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LPN OB review

Terms in this set (126)

gravida
# of pregnancies
term
infants born after 37 weeks
preterm
infants born between 20 & 7 weeks
abortion
before 20 weeks
living
number of living children
amenorrhea
absence of menstrual periods
quickening
movement of the baby
GTPAL
Gravitas
Term
Preterm
Abortion
Living
prima gravitas
1st time pregnant
multi para
multi births
null para
no births
1st prenatal visit
Medical Hx
Physical
Psychosocial (Family, economic support, cultural considerations)
Labs: CBC Blood group & typing
Urinalysis (culture and drug screen)
Screen for STI and Tx
Papa smears
Normal prenatal HR
110 - 160
Visits the first 28 weeks
every 4 weeks
visits 28 - 36
every 2 weeks
Basic Diagnostic Test (pregnancy)
Alpha-fetoprotein (AFP)
Glucose tolerance test (GTT)
Oral glucose tolerance test (OGTT)
Ultrasound (US)
AFP
ALFA FETOPROTEIN-- MAJOR SERUM PROTEIN OF EARLY FETAL LIFE. SYNTHESIZED BY YOLK SAC & FETAL LIVER. PEAKS 2ND TRIMESTER. ENTERS AF THROUGH FETAL URINATION, CROSSING MEMBRANES INTO MATERNAL BLOOD.
peaks 16 - 18 weeks
AFP Follow - up:
Follow - up: Abnormal levels
Triple screen test
Ultrasound
Measuring AFP in amniotic fluid
AFP findings
Findings
Increased levels may indicate:
Neural tube defects
Other body wall defects
Threatened abortion
Fetal distress
Death
Decreased levels may indicate:
Trisomy 21 (Down syndrome)
GTT
between 24 - 28 weeks gestation
GTT procedure
Test procedure:
Explain test
A 50 g oral glucose given
Venous plasma glucose
Measured after 1 hour
GTT Findings
> 140 mg/dl abnormal
OGTT Procedure
eat high carbohydrates diet for 3 days before test
on day of test:
Fast for 8 hours (overnight)
A fasting oral glucose is obtained
100 grams of oral glucose is administered
Glucose levels measured at 1, 2, & hours
OGTT Findings
Gestational diabetes is diagnosed if:
2 or more results abnormal
Borderline results:
Repeat in 1 month
1st Trimester Education
Physical and psychosocial changes of pregnancy, self care
Protecting and nurturing the fetus, prenatal exercise
Choosing a care provider and birth setting
Relief of common early pregnancy discomforts
2nd Trimester Education
Planning for breast feeding, sexuality in pregnancy
Relief of common later-pregnancy discomforts
3rd Trimester Education
Preparation for childbirth, development of birth plan
Relaxation techniques, postpartum self-care
Infant care and safety
N/V mgmt
Avoid strong odors and drinking while eating, drink carbonated beverage, eat crackers before getting out of bed, eat small, frequent meals, avoid spicy or greasy foods
breast tenderness
wear a well-fitting bra
urinary frequency
increase daytime fluid intake
decrease evening fluid intake
empty bladder as soon as urge is felt
fatigue
plan rest period or nap during the day
ptyalism (excessive salivation)
use gum, mint, hard candy mouthwash
nasal stuffiness/bleeding
use cool air vaporizer
psychosocial dynamic/ mood swings/ mixed feelings
participate in pregnancy support group, communicate with partner, family, and others, request referral for supportive services
Hegar's sign
A softening of the lower uterine segment found upon palpation in the second or third month of pregnancy.
Goodell's sign
Softening of the cervix and vagina with increaased leukorrheal discharge; palpated at 8 weeks, (blue)
Chadwicks's sign
sign of early pregnancy in which the vaginal, cervical, and vulvar tissues develop a bluish color.
Ballotment
about 16 weeks
feeling something in the uterus bouncing back on your finger tips when doing an internal or bi-manual assessment.
Cardiovascular (pregnancy)
Total volume increase 40 - 50%
Cardiac output 30 - 40%
Heart size increases and elevates
Pulse increases about 2nd trimester about 10 beats
Supine hypotension (Tx always roll on the left side)
Respiratory (pregnancy)
Consumption increase 15 - 20%
Diaphragm elevated
RR unchanged
Epistaxis
Musculoskeletal (pregnancy)
Pelvic joints loosen
Lordosis
Diastasis recti
Lordosis
This increase in Lumbar curve will be present in Maternal Musculoskeletal system, due to increased size & weight of uterus (out front). Will cause back aches.
Diastasis recti
Separation of the two rectus abdominis muscles, through which abdominal contents form a midline ridge when the patient raises their head and shoulders. Often seen with repeated pregnancies, obesity, and chronic lung disease. No clinical significance
GI (pregnancy)
N/V
Poor appetite
Constipation - hemorrhoids
Pica
Ptyalism
GERD
Pica
the craving and action for weird things (raw meat, dirt, chalk, pennies, etc.)
