ATI Maternal Newborn Nursing
Caput succedaneum
(localized swelling of the soft tissues of the scalp caused by pressure on the head during labor) is an expected finding that may be palpated as a soft edematous mass and can cross over the suture line. Caput succedaneum usually resolves in 3 to 4 days and does not require treatment.
Epstein pearls
(small white cysts found on the gums and at the junction of the soft and hard palates) are normal in newborns. They result from the accumulation of epithelial cells and disappear a few weeks after birth
APGAR Heart Rate
0- absent, 1- less than 100, 2- greater than 100
APGAR Respiratory Rate
0- absent, 1- slow, weak cry, 2- good cry
APGAR Color
0- blue, pale, 1- pink body, cyanotic hands and feet (acrocyanosis, 2- completely pink
APGAR Muscle Tone
0- flaccid, 1- some flexion, 2- well flexed
APGAR Reflex Irritability
0- none, 1- grimace, 2- cry
Normal bilirubin values
0-6 day 1, 8 or less day 2, and 12 or less day 3
to get jaundice your bilirubin had to increase how much an hour and get to what level
0.5 an hour over 15
Amnioinfusion
0.9% sodium chloride or lactated ringer's solution is instilled into amniotic cavity to supplement the amount of amniotic fluid. Reduces severity of variable decelerations caused by cord compression
Fundus location postpartum
1 cm above umbilicus 12 hours postpartum
postpartum period
1-4 hours after birth
What score does a nurse want for a women who is doing a biophysical profile
10 4-6 suspect asphyxia under 4 severe asphyxia
Healthy newborn fluid intake
100-140 mL/kg/24 hr
Healthy newborn caloric intake
110 kcal/kg/day then 3-6 months it's 100 kcal/kg/day
Normal baseline FHR
110-160
Expected newborn HR
120-160
hgb RBC count Leukocytes Hct PLatelets Glucose
14.5 to 22.5 g/dL 4,800,000 to 7,100,000/mm 9,000 to 30,000/mm 48% to 69% 150,000 to 300,000/mm 40 to 60 mg/dL
Methylergonovine (Methergine)
140/90 and above BP- don't give. Also assess for n/v and headache
First period of reactivity
15-30 min after birth, HR may be 160-180
When can you do Quad testing
16-18 weeks
Reactive FHR
2 reactive 0 non reactive accelerates 15beats/min for at least 15 seconds two or more times during 20 minute period
When does birth defects typically happen
2 to 8 weeks
Expected newborn weight
2,500-4,000 g
Second period of reactivity
2-8 hours after birth. Often gags or chokes on mucus that has accumulated in his mouth
body movements
2-at least three body extensions with return to flexion
Breast milk and formula caloric amount
20 kcal/oz
How long does it take for BP to return to normal following a birth
20 weeks
What percent of moles becomes choriocarcinoma
20%
How many mg should a pregnant woman have of caffeine
200mg/daily
Lab test for Gestational Diabetes Mellitus
24-28 weeks gestation, a glucola screening test/1-hr glucose tolerance test (50 g oral glucose load followed by plasma glucose analysis 1 hr later, fasting not necessary (positive reading is 130-140 mg/dL or above
When is the one hour glucose done three hour glucose tolerance 1,2,3 hours later
24-28weeks if first test was above 140 when tested
How much does a woman gain during pregnancy 1st trimester? 2nd and 3rd trimester?
25-35lbs clients should fain 1-2kg (2.2 to 4.4) during first trimester and 0.4kg (1lb) a week for the last two trimesters underweight should gain- 28-40lbs overweight-15 to 25lbs
Return of menses for lactating clients
3 months or until cessation of breast feeding
Period of relative inactivity
30 min- 2 hr after birth, newborn is quiet, HR and RR will decrease
Expected newborn RR
30-60
How much should a womans calorie intake increase for the first 6months of brestfeeding
330 cals
How much should womans calorie intake increase during the 2nd trimester
340cals
When does Group B streptococcus testing get done
35-37 wks
Expected newborn temp
36.5-37.2
physiological jaundice appears at what day
3rd - normal will go away
When does leg cramps usually happen
3td trimester
Return of menses for nonlactating clients
4-10 weeks
to be considered hypoglycemic as a newborn what does the glucose level have to be under
40 get glucose test within the first two hours of life
how much should a womans calorie intake increase for the second 6months of breastfeeding
400 calories
Expected newborn length
45-55 cm
how much should a womans calorie intake increase during the 3rd trimester
452cals
How much does a womans BP decrease during the second trimester
5-10mm hg
What does hCG begins to peak after implantation
50 to 70 days higher levels can indicate multifetal pregnancy, ectopic pregnancy, or Down syndrome
Average uterine pressure
50-85 mm Hg
Moderate variability
6-25/min
Expected newborn BP
60-80 S, 40-50 D
Findings for LGA
90th percentile or more than 8 lbs, 12 oz, findings of increased ICP (dilated pupils, vomiting, bulging fontanels), plump face, tachypnea, retractions, cyanosis, hypotonic muscles
Temp when bathing can be initiated
97.7 or 36.5
Minimal variability
<5/min
Leopold Maneuver
