ATI Maternal Newborn
Biophysical Profile (BPP) Scoring
0 - 10 score, score of 8 - 10 means a healthy baby
How much weight should be gained in the second and third trimester?
1 pound per week
Preeclampsia signs and symptoms or hypertensive disorder
1. Sudden weight gain 2. Face and hands swollen because they are losing protein so fluid will not stay in the vascular space 3. Headache 4. Blurred vision and seeing spots 5. HYPER-Reflexia 6. Clonus -> SEIZURES
newborn bath steps
1. ensure the bathwater is between 36.6-37.2C (98-99F) 2. wash the infant's head before unwrapping or undressing to prevent heat loss 3. wash the infant's face with water starting at the inner canthus of the eye moving outward 4. wash each area of the body, rinse, and dry (no soap left) 5. thoroughly dry and swaddle
BPP tests for...
1. reactive HR 2. breathing 3. body movement 4. fetal tones 5. amniotic fluid volume
normal fetal heart rate
110-160 bpm (with FHR accelerations noted)
When is an amniocentesis done?
14 weeks
Weight gain for overweight women
15 to 25 pounds
Nageles rule for calculating a due date is?
1st day of the last menstrual period Add a year Add 7 days Subtract 3 months
When it comes to BPP scoring, 2 means ____ and 0 means _____
2 = normal 0 = NOT normal
How much weight should be gained for the first trimester?
2 to 4 pounds
head circumference should be _______________ than chest circumference
2-3 cm larger
1h glucose test performed at
24-28 weeks (if high then 3h glucose tolerance test performed)
Normal BMI weight gain during pregnancy
25 to 35 pounds
Weight gain for underweight women
28 to 40 pounds
normal fetal respirations
30-60 breaths/min (periodic apnea up to 15s considered normal)
When is the cerclage removed?
37 weeks or when spontaneous labor occurs
How many cm do you need to be dilated to receive epidural?
4 cm or more
Normal newborn length
45 to 55 cm (17.7 to 21.7 in)
Normal newborn weight
5.5 to 8.8 lbs
Halfway between the umbilicus and synthesis pubis
6 days postpartum where should the fundus be?
How long should a diaphragm remain in place after sex?
6 hours after sex
normal fetal temperature
97.7-98.6 F
Normal newborn temp
97.7-99.5
client in labor with contractions 4 minutes apart. what should fetal monitor show
A contraction interval is how often a uterine contraction occurs. The nurse will measure the interval from the beginning of one contraction to the beginning of the next contraction. A contraction lasting 60 seconds with a relaxation period of 3 min is equivalent to contractions every 4 min.
Hydatiform Mole (Molar Pregnancy)
A hydatidiform mole, or a molar pregnancy, is a benign proliferative growth of the chorionic villi, which gives rise to multiple cysts. The products of conception transform into a large number of edematous, fluid-filled vesicles. As cells slough off the uterine wall, vaginal discharge is usually dark brown and can contain grapelike clusters.
cervical cerclage
A surgical procedure in which the cervix is sewn closed during pregnancy used to treat incompetent cervix
Bulging/sunken fontanels Low set ears Grey/white patches on the tongue and gums (thrush)
Abnormal findings in newborn assessment
4 to 7 cm, restless, anxious, feelings of helplessness
Active Phase
Teaching for women taking Depo Prevera
Adequate intake of calcium and vitamin D
Hypertension, fever and diarrhea
Adverse effect of Carboprost
hypokalemia
Adverse effect of Terbutaline
Alpha-fetoprotein (AFP) screening
Alpha-fetoprotein (AFP) is a protein produced in the liver of a developing fetus. During a baby's development, some AFP passes through the placenta and into the mother's blood. An AFP test measures the level of AFP in pregnant women during the second trimester of pregnancy. Too much or too little AFP in a mother's blood may be sign of a birth defect or other condition
Risks for amniocentesis procedure...
Amniotic fluid emboli, hemorrhage, infection, leakage of amniotic fluid, ruptured membranes or miscarriage
Calcium Gluconate
Antidote for Mag Sulfate
YES!!! and NOTHING!
