Maternal Newborn Final
APGAR scoring
A= appearance, P= pulses, G= grimace, A= activity, R= reflexes (Done at 1 and 5min with a score of 0 for absent, 1 for decreased, and 2 for strongly positive)
Spinal blocks are primarily used for
C-sections
Diagnostic testing for sepsis
CBC with differential C-reactive protein Cultures Chest x-ray
Name some indications for cesarean birth
CPD placenta abruptio umbilical cord prolaps breech genital herpes failure to progress fetal distress dytocia maternal hypertension vertical uterine incision
Essential Minerals for Newborns
Calcium >> skeleton is growing rapidly Iron >> mom may need supplements / iron formula Fluoride >> essential for teeth
Treatment for Transient Tachypnea of the Newborn (TTN)
Oxygen administration Mild Glucosteroid to minimize inflammation NOTE: Typically by 72 hours of life this spontaneously fades as the lungs absorb the lung fluid and respiratory activity becomes effective!
Treatment when mom is actively bleeding
Oxygen by mask IV fluid with 18 gauge Monitor IV sites, gums, etc for DIC Prepare for cesarean delivery
What are the classic signs of mild preeclampsia
PRE: proteinuria rising BP edema
What labs are we watching if mom has a DVT?
PTT -we want it maintained at a therapeutic level of 1.5-2.5
Human Placental Lactogen
Structure and function are similar to growth hormone. It modifies the metabolic state of the mother during pregnancy to facilitate the energy supply of the fetus. Has anti-insulin properties.
What can cause late postpartum hemorrhage?
Subinvolution of the uterus Retained placental fragments Infection
Ballottement
a sharp upward pushing against the uterine wall with a finger inserted into the vagina for diagnosing pregnancy by feeling the return impact of the displaced fetus
What is an episiotomy? Why do we do it?
a surgical incision of the perineal body -to prevent damage to the periurethra area, and to prevent laceration or tears
umbilical cord
a tube containing the blood vessels connecting the fetus and placenta
Boggy uterus
a uterus that feels soft and spongy, rather than firm and well contracted.
nullipara
a woman who has had no births at more than 20 weeks gestation
primipara
a woman who has had one birth at more than 20 weeks, regardless is baby was born dead or alive
multipara
a woman who has had two or more births at more than 20 weeks gestation
nulligravida
a woman who has never been pregnant
primigravida
a woman who is pregnant for the first time
Alfuzosin
a1 antagonist used for BPH only
Tamsulosin
a1a selective blocker used only for BPH
BUBBLEHE; bowels
abdomen should be soft with no distention. Normal bowel sounds in all quadrants Should be passing flatus, BM's occurring without difficulty. *women with 3rd or 4th degree lacerations need stool softners
Diastasic recti hernia
abdominal muscles separate; can see ridge when patient raises head. Can occur when decrease in and muscle tone, result of pregnancy, or marked obesity
Complications during labor if multiple gestation?
abnormal fetal presentation, uterine dysfunction, prolapsed cord and hemorrhage
lordosis
abnormal increase in the forward curvature of the lumbar spine
What are some causes of infertility in men?
abnormalities of sperm obstructed genital tract ejaculation issues
How long can we leave an infact in a car seat/ swing?
about 2 hours! You need to get them out and walk around. DO NOT let their head lag in a car seat! Can block airway
When is the placenta expected to expell
about 5 minutes after birth of baby
How fast does mom get back to prepregnany weight
about 6-8 weeks. Recommended loss of 1-2 pounds a week!
amenorrhea
absence of menstruation
How do you do a semen analysis
abstain from sex for 2-3 days and then get a sample of semen
What is a nonreactive reaction to a NST?
accelerations are not present or do not meet the criteria, this means they are at risk or asleep
Oral estradiol/norethindrone
activella
Hyperbilirubinemia may lead to
acute bilirubin encephalopathy-which may lead to kernicterus
Naegele's Rule
add 7 days to first day of LMP, subtract 3 months, and add 1 year
Teratogens
agents, such as chemicals and viruses, that can reach the embryo or fetus during prenatal development and cause harm
How do we score the variables of a biophysical profile?
all normals are given a 2, abnormals are given a 0
Progestin only contraception
all progesterone receptor-binding compounds. available in only the 28 day pack * must be taken within the same 3 hour window each day
What test determines fetal lung maturity
amniocentesis
Why might a baby have hearing loss?
amniotic fluid in ear
What is an amniocentesis?
amniotic fluid is obtained for testing of fetal abnormalities -or to determine fetal lung maturity in 3rd trimester
Mcdonald sign
an ease in flexing the body of the uterus against the cervix
Oxandrolone
anabolic androgen that promotes weight gain where protein breakdown is part of the underlying condition
Oxymethalone
anabolic androgen used for anemias from deficient RBC production
How do we manage superficial venous thrombosis?
analgesics rest support hose elevation of extremity heat
human placental lactogen (hPL)
antagonist of insulin. It increases the amount of circulating fatty acids for maternal metabolic needs and decreases maternal metabolism of glucose to favor fetal growth
Pelvic outlet; 2 measurements
anteroposterior diameter: 9.5-11.5 cm transverse diameter: 8-10 cm
Babies have acquired passive immunity from mother from
antibodies that have crossed the placental barrier
What medication are we doing for a woman with HIV?
antiretroviral therapy -HAART and ZDV (Retrovir, zidovudine)
Women at risk for PTSD
anxious or afraid of child birth poor coping abilities prior psychiatric history
gravida
any pregnancy
What does APGAR stand for?
appearance, pulse, grimace, activity, respiration
isthmus uterus
area of the uterus between the corpus and the cervix
Mongolian spots
areas of deep bluish-gray pigmentation most commonly on the sacral aspect of a newborn (hereditary)
What is an amniotomy
artificial rupture of membranes
Risk factors for placenta previa
asian women previous c-section lots of pregnancies older moms previous miscarriage smoking male fetus
Body conditioning exercises
pelvic tilt, pelvic rock, kegel exercises
What may happen to a moms back?
physiologic lordosis, compensation for the large uterus
erythema toxicum
pink rash that appears suddenly anywhere on the body of a term newborn during the first 3 weeks.
Describe serosa lochia..when does it occur?
pinkish brown, occurs 4-10 days post partum. Usually no blood clots.
An obstetrical client is to receive oxytocin (Pitocin). The nurse knows that the use of oxytocin for induction of labor is contraindicated in
positive contraction stress test at 38 weeks of gestation.
Effects of marijuana on baby
possible impaired neurodevelopment in children exposed in utero, they may also use someday. They have similar risks to tobacco smoking.
How do we set up a critical congenital heart disease screening?
pre-ductal pulse ox on RW post-ductal pulse ox on either foot
-gravida
pregnant woman
Modified Bishop scoring system
prelabor status evaluation scoring system
Vaginal conjugated equine estrogens brand and dosing
premarin (cream) -- once daily
Circumcision should not be performed on..
premature or compromised newborns with bleeding disorders or GI defects like hypospadius
Two prostaglandin agents that help with cervical ripening
prepidil cervadil: vaginal insert
Gomco circumcision
prepuce is drawn over cone and clamp applied, held on there for 3-4 minutes and then excess prepuce is cut away -GAUZE AND PETROLEUM USED
Counter pressure
pressure to the sacral area of the back during uterine contractions
RDS is most common in
preterm babies, specifically those less than 28 weeks gestation
Newborn assessment; male genitals
preterm newborn testes are not in the scrotum and little rugae is seen. Full term the newborns testes are generally fully descended and the entire surfaceof the scrotum is covered in rugae.
Newborn assessment; skin
preterm newborns appear thin and transparent, you can see their veins easily on their abdomen. As the newborn approaches full term the babies skin should appear opaque bc of subcu fat. If there is little vernix the baby is probably post term.
What is PPROM
preterm premature rupture of membrane -before 37 weeks
How do we treat iron deficiency anemia?
prevent it! Look at iron supplements, taken in addition to prenatal vitamins.
Management of SGA
prevention with good prenatal care -NST's -we want them to keep coming in so we can check on baby
preeclampsia risk factors
primigravida, african american, family history, chronic hypertension, renal disease, overweight, diabetic, multi-fetal pregnancy
Estrogen
produced primarily by the placenta as early as the 7th week, it stimulates uterine development to provide a suitable environment for the fetus. It also helps develop the ductal system of the breasts!
Gametogenesis
production of gametes, produced by meiosis
Progesterone gel
progesterone product used for infertile women with progesterone deficiency and secondary amenorrhea
Megestrola acetate
progestin product used as an appetite stimulant and can also help treat metastatic breast cancer
Micronized progesterone
progestin product used for prevention of endometrial hyperplasia in non-hysterectomized postmenopausal women who are receiving conjugated estrogen tablets
Medroxyprogesterone acetate
progestin product used for secondary amenorrhea and abnormal uterine bleeding, also prevents endometrial hyperplasia in non-hysterectomized post menopausal women receiving conjugated estrogen tablets
Norethindrone acetate
progestin product used for secondary amenorrhea, endometriosis, and abnormal uterine bleeding
relaxation techniques
progressive neuromuscular dissociation relaxation against pain
Name some factors that can slow involution? (9)
prolonged labor anesthesia difficult labor grand multiparity full bladder incomplete expulsion of placenta infection overdistention of uterus
Lactose free formula should only be used if
proven lactose allergy
Describe exchange transfusion
providers take out small amounts of blood at a time and replace it with fresh donor blood, at the end they will have replaced all the blood. This prevents *kanicterus*
What are the advantages of NST?
quick, inexpensive, easy to interpret, outpatient, no known side effects
Podalic version
reaching inside of mom and physically rotating baby from breech to cephalic presentation
BUBBLEHE; hemorrhoids
rectum should be intact, hemorrhoids may be present by are small and nontender *teach them about topical agents *try manual replacement, increase fluids and fiber *encourage sitz bath and side-lying position *HOMANS SIGN
Episiotomy healing evaluation: REEDA
redness, edema, ecchymosis, drainage, approximation (how well the edges are repaired)
Extended cycle estrogen/progestin considerations
reduced number of menstrual cycles/year Less premenstrual symptoms Less dysmenorrhea (menstrual cramps)
True labor signs
regular contractions that increase discomfort in back radiating to front contractions intensify with activity cervix is becoming effaced and dilated
what is the fetal attitude
relationship of the fetal parts to one another- we want them to be flexed
stationing
relationship of the presenting part of the fetus compared to these imaginary lines drawn between the ischial spines of pelvis....ones the babys head is in the positive numbers, its coming out!
Centering Pregnancy
relationship-centered program which provides complete prenatal care in a group setting
Contraceptive patch
releases hormones through skin into bloodstream. apply a new one once a week for 3 weeks. don't use one on the 4th week
Hormonal IUD
releases progestin in the uterus and remains in place for 3-5 years
In the first 24 hours of life we have to be looking for signs of distress. What are these signs?
respiratory changes, color changes, abdominal distention, vomiting bile, no meconium in 48 hours, no urine in 24 hours, temp instability, jitteriness, signs of lethargy, weigh changes greater than 10% loss from birth weight
Closure of the ductus venosus
results from the pressure change of cutting the cord
Asphyxia causes what kind of biochemical changes?
results in pulmonary constriction -hypoxemia -metabolic acidosis -hypercarbia
The nurse recognizes that a hazard of oxygen therapy for a preterm newborn would be
retinopathy.
Two different types of episiotomies
right mediolateral: more painful midline: right down the middle
What is cytotec?
ripens the cervix before labor (most common)
fundus
rounded upper portion of the uterus
Name the three types of lochia
rubra serosa alba
Cutaneous stimulation is a form of pain management, what is it?
self massaging massage by spouse counter pressure thermal stimulation acupressure
Ballotment Test
sensation of an object rebounding after being pushed by the examiners hand...we are seeing if the baby is engaged
What is diastais recti?
separation of the abdominal muscles
The baby scored a 0-3 on the apgar test
severely depressed
fetal stage; 16 weeks
sex determined by ultrasound
What are some complimentary methods to induce birth?
sex! nipple stimulation use of herbs castor oil or enemas acupuncture mechanical dilation of the cervix (balloon) 37 % of women will use these
If mom scored a 8+ on the bishop scoring system
she can probably have a vaginal delivery!
Binds in means
she is accepting she's pregnant in the 1st trimester
if the mom has a marginal or low lying placenta previa..
she may can try labor
What needs to happen if mom has HELLP?
she must deliver ASAP, regardless of gestational age
How much fish should a pregnant women eat? What should she not eat?
should eat 8-12 oz of fish low in mercury -NO swordfish, shark, tilefish, or king mackerel
Soy milk
should not be used on preterm babies or babies in renal failure
when the baby is in a transverse lie
shoulder presentation....laying in the womb horizontally
First period of reactivity
show pattern of behavior within first few hours of life. They are alert and watching for about 15-30 min of first life. They respond to stimulation.
3rd generation progestin
similar potency as 2nd generation with fewer androgenic and metabolic effects
What does the bili light do for the baby?
skin absorbs fluorescent lights and changes bilirubin to water soluble products, which can be excreted in bile and urine
What does moms blood pressure look like after labor?
slight rise in BP right after delivery. Should return to normal within a few days.
What does moms pulse look like after labor?
slow for 6-10 days after birth. Due to increased cardiac effort, blood volume, and increased stroke volume.
uterine souffle
soft blowing sound, at the same rate of maternal pulse. This is moms blood in the placenta
Goodell's sign
softening of the cervix
Goodell's sign
softening of the cervix..so it can stretch
Hagar's sign
softening of the lower uterine segment
Why do we delay cord clamping now?
some of the blood from the placenta passes to the newborn and increases the newborns blood volume and improves the blood flow to newborns organs
First/same day start (progestin)
start the progestin only on the first day of period and no need to use backup
What does prolactin do?
stimulates milk production -NIGHT SWEATS
Striae
stretch marks
Genomics
study of whole genomes, including genes and their functions
S/S of neonatal sepsis
subtle changed will occur -fatigue -dusky coloring -temp changes (hypothermia) -feeding difficulties -tachycardia
fetal stage; 28 weeks
surfactant needed for respiratory functions
Vasectomy
surgical cut and close off two vas deferens
Episiotomy
surgical incision of the perineum to enlarge the vagina and so facilitate delivery during childbirth
What are the maternal risks if she has iron deficiency anemia?
susceptible to infections fatigue risk for PIH (pregnancy induced htn) postpartum hemorrhage
S/S of a DVT
swelling of the leg erythema heat tenderness over area temp and chills
S/S of RDS
tachypnea nasal flaring retractions cyanosis grunting on expiration rales or rhonchi
Estrogen/progestin missed 1 dose - counseling
take ASAP (may have to have 2 tabs in one day) continue the rest of the pack on schedule no back up needed **varies with diff brands**
Quick start
take the first tablet as soon as possible regardless of cycle day. use alternative method of contraception for 7 days less confusion
Thermal factors of a newborn
taking them from warm belly to room temp will chill them
natal teeth
teeth present at birth (NOT NORMAL NOTIFY PROVIDER) Aspiration risk!!!!!
S/S of puerperal infection?
temp of 100.4 or greater after the first 24 hours after delivery, on at least two of the first 10 days after birth
TPAL
term (37 weeks and beyond) preterm (born 20 weeks to 36 6/7) abortion (born before 20 weeks) Living children
Dystocia
term for difficult labor or birth
What is the nuchal translucency testing? (NTT)
test this from 11-13 weeks gestation. -nuchal fold test -screens for aneuplodies such as trisomy 13, 18, 21
What is a Spinnbarkeit test
testing the elasticity of cervical mucus, if its too think then the sperm may not can get through
If mom is having eclampsia seizures, where does she go?
the ICU
What are some changes that happen to the cervix and vagina after birth?
the cervix may be soft and spongy, if she had a vaginal delivery her cervix may be bruised. Her vagina may be swollen and bruised.
We facilitate cervical ripening when
the cervix needs to be softened and effaced for L&D
fetus
the developing human organism from 9 weeks after conception to birth
embryo
the developing human organism from about 2 weeks after fertilization through the second month
Hyperbilirubinemia may be seen in
the first 24 hours of life
First voiding should occur in
the first 24-48 hours of life. Most will have it in the 24
Quickening
the first movement of the fetus in the uterus that can be felt by the mother
Infertility
the inability to conceive a child
Protein in the breast milk depends on
the infants needs and ability to metabolize
what is labor like with breech or shoulder presentaiton?
the labor is longer because of ineffective dilation, the head provides the right amount of pressure at the cervix. The butt/feet/shoulders do not
conception
the moment at which a female becomes pregnant
eclampsia? when does it occur?
the occurence of seizure in a women who has signs of preeclampsia. She may have one, or many. -before labor, during labor, or early pospartum
What happens when the lower uterine segment begins to dilate in the later weeks of pregnancy, and she has placenta previa?
the placenta vili are torn from the uterine wall and bleeding begins, may be scant or profuse. *bright red blood with no pain*
abruptio placentae
the premature separation of a normally implanted uterus from the uterine wall
Oogenesis
the production, growth, and maturation of an egg, or ovum
Medication action in the body depends on..
the rate at which the substance is metabolized by liver enzymes and excreted by kidneys
decidua
the thick layer of modified mucous membrane that lines the uterus during pregnancy and is shed with the afterbirth.
Estrogen therapy
therapy in menopause that relieves GU atrophy, reduces pain with intercourse, relieves vasomotor instability and decreases hot flashes
IgA does not cross the placenta but..
there are high levels in colostrum -produced 4 weeks after birth -protects eyes, lungs, GI
Why is caffeine a teratogen?
theres really no current risk..but we should tell women to limit caffeine intake to 1 cup a day!
How do systemic pain medication work?
they cross the placental barrier by simple diffusion, some cross more readily than others
Things to know about adolescent mom diets
they don't eat a lot of calcium, need to encourage. They may need iron supplements. Encourage a regular timed diet, not sporadic! *diet recall* 72 hours
What is "Centering Pregnancy"
they provide prenatal assessment and education groups for women, it provides a support system!
What can we expect for bowel sounds after labor?
they will be sluggish..due to lingering effects of progesterone
Asymmetric IUGR babies will look like?
thier head will be proportionally larger than thier body
What are some characteristics of a newborn that lead to heat loss?
thin skin blood vessels close to surface little SC fat
How do we make sure choriocarcinoma is not present?
this has to be ruled out!! -she is going to be advised to be on birth control for 6 months until her HCG levels return back to normal. IF they return to normal she can try to get pregnant again.
What is Cell-Free Fetal DNA testing?
this is a screening tool used to test for trisomy 13, 18 , 21
Peripartum major mood episodes
this is also called postpartum depression, it is clinical depression
Glycosuria
this is glucose in the urine. It's normal during pregnancy because the kidneys may not be able to absorb all the sugar at this time--->further testing
What is Maternal Role Attainment? (MRA)
this is when a woman is learning mothering behaviors and becomes comfortable with the idea of being a mom
marked variability in FHR
this means the FHR fluctuates 25 bpm from peak to trough
Moderate variability in FHR
this means the FHR fluctuates 6-25 bpm from peak to trough
postpartum
time from birth until women's body returns to an essentially pre pregnant condition
intrapartum
time from onset of true labor to birth of baby and placenta
how and why do you assess skin turgor on a newborn
to determine hydration status. Test over abdomen, forearm, or thigh. Should return rapidly !
oligohydramnios
too little amniotic fluid
Where should the fundus be immediately after delivery?
top of fundus is about midway between the symphysis pubis and the umbilicus
Where should the fundus be 6-12 hours after birth?
top of fundus is in the midline and at the level of the umbilicus
Where should the fundus be 1 day after birth?
top of fundus is midline and 1 finger breadth below umbilicus
Where should the fundus be 2 days after birth?
top of fundus should remain midline and descends about 1 fingerbreadth per day
Drowsy sleep state
transition from sleep to wakefulness, eyes are open but glazed over. They may go back to sleep or if stimulated will wake up
What are some maternal risks if we use forceps?
trauma, laceration, bruising, hematoma, post partum infection
TOLAC
trial of labor after cesarean
Abnormalities of chromosomal number are most commonly seen as ____ or _____
trisomies or monosomies
tonic neck reflex
turning the head to one side, extending the arm and leg on that side, and flexing the limbs on the opposite side
How many security bands should be on the newborn?
two bands on the newborn, one of the wrist and one on the ankle. Mom and dad also get a band.
biphasic COC
two combinations of estrogen and progestin - can be used for treatment of acne
What causes murmurs in newborn? Is it normal?
typically caused by turbulent blood flow, this is often normal in first 48 hours of life
How is infertility defined?
unable to conceive after 12 months or more of trying
Secondary infertility
unable to conceive after one or more successful pregnancies
Tachysystolic Labor
uncoordinated and irregular infrequency and intensity in latent phase of labor -painful, but not effective -resting tone between contractions are high
Absent variability
undetected amplitude: FHR is consistently the same
What is hydrotherapy
use of hot water either by shower or bath to reduce pain levels
estrogen plus progestin
use this if your patient has menopause and has an intact uterus
estrogen
use this if your patient has menopause and has had a prior hysterectomy
Extended cycle
used for 84 days then 7 days placebo
EDB wheel
used to calculate the due date, place the arrow on the first day of the last period
Couvade
used to describe the physical symptoms of pregnancy experienced by the male **sympathy pregnancy**
ampulla
usual site of fertilization
What type of anesthesia is normally done with a C-section?
usually a spinal block, can use general anesthesia
When does MRA occur?
usually happens within 3-10 months after birth of baby...on average take s4 months:)
classical vertical incision puts moms at risk for what
uterine rupture
LAte decelerations indicate
utero-placental insufficiency...maybe decreased blood and oxygen
VBAC
vaginal birth after cesarean -success rate? 60-80 %
Signs and symptoms of a hydatidaform mole
vaginal bleeding (prune juice) excessively large uterus high HCG hypertension before 20 weeks
epidural is used mostly for
vaginal deliveries
Lochia
vaginal discharge following childbirth
What signs may indicate mom is being abused?
vague complaints, bruises in different stages of healing. We want to look for scarring on the breasts or genitalia. -decreased eye contact -partner speaking for her
VEAL CHOP
variable- cord compression early- head compression accelerations- okay late- placental insufficiency
Name 4 illnesses we are assessing for during preconception
varicella rubella Hep B HIV
predisposing factors for thromboembolic events?
varicose veins, obesity, smoking, older mothers
Menopause hormone therapy When to use systemic hormones
vasomotor symptoms (hot flashes, night sweats) +/- urogenital symptoms can be estrogen/progestin or estrogen only
Alternatives to systemic hormone therapy
venlafaxine, paroxetine, megestrol acetate, clonidine, gabapentin
fetal stage; 24 weeks
vernix caseosa forming
A nurse is caring for a client who is in labor. A vaginal examination reveals the following information: 2 cm, 50%, +1, right occiput anterior ROA. Based on this information, the nurse expects the presentation of the fetus to be
vertex.
How do we tell the mom to promote healing of her episiotomy?
warm sitz bath 2-3x a day, may need additional pain meds
Thermal Stimulation
warm towels are applies to back abdomen and shoulders
What is the one test approach?
we ask mom to fast overnight, then she digests a 75 gram oral glucose solution
How do we prevent vitamin K deficiency bleeding in a newborn?
we give a prophylactic injection of phytonadione vitamin K to prevent hemorrhage -0.5-1.0 dose is given one time IM
What kind of clinical therapy will we do for hydramnios?
we may remove fluid
How will we manage trauma that has occurred to the birth canal?
we will immediately want to fix it, either manually or surgically
If the mom is bottle feeding we teach them to
wear a well fitted bra and apply cold packs
IDMS have excessive
weight gain -only organ not effected is the brain
What signs of complications are we assessing for if mom is on HIV therapy?
weight loss fever vaginal infections
Signs of dehydration in preterm
weight loss, decrease urine output, dry skin and membranes, sunken fontanel, poor skin turgor
Sildenafil Tadalafil
what are the PDE5 inhibitors that can be used for pulmonary arterial hypertension?
Sildenafil Vardenafil Avanafil Tadalafil
what are the PDE5 inhibitors?
- preferable in lactating women - fertility returns rapidly
what are the advantages of progestin?
- headache - flushing of the skin - hypotension - blurring and color changes
what are the adverse effects of PDE5 inhibitors?
- nausea - breast tenderness - headaches - weight gain - dysmenorrhea - fibroid growth
what are the adverse effects of excess estrogen?
- increased appetite - weight gain - bloating - acne - hirsutism - depression
what are the adverse effects of excess progestin?
- Pregnancy Cat. X - women advised to avoid contact with crushed tablets and semen from a male partner exposed to finasteride
what are the adverse effects of finasteride?
- spotting or irregular bleeding - loss of libido - increase/decrease in acne/oily skin - bone density loss - possible hair loss - change in body hair - ave. 2 lb. weight gain
what are the adverse effects of progestin?
- Azoospermia in adult males - Stunting of growth due to premature closure of bone epiphyses
what are the adverse effects of taking androgens?
- should not be used in patient over 198 pounds - contact dermatitis - thromboembolism risk higher
what are the adverse effects of the transdermal patch route of contraceptives?
- vasomotor symptoms - nervousness - Early/mid cycle: breakthrough bleeding - amenorrhea
what are the adverse effects of too little estrogen?
- late cycle (14-21) breakthrough bleeding - dysmenorrhea
what are the adverse effects of too little progestin?
