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Labor and Delivery 5
Terms in this set (76)
Pt gets an epidural , how often do we chart on motor sensory?
*half hour after insertion
*one hour after delivery
How often should we chart on the IV access?
every two hours
What is the minimal amount of time to be considered a contraction?
How many women get PP depression?
How many fathers will experience Paternal depression and when does it usually present?
When lactating how many calories should you up your diet?
Symptoms of PP depression?
*OCD type behavior
*PTSD can occur from traumatic delivery
What is the goal with postpartum depression?
How do we treat postpartum depression?
What is the breast feeding goal ?
When have a diabetic mother in labor the goal is to try and have stabile blood sugars especially right before birth to ?
*attempt to keep baby's blood sugars stable
Remember hypothyroid problems can mimic?
Teach women that they will ovulate two weeks prior to the period starting so they?
can get pregnant prior to period.
How fast can a women ovulate after baby?
27 days or more (usually depends on breastfeeding)
After delivery what pathophysiological things can you see?
*mild proteinuria (due to uterine atony)
*GFR rise (remember oxytocin cause water intoxication)
*diminished bladder tone
How long does ice work after delivery?
Remember after delivery a women's blood volume has decreased dramatically so?
*orthostatic hypotension is common
*no showers for twelve hours
Pt complains of headache after delivery?
*lye them flat to r/o spinal headache
*check blood pressure to r/o elevated blood pressure which can occur after delivery
What is Diastasis recti?
separation of the rectus muscle in the abdomen
If mother is getting breakdown on her breast , change?
Breastfeeding decreases the chances of a women getting? later in life?
*Type II diabetes
Prolactin is the hormone that prepares the breast for lactation and ? hormone produces let down?
Things to know about Colostrum?
*comes in at 1-5 days
*rich in Immunoglobins
*increased protein and minerals
*laxative effect to get baby to poop
Thing to know about breast milk?
*comes in by the 5th day
*mature milk at ten days
*fat content increase as it matures
*if feeding toddler and new baby, feed baby first
*hydration is key/4000ml of water or more
*works by supply and demand
*during growth spurts baby will constantly feed, it takes the mother's milk a day to catch up with increase in demand.
*increase diet 500 calories
*avoid high sugar drinks
Your postpartum pt keeps trickling blood. What can this be?
laceration of vaginal wall or cervix, call doctor to come assess.
What are the drugs for hemorrhage?
Your postpartum pt is complaining of severe pressure and pain in the perineal area?
Turn pt on her side and check perineum for a hematoma.
How long after birth can a pt get a uterine infection?
How do we treat endometritis?
Encourage Postpartum pts to void?
every two -three hours to cleanse bladder and keep uterus down.
What is a cystocele?
bladder prolapses into vagina
What is a rectocele?
rectum prolapses into bladder
Signs and symptoms of Pulmonary embolism are?
*anxious because they can't breathe
*chest pain that is worst when they take a breath
*pink foamy mucous with cough
Pt needs rhogam shot, how long do we have?
Why do we give Rubella after delivery?
*because she can't get pregnant for three months
What is the current recommendation for TDAP?
*every pregnancy to protect the baby from whopping cough.
What wt is considered macrosomnia?
What is considered LGA?
*must get three good glucoses on baby above 45
What occurs in the third trimester for baby?
*suck, swallow and breath reflex
Placental grading by ultrasound?
Grade 0-Grade 3
Grade 0 is the best
What are the leading causes of sepsis in a newborn and when does it typically present?
*presents within twenty four to forty eight hours
*Group Beta strep
When running Gentamycin or Vancomycin remember you need a ?
peak and trough to watch kidneys
Baby is suspected of sepsis , what do we need to order?
When dealing with newborns and having some type of issue , remember to watch?
their glucose levels
Factors that can affect placental integrity?
*abnormal placental development
What FHR indicate decreased placental function?
*abnormal baseline ranges
*absent fetal variability
What extrinsic factors can affect umbilical cord integrity?
What changes in the FHR would you see if the cord is compromised?
