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Ameritech OB Final

Terms in this set (330)

Diaphragm
A dome shaped cup with a flexible rim made of silicone that fit. Snugly over the cervix. Mechanically halts the passage of sperm.
Diaphragm Education
Replace every 2 years. Refit for 20 lb weight fluctuation. Spermicide must be reapplied with each act of coitus
Diaphragm Risks
Not recommended for clients who have a history of toxic shock. Cystocele, UTI's, or uterine prolapse.
Combined Oral Contraceptives
Hormonal contraception containing estrogen and progestin, which acts by suppressing ovulation, thickening the cervical mucus to block semen. Prevents implantation.
Combined Oral Contraceptives Education
a. Medication requires consistent and proper use to be effective. b. Observe for and report manifestations of complications (chest pain, SOB, leg pain, headache, vision changes, hypertension). c. Most symptoms are from estrogen.
Combined Oral Contraceptives Risks
Not recommended for clients with any thromboembolic disorders, smoking, hypertension.
Ovulation
Involves determining fertile days by tracking the menstrual cycle to estimate the time of ovulation, which occurs about 14 days before the onset of the next menstrual cycle.
Ovulation Education
The fertile period begins when the cervical mucus is thin, slippery, and stretchable between the fingers.
Nagele's Rule
to determine the estimated delivery date.
Nagele's Rule Education
Subtract 3 months, and add 7 days and if, necessary a year. For example: May 4. Convert May to 5. EDD is February 11. Add a year, subtract 3 months, and add 7 days to the origin of gestational age.
Functions of the Placenta
Grows from a few identifiable trophoblast cells at the beginning of pregnancy to an organ that covers about half the surface area of the internal uterus at term.
Placenta Education
Source of oxygen and nutrients for the fetus
Hormones of the Placenta
human chorionic gonadotropin (hCG), progesterone, estrogen, human placental lactogen
Human chorionic gonadotropin (hCG)
Acts as a fail-safe, found in maternal blood and urine as early as the first missed menstrual period, shortly after implantation has occurred.
Progesterone
Necessary to maintain endometrial lining of uterus during pregnancy.
Estrogen
Contributes to mammary gland development in preparation for lactation, stimulates uterine growth to accommodate developing fetus.
Human placental lactogen
Promotes mammary gland growth in preparation for lactation for the mother. Serves important role of regulating maternal glucose, protein, and fat levels so adequate amounts of these are always available to the fetus
Nagele's Rule
to determine the estimated delivery date.
Nagele's Rule Education
Subtract 3 months, and add 7 days and if, necessary a year. For example: May 4. Convert May to 5. EDD is February 11. Add a year, subtract 3 months, and add 7 days to the origin of gestational age.
Functions of the Placenta
Grows from a few identifiable trophoblast cells at the beginning of pregnancy to an organ that covers about half the surface area of the internal uterus at term.
Placenta Education
Source of oxygen and nutrients for the fetus
Hormones of the Placenta
human chorionic gonadotropin (hCG), progesterone, estrogen, human placental lactogen
Human chorionic gonadotropin (hCG)
Acts as a fail-safe, found in maternal blood and urine as early as the first missed menstrual period, shortly after implantation has occurred.
Progesterone
Necessary to maintain endometrial lining of uterus during pregnancy.
Estrogen
Contributes to mammary gland development in preparation for lactation, stimulates uterine growth to accommodate developing fetus.
Human placental lactogen
Promotes mammary gland growth in preparation for lactation for the mother. Serves important role of regulating maternal glucose, protein, and fat levels so adequate amounts of these are always available to the fetus
Nagele's Rule
to determine the estimated delivery date.
Nagele's Rule Education
Subtract 3 months, and add 7 days and if, necessary a year. For example: May 4. Convert May to 5. EDD is February 11. Add a year, subtract 3 months, and add 7 days to the origin of gestational age.
Functions of the Placenta
Grows from a few identifiable trophoblast cells at the beginning of pregnancy to an organ that covers about half the surface area of the internal uterus at term.
Placenta Education
Source of oxygen and nutrients for the fetus
Hormones of the Placenta
human chorionic gonadotropin (hCG), progesterone, estrogen, human placental lactogen
Human chorionic gonadotropin (hCG)
Acts as a fail-safe, found in maternal blood and urine as early as the first missed menstrual period, shortly after implantation has occurred.
Progesterone
Necessary to maintain endometrial lining of uterus during pregnancy.
Estrogen
Contributes to mammary gland development in preparation for lactation, stimulates uterine growth to accommodate developing fetus.
Human placental lactogen
Promotes mammary gland growth in preparation for lactation for the mother. Serves important role of regulating maternal glucose, protein, and fat levels so adequate amounts of these are always available to the fetus
Nagele's Rule
to determine the estimated delivery date.
Nagele's Rule Education
Subtract 3 months, and add 7 days and if, necessary a year. For example: May 4. Convert May to 5. EDD is February 11. Add a year, subtract 3 months, and add 7 days to the origin of gestational age.
Functions of the Placenta
Grows from a few identifiable trophoblast cells at the beginning of pregnancy to an organ that covers about half the surface area of the internal uterus at term.
Placenta Education
Source of oxygen and nutrients for the fetus
Hormones of the Placenta
human chorionic gonadotropin (hCG), progesterone, estrogen, human placental lactogen
Human chorionic gonadotropin (hCG)
Acts as a fail-safe, found in maternal blood and urine as early as the first missed menstrual period, shortly after implantation has occurred.
Progesterone
Necessary to maintain endometrial lining of uterus during pregnancy.
Estrogen
Contributes to mammary gland development in preparation for lactation, stimulates uterine growth to accommodate developing fetus.
Human placental lactogen
Promotes mammary gland growth in preparation for lactation for the mother. Serves important role of regulating maternal glucose, protein, and fat levels so adequate amounts of these are always available to the fetus
Nagele's Rule
to determine the estimated delivery date.