Letrozole Anastrozole Exemestane
what are the aromatase inhibitors?
- men with predisposition to priapism - men with fibrotic conditions of the penis
what are the contraindications for Alprostadil?
- micronized estradiol - conjugated estrogens
what are the estrogen vaginal creams used for menopause?
- 17-B estradiol - Estradiol acetate
what are the estrogen vaginal rings used in menopause?
endometrial, breast, lung and ovarian cancer
what are the neoplastic adverse effects of using prolonged estrogen?
- Fluoxymesterone - Methyltestosterone
what are the oral androgens?
- Synthetic A - Synthetic B - 17 B-Estradiol - Esterified Estrogens - Estropipate - Conjugated estrogens
what are the oral estrogen products for menopause?
Ospemifene Tamoxifen Raloxifene
what are the selective estrogen receptor modifiers (SERM)?
- Estradiol (ovaries/most abundant) - Estrone (ovaries) - Estriol (placenta)
what are the three forms of estrogen?
- Levonorgestrel (OTC) - Ulipristal acetate (Rx)
what are the two emergency contraceptives?
- symptomatic BPH - approved to treat male pattern baldness
what are the two uses of finasteride?
Medroxyprogesterone
what drug has been studied the most for progestin replacement in menopause?
Nitrates
what drugs are contraindicated with PDE5 inhibitors?
Estrogen
what is deficient: - hot flashes/vasomotor symptoms - GU atrophy - osteoporosis
Progestin
what is deficient: - late breakthrough bleeding - dysmenorrhea - menorrhagia
Medroxyprogesterone - eat more calcium and Vit. D
what is injected for injectable birth control every 3 months? what should the patient eat more of?
EE 20 mcg x 21 days, pacebo x 2 days, 10 mcg x 5 days or EE 35 mcg
what is the dosage of estrogen for biphasic pills?
EE 20 mcg
what is the dosage of estrogen for continuous cycle pills?
EE 10 mcg x 26 days or EE 20 mcg x 24 days or EE 20 mcg x 84 days, 10 mcg x 7 days or EE 30 mcg x 84 days
what is the dosage of estrogen for extended-cycle pills?
Estradiol valerate 3 mg x 2 days, then 2 mg x 22 days, then 1 mg x 2 days, then 2 day pill free interval
what is the dosage of estrogen for four-phasic pills?
EE 50 mcg
what is the dosage of estrogen for high-dose monophasic pills?
EE 20-30 mcg
what is the dosage of estrogen for the low-dose monophasic pills?
EE 20 mcg x 5 days, 30 mcg x 7 days, 35 mcg x 9 days or EE 25 mcg x 21 days
what is the dosage of estrogen for triphasic pills?
Estradiol hemihydrate
what is the estrogen vaginal tablet used in menopause?
- breastfeeding and non-breastfeeding mothers who just gave birth - Hx of migraine - CV risk
what is the ideal patient population for progestin contraception?
Estrogen and venous thromboembolism
what is the major CV concern when taking COC's?
Rifampin
what is the only antibiotic proven to decrease estrogen (not progestin)?
Flibanserin
what is the only medication approved for female sexual dysfunction?
monophasic
what schedule of pills is recommended for extended or continuous regimens because of the consistent hormone content throughout the cycle?
take the dose ASAP and use a back up method for 48 hours
what should a pt. do if they miss a dose of progestin only contraception for more than 3 hours?
short term: 2-3 years and not more than 5 years
what should the duration of menopausal hormone replacement therapy be?
take the late pill ASAP. no additional contraceptive needed
what should the pt. do if they miss 1 hormonal dose of their COC?
take the missed dose ASAP and use backup contraception for 7 consecutive days. consider emergency contraception if during the 1st week
what should the pt. do if they miss 2 or more consecutive doses or their COC?
discard the placebo week and start a new pack immediately after the last active dose.
what should the pt. do if they miss a dose of COC during the 2nd or 3rd week of the current pack?
Closure of ductus arteriosus
when pulmonary resistance becomes less than systemic resistance. Usually closes within 10-15 hours after birth
How does a dr strip the membranes? Is it full proof?
when the examiner sweeps a finger as far pssible into the cervical os, rotates finger 360 degrees twice -not full proof..the goal is to get labor started within 24-48 hours
What is the moro reflex?
when the newborn is startled by a loud noise or lifted slightly above the crib and then lowered suddenly, the newborn straightens arms and hands outward with knees flexed. The arms will return to the chest and the babys fingers will spread and make a C.
What is placenta previa
when the placenta is implanted in the lower uterine segment rather than the upper segment (no known cause)
engagement
when the presenting part of the fetal head settles into the pelvis
When is a BPP indicated?
when there is a risk of placental insufficiency or fetal compromise because of the following -IUGR -maternal diabetes, heart disesase, chronic hypertension -maternal preeclampsia or eclampsia, sickle cell disease -suspected fetal postmaturity -history of still births -RH alloimmunization -abnormal estriol -hyperthyroidism -renal disease
leukorrhea
white discharge from the vagina
Describe alba serosa..when does it occur?
whitish color, some moms report pink tinged. Lasts for about 24 days. If she is breast feeding this may last longer
no systemic estrogen absorption
why are vaginal estrogen products useful for menopause Tx?
Severe preeclampsia urine sample..
will show proteinuria of 3+ or 4+, greater than 5 grams in a 24 hour specimen
When must we establish gestational age?
within first 4 hours after birth
multigravida
woman who has been pregnant more than once
Positive signs of pregnancy
xray, ultrasound, auscultation of fetal HR on doppler 10 weeks, examiner (not the mother) palpates fetal movement
jaundice
yellowing of the skin and the whites of the eyes caused by an accumulation of bile pigment (bilirubin) in the blood
Can moms have the flu vaccine?
yes
Incomplete Miscarriage
Part of the conceptus is expelled (usually the fetus) but the membranes and the placenta are retained in the uterus. Dilatation and curettage (D&C) or dilation and evacuation (D&E) is performed to remove the remaining products of conception.
RhoGAM
Passive Rh antibodies given to an Rh- mom who gives birth to an Rh+ baby within 72 hours of the babies birth to prevent sensitization.
Class T
Patient had a renal transplant
Hormones at ovulation
Peak levels of LH and estrogen Estrogen starts to decrease towards the end of ovulation
A nurse knows that a client is at risk for an ectopic pregnancy if her history includes which of the following?
Pelvic inflammatory disease (PID)
Exercises to prepare for childbirth
Pelvic tilt, kegel, taylor sit, abdominal
Twin-to-Twin Transfusion
Phenomenon that can occur with monozygotic twins. Donor twin will be anemic, pale, hypoglycemic and SGA Receiving twin will have polycythemia and hyperbilirubinemia
Areola
Pigmented circle surrounding the nipple Infants mouth should cover both this and the nipple while breastfeeding.
Sings of Dermal Sinus or Spina Bifida Occulta in newborns?
Pinpoint opening, dimpling, or sinus tract in the skin at the end of the spine
A pregnant client has severe iron deficiency anemia. The provider orders an injection of iron dextran (Imferon) IM. How should the nurse plan to administer the injection?
Select a 20-gauge needle, and administer using the Z-track method.
If moms coombs test is negative and the babies coombs test is negative, what do we do?
Sensitization has not occurred, we administer rogam 72 hours after she gives birth
Estrogen - BBW
Serious CV events if > 35 YO + smoking
Estrogen - side effects
Serious but rare - MI, stroke, DVT/PE, breast cancer Others - N/V, breast tenderness, bloating, weight gain, high bp
What are some other symptoms of severe preclamp?
Severe epigastric pain, RUQ pain, NV, visual disturbances -pulmonary edema -cerebral edema
Class IV Heart Disease
Severely Compromised Mom is uncomfortable even at rest. Symptoms of cardiac insufficiency and angina are present all the time.
cardiac disease: class 4
Severely compromised -cannot perform activity without increasing discomfort, some angina and cardiac insufficiency while at rest
Molding
Shaping of the fetal head during movement through the birth canal.
What happens if the mom fails her first glucose test?
She does the 3 hour glucose test
The moms indirect coombs test was positive, and the babies direct coombs test was also postiive. What does this mean? What do we do?
She has been sensitized, we DO NOT administer rogam but we monitory for hemolytic disease of the newborn
Why might mom have infeeffective contractions?
She's tired Inactivity (no dilation or effacement) F&E imbalance Hypoglycemia Excessive anesthesia CPD Over distention of uterus
What is hypovolemic shock?
Shock caused by excessive blood loss
Benefit of 24 active tabs vs 21 active tabs
Shorter placebo (bleeding) time period
What is the normal lochia we are looking for after birth
Should be bright red, small to moderate amount and doesn't exceed the saturation of the perineal pad in one hour
BUBBLEHE; breasts
Should feel full, no cracking or bleeding from nipples. Nipples erect with stimulation, colostrum present
Involution
Shrinking of the uterus (womb) to its normal size after childbirth.
Seizure Precautions for Mom with Eclampsia
Side rails up Call light within reach Bed in lowest position Suction Oxygen NG tube - place after seizure to suction Foley - place after seizure Administer MgSO4 Be ready for emergency delivery
What must we do in the third and fourth stages of labor?
Skin to skin contact! They should be dried and kept warm by placing them on the mother
signs of postpartum psychosis
Sleep disturbances, depersonalization, hallucinations, confusion, psychomotor disturbances -may think killing their baby is the best things to do
Class II Heart Disease
Slightly Compromised Mom is comfortable at rest but ordinary activity causes symptoms of fatigue, palpitations, dyspnea, and anginal pain
cardiac disease: class 2
Slightly compromised -slight limitation of physical activity
What does moms temp look like after labor?
Slightly elevated due to labor strain and dehydration. Normal for 24 hours.
Pulse rate should be _______ after birth
Slightly lower. Caused by a vagal response
Epsteins pearls are?
Small,white epithelial cysts on babys gums.(normal)
Social Smile
Smiling in response to other individuals Normally around 6 weeks!
IF your mom is bottle feeding, how do we suppress lactation?
Snug bra, avoid hear to breasts, ice packs
Socioeconomic factors
Social and financial issues that can affect an individual
Medical management of possible abortion?
Speculum examination Ultrasound Labs: hCG, H/H, type and crossmatch
Foods to AVOID for Baby Food
Spinach Carrots Beets Green Beans Squash They contain excessive amounts of nitrates
Risks with Left-sided Heart Failure
Spontaneous Miscarriage Preterm Labor Maternal Death
What type of delivery is recommended if they have class 1-2 failure?
Spontaneous natural labor with adequate pain relief
What causes mastitis?
Staph aureus, e-coli, or streptococci (engorgement of milk or stasis of milk can also cause it)
Progestin only Starting the pack
Start at any time, back up needed for 48 hrs
Estrogen/progestin Starting the pack
Start on first day of period (no back-up needed if started within 5 days) or start first Sunday after period begins (back-up needed for 7 days) *benefit: period free weekends
When can we introduce dairy products?
End of year 1
Normal birth weight
2500-3999g
Average Weight
2500-4000 grams (5-8 lbs) NOTE: 1 lb = 500 grams
What week do we perform glucose screen?
28 weeks NOTE: given 50g glucose load, followed by a 3 hour glucose tolerance test if first test is high
fetal monitoring typically advised to begin at ___
28 weeks, start advising mom to "kick count"
When is the most dangerous time for mom's during pregnancy due to peak in blood volume?
28-32 weeks NOTE: Heart may become so overwhelmed by increase of blood volume that cardiac output fails to perfuse vital organs (including the placenta)
Lysozyme
Enzyme in breast milk that actively destroys bacteria by lysing their cell membranes
Where in the abdomen may preeclampsia women have pain
Epigastric pain from impaired liver function
Oral 17-beta-estradiol
Estrace
Vaginal 17-beta-estradiol brands and dosing
Estrace (cream) -- 1 to 3 times per week Estring (ring) -- every 3 months
Estrogen/progestin - generic
Ethinyl estradiol (EE)
How often do we check the fundus after the first hour of delivery?
Every 15 min
How often should diapers be changed?
Every 2-4 hours!
Which manifestation should the nurse anticipate in a neonate born to a drug addicted mother?
Exaggerated reflexes
Hyperbilirubinemia
Excessive levels of bilirubin (bile pigment) in the blood. Common in the second or third day of life in newborns!
The gestational age assessment tool has two components
External physical characters Neurologic or neuromuscular dev.
Polydactyly
Extra fingers or toes
fetal tachycardia
FHR at 161 and above
Asphyxia causes what kind of respiratory changes?
Failure of the lungs to expand
T or F The bladder should be palpable after birth
False
Fasting Plasma Glucose
Fast for 8 hours, sugars should be under 126
Signs and Symptoms of Anemia
Fatigue Irritability Anorexia Pallor Lack of sense of well-being / depression Cold intolerance Tachycardia Dyspnea Dizziness Edema Headache Fever
S/S of postpartum major mood disorder
Feelings of depression for atleast 2 weeks and worsens with time -no feelings of happiness -loss of interest in newborn, and activities -anxiety, guilt, agitation -RISK FOR SUICIDE
Ductus Venosis
Fetal shunt between the inferior vena cava / right atrium and the umbilicus to bypass the liver Begins to close with decreased pulmonary artery pressure
Ductus Arteriosus
Fetal shunt between the pulmonary artery and the aorta to bypass the lungs Begins to close after babies first breath and pulmonary artery pressure decreases and PO2 increases
When do children start producing IgM?
Fetuses start producing IgM around 20 weeks gestation. This DOES NOT cross the placenta.
Symptoms of Sickle Cell Crisis
Fever Severe PAIN Edema Bacturia Low Hemoglobin (6-8)
Lanugo
Fine, downy hair that covers a term newborn's shoulders, back, upper arms and possibly the forehead. After 42 weeks more than likely will not have it 37-39 weeks will have a generous supply. By 2 weeks it is totally disappeared
When does physiologiv jaundice occur?
First 24 hours of life -peaks from days 3-5
What can we do to prevent complications with pregnancy?
Give early access to healthcare
Menstrual cycle phases
Goes from menses, to follicular (proliferative) phase, to ovulation, to luteal (secretory) phase
S/S of superficial venous thrombosis
*Enlarged, hardened veins.* -swelling -tenderness -warmth
What can cause hyperbilirubinemia?
*hemolytic disease of the newborn* -infants with erythroblastosis fetalis -infants of diabetic mothers -macrosomia -anything destroying RBC and liver function
Name 3 medications we give for a boggy uterus
*pitocin* methergine ergotrate
How do we manage a DVT?
*prevention* -prophylactic heparin -padded stirrups -early ambulation, ROM -compression stockings
What is a quadruple screen used for?
*widely used tool for downs syndrome and neural tube defects* -also for trisomy 13, 18
Doppler Flow
- Also called duplex study - Ultrasound - Ultrasonic waves that create an image - Test of choice to diagnose DVT is venous duplex
We suspect GDM if any one of the following are equaled or exceeded
- Fasting: 92 mg/dl - 1 hour: 180 mg/dl - 2 hours: 153 mg/dl
When to use progestin only pills
- Patients at risk for stroke (migranes with aura, venous thromboembolism, CVD) - Patients with estrogen dependent cancer - Smokers > 35 YO - Postpartum and/or breastfeeding (estrogen reduces milk production, also increase risk of thrombosis during this time)
Planning for birth
- choose a provider - choose a place - plan for the birth - preparing for labor through education
Estrogen - MOA
- stabilizes endometrial lining and provides cycle control. - Suppresses FSH release from pituitary - Blocks LH surge and prevents ovulation
Progestin - MOA
- thicken cervical mucus to prevent sperm penetration, slows tubal motility to delay sperm transport. - Induces endometrial atrophy - Blocks LH surge which inhibits ovulation.
CST is contraindicated if
-3rd trimester bleeding -unexplained vaginal bleeding -previous c-section with classic incision -ROM -cervical insufficiency -cerclage in place (stitched cervix) -anomalies of reproductive organs -hx or preterm labor -multiple gestation
Paternal Adaptation
-Accepting the pregnancy -Identifying with the father role -Couvade -Reordering personal relationships -Establishing relationship with fetus -Preparing for childbirth
Nursing interventions to avoid skin problems in the preme
-avoid adhesives (silk tape) -mild cleansers -position changes to avoid pressure, if tolerated
Nursing management of placenta previa
-bed rest with bathroom privileges as long as theres no bleeding -NO vaginal examinations -monitor blood loos -external fetal monitor -VS -H/H, Rh factors, UA -IV fluids (LR) -type and cross match for 3 units
hospital care for mild preeclampsia
-bedrest -daily weight -well balanced diet with mod-high protein -NST -ultrasound -BPP
Newborn Screening Tests (4)
-blood spot screening -hearing screen -hyperbilirubinemia screening -critical congenital hear disease screening
How can lack of glucose damage the babies brain?
-brain needs constant supply of glucose -could be damaged without out it
What are "afterpains"
-caused by uterine contraction -more frequent or multipara -lasts 2-3 days -breast feeding may increase frequency and severity of pains
Physical factors that can increase pain
-cervical readiness: if it isn't "ripe" pain may be worse -fetal position -size of pelvis -fatigue and hunger: can reduce pain threshold and coping -we just provide support and encouragement!!!
S/S of preterm labor
-contractions every 10 min or less, with or without pain -low abdominal cramping -pelvic pressures -ROM -dull backache -change in discharge (pink)
Disadvatages of an amniotomy
-deliver within 24 hours: MUSTTT -prolapsed cord risk: if baby not engaged -molding of the fetal head -abruptio placentae: placenta seperates from uterus
What can predispose a woman to late hemorrhage?
-delivery of placenta before separation (pulled by physician?) -manual removal of placenta -previous c section
When do we not try any type of version?
-do not do this if fetus is engaged -should not do if maternal bleeding probs -if mom has had C-section (could rupture) -multiple gestation (we can only manipulate one baby at a time) -dont do if fetal anomalies
Labor assessments before administering pain medication?
-document the labor pattern -make sure mom is dilating
How do we diagnose preterm labor?
-documented uterine contractions of 4 in 20 min, or 8 in one hour (with EFM) -dilation of more than 1 cm -effacement of 80% or greater
What is puerperal diuresis? How many ml can this be?
-due to an increased output. The body is wanting to get rid of all the extra fluid. -2000 to 3000 ml -will have to use bathroom a lot!
Small for gestational age (SGA)
-fall below 10th percentile -maybe preterm, term, or postterm
S/S of mastitis
-fatigue, muscle aches -temp 102.2 of higher -chills -malaise -headache -localized lump or area of pain in breast
Common complications with SGA
-fetal hypoxia -aspiration syndrome (they gasp amniotic fluid)MA -hypothermia -hypoglycemia -polycythemia (increased RBC in SGA babies, results in chronic hypoxia)
Fetal risks of oligohydramnios
-fetal skin and skeletal abnormalities -cord compression during labor -fetal head compression
Describe the "Taking-In" part of Rubin
-first 12 hours -mom is dependent on others -wants to talk about birth -may be hesitant to make decision -need sleep and food !!!
2 ways babies conserve heat
-flexed fetal position (decreases body surface -peripheral vasocontriction
Appearance of preterm infant
-frail and week, extremities extended. Head is large compared to body. -Little subcu fat, skin looks translucent -no plantar creases if less than 32 weeks
POWERS: Physiological Forces of Labor
-frequency, duration, and strength of the uterine contractions to cause complete cervical effacement and dilation -purpose of contractions are to accomplish effacement and dilation, facilitate the descent and rotation of the fetus through the passages, facilitate the expulsion of the fetus, faciliate the separation and expulsion of the placenta, & controls bleeding after delivery by compressing blood vessels
What are some ways we try to manage uterine atony?
-fundal massage -check bladder for fullness -medications -bimanual compression -balloon or uterine packing -laparotomy (last resort; trying to find cause) -IV fluids
Signs and symptoms of uterine atony
-fundus that is difficult to locate -boggy uterus -uterus that wont stay firm -fundus above expected level -excessive lochia and clots (like huge)
What are some risk factors that predispose women to episiotomies?
-holding their breath while pushing -if the baby is stalled and not moving, they may cut her to facilitate labor
What are we watching for in the baby right after delivery
-immediate respirations! -maintain body temp -assign APGAR score -assess umbilical cord, AVA -general assessment -identification procedures
What are some factors influencing physiologic jaundice? (5)
-increased amounts of bilirubin to liver -defective heptic uptake of bilirubin from plasma -defective conjugation of bilirubin -defect in its excretion -increased absorption of bilirubin from intestines
Things to know about IV's in babies
-little dilution of meds -assess the site every hour bc they can go bad very quickly!
3 facts about CVS
-looking at a karyotype for fetus -DOES NOT look at neuro tube defects
Risks of precipitous labor and birth
-loss of coping skills -laceration of cervix, vagina -pospartum hemorrhae -nonreassuring fetal status -hypoxia: the baby -brachial plexus injury: the baby
Nursing cae for hyperbili
-maintain NTE -nutrition -protect eyes -photometer measuring -parental teaching (dont wrap them, they need the light!)
Harlequin sign
Harmless color change in a newborn in which the dependent side of the body is a deep color while the other side is pale.
Risk factors for infection in the preme
-maternal infection -inadequate passive immunity -immune response to infection is less mature than a full term!
Signs of hypovolemic shock?
-mild tachycardia that worsens -hypotension** -increased respirations -worsening pale clammy skin -decreased urine output -anxious, confused, tired
symptoms of ectopic pregnancy
-missed periods -positive pregnancy test -abdominal pain...mom will com ein foro this -vaginal "spotting"
Nursing care for moms under general anesthesia?
-moms will need an IV and oxygen therapy -may need antacid
How are we managing the spinal block?
-monitor vital signs and FHR -moms MUST STAY in bed!! for 6-12 hours after administration
What are the maternal risks for folic acid deficiency?
-need for blood transfusion following birth -increases the risk for postpartum hemorrhage. -risk for infection
Safety tips for baby
-never leave baby in room alone -have parents call if they dont feel good -keep eye and hand on baby when when out of crib -WASH HANDS!
When does a mom who is not breast feeding have her period return? Ovulation?
-normally starts 7-12 weeks after birth. -Ovulation can occur between 70-75 days
Clinical manifestations of PTSD
-numb -unaware of surroundings -difficulty sleeping and thinking, self imposed isolation -Nausea, tachycardia, hyperventilation
A baby is probably getting enough milk if
-nursing at least 8 times in 24 hours -breast appears softer after nursing -maintain 6-8 wet diapers -stools lighten in color and are yellow and SEEDY by DOL 5
Management of transient tachypnea
-oxygen if cyanotic (but should resolve) -gavage or IV nutrition -rule out sepsis bc this can make respiratory effort increase
Management of late hemorrhage?
-pitocin, methergine, hemabate, cytotec -D&C (sucking of placental fragments?) -antibiotics for infection
How does relaxation help labor?
-promotes uterine blood flow: increases fetal oxygen -promotes efficient contractions -reduces tension
What is our goal of pain management?
-provide maximum relief of pain with maximal safety for mom and baby -provide positive experiance
How do we initially treat a DVT?
-put mom on bedrest -heparin -analgesics -antibiotic therapy -continuous moist heat -gradual ambulation
3 types of formula
-ready to use: most expensive -concentrated liquid: must be diluted only good for so long -powdered: cheapest, has to be used within 24 hours
Care of preterm infants
-scheduled care to promote rest -alternate feedings -support and educate parents
S/S of abruptio placentae
-sudden and stormy -blood is dark venous (or concealed) -very painful -uterus is tender -abdomen is firm to stony hard -baby may be engaged
how do we manage RDS?
-surfactant therapy works well -oxygen -CPAP -mechanical ventilation
Call provider if
-temp above 100.4 or less than 97.8 -forceful vomiting more than once in 6 hours -refusal of two feedings in a row -lethargy -cyanosis w or w/o feeding -no breaths longer than 20 seconds -inconsolable -discharge from cord -less than 6-8 diapers after DOL 4 -yellowing of skin
Late preterm infant nursing considerations (feeding?)
-they may have weak suck reflex -should be fed every 3-4 hours -monitor for weight loss -glucose levels -they must go a few days taking all feedings by mouth!
Effects of heroin on baby
-withdrawal symptoms (neonatal abstinence syndrome) -tremors, sneezes, vomiting, fever, diarrhea -abnormal respiratory function -possible seizures -shrill cry -fist sucking
Mom is in the first stage of labor, the latent phase. How much is she dilated? What are her contractions like?
0-3 cm Contractions occurring every 10-30 min about 30 seconds
Apgar score levels
0-3: severely depressed 4-6: watch baby to see which way its going 7-10: good condition
What is the female MILESTONE for puberty?
1 menstrual cycle
When do we do APGAR?