Are early decelerations okay? What do we do about them?
May go up 1 cm above the umbilicus
At 12 hours where should the fundus be?
500 mL for vaginal birth and 1000 mL for c-section
Average amount of blood loss for birth?
gestational hypertension =
BP > 140/90 recorded at least twice 4-6h apart, within 1 week
Findings for severe preeclampsia
BP over 160/100, more protein in the urine 3+, creatnine levels greater than 1.2, headache, blurred vision, hyperreflexia, peripheral edema, EPIGASTRIC PAIN
If the nonstress test is nonreactive what tests should be done next?
BPP or Contraction stress test (CST)
Reduce infection, brain growth, inexpensive, reduce SIDS
Benfits of breast milk
When can a Chorionic Villus Sampling Test (CVS) be done?
Between 10 and 12 weeks
Test for gestational disbetes occurs when?
Between 24 to 28 weeks of gestation
S/S of molar pregnancy
Bleeding that resembles prune juice (dark brown)
intended action of naloxone on cns
Block effects of narcotics on the CNS By blocking the effects of narcotics on the CNS, naloxone prevents CNS and respiratory depression in the newborn following delivery.
What does Nifidepine do?
Block the entrance of Calium into the smooth muscles which suppress contractions
100.4 or higher
Call the provider when temperature reaches _______
Lose 5 - 10% of body weight right after birth but should regain it in 10 to 14 days
Can babies lose weight? How much?
Define Presumptive signs of pregnancy
Can be explained by a reason other than pregnancy
Procedure for fetal tachycardia
Can mean maternal infection, give oxygen and may need something for a fever
What does late decelerations mean?
Can mean uterio/placental insufficency. Lack of fetal oxygenation.
Procedure for fetal bradycardia...
Can mean uterio/placental insufficiency. D/c oxytocin, put client on her side, give more oxygen and call provider
Risks for CST (contraction stress test)?
Can send woman into preterm labor
Uterine atony, retained placental fragments
Causes for prolonged lochia rubra
Incompetent cervix
Cervix does not stay closed, opens up and released the contents of the uterus...can result in miscarriage
Incomplete/Partial Placenta Previa
Cervix is partially covered by placental attachment
What should a nurse do before administering analgesics during active phase of labor
Check the cervix prior to analgesic administration. Prior to administering an analgesic during active labor, the nurse must know how many centimeters the cervix is dilated. If administered too close to the time of delivery, the analgesic could cause respiratory depression in the newborn.
epidural anesthesia teaching
Clients who receive anesthesia before the active phase of labor usually find the progression of their labor to slow. The medication depresses the central nervous system. Therefore, it will take longer for the cervix to dilate and efface. An epidural will be most effective when the client is in active labor, where there will be uterine contractions occurring at least every 3 to 5 min that last between 40 and 70 seconds, and contractions will be moderately strong in intensity. Epidural anesthesia will cause the maternal blood pressure to decrease rather than increase because of central nervous system depression. An adverse effect of epidural anesthesia is maternal hypotension, which can cause bradycardia in the fetus. This adverse effect has nothing to do with the timing of the epidural and is usually prevented by administering a bolus of 500 mL of an IV fluid prior to the insertion of the epidural catheter.
What do early decelerations mean?
Compression of the fetal head during contractions normal
What is Umbilical cord compression?
Cord is protruding through the cervix
S/S of yeast infections
Cottage cheese discharge, vulva redness, white platches on the vaginal wall
Procedure for phototherapy
Cover the baby eyes keep baby undressed avoid lotions (increase risk for burns) remove from phototherapy every 4 hours (unmask eyes & check skin)-skin to skin reposition every 2 hours,
Contractions or cervical changes that happen between 20 and 37 weeks
Define preterm labor
Main thing you want to monitor for with phototherapy?
Dehydration (sunken fontanels, check # diapers)
Low Alpha-fetoprotein (AFP) means
Down Syndrome
For an amniocentesis you want the bladder full or empty?
EMPTY
For any invasive procedure do you want the bladder full or empty?
EMPTY
Interventions for displaced uterus
Empty bladder
How often do you reposition the baby under phototherapy?
