Collins Spring 2013
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| Antidote for Magnesium Sulfate | calcium gluconate
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| Side effects of Yutopar | hypotension, cardiac arrhythmia, tachycardia, palpitations, MI, pulmonary edema, hyperglycemia
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| action of Betamethasone | induce pulmonary maturation & decrease incidence of RDS
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| Initial weight loss postpartum | 15-18 lbs
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| temp is increased for 24 hrs AFTER milk comes in | 100.4 & below
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| uterus palpable where | midline contracted size of grapfruit
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| lochia alba | days 10-12 white light WBC & D/C
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| lochia serosa | days 3-10 cell component decreases=serosanguous
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| lochia rubra | 1st 2-3 days increased with activity/breastfeeding, no odor or clots
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| 1st period occurs when | breastfeeding 36 weeks or 3 months
nonbreastfeeding 6-10 weeks
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| striae | take on different colors based on moms skin tone
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| what can delay elimination? | pain d/t episiotomy/laceration/hemorrhoids
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| after pain help with breastfeeding | NSAID prior to breastfeeding
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| taking in | dependent mom expresses need for food & rest
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| taking hold | focus on newborn, independence for self & newborn
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| letting go | end of 1st postpartum phase, realize what REALLY happens
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| postpartum blues | 1st 10 days, spontaneous recovery & self limiting
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| postpartum depression | anytime in the 1st year, affective mood disorder, & requires MEDICAL Interventions
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| BUBBLEHE | breasts
uterus
bowel
bladder
lochia
episiotomy/laceration
homan's/hemorrhoids
emotional
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| prevent UTI | front to back wiping & change frequent pads
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| REEDA | redness, edema, ecchymosis, discharge, approximation
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| ice when | 1st 24 hrs
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| heat when | after 1st 24 hrs
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| rubella vaccine given do not become pregnant for how long? | 3 months
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| threatened abortion | pt has slight bleeding, decrease uterine pain, no dilation/effacement
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| Treatment for threatened abortion | bedrest
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| total placenta previa | completely covers cervical opening
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| why not to do a cervical exam | placenta previa
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| abruptio placentae bleeding | dark port wine, no clot, quick shock state or can be conceeled
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| typical location for ectopic pregnancy | falllopian tubes
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| treatment for ectopic pregnancy | methotrexate 1-2 doses to prevent cells from rapidly dividing OR surgical
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| Pt with gestational trophoblastic disease is told what | DO NOT become Pregnant
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| PUBS | under US guide, removes blood form cord for testing
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| PUBS tests for what | hemophilia, hemoglobinopathies, fetal infections, chrom. abnormalities, nonimmune hydrops
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| CVS | early genetic testing
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| CVS detects what | genetic, metabolic & DNA abnormalities
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| Amniocentesis | 15-20 weeks removes fluid for genetic testing
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| Amniocentesis can detect what | enzyme analysis, AFP, NTD, blood typing, cytogenic (metabolic/DNA testing)
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| LS Ratio | determines RDS
2:1 unlikely
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| PG | 2nd most abundant phopholipid in surfactant
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| PG detects | PROM, vascular disease, severe preeclampsia before 35 weeks
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| Quad Marker Screening | AFP, HCG, diameric inhibin A, & estriol
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| Quad Marker Screening detects | NTD, trisomy 21, downs syndrom & trisomy 18
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| Preterm | labor that begins between 20 & 37 weeks
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| diagnosis of preterm labor | uterine contractions every 5 mins ofr 20 mins OR 8 contractions in 60 mins AND documented cervical change or cervical effacement of 80% or more OR dilation greater than 1 cm
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| weaned from open crib | 1500 g, 5 days wt gain, respiratory & cardiac stability, & PO feeds
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| Mild preeclampsia dx | BP 140 systolic or 90 diastolic
proteinuria 3 g/L or greater in 24 hr urine
+1 or +2 dipstick
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| epigastric or RUQ pain | severe preeclampsia S & S
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| eclampsia main symptoms | seizures
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| only cure for PIH | delivery
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| during a seizure | nothing in mouth, stay with pt, call for help, O2 via facemask 8-10 L/min, protect from harm, side-lying, suction
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| glucose challenge test | 130-140
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| main complication of gestational diabetes in infant | macrosomia (large tissue growth)
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| newborn caloric need | 110-130 kcal/kg/day
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| blood loss from delivery | approximately 5 lbs
vaginal 500cc
C-section 1000cc
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| prepregnancy weight by | 6-8ths week post delivery
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| if lochia doesn't follow the one way flow pattern what is suspected & should be done? | hemorrhage & call the doctor
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| NI for constipation & bowel issues | walking, drinking H2O, stool softner, dietary fiber (roughage)
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| afterpains | cramping experienced as the uterus contracts down. gives pt contraction sensation
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| pulmonary thrombi alerts | sudden chest pain & + Homan's sign
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| 3+ or 4+ Deep Tendon Reflex indicates | PIH
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| care for breast for breast feeding | heat, no restrictive bra or clothing, face water in shower.
