ATI Maternal Newborn Nursing

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Caput succedaneum

(localized swelling of the soft tissues of the scalp caused by pressure on the head during labor) is an expected finding that may be palpated as a soft edematous mass and can cross over the suture line. Caput succedaneum usually resolves in 3 to 4 days and does not require treatment.

Epstein pearls

(small white cysts found on the gums and at the junction of the soft and hard palates) are normal in newborns. They result from the accumulation of epithelial cells and disappear a few weeks after birth

APGAR Heart Rate

0- absent, 1- less than 100, 2- greater than 100

APGAR Respiratory Rate

0- absent, 1- slow, weak cry, 2- good cry

APGAR Color

0- blue, pale, 1- pink body, cyanotic hands and feet (acrocyanosis, 2- completely pink

APGAR Muscle Tone

0- flaccid, 1- some flexion, 2- well flexed

APGAR Reflex Irritability

0- none, 1- grimace, 2- cry

Normal bilirubin values

0-6 day 1, 8 or less day 2, and 12 or less day 3

to get jaundice your bilirubin had to increase how much an hour and get to what level

0.5 an hour over 15

Amnioinfusion

0.9% sodium chloride or lactated ringer's solution is instilled into amniotic cavity to supplement the amount of amniotic fluid. Reduces severity of variable decelerations caused by cord compression

Fundus location postpartum

1 cm above umbilicus 12 hours postpartum

postpartum period

1-4 hours after birth

What score does a nurse want for a women who is doing a biophysical profile

10 4-6 suspect asphyxia under 4 severe asphyxia

Healthy newborn fluid intake

100-140 mL/kg/24 hr

Healthy newborn caloric intake

110 kcal/kg/day then 3-6 months it's 100 kcal/kg/day

Normal baseline FHR

110-160

Expected newborn HR

120-160

hgb RBC count Leukocytes Hct PLatelets Glucose

14.5 to 22.5 g/dL 4,800,000 to 7,100,000/mm 9,000 to 30,000/mm 48% to 69% 150,000 to 300,000/mm 40 to 60 mg/dL

Methylergonovine (Methergine)

140/90 and above BP- don't give. Also assess for n/v and headache

First period of reactivity

15-30 min after birth, HR may be 160-180

When can you do Quad testing

16-18 weeks

Reactive FHR

2 reactive 0 non reactive accelerates 15beats/min for at least 15 seconds two or more times during 20 minute period

When does birth defects typically happen

2 to 8 weeks

Expected newborn weight

2,500-4,000 g

Second period of reactivity

2-8 hours after birth. Often gags or chokes on mucus that has accumulated in his mouth

body movements

2-at least three body extensions with return to flexion

Breast milk and formula caloric amount

20 kcal/oz

How long does it take for BP to return to normal following a birth

20 weeks

What percent of moles becomes choriocarcinoma

20%

How many mg should a pregnant woman have of caffeine

200mg/daily

Lab test for Gestational Diabetes Mellitus

24-28 weeks gestation, a glucola screening test/1-hr glucose tolerance test (50 g oral glucose load followed by plasma glucose analysis 1 hr later, fasting not necessary (positive reading is 130-140 mg/dL or above

When is the one hour glucose done three hour glucose tolerance 1,2,3 hours later

24-28weeks if first test was above 140 when tested

How much does a woman gain during pregnancy 1st trimester? 2nd and 3rd trimester?

25-35lbs clients should fain 1-2kg (2.2 to 4.4) during first trimester and 0.4kg (1lb) a week for the last two trimesters underweight should gain- 28-40lbs overweight-15 to 25lbs

Return of menses for lactating clients

3 months or until cessation of breast feeding

Period of relative inactivity

30 min- 2 hr after birth, newborn is quiet, HR and RR will decrease

Expected newborn RR

30-60

How much should a womans calorie intake increase for the first 6months of brestfeeding

330 cals

How much should womans calorie intake increase during the 2nd trimester

340cals

When does Group B streptococcus testing get done

35-37 wks

Expected newborn temp

36.5-37.2

physiological jaundice appears at what day

3rd - normal will go away

When does leg cramps usually happen

3td trimester

Return of menses for nonlactating clients

4-10 weeks

to be considered hypoglycemic as a newborn what does the glucose level have to be under

40 get glucose test within the first two hours of life

how much should a womans calorie intake increase for the second 6months of breastfeeding

400 calories

Expected newborn length

45-55 cm

how much should a womans calorie intake increase during the 3rd trimester

452cals

How much does a womans BP decrease during the second trimester

5-10mm hg

What does hCG begins to peak after implantation

50 to 70 days higher levels can indicate multifetal pregnancy, ectopic pregnancy, or Down syndrome

Average uterine pressure

50-85 mm Hg

Moderate variability

6-25/min

Expected newborn BP

60-80 S, 40-50 D

Findings for LGA

90th percentile or more than 8 lbs, 12 oz, findings of increased ICP (dilated pupils, vomiting, bulging fontanels), plump face, tachypnea, retractions, cyanosis, hypotonic muscles