Every 2 to 3 hours
when to be refitted for a diaphragm
Every 2 years for 20% weight fluctuation post abdominal or pelvic surgery after every pregnancy
Polyhydramnios can cause...
Fetal gastrointestinal anomaly
What does LS ratio test for?
Fetal lung maturity
born to moms with diabetes, hypoxia, hypoglycemia, hypocalcemia
Findings for LGA babies
wasted appearance, peeling/cracked/dry leathery skin, hair and nails are long, meconium staining on their nails and umbilical cord
Findings for post term infant
Constant vaginal or rectal pain, vaginal pressure
Findings for vaginal hematoma
RR distress, bronchopulmonary displasia (lung are stiff and noncompliant), necrotizing entrocolitis (inflammation of the GI system)
Finsings for preemies
Iron fortified rice cereal
First food introduced?
onset of labor until full dilation of the cervix
First stage of labor
Delivery of placenta to the stabalization of maternal vital signs
Fourth stage of labor
Causes for displaced uterus?
Full bladder
GTPAL acronym
G = gravida (# times woman has been pregnant, including current) T = term (# of pregnancies that's gone 38 weeks or more) P = preterm (less than 38 weeks) A = abortion/miscarriage L = living children
7 to 10
Good APGAR score is?
36 to 37 weeks
Group B Streptococcus test (GBS) is done when?
4
How many stages of labor?
BACK TO SLEEP
How should your baby sleep?
Room temp in clean conditions up to 8 hours, refridgerated in sterile bottles up to 8 days, can be frozen u to 6 mos (regular fridge) 12 mos (deep freezer), thaw for 12 hrs, do NOT microwave, do NOT refreeze thawed milk, used portions of breast milk need to be tossed away
How to store breast milk
Can be in fridge for 48 hrs, toss unused portions
How to store formula milk
teaching after removal of hydatidiform mole
Hydatidiform moles are uncontrolled growths in the uterus arising from placental or fetal tissue in early pregnancy. There is an increased incidence of choriocarcinoma associated with molar pregnancies. Pregnancy must be avoided for 1 year so the client can be closely monitored for manifestations of this condition. A baseline human chorionic gonadotropin (hCG) level should be obtained following evacuation of the hydatidiform mole and then weekly until levels are normal for 3 consecutive weeks. Additional hCG levels should be obtained every 4 weeks for the next 6 to 12 months. not genetic
Eat protein following a snack, alternate liquid and solids every 2 to 3 hrs to avoid an empty stomach, avoid going to be with an empty stomach and should eat to taste
Hyperemesis gravidarum teaching
Contradictions for oral contraceptives
Hypertension, Cholecystitis and migraines
Treatment for hyperemesis
IV fluids, administration of vitamin B6, antiemetic meds
Massage the fundus
Intervention for hemorrhage
Sit client upright after epidural and get baseline BP before administration and assess every 5 to 10 minutes afterwards for maternal hypotension
Intervention for spinal epidural
Reposition from side to side or knee-chest position, d/c oxytocin and administer oxygen
Intervention for variable decelarations
Empty bladder, monitor peri pads, monitor for tachycardia and hypotension
Interventions and S/S for hemorrhage
EAT! breastfeed, supplement with formula
Interventions for hypoglycemia
ice packs, sitz baths
Interventions for vaginal pain after birth
0 to 3 cm, talkative, eager
Latent Phase
Resuming role as partner/individual
Letting go phase
Anticonvulsant
Mag Sulfate used for?
A nurse is caring for a client 2 hr postpartum. Clients perineal pad has large amount of lochia rubra and several clots. What should nurse do
Massage the fundus. The primary cause of early postpartum bleeding is uterine atony manifested by a relaxed, boggy uterus. Thus, the greatest risk for the client is hemorrhage. The nurse should massage the client's fundus first.
S/E of epidural
Maternal hypotension and fetal bradycardia
Small raised white spots on the nose or chin clogged sebaceous glands that are commonly found on the forehead and nose
Milia
4 to 7
Moderate distress APGAR score?
bluish purple spots on back/bottom (normal)
Mongolian spots
Contraindications for diabetic medication
Most oral antidiabetic meds, will likely use insulin
Nonreactive Nonstress test
NOT normal = NO accelerations
What does Indomethacin do?
