Maternal Child Test 2
Phototherapy
-most common treatment of jaundice and involves placing the infant under special lights. -bilirubin in the skin absorbs the light and changes into water-soluble products, the most important of which is lumirubin.
Uterine Fibroids:
-most common type of tumor for female -benign tumors of uterine muscles and connective tissue -disappear with menopause -can cause infertility by blocking tubes
The __________ ____ infant excretes pale yellow to light brown stools. They are firmer in consistency. The infant may excrete several stools daily, or only one or two. The stools have the characteristic odor of feces
formula fed
Dystocia
Difficult labor, usually from having a large baby.
Direct Coombs' Test
Done on the infant's blood to detect antibody-coated Rh+ RBCs.
Indirect Coombs' Test
Done on the mother's blood to measure the number of Rh+ antibodies.
____________ occurs when the endometrial tissue is present outside the uterus. Often associated with secondary dysmenorrhea, chronic pelvic pain, dyspareunia (painful intercourse), and infertility. This pain may be deep, unilateral or bilateral, and either sharp or dull.
Endometriosis
_______ refers to the prolapse of the upper posterior vaginal wall between the vagina and rectum.
Enterocele
_______ is an incision of the perineum just before birth to enlarge the vaginal opening.
Episiotomy
Types of Breech
complete--(full)-head, knees, hips flexed-butt is presenting. frank--legs are extended across abdomen towards shoulders. footling--one or both feet are presenting
The antibodies may be either IgG or IgM. When the woman becomes pregnant, the IgG antibodies ______ ___ _________ _________ and cause hemolysis of fetal red blood cells.
cross the placental barrier
When the weakened upper anterior wall of the vagina is no longer able to support the weight of the urine in the bladder, a _______ develops.
cystocele
Pessary:
device inserted into the vagina to support the uterus. *prevents uterine prolapse*
A and B blood types are a _______ trait.
dominant
Rh-positive blood is a _______ trait.
dominant
RhoGAM is also administered after:
each abortion (spontaneous or therapeutic), ectopic pregnancy, or amniocentesis
The orientation of the long axis of the fetus to the long axis of the woman is the _______ ______.
fetal lie
Rh incompatibility is a problem that affects the ______; it causes no harm to the _________.
fetus; mother
Fetal attitude
flexion or extension of the fetal body and extremities
The ______ are wider spaces at the intersections of the sutures. Also know as the soft spots.
fontanels
4 methods of heat loss in the neonate:
-convection -radiation -evaporation -conduction
Thermogenesis
Heat production
Precipitous Labor:
-*Rapid birth that occurs within 3 hours of labor onset* Causes: -lack of resistance to maternal tissue that slows the baby -contractions become too strong -multigravidas, multiparas -large pelvis -maternal cocaine use Complications: -precipitate birth with no attendent -abruptio placentae -fetal meconium aspiration syndrome -postpartum hemorrhage -low Apgar score for infant
Passage
forms the bony canal through which the baby must pass. -pelvis size and shape
Second Stage of Labor:
(expulsion) stage begins with complete (10cm) dilation and full (100%) effacement of the cervix and ends with the birth of the baby. Contractions will be strong, but the woman may feel more in control because she is actively completing the process by pushing with them. "Labor" describes this stage well. *Complete dilation to the birth of the baby.* -involves crowning-fetal head is seen.
Physical maturity: Lanugo
(fine hair-covers body of baby) -appears by 20 weeks of gestation and increases in amount until 28 weeks, when it begins to disappear -most shed at 32 weeks to 36 weeks
Third Stage of Labor:
(placental) stage begins with the birth of the baby and ends with the expulsion of the placenta. Pain during this stage results from uterine contractions and brief stretching of the cervix as the placenta passes through it. **delivery of placenta **Uterus shrinks after baby is delivered. The reduced size decreases size of placenta site, causing placenta to separate from the uterine wall.
IgA
**appears in body secretions (nasal and respiratory secretions, saliva, tears, BREAST MILK) -prevents infection across mucous membranes (local immunity). -especially important in antiviral protection -passes to neonate in breast milk
Neuromuscular maturity: Popliteal Angle
**degree of knee flexion -to measure this, the newborn's lower leg is folded against the thigh, with the thigh on the abdomen -then the lower leg is straightened just until resistance is met -the angle is scored when resistance is first met -the preterm infant extends the leg farther than the full-term infant
IgD and IgE
*Always in the blood in small amounts* -Produced by plasma cells in mucous membranes and tonsils and in lymphoid tissue. -Leads to release of histamines, *producing an allergic response* -elevation may indicate allergy in children -plays a role in defense against parasites
IgM
*Released into plasma (blood) during immune response* *First immunoglobulin produced in response to bacterial and viral infections* -Responsible for transfusion reactions in the ABO blood typing system *Does not cross placenta, so values are low in neonates* -produced early in life, and level increases after 9 mo of age -Presence in cord or infant blood may mean infection in utero or in newborn period
Fourth Stage of Labor:
*Stage of physical recovery for the mother and the infant.* It lasts form delivery of the placenta through the first 1 to 4 hours after birth. The vaginal drainage during this stage is lochia rubra, which consists mostly of blood. Small clots may also be presented.
