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400 Cards in this Set

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asphyxia
condition of hypoxemia, hypercapnia (increased CO2 in the blood) & acidosis
Thermal stimulation
sudden chilling of the infant who leaves a warm environment and enters a relatively cooler atmosphere. This abrupt change in temperature excites sensory impulses in the skin that are transmitted to the respiratory center
Factors that predispose the newborn to heat loss
1.The newborn's large surface area facilitates heat loss to the environment, 2. The newborn's thin layer of SC fat provides poor circulation of heat. 3. The newborn's mechanism for producing heat is different from that of the adult, who can increae heat production through shivering. The chilled neonate cannot shiver
How does a newborn produce heat?
The neonate produces heat through nonshivering thermogenesis, which involves increased metabolism and O2 consumption
enzyme that contributes to physiologic jaundice of the newborn
glucuronul transferase
Newborn is prone to hypoglycemia because
the liver stores less glycogen at birth than later in life
hypoglycemia in newborn is prevented by
early feeding
stomach capacity of newborn
90mL
specific gravity of a newborn's urine
1.020
milia
plugging of the sabaceous glands
ecrine glands
produce sweat in response to heat or emotional stimuli
eye of the newborn and the ciliary muscles
ciliary muscles are immature, limiting the ability of the eyes to accommodate and focus on an object for any length of time
when does the tear gland develope in the new born
tear glands usually do not begin to function until 2-4 weeks of age
How far can a newborn focus
as far as 8" or 20cm
4 phases of physical assessment of the newborn
1.the initial assessment using the Apgar scoring system, 2.Transitional assessment during the periods of reactivity, 3.Assessment of gestational age, 4.Systematic physical examination
ecrine glands
produce sweat in response to heat or emotional stimuli
eye of the newborn and the ciliary muscles
ciliary muscles are immature, limiting the ability of the eyes to accommodate and focus on an object for any length of time
when does the tear gland develope in the new born
tear glands usually do not begin to function until 2-4 weeks of age
How far can a newborn focus
as far as 8" or 20cm
4 phases of physical assessment of the newborn
1.the initial assessment using the Apgar scoring system, 2.Transitional assessment during the periods of reactivity, 3.Assessment of gestational age, 4.Systematic physical examination
Apgar score
based on observation of heart rate, respiratory effort, muscle tone, reflex irritability and color
Scores of Apgar
0-3 represent severe distress, 4-6 represents moderate difficulty and 7-10 indicate absence of difficulty in adjusting to extrauterine life
full term infant avg head circumference
33-35cm (13-14 inches)
chest circumference of a newborn
30.5-33cm (12-13")
crown to rump measurement of the newborn
31-35cm (12.5-14") approx. equal to the head circumference
Avg lenth of the newborn
48-53cm (19-21")
most birth wgt are
2700-4000g (6-9lbs)
Schedule for monitoring VS in the new born
on admission to the nursery, once q 30min, until the newborn has been stable for 2 hours, once very 8 hrs until discharge
vertex presentation
top of head: the highest point of a body part, especially the top or crown of the head
general appearance-behavior
behavior is carefully noted, especially the degree of alertness, drowsiness and irritability, which are common signs of neurological problems
bones that make up the cranium
frontal, occipital, two parietals, and two temporals
shape of anterior fontanel
diamond shaped
shape of posterior fontanel
triangular shaped
what causes the fontanel to bulge
coughing, crying or lying down
physiologic craniotabes
snapping sensation similar to the indentation of a ping pong ball, may be found normally, especially in newborns of breech birth, but also may indicate hydrocephalus, congenital syphilis or rickets
edema of the eyelid in the neonate
edema is normally present for the first two days after delivery
purulent discharge from the eyes in the neonate
purulent discharge after birth in the neonate is abnormal
frenulum
band of thick, pink tissue that lies under the inner surface of the upper lip and extends to the maxillary alveolar ridge. Evident as the infant yawns or smiles. Disappears as the maxilla grows
normal respirations of newborn
30-60 breaths/minute
Crackles in the neonates lung
Crackles soon after birth indicate the presence of fluid. Any prolonged crackles or wheezies over 2hrs should be reported for further investigating
Point of maximum intensity
usually found in the 4 and 5th intercostal space, medial to the left midclavicular line
Dextrocardia
an anomaly wherein the heart is on the right side of the body
Murmur
sound in chest: a soft blowing or fluttering sound, usually heard via a stethoscope, that originates from the heart, lungs, or arteries and may indicate disease or structural concerns. It is caused by turbulent blood flow.
