OB Test 3
What is Physiological Hyperbilirubinemia?
(3rd to 4th day of life) Early-onset breast=feeding jaundice Late-onset breast-feeding jaundice
WITHDRAWAL ACRONYM Assess the newborn for signs of neonatal abstinence syndrome using the acronym WITHDRAWAL to focus the assessment:
(W) - Wakefulness: sleep duration less than 3 hours after feeding (I)Irritability (T)emperature variation, tachycardia, tremors (H)yperactivity, high-pitched persistent cry, hyperreflexia, hypertonus (D)iarrhea, diaphoresis, disorganized suck (R)espiratory distress, rub marks, rhinorrhea (A)pneic attacks, autonomic dysfunction (W)eight loss or failure to gain weight Alkalosis (L)acrimation (Hamdan, 2012)
What is Pathological Hyperbilirubinemia?
(within first 24 hours of life) Kernicterus (bilirubin builds up in the brain and causes brain damage and severe jaundice). Rh isoimmunization ; ABO incompatibility
Neonatal Asphyxia (define and compare with normal neonate)
*** Assess after DRYING, AIRWAY SUCTIONING & MILD STIMULATION *** Normal Neonate - able to breathe spontaneously and self-sufficiently after 1 minute of birth. Neonatal Asphyxia - unable to establish adequate, sustained respirations after birth. Insufficient oxygen levels to meet metabolic demands.
precipitate
*Ineffective* pushing - could be incorrect pushing technique/knowledge *Prolonged* Labor - no time limit if mother/baby ok (encourage rest _______________ Labor - a delivery which results after an unusually rapid labor (combined 1st stage and second stage duration is *<2hrs*) and culminates in the rapid, spontaneous expulsion of the infant. total labor 3hrs or less
Explain the TORCH acronym.
*T*oxoplasmosis *O*ther (syphilis, varicella-zoster, parvovirus B19) *R*ubella *C*ytomegalovirus (CMV) *H*erpes
Necrotizing Enterocolitis -- Nursing Management
*if NEC is suspected -- immediately stop enteral feedings until a diagnosis is made* 1. Enteral antibiotics & probiotics 2. parenteral fluids (restore proper fluid balance) 3. Human milk feedings 4. Antenatal corticosteroids 5. Parental Support & Education (ostomy care)
SEVERE PREECLAMPSIA ASSESSMENT - cerebral and visual symptoms -Weight gain and edema, pitting degree - pulmonary edema - thrombocytopenia: < ____________mm3 - epigastric or RUQ pain, HELLP - labs:
- < 100,000 mm3 - labs: CBC, serum electrolytes, BUN, creatinine, hepatic enzyme levels
MILD PREECLAMPSIA - BP > ___/__ after __ weeks (x_, __-__ hours apart) - proteinuria= _____ mg or more of urinary protein per 24 or 1+ protein on dipstick with ___ random samples collected __-__ hours apart with no UTI - seizures/coma: yes/no - hyperreflexia: yes/no - other s/s: mild ____ or _____ edema, weight gain - risk for __________
- BP > 140/90 after 20 weeks (x2, 4-6 hours apart) - 300 mg, 2 samples, 4-6 hours apart - mild facial or hand edema - risk for postpartum HTN
MANAGEMENT OF CONGEN/ACQUIRED HD - focus: ______ - drug therapy:_____, except what drug is not recommended? - education:
- Focus: stabilize the mother's hemodynamics status - drug therapy: diuretics (lasix), inotropics (lanoxin), antiarrhythmic agents (lidocaine), beta blockers (labetalol), calcium channel blockers (nifedipine), anticoagulants (hearing) - NO WARFARIN BC IT CROSSES THE PLACENTA - education: reducing risks leading to cardiac complication --> compliance cardiac mess, frequent antepartal visits, conserve energy, rest left side, nutrition, limit Na_ D.C. Tests for fetal well-being (EKG, echo, no stress test, monitor fetal activity and movements), s/s cardiac decompensation, monitor fluid volume during/after labor for 48h
Assessment findings of hypertrophic pyloric stenosis are
- Forceful, nonbilious vomiting, unrelated to feeding position - Hunger soon after vomiting episode - Weight loss due to vomiting - Progressive dehydration with subsequent lethargy - Possible positive family history
Birth Trauma Types:
- Fractures - Brachial plexus - Cranial nerve trauma - Head trauma 1. Cephalhematoma - does not cross cranial suture lines. Firmer to the touch "bumps" appear 2-3 days after birth. Goes away 2-3 weeks on it's own. 2. Caput Succedaneum - an edematous swelling formed on the presenting portion of the scalp of an infant during birth. Swelling is not limited by suture lines. Goes away over first few days
Esophageal atresia and tracheoesophageal fistula -- Assessment
- Hydramnios - Copious frothy bubbles of mucus and drooling - Abdominal distention - Coughing, Chocking, Cyanosis
Trisomy 21 (Down syndrome) -- Assessment findings
- Hypotonia - Short stature - Flattened occiput - Small (brachycephalic) head - Flat facial profile - Depressed nasal bridge and small nose - Oblique palpebral fissures (an upward slant to the eyes) - Brushfield spots (white spots on the iris of the eye) - Low-set ears - Abnormally shaped ears - Small mouth - Protrusion of tongue; tongue is large compared to mouth size - Arched palate - Hands with broad, short fingers - A single deep transverse crease on the palm of the hand (simian crease) - Congenital heart defect - Short neck, with excessive skin at the nape - Hyperflexibility and looseness of joints (excessive ability to extend the joints) - Dysplastic middle phalanx of fifth finger (one flexion furrow instead of two) - Epicanthal folds (small skin folds on the inner corner of the eyes) - Excessive space between large and second toe
CLINICAL PICTURE OF FETAL ALCOHOL SYNDROME
- Microcephaly (head circumference <10th percentile)* - Small palpebral (eyelid) fissures* - Abnormally small eyes - Intrauterine growth restriction - Maxillary hypoplasia (flattened or absent) - Epicanthal folds (folds of skin of the upper eyelid over the eye) - Thin upper lip* - Missing vertical groove in median portion of upper lip* - Short upturned nose - Short birth length and low birthweight - Joint and limb defects - Altered palmar crease pattern - Prenatal or postnatal growth ≤10th percentile* - Congenital cardiac defects (septal defects) - Delayed fine and gross motor development - Poor eye-hand coordination - Clinically significant brain abnormalities* - Mental retardation - Narrow forehead - Performance substantially below expected level in cognitive or developmental functioning, executive or motor functioning, and attention or hyperactivity; social or language skills* - Inadequate sucking reflex and poor appetite **Diagnosis of fetal alcohol syndrome requires the presence of three findings: 1. Documentation of all three facial abnormalities 2. Documentation of growth deficits (height, weight, or both <10th percentile) 3. Documentation of CNS abnormalities (structural, neurologic, or functional)
Factors that might predispose the newborn to hyperbilirubinemia, such as:
- Polycythemia - Significant bruising or cephalhematoma, which increases bilirubin production - Infections such as TORCH (toxoplasmosis, hepatitis B, rubella, cytomegalovirus, herpes simplex virus) - Use of drugs during labor and birth such as diazepam (Valium) or oxytocin (Pitocin) - Prematurity - Gestational age of 34 to 36 weeks - Hemolysis due to ABO incompatibility or Rh isoimmunization - Macrosomic infant of a diabetic mother - Delayed cord clamping, which increases the erythrocyte volume - Decreased albumin binding sites to transport unconjugated bilirubin to the liver because of acidosis - Delayed meconium passage, which increases the amount of bilirubin that returns to the unconjugated state and can be absorbed by the intestinal mucosa - Siblings who had significant jaundice - Inadequate breastfeeding leading to dehydration, decreased caloric intake, weight loss, and delayed passage of meconium - Ethnicity, such as Asian American, Mediterranean, or Native American - Male gender
Hypertrophic Pyloric Stenosis Nursing Management
- Preoperative management of infants with pyloric stenosis is aimed at fluid management and correcting abnormal electrolyte values. - Family anxiety is high during this time because of the impending surgery for an otherwise healthy infant. - Provide emotional support to the family. - Teach them about the surgical procedure and what to expect postoperatively. - After surgery, infants usually resume oral feedings after 1 to 2 days.
cleft lip and palate -- Nursing Management
- Promoting Adequate Nutrition Preoperatively, the baby with a cleft lip may demonstrate enhanced growth patterns if breastfed. The contour of the breast against the lip may allow for a better seal to be maintained for adequate sucking - Support the parents in providing care for the infant, particularly feeding, which is viewed as a significant nurturing function. Provide education about the anticipated surgical procedure and eventual normal appearance of the infant's lip. - Preventing Injury to the Suture Line It is critical to prevent injury to the facial suture line or to the palatal operative sites. Do not allow the infant to rub the facial suture line.
ECLAMPSIA INTERVENTIONS - priority concern= client safety - turn client to left side and remain with client - side rails up and padded - dim lights, keep room quiet - after seizure- ______ as necessary and administer ________ - continue ____________ infusion to prevent further seizures - control HTN with antihypertensive medications - continue EFR monitoring and assess client for _______________ ___________ - after client is stable, prepare for ________________ process ASAP to reduce risk of ______________ ________ - administer __________________ tx to mature lungs - provide emotional support and keep family informed - follow up care after delivery for ____ hours -continue mag sulfate for _______ hours and monitor for toxicity, assess vs q __ hours and pp assessment - resolution: pos sign of ____ w decrease in ____
- after seizure: suction, administer oxygen - continue mag sulfate - assess client for uterine contractions - prepare for birthing process to reduce risk of perinatal mortality - administer glucocorticoids - follow up care after delivery for 48 hrs - continue mag sulfate for 24 hours, assess vs q 4 hours - resolution: pos sign of diuresis w decrease in proteinurea
AORTIC STENOSIS: - narrowing of _____ valve, blocks flow into _____, leads to thickened _________ ventricle, leading to less room for adequate amount of blood supplied to body - most pregnant women managed medically
- aortic - aorta - left
PREECLAMPSIA: -def: multisystem disorder that targeted the cv, hepatic, renal, and CNS; classified as mild or severe with potential to progress to eclampsia - characterized by ______, ______, and ______ - patho: generalized ______= increase in _____ and decrease in _____ to brain, liver, kidneys, placenta, and lungs
- characterized by HTN, proteinuria, and organ damage - generalized vasospam, increase in by, and decrease in BF to brain, etc
GROUP B STREP - colonizes in _________________ of pregnant women - if positive--> __________ - naturally occurring bacterium found in approx 50% of healthy adults, approx 20% of pregnant women carry GBS - most common cause of _______ and ________ in newborns and frequent cause of _____________ - women screen at _____-______ weeks and tx with ____ therapy (_______________) --> abx also given ___ hours before birth
- colonizes in vagina/rectum/cervix/urethra - if pos: IV abx -most common cause of sepsis and meningitis, frequent cause of pneumonia - women screen at 35-37 weeks and tx with abx therapy (Penicillin G) - abx also given 4 hours before birth
GESTATIONAL DIABETES - urinalysis with glycosuria - glucose screening test ___ to ___ weeks gestation -->oral glucose followed by glucose analysis___ hr later (fasting yes/no necessary) --> blood glucose above ___mg/dL requires additional testing with __hr glucose tolerance test ------:> glucose levels are then determined at 1,2,and 3 hours following glucose ingestion - presence of ketones in the urine= assess _______ - dx procedures: (3)
- glucose screening test 24 to 48 weeks gestation - glucose analysis 1 hr later - blood glucose above 140 mg/dL with 1 hr later - ketones--> assess ketoacidosis - dx procedures: biophysical profile, amniocentesis, nonstress test
MILD PREECLAMPSIA ASSESSMENT
- identify risk for preeclampsia - nutritional assessment - BP and weight - amt and location of edema - FHR - clean catch urine specimen - labs: CBC, serum electrolytes, BUN, creatinine, hepatic enzyme levels
SEVERE PREECLAMPSIA - may develop suddenly--> immediate ___________ required - BP > ____/____ - proteinuria >____mg in 24 hours: greater than 3+ on random dipstick urine sample - oliguria of less than ___ ml in 24 hours - seizures/coma: yes/no Hyperreflexia: yes/no Other s/s: - only cure:?
- immediate hospitalization required - BP > 160/110 - proteinuria >500 mg - oliguria of less than 400 ml - seizures/comaL no - hyperreflexia: yes - only cure- birth of infant
tests for Habitual miscarriage
- karotyping? - placental assessment - uterine assessment -antiphospholid antibodies check - thyroid disease
GESTATIONAL DIABETES MANAGEMENT - exercise improves glucose metabolism - instruct on self admin of glucose and monitoring - fetal surveillance: perform daily kick counts around __ weeks, usually ___ within ___ hours - frequent ultrasounds, amniocentesis for ____ maturity, stress test for ___ - educate on need for lab tests ___ and ______ levels - meds:
- kick counts around 28 weeks, usually 10 within 2 hours - amnio for lung maturity, stress test for fetal well being - educate on need for ogtt and blood glucose levels - meds: glyburide and metformin (do not cross placenta= no fetal hypoglycemia)
SEVERE PREECLAMPSIA INTERVENTIONS - bed rest: _______ lying position - room dark and quiet to reduce stimulation - administer ____ as ordered to encourage bed rest - seizure precautions (_________) - closely monitor BP, administer __________ - assess vision and lOC (headache and visual disturbance) - assess s/s pulmonary edema - offer high _____ diet with 8-10 glasses water - monitor intake/output 1 hours to check for _____ function - administer fluid and electrolyte replacement - fetal monitoring
- lateral lying - precautions: padding, side rails, O2, suction equipment, call light - administer hypertensives - high protein diet - check for kidney function
MITRAL VALVE PROLAPSE: - valve between ______ and ______ does not close properly -leaflets of mitral valve prolapse upward or back into the ___________ as the heart __________ -symptoms/precautions?
- left atrium and ventricle - left atrium - contracts - asymptomatic/occasional palpitations but no special precautions
MITRAL VALVE STENOSIS: - narrowing of the mitral valve, blocks flow into ____________, leading to _____________ - pulmonary HTN and _________ ventricular failure - most pregnant women managed medically
- left ventricle - pulmonary edema - right
Inevitable or incomplete miscarriage
- marked by heavy bleeding - mild to severe cramping - cervical dilation
MILD PREECLAMPSIA ASSESSMENT - mild at home: - hospital: - labor:
- mild at home: Bed rest, lateral position, increased antepartal visits with labs: CBC, clothing studies, liver enzymes, platelets, BP and weight monitoring, protein measure with dipstick, daily fetal kick counts,balanced diet, 6-8 8oz glasses of water daily - hospital: BP not reduced at home. Monitored for s/s severe preeclampsia. BP and weight, fetal monitoring, management continues until pregnancy reaches term, fetal lung maturity, or complications warranting immediate birth - labor: focus on preventing progression to eclampsia. BP monitoring, quiet environment, IV mag sulfate, antihypertensive med (if needed), calcium gluconate, neuro checks, urinary catheter
(torch) herpes simplex maternal: herpes simplex fetus:
- mother: lesions and tender lymph nodes - fetus: miscarriage, preterm labor, intrauterine growth restriction
ECLAMPSIA - the onset of _________________/______ - preceded by ______ (4) - starts with _____ followed by ____ - BP >___/___ - protein: yes/no - seizures: yes/no - hyperreflexia : yes/no other s/s: severe headaches, generalized edema, RUQ or epigastric pain, visual disturbances, cerebral hemorrhage, renal failure, HELLP
- onset of seizure activity or coma - preceded by headache, severe epigastric pain, hyperreflexia, hemoconcentration - starts with facial twitching, followed by generalized muscle rigidity - BP > 160/110 - proteinuria: marked protein - seizures: yes - hyperreflexia: yes
MAGNESIUM SULFATE - preeclampsia: - eclampsia: - acts as a CNS depressant - potent neuromuscular blockade and ________ may develop TOXICITY: - resp rate <____ bpm - absence of _____ - decrease in __________ (<___ml/hour) - serum mag levels > ___mEq/L - antidote: _________
- preeclampsia: prevents seizures - eclampsia: controls seizures - hyporeflexia may develop - resp rate <12 bpm - absence of DTRs - decrease in urinary output <30 ml/hour - serum mag levels > 8 mEq/L - antidote: calcium gluconate
GESTATIONAL DIABETES - glucose intolerance develops with pregnancy--> results in progressive resistance to insulin - resistance to insulin: inability of body to obtain nutrients for fuel and storage, result in _______ _________ - complications: (4)
- results in postprandial hyperglycemia - complications: macrosomia, hyperglycemia, birth trauma, maternal complications
GESTATIONAL DIABETES - risk factors: (5) - effects on mother: - effects on fetus: (10)
- risk factors: obesity, maternal age >25 years, family hx of DM, previous delivery of infant that was large or stillbown, african american/hispanic/native american/asian women - effects on mother: hydramnios, gestational HTN, ketoacidosis, preterm labor r/t premature membrane rupture, stillbirth, hypoglycemia, UTIs, difficult labor, c/s, pp hemorrhage, s/t overdistended uterus to accommodate macrosomic infant - effects on fetus: cord prolapse, congenital anomaly, macrosomia, birth trauma, preterm birth, fetal asphyxia, intrauterine growth restriction, respiratory distress, polycythemia, hyperbilirubinemia, hypoglycemia, childhood obesity
TORCH client education - rubella: vaccination ________ during pregnancy r/t risk of ___________ developing. avoid ________. women not immune should be vaccinated during _____________ period so they are immune before becoming pregnant again - cytomegalovirus: no tx exists, frequent hand washing before eating, avoid _______ - emphasize compliance of tx - provide emotional support
- rubella: vaccination contraindicated during pregnancy r/t risk of rubella infection developing. avoid crowds of young children. should be vaccinated during immediate pp period. cytomegalovirus: avoid crowds of young children
GESTATIONAL HTN: - term used for pregnant women who do not meet criteria for ______ or _____ - HTN without ________ after ___ weeks gestation resolving by ___ weeks postpartum - systolic BP> __/__ on at least ___ occasions at least __-__ hours apart within __ week period--> BP returns to baseline - progesterone supplementation during 1st trimester significantly reduced incidence of ___ and _______ in primigravida women - management: monitor BP, encourage _____ positioning (off of liver)
- term used for pregnant women who do not meet criteria for PRECLAMPSIA or CHRONIC HTN - HTN without PROTEINURIA after 20 weeks gestation resolving by 12 WEEKS postpartum - systolic BP > 140/90 on at least TWO occasions at least 4-6 HOURS apart within ONE WEEK period - reduced incidence of GH AND FETAL DISTRESS - encourage LATERAL
GESTATIONAL DIABETES - caused by eating raw/undercooked meat or handling cat feces: ________ - hep A&B, syphilis, mumps, parovirus B1 (5th disease), varicella-zoster (chickenpox and shingles), HIV - rubella (german measles): contracted through _______ or to neonates who are born to mothers who had rubella during pregnancy -viral infection, transmitted through body fluids: _____________ - herpes simplex: spread by _________, transmission to fetus during vaginal birth if women has _____ lesions, thus C/S may breast feed as long as no lesions on breast, wash hands
- toxoplasmosis - rubella: infected children - viral through body fluids: cytomegalovirus - herpes spread by direct contact, active lesions
Fertility assessment
--male factor assessment: semen analyis, sexual characteristics, external and internal reproductive organ exam, digital prostate exam -female factor assessment: ovaria function, pelvic organs -Laboratory and diagnostic testing: home ovultion predictor kits, clomiphene citrate challenge est, hysterosalpingogram, laparoscopy
fertility-awareness based methods
--use physical signs and symptoms that fluctuate throughout menstrual cycle to predict fertility -pregnancy is avoided by abstinence or barrier methods during times of fertility -most effective if menstrual cycles are regular
requirements for effective contraception
-100% safe and effective -inexpensive -simple to use and understande -not directly connected to intercourse -readily available -no side effects -non sexist
contraception facts
-98% of sexually active females report usng some form of contraception -nearly half of pregnanciesin US and globally are unwanted
minipill advantages
-98%effective -idealf or breastfedding mothers -spontaneity -ok for women who can't take combined OCs -antibiotics do not interefere with effectiveness
Deproprovera advantages
-99%effective -convvenient -may be used by women over 35 who smoke, women with sickle cell , congenital heart -decreased risk of endometrialcancer, less PID, fewer uterine fibroids
Initial care for threatened pregnacies
-BED REST--> does not always prevent miscarriage - transvaginal ultrasound - hCG and progesterone measurement to see if fetus is still alive
The Pill
-First introduced in 1960, the first combo (estrogen and progesterone), oral contraceptive greatly influenced the lives of many women and marked a revolutionary step in social change. -Today there are over 30 different OCs with lower dose estrogen and fewer health risks OCs work by adding hormones to system that mimics pregnancy and suppresses ovulation -thickens cervical mucus to interfere with sperm surviving to join egg
ELLA: Emergency contraception
-Just approved -prevents pregnancy when taken orally with 5 days after contracpetive failure or unprotected intercourse --not intended for routine contraception -progesterone agonist/anatogonist: main effect is to delay or inhibit ovulation -has been available in Europe
emergency contraception
-approx 1/3 of all unintended pregnancies end in abortion -Emergency contracpetion is NOT a form of abortion, and may provide a womans last chance to avoid pregnancy -plan B must be used within 72 hours of unprotected intercourse or failed contraception -the sooner used the better. Reduces chance of pregnancy by 50%
-cervical mucus ovulation method
-cervical mucus consistency changes during cycle and play key role in fertilization of egg -as ovulation approaches there is an increase in amount of clear, thin, stringy, sticky mucus known as "spinnbarkeit". favorable to sperm and increases fertilization -avoid intercourse or use another emthod from beginning of mucus changes until 4th day after
minipill
-contain progesterone only -Alters endometrium-becomes atrophic hostile t implnataion of fertilied egg -cervical mucus becomes thick and imeprmeable by sperm -40-50% of women ovulate normally -used fr women who need to avoid estrogens, due to severe side effects of the combined pill
The patch
-contains estrogen and progesterone as the BC pill does (ortho evra) -pathc is a thin beige patch that is to be replaced once a week for 3 weeks, 4th week is patch free when menses occurs -should be placed on skin in time for greatest effectiveness -side effects are the same as ?
injectable hormone: depoprovera
-contains progesterone only -given IM or SQ every 90 days -suppresses ovulation and endometrial growth,a dn thickens cervical mucus
spermicide advantages
-easy to use and readill available -doesnt require a medical exam -kills some microbes -inexpensive
IUC advantages
-effective for years -long-term cost advantage -allow for sexual spontaneity-no mess -decrease bleeding (Mirena) -no hormonal SEs (Para Guard)
The Pill contraindications
-family history of stroke, diabete, breast or endometrial cancer -history of liver or renal disease, thromboembolic disease, sickle cell disease, hypertension, smoking of 15 cigarettes per day or more, depression, migraines, convulsions and asthma
Nursing assessment for htn
-hx and physical for risk factors (smoking, obesity, caffeine intake, alcohol intake, excessive salt intake, use of NSAIDs, increasing age, African American race) - VS: BP sitting, lying, standing, orthostatic HTN - lifestyle modifications and effectiveness
minipill disadvantages
-irreguar periods -has to be taken everyday at the same time -acne, development of ovarian cysts
basal body temperature method
-lowest upon waking in am - temp rises within a day or 2 after ovulation occurs and remains elevated about2 weeks until menstruation begins -abstain from end of period to 3-4 days after increased temp (days 6-17)
condoms
-made for males and females -male condom is made from latex, polyurethane or lambskin, traps seminal fluid and sperm and protects against STIs. latex condom is most effective and least likely to break -female condom: a polyurethane pouch inserted into the vagina vault held in place by pubic bone. blocks sperm from entering the cervix and protects vaginal mucosa against STIs
Depoprovera disadvantages
-menstruation irregular or absent -reestablishment of regular ovulation may take more than a year after stopping -weight gain, breast tenderness, depression -may adversely affect lipids -injection q 3 months -bone loss
S/S placenta previa and who's at risk?
-minimal to moderate bright red bleeding with or w/o pain - Fundal height is greater for gestational age - C- section or cutterage in previous pregnancies-> uterine/endometrial scarring
IUC disadvantages
-must be inserted and removed by NP or DR. -no protection against STIs -possible adverse reactions including dysmenorrhea (painful periods), heavy bleeding, uterine perforation, ectopic pregnancy
spermicide disadvantages
-must be reapplied to reusable devices each tiem intercourse is repeated -time it 10 to 30 minutes before sexual activity -increase risk of UTIs colonization of e. coli -failure rate 20-40%
Sterilization implant: (Essure)
-non surgical method of sterilization -thin tube with spring like device is threaded into the vagina and up into the uterus and fallopian tubes -causes scar tissue to from and block the tubes from allowing egg and sperm to join. -can take 3 months for scar tissue to form -other BC must be used until then
fertility awareness based methods rely on the following
-ovum is released 14 days prior to menstruation and it lives approximately 24 hours -sperm can live 5 days after intercourse. fertile or unsafe period is 3 days before and 3 days after ovulation. -exact time of ovulation cannot be precisely determiined so an addiitonal 2-3 days should be added tot he beginnning and end of fertile period -
Infertility
-primary or secondary -cultural expectations for reproduction -impact of culutre, ethnicity, and religion on perceptions and management of infertility -multiple known and unknown factors affecting infertility -male and female risk factors -therapeutic management: drugs or surgery
Nursing Management of Infertility
-respect for couple -education, anticipatory guidance, stress management, counseling -Assistance in decision making, advocacy -assistance with financial strategies
diaphragm
-rubber dome used with spermicide covers cervix -held in place by rim fitting under the symphysis pubis and posterior vaginal vault -80% effective -mode of action-prevents union of sperm and ovum -holds spermicide in place to destroy sperm. Must remain in place 6 hours after intercourse. remove within 24 hours.
