The OB Cluster **** (FINAL!)
transient strabismus (pseudostrabismus)
"Doll's eyes"; caused by poor neuromuscular control of eye muscles/poor hand-eye coordination - eyes move in the opposite direction in which the body is moving - can be normal lasting up to 10 days after birth
zuoyuezzi
"doing the month"; Chinese practice in which there is a period of isolation after childbirth - mother is supported by the baby's grandmother or close family member - rest is encouraged; no chores, activities, bathing,etc. - goal is to maintain balance of hot and cold
nevus pilosus
"hairy mole"; dermal sinus/hair tuft at the base of the spine commonly associated with spina bifida
assess need for resuscitation
"is the baby full term?" "is the baby breathing or crying?" "does the baby have good muscle tone?" -if you answered no, you may need to do what?
stork bites
"telangiectactic nevi" dark red spots on the eyelids, forehead, or nape of the neck, that usually fade in time; birthmarks - want to document these
amniotic fluid embolism
(anaphylactoid syndrome of pregnancy); rare labor complication with very high mortality rate - frequency occurs during or after the birth when the woman has had a difficult, rapid labor
spermicide
(nonoxynol-9) available as jelly, foam, vaginal film, or suppository; inserted into vagina before sex to destroy sperm by disrupting the cell membrane - applied 30 minutes before - does not protect from STDs (can increase a women's risk due to irritation of vagina) - has a failure rate of 28% or more (effectiveness increases with barrier method)
condom
- barrier method that can be used by the male or female - space left to trap sperm - effective if used correctly - protect against STDs - breakage, displacement, irritation, and dulled sensation are possible risks (heat makes them susceptible to breakage)
polyhydramnios
- can increase maternal discomfort, dyspnea, risk of preterm labor, edema of LE, and risk of cord prolapse and spontaneous rupture of membranes - can increase fetal risk of atresias and CNS anomalies
abnormal presentation
- can increase maternal incidence of C/S and prolonged labor - can increase fetal incidence of placenta previa, prematurity, risk of congenital abnormality, neonatal physical trauma, and IUGR
multiple gestation
- can increase maternal risk for uterine distention and postpartum hemorrhage, C/S, and preterm labor - can increase fetal risk for LBW, prematurity, congenital anomalies, and twin to twin transfusion
premature rupture of membranes
- can increase maternal risk of infection, preterm labor, anxiety, prolonged hospitalization, and incidence of tocolytic therapy - can increase fetal incidence of perinatal morbidity, prematurity, increased birth weight, risk of respiratory distress syndrome, and prolonged hospitalization
fetal alcohol syndrome
- caused by maternal binge drinking 1-2x/week, with atleast 6 drinks each occasion
football hold position
- commonly used in hospital
placenta
- development does not begin until 3rd week of embryonic development - nutrition, excretion, fetal respiration, production of fetal nutrients, and production of hormones occur here - has 2 parts: maternal and fetal - by 14 weeks gestation, it is its own organ
iodine
- essential part of thyroxine - deficiency can lead to cretinism - 220 mcg/day from salt intake
human menopausal gonadotropins (hMGs)
- first line of therapy for anovulatory infertile women with low to normal levels of gonadotropins (FSH and LH) - second line of therapy in women with failed ovulation or absence of conception with clomid - also can be used in women undergoing controlled ovarian stimulation with assisted reproduction - requires close observation; follicle development must be monitored to minimize risk of multiple pregnancies and ovarian hyperstimulation
colostrum
- high in calories - high in protein - alot of antibodies
oligohydramnios
- increases maternal fear - increases fetal incidence of congenital anomalies, renal lesions, IUGR, acidosis, cord compression, and postmaturity
SGA
- less than the 10th percentile for birth weight - may also be classified as having IUGR
PKU (phenylketonuria)
- most common amino acid disorder, unable to convert phenylalanine to tyrosine; a condition that makes it impossible for babies to metabolize certain proteins - leads to progressive mental retardation - without tx, infant will develop vomiting, rashes, and failure to thrive (special formula) - babies must be screened before d/c (guthrie blood test), if abnormal results- must go back to pediatrician ASAP to begin treatment
frank breech
- most common type of breech presentation - hips flexed, knees extended
modified cradle position
- most commonly used for new moms; first time breastfeeders
x linked recessive disorders
- no male to male transmission, abnormal gene carried on x chromosome - disorder manifested in a male who carries gene only on his x chromosome or a mother who carries it - 50% chance carrier mother will pass abnormal gene to sons (affected) - 50% chance carrier mother will pass abnormal gene to daughters (carrier) - 100% chance affected fathers will pass abnormal gene to daughters (carrier) - ex. hemophilia, color blindness, muscular dystrophy
depression
- often goes undiagnosed or untreated - potentially associated with increased likelihood of preterm birth, SGA, or low birth weight in newborns - may reduce the mom's ability to concentrate
nuchal translucency testing (NTT)
- performed at 11-13 and 6 weeks gestation; can be performed in 1st trimester - measures fat on the back of neck - screens for aneuploidies such as trisomies 13,18, and 21 - no known risks - can provide false positives
mongolian blue spots
- prevalent in darker skinned babies and hispanics - blue mark on the buttocks - needs to be documented
ovary
- primary source of estrogen and progesterone - produce mature gametes (oocytes/egg) - composed of 3 layers: tunica albuginea, cortex, and medulla - lack of peritoneal covering on this organ assists mature ovum to erupt; however, it also allows easier spread of malignant cells
breasts
- provide nourishment and protective maternal antibodies through lactation - source of pleasurable sexual sensation
uterine rupture
- rare, life threatening complication of trauma to a pregnant woman - may precipitate traumatic separation of the placenta or premature labor - baby usually dies because it is suspended in the abdomen - mom is hemorrhaging
total abdominal hysterectomy (TAH)
- surgical removal of the uterus - abdominal incision - can be done in junction with a BSO: removal of both fallopian tubes and ovaries - used for tx of several cancers, large fibrioids, severe endometriosis, chronic PID, and adenomyosis - when cancer is suspected, it permits exploration of the abdomen, preferred when large masses are present - cons include large abd incision with scar, postop pain, blood loss and anesthesia risks, and longer hospital stay
Laparascopic assisted vaginal hysterectomy (LAVH)
- surgical removal of the uterus; surgeon inserts scope through incision near umbilicus and uses it to assist with visualization and dissection - uterus is removed vaginally - tx for pelvic relaxation, abnormal bleeding, and small fibroids - no large incision, earlier ambulation, less anesthesia/OR time, less blood loss; however, there is an increased risk of trauma to the bladder
internal FHR monitoring
- uses fetal scalp electrode (fine surgical spiral wire is attached to scalp or other presenting part) - provides clear tracings and info about short term variability - risk for infection and injury
chiropractic therapy
-3rd largest independent health profession in the US - alternative therapy based on concepts of manipulation to address health problems thought to be the result of abnormal nerve transmission caused by misalignment of the spine - stress the importance of proper nutrition and good health
polycythemia
-A disorder characterized by an abnormal increase in the number of red blood cells in the blood occurs in: -IUGR, full term or late preterm infants -newborns with placental transfusion or receiving maternal-fetal or twin-to-twin transfusions -babies exposed to intrauterine hypoxia -babies of mothers who smoke, suffer from asphyxia, diabetes, or hypertension, or took propranolol during pregnancy
ABO incompatibility
-O mother -A or B fetus -results in jaundice -rarely results in severe hemolytic disease
Rh incompatibility (give rhogam)
-Rh negative mother -Rh positive fetus
nosocomial infections
-acquired while the infant is in the NICU -two most common: MRSA and candida -related to invasive procedures and the infant's immature immune system -presents as sepsis, UTIs, meningitis, or pneumonia
kernicterus
-bilirubin in the basal ganglia -can lead to: cerebral palsy, mental retardation, hearing loss/perceptual impairment, delayed speech development -if bill is 21-22: aggressive therapies are used besides just phototherapy
sepsis
-blood infection in infants younger than 90 days old -early-onset- first week of life -late-onset-between days 8 and 89 -worried about GBS positive babies (can be transient and mom may be reading negative) -S/s: respiratory distress, being tired (SUBTLE!)
Coombs' test
-direct test determines whether jaundice is because of Rh or ABO incompatibility -indirect test detects the presence of Rh- positive Ab in the mother's blood -if test is positive, baby is likely to have pathological jaundice because there is an ABO compatibility (serum bill)
pathologic jaundice
-due to a decrease in the number or affinity of bilirubin binding sites of albumin -caused by: asphyxia, neonatal or maternal drugs, hypothermia, hypoglycemia, infant prematurity -occurs within 24 hours, severe -due to Rh or ABO incompatibility -put low risk babies in sunlight, if aggressive treatment, baby may need to be under double lights -serum bilirubin concentration rises by more than 0.2 mg/dL per hour -bilirubin concentrations exceed the 95th percentile -conjugated bilirubin concentrations are greater than 2 mg/dL -clinical jaundice persists for more than 2 weeks in a term newborn
cold stress
-excessive heat loss (increased respirations and non shivering thermogenesis) -ability to compensate is impaired due to hypoxemia, CNS abnormalities, hypoglycemia
phototherapy
-exposure of the newborn to high intensity light -decreases serum bilirubin levels by increasing biliary excretion of unconjugated bilirubin -may be performed prophylactically on high-risk, very-low-birth-weight, and severely bruised infants
where do you heel stick?
-fat pads of heel
meconium aspiration syndrome
-fetal asphyxia causes intestinal peristalsis and relaxation of the anal sphincter -this allows release of meconium into the amniotic fluid, which can be aspirated during the infant's first breaths -"when the baby takes his first breath: if it has poop in it, it can aspirate"
respiratory distress syndrome
-inadequate production of pulmonary surfactant -occurs in premature infants and infants with surfactant deficiency disease -required for alveolar stability -instability causes atelectasis -causes hypoxemia, hypercarbia, acidemia -may need to but surfactant down each lung through ET tube
be prepared to resuscitate
-meconium in amniotic fluid -significant bleeding (abruption, previa) -SGA or premature -unexpected congenital anomalies -oligo or poly are risk factors -IV narcotics:birth is 2 hours after narcotic -diabetic mother -infant is anemic
hydrops fetalis
-most severe form of Rh incompatibility -maternal antibodies attach directly to the Rh site on the fetal red blood cells -results in severe anemia and multi organ system failure
exchange transfusions
-newborn's blood is removed and replaced with donor blood -used to treat anemia related to mother-infant blood incompatibility -removes red blood cells that are marked for lysis -removes serum bilirubin -increases the albumin binding sites for bilirubin
physiologic jaundice
-normal process -due to: newborn's shortened red blood cell lifespan, slower uptake of bilirubin by the liver, lack of intestinal bacteria, poorly established hydration -total bilirubin levels peak around 4-5 days after birth
physiologic anemia
-occurs when hemoglobin levels drop in the first 8-12 weeks of life -hemoglobin drops to 10-11 g/dL (term) or 7-9 g/dL (preterm) -then bone marrow begins to produce red blood cells and anemia disappears
hypoglycemia
-plasma glucose concentration less than 40 mg/dL -risk factors: preterm infants, infant of diabetic mother, SGA infant -risk factors: stressed at delivery, low APGAR scores
relieves hemorrhoidal discomfort
-sitz baths, topical anesthetic ointments, rectal suppositories, or witch hazel pads -assume side-lying position when possible and avoid prolonged sitting -adequate fluid intake and stool softeners -epifoam -may give donut to sit on -educate on no straining -adequate fluid and fiber intake
weaning
-substitute one cup feeding or bottle feeding for one breastfeeding session over a few days to a week so breasts gradually produce less milk -over a period of several weeks, substitute more cup feedings or bottle feedings for breastfeeding
postpartum blues
-transient period of depression; sometimes occurs during the first few days postpartum -mood swings, anger, weepiness, anorexia, difficulty sleeping, feel of being let down -educate significant other on things to look for so she doesn't develop postpartum depression (significant other may see before patient even notices it)
chest compressions
-two finger method -1 and 2 and breathe and
how do you heel stick?
-warm up heel with heel warmer -stick -wipe away first drop of blood and then collect sample
jaundice
-yellowish coloring of the skin and sclera -develops from the deposit of bilirubin in tissues -works from top down (starts in face, moves to chest) -phototherapy changes from of bilirubin to excretable form (unconjugated to conjugated)
1
1 gram = ___ mL?
folic acid and vitamins
2 substances needed maternally in order to prevent neural tube defects
late preterm
35 to 36 weeks and 6 days gestation
term
37+ weeks gestation
amniocentesis
99% accurate in dx genetic abnormalities - tests to determine fetal abnormalities and lung maturity - done in 3rd trimester - sample of amniotic fluid, aspirated from uterine cavity - complications are rare; could potentially cause water to break prematurely - mom may experience cramping afterwards, want to avoid physical stress
vaginal vestibule
A boat-shaped depression enclosed by the labia majora and visible when they are separated; contains the vaginal opening (introitus), hymen, Bartholin's glands
ovulation method
A fertility awareness method of contraception that relies on prediction of ovulation by tracking the viscosity of the cervical mucus - at time of ovulation, mucus is clearer, more stretchable, and more permeable - during luteal phase, mucus is thick and sticky, trapping sperm
delirium tremens (DTs)
A group of severe withdrawal symptoms characterized by restlessness, fever, sweating, disorientation, agitation, and seizures; can be fatal if untreated.
graafian follicle
A large, mature, ovarian follicle with a secondary oocyte; ovulation of the oocyte occurs from this type of follicle. - zona pellucida will develop around oocyte - appears on 14th day of follicular phase - as it matures and enlarges, it comes close to the surface of the ovary and the walls thin, allowing the secondary oocyte, polar body, and follicular fluid to be pushed out (fimbriae catch and pull them into fallopian tube)
septic abortion
A life-threatening emergency in which the uterus becomes infected before, during, or after an abortion - may occur with prolonged, unrecognized rupture of the membranes - increased risk if a mom gets pregnant with an IUD or has had attempts to abort from unqualified individuals
lay midwife
A person with special training in the care of pregnant women and normal deliveries, but who does not have a nursing or medical degree
guided imagery
A state of intense, focused concentration used to create compelling mental images. It is sometimes considered a form of hypnosis.
zona pellucida
A thick, elastic capsule that develops around the oocyte in a graafian follicle
>6.5
A1C that is concerning
positive
ABO incompatibility will give positive or negative indirect Coombs' test?
pilonidal dimple
Abnormal opening between buttocks, can be direct opening to spinal canal - needs to be examined to verify no connection to spinal canal
recurrent pregnancy loss
Abortion occurs consecutively in three or more pregnancies
palmar grasp
An infant reflex that occurs when something is placed in the infant's palm; the infant grasps the object.
couvelaire uterus
Associated with placental abruption; occurs when blood accumulates between the separated placenta and the uterine wall; uterus is bruised
kernicterus
Bilirubin encephalopathy; a form of preventable brain damage/retardation resulting from unconjugated bilirubin entering the brain -characterized by lethargy, poor feeding, vomiting, irregular respiration, and death
hindmilk
Breast milk received near the end of a feeding; contains higher fat content
complete breech
Breech position where the baby comes out with legs crossed
subconjunctival hemorrhage
Bright red patches in conjunctiva of eyes due to ruptured blood vessels; caused by birth trauma - make sure to document
melasma
Brownish pigmentation of the face during pregnancy; also called chloasma and "mask of pregnancy"
heroin
CNS depressant that alters perception; creates high risk pregnancies because of increased incidence of health problems in using mothers - many rely on prostitution to support their habit, and participate in other risky behavior (sharing needles) - results in withdrawal that can affect maternal attachment
monosomy
Chromosomal abnormality consisting of the absence of one chromosome from the normal diploid number - lost in meiosis (2n-1)
disseminated intravascular coagulation (DIC)
Complex, acquired disorder in which clotting and hemorrhage simultaneously occur; complication of severe preeclampsia, eclampsia, and HELLP syndrome - occurs when clotting factor is used up somewhere else too fast, to the point where there is none left - results in severe, unstoppable bleeding, potentially out of every orfice of the body
pelvic diaphragm
Deepest layer of pelvic floor; help with dilation during birth and return to prepregnancy condition following birth
estimated date of birth (EDB)
During a pregnancy, the approximate date when childbirth will occur; calculated by a combination of menstrual dates and ultrasound dates
ELISA test
Enzyme-Linked immunosorbent assay, diagnose HIV and pregnancy
fimbriae
Fingerlike projection of the fallopian tubes that drape over the ovary; help increase the chances of intercepting the ovum as it is released
clonus test
Flex the dorsal foot upward and have patient try to relax it slowly - Positive test = 5 or more uncontrollable shaking of the dorsal foot (beats)
Nurse Practitioner (NP)
HCP who received specialized education in a DNP program or a masters program; can function in an advanced practice role - provides ambulatory services to expectant families - may function in acute, high risk settings
- preterm: clitoris is prominent, labia majora are small and widely separated - term: labia majora cover the labia minora and clitoris
How are female genitals different in a preterm baby vs term baby?
- preterm: small scrotum, few rugae, testes are palpable in inguinal canal - term: testes are generally in the lower scrotum, which is pendulous and covered with rugae
How are male genitals different in a preterm baby vs term baby?
72-96 hours
How long does it take for the ovum to reach the uterus after its release from the ovary?
gestational hypertension
Hypertension beginning after 20 weeks; transient elevation of BP - no proteinuria - no other signs of preeclampsia
nidation
Implantation of the fertilized ovum (zygote) in the uterine endometrium; the uterus is cyclically prepared for this by steroid hormones
amnion
Innermost membrane surrounding the developing fetus and yolk sac, leaving space where the umbilical cord attaches; contains fluid - as embryo grows, it expands until it comes in contact with chorion; forms the amniotic sac that protects the embryo
2:1
L/S ratio that indicates mature fetal lungs
Trisomy 18 and 13
Less common and more severe birth defects; average life expectancy a few weeks, most likely stillborn - usually aborted
infundibulopelvic ligament
Ligament that suspends and supports the ovaries; contains the ovarian blood vessels and nerves
uterosacral ligaments
Ligaments that provide support for the uterus and cervix at the level of the ischial spines - contain sensory nerve fibers that contribute to dysmenorrhea
stillbirth
Loss of fetus after 20 weeks of pregnancy
leopold's maneuver
Method to determine presentation and position of fetus and aid in location of fetal heart sounds
Biophysical Profile (BPP)
NST+ultrasound - tells you how the baby is doing in utero - provides assessment of placental functioning - there are many reasons for doing them
brachial palsy
Nerve damage of upper limbs due to shoulder trauma at birth; Can cause single or bilateral paralysis
- placental abruption - amniocentesis - bleeding during pregnancy - cervical insufficiency - history of LEEP - hydramnios - infection - low BMI - low SES - maternal genital tract anomalies - multiple pregnancy - placenta previa - previous hx of PPROM - tobacco use - trauma - UTI
PROM and PPROM are associated with:
fertile window
Period during which the viability and survivability of both oocytes and sperm are at maximum; 3-6 days before ovulation, 1 day post ovulation (day 8-18, best days to have sex if you're trying to get pregnant)
postconception age
Period of time in embryonic/fetal development calculated from the time of fertilization of the ovum; 38 weeks, or 9.5 mo
early deceleration
Periodic change in fetal heart beat pattern caused by head compression; begins and ends before contraction
variable deceleration
Periodic change in fetal heart rate caused by umbilical cord compression; change in onset, occurrence, and waveform.
placental abruption
Premature separation of the placenta from the uterine wall after 20 weeks' gestation and before the fetus is delivered - prevents blood flow to the placenta; drains out into the uterus instead - lack of O2 and nutrients can cause death in baby - hemorrhage can cause death in mother - emergency c-section needed to save mom/baby
chorionic villus sampling (CVS)
Prenatal diagnostic technique that involves taking a sample of tissue from the chorion of the developing placenta - done at 10-13 wks gestation; first trimester dx of genetic abnormalities and DNA studies - done especially if family has hx of anomalies - approach may be transabdominal or transcervical - it is risky - give Rogam after procedure if mom is Rh-
cephalic version
Procedure for turning the fetus so that its head is the presenting part to enter the birth canal first - can be attempted at 36-38 wks as long as the woman is not in labor
American Nurses Association (ANA)
Professional organization that represents all registered nurses; has published standards of professional practice for maternal-child health
umbilical cord prolapse
Protrusion of the umbilical cord alongside or ahead of the presenting part of the fetus - comes through when water breaks, becomes compressed and cuts off circulation - need to get baby out immediately
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
uterine atony
Relaxation of uterine muscle after birth; can lead to excessive postpartum bleeding and hemorrhage
positive
Rh incompatibility will give positive or negative direct Coombs' test?
sepsis
S/S of what? -respiratory distress -lethargy or irritability -hypotonia -pallor, duskiness, or cyanosis -cool and clammy skin -temperature instability -"is the baby sick or just being lazy? can be scary" -high CRP can indicate -if mom is GBS positive, baby has to stay for 48 hours to be monitored -feeding intolerance -hyperbilirubinemia -tachycardia followed by apnea/bradycardia
molding
Shaping of the fetal head by overlapping of the cranial bones to facilitate movement through the birth canal during labor; the longer they sit in the birth canal, the more they may have
epstein pearls
Small white cysts found on the gums and at the junction of the soft and hard palates of newborns; look like teeth
moro reflex
Startle reflex; in response to a loud sound or sudden movement - present at birth, and lasts until about six months
nevus vasculosus
Strawberry mark; raised, clearly delineated, dark-red, rough-surfaced birthmark commonly found in the head region
stercobilinogen
Substance derived from urobilinogen that is found in the feces and is oxidized to form urobilin forming the brown color of feces
moxibustion
TCM therapy involving application of heat from a piece of burning herb; used to help turn a breech baby to a birthing position
qigong
TCM therapy involving meditation, self massagem and movement to stimulate the flow of chi
tai chi
TCM therapy; form of martial art focusing on physical fitness, self defense, and improvement of overall health
acrocyanosis
Temporary cyanotic condition in newborns resulting in a bluish color around the hands and feet (extremities) - can last for up to 24 hours after birth
coombe's test
Test for maternal antibodies to fetal blood type (not Rh) in fetal blood. - If present, baby is monitored for jaundice
ovarian cycle
The 28 days of the menstrual cycle as they apply to events in the ovary; follicular and luteal phases
cardinal ligaments
The chief uterine supports, suspending the uterus from the side walls of the true pelvis - prevent uterine prolapse and support upper vagina
broad ligament
The ligament extending from the lateral margins of the uterus to the pelvic wall; keeps the uterus centrally placed and provides stability within the pelvic cavity.
linea negra
The line of darker pigmentation extending from the umbilicus to the pubis noted in some women during the later months of pregnancy.
foremilk
The milk at the beginning of a breastfeeding; low fat content, watery, proteins
low lying placenta previa (grade 1)
The placenta is implanted in the lower uterine segment in close proximity to the internal cervical os; off to the side
embryonic stage
The second stage of prenatal development; day 15- 2 months (end of 8th week) - or until embryo reaches CRL of 3 cm - most important time for development of embryo - in this stage, tissues differentiate into organs and main external features develop - where teratogenic effects are most likely to occur
enculturation
The social process by which culture is learned and transmitted across generations
fetal stage
The third stage of prenatal development, lasting from two months through birth.
plantar grasp
Touch sole of foot, toes curl downwards
nuchal cord
Umbilical cord around the fetal neck.
nuchal cord
Umbilical cord around the fetal neck; causes compression
vernix caseosa
Waxy or "cheesy" white substance found coating the skin of baby en utero to help protect the skin in the amniotic fluid - term babies will have barely any; some may be left over under the arms or neck - preterm babies will have more; more spread over body
perineal body
Wedge-shaped mass of fibromuscular tissue found between the lower part of the vagina and the anal canal - during the last part of labor, it thins out to just a few cm thick; often the site of an episiotomy of lacerations during childbirth
rooting reflex
a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple
megaloblastic anemia
a blood disorder characterized by anemia in which the red blood cells are larger than normal; results in less RBCs
harlequin sign
a change in color on one side of the body; one side may be pink while the other is pale - caused by dilation of blood vessels - something that needs to be documented/let nurse know
trisomy
a condition in which an extra copy of a chromosome is present in the cell nuclei, causing developmental abnormalities ( 3 copies instead of 2) - occurs in meiosis
cretinism
a congenital form of hypothyroidism caused by iodine deficiency
child free family
a couple that resides together without children; either by choice or by medical issues (infertility)
single parent family
a family in which only one parent is present to care for the children; the parent may be widowed, divorced, abandoned, separated, or never married - often face difficulties due to sole parent lacking social and emotional support, and assistance
calendar rhythm method
a fertility awareness method of contraception that takes account of variability in the length of a woman's menstrual cycles - recording of cycles and abstinence until fertile window
baby kick count
a fetal activity assessment is also referred to as:
X - since it came from a woman, XX
a mature ovum has what sex chromosome?
Montevideo units (MVUs)
a method for evaluating the adequacy of uterine activity for achieving progress in labor; measured by an IUPC
essure
a method of tubal sterilization that blocks the fallopian tubes by use of metal coils
24 hrs
a newborn needs 1 void and 1 BM (meconium) in the first:
cortical reaction
a reaction that occurs during fertilization, when the sperm cell unites with the egg's plasma membrane, that prevents entry of a second sperm. - the release of enzymes to prevent additional sperm from entering egg
rooting
a reflex in which a newborn turns its head in response to a gentle stimulus on its cheek
APGAR score
a scale of 1-10 to evaluate a newborn infant's physical status at 1 and 5 minutes after birth
toxic shock syndrome (TSS)
a severe illness characterized by high fever, rash, vomiting, diarrhea, and myalgia, followed by hypotension and, in severe cases, CNS depression, loss of consciousness, shock and death; usually affects menstruating women using extra absorbent tampons; caused by Staphylococcus aureus and Streptococcus pyogenes
morula
a solid ball of cells resulting from cleavage; contains 12-32 blastomeres - when it enters the uterus, its ICF increases and a central cavity forms within the cell mass, where the blastocyst forms (an inner solid mass of cells)
yolk sac
a specialized structure that leads to the digestive tract of a developing organism and provides it with food during early development - forms RBCs during first 6 wks of development, until the liver takes over - develops as a second cavity in the bastocyst on day 8-9 of conception - incorporated into the umbilical cord as the embryo develops
alternative therapy
a substance or procedure that is used in place of conventional medicine; not usually available in conventional clinics and hospitals, and not typically covered by insurance
intrauterine fetal surgery
a therapy for certain anatomic lesions that can be corrected surgically and are incompatible with life if not treated - generally considered experimental - involves opening the uterus during the 2nd trimester (before viability), doing the surgery, then replacing the fetus in the uterus - poses substantial risk to fetus, and commits mother to c-section births for future pregnancies
external version
abdominal manipulation; used to turn a breech baby around - be prepared for emergency C/S; potential cord problems - if 37+ weeks, they may induce labor after procedure
hypospadias
abnormal congenital opening of the male urethra on the undersurface of the penis
epispadias
abnormal congenital opening of the male urethra on the upper surface of the penis
sickle cell anemia
abnormal formation of normal adult hemoglobin;decreased oxygenation produces cresent shaped RBCs - prevalence is primarily African descent - rare autosomal recessive disease
mediastinal shift
abnormal movement of the structures within the mediastinum to one side of the chest cavity; causes heart/heart tones to shift - can be caused by diaphragmatic hernia (stomach contents are up in chest pushing heart over)
imminent abortion
abortion characterized by bleeding and cramping that increases while the internal cervical os dilates - membranes may rupture
threatened abortion
abortion in which embryo or fetus is jeopardized by unexplained bleeding, cramping and back ache - cervix is closed - bleeding may persist and be followed by partial or complete expulsion of products of conception - it can also resolve without threatening the fetus
induced abortion
abortion occurring as a result of artificial or mechanical interruption
incomplete abortion
abortion without expulsion of all of the products of conception - some products of conception are retained, usually the placenta
amenorrhea
absence of menses - can be primary (no menses by 16 or within 4 yrs of breast development) - can be secondary (pregnancy, strenuous exercise, anorexia)
menopause
absence of menstruation for 1 full year - marks end of reproductive abilities - occurs between 45-52
respiratory acidemia
acidemia that occurs toward the end of labor; is easier to fix
mixed acidemia
acidemia that occurs when PCO2 and base deficit are high
date rape
acquaintance rape in which occurs between a dating couple - in some cases, alcohol/drugs are used to sedate victim
autosomal dominant disorders
affected individual has an affected parent; 50% chance of passing on the gene - males and females equally affected - varying degrees of penetration ex. Huntington Disease
-start to administer medications -epinephrine down ET tube or through umbilical catheter
after 30 seconds of chest compressions, if infant's HR is still below 60, what do you do?
- placenta begins degrading - amniotic fluid will decrease by 30% each week - bad placenta results in late decels - low amniotic fluid results in variables/early decels - can cause IUGR (placental insufficency)
after 40 weeks gestation, what happens to the placenta and amniotic fluid? what does it result in?
- check the fetal HB/HR - removing amniotic fluid to fast can cause a sharp drop in BP/HR
after an amniocentesis, what should the nurse do?
para
after delivery; 20 weeks or greater
- head circumference - weight - length - if 2/3 of those points are within the graph lines, then they are AGA - if 2/3 of those points are above the line (90th percentile), then they are LGA - if 2/3 of those points are below the line (10th percentile), then they are SGA
after scoring the dubowitz, what do you plot on the dubowitz graph? How is the graph interpreted?
- assess the placenta; make sure it is all there - retained placenta can cause postpartum hemorrhage (hormones are still releasing, causing blood flow into uterine cavity)
after the placenta has been delivered, what should the nurse assess?
gravida
all pregnancies, of any duration, no matter what happens to the fetus
complete abortion
all products of conception are expelled
foramen ovale
allows already oxygenated blood to bypass the lungs to go out into circulation (goal is to get it to the brain first) - 60% of oxygenated blood that goes into heart
ductus venosus
allows oxygenated blood to bypass the liver to get to the brain - a small amount will be let into the liver for nourishment
base deficit
amount of base needed to achieve a pH of 7.10 in the cord blood sample
Clinical Nurse Specialist (CNS)
an APRN who is an expert clinician in a specialized area of practice - often found on mother/baby, pediatric, and intensive care units
Certified Nurse-Midwife (CNM)
an RN who has received special training and education in the care of the family during childbearing, prenatal, labor, birth, and postpartum periods
variable deceleration
an abrupt descent from baseline FHR; caused by a vagal reaction when peak of contraction takes place and arteries close off
pelvic exam
an examination of the internal female reproductive organs; used for diagnostic purposes, can be preformed alone or in junction with a pap smear
ovarian ligaments
anchor ovaries to uterus; attach to cornua - contract to help fimbriae catch the ovum as it is released
-blood loss -hemolysis -impaired red blood cell production
anemia is due to what?
rectocele
anterior wall of the rectum sags forward, ballooning into the vagina; pocket of rectum may trap stool, resulting in constipation - woman may find it necessary to press the tissue between the vagina and rectum, which alleviates it - tx often involves surgery
teratogen
any agent that can cause development of abnormal structures in an embryo - drugs, virus, radiation
gestational DM
any degree of glucose intolerance with onset or initial diagnosis during pregnancy
malpresentation
any fetal position that is not OA; OP is the most common
complimentary therapy
any procedure of product that is used as an adjunct to conventional medical tx - acupuncture, massage therapy, etc.
physiologic jaundice
appears after the first 24 hrs postnatal; accelerated destruction of fetal RBCs - results in increased amounts of bilirubin delivered to liver and inadequate hepatic circulation (immature liver) - impaired conjugation and increased reabsorption - can result from bruising during delivery; forceps/vacuum assisted delivery
integrative medicine
approach to treatment that combines mainstream medical therapy with complimentary therapies for which there is some high quality scientific evidence of safety and effectiveness
amniotomy
artificial rupture of amniotic membranes; involves a use of a hook - must be atleast 2 cms dilated - if they are high stationed in pelvis (-3), they will be at risk for UC prolapse
- ballard - dubowitz
assessment scales used to determine the actual age of the baby (rather than estimated)
HSV-1
associated with genital herpes via oral-genital contact
hypovolemia
associated with severe placental abruption; life threatening - requires administration of whole blood - if fetus is alive, but experiencing stress, emergency C/S is immediate.