Nagele's Rule Education
Subtract 3 months, and add 7 days and if, necessary a year. For example: May 4. Convert May to 5. EDD is February 11. Add a year, subtract 3 months, and add 7 days to the origin of gestational age.
Functions of the Placenta
Grows from a few identifiable trophoblast cells at the beginning of pregnancy to an organ that covers about half the surface area of the internal uterus at term.
Placenta Education
Source of oxygen and nutrients for the fetus
Hormones of the Placenta
human chorionic gonadotropin (hCG), progesterone, estrogen, human placental lactogen
Human chorionic gonadotropin (hCG)
Acts as a fail-safe, found in maternal blood and urine as early as the first missed menstrual period, shortly after implantation has occurred.
Progesterone
Necessary to maintain endometrial lining of uterus during pregnancy.
Estrogen
Contributes to mammary gland development in preparation for lactation, stimulates uterine growth to accommodate developing fetus.
Human placental lactogen
Promotes mammary gland growth in preparation for lactation for the mother. Serves important role of regulating maternal glucose, protein, and fat levels so adequate amounts of these are always available to the fetus
Nagele's Rule
to determine the estimated delivery date.
Nagele's Rule Education
Subtract 3 months, and add 7 days and if, necessary a year. For example: May 4. Convert May to 5. EDD is February 11. Add a year, subtract 3 months, and add 7 days to the origin of gestational age.
Functions of the Placenta
Grows from a few identifiable trophoblast cells at the beginning of pregnancy to an organ that covers about half the surface area of the internal uterus at term.
Placenta Education
Source of oxygen and nutrients for the fetus
Hormones of the Placenta
human chorionic gonadotropin (hCG), progesterone, estrogen, human placental lactogen
Human chorionic gonadotropin (hCG)
Acts as a fail-safe, found in maternal blood and urine as early as the first missed menstrual period, shortly after implantation has occurred.
Progesterone
Necessary to maintain endometrial lining of uterus during pregnancy.
Estrogen
Contributes to mammary gland development in preparation for lactation, stimulates uterine growth to accommodate developing fetus.
Human placental lactogen
Promotes mammary gland growth in preparation for lactation for the mother. Serves important role of regulating maternal glucose, protein, and fat levels so adequate amounts of these are always available to the fetus
Nagele's Rule
to determine the estimated delivery date.
Nagele's Rule Education
Subtract 3 months, and add 7 days and if, necessary a year. For example: May 4. Convert May to 5. EDD is February 11. Add a year, subtract 3 months, and add 7 days to the origin of gestational age.
Functions of the Placenta
Grows from a few identifiable trophoblast cells at the beginning of pregnancy to an organ that covers about half the surface area of the internal uterus at term.
Placenta Education
Source of oxygen and nutrients for the fetus
Hormones of the Placenta
human chorionic gonadotropin (hCG), progesterone, estrogen, human placental lactogen
Human chorionic gonadotropin (hCG)
Acts as a fail-safe, found in maternal blood and urine as early as the first missed menstrual period, shortly after implantation has occurred.
Progesterone
Necessary to maintain endometrial lining of uterus during pregnancy.
Estrogen
Contributes to mammary gland development in preparation for lactation, stimulates uterine growth to accommodate developing fetus.
Human placental lactogen
Promotes mammary gland growth in preparation for lactation for the mother. Serves important role of regulating maternal glucose, protein, and fat levels so adequate amounts of these are always available to the fetus
Nagele's Rule
to determine the estimated delivery date.
Nagele's Rule Education
Subtract 3 months, and add 7 days and if, necessary a year. For example: May 4. Convert May to 5. EDD is February 11. Add a year, subtract 3 months, and add 7 days to the origin of gestational age.
Functions of the Placenta
Grows from a few identifiable trophoblast cells at the beginning of pregnancy to an organ that covers about half the surface area of the internal uterus at term.
Placenta Education
Source of oxygen and nutrients for the fetus
Hormones of the Placenta
human chorionic gonadotropin (hCG), progesterone, estrogen, human placental lactogen
Human chorionic gonadotropin (hCG)
Acts as a fail-safe, found in maternal blood and urine as early as the first missed menstrual period, shortly after implantation has occurred.
Progesterone
Necessary to maintain endometrial lining of uterus during pregnancy.
Estrogen
Contributes to mammary gland development in preparation for lactation, stimulates uterine growth to accommodate developing fetus.
Human placental lactogen
Promotes mammary gland growth in preparation for lactation for the mother. Serves important role of regulating maternal glucose, protein, and fat levels so adequate amounts of these are always available to the fetus
Nagele's Rule
to determine the estimated delivery date.
Nagele's Rule Education
Subtract 3 months, and add 7 days and if, necessary a year. For example: May 4. Convert May to 5. EDD is February 11. Add a year, subtract 3 months, and add 7 days to the origin of gestational age.
Functions of the Placenta
Grows from a few identifiable trophoblast cells at the beginning of pregnancy to an organ that covers about half the surface area of the internal uterus at term.
Placenta Education
Source of oxygen and nutrients for the fetus
Hormones of the Placenta
human chorionic gonadotropin (hCG), progesterone, estrogen, human placental lactogen
Human chorionic gonadotropin (hCG)
Acts as a fail-safe, found in maternal blood and urine as early as the first missed menstrual period, shortly after implantation has occurred.
Progesterone
Necessary to maintain endometrial lining of uterus during pregnancy.
Estrogen
Contributes to mammary gland development in preparation for lactation, stimulates uterine growth to accommodate developing fetus.
Human placental lactogen
Promotes mammary gland growth in preparation for lactation for the mother. Serves important role of regulating maternal glucose, protein, and fat levels so adequate amounts of these are always available to the fetus
Hydramnios
More than 2,000 ml. Excessive amniotic fluid
Hydramnios Education
a. This is a GI problem with the baby. b. When baby is born, assess for esophageal atresia
Non-Stress Test
A tool to measure the response of the fetal heart rate to fetal movement. This is a noninvasive test. Done to assess fetal well-being.
