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peds/ob 2
| Question | Answer |
|---|---|
| Prenatal tests and labs | blood type, Rh, CBC, rubella, syphilis, hep b, hiv, chlamydia, urinalysis, GDM at 24-28 wks, groub b strep at 36-37 wks |
| Pt education for travel, activity, sex, exercise | -travel safe up to 36 weeks -avoid long immobility, walked every 1-2 hrs -sex safe unless contraindicated (placenta previa) -moderate exercise 30min/day -avoid overheating, heavy lifting, contact sports |
| Hyperemesis and nausea s/s treatment education | -severe persistent vomiting, dehydration, weight loss, ketonuria -vitamin B6, doxylamine, IV fluids, electrolytes, ginger, antihistamines -Eat small frequent meals, avoid triggers, bland diet |
| supplements and food sources | -nutrition 70-100g protein, 8-12 eight oz glasses of water, 600mcg folate iron- red meat, beans, fortified cereals calcium- dairy, leafy greens folic acid- leafy greens, citrus, fortified grains |
| Education for adolescents adults older gravidas | -contraception counseling, nutrition emphasis, STI prevention -work-life balance, substance avoidance -genetic testing, chronic disease management |
| GDM | increased insulin resistance in 2nd- 3rd trimester risk increases with obesity, PCOS, fam history |
| GDM screening diagnosis treatment education | -1hr GCT at 24-28 wks, is >140 then 3 hr test -diagnosis requires 2 or more abnormal values -diet exercise, insulin -diet control, signs of hypo/hyperglycemia |
| GDM and infants | -risk of still birth, preterm, congenital defects -hypoglycemia, macrosomia, heavy vernix, tremors, jitteriness -could be opposite and be a small baby |
| Presumptive signs | Amenorrhea Nausea and vomiting Fatigue Urinary frequency Breast enlargement and tenderness Quickening |
| Probable signs | Chadwick sign Goodell sign Hegar sign Enlargement of the uterus Skin hyperpigmentation Palpation of the fetus Positive pregnancy test |
| Positive signs | Auscultation of the fetal heart rate Palpable fetal movement Visualization of the embryo or fetus via ultrasound |
| Gravita Para GP GTPAL | G: # of of pregnancies, including current (P: # of pregnancies that has reached 20 wks) T: : # of births at 37 wks and later P: # of births > 20 weeks and before 37 A: # of pregnancies ending before 20 wks L: #of living children |
| Determining EDD | naegele's rule: LMP- 3 months + 7 days |
| Weight recommendations | Normal BMI- gain 25-35 lbs Underweight- 28-40 Overweight- 11-20 |
| Prenatal teaching | -signs of complications Persistent vomiting- hyperemesis Dysuria- UTI Back pain- preterm labor Vaginal bleeding- abortion, placenta previa, abruption Temp increase- infection Abdominal pain- GERD, HELLP elevated liver enzymes, preeclampsia |
| signs of complications continued | dizziness- anemia leaking of fluid- vaginitis, PROM headache- hypertension headache WITH edema, visual disturbances, upper right quad pain- preeclampsia |
| First stage of labor assessment | contractions should be 30-60 sec and increasing in intensity, cervial dilation, ROM, bloody show, pain, vital signs every hr Active stage starts at 6 cm dilated and contractions every 2-5 min |
| Second stage assessment | 10 cm dilated and 100% effaced, vital signs every 30 min, check fetal descent, and presenting part |
| Third stage assessment | birth has occurred and placenta should be delivered within 30min, signs of placental separation include shape of uterus change, gush of blood from behind placenta, umbilical cord lengthens |
| Baby assessments after birth | apgar within 1-5 min temp within 15 min apical pulse and respiratory rate done every 30 min for low risk and every 5 min for high risk |
| When is rhogam started | around 28 weeks and given postpartum |
| Fourth stage assessment | vital signs start at q15min, uterus involution and should be firm midline, lochia should not have large clots, perineum moitored for infection, pain management, recovery from anesthesia to normal sensation |
| Postpartum assessment | breasts, uterus or cesarean incision, bladder, bowels, lochia, episiotomy or perineum, extremities, emotional status |
| vaginal exams | -determines dilation, effacement, cervical position, station, presenting part of fetus -complication of infection, ruptured membranes, discomfort/pain, cervical edema/bleeding |
| Techniques for inducing labor | -oxytocin and ROM |
| PP discomforts, education, management | -increases diaphoresis and urination to rid body of fluids, 2 L of fluid loss PP -decreased sensation of bladder -1-4 pp days is lochia rubra-dark red, lochia serosa is pinkish-brown 4-10 days, lochia alba is yellow-white |
| continued PP discomforts, education, management | -lacerations take 2-3 weeks to heal -diastasis recti abdominis -should not fill a pad in less than an hour Ice pack, witch hazel, sitz bath, peri bottle, lidocaine, stool softener, hemorrhoid cream |
| Magnesium sulfate use and what to monitor | -for preterm labor and eclampsia -Monitor for signs of toxicity (deep tendon reflexes, respiratory depression) |
| Nifedipine use and what to monitor | -used to stop preterm labor -dizziness, palpitations, hypotension, peripheral edema |
| corticosteroid- Betamethasone (Celestone) uses and what to monitor | -promotes fetal lung maturity -hyperglycemia, hypertension, uterine irritability, fetal heart rate changes |
| Oxytocin use and what to monitor | -prevention and treatment of postpartum uterine atony and hemorrhage and induce labor -tachysystole |
| Misoprostol (Cytotec) use and what to monitor | -treatment of postpartum uterine atony and hemorrhage, and induce labor -Nausea, vomiting, diarrhea, fever, chills, some BP increase |
| PP infections | -wound infection look for redness, fever, pain, drainage, fatigue -mastitis look for flu-like symptoms, they can still breast feed |
| Breastfeeding and bottle feeding education | every 2-3 hrs for formula: clean bottles and feed every 3-4 hours |
| Bleeding expectations | -should not fill a pad in less than an hour |
| Medications PO, IVP, regional | -acetaminophen, ibuprofen -opioids -epidural, spinal, perineal |
| adverse effects of meds and pt teaching | opioids- respiratory depression epidural- hypotension call for assistance with ambulation |
| Preeclampsia s/s labs management | -hypertension, proteinuria, headache, RUQ pain, edema -elevated liver enzymes, low platelets -mag sulfate, antihypertensives, possible early delivery |
| Eclampsia | -tonic-clonic seizures in preeclamptic pt -priority is airway, mag sulfate bolus, prepare for delivery |
| Abruption risk factors s/s management | -HTN, smoking, cocaine, trauma from fall or car accident -painful bleeding -stabalize, deliver if fetal/maternal distress |
| Placenta previa s/s management | -painless bright red bleeding -avoid vaginal exams, bed rest, c-section often required |
| PPH signs blood loss expectation causes management | -hypovolemia (weak, dizzy, anxious, decreased bp and increased hr, rr) impaired tissue perfusion ->1000mL, early is up to 24hr --Causes: atony, retained placenta, lacerations -fundal massage, oxytocin, IV fluids, surgery if needed |
| Maternal/fetal oxygentation | -monitor FHR and maternal vitals -interventions, reposition, O2, stop oxytocin |
| general anesthesia reminder | causes relaxation of smooth muscles, makes uterus boggy!! |
| urinary output should be | at least 30mL per hour |
| side effect of iron | constipation |
| caloric intake needs | increase of 300 in 2nd tri and 400 in third |
Created by:
yeaitsliv