Temp when bathing can be initiated

97.7 or 36.5

Minimal variability

<5/min

Leopold Maneuver

Abdominal palpation of fetus, lie, attitude, helps nurse assess the position of the fetus to determine the optimal placement of the fetal monitoring transducer. Empty bladder beforehand, supine positioning

Ectopic pregnancy

Abnormal implantation of a fertilized ovum outside the uterine cavity usually in fallopian tubes. Abrupt unilateral lower-quadrant abdominal pain with or without vaginal bleeding, scant dark red vaginal spotting occurring 6-8 weeks after last normal menses

Dystocia

Abnormal labor related to the 5 P's. Hypotonic or hypertonic contractions, with failure to efface and dilate the cervix

Magnesium Sulfate toxicity

Absence of patellar deep tendon reflexes, urine output less than 30 mL/hr, respirations less than 12/min, decreased LOC, and cardiac dysthythmias

Care for anaphylactoid syndrome

Administer 02, intubate, cardiopulmonary resuscitation as necessary, administer fluids, position client on side with pelvis tilted 30 degrees to displace uterus, administer blood products

Fetal tachycardia

Administer antipyretic if maternal fever is present, administer 02, administer IV bolus

Interventions for DIC

Administer fluid volume replacement (blood products), administer antibiotics, vasoactive drugs, and uterotonics, administer 02, and provide protection from injury

RhoGAM

Administered at 28 weeks gestation to a mother who is Rh-negative and gives birth to an Rh-positive infant. Recommended following an amniocentesis

Tetanus-diphtheria-acellular pertussis vaccine

Administered prior to discharge

Preterm premature rupture of membranes

After 20 weeks of gestation and prior to 37 weeks

High levels of AFP

Alpha-Fetoprotein is measured between 16 and 18 weeks and is used to detect neural tube defects (anencephaly), spina bifida, and omphalocele-normal if multifetus

Chorionic Villus sampling

Alternative to amniocentesis (10-13 weeks gestation) results with 24-48 hours

Anaphylactoid Syndrome

Amniotic fluid embolism. Rupture of amniotic sac causing infiltration of amniotic fluid into the maternal circulation. Amniotic fluid travels to and obstructs pulmonary vessels

Magnesium Sulfate

Anticonvulsant, monitor BP, pulse, RR, deep tendon reflexes, LOC, urinary output, presence of headache, visual disturbances, epigastric pain, uterine contractions, and FHR, maintain fluid restriction of 100-150 mL/hr

Retrovir

Antiviral given at 14 weeks gestation throughout pregnancy for HIV/AIDs. Given to infant for 6 weeks following birth

Perineum comfort care

Apply ice packs for first 24-48 hours, encourage sitz baths at temp of 38-40 degrees Celsius, administer analgesia

Amniotomy

Artificial rupture of amniotic membranes

Rubella vaccine and RhoGAM

Assess after 3 months to determine whether immunity to rubella has been developed

HIV/AIDs

Avoid amniocentesis and episiotomy because of the risk of blood exposure

Cocaine addiction

Avoid eye contact, and use vertical rocking and a pacifier

Chlamydia medications

Azithromycin (Zithromax), amoxicillin (Amoxil), erythromycin (Ery-Tab)-infants after birth

What does BUBBLE stand for

B - Breasts U - Uterus (fundal height, uterine placement, and consistency) B - Bowel and GI function B - Bladder function L - Lochia (color, odor, consistency, and amount [COCA]) E - Episiotomy (edema, ecchymosis, approximation

Severe preeclampsia

BP 160/100 or greater, proteinuria greater than 3+, oliguria, elevated serum creatinine- 1.2+, cerebral or visual disturbances (headache or blurred vision), hyperreflexia with ankle clonus, peripheral edema, hepatic dysfunction, RUQ pain, and thrombocytopenia

Category 1

Baseline 110-160, variability is moderate, accelerates present or absent, early decelerations present or absent, and variable or late decelerations absent

Gestational Hypertension

Begins after 20th week of pregnancy, elevated BP of 140/90 or greater recorded at least twice, 4-6 hours apart, within 1 week period. NO proteinuria

Dependent-independent: taking hold phase

Begins on day 2 or 3, up to 10 days to several weeks. Focus on baby care, wanting to take charge but needs acceptance from others, wants to learn and practice

Findings for SGA

Below 10th percentile, hair is sparse, dry, loose skin, decreased fat, dry yellow umbilical cord, acrocyanosis, wide-eyed and alert

Medication for respiratory distress syndrome

Beractant (Survanta)

Term

Birth between week 38 and 42

Hep B dosage schedule

Birth, 1 month, and 6 months

Hypoglycemia: monitor for

Blood glucose less than 40, jitteriness, twitching, weak high pitched cry, irregular respiratory effort, cyanosis, seizures, eye rolling, give formula immediately