1 min and 5 mins after birth
Sitting Position
1 month >> back is rounded and head lags 4 months >> no head lag when pulled into sitting position 6 months >> can sit momentarily without support 8 months >> can sit securely without additional support
Language Development
1 month >> cooing 2 months >> differentiating cry 3 months >> smile and laugh in response to a smiling face 4 months >> very talkative, cooing and babbling 6 months >> start imitating 9 months >> first word 10 months >> two words 12 months >> two meaningful words in addition to mama and dada
Infant Play
1 month >> mobiles above bed, looking at faces, music / noises 3 months >> small blocks or rattles 4 months >> playpen so they can roll over 5 months >> objects they can hold. rings, keys, squeeze toys 6 months >> rubber ducks in the back, teething rings 7 months >> objects they can transfer from hand to hand 8 months >> sensitive to different textures 9 months >> start creeping so give them room to do so 10 months >> peek-a-boo and patty cake 11 months >> cruising while holding on 12 months >> containers
Standing Position
1 month >> stepping reflex 4 months >> able to support their own weight on their legs 10 months >> can pull themselves into standing position while holding onto something 12 months >> can stand on their own without support, may start walking
Fine Motor Development
1 month >> strong grip reflex so hands are fisted 4 months >> infants bring hands in and pull at their clothes. Can manipulate large objects 5 months >> accept objects handed by grasping them with the whole hand 6 months >> hold objects with both hands and hold a spoon to feed themselves 10 months >> pincer grasp (ability to bring thumb and first finger together) 12 months >> can hold a crayon and draw lines, play with blocks, can hold their own cup and spoon
Male anatomy
Scrotum (1) Testes (2) Epididymis (2) Vas deferens (2) Urethra (1) 3 glands Penis (1)
What is folic acid deficiency anemia?
Second most common, it is a result of absence of folic acid
Maternal tasks of pregnancy
Seeking safe passage Securing acceptance Learning to give of self Committing self to unknown child
Normal RR at 1 year
20-30 breaths per min
Intake is considered adequate when they have a consistent weight gain of
20-30 grams/day
When is preterm labor
20-36 weeks
Encourage fluid intake of ____ cc. /day
2000
Encourage fluid intake of _____ ml a day
2000
Kidneys are completely developed by ____
36-38 weeks
Term Babies
37 - 42 weeks or within 2 weeks of their due date! NOTE: Typically aim for 39 weeks. Most docs will not induce before this!
Preterm Babies
37 weeks or less Appears immature and has a low birth weight but is well proportioned for age because the baby appears to have been doing well in utero
Early term
37 weeks to 38 weeks and 6 days
Early Term
37-38 weeks 6 days
When do we want to do a moms c-section if she has HIV?
38-39 weeks and BEFORE her ROM!!! This can spread the HIV
Term
39 weeks to 40 weeks 6 days
full term
39-40 weeks and 6 days
Witch's Milk
A thin, watery fluid sometimes secreted by newborns due to hormones from mom.
lacto-ovovegetarian
A vegetarian whose diet includes milk products and eggs.
Vitamins in breast milk? Which one is often low?
A,D,E, and K -D is often low and moms can supplement
Ovulation
The process of releasing a mature ovum into the fallopian tube each month (graafian follicle release)
Isoimmunization
The production of antibodies against Rh-positive blood. Occurs when Rh negative mom carries an Rh positive fetus and the fetal blood enters mom's circulation. Can cause problems if mom's next child has Rh positive blood because the antibodies would attempt to destroy the infants RBCs in utero. Rh (D antigen) immune globulin (RhIG) can be administered to prevent the buildup of antibodies to prevent the above scenario.
genetics
The scientific study of heredity
What is diastasis recti abdominis? How does exercise with these moms work?
The stomach muscles separate. They have to be cleared for exercise by DR...most often they can do exercise again
How do you assess the popliteal angle?
The thigh is flexed on the abdomen and chest and the nurse places her index finger behind the ankle and extends the lower leg up until resistance is felt..angle is measured. No resistance means very immature, 80 degree angle in the term newborn
Genetic testing
The use of methods to determine if someone has a genetic disorder, will develop one, or is a carrier
Preterm and fluid loss relationship?
The younger they are the more easily they will loose fluid
Xray difference in transient tachypnea vs. RDS?
There are little streaks on the xray with transient tachypnea
How many times do we have to check a BP for mild preeclampsia?
There has to be two separate recordings that meet the requirements, at least 6 hours apart
What symptoms will occur in a mom with trauma to the birth canal?
There will more than likely be excessive bleeding, but the uterus will be firm because uterine atony is not the cause of her bleeding
Late preterm infant nursing considerations (temp concerns?)
Thermoregulation (take temp every 1-4 hours) encourage kangaroo care or radiant warmer.
What are objective (probable) changes in pregnancy?
These can be seen and noted by the examiner! Does not always mean pregnancy
Can pregnant women have vaccines?
They CANNOT have immunizations with live viruses because of the teratogenic effects on the fetus
What does it mean if diuresis doesn't occur in an RDS baby?
They aren't getting enough oxygenation to the kidneys, we will need to investigate this further
Why are breathing techniques important for women in labor?
They can increase the moms pain threshold, permit relaxation, provide a sense of control, and allow the uterus to function more efficiently
What is nonshivering thermogenesis?
They cannot shiver so they have "brown fat metabolism" in effort to warm up
What are the insulin needs postpartum?
They decrease
Vegans, what do we add to their diet?
They eat no food from any animal source!!! -add 1200 mg of calcium and 10 mg of Vit D
What is most likely to happen to low birth weight babies?
They have a higher risk to die in the first year of life
How do babies regulate their body temperature?
They increase and decrease their metabolism which effects LOTS of other body systems and can cause severe problems
Type I Diet
American Diabetes Association (ADA) Diet 25-35 or 35-50 kcal/kg >> roughly 1800-2400 kcals a day 3 meals and 3 snacks, this keeps glucose levels even 50% complex carbs 30% fats 20% proteins >> if renal disease limit to 90g
Extended cycle estrogen/progestin 84 low dose active tabs + 7 low dose EE tabs
Amethia Lo Seasonique Quartette
Extended cycle estrogen/progestin 84 active tabs + 7 low dose EE tabs
Amethyst
How do we treat the baby if its thick meconium that is aspirated?
Amnioinfusion -we will take an isotonic fluid like NS or LR and instill it into the amniotic cavity to thin out the meconium
Disseminated Intravascular Coagulation (DIC)
An abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues. This can occur if a deceased fetus remains in utero too long.
Septic Abortion
An abortion complicated by infection, typically from self abortions or illegal abortions. Symptoms of fever (100.4 F) and crampy abdominal pain Requires D&C or D&E to remove all infected or necrotic tissue. If it goes untreated can result in toxic shock syndrome, septicemia, kidney failure, and death. Also given TETANUS TOXOID and antibiotics as prophylaxis
Retinopathy of Prematurity (ROP)
An acquired ocular disease that leads to partial or total blindness in children caused by vasoconstriction of immature retinal blood vessels. Infants who are most immature and most ill are at the highest risk of developing this. Cryosurgery or laser therapy may be effective at preserving sight!
Histidine
An amino acid that appears to be essential for infant growth but is not necessary for adult growth. It is found in both breast milk and formula
How much Iron does a fetus need in the second half of pregnancy?
An average of 300 mg due to the expansion of RBCs!
What is erthema toxicum?
An eruption of lesions in the area surrounding a hair follicle that are firm, and vary in size. They have a white or pale yellow pustule with a red base. This is often called a "new born rash"
Linoleic Acid
An essential fatty acid that is necessary for brain growth and skin integrity in infants
Apparent Life-Threatening Event
An event that causes unresponsiveness, cyanosis, and apnea in an infant, who then resumes breathing with stimulation. These babies are typically put on apnea monitoring systems that alarm parents when child has not breathed in 20 seconds.
Hydraminos
An excessive amount of amniotic fluid
Supernumerary Nipple
An extra nipple, usually found below and in line with the other nipples
What are the insulin needs during labor and delivery?
They increase! Mom has increased energy needs
What is babys stomach compacity by 36-38 weeks?
by then it is fully mature! The capacity is 50-60 ml. -empties as they eat
Downs syndrome
called trisomy 21
Younger moms will need more ____
calories, bc they are growing!
Period of inactivity to sleep
can last 2-4 hours..babies are often in a deep sleep and are difficult to arouse
What is mental stimulation, in terms of pain management?
can reduce moms awareness of her pain, she can look at imagery or focal points
How do we manage a UTI?
catheritization to get urine out, C&S of urine and antibiotics
What do we do if there is an abnormal cervical length, or if they are dilating to early?
cerclage
Effects of cocaine on baby
cerebral infarctions -microcephaly -learning disabilities -decreased interactive behavior -CNS and cardiac anomalies -genitourinary anomalies -SIDS
What are some causes of infertility in women?
cervical issues clear passage from cervix to tubes patent fallopian tubes ovulation and release of ova obstruction between ovary and tube endometrial issues
A client has active herpes type 2. The nurse anticipates that the best plan for delivery for a client with herpes lesions would be
cesarean birth prior to the onset of labor.
If mom scored a 6 or less on the bishop scoring system
chances are she wont have a vaginal delivery...a 7 can go either way
Mottling
changes in skin color (pale and bluish) of the hands, arms, feet, and legs when death is near
Presumptive signs of pregnancy
changes that might make a woman think she is pregnant. such as amenorrhea, fatigue, nausea, vomiting, polyuria, breast changes(darkened areolae, enlarged Montgomery glands), quickening(slight fluttering movements of the fetus felt by the women, usually between 16-20 wks of gestation).
Group Beta Strep
check around 36 weeks near rectum/vag give antibiotics to protect baby from mom
vernix caseosa
cheesy substance covering the skin of the fetus. Less of this on a full term baby, their skin will be dry and sometimes peel on the hands and feet
babies first breath is triggered by
chest recoil and cord clamping
CVS
chorionic villus sampling
Bronchopulmonary Dysplasia (BPD)
chronic pulmonary disease that develops in premature infants who were treated with mechanical ventilation for longer than 28 days of life
Achondroplasia / Chondrodystrophia
An inherited failure of bone growth. The epiphyseal plate of the long bones cannot produce adequate cartilage for longitudinal bone growth, so arms and legs become stunted.
Necrotizing Enterocolitis (NEC)
An intestinal dysfunction in which the bowel develops necrotic patches, interfering with digestion and possibly leading to a paralytic ileus, perforation, and peritonitis. It occurs because of anoxia to the bowel.
What might PALLOR in newborns indicate?
Anemia Requires therapy with supplemental iron or a packed RBC transfusion
What do newborn heel sticks test?
Anemia Polycythemia Hypoglycemia
Examples of objective changes?
Goodell's sign Hagars sign Chadwicks sign McDonald sign Uterine enlargement Changes in skin pigmentation Uterine Souffle PRegnancy tests to determine hCG
When do we assess for DVT on our BUBBLEHE assessment?
BUBBLEH(omans sign)E -even if she doesn't report pain, we should still be checking for S/S on our assessment. If we notice anything, let the Dr know.
stillbirth
Baby born dead after 20 weeks gestation
Why is postpartum psychosis considered emergent?
Bc baby is at risk for infanticide!!! Also mom at risk for suicide
What labs do you expect to be affected from preeclampsia
Because there is decreased renal perfusion, the BUN and creatinine will increase as will uric acid. -decreased GFR -increase HCT -thrombocyotpenia
Treatment for DVT in Pregnancy
Bed Rest Intravenous Heparin for 24-48 hours Maybe subq Heparin for remainder of pregnancy Heat Elevation
Management for Mild Eclampsia
Bed rest in left lateral position Take daily weights Monitor BP Protein intake should be 80-100 g/d Lower sodium intake to less than 6 gm a day Use dipstick to check protein in urine REPORT >> Headache, epigastric pain, and visual disturbances
When does the second stage of labor begin and end?
Begins with complete cervical dilation and ends with delivery of the fetus
When does the third stage of labor begin and end?
Begins with the delivery of the fetus and ends when the placenta is deliverd
When does the fourth stage of labor being and end?
Begins with the delivery of the placenta and continues till 1-4 hours after delivery
When does the first stage of labor begin and end?
Begins with the onset of regular contraction and ends with complete dilation
Hemangiomas
Benign vascular tumors of the skin "Birthmarks"
Milia
Benign, keratin-filled cysts that can appear just under the epidermis and have no visible opening.
Neonatal Period
Birth to 28 days
Effects of Sickle Cell Anemia on Baby
Blockage to the placental circulation can cause low birth weight and possibly fetal death
Postpartum hemorrhage is defined as
Blood loss of >500 ml (vaginal) Blood loss of 1000ml (csection) Decrease of 10% in Hematocrit
Gestational Hypertension
Blood pressure is elevated to 140/90 mmHg but no signs of edema or proteinuria. This requires careful observation, but no drug therapy.
Chadwick's sign
Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion.
Types of trauma that cause concern, what might this cause?
Blunt trauma (like from a crash) Penetrating abdominal injuries --->results in maternal shock, premature labor, or spontaneous aboriton
Newborn Immune System
Born with passive antibodies (IgG) that passed through the placenta from mom. Not able to produce their own antibodies until 2 MONTHS
A nurse is caring for a client diagnosed with trichomoniasis and metronidazole (Flagyl) is prescribed. Which instructions should the nurse give to the client regarding the treatment plan?
Both partners need to take the medication and abstain from intercourse until cultures are negative.
Deep Tendon Reflexes
Both patellar and biceps reflex should be intact in newborns.
Pregnanediol
Breakdown product of progesterone found in breast milk that depresses the action of glucuronyl transferase, the enzyme that converts indirect bilirubin into its direct form so it can be readily excreted in the bile. Only remains in the breast milk for 24-48 hours
Bubble Pleb
Breasts Uterus Bladder Bowels Lochia Episiotomy Pain Lower and upper extremities Emotional Status Bonding
cephalic fetal presentation
fetal head first (most favorable)
What are the diagnostic (positive) changes of pregnancy?
fetal heartbeat (fetascope at 20 weeks) fetal movement (18-20 weeks) visualization by ultrasound (6-8 weeks) can see flutter
Lanugo
fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn.
When does colostrum come in, and what is its composition?
first 3 days after delivery -high in protein, fat-soluble vitamins and minerals -low in fat and lactose -antioxidants, IgA -laxative effect
What is meconium stool?
first poop! Sticky and black
primigravida
first pregnancy
First/same day start
first tablet on the first day of menses. backup contraception not needed
Sunday start (most popular)
first tablet taken on the first sunday after the beginning of menstruation. use alternative contraception for 7 days
Newborn assessment; ankle dorsiflexion
flex the ankle on the shin. Support the back of the ankle with hand and push on the sole with your thumb. A full terms should flex less than 45 degree
Cardinal movements of labor
flexion internal rotation extension restitution external rotation expulsion
amniotic fluid
fluid within the amniotic sac that surrounds and protects the fetus
term
formerly used to identify the normal duration of pregnancy. Now discouraged because theres such a wide range
Casin
forms large curds that are hard to digest
Closure of the foramen ovale
function of changing arterial pressure. Should close 1-2 hours after birth
BUBBLEHE; uterus
fundus should be firm, midline, position dependent on time since giving birth. But, it should always be at or below the umbilicus *advise frequent voiding to reduce bleeding *teach woman how to palpate uterus *try uterine massaging for moms bleeding a lot
Active alert state
fussy, respirations are increased and they may be cold or hungry
What are some factors we have to consider for pain interventions?
gestational age frequency and duration of contractions labor progress maternal response to pain allergies to anlagesics
Immediate care after delivery
give mom pitocin to prevent hemorrhage assess VS maintain adequate hydration and nutrition
4 signs of placental separation
globular shaped uterus fundus rises in the abdomen sudden blood lengthening umbilical cord
Hypoglycemia
glucose level less than 40 at anytime in newborn
decreased renal threshold for glucose=
glycosures
Recommended weight loss after pregnancy?
goal of 1-2 pounds/week is usually suggested
Quiet alert state
great time for bonding! They are still but can focus
High birth weight
greater than 4000 grams
preffered type of pelvis
gynecoid
Nipple confusion
happens in babies who go from bottle to breast
Nursing consdieratations if she is on mag
have antidote at bedside!!! *calcium gluconate* when baby is born...watch for respiratory depression
A nurse recognizes intrauterine devices (IUDs) are least likely to be recommended as a method of birth control for women who
have multiple sexual partners.
false labor characteristics
having irregular contractions pain located chiefly in abdomen walking has no effect no bloody show no cervical changes warm bath and rest eases pain
Additional signs of mild preeclampsia
head ache visual distubances brisk DTR's generalized edema
when the baby is in a longitudinal lie
head down, long axis of the baby and moms spine is in same direction
Common discomforts of pregnancy; 2nd and 3rd trimester
heartburn (pyrosis) ankle edema varicose veins flatulence hemorrhoids constipation backache leg cramps faintness SOB difficulty sleeping round ligament pain carpal tunnel syndrome
Heat loss: conduction
heat is lost to cold surfaces or objects with which the infant comes into contact with EX: cold hands, stethoscope
Heat loss: evaporation
heat loss bc water evaporation from the skins surface EX: amniotic fluid on baby taking bath
Heat loss: convection
heat loss to air or fluid around the infant that is cooler than the infants temp EX: baby by air vent, O2 mask
BUBBLEHE
Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy, Homan's Sign, Emotional Status
BUBBLEHE assessment
Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy, Homan's Sign, Emotional Status
What color are newborn iris'? When do they assume their permanent color?
Gray / Blue 3-12 months
How do we treat neonatal sepsis?
Broad spectrum antibiotics until C&S is available -ampicillin, cephalosporins, vancomycin
Melasma
Brownish pigmentation of the face during pregnancy; also called chloasma and "mask of pregnancy"
What is the rooting reflex?
Brushing an infant's cheek will cause the baby to turn in that direction.
What are the three imminent indications of birth?
Bulging of perineum uncontrollable urge to bear down increased bloody show "I think I need to have a BM"
What are the insulin needs in the 2nd trimester?
They increase! There is an increased level of HPL, which is an insulin antagonist. (as the placenta grows, the need increases)
Why are moms at risk for distention after labor? How do we help this?
They may have had the epidural or spinal block. Maintain this with a foley.
What type of delivery is recommended for class 3 and 4 cardiac failure women?
They may have induced labor and may be hospitalized before labor begins, with intensive cardiac monitoring. -vaginal delivery with epidural and maybe forceps or vacuum
Antihypertensives to AVOID while Breastfeeding
Thiazides Beta Blockers
Neonatal Skin
Thin and pale
Transitional Stool
Thin, slimy, brownish green, passed 3rd-6th day May look like diarrhea to a new parent!
Colostrum
Thin, watery, yellow fluid composed of protein, sugar, fat, water, minerals, vitamins, and maternal antibodies. Breast milk for the first 3-4 days after baby is born Easy to digest and provides adequate nutrition for the newborn until it is replaced by traditional breast milk.
What are the postpartum blues?
This a transient period of depression that can occur a few days after delivery. Normally resolves in about 10-14 days.
What is a cord blood collection and why would parents want to do that?
This involved collecting the newborns umbilical blood from the cord immediately following birth. Cord blood contains hematopoietic stem cells so it can be used to treat numerous cancers, genetic and blood disorders, cerebral palsy and immune disorders no risk procedure, no pain
Newborn assessment; lanugo
This is a fine hair covering. IT decreases as the gestational age increases. The amount of hair is greatest from 28-30 weeks. Its most abundant on the back but can be seen everywhere else, it disappears first from the face.
What is "adjustment reaction with depressed mood" ?
This is also called postpartum blues -common in first time moms -can last up to 6 weeks postpartum
why do women have heartburn, bloating, and constipation during pregnancy?
This is due to increased progesterone and steroid levels
What is a monosomie?
This is when a normal gamete unites with a gamete that is missing a chromosome, the result is 45 chromosomes
minimal variability in FHR
This means the FHR fluctuates 5 or less bmp from peak to trough
What is a reactive reaction to a NST?
This means the babys HR increases 15 beats/min above the normal baseline (twice!!!). This occurs for at leasts 15 seconds in a 20 minute window -10 beats/min for 10 seconds for a preterm fetus
What does the babies initial gasp and scream do?
This opens up the lungs and clears out amniotic fluid
How long should a baby be breastfed?
Through at least 1 year is ideal!
Medical Conditions that may present Symptoms similar to Depression
Thyroid Function Anemia Rule these out when assessing for postpartum depression
Polyhydramnios
To much amniotic fluid! Greater than 2000 ml
Extrusion Reflex
Tongue thrusting reflex until 3-4 months to prevent infants from eating solid food effectively
TORCH
Toxoplasmosis Rubella Cytomegalovirus Herpes simplex virus
Oral vs transdermal estrogens side effect considerations
Transdermals have less risk of nausea, headaches, breast tenderness, and DVT.
8-10cm..what kind of dilation?
Transitional
Obvious clinical sign of hypocalemia?
Tremors
How much should baby weigh at 12 months?
Triple birth weight!
If the markers for the quadruple screening are abnormal, what is the baby at risk of?
Trisomy 18 Trisomy 21 (DS) Neurotube defects
A nurse is caring for a client in active labor when the client's membranes rupture. An internal electrode is applied to the fetal scalp and late decelerations are noted. Which of the following is the first action the nurse should take?
Turn the client onto her left side.
What is an example of a monosomie?
Turners syndrome-X
external cephalic version
Turning a breech baby to cephalic presentation through the maternal abdominal wall
Epstein Pearls
Two small, round, glistening cysts on the palate of some newborns due to having extra calcium deposits in utero. These are NORMAL and require no treatment
If a woman has gestational diabetes, what is she at risk for developing?
Type 2 diabetes, maybe a few years later
Maternal risks for sickle cell anemia
UTI, pneumonia, acute chest syndrome, gestational hypertension, congestive heart failure, acute renal failure
Overt Cord Prolapse
Umbilical cord descends past the presenting part of the fetus and is protruding through the cervix. Requires immediate action!! Check dilation and effacement Elevate the presenting part >> Mom's knee to chest Apply oxygen Keep continuous pressure DO NOT replace cord
Funic Cord Prolapse
Umbilical cord is between the presenting fetal part and fetal membranes. The cord has not passed the opening of the cervix, and the membranes have not ruptured. Prepare for expeditious vaginal delivery or cesarean
cardiac disease: class 1
Uncompromised -cardiac disease with no resulting limitation of physical activity or cardiac insufficiency
Class I Heart Disease
Uncompromised Mom is asymptomatic, has no activity limitations, and no pain
How long should babies eat fortified infant cereal?
Until age 3 or 4!
A client is receiving magnesium sulfate as treatment for pregnancy induced hypertension (PIH). Which of the following assessments by the nurse should warrant notifying the primary care provider immediately?
Urinary output 40 mL in 2 hr
Menopause hormone therapy When to use topical hormones
Urogenital symptoms only Vaginal preparations are estrogen only
Tocolysis
Use of medications to arrest preterm labor.
Heat loss: radiation
heat loss to solid objects near the infant that are cooler than the infants temp EX: putting bag of ice in crib with baby bc of blood test?
Risks for TOLAC or VBAC?
hemorrhage uterine rupture
What if moms blood pressure is dropping??
hemorrhage !!!
What might be the cause of hyperemesis gravidarum?
high levels of hCG high levels of estradiol low levels of prolactin
Risk facor for ROP?
high levels of oxygen, damages blood vessles
Will medication remain in the fetus after birth?
high medication doses may remain in the baby because their fetal liver enzymes and kidney excretion cannot break down analgesic agents as quickly
Fetal risks of multiple gestation?
high mortality rate IUGR fetal anomalies prematurity abnormal presentation cord accidents cerebral palsy long term disabilities
Disadvantages of spinal block
high rate of maternal hypotension
What is the stepping reflex?
hold infant upright and allow one foot to touch tables surface, the other foot will lead forward like its trying to walk
Newborn assessment; ventral suspension
hold the baby prone on the nurses hand, the position of the head/back and the degree of flexion of the arms and legs are noted. Full flexion is a full term baby
Triphasic COC
hormone dose change every 7 days during 1st three weeks - reduced progestin is useful for women with complaints of progestin-associated side effects (increased appetitie, acne and weight gain) - good for women with CV disease or metabolic abnormalities
Quadriphasic COC
hormone levels change four times per cycle, reduces side effects
human chorionic gonadotropin (hCG)
hormone produced by the placenta to sustain pregnancy by stimulating the ovaries to produce estrogen and progesterone
Symptoms of menopause
hot flashes, night sweats, vaginal dryness, painful intercourse, sleep disturbances, mood swings, loss of libido, problems concentrating and with memory, joint pain
How do we educate the mother before giving regional anlagesia or anesthesia?
how is it given? expected effect? advantages and disadvantages? risks?
- avoid estrogen containing contraceptives for 42 days
how long after delivery should a non-breastfeeding woman with CV risk be started on contraception?
Why would we do a gavage or IV nutrition for a baby with transient tachypnea?
Imagine panting and trying to eat or drink, they may choke. SO we have to do alternate feedings with them.
1-4 hours after birth the fundus should be..
In the midline at the umbilicus, or 1-2 fingerbreadths below the umbilicus
single parent
Includes one parent and one or more children
Signs of overhydration in preterm
Increase in urine output with below than normal specific gravity, edema or weight gain, bulging fontanel, moist breath sounds
BP levels of mild preeclampsia
Increase of 30 systolic or 15 diastolic over her pre pregnancy BP. -or 140/90
Hormones during follicular (proliferative) phase up until ovulation
Increase of FSH (peaks mid-way through follicular phase) Increase in LH (peaks at ovulation)
Hormones during luteal (secretory phase)
Increase of progesterone Second wave of estrogen, not as much estrogen as progesterone and not as much estrogen as during ovulation.
Physiologic response to pain
Increased BP, pulse, respirations, and muscle tension
If a baby has RDS and is on a ventilator, what are signs of improving condition?
Increased diuresis and urination
What happens to intraocular pressure during pregnancy? What can this cause?
