OB test 2

Vitamin K is given to

stimulate appropriate clotting *not giving Vit K can cause hemorrhage*

PROM

women beyond 37 weeks gestation

PPROM

women less than 37 weeks

Formula fed newborn sools

yellow, yellow-green, loose, pasty or formed, unpleasant odor stool not as often

nursing considerations for the pregnant adolescent

body image issues nutrition social support

Preterm

born before completion of 37 weeks

Late preterm

born between 34 and 36 6/7 weeks

Postterm

born beyond 42 completed weeks

Term

born from the first day of the 38th week through 42 weeks

Choriocarcinoma

cancer that may present as a pregnancy

Apnea

cessation of breathing for 20 sec or more is concerning

The cues to start breathing

chemical, mechanical, thermal

bronchopulmonary dysplasia

chronic lung disease, with newborns who have lung injury; need continued oxygen after initial 28 days of life

Assessment and management of polyhydraminos

close monitoring, removal of fluid (amniocentesis), assess fundal height, abdominal discomfort, difficulty obtaining FHR

Nursing management of hyperemesis

comfort and nutrition (NPO, IV fluids, I&O, oral care) support and education; reassurance; home care follow up

1st trimester spontaneous abortion

commonly due to fetal genetic abnormalities

Neural tube defects

congenitial CNS disorders; occur when the neural tube fails to close properly, normally occurs between 17 and 30 days of gestation (Anencephaly, spina bifida, meningocele, myelomeningocele)

Therapeutic management of hyperemesis

conservative diet and lifestyle changes hospitalization with parenteral therapy

Nursing management for SA

continued monitoring: bleeding, pad count, passage of products, pain, medications, prep for procedure support: physical/emotional, grief support

SA Habitual

continuous miscarriages

Heat is lost through the processes of

convection, conduction, evaporation and radiation

What should the baby do after delivery to help absorb fluid in lungs

cry

Convection

flow of heat from body surface to cooler surrounding air to air circulating over a body

All these fetal shunts must clothes so that blood will travel to the lungs for gas exchange and route blood to liver

foramen ovale ductus arteriosus ductus venosus

HPV causes what and can lead to what?

genital warts and can cause heavy bleeding during delivery *the fetus can contract HPV through vaginal secretions*

Care for mom with pregestational diabetes includes

glycemic control to prevent fetal consequences ongoing fetal surveillance

SA Threatened

has potential to happen

Most heat of a baby is lost through their

head

Other signs of hypertension for pregnant mom

headache visual changes proteinuria prolonged edema

If the fallopian tube ruptures the woman will experience

hemorrhage into the abdominal cavity and may develop hypovolemic shock

Nursing considerations for pregnant mom with STI

informing woman about her risk for additional infections risk for fetal complications treatment plan observing for decreased self-esteem

If labor does not begin after SROM/PROM what may be done

induction

Extremely low birthweight (ELBW)

infant weighs <1,000g or 2lb 3oz

Low birthweight (LBW)

infant weighs <2,500 or 5.5lbs

Very low birthweight (VLBW)

infant weights <1,500g or 3lb 5oz

Amnioinfusion is a risk for

infection

The more vaginal exams done theres an increased risk for

infection

Vitamin K supplementation during the last weeks of pregnancy help to prevent

neonatal hemorrhage

Folic acid supplements help prevent

neural tube defects

SA Incomplete

not all products of conception are removed

The first phase of transition period

occurs 1-2 hours after birth Infant should be awake and alert optimal time for breastfeeding and bonding

Nursing assessment of hyperemesis

onset, duration diet risk factors weight liver enzymes, CBC, BUN, electrolytes

3 groups of jaundice

overproduction decreased conjugation impaired excretion

S/s of PP

painless bright red vaginal bleeding in 2nd or 3rd trimester

Woman over 35 are at an increased risk for

pregnancy complications

Hydatidiform mole

pregnancy does not progress, empty sac

Cervical insufficiency

premature dilation of cervix (cervix shortening/opening) cause is unknown: possibly d/t cervical damage (infection, cone biopsy, abnormal paps)

Special concerns for the pregnant adolescent

prenatal care screening for domestic violence anemia preterm delivery preeclampsia-eclampsia

Nursing management for GTD

preop prep emotional support education: tx, hCG monitoring, prophylactic chemo

Nursing management for EP

prep for tx: analgesics for pain, medications for tx, teaching about s/s of rupture, surgery Emotional support Education