Abdominal palpation of fetus, lie, attitude, helps nurse assess the position of the fetus to determine the optimal placement of the fetal monitoring transducer. Empty bladder beforehand, supine positioning
Ectopic pregnancy
Abnormal implantation of a fertilized ovum outside the uterine cavity usually in fallopian tubes. Abrupt unilateral lower-quadrant abdominal pain with or without vaginal bleeding, scant dark red vaginal spotting occurring 6-8 weeks after last normal menses
Dystocia
Abnormal labor related to the 5 P's. Hypotonic or hypertonic contractions, with failure to efface and dilate the cervix
Magnesium Sulfate toxicity
Absence of patellar deep tendon reflexes, urine output less than 30 mL/hr, respirations less than 12/min, decreased LOC, and cardiac dysthythmias
Care for anaphylactoid syndrome
Administer 02, intubate, cardiopulmonary resuscitation as necessary, administer fluids, position client on side with pelvis tilted 30 degrees to displace uterus, administer blood products
Fetal tachycardia
Administer antipyretic if maternal fever is present, administer 02, administer IV bolus
Interventions for DIC
Administer fluid volume replacement (blood products), administer antibiotics, vasoactive drugs, and uterotonics, administer 02, and provide protection from injury
RhoGAM
Administered at 28 weeks gestation to a mother who is Rh-negative and gives birth to an Rh-positive infant. Recommended following an amniocentesis
Tetanus-diphtheria-acellular pertussis vaccine
Administered prior to discharge
Preterm premature rupture of membranes
After 20 weeks of gestation and prior to 37 weeks
High levels of AFP
Alpha-Fetoprotein is measured between 16 and 18 weeks and is used to detect neural tube defects (anencephaly), spina bifida, and omphalocele-normal if multifetus
Chorionic Villus sampling
Alternative to amniocentesis (10-13 weeks gestation) results with 24-48 hours
Anaphylactoid Syndrome
Amniotic fluid embolism. Rupture of amniotic sac causing infiltration of amniotic fluid into the maternal circulation. Amniotic fluid travels to and obstructs pulmonary vessels
Magnesium Sulfate
Anticonvulsant, monitor BP, pulse, RR, deep tendon reflexes, LOC, urinary output, presence of headache, visual disturbances, epigastric pain, uterine contractions, and FHR, maintain fluid restriction of 100-150 mL/hr
Retrovir
Antiviral given at 14 weeks gestation throughout pregnancy for HIV/AIDs. Given to infant for 6 weeks following birth
Perineum comfort care
Apply ice packs for first 24-48 hours, encourage sitz baths at temp of 38-40 degrees Celsius, administer analgesia
Amniotomy
Artificial rupture of amniotic membranes
Rubella vaccine and RhoGAM
Assess after 3 months to determine whether immunity to rubella has been developed
HIV/AIDs
Avoid amniocentesis and episiotomy because of the risk of blood exposure
Cocaine addiction
Avoid eye contact, and use vertical rocking and a pacifier
Chlamydia medications
Azithromycin (Zithromax), amoxicillin (Amoxil), erythromycin (Ery-Tab)-infants after birth
What does BUBBLE stand for
B - Breasts U - Uterus (fundal height, uterine placement, and consistency) B - Bowel and GI function B - Bladder function L - Lochia (color, odor, consistency, and amount [COCA]) E - Episiotomy (edema, ecchymosis, approximation
Severe preeclampsia
BP 160/100 or greater, proteinuria greater than 3+, oliguria, elevated serum creatinine- 1.2+, cerebral or visual disturbances (headache or blurred vision), hyperreflexia with ankle clonus, peripheral edema, hepatic dysfunction, RUQ pain, and thrombocytopenia
Category 1
Baseline 110-160, variability is moderate, accelerates present or absent, early decelerations present or absent, and variable or late decelerations absent
Gestational Hypertension
Begins after 20th week of pregnancy, elevated BP of 140/90 or greater recorded at least twice, 4-6 hours apart, within 1 week period. NO proteinuria
Dependent-independent: taking hold phase
Begins on day 2 or 3, up to 10 days to several weeks. Focus on baby care, wanting to take charge but needs acceptance from others, wants to learn and practice
Findings for SGA
Below 10th percentile, hair is sparse, dry, loose skin, decreased fat, dry yellow umbilical cord, acrocyanosis, wide-eyed and alert
Medication for respiratory distress syndrome
Beractant (Survanta)
Term
Birth between week 38 and 42
Hep B dosage schedule
Birth, 1 month, and 6 months
Hypoglycemia: monitor for
Blood glucose less than 40, jitteriness, twitching, weak high pitched cry, irregular respiratory effort, cyanosis, seizures, eye rolling, give formula immediately
Neonatal Hypoglycemia
Blood glucose of 40 or less or in a preterm newborn 25 or less
Decreased placental enzyme insulinase
Blood sugar lowers immediately after birth
Quad marker screening
Blood test that ascertains info about likelihood of fetal birth defects. Includes AFP, hCG, Estriol, Inhibin-A 16-18 wks
Uterine atony
Boggy uterus, tachycardia, hypotension, skin is pale, cool, clammy, loss of turgor, may result in hysterectomy
