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WVC OB Lecture

WVC OB Obsterics Lecture

Naegele: Who, Rule? German Obstetrician 1777-1851. Naegele’s Rule: 1st day of last menstrual period (LMP) + 7 days – 3 months + 1 year.
Normal Period of Gestation: Weeks, Days after Fertilization, Lunar Months, Calendar Months? 40 Weeks, 280 days after fertilization, 10 lunar months, 9 calendar months.
Conception Includes these 4 things (All events must be completed before embryonic and fetal development can begin)? 1. Egg and sperm formation 2. Ovulation 3. Union of egg and sperm 4. Implantation of embryo in uterus
How ova is fertile for _________ hours after_________? If unfertilized by __________ ovum __________ and is ___________. 24 hours, ovulation. Sperm, degenerates, reabsorbed.
Ovulation occurs when? Around day 14 of a women’s cycle.
Ejaculation during intercourse propels how much semen containing how many sperm into the vagina? How long do they stay viable within the women? 1 tsp of semen, 200-500 million sperm. 2-3 days.
As sperm travel where, what aids in their capacitation? Where: through uterine tubes. What: enzymes produced there.
Most sperm become______ in the ________, with ________ __________, in ____________, or they _________ a tube ______that contains ____ _________. Most sperm become lost in the vagina, with cervical mucus, in endometrium, or they enter a tube that contains no ovum.
Fertilization takes place where? When what happens? Forming what? Where: distal third of fallopian tube (ampulla). When: nuclei of ovum and sperm come together to form a new cell. What: a new cell zygote with 46 chromosomes.
When is sex determined? How is each sex represented? Sex determined at fertilization. XX = female, XY = male.
When the ovum is fertilized, what happens and what are the 3 parts of this process? Mitosis. Begins to divide, differentiate, and grow.
The fertilized ovum forms a what, which is….? This moves through where into where? How long does this take. Morula, solid ball of cells. Moves through fallopian tube into cavity of uterus. Takes 3 days or more.
The outer cells of the morula secrete fluid creating a sac of cells called a ________. The inner solid mass of cells develop into ___1_____, and ______2_________, aka_______? Blastocyst. 1.Embryo 2. Embryonic membrane AKA: Amnion.
The inner layer of cells of the morula become the ________. Which the (2) develop from? Acronym. Trophoblast. 1.Chorion 2.Embryonic part of the placenta. A before C (Amnion is closer to fetus than the Chorion.
ductus arteriosus right ventricle to the aorta (by passing some fetal lung tissue)
foramen ovale between left & right atrium
Ductus venosus between umbilical vein and inferior vena cava (bypassing the liver)
During implantatition the Trophoblast attaches itself where? Then what happens? This causes? When? Uterine endometrium. Endometrial blood vessels erode. Very slight spotting. During time of 1st menstral period.
Chorionic Villi: What? Develop out of? Extend into? Secrete, which is? Dispose of (2), where? Fingerlike projections. Develop out of trophoblast. Extend into blood filled spaces of the endometrium; vascular processes. Secrete human chorionic gonadotropin, HCG. Dispose of 1.CO2 2. Wastre Products, in the maternal blood.
HCG:. what, detected when? Human Chorionic Gonadotropin. Detected in maternal blood 3-7 days after conception.
Amniontic Fluid: AKA, Inner Memberane, Outer, Produced by(2), Amount @ Term, Replaced when, Moves where, Functions (3)? ”Bag of Waters”, Inner=Amnion, Outer=Chorion, 1. Maternal Blood 2. Fetal secreations, 800-1200mL @ birth, Replaced every 3 hours, Moves back & forth across placental membranes, 1.Protection 2. Fetal Motion 3.Oral Fluids.
Polyhydraminos: what, amount, associated with? Too much amniotic fluid, > 2L, Associated with fetal GI problems.
Olioghydramnios: what, amount, assoc. with, major potential problem? Too little amniotic fluid, <300cc, Associated w/fetal renal problems, fetal hypoxia.
Chorion develops into (2)? 1. Fetus 2. Cord
Number of Vessels in cord, what they carry, surrounded by? 3, 2 arteries carry deoxygenated blood, 1 vein carries oxygenated blood, wharton’s jelly.
Maternal and fetal circulation? Does not mix, babies blood does not mix with mother’s.
1st Trimester (when), stages of growth/dev, conception begins when, weeks after conception, most susceptible to _______ because…? Up to 14 weeks, Pre-embryonic (up to 2 wks) Embryonic (2-8 wks), Fetal (8-40 wks), conception begins @ 14 days/2 wks, fetal systemic deficts, all basic systems forming.
Heartbeat begins when, can be auscultated by_________@________? 17days, doppler, 10-12 weeks.
2nd trimester is when, systems…, 1st…, viable when (% that survive this early delivery)? 15-27 weeks, systems are refining structure and funx, 1st movements felt @ 18-20 wks (quickening), 20 weeks, 5%.