Neonatal Hypoglycemia

Blood glucose of 40 or less or in a preterm newborn 25 or less

Decreased placental enzyme insulinase

Blood sugar lowers immediately after birth

Quad marker screening

Blood test that ascertains info about likelihood of fetal birth defects. Includes AFP, hCG, Estriol, Inhibin-A 16-18 wks

Uterine atony

Boggy uterus, tachycardia, hypotension, skin is pale, cool, clammy, loss of turgor, may result in hysterectomy

Postterm

Born after completion of 42 weeks gestation

Preterm or premature

Born prior to completion of 37 weeks

Adequately fed newborn signs

Bowel movements are yellow, soft, and formed, stool after every feeding, after couple of weeks movements will decrease to 1-2 times a day, void 6-8 times per day

Decreased estrogen

Breast engorgement, diaphoresis, diuresis, diminished vaginal lubrication

Postpartum focused exam- BUBBLE

Breasts, uterus, bowel, bladder, lochia, episiotomy

Lochia Rubia

Bright red color, bloody consistency, fleshy odor, possible small clots, transient flow increases during breastfeeding and upon rising. Lasts 1 to 3 days after delivery

Lochia rubra

Bright red, clots, 1-3 days after delivery

Epidural

Bupivacaine, along with morphine or fentanyl (given when client is dilated at least 4 cm). Administer bolus of fluids to offset hypotension, place client in side-lying, sitting, or modified Sims' position

Female sterilization

Burning or blocking the Fallopian tubes. Not reversible

-barbitals

Can be used during early or latent phase of labor to relieve anxiety and induce sleep

Gestational Diabetes Mellitus

Can result in spontaneous abortion, infections (r/t increased glucose in urine), hydraminos, ketoacidosis, hypoglycemia, and hyperglycemia

Nevus flammeus

Capillary angioma below the surface of the skin that is purple or red, caries in size and shape, is commonly seen on the face, and does not blanch or disappear

Gonorrhea medications

Ceftriaxone (Rocephin) and azithromycin

Latent phase

Cervix 0-3 cm (non pharmacological pain management)

Active phase

Cervix 3-7 cm (opioids and epidural)

Transition phase

Cervix 8-10 cm

Low levels AFP

Chromosomal disorders (Down syndrome) or gestational trophoblastic disease

Nonstress test

Client presses a button whenever they feel fetal movement which allows nurse to assess FHR in relationship to the fetal movement

Varicella vaccine

Client should not get pregnant for 1 month following immunization. A second dose is given at 4-8 weeks

Rubella vaccine

Client should not get pregnant for 1 month following the immunization

What is effleurage?

Client strokes abdomen using circular motion during contractions

Medication for endometritis

Clindamycin (Cleocin)

Cephalohematoma

Collection of blood between the periosteum and skull bone

Sacral counterpressure

Consistent pressure against sacral area to counteract pain of lower back

GI changes postpartum

Constipation, hemorrhoids

Toxoplasmosis

Consumption of raw or undercooked meat or handling cat feces, fever and tender lymph nodes

Conduction heat loss

Contact with cooler surface

Rubella

Contracted through children who have rashes or neonates who are born to mothers who had rubella during pregnancy, rash, mild lymphedema, fever, and fetal consequences

What test do they use from Rh testing when can you get treatment

Coombs test 28 weeks

Category 2

Could be tachycardic or bradycardic

False labor contractions

Decrease in frequency, duration, and intensity, painless, irregular frequency, felt in lower back or abdomen above umbilicus, often stop with sleep or comfort measures, no change with dilation

Braxton Hicks contractions

Decrease with hydration and walking

Postpartum fundus

Decreased in size from 1,000 g to 60 g in two weeks

Third stage

Delivery of neonate and ends with delivery of placenta

Fourth stage

Delivery of placenta and ends with maternal stabilization of vital signs

Kleihauer-Betke test

Determined amount of fetal blood in maternal circulation if large fetomaternal transfusion is suspected

Bishop score

Determines maternal readiness for labor by evaluating whether the cervix is favorable by rating cervical dilation, effacement, consistency, position, and station

Postpartum psychosis

Develops within the first 2-3 weeks. Confusion, disorientation, paranoia, pronounced sadness, and obsessive behaviors

Fetal bradycardia

Discontinue pitocin, assist client to side-lying position, administer 02, insert IV, administer tocolytic, notify provider

If magnesium sulfate toxicity is expected

Discontinue, administer calcium fluconate, prepare for actions to prevent respiratory and cardiac arrest

Circumcision care

Do not wash off the yellowish mucus that forms over the glans, avoid wrapping in tight gauze, check for bleeding every 15 min after procedure for the first hour, monitor for the first void

What does a low AFP indicate

Downs syndrome

hCG elevation in hyperemesis gravidarum

Elevated because inability to retain fluid results in hemoconcentration

EL-------> in HELLP

Elevated liver enzymes (ALT and ASP), epigastric pain, and n/v

Vital sign changes postpartum

Elevated pulse, temp (100 degrees F), cardiac output, orthostatic hypotension

Continued flow of lochia serosa or alba indicative of

Endometritis

Care for uterine atony

Ensure bladder is empty, assess uterus, monitor vitals, IV fluids, 02 2-3 liters via NC, medications for postpartum hemorrhage

How often should newborns breastfeed?

