Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
183 Cards in this Set
- Front
- Back
|
What decreased in home births and midwives |
In the 19th century technological developments were only available to Physicians |
|
|
Period of pregnancy before the onset of Labor |
Antepartum |
|
|
The time of Labor and childbirth |
Intrapartum |
|
|
First six weeks after childbirth |
Postpartum |
|
|
History changes in birthing |
Better pain control in decreased length of stay |
|
|
Time when birthing change from home to traditional Hospital |
1950s |
|
|
Advantage of birth centers |
Less expensive, more home like birth and staff they've known throughout the pregnancy |
|
|
Disadvantage of birth centers |
Most are not equipped for obstetric emergencies |
|
|
Biggest ethical issue |
Abortion |
|
|
Number of deaths per thousand live births that occur within the first 12 months of life |
Infant mortality rate |
|
|
Death before 28 days of life |
Neonatal mortality rate |
|
|
Five leading causes of infant mortality |
Congenital malformations, deformations&chromosome abnormalities, disorders related to low birth weight, newborn problems related to maternal complications, sudden infant death syndrome, unintentional injury |
|
|
Ratio of sick too well persons in a defined population |
Morbidity |
|
|
Determining the best course of action and a certain situation |
Ethics |
|
|
Application of Ethics to healthcare |
Bioethics |
|
|
One is required to promote good for others |
Beneficence |
|
|
One must avoid risking or causing harm to others |
Nonmaleficence |
|
|
have the right to self-determination this includes the right to respect privacy and information necessary to make decisions |
Autonomy |
|
|
All people should be treated equally and fairly regardless of disease or social or economic status |
Justice |
|
|
Number one reason for not receiving prenatal care |
Poverty |
|
|
Cycle of poverty |
Childbearing at a young age interferes of education and work, child born into poverty is likely to become a poor adult, poor children are more likely to leave school before graduating |
|
|
Important contributors to homelessness |
Pregnancy and birth especially among teenagers |
|
|
Insurance that provides healthcare for the poor, aged, disabled, pregnant women and young children |
Medicaid |
|
|
Highest liability in nursing |
OB |
|
|
We're the greatest risk lies with OB |
Intrapartum |
|
|
Requirements for informed consent to be considered |
Competence, full disclosure, understanding information |
|
|
Families headed by two parents who view parenting as the major priority in their lives and whose energies may not be depleted by stressful conditions such as poverty, illness and substance abuse |
Traditional families or nuclear families |
|
|
Families formed when single, divorced, or widowed parents bring children from a previous Union into their new relationship |
Blended families |
|
|
Families that consist of members from three or more Generations living Under One Roof |
Multi-generational families or extended family |
|
|
Groups of people who have chosen to live together as extended family groups |
Communal families |
|
|
Characteristics of Healthy Families |
Communicate openly, flexible, adults agree on basic principles of parenting, adaptable, volunteer assistance, spend time together, seek appropriate resources, transmit cultural values to children |
|
|
High risk families |
Marital conflict and divorce, adolescent pregnancy, violence, substance abuse, children with special needs |
|
|
Situation in which no solution seems completely satisfactory |
Ethical dilemma |
|
|
Beliefs of Jehovah's Witness |
No infant baptism, birth control a personal decision, abortion opposed, blood transfusions not allowed |
|
|
Practices of Roman Catholics |
Infant baptism |
|
|
Practices of Christian science |
Physician or Midwife during birth, no baptism ceremony, seek exemption from immunizations |
|
|
Practices of Mormons |
Baptism by immersion, abortion opposed unless life of mother is in danger, only natural methods of birth control, cleanliness is important |
|
|
Traditional methods of preventing illness |
Practices developed from the beliefs about its cause |