Ptyalism
excessive secretion of saliva
Renal (pregnancy)
Urinary frequency
Decreased bladder tone, capacity
Glomerular filtration increases 50%
Renal threshold for glucose decreased
chloasma
Condition characterized by increased pigmentation on the skin in spots that are not elevated.
, aka "Mask of Pregnancy"; darkening of the forehead, cheeks and area around the eyes
Linea nigra
is a pigmented line extending from the symphysis to the top of the fundus in the midline. This line is known as linea alba before hormone induced pigmentation.
Striae gravidarum
stretch marks; usually appear over the abdomen, thighs, and breasts of pregnant women; they fade after delivery but never disappear
Endocrine (pregnancy)
Metabolism increases
Hormones:
HcG, estrogen, progesterone
Human placental lactogen
Relaxin
Relaxin
A female hormone produced by the ovaries and placenta that increases flexibility of the pubic symphysis and helps dilate the uterine cervix to ease delivery of a baby.
A hormone produced by the placenta that causes softening in the collagen connective tissue of the symphysis pubis and sacroiliac joint
Dietary Reference Intake
2200 calories
+300
Never less than 1500 cal/day
Folate or Folic Acid (pregnancy)
400 mcg
development by 56 days
Protein
(40) up 60 g
Iron, B vitamin, calcium, phosphorus, zinc
Calcium
1200 - 1500 mg
inadequate intake = osteoporosis
Iron
To build hemoglobin levels
At 20 weeks stores iron in liver
Iodine
Proper thyroid function
Fluoride
Teeth production
Zinc
DNA synthesis
May be associated with preterm birth (lack of zinc)
Fluids (pregnancy)
64 oz/ 8 cups
Normal pregnancy weight gain
Total: 25 - 35 lbs.
Fetus: 7 - 8.5 lbs.
Placenta: 2 -2.5 lbs.
Amniotic fluid: 2 lbs. (1000mL)
Increase in uterine tissue: 2 lbs.
Breast tissue: 1 - 4 lbs.
increased blood volume: 4 -5 lbs.
Increased tissue fluid: 3- 5 lbs.
Increased fat stores: 4 - 6 lbs.
Normal Blood loose at birth
500 mL
weight gain at pregnancy
10 - 13 lbs = 20 weeks
add a pound a week each following week
fetal heart begins beating
4 weeks
all body organs formed
8 weeks
fetal heart tones (Doppler)
8-12 weeks
sex can be determined
16 weeks
heartbeat with fetoscope, Mom feels movement, hands can grasp, can taste
20 weeks
Fetal respiratory movements: responds to sound
24 weeks
eves open, responds to light: surfactant start to form
28 weeks
fingernails and toenails: Sufficient surfactant
32 weeks
baby gets antibodies from mom
38 - 40 weeks
Igm
Main antibody in the initial "primary" immune response and allows good complement activation is
Iga
Major antibody in secretions and plays a significant role in first-line defense at the mucosal level is
Vernix
At birth the skin is covered with a yellowish white, cream cheese-like substance vernix caseosa. This substance protects the infant's skin from the amniotic fluid. When the vernix is removed the skin may appear dry and may crack, flake, and peel.
Meconium
Dark green or black material present in the large intestine of a full-term infant; the first stools passed by the newborn.
5 P's
Passageway - Bony pelvis
Passenger - fetus
Powers - contractions
Psyche - Psychological aspect of childbirth
Position - How the mother is sitting or lying
Passageway
Bone pelvis:
False pelvis (above brim)
Pelvic Types
Gynecoid - 50% wide
Android - 20 - 23% narrow
Anthropoid - 24 - 25% narrow - oval
Platypelloid - 3 - 5% wide (would need a C-section)
Passenger
Attitude: Relationship of fetal parts to one another
Vertex (most common) - chin to chest
Sinciput, brow, or face (mentum)
Lie: Longitudinal or vertical
Transverse or horizontal
Oblique
Presentation (what do you feel first): Cephalic (most common) head
Breech
shoulder
Passenger Position
ROA (most common) right occiput anterior
LOA (most common) Left occiput anterior
ROP right occiput posterior
LOP Left occiput posterior
Passenger Engagement
Floating
Ballotable
Engaged
Station: - Minus - 0 - Plus
Passenger - Fetal head
Size
Fontanels: Anterior (Diamond shape)
Posterior (Triangle shape)
Posterior fontanels close?
3 days to move into place, closes in 6 -8 weeks
Anterior fontanels close
3 days to move into place, closes in 12 - 18 months
Psyche
Emotions - try to be as relax as possible
Physiological
Knowledge
True Labor
Cervical dilation & effacement are progressive. (true test)
Contractions increase in duration & intensity
Positioning has no effect on contractions
False Labor
Does not produce dilation, effacement, or descent.
