure
What is normal kick count At least 10 kicks in 1 hour
What is the first assessment a nurse will perform upon admission to the hospital for L&D Fetal heart tones; Maternal come second
A 38 week pregnant mom presents with straw-colored discharge but is unsure if her water has broken or not, how can we check? Nitrazine tape (turns bright blue for amniotic fluid); microscopic observation ("farming" look for amniotic fluid)
In comparing FHT to maternal contractions, which should you monitor first Contraction patterns
How do we establish baseline for FHR The mean of the highest and lowest value
What is variability in FHR and the implications Variability is irregular fluctuations from baseline in FHR. This is a good and normal finidng
What is acceleration in FHR An increase in FHR by 15 bpm for 15 seconds in a 10 minute strip; this is good and normal
What are early decelerations and what do they indicate A decrease in FHR that happens with contractions and recovers to baseline before the contraction ends; head compression
What are variable decelerations and what do they indicate When the FHR decreases with or without contractions; cord compression
What are late decelerations and what do they indicate When the FHR decreases with contractions and does not recover to baseline before the contraction ends; placental insufficiency
A fetus is experiencing variable decels with increasing frequency, what is this a sign of Potential nucal cord (wrapped around baby)
A fetus is experiencing late decels during labor, what immediate interventions should you take Maternal O2, maternal left lateral position, IV fluid bolus, notify provider
What are the 4 components for documenting maternal contractions Frequency, duration, intensity, resting tone
What are the four components for documenting fetal heart tones base line, variability, accelerations, decelerations
How often should vital signs be collected on moms in labor Every 1 hour
How do we measure the intensity of maternal contractions Pulsation; mild (tip of the nose); moderate (chin); strong (forehead)
When the cervix is 100% efface what is it comparable to As thin as a sheet
Vaginal exams are done under what technique Sterile
A mom is in labor, dilated to 6cm, has received an epidural, and is on IV lactated ringers solution 500mL running. On assessment she is experiencing +1 edema on the lower extremities and crackles in the lungs with no increase in temp. What should you do? Suspect over-hydration; slow IV infusion rate and notify provider
What is the different between induction and augmentation Induction is initiation of labor before it begins naturally; augmentation is stimulation of contractions after they have begun naturally
What are some common drugs used for induction or augmentation of labor Pitocin (stimulate contractions), Cervidil (gel to soften cervix), Cytotec (insert to soften cervix)
What is Cervidil and some problems with it A gel used to soften the cervix during labor; cannot be removed once applied; can cause very intense contractions
What is Cytotec and some problems with it A vaginal insert used to soften the cervix; can cause intense contractions
What are nursing considerations for administering Pitocin Do not bolus; keep on drip to regulate contractions; too much Pitocin can slow down labor; contractions may become too strong to allow perfusion to the fetus, increased risk of uterine rupture and pain
A 40 week pregnant women presents to L&D, she is 2cm dilated and requesting pain medications; what should you explain to her about pain medications in the latent phase Pain medications in the latent phase can slow or stop the progression of labor is given too early
A 40 week pregnant women is 9cm dilated and requesting pain meds. What should you explain to her about pain meds during transition Pain meds given during transition are unlikely to affect pain level at this point, and epidurals will be unlikely to kick in until after you have begun pushing
What are common narcotic drugs given during labor for pain management and considerations Stadol, Nubaine, and Fentanyl. Will not be effective during transition, short-acting, do not give within one hour of delivery, have Narcan in the room in case of CNS depression
What are some adjunct medications given with narcotic drugs during labor and why Benadryl (itching); Phenergan (nausea); both cause mild sedation
What is lidocaine used for Local anesthetic; used with episiotomy and repairing tears
What would a pudendal block be used for When delivery of the baby is moving too quickly for an epidural this can block pain in the lower 2/3rds of the vagina
A patient in labor has requested an epidural. What are the nursing actions associated with this request in order Obtain informed consent; assess labs (do not give if platelet counts are low); bolus with fluid; assess FHT and maternal vital signs before and after insertion of epidural; position mom in left tilt position; watch HR and BP very closely
