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184 Cards in this Set
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- Back
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not diagnostic, may have other causes. Amenorrhea, nausea and vomiting, breast tenderness, increased urination, fatigue, abdominal enlargement, quickening.What type of pregnancy DX
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presumptive
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Goodell’s sign (softening cervix), Hegar’s sign (uterine isthmus [ constriction of the uterus btwn the body & the cervix] softening), Chadwick’s sign ( vagina, cervix and vulva with purplish discoloration during first 12 weeks), uterine enlargement, palpable fundus, Braxton Hicks [@ 28w], increased pigmentation (nipples, linea nigra, chloasma, striae gravidarum), pregnancy tests. What type of pregnancy DX
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probable
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conclusively prove pregnancy. Fetal heartbeat, abdominal ultrasound, fetal movement felt by the examiner.
Fundus = The upper portion of the uterus.Is palpable just above the symphisis pubis @ 12w, and @ umbilicus @ 20w What type of pregnanchy DX |
positive
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What type of cardio changes in pregnancyh
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increased blood volume 30%, increased cardiac output 25-50%, increased HR by 10.
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what type of hormonal changesof pregnancy
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increased estrogen and progesterone cause thickening of uterine walls, cervix cells proliferates and secrete a thick, tenacious mucus. The corpus luteum secretes progesterone to maintain the endometrium until the placenta produces enough progesterone to maintain the pregnancy.
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Couvade syndrome
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The expectant father develops physical symptoms of pregnancy: fatigue, depression, headache, backache, and nausea.
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Nagels"s rule
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first day of last menses, subtract 3 mos. And add 7 days
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When is amniocentesis preformed and what is risk
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- 14-16 week withdrawal of amniotic fluid through the abdominal wall, carries only a 0.5% risk of abortion
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Chronic Villi Sampling when performed and what is risk
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- 8-10 week retrieval and analysis of chorionic villi for chromosome analysis. 2-4% risk of excessive bleeding leading to loss of pregnancy.
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LS test for what and what is ratio
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2:1 good lungs test for lung maturity
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When to test for PKU
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after infant has drank milk test for metabolic disorders
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Stress test
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Oxytocin challenge test evaluates placental function and fetal health. Contractions are induced and monitored by external fetal monitor.
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Nonstress test
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does not induce contractions, assesses fetal heart rate related to fetal movement.
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what should you know about rubella
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has a teratogenic effect on the fetus. Immunization can not take place during pregnancy. Pregnancy should not occur in less than 3 mos. after immunization
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how does nutrition change during pregnancy and how many more calories a day does a pregnant woman need
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a pregnant woman needs an additional 300kcal a day (2 milk and 1 protein). Lactating women need 500kcal increase/day
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Bradley (husband coached) method
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abdominal breathing, ambulation and use of a focal point to disassociate the pain of labor and birth
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psychosexual method
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conscientious relaxation, progressive breathing, flow with contractions rather than struggle
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Dick Reed method
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- fear leads to tension leads to pain. Use of abdominal breathing with contractions.
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Lamaze method(physoprophalatic)
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stimulus response conditioning. Controlled breathing is used to reduce pain sensation during labor
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Leopaold method
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= series of specific palpations of uterus to determine position and presentation
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Leboyer method
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= rm is dark & kept warm, soft music. Cord’s cut p immerse baby in warm H20.
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Prenatal Vitimans
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folic acid prevents neural tube defects.
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Magnisum Sulfate
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- CNS depressant halts premature labor
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ritodine(Yupator)tocoylotic
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Relaxes uterine muscle through beta-2 receptor sites. Infusion for 12-24 hours after uterine contractions stop before oral administration.
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turbutaline sulfate tocolytic
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Oral dose is quite large to maintain uterine inactivity.
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iron preperation
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- 60 mg recommended. Best absorbed when taken with orange juice.
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ducosate sodium (colace)
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stool softener that lowers the surface tension of feces. Should be swallowed with a full glass of water
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bethamethasone sodium phosphate
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) corticosteroid administered to accelerate lung surfactant formation in the fetus. Takes 24 hours to be effective.
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contraction intervals are regular and gradually shorten. Intensity and duration increases, may become stronger with ambulation. The cervix softens, effaces and dilates.
