OB test 2
Vitamin K is given to
stimulate appropriate clotting *not giving Vit K can cause hemorrhage*
PROM
women beyond 37 weeks gestation
PPROM
women less than 37 weeks
Formula fed newborn sools
yellow, yellow-green, loose, pasty or formed, unpleasant odor stool not as often
nursing considerations for the pregnant adolescent
body image issues nutrition social support
Preterm
born before completion of 37 weeks
Late preterm
born between 34 and 36 6/7 weeks
Postterm
born beyond 42 completed weeks
Term
born from the first day of the 38th week through 42 weeks
Choriocarcinoma
cancer that may present as a pregnancy
Apnea
cessation of breathing for 20 sec or more is concerning
The cues to start breathing
chemical, mechanical, thermal
bronchopulmonary dysplasia
chronic lung disease, with newborns who have lung injury; need continued oxygen after initial 28 days of life
Assessment and management of polyhydraminos
close monitoring, removal of fluid (amniocentesis), assess fundal height, abdominal discomfort, difficulty obtaining FHR
Nursing management of hyperemesis
comfort and nutrition (NPO, IV fluids, I&O, oral care) support and education; reassurance; home care follow up
1st trimester spontaneous abortion
commonly due to fetal genetic abnormalities
Neural tube defects
congenitial CNS disorders; occur when the neural tube fails to close properly, normally occurs between 17 and 30 days of gestation (Anencephaly, spina bifida, meningocele, myelomeningocele)
Therapeutic management of hyperemesis
conservative diet and lifestyle changes hospitalization with parenteral therapy
Nursing management for SA
continued monitoring: bleeding, pad count, passage of products, pain, medications, prep for procedure support: physical/emotional, grief support
SA Habitual
continuous miscarriages
Heat is lost through the processes of
convection, conduction, evaporation and radiation
What should the baby do after delivery to help absorb fluid in lungs
cry
Convection
flow of heat from body surface to cooler surrounding air to air circulating over a body
All these fetal shunts must clothes so that blood will travel to the lungs for gas exchange and route blood to liver
foramen ovale ductus arteriosus ductus venosus
HPV causes what and can lead to what?
genital warts and can cause heavy bleeding during delivery *the fetus can contract HPV through vaginal secretions*
Care for mom with pregestational diabetes includes
glycemic control to prevent fetal consequences ongoing fetal surveillance
SA Threatened
has potential to happen
Most heat of a baby is lost through their
head
Other signs of hypertension for pregnant mom
headache visual changes proteinuria prolonged edema
If the fallopian tube ruptures the woman will experience
hemorrhage into the abdominal cavity and may develop hypovolemic shock
Nursing considerations for pregnant mom with STI
informing woman about her risk for additional infections risk for fetal complications treatment plan observing for decreased self-esteem
If labor does not begin after SROM/PROM what may be done
induction
Extremely low birthweight (ELBW)
infant weighs <1,000g or 2lb 3oz
Low birthweight (LBW)
infant weighs <2,500 or 5.5lbs
Very low birthweight (VLBW)
infant weights <1,500g or 3lb 5oz
Amnioinfusion is a risk for
infection
The more vaginal exams done theres an increased risk for
infection
Vitamin K supplementation during the last weeks of pregnancy help to prevent
neonatal hemorrhage
Folic acid supplements help prevent
neural tube defects
SA Incomplete
not all products of conception are removed
The first phase of transition period
occurs 1-2 hours after birth Infant should be awake and alert optimal time for breastfeeding and bonding
Nursing assessment of hyperemesis
onset, duration diet risk factors weight liver enzymes, CBC, BUN, electrolytes
3 groups of jaundice
overproduction decreased conjugation impaired excretion
S/s of PP
painless bright red vaginal bleeding in 2nd or 3rd trimester
Woman over 35 are at an increased risk for
pregnancy complications
Hydatidiform mole
pregnancy does not progress, empty sac
Cervical insufficiency
premature dilation of cervix (cervix shortening/opening) cause is unknown: possibly d/t cervical damage (infection, cone biopsy, abnormal paps)
Special concerns for the pregnant adolescent
prenatal care screening for domestic violence anemia preterm delivery preeclampsia-eclampsia
Nursing management for GTD
preop prep emotional support education: tx, hCG monitoring, prophylactic chemo
Nursing management for EP
prep for tx: analgesics for pain, medications for tx, teaching about s/s of rupture, surgery Emotional support Education
Pregnant woman with an STI is at an increased risk for
preterm delivery
Chlamydia increases the woman's risk for
preterm labor
What is the goal of tx for the woman with sickle cell anemia
preventing a crisis
The main goal of tx for the pregnant woman with heart disease is
prevention and early detection of cardiac decompensation
The best tx strategy for TORCH is
prevention of infection
HIV therapy during pregnancy is
prophylactic administration of oral ZDV throughout pregnancy *combination therapies or HAART are ordered to keep viral loads low*
What would the nurse expect to assess in a woman with placenta previa?