NSAID, inhibit prostoglandins, suppress uterine contractions
High Alpha-fetoprotein (AFP) means
Neural tube defects
If baby is full term it will be well flexed... 1. square window 2. arm recoil 3. scarf sign 4. polateal angle 5. heel to ear test
Neuromuscular Maturity
Medications that may be given for preterm labor
Nifidepine, Magnesium, indomethacin or betamethasone
Check for ___________ before any test that requires any type of dye...
No allergy to shellfish or Iodine Kidney Function (creatinine)
EFFLEURAGE (light gentle circular strokes on the client abdomen), SACRAL COUNTERPRESSURE (heel of hand/fist push against sacral area), auroma therapry, music
Nonpharmacological therapy
Reactive Nonstress test
Normal = fetal HR accelerations
12 to 20
Normal BUN level
2 - 3 cm larger than the chest Barrel chest Fontanels present anterior 5 cm & diamond shape, posterior triangle shape Mongolian spots Milia Cuput succedaneum (elongated head) lasts 3 - 4 days blue/grey eyes at birth (eye color established at 12 mos) Epstein's pearls (small white spots on the gums & hard pallet)
Normal findings in newborn assessment
RR depression of the baby, sedation, hypotension, decreased varability on the fetal HR
Opiate and analgesic S/E
S/S of placenta previa
PAINLESS bright red vaginal bleeding during the second/third trimester
1. Dependent taking in phase 2. Dependent/independent taking hold phase 3. Interdependent letting go phase
Phases of maternal role enphasement
Treatment for high bili levels
Phototherapy or increase feedings
Interventions for late decelerations
Place mom into side lying position FIRST! increase IV fluids, d/c oxytocin, administer oxygen & notify provider
Infection (especially if more than 24 hours goes by between the time of rupture and birth)
Premature of membranes can cause...
Findings for mild preeclampsia
Protein in the urine 1+, blood pressure is abnormal like gestational hypertension
nursing care of a newborn born to a narcotic using mother
Reduce frequent stimulation This newborn needs a quiet, calm environment with minimal stimulation to promote rest and reduce stress. A stimulating environment can trigger irritability and hyperactive behaviors. skin to skin swaddle
What does Magnesium do?
Relax the smooth muscle of the uterus
Nitrazine paper test (should turn blue), if yellow its probably urine,
Rupture of membranes is tested by...
Maternal hypotension, fetal bradycardia, potential headache from leakage of the spinal fluid , higher incident of bladder and uterine aptomy
S/E of spinal block
Unilateral sweeling/warmth and redness in the legs, calf tenderness
S/S of DVT
Jittery, twitching, weak high pitch cry, irregular RR, cyanosis, lethragy, eye rolling, seizure, poor feeding and blood sugar under 40
S/S of hypoglycemia
painful/tender localized hard mass, reddened area usually on one breast, flu like symptoms (chills, fatigue)
S/S of mastitis
Last up to 10 days, tearfulness, insomnia, lack of appetite, feeling of let down
S/S of postpartum blues
Occurs within 6 months of delivery, persistant feelings of sadness and intense mood swings
S/S of postpartum depression
Common with moms who have hx of bipolar disorder, delusion, disorientation, obsessive behavior, paranoia
S/S of postpartum psychosis
Chest pain, difficulty breathing, dry cough
S/S of pulmonary embolism
Woman being fully dilated to the birth of the baby
Second stage of labor
Consuming mineral oil can cause....
Severe cramping, diarrhea, fluid loss and preterm contractions
Under 4
Severe distress APGAR score?
Diaper output, void 6 to 8 diapers per day
Signs your baby is getting enough breast milk
Usually used for c-sections, lack of sensation from the nipple to the feet
Spinal block is used for ______, no sensation from the ______ to the ______.
What does Betamethasone do?