IgG
*appears in all internal body fluids* -contains most antibodies against bacteria, viruses, and fungi in blood and body spaces *only immunoglobulin that crosses the placenta; provides maternal antibody protection to infants* -responsible for Rh reactions -Response is longer and stronger than that of the other immunoglobulins
Active
*dilated 4-6cm* -Frequency: every 2-3 minutes -Duration: 60 seconds -Intensity: Begin as moderate an progress to strong
Passenger
*fetus plus the membranes and placenta* Fetal head: -molding -sutures -fontanelles Fetal attitude Fetal lie Fetal presentation Fetal position
Moro Reflex:
*is the most dramatic reflex* -occurs when the infant's head and trunk are allowed to drop back to 30 degrees when the infant is in a slightly raised position *the infant's arms and legs extend and abduct, with the fingers fanning open and thumbs and forefingers forming a C position* -the arms then return to their normally flexed state with an embracing motion -the legs may also extend and then flex
Latent Phase
*start of labor to dilation of 0-3cm* -Frequency: Every 10-30 minutes -Duration: 15-30 seconds progressing to 30-40 seconds -Intensity: Begin as mild and progress to moderate
Conduction
-*movement of heat away from the body occurs when newborns come in direct contact with objects that are cooler than their skin* -when the infant comes in contact with cold object or surfaces such as a scale, a circumcision restraint board, cold hand, or a stethoscope -contact with warm objects increases body heat -warming objects that will touch the infant or placing the unclothed infant against the mother's skin ("skin to skin") helps prevent heat loss
Convection
-*occurs when drafts come from open doors, air conditioning, or even air currents created by people moving about* -transfer of heat from the infant to cooler surrounding air -when infants are in incubators, the circulating warm air helps keep them warm -providing a warm, draft-free environment avoids this
The bones of the fetal head involved in birth are the:
-2 frontal bones on the forehead -2 parietal bones at the crown of the head -occipital bone at the back of the head
Primary sources of infection for PID:
-C. trachomatis -N. gonorrhoeae
Birth Injuries:
-Caput succedaneum -Cephalohematoma -Subdural hematoma -fractures -paralysis: --facial --Erb's palsy (brachial palsy)
Erythroblastosis Fetalis
-Caused by excessive hemolysis Agglutination and hemolysis of fetal erythrocytes resulting from incompatibility between maternal and fetal blood. In most cases the fetus is Rh-positive and the mother is Rh-negative.
Noninvasive Breast Cancer
-Ductal Carcinoma in situ (DCIS) tends to be unilateral and most likely would progress to invasive breast cancer if left untreated -carcinoma in situ is an early form of cancer defined by the absence of invasion of surrounding tissue -cancer becomes invasive when it is no longer confined to the duct and it spreads to surrounding breast tissue -treatment: local excision, mastectomy with breast reconstruction, breast-conserving treatment (Lumpectomy), radiation therapy and/or tamoxifen (Nolvadex)
Effects of syphilis on pregnancy:
-If pregnant during the primary and secondary stages there is a high change of stillbirth -the disease can reach the placenta -if untreated can cause abortion -fetus can be born premature
Newborn Characteristics: Vital Signs
-Respiration: 30-60bpm, 5-15 second periods of apnea -Heart Rate: 120-160bpm -BP: term 74/47; preterm 64/39 -Temperature: axillary 97.7 to 99.7F; rectal 99.7 to 100.7F
The cephalic presentation is more favorable than others, for several reasons:
-The fetal head is the largest single fetal part. After the head is born, the smaller parts follow easily as the extremities unfold. -During labor the fetal head can gradually change shape to adapt to the size and shape of the maternal pelvis. The fetal head is smooth, round, and hard; making it an effective part to dilate the cervix, which is also round.
Maternal Nutrition:
-a balanced diet is the best way to receive nutrients, but vitamin supplements can also be beneficial -pregnant women should only take vitamin supplements on a health care provider's recommendation -supplements do not replace a healthy diet but rather ensure that a woman is receiving enough daily nutrients -vitamin supplements work best when taken as part of a healthy diet and not as a substitute for a healthy diet
General Anesthesia:
-a systemic pain control that involves loss of consciousness -rarely used for vaginal births -used for C-sections and emergency procedures Adverse Effects- maternal aspiration of gastric contents, respiratory depression, uterine relaxation, post-partum hemorrhage-may occur if uterus relaxes after birth.
Findings during physical examination for PID:
-abdominal or adnexal tenderness (accessory organs to the uterus such as fallopian tubes and ovaries) and pain of the uterus and cervix when they are moved during bimanual examination
Evaporation
-air-drying of the skin that results in cooling -drying the infant immediately when wet helps prevent loss of heat -insensible water loss from the skin and respiratory tract increases heat loss from evaporation
Lobular Carcinoma in situ LCIS:
-although this is a risk factor developing breast cancer it is not known to be a premalignant lesion -no treatment is necessary
Treatment for PID:
-antibiotics -surgery may be required for women who have a pelvic abscess or other persistent problems.
Hypoglycemia in the newborn:
-appears within 2 to 4 hours after delivery of babies of diabetic mothers **hypoglycemia is serum glucose <40** S/S: jitteriness, restlessness, tremors -can lead to sepsis Tx: feed ASAP and monitor closely Normal blood sugar levels: First day (day of birth): 40-60 After first day: 50-90
Estimation of Gestational Age:
-assessment of the newborn to determine the number of weeks from conception to birth -the determination is based on physical and neurologic characteristics -it is important because neonates born before or after term and those whose size is not appropriate for gestational age are at increased risk for complications
Maternal post-partum assessments:
-breasts -fundus -lochia -perineum/episiotomy-REEDA -lower extremities -vital signs-temperature is most important, can show signs of infection -nutrition -elimination -sleep -comfort/relief of pain -bonding with infant
S/S of placenta previa:
-bright red bleeding -nonrigid abdomen -no pain -effect on blood pressure and pulse depends on amount of bleeding
Opioid Analgesics
-causes respiratory depression Meperidine (Demerol)-causes dysphoria and loopy feeling Fentanyl (Sublimaze)-given at the start of labor Butorphanol (Stadol)-should not be given to opioid dependent women. Has some narcotic antagonist effects Nalbuphine (Nubain)-shows lower FHR accelerations, lower neuro behavior in newborns.