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True labor
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contractions are irregular, interval stays the same, no change in intensity or duration and may stop with ambulation. The cervix only softens
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False labor
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when does Lightnening occur
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d of or 10-14 before labor begins
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When does quickening occur
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16-20w
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stages of labor first
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latent ,, active transition phases
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latent phase
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(preparatory) onset to rapid cervical dilatation
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First stage of labor starts and ends when
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begins with contractions and ends with fully dilated cervix
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active phase
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cervical dilatation 4 centimeters to seven. Stronger contractions lasting 40-60 seconds and occurring 3-5 minutes
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transition phase
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maximum dilatation of 8-10 centimeters. Contractions reach their intensity peak, full dilatation, complete cervical effacement. Phase ends with an irresistible urge to push
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second stage of labor consits of
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full dilatation to birth of infant. Crowning to pushing the fetus out of the birth canal
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thrid stage of labor consits of
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placental stage
Placental separation- approx. 5 minutes after birth of the infant. Placental expulsion- placenta delivered by bearing down or gentle exterior pressure. |
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most common fetal position
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is LOA (left, occipital-anterior
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2nd most common fetal postion
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ROA
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What does first letter stand for in position of fetus
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The first letter indicates pointing to the Left or Right of the mother
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What does middle letter stand for in position of fetus
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The middle letter is for presenting part/fetal landmark: O for occiput, M for mentum[chin], Sa for sacrum and A for acromion process
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what does last letter stand for in position of fetus
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. The last letter defines where the landmark points: A-anterior, P- posterior, and T- transverse. [Vertex = is the skull bone @ the top of the head.]
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PROM what are complications and what to watch for in mother
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[premature rupture of membranes] increased risk of infection, dangerous to both mother and infant. Must avoid tub bathing, coitus, and douching. Report fever greater than 100.4, uterine tenderness, or odorous vaginal discharge
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early decelerations
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viewed as normal, normally occurs late in labor when the head is fairly low represent pressure on the fetal head during contractions.
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late decelerations
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delayed 30-40 seconds after contraction onset and continue after the contraction. Suggests uteroplacental insufficiency or decreased blood flow. Maternal position should be changed to lateral, oxytocin should be stopped or slowed, O2 and fluid admin should be considered. Prompt delivery should be prepared for.
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variable unpredicatable decelerations
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-unpredictable, indicates compression of the cord. Position should be changed to lateral or trendelenburg, O2, fluids and possible amnioinfusion with NS or lactated ringer’s.
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how can prolapse occur
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can occur with PROM, placenta previa, small fetus, hydramnios, cephalopelvic disproportion and multiple gestation. Compression and resulting anoxia must be relieved.
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Inertia ( complication)
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sluggish contractions, dysfunctional labor.
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primary inertia
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occurs at the onset of labor
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secondary inertia
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occurs late in labor
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Amniotomy
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artificial rupturing of membranes with woman in dorsal recumbent position.
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Episotomy
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surgical incision of perineum done to allow fetal head to pass, preventing a tear to the perineum. Shortens the last portion of 2nd stage of labor
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Induction
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artificail starting of labor at term
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hygroscopic
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suppositories of seaweed and prostaglandin gel can be used to ripen cervix
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oxytocin
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induces contractions
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vaccum contradicted in
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preterm births
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when would a c-section be necessary
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birth through a surgical abdominal incision into the uterus. Indications include cephalopelvic disproportion, active genital herpes or papilloma, previous c-section, PIH, heart disease, placenta previa, premature separation of the placenta, transverse fetal lie, low birth weight, fetal distress.
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prostaglandins
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cervical softening to prepare for labor induction
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oxytocin
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synthetic form of posterior pituitary hormone used to initiate uterine contractions.
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epideral anesthecia
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narcotic injected into the epidural space
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analgesic effect by may cause fetal CNS depression. Demerol, Morphine, Nubain, Fentanyl, and Stadol
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Narcotic analgesics
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postpartal period Involution
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return of reproductive organs to prepregnancy size and condition.
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Fundal Decent
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descends @ 1 cm/day for 10 days after birth. Breastfeeding and an empty bladder facilitate fundal decent
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when does cervix regain its shape
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by 18 hours after birth
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What is Luchia
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uterine/vaginal discharge after birth.