bowel sounds in the neonote
heard in the first 15-20 minutes after birth
pseuomenstruation
manifestation of the abrupt decrease of maternal hormones- disappears in two weeks
smegma
white cheesy
sign of spina bifida in the newborn
protruding sac at sacrum
sinus
a widened channel containing blood, especially venous blood
pilondal sinus
a small sinus which may or may not be communicating with the spine. Frequently covered with a tuft of hair.
polydactyly
supernumerary digits
syndactyly
fusion of digits
abscence of arm movement in a newborn signifies
signifies a potential birth injury paralysis such as Klumpke or Erb-duchenne palsy
hypotonia in newborn
suggests some degree of hypoxia or neurologic disorder and is common in Down syndrome
Asymmetry of muscle tone in new born
may indicate a degree of paralysis from brain damage or nerve damage. Failure to move the LE suggests a spinal cord lesion or injury
Tremors, twitches and myoclonic jerks
characterize neonatal seizures or may indicate neonatial narcotic withdrawal syndrome. Quivering or momentary tremors are usually normal
First period of reactivity
4-6 hours after birth the newborn is in the first period of reactivity
VS during 1st period of reactivity
respirations 80/min, crackles, HR 180/min, + bowel sounds, increased mucus and may experienced temperature
Second stage of the 1st reactive period
Lasts 2-4 hours. HR, RR decreased, Temp. decreased, no urine or stool passed, Very sleepy. Undressing or bathing S/B avoided
Second period of reactivity
begins when neonate awakes from a deep sleep, lasts 2-5 hours, alert and responsive, HR, RR increased, may pass meconium
six sleep states in the infant
quiet (deep) sleep, active (light) sleep, drowsy, awake (quiet) active alert, and crying
Crying in the newborn
Variation in initial crying can indicate abnormalities. A weak, groaning cry/grunting during expiration usually indicates resp. disturbance. Absent, weak/constant crying requires further investigation for possible drug withdrawal/neurologic problem
how long to suction and infant orapharangeal
performed for 5 seconds, with sufficient time between suctions
atresia
the often hereditary absence of a usual body opening such as the anus or ear canal
cardinal sign of respiratory distress in the infant
tachypnea, nasal flaring, grunting, intercostal retractions and cyanosis
major cause of heat loss in the neonate
evaporation and radiation (eg placing incubator close to a window, drafty doorway or air conditioning unit)
Heat loss through conduction
involves loss of heat from the body because of direct contact of skin with a cooker solid object.
How to prevent conduction heat loss in the new born
placing the newborn close to the mother, such as in her arms or on her abdomen immediatley after delivery
Heat loss by convection
similar to conduction except that heat loss is aided by surrounding air currents. (eg placing the infant in the direct flow of air fr. a fan/airconditioner vent will cause rapid heat loss through convection
Vit K administration
to prevent hemorrhage in the neonate
Treatments used for ophthalmia neonatorum (conjunctivitis of the newborn)
1.silver nitrate 1%, (solution) 2.erythromucin 0.5%, (ointment/drops), 3. tetracycline 1% (ophthalmic ointment or drops)
major cause of ophthalmia neonatorum
chlamydia trachomatis
major function of vitamin k
to catalyze the synthesis of prothrombin in the liver, which is needed for clotting and coagulation
how to reduce pain on IM injection in neonates
give sucrose orally
Diseases screened in the newborn routinely
PKU, HIV
cephalocaudal
head to toe
Baby-Friendly Hospital Initiative(BFHI)
joint effort of the WHO and UNCF to encourage, promote and support breast-feeding as the model for optimum infant nutrition.