Postterm
Born after completion of 42 weeks gestation
Preterm or premature
Born prior to completion of 37 weeks
Adequately fed newborn signs
Bowel movements are yellow, soft, and formed, stool after every feeding, after couple of weeks movements will decrease to 1-2 times a day, void 6-8 times per day
Decreased estrogen
Breast engorgement, diaphoresis, diuresis, diminished vaginal lubrication
Postpartum focused exam- BUBBLE
Breasts, uterus, bowel, bladder, lochia, episiotomy
Lochia Rubia
Bright red color, bloody consistency, fleshy odor, possible small clots, transient flow increases during breastfeeding and upon rising. Lasts 1 to 3 days after delivery
Lochia rubra
Bright red, clots, 1-3 days after delivery
Epidural
Bupivacaine, along with morphine or fentanyl (given when client is dilated at least 4 cm). Administer bolus of fluids to offset hypotension, place client in side-lying, sitting, or modified Sims' position
Female sterilization
Burning or blocking the Fallopian tubes. Not reversible
-barbitals
Can be used during early or latent phase of labor to relieve anxiety and induce sleep
Gestational Diabetes Mellitus
Can result in spontaneous abortion, infections (r/t increased glucose in urine), hydraminos, ketoacidosis, hypoglycemia, and hyperglycemia
Nevus flammeus
Capillary angioma below the surface of the skin that is purple or red, caries in size and shape, is commonly seen on the face, and does not blanch or disappear
Gonorrhea medications
Ceftriaxone (Rocephin) and azithromycin
Latent phase
Cervix 0-3 cm (non pharmacological pain management)
Active phase
Cervix 3-7 cm (opioids and epidural)
Transition phase
Cervix 8-10 cm
Low levels AFP
Chromosomal disorders (Down syndrome) or gestational trophoblastic disease
Nonstress test
Client presses a button whenever they feel fetal movement which allows nurse to assess FHR in relationship to the fetal movement
Varicella vaccine
Client should not get pregnant for 1 month following immunization. A second dose is given at 4-8 weeks
Rubella vaccine
Client should not get pregnant for 1 month following the immunization
What is effleurage?
Client strokes abdomen using circular motion during contractions
Medication for endometritis
Clindamycin (Cleocin)
Cephalohematoma
Collection of blood between the periosteum and skull bone
Sacral counterpressure
Consistent pressure against sacral area to counteract pain of lower back
GI changes postpartum
Constipation, hemorrhoids
Toxoplasmosis
Consumption of raw or undercooked meat or handling cat feces, fever and tender lymph nodes
Conduction heat loss
Contact with cooler surface
Rubella
Contracted through children who have rashes or neonates who are born to mothers who had rubella during pregnancy, rash, mild lymphedema, fever, and fetal consequences
What test do they use from Rh testing when can you get treatment
Coombs test 28 weeks
Category 2
Could be tachycardic or bradycardic
False labor contractions
Decrease in frequency, duration, and intensity, painless, irregular frequency, felt in lower back or abdomen above umbilicus, often stop with sleep or comfort measures, no change with dilation
Braxton Hicks contractions
Decrease with hydration and walking
Postpartum fundus
Decreased in size from 1,000 g to 60 g in two weeks
Third stage
Delivery of neonate and ends with delivery of placenta
Fourth stage
Delivery of placenta and ends with maternal stabilization of vital signs
Kleihauer-Betke test
Determined amount of fetal blood in maternal circulation if large fetomaternal transfusion is suspected
Bishop score
Determines maternal readiness for labor by evaluating whether the cervix is favorable by rating cervical dilation, effacement, consistency, position, and station
Postpartum psychosis
Develops within the first 2-3 weeks. Confusion, disorientation, paranoia, pronounced sadness, and obsessive behaviors
Fetal bradycardia
Discontinue pitocin, assist client to side-lying position, administer 02, insert IV, administer tocolytic, notify provider
If magnesium sulfate toxicity is expected
Discontinue, administer calcium fluconate, prepare for actions to prevent respiratory and cardiac arrest
Circumcision care
Do not wash off the yellowish mucus that forms over the glans, avoid wrapping in tight gauze, check for bleeding every 15 min after procedure for the first hour, monitor for the first void
What does a low AFP indicate
Downs syndrome
hCG elevation in hyperemesis gravidarum
Elevated because inability to retain fluid results in hemoconcentration
EL-------> in HELLP
Elevated liver enzymes (ALT and ASP), epigastric pain, and n/v
Vital sign changes postpartum
Elevated pulse, temp (100 degrees F), cardiac output, orthostatic hypotension
Continued flow of lochia serosa or alba indicative of
Endometritis
Care for uterine atony
Ensure bladder is empty, assess uterus, monitor vitals, IV fluids, 02 2-3 liters via NC, medications for postpartum hemorrhage
How often should newborns breastfeed?