Increases! Because of increased vitreous outflow and cornea thickens because of fluid retention. -causes moms contacts to not fit -disappears 6 weeks postpartum
Nifedipine (Procardia, Adalat, Nifedical, Nifediac)
Indicated for hypertension ROUTE: PO AEs >> flushing, dizziness, headache, peripheral edema, rash, gingival hyperplasia
Labetalol
Indicated for hypertension, SAFE during pregnancy Causes vasodilation Does cross the placenta and through breastmilk ROUTE: IV SLOW PUSH!!! AEs >> aggravate bronchial asthma, HF, bradycardia
Hydralazine (Apresoline)
Indicated for hypertensive crisis Causes vasodilation and prevents muscle contraction ROUTE: IV SLOW PUSH!!! AEs >> reflex tachycardia, renin release, fluid retention, headache, dizziness, weakness, and fatigue
Inevitable (Imminent) Miscarriage
Moderate to heavy bleeding, cramps, cervical dilation, and passage of some tissue and/or fluid. If no fetal heart sounds are detected or an ultrasound reveals an empty uterus, dilatation and curettage (D&C) or dilation and evacuation (D&E) may be performed to ensure all the products of conception are removed.
Gestational / Transient Hypertension
Mom is preeclampsic at time of delivery, but BP is normal by 12 weeks postpartum
On assessing a newborn, what will their skin normally look like?
It is normal to have a pink trunk and blue limbs!
What is molding? is it normal?
It is the overriding of the cranial bones, occurs during a natural labor. Normal!
What is the fetal circulatory system?
It maintains the blood flow to the placenta, therefore providing nutrients and oxygen and removing carbon dioxide -acts as the lungs!
Extended cycle estrogen/progestin 84 active tabs + 7 inactive tabs
Jolessa
Extended cycle estrogen/progestin brands
Jolessa Amethyst Amethia Lo Seasonique Quartette
Symptoms of Right-sided Heart Failure during Pregnancy
Jugular Venous Distention Enlarged / Distended Liver and Spleen Peripheral Edema
Monophasic estrogen/progestin 24 active tab brands
Junel Fe 1/20 Loestrin 24 Fe Yaz Minastrin 24 Fe
How do we manage hyperemesis?
Just like morning sickness -Vitamin B6 -phergran, zofran, zantac, bendryl -IV fluids
Inpatient Management of Eclampsia
Keep patient in a quite room Check BP every 4 hours Take daily weights Keep a close eye on lab results >> High H&H, High bilirubin, High uric acid, High BUN, High creatinine, and Low platelets
What do we do for moms that have cardiac failure in the postpartum period?
Keep them in semifowlers position and side lying!
If moms blood glucose gets really low, what are we worried about?
Ketoacidosis, moms with GDM are at risk for this
two values used to assess lung maturity?
L/S ratio (lecithin/sphingomyelin) PG level (phosphatidylgylcerol)
Predictive indicator for respiratory distress syndrome and preterm newborns
LBC lamellar body count
What do we do if there is an abortion in the 2nd trimester
Labor induction, or dilation and evacuation (D&E)
3 types of trauma to the birth canal
Lacerations to the canal Hematomas Uterine inversion (prolapse of the fundus to or through the cervix)
Caudal Regression Syndrome
Lack of development of the caudal spine and cord that may occur in the fetus of a diabetic mother
0-3cm...what type of dilation?
Latent
What eye prevention do we do in new borns?
Legally required prophylactic eye treatment of gonorrhea and chlamydia -if untreated can lead to blindness
Monophasic estrogen/progestin considerations
Less complicated (only one color tablet) More flexible (easier to postpone menses, by skipping inactive period)
Progestin only considerations
Less effective Higher risk of ectopic pregnancy Irregular/unpredictable bleeding Must be taken at the same time everyday (within 3 hrs)
Small Gestational Age (SGA)
Less than the 10th percentile Small because they have experienced intrauterine growth restriction or failed to grow at the expected rate in utero. Below average weight, height, length, and head circumference. Poor skin turgor, skull sutures may be widely separated, hair may be dull and lusterless. Typically related to lack of nutrition, sometimes related to placental anomaly (placenta did not attain sufficient nutrients or was insufficient in transporting to the fetus. Could be due to mom smoking heavily or using opiates.
Progestin - generics
Levonorgestrel, norethindrone, norgestrel, norgestimate, desogestrel, drospirenone
Craniotabes
Localized softening of the cranial bones caused by the pressure of the fetal skull against the mother's pelvic bone in utero. Condition corrects itself without treatment after a few months as the infant takes in calcium from milk.
How do we treat folic acid def. ?
Looking at giving moms 1 mg of folic acid daily, in addition to the prenatal vitmain
ABG levels of a newborn?
Low PO2 High CO2 Low pH: acidosis
What are the fetal risks of iron deficiency anemia?
Low birth weight preterm still birth
Blood loss may be reflected by what?
Lowering BP, rising pulse
How to use bulb syringe
M outh N ose
Advantages of Breastfeeding for Baby
MANY anti-infective properties including IgA from mom Ideal electrolyte and mineral composition for human infant growth High in lactose which provides ready glucose for rapid brain growth Protein is easily digested Contains more linoleic acid, an essential fatty acid for skin integrity and brain growth Less sodium, potassium, calcium and phosphorus Better balance of trace elements like zinc Spares the infant's kidneys from processing high renal solute of unused nutrients Found to reduce allergies Able to regulate calcium and phosphorus levels better than infants who are formula fed Help prevent excessive weight gain, potentially into adolescence Helps with formation of the dental arch May help prep for forming common speech sounds
Effects of Iron-deficiency Anemia on Baby
MILDLY associated with low birth weight and preterm birth
conjugated estrogens / bazedoxifene
MOA: Selective Estrogen Receptor Modulator (SERM): estrogen agonist and antagonist Adverse: malignant neoplasms and gallbladder disease Pregnancy: X Limitation: should only be considered for women at significant risk of osteoporosis
Drospirenone
MOA: analog of spironolactone - decreases bloating effect of ethinyl estradiol - low androgenic: best for acne
Danazol
MOA: androgen derivative with weak progestational, androgenic and glucoroticoid activity
Finasteride
MOA: competitive inhibitor of 5a reductase - halts BPH progression and reduces prostate size and symptoms over time
Mifepristone
MOA: inhibits progesterone activity - used for termination of intrauterine pregnancy - used for hyperglycemia in patients with cushing's
Phosphodiesterase 5 inhibitors (PDE5)
MOA: inhibits the enzyme responsible for degredation of cGMP in the corpus cavernosum - no effect in the absence of sexual stimulation
Aromatase inhibitors
MOA: inhibits the production of estrogen by blocking aromatase
Clomiphene
MOA: ovulation-inducing agent that mediates ovulation through increased output of pituitary gonadotropins
Alprostadil
MOA: prostaglandin E1 (PGE1). causes vasodilation by means of direct effect on vascular and ductus arteriosus smooth muscle Use: alternative to conventional treatment of ED
Combined Oral Contraceptives
MOA: suppress release of LH and FSH from pituitary gland via negative feedback by providing exogenous estrogen/progesterone - prevents ovulation
SERM's
MOA: works as an estrogen agonist to improve lipid profile, decrease bone resorption and also works as an estrogen antagonist to reduce the chance of breast cancer
Managing Gestational Diabetes
MONITOR FOR >> UTI Excessive weight gain Edema early in pregnancy Macrosomia and/or polyhydramnios in the fetus DIET >> 20-25 kcal/kg >> roughly 1800-2400 kcals Increase fiber Decrease fats KEEP A FOOD DIARY
Do we clear mouth or nose first?
MOUTH
Anticonvulsant medication given for severe pre clamp
Magnesium sulfate!! WE often give this for preterm labor, but in this case it acts as an anticonvulsant
Postpartum Management of Eclampsia
Maintain MgSO4 for 24-48 hours Assess uterine tone every 4 hours Monitor blood loss DO NOT use Methergine for hemorrhage Administer antihypertensive if BP remains high Diuretics if necessary MIGHT give oxytocin to keep uterine muscles contracting
Types of abruptio placenta
Marginal: placenta separates at edge Central: separates centrally but blood is trapped Partial: separation occurs but is not complete Complete: massive vaginal bleeding is seen
Where will you notice edema with severe preeclampsia?
Marked edema noticeable in the hands, face, and over bony prominences
Class III Heart Disease
Markedly Compromised Mom is comfortable at rest but SLIGHT activity causes symptoms of excessive fatigue, palpitations, dyspnea, and anginal pain
cardiac disease: class 3
Markedly compromised -comfortable at rest, less than usual activity causes fatigue, dyspnea, palpitations, angina
What are disadvantages of NST?
May be difficult to get a solid tracing -high false reading because of baby sleep cycle
Effects of Iron-deficiency Anemia on Mom
May develop pica, or the craving of ice or starch Restless Leg Syndrome
Meconium Ileus
Meconium plug obstructs intestine preventing stool passage at birth Common in cystic fibrosis
Monophasic estrogen/progestin 21 active tab brands
Microgestin Fe 1/20 Ortho-cyclen Yasmin Sprintec 28
Domperidone (Motilium)
Milk production stimulant often used by moms with preterm infants
Bi- Tri- and Quadri- phasic considerations
Mimic natural cycle Different color pills may be confusing Less flexible when trying to postpone menses
Menopause hormone therapy Progestin - dosing
Minimum 12-14 days each month of progestin for complete protection Increased risk of spotting if taken intermittently (not daily)
When do we give RhoGAM?
Mismatched transfusions Previous Rh+ baby Abortion, miscarriage, ectopic pregnancy Amniocentesis or CVS Placenta Previa, abruption, marginal separation Trauma Manual removal of placenta Cesarean Intrauterine fetal death
What can cause thromboembolic disorders to occur?
Mom may have -venous stasis -hypercoagulation -blood vessel injury -predisposing factors
Why do we ask mom to evaluate basal metabolic temp?
Mom should take her temp at the same time everyday, it changes right before ovulation
What are signs of fallopian tube rupture?
Mom will have sharp right/left sided pain, she may complain of syncope and have right sided shoulder pain
What happens if the fallopian tube ruptures?
Mom will lose the fallopian tube and may result in a full hysterectomy
Postpartum Care for moms with Heart Disease
Monitor blood volume >> LOCHIA, weight pads CAUTIOUS use of oxytocin >> it can cause water intoxication Limit activity Antiembolic Hose Prevent constipation
Fetal Surveillance when Mom has Eclampsia
Monitor fetal movement >> kick counts Apts for fetal monitoring twice weekly Serial ultrasounds to assess growth Biophysical profiles Doppler velocity to screen for compromise Amniocentesis to assess lung maturity May need corticosteroids at 24-34 weeks >> to enhance fetal lung development
What level of bilirubin requires treatment and how is it treated?
More than 10-12 mg/100mL requires PHOTOTHERAPY (Exposing the infant to light to initiate maturation of liver enzymes).
Post Term Babies
More than 41 weeks (book) 42 weeks (Baton) These babies are at risk because the placenta only functions effectively for 40 weeks. After that it loses ability to carry nutrients effectively and the fetus begins to lose weight. Skin is dry, cracked, and leather-like from lack of fluid and vernix is absent. Baby may demonstrate alertness like a 2 week-old rather than a newborn.
What indicates "true labor"?
More than 5 contractions / hour Cervix at least 4 cms Effacement at least 50% (according to baton) Cervical effacement over 80% and over 1 cm dilated (according to the book) NOTE: If mom walks around and contractions go away, this is FALSE labor
- progestin only: immediately - estrogen: wait 21 days
how long after delivery should a non-breastfeeding woman with no CV risk be started on contraception?
6 weeks postpartum
how long after delivery should progestin-only contraception be started on a breastfeeding woman?
- remain in place for 6-8 hours - remove within 48 hours
how long is the cervical cap meant to stay in place?
- remain in place for 6-8 hours - remove within 24 hours
how long is the diaphragm meant to stay in place?
no more than 3 courses
how many courses of Clomiphene should the patient be limited to?
11-13 weeks
how often does a pt. need to return to the clinic to get depo-medroxyprogesterone acetate shots?
Cold stress can cause
hpoxemia, intracranial hemorrhage, and hypoglycemia
Cold stress increases the risk of
hyperbilirubinemia (jaundice) hypoglycemia
What are the risks of oxytocin infusion?
hyperstimulation of uterus uterine rupture non-reassuring fetal heart tones
Causes of symmetric IUGR?
hypertension, malnutrition, substance abuse, alcohol
common complications of IDM
hypoglycemia hypocalemia hyperbili polycythemia RDS
In the immediate post birth recovery period, there are 5 conditions that should be reported to the healthcare provider
hypotension tachycardia uterine atony excessive bleeding hematoma
Postmaturity syndrome
hypoxia and malnourishment
Goals for helping mom that is being abused
identify her and get her resources that will help her make a decision, keep them safe
Maternal complications of hydramnios?
if fluid is >3000 ml she may have SOB and edema in lower extremities -at risk for abruptio placentae
Anemia level
if its less less than 11 g/dl
When is labor induction contraindicated?
if mom has CPD (cephalopelvic disproportion) if baby is transverse if mom has had transverse C-section umbilical cord prolapse
Chronic hypertension; diagnosis?
if moms BP is elevated before pregnancy occurs or before 20 weeks gestation -no protein in urine
When do we try and manipulate baby position?
if the baby is 36 weeks or more and if the baby is healthy and not under stress
How do we read a critical congenital heart disease screening?
if the pre and post ductal values differ less than 3% = good!
What are the results of a positive CST?
if there is repetitive decelerations with more than 50% of contractions
How do we diagnose gestational diabetes after they have taken the 3 hour glucose test?
if two of the values are met: -fasting: 95 mg/dl -1 hour: 180 mg/dl -2 hours: 155 mg/dl -3 hours: 140 mg/dl
What are the results of a negative CST
if you have 3 or more contractions of good quality lasting 40 seconds or more in 10 minutes without evidence of late decelerations
Tamsulosin (a1a)
if your patient is on a PDE5 inhibitor for ED, but they also have BPH, what alpha blocker is preferred because it is less likely to cause HoTN?
progestin only due to risk for CV disease
if your pt. is a smoker over 35, what is the recommened BC?
Carbs and lactose do what for the baby?
improves absorption of calcium and provides energy for brain and CNS growth
Breastfeeding jaundice occurs when? and what is it related to?
in 1st day of life -poor feeding practices, NOT related to milk composition
How do we tell moms to store their breast milk?
in sterile container -24 hours in a cooler pack -8 days refrigerated -3 months in a freezer
IVF
in vitro fertilization
S/S of BPD
inability to be weaned off the vent/oxygen -tachycardia, tachypnea -retractions, rales, wheezes -pulmonary edema
lacto-vegetarian
includes dairy but no eggs
What are the signs of male puberty?
increase hair growth increase size of penis and scrotum Growth spurts
What are the signs of female puberty?
increase hair growth increase breast size growth spurts
Risks of delayed cord clamping
increased risk for jaundice/ need for photoptherapy
The three fetal growth stages
increases in cell number (#) increases in cell number and size (# and S) increases in cell size alone (S)
Why is alcohol a teratogen?
increases risk for fetal alcohol syndrome--->CNS disfunction, growth retardation, facial anomalies
Estradiol acetate
indicated to treat moderated to severe vasomotor symptoms due to menopause and moderate/severe vulvar and vaginal atrophy - only vaginal product that has systemic effects
Labs to monitor with hyperbilirubinemia
indirect and direct coombs (look for hemolytic disease) bilirubin levels and CBC
What is general anesthesia?
induced unconsciousness
palmar and plantar grasp
infant grasps examiner's finger when stroked against palm/plantar surface of infant
Large for Gestational Age (LGA)
infants above 90th percentile -weigh more than 8.13 lbs
Group B Strep
infection found in 30% of moms, it is in the vagina or rectum of pregnant women. We need to know about this because she can pass it on to the baby!
What is mastitis?
infection of the breast 2-4 weeks after delivery
Women at risk for PROM
infections placenta previa/abruptio fetal abnormalities incompetent cervix over distention of uterus lower socioeconomic status tabacco use
What happens to platelets after L&D?
initially they fall..they start to rise again in 3-4 days but may take 6 weeks to return to normal.
Pudendal block
injected in perineal area, relief of perineum
endometrium
inner lining of the uterus
Amnion
innermost lining of the membrane that produces amniotic fluid
RDS results from
insufficient production of surfactant which reduces the surface tension within the lungs-prevents the alveoli from collapsing at the end of expiration
Effects of alcohol on baby
intelectual disability -microcephal -cardiac anomalies -IUGR -fetal alcohol syndrome
Braxton Hicks contractions
intermittent painless uterine contractions that occur with increasing frequency as the pregnancy progresses (false labor)
IPV
intimate partner violence
hydatidiform mole (molar pregnancy)
is a gestational trophoblastic disease; results in a placenta characterized by grape like clusters 1) complete 2) partial
A nurse in an obstetrical clinical is caring for a client who received results from a Papanicolaou test (Pap smear). The client states, "What does Class III mean from a pap smear result?" The nurse should be aware that a Class III result
is not definitive for cancer and further testing is needed.
trophoblast
is the wall of the blastocyst that becomes the placenta, it develops villi that allow it to latch to the uterine wall (7-10 days after fertilization)
CPR can be improved if we do a c-section, why?
it alleviates the compression of the inferior vena cave and improves resuscitation efforts for both the mom and the baby
What happens to BP during pregnancy?
it decreases! due to hormones in the 1st and 2nd trimester. During the 3rd trimester, it increases back to normal.
What happens to Hb and Hct during pregnancy?
it decreases.....most have anemia
What is the 3 hour glucose test?
it is an overnight fast, the woman ingests 100 gram oral glucose solution.
What is a trisomie?
it is the product of normal gamete and gamete with an extra chromosome - the final product would have 47 chromosomes (normal is 46, 23 pairs)
How long does it take for the uterus to go back to normal size
it never goes back to original size! It involutes over 6 weeks, sometimes 7
How does diabetes mellitus in pregnancy develop?
it results when the pancreas is unable to meet the increased demands for insulin production during pregnancy
When would we use vacuum extraction?
it's used in prolonged second stage of labor or non-reassuring fetal heart pattern (can be used in vaginal or c-section)
What is Clomiphene citrate and why do we give it?
its like a first line therapy to induce ovulation
What is periodic breathing of the newborn?
its normal for a brand new baby...they can have pauses that last for 5-15 seconds -OK as long as they maintain a normal HR
Adverse effect of epidural block
maternal hypotension bladder distention maternal temp elevation
Limitations of an ultra sound
maternal obesity, fetal positioning, technician skill, cannot guarantee defects
When would maternal antibiotics be given in a PROM?
may be given if the gestational age is less than 37 weeks to prevent infection
Disadvantages of pudendal block
may have multiple injections may perforate rectum trauma to sciatic nerve
A nurse is explaining to a client why epidural anesthesia is not given until a good labor pattern has been established. In the course of the teaching, the nurse tells the client that anesthesia given too early
may prolong labor.
Quick start (progestin)
may start progestin on any day of the cycle and use backup method for 48 hours
Oligohydramnios
means to little amniotic fluid! Less than 400 ml
Photometer measuring
measure the light intensity of the bililight, making sure they actually work. Normally 12 inches above baby.
What is the pelvic inlet?
measured to see if a woman can do a vaginal delivery 1. Diagonal conjugate (11.5 cm) : distance from lower posterior border of pubis to sacral promontory 2. Obstetric conjugate (10 cm or more) : a measurement apprx 1.5 cm smaller than the diagonal
Meconium aspiration develops when
meconium in the amniotic fluid enters the lungs -can completely or partially obstruct the lungs
prenatal health care
medical care provided to a pregnant woman from the time of conception until the birth process occurs
Name 4 common tertogens
medications tobacco alcohol caffeine
Menopause hormone therapy Progestin only products - generics
medroxyprogesterone acetate micronized progesterone norethindrone norgestrel levonorgestrel Used for endometrial protection
Behavioral signs of substance abuse
memory lapse mood wings pattern of missed appointments frequent accidents, falls signs of depression, agitation suicida gestures
Hypoallergenic (Alimentum) formula is good for
metabolic disorders
myometrium of uterus
middle smooth involuntary muscle
Where should the fundus be after delivery?
midway between symphisis pubis and umbilicus
Signs of postpartum depression?
mild depression interspersed with happier feelings -emotional let down after birth, anxiety, PMS
BUBBLEHE; episiotomy
mild edema in the perineum area, laceration or episiotomy should be intact and well apporximated *apply ice fro 20 min on then 20 min off for first 24 hours *give local perineal meds *provide sitz bath after first 24 hours
Grade 1 abruptio placenta
mild separation with slight bleeding
the baby scored a 4-6 on the apgar test
moderately depressed
Stop trying version when
mom is having severe pain or baby has significant bradycardia
Some things to consider about elimination after birth
mom may have hemmorhoids or lacerations. She will be scared to go to bathroom.
Why do we do a pudendal block?
mom may have not had any pain meds and she lacerated, she may need stitches. Or she may need some relief right near end of delivery
psychological response to pain
mom may withdraw or react hostile, she may have fear and anxiety or depression
Adverse effects of general anesthesia?
mom will have greater blood loss she may vomit risk for aspiration may have some amnesia
what is the desired outcome for fetal movement count?
moms should feel 10 movements within 3 hours
What does puerperium mean?
moms uterus goes back to pre pregnancy state
What are we doing during the amniocentesis?
monitoring VS before during and after
Continuous cycle
monophasic COC that does not have placebo days at all
What some things we can expect from a mom with post partum blues?
mood swings, angry, anxious, weepy, may have difficulty sleeping, may feel "let down" -just let them talk to you:)
How do we adjust preterm formula?
more calories in less fluid
Women cant fly after how may gestational weeks?
most airlines restrict from flying at 36 weeks!
What is iron deficiency anemia?
most common, it is caused by an inadequate iron intake. It is also a result of expansion of plasma volume.
fetal stage; 20 weeks
mother feels movement!
Wharton's jelly
mucoid connective tissue that surrounds the vessels within the umbilical cord
HELLP syndrome
multiorgan failure associated with severe preeclampsia H: hemolysis EL: elevated liver enzymes LP: low platelets
multiparity
multiple births
Predictors of preterm birth?
multiple gestations bleeding during pregnancy abnormal cervical length history of preterm birth infection paternal smoking
What if the uterus does not relax in between contractions?
must STOP infusion of oxytocin because the baby needs time to oxygenate
if mom has complete or partial placenta previa..
must have c-section
A nurse is preparing to administer naloxone (Narcan) to a newborn. The nurse understands the use of naloxone in a newborn is indicated in the case of respiratory depression related to
narcotics given to the mother in labor.
S/S of HELLP syndroms
nausea vomiting flulike symptoms epigastric pain (bc of liver failing) RUQ tenderness
Advantages of a spinal block
needle is passes through epidural space and the medication is directly inserted into CSF, RAPID onset
How is a lumbar epidural given?
needle is placed into the lumbar space at L3 and L4 level, a very small catheter is introduced into the space and local anesthetic agents are injected
When should the baby urinate? When should the baby have meconium?
needs to happen in 24 hours needs to happen in 48 hours
if the baby baseline FHR is fluctuating between 120-160 this may indicate
neurologic impairment
What is a neutral thermal environment (NTE)
neutral environment that maintains body temp with minimal metabolic changes
nulligravida
never been pregnant
Things to know about hearing screen
never say baby "Failed" -results are reported to state and follow up within first 6 months of life
Sterility
no absolute factor preventing reproduction
caloric requirements in the first trimester
no change needed
Advantages of a ultrasound
noninvasive, painless, no known harmful effects
After birth, the womans BP should return to..
normal prelabor BP monitored ever 5-15 min
Gum tissue softening is..
normal. They may bleed.
What happens to a mom WBC count after delivery?
not sure lol
In preparation for birth..
notify the physician -prepare delivery equipment and maintain sterility -cleanse perineum, pubic area, and inner thighs with soapy water or beta-dine
Level of anesthesia for vaginal birth? (spinal block)
numb down to pelvis
Level of anesthesia for cesarean birth?
numb to upper abdomen
Maternal Mortality
number of deaths from any pregnancy related cause, including up to 42 days postpartum per 100,000 live births
infant mortality
number of deaths of infants under 1 year of age per 1000 live births
Birth rate
number of live births per 1,000 people in a year
gestation
number of weeks since the first day of the last menstrual period
How is a chorionic villus sampling done?
obtain a small sample of the chorionic villi from the developing *placenta*
At 6 hr postpartum, a mother and neonate are moved from the labor and delivery recovery room to the postpartum floor. On admission to the newborn nursery, the nurse notes slight jaundice of the infant's face and trunk. The initial nursing action is to
obtain an order for a stat bilirubin level.
Menopause hormone therapy Oral estrogen - dosing
once daily
Menopause hormone therapy Oral estrogen/progestin - dosing
once daily
Menopause hormone therapy topical estrogen - dosing
once daily
Morula
one the fertilized eggs travels through the fallopian tube for three days, and reaches the uterus it is called a morula
Paroxetine mesylate
only FDA approved SSRI that can be used as a non-hormonal option for menopause
When does breast milk jaundice occur? Why?
onset in 4-7 days of life -milk containes higher than normal concentrations of free fatty acids -increased bilirubin reabsorption from intestines
chorion
outermost later that forms from the trophoblasts
Female Anatomy
ovaries - contain follicles + an egg fallopian tubes uterus cervix vagina breasts
A nurse in a prenatal clinic is educating a client about the antepartal period. The client asks the nurse how much weight is safe for her to gain during her pregnancy. Which of the following is an appropriate response?