3rd trimester is when, least likely time…,_______ __________ produced know, key to _____ ________, allows for ______ & ________? 28-40 wks,… for congenital anomalies, lung surfactants, lung maturity, deflation & inflation.
Teratogens: definition, types (6)? Environmental substances or exposures that cause adverse effects to the fetus 1. Drugs 2. Chemicals 3. Infections 4. Maternal Hyperthermia 5. Radiation 6. Maternal disorders (diabetes mellitus, phenylketornuria).
Acronym for infectious teratogens? 1.TORCH: Toxoplasmosis (protozoan in raw mets, cat litter, tx:spiramycin), Rubella (German Measles, may cause sterility/deafness), Cytomegalovirus (type of Herpes, affects liver/brain/blood), Hsv (vaginal transmission at birth).
Gravida: definition, includes, twins? Number of pregnancies, abortions, one gravida (pregnancy).
Para: definition, even if…? Number of pregnancies where fetus has reached age of 20 wks (age of viability), …baby did not survive past 20 wks.
GTPAL? Gravida, Term, Preterm, Abortions, Living Children.
Multigravida, Primigravida Nullipara, Grand Multipara? Multigravida: 2 or more pregnancies, Primigravida: first pregnancy, Nullipara: no viable births, Grand Multipara: greater than 4 births.
6 Methods to Assess Fetal Status? 1Fetal Heart Tone 110-160, 2Fetal Kick, 3Non-Stress Test (Reactivity/Variability is good,^ in FHT w/ fetal movement), 4Mom Wht Gain (25-35) 5. Ultrasound (due date, placental positioning), 6.AFP (alpha fetoptotein), bl test for neural tube deficits.
7 presumptive signs of pregnancy? 1.Amenorrhea 2.N/V 3. Fatigue 4.Urinary Frequency (can subside during the 2nd tri) 5.Breast (stretching, tenderness, fullness)/Skin (linea nigra, melasma) 6.Vaginal/Cervical Changes (Chadwicks’s sign: become blue/purple) 7.Fetal Movement (late sign)
8 proabable signs of pregnancy? 1.Abd enlargement 2.Goodell’s sign(softening the cervical tip) 3.Hegar’s sign (softening/compressibility lower uterus) 4.Ballottment: rebound of unengaged fetus 5.Braxton-Hicks Cx 6.Uterine Souffle 7.Palpation of fetal outline 8.+ pregnancy test
3 Positive signs of pregnancy? 1.Auscultation of fetal heart sounds 2.Fetal Movements felt by examiner 3. Visulaization of the fetus by ultrasound
Weight gain during pregnancy? About 20% due to growing fetus, placenta, fetal membranes, amniotic fluid, uterus, breast, ^ blood volume, extravascular fluids, and fat reserves.
Gestational diabetes: why, management? Why: a result of ^ demands and marginally functionally pancreas. Can usually be managed by diet alone.
Fasting blood sugar during pregnancy? Usually decreases from ^ insulin secreted by pancreas.
Plasma proteins during pregnancy (3)? 1. Decrease in albumin 2. Increase in fibrinogen 3. Decrease in immunoglobin
Vitamin/Mineral changes during pregnancy (2)? 1. Iron needs increase 2. Calcium levels decrease in maternal serum because they are being retained in maternal bone for use by fetus late in pregnancy.
Blood volume changes during pregnancy (3)? 1. Increased production of red blood cells. 2.Increase in fluid circulating in vessels 3. Increase fluid in cells = decrease in hematocrit levels = physiologic anemia of pregnancy (pseudoanemia).
Respiratory changes during pregnancy? 1. SOB from pressure on diaphragm and lungs due to englarged uterus late in pregnancy 2. Rib cage flares out and results in decrease lung capacity.
3 GI changes of intestines and stomach + risk for…? 1. Decreased motility 2. Decreased gastric emptying time 3. Increase intestinal transit time: at risk for constipation.
3 more GI changes during preg? 1.Increase frequency of heartburn 2.Increase frequency of gastroesophageal reflux due to decrease of intraesophageal pressure 3.Increase intragastric pressure and slowed esophageal peristalsis.
Pregnancy and the mouth? Gums swell and become soft; bleed with brushing.
Pregnancy and digestion? 1st trimester a decrease in appetite due to Nausea. 2nd/3rd Tri and increase in appetite.
Pregnancy and the liver and gallbladder(4)? 1. Decrease in gallbladder tone. 2. Contents thicken can cause itching (pruritis). 3. Increase in distention 4. Mom predisposed for gallstone formation.
Renal system and pregnancy: What is common, places one at risk for, 1…, can….?
Major endocrine gland during pregnancy? Produces (4)? The placenta. 1.Human Chorionic Gonadotropin 2.Human Placental Lactogen 3.Estrogen 4.Progesterone
Progesterone during pregnancy: Maintains…., Prevents (2), Stimulates…, Facilitates…? Maintains endometrial layer for implantation, Prevents tissue rejection & spon abor by relaxing smooth muscle of uterus, Stimulates dev of lobes/lobules for lactation, Facilitates deposit of maternal fat stores which provide a reserve of energy.