Fibrocystic Breast Changes:
-common breast changes during the reproductive years -fibrosis or thickening of the normal breast tissue, occurs in early stages -cysts form in the latter stages and are felt as multiple, smooth, well-delineated nodules that have a **tender, moveable** character -the lumpy, rubbery, rope-like nodules vary in size for less than 1 cm to several cm -causes breast pain and tenderness
True Labor:
-contractions are at regular intervals -intervals between contractions gradually shorten -contractions increase in duration and intensity -discomfort begins in back and radiates around to abdomen -intensity usually increases with walking -cervical dilatation and effacement are progressive
False Labor:
-contractions are irregular -discomfort is usually in the abdomen -walking has no effect or lessens contraction
Physical maturity: Sole Creases
-creases begin to appear at 28-30 weeks of gestation and cover the entire sole by term
S/S of Marginal Abruptio Placentae:
-dark red vaginal bleeding -nonrigid abdomen -tenderness over uterus -decreased blood pressure
Causes of pre-term labor:
-diabetes -infections-such as UTI -uterine anomalies -age <16 or 40> -prior abdominal surgery -multiple pregnancies (ex. twins)
Cancer of the Ovary:
-diagnosed generally between 55-65 yoa -usually far advanced before diagnosis -Diagnosed by: CA-125 tumor markers, *ultrasounds, and pelvic exam* -Causes: menses started at <12 yoa, family hx of ovarian/breast/colorectal cancer, nullipara, increased fatty diet, late menopause, infertility/infertility drugs, personal hx of breast cancer -S/S: usually asymptomatic, gas pains. Later s/s: vaginal draining/bleeding, ascites, edema in legs, abdominal discomfort. -Treatment: total hysterectomy, chemo/radiation
Syphilis:
-divided into the primary, secondary and tertiary stages If not treated it will progress and can become terminal -Primary-outbreak last 3-6 weeks -Secondary- lasts 1-2 years -Tertiary-lasts several years (4), still contagious up to 4 years. -Diagnosis: serum blood test -Treatment: Penicillin
Neuromuscular maturity: Square Window
-elicited by flexing the hand at the wrist until the palm is as flat against the forearm as possible with gentle pressure -the more mature the neonate, the smaller the angle, until the palm folds flat against the forearm at term
Babinski Reflex:
-elicited by stroking the lateral sole of the infant's foot from the heel forward and across the ball of the foot -this causes the toes to flare outward and the big toe to dorsiflex
Chlamydia:
-enters body through abrasions or lacerations and infects cells of the conjunctiva or cells lining mucous membranes of urinary or reproductive tract
Sucking Reflex:
-essential to normal life -when the mouth or palate is touched by the nipple or a finger, the infant begins to suck
Signs and symptoms of ruptured uterus:
-excruciating pain -contractions stop Complications: -could lead to hypovolemic shock -fetal death
Physical maturity: Eyes and Ears
-eyelids are fused until 26-28 weeks -the incurving of the upper pinnae at the top and continues around the ear -the ear is folded to assess the resistance and the speed with which it returns to its original state -in infants less than 34 weeks of gestation, the ear has little cartilage to keep it stiff -with the term neonate, the ear springs back to its original position immediately
Newborn Cares:
-eyes-erythromycin ointment administered in lower conjunctiva to prevent ophthalmia neonatorum. Given to all newborns -umbilicus-should be checked for bleeding or oozing. Monitor for signs of infection. Clean with water when necessary, otherwise keep clean and dry. -circumcision-assure that diaper is attached loosely to prevent pressure. Monitor for signs of complications, assess wound frequently for bleeding during first few hours post-op. Monitor for first urination, because edema can cause obstruction. -vitamin K-given within 2 hrs after birth, lasts 8 days. Prevents excessive bleeding, especially from circumcision. -Nutrition
Risk factors for breast cancer:
-female, age 50 or over -family history or personal history of breast cancer, colon cancer, endometrial cancer, ovarian cancer -early menarche (<12); late menopause (>55) -first time pregnancy after age 30 -benign breast disease with atypical epithelial hyperplasia, lobular carcinoma in situ -weight gain and obesity after menopause -exposure to ionizing radiation -high consumption of alcohol -decreased physical activity-sedentary lifestyle
Causes of hydramnios:
-fetal hyperglycemia -diabetic mother -Rh sensitized mother -multiple gestations
Platypelloid
-flat and narrow-front to back, wide-side to side -not adequate for vaginal delivery
Neuromuscular maturity: Ankle Dorsiflexion
-flexion of the ankle to the shin
Neuromuscular maturity: Scarf Sign
-for this, the nurse grasps the infant's hand and brings the arm across the body to the opposite side, keeping the shoulder flat on the bed and the head in the middle of the body -the position of the elbow in relation to the midline of the infant's body is noted -the full-term infant's elbow does not cross the midline but the preterm infant's arm extends farther toward the opposite side
Newborn Ballard Score
-frequently used to determine gestational age based on neuromuscular and physical characteristics -it is accurate within 2 weeks of gestation -a score is given for each assessment, and the total score is used to determine the gestational age of the infant
Vernix on different ages of infants:
-full-term--little vernix left on the body except small amounts in the creases -preterm--has a thick vernix covering yellow-tinged vernix--may indicate elevated bilirubin levels in utero green-tinged vernix--caused by meconium staining
Types of pelvis':
-gynecoid -android -anthropoid -platypelloid
Newborn Measurements:
-head circumference: 13-15 inches -chest: 12-13 inches -crown to rump length: 12.5-14 inches -weight: 7.5 pounds -*pulse and respirations: 120-160bpm* *100 bpm while sleeping* *180-200bpm while anxious, crying, hungry, etc.* *30-60 respirations per minute*
The Apgar Score assesses:
-heart rate -respiratory effort -muscle tone -reflex response -color
Heat Loss
-heat is readily transferred from the warmer internal areas of the body to the cooler skin surfaces and then to the surrounding air
Rooting Reflex:
-important in feeding and is most often demonstrated when the infant is hungry -when the infants cheek is touched near the mouth, the head turns toward the side that has been stroked
Premature Infants:
-infant born prior to 38 weeks gestation -infants often appear frail and weak, and they have less developed flexor muscles and muscle tone compared to full-term infants -their extremities are limp, and infants typically lie in an extended position -#1 risk for these infants is infection -they can also develop oxygen toxicity which can cause retinal detachment; the nurse should keep the infant's eyes closed
Gonnorhea (AKA: clap or drip)
-infection of the genitourinary tract -S/S: often asymptomatic in women, but symptoms that do occur may include purulent discharge, dysuria, and painful intercourse, urinary frequency, PID, swelling of genitals and cervix -diagnosis: based on positive culture of discharge -Treatment: involves treatment of all sexual partners to prevent outbreak, antibiotics then re-culture of drainage, man should wear condom until cure is confirmed
Causes of premature rupture of membranes:
-infections of vagina or cervix -amniotic sac with a weak structure -Chorioamnionitis (intraamniotic infection) -previous preterm birth, especially if preceded by PROM.