Pregnant woman with an STI is at an increased risk for

preterm delivery

Chlamydia increases the woman's risk for

preterm labor

What is the goal of tx for the woman with sickle cell anemia

preventing a crisis

The main goal of tx for the pregnant woman with heart disease is

prevention and early detection of cardiac decompensation

The best tx strategy for TORCH is

prevention of infection

HIV therapy during pregnancy is

prophylactic administration of oral ZDV throughout pregnancy *combination therapies or HAART are ordered to keep viral loads low*

What would the nurse expect to assess in a woman with placenta previa?

relaxed uterus

How long does the transition period of adapting to extrauterine life last

6- 8 hours

How many voids a day are considered normal for infant

6-8

Hallmark sign of ectopic pregnancy

abdominal pain with spotting 6-8 weeks after missed period

Gestational trophoblastic disease

abnormal cells or tumors that start in the womb from cells that would normally develop into the placenta (exact cause is unknown)

To increase thermoregulation for baby what should be done

Dry baby when it comes out Wrap baby in new warm blanker Skin to skin

S&S of ectopic pregnancy

missed menstrual period N/V abdominal pain shoulder pain vaginal spotting/bleeding

If there is no labor within 48 hours after PPROM what happens

mom is discharged home

Nursing interventions for cardiac issues

monitoring activity levels managing stress diet modification medication therapy

Nursing interventions for diabetic mom

monitoring therapeutic regimen screening for maternal/fetal injury risk for infection fetal macrosomia

Jaundice before 24 hours old is

more alarming than after 24 hours

2nd trimester spontaneous abortion

more likely related to maternal conditions

Factors predisposing to heat loss

Thin skin Lack of shivering ability Limited use of voluntary muscle activity Lack of subq fat Not able to adjust own clothing/blankets Cannot communicate if too cold/hot

Types of spontaneous abortions

Threatened Inevitable Incomplete Complete Missed Habitual

Cytotec

used to rid body of remaining products of conception

Nursing assessment of spontaneous abortion

vaginal bleeding cramping/contractions vitals/pain clients understanding

What needs to be avoided if pt has PP

vaginal exams

Pregnant women (w/out heart issues) with edema should

walk more drink more fluids elevate legs rest

small for gestational age (SGA)

weight <2,500g at term or below 10th percentile

Preterm newborn common characteristics

weight <5.5 lb Scrawny Poor muscle tone Minimal subq fat Undescended testes Plentiful lanugo Poorly formed ear pinna Fused eyelids Soft spongy skull bones Matted scalp hair Absent/few creases in foot sole Thin transparent skin Abundant vernix Minimal scrotal rugae; prominent labia

Large for gestational age (LGA)

weight >90th percentile >4,000g at term

Characteristics of SGA newborn

Head larger than body Wasted appearance of extremities; loose dry skin Reduced subq fat stores Decreased amount of breast tissue Scaphoid abdomen Wide skull sutures Poor muscle tone Thin umbilical cord

Rh incompatibility

If mother is Rh- and baby is Rh+, then mother may develop antibodies against the infant's blood

hyperbilirubinemia

Imbalance in rate of bilirubin production and elimination; total serum bilirubin level >5 mg/dL

Therapeutic managment of GTD

Immediate evacuation of uterine contents (D&C) Long-term follow up and monitoring of hCG levels

Nursing management for AP

Tissue perfusion: left lateral position, bed rest, O2, vitals, fundal height, continuous fetal monitoring Support: empathy, explanations, possible loss of fetus

TORCH stands for

Toxoplasmosis Other (Hep B, syphilis, varicella, herpes zoster) Rubella CMV HSV

Causes and Tx for AP

Trauma can cause abruption of placenta STAT c-section

Newborns are typically fed how much and how often

1-3oz and q 2-4 hours

A protozoan causes what and what med is given to tx?

Trichomoniasis (parasite) - can also increase risk of preterm labor Tx is oral Flagyl

physiologic jaundice

*3rd-4th day* Early and late onset breastfeeding jaundice

Neonates lose up to __% of birth weight in the first few days of life

5-10%

Mild preeclampsia management

-bed rest, daily BP monitoring and fetal movement counts -hospitalization, and IV magnesium sulfate during labor

pathologic jaundice

(within first 24 hours of life) Kernicterus Rh isoimmunization ABO incompatibility

Omphalocele and Gastroschisis

- Omphalocele: umbilical ring defect with evisceration of abdominal contents into external peritoneal sac - Gastroschisis: herniation of abdominal contents through abdominal wall defect (no peritoneal sac)

When is Rhogam given?