relaxed uterus
How long does the transition period of adapting to extrauterine life last
6- 8 hours
How many voids a day are considered normal for infant
6-8
Hallmark sign of ectopic pregnancy
abdominal pain with spotting 6-8 weeks after missed period
Gestational trophoblastic disease
abnormal cells or tumors that start in the womb from cells that would normally develop into the placenta (exact cause is unknown)
To increase thermoregulation for baby what should be done
Dry baby when it comes out Wrap baby in new warm blanker Skin to skin
S&S of ectopic pregnancy
missed menstrual period N/V abdominal pain shoulder pain vaginal spotting/bleeding
If there is no labor within 48 hours after PPROM what happens
mom is discharged home
Nursing interventions for cardiac issues
monitoring activity levels managing stress diet modification medication therapy
Nursing interventions for diabetic mom
monitoring therapeutic regimen screening for maternal/fetal injury risk for infection fetal macrosomia
Jaundice before 24 hours old is
more alarming than after 24 hours
2nd trimester spontaneous abortion
more likely related to maternal conditions
Factors predisposing to heat loss
Thin skin Lack of shivering ability Limited use of voluntary muscle activity Lack of subq fat Not able to adjust own clothing/blankets Cannot communicate if too cold/hot
Types of spontaneous abortions
Threatened Inevitable Incomplete Complete Missed Habitual
Cytotec
used to rid body of remaining products of conception
Nursing assessment of spontaneous abortion
vaginal bleeding cramping/contractions vitals/pain clients understanding
What needs to be avoided if pt has PP
vaginal exams
Pregnant women (w/out heart issues) with edema should
walk more drink more fluids elevate legs rest
small for gestational age (SGA)
weight <2,500g at term or below 10th percentile
Preterm newborn common characteristics
weight <5.5 lb Scrawny Poor muscle tone Minimal subq fat Undescended testes Plentiful lanugo Poorly formed ear pinna Fused eyelids Soft spongy skull bones Matted scalp hair Absent/few creases in foot sole Thin transparent skin Abundant vernix Minimal scrotal rugae; prominent labia
Large for gestational age (LGA)
weight >90th percentile >4,000g at term
Characteristics of SGA newborn
Head larger than body Wasted appearance of extremities; loose dry skin Reduced subq fat stores Decreased amount of breast tissue Scaphoid abdomen Wide skull sutures Poor muscle tone Thin umbilical cord
Rh incompatibility
If mother is Rh- and baby is Rh+, then mother may develop antibodies against the infant's blood
hyperbilirubinemia
Imbalance in rate of bilirubin production and elimination; total serum bilirubin level >5 mg/dL
Therapeutic managment of GTD
Immediate evacuation of uterine contents (D&C) Long-term follow up and monitoring of hCG levels
Nursing management for AP
Tissue perfusion: left lateral position, bed rest, O2, vitals, fundal height, continuous fetal monitoring Support: empathy, explanations, possible loss of fetus
TORCH stands for
Toxoplasmosis Other (Hep B, syphilis, varicella, herpes zoster) Rubella CMV HSV
Causes and Tx for AP
Trauma can cause abruption of placenta STAT c-section
Newborns are typically fed how much and how often
1-3oz and q 2-4 hours
A protozoan causes what and what med is given to tx?
Trichomoniasis (parasite) - can also increase risk of preterm labor Tx is oral Flagyl
physiologic jaundice
*3rd-4th day* Early and late onset breastfeeding jaundice
Neonates lose up to __% of birth weight in the first few days of life
5-10%
Mild preeclampsia management
-bed rest, daily BP monitoring and fetal movement counts -hospitalization, and IV magnesium sulfate during labor
pathologic jaundice
(within first 24 hours of life) Kernicterus Rh isoimmunization ABO incompatibility
Omphalocele and Gastroschisis
- Omphalocele: umbilical ring defect with evisceration of abdominal contents into external peritoneal sac - Gastroschisis: herniation of abdominal contents through abdominal wall defect (no peritoneal sac)
When is Rhogam given?
