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215 Cards in this Set
- Front
- Back
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Gestational age considered overdue |
42 weeks |
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Number one advantage of IA |
Mobility |
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Advantages of auscultation and palpation monitoring |
Mobility, can use water-based pain management methods, more natural |
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Disadvantages of auscultation and palpation monitoring |
Not recorded during every contraction, only small part Labor assessed, interruptions, pressure on abdomen uncomfortable |
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Advantages of electronic fetal monitoring |
More data, permanent record coma can show response before during and after contractions, Comfort to patients |
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Disadvantages of electronic fetal monitoring |
Decreased Mobility, position change causes need to adjust monitor and when the infant moves down, felt uncomfortable, technical environment |
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Things to evaluate from electronic fetal monitoring strips |
Baseline rate, variability, any pattern of rate change from Baseline |
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What you can teach about electronic fetal monitoring |
Teach support person to coach their contractions, the heart rate variability is good and may need repositioning |
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4 things to document on the strip |
Name, medications given, vag exams, bathroom or walk |
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Acronym to remember |
V-variable. C-cord E-early. H-head A-accel. = O-ok (oxygenated) L-late. P-placenta |
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Average heart rate rounded to five beats per minute measured over two minutes within a 10 minute window |
Baseline fetal heart rate |
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Conditions needed for a baseline fetal heart rate |
Uterus must be at rest, no significant increase or decrease in rate |
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Average fetal heart rate |
110 to 160 beats per minute |
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Bradycardia |
Less than 110 beats per minute for 10 minutes |
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Tachycardia |
Over 160 beats per minute for 10 minutes |
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What decreases variability |
Fetal sleep, narcotics given to Mom, alcohol, illicit drugs, increased fetal heart rate, gestation less than 28 weeks, fetal anomalies affecting CNS, hypoxia, low platelet or hypoxemia in mom |
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Four categories of variability |
Absent =undetectable, minimal=undetectable to less than or equal to 5 beats per minute, moderate = 6 to 25 beats per minute, Marked = greater than 25 beats per minute |
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Temporary increase in fetal heart rate, Peaks at at least 15 beats per minute above Baseline for 15 seconds |
Accelerations |
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Causes of accelerations |
Fetal movement, vag exams, uterine contractions, mild cord compression |
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Measurements for a prolonged acceleration |
Longer than 2 minutes less than 10 minutes |
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Decel that occurs from fetal compress such as increased pressure, decreased heart |
Early deceleration |
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Interventions for early deceleration |
No intervention needed. Not associated with fetal compromise |
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Appearance of early decelerations |
Consistent in appearance, mirror contraction |
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Deceleration that may result from impaired exchange of o2 and waste products in placenta( utero placental insufficiency) |
Late decelerations |
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Appearance of late decelerations |
Looks like early deceleration but shifted to right of contraction |
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Similarities between early and late decelerations |
Decrease from Baseline fetal heart rate and return to Baseline gradually, occur with contractions, decrease at a rate rarely more than 30 to 40 beats per minute below the bassline |
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Difference between early decelerations and late decels |
Mirror image of contraction, return to Baseline fetal heart rate by end of contraction, usually unaffected by maternal position changes, associated with fetal head compression, not associated with real compromise and require no added intervention |
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Difference of late decelerations compared to early decelerations |
Looks similar but again after the contraction begins, characterized by the occurrence of the nadir after the contraction Peak, May remain in the normal range of deceleration and may not fall far from the Baseline, collect possible impaired placental exchange, are occasional accompanied by moderate variability, should be addressed with nursing interventions |
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Nursing interventions for non reassuring fetal heart rate patterns |
Identify cause, evaluate maternal vital signs, stop oxytocin, reposition, increase Main Line IV, administer oxygen, consider starting continuous monitoring with internal devices, notify physician and Report the pattern the interventions the fetal response after |
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Major reason for inductions |
Convenience |
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Most common incision for C-sections |
Low transverse |
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Reason for low transverse cesarean incision |
Unlikely to rupture during future birth, makes vbac possible, less blood loss, easier to repair, less adhesion formation |
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Disadvantages for low transverse incision |