Steroid, help promote fetal lung maturity before birth
S/S of Abruptio Placental
Sudden onset of intense localized uterine pain with bright red vaginal bleeding
Fetal fibrinectin
Swab vagina to test for ____ to see if woman in in labor
Procedure for a CVS test?
Taking a piece of the placenta and using it for testing
Begins on day 2 to 3 until the next couple of weeks, practice skills to take care of baby
Taking hold phase
Eager to talk about birth experience, first 24-48 hours after birth, relies on others for assistance
Taking in Phase
Cold compresses between feedings, wamr showers prior to breastfeeding to promote milk flow, cold fresh cabbage leaves on the breast or mild analgesics
Teaching for breast engorgement
15 - 20 mins per breast, try to empty the breast
Teaching for breastfeeding
Apply petroleum jelly with each diaper change at least 24 hrs after circ to prevent it from sticking to the diaper, no tub bath until healed, film of yellow mucus is normal (DO NOT WASH OFF), should be completely healed within a couple weeks
Teaching for circ care
Keep dry, keep above diaper, sponge bath until cord falls off, make sure its not moist/red/drainage and have no foul odor
Teaching for cord care
Wash hands prior to breastfeeding, allow nipples to air dry, make sure the baby is taking in the niple & areola when breastfeeding, empty breasts during each feeding
Teaching for mastitis
No wamr showers, tight bras, cold compresses
Teaching for nonbreastfeeding
what can help relieve constipation during pregnancy
The nurse should encourage the client to participate in moderate physical activity, such as walking or swimming, 30 min every day. This activity increases intestinal peristalsis, which will help alleviate constipation.
When should group B streptococcus ß-hemolytic (GBS) be tested for
The nurse should obtain a vaginal/anal group B streptococcus ß-hemolytic (GBS) culture at 35 to 37 weeks of gestation to screen for infection. Prophylactic antibiotics should be given during labor to the client who is positive for GBS.
what should be planned to be given when a women comes in for preterm labor
The nurse should plan to administer betamethasone IM, a glucocorticoid, to stimulate fetal lung maturity and thereby prevent respiratory depression.
Birth of the baby to the delivery of the placenta
Third stage of labor
Umbilical cord wrapped around the nec, can cause petechiae over the head
Tight nuchal cord
8 to 10 cm, "I can't go on", "I can't continue", may have URGE to push, may feel the need to have bowel movement (increased rectal pressure)
Transition Phase
Fluid IV bolus
Treatment for maternal hypotension
what is used for pregnancy testing
Urine test for Human chorionic gonadotropin is excreted by the placenta and promotes the excretion of progesterone and estrogen. This hormone is the basis for pregnancy testing.
Neuromusclular maturity and physical maturity
What 2 areas does the New Ballard test?
1. Conduction (indirect contact with cold surface) 2. Convection (lose heat thru cooler environmental air) 3. Evaporation (bath, dry them right away or after delivery) 4. Radiation (lose of heat from body to cooler outlet, like window or AC)
What 4 mechanism can the baby lose heat?
1. Heart Rate 2. RR 3. Muscle tone 4. Reflex irritability 5. Color
What 5 things does the APGAR test score on?
Thicker skin Lots of creases on the bottom of feet Developed breast buds 5 - 10 mm in width Boys: more developed like a pendulum with rugae Girls: labia bigger/developed, clitorus wont be so promident
What a full term baby will look like....
Wrinkled, cracked skin almost like leather
What a post mature baby will look like...
Oxytocin, methylergonovine, carboprost and misoprostol all help the uterine contract
What are 4 uterotonic (uterus stimulants) that can be used for hemorrhage?
Uterine cramps, d/t the release of oxytocin
What can the mom expect during breast feeding?
yellowish/white creamy color, have fleshy odor, day 11 to 6 weeks postpartum
What does lochia alba look like? When does it occur?
pinkish brown in color, occurs day 4 to 10
What does lochia serosa look like? When does it occur?
Bright red, may be some clots, occurs day 1 to 3 after birth,
What does rubra lochia look like? When does it occur?
Umbilical cord compression
What does variable decelerations mean?
Soaking a peri pad in 15 minutes or spurting bright red blood
What is a sign of bleeding issue?
