H-Maternity
Postpartum Blues: --"baby blues" after childbirth, which commonly include mood swings and crying spells that fade quickly.
...Signs and symptoms of the baby blues — which last only a few days to a week or two — may include: •Mood swings •Anxiety •Sadness •Irritability •Crying •Decreased concentration •Trouble sleeping
Quickening===16---20 wks.
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In Multiple Gestations: ---Perinatal mortality is two to three times more likely in multiple than in single births.
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Infants of *diabetic* mothers are at risk for *respiratory distress syndrome* as a result of delayed synthesis of surfactant caused by a high serum level of insulin.
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Lacerations are easier to repair than an episiotomy.
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The name *HELLP* stands for: •H- hemolysis ( breakdown of red blood cells) •EL- elevated liver enzymes (liver function) •LP- low platelets counts (platelets help the blood clot)
---*Lactate dehydrogenase* (LDH)---{100 to 190 IU/L} --(to assess liver function) ---*Aspartate aminotransferase* (AST)---{0 to 35 IU/L}
A mother who notes that her newborn regurgitates after feedings asks the nurse whether her baby is ill.
---An underdeveloped cardiac sphincter causes regurgitation.
*First* degree episiotomy:
--Involves only the *epidermis*
At any point in the postpartum period, the lochia should be dark in color, rather than bright RED..
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Colostrum--is expressed====16 wks.
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False positive may occur when Nitrazine paper is exposed to blood or semen. --The definite test for rupture of membranes is *fern testing*, where amniotic fluid is allow to dry on a slide and it will form a fern pattern.
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Future Office Visits: a. Every 4 wks. until 28 wks. b. Every 2 wks. from 28 wks. until 36 wks. c. Every week from 36 wks. until delivery.
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If parents desire open-eye BONDING period, may delay eye prophylaxis up to 1 hour.
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Anticoagulant medications: (that can be given to a pregnant woman) --*Enoxaparin* (Lovenox) --*Heparin* (Hep-Lock)
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A nurse is assessing the newborn of a known opioid user for signs of withdrawal:
1. Sneezing 2. Hyperactivity 3. High-pitched cry
Milia on the infant's face: ---Avoid squeezing them and don't try to wash them off.
Although milia are common, they do not disappear for several weeks after birth. Milia are not birthmarks; the tiny plugged sebaceous glands are the result of maternal hormonal influence. Attempts to remove milia will irritate the infant's skin, and such attempts are not needed because the milia will disappear during the first month of life.
Weight gain====1 lb. per week--beginning in the 2nd Trimester.
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*Vernix* is found on a newborn at about *38* weeks' gestation and *disappears* after *40* weeks' gestation.
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Pregnancy N/V from persistent morning sickness: 1. Hypo-K+-------(Metabolic Alkalosis) 2. Hypo-Na+ 3. Hypo-Ca+ 4. Hypoglycemia 4. Hyperbilirubinemia
...hyperemesis--related to high levels of *estrogen*
A pregnant client with a history of rheumatic heart disease
1. Labor may be induced. 2. Birth may be vacuum extraction assisted. 3. Regional anesthesia may be administered. ---(An oxytocin (Syntocinon) infusion is carefully monitored for the gentle induction or augmentation of labor. The health care provider may prefer a vacuum extraction-assisted birth to reduce the need to push and to conserve energy. Regional anesthesia relieves the stress of pain, and it does not compromise cardiovascular function. A midforceps-assisted birth is not needed. Low or outlet forceps may be used to reduce the need to push and to conserve energy. Inhalation anesthesia is contraindicated because it could compromise cardiovascular function. )
Paternal Responses: 1. Announcement Phase: --acceptance of the biologic fact of pregnancy 2. Moratorium Phase: --the period of adjustment to the reality of pregnancy.
3. Focusing Phase: (begins in the last trimester) --active involvement in both the pregnancy and his relationship with his child. ---Negotiates w/the mother the role he is to play in labor and to prepare for parenthood.
1st Trimester====first day of LMP through 13 wks. 2nd Trimester====14 wks. through 26 wks.
3rd Trimester===== 27 wks. to 40 wks.
Zygote====12 to 14 days after fertilization, until implanted in the uterus. Embryo===== 3 to 8 weeks after fertilization.
Fetus=====9 weeks after fertilization to term (38 wks.)
Severe preeclampsia : 1. H/A 2. Visual Disturbances 3. Abd. Pain
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1st Trimester: --Ambivalence
2nd Trimester: --Quickening occurs and pregnancy becomes real.
Postpartum blues are usually normal, especially 5 to 7 days after delivery.
--encourage use of support persons to help w/housework for first 2 postpartum weeks. --Refer to community resources.
*Fourth* degree episiotomy:
--extends up the *rectal mucosa*.
After the first postpartum day, the most common cause of uterine atony is retained placental fragments.
--The nurse must check for the presence of fragments in lochial tissue.