Every 3 hours during day, every 4 hours during night (8-12 times within a 24 hr day)

Hyperemesis Gravidarum

Excessive n/v possibly related to elevated hCG levels prolonged past 12 weeks of gestation

Recurrent premature dilation of the cervix (Incompetent cervix)

Expulsion of the products of conception occurs

2nd degree laceration

Extends through skin and muscle

1st degree laceration

Extends through skin of perineum

4th degree laceration

Extends through skin, muscle, anal sphincter, and anterior rectal wall

3rd degree laceration

Extends through skin, muscle, perineum, and anal sphincter muscle

What is the purpose of a doppler

FHR

Nonreactive stress test

FHR does not accelerate adequately with fetal movement. Does not meet criteria after 40 minutes. Contraction stress test or biophysical profile is indicated Fowlers

Reactive stress test

FHR has moderate variability, accelerated to 15 beats/min for at least 15 seconds and occurs two or more times during a 20 minute period

Contraction stress test

FHR in response to contractions which decreases placental blood flow

Fetal Alcohol syndrome withdrawal

Facial anomalies, stabismus, ptosis, cleft lip or palate, deafness, abnormal palmar creases, irregular hair, developmental delays, prenatal and postnatal growth retardation

Tracheoesophageal atresia

Failure of the esophagus to connect to the stomach

Meds that increase breast milk production

Fenugreek and metoclopramide (Reglan)

Medication for Anemia

Ferrous sulfate, take on empty stomach, encourage diet rich in vitamin C to increase absorption. Iron dextran when oral supplements cannot be tolerated

Biophysical profile assesses?

Fetal HR, breathing, body movements, fetal tone, and qualitative amniotic fluid volume

Passenger

Fetus and palcenta, presentation, lie, attitude, and fetopelvic or fetal position

Dependent: taking in phase

First 24-48 hours, meeting personal needs, needs others for assistance, excited, talkative, need to review birth experience with others

Absent variability

Flat line

Telangiectatic nevi

Flat, pink or red marks that easily blanch and are found on the back of the neck, nose, upper eyelids, and middle of forehead

Convection heat loss

Flow of heat from body to cooler air

Candida Albicans medications

Fluconazole (Diflucan) and clotrimazole (Monistat)

Interdependent: letting go phase

Focuses on family as a unit, resumption of role (partner, family member)

Second stage

Full dilation and ends with birth (intense contractions every 1-2 minutes) (spinal block, pudendal, and local infiltration)

Mild Preeclampsia

Gestational hypertension along with proteinuria of greater than 1+

Betamethasone (Celestone)

Glucocorticoid administered IM in 2 injections 24 hr apart, given to stimulate fetal lung maturity if early delivery is anticipated and to prevent respiratory distress. Can cause pulmonary edema (crackles, chest pain, SOB)

Marked variability

Greater than 25/min

Prolonged or too frequent contraction

Greater than 90 seconds or more than five in a 10-min period

Intrauterine growth restriction

Growth rate does not meet expected norms

Fetal distress

HR below 110 or above 160, shows decreased or no variability, and is hyperactive or no activity

HELLP syndrome

Hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction

H------> in HELLP

Hemolysis resulting in anemia and jaundice

Greatest risks during postpartum period

Hemorrhage, shock, and infection

Lab tests for Anemia

Hgb less than 11 in 1st and 3rd trimester and 10.5 in 2nd trimester, and Hct less than 33%

Neonatal withdrawal

High pitched shrill cry, tremors, increased Moro reflex, increased deep tendon reflexes, increased muscle tone, tachypnea, sweating, temp greater than 99 degrees

Depo-Provera

IM injection given every 11-13 weeks (start should be during first 5 days of clients menstrual cycle)

Ferning test

If positive, indicates rupture of membranes

FUNDUS PRESENTATION

Immediately after delivery, the fundus should be firm, midline with the umbilicus, and approximately at the level of the umbilicus. At 12 hr postpartum, the fundus can be palpated at 1 cm above the umbilicus

Galactosemia

Inability to metabolize galactose into glucose, give newborn soy-based formula because galactose is present in milk, breastfeeding is contraindicated

Decreased progesterone

Increase in muscle tone

Hct, Hgb, and leukocyte changes postpartum

Increased Hct and Hgb (up to 72 hr) leukocytosis of up to 20,000-25,000 (10-14 days)

Methadone withdrawal

Increased incidence of seizures, higher birth weight, higher risk of SIDs

Essure

Insertion of agent resulting in development of scar tissue in Fallopian tubes. Not reversible

Anemia

Iron-deficiency occurs during pregnancy due to inadequacy in maternal iron stores and consuming insufficient amounts of dietary iron

Hypoglycemia

Jittery, nervousness, weak shrill cry, hypothermia, flaccid muscle tone, headache, weakness, irritability, hunger, blurred vision, tingling of mouth and extremities

Precipitous labor

Labor that lasts 3 hours or less from onset of contractions to time of delivery

How is a pregnant womans endocrine system effected

Large of hCG, progesterone, estrogen, prostaglandins.