|
|
Traditional practices to maintain health |
Various. Mental and spiritual health is maintained by activities such as violence, meditation, and prayer |
|
|
Some of the most common practices to restore health |
Herbs and plants, religious charms, holy words, traditional Healers, wearing religious medals, carrying prayer cards, performing sacrifices |
|
|
Refers to a woman who is or has been pregnant regardless of the duration of the pregnancy |
Gravida |
|
|
A woman who is pregnant for the first time |
Primigravida |
|
|
A woman who has been pregnant more than once |
Multigravida |
|
|
Refers to the number of pregnancies that have ended at 20 or more weeks regardless of whether the infant was born alive or stillborn |
Para |
|
|
A woman who has never completed a pregnancy Beyond 20 weeks of gestation because she has never been pregnant or has had a spontaneous or elective abortion |
Nullipara |
|
|
A woman who has delivered one pregnancy at 20 or more weeks of gestation |
Primipara |
|
|
A woman who has delivered two or more pregnancies at 20 or more weeks of gestation |
Multi Para |
|
|
GTPAL |
G-gravida T-term births (pregnancies between 38-42 weeks) P-preterm births (between 20 and 38th week) A-abortions L-living children |
|
|
How to calculate Para |
Only children have been born. Do not count if they are not out |
|
|
GPA |
Gravida, para, abortions |
|
|
Full term |
38 weeks and Beyond |
|
|
Preterm |
20 to 37 weeks and 6 days |
|
|
What increases the risk of postpartum hemorrhage |
Number of pregnancies |
|
|
Involution of the uterus after childbirth |
Begins immediately after placenta delivery, includes three processes contraction of muscle fibers, catabolism, and regeneration |
|
|
Process in which the placenta site heals |
Exfoliation or scaling off of dead skin |
|
|
Descent of fundus |
Approximately one centimeter or fingerbreadth per day |
|
|
Lochia for the first 3 days |
Lochia rubra. Contains almost entirely blood |
|
|
Lochia from the fourth day to approximately the 11th day |
Lochia serosa. Red to pink or brown tinged |
|
|
Lochia approximately by the 11th day |
Lochia Alba. White cream or light yellow |
|
|
Length of time for lochia |
Usually present until the 3rd week but maybe present until the 6th week |
|
|
Scant lochia |
Less than 2.5 cm or 1 in |
|
|
Light lochia |
2.5 to 10 cm or 1 to 4 in |
|
|
Moderate lochia |
10 to 15 cm or 4 to 6 in |
|
|
Heavy lochia |
Saturated peri pad |
|
|
Excessive lochia |
Saturated perineal pad in 15 minutes |
|
|
Postpartum changes of the cervix |
Cervix is formulas, flabby, and open wide. Small tears or lacerations. After the first week cervix feels firm. Internal os closes as before pregnancy but external os shape is permanently changed |
|
|
Vaginal postpartum changes |
Multiple small lacerations , Take 6 to 7 weeks to complete involution and gained approximately the same size and Contour had before, breastfeeding moms may have vaginal dryness |
|
|
Postpartum perineum changes |
Swollen and bruised. If an episiotomy took place it takes 2 to 3 weeks but possibly 4 to 6 to heal. |
|
|
Nursing interventions to relieve perineal discomfort |
Apply ice, used topical anesthetic and take ordered analgesics |
|
|
Postpartum cardiovascular changes |
Increase cardiac output, plasma volume decreases through diuresis and diaphoresis, white blood cells are increased, increased coagulation |
|
|
Postpartum GI changes |
Constipation( first stool usually 2 to 3 days postpartum normal elimination returns 8 to 14 days) |
|
|
Postpartum gu changes |
No sensation to void when bladder is distended, bladder feels rapidly from diuresis, urinary retention and distention of bladder can cause UTIs and increase postpartum bleeding. Possible stress incontinence. Possible acetone and protein in urine for the first few postpartum days |
|
|
Muscle and joint postpartum changes |
Muscle fatigue and aches particularly to the shoulders and neck and arms (provide Comfort by warm and gentle massage). Hip or joint pain with ambulation and exercise |
|
|
Abdominal muscles postpartum |
Weak soft and flabby. If there is diastasis it usually results within 6 weeks |