Progesterone and respiration? Raises the respiratory sensitivity to CO2 thus stimulating increased ventilation, increasing the amount of air entering the lungs.
Musuloskeletal System and Pregnancy(2)? 1. Calcium is stores and absorbed easier (no loss in maternal bone density) 2.Tendency to lean back to maintain balance in late pregnancy: aches, lordosis, waddling (due to increased pelvic bone motility(relaxin, pro, est)).
Lab Tests during Pregnancy (what do they screen for): blood grouping, Hgb/Hct, CBC, Rh factor/antibody, VDRL, Rubella Titer, PPD, Genetic Testing, Hep B, HIV, UA, Pap, Cervical Culture, Mulitple Marker Screen,Glucose? Blood Type and Rh, Anemia, Infection/An/Cell Abnormalities, Rh, Syphillis, Rubella, TB, Sickle/Cystic Fib/Tay-Sachs, Hep B, HIV/AIDS, Renal Disease/Infection, Cervical, , Neoplasia, Strep B, Down Syndrom/Neural Tube defects, Gestational Dia.
Normal levels for Hematocrit and Hemoblogin? Hct: 37-47, Hgb: 12 – 16.
Rh factor: what is it, who has it/who doesn’t, Rh sensitivity, bad scenario? Rh factor is a type of protein, 85% of people have it/15% do not, causes the production of antibodies to attach Rh proteins, Rh- mom has Rh+ baby and comes into contact with blood increasing risk of harm to subsequent children.
Rh factor attach on baby: called, what happens, causes? Hemolytic Disease, Rh antibodies attach RBC’s of fetus producing anemia, causes illness/brain damage/death.
Rh sensitization can occur when (5), because…? 1.Misscarriage 2.Induced Abortion 3.Ectopic Pregnancy 4.Amniocentesis 5.Birth, Because there is a possibility of sharing blood during these events.
Name of preventative Tx for Rh sensitivity, given how and where? Rhogam. How: IM. Where: Deltoid/Buttocks.
No Rh issues if (2)? 1.Mom is Rh+ 2. Mom and dad are Rh—
Emotional maternal responses during pregnancy: 1st trimester (3), 2nd Tri (4), 3rd (3)? 1st:1Uncertainty 2Ambivalence 3Focus on Self, 2nd:1Wonder 2Increased Narcissism 3Introversion 4Concern about body chgs/sexuality, 3rd:1Vulnerability 2Increased Dependence 3Acceptance that fetus is separate yet totally
Maternal physical validation during pregnancy by trimester? 1st: no obvious signs of fetal growth, 2nd:Quickening and enlarging abdomen, 3rd: Obvious fetal growth, discomfort, decreased maternal activity.
Role changes in maternal response to pregnancy by trimester? 1st:May begin to seek safe passage for self and fetus, 2nd:seeks acceptance of fetus and her role as a mother, 3rd: Prepares for birth.
6 danger signs in 1st trimester pregnancy? 1.Chills/Fever 2.Vomiting 3.Burning w/urination 4.Diarrhea (Flu) 5.Abdominal Cramping 6.Vaginal bleeding.
6 danger signs during the 2nd/3rd trimesters? 1Change in fetal movements 2Contractions 3Visual Disturbances 4Swelling of hands/feet/face (pitting lower extremity edema) 5Muscle irritability/convulsions 6Epigastric pain
4 common aspects of childbirth preparation classes? 1.Physiologic aspects of pregnancy and birth. 2.Relaxation techniques 3. Breathing techniques 4. Teambuilding w/dad and other support persons.
4 educational area foci for expectant parents? 1.Posture/Body Mechanics 2.Exercise 3.Nutrition 4.Transition to parenthood.
Recommended maternal weight gain, weight gain before pregnancy and during…? 25-35 lbs, more obese the less weight you will gain, more underweight the more weight you will gain.
The 4 stages of labor? 1.Dilation: labor to dilate cervix, 2.Expulsion of baby, 3.Birth of placenta (about 15 min after birth of baby. 4.First hr postpartum.
5 P’s of Labor? 1.Passenger 2.Passageway 3.Powers 4.Position 5.Psyche
Passenger: what is it, and assessment and pregnancy? Fetus + membranes + placenta, Palpate fontanels and sutures during vaginal exam to identify fetal presentation, fetal position, fetal attitude.
Fetal presentation: what is it, different types and %’s(3)? The part of the baby that is coming first, Cephalic (head, AKA vertex) 96% (can also be brow of mentum (chin)), Breech (buttocks or feet) 3% (complete = bottom first, footling = 1 or 2 feet), Shoulder 1%.
Fetal position: what, labeled how (3)? How the presenting part of the baby is situated in pelvis, Right or left, Occiput/Mentum/Sacrum, Anterior/Posterior/Transverse.
How can you change fetal position? Lunge movement, walking, stairs.