80-100 mL - during the birth process, the fetal chest is compressed and squeezes fluid out - after birth, the chest recoils; allows for room air to come in and the rest of the fluid is dispersed out into the lung tissue
at the time of delivery, how much fluid remains in the lungs of a full term infant? how is it removed?
below 97.6
at what temperature do you want to avoid bathing a newborn?
body stalk
attaches the embryo to the yolk sac, contains blood vessels that extend into the chorionic villi; fuses with the embryonic portion of the placenta to provide a circulatory pathway form villi to the embryo - elongates to form the umbilical cord
7 lb, 8 oz (3405 g)
average normal weight for a newborn
gestation
baby age
+3 station
baby's head is crowning
Group B Streptococcus (GBS)
bacteria normally found in vaginal flora, it comes and goes - tested in prenatal screening because it can cause your child to go septic and possibly kill them - if the swab is positive, penicillin is used during birth to kill it off and reduce risk of the child contracting it - clindamycin can also be used
diaphragm
barrier method used with spermicidal cream or jelly and offers a good level of protection from conception - woman must be fitted for device and educated on how to use it - should be rechecked for size after each childbirth - inserted before sex, with spermicidal inside - leave diaphragm in place for 6 hrs after sex
vaginal sponge
barrier method; contains spermicide - fits over the cervix, has a loop for easy removal - get wet with water before insertion to activate spermicide - should be left in place for 6 hours after sex - problems associated with method include problems removing it, irritation, and dryness - slightly less effective than diaphragm
equilibrium model of health
based on concept of balance between light and dark, heat and cold; some philosophies focus on the notion of "yin and yang"
wandering baseline
baseline that fluctuates between 120-160 in an unsteady pattern; can be associated with neurologic impairment of the fetus or preterminal event
embryonic membranes
begin to form at the time of implantation to protect and support the embryo as it grows and develops inside the uterus; chorion and amnion
taboo
behavior or thing that is to be avoided; many cultures have these behaviors centered around the unborn baby and/or newborn, meant to ensure that the baby will survive
gynecoid
best birthing hips/pelvis
breast self examination (BSE)
best method for early detection of breast masses - teach technique as monthly practice; helps woman become familiar with her breasts and more likely to detect change - should be preformed periodically or on a monthly basis about 1 week after each period, when the breasts aren't tender or swollen - after menopause, it should be done on the same day each month
gynecoid pelvis
best type of pelvis for giving birth
terbutaline
beta agonist (b-mimetic) used for tocolysis and hypertonic labor patterns; smooth muscle relaxer - severe side effects can occur: tachycardia, palpations, jitteriness/restlesness - increases risk of hemorrhage - brethine: oral form
round ligament
binds the uterus to the anterior body wall; help the broad ligament keep the uterus in place
step family
biologic parent with children, and a new spouse who may or may not have children - aka blended family
preterm labor
birth before 37 weeks
cephalohematoma
blood collection between the surface of a cranial bone and the periosteal membrane that does not cross the suture line on the baby's scalp; stays on one side of the head - usually disappear after 2-3 weeks
corpus luteum
body that develops within a ruptured ovarian follicle; it secretes progesterone and small amounts of estraidol in the 2nd half of the menstrual cycle (secretory phase) and during the luteal phase of ovarian cycle - atrophies about 3 days before menstrual flow and loses its secretory function (progesterone and estrogen production diminish) and it becomes the corpus albicans - then, pituitary produces large amounts of FSH to induce LH production so new follicles begin maturing for the next ovarian cycle - if pregnancy occurs, it doesn't atrophy and continues to produce progesterone until the placenta takes over
choanal atresia
bony or membranous septum between the nasal cavity and pharynx of a newborn; causes nasal obstruction
autosomal recessive disorders
both parents carry abnormal gene; 25% chance of passing on gene, 25% chance child will be affected, 50% chance that unaffected child will be a carrier - males and females equally affected - ex. CF, sickle cell, tay-sachs, most metabolic disorders
Dual-career/dual-earner family
both parents work; makes up 2/3 of all 2 parent families - have to address issues rt childcare, household chores, and spending time together
2
breast feeding mothers should not consume alcohol for at least how many hours before nursing?
300 kcal
breastfeeding mothers increase intake by how many calories?
bilirubin
by product of the breakdown of RBCs, liver is not mature enough to handle breakdown
Unconjugated bilirubin (indirect)
byproduct of hemoglobin released from destroyed RBCs; not excretable and potentially toxic
conjugated bilirubin (direct)
byproduct of hemoglobin released from destroyed RBCs; transformed into a water soluble, excretable form - excreted in feces or urine
yes - in most states they will be considered emancipated, but some they will only be able to give consent for their child and not themselves
can a pregnant minor give consent for herself?
abstinence
can be considered a method of contraception; refraining from sex
pitocin
can be given to make contractions stronger
surgical abortion
can be preformed in the first and second trimester - d&c - minisuction - vacuum curettage
fiber
carbohydrate; essential for bowel function
expulsion
cardinal movement; after external rotation, pushing allows the shoulders to move out of the birth canal and flexion occurs - anterior shoulder is born before posterior shoulder - body follows quickly
external rotation
cardinal movement; as shoulders rotate to the antero-posterior position of the pelvis, the head turns farther to one side
internal rotation
cardinal movement; fetal head must rotate to fit the dm of the pelvic cavity - as the occiput meets resistance, it rotates (L to R) - sagittal suture aligns in the AP pelvic dm
flexion
cardinal movement; occurs as the fetal head descends and meets resistance from the pelvis, pelvic floor, and cervix - fetal chin flexes downward onto the chest
extension
cardinal movement; resistance of pelvic floor and and movement of vulva opening assists in pushing the occiput, then brow and face, through the vagina
restitution
cardinal movement; shoulders enter the pelvic inlet obliquely and remain in that position when the head rotates through internal rotation - neck becomes twisted, and untwists after head is pushed through vagina - shoulders turn to follow head
primary care
care that includes a focus on health promotion, illness prevention, and individual responsibility for one's own health - best provided in community based settings (schools, clinics, workplaces, etc.)
umbilical vein
carries oxygenated blood from placenta into the fetus
umbilical arteries
carry deoxygenated blood from the fetus to the placenta
oxytocin
causes milk letdown
apnea
cessation of breathing > 20 seconds; may or may not be associated with HR or color changes - always needs further evaluation
eclampsia
characterized by grand mal convulsions or coma - may occur before onset of labor, during labor, or early postpartum - women may have one or more seizures - can cause the placenta to work less effectively; potential for fetal demise
smegma
cheesy substance secreted by glands in the foreskin and clitoral hood
placenta accreta
chorionic villi attach directly to the uterine myometrium
syphillis
chronic STI; caused by the spirochete Treponema pallidum - primary s/s: chancre, flulike symptoms - secondary s/s: 6 wks- 6 mo chancre disappears and warts appear with other systemic reactions - dx via RPR and dark field examinations (RPR is reactive if they have it)
class IV
classification of heart functional capacity; any physical activity produces discomfort - symptoms of cardiac insufficiency or angina even at rest - discomfort increases with activity
class I
classification of heart functional capacity; asymptomatic, no limitation of physical activity
class III
classification of heart functional capacity; marked limitation of physical activity, comfortable at rest but symptomatic during less than ordinary physical activity
class II
classification of heart functional capacity; slight limitation of physical activity, asymptomatic at rest - symptoms occur with ordinary physical activity
familism
close knit, interdependent network of nuclear and extended family members who are connected for the good of the family; occurs when young mothers seek the advice of their mothers/grandmothers about childbirth - decisions about health tend to be made by the family - occurs in traditional mexican-american cultures
caput
collection of fluid that crosses the suture line; usually reabsorbed within 12 hrs after birth
urobilinogen
colorless compound produced in the intestine after the breakdown of bilirubin by bacteria
- heartburn - ankle edema - varicose veins - flatulence - hemorrhoids - constipation - backache
common discomforts of the second and third trimesters?
clomid (clomiphene citrate)
common first line therapy for inducing ovulation in women with normal ovaries, prolactin level, and an intact pituitary gland - stimulates hypothalamic release of GnRH
polycystic ovarian syndrome (PCOS)
complex endocrine disorder of ovarian dysfunction, characterized by menstrual dysfunction or irregularity, signs of androgen excess (hirsutism and acne) - s/s: obesity, hyperinsulinemia, infertility, menstrual dysfunction
therapeutic touch
complimentary therapy meant to be used with conventional medical care; grounded in the belief that people are a system of energy with a self healing potential
female reproductive cycle
composed of ovarian cycle and menstrual cycle; take place simultaneously - occurs for a period of 30-40 years, can be disrupted by pregnancy - under neurohormonal control
clinical practice guidelines
comprehensive interdisciplinary care plans for a specific condition that describe the sequence and timing of interventions that should result in expected client outcomes - adopted within a healthcare setting to reduce variation in care mgmt, to limit cost of care, and evaluate care effectiveness
endometriosis
condition characterized by the presence of endometrial tissue outside the uterine cavity - endometrial tissue bleeds cyclically in response to hormonal changes of period; results in inflammation, scarring, and formation of adhesions - most common in ages 20-45 - cause is unknown - often dx when a woman seeks evaluation for infertility (it can cause infertility)
gestational trophoblastic disease (GTD)
condition in which trophoblastic tissue overtakes the pregnancy and propagates throughout the uterine cavity - includes molar pregnancy
ductus arteriosus
connects the pulmonary artery to the aorta, bypassing the lungs
foramen ovale
connects the two atria in the fetal heart
ductus venosus
connects the umbilical vein to the inferior vena cava, bypassing the liver
nuclear family
consists of a husband/provider, a wife who stays home, and children - used to be the norm; no longer most common type of family
ethnocentrism
conviction that the values and beliefs of one's own cultural group are the best or only acceptable ones; characterized by the inability to understand the beliefs and worldview of another culture
pH<7.10
cord blood acidemia
variable decelerations
cord compression - seen often when mom gets to 8-10 cm; cord may stretch as they descend - oligohydramnios prevents the cord from being cushioned - nuchal cord
extended family
couple shares household and childrearing responsibilities with parents, siblings, or other relatives - multigenerational; more common in non US cultures and working class families
rugae
cover the walls of the vagina; allow vaginal tissues to stretch enough for fetus to pass through during childbirth and during sex
menstrual (uterine) cycle
cyclic buildup of the uterine lining, ovulation, and sloughing of the lining occuring approximately every 28 days in nonpregnant females; 4 phases: menstrual, proliferative, secretory, ischemic
menstruation
cyclic uterine bleeding in response to cyclic hormonal changes; occurs when the ovum is not fertilized and begins about 14 days after ovulation in the absence of pregnancy - occurs approx. every 29 days (can range from 21-35 days) - lasts from 2-7 days (avg blood loss 25-60 mL)
fetal death
death in utero at 20+ weeks gestation
missed abortion
death of a fetus or embryo within the uterus that is not naturally expelled after death - uterine growth ceases, breast changes regress, and the woman may report a brown vaginal discharge - cervix is closed
prolonged decelerations
decelerations that leave the baseline for more than 2 minutes, but less than 10 minutes
thermal stimuli
decrease in environmental temperature after birth - newborn responds with increase in respirations - avoid prolonged exposure to cold; can result in cold stress and apnea
fetal circulation
delivers the highest available O2 concentration to the head, neck brain and heart (coronary circulation) and less to the abdominal organs and lower body; cephalocaudal development
descriptive statistics
describe or summarize a set of data - report facts, identify certain trends and high risk groups - help generate research questions - provide no explanation on why/how some phenomenon has occured - birth rate, death rate
integrative health
describes the use of complimentary therapies within mainstream healthcare
malignant gestational trophoblastic disease
develops following evacuation of a mole in about 20% of women - early detection requires extensive follow up (chest XR, physical and pelvic exam, serial hCG measurements)
umbilical cord
develops in the amnion along with the placenta (starts as body stalk); connects the placenta to the umbilicus of the fetus (central attachment is considered normal) - used to exchange nutrients and wastes from mother to baby - contains 2 arteries and a vein to supply blood to the fetus; surrounded by wharton jelly - no innervation
bloody show
dislodging of thick (blood tinged) cervical mucus plug at end of pregnancy, which is a sign of beginning of labor - brown-reddish brown, with tinged mucus vaginal discharge
- no, because they will tire out very quickly; risk of aspiration - want to slow RR down first
do you want to feed a newborn that has a high RR?
skin to skin
done in the first hour of newborn's life; helps calm baby and stabilize their blood sugar
cystocele
downward displacement of the bladder - genetic predisposition, obesity, childbearing, and increased age increases risk - s/s: stress incontinence, vaginal fullness, bulging out of the vaginal wall, dragging sensation - tx: kegel exercises, estrogen, duloxetine, vaginal rings, surgery
cocaine
drug that acts at the nerve terminals to prevent reuptake of dopamine and norepinephrine; results in vasoconstriction, tachycardia, and HTN - vasoconstriction in the placenta causes decreased blood flow to the fetus - can cross into breastmilk and cause symptoms in the baby (extreme irritability, apnea, diarrhea, etc.)
mifespristone and misoprostol
drugs used in combination that cause smooth muscle to contract, leading complete abortion in approximately 92% of women - used for medical abortions of early pregnancy - FDA approved for use up to 49 days after last menstrual period
start assessing before birth - nipple retraction requires therapy so baby can breastfeed properly
during pregnancy, when should breasts be assessed?
marginal placenta previa (grade 2)
edge of the placenta is at the margin of the internal cervical os, but doesn't cover it
fetal presentation
engagement; how far the fetus is in the birth canal - dilation, effacement, stations
dermal sinus
epithelial lined tract that extends from the skin to deep soft tissues (sometimes the spinal canal, sometimes a dermoid or lipoma)
protein
essential acids needed for maternal tissue hyperplasia and hypertrophy and fetal growth; contribute to energy metabolism
herbalism
essential part of traditional Indian, Asian, Native American, and naturopathic medicines - many homeopathic remedies are developed from this - most of earth's population depends on it to treat common ailments
1 day
estrogen levels fall how many days before ovulation?
estradiol
estrogen secreted by the ovaries
contraction stress test (CST)
evaluates placental respiratory function; allows ID of fetus at risk for intrauterine asphyxia - done at term, don't want to induce contractions in preterm - goal is 3 contractions in 10 minutes, then look at fetal strips for decelerations - done less often clinically; BPP done instead - time consuming - high false positive rate
hyperemesis gravidarum
excessive vomiting during pregnancy; leads to dehydration, hypovolemia, hypotension, tachycardia, etc. - can't get anything down - can cause starvation in fetus
bartholin glands (vulvovaginal glands)
external to hymen at base of vestibule, lie under vaginal constrictor muscle - secrete a clear, thick, alkaline mucus that enhances the viability and motility of the sperm deposited into the vestibule - can harbor bacteria, which can cause pus formation and abcess
- maternal parity - duration of pregnancy - stage of lactation - single feeding variability
fat content in breastmilk is influenced by:
vitamin D
fat soluble vitamin needed for absorption and utilization of Ca and Phosphorus
vitamin E
fat soluble vitamin needed for antioxidation and maintenance of cell membrane health
vitamin A
fat soluble vitamin needed for growth of epithelial cells, synthesis of glycogen, and development of healthy eyes in the fetus
vitamin K
fat soluble vitamin needed for the synthesis of prothrombin
AIDS
fatal disorder caused by HIV; profound implications for the fetus if woman is pregnant
DHA
fatty acid that may reduce risks of preterm birth, preeclampsia, and low birth weight - may also enhance fetal and infant brain development - oily fish is the best source, risk for excessive maternal mercury intake
gavage feeding
feeding method used for infants with a poor suck/swallow reflex or on a ventillator; can be used with bottle or breastfeeding if infant tires easily or is losing weight
symptothermal method
fertility awareness method that consists of various assessments recorded by the couple; include information regarding cycle days, sex, cervical mucous change, and secondary signs such as increased libido, bloating, midcycle abdominal pain, and basal body temp. - eventually, couple recognizes the signs that indicate ovulation
basal body temperature
fertility awareness method to detect ovulation; requires the woman to take her temperature every morning upon awakening and record readings on a graph - temperature drops right before ovulation, and then increases during beginning at fertile window (due to increase in progesterone) - after 3-4 mo, the woman should be able to predict when ovulation occurs - sex on the day your temp increases or 3 days after = pregnant
zygote
fertilized ovum
- IUGR - small head circumference - cerebral infarctions - shorter body length - altered brain development - malformations of the GU tract - lower APGAR scores - neurobehavioral disturbances - exaggerated startle reflex - labile emotions - subtle behavioral and learning problems - increased risk for SIDS, spontaneous abortion, placental abruption, still birth, and preterm birth
fetal cocaine exposure in utero can cause:
occiput posterior
fetal head position; "sunny side up" - harder to deliver vaginally; more back pain, may not engage as fast
Right Occiput Anterior (ROA)
fetal head position; back of baby's head is still anterior but they're turned slightly to the right
left occiput anterior (LOA)
fetal head position; back of baby's head is still anterior, but they are turned slightly to the right
left occiput transverse (LOT)
fetal head position; occiput is on left side of mom's pelvis, baby is turned on left side
right occiput transverse (ROT)
fetal head position; occiput is on the right side of mom's pelvis, baby is turned on its right side
compound presentation
fetal position in which there are 2 presenting parts - ex. hand is resting on head - try to manually move one presenting part away - most resolve spontaneously
transverse lie
fetal position; shoulder presentation - fetus is laying sideways - leopold's maneuver will help confirm - if you feel something hard during a vaginal exam, they may be positioned this way
sinciput (military) presentation
fetal presentation in which top/front of head is the presenting part
moderate variability
fetal strip activity that indicates the baby is well oxygenated; helps rule out acedemia
cephalopelvic disproportion (CPD)
fetus is larger than its passageway
prembryonic stage
first 14 days of fetal development; divided into cellular multiplication and differentiation - characterized by rapid cell multiplication, differentiation and establishment of the primary germ layers and embryonic membranes - synchronized development of the endometrium and embryo is a prerequisite for implantation to succeed
chorion
first and outermost embryonic membrane to form; develops from the trophoblast, has many fingerlike projections called chorionic villi - chorionic villi used in sampling for genetic testing of the embryo at 8-11 weeks gestation - as pregnancy progresses, all villi except for those just under the embryo degenerate; these form the fetal portion of the placenta
follicular phase
first phase of ovarian cycle (days 1-14); follicle matures as a result of FSH, and ovulation occurs - oocyte grows within the follicle - just before ovulation, the mature oocyte completes meiosis I (forms polar body and secondary oocyte) - a mature graafian follicle appears on day 14 under dual control of FSH and LH - varies in length
primipara
first time giving birth
traditional chinese medicine
focus is prevention, although dx and tx play important roles; seeks to ensure balance of energy (chi), that maintains health, vitality, and enables the body to carry out its physiologic function - chi flows along certain pathways/meridians - yin and yang - acupuncture, acupressure, herbal therapy, qigong, tai chi, moxibustion
acrosomal reaction
follows capacitation, must occur before fertilization can; acrosomes of the sperm surrounding the ovum release enzymes that break down the corona radiata, so a sperm can penetrate the zona pellicuda and begin fertilization - enzymes are released from the ovum to prevent more than 1 sperm from entering an ovum
primary germ layers
form 10-14 days after conception; blastocyst cells differentiate into 3 layers; ectoderm, mesoderm, endoderm - formed at the same time as the embryonic membranes - all tissues, organs, and organ systems will develop from these
pap snear
form if cervical cytology testing used to screen for cellular abnormalities by obtaining a sample containing cells from the cervix and endocervical canal - begin annual testing at 21, or earlier if sexually active - method of choice for cervical cancer screening, and allows testing for HPV and some other STIs - findings reported using bethesda system
vaginal ring
form of low dose, sustained release hormonal contraceptive - inserted into the vagina, left in place for 3 weeks and removed for 1 week to allow bleeding - highly effective, has minimal side effects - can be worn during sex - needs to be kept in the fridge
-the fundus is the top portion of the uterus -fundus will be at the level of the umbilicus 6-12 hours postpartum -fundus will be 1 cm below the umbilicus on the first postpartum day -fundus will descend 1 cm per day until it is in the pelvis on the 10th day -if fundus starts getting higher, we start worrying that the uterus is filling with blood, and postpartum hemorrhage -if fundus is shifted, bladder could be full
fundus changes in postpartum mom?
Vulvovaginal Candidiasis (VVC)
fungal or yeast infection, usually caused by Candida albicans; most common form of vaginitis - possible for male to be symptomatic while female is asymptomatic - contributing factors include use of COC, immunosuppressants, and antibiotics - can be transmitted from M to F
human papillomavirus (HPV)
genital warts; caused by condylomata acuminata - precancerous cells, linked with cervical cancer - s/s: cauliflower like lesions on genital area - dx with biopsy
multipara
given birth more than 3 times
post term
greater than 42 weeks gestation
postterm
greater than 42 weeks gestation
prostaglandin F (PGF)
group of prostaglandins that are potent vasoconstrictors and increase the contractility of muscles and arteries
prostaglandin E (PGE)
group of prostaglandins that relax smooth muscle and are potent vasodilator
polydactyly
having more than the normal number of fingers or toes - if there is not a bone, they will be tied off and eventually they will fall off - if there is a bone, there's a more extensive removal process
-1 station
head is 1 cm above the ischial spines
-2 station
head is 2 cm above ischial spine
cephalopelvis disproportion (CPD)
head unable to fit through pelvis
naturopathy
healing system that combines safe and effective traditional means of preventing and treating disease with the most current advances in modern medicine - use of a variety of therapies to produce precise care
conduction
heat loss that occurs when an object is directly touching the baby, causing the loss - cold hands, cold stethoscope
convection
heat loss that occurs when their is an air current around the baby that is colder than the baby
radiation
heat loss that occurs when there are cold things around the baby, but they aren't in direct contact
evaporation
heat loss that occurs when there is moisture on the baby; want to make sure baby is dry after birth and baths
HSV-2
herpes associated with genital infections
cytomegalovirus
herpes-type virus that usually causes disease when the immune system is compromised; can cause mental retardation, hearing loss, CP, and micro/hydrocephaly in infants
nonmarital heterosexual cohabitating family
heterosexual couple, who may or may not have kids, that lives together outside of marriage - may include never married individuals, divorced or widowed individuals, etc - sometimes done for personal/financial reasons
innominate bones
hip bones; ileum, ischium, pubis - form the acetabulum (articulates with femur)
uterus
hollow, muscular, thick-walled organ; lies in the center of the pelvic cavity between the base of the bladder and the rectum, above the vagina - its position can vary because it can move freely - supported by 4 pairs of ligaments (cardinal, uterosacral, round, broad) - innervated by the ANS; can contract without intact nerve supply - divided into 2 major parts: corpus and cervix - changed permanently by pregnancy
combined oral contraceptives
hormonal contraception; combination of estrogen and progestin - highly effective, rapidly reversible - prevents ovulation - generally taken for 21 days, typically beginning on the sunday after the first day of menstrual cycle (can start on day 1 of menstrual cycle and other times) - menses occurs 1-4 days after last pill is taken - different formulations allow extended use, which reduces periods to 4 a year, or no bleeding at all - reduce the side effects of bloating, headache, cramping, swelling, acne, etc.
estrogen
hormone associated with secondary female characteristics; breast growth/development, hair growth, widening of hips, deposits of fat - also assist in proliferation of endometrial mucosa after menstruation - cause the uterus to increase in size and weight - secreted largely by the ovaries, and by the adrenal cortex in small amounts in nonpregnant women (produced by placenta in pregnant women) - fat cells produces secondary amounts - between the ages of 45-55, the amount secreted by the ovaries is decreased, and eventually menopause occurs - inhibit LH production and stimulate FSH production - estrone, B-estraidol, estriol
thyroxine
hormone produced and secreted by follicle cells in the thyroid gland; targets all cells in the body and increases overall body metabolism
human chorionic gonadotropin (hCG)
hormone produced by placenta; similar to LH, prevents normal involution of the corpus luteum at the end of the menstrual cycle - present in maternal blood 8-10 days after fertilization, as soon as implantation occurs (detectable in urine at time of missed menses) - causes the corpus luteum to secrete increased amounts of estrogen and progesterone - helps male fetus produce testosterone - if there's pregnancy, it continues to produce until 50-70 days gestation where it decreases as placental hormone production increases
human placental lactogen (hPL)
hormone produced by the placenta; stimulates certain changes in the mother's metabolic process that ensure more protein, glucose, and minerals are available for the fetus - can be detected about 4 wks after conception
- late decelerations (POSITIVE CAUSATIVE CST)= bad sign: indicates that baby will not be able to handle labor; medical emergency, do not send them home and have baby asap - no decelerations= NEGATIVE CST: a healthy baby can tolerate the decrease in O2 transport and increased pressure caused by a contraction, while maintaining a normal FHR
how are CSTs interpreted?
- want to be between 180-200 to be in adequate labor; may need more ptocin - if 180-200, but cervix is not dilating then they are failure to progress
how are MVUs interpreted?
- frequency - duration - intensity
how are contractions described?
- nipple stimulation - ptocin - both release oxytocin that causes contractions
how are contractions induced in a CST?
- fewer than 2-3 contractions in a 10 minute period - coupling: 2 contractions close together, than a large gap - low intensity and minimally uncomfortable contractions
how are hypotonic labor patterns characterized?
- gestational age (ballard score) - size (LGA, AGA, SGA): length, weight, and head circumference
how are newborns classified?
- feels like the tip of the nose: mild - feels like the chin: moderate - feels like the forehead: strong
how are palpations for intensity of a contraction interpreted?
a full term baby's crease will extend all the way to the heel - as gestation progresses the further it gets to the heel
how are sole (plantar) creases in a full term baby different from a preterm baby?
- -4: can't touch the child; ballodable (baby isn't engaged) - -1: 1 cm above ischial spine - 0: even with ischial spine - +1: 1 cm below ischial spine; top of head is felt during contraction - +2: 2 cm below ischial spine; top of head is felt during contration - +3: crowning (above the ischial spine= negative number, below ischial spine=positive number)
how are stations interpreted?
- assess uterine contraction pattern, uterine resting tone, and F/D/I of contractions
how are uterine contractions evaluated using fetal monitoring?
hysterosalpingography and laparoscopy - direct visualization of pelvic organs, evaluation of endometriosis and pelvic adhesions, used only if strong clinical suspicion of these conditions or before considering more aggressive txs hysteroscopy- definitive method for both dx and tx of intrauterine pathology
how are uterine structures and tubal patency evaluated in a woman?
- create an atmosphere of trust - help woman maintain a sense of control - position and drape woman to maintain eye contact with practitioner - encourage questions, give feedback
how can a nurse make a pelvic exam less threatening?
- after birth, 300-500 mL of blood goes back into maternal circulation
how can systemic responses to labor affect someone with a cardiac issue?
veganism may restrict the amount of protein the child gets
how can the fact that the parents are vegan affect the child?
- draw blood into a red top tube - if blood doesn't clot= indicative of DIC
how can you test for DIC during high risk labor?
- they increase by 300 kcal/day
how do caloric needs change during pregnancy?
- it can affect vision - they may not be able to see through their contacts/glasses anymore
how do changes in intraocular pressure affect the mom?
through breaks in the capillaries and placental membrane, particularly during labor and birth
how do fetal RBCs pass into the maternal circulation?
- they increase by 60 g/day
how do protein needs change during pregnancy?
- sibling rivalry - fear of changing parent relationships - regression - may need reassurance
how do siblings respond to pregnancy?
high estrogen levels increase peristalsis within the fallopian tubes, which helps move down toward the uterus - the high estrogen levels also thin the cervical mucus, facilitating the movement of sperm through the cervix and uterus, into the fallopian tube - prostaglandins in the semen may increase uterine smooth muscle contraction, which can help propel them toward the uterus
how do the ovum and sperm move to the ampulla?
-depression scales -anxiety and irritability -poor concentration and forgetfulness -sleeping difficulties -appetite change -fatigue tearfulness -psychosis: can hurt themselves or baby
how do you assess postpartum psychiatric disorders?
-fatigue -adequacy of sleep -nutritional status
how do you assess psychological adaptation and nutrition in the postpartum mom?
-active listening -provide nonjudgmental support -show concern and compassion -personalize care for the mother
how do you care for a mother who relinquishes her infant?
-tight-fitting sports bra -apply ice to breasts -avoid breast stimulation (warm things cause let down, ice causes milk to not let down) -don't let partner stimulate
how do you educate suppression of lactation in the nonbreastfeeding mother?
-pump breasts to express great milk -ensure adequate intake by drinking extra fluid at each break and when possible, during the day -more frequent nursing on weekends and at night -nutritionally sound diet -continue manual expression or pumping when not nursing
how do you maintain lactation after returning to work?
- use interpreters - provide printed material available in the woman's language - learn at least several key phrases of the language spoken by a common cultural group encountered in the healthcare setting
how do you overcome language barriers during perinatal care?
-check and maintain equipment -prepare warmed towels or blankets and hat -pre-warm the radiant warmer -obtain training in resuscitation -provide a support for parents
how do you prepare for resuscitation?
-frequent nursing -variety of positions to ensure complete emptying -pressure from purse strap, infant sling, or a car seat belt may cause recurring plugged ducts in the compressed area -prevention and prompt correction are important because plugged ducts can lead to mastitis
how do you prevent plugged ducts?
-help parents understand the lifestyle changes and role demands -provide realistic information -provide anticipatory guidance -dispel myths about the perfect mother or the perfect newborn -educate on support groups
how do you prevent postpartum psychiatric disorders?
-promote effective perineal care -ice packs, sits baths, and topical agents -peri bottle from front to back -ice packs for the first 24 hours -sitz bath for TID after 24 hours and then PRN -dermoplast spray on stitches -tuck's to put on pads -
how do you relieve perineal discomfort and hemorrhoids?
-heat and massage -warm compresses -frequently change babies position -purse strap can plug milk ducts
how do you treat plugged ducts?
- effectively initiates uterine contractions to induce labor - rate of infusion can be titrated - risks included hyperstimulation, uterine rupture, water intoxication, hypoxia, and fetal death
how does IV pitocin induce labor?
- may result in fetal alcohol spectrum disorder - can cause physical and mental defects in fetus that vary in severity and combination - common defects include: microcephaly, long frenulum, small upper lip, cardiac anomalies, mental retardation - FLKs - IUGR - possible teratogenic effects - fetal withdrawal can occur; possible seizures 24-48 hrs after cessation
how does alcohol use during pregnancy affect the baby?
- intrapartum: withdrawal seizures may occur as early as 12-48 hours after cessation - postpartum: DTs may occur
how does alcohol withdrawal affect the pregnant woman?
- during pregnancy - during labor/birth (most common) - through breast milk
how does maternal-child HIV transmission occur?
can result in: - episodic prenatal care - the need to take psychotropic meds during pregnancy - increased stress during pregnancy (PTSD) - engagement in high risk behaviors because of this the babies are at risk for: - low birth weight - preterm birth and the mom is at risk for: - postpartum mood disorders/PTSD
how does mental illness cause a high risk pregnancy?
- presents with anemia and infection tx focuses on correcting underlying abnormalities; may include: - digitalis - diuretics - vasodilators - anticoagulants - Na restriction - strict bed rest ** subsequent pregnancy is strongly discouraged
how does peripartum cardiomyopathy present itself? how is it treated?
- provides evidence on which to base nursing practice - leads to "best practices" - it helps advance the role of nursing; helps determine risks and benefits of new interventions
how does research improve nursing care?
11 weeks gestation
how early can fetal breathing movements (FBMs) be detected via ultrasound?
- the abdomen is divided into 4Qs; umbilicus divides the upper and lower sections, linea negra divides the left from the right - the vertical dm of the largest amniotic fluid pocket in each Q is measured (want to look for pockets that are atleast 2cm) - all measurements are totaled to get the AFI
how is AFI obtained?
- you have to keep them on their left side in order to keep the uterus off the vena cava for adequate blood flow - you're unable to monitor the baby - you can't use an AED - mom is priority over baby, will get baby out if possible - baby needs to be out in first 4 minutes of CPR for it to have the best chance at life - chest compressions are less effective in the 3rd trimester - cesarean birth improves both fetal and maternal resuscitation efforts
how is CPR done in pregnant women?
- Q1hr measurement of maternal glucose levels - control maternal glucose levels - prevent neonatal hypoglycemia - administer insulin if needed (additional insulin may not be needed during second stage of labor and immediate postpartum period)
how is DM managed during labor?