Reactive Non-Stress Test
If the FHR accelerates at least 15 beats above baseline, for 15 seconds and occurs two or more times during a 20- minute period.
Amniocentesis
Aspiration of amniotic fluid from the pregnant uterus for examination.
Amniocentesis Education
a. Lecithin/sphingomyelin (L/S) ration: in surfactant, primary test of fetal lung maturity. L/S rations is 2:1. b. Empty bladder before procedure.
Signs of Pregnancy
probable, presumptive, positive. recognizing changes during pregnancy is helpful for both clients and nurses. The nurse and provider assess findings during the client's initial prenatal visit.
Presumptive Signs
changes that the client experiences that make them think that they might be pregnant. Amenorrhea, fatigue, nausea/vomiting, urinary frequency, breast changes, quickening, uterine enlargement.
Probably Signs
changes that make the examiner suspect a client is pregnant. Abdominal enlargement, Hegar's sign, Chadwick's sign, Goodell's sign, Ballottement, Positive pregnancy test, fetal outline felt by the examiner.
Positive Signs
those that can be explained by pregnancy. Fetal heart sounds, visualization of fetus by ultrasound, fetal movement palpated by the experienced examiner.
Reproductive System Changes
Reproductive changes are those involving the uterus, ovaries, vagina, and breasts.
Uterine changes
(the most obvious alteration in a woman's body during pregnancy is the increase in size of the uterus to accommodate the growing fetus
Hegar's sign
softening and compressibility of lower uterus
Chadwick's sign
deepened violet-bluish color of cervix and vaginal mucosa.
Goodell's sign
softening of cervical tip.
Couvade Syndrome
Many partners experience symptoms such as nausea, vomiting, and backache to the same degree or even more intensely than their partners during a pregnancy; some begin to gain weight along with their partner.
Integumentary Changes in Pregnancy
Women may have itching and scratches on palms of hands due to increased estrogen. Linea nigra, striae gravidarum adn diastasis recti. Linea nigra Dark line of pigmentation from the umbilicus extending to the pubic area.
Striae gravidarum
Stretch marks, most notably found on the abdomen and thighs.
Diastasis recti
Separation of the abdomen, muscle related, not integumentary.
Prenatal Care Education
Involves nursing assessments and client education for pregnant women Establish baseline of present health, determine gestational age of fetus, monitor fetal development and maternal well-being, identify women at risk for complications, minimize risk of possible complications by anticipating and preventing problems before they occur, and provide education about pregnancy, lactation, and newborn care.
Gynecoid
female, ideal for childbirth
Android
male, lower dimensions are extremely narrow
Anthropoid
ape-like, transverse diameter is narrow
Platypelloid
flattened, anteroposterior diameter is shallow
GTPAL
A more comprehensive system for classifying pregnancy status and provides greater detail on a woman's pregnancy history. G - pregnancies, T - term, P - preterm, A - abortions, L - living.
miscarriage
0-19 weeks
preterm
20-37 weeks
term
38-41 weeks
postdates
42 weeks
Estimating Pelvic Size
Internal pelvic measurements reveal the diameters of the inlet and outlet and can be obtained by pelvimetry.
Estimating Pelvic Size Education
a. Need to do a bimanual b. Diagonal conjugate - the measurement between the anterior surface of the sacral prominence and the posterior surface of the symphysis. c. Ischial tuberosity diameter - the distance between the ischial tuberosities.
Diet During Pregnancy
Adequate nutritional intake during pregnancy is essential to promoting fetal and maternal health
Diet During Pregnancy Education
a. Calories needs - the average recommended daily allowance of calories for women of childbearing age is 2,200. An additional 300 calories, or a total caloric intake of 2,500 calories, is recommended to meet the increased needs of pregnancy. b. Should gain 25-35 pounds.
Protein found in
meat, eggs, poultry, fish, yogurt, and milk
Calcium and phosphorus found in
milk, orange juice, nuts, legumes, dark green leafy vegetables.
Folic acid
(folate) found in leafy vegetable, dried peas and beans, seeds, orange juice. Prevents neural tube defects.
Iodine found in
seafood
Iron found in
red meat, fish, poultry, dried peas and beans, fortified cereals and breads. Take iron with orange juice. If a woman has a hemoglobin of 10.5, would you consider her to be anemic? Yes. Recommend red meat.
Zinc found in
meat, liver, eggs, seafood
Lactose Intolerance
The sugar in milk is called lactose. Some people, by school age, have difficulty digesting lactose and become lactose intolerant.
Lactose Intolerance Education
a. When people who are lactose intolerant drink milk, they experience nausea, diarrhea, cramps, gas, and a general feeling of bloating. b. Client should be asked if there is a history of kidney stones, because giving calcium can make kidney stones come back.
Hypercholesterolemia
Women with a family history of hypercholesterolemia, may enter pregnancy with already elevated cholesterol levels. During pregnancy, increasing progesterone levels, cause a further elevation. Combined with intrahepatic cholestasis, this an lead to an increased risk for gallstone formation.
Hypercholesterolemia Education
Helpful ways to reduce cholesterol, include: Eating oat cereal, broiling, grilling, or baking rather than frying and eating fish high in Omega-3.
Fetal Head Positions Overview
Fetal position is the relationship of the presenting part to a specific quadrant and side of a woman's pelvis. OA is ideal. OP is back labor. LOP, LOT, LOA, ROP, ROT, ROA.
Engagement
occurs when the presenting part, usually the biparietal (largest) diameter of the fetal head passes the pelvic inlet at the level of the ischial spines, referred to as station 0.
Station
the relationship of the presenting part of the fetus to the level of the ischial spines.
Fetal lie
relationship between the long axis of the fetal body to the long axis of the woman's body
Fetal presentation and position
The part of the fetus that is entering the pelvic inlet first; it can be the back of the head (occiput), chin (mentum), shoulder (scapula), or breech (sacrum or feet).
ROA
means the occiput of the fetal head points toward the mother's right anterior pelvis; the head is the presenting part. With full flexion is ideal and most conducive with labor.