Intrauterine contraceptives
-small plastic T-shaped device placed inside uterus by Dr. or NP to provide contraception -2 types: copper paraguard and Mirena -paraguard: may be used for up to 10 years. release of copper ions prevents pregnancy by making the endometrium of uterus hostile to implantation of a fertilized egg by causing a nonspecific inflammatory reaction and inhibiting the meeting of sperm and egg -Mirena: Effective for 5-7years. CAuses thinning endometrium of the uterus and thickening of mucus that is hostile to sperm. -both are approx. 98% effective
implantable hormonal contraceptives
-subdermal tie release that deliers synthetic progestin which inhibits ovulation -minor surgical procedure to implant and later remove -delivers 3 years of continusous, effective contraception -mechnism of action and side effects identical to other progesterone only hormonal contraceptives -women should be counseled prior to insertion that they may experience intial irregular bleeding and/or amenorrhea as time progresses
vaginal ring
-thin, flexible ring that releases progestin anf estrogen -ring is placed by squeeaing it between thumb and index finger while inserting it into vagina -ring is worn for 3 weeks, removed for one week (taken out week of period). then new ring is inserted -side effects are the same as the pill
The pill possible side effects
-thromboemolic disorders and other vascular problmes inlcuding CVA, and MI -nausea, breast discomfort, weight gain -risk of side ffects is highest in older women, in those with long durtion of use and those who smoke -please note: many antibiotice interfere with the effctiveness of Ocs, an alternative method of contraception hould be used for duration of antibiotic and a week after.
permanent birth control methods
-tubal ligation: sterilization for women, a laprascope inserted' fallopian tubes are grasped and sealed -vasectomy: sterilization for men, usually perfomred under local anesthetia, involves cutting the vas deferens, which carries the sperm.
minipill contraindications
-undiagnosed vagial bleeding -liver nodules or tumors -heart disease -ovarian cyst or ovarian cancer -ectopic pregnancy
What are the 3 types of Cord Prolapse?
.
deep tendon reflexes 0 1 2 3 4 6. diminished or absent reflexes? 7. brisk reflexes? (hyperflexia) look at slide 29
0 - reflex absent, none elicited 1 - hypoactive response, sluggish 2 - reflex in lower half of normal range 3 - reflex in upper half of normal range 4 - hyperactive, brisk, clonus present 6. magnesium toxicity 7. irritable cortex and ins involvement
DTRs 0: 1: 2: 3: 4: diminished or absent reflexes= brisk reflexes (hyperreflexia)=
0: reflex absent, none elicited 1: hypoactive response, sluggish 2: reflex in lower half of normal range 3: reflex in upper half of normal range 4: hyperactive, brisk, clonus present diminished or absent= mag toxicity brisk= irritable cortex and CNS involvement
What is late hemorrhage?
1-2weeks
Persistent Pulmonary Hypertension of the Newborn -- Nursing Assessment
1. **Assess status closely** 2. Tachypnea (within 12 hrs after birth) 3. Cyanosis 4. Expiratory retractions 5. Respiratory distress 6. Abnormal Heart Sounds (harsh murmur) 7. Monitor BP (hypotensive) 8. Monitor O2 Sat 9. Electrocardiogram (to reveal R->L shunting)
Persistent Pulmonary Hypertension of the Newborn -- Nursing Management
1. **Continuous Monitoring of BP, O2 Sat, perfusion.* 2. IV fluids (counteract hypovolemia & hypotension) 3. Nitric Oxide (to correct acidosis...inducing metabolic alkalosis by administering sodium bicarbonate) 4. O2 Therapy and Respiratory Support (ventilation) 5. Resuscitation 6. ABG 7. Parent Education and Support
interventions for mild preeclampsia 1. mild at home -rest how? what position -visits with? (5) -what with with dipstick -daily? -balanced? -how much water a day 2. hospital -why? -monitor for? -assess (3) -management continues for how long? -assess fetal? or? 3. labor -focus on preventing? -monitor? -environment? -give what iv? -give what med? -have what at the bedside -check? -insert?
1. -best rest, lateral position -cbc, clotting studies, liver enzymes, platelets, bp and wt monitoring -protein measure -fetal kick counts -diet -6 8oz glasses 2. -bp not v at home -s/s of eclampsia -bp, weight, fetal monitoring -until term -fetal lung maturity or complications leading to immediate birth 3. -progression to eclampsia -bp -quiet -mag. sulfate -antihypertensive if needed -calcium gluconate -bedside -catheter
Preterm labor 1. prevention -provide -improve -identify -adequate -give client 2. treatment -identify ? and do what with this? -limit -provide -administer -do what for fetus 3. what is seen on an ultrasound? 4. mom should be on? she should take her own? and do?
1. -education -access to care -risk factors -nutrition -empowerment 2. -symptoms and treat -activity -hydration -tocolytic meds -give corticosteroids to accelerate fetal lungs 3. cervical length 4. bedrest, heart rate, fetal kick counts
nursing interventions for... 3. ineffective pushing -check position of? -assess what on mom? -this can be caused by? 4. precipitate labor -monitor closely if what? -anticipate? -administed (4 examples) -what do they do? -remain where and why 5. Prolonged labor -give what iv? -offer? -changes in? -what reassurance?
1. -fetus -mental state of mom -spinal block and mother cannot feel 2. -mom has previous history of this -scheduled induction -tocolytics: magnesium sulfate, indomethacin, nifedipine, atosiban -reduce muscle ability to contract -in room to monitor labor 3. -hydration for iv fluids -nutrition -position -emotional
SGA 1. conditions affecting fetal growth -<28 weeks leading to? ->28 weeks 2. why are some SGA's, SGA's?
1. -leading to overall growth restrictions (never catch up in size) -intrauterine malnutrition (normal growth potential with optimal postnatal nutrition 2. iugr (head will be normal or bigger and the body will be smaller) look at box 23.1 in chapter for contributing factors and slide 9
substance abusing mothers nursing assessment and management 1. assessment -hx of? (2) -nb behaviors (1) 2. management -promote (2) -proper? -prevent? -interaction of? 3. mom might not? 4. will get what on mom? will do what to baby?
1. -maternal hx (risk behaviors and toxicology) - withdrawal assessments 2. -comfort and stimuli reduction -nutrition -of complications -parent-newborn 3. admit to it, thinks she will go to jail 4. urine toxicology on mom, will run it if baby has signs
Nursing interventions for... 1. shoulder dystocia -what maneuver and how? -explain what? 2. occiput posterior -encourage? -position (2) -apply what pressure? -administer? 3. macrosomia and shoulder dystocia are?
1. -mcroberts maneuver (thighs are brought up and opened wide while she pushes, nurse is pushing down on pelvic bone to displace fetal shoulder) -dysfunctional pattern 2. -position changes -all4's (pelvic rocking, side lying -lower back counter pressure -pain meds 3. emergencies
hyperbilirubinemia nursing assessment 1.-risk? -yellow? -signs of what incompatibility (2) -levels of? management 2. -reduction of? how (3) -education and support?
1. -risk factors -jaundice -rh and abo -bilirubin 2. -bilirubin levels (early feeding, phototherapy, exchanged transfusions) -home phototherapy
Powers 1. hypotonic uterine -hypo means? -leads to lack of? -what does not affect the fetus? -what can happen to the mother? -the fetus does not?
1. -the contractions are not strong enough -lack of dilation or effacement -no issues to the infants blood flow -the mother can hemorrhage because the uterus is not contracting -the fetus does not descend look at page 798
Nursing interventions for...... 1. hypotonic uterine dysfunction -sit? -what to amniotic sac? -give what iv? -monitor? (3) -assess for? -explain? -plan for? 2. hypertonic uterine dysfunction -sit? -promote (4) -assess for? (3) -monitor? -give what iv? -management of? -explain? -plan for?
1. -upright position -amniotomy -pitocin -vs, contractions and cervix -s/s of infection on both -dysfunctional pattern to women and family -surgical birth 2. -latent position for max blood flow to fetus, uterus and kidneys -bedrest, sedation, relaxation and comfort -fetopelvis disproportion, malpresentation, infection -fhr -iv therapy to promote hydration -pain -dysfunctional pattern -surgical birth
nursing assessment for HPS 1. adequate health history: all (5) 2. physical assessment 3. lab tests
1. -when did symptoms begin -description of face and vomitus -diet -# of wet diapers -types of stool -family hx of hps 2.Hard moveable "olive" in right upper quadrant If present then surgical consult should be called. If no mass palpable then abdominal ultrasound or upper GI series should be ordered. 3.Observe for metabolic alkalosis and dehydration
Prolonged Pregnancy 1. how many weeks? 2. post term is? 3. most common cause? 4. greatest risk is to who? why? 5. 3 ways to manage this?
1. 38-42 weeks 2. more than 42 weeks 3. miscalculated edd 4. fetus, aging placenta that is not working as well, decreased nutrients and oxygen, fluid volume decreasing, aspiration of meconium, cord compression 5. have accurate dates, if no PNC, do ultrasound, take fundal heights
gestational age 1. term 2. preterm 3. late preterm 4. postterm
1. 38th -42nd week 2. before completion of 37th week 3. 34 and 36 6/7 weeks 4. beyond 42 weeks
cardiac disease 1. increases by how much in pregnancy? 2. what 2 factors increase? 3. this makes you susceptible to? (2) 4. cardiac disease is? 5. risk factors (6)
1. 50% 2. rbc and fibrinogen 3. dvt, pulmonary embolism 4. leading cause of death in the US 5. smoking, weight, diabetes, hypertension, high cholesterol, age
baby blues 1. % of moms affected? 2. self? lasts how long? 3. cause? 4. symptoms? (2)
1. 50-80% 2. self-limiting, up to 10 days 3. related to changes in progesterone, estrogen and prolactin levels 4. tearful yet happy, overwhelmed
diaphragm 1. perfect effectiveness 2. typical effectiveness 3. fitted by? 4. must be refitted when? (4) 5. when to place in? 6. spermicide must be reapplied when? 7. increase with of? 8. no protection against? look at slide 43
1. 94% 2. 80% 3. doctor 4. after pregnancy, abd surgery, wt gain or loss of 10 lb or more 5. 4 hrs before intercourse and leave in for 6 hrs after 6. with each sex 7. tts 8. sti's
male condom 1. perfect effectivness 2. typical effectiveness 3. what increases effectiveness to 99%
1. 98% 2. 82% 3. combining with spermicides
IUD 1. how effective? 2. increase risk of? (3) 3. no protection against? 4. teach to regularly check placement of? 5. s/e?
1. 99% effective 2. PID, uterine perforation, topic pregnancy 3. sti's 4. strings 5. menstrual irregularities
Preterm newborn assessment 1. weight? 2. appearance is? 3. poor? 4. minimal? 5. undescended? 6. plentiful? 7. poorly formed? 8. eyelids are? 9. skull bones? 10. scalp hair? 11. creases? 12. minimal scrotal? 13. skin? 14. abundant?
1. <5.5 lb 2. scrawny 3. muscle tone 4. subq fat 5. testicles 6. lanugo 7. ear pinna, not a lot of cartilage 8. fused, less than 24 wks 9. soft and spongy 10. matted 11. absent to few on sole and palms 12. rugae, prominent labia and clitoris 13. thin transparent 14. vernix
Define & List Possible Causes of: Acquired/Congenital Disorders
1. Acquired - Occur at or soon after birth - Possibly caused by conditions present throughout fetal development (not just a certain stage) or by problems present at childbirth. - No known etiologies. 2. Congenital - Disorders present at birth - Caused by malformation during the very early stages of fetal development. - Multiple complex etiologies.
LGA Newborn -- common problems (with rationales):
1. Birth trauma (vaginal births become very difficult due to their large size. Note fx clavicle, fx skull, facial paralysis, brachial palsy, etc) 2. Hypoglycemia (lack of glucose from mother while newborn continues to produce insulin) 3. Polycythemia (increase RBC production caused by chronic fetal hypoxia) 4. Hyperbilirubinemia (breakdown of RBC produced under polycythemia)
Necrotizing Enterocolitis -- Label the 3 pathologic mechanisms
1. Bowel Ischemia 2. Bacterial Flora 3. Effect of Feeding
Infants of Diabetic mothers -- Nursing assessment
1. Check to see if mom is diabetic 2. New born will have: Full rosy cheecks ruddy skin color short neck buffalo hump massive shoulders distended upper abdomen excessive subcutaneous fat tissue 3. hypoglycemia 4. polycythemia 5. hyperbilirubinemia
Respiratory Distress Syndrome -- Nursing Management
1. Close Monitoring 2. Oxygen Therapy (ventilators, CPAP, PEEP) 3. Surfactant Therapy 4. IV Fluids or Gavage feedings (NG tube feedings) 5. Blood Glucose Level (increased need for energy to maintain effective oxygenation) 6. Cluster of Care (therapeutic neglect) 7. Antibiotic (Prophylactically, continued if cultures are positive) 7. Parental Support and Education
Postterm Newborns -- typical characteristics
1. Dry, cracked, peeling, wrinkled skin 2. Absent or limited vernix (cheesy substance) and lanugo (baby hair) 3. Long, thin extremities. 4. Abundant hair on scalp 5. Creases over entire sole of feet 6. Wide-eyed, alert expression 7. Thin umbilical cord 8. Long nails 9. Meconium stained skin and nails
Retinopathy of Prematurity -- Nursing Management
1. Follow-up with Ophthalmologist (possible treatment with laser sx) 2. Protection from light 3. Development of Strabismus (asymmetrical corneal reflex) 4. Parental Education & Support
SGA Newborn -- typical characteristics:
1. Head disproportionally larger than rest of body 2. Loose, dry skin. 3. Reduced subcutaneous fat stores 4. Decreased amount of breast tissue 5. Scaphoid (sunken) abdomen 6. Wide skull sutures 7. Poor muscle tone over buttocks and cheeks 8. Thin umbilical cord
Maternal conditions associated with (SGA) babies include:
1. Hypertension (chronic or pregnancy included) 2. Cardiac, pulmonary, or renal disease 3. Diabetes mellitus 4. Poor nutrition 5. Use of alcohol, tobacco, and drugs 6. Age ( under 20 yrs old and over 35 yrs old HIGH RISK) 7. Multiple gestations (twin/triplets etc.) 8. Placental insufficiency 9. Placental fetal abnormality 10. Pregnancy that occurred at high altitudes.
Preterm Newborn -- common problems (with rationales)
1. Hypothermia (lack of subcutaneous fat) 2. Hypoglycemia (body requires a lot of energy to regulate body system, digestion of sugar occurs rapidly to meet increasing demands) 3. Hyperbilirubinemia ( body increases RBC production to compensate for immature respiratory system) 4. Problems related to immaturity to body systems
Neonatal Asphyxia -- Nursing Management
1. Immediate Resuscitation 2. Continuous Observation 3. Neutral Thermal Environment 4. Blood Glucose Levels 5. Parental Support/Education
LGA Newborn -- typical characteristics:
1. Large, plump body, full face 2. Proportional increase in body size 3. Poor motor skills 4. Difficulty in regulating behavioral states
Birth Trauma -- Nursing management
1. Management is primarily supportive and focuses on assessing for resolution of the trauma or any associated complications along with providing support and education to the parents 2. Provide the parents with explanations and reassurance that these injuries usually resolve with minimal or no treatment. 3. Provide parents with a realistic picture of the situation to gain their understanding and trust. 4. Be readily available to answer questions and teach them how to care for the newborn, including any modifications that might be necessary. 5. Spending time with the parents and providing them with support, information, and teaching are important to allow them to make decisions and care for their newborn.
Maternal conditions associated with LGA babies include:
1. Maternal diabetes 2. Multiparty (multiple pregnancies) 3. Prior hx of macrosomic (large) infant 4. Post-date gestation (+42 weeks) 5. Maternal obesity or excessive maternal weigh gain during pregnancy 6. Male fetus 7. Genetics predisposition
Factors Affecting Fetal Growth
1. Maternal nutrition 2. Maternal habits 3. Genetics 4. Placental function 5. Environmental factors
post partum psychiatric disorders 1. mental health problems can? 2. there are days when?
1. Mental Health problems can complicate the puerperium. 2. There are days when each new mother may feel inadequate, but the mother who has a constant feeling of inadequacy needs professional counseling.
reasons for abstaining (6) *couples who use no birth control?
1. Moral or religious values 2. Personal beliefs 3. Medical reasons 4. Not feeling ready for an emotional, intimate relationship 5. Future plans 6. Avoiding pregnancy or STI's *86% chance of pregnancy within first year
List: Acquired Conditions of the Newborn
1. Neonatal Asphyxia 2. Transient Tachypnea of the Newborn (TTN) 3. Respiratory Distress Syndrome (RDS) 4. Meconium Aspiration 5. Persistent Pulmonary Hypertension of the Newborn (PPHN) 6. Bronchopulmonary Dysplasia (BPD) 7. Rentinopathy of Prematurity (ROP) 8. Peri/Intraventricular Hemorrhage (PVH/IVH) 9. Necrotizing Enterocolitis (NEC) 10. Infants of Diabetic Mothers (IDM) 11. Birth Trauma 12. Newborns of Perinatal Substance-Abusing Mothers 13. Hyperbilirubinemia 14. Newborn Infections
Meconium Aspiration Syndrome -- Nursing Management
1. Neutral Thermal Environment 2. Therapeutic Neglect 3. Oxygen Therapy 4. Monitor O2 sats 5. Monitor for Adventitious Breath Sounds (may be progressing to Acelectasis) 6. Broad Spectrum Antibiotics 7. Monitor Newborn's condition 8. Parental Education and Support
Bronchopulmonary Dysplasia -- Nursing Management
1. Nutrition (increased calorie formula for adequate growth) 2. Oxygen Supplementation and Education 3. Fluid Restrictions/Diuretics 4. Electrocardiograms (resolution of Pulmonary HTN when weaning off of O2) 5. Antepartal Steroid Treatments (to mature lungs) 6. Surfactant Treatments 7. Parental Support & Education
Preterm Newborn -- nursing management
1. Oxygenation 2. Thermal Regulation 3. Nutrition/Fluid Balance (be cautious of overload) 4. Infection prevention 5. Stimulation/ Kangaroo Care 6. Pain management 7. Growth and Development 8. Parental support
Transient Tachypnea of the Newborn -- Nursing Management
1. Oxygenation (w/ Supplemental Oxygenation) 2. Supportive Care 3. IV fluids or Gavage feedings (NG tube feedings) 4. Neutral Thermal Environment 5. Parental Education & Progress Reports
SGA Newborn -- common problems (with rationales):
1. Perinatal asphyxia (hypoxic environment prior to birth or poor tolerance to stress of birth) 2. Difficulty with thermoregulation (low muscle mass, low subcutaneous fat stores) 3. Hypoglycemia (increased metabolic rate to produce body heat, lack of glycogen stores to meet the increased metabolic needs) 4. Polycythemia (increased RBC production caused by chronic fetal hypoxia) 5. Meconium aspiration (passing of meconium in utero with are later inhaled causing aspiration) 6. Hyperbilirubinemia (breakdown of RBC produced under polycythemia) 7. Birth trauma (not oftenly seen in in SGA newborns)
Postterm Newborns -- common problems (with rationales)
1. Perinatal hypoxia (placenta unable to adequate O2 levels after 42 weeks due to placental aging or olighydraminos) 2. Hypoglycemia (exhaustion of CHO reserves during acute episodes of hypoxia) 3. Hypothermia (due to loss of subcutaneous fat) 4. Polycythemia (increase of RBC to compensate for acute hypoxic episodes) 5. Meconium aspiration (passing of meconium in utero with is later inhaled causing aspiration)
Periventricular/Intraventricular Hemorrhage -- Nursing Management
1. Prevention (understand risk factors and devise early interventions) 2. Correct anemia, acidosis, hypotentions (via fluids [adm slowly to avoid fluctuations in bp] and medications) 3. Flexed, contained positioning (swaddle) 4. Daily head circumferences 5. Continuously monitor for signs of hemorrhage (changes in the level of consciousness, bulging fontanel, seizures, apnea, and reduced activity level) 6. Parental support (potential long-term sequelae)
Infants of Diabetic mothers -- Nursing management
1. Prevention of hypoglycemia (start oral feedings, neutral thermal environment, rest periods) 2. Maintain fluid and electrolyte balance (Calcium level monitoring, fluid therapy, bilirubin level monitoring) 3. parental support and education
What are the 5 causes of Uterine Inversion?
1. Pulling on cord 2. Fundal pressure during birth 3. Very adherent placenta 4. Fundal placenta implant 5. Weak uterine wall
Birth Trauma -- Nursing assessment
1. Recognition of trauma and birth injuries is imperative so that early treatment can be initiated. 2. Review labor and birth history for risk factors such as: - Prolonged or abrupt labor - Abnormal or difficult presentation - Cephalopelvic disproportion - Mechanical forces (forceps, vacuum during delivery) - Multiple fetuses - Large for date infants - Extreme prematurity - Large fetal head - Newborn with congenital anomalies 3. Complete physical and neurologic assessment of every newborn to establish injuries. Check for facial paralysis and symmetry of the face and body movements. 4. Note swelling, bruising, lumps, bumps and if they cross the suture line.
Preterm Newborn -- List Body Systems effected
1. Respiratory (surfactant deficiency, small passages, inability to clear passages, immature respiratory control centers) 2. Cardiovascular (maintenance of fetal circulation due to perinatal hypoxia, congenital cardiac abnormalities) 3. GI ( poor suck/swallow/breathe coordination, limited ability to digest and absorb protein/nutrients) 4. Renal (unable to concentrate urine, limited ability to clear drugs from system 5. Immune (immature immunity) 6. Central Nervous System (increasing difficulty to regulate temperature, highly susceptible to injury/insult)
Postterm Newborns -- nursing management
1. Resuscitation, suctioning, O2, warming tables, ET & laryngoscope, narcan, epinephrine, chest percussor 2. Blood glucose monitoring 3. Initiation of oral feeing + IV glucose 4. Prevention of heat loss (warming tables, stimulation) 5. Monitor for s/s of polycythemia 6. Parental support
Meconium Aspiration Syndrome -- Nursing Assessment
1. Risk Factors ( placental insufficiency, maternal hypertension, preeclampsia, oligohydramnios, and maternal drug abuse) 2. Staining of amniotic fluid, nails, skin, umbilical cord. 3. Increasing Respiratory distress (meconium can cause airway obstruction or surfactant dysfunction) 4. Barrel Shaped Chest 5. Prolonged Tachypnea 6. Retractions 7. Expiratory Grunting 8. Cyanosis 9. Chest X-ray (patchy fluffy infiltrates, hyperaeration with atelectasis) 10. Arterial Blood Gases (metabolic acidosis)
Bronchopulmonary Dysplasia -- Nursing Assessment
1. Risk Factors ( pulmonary immaturity, acute lung injury, barotrauma [mechanical ventilation], inflammatory mediators, fluid overload[volutrauma]) 2. Continued Tachypnea and Work of Breathing (airway edema) 3. Adventitious Breath Sounds (diminished at bases, rales with fluid overload) 4. Monitor for Reactive Airway Episodes (wheezing during exacerbation) 5. Poor Weight Gain 6. Nasal Flaring/Retraction 7. ABG (hypoxia)
Neonatal Asphyxia -- Nursing Assessment
1. Risk Factors (Maternal Hypoxia, Anemia, Cardiac/Respiratory disorders, Postural Hypotension) 2. APGAR assessment [1 & 5 minutes after birth, Scored 0-10] (A-activity, P-pulse, G-grimace, A-appearance, R-respiration.) 3. Assess work of breathing 4. Assess temperature
Transient Tachypnea of the Newborn -- Nursing Assessment
1. Risk Factors (Maternal Sedation, Maternal Asthma, Cesarean birth, lower gestational birth, male) 2. Tachypnea (**do not feed if RR >60**) 3. Expiratory grunting 4. Retractions 5. Labored breathing 6. Nasal flaring 7. Cyanosis 8. Barrel-shaped chest (hyperinflation) 9. Slightly decreased breath sounds (alveoli not fully expanding) 10. Chest XRay (mild symmetric lung overaeration and prominent perihilar interstitial markings and streaking)
Periventricular/Intraventricular Hemorrhage -- Nursing Assessment
1. Risk Factors (Preterm birth, low birth weight, acidosis, asphyxia, unstable blood pressure, seizures, acute blood loss/hypovolemia, use of hyperosmolar solutions or rapid volume expansion) 2. Evaluate for respiratory distress 3. Monitor for weakness, seizures, lethargy, pallor, hypotonia 4. Assess fontanels for tenseness 5. Assess Vitals (hypotension/bradycardia) 6. Glucose instability, ABG (metabolic acidosis) 7. *Prepare for Cranial Ultrasound* 8. *Head of Bed Elevated* 9. Daily head circumferences (during hemorrhage)
Necrotizing Enterocolitis -- Nursing Assessment
1. Risk Factors (Preterm labor, prolonged rupture of membranes, preeclampsia, maternal sepsis/amnionitis, RDS, patent ductus arteriosus, congenital heart disease, low birthweight, low Apgar scores, hypothermia, hypoglycemia, asphyxia) 2. Abdominal Distension, Tenderness, Bloody Stools 3. Feeding Intolerance 4. Sepsis (due to static blood in intestines) 5. Lethargy, Apnea, Shock 6. *KUB XRay* (air in bowel wall, dilated bowel loops)
Retinopathy of Prematurity -- Nursing Assessment
1. Risk Factors (low birthweight, early gestational age, sepsis, high light intensity, and hypothermia) 2. Associating Factors (changes in O2 tension causing hypoxia, duration/concentration of supplemental oxygen) 3. Administer O2 cautiously (lowest concentration and shortest duration possible)
Respiratory Distress Syndrome -- Nursing Assessment
1. Risk Factors (prematurity, term births via C-sections, 2. Expiratory Grunting 3. Increased Work of Breathing (retractions) 4. See-Saw Respirations 5. Generalized Cyanosis 6. Elevated Heart Rate 7. Fine Inspiratory Crackles 8. Tachypnea 9. Silverman-Anderson Index (basically #2,3,4) 10. Chest X-Ray (hypoaeration ->underexpansion, ground glass pattern)
Preterm Newborn -- typical characteristics
1. Scrawny appearance 2. Poor muscle tone and flexion 3. Minimal subcutaneous fat 4. Undescended testes (males), prominent labia and clitoris (females) 5. Plentiful lanugo (baby hair) 6. Poorly poorly formed ear pinna 7. Fused eyelids (do not force open) 8. Breast and nipples not clearly delineated 9. Abundant vernix (cheesy substance)
1. barrier methods (5) 2. prevents pregnancy how? 3. placed where? 4. may be used with? 5. why do they have higher failure rate?