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| care for breast for bottle feeding | cold, tight bra, back to water in shower, cabbage leaves
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| Nipple care | lanolin & vitamin E cream. cleansed off prior to breastfeeding.
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| hemorrhage signs | saturates 1 pad in 15 mins or less
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| heavy bleeding signs | saturates 1 pad in every 2 hrs
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| when to resume sexual activity | once episiotomy healed & lochia has stopped
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| symptoms to report | depression, increased bleeding, fever over 100.4, D/V, dizziness, unrelived HA, swelling, breast tenderness, mastitis, abd pain
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| Spontaneous Abortion occurs when | before 16 weeks
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| incomplete abortion | fetus partially expelled surgery done to scrape uterus
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| complete abortion | everything comes out pain & bleeding STOP
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| missed abortion | fetus dies enutero & all remains in uterus. pregnancy symptoms stop. increased risk for infection. surgery treatment.
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| placenta previa | placenta implants & develops in the low uterine area & covers cervical opening
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| partial (marginal) | partially covers cervical opening
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| low-lying | close to covering cervical opening
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| S&S for placenta previa & treatment | S&S: painless vaginal bleeding after 24 weeks that will stop spontaneously.
Tx: 36 week planned c-section until then monitor H&H & Bedrest
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| Placenta previa is a risk for | bleeding
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| abruptio placentae | placenta prematurely separates from the uterine wall after 20 weeks gestation
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| S&S for abruptio placentae | uterus hard, constant contractions, decreased perfusion, board like abd
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| Placenta previa is a risk for | sudden massive bleeding
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| ectopic pregnancy | tubal pregnancy implantation outside the uterus
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| S&S of ectopic pregnancy | doubled over in pain, syncope, referred shoulder pain
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| intrauterine fetal demise | fetus dies enutero after 20 weeks
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| complete gestational trophoblastic disease | sperm meets egg with no neucleus 23+ chromosomes
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| partial gestational trophoblastic disease | normal ovum fertilized by 2 sperms 69 chromosomes
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| invasive gestational trophoblastic disease | same as complete but invades the uterus
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| carcinoma gestational trophoblastic disease | malignant highly treatable if found early
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| S&S of gestational trophoblastic disease | vaginal bleeding @ 4 weeks, dark bleeding, uterine size larger than gestation, increased HcG, N/V, manifest PIH symptoms, cause hyperthyroidism
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| after removal gestational trophoblastic disease | weekly HcG levels until prepregnancy than monthly for 1 yr
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| transabdominal ultrasound needs what | FULL bladder 1-2Quarts
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| fetal surveillance occurs because | PIH, GDM, DM, decreased fetal movements, chronic medical conditions
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| NST | reactive (HR of 15 beats up for 15 secs from baseline) is wanted
nonreactive (none in 40 mins)
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| CST | negative is wanted
positive is where late decelerations are present in 50% of contractions
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| BPP checks for | FHR acceleration, FHR breathing, fetal movements, fetal tone, amniotic fluid volume
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| BPP results to induce | 6/10 or lower
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| Quad marker screening is done when | around 15-18 weeks
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| S&S of preterm labor | change in DC, vaginal bleeding, ROM, D, fetal engagement prior to 32 weeks, UTI, low back pain that is different, pelvic/thigh pressure, sensation of uterine tightening, lower abd cramping
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| treatment for Inpatient preterm labor | fetal/uterine monitoring, bedrest, side-lying, tocolytics, evaluate fetal lung maturity
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| treatment for outpatient preterm labor | uterine monitoring, modified bedrest, side-lying, tocolytics, non-caffeinated fluids, empty bladder, no heavy lifting, no sexual activity
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| preterm neonate kidneys immaturity increases risk for | metabolic acidosis so avoid & caution meds due to nephrotoxicity
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| if preterm neonate is stressed due to things like touch, noise, & light reacts by | decreasing HR & O2
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| severe preeclampsia | 160 systolic or 110 diastolic
proteinuria 5g/L or more in 24 hr urine
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| S&S of severe preeclampsia | cereral/visual disturbances (HA, altered concsiousness, blurred vision), pulmonary edema or cyanosis, epigastric or RUQ pain, thrombocytopenia or impaired liver funciton, oliguria (<500cc/24hrs)
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| pathophysiology of PIH | exaggerated response to angiotensins & thromboxane increases. arteriolar vasospasm, endothelial damage, stimulates platelet & fibrinogen use. systemic vasospasm, vascular damage & fluid shifts.
