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.