Fetal attitude: what, 2 types and what do they do to labor? Whether head is flexed or extended, Flexed = eaier delivery, extension = difficult delivery.
Fetal lie: what, two types? How long axis of fetus is positioned compared to long axis of mom, 1.Longitudinal: long axis of fetus is parallel with long axis of mom. 2.Transverse: long axis of fetus is prependciular to long axis of mom.
Fetal engagement? When biparietal diameter of fetal head reaches level of maternal ischial spines.
Fetal station: what, 0, +4, -4? What: where the presenting part is in relation to the ischial spines, 0 = Engaged (head has passed pelvic inlet and entered pelvic cavity), +4 = at outlet, -4 = “floating” “high”.
Who does pelvic exams (3), who does not, why? Nurses/ARNP’s/MD’s, Nursing students, risk of infection.
The 6 cardinal movements of fetal descent? 1.Engagement/descent 2.Flexion 3.Internal Rotation 4.Extension 5.External Rotation/Restitution 6. Expulsion.
4 things that effect the passageway? 1.Size of bony pelvis 2.Shape of pelvis 3.False pelvis 4.Ture pelvis
4 shapes of pelvis and % of women that have them? 1.Gynecoid - round 50% 2.Android (normal male) 20% 3.Anthropoid – longitudinal oval (ape) 25% 4.Platypelloid – flat 5%.
False pelvis: what, helps? What: broad area between iliac crests, Helps support pregnant uterus.
3 main parts of the true pelvis? 1.Pelvic inlet 2.Bony canal (pelvid cavity) 3.Pelvic cavity outlet.
2 types of cervical changes during labor? 1. Effacement (cervical thinning/shortening): measured in 0-100%. 2. Dilation (size of opening): measured in 0-10cm.
2 passageway related reasons for a C-section? 1.Moms cervix doesn’t soften or dilate. 2.Cervix softens/dilates but baby’s head is too big (Cephalopelvic Disproportion)
Powers relates to, 2 types? Powers = contractions. 1.Voluntary (abdominal muscles that mom controls) 2.Involuntary contractions (uterine muscle that mom wishes she could control).
3 terms used to describe contractions and what they measure? 1.Frequency: beginning of one cx to beginning of next 2.Duration: beginning of one cx until end of that cx. 3.Intensity: strength of cx (strong = non identable, moderate = identable, milk = barely palpable.
How do you track and document contractions? Electronic fetal monitoring (can be internal or external).
Gravity and position of mom: assists…, beneficial to…, decreases…, assists…? Assists descent, beneficial to cardiac output, decreases umbilical cord compression, assists in dilation of cervix.
True labor cx’s vs. Braxton-Hicks cx? Ture cx’s occur with more regularity, increase in intensity and frequency, are felt in the lower back, and cannot be chased away. Braxton-Hicks Cx’s felt in the front of the belly.
9 nursing actions following rupture of membranes? 1.Call MD 2.Cck for prolapsed cord 3.Chk Fetal Heart tones 4.Test for ferning (amni fluid will look like a fern w/ micro) 5.S/Sx of infection 6.Check for meconium 7.Fluid should be clear 8.Fluid should keep coming 9. Cx’s will become more intense.
SROM vs. AROM? Spontaneous rupture of membranes, Artificial rupture of membranes (amniotomy via amniohook).
4 reasons to cause a AROM via amniotomy? 1.Induce labor 2.Speed up a very slow labor 3.Move along labor that is risky to mom (Hypertensive mom, etc.) 4.Fetal demise.
4 alternative to amniotomy to induce labor? 1. Intercourse to increase production of prostaglandins 2.Enema 3.Tea 4.Nipple stimulation.
5 things the mom does to start the onset of labor? 1.Changes in uterus 2.Increse in estrogen and prostaglandins 3.Decrease in progesterone levels 4. Pituitary gland 5.Aging placenta
Baby does this to produce onset of labor? Hormones secreted by hypothalamus, pituitary, adrenal cortex.
Stage 1 of labor? Dilation of cervix from 0 to 10 cm.
3 phases of Stage 1 of labor: Phase name – time length - cervix dilation – cx’s? Phase 1: latent phase – long time – 0-3 cm dilation – slow contraction, Phase 2: accelerated/active phase – shorter time – 4-7cm of dilation – faster contractions, Phase 3: transition phase – shortest time (exhausting) – 8-10cm – Crazy contractions.
Late descent may mean what, nursing action? What: fetal distress. Nx: turn women on her side.
Variable decelartion: why (2)? 1.Cord problem 2.Amniotic fluid problems
Cord comprssion and fetal heart rate (increased or decreased)? Decreased.
Leopold’s maneuvers: what, why (4)? What: palpation to assess, Why: 1.Number of fetus 2.Presenting part, lie, attitude 3.Descent into pelvis (engaged?) 4.Location of FHT.
Important question to ask concerning labor pain? Where is the pain (location determines treatment).
Major cause of pain (2)? 1.Fear/Anxiety 2.Tension
Major reliever of pain once it has begun (2)? 1.Relaxation 2.Preparation
Effleurage? Self massage of the abdomen or other body part during labor contractions to decrease pain.