1. Spermicides, Condom (male/female), Diaphragm, Cervical Cap, Sponge 2. blocks egg and sperm from meeting 3. over penis or cervix to physically obstruct 4. chemical barriers (spermicides with destroy sperm in the vagina) 5. design and human error
LGA Newborn -- nursing management:
1. Vital sign monitoring 2. Blood glucose monitoring 3. Initiation of oral feedings + IV glucose 4. Monitoring for s/s of polycythemia and hypoglycemia 5. Hydration 6. Phototherapy (hyperbilirubinemia)
SGA newborn -- nursing management:
1. Weight, length and head circumference measurements 2. Blood glucose monitoring 3. Vital sign monitoring 4. Small frequent feedings of high calorie formula or fortified breast milk + IV glucose 5. Monitoring for s/s of polycythemia 6. Guidance, education, support
neonatal infections nursing management 1. therapy? observe for? 2. what support (4) 3. educate parents on? 4. primary? 5.. family
1. abx therapy, distress 2. circulatory, respiratory, nutritional and developmental support 3. prevention and early recognition 4. disease prevention 5. education
Post partum hemorrhage- late 1. occurs when? 2. causes (2) 3. if increased bleeding happens at home? 4. if it continues? 5. 3 things to do?
1. after 24 hours, 1-2 weeks postpartum 2. retention of placental tissue, abnormal involution of the placental 3. rest 4. contact dr asap 5. ambulate, empty bladder, check to see if loch is progressing (don't want it to remain rubra)
Anaphalactoid syndrome 1. what is this? 2. how common? 3. morality rate? 4. how many die in the first hour? 5. how many survivors have neurological damage? 6. this is ??? 7. how does it happen? 8. s/s (6)
1. amniotic fluid embolism (AFE) 2. 1/8000 births 3. 80% 4. 60% 5. 85% 6. breaks and its into moms blood stream and obstructs the pulmonary vessels causing pulmonary distress and circulatory collapse, barrier is broken b/w fluid and system 7. difficult breathing, hypotension cyanosis, low o2, rest. distress, possible cardiac arrest, DIC
prevention for postpartum infections 1. prompt treatment of? 2. well-balanced? 3. avoid what when? 4. have strict what? 5. teach postpartum hygiene measures (4)
1. anemia 2. diet 3. avoid sex in late pregnancy 4. strict asepsis during l&d 5. keep pads snug, change pads frequently, wipe front to back, use peri bottle after each elimination
Passenger 1. if fetus is facing? what will this cause? 2. babies heads should be in what position during labor 3. two cases that can cause problems during labor 4. macrosomia? 5. shoulder dystocia 6. ^ mom risks (4) 7. ^ baby risks (4) 8. mulltip can lead do? (3) what will prevent this?
1. anteriorly increases the possibility of dystocia 2. down, posterior 3. breeched, twins 4. baby more than 8 lbs. 13 oz. or 4000 grams, caused by gestational diabetes 5. delivery of head but shoulder is not appearing, can cause harm to both mom and baby 6. hemorrhage, vaginal lacerations, anal tears, uterine rupture 7. transian erbs, bracio plexus palsy, clavicle or humeral fractures 8. uterine over distention, contractions, abnormal presentation of fetus. prenatal care will prevent this
birth-weight variations 1. AGA 2. SGA 3. LGA 4. low birth weight 5. extremely low birth weight
1. appropriate for gestational age: 80% of nub's, normal height, wt, length, head cir., body mass index, length 2. small for gestational age: weight <2,500 g (5lb8oz) at term or below 10th percentile 3. large for gestational age: weight >90th percentile on growth chart wt >4000 g (8lb13oz at term 4. (lbw) <2500 g or 5.5 lb 5. (wlbw) <1000 g or 2 lb 3 oz
periventricular-intraventricular hemorrhage 1. peri means? 2. intra means? 3. what is this? 4. most common when? 5. symptoms? 6. stress in? sudden drop in? 7 nursing assessment (3)
1. around ventricles 2. in ventricles 3. bleeding in brain from fragility of cerebral vessels 4. 1st 72 hrs ; grades 1 to 5 5. sometimes there are none 6. utero, hematocrit 7. risk factors, unexplained drop in hot, pallor, poor perfusion, seizures, lethargy, weak suck, high pitched cry, hypotonia
SGA NB common problems 1. perinatal? 2. difficulty with? 3. hypo? 4. poly? 5. aspiration of? 6. hyper? 7. trauma from? 8. see table 23.1!!!
1. asphyxia 2. thermoregulation 3. hypoglycemia 4. polythemia 5. meconium 6. hyperbillirubinemia 7. birth
Fetal demise 1. can occur when? 2. what affect does this cause on the family? 3. can cause what mentally (2) 4. mother may need to deliver how? 5. may need to give the family what information 6. refer to?
1. at any gestational age, there are no warning signs 2. same affect as losing a family member, loss is real to everyone 3. ptsd, anxiety 4. may need to be put into labor to deliver the stillborn, may need to get religious presence 5. funeral information 6. support groups
common mood disorders: (3)
1. baby blues: happy one minute, crying the next 2. postpartum depression 3. bipolar disorder: have a greater chance of becoming depressed
instruction after contraception is chosen 1. emphasize 2. provide what instructions 3. discuss need for? 4. inform about?
1. backup method 2. written and oral 3. sti protection if not using condom 4. about ec's
look at classes 1. class 3 2. class 4 look at slide 12
1. bedrest during pregnancy 2. should not get pregnant
LGA problems 1. trauma from? (example) 2. hypo? 3. poly? 4. hyper?
1. birth trauma, shoulder dystocia 2. hypoglycemia 3. polythemia 4. hyperbilirubinemia
post partum hemorrhage early; 1. occurs when blood? 2. causes (6) 3. 5 causes .. easy to remember
1. blood loss is greater than 500 ml in the first 24 hours after a vaginal delivery or greater than 1000 ml after a c-section 2. uterine atony lacerations (tears) retained placental fragments ( look to make sure the whole placenta is out) version of the uterus (protrudes into the wall, goes inside) placenta accreta (may complain of pressure in rectal area) 3. tone, tissue, trauma, thrombin, traction (pull)
LGA newborn common characteristics 1. large? 2. proportional? 3. poor? why? 4. difficulty?
1. body, plump full faced 2. increase in body size 3. poor motor skills because they are too fat to move 4. regulating behavioral states
Necrotizing enterocolitis 1. 3 pathological mechanisms 2. nursing assessment -see box 24.1 for? -s/s (8) -kub s? -numatosis? 3. -prom can cause? -septic will interfere with? -anm will? -uterine hypoxia?
1. bowel ischemia , bacterial flora, effect of feeding 2. -risk factors -abdominal distention and tenderness, bloody stools, feeding intolerance (bilious vomiting), sepsis, lethargy, apnea, shock -air in bowel wall, dilated bowl loops -look up 3. -infection in baby and mom -blood flow -inflammation of sac and fluid -contraction but not perfusing LOOK AT ALIDE 51
chronic htn 1. guidelines? 2. nursing assessment -get hx and physical for? -get bp how? -what modifications? -is she on any? -monitor what in the fetus? 3. nursing interventions -diet -what as tolerated? -cessation of? (2) -scheduling? -monitor? -rest on? -home? -compliance of? -continued 4. if bp exceeds 160/100, use?
1. bp over 140/190 b4 pregnancy or 20 wk. gestation or sustained htn before 12 wks. 2. -risk factors smoking, obesity, caffeine intake, alcohol intake, excessive salt intake, use of NSAIDS, increasing age, African American race) -sitting, lying, standing, orthostatic -lifestyle -bp meds -kick counts, fhr 3. -dash -aerobic exercise -smoking, alcohol -appointments -placental abruption and superimposed preeclampsia -left side -bp monitoring -meds -medical supervision 4. Methyldopa and low-dose ASA
amniotomy 1. is? 2. done with what? 3. can pull on? puts both at risk for? 4. limit? document (4) 5. monitor (2)
1. breaking the water with a little hook, breaking of the sac 2. pitocin 3. can pull on placenta, puts both at risk for infection 4. exams, color, clarity, odor, time, amount of fluid 5. maternal temp and comfort
postpartum infection treatment and nursing care 1. administer what med? 2. provide warm? 3. promote? 4. force? 5. keep uterus? 6. provide what med for pain 7. if peritonitis develops *reminder and review: classic signs of infection
1. broad spectrum antibiotic 2. sitz bath 3. drainage, high fowlers position 4. fluids, hydrate with iv 3000-4000 cc/day 5. contracted, give methergine 6. analgesics 7. nasogastric suction *100.4 x 2 days excluding the 1st 24 hours Elevated wbc Foul smelling lochia
spermicides 1. how does it work 2. some work how? others require? 3. different forms (4) 4. how effective? should be used with? 5. no protection against?
1. chemicals destroy sperm in vagina 2. instantly, others need pre-insertion 3. jelly, foam, vaginal films, suppository 4. 76% use with other method 5. sti's
Bronchopulmonary Dysplasia 1. referred to as? 2. possible causes? (5) 3. therapeutic management -administer? (2) 3. caused by? 4. give what to encourage lung maturity? 5. happens to who more?
1. chronic lung disease (lung injury, need oxygen until 28th day of life) 2. surfactant def., pulmonary edema, lung maturity, barotrauma from mechanical ventilation, fluid overload 3. trauma 28 weeks or younger 4. dexamethasone 5. white males more, black females do the best
Eclampsia management/interventions 1. what is a priority? turn to? and do what? safety precautions ? 2. after seizure? 3. continue what meds? (2) 4. continue what monitoring? and assess? 5. after stable, prepare for? why? 6. administer what tx 7. provide? keep family? 8. follow up care?
1. client safety. side and remain with them, side rails up, padded, dim lights, keep room quiet 2. suction and give o2 3. mag. sulfate, antihypertensive 4. electronic fetal monitoring and assess contractions 5. birth asap, reduce risk of morality 6. glucocorticoid 7. emotional support, updated 8.Follow-up care after delivery for 48 hrs, continue Magnesium sulfate for 24 hrs, monitor magnesium levels for toxicity, assess vs q 4 hours and postpartum assessment. Diuresis is a + sign along with decrease in proteinuria signaling resolution
Uterine rupture 1. 3 types 2. this is? 3. examples (3) what is present? 4. occurs with dehiscence when? 5. dehiscence ? 6. signs and symptoms ( 5) 7. urgent? monitor? may have? (2)
1. complete, incomplete, dehiscence 2. rare 3. uterine wall, peritoneal cavity and or broad ligaments, internal bleeding is present but nothing comes out 4. at sight of prior scar (c-section, surgical) internal bleeding is life threatening 5. protruding 6. rapid severe abdominal pain, chest pain, fhr does down, contractions will stop, may need to have hysterectomy 7. c-section, maternal vs, htn and tachycardia
1. brachial plexus injury (erbs palsy or waiters sign is? 2. will have? (2) 3. is physical therapy is started immediately? 4. if clavicle is fractured? 5. how will triplets be delivered 6. sacral dimple is a sign of?
1. complication of or fractured clavicle 2. nerve damage, limp 3. can be very good 4. will have crepitus 5. c-section 6. spinal bifida or hair
Nursing interventions and client education for problems with the passage 1. assess (3) 2. evaluate what status (2) 3. void how often? increases? insert what if what? 4. explain to women and family? 5. plan for?
1. contractions, dilation and progression of labor 2. bowel and bladder 3. q2h, increases pelvic space, insert foley if mom has spinal block 4. dysfunctional pattern 5. cesarean birth
Prolapsed Cord 1. why does this happen? what does it cause? 2. fetus is stationed? or is? 3. the lie will be? 4. hydramnios 5. 3 types of this? 6. when the cord is visible, this is called? 7. occult is?
1. cords slips down after rupture of membranes and this leads to compression 2. stationed high or is small 3. breeched or transverse 4. experts pressure 5. occult, front of head, complete 6. complete 7. when you can't see the cord but the monitoring is telling you that is is compressed, will see deceleration
acquired heart disease 1. what does this mean? 2. mitral valve prolapse 3. mitral valve stenosis 4. aortic stenosis
1. developed during a persons lifetime 1. valve between left atrium and ventricle does not close properly. Leaflets of mitral valve prolapse (bulge) upward or back into the left atrium as heart contracts Asymptomatic, occasional palpitations, no special precautions (valve is in the left atrium-micuspid) 2. narrowing of mitral valve, blocks flow into left ventricle = pulmonary edema, pulmonary HTN, and right ventricular failure. Most pregnant women managed medically. 3. narrowing of aortic valve, blocks flow into aorta = thickening left ventricle = less room for adequate amount of blood supplied to body. Most pregnant women managed medically
retinopathy of prematurity 1. what is it? 2. there are how many stages? based on? (3) 3. if newborn is premature? 4. develops how? why?
1. developmental abnormality affecting immature blood vessels of retina 2. five stages from mild to severe. based on severity, location by zones in the retina and proportion of retinal circumference 3. vessels may cease to develop 4. in both eyes from hyperemia (bc of assisted ventilation and high 02 exposure), acidosis or shock
Risk factors for LGA newborns 1. maternal? (3) 2. # of? 3. hx of? 4. gestation is? 5. fetus is? 6. think family line
1. diabetes, glucose intolerance and obesity 2. multiparty, more baby's, bigger 3. macrocosmic infant 4. post date 5. male 6. genetics
SGA NB assessment 1. head is? 2. wasted appearance of? 3. reduced? 4. decreased amount of? 5. abdomen is? 6. wide? 7. poor? over where (2) 8. thin? 9. will have problems regulating?
1. disproportionately large compared to the rest of body 2. extremities; loose dry skin 3. subq fat 4. breast tissue 5. scaphoid number, sunken appearance 6. skull sutures 7. muscle tone, over buttocks and cheeks 8. umbilical cord 9. temp
emergency contraception considerations 1. does not do what? is not? 2. how can you get it? what is the exception 3. causes what s/e? (5) 4. no protection against 5. not be used in place of? 6. may delay? 7. this pill is literally? 8. contraindicated during ?
1. does not terminate pregnancy, is not abortion pill 2. without prescription by 17 and older, except ella (can get online) 3.N/V, headache, fatigue, heavy than normal menstrual bleeding, lower abd pain 4. sti's 5. regular birth control 6. next menses 7. regular birth control pills give at a higher dose 8. pregnancy
emergency contraception 1. reduce preg. by how much if taken when? 2. types (5) 3. plan by does what to body? know slide 22
1. down by 75% if taken within 72 hours 2.Progestin-only pills, Plan B, Next Choice, combined estrogen and progestin pills, copper-releasing IUD up to 7 days, Ulipristal acetate 3.Floods the ovaries with high amount of hormone and prevents ovulation Alters the environment of the uterus, making it disruptive to the egg and sperm
duodenal atresia 1. common in what babies 2. first part of small bowel is? 3. portion of bowel is not? 4. stomach contents? 5. what is a must? 6. how common 7. twice as common as? look over slide 71
1. down syndrome 2. not developed properly 3. not opened 4. cannot pass thru 5. surgical intervention 6. 1/2500 births 7.jejunal or ill atresia
The components of Birth 1. General term for difficult labor or birth? 2. starts with? 3. 2 early signs? 4. what happens when it is dilated 5-6 cm? 5. ftp? 6. 1-3 women delivery how?
1. dystocia 2. regular contractions 3. irregular cervical effacement and dilation are gradual 4. become more powerful, active phase begins and this is when dystocia is seen 5. failure to progress (means lack of cervical dilation, fetal head or both) 6. give birth through c-section
are these early, late or both? 1. uterine atony 2. retained placental fragments? 3. lacerations 4. inversion of uterus 5. placental accreta 6. hematoma
1. early 2. both 3. both 4. early 5. early 6. both
Risk Factors for TORCH 1. toxoplasmosis is caused be? 2. other is? 3. rubella 4. herpes simplex
1. eating raw or undercooked meat and handling cat feces 2. hep. a & b, syphilis, mumps, pap b19, varicella zoster (chicken pox and shingles), HIV 3. through infected children or neonates who are born to moms who had during pregnancy. cytomegalovirus-coral infection, transmitted through body fluids 4. direct contact, transmission to fetus during vaginal birth if woman has active lesions (C/S) may breast feed as long as no lesions on breasts, wash hands
acquired: neonatal asphyxia 1. failure to? 2. path? 3. nursing assessment (6) 4. management (5) 5. after baby's first breath? if it has asphyxia in utero?
1. establish adequate respirations after birth 2. insufficient o2 delivery to meet metabolic demands 3. risk factors, color, breathing work, pulse, temp, apgar 4. immediate resuscitation, congiure observation, thermal environment, blood glucose, support and education 5. wil need to breathe on its own, it will make it hard for the baby to breathe
vaginal ring 1. contains what hormones delivered how? 2. usage is how long? 3. does not need to be? 4. effects similar to? 5. no protection against? 6. how effective?
1. estrogen and progesterone delivered continuously 2. 3 weeks with one week ring free for menses 3. fitted 4. oc's 5. sti's 6. 92-99%
management for amniotomy 1. limit 2. assess and document? (3) 3. monitor? (2) 4. provide? frequently change?
1. exams 2. characteristics of amniotic fluid including color, odor and consistency 3. fhr, maternal temp every 2 hr 4. comfort, pads and perineal cleansing
Symptoms/effects of torch 1. toxoplasmosis (2) 2. rubella (mom and fetus) 3. herpes simplex (mom and fetus) 4. GBS (6) 5. HIV (5)
1. fever and tender lymph nodes 2. mom -rash, mild lymphedema and fever fetus-miscarriage, congenital anomalies and death 3. mom-lesions and tender lymph nodes fetus-miscarriage, preterm labor, and iugr 4. premature rom, preterm labor and delivery, uti, maternal sepsis, uti 5. diarrhea, wt loss, lymphadenopathy and rash, anemia
complications of postpartum infections pelvic cellulitis peritonitis s/s
1. fever of 102 to 104 2. elevated wbc 3. chills 4. extreme lethargy 5. n/v 6. abdominal rigidity and rebound tenderness
cleft lip/palate 1. cleft lip involves? cleft palate involves 2. most common? 3. therapeutic management 4. nursing management
1. fissure or opening in lip, roof of mouth 2. craniofacial birth defect 3.cleft lip, surgical repair between 6 and 12 weeks; cleft palate, surgical repair between 6 and 18 months 4.Provide adequate nutrition and parental education and promote parental bonding look over slide 73 and 74
necrotizing enterocolitis nursing management 1. maintain? -rest? give what therapy? -surgery with? -what type of care? -educate who?
1. fluid and nutritional status 2. rest bowel and antibiotic therapy, iv fluids 3. with proximal enterostomy 4. supportive care 5. family
birth trauma 1. injuries due to? 2. types (4) 3. nursing assessment -risk? -physical and neurological assessment? (7)
1. forces of labor and birth 2. fractures, brachial plexus injury, cranial nerve trauma, head trauma (cephalohematoma, caput succedaneum) see table 24. 3 3. -risk factors -bruising, bumps, swelling, paralysis, symmetry of structure and function, infant position, precipitous labor
How to prevent mastitis 1. meticulous? 2. frequent? 3. rotate? complications of mastitis 4. what is it? 5. treatment?
1. handwashing 2. feedings and massage distended area to help emptying 3. position of baby on the breast 4. breast abscess (breast feeding is stopped on the affected side, but feed on unaffected side 5. incision and drain
The components of Birth.. cont... 1. must make sure the mother? 2. labor is the last? 3. difficult labor is influenced by? 4. problems with what?
1. has all of the support she needs 2. linger because of high bmi, epidural use, early admission 3. maternal or fetal factors, this is the primary reason for a c-section 4. mother, passenger and baby
treatment of thromboembolic disease 1. give? (2) 2. antidote? 3. teach patient what? 4. complication?
1. heparin (doesn't cross into breast milk), Coumadin 2. protamine sulfate 3. report any unusual bleeding or petchaie, bleeding gums, hematuria, epistaxis etc. 4. pulmonary embolism
infant of diabetic mother nursing management 1. prevent? with? (3) 2. maintain what balance? (2) how (3) 3. parental (2)
1. hypoglycemia.... oral feedings, neutral thermal environment, rest periods 2. fluid and electrolyte balance (calcium level monitoring, fluid therapy, bilirubin level monitoring) 3. support an education
episiotomy 1. do what for the first 12 hours 2. don't want what to develop?
1. ice 2. hematoma
Deliveries outside of the hospital 1. settle mom how? 2. control 3. rupture 4. deliver? check? 5. clear? 6. deliver? then? 7. hold? 8. place baby where? 9. tie? 10. deliver? put where? 11. put baby? 12. monitor? 13. transport?
1. in position 2. breathing 3. membranes 4. head, check cord loops 5. airway 6. shoulders, then body 7. dependent to clear mucous 8. moms stomach 9. cord 10. placenta, put on stomach 11. to breast 12. uterus 13. asap
meconium aspiration 1. what? 2. nursing assessment (4) -find out? -staining of? where? -chest is? -chest xray for?
1. inanition of meconium with amniotic fluid into lungs, s/t hypoxic stress 2. -risk factors -barrel shaped ( prolonged tachypnea, increasing resp. distress, intercostal retractions, end expiatory grunting, cyanosis -patchy fluffy infiltrate, hyper aeration with atelectasis, abg, metabolic acidosis
Signs and symptoms of postpartum infection 1. temp? 2. lochia is? 3. 4 things? 4. pain in? 4. elevated?
1. increase of 100.4 or higher on any 2 consecutive days of the first 10 days postpartum, not including the first 24 hours 2. foul smelling 3. malaise, anorexia, tachycardia, chills 4. pelvic pain 5. wbc
localized infection 1. what is it? 2. signs? 3. treatment look at slide 35
1. infection of episiotomy, perineal laceration, vaginal/vulva lacerations 2. reddened, edematous firm tender edges or skin edges separate and purulent maternal drains from the wound 3. antibiotics, wound care
1. TORCH is? 2. T O R C H
1. infections that negatively affect a woman who is pregnant. can cross the placenta and have bad affects on the fetus T-toxoplasmosis >256 anltibodies, recent infection O-other (syphillis, hepatitis, HIV) R-Rubella >20 immune to rubella C-cytomegalovirus (CMV) no CMX to antibodies H- Herpes simplex (HSV) no hsv antibodies
etiology leading to preterm birth (4)
1. infections/inflammation 2. maternal, fetal distress (knot in the cord, placenta insufficiency 3. bleeding in mom 4. stretching the wrong way
postpartum cystitis 1. what is it? 2. prevention -monitor -dont allow to go how long before intervening? -if mom didn't void? 3. treatment (2) 4. causes -what to the base of the bladder -something during c-section
1. inflammatory disease of the kidneys 2. -monitor patients urination diligently -3-4 hours -straight cath her 3. ampicillin urinary tract antispasmotics 4. -stretching or trauma to the base of the bladder results in edema of the trigone that is great enough to obstruct the urethra and to cause acute retention. -Anesthesia
treatment of lacerations 1. meticulous? 2. do what to bleeders? 3. do what to vagina? 4. replace? 5.You are assigned to a client who delivered vaginally. As you do your post-partum assessment, you notice that she has a large amount of lochia rubra. What would be the first measure to determine if it is related to uterine atony or a laceration?
1. inspection of the entire lower birth canal 2. suture 3. vaginal pack- nurse may remove and assess for bleeding after removal 4. blood replacement 5. feel the fundus, assess the perineum
injectable side effects 1. periods will be? for how long? 2. after 3-6 months? 3. what goes up? 4. sad 5. delayed 6. decreased (loss of)? 7. no protection against 8. not every women has? read labels on slide 14!!!
1. irregular and spotting for 3-6 months 2. no period 3. weight 4. depression 5. return to fertility 6. bone mineral density (calcium) take vitamin D 7. sti's 8. side effects
cervical cap 1. what is it? does what? 2. fill with 3. insert when 4. protection how long? 5. keep in for how long after? 6. replace when (4) 7. must get what to get it? 8. perfect effectiveness? 9. typical effectiveness? 10. more effective when? 11. no protection against?
1. latex/silicone inserted before sex, caps around cervix with suction 2. spermicide 3. 36 hr before sex 4. 48 hours 5. 6 hours 6. every year, after pregnancy, abortion or wt change 7. presctiption 8. 86% 9. 71% 10. if not given birth 11. sti's
severe preeclampsia interventions 1. bed rest in what position? 2. what type of room? 3.administer? (3) 4. precaution for? 5. closely monitor (2) 6. assess? (3) 7. offer? 8. how often do you measure i/o 9. fetal?