Fetal lung tests

Lecithin/sphingomyelin ratio- 2:1 indicating lung maturity or 3:1 for diabetes mellitus

Light

Less than 10 cm

Scant

Less than 2.5 cm

Newborn bradycardia

Less than 25

Vasectomy

Ligation and severance of vas deferens. Need alternate form of birth control for 20 ejaculations

Effleurage

Light, gentle, circular stroking of client's abdomen

Position for transvaginal ultrasound

Lithotomy position

Pudenal block

Local anesthetic such as lidocaine or bupivacaine administered transvaginally

Caput succedaneum

Localized swelling of the soft tissue of the scalp caused by pressure in the bead during labor. Resolved in 3-4 days

Evaporation heat loss

Loss of heat as surface liquid is converted to vapor

Radiation heat loss

Loss of heat from body to cooler surface that is close to but not in direct contact

Heroin withdrawal

Low birth weight, SGA, decreased Moro reflex, hypo or hyperthermia

LP-------> in HELLP

Low platelets (less than 100,000) resulting in thrombocytopenia, abnormal bleeding and clotting, bleeding gums, petechiae, and possible DIC

Signs of Downs Syndrome

Low set ears, protruding tongue, absence of head control

Phototherapy indications

Maintain eye mask over neonate's eyes, keep female undressed, avoid lotions or ointments, remove from phototherapy every 4 hours, reposition every 2 hours

What to do with hypertonic contractions?

Maintain hydration, promote rest and relaxation, and place client in lateral position and provide 02 by mask

Psychological response

Maternal stress, tension, and anxiety

Cytomegalovirus

Member of the herpes family, transmitted by droplet infection, found in semen, cervical or vaginal secretions, breast milk, placental tissue, urine, feces, or blood

Opioids

Meperidine, fentanyl, butorphanol, and nalbuphine (have nalozone ready as the antidote)

Gestational hypertension medications

Methyldopa, Nifedepine, Hydralazine, Labetalol hydrochloride, avoid ACE inhibitors and angiotensin 2 receptor blockers

Breast milk

Milk is produced 2-3 days after delivery of newborn

Cervical ripening

Misoprostol and dinoprostone are agents to ripen servix

Warfarin monitoring

Monitor PT (should be 1.5-2.5 times 11-12.5 seconds) and INR of 2 or 3

Heparin monitoring

Monitor aPTT (should be 1.5-2 times 30-40 seconds), have protamine sulfate ready

Carboprost Tromethamine (Hemabate)

Monitor for adverse effects such as fever, chills, diarrhea, headache, and n/v

Oxytocin (Pitocin)

Monitor for water intoxication (lightheaded, n/v, headache, malaise) which can lead to cerebral edema, seizures, coma, and death. Contraindicated based on late decelerations

Moderate

More than 10 cm

Newborn tachycardia

More than 60

How Is a pregants womans GI system effect

N/V Constipation

Hepatitis vaccine

Newborns born to infected mothers should receive the hep B vaccine and hep B immune globulin within 12 hours of birth

Medications for preterm labor

Nifedipine (inhibits calcium which suppresses contractions) and Magnesium sulfate

Physiologic jaundice

Normal newborn physiology, no other manifestations, appears after 24 hours

Rubella titer

Obtained at initial prenatal visit (about 6 weeks gestation)

Percutaneous blood sampling

Obtains fetal blood from umbilical cord which evaluates isoimmune fetal hemolytic anemia and assesses need for fetal blood transfusion

Postpartum depression

Occurs within 6 months of delivery and is characterized by persistent feeling of sadness, guilt, weight loss, flat affect, rejection of infant, anxiety, irritability, intense mood swings

Position

Of the woman who is in labor, should engage in frequent position changes during labor to increase comfort, relieve fatigue, and promote circulation

Antiemetics

Ondansetron and metoclopramide

Excessive blood loss

One pad saturated in 15 min or less or pooling of blood under buttocks

Heavy

One pad saturated within 2 hr

Herpes Simplex Virus

Oral or genital lesions, transmission to the fetus is greatest during vaginal birth if the woman has active lesions. Fetal consequences include miscarriage, preterm labor, and intrauterine growth restriction

OGTT

Overnight fasting, avoid caffeine, no smoking for 12 hours prior to test, fasting glucose is obtained, 100 g glucose load is given, and serum glucose levels are determined at 1, 2, and 3 hours following ingestion