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Lochia Rubrua what does it look like and how long does it last?
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first three days, mostly blood with pieces of decidua and mucus.
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Lochia Serosa
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- fourth day amount decreases and color changes to pink/pinkish brown.
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Lochia Alba
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after 10th day discharge becomes yellowish white. May last for 6 weeks or more.
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Fundus how does it decrease
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decreases 1 cm q d for 10 d p preg. [hght during preg tells wks of gestation btwn 18-30w]
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Taking in Phase
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mother’s need for food, fluid and sleep. Phase of nurturing and protective care. Integration of labor/birth experience.
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Taking hold phase
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becomes more independent and takes responsibility for her care and shifts focus to the care of the infant. Lasts @ 10 days
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Letting go Phase
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Role change from carefree lifestyle of being only a couple. The parents move forward as a unit with a new member.
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Postpartum Blues
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mild, transient condition. Lasts about two weeks with crying for no apparent reason, fatigue, anxiety, restlessness, letdown feeling, headache and sadness.
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Post partum depression(PPD)
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serious, intense, persistent. Characterized by inability to feel love, irritability, guilt, shame, unworthiness, loss of self, spontaneous crying, insomnia/hypersomnia, fatigue, decreased concentration. Negative feelings may be directed to the infant like disinterest, annoyance with care demands and thoughts of harm to the infant.
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Purpueral infection
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infection between birth and 6 weeks postpartum with a temp of 100.4 or more on 2 consecutive days during the first 10 after birth. Common postpartum infections are wound, metritis, mastitis and UTI.
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Laceration/tears
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of the birth canal, cervix vagina or perineum. Perineal are classified from first to fourth degree dependent on depth and extent of tissue involvement.
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Cardiac decompensation- Postparatal PIH
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Easier to tx with antihypertensive therapy because fetal risk is no longer present.
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Oxytocin
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is used to contract the uterus if extensive bleeding is evident due to uterine atony, retained placental fragments, or laceration of the birth canal.
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self care postpartum
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Fundal massage
Lochia assessment Breast care Alterations to exercise- frequent ambulation and bathroom visits. Incisional care- episiotomy care and kegel exercises. |
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NAACOG
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Nurses Assoc. of the American College of Ob/Gyn) formed in 1969 to improve women and newborn health. Name change in 1993 AWHONN
(Assoc. of Women’s Health, Obstetric, and Neonatal Nurses |
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Venalcaval syndrome
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uterus compresses the aorta and vena cava when mother is supine decreasing fetoplacental blood flow. Treatment is changing position of mother, elevating one hip in a side-lying position, providing oxygen and IV fluids
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When administering Mag sulfate what do you need available?
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CAlcium gluconate ANTIDOTE
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Sperm and ovum unite
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to form a zygote in the distal third of the fallopian tube.
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after 5 days form of zygote what does it become
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Thromboplast and implant in the edometrium
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stage one of fetal development 1. Preembryonic/germinal
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first 14 days
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stage 2 Embryonic fetal development timeline
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day 15 through week 8
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stage 3 of fetal development EMBRYONIC
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week nine to full term (38-40 weeks
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1ST TRIMESTER
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0-12 WEEKS
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2ND TRIMESTER
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13-27 WEEKS
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3RD TRIMESTER
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28-40 WEEKS
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LENGTH OF UMBILICAL CORD
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21 INCHES
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WHAT DOES UMBILICAL CORD CONSIST OF
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2 ARTERIES 1 VEIN
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WHAT DOES VEIN OF UMBILICAL CORD DO
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CARRIES OXYGENATED BLOOD
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WHAT DO ARTERIES OF UMBILICAL CORD DO
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CARRIE UNOXYGENATED BLOOD FROM THE FETUS TO THE MOTHER
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ALL VESSELS ARE SURROUNDED AND PROTECTED BY
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WHARTONS JELLY
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THE UMBILICAL CORD FUNCTION IS TO
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eliminate waste and carbon dioxide from the infant and deliver nutrients, hormones, antibodies etc to the fetus
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WHAT ARE THREE MAIN FUNCTION OF PLACENTA
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transport, endocrine, and metabolic
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WHAT ARE THE 5 HORMONES SECRETED BY THE PLACENTA THAT ARE ESSENTIAL TO PREGNANCY
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1. HCG- human chorionic gonadotropin: responsible for positive pregnancy tests.