Intrathecal (Subarachnoid) Analgesia:
-injection of opioid analgesic into the subarachnoid space in a single dose. Disadvantages: -limited duration, may require another procedure -inadequate pain relief for labor and delivery
Treatment for Endometriosis
-laparoscopy -birth control -Danosil (danocrine)-suppresses menstruation -Depo shot-inhibits progesterone -Micronor (norethindrone)-inhibits growth of excessive endometrial tissues.
Treatment for Ovarian Cysts:
-laparoscopy -laparotomy
Prolonged Labor:
-lasting more than 24 hours Causes: -cephalopelvic disproportion Complications: -may have maternal infection, intrapartum or postpartum -neonatal infection, which may be severe or fatal -maternal exhaustion -higher levels of anxiety and fear during a subsequent labor
Pyelonephritis
-leads to increased risk for preterm labor and premature delivery. -maternal complications include a high fever, septic shock, and adult respiratory distress syndrome. -pregnant women often require hospitalization for acute care. Caused from back-flow of urine from bladder to kidneys.
Premonitory signs of labor:
-lightening (engagement) - dropping-present in primigravida and nullipara -Braxton Hicks Contractions -Cervical changes-soft cervix-effacement and dilation. -Bloody show-loses cervical plug-deliver in 32-48 hrs -rupture of membranes (ROM)-creates pooling beyond 37 weeks -sudden burst of energy (nesting)-24-48 hrs before delivery
Anthropoid
-long, narrow oval -second most favored for vaginal delivery -may need forceps
Partial Placenta Previa
-lower border of placenta is within 3 cm of internal cervical os but does not fully cover it
Prevention of pre-term labor:
-magnesium sulfate -bedrest -monitor contractions and FHR -calcium channel blockers
Android
-male pelvis -not adequate for childbirth
Complete Abruptio Placentae
-massive vaginal bleeding -rigid abdomen -acute pain in abdominal area -profound shock
Psyche
-maternal emotions (ex. anxiety, fear, fatigue)
Ovarian Cysts:
-may either be follicular or luteal -if the ovarian follicle fails to rupture during ovulation, a follicular cyst may develop -a lutein cyst may develop if the corpus luteum becomes cystic and fails to regress. -a lutein cyst is more likely to cause pain and some delay in the next menstrual cycle Can be diagnosed by transvaginal ultrasound
Inflammatory Breast Cancer:
-most malignant form of all breast cancers, is rare -an aggressive and fast-growing cancer -the skin of the breast looks red, feels warm and has a thickened appearance that is often described as resembling an orange peel -metastases occurs early and widely -radiation therapy, chemotherapy and hormone therapy are more likely to be used for treatment than surgery
Narcotic addicted infants:
-narcotics pass placental barrier -withdrawal symptoms appear 12-72 hours after birth -infants become passively addicted -can lead to meconium aspiration syndrome Medical Tx: -morphine, tincture of opium, methadone, phenobarbital
Teenage Pregnancy:
-need early prenatal care -greater risk for complications--such as: premature labor, decreased birth weights, increased fetal death, toxemia, hypertension, anemia, prolonged labor. -education--of infant needs and parenting skills, importance of eliminating unhealthy habits -diet--encourage iron and calcium. Folic acid is needed and is very important
S/S of fibrocystic breast changes:
-nipple discharge that can be green/yellow and milky -bilateral pain that is worse before period starts (pre-menstrual)
Central Abruptio Placentae
-no overt bleeding from vagina -rigid abdomen -acute pain in abdominal area -decreased blood pressure
Stepping Reflex:
-occurs when the infants are held upright with their feet touching a solid surface -they lift one foot and then the other, giving the appearance that they are trying to walk
Palmar Grasp Reflex:
-occurs when the infants palm is touched near the base of the fingers -the base of the fingers -the hand closes into a tight fist -may be weak or absent if the infant has injury to the nerves of the arms
Interval
-period between the end of one contraction and beginning of next -time when most fetal exchange of oxygen, nutrients, and waste products occurs.
Total Placenta previa
-placenta completely covers internal cervical os.
Marginal Placenta Previa
-placenta is implanted in lower uterus but its lower border is >3cm from internal cervical os.
Premature rupture of membranes lead to:
-placenta previa -placenta abruptio -infection -prolapsed cord -pulmonary hypoplasia -post natal endometriosis -fetal death **Mother needs to be on bed rest.
Newborn Assessments:
-posture -skin -caput succedaneum -vernix -lanugo -milia -reflexes
Neuromuscular maturity: Posture
-posture and degree of the extremities are scored before disturbing the quiet infant -preterm neonates with immature flexor muscles have extended limp arms and legs -the limbs of full-term infants are sharply flexed -the legs should be flexed at the hips, knees, and ankles
4 p's of normal childbirth
-powers -passage -passenger -psyche
Epidural Block Anesthesia:
-provides pain control during much of labor and for the birth. -used for both vaginal and cesarean births. -injection of local anesthetic and opioids into the epidural space. Between L3 and L4 Adverse Effects- maternal hypotension, bladder distention, prolonged 2nd stage, migration of epidural catheter, fever, pruritis.
Paget's Disease:
-rare breast malignancy characterized by a persistent lesion of the nipple and areola with or without a palpable mass -itching, burning, bloody nipple discharge with superficial erosion, and ulceration may be present -diagnosis confirmed by pathologic exam of the erosion -treatment is a simple or modified radical mastectomy
Tonic Neck Reflex:
-refers to the posture assumed by newborns when in a supine position -the infant extends that arm and leg on a side to which the head is turned and flexes the extremities on the other side
Treatment of renal problems during pregnancy:
-rest -force fluids -antibiotics
Post-partum home instructions:
-rest-in order to conserve energy -exercise-ab exercises to strengthen abdominal muscles and strengthen the waist -intercourse-can begin intercourse as early as 2 weeks after delivery, if desire and comfort allow. -breasts-avoid using soap on nipples. Wash before and after baby feeds. Keep nipples lubricated. -perineum-ice then heat, and sitz bath -hemorrhoids-hydrocortisone ointments, facilitate bowel elimination with stool softeners and ambulation. -diet-should increase fluid and caloric intake (330 kcals in first 6 months for mother. 170 kcals for the baby) (After 6 months mom needs to increase it to 400kcals)
Facial nerve paralysis
-result of pressure on the facial nerve during delivery -should disappear after a few months, if not there may be permanent damage.