1. left lateral lying 2. dark, quiet room 3. sedatives, fluid, electrolyte replacements 4. seizures (padding, side rails, 02, suction, call light) 5. bp, administer antihypertensives 6. vision, LOc. s/s of pulmonary edema 7. high protein diet with 8-10 water glasses 8. every hour 9. monitoring
nexplanon 1. considered what type of birth control? how long? 2. requires no? and is? 3. increased risk of what type of pregnancy? 4. pain in head 5. if bleeding is heavy, what can happen?
1. long term, 3 years 2. no upkeep, reversible 3. ectopic pregnancy 4. headaches 5. anemia
acquired: respiratory distress syndrome 1. what is it? 2. risk factors ( 2) 3. mostly in who? why? will do what? 4. nursing management (9)
1. lung immaturity and lack of alveolar surfactant 2.Expiratory grunting, nasal flaring, chest wall retractions, see-saw respirations, generalized cyanosis; heart rate > 150 to 180; fine inspiratory crackles, tachypnea (rates > 60), Silverman-Anderson Index score > 7. Chest x-ray: hypoaeration, underexpansion, and ground glass pattern 3. preterm, not enough surfactant will give synthetic through et tube and into lungs 4.Supportive care; close monitoring Respiratory modalities: ventilation (CPAP, PEEP); exogenous surfactant; oxygen therapy Antibiotics for positive cultures; correction of metabolic acidosis Fluids and vasopressors; gavage or IV feedings Blood glucose level monitoring Clustering of care; prone or side-lying position Parental support and education blood cultures, prophylactic antibiotics, don't bother baby
vasectomy 1. for who? 2. what is it? 3. what technique available? 4. why is it better than tube ligation 5. submit what? look over slide 52
1. male 2. small incision into scrotum an cutting the vas deferens 3. no scalpel technique 4. faster and easier recovery 5. semen specimen for anaylisys 8-16 wks after procedure until 2 show no sperm present
uterine version 1. is? 2. this is done how? 3. when is it done? 4. give? and do? 5. prepare to give what to mom is negative? 6. mom must not be? 7. done why? 8. do what before hand? 9. want to locate? 10. during monitor? and after?
1. manipulation to gain better fetal position 2. eternally 3. after 37 week s 4. analgesia and do ultrasound 5. RH 6. in labor 7. if baby is breeched or transverse 8. non stress test 9. umbilical cord and placenta 10. monitor fhr and vs, and for 1 hour after
Persistant pulmonary hypertension of the newborn 1. what is it? 2. nursing assessment (4) -what within 12 hours? -marked? and (2) -systolic? -echocardiogram? 3. nursing management -monitor? -immediate? -support of? -administer? -clustering of? -parental (2) -may need? (2)
1. marked pulmonary hypertension causing right to left extrapulmonary shunting and hypoxemia 2.-tachypnea -cyanosis and grutning and retractions -ejection murmur -right to left shunting of blood 3. -o2 and perfusion, bp -resuscitation -respiratory -medications -care -support and education -nitric oxide on vent, go on eccmo look at slide 41
factors affecting fetal growth (5)
1. maternal nutrition: smoking, cocaine, alcohol, drugs 2. maternal habits 3. genetics 4. placental function: fetus not eating all nutrients, if mom is diabetic, sugar is going to be elevated and insulin level will take over 5.enviornmental factors: radiation, excess lead, pollution
intrauterine infection 1. 4 symptoms 2. 4 ways to manage this?
1. maternal temp is higher than 100.4 maternal tachycardia and tachypnea fetal tachycardia > 10 min abnormal amniotic fluid 2. wash hands wear gloves limit vaginal exams clean excessive secretions keep under pads dry
acquired: transient tachypnea of the newborn 1. what is it? resolved by? 2. nursing assessment -maternal sedation or birth my c-section -chest x ray 3. management (5) 4. 60 bpm at rest? 5. won't see in who?
1. mild resp. distress; pulmonary liquid removed slowly or incompletely, resolution by 72 hours of age 2.-Maternal sedation or birth by cesarean; tachypnea, expiratory grunting, retractions, labored breathing, nasal flaring and mild cyanosis; respiratory rates possibly 100 to 140; barrel-shaped chest; slightly ↓ breath sounds -Chest x-ray: mild symmetric lung overaeration; prominent perihilar interstitial marks and streaks 3.Oxygenation Supportive care IV fluids or gavage feedings Supplemental oxygen Neutral thermal environment 4. don't feed, in 70's don't feed 5. preterm, mostly in terms
psyche 1. woman perception of stress is? 2. what will decrease in body? 3. what kicks in? 4. this increases what in the newborn?
1. more important than the actual existence of a threat 2. gulcose 3. flight and flight 4. poor newborn adjustment
male condom 1. why is this good? 2. materials? used when? 3. natural condoms are not good for what? 4. what type of lube should be used? 5. sit's spread how? 6. sti's you can get while wearing a condom (4)
1. most common and effective barrier when used properly 2. latex and polyurethane to prevent pregnancy and sti 3. preventing sti's 4. water-soluble 5. skin to skin contact, not covered by condom 6.HPV - genital warts not covered by condom Genital herpes - sores on anus or upper thigh Syphilis - via sores, skin-to-skin contact Pubic lice/crabs - pubic hair
management of congenital and acquired HD 1. focus on stabilizing? 2. drug therapy (6) don't give? 3. educate? 4. rest on what side
1. mothers hemodynamic status (hemodynamic is everything in the blood 2.diuretics (Lasix) gets rid of water prefer this over htn pill, inotropics (Lanoxin), antiarrhythmic agents (Lidocaine), beta blockers (Labetalol), calcium channel blockers (Nifedipine), anticoagulants (Heparin). Warfarin is not recommended as it crosses the placenta 3. reducing risks leading to cardiac complications Compliance cardiac meds, medications, frequent antepartal visits, conserve energy, rest left side, nutrition, limit Na+, dx tests for fetal well-being (EKG, echo, nonstress test, monitor fetal activity and movements), s/s cardiac decompensation, monitor fluid volume during /after labor for 48 h. 4. rest on the left side
info: 1. provide 2. right info will?
1. necessary info to help select method without fear 2. clear myths and rumors
natural family planning 1. does not use? what is it? 2. nfp does what 3. fam does what? 4. perfect effectiveness? 5. typical effectiveness? 6. no 100%? 7. only 100% protection?
1. no drugs or devices, calendar method, cervical mucous and basal body temp 2. abstain during fertile time 3. barrier methods during fertile time 4. 91% 5. 75% 6. safe day, especially with irregular periods 8. abstinence
Vacuum-assisted forceps-assisted 1. want to make sure of what before doing? 2. membranes have to be? 3. cervix must be? 4. at risk for (2) 5. risks to fetus (4)
1. no soft tissue obstruction, void 2. ruptured 3.completely dilated and effaced 4. hematoma and possible tears 5. scalp lacerations, tears, bruising, cehalohematoma
preterm newborns nursing management 1. provide? 2. regulate 3. balance between? 4. prevention of? 5. what type of care (2) 6. management of? 7. what is at risk? 8. support of? 9. preparation for?
1. o2 2. thermal regulation 3. nutriton and fluid 4. infection 5. stimulation and kangaroo 6. pain (can feel pain in utero) 7. growth and development 8. parental support, possible loss 9. discharge
gestational db risk factors 1. big? 2. maternal age? 3. family history of? 4. previous? 5. cultural? (4)
1. obesity 2. above 25 3. diabetes mellitus 4. lga or stillborn 5. african american, hispanic, native american, asian
1. acquired disorders 2. congenital disorders
1. occur at, soon after birth conditions experienced by woman during pregnancy.. possibly no identifiable cause 2. present at birth, some type of malformation occurring in antenatal period.. sometimes with inheritance (sometimes related to genetics)
taking the pill 1. timing? 2. use what for the first month? 3. when on antibiotics, use? 4. if you miss a pill or take one late? 5. the pills have no protection against?
1. once a day at the same time everyday 2. condoms ( 3. condoms 4. use condoms for one week 5. sti's
transdermal patch considerations 1. same side effects as? 2. what may occur from application 3. who should not use? 4. how effective? 5. does not protect against? 6. who might want this
1. oral contraceptives 2. skin reaction 3.Overweight women (exceeding 198 lbs) (down) effectiveness and ^ thromboembolism and weight gain 4. 99%, typical use 92% 5. sti's 6. if can't take certain pills because GI issues
retinopathy of prematurity nursing management 1. administer? how? ensure? 2. assist with scheduling? administer? may not do what well? 3. protect eyes from? 4. provide what to parents? how>
1. oxygen therapy cautiously, lowest concentration and shortest duration (owl: oxygen with love) 2. scheduling opthalhis exam; admin. mydriatic eye agent 1 hr before appointment (dilates eyes, may be tacycardic, apnea, may not eat well after 3. light 4. support, give info and provide details about condition and f/u exams
Hematoma 1. major symptoms 2. many times the bleeding is? major symptom of this is? 3. treatment 4. this is a result of? usually not? 5. will see where? (2) will have what? 6. will say stitches feel what? and have severe? 7. will feel like unrelieved? this can occur? 8. large will be? 9. small will be? 10. can go up to what? may be? will complain about? palpate? and do? 11. if large it requires ?
1. pain, deep, severe, unrelieved feelings of pressure 2. concealed, major symptom is rectal pain and tachycardia 3. incised and drained 4. injury to the blood vessel, usually not visible 5. vagina and vulva, will have severe pain 6. going to burst and severe rectal pain 7. pain and pressure 8. unilateral, tense, bulging mass 9. unilateral, skin may be blue or red very firm when touched 10. broad ligaments, may be hard to dx. complain about flank or abdominal distention. palpate abd. do rectal exam 11. surgery
nursing interventions for clients with Psyche problems 1. have ? 2. promote? 3. provide what to client and family (2) 4. educate on? encourage what in decision making?
1. patience 2. progression of labor 3. physical and emotional support 4. educate on dysfunctional labor, encourage partnership in decision making
labor induction 1. give what med? 2.ld rn will know what? 3. do not want what type of situation? 4. if fhr declines? 5. give post partum why?
1. pitocin 2. when to start 3. hypertonic 4. stop piton, put in side lying position for good perfusion 5. prevent hemorrhage and promote contractions
female condom 1. what is it? made of? 2. can be used with? 3. perfect effectiveness? 4. typical effectiveness? 5. used with what lube?
1. pouch in vagina, nitrile (synthetic rubber) 2. spermicide for increased effectiveness 3. 95% 4. 79% 5. oil based because not latex
gestational HTN 1. term used for? 2. what is it? and when? 3. guidlines? 4. progesterone supplementation does what? 5. management 6. those at risk (5)
1. pre woman who do not meet criteria for preeclampsia or chronic htn 2. htn w/o proteinuria after 20 wks gestation resolving by 12wk postpartum 3. systolic bp >140/90 on 2 occasions at least 4-6 hr apart within 1 wk period. returns to baseline 4. during 1st trimester, significantly reduces incidence of gh and fetal distress in primigravida women 6. primigravida, <19, >40, chronic renal disease, hx of preeclampsia
preeclampsia assessment 1. identify risk for 2. assess? 3. take what two measurements 4. what about edema (2) 5. monitor? 6. get what with the urine? 7. labs (5)
1. preeclampsia 2. nutrition 3. bp and wt 4. location and amount 5. fhr 6. clean catch urine specimen 7. cbc, serum electrolytes, BUN, creatinine, hepatic enzyme level
HELLP Syndrome 1. is ? 2. HELLP
1. preeclampsia with liver involvement 2. hemolysis, elevated liver function tests, low platelet count
positive benefits of birth control 1. prevents? 2. eases? 3. shortens? 4. regulated? 5. decreases chance of? 6. prevents what cancers? (2) 7. decreases what on face
1. pregnancy 2. menstrual cramps 3. periods 4.period 5. ovarian cysts 6. ovarian and uterine cancer 7. acne
Birth control pills 1. can be taken to? 2. are what when taking properly? 3. how effective? 4. women must have what done to get prescription 5. mini pill only has what hormone? 6. regular pill has what hormones?
1. prevent pregnancy 2. safe and effective 3. over 99% 4. pap-smear 5. progesterone 6. estrogen and progesterone
periventricular intraventricular hemorrhage nursing management 1. prevent? 2. correction of (3) 3. flexed? 4. daily measurement of? want it to do what? causes? do? 5. clustering of? limiting? 6. parental support for? 7. what is a surgery that can be done?
1. prevention (stress) 2. anemia, acidosis, hypotension 3. flexed contained positioning 4. head circumference. want it to grow proportionally and see if there is spinal fluid buildup. causes hydrocephalus. and do daily cranial ultrasounds 5. of care; of stimulation 6. possible long term sequale 7. shunt that reroutes the fluid from brain to peritoneal
Postpartum depression 1. risk factors? (3) 2. clinical therapies (3)
1. primiparity, hx of ppd, lack of social and relational support 2. counseling and support groups, medications (SSRI), childcare assistance
transdermal patch 1. contains what hormones? delivered how? 2. placements (4) 3. how long? when is it removed? what begins?
1. progesterone and estrogen through skin 2. lower abdomen, upper outer arm, upper torso avoiding breast 3. 3 weeks, 4th week removed, menses begin
injectable contraceptive: deep-provera 1. what types available regarding hormones (2) 2. given how often 3. how effective? 4. how many injections per year? 5. convenience? 6. the shot stops? (2) 7. thickens?
1. progestin-only and estrogen/progestin 2. every 12 weeks 3. 99.7% 4. 4, I'm and subq 5. no daily pills to remember 6. ovulation and periods 7. cervical mucus
Post term new baby 1. inability of placenta to do what? 2. skin will be? (4) 3. extremities will be (2) 4. nails will be? soles will be? 5. LOC will be? 6. hair is? 7. umbilical cord? 8. limited? (2) 9. after 42 weeks, placenta does what?
1. provide adequate oxygen and nutrients of fetus after 42 weeks 2. dry, cracked, wrinkled, possibly meconium stained 3. long and thin 4. long, creases over entire sole 5. wide-eyed, alert expression 6. abundant 7. thin, because wasting affect 8. vernix and lanugo 9. will start to shut down
uterine inversion 1. possible causes (5) 2. on assessment? fundus will? mom will feel (4) 3. management -give? -md immediately?
1. pulling on cord (md doesn't wait enough time and starts pulling, if placenta is still adhered and there is a weak uterine wall fundal pressure during birth very adherent placenta fundal placental implant weak uterine wall 2. going to find it coming out, funds will not be palpable, mom will feel low pelvic pressure, heavy bleeding, hypotensive and sweating 3. uterine relaxants, manual replacement of uterus by md
IUD 1. size of a? 2. non hormonal? 3. hormonal hormonal 4. usage is how long? 5. how does it work? non-hormonal 6. lasts how long? 7. copper asks as? 8. causes uterine environment to be? review slide 31
1. quarter 2. paragard 3. mirena hormonal 4. 5-7 years 5. releases low does of progesterone non-hormonal 6. 10 years 7. spermicide 8. inflammation action leading to hostile uterine enviornment
withdrawal 1. what is it? 2. not? 3. effectiveness? 4. how many become pregnant? 5.why is this bad for male? 6.first few drops of true ejaculate?
1. remove penis from vagina before ejaculation 2. sufficient 3. 73%, unpredictable 4. 1 in 5 5. very hard to control 6. contain greatest concentration of sperm, pre-cum can escape urethra before orgasm, may have conception
Treatment of mastitis 1. mom must? 2. use appropriate? 3. apply? 4. don't stop? why? (3)
1. rest 2. antibiotics, cephalosporins 3. hot/cold packs 4. breastfeeding ...If the milk contains the bacteria, it also contains the antibiotic Sudden cessation of lactation will cause severe engorgement which will only complicate the situation Breastfeeding stimulates circulation and moves the bacteria containing milk out of the breast
poster newborn nursing management 1. may need to? (emergency) 2. monitor (2) 3. initiate 4. prevent 5. evaluate? 6. parental
1. resuscitate 2. blood glucose and cbc 3. feedings; iv dextrose 10% 4. heat loss 5. polycythemia 6. support
choice of method: 1. offer the right to pt to? 2. he/she feels more comfortable when? 3. good communication -conveys? -language? -get acquainted to?
1. right to choose, gives confidence 2. when using method that fits their needs 3. -right message to build rapport -simple, without technical terms -to pt knowledge, attitude, perceptions and feelings about subject
Retinopathy of prematurity 1. review prenatal hx for (5) 2. assess newborn's? (2) 3. evaluate the newborns hx of?
1. risk factors (htn, substance abuse, preeclampsia, heavy cigarette smoking, placental insufficiency 2. gestational age and weight.. newborns weighing less than 1500 g or born at 28 weeks gestation or less are at risk 3. duration of intubation, use of o2 therapy, intraventicular hemorrhage and sepsis
Bronchopulmonay dysplasia nursing assessment 1. assess history for? (9 examples) 2. s/s? (7)
1. risk factors (male, preterm birth <32 weeks, nutrition deficiency, Caucasian, excessive fluid intake, patent ductus arteriosus, severe RDS treated with mechanical ventilation >1 week, sepsis) 2.tachypnea, poor weight gain, tachycardia, sternal retractions, nasal flaring, bronchospasm (abnormal breath sounds-crackles, wheezing); abnormal blood gas results (hypoxia)
Vaginal birth after c-section 1. what are two risks? 2. how long is it recommended to wait? 3. caution when?
1. rupture and hemorrhage 2. 2 years after c-section before considered 3. after 2 or more c-sections
management of anaphylactoid syndrome 1. position 2. have what inserted? 3. monitor (3) 4. give ? 5. prepare to give? why? 6. prepare for?
1. side lying with pelvis tilted at 30 degrees 2. foley 3. maternal, fetal status and o2 4. iv fluids 5. blood products to correct coagulation 6. emergency c/section
Postpartum psychosis 1. predisposing factors? 2. assessments (5)
1. similar to those of ppd 2. grandiosity decreased need for sleep (insomnia) flight of ideas psychomotor agitation/hyperactivity rejection of infant
thromboembolic disease predisposing factors: 1. slowing of? 2. what to veins? s/s 3. sudden? 4. what in calf 5. what in skin (2) 6. positive?
1. slowing of blood in the legs 2. trauma 3. onset of pain 4. tenderness 5. redness and ^temp 6. homans sign
contraceptive sponge 1. barrier with? 2. must be what before inserting? 3. insert when? 4. leave in for how long? 5. protection is how long? 6. dont leave in for longer than? 7. no protection against?
1. spermicide 2. wet with water 3. 24 hrs before 4. 6 hours 5. 12 hours 6. 30 hpurs 7. sti's
Lacerations predisposing factors: 1. spontaneous? 2. what of baby (3) 3. inspection of the vagina (5) signs and symptoms: 4. bleeding how? 5. ^because of this? 6. LOOK IN BOOK AT DEGREE OF LACERATIONS!!!
1. spontaneous or precipitous delivery (within 3 hours) 2. size, presentation, and position 3. vulvar, cervical, perineal,uretheral are and vaginal varicies 4. bright red bleeding with a steady trickle of blood and firm uterus 5. hypovolemia
how does birth control work 1. stops? 2. what to uterine lining? 3. thins what?
1. stops ovulation 2. thins uterine lining, not a good environment for implantation 3. thickens cervical mucous, hard for sperm to get through it (the body thinks it pregnant, levels of hormones are always stable, won't peak and be fertile
severe preeclampsia 1. may develop? what is required? 2. guidelines? 3. oliguria? 4. seizures/coma 5. hyperflexia? 6. other s/s? 7. what is the cure? look over slide 23
1. suddenly, hospitalization 2. >160/110 3. of less than 400 ml/24 hrs 4. no 5. no 6. headache, blurred vision, blind spots, rapid weight gain, pulmonary edema, thrombocytopenia, cerebral disturbances, epigastric or ruq pain, HELLP 7. birth of the infant
birth trauma nursing management 1. must be? 2. assessment for (2) 3. realistic? 4. community referral for?
1. supportive 2. resolution or complications 3. appraisal of situation 4. ongoing f/u and care
hypertrophic pyloric stenosis 1. most common? 2. caused by ? 3. symptoms -begins when? -vomiting is? (2) -occurs how often? -occurs more in? -percentage? -causes? look at slide 66
1. surgical procedure in infants <2 mo 2. hypertrophied pyloric muscle causes gastric outlet obstruction 3. -2-4 weeks -non-bilous, more forceful and projectile -2 to 4 of 1000 live births -males -30% in first males -multifactorial
retained placental fragments 1. occurs when? 2. signs? (2) 3. treatment? (3)
1. there is an incomplete separation of the placenta and fragments of placental tissue 2. boggy relaxed uterus and dark red bleeding (means old) 3. d&c, oxytocin (pitocin), prophylactic antibiotics
implantable contraceptive (nexplanon) 1. what is this? 2. how is it put in? 3. how effective? 4. does not protect against 5. side effects 6. how does it look in the skin?
1. time release implant placed in body with synthetic progestin that inhibits ovulation 2. minor surgery inner side of upper arm 3. 99.95% 4. sti 5. smililar to progestin-only pills 6. radiopaque, side of match stick
newborns of substance abusing mothers 1. most common substances (3) 2. fetal alcohol syndrome? 3. fetal alcohol? 4. alcohol related? 5. neonatal abstinence syndrome? 6. what med for withdrawal
1. tobacco, alcohol and marijuana 2.physical and mental disorders appearing at birth and remaining problematic throughout the child's life (see Box 24.2) 3. spectrum disorders 4. birth defects 5.drug dependency acquired in utero manifested by neurologic and physical behaviors 6. methadone
Preterm newborn 1. body system immaturity affects? increases? 2. 6 systems
1. transition to extrauterine life, increasing risk for complications 2. resp. system cardiovascular system (patent ductus arteriosis) gi system renal system immune system (susceptible to infection) cns (bilirubin in brain can cause hemorrhage)
Nursing intervention for a prolapsed cord 1. pelvis goes? 2. wear? 3. position 4. monitor? 5. inform? and offer? 6. dont do what to mom? 7. do what until delivery? 8. give what if needed 9. if there is a decrease in the fhr?
1. up 2. sterile gloves 3. trendekenburg, modified sims or knee to chest 4. fhr 5. client and offer emotional support and comfort 6. do not leave her alone 7. place hand in vagina and hold presenting part that is on the cord until delivery 8. oxygen 9. first action would be to check for prolapsed cord, do a vaginal exam to check the cord
inversion of the uterus 1. what is it? 2. complete inversion? 3. incomplete inversion 4. predisposing factors -what on the cord? -dont do what unless? -incorrect? especially when? -dont use what to push placenta out? look over slide 19 and 20
1. uterus inverts or turns inside out after delivery 2. large, red rounded mass protrudes from vagina 3. uterus cannot be seen, but felt 4. -traction applied on cord before placental separation -dont pull unless separated -incorrect traction and pressure applied to fundus, when uterus is flaccid -dont use fundus to push the placenta out
treatment and nursing care of inverted uterus 1. replace? (3) 2. combat? usually from? 3. give what med? 4. initiate what med? 5. may need to insert? 6. notify who?
1. uterus, manually and pack.. blood and fluid 2. shock, which is usually out of proportion to the blood loss 3. oxytocin 4. broad spectrum antibiotics 5. nasogastric tube to minimize paralytic ileus 6. recovery nurse, care must be taken when massaging
Group B strep 1. colonizes where? (4) 2. is it natural? % of healthy adults? % of pregnant women? 3. common cause of what in newborns (3) 4. screened at home many weeks? teat with? given when?
1. vagina, rectum, cervix, urethra of preg. women 2. naturally occurring bacterium found in 80% healthy adults and 20% pregnant women 3. sepsis, meningitis and pneumonia 4. 35-37 weeks treat with antibiotic (penicillin G), given 4 hours before birth
Nursing care of uterine atony 1. document? 2. do what to fundus? 3. assess what for what? 4. give? (3) 5. do? (2) 6. replace (2)
1. vaginal bleeding 2. massage/bimanual compression 3. vital signs for shock 4. medications (pitocin, methergine, hemabate) 5. d&c, hysterectomy 6. blood, fluids
PROM (premature rupture of membranes) 1. possible causes (2) 2. complications (3) 3. management depends on? 4. s/s of infection (3) 5. when is there greater risk? 6. s/s of preterm labor (3) 7. PROM can cause 8. some other causes (look at page 812)
1. vaginal infections, chorioamniontis 2. m/f infection, RDS, compression 3. depends on gestational age, this can happen at any gestational age, do daily kick counts 4. fever, foul odor, unclear discharge 5. prom < 34 weeks (preterm) 6. regular contractions with effacement and dilation before the end of the 37th week 7. infant morality 8. periodontal disease, gestational db, gestational hen, drug and alcohol use, hx of preterm labor
Passage 1. they are? 2. what is a soft tissue obstruction? 3. 2 good pelvis shapes 4. what type is better
1. variations in bony pelvis 2. moms bowel or bladder is in the way 3. gynecoid, anthrocoid 4. the rounder, the better
Bronchopulmonary dysplasia nursing assessment 1. continuous? and what support? 2. optimal? administer what prn? 3. monitor their? 4. provide what type of diet? 5. educate parents and family on?
1. ventilator and oxygen support 2. nutrition, admin. bronchodilators, anti-inflammatory agents and diuretics prn 3. respiratory status 4. high calorie diet plan 5. ongoing care if needed
c-secition birth 1. what is done outside of the US 2. most common reason for c-section 3. other reasons (4) 4. done in the us
1. vertical 2. cephelo pelvic disproportion 3. placenta previa, abnormalities, hemorrhage, herpes 4. low transverse
LGA Nursing Management 1. monitor? 2. why would you monitor blood glucose? 3. initiation of? 4. continued monitoring of? 5. keep the baby? (think nutrition) 6. phototherapy for? 7. look for signs of(3) 8. what is good for bringing bilirubin down?