Limited ability to extend laterally |
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Non reassuring assessments |
Tachycardia, bradycardia, decreased or absent variability, late decelerations, variable decelerations |
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Causes for tachycardia |
Maternal fever, material dehydration, fetal acidosis, hypovolemia, cardiac dysrhythmias, maternal anemia, maternal hyperthyroidism, drugs administered to mother |
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Possible causes for bradycardia |
Fetal head compression, fetal hypoxia, fetal acidosis, fetal heart block, under local cord compression |
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Possible causes for decreased or absent variability |
Feel asleep, fetal hypoxia with acidosis, drug effects |
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Possible causes of late decelerations |
Utero placental insufficiency, maternal hypertension or hypotension, placental Interruption, maternal diabetes, maternal severe anemia, maternal cardiac disease |
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Possible causes for variable decelerations |
Umbilical cord compression from prolapsed cord, cord around fetal neck, cord around fetal body parts, oligohydramnios, cord between fetus and mother's uterus or pelvis, knot in cord |
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Reassuring patterns |
Accelerations |
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Indeterminate patterns |
Tachycardia, bradycardia with variability, minimal are marked Baseline variability, absent variability with no recurrent decelerations, absence of accelerations after fetal stimulation, recurrent variable decelerations accompanied by minimal or moderate Baseline variability, prolonged deceleration 2 minutes but less than 10, recurrent late decelerations with moderate variability |
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Non reassuring |
Absent Baseline variability and recurrent late decelerations, recurrent variable decelerations or bradycardia |
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Big advantage of pharmacological pain management |
Works for pain control |
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Disadvantage of pharmacological pain management |
Decreased Mobility, can affect the baby |
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Number one risk of epidurals |
Hypotension |
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Two types of childbirth pain |
Visceral and somatic |
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Visceral pain in childbirth |
Described as throbbing. Related to contractions of the uterus and dilation and stretching of the cervix |
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Somatic pain |
Sharp and localized. Directly related to the stretching of the perineal tissue and adjacent structures |
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Four potential sources of pain |
Tissue ischemia, cervical dilation, pressure and pulling on pelvic structures, distention of the vagina and perineum |
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Factors that influence the perception or tolerance of pain |
Intensity of Labor fetal position in size, characteristics of pelvis, fatigue, interventions of caregiver |
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Psychosocial factors affecting pain |
Culture, anxiety and fear, previous experiences with pain, preparation for childbirth, support system |
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Advantages of non pharmacological pain management |
Doesn't slow labor, no side effects, no risk of allergy or sedation, can use in combination, only option for advanced labor |
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Limitations of non-pharmacological pain management |
Don't always achieve desired level of pain control using them alone. |
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Preparation for non-pharmacological pain management |
Ideal time is before Labor. If unprepared, can be taught in the latent phase of Labor |
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Application of non-pharmacological techniques |
General Comfort, reduce anxiety and fear, relaxation, Mind Body stimulation, hydrotherapy, mental stimulation, breathing techniques |
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Effects of relaxation |
Promotes uterine blood flow, promotes efficient uterine contractions, reduces tensions that increase pain perception and decrease pain tolerance, reduces tension that can inhibit fetal descent |
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Benefits of water therapy during labor |
Associate with more natural atmosphere, gives women greater control, upright position facilitates progress, buoyancy relieves tired muscles and reduces pressure, facilitates fetal rotation, many women report perception of less pain, reduction in mean arterial pressure edema and increase diuresis |
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Disadvantages of water therapy during labor |
Fetus must be assessed intermittent auscultation rather than electronic fetal monitoring |
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Special considerations when medicating a pregnant woman |
Affect the fetus, may affect differently in pregnancy but not pregnant, can affect course of Labor, complications, interactions |
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Adverse effects of epidural block |
Maternal hypotension, bladder distention, prolonged second stage, migration of epidural catheter, fever nausea and vomiting, pruritus respiratory depression |
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Risk with amniotomy |
Cord displacement |
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Indications for Schedule C sections |
Breach or LGA. Previous C-section is not a true reason |
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Indications for induction |
Silvers, hypertension, preeclampsia, overdue |
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Nursing considerations with amniotomy |
Obtaining Baseline information, assisting with amniotomy and providing care after |