How is the pregnant womans respiratory effected

Oxygen needs increase. last trimester- size of chest can enlarge respiratory rate increases while total lung capacity decreases

Postpartum hemorrhage medications

Oxytocin, methylergonovine (Methergine), misoprostol (Cytotec), and Carboprost tromethamine (Hemabate)

Oxytocics

Oxytocin, methylergonovine maleate, and carboprost

Treatment of retained placenta

Oxytocin. If it doesn't work then move to Terbutaline (Brethine)

Phenylketonuria

PKU is a defect in protein metabolism which can result in mental retardation

Signs of inversion of the uterus

Pain in the lower abdomen, large, red mass protruding 20-30 cm outside the vaginal opening , dizziness, hypotension, pallor

Gonorrhea

Painful urination, frequency, lower abdominal pain (female), dysmenorrhea, yellow-green vaginal discharge, reddened vulva and vaginal walls, if left untreated it can cause PID, heart disease and arthritis

Signs of placenta previa

Painless vaginal bleeding

Steps of Leopold Maneuver

Palpate client's fundus, determine location of fetal back, palpate fetal part presenting at the inlet, and palpate the cephalic prominence to identify the attitude of the head

5 P's that define the labor process

Passenger, passageway, powers, position, and psychological response

Transdermal contraceptive patch

Patch applied to dry skin overlying subQ tissue, excluding breast

What do they want the outcome to be for the fetus for the nipple stimulated stress test

Pattern of three contractions within 10 min with a duration of 40-60 sec

Medications for GBS

Penicillin G or Ampicillin (Principen)

Amniocentesis

Performed after 14 weeks gestation, empty bladder beforehand, client in supine position

Lochia Serosa

Pinkish brown color and serosanguineous consistency. Lasts from approximately day 4 to day 10 after delivery

Lochia serosa

Pinkish/brown, serosanguineous. Lasts day 4-10 postpartum

Late deceleration of FHR

Place client in side-lying position, insert IV catheter and increase fluids, discontinue pitocin, administer 02

Placenta previa

Placenta abnormally implants in the lower segment of the uterus near or over the cervix. Results in abnormal bleeding during the 3rd trimester as cervix begins to dilate

Placenta previa- marginal or low lying

Placenta is attached to lower uterine segment but does not reach cervix

Nursing care for fetal distress

Position client in left side lying reclining position with legs elevated, 8-10 liters of 02

Group B Streptococcus B-hemolytic

Positive GBS may have effects including premature rupture of membranes, preterm labor, chorioamnionitis, infections of urinary tract, and maternal sepsis. Vaginal and rectal cultures are performed at 36-37 weeks of gestation

Nitrazine paper test or ferning test

Positive test (blue, pH 6.5-7.5) verifies rupture of membranes

Spontaneous abortion

Pregnancy is terminated before 20 weeks or fetal weight is less than 500 g. Vaginal bleeding, uterine cramping, and partial or complete expulsion of products of conception

Abruptio placenta

Premature separation of placenta from uterus. Can occur after 20 weeks gestation

Marijuana withdrawal

Preterm birth and meconium staining

Amphetamine withdrawal

Preterm or SGA, drowsy, jittery, respiratory distress, frequent infections, poor weight gain, emotional disturbances

Phototherapy

Primary treatment for hyperbilirubinemia, prescribed if the level is greater than 15 mg/dL prior to 48 hr of age, greater than 18 mg/dL prior to 72 hr of age, and greater than 20 mg/dL at any time

Treatment for recurrent premature dilation of the cervix

Prophylactic cervical cerclage is the surgical reinforcement of the cervix with a heavy ligature that is placed submucosally around the cervix to strengthen it and prevent premature cervix dilation (best done 23-24 weeks of gestation)

Opiate withdrawal

Rapid mood changes, hypersensitivity to noise, dehydration, and poor weight gain

Variable deceleration of FHR

Reposition client from side to side or into knee-chest

Pathologic jaundice

Result of an underlying disease appearing before 24 hours (or persistent after day 7)

Kernicterus

Results from untreated hyperbilirubinemia with levels t or higher than 25 mg/dL

immunizations statuses

Review rubella status - A client who has a titer of less than 1:8 is administered a subcutaneous injection of rubella vaccine or a measles, mumps and rubella vaccine during the postpartum period to protect a subsequent fetus from malformations. Clients should not get pregnant for 1 month following the immunization. ■ Review hepatitis B status - Newborns born to infected mothers should receive the hepatitis B vaccine and the hepatitis B immune globulin within 12 hr of birth. Review Rh status - All Rh-negative mothers who have newborns, and are Rh-positive, must be given RH (D) immune globulin (RhoGAM) IM within 72 hr of the newborn being born to suppress antibody formation in the mother. Review varicella status - If the client has no immunity, varicella vaccine is administered before discharge. The client should not get pregnant for 1 month following the immunization. A second dose of vaccine is given at 4 to 8 week