|
|
Skin postpartum changes |
Mask of pregnancy and Linea nigra fade and disappear for most women. Stretch marks gradually Fade to silvery lines. Loss of hair |
|
|
Neurologic postpartum changes |
Anesthesia or analgesia may produce temporary lack of feeling in legs. Headache, proteinuria, blurred vision, photophobia and abdominal pain May indicate development of worsening preeclampsia |
|
|
Ovulation after birth |
May occur before the first menses can resume as early as 3 weeks |
|
|
Lactation |
Prolactin initiates milk production within 2 to 3 days after childbirth and then it continues and response to frequent removal from the breast. Oxytocin is necessary for milk ejection |
|
|
Weight loss after childbirth |
Approximately 5.5 kilograms or 12 lb is lost during birth. Many women do not lose all the weight gained. |
|
|
Signs and symptoms of thrombophlebitis |
Area of redness, heat, edema, tenderness, obstructed pedal pulses |
|
|
What hyperactive reflexes suggest |
Preeclampsia |
|
|
Need for rhogam injection |
If mother is Rh negative and baby is Rh positive and mother is not already sensitized. Prevent the development of maternal antibodies that would affect future pregnancies. Should be administered within 72 hours after childbirth |
|
|
Risk factors for hemorrhage |
Five or more babies, overdistention of the uterus, Rapid or prolonged labor, retained placenta, operative procedures, uterine fibroids, hx of postpartum hemorrhage, preeclampsia, coagulation defect |
|
|
Risk factors for postpartum infection |
Operative procedures, multiple cervical examinations, prolonged labor, prolonged rupture of membranes, manual extraction of placenta or retain fragments, diabetes, catheterization, bacterial colonization of lower genital tract |
|
|
Postpartum blood pressure |
Above 140 over 90 maybe preeclampsia. A decrease in blood pressure May indicate dehydration or hypovolemia from excessive bleeding. Orthostatic hypotension may be present. |
|
|
Postpartum pulse |
May have bradycardia. If there is tachycardia additional assessment should be included of blood pressure location firmness of uterus, amount of lochia, estimated blood loss at delivery, hemoglobin hematocrit values |
|
|
Postpartum temperature |
Up to 38 degrees Celsius or 100.4 degrees Fahrenheit. Need to report to physician if elevated temperature persist for longer than 24 hours if it exceeds 100.4 degrees Fahrenheit or if the woman shows other signs infection |
|
|
Need for intervention with lochia |
A constant trickle dribble or losing. Excessive lochia in the presence of contracted uterus. Foul odor. Absence of lochia. |
|
|
Assessment of perineum laceration or episiotomy |
R-redness E-edema E-ecchymosis D-discharge A-approximation |
|
|
Normal findings of the uterine fundus |
Firmly contracted, remains contracted when massage is discontinued, located at level of umbilicus and midline |
|
|
Comfort measures in the postpartum period |
Ice packs, sitz bath(cool water for 1st 24 hours&warm water after 24 hours), perineal care, topical medications, sitting measures(squeeze buttocks before sitting, lower wt slowly onto buttocks, slightlyto one side), analgesics |
|
|
Promoting bladder elimination postpartum |
Privacy, adequate time, medicating for perineal pain, running water in the sink or shower, placing mother's hand in warm water, pouring water over the vulva, encouraging urination in the shower, providing hot tea or fluid of choice, asking mother to blow bubbles through a straw |
|
|
When postpartum catheterization is necessary |
Unable to void, voided less than 150 ml and can be palpated, fundus is elevated or displaced from midline |
|
|
Interventions if post cesarean section mother has respiratory rate less than 12 to 14 breaths per minute or the pulse oximeter shows persistent oxygen saturation less than 95% |
Notify anesthesiologist, Elevate head of bed to facilitate lung expansion, ask women to breathe deeply, administer oxygen and apply pulse ox if not already applied, follow facility protocol to administer a narcotic antagonist, observe for recurrence of respiratory depression, recognize that naloxone reduces level of pain relief |