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Risks with amniotomy |
Prolapse of the umbilical cord, infection, abruptio placentae |
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Risks with induction and augmentation of Labor |
Uterine text systole, uterine rupture, maternal water intoxication, greater risk for chorioamnionitis and cesarean birth |
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Nursing steps with induction |
Need Baseline, give pitocin secondary, has to be monitored |
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Advantages of median or midline episiotomy |
Minimal blood loss, healing with little scarring, less postpartum pain than the medial lateral episiotomy |
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Disadvantages of the median or midline episiotomy |
An added laceration May extend the median episiotomy into the anal sphincter, limited enlargement of the vaginal opening because of perineal length |
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Advantages of medial lateral episiotomy |
More enlargement of the vaginal opening, little rest at the episiotomy to extend into the anus |
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Disadvantages with medial lateral episiotomy |
More blood loss, increase postpartum pain, more scarring and irregularity in the healed scar, prolong painful intercourse |
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Risks with cesarean birth |
Infection, had married, urinary tract Tramadol, thrombophlebitis, paralytic ileus, act like assist, anesthesia complications, injury to fetus |
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Advantages of vertical cesarean incision |
Quicker to perform, better visualization, quickly extend up word for greater visualization, more appropriate for obese women |
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Disadvantages of vertical cesarean incision |
Easily visible when healed, greater chance of dehiscence and hernia formation |
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Advantages of low transverse cesarean incision |
Flexibility when healed, less chance of dehiscence or formation of a hernia |
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Disadvantages of low transverse cesarean incision |
Les visualization of the uterus, cannot be done as quickly, cannot easily be extended to give greater operative exposure, reentry at subsequent cesarean birth may require more time |
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Nursing care before a cesarean birth |
Assess the time of last oral intake and what it was, does allergies, determine meds and last dose, consent forms, obtain lab work, preoperative teaching, start ordered IV infusion, clip abdominal hair, administer ordered medications, insert indwelling catheter, assist women's operating table, apply grounding pad, do sterile prep of abdomen |
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Nursing care in the recovery period of a cesarean birth |
Begin anesthesia related interventions like pulse oximeter oxygen Administration and cardiac monitor, do routine assessments every 15 minutes for the first hour, every 30 minutes during the second hour, and hourly thereafter, assess need for analgesia and Mister as ordered, change position hourly, have breathe and deep cough |
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Environmental substances known or thought to harm the fetus |
Alcohol, aminoglycosides, anticonvulsant agents, anti thyroid drugs, cocaine, lithium, Mercury, tetracycline, tobacco, Warfarin, folic acid antagonist, infections like zika varicella rubella syphilis HIV herpes simplex |
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Agents that either cause a birth defect or increase the likelihood that a birth defect will occur |
Teratogens |
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What non directional genetic counseling means |
Don't tell decision just make sure to give the info |
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Where fertilization occurs |
In the tube |
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Development from fertilization to implantation |
Fertilization, zygote,morula, blastocyst |
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Implantation time |
Gradually occurs from 6th through the 10th day. Complete by the 10th today |
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Three reasons upper uterus is best for placental development |
Upper uterus is richly supplied with blood for optimal fetal gas exchange and nutrition, uterine lining is thick preventing the placenta from attaching so deeply that doesn't attach easily after birth, limits of blood loss after birth |
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What forms the fetal side of the placenta |
Chorionic villi |
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What forms the maternal side of the placenta |
Decidua basalis |
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Embryonic period |
From beginning of the third week through the end of the eighth week |
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Formation in week 3 |
Beginning of CNS formation, heart starts to beat |
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Formation in week 4 |
Neural tube closes |
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Week 5 |
Rapid brain growth |
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Week 6 |
Beginning of facial development |
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Week 8 |
Definite human form. By end of week everything is formed |
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Fetal period |
Beginning of 9th week to birth |
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Week 13 to 16 |
Quickening felt by Mom |
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When sex can be determined on an ultrasound |
By end of 12th week |
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17 to 20 weeks |
Vernix, Brown fat formed, fetal movement feels like butterflies |
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Fatty cheesy like secretion to protect from constant exposure to amniotic fluid |
Vernix caseosa |
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Week 21 to 24 |
Skins translucent, surfactant begins to form |