Breast milk storage

Room temp 8 hr, refrigerated 8 days, freezer 6 months, and deep freezer 12 months

Maternal Serum Alpha-Fetoprotein

Screening tool for neural tube defects that is effective between 15 and 22 weeks. levels above indicate the need for an ultrasound

3 hour glucose tolerance test

Screens for gestational diabetes and is done at 28 weeks of gestation

Pulmonary embolism interventions

Semi-fowler's position, administer 02, administer alteplase or streptokinase

Eclampsia

Severe preeclampsia symptoms along with seizure activity or coma. Preceded by headache, severe epigastric pain, hyperreflexia, and hemoconcentrations

Category 3

Sinusoidal pattern, absent baseline fetal HR variability, nervous system of neonate not intact

Epstein Pearls

Small white cysts found on the gums and at the junction of the soft and hard palates

Diaphragm

Spermicide must be applied with each act of sexual intercourse and should remain in place 6 hrs after. Empty bladder prior to coitus

Premature rupture of membranes

Spontaneous rupture of amniotic membranes 2 hour or more prior to the onset of true labor

Moro reflex

Startle

Decrease or loss of FHR variability

Stimulate fetal scalp, assist provider with application of scalp electrode, and place client in left lateral position

Dehydration

Stimulates uterine contractions

True labor contractions

Stronger, last longer, more frequent, felt in lower back radiating to abdomen,doesn't decrease with comfort measures, walking can increase intensity, cervix shows progressive change

Sign of anaphylactoid syndrome

Sudden chest pain, cyanosis, dyspnea, pulmonary edema, respiratory arrest

Signs of abruptio placenta

Sudden onset of dark red vaginal bleeding, sharp abdominal pain, and tender rigid uterus (board like)

Gestational trophoblastic disease

Swollen, fluid-filled grape like clusters in the placenta. Associated with choriocarcinoma which is a rapidly metastasizing malignancy

Respiratory distress syndrome, asphyxia, meconium staining

Tachypnea, nasal flaring, expiratory grunting, retractions, fine crackles, cyanosis

What is Naegele's rule

Take the first day of the womans last menstrual cycle, subtract 3 months and then add 7 days and 1 year

Postpartum blues

Tearfulness, insomnia, lack of appetite, sleep pattern disturbances, crying, and feeling letdown. Typically resolve in 10 days without intervention

Medication for inversion of the uterus

Terbutaline (Brethine) which relaxes the uterus in order to place it back into the uterine cavity

What does biophysical profile indicate?

The risk of asphyxia-deficient oxygen

Passageway

The size and shape of the bony pelvis must be adequate to allow fetus to pass through

Candida Albicans

Thick, creamy, white vaginal discharge, vulvar redness, white patches on vaginal walls, grey-white patches on tongue and gums (neonate)

Hyperglycemia

Thirst, nausea, abdominal pain, frequent urination, flushed dry skin, and fruity breath

Vitamin K

To prevent hemorrhagic disorders because this vitamin is not produced in the GI tract until day 8 (once breast milk is introduced into gut)

Application of Erythromycin

To prevent ophthalmia neonatorum. Lower conjunctival sac of each eye starting from inner canthus and moving outwards

Plantar grasp

Touch sole of foot, toes curl downwards

TORCH

Toxoplasmosis, Rubella, Cytomegalovirus, and Herpes Simplex Virus

Inversion of uterus

Turning inside out of the uterus (emergency situation)

Urinary and bladder changes postpartum

Urinary retention (resulting in distended bladder) assess client's ability to void every 2-3 hours. Excessive diuresis (1500-3000 mL/day) is normal within the first 2-3 days

what should be the output findings of the newborn

Urine should be passed within 24 hr after birth. Uric acid crystals will produce a rust color in the urine the first couple of days of life. Meconium should be passed within 24 to 48 hr after birth.

Car seat safety

Use rear-facing car seat in back seat, preferably the middle until age 2 or until the child reaches max height and weight

Signs of retained placenta

Uterine atony, subinvolution, inverstion, clots larger than a quarter, the return of lochia rubra, malodorous discharge, elevated temp

Preterm labor

Uterine contractions and cervical changes occurring between 20 and 37 weeks gestation, persistent low back ache

Powers

Uterine contractions cause effacement and dilation of the cervix

Signs of gestational trophoblastic diease

Uterine size increasing abnormally fast, abnormally high levels of hCG, nausea and increased emesis, no fetus present on ultrasound, and scant or profuse dark brown or red vaginal bleeding

Subinvolution of uterus

Uterus remains enlarged with continued lochial discharge which may result in postpartum hemorrhage

Chlamydia

Vaginal spotting, vulvar intching, postcoital bleeding and dysuria, white watery discharge

Diagnostic for preterm labor

Vaginal swab for fetal fibronectin which appears between 24-34 weeks. Found when fetal membrane integrity is lost