Every 3 hours during day, every 4 hours during night (8-12 times within a 24 hr day)
Hyperemesis Gravidarum
Excessive n/v possibly related to elevated hCG levels prolonged past 12 weeks of gestation
Recurrent premature dilation of the cervix (Incompetent cervix)
Expulsion of the products of conception occurs
2nd degree laceration
Extends through skin and muscle
1st degree laceration
Extends through skin of perineum
4th degree laceration
Extends through skin, muscle, anal sphincter, and anterior rectal wall
3rd degree laceration
Extends through skin, muscle, perineum, and anal sphincter muscle
What is the purpose of a doppler
FHR
Nonreactive stress test
FHR does not accelerate adequately with fetal movement. Does not meet criteria after 40 minutes. Contraction stress test or biophysical profile is indicated Fowlers
Reactive stress test
FHR has moderate variability, accelerated to 15 beats/min for at least 15 seconds and occurs two or more times during a 20 minute period
Contraction stress test
FHR in response to contractions which decreases placental blood flow
Fetal Alcohol syndrome withdrawal
Facial anomalies, stabismus, ptosis, cleft lip or palate, deafness, abnormal palmar creases, irregular hair, developmental delays, prenatal and postnatal growth retardation
Tracheoesophageal atresia
Failure of the esophagus to connect to the stomach
Meds that increase breast milk production
Fenugreek and metoclopramide (Reglan)
Medication for Anemia
Ferrous sulfate, take on empty stomach, encourage diet rich in vitamin C to increase absorption. Iron dextran when oral supplements cannot be tolerated
Biophysical profile assesses?
Fetal HR, breathing, body movements, fetal tone, and qualitative amniotic fluid volume
Passenger
Fetus and palcenta, presentation, lie, attitude, and fetopelvic or fetal position
Dependent: taking in phase
First 24-48 hours, meeting personal needs, needs others for assistance, excited, talkative, need to review birth experience with others
Absent variability
Flat line
Telangiectatic nevi
Flat, pink or red marks that easily blanch and are found on the back of the neck, nose, upper eyelids, and middle of forehead
Convection heat loss
Flow of heat from body to cooler air
Candida Albicans medications
Fluconazole (Diflucan) and clotrimazole (Monistat)
Interdependent: letting go phase
Focuses on family as a unit, resumption of role (partner, family member)
Second stage
Full dilation and ends with birth (intense contractions every 1-2 minutes) (spinal block, pudendal, and local infiltration)
Mild Preeclampsia
Gestational hypertension along with proteinuria of greater than 1+
Betamethasone (Celestone)
Glucocorticoid administered IM in 2 injections 24 hr apart, given to stimulate fetal lung maturity if early delivery is anticipated and to prevent respiratory distress. Can cause pulmonary edema (crackles, chest pain, SOB)
Marked variability
Greater than 25/min
Prolonged or too frequent contraction
Greater than 90 seconds or more than five in a 10-min period
Intrauterine growth restriction
Growth rate does not meet expected norms
Fetal distress
HR below 110 or above 160, shows decreased or no variability, and is hyperactive or no activity
HELLP syndrome
Hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction
H------> in HELLP
Hemolysis resulting in anemia and jaundice
Greatest risks during postpartum period
Hemorrhage, shock, and infection
Lab tests for Anemia
Hgb less than 11 in 1st and 3rd trimester and 10.5 in 2nd trimester, and Hct less than 33%
Neonatal withdrawal
High pitched shrill cry, tremors, increased Moro reflex, increased deep tendon reflexes, increased muscle tone, tachypnea, sweating, temp greater than 99 degrees
Depo-Provera
IM injection given every 11-13 weeks (start should be during first 5 days of clients menstrual cycle)
Ferning test
If positive, indicates rupture of membranes
FUNDUS PRESENTATION
Immediately after delivery, the fundus should be firm, midline with the umbilicus, and approximately at the level of the umbilicus. At 12 hr postpartum, the fundus can be palpated at 1 cm above the umbilicus
Galactosemia
Inability to metabolize galactose into glucose, give newborn soy-based formula because galactose is present in milk, breastfeeding is contraindicated
Decreased progesterone
Increase in muscle tone
Hct, Hgb, and leukocyte changes postpartum
Increased Hct and Hgb (up to 72 hr) leukocytosis of up to 20,000-25,000 (10-14 days)
Methadone withdrawal
Increased incidence of seizures, higher birth weight, higher risk of SIDs
Essure
Insertion of agent resulting in development of scar tissue in Fallopian tubes. Not reversible
Anemia
Iron-deficiency occurs during pregnancy due to inadequacy in maternal iron stores and consuming insufficient amounts of dietary iron
Hypoglycemia
Jittery, nervousness, weak shrill cry, hypothermia, flaccid muscle tone, headache, weakness, irritability, hunger, blurred vision, tingling of mouth and extremities
Precipitous labor
Labor that lasts 3 hours or less from onset of contractions to time of delivery
How is a pregnant womans endocrine system effected
Large of hCG, progesterone, estrogen, prostaglandins.