Contractions are irregular without progression
Walking relieves contractions
Crowning
when the head of the baby is visible through vaginal canal
Crowning assessment
B/P, HR, RR Q15min
Palpate contractions
FHR (fetal heart rate)
Q15min (High risk q5min)
Non-reassuring pattern-continuous
Crowning implementation
Position for pushing
Encourage rest & relaxation
Stages of Labor
Stage 1 onset to complete dilation: Latent, Active, Transition
Stage 2 dilation to birth
Stage 3 birth to placenta
Stage 4 1-4 hours after (a return to homeostasis)
Latent stage
1 - 4 cm dilated (5-8 hrs.)
Active stage
5 - 7 cm dilated (2.5 - 4.5 hrs.)
Transition stage
8 - 10 cm dilated (1-4 hrs.) contractions: 1.5 - 2 min (last), 60 -90 second (break)
ROM timeframe
within 24 hours
ROM
Rupture of membrane
FERN test
Appearance of a fernlike pattern found on microscopic examination of certain fluids such as amniotic fluid
Management of Discomfort part 1
Pain:
common fears: how will the pt react and cope
Variety of methods available: depends on situation, availability
Preference of woman & physician
Management of Discomfort part 2
Distraction/Breathing
Touch/Effleurage/massage
Water therapy
TENS
Breathing exercise
Management of Pain Pharmacological part 1
Active phase of 1st stage: Cervix dilated 4-5 cm
Local: Block pain - episiotomy
Paracervical block - 1st stage, rapid, may cause fetal bradycardia (reduces the pain of the cervix)
Management of Pain Pharmacological part 2
Pundendal block: right before birth (lasts 30 mins)
Epidural block: L3-L4, may cause hypotension, DOES NOT cause headache
Ataractics: reduces N/V (reglan), Valium or ativan
Early deceleration
Mirror - head compression (Tx - nothing) (before contraction)
Variable
Rapid decal, U, V, W - cord compression (Tx Left side, IV fluids, O2)
Late
after contraction, Utero placenta insufficiency (Tx Left side, IV fluids, O2) (bad) always good to be early, always bad to be late
Postpartum
Puerperium
Postpartum involution
Rapid decrease in uterine size
2 lbs. to 2 z in 6 wks.
Postpartum Assessment
1 H PP at the umbilicus
24 H PP _ 1 FB/day
10 Days PP - )
about a 1 cm/day
Fundus - Tender
infection
Fundus - boggy
uterine atony
If uterus remains boggy post massage/clots: THE NURSE SHOULD REMAIN WITH THE WOMAN. CALL THE PHYSICIAN IMMEDIATELY.
Fundus - boggy - Interventions
Massage the fundus
IV fluids
Oxytocic medications (Pitocin)
Have the mother breast feed the baby
THE NURSE SHOULD REMAIN WITH THE WOMAN. CALL THE PHYSICIAN IMMEDIATELY.
Lochia
Discharge from birth, has a musty stale odor, not offensive
Lochia Assessment
Rubra: Bright red day 1 - 3
Serosa: Brownish pink day 4 - 10
Alba: Yellowish white day 10 - 6 weeks
Postpartum changes
After pains: caused by intermittent contractions post birth
worse in multip & breastfeeders
Cervix: soft, irregular, edematous
closes 2-3cm post 1wk
permanent change
Vagina: Pain free in 2 weeks
decreased lubrication for 6 - 10 weeks
Other Postpartum changes
Perennial pain: 1st 24H (ice), 2nd 24 H (sitz bath)
Episiotomy - REEDA
Breast changes: Ice (non-breastfeeding) no stimulation, cabbage leaf.
Warm soak (breastfeeding)
Episiotomy - Assessment
REEDA
REEDA
Acronym for redness, ecchymosis, edema, discharge, and approximation; useful for assessing wound healing or the presence of inflammation or infection.
Postpartum cardiovascular
Prepregnant state 2 wks.
bradycardia (50 - 70) common during 1st - 6-10 days
Postpartum Urinary
increased bladder capacity and lowered bladder tone
PP diuresis (2000-3000 mL) 1st 12-24 hours
Postpartum GI
Hunger and thirst common following birth
risk for constipation
Postpartum Endocrine
Estrogen and progesterone levels drop quickly
menstruation usually resumes in 7-9 weeks
lactation (nipple stimulation, good latch, colostrum)
BUBBLEHEB
Breast
Uterus
Bladder
Bowel
Lochia
Episiotomy/Incision
Homan's sign
Emotional Status/Education
Bonding/Attachment
Homan's sign
Early sign of thrombophlebitis of the deep veins of the calf in which there are c/o pain when the leg is in extension and the foot is dorsiflexed. Examine the pts legs by stretching and straightening each leg, then dorsiflexing the foot. Pain in the calf is a positive sign, which indicates inflammation of the blood vessels of the leg. Notify the physician promptly.
Puerperium
Period from the end of childbirth until involution of the reproductive organs is complete, approximately 6 weeks.
Maternal Adjustment
Taking in: 1st days postpartum (dependant)
Taking hold: 3rd - 10 days postpartum (dependant - independent)
Letting go: 10 days - 6 weeks postpartum (independent)
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