28 weeks and within 72 hours of delivery

Necrotizing Enterocolitis (NEC)

3 pathologic mechanisms: bowel ischemia, bacterial flora, and effect of feeding KUB- air in bowel wall; dilated bowel loops

congential heart disease

4 physiologic categories: Increased pulmonary blood flow Obstructed blood flow out of heart Decreased blood flow Mixed blood

Within how many hours of life will any newborn complications be noticeable

8 hours

Postterm newborn characteristics

Inability of placenta to provide adequate nutrition and oxygen Dry, cracked,, wrinkled skin Long, thin extremities; long nails, creases cover entire sole of feet Wide-eyed, alert Abundant hair on scalp Thin umbilical cord Limited vernix and lanugo

Common problems of LGA

Birth trauma Hypoglycemia Polycythemia Hyperbilirubinemia

Periventricular-intraventricular hemorrhage

Bleeding in the brain d/t fragility of cerebral vessels; most common in the first 72 hours after birth

What is the result of gestational diabetes in a normal pregnancy?

Blood glucose levels are higher than normal after meals

Labs and diagnostics for AP

CBC, fibrinogen levels, PT/aPTT, type and cross match, nonstress test, biophysical profile

Why is TORCH so important during pregnancy?

They are teratogenic

What is mom at risk for what hyperemesis gravidarum?

Dehydration metabolic acidosis/alkalosis hypokalemia

Retinopathy of Prematurity (ROP)

Developmental abnormality affecting immature blood vessels of the retina Premature vessels might stop developing

The cornerstone of therapy for gestational diabetes

Diet therapy

Neonatal Asphyxia

Failure to establish adequate, sustained respirations after birth

Acquired immunity

From vaccines, breast milk and getting sick

Neonate

Full term baby 37-42 weeks

HELLP

Hemolysis, elevated liver enzymes, low platelets

infants of diabetic mothers

High levels of maternal glucose crossing placenta, stimulating increased fetal insulin production leading to somatic fetal growth Prevent hypoglycemia of infant

Nursing management of gestational HTN

Home management for mild preeclampsia Hospitalization for severe; quiet environment, sedatives, seizure precautions, antihypertensives, DTR testing, assessing for mag toxicity Seizure management; fetal monitoring, uterine contraction monitoring, prep for birth

severe preeclampsia management

Hospitalization; oxytocin and magnesium sulfate; preparation for birth

2 types of GTD

Hydatidiform mole Choriocarcinoma

Gestational Hypertension

Hypertension without proteinuria after 20 weeks; bp returns to normal postpartum

Preterm newborn common problems

Hypothermia Hypoglycemia Hyperbilirubinemia Immaturity of body systems

meconium aspiration syndrome

Inhalation of particulate meconium with amniotic fluid into lungs; secondary to hypoxic stress

Birth trauma

Injuries d/t forces of labor and birth; fractures, cephalhemtoma, caput succedaneum

Esophageal atresia and Tracheoesophageal fistula

Lack of normal separation of esophagus and trachea during embryonic development Atresia- congenitally interrupted esophagus Fistula- abnormal communication between trachea and esophagus *prep for surgery*

Characteristics of LGA newborns

Large body, plump, full-faced Proportional increase in body size Poor motor skills Difficulty regulating behavioral states

respiratory distress syndrome

Lung immaturity and lack of alveolar surfactant Expiratory grunting, nasal flaring, retractions, generalized cyanosis, HR >150-180

Risk factors for congenital heart disease

Maternal alcoholism Maternal diabetes mellitus single gene mutation maternal exposure to xrays poor maternal nutrition maternal age >40 amphetamines genetics

Large for gestational age newborn risk factors

Maternal diabetes mellitus or glucose intolerance Multiparity Prior history of a macrosomic infant Maternal obesity Male fetus Genetics

Transient Tachypnea of the Newborn (TTN)

Mild respiratory distress; pulmonary liquid removed slowly or incompletely; resolution by 72 hours of age