- Nagele's rule - EDB wheel - uterine size - quickening - auscultation (using a fetoscope of ultrasound)
how is EDB determined?
- screenings are done at 35-37 weeks gestation - if positive, intrapartal antibiotic prophylaxis with penicillin G is given
how is GBS transmission prevented?
- antibodies that are developed can be detected with a reactive enzyme immunoassay (EIA) - confirmed with a western blot test or IFA - confirmed case is categorized into one of four HIV infection sages
how is HIV diagnosed?
-ART (highly active antiretrovirals for a longer duration); begin after 1st trimester and no later than 28 wks - evaluate and treat for other infections - give Hep B vaccine if possible - recommend annual flu shot - focus on maintaining health of mother before, during, and after pregnancy - prevent transmission to potentially seronegative father - prevent mother-child transmission
how is HIV treated in pregnant women?
- a score of 2 is assigned to each normal finding - a score of 0 is assigned to each abnormal finding - max score of 10 - 8+= good -<6= concerning
how is a BPP scored?
- the doppler creates a waveform that looks like a series of waves - want to find the S/D ratio by finding the systolic (highest velocity peak) and dividing by end diastolic (lowest point) - normal S/D ratio is 2 at 20 wks and below 3 after 30 wks - with each heartbeat, there should be a gush of fluid going through the umbilical cord - if one of those vessels starts to narrow, there is decreased perfusion which causes an increase in placental bed resistance and a decrease in diastolic flow, results in an elevated S/D ratio - absent end flow can occur with decreased diastolic blood flow; seen when a problem is arising (preeclampsia, drug use, diabetes) - if the BV gets too narrow reverse end flow occurs (backflow), and baby will die within 72 hrs, no matter the gestation
how is a doppler flow study interpreted?
- abnormal structural development: alot of facial abnormalities (thin upper lip, long frenulum) - SGA - delayed growth milestones - CNS dysfunction - growth deficiency - facial abnormalities - associated anomalies: heart, eyes, ears, kidneys, skeleton
how is a newborn with FAS characterized?
membranes are probably intact if the strip is: - yellow= pH 5.0 - olive= pH 5.5 - olive green= pH 6.0 membranes are probably ruptured if the strip is: - blue-green= pH 6.5 - blue-gray= pH 7.0 - deep blue= pH 7.5
how is a nitrazine test interpreted?
- an adequately oxygenated fetus with an intact CNS should demonstrate acclerated fetal HR in response to fetal movement - you want 2+ accelerations within 20 minutes (REACTIVE, very reassuring) - if there isn't atleast 2 within 20 mins, look for a cause (NONREACTIVE); could be because of sleep or lack of O2
how is a nonstress test interpreted?
- IV rehydration - oxygen supplement - antibiotics (if infection is present) - analgesics - the fetus is monitored throughout
how is a sickle cell anemic crisis treated in pregnancy?
- need atleast 2 mins of identifiable tracing within 10 mins, with no accelerations or decelerations - rounded to increments of 5 beats/min
how is baseline FHR established?
- diet; 3 meals and 3 snacks daily - combination of intermediate and regular insulin (regimens vary) - no oral hypoglycemic agents currently FDA approved for use during pregnancy - monitor blood sugar Q1hr while in labor - if the mom is very sick, they may be put on an insulin drip
how is blood sugar controlled/monitored during pregnancy?
- education of the importance of daily rest periods in L lateral position - education of the importance of home BP monitoring in recumbent position - Na restriction - antiHTN medication
how is chronic hypertension treated during pregnancy?
- skin to skin contact immediately after birth; want to get them to feed within that first hour - formula fed infants are given small sips of water to assess for TE fistula and feeding cues before given formula
how is early feeding encouraged in the newborn?
examination: - up to 2nd knuckle: 0% - up to 1st knuckle: 50% - middle of fingernail: 80% - paper thin: 100%
how is effacement determined?
- its where the back of the baby's head is in relation to the mother
how is fetal head position determined?
treat the underlying maternal cause - fever? give mom analgesics - hypoxemic? give mom O2
how is fetal tachycardia treated?
- stretch the heel back and see how far it will go towards the baby's head - preterm babies heel will go all the way back to head - term baby will not be that flexible
how is heel to ear extension assessed/interpreted?
- zofran or phenergan - tell them to eat a cracker before standing up, because they're hypotensive and need something in their stomach to vomit up
how is hyperemesis gravidarum treated?
- Fe supplements - Fe rich diets - orange juice (helps absorption of Fe)
how is iron deficiency anemia treated/prevented?
- position changes (L lateral) - increase IV fluid rate - vaginal exam to detect prolapsed cord - turn off Pitocin
how is maternal hypotension corrected?
- give baby a bath immediately after birth - wait on any assessments or breaks in skin until afterwards (vitamin K shot) - no breastfeeding
how is maternal-child HIV transmission prevented?
- determine gestational age of 20-37 wks - uterine contractions: atleast 4 in 20 mins or 8 in an hour - cervical change or dilation >/= 80% - avoid vaginal exams less than 35 weeks; don't want to induce labor - look for cervical length via ultrasound to see if it is thinning - fetal fibronectin: positive infers preterm labor (negative=5-7 days until potential labor)
how is preterm labor diagnosed?
- take the baby's arms/legs and put them down by their side and assess how they return up to flexion - preterm babies will not recoil as much - legs have greater recoil in full term infants - elbows form angle of less than 90 degrees and rapidly recoil back to a flexed position
how is recoil tested/interpreted?
- term babies should be flexed - preterm babies should be extended
how is resting posture assessed/interpreted?
- take the baby's arm and bring it across the body - in a preterm baby the elbow will be all the way across past the chin - in a term baby the elbow will not meet the midline
how is scarf sign assessed/interpreted?
- position woman on her left side - place a pillow or wedge under her right hip as she lies supine
how is supine hypotensive syndrome corrected?
- goal is to try to spread contractions out and control them - assess contractions, VS, and FHR - provide comfort and support - change positions provide back rubs - warm showers - sedation, pain medications - fluids - terbutaline to relax uterus
how is tachysystole managed?
- feel under the nipple for a small lump - may not feel it in preterm babies - in term babies it will be 3-4mm (0.5-1cm)
how is the breast bud assessed/interpreted?
from onset of last normal menstrual period to the time of birth
how is the length of pregnancy calculated?
- flexion of the knee; put the knee up and see how the thigh is flexed against the abdomen - preterm babies will be more flexible than term babies
how is the popliteal angle assessed/interpreted?
- typing and crossmatching for blood transfusions ahead of time; having atleast 3 units ready - evaluating clotting mechanism - administering IV fluids
how is the risk of DIC during placental abruption decreased?
- take baby's hand and push it back towards wrist and see how far it will go; full term babies' hands will go all the way back, while late preterm babies' hands may not - newborns 40-42 wks gestation demonstrate 0-15 degree angle
how is the square window sign tested/interpreted?
- large body surface compared to body mass (fast heat loss) - inability to generate heat from shivering (can't generate their own body heat) - thin layer of subq fat (especially in preterm babies, less brown fat) - difficulty conserving body heat, lose alot of heat through their head (why we put a hat on them)
how is thermogenesis affected in a newborn?
- most women with any type of DM are allowed to go to term with spontaneous labor - induction of labor may be indicated to avoid problems rt decreased perfusion as the placenta ages - c-section may be indicated if evidence on nonreassuring fetal status
how is timing of birth affected by GDM?
- depends on gestational age - if discovered before term, management is expectant (watchful- see if they turn themselves) - if still evident at 37 weeks, cephalic version is attempted, followed by induction of labor if successful (don't want it to turn back around)
how is transverse lie presentation managed?
12-16 mins
how long can a fetus be bradycardic before brain damage is probable?
48-72 hours - only expected to be healthy and highly fertile for 24 hrs
how long can sperm survive in the female tract?
17 days - when the embryonic heart begins functioning
how long does it take after conception for fetal circulation to be complete?
- after procedure, it takes about 4-6 weeks and 6-36 ejaculations to clear the remaining sperm from the vas deferens - other birth control methods should be used during this period - the man is rechecked at 6-12 mos to make sure fertility hasn't been restored by recanalization
how long does it take for a vasectomy to be effective?
2 minutes
how long does it take for milk to come down on initial breastfeed?
5-7 days
how long does it take for milk to suppress?
6-24 hours
how long is an ovum fertile?
10 lunar months - 40 weeks or 280 days
how long is pregnancy calculated to last?
15-20 minutes
how long should a mom breastfeed on the initial feed?
2-3 weeks
how long should it take for a laceration to heal?
20-35% of total calories
how many calories should come from fat?
8 times
how many times does a newborn need to breastfeed in a 24 hr period?
5-8 times; if fewer, may need to consult PCP
how many times should a baby void per day?
- closer relationship with expectant couple - clarify role of helping grandparent - set boundaries with grandparents
how might grandparents respond to pregnancy?
- younger than 19: 1300 mg/day - 19+: 1000 mg/day
how much Ca does a pregnant women need?
1-2 glasses; pump and dump if you drink a lot (bachelorette party)
how much alcohol is recommended?
400-2000 mL
how much amniotic fluid needs to be in the uterus?
11.5-16 kg (25-35 lb)
how much should a normal weight woman gain during pregnancy?
500 calories, 200 in 1st trimester
how much should a woman increase her caloric intake during pregnancy?
5-9.1 kg (11-20 lbs)
how much should an obese woman gain during pregnancy?
7-11.5 kg (15-25 lbs)
how much should an overweight woman gain during pregnancy?
12.5-18 kg (28-40 lb)
how much should an underweight woman gain during pregnancy?
dilation
how much the cervix has widened; how far can you spread your fingers
- 1 oz/day OR - 1/2 lb/week
how much weight should a newborn gain in the first few weeks?
- in the 1st trimester, 1-4 lbs should be gained, then 1 lb a week after - 25-35lb weight gain total with normal BMI prior to pregnancy - 15-25lb total weight gain if overweight prior to pregnancy - 11-20lb total weight gain if obese prior to pregnancy
how much weight should someone gain throughout pregnancy?
Q15 for 4 and then Q30 for 2 and then Q6
how often do you assess vital signs postpartum?
every 3-4 hrs, 15-30 mL
how often should a bottle fed newborn eat?
low risk women: - every 30 mins in first stage of labor - every 15 mins in second stage high risk women (on ptocin, HTN, etc): - every 15 mins in first stage - every 5 mins in second stage
how often should a nurse auscultate FHR with a doppler?
- every 1-3 years for ages 20-39 - annually for ages 40+
how often should a woman have a clinical breast exam?
- assess at the same time each day (pick a time when they're usually active) - avoid assessing after meals (food increases baby's energy and prevents accurate results) - less than 10 movements in 2 hours or significantly less movement in 24 hrs: call doctor (could be a sign of preeclampsia, DM, hypoxia, growth restriction, or death)
how should a mom assess for fetal activity?
- lips need to attach to areola, not nipple - stimulate infant to open mouth wide - quickly and gently draw baby in (nose to nipple) - observe infant for sucking, movement of mandibular joints, and swallowing - monitor latch score - teach where necessary; change positions if needed
how should an infant latch onto a nipple?
soft with no red streaks, want erect not inverted nipples; no cracks or blisters; minimal assist breastfeeding (make sure baby can latch and mom is ready to go home; knows what she is doing)
how should breasts be upon assessment postpartum?
- screen at 24-28 wks gestation - drink thick sweet fluid, plasma glucose levels determined while fasting and at 1 and 2 hours - screened using two step approach: 1 hr OGTT at 24-28 wks, oral glucose given at any time of the day, no requirement for fasting; 3 hour test if plasma glucose >130-140
how should someone screen for GDM?
put one more layer on them than you have on
how should you dress your newborn?
file, don't clip (could take off skin)
how should you manage newborns nails?
-avoid prolonged standing or sitting -avoid crossing legs -take frequent breaks while taking car trips
how should you prevent thrombophlebitis?
intensity
how strong the contraction is; can be palpated through the contraction - with an IUPC, look at the top of the contraction on monitor
effacement
how thin the cervix is
-prone positioning with a pillow beneath the abdomen (may at first intensify the discomfort for about 5 minutes, but discomfort then diminishes greatly if not completely) -treat with pain meds
how to treat afterpains?
-infant should suckle for an average of 15 minutes per feeding and should feed at least 8-12 times in 24 hours -mother may express milk manually or with a pump -warm compresses before nursing -cold compress after nursing -well-fitted nursing bra 24 hours a day -get infant to deed more often if the breasts are engorged -cabbage leaves: milk is so engorged that baby cannot latch properly, gets milk to dry up just a little bit -wear a well fitting bra for 24 hours a day
how to treat breast engorgement?
-mother's own milk (colostrum and let it sit there) -hypoallergenic medical-grade anhydrous lanolin cream -peppermint gel -protective bra shells -consult certified lactation consultant if nipple soreness persists
how to treat nipple soreness?
Chronic hypertension with superimposed preeclampsia
hypertension before 20 weeks gestation with atleast 1 symptom of preeclampsia
chronic hypertension
hypertension present before 20 wks gestation
tachysystole
hypertonic labor pattern, ineffective uterine contractions in latent phase of labor; increased myometrial resting tone - too many contractions - can prolong labor and result in fetal hypoxemia
40: get them to eat or give glucose gel, dextrose 20: possible brain damage, NICU
if BS is below 40 what do you do? 20?
- signs and timing of ovulation - most effective times for intercourse - other fertility awareness behaviors: don't pee for an hour after sex to allow sperm to move, have sex every other day during ovulation period
if a couple is trying to get pregnant, what should you educate on?
increase their HR - if it is above 160, the baby isn't getting enough O2, or mom is running a fever
if a fetus is beginning to go hypoxic, what will they do?
down's syndrome
if a newborn has a single palmar crease, what is that a sign of?
- call for help - begin massaging the uterus - give pitocin IV bolus, cytotec (800 mcg rectal), hemabate, methargine - don't give hemabate if there is asthma hx, or methargine if hx of HTN - prep large bore IV for blood transfusion - take vitals - fluid volume replacement - monitor I/Os - insert foley if needed - weigh pads - assess for signs of shock; if signs found, put in trendelenburg, draw labs (H/H), type and cross match, and transfuse blood (via rapid infuser if a severe hemorrhage) - MMJ: balloon put into uterus that is filled with saline to put pressure on uterus; tamponade - if MMJ doesn't work, a D&C is needed to remove possible retained placenta - if D&C doesn't work, a hysterectomy is needed
if a nurse notices a probable hemmorhage, what should they do?
- check blood sugar - if its normal, check maternal hx for drug use - if both of these are ruled out, then it may be an immature nerve reflex
if a nurse sees a baby that is very jittery, what should they do?
- RBCs can breakdown in the fetus ( positive coombe's test) - severe risk for developing jaundice, brain damage, and anemia
if a pregnant mom is type O and their baby is type A or B, what can happen?
take a blanket home that smells like the baby so the dog will get comfortable with it - reduces aggression toward the baby
if a pregnant woman has dogs, what should she do before the newborn comes home with them?
- put baby under phototherapy (turns unconjugated bilirubin to conjugated bilirubin) - feed the baby a little more, to cause it to poop more and excrete more bilirubin
if an infant's bilirubin levels are high, what is done?
underlying kidney dysfunction
if an umbilical cord is missing one of the arteries, what could that be a sign of?
can cause brain or neurologic issues
if blood sugar gets too low, what can happen?
- change shirts - wash herself
if mom is smoking, what does she need to do before she breastfeeds?
make sure they fill out birth certificate info before they leave
if mom leaves within 24 hours, what do you want to make sure they do?
classical c-section
if someone has had this type of c-section, they are required to have subsequent c-sections - vertical incision - done in emergencies and with micro-premature births
- when the baby is in low station
if someone is indicated for a forceps assisted birth, when can it be done?
- baby's temperature - baby's blood sugar (may be low) (all has to do with brown fat)
if we have a macrosomic or microsomnic baby, what do we have to worry about?
even with the belly button
if you are using the Leopold's maneuver to find positioning of a child, about where should you find them at 20 weeks?
cultures come back negative
if you suspect sepsis, you will do antibiotic therapy for 7-14 days until what?
-engorgement -mastitis
if you wean abruptly, what can happen?
early pregnancy factor (EPF)
immunosuppressant protein secreted by trophoblastic cells; appears in maternal serum within 24-48 hours after fertilization and forms the basis of a pregnancy test during the first 10 days of development
ectopic pregnancy
implantation of a fertilized ovum in a site other than the uterus, commonly in the ampulla of the fallopian tube - could cause the tube to rupture, resulting in hemorrhage and potential death in the mom - these babies do not live
herbal therapy
important part of TCM; difficult to use in the US due to lack of skilled professionals
>140/90
in chronic HTN, BP is:
perinatal mortality
includes both neonatal and fetal deaths per 1000 live births
Fertility-Based Awareness Methods
includes methods that require a woman to monitor her fertile window and abstain from intercourse or use barrier methods during that time - useful for planning pregnancy, requires extensive record keeping - can be hard for women with irregular cycles - may interfere with spontaneity - require extensive counseling
emergency contraception
indicated when a woman is worried about pregnancy because of unprotected sex, rape, or possible contraceptive failure - progestin only - needs to be taken within 72 hours of unprotected sex - IUDs can be used as well (needs to be placed within 5 days)
family
individuals who are joined together by marriage, blood, adoption, or residence in the same household - characterized by bonds of emotional closeness, sharing, and support
gonorrhea
infection caused by neisseria gonorrhoeae - if a nonpregnant women contracts it, they are it risk for PID - if a women becomes infected after pregnancy, it can put the baby at risk for neonatal conjunctivitis - most women present asymptomatic - s/s can include purulent, green/yellow discharge, dysuria, frequency - common to screen for infection during initial prenatal exam - dx confirmed with NAAT or swab specimens
puerperal infection
infection inside the reproductive tract
mastitis
infection of the breast; most commonly occurs in women who are breastfeeding - presents with flu like symptoms
pyelonephritis
inflammation of the kidney and renal pelvis; may be preceded by a lower UTI - more common in the latter part of pregnancy or early postpartum (can increase risk of preterm birth) - s/s: chills, high temp, flank pain, dysuria, urgency, frequency, n/v, malaise - tx with hospitialization, IV antibiotics
pelvic inflammatory disease (PID)
inflammation of the upper female genital tract; can be caused by chlamydia or gonorrhea - can result in infertility due to postinfection tubal damage - s/s: bilateral, sharp, cramping pain in lower Qs, fever, chills, purulent discharge, irregular bleeding, malaise, n/v
braxton hicks contractions
intermittent painless uterine contractions that occur with increasing frequency as the pregnancy progresses; believed to facilitate placental circulation by enhancing the movement of blood
postpartum diaphoresis
interventions for what? -clean bed linen -cool shower -warm or cool cloth -warm or cool beverage
sexual assault
involuntary sexual contact with another person
therapeutic insemination
involves mechanical deposit of semen at the cervical os or in the uterus - THI and TDI
generally not, although alcohol is excreted in breast milk - excessive alcohol consumption could intoxicate the baby and inhibit maternal letdown reflex
is breastfeeding contraindicated in a mother who may abuse alcohol?
no - most professionals are concerned that in the event of an unanticipated complication, delay in receiving emergency care might pose risk to the baby and mother - some CNMs can attend home births, but if any midwifes attend, most of the time its other types of midwifes
is it recommended to give birth at home?
no, unless: - there is a risk for preterm birth (sex can be used to help induce labor in a full term pregnancy)
is sex contraindicated during pregnancy?
- no, unless there is medical reasons such as risk for threatened spontaneous abortion or preterm labor - there is no medical reason to limit sexual activity during a healthy pregnancy - "what gets the baby in can help it get out"
is sexual activity contraindicated during pregnancy?
pathological jaundice
jaundice that occurs when there is an ABO incompatibility; seen within the first 24 hours - harder to treat, can be more deadly
hypotonic labor patterns
labor patterns that develop in the active phase of labor; low intensity contractions
LEEP procedure
lasering of precancerous HPV cells off of the cervix; subsequently thins the cervix
affordable care act
law passed in 2010 to expand access to insurance, address cost reduction and affordability, improve the quality of healthcare, and allow young adults to be covered for a longer period with no annual limits on coverage
informed consent
legal concept that protects the client's right to autonomy and self determination by specifying that no action may be taken without that person's prior understanding and freely given permission
preterm
less than 37 weeks gestation
scope of practice
limits of nursing practice set forth in state statutes - includes collaborations with other HCPs in planning/providing care - delegation
urethral meatus
located beneath the clitoris; puckered, slit like opening, midline of the vestibule - sometimes hard to visualize because of small folds and variation in location
clitoris
located between the labia minora, erectile tissue - glans is partly covered by the prepuce (clitoral hood) - can be confused with the urethral meatus - rich blood and nerve supplies - primary erogenous organ of women - secretes smegma, which along with other secretions that may be sexually stimulating to the male
intrauterine device (IUD)
long acting reversible contraception; inserted into the uterus by a HCP and left in place for an extended period, providing continuous contraception protection for 3-10 years - high rate of effectiveness (99%), relatively inexpensive - can cause increased breakthrough bleeding, pelvic infection, risk of perforation of the uterus, dysmenorrhea - hormonal devices are better for decreasing amount of flow
labia majora
longitudinal, raised folds of pigmented skin, on either side of the vulvar cleft - protects the structures lying between them - covered by hair follicles and sebaceous glands, with underlying adipose and muscle tissue - inner surface is membrane-like, becomes more skin like after multiple births - varicosities/hematomas can occur during sex or pregnancy due to an extensive venous network - lymphatic supply can facilitate the spread of cancer
abortion
loss/termination of a pregnancy before 20 wks gestation
microsomnia
low birth weight newborns; less than 2.5 kg at birth
cortex
main functional layer of ovary; contains ova, corpora lutea, graafian follicles, and degenerated follicles
abortion
major cause of bleeding in second and third trimester - pregnancy termination prior to 20 weeks gestation or with a fetus weighing less than 500g.
spermatogenesis will produce 2 sperm with an X and 2 with a Y - since it came from a male, XY
mature sperm will have what sex chromosome?
vitamins B and E
may help with primary dysmenorrhea; decrease bloating and cramps
Rhogam
medication used to prevent a Rh- mother from creating Rh+ antibodies against her Rh+ child
magnesium
medication used to prevent seizures in preeclampsia-eclampsia patients; increases the seizure threshold - has a lot of S/E - high risk for toxicity, especially with renal impairment - monitor LOC, SpO2, RR, and DTRs Q1hr during administration
allopathic medicine
medicine that uses remedies that produce effects differing from, or in opposition to, those of the disease being treated - conventional, western medicine
resuscitation
methods to what? -rub back with blanket or towel, suction if needed -administer 21% oxygen, evaluate respirations, heart rate, pulse oximetry -positive-pressure ventilation -administer 100% oxygenation with chest compressions -administer epinephrine
hypnosis
mind based therapy in which a person is guided into a state of great mental and physical relaxation; during this time, the person is very open to suggestions, and is able to modify body responses - pregnant women who receive this therapy before birth have reported shorter, less painful, labors
biofeedback
mind-based therapy used to help individuals learn to control their physiologic responses, based on the concept that the mind controls the body
magnesium
mineral needed for cellular metabolism and bone mineralization
zinc
mineral needed for protein metabolism and synthesis of DNA and RNA
sodium
mineral needed for regulation of fluid balance
iron
mineral needed to carry out the oxygen carrying capability of blood, and for expansion of maternal blood volume
calcium and phosphorus
minerals needed in prenatally for mineralization of fetal bones (last 2-3 months of pregnancy) and teeth (8 weeks), and acid base buffering
spontaneous abortion
miscarriage; abortion that occurs naturally
fibrocystic breast changes
most common benign breast disorder; prevalent in ages 20-50 - thickening of normal tissue, can be accompanied with cyst formation - may be caused by an imbalance in progesterone and estrogen - s/s: increased breast tenderness, swelling before period, irregularity in breasts (lumpiness), nipple discharge - tx: take diuretics, limit salt and caffeine
folic acid deficiency anemia
most common cause of megaloblastic anemia; caused by increased metabolism during pregnancy and lactation
iron deficiency anemia
most common medical complication of pregnancy
chlamydia
most commonly reported infectious disease; often asymptomatic - most common in people under 25 - newborn at risk for ophthalmia neonatorum and pneumonia - s/s can include: thin, purulent discharge, burning/frequent urination, friable cervix (bleeds easily), lower abdominal pain - dx often made after male partner is tx for NGU or in a symptomatic woman with a negative gonorrhea culture - NAAT is most sensitive test
methadone
most commonly used drug in therapy for people who are addicted to opioids; blocks withdrawal symptoms and reduces cravings - can cross the placenta and cause NAS in babies
trichomoniasis
most prevalent nonviral STI - pregnant women with this may be at increased risk for premature rupture of membranes, preterm birth, and low birth weight - yellow/green frothy odorous discharge accompanied by inflammation, itching, dysuria, and dyspareunia, vaginal pH is 5.0+ - dx by microscope - most males asymptomatic
endometrium
mucosal layer of uterine corpus
myometrium
muscular layer of uterine corpus; continuous with muscle layers of fallopian tubes and vagina - cause descent of fetus, which places pressure on the cervical fibers leading to effacement and delivery - surrounds large blood vessels; produces a tourniquet action on contraction to stop bleeding after birth - inhibits the expulsion of uterine contents during pregnancy, but stretches in labor as dilation occurs - prevents menstrual blood from flowing back into the fallopian tubes from the uterus
pelvic floor
muscular membrane of pelvis; acts as a supporting structure to the irregular shaped pelvic outlet, providing stability and support for surrounding structures and pelvic organs
vagina
muscular, membranous tube that connects the external genitalia with uterus; extends from the vulva to the uterus in a position parallel to the pelvic brim - aka birth canal
phimosis
narrowing (stricture) of the opening of the prepuce (foreskin) over the glans penis
nullipara
never been pregnant
erythema toxicum
newborn rash; may look like flea bites or pimples, may appear all over the baby's body - can be a normal finding; inform pediatrician because sometimes rashes are bad (blisters= systemic herpes)
macrosomnia
newborns greater than 4kg at birth; can be caused by gestational DM - identified as a predictor of birth related trauma and is a risk factor for both fetal and maternal morbidity
200 kcal (back to normal)
nonbreastfeeding mothers decrease intake by how much?
joint commission
nongovernmental agency that audits the operation of hospitals and healthcare facilities - focus on patient safety, informed consent, and right to privacy
amniotic membrane stripping
nonparmacologic method of induction; believed to release prostaglandins that stimulate contractions - uncomfortable; rough vaginal exam - may cause cramping, contractions, and bleeding
110-160
normal FHR
locia
normal discharge after birth
110-160
normal fetal HR
ovulation
normal process of discharging a mature ovum from an ovary - takes place following the rapid growth of a follicle, as the sustained high level of estrogen diminishes and progesterone secretion begins, 14 days before the onset of menses
L (living)
number of currently living children
maternal mortality rate
number of deaths from any cause related to or aggravated by pregnancy or pregnancy mgmt during the pregnancy cycle per 100,000 live births - does not include deaths of pregnant women because of external causes (accidents, homicide, etc.)
infant mortality rate
number of deaths of infants under 1 yr of age per 1000 live births in a given population
neonatal mortality
number of deaths of newborns less than 28 days of age per 1000 live births
A (abortions)
number of pregnancies ending in spontaneous or therapeutic abortion (before 20 weeks)
P (preterm)
number of preterm infants born after 20 weeks, but before 37 weeks gestation, regardless of what happens to the fetus
T (term)
number of term infants born; completion of atleast 37 weeks gestation
Respiratory distress syndrome
nursing care for what? -before birth: prevent preterm birth, administer glucocorticoids -after birth: surfactant replacement therapy -keep baby in as long as possible if preterm (magnesium) -give mom betamethasone (corticosteroid injections 24 hours apart) -look for S/S: tachypnea (>60 RR), retractions, grunting, nasal flaring, get pulse ox
HSV (herpes simplex virus)
nursing care for what? -careful hand washing and gown and glove isolation -obtain skin, eye, lesion, and CSF cultures -administer IV acyclovir -initiate follow up referral -support and educate parents
anemia
nursing care for what? -confirmed by laboratory testing -assess the newborn for pallor and shock -treat mild or chronic anemia with iron supplements -treat the underlying cause -blood transfusions used in severe cases (10cc of blood transfusion) -treat symptoms of shock with constant cardiac and respiratory monitoring
transient tachypnea of the newborn
nursing care for what? -do not feed baby that is breathing greater than 60-70 BPM (worry about suck and breathing technique (bradycardia and apnea)) -diagnosed with multiple x-rays -administer supplemental oxygen -IV administration of fluid and electrolytes -abstain from oral feedings -nursing care similar to RDS
meconium aspiration syndrome
nursing care for what? -if baby is crying after it is born, then this is good -if baby is not crying: intubate and suction below vocal cords -tracheal suctioning -umbilical arterial line and venous catheter -high levels of oxygen -exogenous surfactant -prophylactic antibiotics -assess for signs of distress and complications
syphillis
nursing care for what? -initiate standard precautions -administer penicillin -provide emotional support for the family
CMV (cytomegalovirus)
nursing care for what? -obtain urine, saliva, or tissue cultures -schedule a CT scan, eye exam, and hearing test -perform long-term follow-up exams
phototherapy
nursing care for what? -remove clothing except diaper -apply eye coverings -assess serum bill levels -measure irradiance levels -reposition infant every 2 hours -maintain adequate nutrition/hydration -examine skin -allow parents to hold child when it is time to eat (should be the only time they are out)
hypoglycemia
nursing care for what? -routine screening for all at-risk infants -early feedings -5% or 10% dextrose by IV
evidence based practice
nursing care in which all interventions are supported by current, valid research evidence - provides a useful approach to problem solving and decision making - builds on the actions necessary to transform research findings into clinical practice - improves quality of nursing care
-postpartum hygiene -contraceptive counseling -newborn care -include family in teaching -positive feedback -give positive reinforcements so they feel like they can do it
nursing care of the adolescent postpartum?
gonorrhea
nursing management for what? -administration of ophthalmic antibiotic ointment -referral for follow up
chlamydia
nursing management for what? -administration of ophthalmic antibiotic ointment -referral for follow-up
Right Occiput Posterior (ROP)
occiput towards the right side of moms pelvis and turned to posterior surface of her pelvis
cluster feeding
occurs in breastfeeding babies; baby eats every hour for a few hours, then will not eat for 3-4+ hrs - do not want baby to go more than 5 hrs without eating; encourage them to latch at this point, monitor blood sugar if cannot latch and try later (if blood sugar is above 40)
assimilation
occurs when a group completely changes its cultural identity to become a part of the majority culture
precipitous delivery
occurs when labor and birth are completed in 3 hours or less; unduly fast - contributing factors include multiparas, large pelvis, hx of fast labor, small fetus in favorable position
aysmmetrical growth
occurs when the fetus becomes compromised and they begin shunting blood away from the rest of the body and to the head, lungs, and adrenal glands; causes baby to have disproportionate head to body
uterine inversion
occurs when the uterus comes out of the body after the pregnancy; becomes inside out - very rare
breastfeeding jaundice
occurs when there is not enough breast milk supply to the infant, causing it not to poop as much and results in retention of bilirubin
meconium stained amniotic fluid
often associated with fetal distress; can increase risk of asphyxia, aspiration, and pneumonia due to aspiration - increases maternal psychologic stress
incomplete (footling) breech
one foot is presenting, thigh & knee extended
coitus interruptus
one of the oldest and least reliable methods of contraception - requires great self control of the male, urges - preejaculatory fluid can release as soon as the penis becomes erect can contain sperm - the pullout method
paraurethral glands (Skene's glands)
open into the posterior wall of the urethra, close to its opening; lubricate the vaginal opening, facilitating sex
thrush
oral candidiasis in the newborn - can get from the mother, especially if breastfeeding - mom and baby will need to be treated
trophoblast
outer layer of cells that surrounds the blastocyst; replaces the zona pellicuda and eventually becomes one of the 2 embryonic membranes (chorion)
bacterial vaginosis (BV)
overgrowth of normal vaginal flora, causing vaginitis; seen more in sexually active women, but not considered an STD - thin, watery, white or gray discharge - "fishy" odor - can result in premature rupture of membranes
complete mole
ovum containing no maternal genetic material (empty egg) - fertilized by normal sperm - choriocarcinoma is believed to be associated exclusively
prostaglandins
oxygenated fatty acids produced by the cells of the endometrium; classified as hormones - have varied action in the body - two primary types: groups E and F - production increases during follicular maturation, is dependent on gonadotropins, and is critical to follicular rupture - significant amounts are found in and around the follicle at the time of ovulation
cervadil
oxytocin vaginal insert, used for cervical ripening - sits on cervix like a tampon - once taken out, wait 30 mins and give pitocin
dysmeorrhea
painful menstration; can be primary or secondary - occurs at, or a day before, the onset of menses and disappears by the end
primary dysmenorrhea
painful menstruation that begins at puberty and has no clear cause - no underlying disease - due to increased production of prostaglandins - causes ischemia resulting in painful sensation - tx with oral contraceptives, NSAIDs, self care measures, exercise and rest, heat, and good nutrition (avoiding salt)
secondary dysmenorrhea
painful menstruation that begins during adult life, usually as a consequence of a pelvic disorder - occurs after menstruation is established - occurs in PID, endometriosis, etc
cervical insufficiency
painless dilation of cervix without contractions - caused by a structural or functional deficit of the cervix - results in early expulsion of birth products; cause of repetitive miscarriages - woman is usually unaware of contractions and presents with advanced effacement and dilation, and possible bulging membranes
ampulla
part of fallopian tube where fertilization occurs - where cleavage begins, if the ovum is fertilized
medulla
part of ovary that contains the nerves, blood, and lymphatic vessels
IgA
passive acquired immunity via colostrum
IgG
passive acquired immunity via placenta
domestic violence
pattern of coercive behaviors and methods used to exert power and control over another in an adult relationship
mottling
pattern of dilated blood vessels over the legs, abdomen, etc; could signify that the baby is cold - can also be an early sign of prolonged apnea or sepsis - can be normal; keep an eye on it
rubella
perinatal infection that can cause congenital cateracts, sensorineural deafness, congenital heart defects, mental retardation, and CP in the fetus - can be prevented by vaccination prior to pregnancy
herpes
perinatal infection that can cause preterm labor, IUGR, and neonatal infection - if infection is active, prevent transmission with c-section - infection can be treated with acyclovir
toxoplasmosis
perinatal infections that can cause retinochorditis, convulsions, coma, microcephaly, and hydrocephalus in the fetus.