Elevation of the serum bilirubin level results in jaundice
What is hyperbilirubinemia?
AKA bilirubin encephalopthy, results from untreated hyperbilirubinemia, levels can be higher than 25
What is kernicterus?
Infection in the breast
What is mastitis?
extends past 7 days, result from some kind of infection or blood group compatibility
What is pathologic jaundice?
Begnin, occurs around 24 hrs of age, should be resolved in 7 days d/t breakdown of fetal RBC
What is physiologic jaundice?
Stroke outer edge of the foot and toes spread out
What is the babinski reflex?
Hep B at birth, 1 mo and 6 mos
What is the baby's first vaccine? When do they get it again?
Startle reflex
What is the moro reflex?
Hold the infant upright and touch their feet to a surface they respod with stepping
What is the stepping reflex?
Extend the arm/leg on the side they're turned to & flex the opposite side
What is the tonic neck reflex?
Thinner almost transparent, may be sticky, Lanugo present Little to no creases on bottom of foot Littleto no breast development Boys: flat smooth scrotum Girls: flat labia, clitorus very prominant
What preemies will look like...
Gets breast milk
When does the baby make their own vit K?
After 37 weeks
When is full term labor?
6 mos
When is iron fortified rice cereal introduced?
Birth to 8 mos
When is te plantar grasp present?
Birth to 1 yr
When is the babinski reflex present?
Birth to 4 mos
When is the moro reflex present?
Birth to 6 mos
When is the palmar grasp reflex present?
Birth to 1 yr
When is the stepping reflex present?
Birth to 4 mos
When is the sucking & Rooting Reflex present?
Birth to 3-4 mos
When is the tonic neck reflex present?
Administer within 72 hours after giving birth for women who are Rh (-) and their baby was Rh (+) to prevent issues with next pregnancy
When should Rhogam be administered and why?
First 24 hours after birth
When should you see meconium?
2 to 3 days after birth
When will breast milk start to come in?
Lack of sensation from the umbilicus to the thighs
Where does Epidural decrease lack of sensation?
Fundus should be firm and midline with the umbilicus, approximately at the level of the umbilicus
Where should the fundus be after birth?
Should not be able to palpate the uterus
Where should the funud be on day 10 postpartum?
Fontanel
a space between the bones of the skull in an infant or fetus, where ossification is not complete and the sutures not fully formed. The main one is between the frontal and parietal bones
chorionic villus sampling (CVS)
a test made in early pregnancy to detect congenital abnormalities in the fetus. A tiny tissue sample is taken from the villi of the chorion, which forms the fetal part of the placenta
primigravida
a woman in her first pregnancy
multigravida
a woman who has had two or more pregnancies
nulligravida
a woman who has never been pregnant
probable signs of pregnancy
abdominal enlargement, Hegar's sign, Chadwick's sign, Goodell's sign, ballottement, Braxton-Hicks contractions, positive pregnancy test (HCG), fetal outline felt by examiner
bulging fontanels
abnormal and indicate increased intracranial pressure (abnormal)
presumptive signs of pregnancy
amenorrhea, fatigue, nausea/vomiting, urinary frequency, breast changes, quickening, uterine enlargement
infertility definition
an inability to conceive for at least 12 months
chloasma
an increase of pigmentation of the face
Physiological changes that occur right before labor
backache, weight loss (1 - 3 pounds), lightening (fetal head decends into the true pelvis), true contractions, bloody show, energy burst, GI changes (N/V), rupture of membranes
uterine fibroids
benign tumors composed of muscle and fibrous tissue that develop in the uterus Uterine fibroids can increase the risk for postpartum hemorrhage due to the increase in blood supply to the uterus, which supports the fibroid.