Nursing interventions to prevent heat loss

Minimize air currents Dry infant immediately after birth Place infant skin to skin under warm blanket Preheating warmers Delay bath until temp is stable

Cleft lip/palate

Most common craniofacial birth defect Cleft lip repair surgical repair between 6-12 weeks; cleft palate repair 6-18 months

ABO incompatibility

Mother's blood type is O Infant's blood type is A, B, or AB

Acquired conditions

Neonatal asphyxia Transient Tachypnea (TTN) Respiratory Distress Syndrome (RDS) Meconium aspiration Persistent pulmonary HTN Bronchopulmonary dysplasia Retinopathy of prematurity Peri-Intra hemorrhage Necrotizing enteorcolitis Infants of diabetic mothers Birth trauma Perinatal substance abuse Hyperbilirubinemia Infections

Newborn infections

Neonatal sepsis: bacterial, fungal, or viral microorganisms or their toxins in blood or other tissues

Congenital conditions

Neural tube defects Microcephaly Hydrocephalus Choanal atresia Disphragmatic hernia Cleft lip/palate Esophageal atresia and tracheoesophageal fistula Omphalocele and gastroschisis Imperforate anus Hypospadias and epispadias congenital clubfoot hip dysplasia

Types of fetal surveillance

Non-stress test FHR Contraction Stress test

amniotic fluid embolism

Obstetric emergency Sudden onset of hypotension, hypoxia, and coagulopathy d/t breakage in barrier between maternal circulation and amniotic fluid

Acquired disorders

Occur at birth or soon after Problems experienced by the woman during pregnancy or at birth Possibly no identifiable cause for disorder

What is an Ectopic Pregnancy and how is it diagnosed?

Ovum implanted outside the uterus Ultrasound

Preterm Newborn nursing management

Oxygenation Thermal regulation Infection prevention Stimulation Pain management Growth and development Parental support; possible perinatal loss Discharge prep

Gonorrhea increases the risk for

PID, spontaneous abortion, preterm delivery

Common problems of SGA newborns

Perinatal asphyxia; act of blood flow/gas exchange Hypothermia; not enough fat Hypoglycemia Polycythemia; increased RBCs Meconium aspiration

Placenta Previa

Placenta is completely or partially covering cervical os *cause unknown*

Classification of gestational HTN

Preeclampsia Eclampsia (seizures)

Congenital Disorders

Present at birth; usually d/t malformation occurring during antepartal period Majority with complex etiology

Bladder exstrophy

Protrusion of bladder onto abdominal wall Separation of rectus muscles and symphysis pubis

Imperforate anus

Rectum ending in blind pouch or fistulas between rectum and perineum

Preterm newborn has increased risk for these complications

Resp distress Cardiovascular system GI system Renal system Immune system CNS

Postterm nursing management

Resuscitation Glucose monitoring Initiation of feedings; IV dextrose 10% Prevention of heat loss Evaluation for polycythemia Parental support

s/s of preeclampsia

Right epigastric pain Headache unrelieved with analgesic Periorbital edema Proteinuria

Eclampsia management

Seizure management, magnesium sulfate, antihypertensive agents; birth once seizures controlled

Hyperemesis Gravidarum

Severe form of nausea and vomiting continuing past week 20 weight loss >5% of pre-pregnancy weight

What type of pregnancies are more likely to have gestational diabetes

Subsequent

Diagnosis and therapeutic management of PP

Ultrasound Dependent upon bleeding, amount of placenta covering os, fetal position, maternal parity, labor s/s

Nursing management for LGA newborns

Vital signs Blood glucose monitoring Initiation of oral feedings with IV glucose supplementation prn Monitoring s/s of polycythemia and hypoglycemia Phototherapy Hydration

Iron supplements are best absorbed with

Vitamin C *Iron may also cause nausea and constipation*

Breast-fed newborns stool

Yellow-gold, loose, stringy to pasty, sour-smelling stool 4-8x day

Nursing Management for SGA newborns

Weight, length, head measurements Serial blood glucose monitoring Vital signs Early/frequent oral feedings; IV of dextrose 10% Monitor for s/s of polycythemia, flushing, jaundice

Habitual abortions happen d/t

anatomical defects DNA incompatibility

Appropriate for gestational age (AGA)

approx. 80% of newborns normal height, weight, head circumference, BMI

What is a contraction stress test

artificially induce contractions with oxytocin to see how fetus manages contractions