Complications of PROM
-risk for infection of mother and newborn -newborn is at risk for sepsis after birth -oligohydramnios (loss of amniotic fluid cushion)
Why an episiotomy is needed:
-shoulder dystocia -forceps/vacuum assisted -fetus is an occiput posterior -"face up" position -dilated to 3-4 cm
Cancer of the Uterus (AKA: Endometrial Cancer):
-slow growing Causes: HPV, increased age, nulliparas, late menopause, smoker, diabetes, colorectal cancer in family, estrogen replacement therapy -diagnosed by biopsy. -usually occurs around 60 years of age, post-menopausal -survival rate is high if it did not spread -S/S: increased size of uterus -Treatment: total hysterectomy followed by radiation
Cancer of the Cervix:
-slow growing Causes: HPV, young age start of intercourse (<20), multiple sex partners, many pregnancies, obesity, diet low in fruits/veggies, smoker, low socioeconomic status, history of STDs. -S/S: can be asymptomatic, vaginal discharge, spotting between periods, foul smelling vaginal discharge (fishy), increased pain. -Treatment: total hysterectomy, radiation/chemo, LEEP, cryosurgery.
S/S of PID:
-some women with PID are asymptomatic or have subtle, mild symptoms -others experience pelvic pain, fever, purulent discharge, nausea, anorexia, and irregular vaginal bleeding, tender cervix
Causes of renal problems during pregnancy:
-stasis of urine -compression of ureters (baby's wt on ureters) -reflux of urine (goes back up)
Erb's Palsy (brachial palsy)
-stretching or pulling of shoulder/arm during delivery (injury to the brachial nerve plexus) which causes paralysis of shoulder/arm muscles -arm will hang limp and wrist will be pronated
Reflexes:
-sucking -rooting -grasp -moro -tonic neck
Physical maturity: Breasts
-the nipples, areolae, and size of the breast buds are assessed and scored
Neuromuscular maturity: Heel to Ear Extension
-the nurse grass the infant's foot and pulls it straight up toward the ears while the hips remain flat on the surface of the bed -when resistance is first felt, the position of the foot in relation to the head and the amount of flexion of the leg are compared with the diagrams -the more resistance and flexion, the more mature the infant
Physical maturity: Skin
-the very preterm infant's skin is red, sticky, and fragile, with little subcutaneous fat and visible veins -in mature newborns, the skin is thicker and the color is paler -few veins are visible and there is peeling and cracking -peeling becomes even more apparent in the post-term infant and during the hours after birth as the skin loses moisture
Neuromuscular maturity: Arm Recoil
-to test for this, the nurse holds the neonate's arms fully flexed at the elbows for 5 seconds and then pulls the hands straight down to the sides -the hands are quickly released, and the degree of flexion is measured as the arms return to their normally flexed position -preterm infants may move the arms slowly or not at all, whereas full-term infants have a quick return to flexion
Radiation
-transfer of heat to cooler objects that are not in direct contact with the infant -placing cribs and incubators away from windows and outside walls minimizes this type of heat loss -using a radiant warmer transfers heat from the warmer to the cooler infant
Gynecoid
-true pelvis -prognosis for vaginal birth is very good
Four signs suggest placenta separation:
-uterus has a spherical shape -the uterus rises upward in the abdomen as the placenta descends into the vagina and pushes from the fundus upward. -the cord descends further from the vagina. -a gush of blood appears as blood trapped behind the placenta is released.
Other types of physical maturity:
-vernix -hair -skull firmness -nails
S/S of Uterine Fibroids:
-very heavy periods which leads to anemia -low back pain -constipation -dysmenorrhea (painful menstruation; "cramps")
Immediate post-delivery care
-vital signs (for signs of hemorrhage and shock) -bladder distention -episiotomy (may have ecchymosis-apply ice) -uterine firmness -vaginal drainage (3 types of Lochia)
Plantar Grasp Reflex:
-when the area below the toes is touched, the infant's toes curl over the nurse's finger
Causes of abruptio placentae:
-women over age 30 -cocaine use -hydramnios
Extra calorie intake for pregnant women:
0 extra calories for the 1st trimester 340 extra calories per day for the 2nd 450 extra calories per day for the 3rd
If the Apgar Score is between __-__, the infant needs to be resuscitated.
0-3
Voiding of the newborn
1-2 times for the first day of life By the 4th day should be 6 times per day -normal urine output for newborn is 2-5mL/kg/hr
The placenta may be expelled in one of two ways:
1. Schultze 2. Duncan
Measures to relieve cord compression:
1. a gloved hand in the vagina pushes the fetus upward off the cord 2. knee-chest position uses gravity to shift the fetus out of the pelvis. The woman's thighs should be at right angles to the bed and her chest flat on the bed 3. the woman's hips are elevated with two pillows; this is often combined with the Trendelenburg (head down) position.
The true pelvis is most important in childbirth. The true pelvis has three subdivisions:
1. inlet--upper pelvic opening 2. midpelvis--pelvic cavity 3. outlet--lower pelvic opening
Types of Breast Cancer:
1. noninvasive breast cancer 2. Paget's Disease 3. inflammatory breast cancer
Rhesus (Rh) factor incompatibility during pregnancy is possible when two specific circumstances coexist:
1. the expectant mother is Rh-negative 2. the fetus is Rh-positive. The father of the fetus must have an Rh-positive blood type.
The anterior fontanel closes at _______.