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Weeks 25 to 28 |
Increase surfactant, eyes open, move to cephalic position. Increase chance of survival |
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Week 29 to 32 |
Baby put on weight |
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Weeks 33 to 38 |
Gain a half 2 three quarters pounds a week |
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Conditions that make placental attachment low |
Scar tissue and problem at fundus or heart-shaped uterus |
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Major placenta functions |
Metabolic, transfer of substances between mother and fetus, endocrine |
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Two fetal membranes |
Amnion is the inner, chorion is outer |
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How amniotic fluid protects the fetus |
Cushioning against the impact of internal abdomen, provide the stable temperature |
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How amniotic fluid promotes normal prenatal development |
Keeps the membranes from adhering to developing fetal Parts, allow symmetric development of a fetus as body Services full towards the midline, provides room and buoyancy for fetal movement |
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Not enough amniotic fluid |
Oligohydramnios |
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Too much amniotic fluid |
Polyhydramnios |
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Causes and effects of oligohydramnios |
Can be caused by failure of kidneys to develop, excretion of urine being blocked, or inadequate placental blood flow. Causes poor fetal lung development and malformations from compression of fetal parts |
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Causes and effects of polyhydramnios |
Can be caused by severe malformation of the central nervous system in the fetus, or GI tract that prevents normal ingestion of amniotic fluid |
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What the ductus arteriosus and foramen ovale allow the blood to do |
Bypass the lungs |
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What the ductus venosus allows the blood to do |
Bypass the liver |
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Shunt that is part of the atrium |
Foramen ovale |
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Twins that are identical, always the same gender, and are formed by same sperm and egg |
Monozygotic |
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Twins that are formed from two separate eggs and sperms, fraternal, can be opposite genders |
Dizygotic |
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Weak that uterus is able to be felt above the symphysis pubis |
Week 12 |
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Week that fundus is able to be felt at the umbilicus |
Week 20 |
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Wheat the fundus is at the xiphoid process |
Week 36 |
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Cervical changes with pregnancy |
Chadwicks sign which is discoloration, goodells sign which is cervical softening |
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Vaginal changes with pregnancy |
Increased vaginal discharge and acidity |
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Ovary changes with pregnancy |
Secretes progesterone from corpus luteum for first 6 to 7 weeks period ovulation ceased |
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Breast changes during pregnancy |
Increase in size, highly vascular, colostrum present beginning at 12 to 16 weeks |
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Heart changes during pregnancy |
Common to have murmur from increased blood volume, increase work, shifted up and to the left |
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Blood pressure changes in pregnancy |
Stays the same. Possible Supine position cause hypotension |
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Oxygen consumption changes with pregnancy |
Increased, slightly hyperventilate |
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Changes in metabolism with pregnancy |
Gain 25 to 35 lb |
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Anatomical changes of the respiratory system with pregnancy |
Lungs expand horizontally and decrease capacity |
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GI changes with pregnancy |
Heartburn and constipation |
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Bladder changes with pregnancy |
Increased frequency from weight and glomerular filtration, nocturia, stress or urge incontinence |
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Kidneys and ureters changes during pregnancy |
Glucose in urine because of increased blood flow through kidney, increased risk for UTI |
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Skin changes during pregnancy |
Street, Linea nigra, mask of pregnancy, edema ankles and feet but goes away with propped up feet |
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Places for the mask of pregnancy |
Brown patches on forehead cheeks and nose |
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Postural changes with pregnancy |
Begins in second trimester, pelvic instability, wide stance |
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Pituitary gland changes with pregnancy |
Secretes prolactin to prepare breast to produce milk and secrete oxytocin |
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Thyroid gland changes with pregnancy |
Enlarge |
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Pancreas change of the pregnancy |
Glucose 10 to 20% lower |
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Adrenal changes with pregnancy |
Produce cortisol for carb and protein metabolism and aldosterone for absorption of sodium |
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Functions of progesterone |
Prevent spontaneous abortion, increases respiratory sensitivity to CO2, prevents tissue rejection of fetus |
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Functions of estrogen |
Stimulates uterine growth, Aids in development of ductal system in breast, hyperpigmentation |
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Presumptive indications of pregnancy |