Fetal lie
is the relationship between the long axis of the fetal body and the long axis of the mom.
If the fetus is in the LOA position
the fetal monitor would be below the umbilicus on the left side of mom's abdomen.
Phases of Labor Overview
Labor is traditionally divided into 4 stages
Stage 1
is 0 to 10 cms, Respect contraction time, change positions, support, pain management, amniotomy
Latent phase
0 to 3 cm - encourage rest and relaxation thru music
Active phase
4 to 7 cm
Transition phase
8 to 10 cm
Stage 2
extending from full dilation to birth of the baby. Preparing for birth, positioning for birth, pushing, perineal cleaning, episiotomy, birth, cutting and clamping cord.
Stage 3
from delivery of baby to delivery of placenta. Lengthening of the cord and gush of blood is a signal the placenta is ready to deliver. Oxytocin, placental delivery, perineal repair, assessment, immediate postpartum
Stage 4
recovery. Close monitoring of mom and baby
Types of Decelerations
Assessing and interpreting FHR patterns involves evaluating the baseline, rate, and periodic changes.
Types of Decel/Accel Education
a. Periodic acceleration is with a contraction. b. Non-periodic is an acceleration without a contraction
Variable Decel/Accel
Cause: cord compression, Intervention: move mom & amnioinfusion
Early Decel/Accel
Cause: head compression, Intervention: identify progress
Acceleration
Cause: ok, Intervention: nothing
Late Decel/Accel
Cause: uteroplacental insufficiency, Intervention: Execute, turn mom, vital signs, turn off pitocin, IV bolus, oxygen
Leopold's
A systemic method of observation and palpation to determine fetal presentation and position and are done as part of a physical assessment.
Leopold's Education
a. client needs empty bladder. Step 1: The top of the uterus (fundus) is felt (palpated) to establish which end of the fetus (fetal pole) is in the upper part of the uterus. If either the head or breech (buttocks) of the fetus are in the fundus, then the fetus is in vertical lie. Otherwise, the fetus is most likely in transverse lie. Step 2: Firm pressure is applied to the sides of the abdomen to establish the location of the spine and extremities (small parts). Step 3: Using the thumb and fingers of one hand the lower abdomen is grasped just above the pubic symphysis to establish if the presenting part is engaging. If not engaged, a movable body part will be felt. The presenting part is the part of the fetus that is felt to be in closest proximity to the birth canal. Step 4: Facing the maternal feet the tips of the fingers of each hand are used to apply deep pressure in the direction of the axis of the pelvic outlet.
Pain Management of Labor
Pain is a subjective and individual experience, and each client's response to the pain of labor is unique.
Nonpharmacological Methods for Pain Management during Labor
reflexology, sacral counterpressure, complementary, alternative, relaxation, Relaxation, focusing and imagery, prayer, breathing techniques, herbal preparations, aromatherapy and essential oils, heat and cold application, bathing or hydrotherapy, therapeutic touch and massage, yoga and meditation, reflexology, crystal or gemstone therapy, hypnosis, biofeedback, transcutaneous electrical nerve stimulation (TENS), intra-cutaneous nerve stimulation, acupuncture and acupressure)
Reflexology
is the practice of stimulating the hand, feet, and ears.
Effleurage
Light, gentle circular stroking of abdomen in rhythm with breathing during contractions.
Sacral counterpressure
Consistent pressure is applied by the support person using the heel of the hand or first against the client's sacral area to counteract pain in the lower back.
Complementary and alternative
Therapies for pain relief involve nonpharmacologic measures that may be used either as a woman's total pain management program or to complement pharmacologic interventions.
Non-pharmacologic pain management
Measures to reduce anxiety, fear, and tension.
Indication of effective treatment
decreased muscle tension in the arms and face
Epidural anesthesia
Contains a local anesthetic, bupivacaine, along with an analgesic, morphine, or fentanyl, injected into the epidural space at the level of the fourth or fifth vertebrae. NOTE: Epidurals are advantageous for women with heart disease, pulmonary disease, diabetes, and sometimes severe gestational hypertension. Preserves her physical energy. Priority is to give bolus fluids to prevent hypotension. Danger signs: Hypotension, prolonged second stage she can't push, so anesthesiologist may have to come reduce it. Delayed until cervix dilated 3-5cm. Not during latent phase.
If a woman becomes hypotensive
turn her to her left lateral position.
Pudendal Block
an anesthetic agent placed just inside the ligamentum flavum is called a pudendal block
Give O2 via mask
during labor, if a woman has numbness and tingling in her fingers, she is hyperventilating
Psychological Adaptation Overview
Maternal adjustment begin during pregnancy as the client goes through commitment, attachment, and preparation for the birth of the newborn.
Phases of Maternal Role Attainment
taking in, taking hold phase, and letting go phase
Taking in
The time when the new parents review their pregnancy and the labor and birth. Largely a time of reflection. Dependent phase. Relies on others for assistance. First 24-48 hours. Provide comfort, nutrition, hygiene, listen. Talk about reliving their experience over and over.
Taking hold phase
Focuses on material role and care of newborn. Eager to learn, may develop blues. This starts second to 10th day. Provide teaching, follow up appointments, community resources, assess emotional status. Learning more.
Letting go phase
Interdependent. Focus on family and individual roles. Learned everything that can pretty much do.
Bonding
When a woman has successfully linked with her newborn, it is termed bonding. Provide assistance and encouragement with rooming in.
Kegel Exercise
The most effective exercise consists of contracting and relaxing the muscles of the perineum 5 to 10 times in succession, as if trying to stop voiding.
Kegel Exercise Education
a. Reduces stress incontinence (leakage of urine). b. Try to stop and start when voiding.
Lochia
post-birth uterine discharge that contains blood, mucus, and uterine tissue.
Three Stages of Lochia
lochia rubra, lochia serosa, lochia alba
Lochia rubra
dark red color, bloody consistency, fleshy odor, can contain small clots, transient flow increases during breastfeeding and upon rising. Lasts 1 to 3 days after delivery
Lochia serosa
Pinkish brown color and serosanguineous consistency. Can contain small clots and leukocytes. Lasts day 4 to day 10 after delivery.