|
|
Signs and symptoms that should be reported |
Fever, localized area of redness/ swelling/ pain in either breast, persistent abdominal tenderness, pelvic fullness or pressure, persistent perineal pains, frequency/ urgency/ burning on urination, abnormal change in lochia, thromboplhelbitis signs, redness/separation/ foul drainage of incision |
|
|
Development of strong emotional tie of a parent to a newborn, unidirectional, enhanced with touch in first 30-60 min of life |
Bonding |
|
|
Process by which enduring bond between parent and child is developed, begins in pregnancy, reciprocal |
Attachment |
|
|
Reciprocal attachment behaviors |
Eye contact, mutual gazing, move eyes to "track" parent's face, grasp and hold parent's finger, root, latch, comforted by parents voice/ touch |
|
|
Touch attachment behaviors |
Fingertipping, bring baby close, identification |
|
|
Verbal attachment behaviors |
Speak in high - pitched voice |
|
|
Taking - in phase |
Own needs. Less than a day. Tells everyone about labor&delivery |
|
|
Taking -hold phase |
Assumes responsibility for self, shifts attention to infant, teachable |
|
|
Letting- go phase |
Give up previous role and lifestyle, expectations they had of birth |
|
|
Anticipatory stage of mother role attainment |
Begins during pregnancy(chooses physician/ midwife, chooses whether to go to birthing classes) |
|
|
formal stage of mother role attainment |
Begins with birth of infant until 4-6 weeks. Behaviors mainly guided. Major task is for parents to become acquainted with infants |
|
|
Informal stage of mother role attainment |
May overlap formal stage, begins with appropriate responses to cues |
|
|
Personal stage of mother role attainment |
When mother feels sense of harmony in role, infant is central person in her life |
|
|
Postpartum blues |
Mild depression, lasts 2-10 days, report if longer than 2 weeks, characterized by insomnia, irritability, tearfullness, mood instability, anxiety |
|
|
Fathers developing bond |
Engrossment. MAKE SURE TO INCLUDE HIM |
|
|
Sibling adaptations |
Ideal spacing is 5 years, have older sibling out of crib before baby comes, include them in age appropriate care |
|
|
Determinants of grandparent adaptation |
Age, # of grandkids, proximity, relationship with own kid |
|
|
AROM |
Artificial rupture of membranes |
|
|
Factors affecting adaptation |
Lingering pain/ discomfort, chronic fatigue, knowledge about infant needs, available support system, expectations of newborn, previous experience, maternal temperament, infant characteristics, cesarean birth, perterm/ill infant, birth of more than one infant |
|
|
Laceration involving superficial vaginal mucosa and perineal skin |
1st degree |
|
|
Laceration involving vaginal mucosa, perineal skin, and deeper tissues |
2nd degree |
|
|
Laceration involving vaginal.mucosa, perineal skin, deeper tissues, and anal sphincter |
3rd degree |
|
|
Laceration thats extends through anal sphincter and into rectal mucosa |
4th degree |
|
|
Reasons for not feeling fundus |
Obesity, uterus severely posterior |
|
|
Most common reason of uterine atony |
Bladder distention |
|
|
Calories for brestfeeding mom |
Extra 370 |
|
|
Diet for post c-section mom |
Protein (eggs,poultry) |
|
|
Diet for bottle feeding mom |
Same until at least 6weeks |
|
|
Diet for breastfeeding mom |
No dieting |
|
|
3 characteristics of normal labor contractions |
Coordinated, involuntary contractions, intermittent contractions |
|
|
As contraction begins in fundus and spreads throughout uterus |
Increment |
|
|
During which contraction is most intense |
Peak, acme |
|
|
Period of decreasing intensity |
Decrement |
|
|
Period from beginning of one uterine contraction to beginning of next |
Frequency - expressed in minutes |
|
|
Length of each contraction from being to end |
Duration - expressed in seconds |
|
|
Strength of contractions |
Intensity - mild, moderate, strong |
|
|
How to tell intensity |
Palpate. Cant measure objectively without fetal monitor |
|
|
Nose, chin, forehead intensity |
Mild- nose moderate- chin strong - forehead |
|
|
Period between end of one contraction and beginning of next |
Interval - most fetal exchange occurs |