Fetal lung tests
Lecithin/sphingomyelin ratio- 2:1 indicating lung maturity or 3:1 for diabetes mellitus
Light
Less than 10 cm
Scant
Less than 2.5 cm
Newborn bradycardia
Less than 25
Vasectomy
Ligation and severance of vas deferens. Need alternate form of birth control for 20 ejaculations
Effleurage
Light, gentle, circular stroking of client's abdomen
Position for transvaginal ultrasound
Lithotomy position
Pudenal block
Local anesthetic such as lidocaine or bupivacaine administered transvaginally
Caput succedaneum
Localized swelling of the soft tissue of the scalp caused by pressure in the bead during labor. Resolved in 3-4 days
Evaporation heat loss
Loss of heat as surface liquid is converted to vapor
Radiation heat loss
Loss of heat from body to cooler surface that is close to but not in direct contact
Heroin withdrawal
Low birth weight, SGA, decreased Moro reflex, hypo or hyperthermia
LP-------> in HELLP
Low platelets (less than 100,000) resulting in thrombocytopenia, abnormal bleeding and clotting, bleeding gums, petechiae, and possible DIC
Signs of Downs Syndrome
Low set ears, protruding tongue, absence of head control
Phototherapy indications
Maintain eye mask over neonate's eyes, keep female undressed, avoid lotions or ointments, remove from phototherapy every 4 hours, reposition every 2 hours
What to do with hypertonic contractions?
Maintain hydration, promote rest and relaxation, and place client in lateral position and provide 02 by mask
Psychological response
Maternal stress, tension, and anxiety
Cytomegalovirus
Member of the herpes family, transmitted by droplet infection, found in semen, cervical or vaginal secretions, breast milk, placental tissue, urine, feces, or blood
Opioids
Meperidine, fentanyl, butorphanol, and nalbuphine (have nalozone ready as the antidote)
Gestational hypertension medications
Methyldopa, Nifedepine, Hydralazine, Labetalol hydrochloride, avoid ACE inhibitors and angiotensin 2 receptor blockers
Breast milk
Milk is produced 2-3 days after delivery of newborn
Cervical ripening
Misoprostol and dinoprostone are agents to ripen servix
Warfarin monitoring
Monitor PT (should be 1.5-2.5 times 11-12.5 seconds) and INR of 2 or 3
Heparin monitoring
Monitor aPTT (should be 1.5-2 times 30-40 seconds), have protamine sulfate ready
Carboprost Tromethamine (Hemabate)
Monitor for adverse effects such as fever, chills, diarrhea, headache, and n/v
Oxytocin (Pitocin)
Monitor for water intoxication (lightheaded, n/v, headache, malaise) which can lead to cerebral edema, seizures, coma, and death. Contraindicated based on late decelerations
Moderate
More than 10 cm
Newborn tachycardia
More than 60
How Is a pregants womans GI system effect
N/V Constipation
Hepatitis vaccine
Newborns born to infected mothers should receive the hep B vaccine and hep B immune globulin within 12 hours of birth
Medications for preterm labor
Nifedipine (inhibits calcium which suppresses contractions) and Magnesium sulfate
Physiologic jaundice
Normal newborn physiology, no other manifestations, appears after 24 hours
Rubella titer
Obtained at initial prenatal visit (about 6 weeks gestation)
Percutaneous blood sampling
Obtains fetal blood from umbilical cord which evaluates isoimmune fetal hemolytic anemia and assesses need for fetal blood transfusion
Postpartum depression
Occurs within 6 months of delivery and is characterized by persistent feeling of sadness, guilt, weight loss, flat affect, rejection of infant, anxiety, irritability, intense mood swings
Position
Of the woman who is in labor, should engage in frequent position changes during labor to increase comfort, relieve fatigue, and promote circulation
Antiemetics
Ondansetron and metoclopramide
Excessive blood loss
One pad saturated in 15 min or less or pooling of blood under buttocks
Heavy
One pad saturated within 2 hr
Herpes Simplex Virus
Oral or genital lesions, transmission to the fetus is greatest during vaginal birth if the woman has active lesions. Fetal consequences include miscarriage, preterm labor, and intrauterine growth restriction
OGTT
Overnight fasting, avoid caffeine, no smoking for 12 hours prior to test, fasting glucose is obtained, 100 g glucose load is given, and serum glucose levels are determined at 1, 2, and 3 hours following ingestion
How is the pregnant womans respiratory effected
Oxygen needs increase. last trimester- size of chest can enlarge respiratory rate increases while total lung capacity decreases