28 weeks and within 72 hours of delivery
Necrotizing Enterocolitis (NEC)
3 pathologic mechanisms: bowel ischemia, bacterial flora, and effect of feeding KUB- air in bowel wall; dilated bowel loops
congential heart disease
4 physiologic categories: Increased pulmonary blood flow Obstructed blood flow out of heart Decreased blood flow Mixed blood
Within how many hours of life will any newborn complications be noticeable
8 hours
Postterm newborn characteristics
Inability of placenta to provide adequate nutrition and oxygen Dry, cracked,, wrinkled skin Long, thin extremities; long nails, creases cover entire sole of feet Wide-eyed, alert Abundant hair on scalp Thin umbilical cord Limited vernix and lanugo
Common problems of LGA
Birth trauma Hypoglycemia Polycythemia Hyperbilirubinemia
Periventricular-intraventricular hemorrhage
Bleeding in the brain d/t fragility of cerebral vessels; most common in the first 72 hours after birth
What is the result of gestational diabetes in a normal pregnancy?
Blood glucose levels are higher than normal after meals
Labs and diagnostics for AP
CBC, fibrinogen levels, PT/aPTT, type and cross match, nonstress test, biophysical profile
Why is TORCH so important during pregnancy?
They are teratogenic
What is mom at risk for what hyperemesis gravidarum?
Dehydration metabolic acidosis/alkalosis hypokalemia
Retinopathy of Prematurity (ROP)
Developmental abnormality affecting immature blood vessels of the retina Premature vessels might stop developing
The cornerstone of therapy for gestational diabetes
Diet therapy
Neonatal Asphyxia
Failure to establish adequate, sustained respirations after birth
Acquired immunity
From vaccines, breast milk and getting sick
Neonate
Full term baby 37-42 weeks
HELLP
Hemolysis, elevated liver enzymes, low platelets
infants of diabetic mothers
High levels of maternal glucose crossing placenta, stimulating increased fetal insulin production leading to somatic fetal growth Prevent hypoglycemia of infant
Nursing management of gestational HTN
Home management for mild preeclampsia Hospitalization for severe; quiet environment, sedatives, seizure precautions, antihypertensives, DTR testing, assessing for mag toxicity Seizure management; fetal monitoring, uterine contraction monitoring, prep for birth
severe preeclampsia management
Hospitalization; oxytocin and magnesium sulfate; preparation for birth
2 types of GTD
Hydatidiform mole Choriocarcinoma
Gestational Hypertension
Hypertension without proteinuria after 20 weeks; bp returns to normal postpartum
Preterm newborn common problems
Hypothermia Hypoglycemia Hyperbilirubinemia Immaturity of body systems
meconium aspiration syndrome
Inhalation of particulate meconium with amniotic fluid into lungs; secondary to hypoxic stress
Birth trauma
Injuries d/t forces of labor and birth; fractures, cephalhemtoma, caput succedaneum
Esophageal atresia and Tracheoesophageal fistula
Lack of normal separation of esophagus and trachea during embryonic development Atresia- congenitally interrupted esophagus Fistula- abnormal communication between trachea and esophagus *prep for surgery*
Characteristics of LGA newborns
Large body, plump, full-faced Proportional increase in body size Poor motor skills Difficulty regulating behavioral states
respiratory distress syndrome
Lung immaturity and lack of alveolar surfactant Expiratory grunting, nasal flaring, retractions, generalized cyanosis, HR >150-180
Risk factors for congenital heart disease
Maternal alcoholism Maternal diabetes mellitus single gene mutation maternal exposure to xrays poor maternal nutrition maternal age >40 amphetamines genetics
Large for gestational age newborn risk factors
Maternal diabetes mellitus or glucose intolerance Multiparity Prior history of a macrosomic infant Maternal obesity Male fetus Genetics
Transient Tachypnea of the Newborn (TTN)
Mild respiratory distress; pulmonary liquid removed slowly or incompletely; resolution by 72 hours of age
Nursing interventions to prevent heat loss
Minimize air currents Dry infant immediately after birth Place infant skin to skin under warm blanket Preheating warmers Delay bath until temp is stable
Cleft lip/palate
Most common craniofacial birth defect Cleft lip repair surgical repair between 6-12 weeks; cleft palate repair 6-18 months
ABO incompatibility