Lochia alba
Yellowish white creamy color, fleshy odor. Can consist of mucus and leukocytes. Lasts from day 10 up to 8 weeks postpartum.
Moderate lochia
is more than 10 cm. Excessive lochia is saturating a pad.
Notify the physician
if the patient has a firm uterus with a steady trickle of blood 2 hours after the delivery. Could be a missed laceration
Fundal Height
Determine the fundal height by placing fingers on the abdomen and measuring how many finger-breaths fit between the fundus and the umbilicus. Education: After delivery, the fundus should be even with the umbilicus.
Infant Heat Loss
The temperature of a newborn is about 99 degrees F (37.2 C) at birth because the baby has been confined in the mother's warm and supportive uterus, then it drops almost immediately. The majority of heat loss occurs, because of four separate mechanisms.
Convection
Is the flow of heat from the newborn's body surface to cooler surrounding air. Eliminating drafts, such as from air conditioners, is an important way to reduce convection heat loss.
Radiation
Is the transfer of body heat to a cooler solid object not in contact with the baby, such as a cold window or air conditioner.
Conduction
Is the transfer of body heat to a cooler solid object in contact with a baby. For example, a baby is placed on a cold base of a warming unit quickly loses heat to the colder metal surface.
Evaporation
A loss of heat through conversion of a liquid to a vapor. Babies are wet at birth, so they can lose a great deal of heat as the amniotic fluid on their skin evaporates.
When a baby has cold stress
they have an increased respiratory rate.
Infant Reflexes
Newborn reflexes can be tested with consistency by using a number of simple maneuvers. Moro, Babinski, Tonic neck
Moro
Elicit by allowing the head and trunk of the newborn in a semi-sitting position to fall backward to an angle of at least 30 degrees. The newborn will symmetrically extend and then abduct the arms at the elbows and fingers spread to form a "C".
Babinski
Elicit by stroking outer edge of sole of the foot, moving up toward toes. Toes will fan upward and out.
Tonic neck
With newborn in supine, neutral position, examiner turns newborn's head quickly to one side. The newborn's arm and leg on that side extend and opposing arm and leg flex.
Fontanel's & Head Assessment
A newborn's head usually appears disproportionately large because it is about one fourth of the total body length compared to an adult.
Fontanel's & Head Assessment Education
a. Fontanel should be soft and flat. Depressed fontanels may indicate dehydration. Bulging with increased intercranial pressure. b. Anterior fontanel closes at 12 to 18 months. Posterior fontanel closes at 8 weeks.
Cephalohematoma
collection of blood, between the periosteum and the skull bone that it covers. Does not cross a suture line. Happens from a vacuum delivery.
Caput succedaneum
localized swelling of the soft tissues of the scalp caused by pressure on the head during labor. May be palpated as a soft edematous mass and may cross over the suture line. Cone head.
Craniotabes
localized softening of cranial bones probably caused by pressure of the fetal skull against the mother's pelvic bone in utero.
Molding
the part of the infant's head that is engaged with the cervix (usually the vertex) molds (overlaps) to fit the cervix contours during labor.
Breastfeeding
Breastfeeding is the optimal source of nutrition for newborns. Breastfeeding is recommended for the first 6 months. Newborns should be breastfed every 2 to 3 hours.
Diabetes in Pregnancy
Gestational diabetes is an impaired tolerance to glucose with the first onset or recognition during pregnancy.
Insulin
needs will increase as the pregnancy progresses.
Signs of hypoglycemia
nervousness, headache, weakness, irritability, hunger, blurred vision.
Signs of hyperglycemia
polydipsia, polyphagia, polyuria, nausea, abdominal pain, flushed dry skin, fruity breath.
GDM Risk to baby
Hypoglycemia, macrosomia, electrolyte imbalance, birth trauma, spontaneous abortion, congenital anomalies.
GDM Risk to mom
Infections, hydramnios, ketoacidosis, hypoglycemia (caused by overdosing in insulin, skipped or late meals, or increased exercise), hyperglycemia (which can cause excessive fetal growth)
Heart Disease in Pregnancy
Cardiac disease can affect pregnancy in different ways depending on whether it involves the left or the right side of the heart.
Left sided heart failure
Occurs in conditions such as mitral stenosis, mitral insufficiency, and aortic coarctation.
Orthopnea
As pulmonary edema becomes severe, a woman cannot sleep in any position except with her chest and head elevated.
Paroxysmal nocturnal dyspnea
suddenly waling at night with shortness of breath.
Right sided heart failure
Occurs when the right ventricle is overwhelmed by the amount of blood received by the right atrium from the vena cava.
S/S of R sided HF
jugular venous distention, liver and spleen become over extended, distention of abdominal and lower extremity vessels can lead to ascites.
Fetal complication with maternal heart disease
low birth weight, late decelerations (placenta not working well)
Maternal complications of heart disease
cough, edema, possible cesarean birth. Mother should report dyspnea at rest to the provider.
Rhogam
Rh incompatibility occurs when an Rh-negative mother carries a fetus with an Rh-positive blood type. A commercial preparation of passive Rh antibodies against the Rh factor is administered.
Give Rhogam
anytime fetal and maternal blood could mix. Amniocentesis, miscarriage, delivery, ectopic pregnancy.
Indirect Coombs' test
A maternal blood test to see if she needs Rhogam
Mom gets Rhogam at
28 weeks and if her baby is Rh-positive, she gets another Rhogam within 72 hours of delivery.
Causes of Vaginal Bleeding
Spontaneous miscarriage occurs when a pregnancy ends as the result of natural causes before 20 weeks.
Chromosomal abnormalities
account for 50% for the most common reason for miscarriage.
Threatened
possible mild cramps, slight spotting, no tissue passed, cervix closed
Inevitable
mild to moderate cramps, moderate bleeding, no tissue passed, cervix usually dilated
Incomplete
severe cramps, heavy bleeding, tissue passed, dilated with tissue n cervical canal or passage of tissue.