The expected ranges of physical measurements X

Weight - 2,500 to 4,000 g (Weigh newborns at the same time daily.) X Length - 45 to 55 cm (18 to 22 in) X Head circumference - 32 to 36.8 cm (12.6 to 14.5 in) X Chest circumference - 30 to 33 cm (12 to 13 in)

Large for gestational age

Weight is above 90th percentile

Small for gestational age

Weight is below 10th percentile

Appropriate for gestational age

Weight is between 10th and 90th percentile

Low birth weight

Weight is of 2,500 grams or less at birth

When is Rho-GAM administered

Within 72 hrs to women who are Rh-negative and gave birth to an infant who is Rh-positive

Lochia alba

Yellowish, white cream color. Lasts approx 11 days-6 weeks postpartum

Lochia alba

Yellowish, white creamy color, fleshy odor. Lasts from approximately day 11 beyond 6 weeks postpartum

Primigravida

a woman in her first pregnacy

Multigravida

a woman who has had two or more pregnancy

Nulligravida

a woman who has never been pregnany

What is interpreted as a reactive fetal HR

accelerates to 15 beats/min for at least 15 sec and happens 2 or more times in a 20 min period

What is the purpose of a tocotransducer

contractions

Chadwicks sign

deepened violet bluish color of cervix and vaginal mucosa

when using the photo therapy for a jaundiced baby watch for what

dehydration rash bumps- maclopapular

What does a higher ranges of hCG and inhibin A indicate

down syndrome

What does lower than expected levels of estirol mean

downs syndrome

How many times does a women visit the doctor for prenatal care during 8 months

every 2 weeks

how often should your monitor bilirubin levels when they are under the light

every four hours

What does PKU mean

genetic disease in which phenylalanine poses a threat to the baby low phenylalanine foods-protein, eggs, nuts, dairy

What are the causes of bleeding during 2nd trimester

gestational trophoblastic disease

Primipara

has completed one pregnancy to stage of viability

Multipara

has completed two or more pregnancies to stage of viability

fetal lung test purpose

if gestation is less than 37 weeks, In the event of a rupture of membranes, preterm labor, or for compliations indicating a cesearn birth supine with wedge behind hip

How is the pregnant womans cardiovascular effected

increase in cardiac output and heartheart

How are proataglandin given

into the amniotic sac or as a vaginal suppository d4

Nevus flammeus (port wine stain

is a capillary angioma below the surface of the skin that is purple or red, varies in size and shape, is commonly seen on the face, and does not blanch or disappear

Erythema toxicum (erythema neonatorum)

is a pink rash that appears suddenly anywhere on the body of a term newborn during the first 3 weeks. This is frequently referred to as newborn rash. No treatment is required

What are some general symptoms of torch

joint pain malaise rash flulike lymph tenderness

What is the term for when there is an excess of bilirubin the brain up to 25mg

kernicterus causes cerebral palsy, epilepsy and even mental retardation

What are the risk factors for throboblastic disease

low carotene/ animals fat early teen or over 40 ovulation stimulation with clomiphene (Clomid)mz

What is the purpose of the non stress test

monitoring for an intact fetal CNS during the third trimester Ruling out the risk for fetal death in clients who have diabetes. Used twice a week or until after 28 weeks of gestation

how many times does a women visit the doctor for prenatal care from 0-7months

monthy

does a doctor want a positive for neg contraction stress test

negative if within a 10 min period 3 uterine contractions with no deceleration of FHR positive means-cord compression fetal head compression- need contraction for 10-20min

What does a high AFP indicate

neural tube defect

Nullipara

no pregnancy beyond the stage of viability

Head circumference should be 2 to 3 cm larger than the chest circumference.

over that = hydrocephalus

What are the causes of bleeding during the 3rd trimester

placenta previa abrupto placenta

Ballottement

rebound of unengaged fetus

Heartburn, constipation, backaches, varicose veins happens when

second and third trimester

What lab levels do they look at from sickle cell

sickle hcg

Hegar's sign

softening and compressibility of lower uterus

Goodells sign

softening of the cervical tip

What is causes of pregnanct bleeding during the 1st trimester

spontaneous abortion ectopic pregnancy

Telangiectatic nevi

stork bites back of the neck, nose, upper eyelids, and lower occipital area.

How is a pregnant womans renal system effected

urinary frequency

What do the doctors do if the baby does not move during the Non reactive stress test to wake up the baby

vibroacoustic stimulation

How many times does a woman visit the doctor for prenatal care during month 9

weekly

Nipple stimulated stress test

woman lightly brushing her palm across her nipple for 2 min, to cause a release of oxytocin for a contraction one agsin after 5 min if mom cant do it IV oxytocin -observe 30min after for stop in contractions and to make sure there isn't a preterm labor

What are the manifestations of kernicterus

yellow skin lethargic hypotonic poor suck reflex increased sleepiness not treated-arching of back and trunk high pitched cry and fever


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