2 2. HPL human placental lactogen 3 3. estrogen 4. progesterone 5. relaxin |
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THE PLACENTA ALSO PRODUCES
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fatty acids, glycogen, and cholesterol for fetal use and hormone production.
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TRANSITION TO EXTRAUTERINE LIFE CIRCULATORY
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lower pulmonary resistance aids blood flow to the lungs to be oxygenated. Ductus arteriosus has a reversal of blood flow because of increased aortic pressure and increased O2 in the blood. Pressure in the R atrium decreases and the L atrium increase. Blood flow to the liver begins and filtration of the blood begins.
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TRANSITION TO EXTRAUTERINE LIFE RESPIRATORY
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during birth the fetal chest is compressed and fluid is squeezed from the lungs and intrathoracic pressure increases. Chest recoil at birth creates negative intrathoracic pressure which stimulates air movement into the lungs and fluid movement into the interstitial tissue. Change in temperature from intrauterine to extrauterine stimulates breathing
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CONVECTION
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heat flows from the body surface to cooler surrounding air.
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CONDUCTION
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heat transfer to a cooler solid object in direct contact
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Radiation
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body heat transfer to a cooler solid object not in contact
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evaporation
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heat loss through conversion of a liquid to vapor.
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brown fat
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is highly vascularized located btwn scapulae, kidneys, adrenals, axilla, heart, & abd aorta. Once metabolized, infant can no longer produce heat.
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thermoregulation
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heat is generated through metabolism, muscular activity and nonshivering thermogenesis (metabolism of brown fat).
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gastroentestinal system at birth
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sterile at birth, does not provide necessary bacteria to synthesis vitamin K
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describe mecomomium
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thick, sticky and tar like
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child would not do what in first 48 hours if has Hirshsprungs DIsease
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pass meconimum
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rooting reflex
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infant turns head to side when corner of mouth is stroked
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sucking reflex
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elicited by touching the newborn’s lips.
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extrusion reflex
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infant forces the tongue outward when the tip is depressed or touched. Disappears at 4mos. Allowing for easier feeding
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palmer grasp
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fingers flex and grasp a finger placed across their palm.
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tonic (fencing)
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fencing reflex. Flexing and extension of limbs dependant of turning the head.
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moro reflex ( startle)
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Response may be asymmetrical due to injury of the clavicle, humerus, or brachial plexus
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GALLANT REFLEX
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an infant lying prone will turn shoulder and pelvis to the stimulated side when skin near the spine is stroked.
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STEPPING
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AT 3 MONTHS WILL LIFT FEET ALTERNATLY ON FLAT SURFACE IF BEING HELD LIKE WALKING
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Babinski reflex
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stroking the plantar surface of an infant’s foot upward causes great toe dorsiflexion and fanning out of the other toes.
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CROSSED EXTENSION REFLEX
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stimulating the foot of a held down leg will elicit flex, adduct and extension of the other foot. Gone p 1m.
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PLACING REFLEX
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backward step onto a firm surface when one foot is already resting there.
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HOW MUCH DOES THE BABY NEED TO HAVE A DAY IN KCAL
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COMPARE BREAST FEEDING AND BOTTL/lb]E FEEDING TO MEET THE NUTRITIONAL NEEDS OF THE
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KENERCTISUS
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kernicterus) at levels of 20/mg/dL caused yellow staining in the brain
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hyperbillirubin
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excessive billirbuin inblood can lead to Kenicertus
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common cause of hyperbillirubin
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RH incompatibility
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treatment for hyperbillirubin
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phototherapy and fluid intake to Tx jaundice
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respiratory distress syndrome in infant
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the result of the newborn’s failure to clear the airway of fluid and mucus or aspiration of amniotic fluid. Treatment is supportive and may include humidified O2, CPAP or mechanical ventilation.
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small for gestational age SGA
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10th percentile
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LGA large for gestational age alos called
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macrosominia
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preterm infant at risk for
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respiratory distress syndrome, hypoglycemia and intracranial hemorrhage. 5.8lbs>, born before 37w.