Which of the following anticoagulants would the nurse expect to administer when caring for a primigravid client at 12 weeks' gestation who has class II cardiac disease due to mitral valve stenosis? 1. Heparin 2. Warfarin 3. Enoxaparin 4. Ardeparin
(1) 1. Heparin---(Cat. C) 2. Warfarin--(Cat. X) 3. Enoxaparin--(Cat. B)--sometimes used BUT clients are typically switched to heparin near labor because enoxaparin used along w/spinal or epidural anesthesia presents an increased *risk of bleeding* in the epidural or spinal space. 4. Ardeparin--(Cat. X)
A postpartum client tells the nurse, "I was just told that I have an erosion of the cervix. What could have caused this?" What is the nurse's best reply? 1. "Your labor was long and difficult." 2. "The acidity of your vagina is altered." 3. "Your cervical opening was stretched during birth, resulting in lacerations." 4. "The effacement and dilation of the cervix were not complete at the time of birth."
(2) --Changes in the pH of the vaginal tract cause cellular alteration and destruction; erosion involves continuous inflammation or ulceration. The direct effects of labor and birth do not cause cervical erosion; erosion involves continuous inflammation or ulceration.
Hydatidiform Mole: --Pt. is a risk for developing Choriocarcinoma
---A client who has a hydatidiform mole removed should have (hCG) human chorionic gonadotropin levels monitored for 1 year. ---During this year the client is advices NOT to become pregnant, because this would be reflected in rising hCG levels.
--Uterine Stimulants--- --oxytocin-(Pitocin) --Methylergonovine maleate-(Methergine)--{Do NOT give to HTN pts.} --Prostaglandin F2-(Hernabate)--{Do NOT give to ASTHMA pts.}
---Do not give before delivery of placenta, it may result in a retained placenta.
Give Oxytocin (Pitocin) *after* the placenta is delivered because the drug will cause the uterus to contract.
---Do not give before delivery of placenta, it may result in a retained placenta.
McRoberts Maneuver: --Done for Large fetus
---It is employed in case of shoulder dystocia during childbirth and involves hyperflexing the mother's legs tightly to her abdomen. It is effective due to the increased mobility at the sacroiliac joint during pregnancy, allowing rotation of the pelvis and facilitating the release of the fetal shoulder. ---If this maneuver does not succeed, an assistant applies pressure on the lower abdomen (suprapubic pressure), and the delivered head is also gently pulled.
*Cardiff Count to Ten Method*--- --The client begins counting fetal movements at a specified time (ex. 8:00 a.m.) and notes the time when the 10th movement is felt. ----If the client does not feel at least 6 movements in a 1-hour period-she should notify the HCP.
---The fetus typically moves an average of 1 to 2 times every ten minutes or 10 to 12 times per hour.
*Rubella* vaccine--(If titer of < 1:10) --Given Subc. before hospital discharge to nonimmune women.
---Woman may breastfeed.
Contraction Stress Test is used to evaluate fetal well-being during a simulated labor. --A negative contraction stress test indicates no late decelerations and is the desired outcome.
--A positive contraction stress test indicates fetal compromise with frequent late decelerations.
Labor Medications: --Push IV bolus into line slowly, at the *beginning* of a contraction.
--Give medications during contraction, when uterine blood vessels are constricted, so *less* analgesic reaches the fetus.
Hyperventilation results in Resp. alkalosis caused by blowing off too much CO2. s/s: --Dizziness --Stiff mouth --Tingling of fingers
--Have woman breathe into her cupped hands or a paper bag in order to rebreathe CO2.
Cervix must be fully dilated (10cm) before the client begins pushing.
--If pushing starts too early, the cervix can become edematous and never fully dilate.
Rubella is very teratogenic to the fetus.
--If titers are low, the client should get the vaccine *after* delivery and instructed not to get pregnant within 3 months. --Breastfeeding mothers may take the vaccine.
Lochia: --Lochia *Rubra*-- last 2 to 3 days postpartum. --Lochia *serosa*-- 1 week--(pale pink to brownish discharge)
--Lochia *Alba*--4 weeks postpartum.(thicker, whitish-yellowish discharge).
A nurse places the newborn under a radiant warmer. What complication is the nurse attempting to prevent?
--Metabolic acidosis
Signs of placental Separation: 1. Lengthening of umbilical cord outside vagina. 2. Gush of blood. 3. Uterus changes from oval (discoid) to globular.
--Mother describes a "full" feeling in vagina. --Firm uterine contractions continue.
Newborn Prophylactic Eye Care: ---OINTMENTS: --Erythromycin --Tetracycline
--Place along the entire lower lid in conjuctival sac. --after 1 min. may wipe away
RhoGAM is a *blood* product--it MUST be checked by TWO nurses.
--Syringe must be returned to lab w/label. ---Mother must have a NEG coombs test.
Ferrous Sulfate-(Feosol) s/e: --constipation --N/V --Diarrhea --Gastric irritation
--Taken on an EMPTY stomach
Adm. drugs to reduce gastric secretions (e.i. famotidine (Pepcid) or clear [nonparticulate]) antacids to neutralize gastric acid.