contraindications to breast feeding
Maternal CA therapy, Active TB not under tx in mother, Galactosemia in infant, CMV, Maternal Substance abuse, Human T-cell leukemia virus type 1
Contraindication for propping bottle in bottle feeding
1. It denies the infant the important component of close human contact. 2.Infant may aspirate formula while sleeping. 3.May facilitate development of middle ear infections. As the infant lies flat and sucks, milk that has pooled in the pharynx becomes a suitable medium for bacterial growth. Bacteria then enters the eustachina tube, which leads to the middle ear, causing acute otitis media. 4.Encourages continuous pooling of formula in the mouth which can lead to nursing caries when the teeth erupts
effects of whole milk on an infant
can cause intestinal bleeding and lead to iron-deficiency anemia
contradindication in giving electrolyte free water
causes water intoxication, hyponatremia, and subsequent seizures
en face position
in which mother's and infant's eyes meet in visual contact in the same vertical plain- significant for the formation of additional ties
paternal engrossment
forming a sense of absorption, preoccupation and interest in the infant
monotropy
a person can become optimally attached to only one individual at a time.
taking in phase
demonstrate passive and dependent behaviors
Estrogen's action on the cervix
estrogen stimulates the glandular tissue
mucus plug
thick tenacious mucus, seals endocervical canal, prevents bacteria from entering
Goodell's sign
softening of the cervix
Chawick's sign
blue purple cervix
Corpus luteum
secretes progesterone to maintain the endometrium, disintegrates after a while
Estrogen's effect on the vagina
causes thickening of the mucosa, loosening of the connetive tissue, increase in vaginal secretions
Striae
purplish stretch marks that slowly turns silver /p childbirth
Tidal volume in pregnancy
increases during pregnancy (amt of air breathed with ordinary respiration)
vital capacity in pregnancy
increased during pregnancy, (amt of air breathed that could be moved in and out of the lungs with forced respiration)
Blood pressure during pregnancy
decreases slightly during pregnancy, lowest point is in the 2nd trimester, gradullay increases in the third trimester. At term returns to prepregnancy state
Dependent edema in pregnancy
stagnation of blood in the LE, can cause varicose veins
supine hypotensive syndrome aka vena caval syndrome
pressure interferes with returning blood flow and produces a marked decrease in BP, dizziness, pallor and clamminess (lie on left side to prevent)
Physiologic anemia of pregnancy
called psuedoanemia, hematocrit decreased in pregnancy
What causes N/V in pregnancy
Increase in hCG,
Ptyalism
increased saliva during pregnancy
pyrosis
heartburn
chloasma/melaqsma
mark of pregnancy, irregular pigmentation of cheeks, nose and forehead
Changes in the eye during pregnancy
increased occular prressure, cornea thickens
maternal reserves
extra water, fat and protein are stored
recommended wgt gain during pregnancy
25-35lbs
human chorionic somatomammotropin (hCS)
human placental lactogen (hPL)
this hormone is an antogonist of insulin , (it increases the amt of circulating free fatty acids for maternal metabolic needs
relaxin
inhibits uterine activity,diminishes the strength of uterine contractions, aids in the softening of the cervix
Three signs of pregnancy
subjective/presumptive, objective/probable, positive/diagnostic
subjective symptoms
the symptoms the woman experiences and reports- can be caused by other symtoms
primagravida
pregnant for the first time
objective - probable signs of pregnancy
an examiner can percieve the objective changes that occur in pregnancy. They are more diagnostic than the subjective
Heger's sign
softening of the isthmus ( narrow connection or passage between parts of the body
) of the uterus
Ladin's sign
softening of the uterus /p six weeks
Braun von fernwald's sign
irregular softening of the and enlargement at the site of implantation in the uterus
ballottement
passive fetal movement elicited by pushing up against the cervix with two fingers, as fetus goes up examiner feels the fetus rebound
piskacek's sign
generalized enlargement and softening of the body of the uterus
uterine souggle