Mother's blood type is O Infant's blood type is A, B, or AB
Acquired conditions
Neonatal asphyxia Transient Tachypnea (TTN) Respiratory Distress Syndrome (RDS) Meconium aspiration Persistent pulmonary HTN Bronchopulmonary dysplasia Retinopathy of prematurity Peri-Intra hemorrhage Necrotizing enteorcolitis Infants of diabetic mothers Birth trauma Perinatal substance abuse Hyperbilirubinemia Infections
Newborn infections
Neonatal sepsis: bacterial, fungal, or viral microorganisms or their toxins in blood or other tissues
Congenital conditions
Neural tube defects Microcephaly Hydrocephalus Choanal atresia Disphragmatic hernia Cleft lip/palate Esophageal atresia and tracheoesophageal fistula Omphalocele and gastroschisis Imperforate anus Hypospadias and epispadias congenital clubfoot hip dysplasia
Types of fetal surveillance
Non-stress test FHR Contraction Stress test
amniotic fluid embolism
Obstetric emergency Sudden onset of hypotension, hypoxia, and coagulopathy d/t breakage in barrier between maternal circulation and amniotic fluid
Acquired disorders
Occur at birth or soon after Problems experienced by the woman during pregnancy or at birth Possibly no identifiable cause for disorder
What is an Ectopic Pregnancy and how is it diagnosed?
Ovum implanted outside the uterus Ultrasound
Preterm Newborn nursing management
Oxygenation Thermal regulation Infection prevention Stimulation Pain management Growth and development Parental support; possible perinatal loss Discharge prep
Gonorrhea increases the risk for
PID, spontaneous abortion, preterm delivery
Common problems of SGA newborns
Perinatal asphyxia; act of blood flow/gas exchange Hypothermia; not enough fat Hypoglycemia Polycythemia; increased RBCs Meconium aspiration
Placenta Previa
Placenta is completely or partially covering cervical os *cause unknown*
Classification of gestational HTN
Preeclampsia Eclampsia (seizures)
Congenital Disorders
Present at birth; usually d/t malformation occurring during antepartal period Majority with complex etiology
Bladder exstrophy
Protrusion of bladder onto abdominal wall Separation of rectus muscles and symphysis pubis
Imperforate anus
Rectum ending in blind pouch or fistulas between rectum and perineum
Preterm newborn has increased risk for these complications
Resp distress Cardiovascular system GI system Renal system Immune system CNS
Postterm nursing management
Resuscitation Glucose monitoring Initiation of feedings; IV dextrose 10% Prevention of heat loss Evaluation for polycythemia Parental support
s/s of preeclampsia
Right epigastric pain Headache unrelieved with analgesic Periorbital edema Proteinuria
Eclampsia management
Seizure management, magnesium sulfate, antihypertensive agents; birth once seizures controlled
Hyperemesis Gravidarum
Severe form of nausea and vomiting continuing past week 20 weight loss >5% of pre-pregnancy weight
What type of pregnancies are more likely to have gestational diabetes
Subsequent
Diagnosis and therapeutic management of PP
Ultrasound Dependent upon bleeding, amount of placenta covering os, fetal position, maternal parity, labor s/s
Nursing management for LGA newborns
Vital signs Blood glucose monitoring Initiation of oral feedings with IV glucose supplementation prn Monitoring s/s of polycythemia and hypoglycemia Phototherapy Hydration
Iron supplements are best absorbed with
Vitamin C *Iron may also cause nausea and constipation*
Breast-fed newborns stool
Yellow-gold, loose, stringy to pasty, sour-smelling stool 4-8x day
Nursing Management for SGA newborns
Weight, length, head measurements Serial blood glucose monitoring Vital signs Early/frequent oral feedings; IV of dextrose 10% Monitor for s/s of polycythemia, flushing, jaundice
Habitual abortions happen d/t
anatomical defects DNA incompatibility
Appropriate for gestational age (AGA)
approx. 80% of newborns normal height, weight, head circumference, BMI
What is a contraction stress test
artificially induce contractions with oxytocin to see how fetus manages contractions
What intervention needs to be done ASAP with a baby who's mom has HIV
bathe baby ASAP
Therapeutic management for cervical insufficiency
bed rest, pelvic rest, no heavy lifting, cervical cerclage
When should Nitrazine and fern test be done
before a vaginal exam because the lube can cause a false + result