18 months
Types of fetal positions
1st Letter: Right (R) Left (L) 2nd Letter: Occiput (O)-vertex presentation Mentum (M)-face Sacrum (S)-breech 3rd Letter: Anterior (A)-lower quadrant of mother's pelvis Posterior (P)-upper quadrant of mother's pelvis Transverse (T)-between anterior and posterior quadrants
Nutrion for Newborns:
39-45 kcals per pound of body weight every day for formula fed 85-100 kcals per pound of body weight every day for breast fed
If the Apgar Score is between __-__, gentle stimulation by rubbing the infant's back while administering oxygen is needed. Also to determine whether mother received narcotics, which may have depressed infant's respirations.
4-6
What should the pH of urine be?
4.6-8
Afterpains are also known as intermittent uterine contractions that can occur __-__ weeks post-partum.
6-8
If the Apgar Score is between __-__, no action other than support of the infant's spontaneous efforts and continued observation.
7-10
Transition Phase
7cm to complete dilation. -Frequency: every 1.5-2 minutes -Duration: 60-90 seconds -Intensity: very strong contractions
The posterior fontanel closes at __________.
8-12 weeks
Type _____ blood is the universal receiver.
AB positive
______ _______ is the premature separation of a normally implanted placenta.
Abruptio placentae
Bilirubin Encephalopothy (kernicterus)
Acute manifestation of bilirubin toxicity where the bile gets deposited into the baby's brain.
Low vertical C-section incision:
Advantages: -can be extended upward to make a larger incision if needed Disadvantages: -slightly more than likely to rupture during a subsequent birth -a tear may extend the incision downward into the cervix
Classic C-section incision:
Advantages: -may be the only choice in these situations: implantation of the placenta previa on the lower anterior uterine wall. Presence of dense adhesions from previous surgery. Transverse lie of a large fetus with the shoulder impacted in the mother's pelvis. Disadvantages: -most likely of the uterine incisions to rupture during a subsequent birth. Eliminates VBAC as an option for birth of a subsequent infant.
Low transverse c-section incision
Advantages: -unlikely to rupture during a subsequent birth -makes VBAC possible for subsequent pregnancy -less blood loss -easier to repair -less adhesion formation Disadvantages: -limited ability to extend laterally to enlarge the incision
Median or Midline Episiotomy:
Advantages: Minimal blood loss, neat healing with little scarring, less postpartum pain than the mediolateral episiotomy. Disadvantages: An added laceration may extend the median episiotomy into the anal sphincter, limited enlargement of the vaginal opening because perineal length is limited by the anal sphincter.
Mediolateral Episiotomy:
Advantages: More enlargement of the vaginal opening and limited risk that the episiotomy will extend into the anus. Disadvantages: More blood loss, increased postpartum pain, more scarring and irregularity in the healed scar, prolonged dyspareunia (painful intercourse).
_________ is the cramping pain after childbirth
Afterpains
Connects the two frontal and the two parietal bones.
Anterior fontanel
Excessive hemolysis is caused by:
Antibodies that developed during -previous pregnancy -after injury -abortion -amniocentesis -transfusion of Rh-positive blood
_______ _______ is the method for evaluation of the infant's cardiorespiratory adaption after birth.
Apgar Score
Frequency
Beginning of one contraction to the beginning of the next contraction.
Duration
Beginning to end of one contraction
A _________ presentation occurs when the fetal buttocks or feet enter the pelvis first.
Breech
Shoulder (AKA: transverse lie)
C-section is necessary
__________ __________ is the delivery of the infant through an abdominal and uterine incision.
Cesarean delivery
During amniotic fluid embolism the mother can go into ___; when this happens the mother usually does not survive.
DIC (disseminated intravascular coagulation)
Physical maturity: Genitals
Female infant: -the relationship in size of the clitoris, labia minora, and labia majora is noted -as an infant nears term, the labia majora enlarge until the clitoris and labia minora are completely covered Male infant: -the location of the testes and the rugae on the scrotum are assessed -the testes originate in the abdominal cavity but have moved through the inguinal canal into the scrotum by term -rugae forming on the surface of the scrotum cover the sac by 40 weeks -once the testes are completely down into the scrotum, it appears large and pendulous
_______ position refers to the relationship of the landmarks on the presenting part, the front, sides, or back of the maternal pelvis.
Fetal
______ _______ ________ results from the chronic or periodic intake of alcohol during pregnancy. Alcohol is considered teratogenic, so the daily intake of alcohol increases the risk of this.
Fetal Alcohol Syndrome (FAS)
What should you do for a mother that has a spinal headache from a spinal block?
Have the mother lay flat
_______ is the study of the breast tissue using a very low dose of radiotherapy. The American Cancer society recommends a yearly one to screen for breast cancer in women starting at age 40.
Mammogram
________ is excessive volume of amniotic fluid (more than 2000 ml).
Hydramnios (polyhydramnios)
Why will the next fetus be jeopardized if RhoGAM is not administered?
If RhoGAM is not administered to to the mother when the newborn is Rh-positive, she may develop antibodies to fetal Rh-positive blood. These antibodies may cross the placenta and destroy the erythrocytes of the next Rh-positive fetus.
Immunoglobulins
IgG IgM IgA IgE IgD
The following tests are used to detects Rh sensitization:
Indirect Coombs' Test Direct Coombs' Test
________ is the changes that return the reproductive organs to their non-pregnant size and condition. Occurs 6-12 hours after delivery.
Involution
_______ is inflammation (infection) of the breast that is usually caused by cracked or infected nipples.
Mastitis
________ is the first stool excreted by the newborn.
Meconium
_________ is a type of swelling which occurs in lymphatic tissue when excess fluid collects in the arms or legs because the lymph nodes or vessels are blocked or removed. Regarding phlebotomy, this can be a major complication of mastectomies.
Lymphedema
_________ is when the neonate weighs more than 4000 grams (8.8 lbs)
Macrosomia
_______ are hard white spots that look like pimples. Disappear after the first few weeks.
Milia
_______ and _______ can worsen fibrocystic breast changes.
NSAIDs and caffeine
Opioid Antagonist
Narcan-reverses opioid induced respiratory depression
The primary method of heat production is _____________ ____________, the metabolism of brown fat to produce heat. Newborns can increase heat production by 100% using this. Can lead to weight loss.