Chadwick's sign
bluish coloring of cervix and vaginal mucosa
Fetal presentation: breech
bottom part of body closest to birth canal -Frank: legs are extended straight upward -Complete: extension of the legs across the anterior surface of the body -Footling: one or both feet presenting
respiratory changes during pregnancy
breathing more diaphragmatic than abdominal 15-20% increase in O2 consumption deeper and slightly faster breathing may cause nasal stuffiness, nosebleeds, voice changes
antidote for magnesium sulfate
calcium gluconate
Complete Placenta Previa
cervix is completely covered by the placental attachment
s/s adverse effects of IUDs
change in string length foul-smelling vaginal discharge pain with intercourse, fever/chills
s/s of adverse effects of oral contraceptives
chest pain, SOB, leg pain, headache, eye issues indicate hypertension, clots or stroke
integumentary system changes during pregnancy
chloasma linea nigra stria gravidarum
pre-term labor
contractions and cervical changes that happen between 20-37 weeks; vaginal swab to check for fetal fibronectin; meds: nifedipine, magnesium, endomethacin, betamethasone
effleurage
cutaneous stimulation of the abdomen with light circular strokingused before transition to promote relaxation and relieve mild to moderate pain from uterine contractions
acrocyanosis
cyanosis of the hands and feet, common in the first 24h of life skin to skin with mother!
most accurate assessmet of fluid and electrolyte status
daily weight
Sources for Folic acid
dark green leafy veggies, OJ
linea nigra
dark line of pigmentation from the umbilicus extending to the pubic area
Depo Prevera can cause...
decreased bone density and loss of calcium
small white bumps on the roof of the mouth and are common in newborns
epstein's pearls
polyhydraminos
excessive amniotic fluid
positive signs of pregnancy
fetal heart sounds, visualization of fetus by ultrasound, fetal movement felt by experienced examiner
phototherapy places the infant at risk for
fluid loss and dehydration hyperthermia eye damage
measurement of fundal height (in cm)
from the symphysis pubis to the top of the uterine fundus approximates the getational age between 18 and 32 weeks gestation
if the umbilical cord is protruding from the vagina . . .
get help right away hold the presenting part off the umbilical cord to increase perfusion; place the patient in a modified Sims', knee-chest, or Trendelenburg position to prevent compression
GI changes during pregnancy
gums swollen, gingivitis ptyalism (excessive saliva) decreased peristalsis and increased absorption of water and sodium hemorrhoids heartburn prolonged gallbladder emptying nausea/vomiting
primipara
has completed one pregnancy to stage of viability
multipara
has completed two or more pregnancies to stage of viability
fetal presentation: vertex (occiput)
head is closest part to birth canal -LOA -LOP -LOT -ROA -ROP -ROT
HELLP syndrome
hemolysis (anemia), elevated liver enzymes (ALT, AST), low platelets (<100k)
contraindications of oral contraceptives
history of blood clots, stroke, cardiac issues, estrogen related cancers or is a smoker
Who cannot take the pill?
hx of blood clot, stroke, cardiac issues, breast cancer, estrogen cancer and smokers
hyperglycemia in mother predisposes baby to
hypoglycemia -adverse effect of betamethasone (steroids cause hyperglycemia in mother) -LGA baby born to diabetic mother
placenta previa
implantation of the placenta over the cervical opening or in the lower region of the uterus complete or partial/incomplete
cardiovascular changes during pregnancy
increase in blood volume by 50% 500mL of maternal blood goes to placental bed CO increases by 30-50% heart rate increases by 10bpm to normal heart displaced upward, forward, and to the left S3 sound may be heard after 20 weeks
hematological changes during pregnancy
increase in clotting factors, RBC production, plasma volume expansion, iron demands, fibrin and plasma fibrinogen levels leads to hypercoaguable state (greater risk for clots) dilutional anemia
cold stress in an infant can cause
increased oxygen consumption, increased metabolism and metabolic acidosis
renal/urinary system changes during pregnancy
increased risk of pyelonephritis and UTI heavier workload on kidneys due to increased blood flow increased GFR, urine flow and volume may have glucosuria proteinuria abnormal except in first void upon rising
venous pressure changes during pregnancy
increases due to the compression of the iliac veins and inferior vena cava blood flow to legs reduced results in dependent edema, varicosities and hemorrhoids
sunken fontanel
indicates dehydration (abnormal)
complications of IUDs
inflamed pelvis, uterine perforation, ectopic pregnancy
how to use a diaphragm
insert vaginally with spermicide on cervical side of dome can be inserted up to 6h before intercourse must stay in place for 6h after intercourse do not leave in more than 48h empty bladder before insertion reapply spermicide each time wash with warm soapy water
What don't you want to see on a fetal heart monitoring?