"A weight gain of about 12 to 14.5 kg (25 to 30 lb ) is good."
Fore Milk
"Constantly" forming milk that resembles skim milk Watery with very little nutrients
While performing discharge teaching for a client following removal of a hydatidiform mole, an appropriate instruction statement by the nurse is,
"Do not become pregnant for at least one year."
When teaching a pregnant client with pregnancy induced hypertension (PIH) about the preparations and procedures for a nonstress test (NST), the nurse knows the teaching to be effective when the client states,
"I can't get up and walk around during the test."
A nurse instructs a client in how to use a diaphragm. The nurse knows the client understands the instructions when the client states,
"If I lose or gain much weight, I'll need to be refitted."
A client who is at 34 weeks of gestation is taking terbutaline (Brethine) for preterm labor. Which of the following statements made by the client would cause the nurse the most concern?
"My heart feels as if it is racing."
Hind Milk
"New" milk that is formed after the let-down reflex. Much higher in fat than fore milk and helps infant grow most rapidly
Moro Reflex
"Startle" reflex because it is initiated by startling a newborn with a loud noise, jarring the bassinet, or letting head fall back about 1 inch. Newborn should abduct, extend their arms and legs, and swing their arms into a "C" while they pull their legs into their abdomen. It is strong for the first 8 weeks and then fades by the end of month 4 or 5
A nurse is caring for a client with twins who is at 8 weeks of gestation and primigravida. The client states that even though she and her husband planned this pregnancy, she is experiencing many ambivalent feelings about it. What response by the nurse would be most appropriate?
"These feelings are quite normal at the beginning of any pregnancy."
An expectant father tells the nurse that he feels resentful of the added attention others are giving to his wife since the pregnancy was first announced several weeks ago. What is the most therapeutic nursing response to the father?
"These feelings are very common to expectant fathers in early pregnancy."
A nurse is caring for a client who is in labor. The client questions why an internal fetal scalp electrode must be placed on her. Which of the following is an appropriate response?
"We need to observe your baby more closely."
Signs of congestive heart therapy
(most common in pregnancy) -edema (pedal, pitting, pulmonary) -dyspnea on exertion (cyanosis, fatigue) -tachycardia (irregular pulse, murmurs)
What kind of assessment are we doing during the latent phase of labor? Vitals? FHR? Temp?
-All vitals every hour if they are in normal range. -Uterine contractions are palpated ever 15-30 minutes. -We are checking the FHR every 30 min for low risk women, and ever 15 minutes for a high risk mom. -Temp ever 4 hours unless over 99.6 OR if the membrane is ruptured then every 2 hours!!
What does the maternal assessment look like before giving them medication?
-CLEARLY state they want it -stable VS -no contraindications; are they allergic? resp compromise?
How do we manage hypoglycemia?
-Check them every 1-4 hours -Adequate intake (feeding or IV) -we want to make sure they don't go a long time without eating!
Other than amnioinfusion, what other management do we do for meconium aspiration?
-Consider tracheal suctioning after delivery if baby has not taken first breath -oxygen and high pressure ventilation -surfactant replacement -antibiotic therapy
How are we going to manage the molar pregnancy?
-D&C to remove the molar preg
Risk factors for puerperal infection?
-Delivery (vagina or c section) -Prolonged labor -Vaginal infections at time of labor -Prolonged ROM (if its passed 24 hour mark)
What do we assess about the fetus before giving pain medication to mom?
-FHR: 110-160 -Present variability -Term fetus
Cardiff Counting Method
-Focus on counting fetal movements and keeping a record ***Client should feel at least 10 fetal movements in 3 hours*** -Vigorous activity generally provides reassurance of fetal well-being -Decrease or cessation of movement may signal a problem
Describe fore milk and hind milk?
-Fore milk: beginning of feeding, high in protein and low in fat -Hind milk: end of feeding, high in fat and cals -happens every feeding and responds to the needs of the baby!
What are maternal risks for moms that have GDM?
-Hydramniosis (increases in amniotic fluid) -Preeclampsia exlampsia -Hyperglycemia -Retinopathy -UTI's
Neonatal anemia can occur with
-Hypovolemia in utero from placental bleeding -birth trauma -physiologic trauma of infancy
3 questions we should be asking ourselves at every delivery?
-IS this baby term? -Is this baby breathing or crying? -Does the baby have good muscle tone?
Grandparent Adaptation
-Most often associated with joy -May feel regret due to poor health or geographical distance -Grandparents are eager to help -Maternal grandmother is called on the most -Intergenerational relationships shift -Involvement dependent on cultural and familial factors
Risk factors for asphyxia
-Non reassuring FHR -Anything compromising blood flow through placenta -difficult birth -prolonged labor -meconium amniotic fluid -narcotic use in labor -infant of diabetic mother
What can cause an ectopic pregnancy?
-Pelvic infections (like gonorrhea or chlamydia) -possible tubal damage -risk if IUD!! -delayed or premature ovulation -multiple induced abortions
S/S of meconium aspiration
-RDS -over distended, barrel shaped chest -stained nails, skin, and umbilical cord -these kids are very very sick, it can lead to pneumonia and leads to ICU
Sibling Adaptation
-Siblings have to assume new positions within the family hierarchy -Reactions manifested in behavioral changes -Involvement in planning and care -Acquaintance behaviors (sibling rivalry)
what is postpartal chill?
-They are intense tremors that resemble shivering. -can occur as a response to adrenaline or sudden relief of pressure on pelvic nerves
What will we see if observing an infant with postmaturity syndrome
-Unusually alert -Thin, loose skin with little subcu fat - Little vernix or lanugo -abundant hair and long nails -skin wrinkled and cracker -hypoglycemic
What are some risks of labor induction?
-Uterine hyperstimulation...this leads to decreases placental perfusion -uterine rupture
What kind of assessment are we doing when mom is in the transitional phase of labor?
-Vitals ever 30 min -contractions palpated ever 15 min -FHR every 30 min for low risk, every 15 for high risk -noting fetal activity
Administration of lumbar epidural
-We want mom to be in active labor -babies head engaged -mom sits on edge of bed and two nurses are there for her
What can cause a spontaneous abortion?
-abnormal development -maternal infection -endocrine disorder -anatomic defects (problems with the placenta or weakened cervix)
Home Care for Mild Preeclampsia
-activity retrictions -blood pressure -urinalysis for protein -daily weights (weight gain of 3 lb in 24 hours or 4 lb in 3 days = bad) -fetal assessment
Describe the "Taking-Hold" phase of Rubins theory
-after first 12 hours -takes control of self and baby -tell her she's doing a good job! -use this time for redirection and educate
How do we manage mastitis?
-antibiotics -tell mom to keep breast feeding or pumping!! we do not want mom to get engorged! -comfort measures (heat, cold)
Think of some ways to promote comfort to the perineal area
-applying ice ever 20 min on/10 min off for first 24 hours -encourage sitz bath 3 times/day after 12-24 hours -DO NOT WIPE, but blot!!
Breastfeeding moms usually have their period return when? When does their ovulation return?
-around 3 months after delivery. -Ovulation may occur BEFORE menstruation -cannot use this as a time of contraceptive!!
For women with cardiac disease, on assessment we are checking for what things?
-assess for anemia -weight gain (we dont want excessive strian on heart) -limit emotional stress -signs of infection -rest and exercise !!! --> maintain cardiac reserves
What is the opthalmic ointment we use on babies? how do we give it?
0.5% erythromycin -instill into lower conjunctive sac of each eye -administer in delivery room or up to 1 hour
Where do you clamp the cord?
0.5-1 inch away from the abdomen
21 day pill pack
1 pill every day for 21 days and then nothing for 7 days
28 day pill pack
1 pill every day for 28 days and the last 7 pills are placebo
91 day pill pack
1 pill every day for 91 days, last 7 pills are placebo
When do babies begin producing sufficient amounts of lipase?
1 year NOTE: lipase is necessary for the digestion of saturated fats
placenta previa grades
1,2,3,4
How often should a newborn pass bowel movements by 2 weeks of age?
1-2 bowel movements a day
On average how long do healthy sperm survive in female genital tract?
1-3 days (rarely a week)
Normal urinary output for preterm
1-3 ml/hour
How many oz does a breastfed baby typically eat in one sitting and for how long?
1-5.2 oz and is fed every 2-3 hours
What are some predisposing factors that can cause uterine atony?
over distention of the uterus grand multiparity prolonged labor induction with pitocin
How do we prepare moms for breast feeding?
pads in bra incase leakage stress can influence supply pain with breastfeeding if doesn't latch right
5 variables of biophysical profile (for moms and babies at risk)
1. fetal breathing movements 2. gross body movements 3. fetal tone 4. qualitative amniotic fluid reserve 5. reactive fetal heart rate (by NST)
Functions of the placenta (4)
1. gas exchange 2. nutrients and electrolytes 3. excretory products are transferred from fetus to mom 4. endocrine functions 5. Immunologic properties (passive immunity)
Incompetent cervix? What do they present with?
painless dilation of the cervix without contractions -advanced effacement and dilation and bulging of membranes
newborn senses:
1. hearing: acute hearing present within first hours 2. vision: present at birth 3. touch: well developed 4. taste: formed at birth 5. smell: present at birth, know their mom by smell in first week
Name 3 ways to prevent hemorrhage?
1. keep the bladder empty 2. keep fundus firm 3. administer emds if necessary; pitocin, methergine, ergotrate
Preterm infants have respiratory problems due to what critical factors
1. lack of surfactant; results in hypoxia 2. muscular coat of pulmonary vessels is not fully developed 3. ductus arteriosus may remain open: results in pulmonary congestion
Initial management of preterm labor (4)
1. maintain good uterine blood flow 2. detect contractions 3. ensure fetus status (EFM or NST) 4. Therapy: side lying, IV fluids, labs, ultrasoud
5 functions of the amniotic fluid
1. protects against injury 2. maintains fetus temperature 3. allows symmetrical growth 4. prevents fetal adherence to amnion
Effects of cold stress on newborn
1. temp goes down 2. metabolic rate increases 3. heat production increases 4. oxidation of brown far increases
Transitional stools?
part meconium and part fecal material...usually thinner and can be brown to greenish
Grade 2 abruptio placenta
partial abruption with moderate bleeding
there are 3 major assessments during the first 24 hours of life, what are these?
1. Delivery room (immediately after birth) 2. Nursery Admission Examination (during first 4 hours of life..you want parents involved!) 3. Discharge examination
2 types of puerperal infection
1. Endometritis: inflammatory condition of the uterus 2. Wound infection: possibly at c section site, or episiotomy incision
Kick counts (fetal movement counting)
1. Mother sits quietly or lies down on her L side and counts fetal kicks for a period o time, as instructed. 2. Instruct client to notify physician if fewer than 10 kicks in a 12 hr. period or as instructed by doc.
IUGR (2 types)
1. Symmetric: proportional, caused by long term maternal conditions 2. Asymmetric: caused by an acute disruption in uteroplacental blood flow
3 tocolytics
1. Terbutaline: not for long term!1 48-72 hours 2. Magnesium sulfate: offers neuroprotection for fetus, watch for toxicity 3. Procardia: fewer sides effects than mag
What are the 4 signs suggesting placental separation
1. The uterus rises upward in the abdomen 2. As the placenta move downward, the umbilical cord lengthens 3. A sudden trickle or spurt of blood appears 4. the shape of the uterus changes from disk to globe
Average chest circumference and how do you measure it?
12.5, place the tape beneath the scapulae and over the nipples
Fetal movement
16-20 weeks gestation
Antidote for Magnesium Sulfate (MgSO4)
10 mL Calcium Gluconate 10% IV Push
Babies lose about ____% of body weight from day of life to day 3-4, but they gain it back within ____ days
10%, 10-14 days
How much sleep should infants get at night?
10-12 hours
mom loses _____ due to birth of baby placenta and amniotic fluid
10-12 lbs
When is a CVS performed?
10-12 weeks gestation
Hemoglobin Range during Pregnancy
10-14 NOTE: Lowers each trimester Not pregnant is 12-16 (according to baton)
The uterine capacity increases from ___ml to ___ml when pregnant!
10-5000
Newborn Specific Gravity
1.008-1.010
How many calories per kilogram should a 1 year-old intake in 24 hours?
100 kcal/kg NOTE: in contrast, adults should intake 45 kcal/kg
Normal HR at 1 year
100-120 beats per min
How many calories per kilogram should a newborn up to 2 months intake in 24 hours?
100-120 kcal/kg OR 50-55 kcal/lbs NOTE: in contrast, adults should intake 45 kcal/kg
If moms temperature after the first 24 hours is above _____ may indicate ________
100.4, infection Temp is initially elevated after delivery due to dehydration
Weight gain; fetus, placenta, amniotic fluid
11 pounds
When can you detect breathing from an ultrasound?
11 weeks
Lactose
Most easily digested carbohydrate. It improves calcium absorption, aids in nitrogen retention, produces gram positive stools resulting in less gastrointestinal illness, and allows protein to be used for building new cells.
Infant HR
110-160 beats per min
Normal heart rate for newborn
110-160 while awake; 85-110 when asleep
How many pounds in the 2nd and 3rd trimester?
12-15 lbs....1 pound per week!
How long are ova fertile?
12-24 hours
Average head circumference, and where do you take it?
13-14 inches, place measuring tape just above the eyebrows
taking vital sings after labor every ___ min for 1 hour
15
How is IV oxytocin prepped?
15 units = 250 ml 30 units = 500 ml 60 units = 1000 ml
Newborn White Blood Cell Count
15,000-30,000 cells/mm3
How much fluid should a newborn intake every 24 hours?
150-200 mL/kg OR 75-90 mL/lbs
Low birth weight
1500-2500 grams
Newborn Hemoglobin
17-18
Menopause hormone therapy topical estrogen - generics
17-beta-estradiol estradiol
When does the anterior fontanelle close?
18 months
Average length of newborn
18-22
Standard Schedule for INFANT Health Care Visits?
2 weeks 2 months 4 months 6 months 9 months 12 months
First Dental Visit?
2 years
Babies have to be in car seat facing rear of car until
2 years old
When do moms see urinary frequency?
1st and 3rd trimester
What is the male MILESTONE of puberty?
1st ejaculation
Early onset sepsis show signs during
1st week of life (they got this in the womb)
Proteinuria levels (preeclampsia)
2+ or less than 1 gram in a 24 hour specimen
What is a babies voiding pattern?
2 days old: 2-6 voids a day after 2+: 5-25 voids a day
When does an infants immune system become functional?
2 months
When does the posterior fontanelle close?
2 months
Infant Vision
2 months >> follow moving objects with their eyes (binocular vision) 3 months >> hold hands in front of their face and study their fingers 6 months >> begin to perceive distances accurately 10 months >> look under a towel or around a corner for a concealed object
Infant Hearing
2 months >> will stop an activity at the sound of a spoken word 3 months >> turn head to try to find where the sound is coming from 10 months >> recognize their name and listen acutely 12 months >> can easily identify where sounds are coming from in all directions
Babies do not form antibodies against antigens until
2 months of age
weight gain; uterus
2 pounds
Breast milk and formulas for normal newborns have _____kcal/oz
20
Hormonal therapy for menopause
Most effective treatment option for alleviating vasomotor and vaginal symptoms Should not be continued indefinitely, use lowest dose and shortest duration possible.
Pseudomestruation
Mucus vaginal secretion in some female newborns due to hormones from mom.
Age of viability
23 weeks
SGA maternal factors
Multi gestational Hypertension, CHF Excessive exercise Small placenta Chromosomal syndroms (13,18,21)
How much amniotic fluid at 10 weeks?
20 ml
When bilirubin reaches ____ we tell moms to ____
20 or higher, stop breastfeeding. Let the level fall and then you can resume
How much protein should a newborn up to 2 months intake in 24 hours?
2.2 g/kg
Preterm
20 weeks - 33 weeks 6 days
How long does a healthy oocyte (egg cell) survive?
24 hours (rarely 72 hours)
When is a glucose screening done?
24-28 weeks -drinks 50g of sugar drink to see how she tolerated glucose
When do we assess the mother for GDM? How do we do this?
24-28 weeks, we do a 1 hour glucose tolerance test (One Test Approach)
Early Preterm Babies
24-34 weeks NOTE: appears immature and has a low birth weight but is well proportioned for age because the baby appears to have been doing well in utero
Recommended weight gain during pregnancy
25-35 lbs
Precipitous labor occurs when then labor and birth happens in...
3 hours or less
When do babies begin producing sufficient amounts of amylase?
3 months NOTE: amylase is necessary for the digestion of complex carbs
Infant Emotional Development
3 months >> readily smile at parent's faces 4 months >> cry when entertainer walks away, recognize their primary caregiver 5 months >> displeasure when an object is taken from them 6 months >> start noticing a difference between people who take care of them and strangers 8 months >> fear of strangers reaches its height, major stranger anxiety 9 months >> aware of changes in tone of voice 12 months >> overcome fear of strangers, alert and responsive when approached, may like to play and dance with others
Recurrent (Habitual) Pregnancy Loss
3 or more consecutive miscarriages NOTE: Rule out incompetent cervix here. There is a chance they can place stitches to keep the cervix closed!
weight gain; breast tissue
3 pounds
How many oz does a bottle fed baby typically eat in one sitting and for how long?
3-3.5 oz and is fed every 3-4 hours
How many pounds in the first trimester?
3-5 lbs
Hindmilk is higher in what than foremilk?
3-5 times more fat!
When should multipara come into hospital-based on contractions?
Multipara means a mom that has had more than one child, she should come when her contractions are 6-8 minutes apart for one hour
weight gain; increased blood volume
4 pounds
At what dilation do we give epidural?
4-6 cm
How many glasses of water a day should a pregnant woman be drinking?
4-6 glassess 8-10 cups
When should parents introduce solid foods?
4-6 months OR when infant begins nursing vigorously every 3-4 hours and still do not seem satisfied
Mom is in the active phase of labor, how much is she dilated? What are her contractions like? Assessment is the same for this phase as for latent!
4-7 cm Contractions every 2-5 min lasting 40-60 seconds...starts moderate and progresses to strong intensity
BUBBLEHE; bladder
Nondistended and nonpalpable urine should be clear, maybe some lochia *measure first three voids after birth to ensure adequate bladder emptying
Normal respiratory rate for newborn?
30-60
Newborn Stomach Can Hold...
30-60 according to Baton... 60-90 according to the book...
Infant RR
30-60 breaths per min
When do we clamp the cord?
30-60 second delay -when it stops pulsating
caloric requirements in the 2nd and 3rd trimester
300 kcal should be added to the diet
Average Chest Size
32 cm NOTE: Should be smaller than the chest!!
Average Head Size
32-37 cm NOTE: Should be larger than the chest!!
Hematocrit Range during Pregnancy
32-42% NOTE: Lowers each trimester Not pregnant is 37-47% (according to baton)
Which of the following manifestations should most concern the nurse who is caring for a client diagnosed with pregnancy induced hypertension (PIH)?
Nonreactive nonstress test
Treatment of Hypovolemia
Normal saline (isotonic solution) to increase volume Dopamine (vasopressor) to increase BP and improve cell perfusion
When is an amniocentesis typically done?
33-34 weeks
Class E Diabetes
Overt diabetes with calcified pelvic vessels
Late Preterm
34 weeks to 36 weeks and 6 days
When might a preterm baby be ready for nipple feeding?
34-35 weeks
When are babies able to maintain respiratory efforts outside of mom?
34-36 weeks
Late preterm
34-36 weeks gestation
Late Preterm Babies
34-37 weeks NOTE: appears immature and has a low birth weight but is well proportioned for age because the baby appears to have been doing well in utero
How much O2 do we give a newborn less than 32 weeks gestation?
30% NOTE: oxygen should be warmed and humidified!
What percentage does blood volume and cardiac output increase in pregnant women?
30-50% increase during pregnancy (even in healthy individuals!!)
Women are instructed to come to the birthing unit if any of these 4 things occur?
Rupture of membrane (water breaks) Contractions Vaginal bleeding Decreased fetal movement
Therapeutic Range for Magnesium Sulfate (MgSO4)
4.8 - 8.4 mg/dL NOTE: Loss of deep tendon reflexes at 10 mg/dL Respiratory paralysis at 15 mg/dL Cardiac arrest at 25 mg/dL
we want to keep preterm infants axillary temp at
97.3-98.4
Hypoglycemic levels of newborn
40-45
Oligohydramnios
< 500 ml
How much does blood volume increase during pregnancy?
40-45% above prepreg level
blood glucose first day of life
40-60
How much pressure is required to inflate alveoli for newborns FIRST BREATH?
40-80 cm of pressure!!
Hydramnios, ml amount? 2 types?
> 2000 ml! Chronic: volume gradually increases Acute: volume increases rapidly (few days)
Pre op and post op considerations for fetus?
SHIELD THEM from x rays!!!!
Women of all child bearing age should be taking
400 mcg/day Folic acid
Late term
41 weeks to 41 weeks and 6 days
Postterm
42 weeks and beyond
Newborn Hematocrit
43-61%
A term infant needs how many calories per day?
45-50 kcal/lb
Average Length
45-55 cm (17.7-21.7 in)
What are the top 3 reasons for infant death?
SIDS Low Birth Weights Malformation
How long are sperm viable? When is the optimal time of fertilization?
48-72 hours, most fertile in the first 24
Mom loses ___ of sweat during labor and delivery
5 pounds
weight gain; maternal stores
5-10 pounds (nutrients, fats, extra fluids)
normal total serum bilirubin
5-7 mg/dl (sum of conjugated and unconjugated)
How much should infant height increase in the first year?
50% Ex. Birth height is 20 in. so at 1 year they should be about 30 in.
Fats are ___% of calories
50%, they are easily digested
Blood glucose of baby when it has stabilized
50-90
A breast feeding mother should add ___ cal to her diet
500
Lactating mothers add _____ cal to diet
500
How many calories should a lactating mother be eating?
500 kcal over their pre pregnancy diet!
At full term, how long is the umbilical cord?
55 cm and 2 cm in diameter
Newborn Red Blood Cell Count
6 million cells/mm3
When do infants develop the ability to adjust to cold?
6 months NOTE: here they develop the ability to shiver and they have developed additional adipose tissue to serve as insulation. Brown fat decreases as subcutaneous fat increases
How old before using sunscreen?
6 months!! NOTE: sun is most intense between 10AM and 3 PM
When does first baby tooth generally erupt?
6 months, followed by a new one monthly NOTE: it is typically a lower central incisor, but teething patterns can vary greatly among children
How long are car seats good for?
6 years GET RID OF IT if has been in a car crash
When should the umbilical cord fall off?
6-10 days
When is the first ultrasound performed?
6-10 weeks, to confirm pregnancy and determine gestational age
Respiratory rate for infant with transient tachypnea? When does it occur and how long does it last?
60-120 -they develop rapid respirations within hours after birth. Resolves within 12-72 hours.
Partial mole
69 chromosomes, partial fetal tissue present. (a normal ovum was fertilized by two sperm)
How long can it take for the babies umbilical cord to fall off?
7-10 days
When do chewing movements begin?
7-9 months, therefore foods that require chewing should not be introduced until then
How much amniotic fluid at 28 weeks?
700-800 ml (third trimester)
Mom is in the transition phase of labor, how much is she dilated? What are her contractions like?
8-10 cm Contractions ever 1.5-2 minutes and lasting 60-90 second..strong intensity:)
At what age can an infant independently drink from a cup?
8-10 months
An ultrasound is normally conducted at 2 times or 2 reasons, why?
8-12 week window to confirm pregnancy 18-22 week window for measurements
Doppler can detect fetal heart rate at..
8-12 weeks
fetal stage; heart tones can be heard
8-12 weeks
Range to start walking?
8-15 months but normal up to 22 months
Newborn Blood Volume
80-110 mL/kg OR about 300 mL
Neonatal BP
80/46 mmHg 100/50 mmHg by the 10th day
O2 stat for newborn
88-92 is okay
When can cow's milk be introduced?
9-12 months NOTE: curd is large and tough making it more difficult to digest
How much O2 do we give preterm newborns?
90% NOTE: oxygen should be warmed and humidified!
caloric intake necessary for preterm growth?
95-130 kcal/day
What do nurses base ethical decisions on?
A 4 topic ethical decision guide 1 medical indication 2 patient preference 3 quality of life 4 contextual (do they have insurance? is the hospital able to do it?)
Doula
A caregiver who provides continuous physical, emotional, and educational support for the mother before, during, and after childbirth.
Rh Incompatibility
A complication of pregnancy in which a mother who is Rh negative carries an Rh-positive fetus. Under certain conditions, antibodies in the mother's blood can attack the fetus's red blood cells, however, this rarely occurs anymore because now mom's can be injected with RhoGAM (passive Rh antibodies) within 72 hours after birth of Rh+ child and antibody formation will be halted to prevent sensitization.
Why might a mom have cardiac problems in pregnancy?
A compromised heart with inadequate cardiac capacity may not be able to handle the demands of pregnancy. Cardiac output has to increase by 30-50% by mid pregnancy.
Torticollis (Wry Neck)
A congenital abnormality that occurs when the sternocleidomastoid muscle is injured and bleeds during childbirth.