A women who has an epidural inserted starts complaining of pressure pains and thinks her epidural is wearing off, what should you do Explain epidurals do not block pressure pain; the pressure you are feeling probably means we are very close to delivering the baby
A patient with a C-section delivery is given Duramorph right before the removal of her epidural. What is the benefit of this? Duramorph works for 24 hours and can help alleviate the post-op pain for the first day
When is a spinal block used During a C-section for a mother who did not have an epidural in place
When is general anesthesia used During emergency C-sections
What is effleurage non-pharm pain management; "gait control theory" replace the pain stimuli with pleasure
A mother who has been in labor for an extended period of time is offered a forceps delivery. What are the indications for this and the risks? Prolonged labor, maternal exhaustion, ineffective pushing, and fetal distress; risk of fetal injury and maternal tissue damage
What is the difference between forceps and vacuum suction deliveries Vacuum suction does not enter the pelvic cavity like forceps
A baby delivered with vacuum extraction has circular edema on the head, what is this called? Chinogn; caused from the suction delivery
What is placenta previa; and what are the considerations The placenta implants too low for the baby to pass through the birth canal; needs a C-section delivery
What are the 3 incision types for C-section and what do they look like Low transverse (horizontal on the bikini line), Low vertical (looks like an upside down T, allows for bigger babies; classic (vertical incision from the umbilicus down)
What is macrosomia of the fetus and what are some considerations A fetus > 8lb 8oz; may be too big for vaginal delivery
What is shoulder dystocia and considerations during birth The fetal shoulders get stuck above the symphis pubis; put mom in "McRoberts" position (knees to shoulders), may need an episiotomy with manual rotation of the fetus, fetal clavicle may be broken during delivery
A baby who had shoulder dystocia during delivery needs careful assessment after delivery in what areas clavicle (check for breaks or fractures); shoulder ROM (listen for grinding or popping) - Tx with pinning onsie and being gentle with the joint til it heals
What interventions can be used for a baby that is positioned OP during delivery "tug of war" with the mom; positioning on hands and knees
What is hypotonic labor dysfunction Weak uterine contractions that have diminished during the active phase
What is hypertonic labor dysfunction Strong, cramp-like uterine contractions that are very painful and ineffective, often appear in the latent phase
What is the treatment for hypertonic labor dysfunction and considerations Terbutaline (decreases uterine contractions); do not give if maternal HR is >100bpm
What is the risk for a mother with a weak abdominal wall; and treatment The baby cannot hold in vertex position; keep mom upright and apply abdominal pressure
What are uterine fibroids and problems during delivery Benign tumors that develop in the vaginal or uterine walls; can obstruct birth canal drying delivery
What classifies prolonged labor Labor greater than 24 hours (risk of fetal distress and maternal exhaustion; infection)
What classifies precipitous labor Labor less than 3 hours (risk of injury to mother and baby)
A 24 week pregnant woman calls her provider complaining of a backache and flu-like symptoms, what should you do Have her come in to the hospital immediately; these are signs of preterm labor
Why are pregnant women at increased risk for UTIs HPL (human placenta lactogen) causes increased blood and urine glucose
What is the #1 reason for pre-term labor UTI
What is preterm labor Labor after 20 weeks and before 38 weeks of gestation
How do we treat pre-term labor Bed rest, hydration, magnesium sulfate, steroids to improve fetal lung development
Why would a 32 week pregnant women be prescribed betamethasone Pre- term labor; Betamethasone is a steroid to improve fetal lung development
What is premature rupture of membranes (PROM) Rupture of membranes before any contractions have started
What is pre-term premature rupture of membranes (PPROM) Rupture of membranes before 38 weeks and without any contractions
What is involution The gradual returning of the uterus to normal size and position
What is the hormone responsible for involution of the uterus and breast milk let down oxytocin
What are afterpains and treatment for them contraction pains that occur after delivery, usually during breastfeeding and fundal massage; tx with Motrin, Tylenol, or Percocet