Postpartum hemorrhage medications
Oxytocin, methylergonovine (Methergine), misoprostol (Cytotec), and Carboprost tromethamine (Hemabate)
Oxytocics
Oxytocin, methylergonovine maleate, and carboprost
Treatment of retained placenta
Oxytocin. If it doesn't work then move to Terbutaline (Brethine)
Phenylketonuria
PKU is a defect in protein metabolism which can result in mental retardation
Signs of inversion of the uterus
Pain in the lower abdomen, large, red mass protruding 20-30 cm outside the vaginal opening , dizziness, hypotension, pallor
Gonorrhea
Painful urination, frequency, lower abdominal pain (female), dysmenorrhea, yellow-green vaginal discharge, reddened vulva and vaginal walls, if left untreated it can cause PID, heart disease and arthritis
Signs of placenta previa
Painless vaginal bleeding
Steps of Leopold Maneuver
Palpate client's fundus, determine location of fetal back, palpate fetal part presenting at the inlet, and palpate the cephalic prominence to identify the attitude of the head
5 P's that define the labor process
Passenger, passageway, powers, position, and psychological response
Transdermal contraceptive patch
Patch applied to dry skin overlying subQ tissue, excluding breast
What do they want the outcome to be for the fetus for the nipple stimulated stress test
Pattern of three contractions within 10 min with a duration of 40-60 sec
Medications for GBS
Penicillin G or Ampicillin (Principen)
Amniocentesis
Performed after 14 weeks gestation, empty bladder beforehand, client in supine position
Lochia Serosa
Pinkish brown color and serosanguineous consistency. Lasts from approximately day 4 to day 10 after delivery
Lochia serosa
Pinkish/brown, serosanguineous. Lasts day 4-10 postpartum
Late deceleration of FHR
Place client in side-lying position, insert IV catheter and increase fluids, discontinue pitocin, administer 02
Placenta previa
Placenta abnormally implants in the lower segment of the uterus near or over the cervix. Results in abnormal bleeding during the 3rd trimester as cervix begins to dilate
Placenta previa- marginal or low lying
Placenta is attached to lower uterine segment but does not reach cervix
Nursing care for fetal distress
Position client in left side lying reclining position with legs elevated, 8-10 liters of 02
Group B Streptococcus B-hemolytic
Positive GBS may have effects including premature rupture of membranes, preterm labor, chorioamnionitis, infections of urinary tract, and maternal sepsis. Vaginal and rectal cultures are performed at 36-37 weeks of gestation
Nitrazine paper test or ferning test
Positive test (blue, pH 6.5-7.5) verifies rupture of membranes
Spontaneous abortion
Pregnancy is terminated before 20 weeks or fetal weight is less than 500 g. Vaginal bleeding, uterine cramping, and partial or complete expulsion of products of conception
Abruptio placenta
Premature separation of placenta from uterus. Can occur after 20 weeks gestation
Marijuana withdrawal
Preterm birth and meconium staining
Amphetamine withdrawal
Preterm or SGA, drowsy, jittery, respiratory distress, frequent infections, poor weight gain, emotional disturbances
Phototherapy
Primary treatment for hyperbilirubinemia, prescribed if the level is greater than 15 mg/dL prior to 48 hr of age, greater than 18 mg/dL prior to 72 hr of age, and greater than 20 mg/dL at any time
Treatment for recurrent premature dilation of the cervix
Prophylactic cervical cerclage is the surgical reinforcement of the cervix with a heavy ligature that is placed submucosally around the cervix to strengthen it and prevent premature cervix dilation (best done 23-24 weeks of gestation)
Opiate withdrawal
Rapid mood changes, hypersensitivity to noise, dehydration, and poor weight gain
Variable deceleration of FHR
Reposition client from side to side or into knee-chest
Pathologic jaundice
Result of an underlying disease appearing before 24 hours (or persistent after day 7)
Kernicterus
Results from untreated hyperbilirubinemia with levels t or higher than 25 mg/dL
immunizations statuses
