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Community 1 Exam 2 (OB)

Terms in this set (105)

involution
return of the uterus to its non pregnant size by 4 to 6 weeks through process of autolysis
what is autolysis
self-digestion
when is endometrial regurgitation complete
end of 3rd week
when is placenta site regurgitation complete
end of 6th week
factors enhancing involution
messaging the fundus
breast feeding
early ambulation
empty bladder
hemabate
oxytocin, prostoglandin
stimulates uterine ctx
absorption at 13-20 weeks
used when postpartum hemorrhage NOT controlled by other methods
s/s include fever, chills, N/V/D
methergine
oxytocin
stimulates uterine, vascular, smooth muscle, causing ctx
decrease bleeding
treatment of postpartum hemorrhage
increases vasoconstriction, so can increase BP
asses BP prior for baseline
pitocin
oxytocin
synthetic hormone
works directly on myofibrils producing uterine ctx
stimulates milk ejection
induction of labor
prevention of postpartum bleeding
cytotec
misoprostol
synthetic prostaglandin
oral preparation used to prevent and treat gastroduodenal damage induced by NSAIDs
(off label use) cervical ripening and treatment of PP hemorrhage
afterpains occur more often in
multiparae
rather than primips
lochia rubra
bright to dark red
2-3 days after
lochia serosa
pink/brown
3-10 days after
lochia alba
white/yellow
10 days to 6 weeks
perineal changes
sore/pain
edema
bruising/ecchymosis
surgical cut/episiotomy
lacerations/tears
hemorrhoids
primary
secondary
tertiary
(perineum care)
primary- care
secondary- comfort
tertiary- pt teaching
why should c section only have clear fluids
just until return of peristalsis
urinary tract increased risk for
over distention
incomplete emptying
build up=infections
blood loss average for vaginal birth
200-500mL
blood loss average for c section
700-1000mL
leukocytosis is present with elevated WBC of 15,000 to 20,000 during
the first 10-12 days postpartum
initial 10-12 lbs loss due to
baby, placenta, amniotic fluid
5 lbs loss due to
diuresis (increase in urine output)
factors that predispose client to postpartum hemorrhage
older age/high parity
rapid labor
prolonged 1st or 2nd stages of labor
operative delivery
(hemorrhage)
large pad soaked
larger pad at SLH soaked
(weight pads)
100mL
400mL
hematoma
s/s includes intense pain pressure in rectal area like having to have BM, increase pulse, decreases BP, decreasing Hct
return of bowel function
3 days postpartum
postpartum blues time frame
peaks 5th day
subsides 10th day
distinguishing feature with PP depression without psychotics features from PP blues
irritability
PPD with psychotic features
depression
suspiciousness
incoherence
irrations statements
auditory hallucinations
delusions
thoughts of harming self or baby
AAP recommends breastfeeding exclusively for
6 months
beast feeding should cont for at least
12 months
complementary foods may be introduced after
6 months
prolactin levels highest during
first 10 days postpartum
when do growth spurts occur
10 days
3 weeks
6 weeks
3 months
6 months
feeding or pumping should occur how often
q 2-3 hours
8-12 times a day
breast milk and most infant formulas are how many calories/oz
20
how many calories does infant need in first 6 months
110-120 calories/kg
50-55 calories/pound
fluid needs of baby
150 mL/kg a day
may lose up to how many lbs
7-10% of weight
but regain by 14 days
why is carb intake important
small glycogen stores
what supplements does baby need
high protein need
fat (in breast milk)
iron (not in breast milk)
fluoride
what percent of milk is emptied in the first 7 minutes of feeding
90%
feeding should last how long to satisfy infant sucking need and stimulate production
10-30 minutes
APGAR scoring
heart rate
0-absent
1-<100
2->100
APGAR scoring
respiratory rate
0-absent
1-slow, irregular, gasping
2-good, crying
APGAR scoring
muscle tone
0-flaccid
1-some flexion, poor
2-active motion
APGAR scoring
reflex irritability
0- no response
1- weak cry, grimace
2- vigorous cry
APGAR scoring
color
0- blue, pale
1- pink body, blue extremities
2- pink
immediate care of newborn
clear airway
clam/cut cord
dry/kangaroo care
APGAR score at 1 and 5 minutes minimum
why give Vitamin K
liver and GI immature
prevention of bleeding (brain)
why give erythromycin
prevent eye infection
normal blood glucose range
45-90mg/dl
identification of baby/mom
footprints
ID bands
newborn photo
moms right index fingerprint
c section respiratory risk of baby
fluid not naturally SQEEZED out by canal
average respiratory rate of newborn