When would Percocet be prescribed to a postpartum women and considerations with this medication *check for allergies to medications! - frequently used with C-section moms
During a postpartum fundal massage you notice the fundus is deviated to the right, what should you do Ask the mom to try emptying her bladder then check again
Where should the position of the fundus be right after birth At or below the umbilicus
What should the position of the fundus be 48 hours postpartum 2-3 FB below the umbilicus
After a fundus assessment on a postpartum women you determine the uterine tone to be "boggy" what should you expect this patient will be prescribed Oxytocin (to increase uterine tone and contractions) and Methergine (vasoconstriction to decrease bleeding)
What is subinvolution Failure of the uterus to start returning to normal size
What should the lochia of a day 2 postpartum patient look like Rubra (red with small clots)
What should the lochia of a day 7 postpartum patient look like Serosa (pink/brown)
What should the lochia of a 2 week postpartum patient look like Alba (white and mucous-like)
How long does it take for the cervix to return to normal thickness and dilation after delivery About 12 hours
How long does it take for an episiotomy to heal completely About 6 months
How log after delivery before vaginal tone starts to return 2-3 weeks
What is REEDA and what is it used for Redness, edema, ecchymosis, discharge, approximation (used to assess perineal lacerations or episiotomy postpartum)
How long before excess fluid retention is lost after delivery and how About 2 weeks; increased RR, sweating, and urination
A postpartum patient with a swollen urethra has been straight cathed 2 times since delivery and is still unable to void. What should you implement Insert a Foley cath for 24 hours so swelling can decrease
What are the causes of "baby blues" in the postpartum period Fatigue, hormone changes, new roles
What is the difference between baby blues and postpartum depression Baby blues are normal and do not affect the ability to care for the baby; postpartum depression may cause the new mother to become withdrawn and unattached from the baby making daily cares difficult
What is the treatment for postpartum depression SSRI medications (Zoloft)
What is postpartum psychosis and the treatment When the new mother is out of touch with reality and may be homicidal or suicidal (very dangerous for mom and baby); treat with inpatient care
What are the 3 phases of maternal adaptation in the postpartum period Taking in, taking hold, letting go
Describe Taking In Day 1: New moms are passive and receptive; they watch others care for the baby and need help caring for themselves
Describe Taking Hold Day 2: new moms begin assuming the cares of the baby and of themselves, they become more assertive in their role as mom
Describe Letting Go Assumes the parental position, may not be receptive to advice or opinions of others
What is the effect of rh incompatibility in the fetus Fetal hemolytic anemia (the destruction of RBC and release of bilirubin)
What is the effect of fetal hemolytic anemia Pathologic jaundice: increased bilirubin and increased immature WBCs (erythroblastis fetalis)
What is the treatment for rh incompatibility Intrauterine transfusions throughout pregnancy and at delivery
Describe jaundice in newborns Results from destruction of RBC and release of bilirubin; starts in the head and face, the more severe it is the further down it goes; treated with phototherapy lights
What is the hormone that produces breast milk prolactin
What is the hormone that stimulates let down oxytocin
When is colostrum produced; and what are the benefits 0-3 days; small amounts adequate to fill neonate's tummy, rich in calories and antibodies
When does transitional milk come in and considerations 3-4 days; breasts may become engorged, encourage on-demand breast feeding, Motrin, and warm packs
When does mature milk come in; and considerations 8-10 days; foremilk is thin and watery, followed by hind milk which is thick and high in calories
How often should a newborn be fed Every 2-3 hours (breastfeed); every 3-4 hours (formula fed)
How many wet diapers should a newborn have on day 1 1-3 diapers
How many wet diapers should a newborn have on day 2 2-4 diapers
What is the best way to tell if a newborn is getting enough to drink The number of wet diapers
What is the "LATCH" scoring tool stand for Latch, audible swallow, type of nipple, comfort of nipple, hold of baby (0-2 pts each)
What are the considerations for a neonate who has not had a complete bath yet Wear gloves; that baby could be carrying Hep. B
What is the first thing done to a newborn as the head is born Bulb suction of the mouth and nose
What are the 2 supportive measures done to every baby at birth Bulb suctioning and tactile stimulation
Why do we collect cord blood at birth Blood typing and pH testing