4 alternative measure for pain relief? 1.Breathing 2.Walking 3.Guided Imagery 4.Distraction
3 universal worries that women have about pregnancy? 1.Fear of pain 2.Fear of having an abnormal or dad baby 3.Fear of dying in labor
3 givens about labor? 1.It’s hard work 2.You can do it 3.It hurts a lot.
Analgesic pain relief and consciousness? No loss of consciousness.
Anesthetic pain relief and consciousness? Sedatives? Loss of consciousness. Sedatives seldom used.
Problem w/analgesic pain relief? Crosses blood-brain barrier to provide CNS analgesic effects, also crosses placental barrier.
Pure Opioid Agonists (Analgesics): What, so, problem with this? Cause respiratory depression (decrease in respiration rate), So a mixed agonist/antagonist opioid is used, reaches a ceiling of pain relief.
Inhaled Analgesics: Tx, Example, Effect? Not give, laughing gas, risk maternal and newborn respiratory distress.
Local blocks: two types, adverse effect? 1. Lidocaine 2. Marcaine, Decrease in blood pressure.
5 types of regional blocks, are they used, why? 1.Pudendal (perineum block), seldom used, decrease HR in newborn 2.Paracervical, not used, decfetal heart rate 3.Saddle Block, notused, decreased HR & R/headache 4.Epidural, used often, use of effective -caine drugs 5.Intrathecal, used, dec. HR, N/V.
Interthecal opioid analgesics: two types, administered how, 4 side effects, counteract some SE with…? 1.Morphine sulfate 2.Morphine fentanyl, administerd epidurally, 1.Nausea/Vomiting 2.Itching (pruritis) 3.Urinary retention 4.Decrease in respiratory rate, Narcan administered to counteract effects of decreased respiratory rate.
Two philosophies of labor pain? 1.Those who believe that women can cope with pain without drugs and know how to support they through the pain but also when drugs are to be used. 2.The professionals who believe it is foolish to undure pain that drugs can do away with.
Endorpins: what, from where, pain relieving strength, release interrupted by….? Morphine like substances secreted by, the CNS (brain and adrenal glands, 10X more potent than morphine, release of endorphins is interrupted by narcotics and epidurals.
2 patient education factors to tell a women who is in labor? 1.The best pain relief possible and its possible side effects. 2.How far dilated she is.
Epistiotomy: what, why (2), Types (2), RN assessment (3)? What: incision of the perineum just before birth. Why: need to speed expulsion, need for increased room for baby. Types: midline, mediolateral, Asses: hemorrhage, healing, infection.
Epistiotomy RN interventions: 1st 12 hrs, then, teach…, meds, before sitting, do not use, suture is, asses…? Ice 1st 12 hrs to min edema/pain, then sitz bath to promote healing, teach pat to assess own epi, pain meds as ordered, Kegals before sitting, do not use doughtnut to sit on, suture is absorbable, assess perineum w/ or w/o epi.
Vacumn extractor: when to use (5), nursing interventions (2), teach patient (2)? 1.Poor prognosis 2.Fetal distress 3.Occiput posterior position 4.Maternal exhaustion 5.Tight fit, Int: 1.FHT Q5min 2.Assess for cerebral trauma, Teach: 1.Inform parent of progress 2.Inform caput will resolve in a few hours.
Forceps: uses (4), assess for (3), complications (3)? 1.Poor progression 2.Fetal distress 3.Persistent occiput posterior position 4.Maternal exhaustion, Assess for: 1Intra cranial pressure 2.Cranial hemorrhage 3.Facial bruising. Complications: 1.Uterine rupture 2.Lacerations 3.Injury to mom or NB.
Oxytoxics: what, brand name, uses (4)? Potent drug, Pitocin, 1.Induction of labor 2.Speed up labor that is progressing very slowly. 3.Move a along a risky labor (hypertensive mom) 4.Start labor when there is a fetal demise.
6 nursing interventions for the use of oxytoxics? 1.Assess FHT 2.Assess membranes 3.Explain procedure to mon (prepare her) 4.Assess cord prolapsed 5.Assess uterine rupture 6.Stop oxytoxic if Cx are greater than 90 sec or s/sx or fetal distress.
Stage III of labor = ? = placental stage/delivery of the placenta.
Placental delivery: occurs w/…, focus of mom at this time, typical minutes? Occurs w/ contractions, focus of mom is baby, typically takes 30 minutes.
Stage IV of labor: when, crucial to monitor, 24 hr guideline, should be no heavier then…? 1st hour after birth. Monitor for postpartum hemorrhage. Should not be greater than 500mL within 1st 24 hours after birth. Should be no heavier than a normally “heavy” menstrual period.
Fully soaked peri pad = ? =50-80 mL of blood loss.