Complete
mild cramps, minimal bleeding, tissue passed, cervix closed after tissue passed.
Missed
no cramps, no bleeding, no tissue passed, cervix closed
Placenta Previa
Occurs when the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus. The abnormal implantation results in bleeding during the third trimester of pregnancy as the cervix begins to dilate and efface.
Placenta Previa Risks
previous placenta previa, uterine scarring, maternal age greater than 35, multifetal gestation, smoking, closely spaced pregnancies.
Placenta Previa Assessment
Painless, uterus soft, fetus in a breech or oblique or transverse position, reassuring FHR.
Kleihauer-Betke test
used to detect fetal blood in maternal circulation
Placenta Previa Nursing care
no vaginal exam, IV fluids, assess fundal height, assess for bleeding and contractions. If mom has profuse bleeding, place in left lateral because this facilitates uteroplacental perfusion.
Abruptio Placentae
The premature separation of the placenta from the uterus, which can be a partial or complete detachment. The separation occurs after 20 weeks of gestation, which is usually in the third trimester. It has significant maternal and fetal morbidity and mortality and is the leading cause of maternal death.
Abruptio Placentae Risks
maternal hypertension, cocaine use, smoking, premature rupture of membranes, blunt trauma, and multifetal pregnancy.
Abruptio Placentae Assessment
sudden onset of intense localized uterine pain with dark red vaginal bleeding, contractions with hypertonicity, fetal distress, signs of hypovolemic shock, uterine tenderness can be localized or diffuse over uterus and board-like.
Abruptio Placentae Nursing Actions
palpate the uterus for tenderness and tone, perform serial monitoring of the fundal height, assess FHR pattern, IV fluids, blood products, continuous fetal monitoring, oxygen.
Terbutaline
A beta-adrenergic agonist that is used as a tocolytic that relaxes smooth muscles and inhibits uterine activity. Drug of choice when patient first comes in showing signs of preterm labor.
Terbutaline Education
•Assess for history of cardiac disease (this will cause tachycardia) •Assess for GDM (this will cause hyperglycemia) •Assess for preeclampsia (can cause hypotension) •Since this drug is a bronchodilator, assess lung sounds.
Apresoline (Hydrlazine)
Antihypertensive used to decrease hypertension. Education: •Assess for tachycardia
Methotrexate
Inhibits cell division and embryo enlargement, dissolving the pregnancy.
Methotrexate Education
•Can only be given if fallopian tube is not ruptured. •If Methotrexate is given, tell patient not to drink alcohol or take folic acid.
Betamethasone
A glucocorticoid that is administered in two injections 24 hours apart and requires 24 hours to be effective.
Betamethasone Education
•Monitor for maternal hyperglycemia. This medication will affect her blood sugar. •Report findings of pulmonary edema.
Hydatiform Mole (gestational trophoblastic disease)
Proliferation and degeneration of trophoblastic villi in the placenta that becomes swollen, fluid-filled, and takes on the appearance of grape-like clusters. The embryo fails to develop beyond a primitive state.
Hydatiform Mole (gestational trophoblastic disease) Education
a. The complete mole contains no fetus, placenta, amniotic membranes, or fluid. b. Risk factors - prior molar pregnancy and clients in early teenage years or older than age 40.
Hydatiform Mole (gestational trophoblastic disease) Assessment
•Excessive vomiting •Larger than expected uterine growth •Symptoms of hypertension •risk for choriocarcinoma •diagnosed by ultrasound, "snowstorm" appearance •Suction curettage is done to aspirate and evacuate the mole.
Rupture of Membranes
Rupture of fetal membranes with a loss of amniotic fluid.
Rupture of Membranes Education
a. After water breaks, immediately monitor fetal heart rate. b. Check for umbilical cord prolapse c. Mother can become infected after 24 hours of ruptured membranes
Hypovolemia
Occurs in 10% of blood volume or 2 units of blood have been lost.
Hypovolemia Education
•Increased pulse rate •Decreased blood pressure •Increased respiratory rate •Cold, clammy skin •Decreased urine output •Dizziness
Hypovolemia Nursing Actions
•Place woman flat in bed on side •Start IV fluids with a 16 or 18 angiocath •No vaginal exams •Withhold oral fluid
Preeclampsia
A disease in pregnancy that is divided into clinical subsets of the disease based on end-organ effects and progresses along a continuum from mild gestational hypertension, mild and severe preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzymes, low platelets)
Preeclampsia Assessment
•Severe continuous headache (possible maternal hemorrhage) •Nausea •Blurring of vision •Epigastric pain (liver)
Antihypertensive medications
Methyldopa, nifedipine, Hydralazine Labetalol
Anticonvulsant
Magnesium Sulfate
magnesium sulfate toxicity
look for decreased DTR's, Respirations less than 12/min, decreased urine output, decreased level of consciousness. Antidote: calcium gluconate.
Ectopic Pregnancy
An abnormal implantation of a fertilized ovum outside of the uterine cavity usually in the fallopian tube.
Ectopic Pregnancy Assessment
Any factor that compromises tubal patency (STI's), assisted reproductive technologies, tubal surgery, and contraceptive intrauterine device (IUD), and pelvic inflammatory disease (PID).
Ectopic Pregnancy Expected Findings
Unilateral stabbing pain and tenderness in a lower abdominal quadrant. Referred shoulder pain due to blood in the peritoneal cavity irritating the diaphragm or phrenic nerve after tubal rupture.
Ectopic Pregnancy Therapeutic Procedures
Give Methotrexate - if taking methotrexate, avoid vitamins containing folic acid to prevent a toxic response to the medication.
Induction of Labor
When labor contractions are ineffective, several interventions, such as induction and augmentation of labor can occur.
Who can be induced
woman with preeclampsia
Who cannot be induced
active herpes, baby with face presentation, fetal monitor showing late decelerations.