late decelerations and variable decelerations
supine hypotension
lying flat pinches aorta and inferior vena cava causing drop in systolic blood pressure lightheadedness, dizziness, possible nausea; instruct patient to lay on left lateral side
Contraction stress test (CST)
may be done during pregnancy to measure the baby's heart rate during uterine contractions. Its purpose is to make sure the baby can get the oxygen he needs from the placenta during labor Nipple stimulation or Oxytocin
Nonstress test does what?
measures fetal wellbeing in last trimester- tests CNS
nullipara
no pregnancy beyond the stage of viability
gravidity
number of pregnancies
parity
number of pregnancies in which fetus reaches 20 weeks gestation (not the number of fetuses. parity is not affected whether the fetus is born stillborn or alive)
uterine changes during pregnancy
pear shape to ovoid shape Braxton-Hicks contractions felt after 4 months ascent into abdomen after first trimester increased strength and elasticity
proper way to put newborn in a car seat
place the infant in the back seat with the infant semi-reclined facing the rear of the seat
proper breastfeeding
position baby with nose, cheeks, and chin touching the breast break suction on the nipple before removing it from baby's mouth prevent baby from feeding after breast has been emptied
Conditions that increase risk for preeclampsia
pregestational diabetes, hypertension, renal disease, SLE and rheumatoid arthritis
contraindications to IUD
pregnancy bleeding
ballottement test for pregnancy
rebound of unengaged fetus
effects of ice pack on episiotomy
reduce swelling anesthetic effect
S/S Mag Sulfate toxicity
reduced deep tendon reflexes (<2), decreased urine output, decreased RR, decreased LOC, dysrhythmia
side effect of oxygen therapy in newborn
retinopathy Oxygen therapy can cause retinopathy of prematurity, especially in preterm newborns. It is a disorder of retinal blood vessel development in the premature newborn. In newborns who develop retinopathy of prematurity, the vessels grow abnormally from the retina into the clear gel that fills the back of the eye. It can reduce vision or result in complete blindness.
eclampsia =
severe pre-eclampsia + seizures
Hegar's sign
softening and compressibility of lower uterus
Goodell's sign
softening of cervical tip
musculoskeletal system changes during pregnancy
softenng and stretching of ligaments lower back and ligament pain increased swayback and upper spine extension forward shifting of center of gravity increase in lordosis waddle gait
infertility testing
start with sperm analysis (cheaper and easier) then move on to woman
striae gravidarum
stretch marks most notably found on the abdomen and thighs
blood pressure changes during pregnancy
systolic usually remains the same diastolic decreases until midpregnancy then returns posture affects arterial blood pressure (drops)
an indirect Coombs' negative test on maternal blood indicates
that the mother has not been sensitized and RhoGAM should be administered
a direct Coombs' negative result on fetal blood indicates
the fetus was not sensitized and RhoGAM should be administered
viability
the point in time when an infant has the capacity to survive outside the uterus (no specific gestational age but typically 22-25 weeks is threshold)
abruptio placentae (placental abruption)
the premature separation of the placenta from the uterine wall(partial or complete) after 20 weeks' gestation and before the fetus is delivered.; significant maternal and fetal morbidity
TORCH infections
toxoplasmosis, other, rubella, cytomegalovirus, and herpes simplex; all capable of infecting the fetus
S/S of etopic pregnancy
unilateral stabbing pain, tenderness in the lower abdominal quadrant
should a pregnant women with HIV continue to take zidovudine throughout pregnancy
yes The nurse should inform the client that taking prescription antiviral medication every day decreases the risk of transmission of HIV to her newborn.
should a pregnant women have a full bladder for an ultrasound
yes The nurse should tell the client that a full bladder helps to lift the gravid uterus out of the pelvis during the examination. Therefore, it is important to ensure that the client has a full bladder to obtain the most accurate image of the fetus.