Review rubella status - A client who has a titer of less than 1:8 is administered a subcutaneous injection of rubella vaccine or a measles, mumps and rubella vaccine during the postpartum period to protect a subsequent fetus from malformations. Clients should not get pregnant for 1 month following the immunization. ■ Review hepatitis B status - Newborns born to infected mothers should receive the hepatitis B vaccine and the hepatitis B immune globulin within 12 hr of birth. Review Rh status - All Rh-negative mothers who have newborns, and are Rh-positive, must be given RH (D) immune globulin (RhoGAM) IM within 72 hr of the newborn being born to suppress antibody formation in the mother. Review varicella status - If the client has no immunity, varicella vaccine is administered before discharge. The client should not get pregnant for 1 month following the immunization. A second dose of vaccine is given at 4 to 8 week
Breast milk storage
Room temp 8 hr, refrigerated 8 days, freezer 6 months, and deep freezer 12 months
Maternal Serum Alpha-Fetoprotein
Screening tool for neural tube defects that is effective between 15 and 22 weeks. levels above indicate the need for an ultrasound
3 hour glucose tolerance test
Screens for gestational diabetes and is done at 28 weeks of gestation
Pulmonary embolism interventions
Semi-fowler's position, administer 02, administer alteplase or streptokinase
Eclampsia
Severe preeclampsia symptoms along with seizure activity or coma. Preceded by headache, severe epigastric pain, hyperreflexia, and hemoconcentrations
Category 3
Sinusoidal pattern, absent baseline fetal HR variability, nervous system of neonate not intact
Epstein Pearls
Small white cysts found on the gums and at the junction of the soft and hard palates
Diaphragm
Spermicide must be applied with each act of sexual intercourse and should remain in place 6 hrs after. Empty bladder prior to coitus
Premature rupture of membranes
Spontaneous rupture of amniotic membranes 2 hour or more prior to the onset of true labor
Moro reflex
Startle
Decrease or loss of FHR variability
Stimulate fetal scalp, assist provider with application of scalp electrode, and place client in left lateral position
Dehydration
Stimulates uterine contractions
True labor contractions
Stronger, last longer, more frequent, felt in lower back radiating to abdomen,doesn't decrease with comfort measures, walking can increase intensity, cervix shows progressive change
Sign of anaphylactoid syndrome
Sudden chest pain, cyanosis, dyspnea, pulmonary edema, respiratory arrest
Signs of abruptio placenta
Sudden onset of dark red vaginal bleeding, sharp abdominal pain, and tender rigid uterus (board like)
Gestational trophoblastic disease
Swollen, fluid-filled grape like clusters in the placenta. Associated with choriocarcinoma which is a rapidly metastasizing malignancy
Respiratory distress syndrome, asphyxia, meconium staining
Tachypnea, nasal flaring, expiratory grunting, retractions, fine crackles, cyanosis
What is Naegele's rule
Take the first day of the womans last menstrual cycle, subtract 3 months and then add 7 days and 1 year
Postpartum blues
Tearfulness, insomnia, lack of appetite, sleep pattern disturbances, crying, and feeling letdown. Typically resolve in 10 days without intervention
Medication for inversion of the uterus
Terbutaline (Brethine) which relaxes the uterus in order to place it back into the uterine cavity
What does biophysical profile indicate?
The risk of asphyxia-deficient oxygen
Passageway
The size and shape of the bony pelvis must be adequate to allow fetus to pass through
Candida Albicans
Thick, creamy, white vaginal discharge, vulvar redness, white patches on vaginal walls, grey-white patches on tongue and gums (neonate)
Hyperglycemia
Thirst, nausea, abdominal pain, frequent urination, flushed dry skin, and fruity breath
Vitamin K
To prevent hemorrhagic disorders because this vitamin is not produced in the GI tract until day 8 (once breast milk is introduced into gut)
Application of Erythromycin
To prevent ophthalmia neonatorum. Lower conjunctival sac of each eye starting from inner canthus and moving outwards
Plantar grasp
Touch sole of foot, toes curl downwards
TORCH
Toxoplasmosis, Rubella, Cytomegalovirus, and Herpes Simplex Virus
Inversion of uterus
Turning inside out of the uterus (emergency situation)
Urinary and bladder changes postpartum
Urinary retention (resulting in distended bladder) assess client's ability to void every 2-3 hours. Excessive diuresis (1500-3000 mL/day) is normal within the first 2-3 days
what should be the output findings of the newborn
Urine should be passed within 24 hr after birth. Uric acid crystals will produce a rust color in the urine the first couple of days of life. Meconium should be passed within 24 to 48 hr after birth.