perimenopause
period of time before menopause where hormonal deficiencies begin to produce symptoms; hot flashes, PMS, irregular periods, insomnia, decreased libido, mood changes
late deceleration
periodic change in fetal heartbeat caused by placental insufficiency; starts and ends after contraction
meiosis I
phase of meiosis in which DNA replicates, diploid cell divides into 2 haploid cells
meiosis II
phase of meiosis; 2 haploid cells divide to create 4 haploid cells, each with potentially different DNA
menstrual phase
phase of menstrual cycle (days 1-6); estrogen levels are low, cervical mucous is scant, viscous, and opaque - endometrium is shed (menses) - endometrium is in a resting state afterwards
cellular multiplication
phase of preembryonic stage; begins as zygote moves through fallopian tube toward uterus - cleavage occurs, creates blastomeres, which form the morula - the morula enters the uterus, the blastocyst forms inside the morula, and the trophoblast replaces the zona pellucida - blastocyst becomes embryonic disk and the trophoblast becomes the chorion
cellular differentiation
phase of preembryonic stage; creation of primary germ layers, embryonic membranes, amniotic fluid, yolk sac, and umbilical cord
outward adjustment (denial)
phase of recovery following sexual assault; appears outwardly composed, denying and repressing feelings, refuses to discuss assault, denies need for counseling - may go back to work, like everything's normal, but buy a weapon
acute (disorganization)
phase of recovery following sexual assault; fear, shock, disbelief, desire for revenge, anger, anxiety, guilt, denial, embarrassment, humiliation, self blame, a variety of physical reactions, loss or distorted coping mechanisms
reorganization
phase of recovery following sexual assault; makes many life adjustments, like moving to a new residence, changing phone numbers, etc - uses emotional distancing - may engage in risky sexual behaviors - phobias, flashbacks, sleep disorder, nightmares - anxiety - strong urge to talk about and resolve feelings, may seek counseling
integration and recovery
phase of recovery following sexual assault; time of resolution - begins to feel safe and be comfortable trusting others - places blame of perpetrator - may become an advocate for others
secretory phase
phase of the menstrual cycle (days 15-26), follows ovulation; estrogen drops sharply and progesterone dominates - vascularity of uterus increases - tissue glycogen increases, and the uterus is made ready for implantation - if implantation occurs, progesterone continues to thicken the endometrium
ischemic phase
phase of the menstrual cycle (days 27-28); occurs when fertilization does not - estrogen and progesterone levels drop (degeneration of corpus luteum) - spiral arteries vasoconstrict - endometrium becomes pale, blood vessels rupture - blood escapes into uterine cells and prepares to be shed (restart cycle)
proliferative phase
phase of the menstrual cycle (days 7-14); endometrium and myometrium thickness increases - estrogen peaks just before ovulation; mucous becomes clear, thin, watery, alkaline, and more favorable to sperm - mittelshmerz and/or midcycle spotting may occur
luteal phase
phase of the ovarian cycle (days 15-28); begins when the ovum leaves the follicle, and the corpus luteum develops from the ruptured follicle (under the influence of LH)
cholasma
pigmentary skin discoloration usually occurring in yellowish brown patches or spots
total placenta previa (grade 4)
placenta completely covers internal cervical os
placental adherence
placenta grows and attaches in places it isn't supposed to - can result in retention of placental tissue after birth - if there is scar tissue in the uterus, it can grow through it - prepare for hysterectomy
placenta increta
placenta invades myometrium
placenta percreta
placenta perforates the uterine wall and attaches to bladder or bowel
marginal placental abruption
placenta separates from uterine wall at its edges, and the blood passes between the membranes in the uterine wall - blood will escape vaginally - monitor mom and baby; how baby is tolerating it
placenta previa
placental implantation in the lower uterine segment rather than the upper portion of the uterus; placenta tries to deliver before baby - as the lower uterine segment contracts/dilates, placental villi are torn from uterine wall; causes bleeding (amnt depends on number of sinuses exposed)
late decelerations
placental insufficiency; O2/nutrients not getting to baby
central placental abruption
placental separates from uterine wall in the middle; the blood is trapped between the placenta and uterine wall - results in concealed bleeding
partial placental abruption
placental separation occurs but it is not complete; may be minimal or moderate - can progress to complete separation
nevus flammeus
port wine stain; dark red or blue/black in darker skinned babies - permanent birth mark
true pelvis
portion of pelvic cavity that represents the bony limits of the birth canal; consists of pelvic inlet, pelvic cavity and outlet - the size and shape must be adequate for normal fetal passage during labor
false pelvis
portion of pelvic cavity; above pelvic brim - serves to support the weight of the enlarged pregnant uterus and direct the presenting fetal part into the true pelvis below
maternal placenta
portion of placenta that consists of the decidua basalis and its circulation; red and fleshlike (dirty duncan)
presenting part
portion of the fetus that enters the pelvis first
fetal placenta
portion of the placenta that consists of the chorionic villi and their circulation; covered by the amnion
isthmus
portion of the uterus between the internal cervical os and the endometrial cavity; where the uterine lining changes into the mucous membrane of the cervix - joins the corpus to the cervix - takes importance in pregnancy because it becomes the lower uterine segment; at birth, its the site for lower segment c-sections
ballottment
positioning of fetus
introversion
possible response to pregnancy; not talking to anyone
ambivalence
possible response to pregnancy; shock, not knowing how to feel
binuclear family
post divorce family in which the biologic children are members of 2 nuclear households; children alternate between 2 homes - coparenting/joint custody
-educating that after the first couple of weeks, she can go back to what she was doing pre pregnancy -give contraceptives (IUD, deep shot, minipill if breastfeeding) -decreased lubrication to the vagina (pain with sex), but no sex for 6 weeks until cervix closes off -breast feeding is not a form of birth control
postpartum discharge care includes?
3-4 couplets
postpartum nurses usually have how many patients?
occiput anterior
preferred head position for birth; allows for flexion to occur
progesterone
pregnancy hormone; inhibits uterine contractions, relaxes smooth muscle, and causes vasodilation that allows implantation and maintenance of pregnancy - increases secretions of fallopian tubes and uterus to provide nutrients for morula and blastocyst - decreases contractility of uterus, preventing uterine contractions that cause spontaneous abortion - inhibits action of prolactin in alpha-lactalbumin synthesis (prevents lactation during pregnancy) - produced by the ovary, secreted by the corpus luteum (reaches peak 7-10 days after ovulation, implantation occurs simultaneously) - placenta is primary source during pregnancy; takes over after 11 weeks - found in greatest amounts during the secretory (luteal) phase of menstrual cycle
Fluroimmunoassay (FIA)
pregnancy test that uses antibody tagged with fluorescent label to detect serum hCG - takes about 2-3 hours to perform - extremely sensitive - used primarily to identify and follow hCG concentrations
home pregnancy test (HPTs)
pregnancy tests that: - reasonable cost - detect even low levels of hCG in urine - false positive rate is low, but false negative results are higher - follow up if pregnancy symptoms occur; if results are negative, repeat test in 1 week if no menstruation
multifetal pregnancy
pregnancy that may occur with ART due to the use of ovulation inducing meds that trigger the release of multiple eggs - increases the risk of miscarriage, preterm birth, neonatal morbidity and mortality - increases risk of complications in the mother ( C-sections, etc)
placental abruption (abruptio placentae)
premature separation of a normally implanted placenta from the uterine wall - blood is still sent to where it detached from, causing blood to fill uterine cavity - classified based on the extent of separation (partial or complete) and location of separation (marginal or central) - can also be graded according to severity of findings
Rh factor
presence or lack of antigens on the surface of red blood cells, which causes a reaction between Rh-positive blood and Rh-negative blood
mucus plug
prevents bacteria growth in the cervix; develops during pregnancy
estriol
primary estrogen secreted by the placental
carbohydrates
primary source of energy - if unavailable, protein will be used for energy instead of for growth needs
- douching - intercourse - female hygiene products - spermicidal agents
prior to a pap smear, instruct the client to avoid:
fertilization
process by which a sperm fuses with an ovum to form a new diploid cell, or zygote
acculturation
process by which people adapt to a new cultural norm - occurs often when people leave their country of origin and immigrate to a new country - often associated with improved health status and behavior, and improved socioeconomic status
spermatogenesis
process of maturation in which spermatocytes become spermatozoa
oogenesis
process of ovum generation while in gestation; all ova the female will produce in a lifetime are present at birth
cervical ripening
process of softening and effacing of the cervix; may be used for pregnant women who are at term or late preterm and induction of labor is indicated
prolactin
produced by the parathyroid; moderated by supply/demand - responsible for lactation - the more a baby breastfeeds, the more it's released, and the more milk is produced
testosterone
produced by the testes, induced by FSH and LH; maintains spermatogenesis, increases sperm production, and stimulates production of seminal fluid
American College of Obstetricians and Gynecologists (ACOG)
professional organization that affirmed the fundamental right of pregnant women to make informed, uncoerced decisions about medical interventions
depo-Provera shot
progestin only contraception; given via injection - 1st injection protects for 3 months, subsequent injections needed every 10-14 weeks to continue protection - suppresses ovulation - can be given to nursing mothers, because it doesn't contain estrogen - s/e include menstrual irregularities, headache, weight gain, breast tenderness, and depression - may delay fertility
minipill
progestin only oral contraceptive; primarily used by nursing mothers, because it does not interfere with milk production - also used in people who are contraindicated in COCs - amenorrhea and irregular bleeding patterns can occur
hydatidiform mole (molar pregnancy)
proliferation of trophoblastic cells that create the placenta; characterized by fluid fillded clusters - results in loss of pregnancy, and remote possibility of developing choriocarcinoma - increased hCG is a sign that there are fetal material is still there - "pregnancy gone wrong"
tunica albuginea
protective layer of ovary
Fetal fibronectin (fFN)
protein normally found in fetal membranes and decidua, but is not usually present in significant quantities between 22-37 wks - if a test for this is positive before 37 wks puts the woman at increased risk for preterm birth - if it is negative, it associates with a very low risk of preterm birth within 7 days (99% effective)
cleavage
rapid mitotic cell division of the zygote that begins immediately after fertilization; occurs in preembryonic stage of development
vaginal fornix
recess in the vaginal vault (upper part of the vagina) around the cervix - walls are very thin, various structures can be palpated through them, like a uterus, distended bladder, ovaries, appendix, etc.
ductus arteriosus
redirects some of the 40% of oxygenated blood that goes into the pulmonary artery, back into the aorta and out into fetal circulation - important that it closes up soon after birth; if it doesn't, unoxygenated blood will mix with oxygenated blood and decrease baby's SpO2
supine hypotensive syndrome
reduced blood flow to the right atrium due to pressure of the growing uterus on the vena cava - results in decreased BP, dizziness, pallor, and clamminess
vulva
refers to the external genitalia of a female - contains a generous supply of blood and nerves - as a women ages, estrogen secretions decrease, causing vulvar organs to atrophy
birth rate
refers to the number of live births per 1000 people
station
relationship of the presenting part of the fetus to the ischial spines
peripartum cardiomyopathy
relatively rare but serious dysfunction of the left ventricle - occurs in the last month of pregnancy or first 5 months postpartum - increases risk for maternal mortality (increases with maternal age, number of live births, and african descent) - subsequent pregnancy strongly discouraged
tocolysis
repression of uterine contractions; the use of medication to stop labor
inborn errors of metabolism
results from a genetic mutation in an enzyme; blocks metabolic pathway and causes accumulation of toxic metabolites - PKU and congenital hypothyroidism (all states require screenings) - others include: maple syrup urine disease, homocystinuria, CF, sickle cell anemia, congenital adrenal hypoplasia - 5 drops of blood onto a paper that gets sent off
turtle sign
retraction of the fetal head against the mother's perineum after it emerges - occurs in shoulder dystocia
- APGAR scores (1 and 5 mins) - are resuscitative measures needed? (are they transitioning well? breathing well?) - physical examination - VS (q30mins x4hr) - voidings - passing of meconium
right after the birth of the baby, what assessment data should be collected?
right to privacy
right of a person to keep their person and property free from public scrutiny
transient tachypnea of the newborn
risk factors for what? -maternal diabetes -maternal asthma -male sex of the infant ("wimpy white boys") -macrosomnia -cesarean section delivery
fetal/neonatal resuscitation
risk factors for what? -nonreassuring fetal heart rate pattern -sustained bradycardia -anything affecting blood flow through the placenta -difficult birth/prolonged labor -fetal scalp/capillary blood sample-acidosis (>7.20)
fundus
rounded upper portion of the corpus (uterus); extends above the points of attachment of the fallopian tubes
syphillis
s/s of what? -elevated cord serum ism and FTA-ABS -rhinitis -fissures on mouth corners and excoriated upper lip -red rash around the mouth and anus -copper-colored rash over face, palms, and soles -irritability -generalized edema -hepatosplenomegaly -congenital cataracts -SGA -failure to thrive
hydrocele
scrotal swelling caused by a collection of fluid
Gonadotropin-releasing hormone (GnRH)
secreted by hypothalamus; released to the pituitary gland in response to signals received from the CNS - in response to this hormone, the anterior pituitary secretes the gonadotropic hormones: FSH and LH
luteinizing hormone (LH)
secreted by pituitary; increases in production as the follicle matures, peak production can precede ovulation by 12-24 hrs - responsible for the increase in production of progesterone by the granulose cells of the follicle; estrogen production is reduced and progesterone secretion continues
Follicle-stimulating hormone (FSH)
secreted by pituitary; primarily responsible for maturation of ovarian follicle - as follicle matures, it releases increasing amounts of estrogen, which enhance the development of the follicle (this is also responsible for the proliferation phase of the endometrium after its shed during menstruation)
in vitro fertilization (IVF)
selectively used in specific cases of infertility, including: - tubal factors, mucus abnormalities, male infertility, unexplained infertility, male and female immunologic infertility, cervical factors - eggs are collected from ovaries in an OP procedure then they are fertilized in a lab - eggs are placed back in uterus after normal embryo development begins - progesterone supplementation is used to promote implantation and support early pregnancy (mom will not have a period, even if she isn't pregnant) - pregnancy usually determined by transvaginal ultrasound
Pouch of Douglas (Rectouterine Pouch)
separates the upper 1/4 of vagina from the rectum; located posterior to cervix
perimetrium
serosal layer of uterine corpus; composed of peritoneum
ischial spines
serve as a reference point during labor to evaluate the descent of the fetal head into the birth canal.
gametes
sex cells (sperm and egg)
gonads
sex organs (ovaries and testes)
aquaintance rape
sexual assault by someone known to the victim
McRoberts maneuver
sharp flexion of the maternal hips that decreases the inclination of the pelvis increasing its diameter - holding legs up, feet as close to ears as possible - allows nurse to reach in to create suprapubic pressure in order to rotate the child's shoulders and pull them out
presumptive (subjective)
signs of pregnancy observed by the woman
positive (diagnostic)
signs of pregnancy that can only be caused by pregnancy
probable (objective)
signs of pregnancy that may be noticed by the Dr., but could have other causes
respiratory distress
signs of what? -pallor or cyanosis -apnea -slow heartbeat -barrel-shaped chest -decreased air movement -displaced liver -yellowish/pale green skin and nails (meconium has been sitting on the skin)
semen analysis
single most important dx study of male fertility - evaluates sperm quality, quantity, and motility - testing should be conducted early in couple's evaluation, and before invasive testing of the woman
microcephaly
small head in fetus; when head is significantly smaller than chest - signifies a neurologic issue
tubercles of montgomery
small papillae around the nipple and areola; secrete a fatty substance that lubricates and protects the breast when the infant sucks
milia
small raised white spots on nose, chin, and forehead; occurs often in breastfeeding babies (hormones)
ethnicity
social identity that is associated with shared behaviors and patterns, including family structure, religious beliefs, language, dress, eating and health habits.
labia minora
soft folds of skin within the labia majora that converge near the anus, forming the fourchette - composed of erectile tissue and involuntary muscle tissue - shiny mucous membrane appearance, moist, no hair - rich in sebaceous glands; lubricate and waterproof the vulvar skin and provide bactericidal secretions - sebaceous cysts commonly occur in this area, due to glands excreting directly on to skin and not hair - increase in size at puberty and decrease after menopause because of changes in estrogen levels
mammogram
soft tissue XR of the breast without the injection of a contrast medium - can detect lesions earlier than by using palpation - effective screening tool for breast cancer - all women ages 40+ should have them annually - women ages 55+ can transition to biennial
uterine souffle
soft, blowing sound made by the blood in the arteries of the pregnant uterus and synchronous with the maternal pulse
mons pubis
softly rounded mound of subq fatty tissue beginning at the lowest portion of the abdominal wall - covers the front portion of the symphysis pubis - protects the pelvic bones, especially during coitus - typically covered with pubic hair
meiosis
special type of cell division in which diploid cells in the testes and ovaries create gametes (gametogenesis) - starts with a diploid cell, results in 4 haploid cells (n= 23 chromosomes) with different DNA - 2 phases - when fertilization occurs, the normal diploid number is restored
extended kin network family
specific form of extended family in which 2 nuclear families of primary or unmarried kin live near eachother - family shares a social support network, chores, goods, and services - common in latino communities
PPROM
spontaneous rupture of membranes before 37 weeks gestation - increases risk for infection
PROM
spontaneous rupture of membranes before onset of labor
mitosis
starts with one diploid cell, results in the production of 2 diploid cells, which are exact copies of the original cell - each cell has 23 chromosomes from mom and 23 from dad - cycle can be repeated over and over again
inferential statistics
statistics that are used to draw conclusions about what is happening between 2+ variables in a population and to suggest or refute relationships between them - answer specific questions and generate theories to explain relationships
prolactin
stimulates milk production as ducts (milk supply) decreases
mitral valve prolapse (MVP)
structural defect in which the mitral valve flaps protrude into the left atrium during systole, resulting in incomplete closure and backflow of blood
total bilirubin
sum of unconjugated (indirect) and conjugated (direct) bilirubin levels - checked every night
bony pelvis
supports and protects the pelvic contents, and forms a relatively fixed axis of the birth passage - made up of 2 innominate (hip) bones, sacrum, and coccyx; join at the symphysis pubis, sacroiliac joints, and sacrococcygeal joints
episiotomy
surgical incision of the perineum to enlarge the vagina and so facilitate delivery during childbirth; can happen naturally -1st-4th degree
circumcision
surgical procedure in which the prepuce (an epithelial layer covering the penis) is separated from the glans penis and excised - permits exposure of the glans for easier cleaning
sterilization
surgical procedures that permanently prevent pregnancy - vasectomy - tubal ligation
cerclage
surgical therapy for cervical insufficiency; procedure in which a stitch is placed in the cervix to prevent spontaneous abortion or premature birth - after 37 wks, suture may be cut and vaginal birth permitted, or suture is left in and a C/S is performed
wharton jelly
surrounds the blood vessels in the umbilical cord; prevents compression of the umbilical cord in utero
cerclage
suturing of the cervix to prevent it from dilating prematurely during pregnancy, thus decreasing the chance of a spontaneous abortion
preeclampsia
symptomatic gestational hypertension - HTN and vasospasm due to gradual loss of angiotensin II, decrease in prostacyclin and nitric acid - can be mild or severe - can cause the placenta to work less effectively; potential for fetal demise
premenstrual syndrome (PMS)
symptoms associated with luteal phase of menstrual cycle (2 wk before onset of menses) - symptoms must occur between ovulation and onset of menses - irritability, lethargy, depression, anxiety, sleep problems, migraines, n/v, constipation, bloating, cramps, craving for sweets, retention, acne, mammary swelling/tenderness, joint/muscle pain - cause unknown - risk factors: stress, trauma, genes, obesity, psychiatric hx
couvade
symptoms of pregnancy and birth experienced by fathers - observance of certain rituals and taboos to signify the transition to fatherhood
hypoglycemia
symptoms of what? -lethargy -poor feeding and sucking -pallor or cyanosis -hypothermia -respiratory distress -tremors, seizure activity -high-pitched cry -late sign: pale or cyanotic
gonorrhea
symptoms of what? -conjunctivitis -purulent discharge and corneal ulcerations -neonatal sepsis
CMV (cytomegalovirus)
symptoms of what? -intrauterine growth retardation -jaundice -hepatosplenomegaly -thrombocytopenia -pneumonia -lethargy -poor feeding -CNS manifestations
chlamydia
symptoms of what? -pneumonia -conjunctivitis
HSV (herpes simplex virus)
symptoms of what? -small-cluster vesicular skin lesions over entire body -DIC -pneumonia -hepatitis -hepatosplenomegaly -neurologic abnormalities
fetal alcohol syndrome (FAS)
syndrome characterized by microcephaly, IUGR, short palpebral fissures, and maxillary hypoplasia - caused by maternal alcohol ingestion
acupuncture
technique of TCM; use of very fine needles to stimulate specific pressure points, depending on a medical assessment and pt condition
acupressure
technique of TCM; uses pressure from fingers and thumbs to stimulate pressure points
assistive reproductive technology (ART)
term used to describe highly technological approaches used to produce pregnancy - IVF, surrogacy
doppler flow study
test used to determine if the placenta is getting enough O2/nutrients to the baby; measures blood flow changes that occur in the umbilical BVs - done if a baby is IUGR - takes 15-20 mins; woman is supine with wedge under R hip during procedure - if abnormal flow is revealed, monitor for increase in severity
nitrazine test
test used to help determine membrane status; is it amniotic fluid or pee? - also examines pH
vibrocoustic stimulation test
test used to induce fetal accelerations; buzzer is put on mother's stomach, next to head, buzzer "zaps" baby, helps especially if they are asleep - done if there is a nonreactive NST
200-500 million - only hundreds reach the ampulla
the average ejaculation contains how much sperm?
introitus
the border between the external and internal genitals; the vaginal opening
transitional circulation
the conversion from fetal to neonatal circulation
cornua
the elongated portion of the uterus where the fallopian tubes enter
decidua
the endometrium of the uterus during pregnancy (becomes this after implantation)
infertility
the failure to achieve successful pregnancy after 12 mo or more of regular unprotected intercourse - can be primary (woman with no prior pregnancies) or secondary (unable to conceive after 1 successful pregnancy or cannot sustain a pregnancy)
amniotic fluid
the fluid surrounding a fetus; slightly alkaline, contains albumin, uric acid, creatinine, bilirubin, leukocytes, epithelial cells, enzymes, and lanugo - amount decreases dramatically right before birth - the fetus can influence the volume towards the end by swallowing the fluid, excreting lung fluid, and excreting urine into the fluid
DMV
the joint commission at Erlanger
uterine corpus
the middle portion of the uterus; made up of 3 layers: - perimetrium, myometrium, and endometrium
cervix
the part of the uterus that protrudes into the cavity of the vagina; the neck of the uterus - supports the uterus - changed permanently by pregnancy - its mucus lubricates the vaginal canal, acts as a bacteriostatic agent, and provides an alkaline environement to shelter deposited sperm from the acidic vaginal secretions
partial placenta previa (grade 3)
the placenta partially covers the internal os
period of viablity
the point at which the fetus can survive independently of the mother; abortion can be preformed until this point
attitude
the relation of the fetal body parts to one another; are they flexed?
fetal lie
the relationship of the spine of the fetus to that of the mother; longitudinal or transverse
capacitation
the removal of the plasma membrane overlying the spermatozoa's acrosomal area and the loss of seminal plasma proteins - occurs in the female reproductive tract - must occur for the sperm to be able to fertilize the ovum
lightening
the sensation of the fetus moving from high in the abdomen to low in the birth canal; mom feels like she can "breathe again"
induction
the stimulation of uterine contractions before the spontanous onset of labor, with or without ruptured fetal membranes, for the purpose of accomplishing birth - give pain meds/epidural beforehand
duration
the time from start to end of a contraction, in seconds (small lines)
frequency
the time from the start of one contraction to the start of another, in a range of minutes (big lines)
5-6
the uterus reaches its prepregnant size by how many weeks postpartum?
24 hours
the well baby visit is within how many hours?
hymen
thin, elastic collar of tissue that surrounds the vaginal opening; appearance changes during the women's lifetime
colostrum
thin, yellow fluid, precursor of milk, secreted for a few days after birth - "liquid gold" - can start as early as 20 wks gestation
35-36 weeks
time in gestation considered late preterm; - increase in subq fat - lanugo disappears
29 weeks
time in gestation when the mother can induce electively
8 weeks
time in gestation where: - all body organs are formed
37 weeks+
time in gestation where: - baby is full term - head is bigger than chest - skin is smooth and polished, vernix caseosa creases and folds
24 weeks
time in gestation where: - baby is viable - covered by vernix caseosa (protective fatty layer) - eyes are structurally complete - alveoli are beginning to form - grasp and startle reflexes present - fingerprints and footprints present - eyelashes and eyebrows formed - increasing activity
week 6
time in gestation where: - body is straighter - trachea is developed - nares are present - liver produces blood cells - heart begins circulating blood - digits devlop - tail begins to recede
28 weeks
time in gestation where: - brain develops rapidly - NS is regulated - eyes open - testes begin to descend - lungs begin gas exchange
3 weeks
time in gestation where: - embryonic disc enlongates, creates a broad cephalic end and narrow caudal end - beginning of brain and spinal cord development - GI tract appears as a part of yolk sac - single tubular heart forms just outside the body cavity of the embryo
32 weeks
time in gestation where: - fingernails/toenails are present - baby can breathe - surfactant needed for breathing at birth is formed - baby is 2/3 its final length
4 weeks
time in gestation where: - heart begins to beat - somites develop, beginning the vertebrae - eyes and ears begin to form
week 7
time in gestation where: - heartbeat can be detected - GI and GU tracts undergo significant changes (intestines begin to form at end of umbilical cord, rectal and urogenital structures separate) - beginnings of all essential internal and external structures are present
16 weeks
time in gestation where: - lanugo begins to develop - blood vessels can be seen - active movements are present - sucking motion present - begins swallowing amniotic fluid - produces muconium - sex of baby can be seen - fetus begins to look like a baby
20 weeks
time in gestation where: - subq brown fat appears - nipples and nails are present - fetal movement is felt by mother (quickening) - baby develops schedule of sleeping, sucking, and kicking - hands can grasp - fetal HB is heard by fetoscope
12 weeks
time in gestation where: - face is well developed - eyelids are closed - tooth buds appear - genitals are well differentiated - urine is produced - spontaneous movement occurs - fetal heart tones can be heard with ultrasound
0 station
tip of head is right at the level of the ischial spine
oligohydraminos
too little amniotic fluid; less than 400 mL, AFI less than 5
polyhydramnios
too much amniotic fluid; more than 2000 mL, AFI more than 20
finnegan score
tool used to determine severity of fetal withdrawal - with a score of 8-10, a baby will go to the NICU to get treatment
precocious teeth
tooth buds that have no roots, remove as soon as possible to prevent them from breaking off and causing aspiration
complete placental abruption
total shear/separation of placenta from uterine wall; results in massive bleeding, fetal demise, and maternal CV collapse
homeopathy
treatment of disease with minute doses of a remedy that, if given in massive doses to healthy persons, would produce effects like those of the disease - like to cure like - often used throughout natal care
pathologic hyperbilirubinemia
treatment of what? -measuring transcutaneous and total serum bilirubin levels -resolving anemia -removing maternal antibodies (this is why we give rhogam) -increasing serum albumin levels -reducing serum bilirubin levels -minimizing the consequences -phototherapy -exchange transfusions (if really high) -drug therapy
true
true or false, when mom is getting out of bed, lochia may pull and you may see a gush of blood come from their legs?
false
true or false? babies can sweat an shiver
true
true or false? excessive heat loss will increase respiratory rate
true
true or false? fair red heads are at risk for postpartum hemorrhage
true
true or false? lochia should go down in amount and color
true
true or false? premature newborns have slightly lower hemoglobin levels
true; you need to be NRP certified every 2 years
true or false? you need certification to be able to resuscitate a neonate
true
true or false? you should sponge bath until cord falls off
fallopian tubes
tubes which carry eggs from the ovaries to the uterus and which provides the place where fertilization occurs; divided into 3 parts: isthmus, ampulla, and fimbria - provide transport for the ovum from the ovary to the uterus (3-4 days) - provide a site for fertilization - serve as a warm, moist, nourishing environment for the ovum or zygote
di di twins
twins that arise from two separate ova fertilized by two separate sperm; each baby has their own placenta and amniotic sac - occurs most likely in fraternal twins - separate within 3 days
identical twins
twins with 1 fertilized ovum; originate at different stages
fraternal twins
twins with 2 ova and 2 sperm; originate at conception
mono mono twins
twins with same umbilical sac, same placenta - high risk for twin to twin transfusion (greedy twin) - high risk for cord entanglement, because they move around alot - separate within 12 days
mono di twins
twins with the same placenta, but different amniotic sacs - one baby may get greedy and take all the nutrients (twin to twin transfusion) - results in one fetus significantly larger than the other - separate within 5 days
transvaginal ultrasound
ultrasound in which a probe is inserted in the vagina - has clearer images - utilized earlier in pregnancy
transabdominal ultrasound
ultrasound technique in which a transducer is used with transmission gel over the abdomen
fetal alcohol spectrum disorder (FASD)
umbrella term that includes all categories of prenatal alcohol exposure, including FAS
- vaginal epithelium proliferation - cervix will secrete thick, viscous mucous - breast glandular tissue will increase in size and complexity - breasts prepare for lactation - temp will rise about .5- 1 F (accompanies ovulation and persists throughout secretory phase of menstrual cycle)
under the influence of progesterone, what will occur?
cryptorchidism
undescended testes
postpartum
up to 6 weeks post-birth
therapeutic donor insemination (TDI)
use of donor semen, considered in cases of: - azoospermia (no sperm) in partner - severe oligospermia or asthenospermia - inherited male sex linked disorders in partner - autosomal dominant disorder in partner - if lesbian couple wants a child - there is mandatory genetic/infectious disease testing for both donor and recipient, informed consent from all parties, etc.
therapeutic husband insemination (THI)
use of husband's semen during therapeutic insemination, generally indicated for seminal and anatomic deficiencies including: - oligospermia - asthenospermia (decreased motility) - teratospermia (low percentage, abnormal morphology) - hypospadia (abnormal urethral opening) - ejaculatory dysfunction - retrograde ejaculation - sperm can be frozen in a bank for 6 mo - also indicated in cases of unexplained infertility, and in some cases of female factor infertility, such as scant mucus, and cervical stenosis
Cytotec (misoprostol)
used as a cervical ripening agent, and also used to control post partum bleeding - given rectal for hemorrhage, orally for cervical ripening, and vaginally for fetal demise (abortion)
metformin
used for infertility tx in women with PCOS - hyperinsulinemia may result in anovulation (80% of women with PCOS don't ovulate)
IUPC
used if we need to know exactly how hard the contractions are
progesterone
used in infertility to treat luteal phase defects and increase hormone levels during that phase - commonly used for luteal phase support in conjunction with ovulation induction agents - increases endometrial receptivity
buprenorphine
used to decrease the severity of NAS in a newborn
L/S ratio
used to determine fetal lung maturity; analysis of amniotic fluid/surfactant components - done in early pregnancy when they believe they may have to induce (low BPP or DFS)
leopold's maneuver
used to determine fetal position and where to get best FHTs - consists of 4 maneuvers
quadruple screen (serum test)
used to evaluate fetal health; most widely used test to screen for Down's syndrome, trisomies 13 and 18, and neural tube defects (spina bifida) - provides assessment of AFP (alpha fetoprotein) , hCG, UE3 (estriol), and dimeric inhibin A - noninvasive - alot of false positives - used only for screening; doesn't dx genetic abnormalities
amnioinfusion
used to increase fluid volume; IUPC used to infuse saline into the uterus when oligohydramnios causes FHR decels and nonreassuring fetal status - also used to dilute meconium, and in preterm labor with PPROM - make sure water is coming out; don't want to increase resting tone by more than 10 mmHg
crown-rump length (CRL) and head circumference
used to measure gestational age of fetus
D&C
used to remove tissue from the uterus in order to terminate pregnancy - risks include perforation of the uterus, laceration of the cervix, hemorrhage, infection, and reaction to anesthesia - used in first trimester
IgM
usually not passively transferred; elevated levels may indicate fetal antigenic activity in utero - comes from infection
corpus
uterine body; composed of the upper 2/3 of the uterus - mainly smooth muscle (myomentrium)
lochia
uterine debris in the uterus is discharged through what?
uterine rupture
uterine dehiscence; results in fetal suspension in the abdomen - fetal death, mom is at high risk for death
uterine prolapse
uterus protrudes downward, and drops into upper vagina, pulling the vagina with it - location of the cervix determines extent of prolapse - s/s: include dragging sensation in groin and backache
sinusoidal pattern
very abnormal baseline characterized by absent variability with a smooth waveform - associated with Rh alloimmunization, fetal anemia, severe fetal hypoxia, UC occlusion, twin to twin transfusion, or a chronic fetal bleed - automatically considered a category 3 FHR tracing
pseudosinusoidal pattern
very abnormal baseline characterized by absent variability with a smooth waveform; however, it is caused by drug administration (opioids, Demerol, Stadol) - usually temporary
B vitamins
water soluble vitamin needed for cell respiration, glucose oxidation, and energy metabolism
vitamin C
water soluble vitamin needed for development of connective tissue and the vascular system
macrosomnia
weight of more than 4000 grams at birth
- recognizing which clinical practices are supported by sound evidence, which have conflicting findings, and which have no evidence to support their use - using data to evaluate care outcomes - integrating scientific bases into practice
what 3 competencies related to evidence based practice do nurses need to meet?