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| in normal pregnancy patho | normal pregnancy blunts response to angiotensin II (increase BP/decreases fluid)
thromboxane (increases BP & promotes platelet aggreagation)
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| Treatment for Mild PIH | IP/OP, rest, NST, BPP, fetal movement, assessment of BP, monitor for advancement
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| treatment for severe PIH | IP seizure precautions, continous fetal monitoring, DTR every hr, BP monitoring, rest & quiet, daily wt, proteinuria, end organ changes, amniocentesis, betamethasone & dexamethasone, mag sulfate
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| treatment for eclampsia | mag sulfate, Na amobarbitol, observe for precipitous labor/delivery & placental abruption, seizure safety
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| S&S for GDM | vary none to coma
3 P's
glucosuria
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| Screening criteria for GDM | prior GDM, LGA infant, marked obesity, dx of polycystic ovarian syndrome, glycosuria, family hx of diabetes
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| if at risk random test | HbA1c >6.5% or fasting glucose >126
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| if not high risk GDM is screened at | 24-28 weeks
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| maternal complications from GDM | infection, HTN, polyhydramnios, postpartum hemorrhage, premature delviery, over distended uterus
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| infant complications from GDM | macrosomia, IUGR, congenital abnormalities, IUFD, birth asphyxia, birth injury, RDS, hypoglycemia
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| self glucose monitoring of GDM | pre below 95, 1 hr post below 130-140, & 2 hrs post below 120
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| nutrition GDM | 3 meals & 3 snacks. 40-50% complex carbs, 15-20% protein, 20-30% fat
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| why is oral hypoglycemics rarely used | crosses the placenta
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| Mag sulfate | neuromuscular relaxation given IV
SE: flushing, warmth, HA, N, nystagmus, dry mouth, dizzy, lethargy, & sluggish
NI: monitor BP, resp, mag levels, DTR, urinary output
infant SE: hypotonia, lethargy, hypoglycemia, hypocalcemia
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| ritodrine hcl (Yutopar) | beta blocker
SE: hypotension, cardiac arrhythmia, tachycardia, palpitations, MI, pumonary edema, hyperglycemia
NI: IV, IM, SQ, oral
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| betamethasone (Celestone Solusapn) | induce pulmonary maturation & decrease incidence of RDS
SE: increase infection, hyperglycemia, pylmonary edema, Na & fluid retention, N, impaired wound healing
infant SE: decrease cortisol levels @ birth, hypoglycemia, increased risk for sepsis
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| NI for betamethasone (Celestone Solusapn) | assess for contraindications, deep in gluteal muscle, monitor BP, HR, wt, & edema, assess lab values for electrolytes & blood glucose
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| Contraindications for betamethasone (Celestone Solusapn) | cant delay birth, adequate L/S ratio, maternal bleeding, maternal infection, DM, more than 34 weeks, Cushing syndrome
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| Terbutaline | same as yutopar
beta blocker
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| Nifedipine | reduces flow of extracellular Ca ions into intracellular space=inhibits contractile activity
SE: hypotension, tachycardia, facial flushing, HA
NI: assess BP, HR, & resp
CI: heart disease, cardio compromise, intrauterine infection, multiple pregnancy, H
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| increases risk for preeclampsia | primigravida <20 yrs old, chronic HTN, low SES, >35 yrs old, & multiple gestation
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| increases risk for GDM | prior GDM, LGA infant, marked obesity, polycystic ovarian disease, glycosuria, history of DM type 2
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| increases risk for preterm | OB complications, poor uterine blood flow, maternal employment, stress, history of Preterm labor
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| increases risk for abruptio placentae | increased parity (multiple gestation), low SES, PIH, increased maternal age, cocaine use, smoking alcohol, history of it
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| increases risk for ectopic pregnancy | damaged fallopian tubes or history of surgery on , pelvic inflammatory disease, increased age
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| increases risk for IUFD | DM especially type 1, PIH, Rh incomptabilities, abruption of the placenta, cord compression, illegal drugs, anything that decreases perfusion to the baby
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| which procedures should you have a full bladder? | abdominal ultrasound & CVS. Not amniocentesis.
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