1. vital signs 2. as soon as cord is clamped, baby doesn't know how to stop sending off insulin and glucose will drop 3. oral feedings (breast is best) with iv glucose supplementation as needed 4. for s/s of polycythemia and hypoglycemia 5. hydrated 6. increased bilirubin levels 7. tachypnea, tachycardia, hypoglycemia 8. feeding protein
placenta accreta 1. should be picked up when? 2. signs -during the 3rd stage of labor? -attempts to remove placenta are? what may occur (2) 3. treatment -if only small portions are attached? -if large portion is attached?
1. with an ultrasound but sometimes not 2. -placenta does not want to separate -are unsuccessful, perforation and laceration of uterus may occur 3. -may be removed manually -hysterectomy
tubal ligation 1. performed on? 2. fallopian tubes are? 3. failure rate? 4. may experience look over slide 48 essure 5. non (2) 6. no need for (2) 7. what is done? 8. use what for 3 months 9. effectiveness look over slide 50
1. woman 2. cut, tied, cauterized prevents egg from reaching perm 3. 0.8%-3.7% 4. heavier periods 5. surgical and hormonal 6. anesthesia or incisions 7. tiny coil placed in fallopian tube to promote tissue birth over 3 months to block tubes 8. contraception 9. 99%
SGA NB nursing management 1. take what measurements? (3) 2. monitor what in the blood 3. monitor what? 4. what type of feedings? 5. monitor for s/s of? 6. anticipatory? (3) 7. they have a lot more? than what? 8. this puts them at risk for? (3) 9. o2 would not be able to? , this will cause (3)
1. wt, length head circumference 2. serial blood glucose 3. vital signs 4. early and frequent oral feedings (iv infusion of dextrose 10% 5. polycythemia 6. guidance with o2, iv solution and be ready to feed 7. rbc than fluid. 8. at risk for clots, thrombosis and hypertension 9. get to organs, will cause respiratory. distress, cyanosis and redness
gestational db management 1. diet 2. exercise 3. glucose level monitoring 4. fetal surveillance 5. educate on? 6. medications?
1.3 meals and 3 snacks per day. 40% calories from carbs, 35% protein, and 25% from unsaturated fats.Small frequent meals to control nausea and vomiting and maintain a normal blood sugar in the body 2. improves glucose metabolism 3.instruct on self admin. and self monitoring 4.perform daily kick counts around 28 wks, usually 10 within 2 hrs. frequent ultrasounds, amniocentesis for lung maturity, stress test for fetal well-being 5.on need for postpartum laboratory testing on OGTT and blood glucose levels 6.glyburide and metformin *does not cross placenta = no fetal hypoglycemia
post partum infections 1. definition? 2. causes (8) 3. change pad how often 4. teach about?
1.A fever of 100.4 F (38 C) or higher after the first 24 hours after childbirth, occurring on at least 2 of the first 10 days, after birth, exclusive of the first 24 hours. 2.Staphylococcus aureus, Klebsiella, Gardnerella vaginalis, gonococci, coliform bacteria, Chlamydia Streptococcus Groups A and B, Clostridium, E. Coli 3. every 2 hours 4. general hygiene, wipe everything
preeclampsia mild 1. bp guidelines 2. proteinuria guidelines 3. seizures/coma 4. hyperreflexia 5. other s/s 6. risk for?
1.BP >140/90 after 20 wks. (x2, 4-6 hrs apart) 2. 300 mg or more of urinary protein per 24 hr or 1+ protein on dipstick with 2 random samples collected 4-6 hours apart with no UTI 3. no 4. no 5. mild facial or hand edema, wt gain 6. postpartum htn
nursing management of HPS 1. preoperative (4) 2. post operative (3)
1.Fluid management, Correcting electrolyte imbalance, Relieve family anxiety, Pre and Post op family education 2. Manage IV fluids Pain management Feedings usually resume in 1-2 days
infants of diabetic mothers 1. there are high levels of? 2. nursing assessment -mothers with? -baby will look (9) -will have (4) -gestational diabetes causes baby to be?
1.High levels of maternal glucose crossing placenta, stimulating increased fetal insulin production leading to somatic fetal growth 2. -diabetes -full rosy cheeks, ruddy skin color, short neck, buffalo hump, massive shoulders, distended upper abdomen, excessive subq fat, hypoglycemia, birth trauma -hypocalcemia, hypomagnesemia, polythemia, hyperbilirubinemia -large
hyperbilirubinemia 1. what is this? 2. physiological jaundice 3rd to 4th day of life) 3.Pathologic jaundice (within first 24 hours of life) 4. 2 s/s 5. patho?
1.Imbalance in rate of bilirubin production and elimination; total serum bilirubin level >5 mg/dL 2.Early-onset breast=feeding jaundice Late-onset breast-feeding jaundice 3.Kernicterus Rh isoimmunization ; ABO incompatibility 4. spinachy poop, dark urine 5. blood type is different between mom and baby
Mastitis 1. what is it? 2. extremely (2) 3. bacteria? 4. can still? make sure baby doesn't get? 5. types (2)
1.Marked Engorgement, Pain, Chills, Fever, Tachycardia, Hardness and Redness, Enlarged and tender lymph nodes 2. painful and sore 3. invades breast tissue 4. breastfeed with antibiotics, doesn't get thrush 5. mammary cellulitis: inflammation of the connective tissue between the lobes in the breast mammary adenitis: infection in the ducts and lobes of the breasts
preeclampsia 1. what? 2. characterized by? 3. patho?
1.Multisystem disorder that targets the cardiovascular, hepatic, renal, and CNS. Classified as mild or severe with potential to progress to eclampsia. 2. htn, proteinuria, organ damage 3. LOOK AT SLIDE 18 & 19!! KNOW THE DIFFERENCE B/W MILD AND MODERATE
permanent methods (sterilization) 1. what is it? 2. female? 3. male? 4. failure rate?
1.Procedure performed on a man or a woman permanently sterilizes 2. tubal litigation or essure 3. vasectomy 4. <1%
gestational db 1. s/s hypoglycemia 2. s/s hyperglycemia
1.Shakiness Sweating Pallor Disorientation Headache Hunger Blurred vision Tingling of mouth or extremities 2.Thirst Nausea Abdominal pain Frequent urination Flushed dry skin Fruity breath Shallow respirations
congenital heart disease 1. does what 2. tetralogy of fallot 3. eisenmengers syndrome 4. atrial septal defect 5. ventricular septal defect 6. patent ductus arteriosis Look over side 7, 8, 9, and 10
1.Structure defects present at birth. Uncorrected, at risk for pulmonary HTN 2. combination of four defects. If repaired, women do well during pregnancy. Uncorrected, high risk for morbidity and mortality, (Avoid pregnancy). 3. Increase pressure in right heart = blood shunts from left to right. Results in cyanosis, pulmonary HTN (Avoid pregnancy) 4. hole in the septum between the atria. Blood shunts from left to right. Arrhythmias may be present 5. hole in the septum between the ventricles. Blood shunts from left to right. Arrhythmias, HF, pulmonary HTN 6. open lumen in the ductus arteriosus between the aorta and pulmonary artery = more blood going to the lungs = increase in respiratory problems.
eclampsia 1. what is it? 2. guidelines? 3. proteinuria? 4. seizures? 5. hyperreflexia 6. other s/s (7)
1.The onset of seizure activity or coma. Preceded by headache, severe epigastric pain, hyperreflexia, and hemoconcentration. Starts with facial twitching, followed by generalized muscle rigidity 2. >160/110 3. marked protein 4. yes 5. yes 6. severe headaches, generalized edema, ruq or epi. pain, visual disturbances, cerebral hemorrhage, renal failure, HELLP
Client education for.... 1. rubella 2. cytomegalovirus 3. emphasize compliance of? 4. provide?
1.Vaccination contraindicated if pregnant r/t risk of rubella infection developing. Avoid crowds of young children. Women not immune should be vaccinated during immediate postpartum period so they are immune before becoming pregnant again 2.no treatment exists. Frequent hand washing before eating, avoid crowds of young children 3. treatment 4. emotional support
newborn infections 1. neonatal sepsis 2. classification 3. nursing assessment 4. will do what on the baby?
1.bacterial, fungal, or viral microorganisms or their toxins in blood or other tissues .. Can cause death 2.Congenital (intrauterine) Early-onset (perinatal period) Late-onset (see Comparison Chart 24.2) 3.risk factors; nonspecific symptoms; elevated C-reactive protein, positive cultures 4. cbc with dif and blood work
1. pre-gestational diabetes is? 2. type 1 3. type 2 4. read over
1.blood sugars poorly controlled before conception 2.insulin deficient, onset childhood or early adulthood 3.insulin resistant-deficient, onset >30, but now seen in children (90% of diagnosed cases) 4.Hormones from the placenta help the fetus develop but also block insulin in the body, (insulin resistance) makes it hard for the mothers body to use insulin. Without insulin glucose cannot leave the blood and be changed into energy thus, glucose build up builds in the blood which causes high levels.
1. gestational db 2. resistance to insulin 3. complications 4 extra sugar does what to the baby?
1.glucose intolerance develops with pregnancy results in progressive resistance to insulin 2.inability of body to obtain nutrients for fuel and storage, resulting in postprandial hyperglycemia 3.macrosomia, hyperglycemia, birth trauma, and maternal complications 4. makes it bigger
Uterine atony 1. what is it? 2. why is this significant? 3. what is the key to successful management? 4. nurses can do what? 5. uterus will be? 6. history of?
1.myometrium fails to contract and the uterus fills with blood b/c of the lack of pressure on the open blood vessels of the placental site. 2. most common cause of hemorrhage 3. prevention 4. can predict which women are at risk for hemorrhage 5. boggy 6. grand multi, trauma
magnesium sulfate 1. action? 2. s/s of toxicity -resp. -absence of? -decreased? -serum magnesium levels? 3. always have what ready? 4. this is always on a ?
1.prevents seizures associated with preeclampsia and controls seizures in eclampsia. Acts as a CNS depressant. Is a potent neuromuscular blockade and hyporeflexia may develop 2. -<12/min -dtr's -urinary output <30/hr >8 mEq/L 3. calcium gluconate 4. pump
What fraction of maternal deaths are caused by hemorrhage?
1/3
Chronic HTN: BP exceeding __/___ before pregnancy or before the ___th week gestation, or sustained HTN >___ weeks p/p
140/90 before preg or before the 20th week gestation , or sustained HTN >12 weeks p/p
What gage IV should be used?
18GIV
PRE-GESTATIONAL DIABETES - blood sugars controlled BEFORE conception - type 1: insulin ________, onset childhood or early adulthood - type 2: insulin _______, onset>30, but now seen in children
1=deficient 2= resistant
when is the greatest risk of hemorrhage?
1st hour after birth
What are aspects of depression
1st year post partum Anxiety, irritability feelings of failure, worthlessness and guilt sleep and appetite changes suicide ideation and excessive concern about infant MORE SEVERE
what percent of post pardum women get UTIs
2-4%
Powers 2. hypertonic uterine -hyper means? -mom doesn't have time to do what? this type of power is? -poorly? -prolongs what phase? -stays at how many cm dilated? -what happens to the fetus? -this is? (3) -when does this happen?(2)
2. -contractions too strong -relax in between contractions, this is less common -coordinated contractions -prolongs latent phase -2-3 cm -placenta profusion becomes compromised by reducing oxygen to the fetus -exhausting, tiring and dehydrating -early labor and mulltips
What is the percent of pph that occurs because of hemorrhage?
20%
GESTATIONAL DIABETES MANAGEMENT - diet: ___meals and ___ snacks per day, ___% calories from carbs __% protein __% unsaturated fats
3 meals, 3 snacks 40% calories from carbs 35% protein 25% unsaturated fats
Powers 3. Ineffective pushing -no time limit for? -want to make sure? 4. prolonged labor -possibility of? (2) -causes what size baby? 5. precipitate labor -happens how? (timing) -how many hours? -can cause? (2) -mom can get? (2) -infant can get? (3)
3. -pushing -both mom and baby are okay 4.-hypoglycemia, analgesic use -LGA size 5. -happens quickly, rapid onset -less than 3 hours from first contraction -maternal injury and fetal risk of oxygen -cervical lacerations, uterine rupture -inter cranial hemorrhage, nerve damage or hypoxia
What are the superficial assessment
3rd-4th PP day Tenderness Warmth Redness Low grade fever PE rare
what is the percent of c sections with infection
4-12%
How long does it take for blood loss to show in the H&H?
48 hours
What percent of women get a UTI with one catheterization?
5%
what percent of women with multiple cauterizations get UTIs
50%
what is the effect of platelets
5000-10,000 per unit
Postpartum infection occurs in what percent of new borns?
6%
What is considered a fever?
> 100.4F
What is Preterm Labor?
A birth that occurs before the 37th week of pregnancy.
What is ABO Incompatibility?
A common and generally mild type of haemolytic disease that occurs if a newborn has blood type A or B, and the mother is type O. RBC's are broken down more quickly than usual which can cause jaundice, anaemia and in very severe cases can cause death.
What is Cleft Lip/Palate?
A fissure or opening in lip; cleft palate involves roof of mouth. Most common craniofacial birth defect.
What is TORCH? How are TORCH infections given to the fetus?
A group of infections capable of crossing the placenta and adversely affecting fetal development. (Mom catches an infectious disease that travels in her bloodstream and carries over to the fetus. Fetus cannot fight off infection in utero, so disease stays in their body and affects their growing organs from developing correctly).
What is Necrotizing Enterocolitis?
A medical condition primarily seen in premature infants, where portions of the bowel undergo necrosis. 3 pathologic mechanisms: bowel ischemia, bacterial flora, and effect of feeding.
Macrosomia
A newborn who is significantly larger than average. Has a birth weight more than 8 lbs 13 ounces (4,000 grams) regardless of gestational age
a, b, d
A nurse administering magnesium sulfate IV to a client who has severe preeclampsia for seizure precautions. Which of the following indicates magnesium sulfate toxicity? Select all that apply. A. Respirations less than 12/min B. Urinary output < 30ml/hr C. Hyperreflexic DTRs D. Decreased LOC E. Increased BP
What is Amniotic Fluid Embolism?
A rare obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enters the mother's blood stream via the placental bed of the uterus and triggers an allergic-like reaction. 1/8000 births 80% mortality rate 60% die in first hour 85% survivors have neuro damage
What lab values are affected?
ABGs H&H electrolytes clothing studies type and cross match
The Pill: danger signals
ACHES A-abdominal pain C-chest pain H-headaches E-Eye problems S-severe leg pain These can signify a prolem with liver, bladder, blood clots in lung, CVA, , hypertension, or clots
What is Aortic Stenosis? Any precautions for someone becoming pregnant?
AHD Narrowing of aortic valve, blocks flow into aorta = thickening left ventricle = less room for adequate amount of blood supplied to body. Most pregnant women managed medically.
What is Mitral Valve Stenosis? Any precautions for someone becoming pregnant?
AHD Narrowing of mitral valve, blocks flow into left ventricle = pulmonary edema, pulmonary HTN, and right ventricular failure. Most pregnant women managed medically.
What is Mitral Valve Prolapse? Any precautions for someone becoming pregnant?
AHD Valve between left atrium and ventricle does not close properly. Leaflets of mitral valve prolapse (bulge) upward or back into the left atrium as heart contracts Asymptomatic, occasional palpitations, no special precautions.
lifetime
Acquired Heart Disease - Develop during a person's ___________
What are AHD?
Acquired heart diseases develop during a person's lifetime.
What are interventions for bacterial agents
Administer medications Maintain fluid/electrolyte balance Promote adequate nutrition Provide comfort Assess vital signs Observe for signs of septic shock Assess vital signs Observe for signs of septic shock Use aseptic technique Assess fundus, lochia Monitor labs Promote rest/sleep
fhr
After the water breaks, the __________ monitored closely
What is an Amniotomy?
Also referred to as artificial rupture of membranes AROM, an Amniotomy is the procedure by which the amniotic sac is deliberately ruptured so as to cause the release of amniotic fluid to induce or expedite labor.
first, neuro
Amniotic Fluid Embolism (AFE) AKA Anaphalactoid Syndrome 1/8000 births *80% mortality rate* *60% die in ________ hour* 85% survivors have ________ damage
maternal
Amniotic Fluid Embolism (AFE) - like blood clot, amniotic fluid enters the __________ blood circulation. (fluid shift during pushing from strong contractions)
amniotomy
An _________________, may be performed by a midwife or obstetrician to induce or accelerate labor. The membranes may be ruptured using a specialized tool, such as an amnihook or amnicot, or they may be ruptured by the proceduralist's finger. Artificial rupture of membranes (AROM)
What is Hyperbilirubinemia?
An imbalance in rate of bilirubin production and elimination; total serum bilirubin level >5 mg/dL.
what meds may be given
Antibiotics, antipyretics, analgesics
aorta, thickening left
Aortic Stenosis- narrowing of aortic valve, blocks flow into _______ = _______ _______ ventricle = less room for adequate amount of blood supplied to body.
stenosis
Aortic ____________ - narrowing of aortic valve, blocks flow into aorta = thickening left ventricle = less room for adequate amount of blood supplied to body. Most pregnant women managed medically
Asymmetrical Intrauterine Growth Restriction (IUGR):
Appropriate head and body lengths but decreased weight and organ sizes.
What nursing interventions and education would you provide for a patient with problems with the passage?
Assess contractions, dilation & progression of labor. Evaluate bowel & bladder status. Void q2h. Explain to woman & family the dysfunctional pattern. Plan for cesarean birth.
How do you assess for ABO Incompatibility?
Assess skin and mucous membranes for jaundice. Skin edema, press down and skin will be yellow before it turns back to skin color.
What are s/s of Mild Preeclampsia?
BP >140/90 after 20 wks. (x2, 4-6 hrs apart) Proteinuria >300 mg/24 hr or 1+ protein on dipstick with 2 random samples collected 4-6 hours apart with no UTI. Seizures/coma = no Hyperreflexia = no Other s/s = mild facial or hand edema, wt gain. Risk for postpartum HTN.
What are s/s of Severe Preeclampsia?
BP >160/110 Protein of >500mg/24 hours (3+ dipstick) Oliguria <400mL/24 hours Cerebral and visual symptoms. Weight gain and edema- pitting degree. Pulmonary edema. Thrombocytopenia <100,000mm3 Epigastric or RUQ pain, HELLP. Labs: CBC, serum electrolytes, BUN, creatinine, hepatic enzyme levels. Hyperreflexia NO seizures.
What do you assess for hemodynamics?
BP, pulse rate, pulse pressure, cap refill
What interventions call be implemented for a patient with Mild Preeclampsia at home?
Bed rest, lateral position, ∧ antepartal visits with labs: CBC, clotting studies, liver enzymes, platelets, BP and WT monitoring, protein measure with dipstick, daily fetal kick counts, balanced diet, six-eight 8oz glasses water daily.
What are symptoms of Hypertrophic Pyloric Stenosis?
Begin 2-4 weeks of life Non-bilious vomiting Vomiting becomes more forceful and projectile Occurs in 2 to 4 of 1000 live births Occurs more in males 30% in 1st born males Cause multifactorial
what are bacterial agents
Beta Strep Genital mycoplasmas Clostridia Klebsiella Anerobic strep Streptococcus hemolyticus E. Coli Staph aureus Chlamydia trachomatis
Periventricular/Intraventricular Hemorrhage (define)
Bleeding in brain due to fragile cerebral vessels. Grading system from I to V (least to most severe). Most commonly occurs 72 hours after birth.
Fetal risks
Blood loss, anemia Hypoxemia - tissue level Hypoxia- organ Anoxia Preterm birth
Gestational age -- Postterm Newborn:
Born after 42 competed weeks
Gestational age -- Preterm Newborn:
Born before 37 completed weeks
Gestational age -- Late Preterm Newborn:
Born between 34 weeks through 36 6/7 weeks
Gestational age -- (Full) Term Newborn:
Born between 38 1/7 week through 42 weeks
crepitus
Brachial Plexus Injury=> Erb's Palsy or Waiters Sign complication of baby going through birth canal. (check if clavicle is broken, or ___________ (bubble wrap sound)
In Preeclampsia, what happens to brain perfusion and what are its affects?
Brain perfusion DECREASES, resulting in small cerebral hemorrhages, headaches, visual disturbances, blurred vision, DTRs.
cortex, cns
Brisk reflexes (hypereflexia) = irritable _________ and _________ involvement
What are interventions
C & S Antibiotics Vital signs Q 4 hrs Increased oral intake Rest, nutrition Provide comfort Monitor bladder Frequent voiding Teaching for prevention Maintain lactation if BF temporarily contraindicated
what are interventions
C & S of milk Antibiotics, antipyretics, analgesics Increase fluid intake Teach preventive measures Vital signs Comfort measures If abscess, incision and drainage Maintain lactation Freq. nsg, involved breast first Nutrition, rest, sleep
What is ASD? What are the risk associated with ASD?
CHD Atrial septal defect (ASD)- hole in the septum between the atrias. Blood shunts from left to right. Arrhythmias may be present.
What is TOF? What are the risks and recommendations associated with TOF?
CHD Combination of four defects. VSD, Right Ventricular Hypertrophy, Pulmonary Stenosis (narrowing of pulmonary valve, obstructing blood flow from RV to PA), and Overriding Aorta (enlarged aorta rises from both ventricles instead of just the LV). If repaired, women do well during pregnancy. Uncorrected, high risk for morbidity and mortality, (Avoid pregnancy).
What is Eisenmenger's Syndrome? What are the risks and recommendations associated with Eisenmenger's Syndrome?
CHD Increase pressure in right heart = blood shunts from left to right. Results in cyanosis, pulmonary HTN (Avoid pregnancy).
What is PDA? What are the risks associated with PDA?
CHD Patent ductus arteriosus (PDA)- open lumen in the ductus arteriosus between the aorta and pulmonary artery = more blood going to the lungs = increase in respiratory problems.
What is VSD? What are the risks associated with VSD?
CHD Ventricular septal defect (VSD)- hole in the septum between the ventricles. Blood shunts from left to right. Arrhythmias, HF, pulmonary HTN.
Hyperreflexi/brisk reflexes are commonly seen in patients with preeclampsia. What is this an indication of?
CNS involvement disrupts equilibrium of impulses between cerebral cortex and spinal cord.
What interventions would you implement for someone experiencing a cord prolapse?
Call for assistance and notify provider. Position pt. pelvis up or side lying. Sterile gloves, insert 2 fingers and raise presenting part off both sides of the cord. O2 8-10L/min via face mask. Trendelenburg, Modified SIMS or Knee-chest. FHR Monitoring. Inform client & offer emotional support.
In Preeclampsia, what happens to capillary permeability in the kidneys and what are its affects?
Capillary permeability in kidneys INCREASES, resulting in DECREASED albumin leading to DECREASED colloid osmotic pressure causing pulmonary and generalized edema.
Shoulder dystocia
Case of obstructed labour wherby after the delivery of the head, the anterior shoulder of the infant cannot pass below
Newborns of substance-abusing mothers -- Fetal Alcohol Syndrome (FAS)
Characterized by physical and mental disorders that appear at birth and remain problematic throughout the child's life Three specific findings: 1. Growth restriction pre and postnatal 2. Craniofacial structural anomalies 3. CNS dysfunction
smoking, obesity
Chronic HTN - Nursing Assessment Hx and physical for risk factors (_______, _________, caffeine intake, alcohol intake, excessive salt intake, use of NSAIDS, increasing age, African American race VS-BP sitting, lying, standing; orthostatic HTN? Lifestyle modifications and effectiveness Medications for BP? Fetal kick counts? Fetal heart rate
160/100, methyldopa, aspirin, 81
Chronic HTN - Nursing Interventions DASH diet teaching, aerobic exercise as tolerated, smoking cessation, alcohol, scheduling appointments, monitor for placental abruption and superimposed preeclampsia, daily rest periods *left side*, home bp monitoring and teaching, compliance of medications, continued medial supervision If BP exceeds ____/____ drug tx used ____ and low-dose _______ (____mg)
140/90, 20, 12
Chronic HTN = BP exceeding ____/____ *before* pregnancy or before the ____ week gestation, or sustained HTN > ____ wks. postpartum
Bronchopulmonary Dysplasia (define)
Chronic Lung Disease. Often seen in infants who experienced RDS and require O2 at 28 days old.
What are the 3 types of C-section incisions?
Classical happens outside the USA.
How do you manage/treat a newborn whose mother is a substance abuser?
Comfort promotion; stimuli reduction Nutrition Prevention of complications Parent-newborn interaction
birth
Congenital Heart Disease - Structure defects present at ___________. Uncorrected, at risk for pulmonary HTN
How is Toxoplasmosis caused and what are the manifestations for the mother and fetus?
Consumption of raw or under cooked meat or handling cat feces. Maternal s/s: fever, tender lymph nodes, malaise, muscle aches (influenza-like symptoms). Fetal s/s: none until after birth
How is Rubella caused and what are the manifestations for the mother and fetus?
Contracted through children who have rashes or neonates who are born to women who had rubella during pregnancy. Maternal s/s: rash, mild lymphedema, fever, joint and muscle pain. Fetal s/s: miscarriage, congenital anomalies, and death.
effects on fetus (9)
Cord prolapse Congenital anomaly Macrosomia (8lb13oz) Birth trauma Preterm birth Fetal asphyxia Intrauterine growth restriction Respiratory distress Polycythemia,hyperbilirubinemia, hypoglycemia, childhood obesity
What potential effects does Gestational Diabetes have on the fetus?