- they won't move as much - minimal variability (myocardial suppression) - acidosis
what 3 things will a fetus do if their O2 needs are not met?
- sufficient enzymes except for amylase - digests and absorbs fats less efficiently - salivary glands are immature - stomach has capacity of 50-60 mL - cardiac sphincter is immature
what GI adaptations occur in a newborn?
- poorly developed gag reflex; higher risk for aspiration - incompetent esophageal cardiac sphincter - poor sucking and swallowing reflexes; unable to suck, swallow, and breathe at the same time (may get apneic and bradycardic during feedings) - difficulty meeting caloric needs for growth - increased metabolic rate and increased oxygen requirements - feeding intolerance (not breathing while eating) - potential for the development of necrotizing enterocolitis (sometimes the gut is forgotten en utero, and it will start dying off- colostrum helps prevent it)
what GI alterations can occur in a premature infant?
- nausea and vomiting - softening and bleeding of gums - increase in saliva - constipation - heartburn - gallstones - hemorrhoids
what GI changes occur during pregnancy?
- PT: longer than 15 secs - PTT: longer than 60 secs - Fibrinogen: less than 150 mg/dL - platelet count: less than 100,000 - fibrinogen degradation product: greater than 100 mg/mL
what abnormal clotting factors are indicative of placental abruption?
- inspect clavicle (especially if there was shoulder dystocia) - inspect head for bruising (especially if forceps were used- cephalohematoma) - inspect for Erb's palsy - ensure close monitoring for cerebral, neurologic, and motor problems
what additional things should be included in the assessment of a macrosomnic newborn?
- unavailability of glycogen and brown fat - lose heat from blood vessels close to skin - high ratio of body surface area to body weight
what alterations in thermoregulation can occur in a preterm infant?
- increased risk to the fetus - IUGR - meconium stained amniotic fluid - increase in admissions to NICU - indication of high risk pregnancy - indication of high risk condition (gestational DM, infection, etc.)
what are AFI abnormalities usually associated with?
- precocious teeth - epstein's pearls - thrush - ridge of frenulum tissue - transient nerve paralyisis
what are assessment variations of the newborn's lips and mouth?
- minimal/absent variability - deceleration
what are bad things to see on a fetal strip?
- O2 mask that is blowing on baby - out of incubator; cooler room air
what are common causes of convection heat loss?
- submissive - passive - dependent, seek approval - low self esteem - hopelessness - hx of being exposed to violence - traditional views of sex roles - don't usually work outside of the home - isolation from family/friends
what are common characteristics of battered women?
- aggressive - manipulative - insecurity, socioeconomic inferiority, other feelings that conflict with their assumptions of male superiority - immaturity - often feel undeserving of their partners, but they constantly blame and punish them - lack of respect toward women - hx of exposure to abuse - poor impulse control
what are common characteristics of batterers?
- nausea and vomiting - urinary frequency - fatigue - breast sensitivity - leukorrhea - nasal stuffiness/discharge - nosebleeds - pytalism
what are common maternal discomforts of the first trimester?
- congenital malformations - intrauterine infections - growth difficulties - cognitive difficulties
what are complications of IUGR?
- fetal hypoxia - aspiration syndrome (meconium) - hypothermia - hypoglycemia - polycythemia
what are complications that can occur in SGA newborns?
- retained placenta - cervical lacerations - placenta accreta
what are complications that occur in the 3rd and 4th stage of pregnancy?
- RR: 30-60 - Breaths: should be irregular with no retractions or grunting - Temp: 97.6-99.4 - HR: 120-160, somewhat irregular - Skin: should be pink with blueish extremities - Cord: should have 2 intact arteries and 1 intact vein - gestational age: 38-42 wks to remain with parents - sole creases that involve heel
what are considered normal findings in a newborn assessment?
- maternal infection: HIV, TB, herpes (active lesion on breast), active chicken pox - maternal habits: illicit drugs, smoking, Rx medications, chemotherapy, polypharmacy
what are contraindications to breast feeding?
- uterine anomalies, uncontrolled preeclampsia, 3rd trimester bleeding - rupture of membranes, oligo/polyhydramnios, placenta previa - previous C/S or other significant uterine surgeries - multiple gestation - nonreassuring FHR or other evidence of insufficency - fetal abnormalities (IUGR)
what are contraindications to external version?
- pain due to nipple tenderness - leaking milk when breasts are full - embarrassment about breastfeeding - feeling tied down to the demands of breastfeeding - unequal feeding responsibilities/father feels left out - perceptions about diet restrictions (if mom eats food that makes her gassy, milk will make mom gassy) - limited birth control options (minipill) - vaginal dryness - safety of medications and breastfeeding
what are disadvantages to breastfeeding?
- midwife - MD - L&D nurses - CRNA - NICU nurse - respiratory therapist - PCT/ scrub techs - doula - case managers - bereavement services - family NP
what are examples of HCPs who may be in the delivery room, or be present pre/post delivery?
- maternal-fetal conflict - abortion - intrauterine fetal surgery - reproductive assistance - embryonic stem cell research
what are examples of ethical issues in maternity care?
- SOB - dyspnea on exertion - backaches - musculoskeletal disorders - pedal edema
what are examples of physical discomfort associated with multiple gestation?
- family hx of genetic conditions - significant health problems - previous or present alcohol intake - drug and tobacco use - blood type and Rh factor - occupation - educational level - methods by which he learns best - attitude toward the pregnancy
what are factors related to the father's health that could affect pregnancy and care?
- respiratory distress (reduced surfactant, alveoli get stuck together and can't refill) - birth trauma - maturational deficiencies
what are fetal implications for preterm labor?
- perinatal mortality - congenital anomalies - macrosomnia - IUGR - RDS - polycythemia - hyperbilirubinemia
what are fetal/neonatal risks with DM?
- UC compression - fetal sepsis - increased perinatal morbidity/mortality - malpresentation - nonreassuring FHR tracings - premature birth - prolapse of UC - respiratory distress syndrome (PPROM)
what are fetal/newborn complications that arise from PROM/PPROM?
- if the child has congenital abnormalities: includes, developmental, cognitive, intellectual disability - familial disorders - known inherited diseases - metabolic disorders - chromosomal abnormalities
what are indications for genetic counseling referral?
- abnormal presentation - multiple gestation - hydramnios - meconium stained amniotic fluid - premature membrane rupture - induction of labor - placental abruption - placenta previa - failure to progress - precipitous labor - UC prolapse - fetal heart abnormalities - uterine rupture - postdates - DM - preeclampsia/eclampsia - HIV/STIs
what are intrapartum high risk factors?
- chromosomal abnormalities (down's syndrome)
what are low set ears (top of the ear below the canthus of the eye) a sign of?
- seizures - hallucinations - pulmonary edema - cerebral hemorrhage - respiratory failure - heart problems - increased incidence of pregnancy complications
what are maternal implications of cocaine use during pregnancy?
- hydramnios - preeclampsia - eclampsia - retinopathy - increased susceptibility to infections
what are maternal risks with DM?
- serial cervical ultrasound assessments - bed rest - progesterone supplements - antibiotics - anti inflammatory drugs
what are medical therapies used to manage cervical insufficiency?
- pharmacologic agents - therapeutic insemination - IVF - other assisted reproductive techniques
what are methods of infertility tx?
- size of labia majora depends on gestation - vaginal tag or hymenal tag is often evident - thick whitish mucus discharge may be present, could be blood tinged (pseudomenstruation-hormones) - smegma is often present between labia
what are normal assessment findings of a female newborn's genitalia?
- correct positioning of urinary orfice (midline) - genitalia appears darker than rest of body (darker skinned babies) - testes are descended - scrotal edema and discoloration is common in breech births (sitting on it in birth canal) - hydrocele is commonly seen
what are normal assessment findings of a male newborn's genitalia?
- patent - no fissure - passage of first meconium stool within 24 hours - no dimple at top of the rectum or at base of the cord (could be a sign of spina bifida if the skin is open)
what are normal assessment findings of a newborn's anus?
- soft and pliable - recoil readily when folded and released - top of the ear (pinna) should be parallel to the outer and inner canthus of the eye - no preauricular skin tags or dimples
what are normal assessment findings of a newborn's ear?
- short - flexible - move symmetrically (one extremity not moving? brachial palsy) - good ROM - no gross deformities, extra digits/webbing, clubfoot, etc - normal palmar creases
what are normal assessment findings of a newborn's extremities?
- sucking (fat) pads located in the cheeks - recessed chin - flattened nose - lips sensitive to touch - sucking reflex easily initiated - symmetry of eyes, nose, and ears - rooting - no cleft palate (want to take finger and feel for one)
what are normal assessment findings of a newborn's face?
- pink, moist - touch on the lips/roof of mouth should produce sucking motions - scant saliva, should be clear - easy discrimination between sweet and bitter flavors - tongue has full ROM (not tongue tied)
what are normal assessment findings of a newborn's lips and mouth?
- initially white and gelatinous - two umbilical arteries and one umbilical vein - cord begins drying within 1 or 2 hours of birth - cord is shriveled and blackened by 2nd or 3rd day - no drainage or foul odor/other signs of infection - cord will fall off within 10-14 days
what are normal assessment findings of a newborn's umbilical cord?
- 30-60 bpm (after a full minute) - predominately diaphragmatic breathing (associated abdominal rise and fall during inspiration/expiration) - irregular respirations/periodic respirations (apnea up to 20 seconds is normal)
what are normal findings during a respiratory assessment of a newborn?
- thorax is cylindric and symmetric - ribs are flexible - xiphoid cartilage may be visible - 2 nipples (doc if there is more), not too wide based - engorged breasts occur frequently in older gestation(in both sexes) - whitish secretion from the nipples may be noted (comes from hormones)
what are normal findings during an assessment of a newborn's chest?
- short neck, creased with skin folds (clean skin folds during bath- vernix may get stuck there) - considerable lag when the newborn is pulled from a supine to a sitting position - newborn is able to raise the head slightly when prone - good ROM - clavicle is intact
what are normal findings during an assessment of a newborn's neck and clavicles?
- should be cylindrical - should protrude slightly - should move with respiration - some abdominal muscle laxness is normal - no cyanosis - few to no apparent blood vessels - no gross distention or bulging
what are normal findings in an assessment of a newborn's abdomen?
- eyelids are usually edematous during first few days of life because of the pressure associated with birth - equal pupils, reactive to light - blink reflex to light present - eyes are symmetrical, not too wide spaced (could be a sign of congenital abnormality) - white sclera
what are normal findings in an assessment of a newborn's eyes?
- small and narrow - nose breathing (nose breathers for first few months of life) - nose is patent (newborn is breathing easily with mouth closed) - sneezing
what are normal findings in an assessment of a newborn's nose?
- rule out miscarriage: assess for fetal loss, s/s of anemia, bleeding disorders - prepare the woman for possible fetal loss and assess her expressions of emotion and her family's response - speculum examination and ultrasound - Labs: H and H, hCG (can confirm if there's a pregnancy) - have mother stay on bed rest and abstain from sex - if an abortion, save products of conception to figure out the cause - give a blood transfusion if necessary - Rhogam needed if mom is Rh- - Cytotec can be given to induce miscarriage and rids of products of conception - a D&C may be needed to remove products of conception
what are nursing interventions for dealing with vaginal bleeding during pregnancy?
- change position to L lateral - IV fluid bolus (increase IV fluids) - turn off ptocin - oxygen via face mask (7-10 L/min) - call physician and monitor BP/HR, especially after an epidural (baby will be at risk for late decels) - check cervical status - treat hypotension per orders - prepare for emergency C/S
what are nursing interventions for late decelerations?
- sterile vaginal exams to assess fetal descent - assessment of FHR Q15min, Q30min if high risk - assessment of maternal VS Q5-15 mins
what are nursing interventions that should be done during the second stage of labor?
- assess temperature Q4; Q1-2 if temp is >99.6 or after membranes have ruptured - monitor BP, HR, and RR Q1 (every 15 mins if high risk) - assess contractions Q30min - continually monitor pain - palpate for positioning/contraction strength - keep pt comfortable; position changes, clean sheets - let them move and ambulate if they want - auscultate FHR Q30min, Q15min for high risk women - continuous FHR monitoring if baseline is abnormal or there are decels
what are nursing interventions that should be done in the latent phase of labor?
-perineum may be edematous, with bruising -lacerations or an episiotomy may be present
what are perineal changes postpartum?
-level of trust -level of self esteem -capactity for enjoying herself -adequacy of knowledge -prevailing mood -reactions to the pregnancy -if mother doesn't know a lot, she may have an attachment issue -mood swings -reactions to pregnancy: was it a wanted or unwanted pregnancy
what are personal characteristics that influence parent-infant attachment?
- auscultation of fetal heartbeat - fetal movement - visualization of the fetus
what are positive signs of pregnancy?
- milk stasis - bacteria - nipple trauma - changes in number of feedings - lowered maternal defenses
what are possible causes of mastitis
- ambivalence - acceptance - introversion - mood swings - fear - changes in body image
what are possible responses by the mother to pregnancy?
- confused by the partner's mood changes - feels left out - resents attention given to the woman - resents changes in their relationship - needs to resolve conflicts about fathering - couvade
what are possible responses to pregnancy by the father?
-abdomen is loose and flabby but will respond to exercise -uterine ligaments will gradually return to their prepregnant state -diastasis recti abdominis may have been ripped during c section -striae will take on different colors based on the mother's skin color -breasts are ready for lactation
what are postpartum abdominal and breast changes?
-increased bladder capacity -swelling and bruising of tissues around the urethra -decrease in sensitivity to fluid pressure -decrease in sensation of bladder filling -urinary output is greater due to puerperal diuresis -increased chance of infection due to dilated ureters and renal pelves
what are postpartum bladder changes?
-woman will experience hunger and thirst -bowels will be sluggish (epidural, or manipulation of abdomen in c section) -episiotomy, lacerations, or hemorrhoids may delay elimination -if patient had a c section: check bowel sounds because they are at risk for an ileus, make sure mom is able to pass gas even if bowel sounds are present
what are postpartum bowel changes?
-cervix is spongy, flabby, and may appear bruised -external os (lower part of the cervix, first part that you come to, goes from round to slit after baby) may have lacerations and is irregular and closes slowly -shape of the external os changes to a lateral slit
what are postpartum cervical changes?
-nonpathologic leukocytosis occurs in the early postpartum period -blood loss averages 200 to 500 mL (vaginal), 700 to 1000 mL (cesarean) -plasma levels reach the prepregnant state by 4-6 weeks postpartum -platelet levels will return to normal by the sixth week
what are postpartum changes in lab values?
-vagina may be edematous, bruised with small superficial lacerations -size decreases and rugae reappear within 3-4 weeks -returns to prepregnant state by 6 weeks -superficial lacerations (or called "skin marks") are painful and burn -decreased lubrication means pain with sex -labia may be more flaccid after 6 weeks
what are postpartum vaginal changes?
-initial weight loss of 10 to 12 pounds -postpartum diuresis causes a loss of 5 pounds -return to prepregnant weight by the sixth to eighth week -wt loss includes baby, placenta, and amniotic fluid
what are postpartum weight changes?
- dehydration - hypovolemia - hypotension - tachycardia - increased Hct and BUN - decreased urine output - metabolic acidosis - renal impairment - cardiac dysfunction - muscle wasting - protein/vitamin deficiencies - fetal/embryonic death - irreversible maternal metabolic changes or death
what are potential consequences of hyperemesis gravidarum?
- small for gestational age fetus - IUGR - C- section for nonreassuring fetal status - 5 minute APGAR score of less than 7 (normal: 7-10) - respiratory distress syndrome - NICU admission - perinatal death
what are potential implications for an abnormal doppler flow study and decreased amniotic fluid?
- loss of pregnancy - preterm labor - low birth weight infants - fetal death
what are potential maternal consequences of intimate partner violence/partner abuse?
- relationships - communication patterns - roles (parenting) - interactions
what are predictable developmental changes over time for a family?
- amenorrhea - nausea/vomiting - excessive fatigue - urinary frequency - breast changes - quickening
what are presumptive signs of pregnancy?
- obesity - smoking - c-sections - high risk pregnancies: PPROM, placenta previa, alot of bedrest
what are risk factors for DVT postpartum?
abdominal muscles used in pushing
what are secondary physiologic forces of labor?
- alterations in lipid metabolism - breast tenderness - fluid retention, weight gain - thromboembolic complications - nausea - HTN - headache
what are side effects of combined oral contraceptives due to estrogen?
- acne - breast tenderness, increased breast size - decreased libido - decreased HDL - depression with fatigue - hirsutism - weight gain - amenorrhea - pruritis - sebaceous cysts - fatigue
what are side effects of combined oral contraceptives due to progestin?
- nasal flaring - substernal retractions (can also be intercostal or xiphoid) - accessory muscle use - expiratory grunt/sigh - tachypnea - see saw respirations
what are signs of newborn respiratory distress?
- variation from normal FHR - decreased fetal movement - meconium stained amniotic fluid - late decels - prolonged decels - variable decels - minimal variability - marked variability - absent variability - sinusoidal patterns - tachycardia/bradycardia (early decels are NOT a sign of nonreassuring fetal status)
what are signs of nonreassuring fetal status?
- subconjunctival hemorrhage - transient strabismus - squinting
what are some assessment variations of the newborn eye?
-physical condition of mother and newborn -maternal reactions to stress, anesthesia, and medications -grief response to loss of the fantasized birth experience (if mom expected vaginal delivery) -meds may make mother sleepy
what are some barriers to parent-infant interaction after cesarean birth?
-want mom to void within 6 hours after vaginal delivery or 6 hours after Foley was removed -make sure bladder isn't displacing the uterus -placenta and oxytocin has antidiuretic effect; once placenta is gone and oxytocin levels decrease after labor, in 12-24 hours, they will diurese (get rid of fluid, no more baby): increased risk for UTI because of dilation of ureters (teach her for S/S of UTI once she goes home)
what are some bladder interventions/nursing care you should consider when dealing with postpartum moms?
-tremors or chills (response to hormones) -postpartum diaphoresis -afterpains: last 2-3 days, simulated by breastfeeding or oxytocin agents (more babies mom has, the more painful it is, it is the uterus trying to get back to normal size)
what are some common discomforts in the postpartum period?
-non-western cultures emphasize postpartum period -food and liquids after birth -hot-cold balance -role of the grandmother -hispanics: huge parental role -viatnamese: seaweed soup for postpartum moms -Indian culture thinks that mom rests for 30 days and grandmother takes care of the baby
what are some cultural differences in the postpartum period?
- pelvic tilt - abdominal exercises - kegel exercises - "tailor-sit" stretch - certain yoga poses
what are some examples of pregnancy exercises?
- availability of certain herbal teas and essential oils for antepartum discomfort - use of massage or therapeutic touch during first stage of labor - music during childbirth - increased use of "skin to skin" and mother-baby bonding
what are some examples of the integration of complimentary medicine into conventional perinatal healthcare settings?
- excessive high pitched cry - jitteriness - sleeping less than 1 hr after feeding - hyperactive moro reflex - mottling - stuffy nose - sneezing more than 3-4 times - respiratory depression: nasal flaring, tachypnea
what are some infant manifestations of withdrawal?
-temperature may be elevated to 38C for up to 24 hours after birth -temperature may be increased for 24 hours after the milk comes in (100.4 you worry though) -BP rises early and then returns to normal -bradycardia occurs during the first 6-10 days -may see a slight rise in temp if mom is dehydrated
what are some postpartum vital sign changes?
-selecting the time that will provide the most accurate date -providing an explanation of the purpose of the assessment -ensuring that the woman is relaxed before starting -recording and reporting the results clearly -body fluid precautions (PPE) -do not assess a mom that has not slept all night (4 hour window until 11 am) -check for hemorrhoids and episiotomy site
what are some principles of conducting a postpartum assessment?
- lack of standardization/regulation - lack of research supporting their use and safety/effectiveness - inadequate training and certification of some healers using these therapies to treat people - financial and health risks of unproven methods
what are some risk of complimentary therapies?
- Copper IUD (ParaGARD): provides protection for 10 yrs - Mirena Levonorgestrel: provides protection for 5 yrs (can cause unscheduled bleeding)
what are some types of IUDs, and how long do they last?
-monitor uterine status, vital signs, cardiovascular status, elimination patterns, nutritional needs, sleep and rest, and learning needs -medication to relieve pain -treat anemia -provide immunity to rubella -prevent development of antibodies in the non sensitized Rh-negative woman -promote comfort and relieve stress -give MMR is mom is not immune to rubella on way out the door because it is a live vaccine -give Rhogam to negative Moms and positive babies
what are some ways you can promote and restore maternal physical well-being?
- atrophic changes - sleep disturbances - dizzy spells - palpitations - weakness - weight gain
what are symptoms of menopause?
- ductus venosus - ductus arteriosus - foramen ovale
what are the 3 parts of fetal circulation that are different than infant circulation?
- total - partial - marginal - low lying
what are the 4 degrees of placenta previa?
4 via ultrasound: - fetal breathing movement - fetal movement - fetal tone (extremity extension and flexion) - amniotic fluid volume and results of the NST (fetal HR: - reactive vs. nonreactive
what are the 5 variables assessed by a BPP?
- provides pressure measurements for contraction intensity and uterine resting tone - allows for very accurate timing of contractions - provides permanent record of uterine activity
what are the advantages of internal electronic uterine monitoring?
- noninvasive - readily accessible, doesn't require equipment - increases "hands-on" care of the patient - allows the mother freedom
what are the advantages of palpating for contractions?
- noninvasive - easy to place - may be used before and following rupture of membranes - can be used intermittently - provides a permanent, continuous recording
what are the advantages of using an external electronic uterine monitor?
- increased maternal age - increased para - smoking - cocaine use - trauma - maternal HTN - PPROM - hx of abruption - male babies - placental anomalies - uterine malformations or fibroids - rapid uterine decompression associated with hydramnios and multiple gestation - amniocentesis - shortened umbilical cord - low SES - subchorionic hematoma - elevated alpha fetoprotein in second trimester
what are the associated risk factors of placental abruption?
- condoms - diaphragm - cervical cap - vaginal sponge
what are the barrier methods?
- emphasize prevention and wellness - place a higher value on holistic healing than on physical cure - noninvasive - few side effects - affordable
what are the benefits of complimentary therapies?
-reduces incidence of complications such as constipation and thrombophlebitis -promotes feeling of general well-being
what are the benefits of early ambulation?
- improves self image - increases energy - improves sleep - relieves tension - helps control weight gain - promotes regular bowel function
what are the benefits of exercise during pregnancy?
- descent - flexion - internal rotation - extension - restitution - external rotation - expulsion
what are the cardinal movements?
- narrowed pelvis - soft tissue dystocia (fibrioids) - stool in GI system - full bladder - reproductive tract anomalies can also impact birthing ability
what are the causes of CPD?
-changing hormones -lack of supportive environment -single moms are more at risk
what are the causes of postpartum blues?
- uterine atony - lacerations of genital tract (fundus will be firm, but they will be bleeding out) - episiotomy - retained placenta - vulvar, vaginal ,or subperitoneal hematomas - uterine inversion - uterine rupture - problems of placental implantation coagulation disorders
what are the causes of postpartum hemorrhage?
- few, if any, symptoms - BP elevated to 140/90+ - proteinuria
what are the clinical manifestations of mild preeclampsia?
- may develop suddenly - BP 160/110+ on 2 occasions atleast 6hrs apart during bed rest - proteinuria > 5g in a 24 hr urine collection - oliguria - visual/cerebral disturbances - cyanosis or pulmonary edema - epigastric pain - impaired liver function - thrombocytopenia - hemolysis - IUGR (in the fetus)
what are the clinical manifestations of severe preeclampsia?
- multipara - active labor - unknown breach presentation
what are the common features of women who have breech vaginal births?
- amniotomy - amniotic membrane stripping - IV pitocin infusion - complimentary methods: sex, foley bulb, nipple stimulation, herbs, castor oil, enemas, acupuncture
what are the common methods of induction?
- nasal flaring - grunting - retracting (accessory muscle use) - tachypnea
what are the common physical manifestations of respiratory distress in a newborn?
- early ID of pregnancy - observation of fetal HB and breathing movements - ID of more than one embryo/fetus - determining gestational age - measurement of the biparietal diameter of the fetal head or length of femur to assess growth patterns (IUGR) - clinical estimations of birth weight - detection of fetal anomalies (anencephaly, hydrocephalus) - examination of nuchal translucency in the first trimester to assess for down's syndrome, etc. - examination of fetal cardiac structures - measurement of fetal nasal bone - ID of amniotic fluid index - location of placenta - placental grading (degree of calcification - IDing placental abnormalities - detection of fetal death - determination of fetal position and presentation - accompanying procedures (amniocentesis, chorionic villus sampling, etc.)
what are the common reasons that ultrasounds are used?
- facial bruising/edema - transient facial paralysis (make sure they are crying right) - cephalohematoma - hyperbilirubinemia - facial lacerations - brachial plexus injuries - rare: cerebral hemorrhages, fractures, brain damage, fetal death - the mother is at increased risk for lacerations, 4th deg episiotomy, and incontinence
what are the complications of forceps-assisted delivery?
- poor self care - inadequate nutrition - self medication - poor maternal-infant bonding - maternal suicide - inability to articulate emotions (irritability, withdrawn) - in the hospital, they will be put on the high risk unit on suicide precautions if necessary
what are the consequences of untreated depression?
- increment: building up of contraction - acme: peak of contraction - decrement: letting up of contraction
what are the contraction phases?
- 3rd trimester bleeding from placenta previa - marginal placental abruption or unexplained vaginal bleeding - previous c-section with classical incision - premature rupture of the membranes - cervical insufficiency - cerclage in place - anomalies of the maternal reproductive organs - hx of preterm labor (if being done before term) - multiple gestation
what are the contraindications for a CST?
- previous hx of thromboembolic disease - acute or chronic liver disease - presence of estrogen dependent carcinomas - undiagnosed uterine bleeding - heavy smoking - gallbladder disease - diabetes - HTN - pregnancy - hyperlipidemia - migraine headaches
what are the contraindications for combined oral contraceptives?
- patient refusal - placenta previa - transverse fetal lie/malpresentation - prior classical C/S - active genital herpes - UC prolapse - absolute CPD - previous ruptured uterus - any time you shouldn't (or don't want) a vaginal delivery
what are the contraindications to induction of labor?
- membranes must be ruptured and adequate dilation (atleast 2-3 cm) must be achieved before it can be put in - invasive - increases the risk of infection and perforation (could accidentally poke placenta) - can't be used if mom has HIV, untreated GBS, or Hep B (don't want to break the fetus's skin) - sometimes hard to find the right spot (make sure its on a hard spot before screwing it in, could end up in butt, etc)
what are the disadvantages of internal electronic uterine monitoring?
- doesn't provide actual quantitative measure of uterine pressure - no permanent record - maternal size and positioning may prevent direct palpation
what are the disadvantages of palpating for contractions?
- if the mom is bigger, or has alot of fat, it is harder for the signal to transmit - must be monitored carefully; nurse must compare subjective findings with the monitor (if the baby is dead, you will be picking up MHTs, check mom's pulse frequently to make sure you're picking up the FHTs) - the belt may be uncomfortable/require frequent adjustment - the mother may feel inhibited to move - make sure to nurse the patient, not the monitor
what are the disadvantages to electronic uterine monitoring?
- favorable cervical mucus - patent tubes with normal motility - ovaries produce and release normal ova - no obstructions between ovary and uterus - favorable endometrium - adequate reproductive hormones
what are the essential components of fertility in a female:
- normal quality, quantity, and motility of sperm - unobstructed genital tract - normal genital tract secretions - ejaculated sperm reach cervix
what are the essential components of male fertility?
- risk of low birth weight, prematurity, and still birth - increased risk of neonatal death with severe anemia (Hgb<6) - increased risk for fetal hypoxia
what are the fetal implications for iron deficiency anemia?
- prematurity and IUGR - fetal death can be caused by sickling attacks in the placenta (rate of fetal death has decreased)
what are the fetal implications for sickle cell anemia?
- no strong evidence that marijuana has teratogenic or other negative effects on fetus - difficult to evaluate impact of heavy marijuana use on pregnancy, usually due to social factors (polydrug use) that can affect the direct results
what are the fetal implications of marijuana use during pregnancy?
- increased risk of small for gestational age - low birth weight - decreased arousal - lower scores on tests of attention, verbal memory, and visual motor integration
what are the fetal implications of maternal meth use?
- depends on degree of abruption - low incidence of fetal death - complications include preterm labor, anemia, and hypoxia
what are the fetal implications of placental abruption?
- macrosomnia; shoulder dystocia - IUGR (postmaturity or dysmaturity syndrome) - SGA - decreased placental perfusion - oligohydramnios - meconium aspiration - low APGAR scores - SIDS - neonatal acidemia - ortho or neurologic injury (lack of blood flow, collar bone) - fetal encephalopathy - CP - fetal demise - still birth
what are the fetal risks involved with growth beyond 42 wks gestation?
- early onset: respiratory distress, pneumonia, apnea, shock - late onset: meningitis
what are the fetal risks of GBS?