Heard when auscultaing the abd. over the uterus. Soft blowing sound at the same rate as the maternal pulse and is due to the increased uterine vascularization and the blood pulsating through the placenta
diagnostic (positive) changes
positive signs of pregnancy are completely objective, cannot be confused with pathologic states and offer conclusive proof of pregnancy
introversion in pregnancy
turning in on oneself- common occurence in pregnancy
couvade
traditionally referred to the observance of certain rituals and taboos by the male to signify the transition to fatherhood
couvade syndrome
male unintensional development of physical symptoms during partner's pregnancy eg, increased appetite, fatigue, difficulty sleeping, depression, headache, or backache
antepartum
time between conception and onset of labor
intrapartum
time from onset of labor until the birth of the infant and placenta
gravida
any pregnancy, regardless of duration including present pregnancy
primigravida
woman who is in her first pregnancy
couvade syndrome
male unintensional development of physical symptoms during partner's pregnancy eg, increased appetite, fatigue, difficulty sleeping, depression, headache, or backache
antepartum
time between conception and onset of labor
intrapartum
time from onset of labor until the birth of the infant and placenta
gravida
any pregnancy, regardless of duration including present pregnancy
primigravida
woman who is in her first pregnancy
couvade syndrome
male unintensional development of physical symptoms during partner's pregnancy eg, increased appetite, fatigue, difficulty sleeping, depression, headache, or backache
antepartum
time between conception and onset of labor
intrapartum
time from onset of labor until the birth of the infant and placenta
gravida
any pregnancy, regardless of duration including present pregnancy
primigravida
woman who is in her first pregnancy
couvade syndrome
male unintensional development of physical symptoms during partner's pregnancy eg, increased appetite, fatigue, difficulty sleeping, depression, headache, or backache
antepartum
time between conception and onset of labor
intrapartum
time from onset of labor until the birth of the infant and placenta
gravida
any pregnancy, regardless of duration including present pregnancy
primigravida
woman who is in her first pregnancy
spider nevi (angioma)
also known as "nevus araneus," are a type of angioma found slightly below the skin's surface. They often contain a central red spot, and reddish extensions that radiate outward like a spider's web.
EDC
Estimated date of confinement
indication of lag in the progression of funda height
may indicate intrauterine growth restriction (IUGR)
clinical pelvimetry
performed by physician and by APRN, series of assessments and measurements
diagonal conjugate
the distance from the lower orderof the symphysispubis to the sacral promontory
obstetric conjugate
smallest and thus the most important anteroposterior diameter through which the fetus must pass.
sudden gush of fluid from the vagina
premature rupture of membranes
vaginal bleeding
abruptio placentae, placenta previa
abd pain
premature labor, abruptio placenta
temperature 101(38.3C) and chills
infection
dizziness, blurring vision double vision, spots before eyes
hypertension, preeclampsia
persistent vomiting
hyperemesis gravidarum
severe headache
hypertension, preeclampsia
edema of hands, face, legs and feet
preeclampsia
muscular irritability, convulsions
pre-eclampsia, eclampsia
epigastric pain
preeclampsia, ischemia in major abdominal vessel
oliguria
renal impairment, decreased fluid intage
dysuria
UTI
absence of fetal movement
maternal medication, obesity, fetal death
Rapid growth of uterus
mutiple gestation, hydatidiform mole, hydramnios, miscalculation of EDB
hydatidform mole
hydatidiform mole (or mola hydatidiforma) is a disease of trophoblastic proliferation. It can mimic pregnancy, causes high human chorionic gonadotropin (HCG) levels and therefore gives false positive readings of pregnancy tests.
hydramnios
(hydramnios) is the medical condition of too much amniotic fluid in the Amniotic sac. It is seen in 0.5 to 2% of pregnancies.
polyhydramnios
Polyhydramnios is generally due to maternal diabetes, can be caused by fetal abnormalities -Anencephaly, Esophageal atresia and Duodenal atresia. It may accompany chromosomal abnormalities s/a Down's syndrome.