What intervention needs to be done ASAP with a baby who's mom has HIV

bathe baby ASAP

Therapeutic management for cervical insufficiency

bed rest, pelvic rest, no heavy lifting, cervical cerclage

When should Nitrazine and fern test be done

before a vaginal exam because the lube can cause a false + result

What med should diabetic moms not receive

betamethasone

S/s of AP

dark red bleeding, knife-like pain, uterine tenderness, decreased fetal movement

Treatment for PROM/PPROM

depends on gestational age no unsterile cervical exams until active labor expectant management if fetal lungs immature

Amniocentesis

determines fetal lung maturity may help determine optimum time for delivery

assessment of amniotic fluid embolism

difficulty breathing, hypotension, cyanosis, seizures, tachycardia, coagulation failure, DIC, pulmonary edema, uterine atony with subsequent hemorrhage, ARDS, cardiac arrest

D&C

dilation of cervix and cleaning out uterus

neonatal abstinence syndrome

drug dependency acquired in utero manifested by neurologic and physical behaviors

Therapeutic management of ectopic pregnancy

drug therapy- methotrexate, misoprostol) surgery if rupture Rh immunoglobin if woman Rh -

SA Complete

everything has been expelled

SA Missed

everything has been expelled all of a sudden

polyhydramnios

excessive amniotic fluid >2,000 mL

Baby becoming cold stressed can cause

hypoglycemia

some SGA newborns experience

intrauterine growth restrictions IUGR

The hepatic system functions

iron storage carbohydrate metabolism bilirubin conjugation

SA Inevitable

is going to happen

Final phase of transition period

is the second phase of reactivity that occurs between 2-8 hours after birth meconium often passed at this time

The most common sign of hypoglycemia is

jitteriness

Radiation

loss of body heat to cooler, solid surfaces in close proximity but not direct contact

Evaporation

loss of heat when a liquid is converted to a vapor

Interventions for mom with anemia

maintaining adequate hydration avoiding infection and stress adequate rest

What effect can Magnesium Sulfate have on baby

make baby flaccid and possible resp issues

Nursing assessment for GTD

manifestations similar to spontaneous abortion ultrasound visualization High hCG levels that continue to rise

Persistent Pulmonary Hypertension of the Newborn (PPHN)

marked pulmonary hypertension causing right to left extra-pulmonary shunting and hypoexmia Tachypnea, marked cyanosis, grunting, systolic murmur

Infants produce heat by

metabolizing brown fat stores

When the cord is clamped and the placenta cannot provide gas exchange this causes what

mild hypoxia which stimulates breathing

Postterm common problems

perinatal asphyxia hypoglycemia hypothermia polycythemia meconium aspiration

fetal alcohol syndrome

physical and mental disorders appearing at birth and remaining throughout life

Natural immunity

physical, chemical barriers, and resident non-pathologic organisms

The woman with epilepsy minimizes the risk to herself and fetus and allows for stabilization on antiepileptic meds by doing what

precenception care

Nursing assessment of Gestational HTN

risk factors, BP, nutritional intake, weight, urine in protein

Nursing assessment for PROM/PPROM

s/s of labor electronic FHR monitoring amniotic fluid characteristics Nitrazine test ultrasound fern test

Nursing management for HELLP

same as for severe preeclampsia

Nursing care for a woman who is a victim of IPV

screening for all pregnant women to identify victims of IPV

What phase should the newborn assessment be done

second phase

Abruptio Placentae

separation of placenta from the uterus leading to compromised fetal blood supply

Assessment and monitoring of oligohydraminos

serial monitoring, amnioinfusion, birth for fetal compromise Assess fluid leaking from vagina

Assessment and management for multiple gestation

serial ultrasounds, close monitoring during labor, operative delivery (common) uterus larger than expected education and support antepartally; labor management; postpartum assessment for hemorrhage

The easiest way to assess blood components is by

skin color

management of amniotic fluid embolism

supportive measures to maintain oxygenation and hemodynamic function and to correct coagulopathy; critical care monitoring

Cerclage

suture cervix closed during pregnancy until 32-34 weeks

Who's cord is clamped first and why

the baby because they have less blood

Second phase of transition period

time of sleep and may last several hours

oligohydramnios

too little amniotic fluid <500 mL *a small leak in amniotic sac*

Conduction

transfer of heat from one object to another with direct contact