- increased risk of neural tube defects - if mom has 1 kid with NTDs, then she is very likely to have another with NTDs (advised to take a larger folic acid supplement)
what are the fetal risks with folic acid deficiency anemia?
- twin to twin transfusion - higher mortality rate - decreased intrauterine growth rate - increased incidence of fetal anomalies - increased risk of prematurity, IUGR - abnormal presentations - increase in cord accidents (mono mono twins) - increase in CP - cord prolapse
what are the fetal/neonatal implications of multiple gestation?
- occur every 1.5-2 mins - last 60-90 secs - strong, 70-100 mmHg
what are the frequency, duration, and intensity of contractions during the second stage of labor?
- acts as a cushion to protect the embryo against mechanical injury - help control the embryo's temperature - permit growth and development of embryo - prevent adherence of the fetus to the amnion to allow freedom of movement (aids in musculoskeletal development) - allow the umbilical cord to be free of compression - acts as an extension of fetal ECF - act as a wedge during labor - provide fluid analysis to determine fetal health and maturity
what are the functions of amniotic fluid?
- to serve as the passage for sperm during sex and for the fetus during birth - to provide passage for the menstrual products from the uterine endometrium to the outside of the body - to protect against trauma from sexual intercourse and infection from pathogenic organisms
what are the functions of the vagina?
- overdose - psychotic response - jeopardizing fetal well being
what are the greatest risks of PCP use in pregnant women?
- women under 21: no screening - 21-29: screening with cytology alone every 3 years - 30-65: screen with cytology and HPV testing every 5 years - 65+: if they have adequate prior screening, no high risk, and/or are post hysterectomy, don't screen
what are the guidelines for cervical cancer screening?
improved protection from: - respiratory tract and GI tract infections - necrotizing entercolitis (babies in NICU are at risk) - UTIs - otitis media - bacterial meningitis - bacteremia - allergies
what are the immunologic advantages to breastmilk?
Risks rt placental insufficiency or fetal compromise: - IUGR - gestational DM - maternal heart disease - maternal chronic HTN - maternal preeclampsia or eclampsia - maternal sickle cell anemia - suspected fetal postmaturity (more than 42 wks gestation) - hx of stillbirths - Rh sensitization - abnormal estriol excretion - hyperthyroidism - renal disease - nonreactive NST
what are the indications for a BPP?
- nonreassuring fetal tracings (2 or 3) - complete placenta previa - placental abruption - CPD - active genital herpes - UC prolapse - failure to progress in labor - failure to descend - malpositioning - repeat C/S
what are the indications for a c-section?
- heart disease (increased workload with pushing) - pulmonary edema - infection - exhaustion
what are the indications for a forceps-assisted birth?
- women age 35+ at time of birth - couples with a balanced translocation (chromosomal abnormality) - family hx of known or suspected mendelian genetic disorders (CF, hemophilia, muscular dystrophy) - couples with a previous child with chromosomal abnormality - couples in which either partner is affected with or are carriers for a dx metabolic disorder - family hx of birth defects/mental retardation (neural tube defects, congenital heart disease, cleft palate) - ethnic groups at increased risk for specific disorders (sickle cell)
what are the indications for preconceptual chromosomal analysis and prenatal testing?
- previous hx of stillbirth at 38+ wks - presence of a complication of pregnancy - induction of labor - preterm labor - decreased fetal movement - nonreassuring fetal status - meconium staining of amniotic fluid - trial of labor after C/S (TOLAC) - maternal fever - placental problems - category II or III tracings
what are the indications of electronic uterine monitoring?
reduced risk of: - DM - lymphoma - leukemia - Hodgkin's disease - obesity - hypercholesterolemia - asthma
what are the infant benefits to breastfeeding?
- pap smear - CBC - Hgb/Hct - HIV screen - STI screens - urinalysis and culture - rubella titer - ABO and Rh typing - Hep B screen - fetal protein - GDM - group B strep
what are the major prenatal screening tests?
if mother breastfeeds for 6 months, it can reduce risk of breast and ovarian cancer
what are the maternal benefits to breastfeeding?
- increases the risk for blood transfusion postpartum - increased risk of hemorrhage - more susceptible to infection
what are the maternal implications for folic acid deficiency anemia?
- poor nutrition - iron deficiency anemia - preeclampsia - higher incidence of STIs and other infections
what are the maternal implications of heroin use during pregnancy?
- tiring easily - more susceptible to infection - increased chance of preeclamspia/eclampsia - increased risk of postpartum hemorrhage - unable to tolerate minimal blood loss during birth - delayed healing of episiotomy/other incisions
what are the maternal implications of iron deficiency anemia?
- anemia - shock - hemorrhage - DIC
what are the maternal implications of placental abruption?
- abdominal surgery during 2nd or 3rd trimester - abdominal trauma - age (less than 17 or over 35) - infection - anemia - BV, E.Coli (ascending intrauterine infection) - bleeding after 12 wks - cervical cerclage in situ - cervical shortening - cervix dilated (1cm at 32 wks) - smoking - clotting disorders - interval of less than 6 to 9 mos between pregnancies - known cervical insufficiency - lack of social support - long work hrs with prolonged standing - low maternal wt - low socioeconomic status - more than 2 1st trimester abortions - multiple gestation - nonwhite race - obesity - DM - peridontal disease - polyhydramnios - poor wt gain - domestic violence - febrile illness - previous preterm birth - STIs - HTN - inadequate or no prenatal care
what are the maternal risk factors for spontaneous preterm labor?
- probable induction - increased risk of dystocia - increased risk for LGA newborn - increased incidence of forceps/vaccum assisted births - increased risk for infection - increased risk of severe peineal trauma rt macrosomnia - high risk for C/S - increased risk for thromboembolitic disease
what are the maternal risks involved with postterm pregnancy?
- risk of 3rd/4th deg episiotomy - increased risk for edema and bruising; increases risk for bilirubinemia/jaundice - no increase in fetal mortality risk unless labor is prolonged or additional interventions, such as forceps or emergency C/S are required
what are the maternal risks of delivering a baby OP?
- continuously produces glycogen, cholesterol, and fatty acid for fetal use and hormone production - produces numerous enzymes required for fetoplacental transfer (insulinase= increases barrier to insulin) - breaks down certain substances such as epinephrine and histamine - stores glycogen and iron
what are the metabolic activities that the placenta performs?
-increase in oxygen requirements -increase in utilization of glucose -acids are released in the bloodstream (could lead to brain damage and death) -surfactant production decreases
what are the metabolic consequences of cold stress?
- convection - radiation - evaporation - conduction
what are the methods of heat loss?
- drowsy or semidozing - quiet alert - active alert - crying
what are the newborn alert behavior states?
- deep or quiet (very hard to wake; may need to take clothes off, tickle feet, etc) - active or light
what are the newborn sleep behavior states?
- marriage may be stressed - relationship affected by intrusiveness - guilt - frustration - anger - shame
what are the physiologic and psychological effects of infertility?
- vaginal bleeding: often brownish, but may be bright red - uterine enlargement greater than expected for gestational age - passage of hydropic vesicles (grape like clusters) - hyperemesis gravidarum - anemia due to blood loss - symptoms of preeclampsia before 24 wks - absent fetal heart tones
what are the possible s/s of a molar pregnancy?
- lightening - BH contractions - bloody show - rupture of membranes (ROM) - sudden burst of energy - weight loss
what are the premonitory signs of labor?
contractions
what are the primary physiologic forces of labor?
- pelvic organ changes - abdominal enlargement - braxton hicks contractions (diarrhea) - abdominal striae - uterine souffle - changes in skin pigmentation - positive pregnancy tests - palpation of fetal outline (ballottement)
what are the probable signs of pregnancy?
- increased self esteem (long term) - enhanced bonding - decreased stress for mother and infant - communicates warmth, closeness, and comfort - can be relaxing - helps learn behavioral cues of baby
what are the psychosocial advantages to breastfeeding?
- obesity - prior hx of GDM - glycosuria - strong family hx of diabetes
what are the risk factors for GDM?
- multiple gestation - repetitive second trimester losses - previous preterm birth - progressively earlier births with each subsequent pregnancy - short labors
what are the risk factors for cervical insufficiency?
- women of asian descent - prior C/S - high gravida - high para - advanced maternal age - previous miscarriage - previous induced abortion - cigarette smoking - male fetus
what are the risk factors for placenta previa?
- maternal mortality - preeclampsia - gestational DM - thromboembolism - postpartum hemorrhage - increased rate of C-sections - greater likelihood of lifelong obesity in offspring
what are the risks associated with obesity in pregnancy?
- spontaneous abortion - placenta previa - abruptio placentae - carbon monoxide exposure: polycythemia, hyperviscosity - interference with development of the nervous system - SGA - IUGR - prematurity - low birth weight - hyperactive moro reflex - nicotine toxicity - SIDS
what are the risks for infants of smoking mothers?
- failure to obtain tissue - rupture of membranes - leakage of amniotic fluid - bleeding - intrauterine infection
what are the risks of CVS?
- increased length of labor - maternal exhaustion/stress - postpartum hemorrhage (not contracting now, won't contract then) - intrauterine infection (long period between membrane rupture and birth) - nonreassuring fetal status - fetal sepsis
what are the risks of hypotonic contractions?
- thick, curdy, white vaginal discharge - itching - dysuria - dyspareunia - swollen labia - rash or excoriation of the penis - pruritis
what are the s/s of VVC?
- sharp, one sided pain - syncope - referred right shoulder pain - lower abdominal pain - abdominal rigidity and tenderness - decreased Hgb and Hct - increased leukocytes
what are the s/s of ectopic pregnancy?
- pelvic pain r/t menstrual cycle - dyspareunia (painful sex) - abnormal uterine bleeding - bimanual examination shows: fixed, tender, retroverted uterus, palpable nodules in cul-de-dac, dx confirmed by laparoscopy
what are the s/s of endometriosis?
- development of single or multiple blister-like vesicles on the genitals - inflammation and pain - flu like symptoms - difficulty urinating - dormant stage: asymptomatic
what are the s/s of genital herpes?
- BP >140/90 (mild) - BP> 160/110 (severe) - headache - blurred vision - generalized edema or in the face/hands - hyperreflexia - liver swelling/liver blood vessel issues (watch for R epigastric pain) - proteinuria - positive clonus - decreased urine output
what are the s/s of preeclamspia?
- uterine contractions that occur atleast every 10 mins (with or without pain) - mild menstrual like cramps felt low in the abdomen - constant or intermittent feelings of pelvic pressure - rupture of membranes - low, dull backache - change in vaginal discharge - abdominal cramping
what are the s/s of preterm labor?
- profound anemia - jaundice - fever - acute pain - if pregnant, the disease can be aggravated and cause a vaso-occlusive crisis
what are the s/s of sickle cell anemia?
- HTN - hyperthermia - diaphoresis - possible coma
what are the signs of PCP overdose?
- frequency and urgency - dysuria - nocturia - hematuria - suprapubic pain - slightly elevated temperature
what are the signs of a UTI?
- excessive bright red bleeding - boggy fundus - abnormal clots - unusual pain - persistent bleeding - elevated pulse - decreased BP - orthostatic hypotension (dizziness/weakness)
what are the signs of a postpartum hemorrhage?
- globular uterus rises in abdomen - gush or trickle of blood - increased protrusion of umbilical cord
what are the signs of placental separation?
- fever - malaise - abdominal pain - foul smelling lochia - larger than expected uterus - tachycardia
what are the signs of puerperal infection?
- may be asymptomatic - fatigue - anemia - malaise - progressive weight loss - lymphadenopathy
what are the signs/symptoms of HIV?
-Lactogenesis I: Last trimester, limited milk production, colostrum production -Lactogenesis II: 2-5 days postpartum; milk secretion (milk comes in) -Lactogenesis III: 10+ days; milk composition stabilizes
what are the stages of lactation?
- mons pubis - labia majora - labia minora - clitoris - urethral meatus and opening of paraurethral glands - vaginal vestibule (vaginal orfice, bartholin's glands, hymen, fossa navicularis) - perineal body
what are the structures in the vulva?
- changes in CO - diaphoresis - hyperventillation - changes in acid/base balance - impaired blood and lymph drainage from base of bladder - reduced gastric motility - increased WBCs - decreased maternal blood glucose - pain
what are the systemic responses to labor?
- decrease effects of hyperandrogenism - restore reproductive functioning for women desiring pregnancy - protect the endometrium (increased risk for cancer) - reduce long term risks (type 2 DM, CV disease)
what are the treatment goals in patients with PCOS?
-uterus decreases in size in a process called involution -spongy layer of the decidua is sloughed off (lochia) -basal layer differentiates into two layers (outer layer sloughs off, inner layer begins the foundation for the new endometrium) -placenta site heals by exfoliation and the uterine cells atrophy
what are uterine changes in postpartum moms?
- duration and course (type of delivery) - status of mother and fetus - antepartum hx: maternal problems, maternal age, EDB, previous pregnancies, presence of congenital anomalies
what assessment data should be collected about labor and birth on newborn admission?
- rooming in; how much time baby spent in nursery - circumcision? have consents/and education been completed? - type of feeding (breast/bottle), way of feeding
what assessment data should be collected relating to parent-newborn interaction on newborn admission?
- membranes ruptured for 24+ hrs - C-section/forceps/vacuum delivery - maternal fever during course of labor
what assessment findings during labor and birth could lead to the baby being monitored closely for sepsis?
- asymmetry of the head in a vertex presentation (molding) - cephalohematoma - caput succedaneum
what assessment variations can occur in a newborn head?
- facial movement asymmetry; facial palsy - facial paralysis: appears when the newborn cries; the affected side is immobile and the palpebral (eyelid) fissure widens (stroke like)
what assessment variations can occur in a newborn's face?
-biochemical changes: hypoxemia, metabolic acidosis, hypercarbia, anaerobic metabolism, brain damage, death -these babies could go down a bad path, fix it quickly, so baby will transition to extrauterine life
what biochemical changes do you see in neonatal asphyxia?
- they should alternate - start on one side, stay for 15-20 minutes, then change to other side for additional time if needed - for the next feed, begin on the opposite side from what you began last feed - encourage different positions for second breast
what breast should a mom have their child breastfeed on?
- infection (chorioamnionitis and endometritis) - placental abruption - retained placenta - hemorrhage - maternal sepsis
what can PROM result in maternally?
want them to pee within the first 6 hours: - run water in sink - put warm water in peri bottle and run over perineum - pain meds to help relax - peppermint may help - if they don't pee=straight cath
what can a nurse do to help a postpartum mom void?
- smoking - taking narcotics - eating (makes the baby more active)
what can affect a fetal activity assessment?
- heel warmers; micropreemies may have warmers underneath blankets,etc - plastic bags over the baby to help it retain heat
what can be done for premature babies to help it retain heat?
- IV fluids and phenergan to help with nausea/vomiting - TPN if necessary (if they can't keep anything down)
what can be done to help manage GI changes during pregnancy?
- expect mild jitteriness and irritability - higher risk for SIDS - sleep supine - home apnea monitoring - feeding techniques; it may be harder to feed them - comforting measures: swaddling - finnegan scoring (at birth and Q6 hrs afterwards)
what can be included in parent education on a drug exposed newborn?
- fan, drinking cool liquid - hormone replacement/ therapy - complimentary therapies - lubricating gel
what can be used to relieve distress/symptoms associated with menopause?
- late (profound) fetal hypoxia (depression of myocardial activity) - maternal hypotension (decreased BF to fetus) - prolonged umbilical cord compression (vagal stimulation) - fetal arrhythmia (associated with complete heart block) - uterine hyperstimulation - placental abruption - uterine rupture - vagal stimulation in second stage - congenital heart block - maternal hypothermia
what can cause fetal bradycardia?
- early sign of hypoxemia (not getting enough blood flow) - maternal fever (speeds fetal metabolism) - maternal dehydration - maternal drug use (stimulants) - anemia - maternal hypothyroidism - early sign of amnionitis - tachydysrhythmias
what can cause fetal tachycardia?
- the pressure can cause a pneumothorax - it can cause damage to the retina, resulting in blindness
what can happen if a premature infant is put on too much oxygen?
- repositioning before fetal rotation; mother rotates from side to side as fetus begins to rotate - knee to chest - hands and knees - external version
what can nurses do to try to correct malpresentation?
- it may not fit through the pelvis, and result in shoulder dystocia (head is through vagina, shoulders stuck at pelvis) - this is a medical emergency because blood flow to the child's head is cut off - to save the child, their clavicle will most likely be broken and/or the mom's tailbone will break - McRobert's maneuver is used
what can occur if a fetus is macrosomnic?
- may not be able to tolerate the higher workload of the heart needed, especially during labor (pushing) - the baby is allowed to move naturally to a certain point then is pulled out with forceps or a vacuum
what can occur if a pregnant mother has heart disease?
- bilirubin can cross the BBB, and result in kernicterus
what can occur if bilirubin levels become too high in an infant?
- may suffer withdrawal - teratogenic drugs result in congenital anomalies and developmental problems - FAS is associated with preventable mental retardation - alcohol related birth defects - alcohol related neurodevelopmental disorder (Finnegan score)
what can occur in an infant of a substance-abusing mother?
- blood volume increases 40-45% - physiologic anemia - decrease in systemic and pulmonary vascular resistance - CO increases by 30-50% - somewhat hypercoagulable state - pulse will increase 10-15 bpm - heart palpitations may occur - short systolic murmurs may occur - BP should be normal until 16-20 wks until it drops by 10 mmHg, then it will increase
what cardiac changes occur during pregnancy?
progesterone relaxes the bowel, lack of peristalsis
what causes constipation during pregnancy?
delayed bile emptying
what causes gallstones during pregnancy?
cardiac sphincter relaxes
what causes heartburn in pregnancy?
- its unclear possible causes: - possible changes in progesterone/estrogen levels - cortiotrophin-releasing hormone - progesterone withdrawal
what causes labor?
- pressure on the gallbladder causes frequency - increased GFR and renal tubular reabsorption - increased renal plasma flow - baby can kick bladder and cause mom to pee
what changes does the urinary system go through during pregnancy?
- enlargement due to increased estrogen/progesterone - become nodular - areolae darken - superficial veins dilate and become more prominent - striae (stretch marks) may develop, especially in multiparas - tubercles of montgomery enlarge - colostrum is secreted (20 weeks)
what changes occur in the breasts during pregnancy?
- chadwic's sign: bluish purple discoloration - goodel's sign: softening of the cervix - development of the mucus plug
what changes occur in the cervix during pregnancy?
- it enlarges due to hypertrophy - fibrous tissue increases - blood flow increases (mom increases blood volume by 40% in pregnancy, 1/6 of total BV moves to the uterus) - braxton hicks contractions begin as uterus begins to practice labor (can be painful)
what changes occur in the uterus during pregnancy?
- mucosa thickens - increase in secretions - loosening of connective tissue - more likely to get yeast infections
what changes occur in the vagina during pregnancy?
- leukocytes increase; not concerned unless crazy high or there's manifestations of infection
what changes occur to the blood during pregnancy?
- enlargement in anterposterior diameter - softening of cervix (goodell's) - softening of the isthmus (Hegar's) - cervix takes on bluish coloring (Chadwick's) - uterus is pear shaped, mobile and smooth
what changes to the pelvis are normal during pregnancy?
lumbar spinal curve may be accentuated
what changes to the spine are normal during pregnancy?
- skull bones are moveable; molding can occur - fontanelles: finding them can help figure out position of baby
what characteristics of the fetal head help with labor?
X
what chromosome determines sex-linked traits?
-circulatory changes: inability to transition to extrauterine circulation -respiratory changes: failure of lung expansion, rapid respiration, pulmonary vasoconstriction, high pulmonary vascular resistance, respiratory acidosis
what circulatory and respiratory changes do you see in neonatal asphyxia?
- decreased intraocular pressure - thickening of cornea - reports of decreased attention, concentration, and memory (pregnancy brain) - extra water, fat, and protein are stored - fats are more completely absorbed
what cognitive, eye, and metabolic changes occur during pregnancy?
- apnea of prematurity - patent ductus arteriosus: blood continues to bypass lungs; oxygenated blood mixes with unoxygenated blood in the aorta and goes out to circulation - respiratory distress syndrome - intraventricular hemorrhage; turning them a certain way can cause brain bleeds - other physiologic problems
what complications can occur with preterm babies?
- acupressure (nausea) - relaxation - exercise and movement - therapeutic touch - guided imagery - prayer/meditation - music therapy - aromatherapy - massage (techniques that are somewhat mainstream and supported with evidence of effectiveness and safety)
what complimentary therapies do nurses often employ to their perinatal patients?
the person must understand: - the recommended procedure/tx - the rationale for having them - the benefits and risks
what constitutes informed consent?
factors that influence the woman's expectations of the childbearing experience - beliefs or practices that maintain her spiritual well being or influence care (dietary restrictions, blood product consent)
what cultural factors affect a pregnancy and care?
- integrity of the placenta - fetal well being - determined by extensive review of the mother; tells us how much the child can tolerate
what determines the amount of reserves a fetus has?
- favorable cervical mucus: cervicitis, stenosis, use of coital lubricants, antisperm bodies (immunologic response) - clear passage between cervix and tubes: myomas, adhesions, adenomyosis, polyps, endometriosis, congenital anomalies - patent tubes/motility: PID, endometriosis, IUDs, recurrent STIs, ectopic pregnancy, tubal ligation - ovulation: ovarian failure, PCOS, hypothyroidism, pituitary tumor, lactation, ovarian adhesions, endometriosis, hyperprolactinemia, turner syndrome - obstruction: adhesions, endometriosis, PID - endometrial: anovulation, luteal phase defect, malformation, uterine infection
what deviations from essential components of fertility can possibly cause infertility in females?
- normal semen: abnormalities, polyspermia, congenital defect, mumps after adolescence, infections, gonadal exposure to XR, chemo, smoking, ETOH, malnutrition, metabolic disease, meds, drug use, constrictive underclothing - unobstruted genital tract: infections, tumors, vasectomy, strictures, trauma, variocele - normal secretions: infections, autoimmunity to semen, tumors - ejaculate: premature ejaculation, impotence, retrograde ejaculation, obesity
what deviations from essential components of fertility could cause a male to be infertile?
- religious and social beliefs - presence and influence of the extended family - socialization within the ethnic group - communication patterns - beliefs and understanding about the concepts of health and illness - beliefs about propriety of physical contact with strangers - education
what do nurses have to be aware of when giving culturally competent care?
- their reflexes aren't develop, so they may stop breathing while they are eating
what do nurses worry about while feeding a premature neonate?
- ideally delay it until postpartum period - early second trimester is the best time to operate, if needed (less risk of spontaneous abortion/early labor, uterus does not impinge on abdominal field) - if they do need surgery, monitor the baby before and after - monitor fetal heart tones throughout - shield the fetus from any radiation - position to promote left uterine displacment during and after surgery ( do not put them on their back) - NG tube may be recommended - insert a foley
what do we do about elective surgery during pregnancy?
- positive Rh factors in the mother are good ( A+, AB+, B+, C+) - if the mother has a negative Rh, cord blood is drawn to see if the baby is Rh+ - if the baby is Rh+, the mom (Rh-) will begin creating antibodies against the Rh+ (Rh- is foreign to her body) - it will not hurt the current pregnancy, but if she gets pregnant again, and that baby is Rh+, the baby will not live, unless meds are given to counteract the antibodies (Rhogam)
what do we need to know about Rh factors?
- how far along are they? - blood type - any bleeding? - GBS/ prenatal testing results - STIs? any blisters/warts on perineum? - Hx data: first delivery? has she had a classical c/s? how long has she been in labor? - physcial assessment data - psychosocial hx and status - cultural assessment data
what do we need to know about the pregnant mom when she comes in?
assess baby at the time of birth, APGAR scores
what do you assess when need for resuscitation?
continue positive pressure, still monitor infant closely
what do you do if your infant's HR is 60-100?
-CPAP or breathe by until infant has transitioned fully
what do you do if your infants HR is 100+?
- microcephaly - distended abdomen
what does a nurse have to think about when a newborn's abdomen is bigger than its head?
trisomy 13, 18, 21, spina bifida, or other neural tube defects
what does an abnormal quad screen indicate?
antibodies
what does human milk have that formula doesn't?
- baby is laying sideways - C/S is required
what does it mean if a fetus' lie is transverse?
- they are either vertex (head down) or breech (feet down)
what does it mean when a fetus' lie is longitudinal?
- cultural assessment - assessment of the family's expectations of the healthcare system - incorporating cultural and spiritual practices into prenatal care as much as possible - having respect and cooperation with alternative healers and caregivers
what does routine prenatal care include?
- it makes it hard for them to breathe; minimal O2 exchange - they aren't getting enough time between contractions to recover (60-90 secs is needed), so they are using up all their reserves - results in minimal variability, and marked variability if they are overcompensating - fetal hypoxemia - can also cause prolonged pressure on their head
what does tachysystole do the fetus?
- increases discomfort and fatigue; get very tired, very fast - stress - dehydration - increase risk of infection - creates nonreassuring fetal status
what does tachysystole do to the mother?
rise in BP immediately postpartum
what does transient birth asphyxia do to BP?
- thyroid enlarges - increase in serum protein bound iodine - start producing prolactin - secretion of oxytocin and vasopressin - increased aldosterone
what endocrine changes occur during pregnancy?
- the birth passageway - the passenger - the physiologic forces of labor - the position of the mother - the mother/s psychosocial considerations (the 5 P's) ** all of these have to match up to have a vaginal birth; if not then a C/S is required
what factors affect labor progress?
- distance in which the substance has to go to diffuse (DM and placental infection can increase diffusion distance) - blood flow alteration changes transfer rate (can be caused during labor, preeclampsia, smoking mothers, DM and fetal hypoxia)
what factors affect placental diffusion?
- overstretched uterus: twins, macrosomnia, polyhydramnios - fetal malposition - prematurity - grand multipara - bladder/bowel distention - CPD
what factors are associated with hypotonic labor patterns?
- nullipara - epidurals - forceps/vaccum assisted births - episiotomy - macrosomnia
what factors are associated with increased incidence of cervical and vaginal lacerations?
- anxiety - fear - pain - medications, especially those that alter consciousness - developmental/cognitive problems - psychological problems
what factors can influence a person's ability to give informed consent?
- low socioeconomic level of the mother - limited or no prenatal care (sign that drugs/violence could be involved) - exposure to environmental dangers (x-rays, etc) - preexisting maternal conditions: heart disease, HTN, DM, hyperthyroidism, renal disease - maternal age/parity: older moms, teenagers (risky behaviors and poor nutrition) - pregnancy complications: abruption, hydramnios, preterm labor, PROM, preeclampsia (these babies will probably need help transitioning)
what factors identify a newborn as "at risk"?
- quality of sperm and/or ovum - genes - adequacy of intrauterine environment - teratogens
what factors influence development of a fetus?
- primigravida - large or marcosomnic fetus - OP position - use of forceps or vacuum - shoulder dystocia
what factors predispose women to episiotomies?
- temperature above 38 C (99.4) or below 36.6 C (97.6) axillary; may be asked to take rectal temp (make sure family knows how) - continual rise in temperature - forceful or frequent vomiting - refusal of 2 feedings in a row - difficulty in awakening baby - cyanosis with or without a feeding - apnea longer than 20 seconds - no wet diapers for 18-24 hrs - fewer than 6-8 wet diapers per day after 4 days of age - development of eye drainage
what findings would need to be reported as signs of illness to the pediatrician?
- if the child is born vaginally, they may contact thrush
what happens if VVC is present in the mother at birth of the child?
- the mom is given atleast 2 steroid betamethazone shots (with 48 hours inbetween) in order to mature the baby's lungs enough to survive outside of the womb - an emergency c-section is done asap - if close to term, labor will be induced
what happens if a doppler flow study indicates reverse end flow?
- she will need to have a c-section to prevent transmission to child (can cause fatal fetal infection)
what happens if a mom has active herpes and is about to have a baby?
- if they have been on that high dose for more than 10 hours, by then it is taking up all of the oxytocin receptors on the uterus - after birth, when they give a bolus of pitocin to help contract the uterus, it will not work because all the receptors are blocked - this woman will be at risk for postpartum hemorrhage
what happens if a pregnant woman is on a high dose of pitocin?
- they can usually tolerate pregnancy well - if they have symptoms, they are often caused by arrhythmias (palpitations, chest pain, dyspnea) - treated with inderal - limit caffeine intake
what happens if a pregnant women has MVP?
it could be a sign of preeclamspia; fluid could be third spacing
what happens if there is too much weight gain during pregnancy?
- the space in the fornix allows for semen to collect near the cervix - the more sperm that collects at or near the time of ovulation, the higher chance of pregnancy
what happens in the fornix when a woman lies on her back after sex?
- it implants in the endometrium and the fertilized egg begins to secrete human chorionic gonadotropin (hCG) - hCG is needed to keep the corpus luteum from degenerating and losing its function (to produce progesterone)
what happens in the luteal phase if the ovum is fertilized?
- insulin requirements decrease; they should still breastfeed and keep track of blood sugar - elevated glucose levels may be treated with an oral antihyperglycemic - they don't necessarily still have DM after birth; retest for DM 6 wks post partum - if at 6 weeks glucose is normal, reasses at a minimum of 3 yr intervals - having GDM puts moms at greater risk for T2DM later in life
what happens to insulin requirements after birth? does the mom still have DM?
- mom's Hgb drops below 11 g/dL - the more severe it gets, the more O2 that may not get to the baby (Hgb carries O2) - at birth, bleeding causes it to drop even more (postpartum hemorrhage)
what happens with iron deficiency anemia?
hCG, hPL, hCS, relaxin, inhibitin, estrogen, and progesterone (steroid hormones)
what hormones does the placenta produce?
- lack of passive IgG antibodies - skin is easily excoriated; very thin
what immune system alterations can occur in preterm infants?
- LGA due to high levels of maternal glucose (chocolate fountain, more common) - SGA if mother has vascular complications (if mom isn't in control of DM or has T1DM) - hypoglycemia (blood sugar protocol, q30 x4, ACHS afterwards) - hypocalcemia - hyperbilirubinemia (alot of bruising in large baby) - birth trauma (check clavicles, brachial plexus) - polycythemia - RDS (c/s babies may have wet lungs) - congenital malformations
what impact does maternal DM have on the newborn?
signs that preeclampsia isn't going away, and may be getting worse: - hemolysis - elevated liver enzymes - low platelets
what is HELLP syndrome?
- used to determine EDB date of 1st day of last period- 3 months+ 1 week= DUE DATE
what is Nagele's rule?
baby up for adoption
what is a BUFA?
- physical and psychosocial assessments - health history - examination - diagnostic testing and procedures - making clinical judgement and beginning appropriate tx (seeking physician consult when necessary)
what is a NP's focus in caring for a child?
- trial of labor after C/S, leads to VBAC - woman with 2 previous C/S (with low transverse incision) who has also had a vaginal birth may attempt - gives 30 minutes to try labor vaginally before C/S is preformed (bad outcome if longer)
what is a TOLAC?
- normal - moderate variability without lates or variables - may or may not have earlies or accels - HR 110-160 - can rule out acidemia
what is a category 1 tier FHR?
- indeterminate - baselines include bradycardia with continued variability or tachycardia - baseline changes in variability - no accels with scalp stimulation - episodic and variable decels - requires evaluation and surveillance - can't rule out acidemia, interventions needed
what is a category 2 tier FHR?
- abnormal - absent variablity in baseline FHR - recurrent lates or variables and/or bradycardia - sinusoidal patterns may be present - highly predictive for acidemia - need to get fetus out for resuscitation ASAP
what is a category 3 tier FHR?
- used when there is a question regarding fetal status, before using a more invasive test (FBS) - involves applying pressure to the fetal scalp while doing a vaginal exam - the fetus with a category 2 or 3 tracing who isn't in any stress, and responds to the pressure with an accel is unlikely to have acidemia and labor can likely continue (means they still have reserves left)
what is a fetal scalp stimulation test?
- mild separation - slight vaginal bleeding - FHR pattern and maternal BP unaffected - 48% of abruptions
what is a grade 1 placental abruption?
(moderate) - partial abruption - moderate bleeding - significant uterine irritability is present - maternal pulse is elevated, BP is still stable - signs of fetal compromise evident inf FHR - 27% of abruptions
what is a grade 2 placental abruption?