Non-shivering Thermogenesis
If the mother's indirect Coombs' test is positive and her Rh+ infant has a positive direct Coombs' test, RhoGAM is:
Not given; in this case the infant is carefully monitored for hemolytic disease.
Type _____ blood is the universal donor.
O negative
Meconium aspiration syndrome
Obstruction and air trapping caused by meconium in the infant's lungs, which may cause severe respiratory distress
_____ ____________ ________ is an infection of the upper genital tract that may cause chronic pelvic pain
Pelvic Inflammatory Disease (PID)
_______ ________ posterior is occiput of the fetal head is directed toward the back of the maternal pelvis. This causes the mother to complain of a lot of back pain. This can cause a 3rd-4th degree tear.
Persistent occiput
_______ _______ is the abnormal implantation of the placenta in the lower uterus.
Placenta previa
________ ______ pregnancy is more than 42 weeks gestation.
Post date
______ ______ _____ is the period of weepiness that often occurs beginning in the 1st week after childbirth. It can develop into post-partum depression if it lasts longer than 2 weeks.
Post-partum blues
Connect the two parietal bones and the occipital bone.
Posterior fontanel
________ labor is between 20 weeks gestation and prior to the end of the 37th week of gestation.
Pre-term
_______ _______ of ______ is the spontaneous rupture of the membranes prior to onset of labor. The gestation may be preterm, term, or post-term
Premature Rupture of Membranes (PROM)
RhoGAM
Prevents maternal development of Rh antibodies, which might be harmful to the current Rh-positive fetus as well as subsequent fetuses. The fetus is presumed Rh-positive.
Powers
Primary power-uterine contractions -Causes effacement and dilation. Contractions consist of: -Frequency -Duration -Intensity Secondary power- use of abdominal muscles to push.
________ _______ is the displacement of the umbilical cord in front of or beside the fetal presenting part.
Prolapsed cord
_______ depends on previous coping skills, previous childbirth experiences, support system, preparation for childbirth, and cultural influences.
Psyche
_______ is the period from birth until involution of the reproductive organs are complete (usually 6 weeks after delivery)
Puerperium
REEDA (5 signs that should be checked at the site of an episiotomy)
R-redness E-edema E-ecchymosis (bruising) D-discharge A-Approximation
_______ occurs when the posterior wall of the vagina becomes weakened and thin.
Rectocele
If the mother's indirect Coombs' test is negative and the infants direct Coombs' test is negative, the mother is given:
RhoGAM (immune globulin) within 72 hours of birth.
________ _______ is the tearing of the uterine muscles or an old uterine scar. C-section then hysterectomy may be required.
Ruptured uterus
Guidelines for assessing the volume of lochia based on the amount of stain on a perineal pad in 1 hr:
Scant: <2.5cm (1 inch) stain Light: 2.5 to 10cm (1-4 inch) stain Moderate: 10-15cm (4-6inch) stain Heavy: saturated within 1 hour
Intensity
Strength of the contraction -mild, moderate, or strong
__________ _________ is bleeding between the dura and arachnoid. Results in an extremely high pitched cry from the baby.
Subdural hematoma
TORCH infections:
T-toxoplasmosis O-other R-rubella C-cytomegalovirus H-herpes genitalis
Sensitization
The expectant mother has been exposed to Rh-positive blood and has developed antibodies against the Rh factor.
How can the expectant mother be Rh-negative and the fetus be Rh-positive?
The fetus can inherit the Rh-positive factor from the father.
What is a blood patch and why is it used for a spinal block?
The mother's blood is injected into the epidural space; in order to stop spinal fluid leaking.
What does it mean to be Rh-negative?
Those who are Rh-negative lack a substance that is present in the red blood cells of those who are Rh-positive.
Number 1 renal problem in pregnancy for mom
Urinary tract infections
_______ _______ occurs when the cardinal ligaments that support the uterus and vagina are stretched during pregnancy and do not return to normal after childbirth. As the ligaments stretch, the uterus may sag backward and downward into the vagina.
Uterine prolapse
______ is a thick white substance, resembles cream cheese and provides a protective covering for the fetal skin in utero.
Vernix
Antigen
a substance that possesses the unique configuration enabling the immune system to recognize it as foreign. AKA: immunoglobulins
With placenta previa the baby may become ______ due to blood loss.
anemic
Tx of Mastitis
antibiotics, incision for drainage, discard milk-do not feed to infant, pumping, apply ice or heat, wear supportive bra, analgesics
Packed red blood cells have ________ removed while whole blood contains everything.
antibodies
Blood types A, B, and AB contain a protein component _______ that is not present in type O blood.
antigen
People who are Rh-positive have the Rh antigen on their red blood cells, whereas people who are Rh-negative do not have the ______.
antigen
Tx of fibrocystic breast changes:
aspiration, surgical removal, if small it is monitored by mammogram, oral contraceptives
It is recommended that RhoGAM be given:
at 28 wks antenatally to decrease possible transplacental bleeding concerns.
Fetal lie
baby's spine (long axis) in relation to the mother's spine (long axis).
Acrocyanosis:
bluish discoloration of hands and feet caused by reduced peripheral circulation
The passage for birth of the fetus consists of the maternal pelvis and its soft tissues. The _____ ______ is usually more important to the outcome of labor than the the soft tissues because the bones and joints do not readily yield to the forces of labor.
bony pelvis
The passage for birth of the fetus consists of the maternal pelvis and its soft tissues. The ______ _______ is usually more important to the outcome of labor than the soft tissues because the bones and joints do not readily yield to the forces of labor.
bony pelvis
hemolysis
breakdown of red blood cells
The stools of infants fed with ______ _____ are seedy, and the color and consistency of mustard with a sweet-sour smell. This infant generally has more frequent stools. With this type of feeding the newborn should have at least four or more stools daily.
breast milk
Lochia rubra
bright red vaginal drainage, 1-3 days after delivery
A __________ ____________ is an area of localized edema that often appears over the vertex of the newborn's head as a result of pressure against the mother's cervix during labor.
caput succedaneum
Amniotic Fluid Embolism (Anaphylactoid Syndrome):
caused by a rupture in the amniotic sac or maternal uterine veins accompanied by a high intrauterine pressure that causes infiltration of the amniotic fluid and its contents into the maternal circulation. This infiltrated amniotic fluid then travels to and obstructs pulmonary vessels and causes respiratory distress and circulatory collapse.