Imperforate Anus
A congenital defect in which the rectal opening is missing or blocked.
Listeriosis
A disease of the nervous system of humans that can cause fever, meningitis, miscarriage, or premature birth and is spread by eating food contaminated with listeria
Nevus Flammeus
A macular purple or dark-red lesion present at birth on the face or the thigh. Typically do not fade with age, but can be cosmetically removed
Newborn Apnea
A pause in respirations for longer than 20 seconds with accompanying bradycardia (may also be cyanosis). Common among preterm babies
Fetal Fibronectin
A protein produced by trophoblast cells that indicates contractions are ready to occur. Absence of these proteins indicates labor will not occur for at least 14 days
What is sickle cell anemia?
A recessive autosomal disorder in which normal hemoglobin is abnormally formed; in a sickle shape.
Seborrhea
A scaly scalp condition often called cradle cap Prevented by washing babies head every day or every other day
Simian Crease
A single straight palmar crease on contrast to the three creases normally seen in the palm.
Placenta
A structure that allows an embryo to be nourished with the mother's blood supply
chronic villus sampling (CVS)
A technique for diagnosing genetic and congenital defects in a fetus by removing and analyzing a sample of the fetal portion of the placenta
Missed Miscarriage
AKA Early Pregnancy Failure Fetus dies in utero but is not expelled. Mom may have had symptoms of threatened miscarriage or may have had none at all. After an ultrasound establishes fetus has died dilatation and curettage (D&C) or dilation and evacuation (D&E) is performed to remove the remaining products of conception.
Which glucose tests should you preload with carbs for and how many days before should you preload?
ALL OF THE GLUCOSE TESTS Should preload with carbs 3 days before
Babies with mom's who have heart disease are typically big or small?
SMALL, babies have intrauterine growth restriction and therefore will more than likely be born rather small.
Assessment in first four hours of life
APGAR physical assessment vital signs I&O
How will we know if the baby needs to be resuscitated?
APGAR scoring of 0-3 (severely depressed)
Before applying the cord clamp, what do we examine the cord for?
AVA artery vein artery
Treatment for Respiratory Depression
AVOID Narcan even if symptoms are from drug overdose as it has little effect and may cause seizures Focus on resuscitation and effective ventilation If HR is inadequate, maybe epinephrine Preterm infants may receive surfactant
Where do nurses get their practice standard from?
AWHONN
Leopold's Maneuvers
Abdominal palpations performed by physician to determine fetal presentation
Effects of Folic Acid-Deficiency Anemia on Mom
Abnormal formation of RBCs
Periventricular Leukomalacia (PVL)
Abnormal formation of white matter of the brain caused by an anoxic episode that interferes with a portion of the brain. Occurs most commonly in preterm infants who experienced cerebral ischemia. There is no treatment for this and it can result in long term effects such as learning disabilities or cerebral palsy.
Placenta Previa
Abnormal implantation of the placenta in the lower part of the uterus. This is the most common cause of painless bleeding in the third trimester of pregnancy. Caused by >> Advanced maternal age Past cesarean births Past uterine curettage Multiple gestation Male fetus Symptoms >> PAINLESS bleeding, bright red blood, soft uterus, FHR normal Treatment >> bed rest until fetal lungs mature, lateral position, monitor fetal HR and maternal vitals, Cesarean delivery if mom is complete previa
Meconium Aspiration Syndrome
Abnormal inhalation of meconium Meconium is present in the fetal bowel as early as 10 weeks gestation. If hypoxia occurs, a vagus reflex is stimulated and the rectal sphincter relaxes, releasing meconium into the amniotic fluid. This causes major problems if baby aspirates the meconium either in utero or with their first breath at birth. Baby who aspirated meconium will have a low APGAR score and almost immediately have tachycardia, retractions, and cyanosis
What is an aneuploidy?
Abnormal number of chromosomes.
When can Rh incompatibility occur?
Abortions Term pregnancies Amniocentesis Blood transfusion Trauma
When does pregnancy weight typically come off?
About 6 months
Agenesis
Absence of testes
4-7cm...what type of dilation?
Active
Prolactin
Acts on the acinar cells of the mammary glands to stimulate milk production
Characteristics of sickle cell anemia
Acute painful episodes jaundice high temp anemia
Intrapartum care for Mom's with Type I DM
Administer IV insulin in 5% glucose solution >> NO SUBQ insulin on day of delivery Keep glucose between 60-100, check hourly with finger-stick Assess ketones every 2 hours Continuous external fetal monitoring Position mom on the left side (especially if hydroaminos)
Treatment for Respiratory Distress Syndrome (RDS)
Administer surfactant at birth for at risk infants Administer O2 to maintain correct Po2 and pH Ventilation Administration of muscle relaxants, liquid ventilation, or inhalation of nitric oxide Extracorporeal Membrane Oxygenation >> rarely needed now because surfactant is so effective!! KEEP BABY WARM to prevent further acidosis and reduce metabolic oxygen demand.
Advantage and disadvantage of lumbar epidural?
Advantage: mom is awake and dose can be adjusted Disadvantage: may take up to 30 min to work and have to have a FOLEY
What race has the HIGEST mortality ratio?
African american women @ 42.8 per 100,000 live births
Menopause - pathophysiology
After 12 consecutive months of amenorrhea (no periods) Loss of ovarian function and hormonal deficiency. Leads to permanent amenorrhea. usually occurs ~ age 50
Chronic hypertension may turn into superimposed preeclampsia, how do we see if this is happening?
After 20 weeks we will check for proteinuria, worsening hypertension, and a rise in serum uric acid levels helps diagnose this
When should we begin weening off pacifier?
After 3 months, definitely by 6-9 months when sucking reflex starts fading
If the meconium is causing a partial obstruction...
Air can enter alveoli but not escape it
Treatment for Lung Expansion
Air or oxygen by bag. Ensure the mask fits snugly over the nose and mouth and oxygen should be warmed and humidified.
Hormones during menses
All hormone levels decrease
Complete Miscarriage
All products of conception (fetus, membranes, and placenta) are expelled spontaneously without any assistance. Bleeding usually slows within 2 hours and ceases within a few days.
Postpartum mood episodes with psychotic features
Also called postpartum psychosis
What are some common feelings of a woman in the first trimester?
Ambivalence Focusing on body changes Experiencing early S/S of pregnancy
What antibody has been found to make women more susceptible to thrombi formation, spontaneous miscarriage, fetal death and hypertension?
Antiphospholipid Antibodies (aPLAs) Women with these antibodies may be started on a prophylactic program of aspirin or subq heparin during pregnancy. Corticosteroids may also help to reduce formation of additional antibodies!
Antihypertensive medications given to women for severe pre clamp
Apresoline (hydralazine) Nifedipine (calcium channel blocker)
Why do doctors stop the mom from pushing, before that final push?
As soon as the head comes out the doctor suctions the mouth and nose really good!! Because the birth canal squeezes the chest on the final push and causes them to take the first breath. We want to be sure no meconium is in there
if the fundus rises and displaces to the right the nurse has to be worried about
As the uterus rises, the contractions become less effective and bleeding could occur The most common cause of this is bladder distention
What are some nursing care/interventions we are doing to the patient if she is in hypovolemic shock?
Assessing vitals ever 3-5 min -fundus assessment -check lochia -oxygen
AWHONN
Association of Women's Health, Obstetric and Neonatal Nurses
Landau Reflex
At 3 months infant's head, legs, and spine should extend when placed in the ventral suspension position Absent reflex indicates child has motor weakness, cerebral palsy, or another neuromuscular defect
Parachute Reaction
At 6 months infant extends arms to "protect" themselves when lowered toward an examination table
When do we start to tell mom to practice relaxation?
BEFORE labor or in early stages of labor
Severe preeclampsia BP levels
BP grater than 160/110, documented at least twice and six hours apart
Clinical therapy for oligohydramnios
BPP NST and ultrasounds Amnioinfusion during labor
A nurse is caring for a client in the obstetrical unit diagnosed with pregnancy-induced hypertension (PIH) and magnesium intoxication as a result of prolonged magnesium sulfate therapy. Which of the following medications should the nurse anticipate that the provider will prescribe?
Calcium gluconate
Norethindrone brands (progestin only)
Camila, Errin, Micronor, Nora-BE, heather, jolivette
What can cold stress do to RDS?
Can make it a lot worse!!! We gradually rewarm babies...because heating them quickly will stress them out
Potential Complications of LGA
Cardiovascular dysfunction >> watch for cyanosis Hypoclycemia >> large infants require large amounts of nutritional stores!
What test will you most likely draw if you suspect a baby with downs syndrome?
Cell free DNA testing, it detects 99% of fetuses affected
How do we manage the incompetent cervix?
Cerclage: purse string suture that ties it up. It is uncomplicated and elective! -emergency
Why might babies delivered cesarean and/or preterm have more difficulty establishing effective respirations?
Cesarean birth does not expel as much lung fluid Preterm babies lack pulmonary surfactant NOTE: fetal ducts and foramen ovale may also not close as usual!!
Vaginal birth or Cesarean birth preferred when a mom has complete previa?
Cesarean delivery!!
A nurse checks a postpartum client's peripad and finds a large amount of lochia rubra with several clots. What is the priority nursing action?
Check the fundus.
A nurse is caring for a client in active labor. Which of the following measures should the nurse include in the plan of care?
Checking the cervix prior to analgesic administration
Signs of Pulmonary Embolism
Chest pain Sudden onset of Dyspnea (SOB) Coughing Tachycardia Palpitations Dizziness / Fainting
Superimposed Hypertension
Chronic hypertension that is worsening with pregnancy (30/15 at 20 weeks). May see nondependent edema or proteinuria
Asphyxia results in what kind of changes to the babies body?
Circulatory changes Respiratory changes Biochemical changes
Moms will be hungry after labor..what kind of diet do we put them on?
Clear liquid diet especially if a C-section! The diet will be advanced.
What should we be inspecting with the newborns nares?
Clear of all mucus and make sure they are not occluded! They are nose breathers! Check palate for cleft palate
Transdermal estradiol/levonorgestrel
Climara Pro -- once weekly
Transdermal estradiol
Climara, Vivelle-dot, minivelle
Talipes Deformity
Clubfoot Requires treatment ASAP
Describe a cephalhematoma. What does the scalp feel like? How long does it take to heal?
Collection of blood resulting from ruptured blood vessels, appears in in the first of second day of life. -scalp feels loose and very edematous. DOES NOT cross the suture lines! -takes 2 weeks-3months to heal
Cephalohematoma
Collection of blood under the periosteum of the skull bone caused by pressure at birth (rupture of a periosteal capillary). Can result in jaundice!
Mongolian Spots
Collections of pigment cells (melanocytes) that appear as slate-gray (blue/purple) patches across the sacrum or buttocks and possibly on the arms and legs of newborns. Occur most often in children of Asian, Southern European, or African ethnicity. Disappear by school age without treatment.
How will we be assessing a baby at risk for asphyxia?
Combined monitoring of fetal pH and fetal HR, assess the need for resuscitation
Gestational Trophoblastic Disease
Condition in which trophoblastic tissue overtakes the pregnancy and propagates throughout the uterine cavity leaving little room for embryo to develop beyond the primitive start. Increases risk of coagulation problems >> PIH, DVT, DIC Occurs most often in >> Women who have low protein intake Women older than 35 Asian heritage Women with A blood who marry blood group O men Symptoms >> Bleeding in 1st trimester, excessive nausea and vomiting, abdominal cramping Treatment >> Comfort measures for cramps, Remove all of the extra tissue, PREVENT PREGNANCY FOR 1 YEAR, Check HCG every 2 weeks until normal and monthly levels after that, Methtrexate as prophylaxis for risk of choriocarcinoma if HCG levels are high
Transient Tachypnea of the Newborn (TTN)
Condition of rapid respirations (80-120 breaths/min) caused by retained lung fluid. May see mild retractions and some nasal flaring and feeding may be difficult. Occurs more often in cesarean births, infants whose mothers received extensive fluid replacements during labor, and preterm infants.
Potential Complications of SGA
Congenital anomalies >> related to poor nutritional intrauterine environment Poor circulation and Acrocyanosis >> related to polycythemia from anoxia during intrauterine life Hyperbilirubinemia >> also associated with polycythemia Hypoglycemia >> decreased glycogen stores
Fetal risks if the mom has GDM?
Congenital defects Macrosomia IUGR Delayed lung maturity (RDS) Hypoglycemia after birth
Anencephaly
Congenital deformity in which the cerebral hemispheres are absent.
A neonate's respiratory rate is irregular and 52/min with several periods of apnea lasting approximately 5 seconds. The neonate's color is pink with acrocyanosis. Which of the following nursing measures is indicated at this time?
Continue to routinely monitor the neonate.
While caring for a client who is having an induction of labor with oxytocin (Pitocin), which nursing assessment is appropriate?
Continuous fetal heart rate monitoring
In report, a nurse is told that a client is experiencing contractions that are 4 min apart. The nurse should expect which pattern when assessing the client?
Contractions that last for 60 seconds with a 3-min rest between
What type of surgery is done if there is an ectopic pregnancy?
Salpingostomy: cleans out the fallopian tubes
Occult Cord Prolapse
Cord lies beside or just ahead of the fetal head Place mom in lateral sims or trendelberg position Apply oxygen Prepare for an amnioinfusion
What do we give to help babies lungs develop if mom has severe pre clamp
Corticosteroids -betamethasone -dexamethasone
What other anticoagulant do we put moms on if they have had a DVT?
Coumadin -for 6 weeks to 6 months. It is safe for breast feeding, but we continue to monitor PT and INR
Acrocyanosis
Cyanosis in a newborn's hands and feet
menstrual cycle
Cycle during which an egg develops and is released from an ovary and the uterus is prepared to receive a fertilized egg.
When mom is getting up and walking to the bathroom, this is also a good time to check for what?
DVT! Ask mom if she is having any pain in her legs while walking
Managing Type II DM during Pregnancy
Decrease dietary fat Increase fiber Increase exercise Increase water intake Discontinue oral agents (metformin may be okay, proven safe during pregnancy) Use small amounts of long-acting insulin if necessary Utilize regular glucose monitoring
What are the insulin needs in the first trimester?
Decreases, because of NV and the embryo doesn't need a lot right now
How do we take a babies temp?
Deep auxiliary!! Should be 36.5 degrees C
Triggers of Sickle Cell Crisis
Dehydration Infection / Fever Strenuous Exercise High Altitude
Causes of transient tachypnea?
Delay in absorption of fetal lung fluids by the pulmonary capillaries and lymph vessels
What is a non-stress test (NST)? When is it performed?
Demonstrated the fetus's ability to respond to its environment by acceleration of FHR with movement -20 weeks
Potential Complications for Postterm Babies
Difficulty establishing respirations Polycythemia due to decreased oxygen Hypoglycemia and low levels of subcutaneous fat because they were used in utero May struggle with fine-motor skills
Physical signs of substance abuse
Dilated pupils evidence of needle track marks poor nutritional status slurred speech or staggering gate
Monophasic estrogen/progestin What does monophasic mean?
Same dose of hormone is released during the 21-24 active days
Popliteal Angle
Determined with the newborn flat on his back, flex the thigh on the abdomen and chest and extend the lower leg till resistance is met, measure angle.
Class H Diabetes
Diabetes leading to ischemic heart disease
Class R Diabetes
Diabetes leading to proliferative retinopathy
Class RF Diabetes
Diabetes leading to retinopathy and nephropathy
Risk factors for hypoglycemia
Diabetic mom Preeclampsia Make newborn SGA
Class F Diabetes
Diabetic nephropathy
How do we tell the mom to manage her diabetes?
Diet Medications Frequent blood and urine glucose Exercise Monitor for complications
If the placenta appears dark and bloody this is the
Dirty Duncan moms side
Maternal risks for multiple gestation
Discomforts: SOB, dyspnea on exertion, backache and pedal edema UTI, gestational hypertension, preeclampsia, placental disorder
Microcephaly
Disorder in which the fetal brain grows very, very slowly
Topical 17-beta-estradiol
Divigel (gel) Evamist (spray)
supine hypotensive syndrome
Dizziness and a drop in blood pressure caused when the mother is in a supine position and the weight of the uterus, infant, placenta, and amniotic fluid compress the inferior vena cava, reducing return of blood to the heart and cardiac output.
If CPR is not successful within the first 4 minutes..
Do a perimortem c-section
How do we diagnose ectopic pregnancy?
Do an ultrasound to find the egg in the fallopian tube
How much should baby weigh at 6 months?
Double birth weight!
When do you draw moms blood for cell free fetal DNA testing?
Draw moms blood after 10 weeks...only if theres an area of concern
What do we tell a mom to do before she comes in for her ultrasound? (Trans abdominal)
Drink 1- 1/2 quarts of water 1-2 hours before the ultrasound! DO NOT VOID
Glucose Tolerance Test (GTT)
Drink a really sweet orange drink and then check glucose 1 hour later, should be less than 135-140
Desquamation
Dryness, primarily on the hands and feet that begins to peel after about 24 hours. Postterm babies may have such dry skin that it has a leathery appearance with actual cracks in the skin folds.
What if pre and post ductal values differ greater than 3%?
ECHO
What are we watching for in a mom that has oligohydramnios?
EFM, watching for variable decelerations
What are the two screening tests for HIV/AIDS?
EIA- detects the antibodies Western blot test or IFA- confirms the result
Is early hemorrhage or late most common?
Early, aka within 24 hours
2 types of postpartum hemorrhage
Early: occurs within first 24 hours after birth Late: occurs after 24 hours after birth up to 6 weeks
An antepartum client tells the nurse that she has been vomiting her breakfast nearly every morning. Which measure will help the client overcome early morning nausea and vomiting?
Eating some crackers before rising from bed in the morning
Caput Succedaneum
Edema of the scalp at the presenting part of the head Disappears at about the third day of life with no treatment needed.
Ectopic Pregnancy
Egg implantation outside of the uterine cavity. Most commonly in the fallopian tube. Results in 9% of maternal deaths Symptoms >> Sharp unilateral or bilateral pain, lower quadrant tenderness, referred shoulder pain, vaginal bleeding, syncope, Treatment >> Methotrexate to destroy proliferating trophoblast, Mifopristone to induce sloughing at implatation site, Laparascopy to ligate bleeding vessels and remove or repair damaged fallopian tube, and RoGAM if Rh negative mom
Topical estradiol
Elestrin (gel)
Strawberry Hemangiomas
Elevated areas formed by a combination of immature capillaries and endothelial cells. Can be present at birth or may first appear up to 2 weeks after birth. May continue to enlarge up to 1 year of age and eventually shrink and disappear completely by age 10.
Labs for severe preeclampsia
Elevated creatnine and BUN Elevated liver enzymes Decreased platelets (less than 100,000)
Moms are at risk for UTI after birth. How can we help them avoid this?
Encourage them to empty bladder completely! Go when you feel the need. Remind them of S/S of a UTI
When is the baby most at risk against teratogens (substance abuses) ?
First trimester
Newborn assessment; resting posture
Have the baby lie undisturbed on a flat surface. The baby should exhibit hyperflexion of all 4 extremities. This means the baby is full term. If the baby is showing extension of the extremities, it is most likely a preterm baby
Large Gestational Age (LGA)
Greater than the 90th percentile AKA Macrosomia These babies appear deceptively healthy because of their weight but often have immature development. These are infants who have been subjected to an overproduction of nutrients and growth hormone. Commonly obese women or women with diabetes. Babies may show immature reflexes and low scores on gestational age in relation to their size.
Foods rich in Iron
Green leafy vegetables Meat Legumes Eggs Almonds Potatoes
Sources of Folic Acid
Green leafy vegetables Whole grains Liver Prenatal vitamins!
Neonatal sepsis can be caused by
Group B Strep Staph A MRSA E-coli Candida albicans (fungi)
Bifidus Factor
Growth-promoting factor in breast milk that interferes with the colonization of pathogenic bacteria in the gastrointestinal tract, thus reducing the incidence of diarrhea
Which immunoglobulins are transferred to baby through colostrum?
IgA DOES NOT cross the placenta, only passed through breast milk
1st produced by fetus at 10 15 weeks gestation
IgM
What are some common feelings of a woman in the second trimester?
Focusing on the fetus..changing diet? Introversion Changes in sexuality Body image..needs encouragement More physical evidence of pregnancy
Spermatogenesis
Formation of sperm
A nurse is caring for a neonate born to a mother who is addicted to crack cocaine. Which of the following nursing actions should be inconsistent with the goals of care?
Frequent stimulation
Newborn assessment; ear form and cartilage distribution
Full term baby will have a firm pinna and stands away from the head. The nurse will bend the ear towards the head and it should spring back quickly.
GTPAL system
G = gravidity (# of times pregnant) T = term (38-42 weeks) P = preterm birth (20-37 weeks) A = abortion (< 20 weeks) L = living children ex: woman who is pregnant now, has 2 children, one born @ 38 weeks, one @ 42 weeks = 32002
Pathophysiology of Hypertension in Pregnancy
Generalized vasospasms and vasoconstriction Loss of plasma proteins EDEMA Hypovolemia >> Resulting in less blood flow to the fetus resulting in growth restriction
When does late hemorrhage typically occur?
Generally peaks around 1-2 weeks after birth
What are 2 contributing factors to cervical insufficiency?
Genetic disorders Cervical Trauma Hormonal (biochemical)
How do you assess the square window sign? What does a preme look like and what does a full term look like?
Gently flex the babys hand toward the ventral forearm until resistance is felt. A 90 degree angle suggests an immature newborn 28-32 weeks. A 30-40 degree and is commonly found in newborns but a 0-15 degree angle occurs in full term and over babies
Square Window
Gently pull babies thumb to wrist. Term baby should be flexible, so they should be able to do this.
Class A1 Diabetes
Gestational diabetes that can be controlled by diet
Class A2 Diabetes
Gestational diabetes that requires medication to be controlled
Prenatal Teaching for Pregnant Women with Heart Disease
Get flu and pneumonia vaccines Get proper nutrition >> iron supplements, low sodium REST >> 10 hours at night, 30 mins after meals Be aware of anxiety >> Increases HR REPORT >> SOB, coughing, tachycardia, increased respirations, edema, decrease in urine output
How do you assess the scarf sign?
Have the newborn lying supine and draw their arm across their chest toward the opposite shoulder until resistance is met. Location of the elbow is then noted in relation to the midline of the chest. A preterms elbow will cross the midline of the chest, a full term newborns elbow will not
Preeclampsia also causes arterial vasospasm, causing what?
Head ache Visual disturbances Hyperactive DTR's Dyspnea
APGAR
Heart Rate Respiratory Effort Muscle Tone Reflex Irritability Color Rate 0-2 8-10 = No apparent distress 7 or less = resuscitation may be needed
If its a threatened abortion, what do we need to keep track of?
Her pads, if she's bleeding more this is a sign of worsening
Encephalocele
Herniation of brain tissues
Type I DM Complications during Second Trimester
Higher glucose after fasting and postprandial (after meals) Insulin needs increase - DOUBLE Fetal levels are about 80% of mom's
Benefits of delayed cord clamping
Higher hemoglobin levels, decreased iron deficiency anemia
Barlow Sign
Hip subluxation >> femur slips in and out of the socket Requires treatment ASAP
Ventral Suspension
Hold baby by abdomen, face down 1 month >> lift head momentarily and drop it again 2 month >> hold head in the same plane as the rest of their body 3 month >> lift and maintain head well above the plane of the rest of the body
Oxytocin
Hormone released when infant sucks on breast to release milk. Causes the "Let-down Reflex" Also causes smooth muscle contraction resulting in afterpains
Why do we give gonadotropins?
Human menopasual gonadotropins are indicated as a first line of therapy for infertile women with low to normal levels of gonadotropins. -It is a second line of therapy for women who fail to ovulate or conceive with clomiphene citrate
What milk is preferred for premes? What is not?
Human milk is the best, may have donor milk. DO NOT use a friends milk or something bought off Amazon lol
Management of Preterm Labor
Hydrate Bedrest Talk with patient about fetal maturity Corticosteroids if baby is 24-34 weeks >> Contraindicated if mom is bleeding, has infection, or is more than 5 cm dilated
2 types of vascular disease that can occur because of GDM
Hypertension Nephropathy: bc of renal impairment
Mild Preeclampsia
Hypertension (greater than 140/90 or elevated 30/15) on two occasions at least 6 hrs apart 1+ Proteinuria of 300gm in 24 hrs Minimal elevation of liver enzymes Edema Mild Headache and Irritability Map increased by 20 mmHg NOTE: This is really tough on the LIVER
Severe Preeclampsia
Hypertension (greater than 160/110) on two occasions at least 6 hrs apart 3+ to 4+ Proteinuria >> KIDNEY is suffering!! Weight gain of more than 2 lbs a week Generalized Edema Headaches Hyperreflexia, greater than 3+ Oliguria (low urine output) Right upper quad pain Visual changes >> blurred vision / spots LIVER enzymes are crazy Epigastric pain from liver swelling
If mom comes in complaining of visual changes and headaches..what do we assume?
Hypertension, until it is ruled out
A nurse is caring for a client in labor. An epidural block is administered during the intrapartum period for pain relief. Which of the following is a complication from the epidural block?
Hypotension
Effects of methadone on baby
IF the mom abruptly stops the durg, severe withdrawal symptoms can include -preterm labor -rapid labor -abruption -non-reassuring fetal status -meconium aspiration -small for age
Increases in Estrogen during pregnancy increase or decrease coagulation?