- large or complete separation - moderate to severe bleeding - maternal shock and painful uterine contractions are present - fetal death common - 24% of abruptions
what is a grade 3 placental abruption?
when someone calls about said patient, you say that the patient is not there (adoption, domestic abuse)
what is a no info patient?
110-160 bpm - regular with no murmurs or arrhythmias
what is a normal HR for a newborn?
17 g/dL
what is a normal Hgb for a newborn?
42-60 mmHg
what is a normal MAP for a full term baby?
30-60 bpm
what is a normal RR for a newborn?
- spine is straight and flat
what is a normal assessment finding of a newborn's back/spine?
97.5- 99 F ( 36.4-37.2 C)
what is a normal axillary temperature for a newborn?
- "on demand" feeding: atleast 8 times in a 24 hr period/every 3 hrs - cluster feeding: 5-10 feeding episodes over 2-3 hours (don't let them go more than 5 hours without feeding without making sure blood sugar is okay) - pattern may change when mom's breasts become fuller; 1.5-3 hrs around the clock (supply/demand) - babies begin demonstrating feeding cues (rooting, sucking on finger, etc); offer the breast at those times
what is a normal feeding pattern for a breast fed newborn?
- generally feed every 3-4 hours; 15-30 mL each time - presence of satiety behaviors: longer pauses, body relaxation, falling asleep
what is a normal feeding pattern for a formula fed newborn?
7.10
what is a normal pH for cord blood?
97.8-99 F (36.6-37.2 C)
what is a normal rectal temperature for a newborn?
110-160 bpm - may drop to 80-100 bpm while sleeping
what is a normal resting infant HR?
96.8-97.5 F (36-36.4 C)
what is a normal skin temperature for a newborn?
- retention of a whole, or parts of the placenta beyond 30 mins after birth - bleeding is excessive (body still thinks its pregnant, sends blood to uterus and causes hemorrhage) - may require manual removal (DNC)
what is a retained placenta?
- one layer extra than what you think you need ex: if you are comfortable in a t-shirt, they probably need a onesie and a blanket
what is a rule of thumb for keeping babies warm?
a point in the fetal strip in which the heart rate is: - 15 beats above baseline for at least 15 seconds in babies 32 wks+ - 10 beats above the baseline for atleast 10 seconds in babies less than 32 weeks
what is an acceleration?
- if a baby is positioned next to a window and it is cold outside
what is an example of radiation heat loss?
-exploration of the newborn (fingertips, palms, enfold in hand and arm) -mother is looking in the baby's eyes -can be positive or negative (if negative, chart)
what is are some actions that would be considered mother-infant attachment?
19.3 plus or minus 2.2g/dL
what is average hemoglobin concentration in a full term newborn
8-9, points will usually get knocked off for color
what is considered a "normal" APGAR score?
6 or below
what is considered a concerning APGAR score?
40
what is considered a low blood sugar for a newborn?
- head is disproportionately large for body - neck appears short - prominent abdomen - sloping shoulders - narrow hips - rounded chest - body appears long and extremities short - tend to stay flexed - hands tightly clenched - abdomen is smaller than head (measure it)
what is considered a normal general appearance for a newborn?
- strong, lusty cry of medium pitch - periods of crying usually vary in length after consolation/feeding (may cry more frequently if withdrawing)
what is considered a normal newborn cry?
- high pitched, shrill cry (cat cry) (may indicate neurologic disorders or hypoglycemia)
what is considered an abnormal newborn cry?
- hemorrhage that occurs in the first 24 hours after childbirth (immediate or primary postpartum hemorrhage)
what is considered early postpartum hemorrhage?
- no cervical effacement or dilation - irregular contractions that do not change; occur mainly in lower abdomen and groin - can be relieved by hot shower, ambulation, repositioning, etc.
what is considered false labor?
- 500 mL or more of bleeding after a vaginal birth - 1000 mL or more of bleeding after a c-section
what is considered hemorrhage?
- hemorrhage that occurs from 24 hours to 6 weeks after birth (delayed or secondary postpartum hemorrhage)
what is considered late postpartum hemorrhage?
- a single vertical pocket >2 cm - AFI between 5-20
what is considered normal amniotic fluid volume?
flexion - it allows for smallest part of the head to come through first, so the perineum is stretched gradually; allows for easier birth - if it is not flexed, there is a higher risk for episiotomy
what is considered normal attitude?
atleast 3 discrete body or limb movements in 30 mins - episodes of active continuous movement are considered as single movement
what is considered normal fetal body movement?
atleast 1 episode of rhythmic breathing lasting atleast 30 sec, within 30 mins
what is considered normal fetal breathing movement?
atleast 1 episode of extension of a fetal extremity with return to flexion, or opening or closing of hand
what is considered normal fetal tone?
more than 5 contractions in a 10 minute window, averaged over 30 mins
what is considered tachysystole?
- progressive dilation and effacement - regular, intense, contractions increasing in frequency, duration, and intensity - pain usually starts in back and radiates to abdomen - not relieved by ambulation or resting
what is considered true labor?
- emphasis on the family - an increasing number of choices about birth experience
what is contemporary childbirth characterized by?
- 98% triglycerides - small amount of cholesterol
what is human milk fat made of?
- community based focus - nurse must be aware of own sexuality, and not allow views to affect their care - nurse must have accurate, up to date information about topics related to sexuality, a/p, and common gynecologic problems
what is important in delivering appropriate nursing care based on sexual history?
obtaining information about: - ethnic background - amount of affiliation with ethnic group - behaviors related to pregnancy and childbirth - health practices based upon beliefs - patterns of decision making - religious preference - language/communication style - common etiquette practices/ values
what is included in a cultural assessment?
- family type - family structure - family roles/values - communication patterns - current level of functioning - support system - sociocultural background/customs - religious beliefs/practices - environment - needs - health information about individual family members
what is included in a family assessment?
- R: redness - E: edema - E: ecchymosis - D: discharge - A: approximation
what is included in a nursing assessment of an incision (c-sections, episiotomies, etc.)?
- gestational age - current and past pregnancies - hx of prenatal/pregnancy issues (c-sections, preeclampsia, DM) - gynecologic history - current and past medical hx, including substance abuse - family medical hx - religious, spiritual, cultural, and occupational hx - partner hx - social hx and preferences - lab work: anemia, GBS
what is included in a prenatal history?
- assessment of signs of abuse (pattern of injury consistent with abuse) - abuse history - pattern of abuse - presence of weapons - strength and support systems - being alert to cues of abuse: hesitation in providing detailed information about injuries/how they occurred, inappropriate affect for the situation, delayed reporting of symptoms, inappropriate explanations, lack of eye contact, increased anxiety (especially in front of batterer, who tries to do most of the talking)
what is included in a screening for sexual abuse?
- cycle length, amount of flow, length of menses, self care measures - sexuality, number of partners - ask about STDs, have they been tested, etc. - any problems? - if problems found, further medical tests/referrals may be completed - education about self care, if needed (pads, tampons, douching, cleansing)
what is included in a sexual history assessment?
- notify physician/CNM - assess effacement, position, dilation, and contractions - not actually in labor? may go home
what is included in admission care of a woman in labor?
- breast consistency: very shiny - skin color: pink with red streaks - surface temperature: hot, feverish - nipple condition: pain - presence of pain: stabbing pain
what is included in an assessment for mastitis?
- Homan's sign (not accurate; can dislodge the clot) - unilateral pain, swelling, or redness - pain in the leg, inguinal area, or lower abdomen - edema - temperature change - pain with palpation
what is included in an assessment for thrombophlebitis?
- person or persons in the L/D room - what to wear - position for birth - temperature of fluids - privacy
what is included in an intrapartal assessment of cultural preferences?
- OLD of pain - onset, duration, intensity of contractions - has pain/contractions noticeably changed? - palpation of contraction strength - dilation, effacement - fetal descent - membranes - how long since water broke - FHT - presentation, activity, positioning
what is included in an intrapartal assessment of labor status?
- color: want them to be clear, could be green if meconium stained (means the baby is stressed)
what is included in an intrapartal assessment of the maternal membranes?
- vitals: BP (wt. gain, signs of preeclampsia, etc.) - lung functioning, SpO2 - fundus: is it hard? boggy?height? - edema? - hydration status - perineum examination - labor status - palpation
what is included in an intrapartal physical assessment?
- preparation for childbirth - response to labor - anxiety - support system
what is included in an intrapartal psychosocial assessment?
- palpation of cervical effacement and dilation - fetal station - fetal presenting part; palpate - assess fetal descent and station by IDing depth of presenting part - test for fluid leakage before procedure - perform the exam during and between contractions to determine status of labor (dilation, effacement and station are affected by contractions) - determine status of membranes and observe for leakage of amniotic fluid; if fluid is expressed, test it
what is included in an intrapartal vaginal exam?
- electronic monitoring of contractions and resting tone (provides info about labor pattern and effectiveness of oxytocin) - hourly abdominal girth measurements (helps to measure fundal height) - monitor for DIC: coagulation tests, levels of fibrin degradation products - administer IV fluids as fast as possible - blood typing and crossmatching/blood transfusion administration - prepare for emergency C/S - prepare for hysterectomy if bleeding doesn't stop after birth
what is included in assessment and care of placental abruption?
- menstrual hx - pelvic exam - transvaginal ultrasound (initial test of choice for detection) - serial hCG measurements - laparoscopic intervention may be necessary
what is included in assessment and diagnosis of ectopic pregnancy?
- positioning - latching: is it a good latch? - breast milk pumping and storage - supplementation: how much, how often?
what is included in breastfeeding education?
- comfort infant - penal block for pain management - sugar water on finger/pacifier for comfort/distraction during/after circumcision - assess every 30 mins for atleast 2 hr - observe first void ( may be d/c before this point) - teach family to assess for bleeding and infection - petroleum ointment and gauze to prevent bleeding and help healing process (if they had a plastibell, you don't want to use vasailine) - assess pain before and after
what is included in care during and post circumcision?
- promote neonatal physiologic adaptation - immediate lab assessment and monitoring (Hgb, cell volume, erythrocyte count) - anticipate potential need for O2, blood administration (if anemic), and admission to NICU
what is included in care of a newborn who had placenta previa?
- maintain respirations - provide and maintain warmth - APGAR score (1 and 5 mins after birth) - care of umbilical cord (2 arteries, 1 vein) - cord blood collection for banking - newborn physical assessment - newborn identification - facilitate and enhance maternal attachment
what is included in care of the newborn?
- vaseline on tip of penis for 3-4 days with every diaper change (gomko and mogen clamps)
what is included in circumcision care?
- stable VS - stable bleeding - undistended bladder - firm fundus - sensations fully recovered from any anesthetic agent received during birth
what is included in d/c criteria for someone who just had a baby?
- temp: q8hr and PRN (before and after a bath); needs to be able to maintain temp through bath - BP: PRN (on admission and d/c); right arm and both lower extremities (don't want more than a 15 beat difference in SBP) - skin color: q4hr and PRN (jaundice) - auscultate lungs qshift, more if necessary; make sure they are clear, no "wet" lungs - assess eyes during newborn assessment for subconjunctival hemorrhage (needs to be documented, but will usually resolve on its own) - assess umbilical cord; no redness, drainage, or foul odor (infection) - educate on cord care; alcohol wipe after every diaper change, no water submersion, d/c cord clamp upon d/c - watch for mucus production; monitor for excessive sneezing - check apical pulse q4hrs; count for full minute - listen for murmurs - watch extremity movements qshift - check that reflexes are present, watch suck and swallow during feeding - bilirubin test every night - PKU is done 24hrs after initial feeding (required on every baby) - hearing test before d/c (sometimes can't be done bc of fluid remaining in ear, may have to be referred to have it later) - weigh before d/c (don't want them to lose more than 10%) - educate on circumcision care - make sure baby is feeding on demand, atleast every 3-4 hrs (if breast feeding) - note all voids - educate parents on proper car seat positioning/use before d/c
what is included in daily care assessments of the newborn?
- extent of injuries - the woman's exact words; subjective date - describe the incident with a diagnosis of probable battering - take pictures as evidence - do not refer to domestic violence or abuse on any d/c papers
what is included in documentation of abuse?
- maternal lateral positioning - bedrest - IV fluids - maternal labs: CBC, C-reactive protein, vaginal and urine culutres - fetal fibronectin test - ultrasounds - betamethazone to mature fetal lungs (if close enough to term) - tocolysis
what is included in interventions for preterm labor?
- perform a vaginal exam to rule out UC prolapse - change maternal position - d/c oxytocin (ptocin) - notify physician of findings - increase IV fluid rate - administer tocolytic if tachysystole is occurring - if intervention does not work, a C/S is needed
what is included in interventions for prolonged decelerations?
- facilitate position changes to relieve pressure on cord (lateral, knee to chest) - administer O2 via facemask (7-10 L/min) - administer more IV fluids - if there is an IUPC, you can give an amnioinfusion of NS (oligohydramnios or with severe decels) - report findings to physician - if decels get deep and wide, a C/S is needed
what is included in interventions for variable decelerations?
- continuous FHR monitoring - most will be delivered via C/S; will only try a vaginal birth if both are confirmed head down
what is included in labor care for a mother with multiple gestation?
- assessment of pelvic and fetal measurements (comparison) - estimate weight of fetus - trial of labor (most insurances make you have a trial with labor before they cover a c-section, unless they can prove CPD)
what is included in management of CPD?
- initial focus of maternal life saving measures: establish airway, control external bleeding, administer IV fluids - maintain left lateral position - preform CPR if indicated - C-section may be indicated
what is included in management of life threatening maternal trauma?
- BPPs and NSTs - serial ultrasounds - doppler flow study - assess for congential abnormalities - amnioinfusion - induction of labor when fetus at term - continuous monitoring of cord compression
what is included in management of oligohydramnios?
- provide counterpressure so baby doesn't cause an episiotomy - wipe nose/mouth and intitiate skin to skin - if this occurs outside the hospital; you can use a shoe string to tie off umbilical cord if scissors aren't available - deliver placenta
what is included in management of precipitous delivery?
assess for painless, bright red vaginal bleeding (most accurate dx sign of previa): - if painless, bright red bleeding develops during last 3 mo of pregnancy, previa should be considered until ruled out by US - bleeding begins scant and becomes more profuse - anticipate blood transfusion if profuse bleeding - anticipate unengaged fetal presenting part, transverse lie is common - assess fetal status/FHR (continuous external monitoring or electric monitor) - watch for sinusoidal patterns; reflects alot of bleeding/severe fetal anemia - prepare for C/S - no vaginal exams (risk of perforating placenta) - bedrest; moving could rupture placental blood vessels - assess maternal VS Q15min if no hemorrhage, Q5min with active hemorrhage
what is included in nursing assessment/management of placenta previa?
- keep patient informed - maintain continuous FHR monitoring - reassure parents that caput on the child's head will disappear within 2-3 days - if the vacuum pops off child's head, can only replace it 3-4 times before a C/S is required - assess newborn: inspection and observation for cephalohematoma, hemorrhage, and jaundice
what is included in nursing care during a vacuum assisted birth?
- determine duration of the rupture of membranes - assess gestational age - monitor for infection (antibiotics) - test for GBS (can result in PROM and other issues, need to treat it) - assess FHR - evaluate maternal childbirth prep and coping abilities - assess uterine activity and fetal response to labor - if membranes have ruptured: no sex, no vaginal exams unless absolutely necessary (reduces bacterial enterance) - bedrest; encourage L lateral positioning - maintain adequate hydration - promote comfort - if it is a micropreemie: NICU will be called in to counsel family
what is included in nursing care for PROM?
- NPO - preoperative antiacids and other meds may be given - epidural anesthesia may be admnistered - monitor VS and fetal status throughout procedure - abdominal and perineal prep - foley catheter insetered - prepare warmer, room, etc - have resuscitation equipment available - assist with positioning on surgical table
what is included in nursing care of a patient who is going to have a C-section?
- provide comfort - keep newborn well nourished - provide good skin care (no injections until they are bathed) - facilitate growth, development, and attachment - monitor for infection - treat prophylactically with AZT - wear gloves/other PPE when dealing with bodily fluids; potentially infectious - hand washing
what is included in nursing care of an infant born to an HIV/AIDS infected mother?
- assess abnormalities in hematocrit levels - assess urinary output - encourage rest and take safety precautions
what is included in nursing intervention for postpartum women who are at risk for hemorrhage?
- monitor maternal BP Q5-15mins - monitor maternal temp - assess bladder for distention - promote urination - assess for signs of bleeding/inspect bloody vaginal discharge - assess fundus
what is included in nursing interventions during the recovery period?
- proper feeding techniques; good latching - supportive bra worn at all times to avoid milk stasis - good hand washing - prompt attention to blocked milk ducts - warm compresses before feeding - NSAIDs and antibiotics - thrush treatment - regular draining of the breast
what is included in nursing interventions for mastitis?
- good perineal hygiene - good fluid intake - sterile technique when necessary - encourage frequent emptying of bladder - void before and after intercourse - wear cotton underwear - increase acidity of urine: cranberry juice, azo pills
what is included in nursing management of a UTI?
- biweekly assessments of fetal well being: BPP, NST, CST - nonreassuring results may suggest need for delivery - educate mother on doing fetal kick counts at home: want atleast 10 movements in 2 hours
what is included in nursing management of postterm pregnancy?
- reassure and support mother - send auxiliary personnel for help and emergency birth pack (precip pack) - get mother in comfortable position, give clear instrucions - remain calm and do not leave mother - if time permits, scrub with soap/water and don sterile gloves
what is included in nursing management of pre-precipitous delivery?
- anticipate excessive uterine stretching, atony, and bogginess (softness) - monitor for and treat uterine hemorrhage - fundal massage - IV/IM Pitocin administration - cytotec, hemobate, methargen addm - monitor maternal VS for development of shock - if other interventions don't work, and mother is bleeding out; try to do a DNC for retained placenta, if no results then a hysterectomy will be done
what is included in postpartum care of a woman who delivered a baby with macrosomnia?
- genetic ultrasound: 16-20 weeks - maternal serum screening: first and/or second trimester - genetic amniocentesis: 15-21 weeks if there are high risk concerns - chorionic villus sampling: 10-13 weeks if there is a high risk concern - diagnostic info available at 10- 13 wks - PUBS: can give blood transfusions/meds to baby via this rate - noninvasive prenatal diagnosis: 8 weeks, currently used for fetal Rh determination in Rh negative women; dx of chromosomal trisomies (down syndrome)
what is included in prenatal diagnostic testing?
- ensure that the physician has explained the procedure - determine if parents have questions; refer back to physician if needed - verify that circumcision consent is signed - check ID band (make sure you have the right baby) - gather equipment - prepare newborn
what is included in preparation for a circumcision?
- monitor woman for s/s: chest pain, dyspnea, cyanosis, frothy sputum, tachycardia, hypotn, and hemorrhage - implementation of immediate life saving efforts - medical interventions are supportive - C/S if necessary
what is included in prevention of an amniotic fluid embolism?
- good perineal care (no soap on incision, pat it dry) - hygiene practices to prevent contamination of perineum - thorough hand washing - sitz baths - adequate fluid intake - diet high in protein and vitamin C
what is included in prevention of postpartum infection?
- breast care: wearing a supportive bra (may need to go up a size), cleanliness, no soap on nipples (dries them out, colostrum is an antibacterial), breast shields for inverted nipples - clothing: loose fitting, high heels increase varicose veins - daily bathing based on culture; no hot tubs - BSE - employment: can work until labor starts, must be aware of environmental hazards - travel: no restrictions unless complications, frequent breaks during car travel, use seat belt
what is included in self care during pregnancy?
- reduce activity; rest - take all meds as prescribed (antibiotics), need to take it all - adequate protein and vitamin C - report signs/symptoms of complications
what is included in self care measures for puerperal infection?
- assessment of FHR: variability (tells you how the baby is tolerating labor) - maternal vital signs - contraction status (frequency, duration, intensity) - vaginal exam (presentation, station, dilation, effacement) - urine test for proteins, ketones, glucose, and leukocytes - Hgb/Hct - HIV screening for 3rd trimester - drug screen
what is included in the assessment of a woman in labor?
- physical exam - pelvic exam (cervical mucus, pelvic organs, infection) - cervical mucus elasticity and ferning capacity - bimanual exam (size, shape, position, etc. of uterus) - hormone labs - tubal patency - ovulatory function
what is included in the female fertility assessment?
- physical exam - urologic exam (looks at testes, vas deferens, and epidydimis, presence of variocele) - sperm adequacy (semen analysis for quantity, quality, and mobility) - rectal exam (prostate and seminal vesicles) - lab work - chromosomal issues (40+)
what is included in the male fertility assessment?
- 400 mcg folic acid/day for all women before conception and through atleast the 1st trimester - diet rich in folic acid ( leafy greens, red meat, fish, poultry) - condition treated with 1 mg folate/daily
what is included in the prevention/treatment of folic acid deficiency anemia?
- outpatient: antibiotics - inpatient: IV fluids, pain meds, IV antibiotics - sexual partner should also be treated
what is included in the tx for PID?
- flagyl: oral or as a vaginal cream, no alcohol for 24 hrs after completion - tinizadole: oral, no alcohol for 72 hrs after completion - clindamycin: oral or vaginal cream - avoid intercourse during tx period
what is included in treatment of BV?
- they will get AZT (antiretrovirals) and other meds to prevent baby from contracting virus - do not break baby's skin AT ALL until they have had a complete bath (babies are usually given a vitamin K shot after birth, this is withheld until post bath) - baby will receive prophylactic tx - contraindicated for mom to breastfeed
what is included in treatment of a pregnant woman with HIV?
- try to turn fetus/mother - start IVs - decrease ptocin - give O2 - if it doesn't come up within a couple of mins= emergency C/S
what is included in treatment of fetal bradycardia?
- immediate intrauterine resuscitation - improve fetal blood flow: turn the mom - decrease intensity and frequency of contractions if present: turn off Pitocin, adm terbutaline - administer IV bolus/fluids - give O2 - gather more info about status; try to get an acceleration to rule out acidemia (fetal scalp stimulation, vibroacoustic stimulation) - look for a prolapsed cord - if abnormal patterns resolve, continue with continuous monitoring, assess q15mins - if no resolve, proceed with vaginal birth if imminent, or prepare for C/S
what is included in treatment of nonreassuring fetal status?
- hydration (IV fluids) - broad spectrum antibiotics - oxygen - prevention through education - in severe cases, dialysis, vasopressors, and intubation may be needed - typically pts with TSS are hospitalized for tx
what is included in tx for TSS?
- erythromycin ophthalmic ointment prophylaxis for baby at birth (EVERY BABY GETS THIS) - both partners are tx with doxycycline or azithromycin - partners should abstain from sex for 7 days - doxycycline is contraindicated in pregnancy, can be treated with azithromycin and amoxicillin, and be retested in 4 weeks - educate about annual screening for infection
what is included in tx for chlamydia?
- surgical removal of visible endometrial tissue - surgical removal of the uterus and ovaries - hormonal therapy - women with minimal symptoms can use analgesics and NSAIDs for pain - mirena IUD has been used to improve symptoms
what is included in tx for endometriosis?
- for nonpregnant women with syphilis less than a year: 2.4 million units of benzathine penicillin G - for syphilis more than 1 yr: 2.4 million units of benzathine penicillin G given once a week for 3 weeks
what is included in tx for syphilis?
- cryotherapy - trichioroacetic acid (TCA) - bichloroacetic acid (BCA) - surgical removal, curettage, or laser surgery - 3 vaccines available: gardasil, cervarix, 9 valent vaccine - condoms may reduce risk
what is included in tx of HPV?
- COC or cyclic progesterone (regulates cycles, balances hormones, and protects endometrium) - medications that improve insulin sensitivity (metformin) - antiandrogens - lifestyle changes (wt loss, exercise, smoking cessation)
what is included in tx of PCOS?
- dietary restrictions: chocolate, soda, coffee, alcohol, nicotine, red meat, salt, sugar - increase frequency of meals, and complex carbs/protein - exercise - take supplements: B vitamins (B6), vitamin E, calcium, Mg
what is included in tx of PMS?
- OTC intravaginal cream or suppositories (miconazole) - Rx treatments (terconazole) - prevention: cotton underwear, avoiding sprays/powders
what is included in tx of VVC?
- methotrexate (stops the cells from growing and ends the pregnancy) - salpingostomy/salpingectomy - Rh immunoglobulin is administered to Rh- nonsensitized women
what is included in tx of ectopic pregnancy?
- baby is given erythromycin eye cream to prevent blindness (given to ALL babies) - both partners treated with ceftriaxone and azithromycin
what is included in tx of gonorrhea?
- cannot be cured - acyclovir and other antivirals - educate on triggers (physical and emotional stress)
what is included in tx of herpes?
- flagyl for both partners administered in a single 2g dose, 7 day regimen is also available - tinidazole can be used the same way (has less GI s/e, but is more costly) - partners should avoid intercourse until cured - symptomatic pregnant women can be considered for tx
what is included in tx of trichomoniasis?
- fine hair on the neck, shoulders, and back - preterm babies will have more than full term babies
what is lanugo?
-white -continues until the cervix is closed
what is lochia alba and when is it seen?
-red -first 2-3 days
what is lochia rubra and when is it seen?
-pink -days 3-10
what is lochia serosa and when is it seen?
preterm birth
what is most of the infant mortality rate in the US attributed to?
- AFI<5 - decreased amniotic fluid - not enough fluid to protect the umbilical cord; could compress and cause variable decels - could indicate kidney problems in the fetus (not peeing)
what is oligohydramnios?
- AFI>20 - excess amniotic fluid - overflow of fluid when water breaks; could cause umbilical cord prolapse (medical emergency) - could be a sign of anomaly (TE, can't drink fluid)
what is polyhydramnios?
- previous C/S with a low transverse incision - an adequate pelvis - no other uterine scars or previous uterine rupture - an available physician for a C/S if needed - anesthesia
what is required for someone to have a VBAC?
mom is focusing and taking care of its needs and what the baby wants
what is the "taking hold" psychological adjustment?
mom just had baby, talking about labor story, all about her
what is the "taking in" psychological adjustment?
temperature, respiratory rate, blood sugar
what is the "triangle" that is very important in infant health?
30-50 g/L - it is variable (foremilk-hindmilk) - can depend on what mom eats
what is the average fat content of breast milk?
-1.2 cm/hr in nulliparas -1.5 cm/hr in multiparas
what is the average frequency of dilation during the active phase?
1 cm/hr
what is the average frequency of dilation in the first stage of labor?
50 cm (20 inches)
what is the average length of a newborn?
- test to see if mother is ready for induction - factors in cervical dilation, effacement, station, cervical consistency, and position - score of 6+ is good (ready for induction) - lower the score, the higher of risk for unsuccessful induction (needs a C/S)
what is the bishop's score?
- increase caloric intake by about 300 kcal/day; about 30 kcal/kg of IBW during first trimester and about 35 kcal/kg of IBW during 2nd and 3rd
what is the dietary recommendation for pregnant women with DM?
- preterm: relatively shapeless and flat, no recoil ("sticks") - term: some cartilage and slight incurving of the upper pinna, good recoil
what is the difference between ear form and cartliage distribution in a preterm baby vs a term baby?
- breastfed: same or higher weight gain in first 3-4 months - formula fed: have greater weight gain; gain weight faster later on
what is the difference in growth rate between a breastfed baby and a formula fed baby?
- used to find what part of the fetus occupies the fundus - if it is hard, the head is expected (breech), if it is soft, the bottom is expected - facing the woman, palpate the fundus with both hands and note the shape, consistency, and mobility
what is the first maneuver of Leopold's?
- first 2 hours of life - baby is bright and alert - best time to breastfeed; baby is ready and wanting to breast feed
what is the first period of reactivity?
- from start of labor to 10cm dilation (latent, active, and transitional phases)
what is the first stage of labor?
- used to find what way the fetus is facing by finding the cephalic prominence/brow - move hands slowly down the sides of the uterus toward the pubis to try to find it - some practitioners may do this first to ID the fetal part in the pelvic inlet (if they can't feel the brow down there, it probably isn't the head)
what is the fourth maneuver of Leopold's?
recovery; first 1-4 hrs after birth
what is the fourth stage of labor?
to provide a safe environment for fetal development
what is the function of the uterus?
- grows 2.5 cm/month in the first 6 months - grows 1.3 cm/month for the next 6 months - double the birth weight by 5 months - triple the birth weight by 1 year - quadruple birth weight by 2 years
what is the growth pattern of a newborn?
- contractions are more frequent and intense - moderate to strong (forehead), every 2-3 mins, lasting 60 seconds - 50-70 mmHg
what is the intensity, frequency, and duration of contractions during the active phase?
- begin mild, every 10-30 mins, lasting 30-40 seconds - progress to moderate intensity, last 30-40 seconds, and occur every 5-7 mins - 25-40 mmHg
what is the intensity, frequency, and duration of contractions during the latent phase?
- contractions every 1.5-2 mins - last 60-90 secs - strong, 70-90 mmHg
what is the intensity, frequency, and duration of contractions during the transition phase?
48-52cm (18-22 inches)
what is the normal length range for a term newborn?
2500-4000 grams
what is the normal newborn weight range? (grams)
4-5 (acidic)
what is the normal pH of the vagina?
- 60-70 breaths/min for first 2 hrs - 30-60 breaths/min afterwards
what is the normal respiratory rate for a newborn?
-pat dry, never wipe because you may pull out a stitch -squirt perineal bottle from front to back, then pat dry
what is the nursing care for a laceration?
- gain of 0.5-2 kg (1.1-4 lbs) during the first trimester - gain of 0.5 lbs per week during the last 2 trimesters
what is the pattern of weight gain for a pregnant woman with an obese BMI?
- gain of 0.5-2 kg (1.1-4 lbs) during the first trimester - gain of 0.6 lbs per week during the last 2 trimesters
what is the pattern of weight gain for a pregnant woman with an overweight BMI?
- gain of 0.5-2 kg (1.1-4 lbs) during the first trimester - gain of slightly more than 1 lb per week of the last 2 trimesters
what is the pattern of weight gain for a pregnant woman with an underweight BMI?
- gain of 0.5-2 kg (1.1-4 lbs) during the first trimester - average gain of 0.45 kg (1 lb) per week during the last 2 trimesters
what is the pattern of weight gain for a pregnant woman with normal BMI?
- used to find the fetus's back and to determine which way it's laying, while looking for the extremities - palpating the abdomen with gentle deep pressure, using the palms; hold one side steady while palpating the other
what is the second maneuver of Leopold's?
- between 4-6 hrs of life - another good time to get breastfeeding in; should be second feeding
what is the second period of reactivity?
- begins complete; 10 cm dilation - birth
what is the second stage of labor?
- between 2-4 hours of life - baby goes into deep sleep in which it is hard to wake them up; want to get breastfeeding in before then
what is the sleep phase of reactivity?
- used to determine if the fetus is down/engaged in the pelvis - determine what fetal part is just above the pelvic outlet by grasping the abdomen with the thumb and fingers just above the symphysis pubis - should confirm what was found in the fundus - if it is not engaged, the presenting part can be moved back and forth
what is the third maneuver of Leopold's?
from birth- to placental expulsion
what is the third stage of labor?
- shoulder dystocia - brachial plexus injury - hypoglycemia - bruising - hyperbilirubinemia/jaundice - meconium aspiration (stress of hard labor causes excretion, gets swallowed) - polycythemia
what is there increased risk for in a baby with macrosomnia?
- CPD - dysfunctional labor - prolonged labor - soft tissue laceration (3rd/4th degree episiotomy) - postpartum hemorrhage
what is there increased risk for maternally with a macrosomnic baby?
- lower GFR - limited ability to concentrate urine or excrete large amounts of fluid - excrete glucose at a lower serum glucose level - buffering capacity is reduced - excretion time of drugs is longer (watch toxicity levels, can't concentrate urine)
what kidney alterations can occur in a preterm infant?
- cycle length - amount of flow - length of menses - self care measures - the fact that they vary and that it is normal - acknowledge the negative aspects (messiness and embarrassment) but stress its positive role as a symbol of maturity and womanhood
what kind of information should a nurse give to a premenstrual girl as education?
- 24 hour urine analysis - serum creatinine - uric acid - hematocrit - ultrasound: repeated atleast once in 2nd and 3rd trimesters
what labs are used to diagnose chronic hypertension during pregnancy?
- iron content stored in liver - low carb reserves - main source of energy is glucose (energy is directly related to blood glucose) - liver begins to conjugate bilirubin - lack of intestinal flora results in low levels of vitamin K (why babies get shot, helps with coagulation)
what liver adaptations occur in a newborn?