Cord prolapse Congenital anomaly Macrosomia Birth trauma Preterm birth Fetal asphyxia Intrauterine growth restriction Respiratory distress Polycythemia, hyperbilirubinemia, hypoglycemia, childhood obesity
follow up (read through)
Correct and continuous follow up of the users is indispensable to monitor the possible complications with the use of contraceptives. It ensures eventually an improved continuation rate among the users.
War are predisposing factors
Cracked nipples Engorgement Lowered maternal defenses (fatigue, stress) Poor hygiene Tight clothing or poor support of pendulous breasts
Diagnostic tests for threatened pregnancies
Cullen's sign- blue around umbilicus vaginal exam pelvic exam vaginal ultrasound decreased progesterone (<5mg) and hCG levels
Nursing interventions for chronic HTN
DASH diet teaching, aerobic exercise as tolerated, smoking cessation, alcohol, scheduling appointments, monitor for placental abruption and superimposed preeclampsia, daily rest periods left side, home BP monitoring and teaching, compliance of medications, continued medial supervision - if BP exceeds 160/100, use Methyldopa and low-dose ASA
deep tendon reflexes
DTRs are ________ ____________ ___________
What increases the risk of a pulmonary embolism.
DVT and SPT
PREECLAMPSIA PATHO Decreased kidney perfusion=
Decreased GFR= decreased urine output= increased levels of Na+, BUN, Ruiz acid, and creatinine
PREECLAMPSIA PATHO Increased capillary permeability in kidneys=
Decreased albumin, decreased colloid osmotic pressure= pulmonary and generalized edema
absent, clonus
Deep Tendon Reflexes (DTRs) 0 - reflex _______ , none elicited 1 - hypoactive response, *sluggish* 2 - reflex in *lower half* of normal range (NORMAL) 3 - reflex in *upper half* of normal range (NORMAL) 4 - hyperactive, brisk, __________ present
cleft lip and palate
Development of the cleft occurs early in pregnancy. The tissue that forms the lip ordinarily fuses by 5 to 6 weeks of gestation, and the palate closes between 7 and 9 weeks of gestation. Therefore, if either the lip or pal- ate does not fuse, then the infant is born with a cleft.
resistant
Diabetes in pregnancy is split up into two different categories -Pre-Gestational Diabetes -Gestational Diabetes Pre-Gestational Diabetes- blood sugars poorly controlled before conception -Type 1 - insulin deficient, onset childhood or early adulthood -Type 2 - insulin _____(a)_____-deficient, *onset >30*, but now seen in children (90% of diagnosed cases)
Although not part of the TORCH acronym, HIV is a TORCH disease. What are maternal s/s?
Diarrhea and wt loss, lymphadenopathy and rash, anemia.
What is DASH
Dietary approach to stop hypertension: low sodium, low cholesterol, no fried/fat foods, more grains/lean meats
Dystocia
Difficult labor or birth
magnesium
Diminished or absent Deep Tendon Reflexes (DTRs) = ____________ toxicity
What actions do you take if you suspect your patient is experiencing Magnesium Sulfate toxicity?
Discontinue Infusion Administer Calcium Gluconate Prevent respiratory and cardiac arrest.
What is the common agent of UTIs
E. coli
What can also cause mastits
E.coli, strep, candida
Physiologic jaundice
Early onset breast-feeding jaundice is probably associated with ineffective breast-feeding practices because of relative caloric deprivation in the first few days of life. Late-onset breast-feeding jaundice occurs later in the newborn period, with the bilirubin level usually peak- ing in the first 6 to 14 days of life. Total serum bilirubin levels may be 12 to 20mg/dL, but the levels are not considered pathologic. The specific cause of late-onset breast milk jaundice is not entirely understood, but it may be related to a change in the milk composition resulting in enhanced enterohepatic circulation.
160/110, yes, yes, renal
Eclampsia Definition & Classification/Assessment BP - > ____/____ (or above) *Proteinuria - Marked protein* Seizures - ____ Hyperreflexia - ____ Other s/s - Severe headaches, generalized edema, RUQ or epigastric pain, visual disturbances, *cerebral* hemorrhage, ________ failure, HELLP
seizure, coma, hyperreflexia, twitching
Eclampsia Definition & Classification/Assessment The onset of _________ activity or _________. Preceded by headache, severe epigastric pain, _________ , and hemoconcentration. Starts with facial _________ , followed by generalized muscle *rigidity*
magnesium sulfate, positive
Eclampsia Management/Interventions Client safety priority concern, turn client to side and remain with client. Side rails up and padded, dim lights, keep room quiet. After seizure, suction as necessary and administer oxygen Continue ___________ ______________ infusion to prevent further seizures Control HTN with antihypertensive medications Continue electronic fetal monitoring and assess client for uterine contractions After client is stable prepare for birthing process ASAP to reduce risk of perinatal mortality Administer glucocorticoid tx Provide emotional support, keep family informed Follow-up care after delivery for 48 hrs, continue Magnesium sulfate for 24 hrs, monitor magnesium levels for toxicity, assess vs q 4 hours and postpartum assessment. Diuresis is a _________ sign along with decrease in proteinuria signaling resolution
What is DVT assessment
Edema ( measure) Initial low fever, chills, followed by high fever Pain leg, lower abd Homan's sign Decreased pulses
How do you prevent Preterm Labor?
Education Improved access to care Identify risk factors Adequate nutrition Empowerment
prolapse, macrosomia, obesity
Effects on Fetus (Gestational Diabetes) Cord __________ Congenital anomaly __________ Birth trauma Preterm birth Fetal asphyxia Intrauterine growth restriction Respiratory distress Polycythemia, *hyperbilirubinemia*, *hypoglycemia*, childhood ________)
hydra, ketoacidosis
Effects on Mother (Gestational Diabetes) _________mnios Gestational HTN _____________________ Preterm labor s/t premature membrane rupture Stillbirth Hypoglycemia UTIs Difficult labor, C/S, postpartum hemorrhage s/t *overdistended uterus* to accommodate macrosomic infant
PREECLAMPSIA PATHO - decreased liver=
Epigastric pain and increased liver enzymes
perineum
Episiotomy Incision of _____________ *just before* birth WAS routine for vaginal births
Symmetrical Intrauterine Growth Restriction (IUGR):
Equally poor growth rates of the brain, abdomen, and long bones.
Brachial plexus injury
Erb's Palsy "Waiter's sign"
What are intervention
Evaluate history for risks Prevention-support hose, SCD's Vital signs Clotting studies Leg assessment Bedrest Increased fluid intake Leg elevation Leg measurement Warm moist soaks Leg exercises and early ambulation as indicated Promote comfort Anticoagulation therapy
What is Precipitous Labor?
Expulsion of the fetus within less than 3 hours of commencement of regular contractions.
failure to progress
FTP mean?
Passenger
Fetal size Fetal presentation Multifetal pregnancy Fetal anomalies
10, 2, amniocentesis, stress
Fetal survellance - perform daily kick counts around 28 wks, usually ______ within ____ hrs. frequent ultrasounds, ____________ for lung maturity, ________ test for fetal well-being
What are findings for endometritis
Fever 101-102, jagged elevations, uterine tenderness, prolonged afterpains, subinvolution, positive lochial culture
What are findings for septic pelvic thrombophlebitis
Fever to 105, dramatic fluctuations possible, flank and lower abdominal pain
What are 3 ways to manage a pregnant patient with a CHD or AHD?
Focus - Stabilize the mother's hemodynamic status Drug therapy- diuretics (Lasix), inotropics (Lanoxin), antiarrhythmic agents (Lidocaine), beta blockers (Labetalol), calcium channel blockers (Nifedipine), anticoagulants (Heparin). Warfarin is not recommended as it crosses the placenta Education - reducing risks leading to cardiac complications. Compliance cardiac meds, medications, frequent antepartal visits, conserve energy, rest left side, nutrition, limit Na+, dx tests for fetal well-being (EKG, echo, nonstress test, monitor fetal activity and movements), s/s cardiac decompensation, monitor fluid volume during /after labor for 48 h.
What interventions call be implemented for a patient with Mild Preeclampsia during labor?
Focus on preventing progression to eclampsia. BP monitored, quiet environment, IV magnesium sulfate, antihypertensive medication (if needed), calcium gluconate bedside, neuro checks, urinary catheter.
After delivery, how is a preeclampsic or ecclampsic patient treated after they've been given Magnesium Sulfate?
Follow-up care after delivery for 48 hrs, continue Magnesium sulfate for 24 hrs, monitor magnesium levels for toxicity, assess vs q 4 hours and postpartum assessment. Diuresis is a + sign along with decrease in proteinuria signaling resolution.
How do you manage Eclampsia after birth? (HINT: what signals resolution?)
Follow-up care after delivery for 48 hrs. Continue Magnesium sulfate for 24 hrs. Monitor magnesium levels for toxicity. Assess VS q4h and postpartum assessment. Diuresis is a + sign along with decrease in proteinuria signaling resolution.
empty
For Vacuum and Forceps, the cervix must be 10 cm and 100% effaced. (bladder must be ______) Maternal risk -laceration -hermatoma -perineal tear Fetus Risk -scalp abrasion -brusing -intercranial hemorrhage -facial nerve injury -cephalohematoma
Retinopathy of Prematurity (define & compare with normal neonate)
For a normal neonate, retinal vascularization occurs within 6-9 mo of fetal growth (or shortly after birth). ROP- Retinal Vascularization is incomplete, however rapid *disorganized* vessel growth occur between the vascularized and non-vascularized areas of retina. Can lead to Retinal Detachment and possibly blindness. *Five stages of severity*
Explain the pathophysiology of Preeclampsia.
Generalized vasospasm >BP <blood flow to brain, liver, kidneys, placenta, and lungs.
macrosomia, hypoglycemia
Gestational Diabetes - glucose intolerance develops with pregnancy results in progressive resistance to insulin *Resistance to insulin* = inability of body to obtain nutrients for fuel and storage, resulting in postprandial hyperglycemia Complications - ___________, ___________, birth trauma, and maternal complications
carbs, protein, unsaturated
Gestational Diabetes Management Diet- *3 meals and 3 snacks per day*. 40% calories from ____ , 35% ____ , and 25% from ____ fats.
glyburide, metformin
Gestational Diabetes Management Exercise-improves glucose metabolism Glucose level monitoring- instruct on self-administration of insulin and self glucose monitoring Fetal survellance - perform *daily kick counts around 28 wks*, usually 10 within 2 hrs. frequent ultrasounds, amniocentesis for lung maturity, stress test for fetal well-being Educate on need for postpartum laboratory testing on OGTT and blood glucose levels Medications - ____________ and _______________ *does not cross placenta = *no fetal hypoglycemia*
obesity, 25
Gestational Diabetes Risk Factors - ___________ - Maternal age > _______ yrs - Family hx of diabetes mellitus - Previous delivery of an infant that was large or stillborn - African American, Hispanic, Native American, and Asian women
140/90, 2, 4-6
Gestational HTN - Term used for pregnant women who do not meet criteria for preeclampsia or chronic HTN Systolic BP > ____ /____ on at least ____ occasions at least ____-____ hours apart within *1-wk* period. BP *returns to baseline*
progesterone, first
Gestational HTN - ____________ supplementation during _________ trimester significantly reduced incidence of Gestational HTN and fetal distress in *primigravida* women (Management- monitor BP, encourage lateral positioning)
What is Gestational Diabetes?
Glucose intolerance develops with pregnancy results in progressive resistance to insulin.
approach to counseling (read through)
Greet the client in a friendly and respectful manner Ask the client about FP/RH needs Tell the client about different methods/services Help the client to make her own decision about which method/service to use Explain to the client how to use the method/service she has chosen Return visit and follow-ups of client scheduled
35-37, 4
Group B Streptococcus Women screened at ____-____ wks and tx with ABX therapy *(Penicillin G)*. ABX also given _____ hours before birth
sepsis, meningitis, pneumonia
Group B Streptococcus most common cause of ________ and ________ in newborns and frequent cause of ________
50, 20
Group B Streptococcus: colonizes in vagina/rectum/cervix/urethra of pregnant women Naturally occurring bacterium found in approx. ____% healthy adults. Approx. ____% of pregnant women carry GBS
How do you diagnose PKU?
Guthrie test to show elevations of phenylalanine in the blood and urine.
Hellp H EL LP 1. patho? 2. symptoms? 3. management? 4. what labs would you expect to see?
H - hemolysis = anemia and jaundice EL - ∧ liver enzymes - elevated alanine aminoransferase (ALT) or aspartate transaminase (AST), epigastric pain, N/V LP - low platelets (< 100,000/mm3) = thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, and possible disseminated intravascular coagulopathy (DIC) 1.vasospasm = blockages in blood vessels = distortion of RBC = hemolysis. Liver enzymes ∧ when blood flow obstructed by fibrin deposits = hyperbilirubinemia = s/s jaundice. Platelets ∨ (thrombocytopenia) due to vascular damage and spasms 2.Nausea, malaise, epigastric or RUQ pain, edema 3.Same as that for severe preeclampsia 4. ask
What lab values is delayed?
H&H
ALT, AST, DIC
HELLP Syndrome H - hemolysis = anemia and jaundice EL - ∧ liver enzymes - elevated _____ or _____, epigastric pain, N/V LP - low platelets *(< 100,000/mm3)* = thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, and possible _____
hemolysis elevated liver low platelet
HELLP Syndrome = (Preeclampsia with Liver involvement) ____________ ____________ ___________ ___________ __________
rbc
HELLP Syndrome Patho - vasospasm = blockages in blood vessels = distortion of _______ = hemolysis. Liver enzymes ↑ when blood flow obstructed by fibrin deposits = hyperbilirubinemia = s/s jaundice. Platelets ↓ (thrombocytopenia) due to vascular damage and spasms Symptoms - Nausea, malaise, epigastric or RUQ pain, edema Management - Same as that for severe preeclampsia What labs would you expect to see ? Hgb, Hct...etc...
What kind of disorder is Preeclampsia and Eclampsia?
HTN disorders.
preeclampsia
HTN in Pregnancy -Preeclampsia-eclampsia -Chronic HTN -Chronic HTN with superimposed ___________ -Gestational HTN
What is Preeclampsia characterized by?
HTN, proteinuria, and organ damage.
What is a Cord Prolapse? How many types are there?
Happens during a breached or transverse lie. Fetus is stationed high or small. Cord slips down after ROM which causes compression. Hydramnios exerts pressure.
cleft lip and palate -- assessment
Health History for the newborn, explore pregnancy history for risk factors for development of cleft lip and cleft palate, which include: - Maternal smoking - Prenatal infection - Advanced maternal age - Use of anticonvulsants, steroids, and other medications during early pregnancy
How would you assess for Hypertrophic Pyloric Stenosis?
Health Hx: When did symptoms begin? Description of force and vomitus. Diet? Number of wet diapers? Type of stools? Family Hx of HPS: Physical assessment. Hard moveable "olive" in right upper quadrant. If present then surgical consult should be called. If no mass palpable then abdominal ultrasound or upper GI series should be ordered. Laboratory Tests: Observe for metabolic alkalosis and dehydration
How much will each 500ml drop the H&H?
Hgb by 1 to 1.5 and Hct 2-4%
Infants of Diabetic mothers (define)
High levels of mother's glucose crossing placenta, stimulating increased fetal insulin production leading to somatic fetal growth.
What potential effects does Gestational Diabetes have on the mother?
Hydramnios Gestational HTN Ketoacidosis Preterm labor s/t premature membrane rupture Stillbirth Hypoglycemia UTIs Difficult labor, C/S, postpartum hemorrhage s/t overdistended uterus to accommodate macrosomic infant
effects of gestational db on mom (7)
Hydramnios (too much aminotic fluid can lead to rupture, pre-mature membranes) Gestational HTN Ketoacidosis Preterm labor s/t premature membrane rupture Stillbirth Hypoglycemia (on baby) UTIs Difficult labor, C/S, postpartum hemorrhage r/t overdistended uterus to accommodate macrosomic infant
How do you treat EA and TEF?
Hydramnios/excess amniotic fluid. Copious frothy bubbles of mucus and drooling; abdominal distention. Coughing, choking, and cyanosis.
During an assessment on a pregnant patient, you notice she is has flushed, dry skin, fruity breath, and shallow respirations. She complains of nausea, abdominal pain, and frequent urination and thirst. What do you suspect this patient has?
Hyperglycemia r/t Gestational Diabetes.
congenital anomalies (7) look them up
Hypertrophic Pyloric Stenosis Duodenal Atresia Cleft Lip/Palate Esopheal Atresia/ Tracheo-esophageal Fistula Congenital Cardiac Defects Metabolic Disorders Genetic Disorders
During an assessment on a pregnant patient, you notice she is shaky, pale, and sweaty. She complains about a headache and blurred vision. Previous symptoms include tingling in her mouth and extremities. She appears disoriented and mentions that she is hungry. What do you suspect this patient has?
Hypoglycemia r/t Gestational Diabetes.
What is Magnesium Sulfate expected to do to a patient's DTR's and why?
Hyporeflexia should develop due to MS being a neuromusclar blockade and nerve pathways don't relay messages properly.
fhr, latent
Hypotonic Uterine Dysfunction -walk -breaking fluid helps baby drop -oxytocin to increase contractions -WATCH __________ Hypertonic Uterine Dysfunction -less common -contractions uncoordinated -during ________ phase -*painful* - give pain med -balance oxytocin (may stop if too demanding on mother)
distended
Hypotonic Uterine Dysfunction concerns: -Maternal fatigue -Hypoglycemia (mother) -Electrolyte Loss -Analgesia -Over ___________ Uterus (lga, multifetal gestation)
Powers
Hypotonic uterine dysfunction Hypertonic uterine dysfunction Innefective pushing Porlonged labor Precipittae labor
Maternal risks associated with hemorrhagic disorders
Hypovolemia Anemia Infection Preterm labor Adverse oxygen delivery
What interventions call be implemented for a patient with Mild Preeclampsia at the hospital?
IF BP not reduced at home! Monitored for s/s of severe Preeclampsia/Eclampsia. BP and WT, fetal monitoring, Management continues until pregnancy reaches term, fetal lung maturity, or complications warranting immediate birth.
How do you assess for Preeclampsia?
Identify risk for Preeclampsia. Nutritional assessment. Blood pressure and weight. Amount and location of edema. FHR Clean catch urine specimen. Labs: CBC, serum electrolytes, BUN, creatinine, hepatic enzyme levels.
How do you treat Preterm Labor?
Identify symptoms & treat Limit activities Hydration Tocolytic medications (calcium channel blockers to prevent preterm labor) Accelerate fetal lungs (surfactant)
Hypertrophic Pyloric
In pyloric stenosis, the circular muscle of the pylorus becomes hypertrophied, causing thickness in the luminal side of the pyloric canal. This thickness creates a gastric outlet obstruction, causing non bilious vomiting that presents between weeks 2 and 4 of life. The vomiting becomes more frequent and forceful as time goes on and is often projectile.
What does it mean to be resistant to insulin?
Inability of body to obtain nutrients for fuel and storage, resulting in postprandial hyperglycemia
What can cause a Thromboembolic disorder?
Increased clotting factors in pregnancy Anesthesia or Cesarean birth, forceps, or tissue trauma Previous history of phlebitis , DVT, varicosities or leg injury High parity Hypothermia Heart disease Endometritis Obesity Age > 40 Sepsis Immobility ( prolonged bedrest) maternal anemia
What is IDM?
Infants of Diabetic Mothers: High levels of maternal glucose crossing placenta, stimulating increased fetal insulin production leading to somatic fetal growth.
Meconium Aspiration Syndrome (define)
Inhalation of meconium(particles) with amniotic fluid in to lungs (while still in utero or upon first breath) caused by hypoxic stress.
Birth Trauma (define)
Injuries due to the forces of labor and birth
Causes of Asymmetrical IUGR:
Insult (poor placental perfusion) to the fetus after rapid cell proliferation.
Causes of Symmetrical IUGR:
Insult (poor placental perfusion) to the fetus during the stages of early gestation.
term, lung
Interventions Mild Preeclampsia *Hospital* - BP not reduced at home. Monitored for s/s of severe preeclampsia/eclampsia. BP and WT, fetal monitoring, Management continues until pregnancy reaches ________ , fetal ________ maturity, or complications warranting immediate birth
eclampsia
Interventions Mild Preeclampsia Labor - focus on preventing progression to __________. BP monitored, quiet environment, IV magnesium sulfate, antihypertensive medication (if needed), calcium gluconate bedside, neuro checks, urinary catheter
renal, liver
Interventions Mild Preeclampsia Mild at Home - bed rest, lateral position, ↑ antepartal visits with labs: CBC, clotting studies, liver enzymes, platelets, BP and WT monitoring, protein measure with dipstick, daily fetal kick counts, balanced diet, six-eight 8oz glasses water daily. (no ________ or ________ problems)
underpads
Intrauterine Infection (Management) Wash hands frequently Wearing gloves Limit vaginal exams Clean excessive secretions Keep __________ dry
tachypnea, tachycardia
Intrauterine Infection (Symptoms) Maternal temp> 100.4 Maternal tachycardia, ____________ Fetal ____________ > *10* min Abnormal amniotic fluid
What is Uterine Inversion?
Inversion of the uterus is the turning inside out of the uterus and can be partial or complete. Uterine inversion is an emergency situation that can result in postpartum hemorrhage and requires immediate intervention.
fatty acids
Ketoacidosis is the break down of?
In Preeclampsia, what happens to kidney perfusion and what are its affects?
Kidney perfusion DECREASES, resulting in DECREASED Glomerular filtration rate leading to DECREASED urine output causing INCREASED levels of Na+, BUN, uric acid, and creatinine.
What do you assess for neuro?
LOC and pain
70-110
Lab Tests/ Diagnostic procedures (Gestational Diabetes) Normal blood sugar is ______-___________
24-28, 140
Lab Tests/ Diagnostic procedures (Gestational Diabetes) Urinalysis with *glycosuria* Glucose screening test _____-_____ wks gestation 1-hr oral glucose followed by glucose analysis 1 hr later (fasting not necessary) A blood glucose above _____ mg/dL requires an additional testing with 3-hr oral glucose tolerance test. *Glucose levels are then determined at 1, 2, and 3 hr following glucose ingestion* Presence of keytones in urine = assess *ketoacidosis* Diagnostic procedures -biophysical profile, amniocentesis, nonstress test
placenta previa
Labor Induction contraindicated for ___________ _____________. (used for IGR, SROM, post date pregnancy, gestational hypertension, fetal death)
What is Tracheoesophageal Fistula/TEF?
Lack of normal separation of esophagus and trachea during embryonic development. Abnormal communication between trachea and esophagus.
What is Esophageal Atresia/EA?
Lack of normal separation of esophagus and trachea during embryonic development. Congenitally interrupted esophagus.
How do you manage an Amniotomy?
Limit exams. Monitor FHR. Maternal temperature q2h. Assess & document the characteristics of the amniotic fluid including color, odor & consistency. Provide comfort measures, frequently change pads & perineal cleansing.
In Preeclampsia, what happens to liver perfusion and what are its affects?
Liver perfusion DECREASES, resulting in epigastric pain and an INCREASE liver enzymes.
8, 13
Macrosomia birth weight is at least ____ lbs ____ oz
hyporeflexia
Magnesium Sulfate Action/indication - prevents seizures associated with preeclampsia and controls seizures in eclampsia. Acts as a CNS depressant. Is a potent neuromuscular blockade and ____________ may develop
How to do you manage/treat Necrotizing Enterocolitis?
Maintenance of fluid and nutritional status Bowel rest and antibiotic therapy; IV fluids Surgery with proximal enterostomy Supportive care Family education
heparin
Management of Congenital and Acquired Heart Disease: Focus - Stabilize the mother's hemodynamic status Drug therapy- diuretics (Lasix), inotropics (Lanoxin), antiarrhythmic agents (Lidocaine), beta blockers (Labetalol), calcium channel blockers (Nifedipine), anticoagulants *(___________).* Education - reducing risks leading to cardiac complications *Compliance cardiac meds, medications, frequent antepartal visits, conserve energy, *rest left side*, nutrition, limit *Na+*, dx tests for fetal well-being (EKG, echo, nonstress test, monitor fetal activity and movements), s/s cardiac decompensation, monitor fluid volume during /after labor for 48 h.
How is Uterine Inversion treated?
Manual replacement of the uterus into the uterine cavity and repositioning of the uterus by the provider. Surgery needed if manual management is not successful.
CLASS OF BREATHLESSNESS: 3
Marked limitation in activity due to symptoms, even during less than ordinary activity, e.g. Walking short distance (20-100m). *Comfortable only at rest*
What is PKU?
Maternal genetic disease. Phenylketonuria is a defect in protein metabolism in which the accumulation of (or the inability to metabolize) the amino acid phenylalanine can result in mental retardation. (Treatment in the first 2 months of life can prevent mental retardation.)
Neonatal Abstinence Syndrome -- assessment
Maternal history to identify risk behaviors for substance abuse: Previous unexplained fetal demise Lack of prenatal care Incarceration Prostitution Mental health disorders History of intimate partner violence History of missed prenatal appointments Severe mood swings Precipitous labor Poor nutritional status Abruptio placentae Hypertensive episodes History of drug abuse Laboratory test results (toxicology) to identify sub- stances in mother and newborn Signs of neonatal abstinence syndrome (Use the WITHDRAWAL acronym; see Box 24.3.) Evidence of seizure activity and need for protective environment
How do you assess a newborn whose mother is a substance abuser?
Maternal history; risk behaviors, toxicology Newborn behaviors; WITHDRAWAL assessment.