Before induction
fetus is in a longitudinal lie, cervix is ripe, fetus is vertex and the presenting part is engaged, there is no CPD, the fetus is 39 weeks gestation.
Cervical ripening
•Bishop score of 8 or higher - A bishop score is an indicator for the client's readiness for labor. •Prostaglandin gel, Cytotec, Cervidil, for example
Induction of labor by Oxytocin
•Cervix must be ripe •Monitor for hyperstimulation
How would the nurse know if prostaglandin is working
by the softening of the cervix and beginning of effacement.
Bishop Score
Used to determine maternal readiness for labor by evaluating whether the cervix Is favorable by rating the following: a. Cervical dilation b. Cervical effacement c. Cervical consistency (firm, medium, soft) d. Cervical position (posterior, mid-position, or anterior) e. Station of presenting part.
Shoulder Dystocia
The problem occurs in the second stage of labor, when the fetal head is born but the shoulders are too broad to enter and be born through the pelvic outlet.
Shoulder Dystocia Education
a. Asking or assisting the woman to flex her thighs sharply on her abdomen (McRobert's manuever) widens the pelvic outlet and mat allow the anterior shoulder to be born. b. The nurse's job is to give suprapubic pressure.
Umbilical Cord Prolapse
A prolapsed umbilical cord occurs when the umbilical cord is displaced, preceding the presenting part of the fetus, or protruding through the cervix. This results in cord compression and, compromised fetal circulation.
Umbilical Cord Prolapse Risk Factors
rupture of amniotic membranes, abnormal fetal presentation, small-for-gestational age, hydramnios or polyhydramnios, placenta previa.
Umbilical Cord Prolapse Nursing Action
push presenting part off cord, give mom 02 via mask, put mom in knee/chest position, call for help.
Forceps Delivery
Consists of using an instrument with two curved spoon-like blades to assist in the delivery of the fetal head. Traction is applied during contractions. This is considered an operative delivery
Forceps Delivery Indications
prolonged second stage of labor, fetal distress, abnormal presentation, and arrest of rotation.
Forceps Delivery Complications
lacerations of the cervix, lacerations of the vagina and perineum, injury to bladder, facial nerve palsy of the neonate, facial bruising on the neonate, and subdural hematoma in the neonate.
Forceps Delivery Nursing Considerations
make sure bladder is empty, water should be broken, and fetus engaged.
Vacuum Delivery
Involves the use of a cuplike suction device that is attached to the fetal head. Traction is applied during contractions to assist in the descent and birth of the head. This is considered an operative delivery
Vacuum Delivery Conditions for Use
vertex presentation, cervical dilation of 10 cm, absence of CPD, ruptured membranes.
Vacuum Delivery Associated Risks
scalp lacerations, subdural hematoma of the neonate, cephalohematoma, and maternal lacerations to the cervix, vagina, or perineum.
Vacuum Delivery Indications
maternal exhaustion, ineffective pushing efforts, fetal distress during the second stage of labor, not used before 34 weeks gestation.
Precipitous Delivery
is defined as labor that lasts 3 hours or less from the onset of contractions to the time of delivery.
Precipitous Delivery Risk Factors
hypertonic uterine dysfunction, oxytocin stimulation, multiparous client.
Maternal Complications of Precipitous Labor
cervical, vaginal, or perineal lacerations, uterine rupture, postpartum hemorrhage, amniotic fluid embolism, and uterine atony.
Fetal Complications of Precipitous Labor
fetal hypoxia due to hypertonic contractions or umbilical cord around fetal neck, fetal intracranial hemorrhage due to head trauma from rapid birth.
Depression
Occurs within 6 months of delivery and is characterized by persistent feelings of sadness and intense mood swings. It occurs in 10% to 15% of new parents and usually does not resolve without intervention.
Depression Assessment
feelings of guilt and inadequacies, irritability, anxiety, fatigue, feeling of loss, lack of appetite, persistent feelings of sadness, sleep pattern disturbances.
Subinvolution
When the uterus remains enlarged with continued lochial discharge and can result in postpartum hemorrhage.
Subinvolution Risk Factors
pelvic infection and endometritis, retained placental fragments not completely expelled from the uterus.
Subinvolution Expected Findings
Prolonged vaginal bleeding, irregular or excessive vaginal bleeding.
Subinvolution Therapeutic Procedures
Dilation and curettage (D&C) is performed to remove retained placental fragments or to debride placenta insertion site, if indicated. If Methergine has been given and still no results, D&C.
Pelvic Thrombophlebitis
Involves the ovarian, uterine, or hypogastric veins. It usually follows a mild endometritis and occurs around day 14 or 15 of the puerperium.
Pelvic Thrombophlebitis Assessment
a woman suddenly becomes extremely ill with a high fever, chills, abdominal pain, weakness, and general malaise.
Pelvic Thrombophlebitis Therapeutic Management
Involves total bed rest and the administration of analgesic, antibiotics, and anticoagulants
Pelvic Thrombophlebitis Nursing Action
measure the leg circumference
Mastitis
Infection of the breast may occur as early as the seventh postpartal day or until the baby is weeks or months old.
Mastitis Etiology
a. Milk stasis which can be caused by a blocked duct, engorgement, or a bra with an underwire. b. Poor breastfeeding technique with improper latching of the infant onto the breast, which can lead to sore and cracked nipples. c. Nipple trauma and cracked or fissured nipples. d. Decrease in breastfeeding frequency due to supplementation with bottle feeding. e. Contamination of breasts due to poor hygiene.
Mastitis Expected Findings
•Painful or tender localized hard mass and reddened area, usually on one breast. •Chills, fever, headache, body ache. •Fatigue
Mastitis Nursing Care
administer antibiotics, allow nipple to air dry, encourage mom to continue breastfeeding frequently, encourage rest, taking analgesics, and maintain fluid intake.