30-60 per minute
early sign of baby in respiratory distress
sternal retraction
nasal flaring
increased respers >60
late signs of rest distress in baby
expiratory grunting
decreased respers <30
normal pulse of baby
110-160 beats per minute
normal temp of baby
how asses temp
98-99f
q 4 first 24 then q shift
dehydration indicator
fontanel dips down
stomach holds
1-2 oz
30-60 mL
s/s of hypoglycemia in baby
tremors
jitteriness
twitches
late preterm time
34-36.6 weeks gestation
confirm late preterm by
4 uterine ctx in 20 minutes
cervical dilation of 2 cm
effacement of 80%
confirm preterm labor
UC more frequently than q 10 minutes for 1+ hours
UC may be painful or painless
predicting preterm labor
fetal fibronectins
what are fetal fibronectins
glycoproteins found in plasma and produced during fetal life
do not stop preterm labor if
6 cm
sever PIH
sever med complications
chorioamnionitis
hemorrhage
fetal complications or death
what is tocolysis
stopping labor
tocolysis drugs currently used
mg sulfate
beta adrenergic receptor stimulants (terbutaline)
ca channel blockers (nifedipine)
prostaglandin synthesis inhibitor (indocin)
complications of BARS
pulmonary edema
linked to maternal death
what is (P)PROM
(preterm) premature rupture of membranes
treatment if premature rupture of members occurs
abx q 4-6 hours
bed rest
foley
monitor
try to keep pregnant for another 24 hours
what is chorioamnioitis
(premature membrane rupture)
an intramniotic infection of the chorion and amnion that is potentially life-threatening for the fetus and woman
spontaneous abortion
"miscarriage"
occurs before 20 weeks/viability
complete abortion
with completely empty uterus and no signs of infection then no treatment. Anticipate and provide emotional support for grieving related to loss of pregnancy
inevitable or incomplete abortion
assist with dilation and cauterization to empty uterus if indicated
threatened abortion
bleeding but not abortion
limit activities for 24 to 48 hours and restrict coitus for 2 weeks
ectopic pregnancy
implantation of the fertilized ovum outside of uterus
fallopian tubes*, ovary, cervix, abd
ectopic pregnancies has increased greatly due to
STIs
managing ectopic pregnancy
low HCG titer, vaginal bleeding and abdominal pain, tenderness, referred pain - shoulder
severe pain indicates ruptured tube which is an emergency
requires salpingectomy (tube removal) or salpingostomy (cutting into tube to remove pregnancy) or Methotrexate
Gestational Trophoblastic Disease
anomaly of placenta called "Molar Pregnancy"
gestational trophoblastic neoplasm that arise from the chorion
benign type
hydatidiform mole
malignant type (rare)
choriocarcinoma
complete mole
fertilization of an egg with a lost or inactivated nucleus
partial mole
two sperm fertilize normal ovum
monitor HCG level why
levels increasing can be a sign of remaining molar tissue
s/s of placenta previa
painless uterine bleeding during third trimester
s/s of abruptio placentae
intense uterine pain with or without bleeding
uterine tenderness
contractions
board like uterus
can be silent
DIC
disseminated intravascular coagulation
what is DIC
overactivation of the clotting cascade and the fibrinolytic system resulting in depletion of platelets and clotting factors
what can DIC result in
hemorrhage
anemia
ischemia
what is battledore
marginal insertion of the cord
what is succenturiate placenta
placenta divided into 2 or more separate lobes
three major s/s of Preeclampsia
HTN
proteinuria
edema
risk factors for preeclampsia
primigravidity or multiparous woman with new partner for current pregnancy
extremes of maternal age: <18 or >35 years
HTN in preeclampsia
BP of 140/90 mm Hg during second and third trimesters
increase of 30 mm Hg systolic increase of 15 mm Hg diastolic from baseline
warrant closer observation
MAP of 105 mm Hg or greater
what warrants HTN in preeclampsia
BP elevation must be present on 2 separate occasions 4 to 6 hrs apart
proteinuria in preeclampsia
>30 mg/dl
with no UTI
24 hour specimen concentration of >300 mg per 24 hours
edema in preeclampsia
12 hours of bedrest
weight gains of 4.5 to 5 lbs per/week
what is hyperreflexia
CNA irritability
assess for clonus
what is clonus
series if involuntary, rhythmic, muscular ctx and relaxations
eclmapsia
occurrence of seizures or coma in patients with signs and symptoms of preeclampsia and there is no other attributable cause
HELLP
Hemolysis
Elevated Liver enzymes
Low Platelet
s/s of HELLP
malaise
epigastric pain
N/V
flu-like symptoms
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