How do you assess TTN?
Maternal sedation or birth by cesarean; tachypnea, expiratory grunting, retractions, labored breathing, nasal flaring and mild cyanosis; respiratory rates possibly 100 to 140; barrel-shaped chest; slightly ↓ breath sounds. Chest x-ray: mild symmetric lung overaeration; prominent perihilar interstitial marks and streaks.
140/90, 20, no, no
Mild preeclampsia Classification Mild preeclampsia - BP >___/___ after ___ wks. (x2, 4-6 hrs apart) Seizures/coma = ___ Hyperreflexia = ___ Other s/s = mild facial or hand edema, *weight gain* Risk for postpartum HTN
300
Mild preeclampsia Classification Proteinuria = _________ mg or more of urinary protein per 24 hr or 1+ protein on dipstick with 2 random samples collected 4-6 hours apart with no UTI
CLASS OF BREATHLESSNESS:2
Mild symptoms (mild shortness of breath and/or angina) and slight limitation during ordinary activity
Early pregnancy bleeding
Miscarriage (spontaneous abortion) Ectopic pregnancy Cervical insufficiency
Other possible diagnosis of ectopic pregnancy
Miscarriage, ruptured corpus luteum cyst, appendicitis, salpingitis, ovarian cysts, torsion of the ovary, and urinary tract infection are possible diagnoses (Lowdermilk 676)
stenosis
Mitral valve ____________ - narrowing of mitral valve, blocks flow into left ventricle =* pulmonary edema*, *pulmonary HTN*, and right ventricular failure. Most pregnant women managed medically.
prolapse, regurgitation
Mitral valve ____________ - valve between left atrium and ventricle does not close properly. Leaflets of mitral valve prolapse (bulge) upward or back into the left atrium as heart contracts. keyword "____________" *Asymptomatic, occasional palpitations, no special precautions*
Types of acquired heart disease
Mitral valve prolapse, mitral valse stenosis, aortic stenosis
pulmonary, pulmonary
Mitral valve stenosis - *narrowing* of mitral valve, blocks flow into left ventricle = ____________ edema, ____________ HTN, and right ventricular failure. Most pregnant women managed medically.
How do you treat Precipitous Labor?
Monitor closely if previous history Anticipate scheduled induction Administer tocolytics, such as Terbutaline Remain in attendance to monitor labor
What is Hypertrophic Pyloric Stenosis?
Most common surgical procedure in infants <2 months of age. Caused by hypertrophied pyloric muscle causing gastric outlet obstruction.
What does it mean to be an infant of a mother who is a substance abuser?
Most commonly abused substances by pregnant mothers include tobacco, alcohol, and marijuana. The infant can have alcohol-related birth defects, fetal alcohol spectrum disorders, and/or neonatal abstinence syndrome. Fetal alcohol syndrome: physical and mental disorders appearing at birth and remaining problematic throughout the child's life. Neonatal abstinence syndrome: drug dependency acquired in utero manifested by neurologic and physical behaviors.
How do you assess for IDM?
Mother with diabetes. Full rosy cheeks, ruddy skin color, short neck, buffalo hump, massive shoulders, distended upper abdomen, excessive subcutaneous fat tissue (see Figure 24.5); hypoglycemia, birth trauma. Hypocalcemia, hypomagnesemia, polycythemia, hyperbilirubinemia.
What is Preeclampsia?
Multisystem disorder that targets the cardiovascular, hepatic, renal, and CNS. Classified as mild or severe with potential to progress to eclampsia. Poor placental perfusion r/t prolonged vasoconstriction = uterine growth restriction, placental abruption, persistent fetal hypoxia, and acidosis.
side effects
N&v diarrhea headache flushing bradycardia bronchospasm wheezing cough chills fever
mild, comfortable, severe
NYHA Class Symptoms I Cardiac disease, but no symptoms and no limitation in ordinary physical activity, e.g. no shortness of breath when walking, climbing stairs etc. II _______ symptoms (mild shortness of breath and/or angina) and slight limitation during ordinary activity. III Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20-100 m). _______ only at rest. IV _______ limitations. Experiences symptoms even while at rest. Mostly *bedbound* patients.
three
NYHA Class ___ has a 25-50% mortality rate
CLASS OF BREATHLESSNESS: 1:
No symptoms and no limitation in ordinary physical activity, e.g. Shortness of breath when walking, climbing stairs etc.
Respiratory Distress Syndrome (define and compare with normal neonate)
Normal Neonate- no sustaining respiratory distress noted, no retractions, no increased work of breathing, no adventitious breath sounds. RDS Neonate- due to lack of surfactant, neonate shows signs of respiratory distress (or immature alveoli in preterm newborns).
Transient Tachypnea of the Newborn (define and compare with normal neonate)
Normal Neonate- when born vaginally, no sustaining respiratory distress noted, normal breathing sounds. TTN- episode of mild respiratory distress, caused by fluid retention in lungs or transient pulmonary edema. Usually resolves itself within 72 hours.
what are predisosisn factors of UTIs
Normal PP Diuresis Bladder hypotonia Increased bladder capacity Decreased sensitivity from stretching or trauma Anesthesia Frequent pelvic exams Catheterization Obesity
infection
Number one risk for Amniotomy is *FHR* and _____________.
What are predisposing factors
Obesity Diabetes Chorioamnionitis Hemorrhage Malnutrition Multiple vag exams Emergency c-section Prolonged postpartal hospitalization Steroid therapy Immunosuppression
What are risk factors for Gestational Diabetes?
Obesity Maternal age > 25 yrs Family hx of diabetes mellitus Previous delivery of an infant that was large or stillborn African American, Hispanic, Native American, and Asian women
What are the intervention of psychosis
Observe client alone, with infant and with family Recognize signs early Seek referral for psychiatric evaluation Support positive parenting behaviors Discuss plans for self and infant Referral to social services
cleft lip and palate -- assessment cont..
Observe the infant for the presence of the characteristic physical appearance of cleft lip. The cleft may involve the lip only or extend up into the nostril. Cleft palate may be visualized on examination of the mouth. Palpate with a gloved finger to discover mild clefts.
hormonal methods
Oral Contraceptives (The Pill) Injections (Depo-Provera) Implantable Contraceptive (Implanon) in the arm Vaginal Ring Transdermal Patch IUD Emergency Contraceptive
How do you manage/treat TTN?
Oxygenation Supportive care IV fluids or gavage feedings Supplemental oxygen Neutral thermal environment
what should the nurse monitor signs for
PE
What are low platelets secondary to
PIH
Predisposing factors
PIH amniotic fluid embolism sepsis abruption prolonged IUFD excessive blood loss
chorioamnionitis
PROM: Premature Rupture of Membranes Possible Causes -Vaginal infections -_____________________ Complications -Maternal/fetal infection -RDS - Respiratory Disease Syndrome -Cord Compression (Medication Management)
fetus
PROM: Premature Rupture of Membranes (Management) Depends on gestational age -PROM @ term (bring in, start antibiotics) -PROM < 34 weeks (greatest risk to ______) (bring in, assess, try to get mother to 36-37 weeks)
true
PROM: Premature Rupture of Membranes happens before _______ onset of labor.
What lab is watched for coumadin
PT and INR
what labs should be monitored with heparin
PTT
What are nursing diagnoses
Pain Knowledge deficit Alteration in tissue perfusion Risk fir infection Impaired mobility Risk for impaired parenting
Hypertrophic Pyloric Stenosis Physical Examination
Palpate for a hard, moveable "olive" in the right upper quadrant (hypertrophied pylorus). If an easily palpable mass is felt, no further testing is necessary and a surgical consult is called.
Cervical insufficiency
Passive and painless dilation of cervix. Due to weak or short cervix. Congenital or acquired (previous births, surgery, tumor biopsy and removed, etc).
As a nurse, what should you educate a patient with Gestational Diabetes on?
Perform daily kick counts. Diet, including standard diabetic diet and restricted carbohydrate intake. (3 meals and 3 snacks per day. 40% calories from carbs, 35% protein, and 25% from unsaturated fats.) Dietary counseling by a registered dietitian. Exercise. Self-administration of insulin. Need for postpartum lab testing to include OGTT and blood glucose levels.
HTN in pregnancy photo
Photo
How do you manage/treat ABO Incompatibility?
Phototherapy- clothes off, cover eyes with mask, cover male genitals, remove from light 4 hrs, change position every 2 hours. Monitor daily weights. Feed frequently (3-4hrs) so stool eliminates bilirubin. Stool might have bile that is greenish. Follow up care in 24 hours for high risk, 2 days for low risk.
Late pregnancy bleeding and its management
Placenta previa and abruption placentae *Gestational age, Amount of bleeding and Fetal condition* -Possible emergency cesarean, esp. if placenta is within 2 cm from opening and is bleeding. -Vaginal delivery is ok woman is asymptomatic
tocolytic
Pre term Labor Prevention: -Education -Improved access to care -Identify risk factors -*Adequate nutrition* -Empowerment Treatment -Identify symptoms & treat -Limit activities -Hydration -_______________ medications -Accelerate fetal lungs
nerve
Precipitate Deliver - QUICK BIRTH -labor within 3hrs or less -birth can happen at anytime once labor done -possible *intercranial hemorrhage* -possible ___________ damage -possible vaginal, perineal, pelvis tear/trauma
urine
Preeclampsia Assessment Identify risk for preeclampsia Nutritional assessment Blood pressure and weight Amount and location of edema Fetal heart rate Clean catch ___________ specimen *Labs: CBC, serum electrolytes, BUN, creatinine, hepatic enzyme levels*
hypoxia, acidosis
Preeclampsia Patho cont. Poor placental perfusion r/t prolonged vasoconstriction = uterine growth restriction, placental abruption, persistent fetal ____________ , and ____________
hypertension, proteinuria, organ
Preeclampsia characterized by_________ , _________ , and _________ damage.
multisystem
Preeclampsia is a ____________ disorder.
increase, decrease
Preeclampsia pathophysiology - Generalized vasospasm = __________ in BP and __________ blood flow to brain, liver, kidneys, placenta, and lungs ↓ liver perfusion = epigastric pain and ↑ liver enzymes ↓ brain perfusion = small cerebral hemorrhages, headaches, visual disturbances, blurred vision, DTRs ↓ kidney perfusion = ↓ Glomerular filtration rate = ↓ urine output = ↑ levels of Na+, BUN, uric acid, and creatinine ↑ capillary permeability in kidneys = ↓ *albumin* = ↓ colloid osmotic pressure = pulmonary and generalized edema Thromboxane/prostacyclin imbalance = thrombocytopenia
cardiovascular, hepatic, renal, cns
Preeclampsia targets the _________ , _________ , _________ , and _________
Although not part of the TORCH acronym, GBS (Group B Strep) is a TORCH disease. What are maternal s/s?
Premature ROM, preterm labor and delivery, UTI, maternal sepsis, chorioamnionits.
Placental abruption and its S/S
Premature separation of placenta or detachment of part or all of a normally implanted placenta from the uterus. -vaginal bleeding, abdominal pain, and uterine tenderness and contractions - abdominal pain w or w/o bleeding (lecture) -greater fundal height indicated concealed bleeding
How do you manage Hypertrophic Pyloric Stenosis? (HINT: think preoperatively and postoperatively).
Preoperatively: Fluid management Correcting electrolyte imbalance Relieve family anxiety Pre and Post op family education Postoperatively: Manage IV fluids Pain management Feedings usually resume in 1-2 days
Esophageal atresia and tracheoesophageal fistula -- Nursing management
Prep for surgrey: - NPO, head elevated, hydration and fluids - O2, suctioning always available - Comfort measures - Educate parents Post OP care: - TPN and antibiotics; oral feedings usually within 1 week - Educate teaching
How do you manage/treat IDM?
Prevention of hypoglycemia (oral feedings, neutral thermal environment, rest periods). Maintenance of fluid and electrolyte balance (calcium level monitoring, fluid therapy, bilirubin level monitoring). Parental support and education.
Why is Magnesium Sulfate given to patients with Preeclampsia or Ecclampsia?
Prevents seizures associated with preeclampsia and controls seizures in eclampsia. Acts as a CNS depressant. Is a potent neuromuscular blockade and hyporeflexia may develop.
What are predisposing factors
Previous history of psychosis or bipolar disease Prenatal stressors (lack of support) Obsessive personality Family history
What are are predisposing factors
Primiparity Maintained ambivalence during pregnancy Hx of depression or bipolar Lack of current stable relationship with parents or partner Body image and eating disorders Lack of supportive relationship with parents as a child
hydramnios
Prolapsed Cord Slips down after ROM=>compression Fetus is stationed high or is small Breech or transverse lie __________ exerts pressure 3types: occult, front of head, complete
occult, front of head, complete
Prolapsed Cord 3 types: _______________ , _______________, _______________
edd, fetus
Prolonged Pregnancy: Term = 38-42 weeks *Post term is >42 weeks* Most often miscalculated __________ Greatest risk is to the __________
What are findings for parametrical cellultits
Prolonged fever 102-104 with fluctuations, increased abdominal pain, hypotension, subinvolution, chills, decreased bowel sounds, N & V
What is Eclampsia characterized by?
Proteinuria, seizures, hyperreflexia, severe headaches, edema, RUQ or epigastric pain, vision problems, cerebral hemorrhage, renal failure, hemolysis, elevate liver function tests, and low platelet count.
If CHD are uncorrected, what are the risks?
Pulmonary HTN.
What are s/s of Magnesium Sulfate toxicity?
R/R <12 breaths/min Decreased LOC Cardiac dysrhythmias Absence of DTRs (esp. patellar) Urinary output <30 ml/hour Serum magnesium levels >8 mEq/L
what are the finding for bacteremia and septic shock
Rapid temp elevation to 103-104, profuse foul smelling lochia, symptoms of shock, decreased urinary output
How do you manage/treat Hyperbilirubinemia?
Reduction of bilirubin levels: early feeding, phototherapy, exchange transfusions, education and support; home phototherapy.
What is RDS?
Respiratory Distress Syndrome: Lung immaturity and lack of alveolar surfactant.
What is the assessment of the psychosis
Review history for risks Assess coping skills Assess self esteem Assess mood and symptoms
RH ISOIMMUNIZATION
Rh incompatibility or isoimmunization develops when an Rh-negative woman who has experienced Rh isoimmunization subsequently becomes pregnant with an Rh-positive fetus.
How do you assess a newborn with Hyperbilirubinemia?
Risk factors Jaundice Signs of Rh incompatibility ABO incompatibility Bilirubin levels
How do you assess for RDS?
Risk factors. Expiratory grunting, nasal flaring, chest wall retractions, see-saw respirations, generalized cyanosis; heart rate > 150 to 180; fine inspiratory crackles, tachypnea (rates > 60), Silverman-Anderson Index score > 7. Chest x-ray: hypoaeration, underexpansion, and ground glass pattern.
How do you assess for Necrotizing Enterocolitis?
Risk factors. Signs and symptoms: abdominal distention and tenderness, bloody stools, feeding intolerance (bilious vomiting), sepsis, lethargy, apnea, shock KUB: air in bowel wall; dilated bowel loops.
What is the diagnosis of psychosis
Risk for impaired parenting Ineffective coping risk for impaired parenting Risk for compromised family coping
cytomegalovirus
Rubella - Vaccination contraindicated if pregnant r/t risk of rubella infection developing. Avoid crowds of young children. Women not immune should be vaccinated during immediate postpartum period so they are immune before becoming pregnant again _________________- no treatment exists. Frequent hand washing before eating, avoid crowds of young children Emphasize compliance of tx Provide emotional support
Some contraceptives help reduce what?
STIs and HIV
Necrotizing Enterocolitis (define)
Serious gastrointestinal disease. *Most common and most serious acquired gastrointestinal disorder among hospitalized preterm neonates* (high morbidity and mortality rates). Usually occurs between 3 and 12 days of life (but can occur weeks later in some newborns)
160/110, 500, 400, 100000
Severe Eclampsia Assessment Blood pressure of more than ______ Protein of more than _______mg in 24 hours Oliguria of less than ________ mL in 24 hours Cerebral and visual symptoms Weight gain and edema- pitting degree Pulmonary edema Thrombocytopenia < than __________mm3 Epigastric or RUQ pain (*LIVER*), HELLP Labs: CBC, serum electrolytes, BUN, creatinine, hepatic enzyme levels
160/110, 400, 24, no, yes, cure
Severe Preeclampsia Classification May develop *suddenly*. Immediate hospitalization is required BP - > ______/______ Proteinuria - >500 mg in 24hrs.; greater than 3+ on random dipstick urine sample Oliguria of less than __________ mL in __________ hours Seizures/coma - __________ Hyperreflexia - __________ Other signs and symptoms - headache, blurred vision, blind spots, rapid weight gain, pulmonary edema, thrombocytopenia, cerebral disturbances, epigastric or *RUQ pain*, HELLP Birth of infant is the only __________
500, 24, 3
Severe Preeclampsia Classification proteinuria - >________ mg in ________ hrs.; greater than ________ + on random dipstick urine sample
sedatives
Severe Preeclampsia- Interventions Bed rest left lateral lying position Room dark and quiet to reduce stimulation Administer _________ as ordered to encourage quiet bed rest Seizure precautions (padding, side rails, O2 , suction equipment, call light) Closely monitor BP, administer antihypertensives Assess vision and Level Of Care (headache and visual disturbance) Assess s/s pulmonary edema Offer high protein diet with 8-10 glasses water Monitor intake/output q hour Administer fluid and electrolyte replacement Fetal monitoring
CLASS OF BREATHLESSNESS:4
Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients.
Diagnosis of placental abruption
Sharp uterine pain - blood clot and visible placenta at examination -50% cases are not identified by ultrasound - ^ fundal height -*abnormal FHR*
How do you manage Amniotic Fluid Embolism?
Side lying with pelvis tilted at a 30 degrees. Foley catheter. Monitor Maternal & Fetal Status. IV fluids. O2. Blood products to correct coagulation. Prepare for emergency C/S.
PREECLAMPSIA PATHO Decreased brain perfusion=
Small cerebral hemorrhages, headaches, visual disturbances, blurred DTRs
How do you manage/treat PKU?
Specialized synthetic formula in which phenylalanine is removed or reduced. The mother, 3 months prior to pregnancy and throughout the pregnancy, should restrict meat, dairy products, diet drinks (artificial sweeteners), and protein during pregnancy. Aspartame must be avoided. Mother's blood should be monitored during pregnancy.
How is Herpes caused and what are the manifestations for the mother and fetus?
Spread by direct contact with oral or genital lesions. Transmission to the fetus is greatest during vaginal birth if the woman has active lesions. Maternal s/s: lesions, tender lymph nodes, and painful blisters. Fetal s/s: miscarriage, preterm labor, and intrauterine growth restriction. (C-SECTION RECOMMENDED!)
How do you manage/treat RDS?
Supportive care; close monitoring. Respiratory modalities: ventilation (CPAP, PEEP); exogenous surfactant; oxygen therapy. Antibiotics for positive cultures; correction of metabolic acidosis. Fluids and vasopressors; gavage or IV feedings Blood glucose level monitoring. Clustering of care; prone or side-lying position Parental support and education.
How do you manage/treat EA and TEF?
Surgery Prep and Pre-op: NPO, head elevation, hydration and fluids Oxygen and suctioning equipment available Comfort measures Parental education Post-op: TPN and antibiotics; oral feedings usually within 1 week. Parental teaching.
Cerclage
Suture around opening of cervix to keep is closed during pregnancy. Can be done at 12- 14 weeks, is then removed at 36 weeks. She has a chance of going into labor when removed. C section is done.
What are the two categories of Intrauterine Growth Restriction (IUGR)?
Symmetrical and Asymmetrical
lymphedema, chorioamnionits
Symptoms/Effects of TORCH Toxoplasmosis - fever and tender lymph nodes Rubella - *rash*, mild _____________, fever Fetal = miscarriage, congenital anomalies, and death Herpes Simplex - lesions and tender lymph nodes Fetal = miscarriage, preterm labor, and intrauterine growth restriction GBS - premature ROM, preterm labor and delivery, UTI, Maternal sepsis, _____________ HIV - *Diarrhea* and wt loss, lymphadenopathy and rash, anemia
teratogenic
TORCH - Infections that negatively affect a woman who is pregnant. These infections can cross the placenta and have __________ affects on the fetus
toxoplasmosis, other, rubella, cytomegalovirus, herpes
TORCH = __________ ___________ __________ __________ ____________
cat, hearing
TORCH Risk Factors Toxoplasmosis - caused by eating raw or undercooked meat or handling ____ feces. Other - Hepatitis A and B, syphilis, mumps, parvovirus B19 (Fifth disease), and varicella-zoster (chickenpox and shingles), HIV Rubella- (German measles), contracted through infected children or to neonates who are born to mothers who had rubella during pregnancy. Cytomegalovirus - viral infection, transmitted through body fluids (member of herpes virus - ________ problems with newborns) Herpes Simplex - Spread by direct contact, transmission to fetus during vaginal birth if the woman has active lesions, thus C/Section, may breast feed as long as no lesions on breast, wash hands
What are assessments for bacterial agents
Temp > 100.4 on any 2 of the first 10 pp days, excluding first 24 hours Abnormal lochia Amt, odor Tachycardia Delayed involution Pain, tenderness Backache Malaise Fatigue Chills Abnormal labs
Types of congenital heart disease
Tet of fallot, eisenmenger's syndrome, atrial septal defect, ventricular septal defect, patent ductus arteriosus
ventricle
Tetralogy of Fallot: -Increased outflow in Aorta -Partial obstruction (stenosis) of right ventricular outflow (to lungs) and pulmonary valve -Ventricular septal defect -Thickened right ____________ (hypertrophy)
turtle
The __________ sign is observed with shoulder dystocia.
What is a Cesarean Section Induction?
The delivery of a baby through a surgical incision in the mother's abdomen and uterus.
Neonatal Abstinence Syndrome. Drug dependency acquired in utero is manifested by a constellation of neurologic and physical behaviors
The manifestations of withdrawal are a function of the drug's half-life, the specific drug or combination of drugs used, dosage, route of administration, tim-ing of drug exposure, and length of drug exposure typical newborn behaviors include CNS hypersensitivity, autonomic dysfunction, respiratory distress, temperature instability, hypoglyce- mia, tremors, seizures, abnormal cry patterns, feeding difficulties, and gastrointestinal disturbances
placenta
The only cure for preeclampsia/eclampsia is delivery of the ____________
What is Eclampsia?
The onset of seizure activity or coma. Preceded by headache, severe epigastric pain, hyperreflexia, and hemoconcentration. Starts with facial twitching, followed by generalized muscle rigidity. BP >160/110
Explain the function/dysfunction of the placenta in a Postterm newborn
The placenta is unable to provide oxygen and nutrient past 42 weeks. Hypoxia and fetus wasting (use of fetal nutrient/fat stores) occurs.
What is the prognosis of infants with Asymmetrical IUGR?
The prognosis is good and normal growth potential will occur with optical postnatal nutrition.
What is the prognosis of Fetuses with IUGR?
The prognosis is poor and it is believed that the fetus growth will never catch up.
Psyche
The woman's perception of stress is more important than the actual existence of a threat
How do you manage/treat Cleft Lip/Palate?
Therapeutic Management: Cleft lip, surgical repair between 6 and 12 weeks; cleft palate, surgical repair between 6 and 18 months. Nursing Management: Provide adequate nutrition and parental education and promote parental bonding.
What teaching needs to be implemented when caring for a patient with a Uterine Inversion?
They will be given a tocolytic to relax uterus before manual repositioning. Cesareans will be needed for future pregnancies.
How do you prepare a patient who you are about to administer a Magnesium Sulfate bolus?
They will initially feet hot, flushed, and sedated. Fluid restrictions of 100-125mL/hr.
PREECLAMPSIA PATHO Thromboxane/prostacyclin imbalance=
Thrombocytopenia (low platelets)
Newborns of substance-abusing mothers
Tobacco, alcohol, and marijuana are the substances most commonly abused during pregnancy
Hyperbilirubinemia
Total serum bilirubin level above 5 mg/dL resulting from unconjugated bilirubin being deposited in the skin and mucous membranes Exhibited as jaundice (yellowing of the body tissues and fluids).
What is TTN?
Transient Tachypnea of the Newborn: Mild respiratory distress; pulmonary liquid removed slowly or incompletely; resolution by 72 hours of age.
How is Cytomegalovirus caused and what are the manifestations for the mother and fetus?
Transmitted by droplet infection from person to person, a virus found in semen, cervical and vaginal secretions, breast milk, placental tissue, urine, feces, and blood. Latent virus can be reactivated and cause disease to the fetus in utero or during passage through the birth canal. Maternal s/s: Asymptomatic or mononucleosis‑like manifestations. Fetal s/s: non until after birth.
How do you manage/intervene Severe Preeclampsia?
Turn pt. to side, rails up, padding on, dim lights, keep room quiet, O2 suction ready, call light. Administer sedatives as ordered to encourage quiet bed rest. Closely monitor BP, administer antihypertensives. Assess vision and LOC (headache and visual disturbance). Assess s/s pulmonary edema. Offer high protein diet with 8-10 glasses water. Monitor intake/output q1h. Administer fluid and electrolyte replacement. Fetal monitoring.