Immediate assessments to perform after birth (4)? 1.Blood pressure 2.Pulse 3.Respirations every 15 min for the 1st hour 4.Fundus assessment
Fundus: palpated when, then, where, should be…, important to also…?D Palpated within 30 min after birth, then at one hour, palpated at the umbilicus, fundus should be firm and not “boggy”, important to also inspect lochia bleeding on the pad.
VBAC? Vaginal birth after caesarean (cannot occur after a classic/vertical incised caesarean).
Two types of c-sections? 1.Classic (Vertical) 2. Bikini cut (transverse).
10 indications for a C-section? 1.Fetal distress 2.Placenta previa 3. Placenta abruption 4.Uterine dysfunction 5.Prolapsed cord 6.Diabetes 7.Cephalopelvid Disproportion 8.Malpresentation 9.Preclampsia 10.Genital herpes.
Post operative (anesthetic used) C-section Nursing Interventions: 1.Side Effects: Tx 2.Potential for (2) 3.Patient teaching (4)? 1.Decreased respiratory rate: Narcan 2.Vomiting & Aspiration (position patient to avoid aspiration and vomiting 3.NPO, IV Infusion, Support Person, Pain Control.
Postpartum C-section RN interventions: Maintain (2), Prevent, Pain control from (2), Anesthesia (2)? Maintain open airway and cardiopulmonary fx, Prevent postpartum hemorrhage, Pain control from incision/gas retention, 1.If epidural ane, assess dermatomes to signal return of motor/sensory fx 2.Assess RR for R depression.
3 interventions for post C-section incisional pain? 1.Patient controlled analgesia 2.Splint incision with pillow 3.Do not let pain get ahead of you.
6 interventions for post C-section gas retention pain? 1.Walk 2.Rock in rocking chair 3.No carbonated beverages 4.No gas forming foods 5.No very hot or very cold liquids 6.Lie on left side.
6 people on hand for newborn post C-section? Priority? 1.Pediatrician 2.Nursery nurse 3.Respiratory therapy present 4.MD 5.A 2nd MD 6.Circulating nurse. Priority is assessing ABC’s.
Postpartum Assesment Acronym? BUBBLE HE: Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy, Humans, Emotional.
Postpartum Assesment of the fundus and lochia: timeline? Must check initially within 30 minutes, then at one hour, then every four hours for the first 24 hours, and then every 12 hours.
Postpartum bladder: Nursing action, why, can increase…? Empy bladder ASAP, A full bladder prevents the uterus from contracting, This can increase hemorrhage.
When inspecting the HUMAN of postpartum assessment you are assessing (4) Calf tenderness, redness, swelling, signs and symptoms of infection.
Taking in? First phase of maternal adaptation, during which the mother passively accepts care and comfort and details about the newborn; the mothers own needs.
Taking hold? Second phase of maternal adaptation, during which the mother assumes control of her own care and initiates care of the infant.
Puerperium? Period from the end of childbirth until involution of the reproductive organs is complete, approxiametly 6 weeks.
Involution? Retrogressive changes that return the reproductive organs, particularly the uterus, to their nonpregnant size and conition.
How long until the uterus returns to the pelvis? About 12 days.
U@U, U/1, 1/U? U@U: uterus @ umbilicus, U/1: Uterus 1 cm below umbilicus, 1/U: Uterus 1 cm above umbilicus.
Breastfeeding speeds…., causes an increased production of…., and an increase in…, these are called, more noticeable in…? Breastfeeding speeds involution, This causes an increase in the production of oxytoxin, Increase in Cx’s, Called afterpains, More noticeable in multiparas.
3 types of lochia, their color, and their timeline? Rubra: bright/dark red, common for 3-4 days. Serosa: pinkish fluid (thin/watery), Day 4ish to 10ish. Alba: white, cream colored, light yellow, 2-6 weeks.
Weighing of pads for lochia estimation? 1 gram = 1cc/mL.
Less locia after, more lochia after (2)? Less lochia after C-section. More lochia after 1.Breastfeeding 2.Activity.
Urinary retention can be secondary to? Urinary retention can be secondary to urethral swelling.
Expulsion of placenta causes 2 hormonal changes, @ 1 week? Decrease in estrogen. Decrease in progesterone. @1 week these will drop to their lowest levels.
Postpartum metabolism related hormonal changes (2), implication for 2nd one? 1.Decrease in cortisol (adrenocorticol hormone). 2.Decrease in insulinase, implication: if diabetic they need less insulin.
Increase in prolaction postpartum causes….? Causes lactation.
Most women menstruate again by…? Most women (90%) menstruate again by 6 months.
A decrease in postpartum steroid secretion causes (2), timeline? Causes dieresis and diaphoreses (body is ridding itself of extracellular fluid), 2-3 days postpartum.
First lactation after childbirth? Colostrum: rich in nutrients and immunities.
Engorgement occurs when? 4 nursing interventions? Engorgement occurs about 2-3 days after birth (indicates milk has come in, does not happen to all women). 1.Hand express milk 2.Warm packs 3.Increase feedings 4.Non nursing moms: ice packs and decrease in H20.