The fetus enters the birth canal in the _______ position more than 96% of the time.
cephalic
A _______________ results when there is bleeding between the periosteum and the skull from pressure during birth.
cephalohematoma
Cervical Dilation
cervical canal widens from <1cm to approximately 10 cm
First Stage of Labor:
cervical effacement and dilation occur in the first stage in the first stage of labor, or stage of dilation. It begins with the onset of true labor contractions and ends with complete dilation (10cm) and effacement (100%) of the cervix. It is the longest for both nulliparas and paras. 3 phases: -latent -active -transition
During labor, multigravida's ________ remains thicker than the primigravida.
cervix
Local Analgesia used in labor and birth:
infiltration of the perineum with a local anesthetic just before preforming an episiotomy or suturing a laceration
Spinal Block:
injection of local anesthetic often combined with an opioid such as fentanyl, into the subarachnoid space in a single dose, often develop a spinal headache -blood patch may be needed with this #1 risk of this--hypotension other risks include--bladder distention, spinal headache
Duncan mechanism (Dirty Duncan)
less common, the rough (dull) maternal side presenting
In the ____________ ____, either the head or the buttocks of the fetus enters the pelvis first.
longitudinal lie
Sensory block (with epidural block)
loss of sensation
Motor block (with epidural block)
loss of voluntary movement
Thermoregulation
maintenance of body temperature
Clinical manifestations of FAS:
microcephaly (small head), undeveloped pinna (outer ear), short nose, missing groove above lip, pointed small chin, small eye openings, flat face, thin lips
The sutures and fontanels allow the bones to move slightly, changing the shape of the fetal head so that it can adapt to the size and shape of the pelvis by ________
molding
Placenta previa is associated with painless bleeding and you _____ do a vaginal exam with painless ______ ___ bleeding.
never; bright red
An ________ ____ is one at some angle between the longitudinal lie and the transverse lie.
oblique lie
S/S of Mastitis
pain, redness, swelling of the breast, fever -can cause staph and strep
Fetal presentation
part that 1st enters the pelvis "presenting part" -cephalic -breech -shoulder
Lochia serosa
pink serous and blood tinged vaginal drainage, 4-10 days after delivery
Hydramnios can lead to ___-____ labor.
pre-term
Pudendal Analgesia used in labor and birth:
pudendal nerves located near each ischial spine are injected with a local anesthetic.
UTIs during pregnancy can lead to ____________ which can lead to premature labor.
pyelonephritis
When blood from a person who Rh-positive enters the bloodstream of a person who is Rh-negative, the body:
reacts as it would to any foreign substance. It develops antibodies to destroy the invading antigen. To destroy the Rh antigen, which exists as part of the red blood cells, the entire red blood cells must be destroyed.
O blood type is a ______ trait
recessive
Rh-negative blood is a _________ trait; therefore a person must inherit the same gene from both parents to be Rh-negative.
recessive
Fetal Position
refers to the relationship of the landmarks on the presenting part to the front, sides, or back of the maternal pelvis.
The _________ presentation is a transverse lie and accounts for fewer than 1 % of births, usually premature. A cesarean birth is necessary.
shoulder
People with O blood develop anti-A or anti-B antibodies naturally as a result of exposure to antigens in the foods they eat or to infection by gram-negative bacteria. As a result:
some women with type O blood have developed high serum anti-A and anti-B antibody titers before pregnancy.
Treatment of Uterine Fibroids:
surgery, tumor removal, hysterectomy, freezing of fibroids, ablation
The five major bones are not fused but are connected by ______ composed of strong but flexible fibrous tissue.
sutures
Amnisure:
swap in the vaginal canal can detect any leak in amniotic fluid -detects trace amounts of placental fluid in the vaginal fluid after rupture of fetal membranes -2 lines make a positive.
Breast Engorgement (afterpain)
swelling from increased blood flow, edema, and presence of milk
Complete cord prolapse:
the cord can be seen protruding from the vagina
Cord prolapsed in front of the fetal head:
the cord cannot be seen but can probably be felt as a pulsating mass during vaginal examination
Occult (hidden) prolapse:
the cord is compressed between the fetal presenting part and the pelvis but cannot be seen or felt during vaginal examination
ABO incompatibility occurs when:
the expectant mother is blood type O and the fetus is blood type A, B, or AB.
Schultze mechanism
the placenta is expelled with the shiny, fetal side first
Station
the relationship of the presenting part to an imaginary line drawn between the ischial spines of the mothers pelvis - Station- baby dropped but is not settled in pelvis. Station 0-baby settled into pelvis-before decent to birth canal +Station- baby moves toward cervix
Effacement
thinning and shortening of the cervix-goes from thick to paper thin (2cm to paper thin)
Why would you need to massage the fundus?
to expel blood clots
Meconium stools are followed by __________ ______, a combination of meconium and milk stools. Are greenish brown and of a looser consistency than meconium. They are then followed by by milk stools characteristic of the type of feeding the infant receives.
transitional stools
A __________ ___ exists when the long axis of the fetus is at the right angles to the woman's long axis; it occurs in less than 1 % of pregnancies.
transverse lie
The fundus starts at the ________ then drops 1 cm (1 finger width) per day and takes __ days to get to its original position.
umbilicus; 10
Cancer occurs most often in the ________ ________ ______ of the breast because it is the location of most of the glandular tissue.
upper outer quadrant
Cephalic presentation
vertex--fetal head is fully flexed military--head in neutral position-neither flexed or extended brow--head is partly extended face--head is fully extended and fetal occiput is near fetal spine.
Engagement
when the largest diameter of the presenting part reaches or passes through the pelvic inlet.
Lochia alba
white vaginal drainage, 11-21 days after delivery