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post term infant
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beyond 42 weeks the placenta loses its ability to effectively carry nutrients to the fetus
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GBS infection strep B
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(lethargy, fever, loss of appetite, increase ICP) receive antibiotics (ampicillin, gentamicin or penicillin
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hyperglycemia in infant
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serum glucose less than 40 mg/dL. Infants at risk include born to diabetic mothers, large for gestational age infants. Tx feed early with formula or admin IV glucose, bolus not recommended.
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cold stress
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keep in warm environment to prevent increased O2 needs due to increased metabolism to stay warm.
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FAS
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growth restriction, CNS depression, cognitive impairment etc demonstrated with tremors, fidgetiness, irritability. Weak sucking reflex and sleep disturbances.
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immunizations at birth Vitiamin K
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intestine is sterile and can not synthesize initially after birth. Needed for clotting process. Most newborns produce enough by day 8. Given within first hour of birth to prevent hemorrhagic disorders.
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Hep B should be given with in how many hours of birth
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12
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Erythromycin
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is administered as a prophylactic ophthalmic ointment. It is mandatory in the United States. May be delayed to promote bonding and attachment
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apgar scoring
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assessment of wellness of newborn at 1 minute and repeated at 5 minutes.
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apgar score heart rate
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0- absent, 1- slow (less than 100), 2- greater than 100
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respiratory apgar score
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0- absent, 1- slow, irregular,weak cry, 2- good, strong cry.
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Apgar muscle tone
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0- flaccid, 1- some extremity flexion. 2- well flexed.
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reflex irratibility apgar score
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sx nostrils with catheter, or slap soles of feet. 0- no response, 1- grimacing, 2- infant coughs, sneezes or cries and withdraws feet.
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apgar score on color
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0- blue or pale, 1- body pink, extremities are blue, 2- completely pink.
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Dubowitz maturity rating
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physical maturity and neuromuscular maturity
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Brazelton neonate behavior
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behavioral capacity and ability to respond to set stimuli.
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cephalahemotoma
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blood between the periosteum of the skull bone and bone itself due to ruptured capillaries at birth. May take weeks to absorb.
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capput succedaneum
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edema of scalp at the presenting part of the babies head. Edema crosses the suture lines and usually disappears on the third day of life.
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linea nigra
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pigmented skin & hair from the sternum to the symphisis pubis
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PIH
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preg induced hypertension
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preeclampsia
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SBP - 30<, or ^ DBP - 15<
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eclampsia
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if convulsion occurs from ht & includes cerebral edema and coma.
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Chlosa Melasa
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darkened areas across cheeks and nose
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hydramnois
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excessive am’t of amniotic fluid.
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straie gravidumun
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stretch marks
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diastasis
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separation of the rectus muscle.
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placentia previa
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placenta near or on cervix. S/s = painless bleeding in last ½ of preg.
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preg test postive
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+ 8d
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urine test
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+ 10-14d
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fetal heartbeat detected
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detected by 8w c doppler
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DM
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^ risk of Ketoacidosis - PVD - PIH
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macrosomnia
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excessive fetal growth from ^glycemia, & IUGR due to vascular changes.
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IUGR
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intrauterine growth retardation
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OCT
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oxytocin challenge test
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AFP
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alpha fetoprotein screening to detect congenital malformations of CNS
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BLOOD GLUCOSE
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60-110
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HEP B
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+ surfactant antigen is active or carrier of the disease. + antibody titer means you have immunity
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ELISA
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detects herpes & HIV
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FSH
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stops periods
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ABORTION
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loss of preg 24>
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GP/TAL
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Gravida - Para - Term - Preterm - Abortions - Living
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GRAVIDA
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# of preg’s
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PARA
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DELIVERY AFTER 24 WEEKS
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PRETERM
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24w - 38w
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TERM
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38-42 SWEEKS
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NULLIGRAVIDA
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NEVER BEEN PREGNANT
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PRIMAGRAVIDA
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preg for the 1st time
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MULTIGRAVIDA
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preg 2 or more x’s
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NULLIPARA
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never having delivered an infant p 24w
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PRIMAPARA
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delivered 1 infant p 24w
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MULTIPARA
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2 or more deliveries p 24w
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POST TERM
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delivery p 42w
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