Breastfeeding can delay…, but is not…? Breastfeeding can delay menses but is not a reliable form of birth control.
Average blood loss for vaginal birth, C-section? Vaginal: 300-400cc. C-section: 800cc.
How does the BP change in postpartum women and timeline? When will normal RR return? It increases slowly, over 4 days. Normal RR will return within 6 months.
Decreased postpartum Hct and RBC count in 1st 2-7 days due to (2)? 1.Hgb concentration 2.Dehydration.
Postpartum risk for developing deep vein thrombosis because of (3)? 1.Hypercoagulable state 2.Vessel damage 3.Immobility
Average postpartum Hgb count? 11.5.
2 nursing action for excessive blood loss? 1.Have baby nurse (oxytocin released) 2.Give synthetic oxytoxics as ordered by MD.
Postpartum check up appointment timeline (2)? 1. Vaginal: 6 weeks after birth. 2.C-section: 2 weeks after birth.
3 phases of maternal adaptation? 1.Taking in 2.Taking hold 3.Letting go.
Normal newborn pulse is (2)? 1.160bpm 2.Irregular
Engrossment? Intense fascination and close face-to-face observation between father and newborn.
Newborn blood pressure at birth? At 2 weeks? At birth: 80/40. At 2 weeks: 100/50.
Newborn WBC: at birth, 1st day, infection…., sepsis…? Normal at birth, increases over the 1st day, infection does not markedly incresase WBC, Sepsis will show a decrease in WBC’s (particulary neutophils).
Newborn Hgb count at birth? Hct? By end of the 1st month? Hemoglobin 14.5-22.5 at birth. Hematocrit is 44-72%. Within one month they will reach the levels of an adult.
APGAR? Appearance (all blue/pale, pink body/blue extremities, all pink), Pulse (Absent, <100bpm, >100bpm), Grimace (none, grimace, sneeze/cough), Acivity (Limp, some flexion, Active), Respiration (Absent, irregular/slow, good/crying).
APGAR scores: range, normal, intermediate, low? Range is 0-10. Normal is 7 – 10 @ 5 minutes. Intermediate is 4-6. Low is 0-3.
Most critical adjustment after birth? Usually begins when? Major factor to this…? Initiation of respiration, usually begins within 1 minute after birth. Surfactant.
Breath reflex triggered by (5)? 1.Pressure changes 2.Chilling 3.Light 4.Noise 5.Chemoreceptors in aorta and carotids (P02 falls from 80-15 mm Hg, Arterial CO2 (PCO2) rises from 40 – 70 mm hg, arterial pH falls below 7.35.
How do babies preferentially breath? If blocked will…, ability to __________ begins after__________? Nose breathers, breath out of mouth, mouth breath @ 3 weeks.
Signs and symptoms of respiratory distress (4), this is normal? 1.Flaring 2.Grunting 3.Tachypnea 4.Retractions.
How is newborn lung surfactant levels measured? A mature level is…? By examining amniotic fluid for lecithin/sphingomyelin levels. Mature level is: > 2:1.
Surfactant aids breathing by….? Maintains alveolar stability by changing surface tension as size of alveolus changes.
Newborn fluid electrolyte balance at birth? I & O? GFR? Newborn should void by, then? Narrow range. 700cc/day. GFR is decreased therefore urine is more dilute and infant is unable to concentrate it (the leads to a decreased ability to remove waste products from the blood. Within 24 hours, then 6x/day.
Urate crystal stain: normal? AKA? Normal. AKA: brick dust.
Newborn and complex carbs: what, when, why? What: unable to digest complex carbs. When: for 3-6 months. Why: lacks necessary enzymes.
Where should mom first place her nipple and why? Mom should place her nipple behind infant’s gums, because infant cannot move food form lips to pharynx at first.
Newborn stomach capacity? 30cc-90cc.
Meconium stool by newborn within…? Within 24 hours.
Transitional stools: general, formula fed, breast fed, smell? Thin and slimy. Formula fed and gree-brown. Breast fed are yellow/loose/non-irritating. Breastfed babies are less fragrant than formula fed.
Newborn Hepatic Response: Fe, Vit K, if not enough Vit K? Store Fe as 5 month supply. Synthesizes Vik K to conjugate bilirubin. Unconjugated free-bound bilirubin cross blood/brain barrier causing necrosis of brain cells.
Jaundice: why (general), normals (3)? Opening day at the liver factory. 1.Less than 24 hours old. 2.Occurs when less than 1 week old. 3.Bilirubin level is less than 10.
Physiologic Jaundice: normal? And bile? Med term? Intervention? Normal. Bile decreases bilirubin. Hyperbilirubinemia. Feed early to decrease jaundice.
Breastmilk jaundice: occurs when, why, common, tx? After first week, breastmik inhibits conjugation, uncommon, discontinue breastfeeding for 12 hrs to diagnose (meanwhile using formula and pumping breast milk to use once resolved).
Non-physiologic jaundice: most common cause, devastating side effect? Hemolytic disease (Rh incompatibility). KERNICTERUS: necrosis of brain cells.