INCREASE, which increases risk of developing DVTs.
Nursing Interventions for Sickle Cell Crisis
IV Fluids Oxygen Analgesics Warm Compresses Antibiotics Transfusion to remove bilirubin AVOID Iron INTAKE Folic Acid to rebuild RBCs
What medications do we give to manage uterine atony?
IV: pitocin IM: methergine, hemabate, prostin
What is the first step for intimiate partner violence during pregnany?
Identify her!!! -screen for abuse on the first prenatal visit, at least once every trimester, and during the post partum period.
Rooting Reflex
If a newborn's cheek is brushed near the corner of the mouth they should respond by turning their head in that direction. Disappears during about the 6th week of life
When do we administer methotrexate?
If baby is 3.5 cm or less in size and fallopian tube does NOT rupture
Magnet Reflex
If pressure is applied to the soles of the newborns feet laying in a supine position he or she should push back against the pressure
Newborn assessment; areolae
If the newborn has a visible raised area greater than 0.75 c, probably full term. IF they have no breast tissue this often indicates premature or SGA
When can trauma to the birth canal occur?
If there if a large infant, difficult or rapid delivery, or they Dr used forceps or vacuum.
What is the number one reason we would do a BPP?
If there is a *nonreactive NST*
Magnesium Sulfate (MgSO4)
Indicated for managing preeclampsia, eclampsia (protecting mom's brain) >> secondarily it decreases BP and relaxes the smooth muscles of the uterus (stop / delay labor) ROUTE: IV pump AEs >> lethargy (this is GOOD), weakness, headache, hypotension, flushing, nausea, vomiting, decreased urine output, depressed deep tendon reflexes, decreased respirations, cardiac arrest MONITOR >> Vitals every 5-15 mins and then 30-60 mins paying special attention to respirations Deep tendon reflexes every hour Serum magnesium levels every 4 hours I&Os Dehydration (oral form may cause diarrhea) NOTE: keep mom NPO because this relxaes smooth muscles and could cause aspiration
Terbutaline (Brethine)
Indicated for preterm labor AEs >> Tachycardia, tremors, anxiety, headache Contraindicated with acute fetal distress, severe hypertension, vaginal bleeding, and cervical dilation of more than 6 cm
Typical Pattern for Introducing Solid Foods
Infant cereal mixed with breast milk, orange juice or formula Vegetables - at lunch time Fruit - one week after veggies Meat (when they can chew) - 6 months at dinner time Egg yolk - at the end of year 1 NOTE: introduce new foods one at a time and allow child to eat that same item for 3-7 days before introducing another new food
Primary Circular Reaction
Infant is exploring objects by grasping them and mouthing them but does not recognize the actions the cause and the actions that occur independently of them 3 months
Moro reflex (startle)
Infant reflex where a baby will startle in response to a loud sound or sudden movement.
Contraindications to Breastfeeding
Infant with galactosemia >> cannot digest lactose Herpes lesions on mom's nipples Maternal exposure to radioactive compounds Mom's receiving anti-metabolites, chemotherapeutic agents, or other harmful medications When environmental contaminants can be carried in breast milk Maternal active, untreated tuberculosis Mom positive for HIV Mom addicted to drugs NOTE: Smoking is not contraindicated, but protein may be less and amount may be less. Also, baby is exposed to second hand smoke which may cause respiratory distress
Infant Smell
Infants can smell accurately within 1 or 2 hours of birth!
Hand Regard
Infants holding their hands in front of their face and studying their fingers for long periods of time 3 months!!
Secondary Circular Reaction
Infants realize their actions can be repeated and they repeat them! 6 months
When do children start producing IgG?
Infants start producing their own IgG around 3 months. However, this DOES cross the placenta so baby is born with some
Amnioinfusion
Infusion of a sterile isotonic solution into the uterine cavity during labor to reduce umbilical cord compression.
Methods of inducing general anesthesia
Inhalation IV or both
Treatment for Hypoglycemia
Initially given 10% dextrose in water intravenously Sodium, glucose, and potassium are added as needed according to lab results
Blastocyst
Inner layer of cells that develops into the embryo
A client calls the antepartum clinic and tells the nurse "I became very dizzy while lying in bed this morning, but the feeling went away when I turned on my side." What is the appropriate nursing action at this time?
Instruct the client about vena cava syndrome and measures she can take to prevent it.
Type I DM Complications during Third Trimester
Insulin needs increase even further - TRIPLE Risk of ketoacidosis
3 types of anemia in pregnancy
Iron deficiency Sickle Cell Folic acid anemia
what mineral is low in breast milk?
Iron, can be absorbed 5x easier than formula though
Lactoferrin
Iron-binding protein in breast milk that interferes with the growth of pathogenic bacteria
What is the most common type of Anemia of pregnancy?
Iron-deficiency Anemia
What do we have to be careful with if baby is under light?
It doesn't actually generate heat, so make sure they are warm and shield their eyes
Why would we use the forceps?
It helps provide traction for the baby or rotate its head. We would do this if there is a threat to mother or fetus that can be relieved by birth. They are used to shorten the 2nd stage of labor.
Describe ruba lochia...when does it occur? What are some things to watch for?
It is RED, occurs 3-4 days post partum. May have some small clots..but if they are golf sized or bigger call doctor!
What do we tell moms about the transvaginal ultrasound?
It is a probe inserted 5-6 weeks after last menstrual period...EMPTY BLADDER!! these produce a cleared image :)
What is jaundice and how do we detect it?
It is first detectable on the face and the mucous membranes of the mouth
How do we diagnose the difference in chronic hypertension and gestational hypertension?
It is gestational hypertension if her BP returns to normal by 12 weeks postpartum
When are corticosteroids given and why?
It is given before labor and it to reduce chance of RDS, its administered with toclytics -given between 24-34 weeks
Peripartal Cardiomyopathy
Myocardial failure due to the stress of the pregnancy on the circulatory system. Occurs most commonly in African American multiparas in conjunction with gestational hypertension. CMs >> SOB, chest pain, nondependent edema, cardiomegaly (increased size of heart!)
Should you administer air under pressure to an infant born with meconium-stained amniotic fluid?
NO, air under pressure could push meconium down into the trachea and create a blockage. Wait for a laryngoscope to be inserted and the trachea to be deep suctioned.
Does baby immediately start gaining weight?
NO, baby loses 5-10% of total weight before they start gaining weight due to change in diet and losing heat/water. NOTE: Should regain this weight within 2 weeks! At 2 weeks should be back to birth weight
Do babies have Thermoregulation?
NO, it is very important to prevent heat loss by... Drying them off thoroughly Double wrapping them (2 blankets) Cover head with hat Keep them under radiant heater when assessing
Can a woman taking Heparin receive an epidural?
NO, routine episiotomies and epidurals are contraindicated in women taking Heparin due to possibility of hemorrhage.
Do nurses get consent?
NO- it is not the nurses job to get consent but to inform the patient of the procedure and follow up questions they might have.
Examples of subjective changes in pregnancy?
NV urinary frequency breast tenderness amenorrhea excessive fatigue quickening
Common discomforts of pregnancy; 1st trimester (7)
NV urinary frequency fatigue breast tenderness leukorrhea- increases vaginal discharge nasal stuffiness and epitaxis ptyalism- excessive bitter saliva
Hyperemisis Garvidarum
NV so severe that it effects the moms nutritional and hydration status
How do we teach moms to avoid NV? Heartburn? Constipation?
NV: avoid spicy foods, limit caffeine, encourage small frequent meals, eat crackers before you get up, drink lots of fluids! Heartburn: watch for those spicy foods, sit up 30 min after eating. Take tums!
What reversal agent do we want at the bedside at all times?
Narcan
Quadriphasic estrogen/progestin brand
Natazia
What is a spontaneous abortion?
Naturally occurring abortion before 20 weeks or if baby weights less than 500 grams
Type I DM Complications during First Trimester
Nausea and vomiting may lead to insulin shock Lower fasting glucose
Biphasic estrogen/progestin brand
Necon 10/11
Effects of Folic Acid-Deficiency Anemia on Baby
Neural tube defects Abdominal wall defects
Prone Position
Newborn >> can turn head when breathing is impaired but cannot hold head up for extended period of time 2 months >> can raise head and maintain position 4 months >> can lift their chest off the ground, look around, and can turn from front to back 9 months >> baby can "creep" / crawl NOTE: babies typically turn front to back first
Trunk Incurvation Reflex
Newborn is lying in a prone position and probed on one side of the abdomen with a finger. Newborn should flex and trunk should swing toward the touch
Erythemia Toxicum
Newborn rash that presents as pinpoint lesions with a lack of pattern. Appears in the 1st to 4th day of life (or up to 2 weeks) and stays for 2-3 days. Does not require treatment.
Meconium
Newborn's first stool! Should be passed within the first 24-48 hours Odorless, sticky, tar-like, blackish-green material formed from mucus, vernix, lanugo, hormones, and carbohydrates
Palmar Grasp Reflex
Newborns grasp an object placed in their palm by quickly closing their fingers around it Disappears at about 6 weeks to 3 months. After it fades baby begins to grasp meaningfully.
Step Reflex / Placing Reflex
Newborns held in a vertical position with their feet touching a hard surface will take a few quick, alternating steps Disappears by 3 months
Is there a heartbeat for a molar pregnancy?
No
Will women with severe preclamp be urinating normally?
No they will have oliguria -less than 500 ml in 24 hours
A nurse is caring for a client in the outpatient surgery hospital who has had a dilation and curettage (D&C). The primary care provider states that the client can go home in 6 hr postoperatively. Which finding should the nurse report to the provider prior to discharging the client?
No voiding since surgery
Do we give RhoGAM if mom is Rh- and fetus is Rh- ?
No, no action is needed.
Potential Complications for Preterm Babies
Normocytic Anemia Acute Bilirubin Encephalopathy >> the destruction of brain cells by invasion of indirect bilirubin Persistent Patent Ductus Arteriosus >> these babies lack surfactant so lungs are noncompliant, leading to pulmonary hypertension which interferes with the closing of the Ductus Arteriosus Periventricular / Intraventricular Hemorrhage >> bleeding into the tissue surrounding the ventricles because of fragile capillaries and immature cerebral vascular development
When can bottle be offered if baby is breastfeeding?
Not until 4-6 weeks of age OR after infant is thoroughly accustomed to breastfeeding.
When should a nulipara come into the hospital- based on contractions?
Nulipara means a first time mom, she should come when her contractions are 5 minutes apart for an hour
Fertility rate
Number of live births per 1000 women 15-44 years of age
Women often get hemorrhoids during 2-3 trimester, how can they help them?
OTC meds, sitz baths
Management for Premature Rupture of Membranes
Observe for infection Administer corticosteroids Administer tocolytics Discharge if afebrile and no labor >> TEACH to check fever every 4 hours and vaginal rest Deliver if fetal lungs are developed
Harlequin Sign
Occasionally when a newborn has been lying on one side that side appears red while the opposite side appears pale. This is NORMAL with no clinical significance and occurs due to immature blood circulation.
Postpartum Depression
Occurs in 10-20% of mothers, anytime after delivery and can last a year This presents as excessive preoccupation, may have intrusive thoughts of harming baby, and interferes with mom's ability to take care of herself Symptoms >> restlessness, irritability, anxious, sad, hopelessness, guilt, worthlessness, eat too much or too little, sleep too much or too little, trouble making decisions or focusing, withdrawal REPORT >> crying A LOT, no motivation or energy, loss of pleasure or interest in activities, chest pain, palpitations
Postpartum Blues
Occurs in about 80% of mothers, 3-5 days postpartum, symptoms PEAK on 4th or 5th day May see spontaneous remission within 2 weeks This DOES NOT interfere with baby care!! Symptoms >> Mood swings, irritability, tearfulness, anxiety
Anemia in pregnancy
Occurs when a woman has haemoglobin levels below 11.0 g/dl during pregnancy.
What is the tonic neck reflex?
Occurs when newborn's head is turned to the side, the arm on that side will extend while the opposite arm will contract
Spina Bifida Occulta
Occurs when the posterior laminae of the vertebrae fail to fuse. This is simply a surface of bone missing, but the spinal cord is intact
abruptio placentae risk factors
Older moms Increased parity Hydramnios Multiple gestation Previous abruption Low economic status Male fetus
Risk factors for chronic hypertension
Older mothers (35+) Obesity Diabetes
Newborn Urine Output
Only about 15mLs and odorless 30-60 mL daily for the first few days. After about 1 week total volume increases to 300 mL FIRST voiding may be pink or dusky due to uric acid crystals, NOT BLOOD and harmless
How long should a mom breast feed? And when should she introduce solid food?
Only breast milk for 1st 6 months, introduce solid foods at this time. You can keep breast feeding up until 1 year.
Class C Diabetes
Onset of diabetes between 10-19 OR duration is 10-19 years OR both
Class D Diabetes
Onset of diabetes is after age 10 OR duration is less than 20 years OR both
Class B Diabetes
Onset of diabetes occurred after age 20 OR duration is less than 10 years
Preterm Labor
Onset of labor between 20-37 weeks Associated with dehydration, UTI, periodontal disease, chorioamnionitis, and large fetus. Symptoms >> persistent dull and low backache, vaginal spotting, feeling pelvic pressure or abdominal tightening, menstrual-like cramping, increased vaginal discharge, uterine contractions, and intestinal cramping
Foramen ovale
Opening between the right and left atria Begins to close after babies first breath when pressure on the left side is greater than the right
What do we teach our mom's to take their iron supplement with?
Orange juice or a Vitamin C supplement! Iron is absorbed best in an acidic medium.
Triphasic estrogen/progestin brands
Ortho Tri-cyclen Necon 7/7/7 Cyclessa Trinessa
Symptoms of Left-sided Heart Failure during Pregnancy
Orthopnea >> unable to sleep unless chest and head are elevated Paroxysmal Nocturnal Dyspnea >> waking suddenly at night with shortness of breath
S/S of UTI
Over distention Dysuria Urgency Frequency Suprapubic pain Hematuria
Treatment for Apnea
Placement of laryngoscope into the airway
Premature Separation of the Placenta (Abruption / Abruptio Placentae)
Placenta suddenly begins to separate and bleeding results. This generally occurs late in pregnancy and is the most frequent cause of perinatal death. Cause is unknown but could be related to >> Hypertension High gravidity Trauma Short umbilical cord Cocaine or cigarette use Symptoms >> bleeding, uterine tenderness, abdominal pain, board-like abdomen, increase in FHR Treatment >> Fluid replacement, Oxygen, Place mom in lateral (not supine) position, monitor fetal heart sounds and maternal vitals every 5-15 mins
Causes of Asymmetric IUGR?
Placental infarcts preeclampsia poor weight gain
Why is chronic hypertension during pregnancy risky?
Places both mom and baby at high risk because of poor heart, kidney, and placental perfusion. Can be managed with beta-blockers and ACE inhibitors to reduce BP by causing peripheral dilation.
Milia
Plugged or unopened sebaceous glands that look like pinpoint white papules on cheeks and nose of newborn. Disappear by 2-4 weeks of age as sebaceous glands mature.
Symptoms of Diabetes
Polyphasia Polyuria Polydipsia Unexplained weight loss
What are the 4 cardinal symptoms of diabetes
Polyuria Polydipsia Polyphagia Weight Loss: from the use of fat and muscle lost, seen in type 1
Signs of thermoregulation problems in preterm
Poor feeding Lethargy Poor muscle tone Mottled skin Hypoglycemia and RDS
Name the three stages of human development
Preembryonic Embryonic stage Fetal Stage
Moms may experience decreased attention, concentration, and memory during and short after pregnancy
Pregnancy brain! Should all go away
Oral conjugated equine estrogen
Premarin
Menopause hormone therapy Oral estrogen/progestin - generics
Premarin/provera estradiol/norethindrone esterified estrogens/methyltestosterone
Craniosynostosis
Premature closure of the sutures of the skull.
Oral premarin/provera
Prempro, premphase
When do children start producing effective levels of IgA, IgE, and IgD?
Preschool age
Newborn assessment; female genitals
Preterm newborn has a prominent clitoris and the labia majora are widely separated. A full term baby will have larger labia majora that covers the clitoris.
What is the goal if mom is in preterm labor?
Prevent it from passing the point that it no longer responds to medical treatment
Therapeutic management of hyperbilirubinemia
Prevent it!! -prevent bruising (can make bili go up) -phototherapy -exchange transfusion
Macrophages in Breast Milk
Produce interferons >> proteins that protect against viruses by interfering with their growth.
Fetal complications if hydramnios?
Prolapsed cord Malpresentations Preterm labor
Micronized progesterone
Prometrium
Intrapartum Care for moms with Heart Disease
Prophylaxis of infection! Vaginal delivery REGIONAL Anesthesia Left lateral HOB elevated Avoid valsalva maneuver Use a vacuum or forceps to prevent mom pushing too hard
Leukocytes in Breast Milk
Protect against common respiratory infectious invaders
Two things that promote healing
Protein Vitamin C
Lactalbumin
Protein present in breast milk
Meningomyelocele
Protrusion of the meninges AND the spinal cord This is most common birth defect affecting the nervous system Child will have partial or complete paralysis, partial or complete loss of sensation of the lower extremities, and loss of bowel and bladder control.
Meningocele
Protrusion of the meninges, generally in the lumbar region.
Medroxyprogesterone Acetate
Provera
Newborn assessment; head lag
Pull the newborn to a sitting position and noting the degree of head lag. Total lag is common in newborns up to 34 weeks. Full term can support their head momentarily
What are the normal vital signs for a newborn?
R: 30-60 HR: 120-160 T: 97.8
What can Group B Strep cause
RDS, meningitis
What side does the placenta normally come out on?
Schultz-shiny baby side
Cavernous Hemangiomas
Raised, irregular hemangiomas caused by dilated vascular spaces. These DO NOT disappear with time and will be permanent marks, unless surgically removed. Children with these kind of skin lesions may have additional lesions on internal organs such as the spleen or liver. Blows to the abdomen may cause internal bleeding so these kiddos have their hematocrit levels assessed regularly.
Nonfasting Plasma Glucose
Random blood sugar checks should be below 200
What is the most common position used during labor?
Recumbent
Postpartum care for Mom's with Type I DM
Reduce insulin dose until Human Placental Lactogen (HPL) clears Encourage ADA diet Recommend Breastfeeding Discuss contraception >> low dose of oral, barrier contraceptives, or IUD if vascular complications but no infection
General Management for Pregnant Women with Heart Disease
Reduce unnecessary cardiac work Avoid weight gain Manage arrhythmias Improve cardiac output >> DIGOXIN Stop oral anticoagulants >> subq heparin if you HAVE TO Wear support hose for chronic insufficiency
Babinski reflex
Reflex in which a newborn fans out the toes when the sole of the foot is touched
sucking reflex
Reflex that causes a newborn to make sucking motions when a finger or nipple if placed in the mouth
Why do moms have a waddling gate?
Relaxation of the pelvic joints
Advantages of Breastfeeding for Mom
Release of oxytocin aids in uterine involution May prevent breast cancer and ovarian cancer Helps lose weight May delay menstruation / family planning Empowering, only woman can do this Reduces cost and preparation for feeding Decreased risk of hip fractures and osteoporosis Enhances bond with baby
Newborn assessment; sole creases
Reliable indicators of gestational age in the first 12 hours of life! Few creases and a slick heel indicated that its preterm. Deep sole creases down to the heel indicates that baby was full-term
Tocolysis
Repressing uterine contractions Meds commonly used >> Mag Sulfate Beta-adrenergic receptors Calcium channel blockers Prostaglandin synthase inhibitors Antibiotics
Lactiferous Sinuses
Reservoirs for milk located right behind the nipple
Respiratory Distress Syndrome (RDS)
Respiratory disorder in which a fibrous membrane begins to line the terminal bronchioles, alveolar ducts, and alveoli. This membrane interferes with effective oxygenation. Occurs due to a low level or complete absence of surfactant (forms around 34 weeks gestation). Most common in preterm infants, infants with diabetic moms, cesarean births, and any infant with decreased blood perfusion to the lungs.
A mother at 34 weeks of gestation receives magnesium sulfate to treat severe pregnancy induced hypertension (PIH) and 26 hr later the client delivers by cesarean birth. Which of the following clinical findings should the nurse who is caring for the newborn anticipate as a result of the magnesium sulfate therapy?
Respiratory suppression
Why does nasal stuffiness and epistaxis occur during pregnancy? How can they ease this?
Result of increased blood supply to the mucus membranes, and a result of increased estrogen -cool mist humidifies, saline drops, rest
Incomplete spontaneous abortion
Retained some products..most likely the placenta
Brown Adipose Tissue (BAT)
Rich fat that acts as a source of heat unique to neonates that is capable of greater thermogenic activity than ordinary fat Deposits are found around the adrenals, kidneys, and neck, between the scapulae, and behind the sternum for several weeks after birth Makes up 2-6% of body weight Preterm babies have much less of this because it is made during weeks 26-30 through 2-5 weeks after birth
Late preterm infant characteristics
Risk for RDS Transient tachypnea Apnea of preme Difficulty regulating temp Hypoglycemia Hyperbili Seizures Feeding difficulties Long term neuro probs
Fetal risks of folic acid def
Risk for infection Neuro tube defects
Maternal complications of PROM or PPROM
Risk for infection: chorioamnionitis Preterm birth
Fetal risks for sickle cell anemia
Risk of death due to RBC sickling in the placenta, they may have a risk of prematurity and IUGR
quadruple screen (name the 4 tests) and when is it run?
Run during 15-20 weeks -AFP: alpha fetoprotein -hCG: human chorionic gonadotropin -UE: unconjugated estriol -Inhibin A: a placental hormone
Treatment of Meconium Aspiration Syndrome
Suction with a bulb at the perineum during birthing process Amnioinfusion in utero to dilute the amount of meconium in the amniotic fluid Schedule cesarean birth After birth, tracheal suction, oxygen administration, and assisted ventilation Antibiotics to prevent secondary infection
Cephalohematoma
Swelling caused by bleeding between the osteum and periosteum of the skull. This swelling does not cross suture lines.
What are subjective (presumptive) changes?
Symptoms that the women experiences and reports ---> does not guarantee pregnancy!
external monitor to assess contractions and FHR
TOCO
What is Erikson's Developmental Task of the Infant Period?
TRUST
Progestin only late or missed dose - counseling
Take ASAP continue rest of pack on schedule (may have to have 2 tabs in one day) Back-up needed until 2 doses have been taken on time for 2 consecutive days
Nursing management/monitoring an abortion?
Take VS and FHR -*assess bleeding* -assess labs -bed rest and abstinence from coitus
Estrogen/progestin missed > 2 doses - counseling
Take rest of pack on schedule (may have to have 2 tabs in one day) Back-up needed for 7 days Consider emergency contraceptive **varies with diff brands**
When the head finally emerges, we ask the mom to do what?
Take shallow breaths to stop from pushing, the babies mouth is being cleared out to take the first breath
Who waits the longest to get prenatal care?
Teenagers
Acrocyanosis
Temporary cyanotic condition, usually in newborns resulting in a bluish color around the lips, hands and fingernails, feet and toenails. May last for a few hours and disappear with warming.
Cardiac Disease Infants
Tend to have low birth weights or are small for gestational age because of acidosis (poor oxygen / carbon dioxide exchange) Preterm labor is common
Ectopic Testes
Testes are present in the abdomen but cannot enter the scrotum because the opening to the scrotal sac is closed.
What is the Group B strep screening?
Tests for Group B steptococcus. This can cause serious problems for the newborn. Rectal and vaginal swabs of the mother are obtained at 35-37 weeks to screen for infection.
How long does the clamp stay on the babies umbilical cord? And what is it called?
The Hollister clamp stays on for 24 hours to keep baby from bleeding out
Binocular Vision
The ability to focus the two eyes in a coordinated manner in order to see one image 2 months!!
Placenta Previa
The abnormal implantation of the placenta in the lower portion of the uterus
asphyxia causes what kind of circulatory changes?
The baby will have the inability to cope with extrauterine circulation, so it will result to trying to fall back to fetal circulation
Family Adaptation
The capacity of the family and its members to modify their behavior to each other and their outer world as the situation demands
What causes eclampsia?
The cerebral edema
What is colostrum? Describe it
The first milk! It is thin and may appear yellow or blue, it is high in protein. Moms may start to leak in the third trimester..tell them to wear a good bra
How do you palpate the fundus?
The left hand is placed above the pubic symphysis, gently pushing down and up, and the right hand is cupped around the uterine fundus
What regulates blood glucose in baby for first 26-40 weeks?
The liver, it is stored as glycogen in the fetal liver
Eclampsia
The most severe classification of gestational hypertension where cerebral edema is so acute grand mal (tonic-clonic) seizures or coma occur. H&H elevated, liver enzymes elevated, decrease in thrombocytes Plasma volume is reduced and generalized vasoconstriction occurs Liver is at risk for rupture Glomular filtration rate decreases due to little perfusion and risk of kidney failure Pulmonary edema occurs and risk of PE increases This is LIFE THREATENING for mom and baby. Damage that occurs can be permanent.