Subjective. Amenorrhea, nausea and vomiting, fatigue, urinary frequency, breast and skin changes, vaginal and cervical changes, quickening |
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Probable indications of pregnancy |
Abdominal enlargement, cervical softening, Braxton Hicks contractions, palpation of fetal outline, pregnancy test |
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Positive indication of pregnancy |
Auscultation of fetal heart sounds, fetal movement felt by The Examiner, visualization of embryo or fetus |
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How to calculate due date |
Subtract 3 months from the first day of the last menstrual period, add 7 days, and correct the year |
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High risk assessments |
Over or underweight, under 16, greater than 35, low economic status, previous OB history |
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Signs of possible complication |
Vaginal bleeding, Escape of fluid from vagina, swelling of fingers or puffy around eyes, continuous headache, visual disturbances, persistent and severe abdominal pain, fever, painful urination, persistent vomiting, change in frequency or strength of fetal movement |
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Common discomforts of pregnancy |
Nausea and vomiting, heartburn, back ache, urinary frequency,varicosities, hemorrhoids, constipation, |
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How to help with nausea and vomiting |
You before you get out of bed, crackers, small meals, separate solids and liquids, take prenatals at bed |
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How to help with heartburn |
Avoid spicy and acidic food, eat small meals, avoid smoking, caffeinated Beverages and coffee, chew gum, sleep with extra pillow |
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How to help with backache |
Don't lift heavy objects, avoid high heels, squat |
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How to help with urinary frequency |
Decrease fluids in evening, Kegel exercises, avoid caffeine |
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How to help with Varicosities |
Avoid constricting clothing, avoid Crossing legs, rest frequently with feet elevated |
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How to help with hemorrhoids |
Avoid constipation, frequent tepid bath, Lions side with hips elevated on a pillow |
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How to help with constipation |
Eight glasses of liquid, increase fiber, decrease cheese, exercise |
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How to help with leg cramps |
Elevate legs often during the day, extend affected leg, avoid excess foods high in phosphorus |
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Teaching with bathing |
non skid pads |
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Teaching with hot tubs and saunas |
Avoid |
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Teaching with douching |
Increases infection, no need, associated with preterm and low birth weight |
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Teaching with Breast Care |
Wide bra straps can distribute the weight |
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Teaching with clothing |
Non restricting |
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Teaching with exercise |
Moderation like swimming, walking, riding stationary bike, yoga |
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Preferable position after 16 weeks |
Left or right lateral |
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Teaching with sleep and rest |
Pillows to support abdomen and back for comfort |
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, immunization teaching |
Usually contraindicated |
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Tobacco with pregnancies |
Increase risk for preterm in respiratory distress |
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Emotional response in first trimester |
Uncertain, ambivalence, focus on self |
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Physical validation during first trimester |
No obvious signs of fetal growth |
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Role in first trimester |
Begin to seek safe passage for self and fetus |
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Emotional response in second trimester |
Wonder, increase narcissism, introversion, concern |
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Physical validation in second trimester |
Quickening, enlarged abdomen |
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Role in second trimester |
Seek acceptance of fetus and role as mother |
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Emotional response in third trimester |
Vulnerable, increase dependence, except fetus separate but totally dependent |
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Physical validation in third trimester |
Obvious fetal growth, discomfort, decreased maternal activity |
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Role in third trimester |
Prepare for birth |
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Undue preoccupation with oneself |
Narcissism |
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Concentration on oneself and one's body |
Introversion |
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Maternal tasks of pregnancy |
Six safe passage, secure acceptance, learn to give of herself, commit herself to unknown child |
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Factors that influence psychosocial adaptation |
Edge, absence of partner, multiparity, socioeconomic status |
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Barriers to prenatal care |
Age, poverty, culture, addiction |
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Cultural differences that can cause conflict |
Health beliefs, time orientation, communication |
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Recommended weight gain during pregnancy |
25 to 35 lb |
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Risks of obesity with pregnancy |
Increased incidence of spontaneous abortion, gestational diabetes, gestational hypertension, preeclampsia, prolonged labor, cesarean birth, postpartum Hemorrhage, wound complications, congenital abnormalities |