--The most common cause of maternal DEATH is aspiration of gastric contents into the lung.
Peridural (epidural, caudal) Block: --Given at the 1st and 2nd Stage.
--To block nerve impulses from T10---to---S5.
Third Trimester:
--pregnant woman becomes introverted & self-absorbed. --Pregnant woman begins to ignore partner (may strain the relationship)
*Fetal Fibronectin* --The absence of fetal Fibronectin in a vaginal swab between (*22 and 37 wks.*) gestation indicates there is less than 1% risk of developing preterm labor.
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*Fetal Scalp stimulation* is commonly prescribed when there is a decreased FHR variability. --This should cause a tactile response in the fetus and increases the FHR and variability.
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-------[*14--16 wks.*]---- *Alpha fetoprotein* (AFP) testing for neural tube defects --*↑ levels* indicate neural tube defects (spina bifida) --*↓ levels* of alpha-fetoprotein (indicates trisomy 21---down syndrome)
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Indications of ovulation: 1.) A slight drop in Temp. 1 day prior to ovulation; a rise of 0.5 degrees to 1 degree F in Temp occurs at ovulation. 2.) *Spinnbarkeit*--egg-white stretchiness of cervical mucus is present. 3.) *Ferning*--is seen under microscope.
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Insulin Dependent Mother: Insulin target ranges: 1. 70 to 100 mg/dL before meals & bedtime snacks. 2. 100 to 120 mg/dL 1 hour after meals.
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Insulin needs *fall* significantly for the *first 24hrs* postpartum because the client has usually been on NPO status for a period of time during labor and the labor process has used maternal glycogen stores.
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Postpartum: --Suspect retention if voiding is frequent and <100 ml per voiding.
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Premature Rupture of Membranes think *Infection*. assess: 1. Temperature 2. Vaginal culture
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Risk factors for Abruptio Placentae---- ---HTN ---Cocaine use ---hypofibrinogenemia ---hydraminos ---multiple pregnancies ---cigarette smoking ---alcohol ingestion ---increased maternal age ---amniotomy
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Teach mother to exhale when pushing--(pushing down on vagina while constantly exhaling through open mouth, followed by deep breath).
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The IUD may cause irritability of the myometrium, inducing uterine contractions and *expulsion* of the device; the presence of the IUD thread should be verified after menstruation and before coitus.
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The first sign of a block's effectiveness is usually warmth and tingling in the ball of the foot or the big toe.
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The normal length of time for pushing is 2 hours. Anything over that time becomes an abnormal situation and the HCP needs to be notified.
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Antihypertensive: Vasodilators --*Hydralazine*-------(Eclampsia) --Minoxidil ---monitor HR and Pulse
Adv./E: --H/A --*Tachycardia* --*Fluid Retention* (HF, pulmonary edema) --Postural hypotension ----------Monitor BP; pulse routinely. --observe for peripheral edema --Monitor I&O --Weigh daily
DTRs
Grade: 0+= absent 1+ diminished but present 2+ Normal 3+ Hyperactive 4+ Hyperactive w/clonus (a rhythmic jerking of the limb)
The woman should be allowed to ambulate during labor only if the FHR is within normal range and if the fetus is engaged (zero station).
If the fetus is not engaged, there is an increased risk that a prolapsed cord will occur.
Insulin resistance==begins as early as 14 to 16 wks.
Insulin resistance is a physiological condition in which cells fail to respond to the normal actions of the hormone insulin. The body produces insulin, but the cells in the body become resistant to insulin and are unable to use it as effectively, leading to high blood sugar.
*Second* degree episiotomy:
Involves the dermis, muscle and fascia.
Post-Partum Depression-- ---more severe depression-- --Usually appears 4 wks. after birth.(but can occur anytime within the first year after birth)
Postpartum depression symptoms may include: •Loss of appetite •Insomnia •Intense irritability and anger •Overwhelming fatigue •Loss of interest in sex •Lack of joy in life •Feelings of shame, guilt or inadequacy •Severe mood swings •Difficulty bonding with your baby •Withdrawal from family and friends •Thoughts of harming yourself or your baby
Fetal Non-Stress test
The test involves attaching one belt to the mother's abdomen to measure fetal heart rate and another belt to measure contractions. Movement, heart rate and "reactivity" of heart rate to movement is measured for 20-30 minutes. If the baby does not move, it does not necessarily indicate that there is a problem; the baby could just be asleep. A nurse may use a small "buzzer" to wake the baby for the remainder of the test.
Ophthalmia neonatorum is diagnosed. What is the nurse's estimate of the infant's age? ---About 3 to 4 days
Untreated ophthalmia neonatorum becomes apparent on the third or fourth postnatal day and provides evidence that the mother may have had gonorrhea or a chlamydial infection.
*Third* degree tear :
extends into the *anal sphincter*.