|
|
Thinning and shortening of cervix |
Effacement |
|
|
Opening of the cervix |
Dilation |
|
|
4 P's |
Powers, passenger, passage, psyche |
|
|
2 Powers |
Uterine contractions and maternal pushing |
|
|
Heart changes during labor |
Supine hypotension |
|
|
Resp system changes during labor |
Increased rate and depth, hyperventilation |
|
|
Narrowest part of moms pubis |
Ischial spines |
|
|
At ischial spine, above ischial spine, perineum |
0, -, + |
|
|
Diamond shaped formed by intersection of 4 sutures |
Anterior fontanel |
|
|
Triangular shape, formed by 3 sutures |
Posterior fontanel |
|
|
Relationship of long axis of baby to mom |
Fetal lie |
|
|
Fetal body parts in relation to each other |
Attitude |
|
|
First part of fetus entering pelvis -want it to be head |
Presentation |
|
|
4 variations of cephalic presentation |
Vertex (most common, head fully flexed) military (head in neutral position) brow (head partially extended) face (head fully extended) |
|
|
Describes location of fetus in relation to 4 quadrants of mothers pelvis |
Position -want occiput anterior |
|
|
Irregular mild contractions, occur throughout pregnancy, stop with activity, no dilation |
Braxton hicks |
|
|
"Dropping" 2-3 weeks before labor |
Lightening |
|
|
6 premonitory signs |
Braxton hicks, lightening, increased vaginal mucosa, bloody show, enery spurt, wt loss |
|
|
Characteristics of false labor |
Inconsistent frequency, duration and intensity, activity doesn't change or may decrease them, felt in abdomen and groin, no dilation or effacement |
|
|
Characteristics of true labor |
Consisten patter of increasing frequency, duration, and intensity, activity strengthens contractions, begins in lower back to lower abdomen, early labot feels like menstrual cramps, effacement and dilation of cervix |
|
|
Cardinal movement that fetal presenting part reaches level of ishcial spines of mothers pelvis |
Engagement-o station |
|
|
Cardinal movement to allow shoulders to rotate internally to fit mother's pelvis |
External rotation |
|
|
Cardinal movement as head passes beneath mother's symphysis pubis |
Extension |
|
|
Cardinal movement to allow largest fetal head diameter to match largest maternal pelvic diameter |
Internal rotation |
|
|
Cardinal movement to allow smallest head diameter pass through pelvis |
Flexion |
|
|
7 cardinal movements |
Descent, engagement, flexion, internal rotation, extension, external rotation, expulsion |
|
|
Stage of effacement and dilation. Begins with onset of true labor contractions, ends with complete dilation and effacement |
1st stage |
|
|
Phase from beginning of labor to 3-5cm dilated. Sociable and excited. |
Latent phase |
|
|
Phase between 4-6cm dilation |
Active phase |
|
|
Phase with cervical dilation complete |
Transition phase |
|
|
Purpose of cardinal movements |
Baby getting to correct position, helps move labor along |
|
|
Stage that begins with complete dilation and ends with baby. Excited tired and anxious. Contractions space out more. Coach and support |
2nd stage |
|
|
Stage of labor that begins with birth of baby and ends with expulsion of placenta. |
3rd stage |
|
|
Stage from delivery of placenta to 1-4 hrs after birth. Skin to skin. Check fundus every 15 min for 1st hour, warm blanket,food, fluid. |
4th stage |
|
|
Biggest risk in 4th stage |
Postpartum hemorrhage |
|
|
Score for absent heart rate |
0 |
|
|
Score for heart rate below 100 |
1 |
|
|
Score for heart rate above 100 |
2 |
|
|
Score for no spontaneous resp |
0 |
|
|
Score for slow resp/weak cry |
1 |
|
|
Score for spontaneous resp w/ stong, lusty cry |
2 |
|
|
Score for limp muscle tone |
0 |
|
|
Score for min flexion of extremities/sluggish movement |
1 |
|
|
Score for flexed body posture/spontaneous&vigorous movement |
2 |
|
|
Score for no reflex response to suction or gentle tap on soles |
0 |
|
|
Score for min response to suction or gentle tap on soles |
1 |
|
|
Score for prompt response to suction/ gentle slap in soles with cry or movement |
2 |
|
|
Score for pallor or cyanosis |
0 |
|
|
Score for bluish hand and feet only |
1 |
|
|
Score for pink or absence of cyanosis/ pink mucous membranes |
2 |