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Pattern of weight gain |
1.1 to 4.4 pounds during the first trimester, 0.8 -1 lb weight gain for the rest of the pregnancy |
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Factors that influence weight gain |
Young, unmarried, low income, poorly educated, poor General Health, receiving insufficient prenatal care |
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Carbohydrates with pregnancy |
Complex carbohydrates such as those present in starchy foods like cereal pasta and potatoes. Important for fiber to prevent constipation |
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Fatty acids in pregnancy |
Canola, soybean in walnut oil as well as bass or salmon |
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Calories in pregnancy |
Need approximately 80000 additional calories over the course of the pregnancy |
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Daily calorie intake for most pregnant women |
2200 to 9200 |
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Calorie intake per trimester |
No added during the first trimester, 340 added during the second trimester and 452 added during third trimester |
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Protein during pregnancy |
Increase 25 grams a day in second trimester to expand blood volume and support growth of maternal and Fetal tissues |
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Folic acid with pregnancy |
Especially important just before conception and during the first trimester |
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Foods high in iron |
Lynn Chuck beef, ground beef, dark meat chicken, Light in Water tuna, dried and cooked kidney beans, dried and cooked lentils, canned chickpeas, cooked soybeans, wheat bread, White & Rich cooked rice, Raisin Bran cereal, prune juice, raisins, baked potatoes with skin, canned sweet potatoes, canned and stewed tomatoes, cooked green peas |
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Calcium with pregnancy |
If less than 18 years need to increase intake because bone density is not complete |
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Best source of calcium |
Dairy products. |
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Factors that influence nutrition |
Culture, age, exercise, nutritional knowledge |
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diet for adolescent pregnancies |
More calcium, magnesium, phosphorus, zinc |
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Common problems with adolescents |
Diets low in vitamin A, B 6, C, full cast and, calcium, iron, zinc and magnesium. I need some payments but don't always take regularly. |
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Calcium sources |
Low-fat fruit yogurt, cheddar cheese, cottage cheese, almonds, Cheerios, instant oatmeal, English muffins, canned sardines, canned salmon with bones, tofu |
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How to increase calcium If you're lactose intolerant |
Increased Sun exposure and take supplement |
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Problem with vegan diets |
Lacking adequate calcium, iron, zinc, ribo Flavin, vitamin D, b6 and b12 |
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How to make energy requirements with a vegetarian diet |
Eat snacks and high calorie foods to increase caloric intake |
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Iron with a vegetarian diet |
Poorly absorbed because of lack of heme iron from meat poultry and fish. Enhanced by eating vitamin C Source at the same time as iron. Iron supplementation important |
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Zinc with vegetarian diet |
You think is best in me and fish so vegetarians may need supplements |
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Vitamin B12 with vegetarian diets |
Only obtained from animal products so vegans may have to eat fortified foods such as cereal and some soy products or take vitamin B12 supplements |
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Diet with pregnancy-related nausea and vomiting |
Small frequent meals, drinking liquids between meals instead of with meals, protein snack at bedtime, a carbohydrate foods such as dry toast or crackers before getting out of bed |
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Diet with anemia |
Increase iron, also increase is zinc and copper |
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Effects of cigarette smoking on pregnancy |
Decreases appetite which may result in lower weight gain, infant birth weight decreases, prematurity spontaneous abortion other complications may also result. Smoking decreases availability of some vitamins and minerals |
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Effects of caffeine on pregnancy |
Less than 200 mg a day is not a major contributing cause of miscarriage for preterm birth, caffeine changes absorption or excretion of calcium zinc thiamine and iron |
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Alcohol effects on pregnancy |
Should avoid completely, associated with fetal alcohol syndrome. Alcohol interferes with absorption and use of vitamin B12, folic acid, and magnesium |
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Calories with breastfeeding |
Increase by 330 during 1st 6 months. Increase by 400 for 2nd six months |
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Dieting after birth |
Postpone for at least 3 weeks. Weight loss of 1-1.5 lbs a week is safe |
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Alcohol and brestfeeding |
Should not breastfeed for at least 2 hours |
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Caffeine and brestfeeding |
2 cups of coffee or equivalent |
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Diet for non lactating mother |
Can go back to prepregnancy but should contain protein and vit C to promote healing |
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Common lab tests performed during pregnancy |
Blood grouping and Rh, CBC, hemoglobin and hematocrit, rubella titer, TB test, genetic testing, B, HIV, urinalysis, Pap test, glucose challenge |