Cervix
The opening to the uterus
Androgens
Use: - senile osteoporosis and anemia - main use is replacement therapy in test. deficiency
Tamoxifen
Use: approved for treatment of breast cancer and prevention of breast cancer in high risk women - not approved for osteoporosis
Raloxifene
Use: prevention and treatment of osteoporosis in: - postmenopausal women at high risk of breast cancer - postmenopausal women who cannot take bisphosphonate - women in 50/60's concerned about bisphosphonates Drug interactions - Bile acid resins - Warfarin - Thyroid hormones
Ospemifene
Use: treatment of moderate to severe dyspareunia caused by valvular and vaginal atrophy - not approved for osteoporosis Adverse: - hot flashes - CV risk - endometrial cancer risk - should not be given with estrogen products
Flibanserin (Addyi)
Use: treatment of premenopausal women with acquired, generalized hypoactive sexual desire disorder (HSDD) - taken daily at nighttime
What is a missed abortion?
When the fetus dies but does not expel
What is an ectopic pregnancy?
When the ovum implants outside of ther uterus!! Most often in the fallopian tubes
ABO Babies
Usually occurs due to O mom and A or B baby Baby can be born jaundice (high risk!!)
Causes of early postpartum hemorrhage?
Uterine atony (boggy) Trauma to birth canal (twins?) Hematomas Retained placenta fragments Uterine inversion or rupture Coagulation abnormalities
What are some maternal considerations we are checking on if she is on mag?
VS, I&O, DTR's
Vaginal estradiol brand and dosing
Vagifem (tablet) -- twice weekly
Threatened Miscarriage
Vaginal bleeding, initially only scant and usually bright red. Mom may experience some cramping but no cervical dilation and no passage of tissue or fluid. Avoiding strenuous activity for 24-48 hours is the key intervention. If bleeding is going to stop, it should stop in these 24-48 hours. Coitus is restricted for 2 weeks to prevent infection and avoid inducing further bleeding. 50% continue the pregnancy.
Vaginal or cesarean delivery preferred for Moms with Eclampsia?
Vaginal delivery preferred
Contraindicated with Abruptions and Previa
Vaginal exams Rectal exams, enemas, suppositories Leopoid maneuvers Internal monitoring
Cesarean or Vaginal delivery preferred for mom with Heart Disease?
Vaginal, cesarean increases cardiac workload (according to baton)
History signs of substance abuse
Vague or unusual complaints family history of addiction history of childhood abuse
What is supine hypotension, or vena cava syndrome? How can we help this?
Vena cava is suppressed when mom is laying down, the decreased blood flow causes her BP to drop. She may get pale, clammy, or dizzy. -don't lay flat! Lay back on pillows
What vitamin is now recommended for breastfed babies?
Vitamin D >> 400 International Units per day
Moms in third trimester may feel some of these emotions...
Vulnerability..worried about baby forming? Dependence...worries about partner Preparation for birth...very excited about L&D but anxious about epidural!
What are the maternal risks for HIV?
Wasting syndrom esophageal candidiasis herpes simplex virus vaginal candida infections
vernix caseosa
Waxy or "cheesy" white substance found coating the skin of newborn humans
While we are waiting for the signs of placental separation, what are we doing?
We are palpating the uterus! Checking for bogginess and fullness caused by uterine relaxation and bleeding int he uterine cavity ----> we want the uterus to feel firm
What do we do about the breast fessing/vaginal delivery problem when a woman has HIV?
We discourage breast feeding, and we will encourage an elective c-section
What is the goal for oxytocin infusion?
We want mom to be having 3 contractions, lasting 40-60 seconds, in 10 minutes
Why do we promote activity in pregnant women?
We want them to do light activity!! Theres a lot of benefits- reduces blood clots, circulation, constipation, excessive weight gain, and improves sleep
How do we manage the hypovolemic shock?
We want to control the bleeding -prevent it from becoming irreversible -IV fluids to maintain urine output of 30ml/hr
How do we provide clinical therapy if mom has a psychologic disorder?
We want to provide strategies that will decrease anxiety, keep her orientated to reality and promote optimal functioning
How do we manage sickle cell anemia?
We will look at folic acid supplements, we will aggressively treat maternal infection bc fever and dehydration causes an exacerbation of the sickling.
Babinski Reflex
When the sole of a newborn's foot is stroked in an inverted "J" curve from the heel upward, the newborn should fan the toes Diminishes after about 3 months
What is a "threatened" spontaneous abortion?
When there is unexplained bleeding, cramping and backache *cervix is closed*
What are 4 tips to give a mom when breast feeding?
Wear a well fitted bra Teach them breast care Encourage her to nurse on demand q 2-4 hours Nurse BOTH breast with each feeding
Syndactyly
Webbed fingers or toes
What test are we doing on babies for moms with HIV?
Weekly NST after 32 weeks: we are looking for IUGR
Menopause hormone therapy transdermal estrogen - dosing
Weekly or twice weekly apply to lower abdomen, below waistline
Very-Low-Birth-Weight Infant
Weigh 1000-1500 g at birth
Extremely-Low-Weight Infant
Weigh 500-1000 g at birth
Low-Birth-Weight Infant
Weigh less than 2500 g at birth
High-risk Pregnancy
When a concurrent disorder, pregnancy-related complication, or external factor jeopardizes the health of the woman, fetus, or both. Can be result of smoking, drugs, no prenatal care, environmental toxin, occupation risk, lack of finances, no transportation, high altitude, sexual abuse, limited education, partner abuse, disruptive family, etc.
Hemolytic Disease of the Newborn / Erythroblastosis Fetalis
When a fetus becomes deficient in RBCs due to isoimmunization that sufficient oxygen transport to body cells cannot be maintained.
Miscarriage
When a fetus is delivered before 20 weeks
Crossed Extension Reflex
When a newborn is laying supine with one leg extended, the extended foot is irritated and the other leg should extend as if to push away the stimulus.
Sucking Reflex
When a newborn's lips are touched the baby makes a sucking motion Begins to diminish at about 6 months
Complete spontaneous abortion
When all products of conception are expelled
Describe Rh incompatibility
When an Rh- mother has a Rh+ fetus, when the first baby is born she becomes "sensitized" and now her body will attack the second Rh+ baby and cause hemolysis in the fetus. We give them *rogam* to prevent this
What is the suckling reflex?
When an object is placed on the newborns mouth, they suck even while sleeping. It can have a quieting effect on the baby.
Plantar Grasp Reflex
When an object touches the sole of a newborn's foot at the base of the toes, the toes grasp in the same manner at the fingers. Disappears at about 8-9 months in preparation for walking
Kernicterus? What can it cause?
When bilirubin is so high it cross the blood brain barrier and is V BAD! -cerebral palsy, intellectual ability, heating loss, neuro probs
What is an "imminent" spontaneous abortion?
When bleeding and cramping increases *cervix begins to dilate, possible ROM*
Gestational hypertension
When blood pressure rises after 20 weeks gestation, NO PROTEIN IN URINE or other symptoms of preeclampsia
Nocturnal Hypoglycemia
When blood sugar drops during sleep often resulting in nightmares, tossing, turning, and headaches. Really tough on mom and baby!!
What is transitional milk?
When colostrum is changing to mature milk. (32-96 hours post partum)
Postterm Syndrome
When fetus begins to lose weight after 40 weeks because placenta is no longer efficiently carrying nutrients
preeclampsia
When hypertension develops in the last half of pregnancy
Tonic Neck Reflex
When newborns lay on their backs they usually turn their head to one side or the other. The arm and the leg on the side toward which their head is turned extend while the opposite arm and leg contract Disappears between months 2 and 3
What is palmar grasping reflex?
When something touches infants' palms, they grip it tightly.
What is the Babinski reflex?
When stroking the sole of the foot causes toes to hyper extend - disappears after age of 1
Acute Bilirubin Encephalopathy / Kernicterus
When too much bilirubin begins to interfere with the chemical synthesis of brain cells, resulting in permanent cell damage. Can result in permanent neurologic damage, including cognitive challenges and vision and hearing disorders.
Vernix Caseosa
White, cream cheese-like substance that serves as skin lubricant in utero. Color is significant because it takes on the color of the amniotic fluid >> yellow implies excessive bilirubin or blood dyscrasia, green suggests meconium.
Crying state
Will occur of active alert state is NOT responded to! May be difficult to comfort
When do we send the placenta to be examined by pathology?
With EVERY high risk pregnancy
Arm Recoil
With infant supine, fully flex both forearms on upper arms and hold for 5 seconds. Pull down on hands to extend fully, and rapidly release arms. Observe rapidity and intensity of recoil to a state of flexion. A brisk return to full flexion = score 4
Appropriate Gestational Age (AGA)
Within the 10th and 90th percentile
Are murmurs and palpitations normal in pregnant women?
YES, functional or transient murmurs are heard in many women WITHOUT heart disease in pregnancy due to increased blood flow past valves. Heart palpitations upon sudden exertion are also common!
Can women with artificial heart valves have successful pregnancies?
YES. They are typically switched from Warfarin / Coumadin to a low-molecular-weight Heparin (category C) before becoming pregnant and during pregnancy. Continuous anticoagulant therapy can cause placental dislodgement, so these mom's need to be observed closely.
Does cold stress make RDS worse?!?!?!
YESSS
Physiologic Jaundice
Yellowing of skin, sclera, and mucous membranes due to increased numbers of red blood cells being hemolyzed following birth. NORMAL for baby 2-3 days old to have jaundice as a result of the breakdown of fetal RBCs
Should a woman still continue prenatal vitamins?
Yes and iron!
Do moms still take prenatal vitamins PP?
Yes! 2-3 months
Do we give RhoGAM is mom is Rh- and fetus is Rh+ ?
Yes, 300 micrograms of RhIgG must be given within 72 hours
Do the HIV antibodies cross the placenta? What will we do for the babies testing?
Yes. All babies born to HIV moms will test positive at birth. IT takes 15-18 months for the antibodies to get out of the body, we will then test them again.
Can moms use tap water to dilute formulas?
Yes..unless well water -sterilize water and bottles if well water or source is questionable
rooting reflex
a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple
circumoral cyanosis
a bluish discoloration around the mouth
What is a doula?
a caregiver who has experience with laboring women, and she is hired by the family. Her job is to decrease the womans anxiety.
A pregnant client is admitted with a diagnosis of preeclampsia. The provider orders an IV solution with 4 g of magnesium sulfate. The nurse realizes that magnesium sulfate will be administered because it is used as
a central nervous system (CNS) depressant.
Subfertility
a couple who has difficulty conceiving because both partners have reduced fertility
linea nigra
a dark line appearing on the abdomen and extending from the pubis toward the umbilicus
What is the Harlequin sign
a deep red color develops over one side of the babies body while one side remains pale. It can occur multiple times, we must document the occurances
What is gestational trophoblastic disease?
a pathologic proliferation of trophoblastic cells (can be hydatidiform mole, invasive mole, choriocarcinoma)
When a nurse assesses a client on the first postpartum day, findings include fundus firm and one fingerbreadth below and to the right of the umbilicus, lochia rubra with small clots, temperature 99.2° F, and pulse rate 52/min. The appropriate initial nursing action is to
ask the client when she last voided.
How do we prevent hemorrhage?
assess the fundus keep bladder empty massage fundus if boggy administer oxytocin
Accupressure
associated with shorter labor and lower pain scores
When would we do a contraction stress test?
at 28 weeks
Where is the fundus 6-12 hours after delivery?
at the level of umbilicus
BUBBLEHE; emotional status
attachment should be observed, verbalize how to take proper care of baby. Some anxiety is normal.
Retinopathy of prematurity in the new born, who does it occur in?
babies 1250 grams and less, or 31 weeks gestation or less
Quiet sleep state
babies are in a deep sleep with no eye movements and have decreased respirations and movements..they have little to no response to stimuli
Matching ID bands are placed on
baby and parents or care givers
Second period of reactivity
baby is awake and responsive, they will normally pass their first stool now!
Puerperal infection
bacterial infection after childbirth
When administering medications to help with cervical ripening, what are we checking?
baseline VS EFM, reactive NST monitor for uterine hyperstimulation
When do a lot of newborns experiance cold stress
bath time -gather supplies before and immediately dress them after. May use a radiated warmer -or skin to skin
antepartum
before birth, time between conception and onset of labor
Naegle's rule - estimate due date
begin with the first day of the LMP, subtract 3 months, add 7 days November 21 - 3 months _________________ August 21 + 7 days _________________ August 28th due date
duration
beginning of one contraction to end of same contraction
frequency
beginning of one contraction to the beginning of the next
When does post partum period begin and end?
begins after birth and lasts for about 6 weeks
When do we start monitoring fetal activity?
begins at 28 gestational weeks....if they are decreased they need to come to hospital
When does the embryonic stage occur? What is happening?
begins on day 15 and lasts 8 weeks -critical stage of development for the embryo -it is extremely vulnerable to teratogen exposure -at the end of the 8 weeks every organ and external structure is present!
When does the second stage of labor begin
begins with complete cervical dilation and effacement and ends with the birth of baby
Plastibell circumcision
bell is fitted over the glans. Suture is tied around bells rim and excess is cut away -rim remains on for 3-4 days -NO OINTMENT OR GAUZE
maternal age
best outcomes associated with maternal age 20 to 35 years
1-4 hours after labor where should the fundus be?
between symphysis and umbilicus
para
birth after 20 weeks regardless if baby was born dead or alive
common complications of LGA
birth injuries: fractured clavicle hypoglycemia polycythemia bruising
breech presentation
birth position in which the buttocks, feet, or knees emerge first
abortion
birth that occurs before the end of 20 weeks gestation or the birth of a fetus/newborn who weighs less than 500 g
late preterm labor
birth that occurs between 34 weeks through 36 6/7 weeks
Neonatal period
birth to 28 days -most fatal for newborn
we classify newborns by their
birth weight and gestational age
A client in labor is prescribed naloxone (Narcan). The nurse understands that naloxone is prescribed to
block the effects of narcotics on the central nervous system (CNS).
Probable signs of pregnancy
blood and urine tests, Chadwick's sign, Goodell's sign, Hegar's sign
Cesarean births result in a higher _______ than vaginal birhts
blood loss
Hypervolemia of Pregnancy
blood volume increases by 1500 mL to support uteroplacental demands and maintenance of pregnancy to provide a cushion in blood loss after/during delivery
Why does the uterus elevate after delivery?
blood, clots, swelling, ligament position change
Acrocyanosis
bluish discoloration of hands and feet, not permanent
Preterm infant
born before 37 weeks
Causes for LGA
born to multiparas large parents diabetic mothers
Premes may be fed by
bottle, breast, or gavage (nasal/oral tube)
Progestin - side effects
breast tenderness, headache, fatigue, mood swings, acne/oily skin
describe caput succedaneum. How long does it take to heal? What causes this?
collection of fluid under the scalp! localized easy identifiable area of the scalp. It results from a long difficult labor. It can be a small area (goes away 12-24 hours) and a large are could go away in several days. The fluid IS REABSORBED.
Modified BPP
combines NST with an AFI as an indicator of short term fetal well being and AFI as an indicator of long term placental function to evaluate fetal well being.
Transdermal estradiol/norethindrone
combipatch -- twice weekly
What is mature milk?
comes in 2 weeks after delivery and may be white or blue tinged
Pica
compulsive eating of nonnutritive substances such as clay or ice
3 types of heart disease in pregnancy
congenital defects rheumatic heart disease mitral valve prolapse
Menopause hormone therapy Oral estrogen - generics
conjugated equine estrogens 17-beta-estradiol
Menopause hormone therapy vaginal estrogen - generics
conjugated equine estrogens 17-beta-estradiol estradiol
monophasic COC
constant dose of estrogen and progestin - avoids mood changes - can be used in women with dysmenorrhea
Advantages of an amniotomy
contractions similar to normal labor no risk for hyperstimulation of uterus fetal scalp monitoring
4 means of heat loss
convection, conduction, radiation, evaporation
Variable decelerations indicates
cord compression look like "U's" acute fall in fetal heart rate with contraction
Oral esterified estrogens/methyltestosterone
covaryx
Two normal screening tests that are run on women?
cystic fibrosis PPD: looking for TB
Late onset sepsis shows signs between
day 8-89 of life. Can be acquired anytime
Neonatal mortality
death of infants under 28 days of life per 1000 live births
Betamethasone (Celestone) is administered at 30 weeks of gestation to a client who is in preterm labor. When planning care for the infant, the nurse anticipates
decreased blood glucose.
What puts infants at higher risk for asphyxia
decreased gestational age
Symptoms of hyperemesis
dehydration electrolyte imbalance hypotension, tachycardia *5% weight loss* from her pre pregnancy weight
If a mom wants to use formula and breast milk, how do we teach them to do this?
delay the formula for 3-4 weeks so her breast milk supply will fully come in
Vaginal ring
delivers synthetic estrogen and progestin analogs for 3 weeks. remove for the 4th week, insert new ring 7 days later
Where do administer rogam
deltoid
relaxin
detectable in the serum of the mom by the first missesd menstrual period. It inhibits uterine activity, diminishes contractions, and softens the cervix. relaxeddddddd
Indirect coombs
detects Rh positive antibodies in moms blood
Direct coombs
detects antibody coated Rh positive RBCs in babies blood
Complete mole
develops from an ovum containing no maternal genetic so *no nucleus*, "an empty egg" -linked to choriocarcinoma
indications for induction
diabetes preeclampsia PROM fetal demise IUGR poor biophysical profile macrosomia: big baby (8 pounds 13 oz)
What is the purpose of a CVS?
diagnosing fetal chromosomal, metabolic, or DNA abnormalities
two important measurements to determine adequacy
diagonal conjugate: narrowest of inlet transverse diameter of outlet: narrowest of outlet
caput succedaneum
diffuse edema of the fetal scalp that crosses the suture lines. reabsorbes within 1 to 3 days
What do we do if there is an abortion in the 1st trimester
dilation and curretage (D&C), or suction an evacuation..this is a surgical procedure
transition phase of labor
dilation: 8-10 cm contractions q2-3 min lasting 60-90 seconds mom may feel NV
McDonald's method (fundal height)
distance from the top of the symphysis pubis to the top of the uterine fundus......take it in CM and the number should correlate with the gestational age! Works from week 22-34
What does it mean if the fundus is elevated and to the right of the midline?
distended bladder
yes
do transdermal estrogen products have systemic absorption?
How do you assess the heal-to-ear extension?
draw the newborns foot towards the ear on the same side until you feel resistance, allowing the knee to bend some. Make sure you are holding the babys bottom down. A preterms leg will remain straight and the foot will go to the ear or beyond. With advancing gestation they should have increased resistance with this maneuver. -dont do this to breech baby yet
UTI prevention
drink at least 2 to 3 liters of fluid every day, get enough sleep, rest, and nutrition daily, clean perineum from front to back, avoid irritating substances wear loose-fitting cotton underwear
Bazedoxifene
drug that acts as an agonist of estrogen receptors in some estrogen sensitive tissues and an antagonist in others (uterus) - reduces the risk of endometrial hyperplasia
Terazosin Doxazosin
drugs that can be used for BPH and hypertension
Neonatal sepsis can occur
during or after birth
Maternal complications of oligohydramnios
dysfunctional and slow labor monitor for hypertension
para refers to
each infant born
When should essential surgeries be performed if the woman is pregnant?
early second trimester, less risk of spontaneous abortion of early labor.
What is Pica?
eating things that are not food...indicates nutritional deficiencies and stops when baby is born
Babies are at risk for what if the vaccuum is used?
edema on the scalp! But it will go away within 2-3 days:)
What are some fetal risks if we use forceps?
edema or hematomas on the head, retinal hemorrhages, facial paralysis
anticipatory guidance
educating parents and caregivers about what to expect in the next phase of development
What is postpartal diaphoresis?
elimination of excess fluid via the skin! NIGHT SWEATS!
How do we tell mom to treat breastfeeding jaundice?
encourage feeding every 2-3 hours, avoid supplementation (dont give formula, just breast feed!)
Menopause hormone therapy contraindications
endometrial cancer, breast cancer, undiagnosed vaginal bleeding, thromboembolism, stroke, transient ischemic attack, active liver disease
How is tummy time good for babies?
enhances gross motor skills and upper body strength
3 types of regional analgesia and anesthesia?
epidural, spinal, or epidural-spinal combined
EDB
estimated date of birth
EDC
estimated date of confinement
Menopause hormone therapy Transdermal estrogen - generic
estradiol
Menopause hormone therapy Transdermal estrogen/progestin - generics
estradiol/norethindrone estradiol/levonorgestrel
Menopause hormone therapy women with hysterectomy
estrogen
Menopause hormone therapy women with an intact uterus
estrogen/progestin (estrogen by itself increases risk of endometrial cancer)
What is the contraction stress test?
evaluates respiratory function of the placenta and identifying fetal risk for asphyxia by watching the FHR respond to a contraction -healthy baby will do well -compromised baby will do bad
how can cold stress happen?
evaporation, convection, conduction, and radiation
progesterone
eventually produced by the placenta, plays THE GREATEST ROLE in pregnancy!!! It maintains the endometrium and inhibits spontaneous contractions, therefore preventing early abortion. Also helps develop the breasts
How long should a baby be on one breast?
every 10-15 min
How often should Mom be voiding after delivery?
every 2-3 hours, assess for urinary retention. ALSO teach moms S/S of a UTI...
Describe the times of prenatal visits
every 4 weeks for 1st 28 weeks every 2 weeks until 36 weeks after 36 weeks, every week until delivery 12-14 visits total
the baby scored a 7-10 on the apgar test
excellent condition
polyhydramnios
excessive amniotic fluid
What is cold stress?
excessive heat loss resulting in the use of compensatory mechanisms to maintain core body temperature close to 98.6
ptyalism
excessive salivation
EDD
expected date of delivery
What are milia?
exposed sebaceous gland, appears as white raised spot on the face. They will clear spontaneously
We promote two kinds of contact between baby and parent
eye to eye skin to skin
Intrauterine growth restriction
fail to grow in utero as expected
What are Braxton Hicks contractions?
false labor..they are irregular and do not cause dilation
Genitals of preterm infants?
females: labia minora and clitoris are larger males: undescended testes, no rugae
How long is the preembryonic stage? What is occuring at this time?
fertilization to 14 days -the cells are constantly dividing
Early decelerations indicate
fetal head compression
What is Wharton's jelly?
jelly like substance surrounding the BV's in the cord to prevent compression
preterm labor
labor that occurs after 20 weeks but before completion of 37 weeks
What is Mottling
lacy pattern of dilated blood vessels under the skin
programs for childbirth preparation
lamaze, kitzinger, bradley, hypnobirthing
Grade 3 abruptio placentae
large or complete separation: mod to severe bleeding
Whey
larger amount of this in milk, softer curds
LMP
last menstrual period
active phase of labor:
lasts longer for a primip dilation: 4-7 cm contractions: q2-5 min lasting 40-60 seconds
4th generation progestin
least potent, anti-mineralcorticoid and antiandrogen effects
fetal bradycardia
less than 110 bpm during a 10 min period
Very low birth weight
less than 1500 grams
What does oxytocin do for breast milk?
let down reflex, release of milk from breast
S/S of hypoglycemia
lethargy, apathy, limpness -poor feeding and suck reflex -pallor, cyanosis -hypothermia -apnea, irregular resp -tremors, jitteriness -weak, high pitch cry
Active sleep state
light sleep! They will move extremities and maybe fuss. REM occurs and they can be startled
Signs of impending labor
lightening backache, accompanied by cramping increased braxton hicks weight loss blood show cervical changes ROM burst of energy "nesting"
Pigmentation changes in pregnancy
linea nigra; dark line that extends from umbilicus to pubic area (will go away) cholasma; increased pigmentation on forehead and under eyes..aggravated by the sun. (will go away)
Why is tobacco a teratogen?
links between smoking during pregnancy or after to SIDS, IUGR, low birth weight, and preterm birth
Behavior of preterm infant
little excess energy for muscle tone, they will have weak cry and some dont even cry. They may just grimace
What is a spinal block?
local anesthetic agent that is injected directly into spinal fluid in subarachnoid space
What is a pudendal block?
local anesthetic injected into lateral vaginal walls near the ischial spines to numb the pudendal nerve
BUBBLEHE; lochia
lochia rubra should be seen right after birth and up to three days. Lochia serosa from 3-10 days Lochia alba after that *sitz bath if ordered *peri care important! clean front to back! *"peri bottle"
Latent phase of labor:
longest of 3 phases lasts longer for a primigravida dilation: 0-3 cm uterine contactions: 10-30 min, lasting 20-40 sec mom is excited !!!
What are we looking for when we test an NTT?
looking for skin fold on the back of the neck -does it look like a little hump back whale? not normal! -should have a inward curving neck *not a guarantee*
Side effect of bililight
loose stools, lactose intolerance, rash -make sure they stay hydrated!!!
Physical abuse during pregnancy may result in
loss of pregnancy preterm labor LBW fetal death
Pt's with eating disorders need to be aware of what effects can happen to the baby?
low birth weight preterm birth defects
Hypoglycemia is seen especially in
low birth weight babies, and preterm
Spinal block
lower on the back, give relief of uterine pain
MRI
magnetic resonance imaging
Birth control implant
matchstick-sized rod containing progesterone inserted in the brachial region of the arm that suppresses ovulation protects for up to 3 years
fetal movement counta
maternal assessment of fetal movement by counting fetal movements in a period of time to identify potentially hypoxic fetuses
Risk factors for transient tachypnea?
maternal diabetes, male babies, macrosomia, asthma, and c section with or without delivery