Postpartum Hemorrhage
Is considered to occur if the client loses more than 500 mL blood after a vaginal birth or more than 1,000 mL after a cesarean birth. Two complications that can occur following postpartum hemorrhage include hypovolemic shock and anemia. Hemorrhage may occur either early (within the first 24 hours following birth) or late (24 hours to 6 weeks after giving birth).
Postpartum Hemorrhage Education
The four main reasons for postpartum hemorrhage are referred to the 4 "T"s. Tone - uterine atony. Tissue - retained placental fragments. Trauma - lacerations. Thrombin - perineal hematomas.
Labial Hematoma
A perineal hematoma is a collection of blood in the subcutaneous layer of tissue of the perineum
Labial Hematoma Education
It appears as an area of purplish discoloration with obvious swelling
Labial Hematoma Therapeutic Measures
a. Pu l cold pack on perineum b. Provider will do a surgical incision for evacuation of the clotted blood from the hematoma.
Uterine Atony
Results for the inability of the uterine muscle to contract adequately after birth. This can lead to postpartum hemorrhage.
Uterine Atony Education
Urine retention, retained placental fragments, prolonged or precipitous labor, magnesium sulfate, anesthesia and analgesia administration, trauma during labor and birth from an operative delivery.
Deep Vein Thrombosis (DVT)
Thrombophlebitis refers to a thrombus that is associated with inflammation. Thrombophlebitis of the lower extremities can be of superficial or deep veins, which are most often of the femoral, saphenous, or popliteal veins. The postpartum client is at greatest risk for a DVT that can lead to a pulmonary embolism
Deep Vein Thrombosis (DVT) Education
a. Maintain sequential compression device until ambulation established. b. Initiate early and frequent ambulation postpartum
Surfactant
Is a phospholipid that assists in alveoli expansion. Surfactant keeps alveoli from collapsing and allows gas exchange to occur.
Surfactant Education
Helps tiny sacs to open and this improves breathing.
Condition of Preterm Infants
Acute bilirubin encephalopathy is the destruction of brain cells by invasion of indirect or unconjugated bilirubin.
Condition of Preterm Infants Education
a. This invasion results from the high concentration of indirect bilirubin that forms in the bloodstream from an excessive breakdown of red blood cells at birth. b. At the point that indirect bilirubin levels rise and jaundice occurs, phototherapy or exchange transfusion can be initiated.
Small-for-Gestational Age (SGA)
describes a newborn whose birth weight is at or below the 10th percentile and who has intrauterine growth restriction.
Large-for-Gestational Age (LGA)
occurs in neonates who weigh above the 90th percentile or more than 4,000 grams
Infant Size Education
a. Both SGA and LGA have expected findings of hypoglycemia, meconium aspiration, respiratory distress b. What neither SGA or LGA have is intraventricular hemorrhage
SIDS (Sudden-Infant-Death-Syndrome)
Is a sudden unexplained death in infancy. It tends to occur at a higher than usual rate in infants of adolescent mothers, infants of closely spaced pregnancies, and underweight and preterm infants.
SIDS (Sudden-Infant-Death-Syndrome) Education
a. Although the cause is unknown, in addition to prolonged but unexplained apnea, other possible contributing factors include •Sleeping prone rather than supine •Viral respiratory or botulism infection •Exposure to secondary smoke •Pulmonary edema •Possible lack of surfactant in alveoli
Phototherapy
A fetus's liver prosses little bilirubin in utero because the mother's circulation does this for the fetus. With birth, exposure to light is believed to trigger the liver to assume this function.
Phototherapy Education
a. Maintain an eye mask over the newborn's eye's b. Feed the newborn early and frequently, every 3 to 4 hours. This will promote bilirubin excretion in the stools. c. Maintain adequate fluid intake to prevent dehydration. d. Keep diaper on.
Respiratory Distress Syndrome
Occurs as a result of surfactant deficiency in the lungs and is characterized by poor gas exchange and ventilatory failure.
Respiratory Distress Syndrome Risk Factors
preterm gestation, maternal diabetes mellitus, premature rupture of membranes, hypovolemia, cesarean birth without labor, maternal hypertension, and maternal use of barbiturates or narcotics
Respiratory Distress Syndrome Nursing Care
maintain thermal environment, maintain adequate oxygenation, and decrease stimuli.
Respiratory Distress Syndrome Diagnosis & Treatment
chest x-ray & lung surfactant
Colostrum
Secreted from the mother's breasts during postpartum days 1-3. It contains the IgA immunoglobulin that provides passive immunity to the newborn. It is a thin, watery, yellow fluid composed of protein, sugar, fat, water, minerals, vitamins, and maternal antibodies, which is secreted by the acing breast cells starting in the 4th month of pregnancy.
True/mature breast milk
Produced by the 10th day.
Breastfeeding Advantages for the mother
Release of oxytocin aids in uterine involution, may serve a protective function in preventing breast cancer and possibly ovarian cancer, may return to pre-pregnant weight sooner, reduces cost of feeding and preparation time for feeding, excellent opportunity to enhance a true bond between mom and baby, long term effect may include decreased risk of hip fractures and osteoporosis in the post-menopausal period for women.
Breastfeeding Advantages for the infant
Lactoferrin is an iron-binding protein that interferes with the growth of pathogenic bacteria, lysozyme actively destroys bacteria by dissolving their cell membranes, possibly increasing the effectiveness of antibodies, interferon helps to interfere with virus growth, ideal electrolyte and mineral composition for human infant growth, high in lactose that provides ready glucose for rapid brain growth, more linoleic acid for skin integrity.
Breastfeeding exclusively for 6 months
can reduce risk of obesity later in life, maternal benefits include decreased risk of breast and ovarian cancer, once established, pacifier can help decrease risk of SIDS.
Treatment for breast engorgement
Cabbage leaves
Breastfeeding Education
a. oxytocin hormone responsible. b. Will provide immunity as well as nutrients for her newborn. c. Mom should lean forward to bring her breast toward the baby d. Teach the mom to slide a finger into the baby's mouth to break suction before removing from the breast.
Lactoferrin
Iron binding protein in breast milk that interferes with the growth of pathogenic bacteria
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