How do you manage/intervene Eclampsia? (In order of priority)
Turn pt. to side, rails up, padding on, dim lights, keep room quiet, remain with pt. Suction and oxygen PRN after seizure. Continue Magnesium sulfate to prevent further seizures. Control HTN with antihypertensives. FHR and contraction monitoring. After stability is established, prep pt. for birth process to prevent perinatal mortality. Administer glucocorticoid to improve liver function and up platelet count. Support family emotionally and keep them informed.
lab tests for gestational db
Urinalysis with glycosuria Glucose screening test 24 to 28 wks gestation 1-hr oral glucose followed by glucose analysis 1 hr later (fasting not necessary) A blood glucose above 140 mg/dL requires an additional testing with 3-hr oral glucose tolerance test. Glucose levels are then determined at 1,2, and 3 hr following glucose ingestion Presence of keytones in urine = assess ketoacidosis Diagnostic procedures -biophysical profile, amniocentesis, nonstress test
Silverman-Anderson Index
Used to grade level of RDS 0- normal 10- severe respiratory impairment
pulling
Uterine Inversion (baby already born) Possible causes: -____________ on cord -Fundal pressure during birth -Very adherent placenta -Fundal placenta implant -*Weak uterine wall*
complete, incomplete, dehiscence
Uterine Rupture Three types: 1. ____________________ 2.. ___________________ 3.. ___________________ *(contractions STOP if uterus torn)*
manipulation, previa
Uterine Version *_________ to gain better fetal position* - DO NOT DO if nuchal or ________ *External* Version -After 37 weeks -Analgesia -Ultrasound -Rh sensitivity -done if woman not likely to deliver vaginally
PREECLAMPSIA PATHO Poor placental perfusion r/t prolonged vasoconstriction=
Uterine growth restriction, placental abruption, persistent fetal hypoxia, and acidosis *always acidosis when not enough perfusion**know criteria*
uterine
VBAC are high risk pregnancies. Caution if 2 or more c-sections because high risk for _________ rupture
Diagnostic assessment
VQ scan blood gas studies x-ray elevated leukocytes elevated sed rates
Passage
Variations in bony pelvis Soft tissue obstruction
What is Passage?
Variations in the bony pelvis, including soft tissue obstruction.
What assessments does the nurse implement in the antepartum period with their client experiencing heart disease?
Vitals, bp, scale, (are there any changes?), weight changes? (could mean that she has edema), if in the second trimester you will want to know fetal kick counts, preterm labor signs, evaluate understanding of condition, signs of decompensation (wheezing, coughing, fatigue, sob, cyanotic lips, palpitations).
What is considered and abnormal lab
WBC increase more than 30% in 6 hours
joint pain, Malaise, Rash, Tender lymph nodes
Which of the following clinical findings indicates a TORCH infection? A. Joint pain B. Malaise C. Rash D. Urinary frequency E. Tender lymph nodes
In Preeclampsia, do you have thrombocytopenia? T or F.
YES Thromboxane/prostacyclin imbalance = thrombocytopenia.
Risks of PA and management
^ IUGR risk--> corticosteroid given to promote fetal maturity - vaginal delivery or cesarean (often necessary but not done if coagulopathy is uncorrected)
clonus
_______ is muscular spasm involving repeated, often rhythmic, contractions.
hypotonic
__________ Uterine Dysfunction - The slowing or complete arrest of the progress of labor, caused by *weak or infrequent contractions of the uterus*. (fetal hypoxia rare)
McRoberts, shoulder
__________ maneuver is employed in case of _________ dystocia during childbirth.
magnesium sulfate
___________ ______________ relaxes the smooth muscles of the heart (prevents seizures in pregnancy)
gestational, proteinuria, 20, 12
____________ HTN = HTN without ____________ after ____ wks gestation resolving by ____ wks. postpartum
hypertonic
____________ Uterine Dysfunction - is defined as either a series of single contractions lasting 2 minutes or more OR a contraction frequency of five or more in 10 minutes. (Uterine hyperstimulation)
warfarin
____________ is not recommended as it crosses the placenta
calcium gluconate
_____________ _______________ reverses the effects of magnesium sulfate toxicity
albumin
_____________ holds everything in blood vessel, if low = edema
macrosomia, 8, 13, 4000
_____________ is used to describe a newborn who's significantly larger than average. (a birth weight of more than ____ pounds, ____ ounces (__________grams), regardless of his or her gestational age.)
magnesium, 12, 30, 8
_______________ Toxicity Respiratory rate < _____ breaths per minute *Absence* of Deep Tendon Reflexes Decrease in urinary output (<_____ml/hour) Serum magnesium levels > _____ mEq/L (Have calcium gluconate readily available as antidote for toxicity)
Group B Streptococcus
________________ most common cause of sepsis and meningitis in newborns and frequent cause of pneumonia
dystocia
________________: General term for difficult labor or birth
atrial septal defect
_________________ - *hole* in the septum between the *atria*. Blood shunts from left to right. Arrhythmias may be present
Ventricular septal defect
_________________ - *hole* in the septum between the *ventricles*. Blood shunts from left to right. Arrhythmias, HF, pulmonary HTN
Eisenmenger's Syndrome
_________________ - Increase pressure in right heart = blood shunts from left to right. Results in *cyanosis*, pulmonary HTN (Avoid pregnancy) *Pulmonary artery thickened wall*
Tetralogy of Fallot
_________________ - combination of four defects. If repaired, women do well during pregnancy. Uncorrected, high risk for *morbidity and mortality*, (Avoid pregnancy).
Patent ductus arteriosus
_________________ - open lumen in the ductus arteriosus between the *aorta* and *pulmonary artery* = more blood going to the lungs = *increase in respiratory problems.*
trophoblastic
_________________ cells that form placenta may cause eclampsia
serious complications of birth control A C H E S
a: abd pain c: chest pain/sob h: headaches e:eye problems/vascular accident, increased bp s: severe leg pain
How long does the baby blues last
about a week
prostaglandin contraindications
active cardiovascular, renal, liver disease, asthma
What are complications of hemmorage?
acute tubular necrosis acute RDS electrolyte imbalance DIC
When are lacerations most common?
after an assisted or operative deliver
what are predisposing factors?
anemia prolonged ROM trauma invasive procedures multiple vaginal exams retained placenta chorioamnionitis pre-existing bacterial vaginosis manual removal of placenta lapses in aseptic technique operative deliver
what medications should be given
antihypertensives
What is considered a postpartum puerperal infection?
any infection of reproduction system within 6 weeks
What Neuro. assessment is done with anticoagulation therpy
apprehension syncope
Appropriate for gestational age (AGA):
approximately 80% of newborns; NORMAL height, weight, head circumference, body mass index
Fetal Alcohol Syndrome (FAS) Disorders
are Alcohol Related Neurodevelopmental Disorder (ARND) and alcohol-related birth defects (ARBD). Children with ARND primarily display intellectual disabilities related to behavior and learning Children with ARBD may have birth defects of the heart, kidneys, and/or bones. The problems associated with any of the FASDs are lifelong and are entirely preventable by avoiding alcohol consumption during pregnancy
Esophageal atresia and tracheoesophageal fistula
are gastrointestinal anomalies in which the esophagus and trachea do not separate normally during embryonic development.
war are postpartum psychiatric disorders
baby blues postpartum depression postpartum psychosis panic disorder
HELLP SYNDROME - basically:___ H: EL: P:
basically preeclampsia with liver involvement H: hemolysis= anemia and jaundice EL: increased liver enzymes, elevated alanine aminotransferase (ALT) or aspartate transaminase (AST), epigastric pain, N/V LP: low platelets (<100,000/mm3)= thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, and possible disseminated intravascular coagulopathy (DIC)
How can a nurse anticipate hemorrhage?
be at the beside, know the patients risks and know the signs so they can detect it early
Management of placenta previa
bed rest and observation to allow fetus to mature 36 weeks old -closely monitor Hbg, Hct, platelet count, FHR, and coagulation studies.
reversible types
behavioral: abstinence, fertility awareness-based methods, withdrawal, Barrier: condom, diaphragm, cervical cap, sponge, Hormonal: oral, injectable or transdermal patch contraceptive, vaginal ring, implantable contraceptive, emergency contraceptive
What is the definition of hemorrhage?
blood loss of 500ml or more, or decrease of hematocrit of at least 10%, or need for transfusion
uterine atony signs and symptoms (4)
boddy uterus that does not respond to massage abnormal clots unusual pelvic discomfort of backache (posterior baby will cause backache) excessive or bright red bleeding
What type of uterus in a patient with uterine atony?
boggy
War is the local breast assessment
breast and nipple condition localized tenderness palpable hard mass warm, red painful area unilateral
Birth control side effects (6)
breast tenderness nausea increase in headaches moodiness weight change spotting (estrogen), seen more with mini pill because it is not as strong
What can cause a wound infection
c section or episiotomy
HPV vaccine only covers
cancer causing sti's, not herpes
Persistent Pulmonary Hypertension of the Newborn (define)
cardiopulmonary disorder characterized by marked pulmonary hypertension that causes right-to-left extrapulmonary shunting of blood and hypoxemia. This drastically lowers the amount of 02 sat blood. (So basically, due to the increased pulmonary pressure, blood does not travel through the Pulmonary veins, but rather the Atrial/Ventricle Septal Defect/Foramen Ovale/Ductus Arteriosis [this is "Right-to-Left Shunting"]) *****note: picture attached does not include the Ductus Arteriosis. This is still a possible route in shunting.
Chronic bilirubin encephalopathy or kernic- terus
characterized by four clinical manifestations: movement disorder 1. aethetosis, dystonia, spasticity, hypotonia 2. auditory dysfunction (deafness) 3. oculomotor impairment, 4. dental enamel hypoplasia of deciduous teeth
What is the generalized assessment
chills fever and flu-like symptoms
What studies should be monitored with anticoagulation therapy
clotting studies
skin assessment
cold clammy pallor fever
What is a hematoma
collection of blood after trauma to a blood vessel
What do you assess for skin?
color temp turgor
What is DIC
complex clotting disorder
Dilation and curettage
conscious sedation or local anesthetic is given, cervix is then dilated and uterus wall is scraped of content.
Disseminated Intravascular coagulation (DIC)
consumptive coagulopathy, is a pathologic form of clotting that is diffuse and consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both and clotting
effects
control of pph ( last resort)
What does a patient with PIH have a risk for after 24 hours?
convulsions
What ventilation assessment is done
decreased PCO2, rales, tacky. dyspnea, hemoptysis, cough, stabbing pain with breathing pleural friction rub
Acute bilirubin encephalopathy
describes the effects of hyperbilirubinemia in the first weeks of life. Clinical signs include lethargy, poor feeding, poor tone, a poor Moro reflex with incomplete flexion of the extremities, and a high-pitched cry.
What it the purpose of a doppler flow studie
detection of proximal DVTs
mechanical barriers
devices palced over the cervix or over the penis to physically obstruct the passage of sperm through the cervix
(torch) HIV:
diarrhea and weight loss, lymphadenopathy and rash, anemia
4 treatments for mood disorders
drug therapy psychotherapy explain importance of good nutrition and rest reintroduce the mother to the baby at the mothers own pace
Methotrexate
early miscarriage/ tubal pregnancy. Fitting for mass < 3.5 cm -antimetabolite and folic acid antagonist, destroys rapidly diving cells.
What are the intervention for anticoagulation therapy
elevate HOB oxygen therapy pulse oximetry IV fluids frequent vital signs blood gases anticoagulants
what is wound infection more common in
emergency c sections
Some causes of early pregnancy bleeding/miscarriages
endocrine imbalance (as in women who have luteal phase defects, hypothyroidism, or insulin-dependent diabetes mellitus with high blood glucose levels in the first trimester), immunologic factors (e.g., antiphospholipid antibodies), systemic disorders (e.g., lupus erythematosus), and genetic factors. -severe dietary deficiencies, morbid obesity, regular or heavy alcohol use, and excessive caffeine . Infection is NOT a common cause
how will a nurse know their is retained placental fragmentation
exams the placenta
what is the effect of fresh frozen plasma?
factors V, XI, XII increases fibrinogen 10mg/dL per unit
What are signs of pyelonephritis
fever CVA tenderness chills malaise hematuria N&V
(torch) toxoplasmosis:
fever and tender lymph nodes
when does psychosis occur
first 3 months
What is an amniotic fluid embolism
fluid goes into the maternal blood vessels
Trisomy 21 (Down syndrome) -- Nursing management
focuses on providing supportive measures such as promoting growth and development, preventing complications, promoting nutrition, and providing support and education to the child and family. Children with Down syndrome tend to grow more slowly, learn more slowly, have shorter attention spans, and have trouble with reasoning and judgment.
What medications are risk factors for uterine atony?
general anesthesia magnesium sulfate oxytocin induction tocolytics
what assessment findings signal abnormal bleeding
heavy lochia, generalized petechiae, bleeding from mucous membrane, hematuria, oozing from punctures
Remember the mother's _______ status determines the health of the fetus.
hemodynamic
What does help stand for?
hemolysis elevated liver enzymes low platelets
What are clinical manifestations of DIC?
hemorrhage anemia ischemia
What are contraindications of methergine?
herpertension or known sensitivity
types of contraception
hormonal barrier behavioral permanent methods
Side effect of oxytocin
hyperstimulation, herpertention water intoxication
side effects
hypertension dizziness headache flushing tinnitus, n&V, chest pain
what are side effects of methergine
hypertension dizziness headache flushing tinnitus, n&V, chest pain
What are contraindications for ergotrate
hypertension of known sensitivity
preterm newborns common problems (5)
hypothermia hypoglycemia hyperbilirubinemia hypothyroidism related to immaturity of body system
voluntary fertility control is vitally important because...
if not, global population will double in 40 year
Nursing diagnosis
impaired tissue perfusion deficient fluid volume risk for injury fear.
Ectopic pregnancy
implanted outside uterine cavity. Leading cause of infertility, causes damage. 90% cases are in tube S/S: vaginal spotting, red or dark brown, intermittent
How do you tell the difference form laceration and uterine atony?
in laceration the blood spirts and the uterus is firm
What is thrombophlebitis
in response to inflammation of vein wall
What causes an increase in mortality with hemorrhage?
inadequate blood banking lack of anticipation underestimation of loss
Complications of cleft lip and palate
include feeding difficulties, altered dentition, delayed or altered speech development, and otitis media. The infant with cleft lip may have difficulty forming an adequate seal around a nipple in order to create the necessary suc- tion for feeding and may also experience excessive air intake.
what is the effect of cryoprecipitate?
increase fibrinogen 10mg/dL per unit
What lab values are found
increased WBC proteinuria blood in the urine most common organism- E.coli
what is the effect of packed RBC?
increased the Hct 3% per unit
Birth-Weight Variations Extremely low birth weight (ELBW):
infant weighing <1,000 grams or 2 lb 3 oz
Birth-Weight Variations Very low birth weight (VLBW):
infant weighing <1,500 grams or 3 lb 5 oz
Birth-Weight Variations Low birth weight (LBW):
infant weighing <2,500 grams or 5.5 lb
Causes of late hemorrage
infection sub involution retained placenta
What is a contrast venography
invasive, contrast dye, usually ordered if doppler study inconclusive
What is pulmonary angiogram
invasive, risk of post procedure bleeding
what is parametritis
involves connective tissue of pelvic structures
Trisomy 21 (Down syndrome)
is a genetic disorder caused by the presence of all or part of an extra 21st chromosome. It is the most common chromosomal abnormality associated with intellectual disability Trisomy 21 is seen in all ages, races, and socioeconomic levels, but a higher incidence is found with a maternal age older than 35 years
Tracheoesophageal fistula
is an abnormal communication between the trachea and esophagus. When associated with esophageal atresia, the fistula most commonly occurs between the distal esophageal segment and the trachea.
Physiologic jaundice
is an unconjugated hyperbilirubinemia that occurs after the first postnatal day and can last up to 1 week.
What do you assess for elimination?
is the bladder empty and output
What is HEELP based on?
labs
What are conditions the over distended the uterus?
large infant multiple gestation (5 or >) polyhydraminos
What is the most common location for a hematoma?
lateral vaginal wall, ischial spine
Signs of shock
lightheaded, nauseated feeling faint anxious ashen color skin cool and clammy rapid shallow respirations increased pulse
Types of reproductive tract infection
local endometritis
what is an endometritis infection
localized infection of uterine lining
What do you assess for reproductive system?
loch, funds, perineum
What are signs of mag sulfate toxicity?
loss of DTRs, respiratory depression, cardiac conduction defects, cardiac arrest
What seizure precautions should be done
lower the bed bed pading side lay
What should be done for a patient with retained placenta?
manual removal drugs (pit, methogen, cytotec)
Some treatment for ectopic
mass taken out of tube and healing is left to heal by secondary intention -tube removal -methotraxate
What should be done for a patient with uterine atony?
massage drugs (pit, methogen, cytotec) embolization hysterectomy
What are treatments for depression
medications individual and group psychotherapy support groups practical assistance with childcare and other life demands
What are anticipate medical or surgical intervention
medications and surgery
What affects uterine contractility?
multiparty precipitous labor dysfunctional or prolonged labor prolonged third stage retained placental fragmentation
Diaphragm continued
must be fitted and available by prescription only must be replaced every 1-2 years or with weight change of 10 pounds or more portable, reusable, and few side effects increases incidences of UTIs decreases incidence of gonnorhea, pelvic inflammatory disease and tubal fertility
Can mastitis result in failure to breast feed?
no
What is sub involution?
not contracting so the uterus isn't moving down.
abstinence
only method to avoid pregnancy, greatly reduces risk of STIs and HIV, viable option for many because they want to: wait until older, wait for long term relationship, avoid pregnancy and STIs, follow religious or cultural expectations
what can DIC be characterized as?
oozing from puncture sites and petecchiae
What happens with psychosis
out of touch with reality
what needs to be monitored with mag sulfate?
output, respirations, deep tendon reflexes
What is part of the assessment?
over distention of the bladder dysuria frequency urgency during low grade fever
what can DIC lead too
overwhelming diffuse hemorrhage with consumption of looting factors
What medication causes uterine stimulants
oxytocin methergine ergotrate prostaglandin
What is a sign of hematoma?
pain unrelieved by analgesics
what can this result in
parametritis and peritonitis
HELLP SYNDROME - patho: __________= blockages in ___________= distortion of _________= __________ - ________ enzymes increased when blood flow is obstructed by _______ deposits= hyper__________= s/s of ____________ - platelets _________ (_____________) due to __________ damage and ________ -symptoms: management: labs:
patho: vasospasm= blockages in blood vessels= distortion of RBC= hemolysis - liver enzymes increased when blood flow is obstructed by fibrin deposits= hyperbilirubinemia= s/s jaundice - platelets decrease (thrombocytopenia) due to vascular damage and spasms -symptoms: nausea, malaise, epigastric/RUQ pain, edema - management: same as that for severe preeclampsia - labs: low hct and hgb, bun high, bilirubin high, uric acid high, platelets low
post term newborn common problems (5)
perinatal asphyxia (not getting oxygenated hypoglycemia (burning calories) hypothermia polycythemia meconium aspiration
what locations do lacerations occur
perineal, vaginal, cervical
What is a local infection
perineum vulva vagina
what is peritonitis
peritoneal cavity
Placenta Previa
placenta is implanted in lower uterine segment such that is completely or partially cover the cervix or is close enough to cervix to cause bleeding.
What is the components of blood replacements?
platelets Cryoprecipitate FFP packed RBCs
What type of women is DVT most common in
polyhydramnios, PIH, operative birth
(torch) GBS:
premature ROM, preterm labor and delivery, UTI, maternal sepsis, chorioamniotis
What are predisposing factors of lacerations?
primipara epidural precipitous birth macrosomia forceps or vacuum mediolateral epic
uterine atony predisposing factors (7) *by knowing this?
prolonged labor trauma due to ob procedures (forceps, lacerations) intrapartum stimulation with pitocin excessive use of analgesia/anesthesia grandmultiparity >5 over distention of uterus retention of placental fragments * by knowing these, you can anticipate complications and reduce the risk of excessive bleeding
What re predisposing factors of hematoma?
prolonged pressure of the fetal head operative delivery prolonged second stage precipitous labor macrosomia pudendal anesthesia
What can reverse heparin
protamine sulfate
barrier methods defintion
puts up a block or barrier to keep sperm from reaching the egg. Not only used as a method of contraception, also used to protect agaisnt STIs
What is an embolization?
radiology procedure that clots off the uterine artery
What are findings for peritonitis
rebound tenderness Fever as high as105, severe pain, paralytic ileus, abdominal rigidity, vomiting, dehydration, weak thready pulse, rapid shallow respirations. excessive thirst, marked anxiety
what is the assessment for wound infection
redness, edema, ecchymosis, discharge, approximation, fever, localized warmth tenderness
Esophageal atresia
refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm
What do tocolytics do
relax the uterus
hormonal methods
rely on estrogen and progestin or progeston alone to prevent ovulation when used consistently, these methods are a very reliable way to prevent pregnancy hormonal methods inculde: oral contraceptives, injections, implants, vaginal rings, and transdermal patches
What are intervention
remain with client call for help fundal message increase IV elevate legs monitor vs, loc, uterine tone, bleeding pitiocin or the medications oxygen, pulse oximeter encourage frequent voiding prep preparation maintain asepsis support significant other
What should be done for a patient with a laceration?
repair
Where can infection occur?
reproductive tract wounds breast urinary tract
What do you assess for ventilation status?
resp. rate and Lung Sounds
contraceptive methods
reversible and permanent
What is the assessment for late hemorrhage?
review history for risk factors assess blood loss count and weigh pads vitals intake and output funds inspection of perineum assess for signs of shock asess bladder assess for pelvic pain and backache
effects of oxytocin
rhythmic uterine contraction that prevent or reverse hemorrhage caused by uterine atony
what are diagnosis
risk for infection knowledge deficit pain impaired skin integrity
(torch) rubella in mother: rubella in fetus:
rubella in mother: rash, mild lymphadema, fever rubella in fetus: miscarriage, congenital anomalies, and death
what are interventions for wound infection
same as for reproductive tract infections assess wound
What is a late miscarriage
second trimester 12-20 weeks
What is medical treatment for depression
serotonin reuptake inhibitors
symptoms
sleep disorders confusion, irrationality agitation, hyperactivity irritability hallucinations delusions potential for suicide and infanticide insomnia -mood lability -difficulty remembering or concentrating -poor judgment
What are symptoms of psychosis
sleep disorders, confusion, agitation, irritability, hallucination, delusions, potential for suicide, infanticide
cervical cap
smaller than diaphragm-covers cervix only used with spermicide and held in place by suction 2 types: prentif cap and Femcap must be fitted and requires a prescription should be replaced every 1-2 years may be inserted up to 12 hours before intercourse and provides protectionf ro up to 48 hours must be left in place for 8 hours after final act of intercourse
contraceptive sponge
soft, disk shaped device with a loop for removal polyurehtane foam with spermicide sponge must be wet inserted loop side down in vagina to cover cervix effective for up to 24 hours should be left in for at least 6 hours after sex must be taken out within 30 hrs of insertion no protection against STIs
chemical barriers
spermicides that chemically destroy sperm in the vagina
Threatened miscarriage
spotted bleeding but cervix is still closed
What is management for DIC?
stabilize VS invasive hemodynamic monitoring blood component replacement delivery
What is the management?
stabilize vitals fluid an blood replacement
what is the most common cause of mastitis
staph aureus
What are signs of late hemorrhage?
sub involution and lochia persisting longer than 2 weeks
What circulatory assessment is done
substernal pain, hypotension, thachycardia
effect
sustained uterine contractions management of sub involution
What is the effect of methergine?
sustained uterine contractions that help prevent hemorrhage caused by uterine atony; management of sub involution
What is the key about preventing late hemorrhage?
teaching
how is local spread
through lymphatic system
TORCH effects (5)
toxoplasmosis rubella herpes simplex GBS HIV
Whats aspects to baby blues
transient onset 3-5 days last 1-10 days fatigue anger anxiety worry oversensitivity episodic tearfulness
postpartum infections 1. predisposing factors (7)
trauma hemorrhage prolonged labor uti anemia and hematomas excessive vag. exams PROM *GPS? look up
What is management for HEELP
treatment of server PIH blood component replacement hemodynamic monitoring
permanent
tubal ligation, vasectomy
What is the assessment for septic thromboplebitis
unresponsive to antibiotics Abd or flank pain with guarding fever tachycardia 2nd and 3rd day fever chills can lead to PE
Treatment of DIC and nursing interventions
usually resolved with birth/delivery, placenta is the main cause - Vit. K administration - administer hemostatic agent, activated clotting factor VII, fibrinogen interventions: O2 at 10 lpm, FHR monitoring, prevent injury to woman
Causes of early hemmorrage
uterine atony trauma difficult third stage placental abnormalities bleeding disorders uterine inversion drugs
What is the most common causes of hemorrhage?
uterine atony (75-90%) and laceration
S/S of miscarriage
uterine bleeding, uterine contraction, abdominal pain - after 12 weeks pain in severe due to the need to expel fetus
how is endometritis infection spread
venous system-infectious thrombophlebitis septicemia
What is a VQ scan
ventilation perfusion scan, non-invasive, results reported as probability, pt with history may have false "high provability" rating
What reverses coumadin
vit K
what are comfort measures the mom can take
warm or cold compresses, support bra, gentle massage before feeding
How is blood loss measured?
weight
Small for gestational age (SGA):
weight <2,500 grams (5 lb 8 oz) at term or below the 10th percentile
Large for gestational age (LGA):
weight >90th percentile on a growth chart; weight >4,000 grams (8 lb 13 oz) at term
What is the difference form the blues and depression
with depression it is more extreme and they can not take care of themselves.
When does septic pelvic thrombophlebitis occur
with infection of reproductive tract, increased with c-section
behavioral methods (4)
withdrawal natural family planning fertility awareness method abstinence
do bowel sounds slow during labor?
yes
is an amniotic fluid embolism deadly
yes
is mastitis unilateral
yes
should stimulation be decreased and how?
yes and turn off lights limit visitors and shut the door