- two frontal bones - two parietal bones - occipital bone - fontanelles
what makes up the fetal head?
- encouraging gradual expulsion of baby at birth by telling mother to "push, take a breath, push"; allows perineum to stretch slowly - avoid immediate pushing after epidural placement - KY jelly to massage perineum
what measures can be taken to help reduce the incidence of episiotomies?
- magnesium sulfate - prostaglandin inhibitors - Ca channel blockers - beta adrenergic agonists (terbutaline)
what medications can be used in tocolysis?
- cytotec, oral (prostaglandins) - cervadil - pitocin
what meds are used for cervical ripening?
- Pitocin: (IV or IM) helps the uterus contract and minimize bleeding - Methergine and Hemabate: given during hemorrhage caused by atony - Cytotec: commonly used when other methods don't work (can't be titrated)
what meds can be given at the time of delivery of placenta?
- decreased Hgb and Hct - low platelets - if platelets are less than 1000, the mother will have trouble clotting, and an epidural won't be allowed
what might a CBC show from a pregnant woman who is preeclamptic-eclamptic?
- increased AST and ALT (liver enzymes)
what might a CNP show from a pregnant woman who is preeclamptic- eclamptic?
- pelvic joints relax - center of gravity changes - separation of rectus abdominus - abdominal binder may be needed to hold muscles together
what musculoskeletal changes occur during pregnancy?
- baby needs to be up in the belly - have mom drink 1 L of fluids and have her bladder full beforehand (helps push baby up)
what needs to happen for a transabdominal ultrasound to visualize the baby?
- baby needs to be lower so the probe can produce accurate imaging - have mom empty bladder beforehand
what needs to happen for a transvaginal ultrasound to visualize the baby?
- increased risk for intraventricular hemorrhage and intracranial hemorrhage - delayed or absent reactivity/reflexes
what neurological alterations can occur in preterm infants?
hypertrophy of gingival tissue
what normal changes can happen to the mouth during pregnancy?
it may be edematous
what normal changes can happen to the nose during pregnancy?
slight hyperplasia by 3rd month
what normal changes can happen to the thyroid during pregnancy?
- purple or silver striae may be present - linea negra - diastasis of the rectus muscle - progressive enlargement - ballottment
what normal changes can occur to the abdomen during pregnancy?
- O2 sat - start oxygen - get in touch with NICU and pediatrician
what nursing interventions are done if a newborn is presenting manifestations of respiratory distress?
- frequent palpation of fundus for firmness and height - gentle uterine massage if uterus is soft (boggy) - cleanse maternal perineum - ice pack perineum to promote comfort and decrease swelling
what nursing interventions should be done during the fourth stage of labor?
- palpate contractions Q15-30min - limited vaginal exams (don't want to rupture membranes early) - auscultate/evaluate FHR Q30min, Q15min for high risk women - assess maternal BP, HR, and RR with FHR assessment, or more often as needed - provide counter pressure on lower back to relieve pain (can help w natural births) - help get them in a comfortable position (squatting) - coach/help them breath; distraction, panting not grunting - insert a foley (can't control bladder, especially with epidural) - prepare for amniotic membrane rupture; assess and document time, COCA, and immediately auscultate FHR if it occurs (meconium stained= continuous monitoring needed)
what nursing interventions should be done in the active phase of labor?
- provide initial newborn care: dry newborn immediately, skin to skin, place them on heater if needed, warm blankets, suction nose/mouth as needed - while awaiting placental separation, palpate to check for uterine bogginess and fullness/height (caused by uterine relaxation and subsequent bleeding) - assist with delivery of placenta, recognize signs of separation - after the placenta separates, ask woman to bear down to aid placental delivery
what nursing interventions should be done in the third stage of labor?
- palpate contractions Q15min (atleast) - assess FHR Q30min (Q15min for high risk women) - assess maternal VS when FHR is assessed - don't encourage pushing until complete dilation; could cause swelling (may not feel urge as soon if they have epidural) - prepare for birth; make sure room is warm, warmer is on and resuscitative equipment is ready - get mom to relax between contractions so they're breathing properly; support with breathing techniques - continually assess pain level
what nursing interventions should be done in the transition phase of labor?
- fat (same percentage, just increases with caloric intake) - Sodium - phosphorus - vitamin E - vitamin K - Ca
what nutritional components won't require change for pregnancy?
- physiologic readjustment - hungry/thirsty - shaking from hormones and fluid shifts (warm blanket) - bladder is often hypotonic; often won't be able to control it, especially after epidural - uterus remains contracted - blood loss of 250-500 mL
what occurs during the fourth stage of labor?
- initiation of respiration (expansion of lungs) - increased PO2 levels result in decreased pulmonary vascular resistance and increased systemic vascular resistance - decreased pulmonary vascular resistance results in increased pulmonary blood flow and increased pressure in the left atrium; all of this plus decreased right atrial pressure closes the foramen ovale - increased systemic vascular resistance causes decreased systemic venous return, cessation of umbilical venous return; this closes the ductus venosus - systemic resistance ends up being greater than pulmonary resistance; this along with left to right shunt results in the closure of the ductus arteriosus
what occurs during transitional circulation?
- if you use a high dose for a long period of time, all the receptor sites fill up - at this point, labor isn't being made faster; the uterus is no longer affected - puts the mom at risk for hemorrhage
what occurs if Pitocin is given in too high of a dose?
- try to feed them; if they are breast feeding, they may have to work which will further lower their blood sugar; so formula feed - glucose gel - if blood glucose is still below 40 after feeding, NICU consult
what occurs if a baby on blood sugar protocol drops below 40?
- usually is a respiratory issue - will give positive pressure ventillation for 30 seconds
what occurs if a baby's apgar score is very low, like 0-1?
- if the baby is to term, birth the baby and put mom on Mg for 24 hrs after birth - if it is too early to birth, monitor for HELLP, CBC, CNP, pulmonary edema, and signs of DIC - give labetelol for severe anemia - give betamethazone if delivering early, to help develop the baby's lungs - if the mom becomes eclamptic, get the child out immediately
what occurs if a mom is diagnosed with preeclampsia?
- it is most likely due to a chronic condition
what occurs if a mom is hypertensive before 20 wks gestation?
- catacholomines (epinephrine and norepinephrine) are released, and it causes vasoconstriction - it can reduce O2 and BF to the fetus; results in late decels and minimal variability
what occurs if a mother has a high anxiety level intrapartum?
- feet/butt are wanting to come out first - can use hyperforceps via vaginal delivery (deeper forceps) - C/S is preferred - higher morbidity/mortality rate - could have prolapsed cord - risk for asphyxia and nonreassuring fetal status, dystocia, and birth trauma - increased risk for spinal cord and brachial plexus injury during vaginal birth - can be turned to cephalic presentation, but must wait until 37 wks
what occurs if the fetus is in a breech presentation?
- the forehead attempts to come out first - caused by lax abdominal and pelvic muscles - unable to deliver vaginally; must have C/S - increased risk in multiparas - increased facial edema/bruising; can lead to biliruibinemia and jaundice - increased incidence of CPD - increased incidence of premature fetuses and PROM
what occurs if the fetus is in brow presentation?
- full face is wanting to come out first - must have C/S, would cause too much bruising to the baby (jaundice) - increased risk for prolonged labor; infection, CPD
what occurs if the fetus is in face presentation?
- if the fetus is retained beyond 6 weeks, the breakdown of fetal tissue results in the release of thromboplastin - can result in DIC - must be hospitalized so the remains can be removed via D&E or suction - if in the second trimester, the mom can be induced to labor
what occurs if the fetus remains in the uterus after a missed abortion for a long period of time?
- increased insulin production and tissue sensitivity
what occurs in GDM with early pregnancy?
- debris gets in the amniotic fluid (meconium) - it is forced out into maternal circulation and causes a PE - mom will have sudden onset of chest pain, dyspnea, cyanosis, and massive hemorrhage; respiratory/circulatory collapse and shock occur - immediate birth is required for a live newborn - only way to dx is a postmortem autopsy
what occurs in an amniotic fluid embolism
- ovary creates oogonia, and mitosis occurs to replicate them in the fetus - oogonia move into meiosis before the female is born to create the primary oocyte and mature it - meiosis stops in the primary oocyte before the first division (meiotic arrest) until puberty - during puberty, the primary oocyte proceeds through the first meiotic division in the graafian follicle of the ovary, results in 2 secondary oocytes - one secondary oocyte may lose cytoplasm and become a polar body, so the other one will be fertilized - the second meiotic division is arrested until the secondary oocyte becomes fertilized; results in a mature ovum with haploid number of cells, and 3 polar bodies (which eventually disintegrate)
what occurs in oogenesis?
- cervical dilation from 4-7 cm - progressive fetal descent - contractions more frequent and intense - great time to get epidural - don't dilate as fast if its their first child - will be agitated; need help breathing/coaching
what occurs in the active phase of labor?
- decreased renal perfusion and GFR - decreased output and retention of Na - increased serum levels of creatinine, BUN, uric acid - decreased placental perfusion - increased viscosity of blood - HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count)
what occurs in the body with preeclampsia?
- beginning of cervical dilation and effacement (0-3 cm) - no evident fetal descent - contractions start mild - happy, not hurting yet
what occurs in the latent phase of labor?
- pulmonary edema - DIC
what occurs in the preeclamptic- eclamptic mother when other organs begin getting involved?
- dilation is complete (10cm) - urge to push; wait until she feels the urge (pressure), sometimes it can't be felt with epidural - laboring down (letting it move naturally, less pushing) - possible "ring of fire" vagina - cardinal movements: descent, flexion, internal/external rotation, extention, restitution, explusion
what occurs in the second stage of labor?
- should last less than 30 mins; if longer, placenta may be trying to retain - signs of placental separation - delivery of placenta; dirty duncan, shiny shultze
what occurs in the third stage of labor?
- cervical dilation of 8-10 cm - progressive fetal descent - contractions don't get much stronger - increase of bloody show, rupture of membranes may occur - may feel pressure (or feel like they have to have a BM); sign that they are complete and ready to push - screaming and yelling
what occurs in the transition stage of labor?
- they aren't getting the "squeeze" from the birth canal, and will still come out with fluid in their lungs ("wet baby") - can result in transient tachypnea of the newborn (TTN); breathing fast so they can try to get the fluid out of their lungs
what occurs to the fluid in the fetal lungs when they are birthed via c-section?
- increased cardiac demand: CO, HR, and blood volume are high - decreased cardiac reserve rt heart disease leads to difficulty accommodating the higher workload of pregnancy
what occurs to the maternal heart during pregnancy?
- alot of them are put on methadone or subutex because it may reduce risk for spontaneous abortion because of its continuous effects compared to heroin - however, there is a debate as to whether or not that is better than just cutting it cold turkey or going to a treatment center - methadone and subutex cause severe withdrawal in babies (long NICU stays) - treatment centers often don't take pregnant people, because of increased risk
what occurs when a pregnant woman is addicted to heroin and wants to get off of it?
- it triggers an antigen-antibody response - anti Rh- agglutinin is formed - individual is said to be sensitized - subsequent exposure to Rh+ blood may cause aggultination and hemolysis of RBCs
what occurs when an Rh- individual is exposed to Rh+ blood?
- increased maternal insulin resistance
what occurs with GDM in the second half of pregnancy?
- irreversible atony in one arm; limp arm - baby will flex and arm will stay limp
what occurs with brachial plexus injury?
50%
what percentage of an infant's caloric intake comes from fat?
10% - if they lost more than this 10%, then there may be feeding problems, etc
what percentage of body fat can a newborn lose in its first days of life?
- preterm: thin and transparent with prominent veins, especially in the abdomen - term: opaque, disappearance of vernix, less visible veins
what physical characteristics of skin differentiate a preterm baby from a term baby?
- mittelschmerz ( midcycle pain) - increased vaginal discharge - midcycle spotting - temperature increase (0.5-1*F) 24-48 hours after ovulation until menstruation begins (used clinically to determine ovulation times)
what physiological changes can occur during ovulation?
- postpartum hemorrhage (uterus is being overstretched to a point where it can't clamp back down normally) - UTIs - threatened abortion - anemia - gestational HTN and preeclampsia - increased mortality rate - preterm labor/birth - PROM - abnormal fetal presentation - cord prolapse
what problems are associated with multiple gestation?
- hx of deprivation or abuse - hx of emotional problems - depression and anxiety - postpartum depression - support systems - overuse/underuse of healthcare system - acceptance of pregnancy, intended or unintended - personal preferences about the birth - plans for care of child following birth - feeding preference for the baby
what psychosocial factors affect pregnancy and care?
- inadequate surfactant production, especially in micropreemies (baby will be intubated, turn to one side, and add surfactant to lungs to help keep alveoli open) - muscular coat of pulmonary blood vessels is not completely developed - greater risk for the ductus arteriosis to remain open
what respiratory alterations may occur in a preterm infant?
- O2 consumption increases by 15-20% to get it to the fetus - respiratory volume increases by 30-40% - nasal stuffiness and epistaxis caused by estrogen increase - subcostal angle and anteroposterior diameter increase - breathing changes from abdominal to thoracic
what respiratory changes occur during pregnancy?
- intense pressure may cause fear ( provide reassurance) - apprehension, irritability, withdrawal - desire for verbal and physical support may vary
what response may the mother have to progressive dilation in the transition stage?
- will have severe symptoms of depression (lack of self care, lack of bonding with child) - during mania, they may exhibit behaviors that are dangerous to herself or her fetus (alcohol/drugs, reckless driving, unprotected sex, psychosis)
what risks are involved with a pregnant woman with bipolar disorder?
- prematurity - SGA - failure to thrive - enlarged spleen and liver - swollen glands
what risks are involved with infants born to HIV/AIDS infected mothers?
- intrauterine asphyxia (cocaine causes placental abruption, smoking causes placental BV dysfunction) - intrauterine infection - alterations in birth weight (SGA) - low APGAR scores - respiratory distress - jaundice (if methadone was used) - congenital anomalies - growth restriction - behavioral abnormalities - withdrawal - poor behavioral control/social interaction skills - cannot habituate to external stimuli - become easily overstimulated (active moro reflex) - have difficulty sleeping - higher incidence of GI and respiratory illness
what risks are involved with the drug exposed infant?
edinburg
what scale do you use for postpartum depression?
- pink tinged - ruddy hue; results from increased RBC concentrations in blood vessels - may see some mottling on lower extremities if the baby is cold - limited subq fat deposits, especially in preterm babies
what should a healthy newborn's skin look like?
- smooth with texture variations depending on ethnic background - scalp hair usually high over the eyebrows, evenly distributed
what should a newborn's hair look/feel like?
- obtain baseline data: maternal VS and FHR - need a category I FHR tracing before beginning an elective induction - continuous FHR montoring demonstrating continuous reassuring FHR, reactive NST, and contraction status
what should a nurse do before administering pitocin?
- look at SpO2 - monitor for signs of respiratory distress (this can be normal within the first couple of hours after birth, if SpO2 is within normal limits and there is no signs of distress)
what should a nurse do if a newborn's RR is over 60?
- if you feel it, immediately relieve pressure by lifting the head up - keep fingers there and call for help - position for gravity to help relieve compression - O2 via face mask - prepare for C-S (nurse will basically ride the bed there)
what should a nurse do if they discover an umbilical cord prolapse?
- relieve pressure on the cord manually - continuously monitor FHR and watch for changes - notify physician - assist woman to knee- chest position or place in trendelenburg - administer O2 - prep for C/S
what should a nurse do when a pregnant woman has an umbilical cord prolapse?
- monitor contractions q15 minutes during the first stage of labor, and q10 mins uring second stage - monitor for tachysystole - monitor for hyperstimulation - monitor for water intoxication (lethargy) - assess maternal VS, contraction status, and FHR before increasing infusion rate
what should a nurse do while Pitocin is being administered?
- weight loss in 2nd or 3rd trimester - fever - vaginal infection - oral infection - pneumonia - enlargement of lymph nodes, liver, and spleen
what should a nurse watch for in a pregnant woman with HIV?
6-10 small yellow stools in breastfeeding babies at 3-4th day; after a month, they should have 1 stool every few days
what should stools be like in breastfeeding babies?
-1-2 stools/day, should be formed, brown
what should stools be like in formula fed babies?
- large, with soft pliable skull bones - two fontanelles (soft spots); want them to be flat (bulging=hydrocephalus, depressed= dehydration)
what should the head of a newborn look/feel like?
- do not preform vaginal exam - assess FHR - evaluate amount of blood loss and initiate a pad count - evaluate labor pattern - notify physician immediately
what should the nurse do if a pregnant woman is admitted with vaginal bleeding or hx of painless vaginal bleeding?
- notify physician - provide truthful information and emotional support to laboring couple - remain with the couple
what should the nurse do if a pregnant woman is has absence of FHR and fetal movement?
- prepare for immediate birth - obtain critical information (EDB, hx of bleeding, hx of medical/OB problems, drug/abuse hx, problems with pregnancy) - determine mother's blood type - assess FHR and maternal vitals - do not leave woman alone; direct someone to call physician for you - provide support to couple - put on gloves
what should the nurse do if a woman is admitted in advanced labor/imminent birth?
- continuously monitor FHR - evaluate dilation of cervix and determine if umbilical cord is prolapsed - evaluate fetal presentation (breech or vertex) - maintain woman on complete bed rest, left lateral - notify physician immediately
what should the nurse do if there is presence of greenish/brownish amniotic fluid?
- explain the purpose of the interview - use eye contact, when culturally appropriate - ask open ended questions - be objective, no judgement - do not assume sexuality - be alert to body language (you don't want them to be afraid to tell you things) - start interview with less intimate areas (med/surg history) then proceed to sexual history toward end (helps pt feel more comfortable)
what should the nurse do when taking a sexual history?
- that it is not necessary, the vagina is supposed to be self cleaning - do not douche after sex, during your period, or while pregnant - generally, HCPs don't recommend them (upsets the vaginal flora)
what should the nurse educate on when they have a patient using a douche?
- most HCPs use urine screening tests because they offer immediate results, minimal cost, reasonable accuracy, and they're non invasive - it should be taken first thing in the morning to get most accurate results - if using the OTC version, get blood work to confirm
what should we know about pregnancy tests?
- uterus rises upward in the abdomen - as the placenta moves downward, the umbilical cord lengthens - a sudden trickle or spurt of blood appears - the shape of the uterus changes form a disk to a globe
what signs suggest placental separation?
- hyperpigmentation - striae - chloasma - vascular spider nevi - decreased hair growth - hyperactive sweat and sebaceous glands - linea negra, striae, melasma may form
what skin changes occur during pregnancy?
- acrocyanosis - mottling - harelquin sign - jaundice - erythema toxicum or newborn rash - milia - vernix caseosa - forceps marks - stork bites - mongolian blue spots - nevus flammeus - nevus vasculosus
what skin variations might be seen in a newborn?
amino acids, Ca, Fe, iodine, water soluble vitamins (C, B complex), glucose - there is a higher concentration of Ca, phosphate, and amino acids in fetal blood than in maternal blood
what substances move across the placenta via active transport?
glucose, galactose, some oxygen - fetus metabolizes glucose rapidly, so there is less glucose in fetal blood than maternal blood. So, glucose is transported rapidly.
what substances move across the placenta via facilitated diffusion?
water, oxygen, CO2, electrolytes, anesthetic gases, and drugs - insulin and steroid hormones from the adrenals cross very slowly
what substances move across the placenta via simple diffusion?
- dilation and extraction (D&E) - hypertonic saline - systemic prostaglandins - intrauterine prostaglandins
what surgical methods are used in second trimester pregnancy termination?
embryonic disc
what the blastocyst develops into; a double layer of cells that will become the embryo and amnion
- ultrasound - establish IV line - adm subq terbutaline and/or regional anesthesia
what things does the nurse need to do before an external version?
- first hour: feel/check fundus height every 15 mins (should stay down and hard), make sure it is not boggy or high up in abdomen - if uterus is boggy, massage it, check locia - make sure uterus is midline (if not, there could be a bladder problem) - monitor for signs of blood loss: increase in HR, decreased BP, light headedness, nausea
what things should a nurse assess during the fourth stage of labor?
- bulb suctioning to clear secretions (put in side of mouth and in nostrils) (DeLee wall suction is used in NICU for deeper suction) - stimulate baby by stroking back to stimulate better crying - initiate skin to skin for 1st hr - wrap in blanket with head covering to prevent heat loss (alot of heat loss through head) - use radiant warmer during assessments/baths - vitamin K shot (doesn't require consent) - erythromycin ointment within 1 hr of birth (doesn't require consent) - initiate feedings within first hour; if mom chooses to bottle feed, give baby a couple of sips of water to test for TE fistula before giving formula - facilitate parental/infant attachment
what things should be done to the newborn after birth/on admission?
- hand washing techniques - circumcision and cord care (need to know how before d/c) - periods of reactivity (built in schedules) - expected newborn responses - normal physical characteristics - bonding process; importance of bonding - things to report to pediatrician - how to bathe baby
what things would the nurse want to educate the parents on before they are discharged with their newborn?
13 and 18
what trisomies are incompatible with life?
blue sclera
what variation in the sclera is a sign of OI?
- fat soluble (ADEK) are found in breast milk and formula - breast milk is low in vitamins D and K (due to maternal diet) - vitamin B complex and vitamin C readily pass from serum to breast milk - water soluble vitamins adequate in formula
what vitamins are found in breast milk and formula?
- religion is an institutionalized system that shares a common set of beliefs and practices; a belief in transcendent power - spirituality is a concern with the spirit or soul
what's the difference between religion and spirituality?
39 weeks
when amniotic fluid volume normally begins to decline
- BP is taken on right arm (preductal) and left leg, and compare the SBPs - if there is a difference, that could indicate narrowing of the aorta
when assessing BP on a newborn, what is usually done?
- when breast feeding is well estabilished, usually takes 3-4 weeks
when can a mom begin introducing pacifiers?
when their viral load is below 1000
when can a pregnant mother with HIV have a vaginal birth?
- after 6 weeks (6 weeks from LMP) - determined by assessing the gestational sac and the presence of fetal HR after 6 gestational week
when can an ultrasound determine gestational age, and how?
- difficult delivery - congenital condition
when can facial paralysis occur in a newborn?
- 37+ weeks - sooner if there is nonreassuring fetal status, etc
when can induction be done?
- when there is a medical reason to do so
when can someone be induced before 29 weeks?
if separation is mild and pregnancy is late midterm - labor will be induced and be born vaginally with as little trauma as possible - if the child is stillborn and bleeding has subsided
when can someone with placental abruption have a vaginal delivery?
2 months
when do babies start producing tears?
when the newborn begins to sit
when do lumbar and sacral curves develop in the spine?
-menstruation generally returns between 7 and 12 weeks (nonbreastfeeding woman) -ovulation usually occurs within 70 to 75 days (nonbreastfeeding women) -menstruation and ovulation take longer to return to normal in breastfeeding women
when do menstruation and ovulation occur postpartum?
- after the baby has been admitted and deemed stable; its breathing okay, keeping its HR up, etc.
when do newborn daily care assessments begin?
-right after she breast feeds (narcotic will be less in the next feed)
when do you want to give pain meds to a post partum mom?
when the fat on the back of the neck is > 3mm
when does a nuchal translucency test suggest possble trisomy 21 (Down's syndrome)?
if their viral load is above 1000 or with unknown viral load levels near the time of birth (regardless if ART is being used) - scheduled at 38 weeks
when does a pregnant mother with HIV have to have a c-section?
7-10 days after fertilization
when does implantation occur?
- when birth is not imminent - if fetal scalp pH is less than 7.2 - if testing suddenly becomes nonreassuring
when does someone with nonreassuring fetal status need to have a C/S:
2-3 days after birth
when does the ductus arteriosus close?
1-2 hrs after birth
when does the foramen ovale close?
- fasting glucose exceeds 92 mg/dL - glucose >180 in 1 hr or >153 in two hours
when is GDM diagnosed?
- If the mother is Rh-, she will get 1 shot during the 1st pregnancy (done at 20-24 weeks in case of rare incidence that fetal and maternal blood mix) - if child's blood work comes back Rh+, the mother will get another shot 72 hours after birth of the child to further prevent antibody production - if child's blood work comes back Rh- then the second shot isn't needed
when is Rhogam given?
- moderate/severe separation: C/S follows tx of hypofibrinogenemia - if mild separation, and labor is not induced by rupture of membranes and Pitocin (long delay increases risk of hemorrhage) - couvelaire uterus: will not contract properly in labor (hysterectomy is needed)
when is a c/s required in placental abruption?
- when bright red vaginal bleeding persists despite a well contracted uterus
when is a cervical or vaginal laceration suspected?
- tachycardia: >160 bpm for more than 10 mins - bradycardia: <110 for more than 10 mins
when is a fetus considered tachycardic/bradycardic?
when the life or health of the mother is threatened - the rights of the fetus take precedence after the period of viability
when is abortion permissible after the period of viability?
- benign: if there is variability - ominous: accompanied by decreased variability and late decels
when is bradycardia considered a benign sign? when is it considered an ominous (preterminal) sign?
in the first 20 weeks
when is normal breast enlargment noted in pregnancy?
in the 1st and 3rd trimester
when is prenatal HIV testing done?
- accompanied by late decels, severe variable decels, or decreased variability
when is tachycardia considered an ominous sign?
During the proliferative phase of the menstrual cycle
when is the amount of estrogens greatest?
at the moment of fertilization when the zygote forms
when is the sex of the fetus determined?
- inability to visualize the fetal HB - separation of bones in the fetal head
when looking at an ultrasound, what things would a nurse see indicating fetal death?
- premature baby; for up to 60 seconds, gives them extra time to get blood from placenta - can decrease chance of necrotizing endocolitis (can cause an increase in bilirubin- watch for jaundice)
when might cord clamping be delayed after birth?
- at approx. 28 weeks
when should a mom begin assessing fetal movement/activity?
when its less than 30 mL/hr
when should we be worried about a pregnant woman's urine output?
-lochia increases -temp -throwing clots (if bigger than the size of a quarter) -redness or swelling or foul drainage at the site of incision -redness or tenderness (DVT) -UTI -postpartum depression
when should you educate the mom to call the PCP?
- PCO2 >60= respiratory - Base deficit >/= 12 = metabolic
when testing ABGs of cord blood, how do you determine whether acidosis is respiratory or metabolic?
seesaw respirations
when the chest retracts and the abdomen expands during inspiration; movement reverses during expirations; sign of respiratory distress
funic presentation
when the umbilical cord is interposed between the cervix and the presenting part
- always pick the minimum absorbency needed to control menstrual flow - change them every 3-6 hours ( max 8) - avoid using them for vaginal discharge or very light bleeding - wash hands before inserting
when using tampons, a woman should:
- after 24 hours, after 12 if severe
when will a nurse begin seeing withdrawal symptoms in a newborn?
at the temples (need to document this)
where are forceps marks usually located on a newborn?
antepartum
while pregnant
- only by HCPs responsible for that person's care
who can information about a patient's tx, condition, and prognosis be shared by?
obese women who underwent a c-section
who is at the highest risk for postpartum infection?
- to determine if the baby is macrosomnic or microsomnic (macrosomnia puts child's life at risk)
why are clinical estimations of birth weight made during an ultrasound?
- foley catheter - overdistended bladder - anesthesia; inability to control bladder
why are postpartum women at higher risk for UTIs?
- it doesn't have the brown fat to keep it warm and keep blood sugar up
why are premature babies typically hypoglycemic?
- mothers want to avoid pain of labor/vaginal birth - avoid pelvic floor damage rt vaginal delivery - desire to "schedule" birth - increased use of epidurals - maternal age over 35
why are there increased C-Sections in the US?
- many OTC meds, like motrin, may cause ductus arteriosus in fetal heart to close
why can't pregnant women take OTC meds for nasal stuffiness/cold symptoms?
- low fluid intake, especially in breastfed babies (high caloric, can only take small amounts) - passage of meconium
why do newborns lose weight in the first 3-4 days of life?
- helps stop bleeding - babies have an immature liver so vitamin K isn't processed; lacks help to clot
why do newborns need vitamin K shots?
there is an increased need for insulin during pregnancy
why do type 1 diabetics need to be watched closely during pregnancy?
- SGA babies do not have developed brown fat - LGA babies do not have enough brown fat for their surface area
why do we have to worry about heat loss in SGA and LGA babies?
- they are getting rid of the vaginal fluid/other buildup in nose - excessive sneezing: can be a sign of withdrawal (want a Phenergan score if that's the case)
why does a newborn sneeze alot?
- they don't carry out respiratory gas exchange; the placenta does this for them - a small amount is passed to the lungs for nourishment only
why does most of the blood in fetal circulation bypass the lungs?
non pathologic leukocytosis occurs in the early postpartum period
why don't you usually use WBC as an indicator in postpartum moms?
- it can cause preterm labor, because oxytocin not only causes milk let down, but contractions too - pumping increases oxytocin, which will increase contractions
why don't you want to begin pumping colostrum/milk before birth?
- the head is the biggest part of the body, it can get stuck and become compromised
why don't you want to have a vaginal birth with a breech baby?
- it can cause hypotension (supine hypotensive syndrome)
why don't you want to lay a late term pregnant woman on her back?
- BBB not fully developed, can cause brain bleeds
why don't you want to trendelenburg a preterm newborn?
the vast majority of healthcare provided to childbearing women and their families takes places outside of hospitals in clinics, offices, etc - maternal child nurses may offer specialized services such as childbirthing and exercise classes
why is community based care important in maternal child nursing?
it monitors fetal well being
why is fetal activity looked at during a maternal assessment?
- it is used to test for trisomies, specifically trisomy 21 (Down's syndrome)
why is fetal protein tested during prenatal screenings?
alot of antidepressants are category X
why is it hard to treat depression in pregnant women?
- while in utero, babies usually grow 1lb/week
why is macrosomnia more common in postterm pregnancy?
- indicative of fetal renal issue; not peeing - can result in cord compression; lack of O2 and nutrients to get kidneys to function - often comorbid with IUGR - can cause skin and skeletal abnormalities, and pulmonary hypoplasia - can be a sing of postmaturity: amniotic fluid decreases after 40 wks
why is oligohydramnios bad?
- as the fetus matures, it calcifies - the grading is used to determine the level of calcification - used to identify internal placenta vasculature, which is associated with preeclampsia and chronic HTN - can also ID disorders such as fetal growth abnormalities, triploidy, infections, etc.
why is placental grading via ultrasound important?
- it is indicative of TE fistula - baby is unable to swallow fluid (neurologic defect) - risk for cord prolapse (breaking the dam)
why is polyhydramnios bad?
- if that is the only drug she has in her system, breastfeeding may help wean the baby and reduce withdrawal
why might a mom who has been on heroin be allowed to breastfeed?
- if mom had DM - if they don't have enough insulin/brown fat for their surface area
why would a macrosomnic baby be hyperglycemic?
- maternal age of 35+ - previous child born with a chromosomal abnormality - parent carrying a chromosomal abnormality - mother carrying an x-linked disease - both parents carrying an autosomal recessive disease - family hx of neural tube defects - fetus with major or minor anomalies on ultrasound - women with positive serum screening results
why would someone need an amniocentesis?
- it is a sign that they are dilating
why would you want to educate a pregnant women with cervical insufficiency about back pain?
magnesium sulfate
widely used as the primary tocolytic agent because it has similar efficacy to terbutaline with far better tolerance; common maternal side effects include flushing, nausea, headache, drowsiness, and blurred vision.
nonstress test
widely used method of evaluating fetal status, alone or as a part of a BPP - looking for accelerations - quick, easy to interpret, no side effects - inexpensive, can be done in an office or clinic setting - sometimes it is difficult to obtain a suitable tracing, woman must remain still for atleast 20 mins - high false positive rate
- 12-16 minutes until neurologic damage to the child
with cord prolapse, how long do you have to get the baby out?
intrapartum
within (during) labor and childbirth
grandmultipara
woman who has given birth 5 or more times; high risk for postpartum hemorrhage
underweight
woman with a BMI <18
normal weight
woman with a BMI of 18.5-24.9
overweight
woman with a BMI of 25-29.9
obese
woman with a BMI over 30
jaundice
yellowing of the skin; caused by immature liver or poor feeding - for darker skinned babies, may need to blanch skin to see
100,000
you don't want platelets to be below what?