When should the first breastfeed be done by By 1 hour after delivery
When is the umbilical cord unclamped and recut and what considerations are there At 24 hours; first assess for cord dryness and discharge; risk for bleeding out if its not dry
What are the considerations for a newborn with an apgar score of 9 This is a healthy baby on birth assessment
What are the considerations for a baby with an apgar score of 7 This baby will need medical interventions to promote health
What are the categories in APGAR tests Heart rate, respiratory effort, muscle tone, reflex irritability, and color
A newborn with a HR of 105 would get what APGAR score in the HR category 2 pts
A newborn with a weak cry would get what APGAR score in respiratory effort category 1 pt
A newborn with flaccid arms would get what APGAR score in muscle tone category 0 pts
A newborn who withdraws their foot and fusses after babinskis reflex test would get what APGAR score in reflex irritability category 2 pts
A baby with acrocyanosis would get what APGAR score for color category 1 pt
Which STD can cause blindness in newborns Chlamydia
What is the use of erythromycin in newborns Eye drops to prevent blindness and eye infections at birth
What is the use of vitamin K in newborns Promotes clotting factors
When should newborn blood glucose be checked Before the first feeding and one hour after the feeding
What is normal newborn blood glucose Greater than 40
Before the first feed for a formula fed baby what should be done offer sterile water to check for any malformations in the digestive tract
When is a gestational age assessment done on a newborn Within 24 hours; it may not be the same as the age by dates
What is Caput in newborns Edema in the soft tissues of the head; crosses suture lines and is normal
What is a cephalohematoma in newborns Collection of blood under the skin of the head; does not cross suture lines; indicates broken blood vessels and may need interventions
Which Fontenelle is shaped like a diamond anterior
What color should the sclera of a newborn be Blue/white or gray
What do skin tags on the ears indicate in newborns Potential renal problems
What causes crepitus shoulders in newborns Dystocia shoulder during delivery
What is the treatment for crepitus shoulder in newborns Pin the gown arm across the chest and use gentle movements
What are the things that must be done before a baby can have a circumcision Informed consent; assess for correct male anatomy; assess for ability of baby to void
What pain management is used for newborns during circumcision SUCROSE (oral) and lidocaine (topical)
How many BMs should a newborn have on day 1 1-5 BMs
What is acrocyanosis Pink skin color with blue-wish color on palms of hands and soles of feet
What is Barlow-Ortolani test used to detect Hip dysplasia
What is "ruddy" colored skin and what does it indicate Red colored skin; excess RBC production due to hypoxic environment in utero
What is "jaundice" colors skin and what does it indicate Yellow colored skin; due to increased bilirubin from RBC destruction; jaundice is neurotoxic
What are "stork bites" in newborns A reddish birthmark from blood vessels under the skin
What are Mongolian spots in newborns Hyperpigmentation of an area of skin that may look like bruising; more common in Hispanic and African groups
What are Milia in newborns "baby acne"
What is a strawberry hemangionoma in a newborn An abnormal formation of capillary vessels under the skin forming a birth mark; usually on the neck
How much formula should a newborn be drinking initially 0.5-1 ounce
A baby that likes to be "squished" is probably pre-term
A baby that likes to be stroked and pat is probably Full term
What is the "Newborn Screen" and considerations A MANDATORY blood test done on newborns to detect congenital conditions; Baby must be fed before this test is done
A baby that is avoiding eye contact or "sleeping" in loud exciting environments is most likely experiencing Sensory overload
What is the 1st developed sense at birth Sense of smell
How many hours of sleep does a newborn need a day 15-20 hours
A mother tells the nurse that her 7 day old baby is sleeping for 8 hours at a time, what should the nurse tell this mom Baby's that sleep for more than 4 hours without feedings are at risk for hypoglycemia
When does a baby take their first breath When the cord is clamped
What is the highest bilirubin level that should be seen in neonates 10-12 mg/dl
What is physiologic jaundice Seen 2-3 days post-delivery and resolves on its own
What is pathologic jaundice Seen in the first day of life; caused by blood incompatibilities or hepatitis; may require intervention
A neonate is displaying mild irregular tremors, what should you do Tremors are a normal finding in newborns; if tremors are severe or sustained, it could indicate seizure activity or hypoglycemia
Created by: jperrault9941