Immunity: passive for, 2 ways to increase? Passive for 1 or more years. 1.Immunizations. 2.Colostrum.
Acrocyanosis? Lanugo? Caput: what, when? Cephalohematoma: what, when? Acro: bluish discoloration especially in the hands and feet. Lanugo: fine hair. Caput: edema on the suture lines of the skull, goes away 3-4 d. Ceph: blood collection in the skull bone and its covering, appears several hrs after, goes away sev wks.
Cephalhematoma does not…? Cross suture lines.
4 integumentary adaptations without tx’s? 1.Mongolian spots 2.Stork bites 3.Milia 4.Toxic erythema neonatorum 5.Vernix caseosa
Milia: what, where, disappear when? White cysts, 1 to 2 mm in size caused by distention of sebaceous glands. Occur on the face (forehead, nose, chin). Disappear within the first few weeks.
Stork bites: what, AKA (2), where, disappear when? Flat pink or reddish discoloration from dilated capillaries. AKA: 1.Salmon Patch 2.Nevus simplex. Where: eyelids, above the bridge of the nose, nape of the neck. Disappear around 1-2 yrs of age.
Vernix caseosa: what, who? What: Thick white substance that protects the fetal skin in utero. Who: usually little vernix on a full term infant: premmie.
Witch’s milk? Breast secretions of the newborn caused as a normal function of maternal hormones.
Newborn mesnes? Pseudo menses due to mom’s estrogen.
Evaporation? Air drying of the skin that results in cooling.
Conduction? Movement of heat away from the body occurs when newborns come into direct contact with objects that are cooler than their skin.
Convection? Transfer of heat to the air surrounding the infant (drafts).
Radiation? Transfer of heat to cooler objects that are not in direct contact with the infant (crib close to wall/window).
3 thermoregulatory differences between the newborn and the adult, + nonfunctional? 1.Less insulation 2.Greater body surface area to weight ratio 3.Greater ability to vasoconstrict blood vessels + Nonfunctional sweat glands.
Cold stress: 2 effects, what to prevent? Increased O2need, Inceased respiratory rate. Keep warm to prevent metabolic acidosis.
Brown fat: what, purpose? What: Superficial fat deposits unique to newborn. Purpose: increase heat production by as much as 100%.
Head at birth (size)? 1/4 of body length.
Moro reflexes? Infants head is allowed to drop back 30 degrees when the infant is in a slightly raised position. Infants arms and legs extend and abduct, fingers fan open, thumbs and forefingers form a C position, then return to normal.
Tonic reflex? Refers to the posture assumed by newborns when in a supine position. The infant extends the arm and leg on the side to which the head is turned and flexes the extremities to the other side
Palmer grasp reflex? When infants palm is touched near the base of the fingers the hand closes into a tight fist.
Rooting reflex? When the infant’s check is touched near the mouth on only one side the head turns toward the side that has been stroked (important for feeding, best done when infant is hungry).
Babinski reflex? When stroking the lateral sole of the infant’s foot from the heel forward and across the ball of the foot, the toes flare outward and the big toe dorsiflexes.
Stepping reflex? When an infant is held upright with their feet touching a solid surface they will lift one foot and then the other giving the appearance that they are walking.
1st 6hrs of life: Test, Temp, ID, Eye, Vit, Breast, Assess, Scale, Measure? Apgar score,Temp: dry baby/warm blankets, ID/Name, Eye Drops, Vitamin K, Breastfeeding/Bonding, Physical Assessment of baby, Weight baby, Measure head and chest circumference.
Normal newborn sleep time, crying time? Sleep 16 hrs/day. Cry 2 hours/day.
3 abnormals for a newborn? 1.Retractions 2.Grunting 3.Flaring 4.Circumoral cyanosis 5.Jitters 6.Jaundice >24 hrs 7.Weak/High-pitched cry 8.Limp 9.Uneven motion in extremities
Infant behavior during the first 6-8hr of age: who studied, what period, periods of…, first 15-30 minutes…, 30minutes to 2 hrs, 2-6hrs? Barry Brazelton. Transitional period. Periods of reactivity. First 15-30 minutes AWAKE/can focus/eyes open, REST/Sleepy, AWAKE.
Birth weight lost immediately after birth, regained by? 5-10% weight loss after birth. Regained by 10-14 days.
Birth weight doubles, triples? Doubles @ 4-5 months. Triples @ 1 year.
Caloric need for the first 3 months? 110Kcal/kg/day.
2 things needed after six months? 1.Flouride 2.Fe
When are solids introduced, why? Introduced at 6 months. To avoid development of allergies.
Formula nutrient ratio? 40-50%carbs, 50%fat, 5-10% Protein.
Type of nipples that help breast feeding? Everted.
Two dietary needs of the breastfeeding mother? 300cc more fluids a day. More protein intake per day.
3 things breastfed babies have less of? GI problems, Ear Infections, Upper Respiratory problems.
Created by: wvc