What med should diabetic moms not receive
betamethasone
S/s of AP
dark red bleeding, knife-like pain, uterine tenderness, decreased fetal movement
Treatment for PROM/PPROM
depends on gestational age no unsterile cervical exams until active labor expectant management if fetal lungs immature
Amniocentesis
determines fetal lung maturity may help determine optimum time for delivery
assessment of amniotic fluid embolism
difficulty breathing, hypotension, cyanosis, seizures, tachycardia, coagulation failure, DIC, pulmonary edema, uterine atony with subsequent hemorrhage, ARDS, cardiac arrest
D&C
dilation of cervix and cleaning out uterus
neonatal abstinence syndrome
drug dependency acquired in utero manifested by neurologic and physical behaviors
Therapeutic management of ectopic pregnancy
drug therapy- methotrexate, misoprostol) surgery if rupture Rh immunoglobin if woman Rh -
SA Complete
everything has been expelled
SA Missed
everything has been expelled all of a sudden
polyhydramnios
excessive amniotic fluid >2,000 mL
Baby becoming cold stressed can cause
hypoglycemia
some SGA newborns experience
intrauterine growth restrictions IUGR
The hepatic system functions
iron storage carbohydrate metabolism bilirubin conjugation
SA Inevitable
is going to happen
Final phase of transition period
is the second phase of reactivity that occurs between 2-8 hours after birth meconium often passed at this time
The most common sign of hypoglycemia is
jitteriness
Radiation
loss of body heat to cooler, solid surfaces in close proximity but not direct contact
Evaporation
loss of heat when a liquid is converted to a vapor
Interventions for mom with anemia
maintaining adequate hydration avoiding infection and stress adequate rest
What effect can Magnesium Sulfate have on baby
make baby flaccid and possible resp issues
Nursing assessment for GTD
manifestations similar to spontaneous abortion ultrasound visualization High hCG levels that continue to rise
Persistent Pulmonary Hypertension of the Newborn (PPHN)
marked pulmonary hypertension causing right to left extra-pulmonary shunting and hypoexmia Tachypnea, marked cyanosis, grunting, systolic murmur
Infants produce heat by
metabolizing brown fat stores
When the cord is clamped and the placenta cannot provide gas exchange this causes what
mild hypoxia which stimulates breathing
Postterm common problems
perinatal asphyxia hypoglycemia hypothermia polycythemia meconium aspiration
fetal alcohol syndrome
physical and mental disorders appearing at birth and remaining throughout life
Natural immunity
physical, chemical barriers, and resident non-pathologic organisms
The woman with epilepsy minimizes the risk to herself and fetus and allows for stabilization on antiepileptic meds by doing what
precenception care
Nursing assessment of Gestational HTN
risk factors, BP, nutritional intake, weight, urine in protein
Nursing assessment for PROM/PPROM
s/s of labor electronic FHR monitoring amniotic fluid characteristics Nitrazine test ultrasound fern test
Nursing management for HELLP
same as for severe preeclampsia
Nursing care for a woman who is a victim of IPV
screening for all pregnant women to identify victims of IPV
What phase should the newborn assessment be done
second phase
Abruptio Placentae
separation of placenta from the uterus leading to compromised fetal blood supply
Assessment and monitoring of oligohydraminos
serial monitoring, amnioinfusion, birth for fetal compromise Assess fluid leaking from vagina
Assessment and management for multiple gestation
serial ultrasounds, close monitoring during labor, operative delivery (common) uterus larger than expected education and support antepartally; labor management; postpartum assessment for hemorrhage
The easiest way to assess blood components is by
skin color
management of amniotic fluid embolism
supportive measures to maintain oxygenation and hemodynamic function and to correct coagulopathy; critical care monitoring
Cerclage
suture cervix closed during pregnancy until 32-34 weeks
Who's cord is clamped first and why
the baby because they have less blood
Second phase of transition period
time of sleep and may last several hours
oligohydramnios
too little amniotic fluid <500 mL *a small leak in amniotic sac*
Conduction
transfer of heat from one object to another with direct contact