Car seat safety
Use rear-facing car seat in back seat, preferably the middle until age 2 or until the child reaches max height and weight
Signs of retained placenta
Uterine atony, subinvolution, inverstion, clots larger than a quarter, the return of lochia rubra, malodorous discharge, elevated temp
Preterm labor
Uterine contractions and cervical changes occurring between 20 and 37 weeks gestation, persistent low back ache
Powers
Uterine contractions cause effacement and dilation of the cervix
Signs of gestational trophoblastic diease
Uterine size increasing abnormally fast, abnormally high levels of hCG, nausea and increased emesis, no fetus present on ultrasound, and scant or profuse dark brown or red vaginal bleeding
Subinvolution of uterus
Uterus remains enlarged with continued lochial discharge which may result in postpartum hemorrhage
Chlamydia
Vaginal spotting, vulvar intching, postcoital bleeding and dysuria, white watery discharge
Diagnostic for preterm labor
Vaginal swab for fetal fibronectin which appears between 24-34 weeks. Found when fetal membrane integrity is lost
The expected ranges of physical measurements X
Weight - 2,500 to 4,000 g (Weigh newborns at the same time daily.) X Length - 45 to 55 cm (18 to 22 in) X Head circumference - 32 to 36.8 cm (12.6 to 14.5 in) X Chest circumference - 30 to 33 cm (12 to 13 in)
Large for gestational age
Weight is above 90th percentile
Small for gestational age
Weight is below 10th percentile
Appropriate for gestational age
Weight is between 10th and 90th percentile
Low birth weight
Weight is of 2,500 grams or less at birth
When is Rho-GAM administered
Within 72 hrs to women who are Rh-negative and gave birth to an infant who is Rh-positive
Lochia alba
Yellowish, white cream color. Lasts approx 11 days-6 weeks postpartum
Lochia alba
Yellowish, white creamy color, fleshy odor. Lasts from approximately day 11 beyond 6 weeks postpartum
Primigravida
a woman in her first pregnacy
Multigravida
a woman who has had two or more pregnancy
Nulligravida
a woman who has never been pregnany
What is interpreted as a reactive fetal HR
accelerates to 15 beats/min for at least 15 sec and happens 2 or more times in a 20 min period
What is the purpose of a tocotransducer
contractions
Chadwicks sign
deepened violet bluish color of cervix and vaginal mucosa
when using the photo therapy for a jaundiced baby watch for what
dehydration rash bumps- maclopapular
What does a higher ranges of hCG and inhibin A indicate
down syndrome
What does lower than expected levels of estirol mean
downs syndrome
How many times does a women visit the doctor for prenatal care during 8 months
every 2 weeks
how often should your monitor bilirubin levels when they are under the light
every four hours
What does PKU mean
genetic disease in which phenylalanine poses a threat to the baby low phenylalanine foods-protein, eggs, nuts, dairy
What are the causes of bleeding during 2nd trimester
gestational trophoblastic disease
Primipara
has completed one pregnancy to stage of viability
Multipara
has completed two or more pregnancies to stage of viability
fetal lung test purpose
if gestation is less than 37 weeks, In the event of a rupture of membranes, preterm labor, or for compliations indicating a cesearn birth supine with wedge behind hip
How is the pregnant womans cardiovascular effected
increase in cardiac output and heartheart
How are proataglandin given
into the amniotic sac or as a vaginal suppository d4
Nevus flammeus (port wine stain
is a capillary angioma below the surface of the skin that is purple or red, varies in size and shape, is commonly seen on the face, and does not blanch or disappear
Erythema toxicum (erythema neonatorum)
is a pink rash that appears suddenly anywhere on the body of a term newborn during the first 3 weeks. This is frequently referred to as newborn rash. No treatment is required
What are some general symptoms of torch
joint pain malaise rash flulike lymph tenderness
What is the term for when there is an excess of bilirubin the brain up to 25mg
kernicterus causes cerebral palsy, epilepsy and even mental retardation
What are the risk factors for throboblastic disease
low carotene/ animals fat early teen or over 40 ovulation stimulation with clomiphene (Clomid)mz
What is the purpose of the non stress test
monitoring for an intact fetal CNS during the third trimester Ruling out the risk for fetal death in clients who have diabetes. Used twice a week or until after 28 weeks of gestation
how many times does a women visit the doctor for prenatal care from 0-7months
monthy
does a doctor want a positive for neg contraction stress test
negative if within a 10 min period 3 uterine contractions with no deceleration of FHR positive means-cord compression fetal head compression- need contraction for 10-20min
What does a high AFP indicate
neural tube defect
Nullipara
no pregnancy beyond the stage of viability
Head circumference should be 2 to 3 cm larger than the chest circumference.
over that = hydrocephalus
What are the causes of bleeding during the 3rd trimester
placenta previa abrupto placenta
Ballottement
rebound of unengaged fetus
Heartburn, constipation, backaches, varicose veins happens when
second and third trimester
What lab levels do they look at from sickle cell
sickle hcg
Hegar's sign
softening and compressibility of lower uterus
Goodells sign
softening of the cervical tip
What is causes of pregnanct bleeding during the 1st trimester
spontaneous abortion ectopic pregnancy
Telangiectatic nevi
stork bites back of the neck, nose, upper eyelids, and lower occipital area.
How is a pregnant womans renal system effected
urinary frequency
What do the doctors do if the baby does not move during the Non reactive stress test to wake up the baby
vibroacoustic stimulation
How many times does a woman visit the doctor for prenatal care during month 9
weekly
Nipple stimulated stress test
woman lightly brushing her palm across her nipple for 2 min, to cause a release of oxytocin for a contraction one agsin after 5 min if mom cant do it IV oxytocin -observe 30min after for stop in contractions and to make sure there isn't a preterm labor
What are the manifestations of kernicterus
yellow skin lethargic hypotonic poor suck reflex increased sleepiness not treated-arching of back and trunk high pitched cry and fever