What structure abnormalities can occur in the umbilical cord?
*two vessel cord
What can cause cord compression?
*maternal/fetal position in relation to cord location
*loops of cord wrapped around parts of the fetal body
Cord cushioning is affected by?
*decreased amounts of amniotic fluid
*decreased amounts of Wharton's jelly
Intrinsic factors affecting fetal oxygenation and fetal heart rate are?
*fetal oxygen transportation
*fetal nervous system
*fetal homeostatic mechanisms
Sympathetic and Parasympathetic nervous system will?
adjust the fetal heart rate.
Chemoreceptors respond to?
changes in fetal blood stream: decreased oxygen, increased carbon dioxide, decreased PH level.
Baroreceptors detect changes in?
fetal blood pressure
Chemoreceptors and baroreceptors send messages to?
CNS and it will active certain hormones to activate the parasympathetic and sympathetic nervous system.
In response to fetal hypoxia the CNS will release:
cathecholamines: epinephrine and norepinephrine and this causes and increase in heart rate and will supply blood to fetus' brain , heart and adrenals and shunt blood from the kidneys, GI.
Vasopressin is released when?
anti-diuretic hormone is will result in an increase in blood pressure and stabilization of the hemodynamic system.
Renin-angiotensin is released by the kidneys to
produce vasoconstricton to minimize blood pressure changes in fetus.
Fetal reserve is defined as?
the amount of hypoxemia that a fetus can tolerate before true tissue hypoxia and acidosis occur.
How do you know if your baby has fetal reserve?
**basically a category I strip
How do you know if your baby has a decreased fetal reserve?
*abnormal baseline range
*minimal or absent variability
***basically a category III strip
When deciding to use a more direct or invasive technique (IUPC, or fetal scalp electrode) you should consider?
whether the added information received is worth the added risk of introducing an internal device. Do the benefits outweigh the risks.
If your tracing becomes confusing and your not sure where the baby is heading toward , you should?
investigate further with your colleagues and charge nurse, hospitalist and your Dr.
Are interventions as a labor nurse are to?
*maximize utero-placental profusion
*maximize umbilical circulation
*reduce uterine activity
Interventions to maximize uterine blood flow are:
*hydration (up the LR)
*anxiety reduction (decrease catecholamines and decrease mothers blood pressure)
*correct the underlying problem
What FHR characteristics might indicate the need to use Uterine resuscitation measures?
*absent or minimal variability
How can we maximize umbilical cord circulation?
*elevate presenting part(this is if you have a prolapse cord, put your hand in their and push the head off of the cord)
By treating underlying problems we can increase oxygenation to our baby . Such problems can be?
Infection: give mother antibiotics and both mother and baby will use less oxygen consumption
*anemia-give mother blood products prior to labor and both mother and baby will have increased oxygen
*treatment of respiratory disease of the mother will tax her whole system and all components of the maternal oxygen transportation.
*hypertension-decrease mothers blood pressure and vasoconstriction and both mother and baby will have increased oxygen consumption.
How can we reduce uterine activity, if needed?
*maternal position change
*reduce/or discontinue pitocin
*terbutaline or some kind of tocolytic
No matter what the uterine activity , it is necessary to?
assess the fetal tolerance to contractions. Even minimal activity may not be tolerated by a fetus who is compromised. ****
How can we modify pushing, when needed on a baby who isn't tolerating it well?
*delayed and non directed pushing, open glottis pushing and upright position can enhance maternal pushing effort and or fetal descent and decrease the time necessitated for maternal active pushing.
Wha are some walks we can assess the fetal oxygenation and acid base status if we have doubts?
*fetal scalp stimulation
*a baby will not have accelerations if you do these interventions if acidotic.
When a pt strip is having repetitive late variable make sure to describe the?
dept and duration to the provider . Example: variable decelerations down to the 70's for approximately one minute
What is minimal variability associated with?
Late decelerations with minimal variability and tachycardic strip, what do you think?
3 strikes with the baseline, variability and lates: get this kid delivered, uterine resuscitation measures, and hydrate and turn off the pitocin.
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