In a multiple gestation pregnancy, Twin-twin transfusion syndrome is usually the cause.
Risks of polyhydramnios
There are a number of risks that are increased in polyhydramnios including cord prolapse, placental abruption and perinatal death. At delivery the baby should be checked for congenital abnormalities.
Nursing diagnosis for prenatal period
constipation R/T the physiologic effects of pregnancy, Altered sexuality pattersn R/T discomfort during late pregnancy
priorities of care for prenatal care
priority care based on the most immediate needs or concerns perceived by the woman.
urinary frequency (pregnancy)
pressure of uterus on bladder in both first and third trimester
nasal stuffiness and nosebleeds (pregnancy)
caused by increased levels of estrogen, fix by: using astringent mouthwashes, chew gum or suck hard candy
leg cramps on pregnancy
inbalance of calcium/phosphorus ratio increased pressure of uterus on nerves fatigue, poor circulation to LE,
Relief of heartburn
limit fatty foods, control portions, avoid lying down /p eating
Contraindications to excercise during pregnancy
ROM, Pre-eclampsia, eclampsia, Incompetent cervix, persistent vaginal bleeding, multiple gestation at risk for preterm labor, Hx of preterm labor, placenta previa, chronic conditions that might be negatively affected by excercise
Category A with drugs
controlled studies in women have demonstrated no associated fetal risk eg Vit C. few drugs fall into this category
Category B with drugs
Either animal studies show no risk, but there are no controlled studies in women/animal studies indicate a risk, but controlled human studies fail to show a risk eg PCN
Category C with drugs
no adequate studies, either in animals or women are available or animal studies show teratogenic effects, but no controlled studies in women are available-many drugs fall into this category,
Category D with drugs
Evidence of human fetal risk does exist, but the benefit of the drug in certain situations are thought to outweigh the risks, eg: tetracycline, vincristine, lithium and hydrochlorothiazide
Category X with drugs
The demonstrated fetal risks clearly outweigh any possible benefit
Three critical components of an effective smoking cessation program
assessment, education and support
fetal alcohol syndrome
characterized by growth restriction, behavioral disturbances, craniofacial abnormalities and brain, cardiac and spinal defects
macrosomia
large for gestational age
Nursing diagnosis of older women
1. Decisional Conflict R/T unexpected pregnancy
2.Impaired social Interaction R/T changes associated with pregnancy
Dietary reference intake divided into two areas
Recommended dietary allowance (RDA) and adequate intake (AI)
calorie
the amt. of heat required to raise the temp. of 1 gram of water 1 degree centigrade (the amt of energy obtained from food)
recommended daily req calcium intake for pregnant women 19yo/older, 18yo and younger
1300mg/day 1000mg/day respectively
recommended daily req phospherous intake for pregnant women 19yo/older, 18yo and younger
1250mg/day, 700mg/day respectively
idodine intake for pregnant woman
220mg/day
magnesium recommendation for pregnancy
320mg/day
megaloblastic anemia
Megaloblastic anemia is anemia resulting from a deficiency of vitamin B12 and folic acid.
major adverse maternal effects of cocaine use
seizures, hallucinations, pulmonary edema, respiratory failure and cardiac problems
Risk to pregnancy with cocaine abuse
increased R/O abruptio placentae, intrauterine growth restriction, preterm birth and stillbirth
Risk to fetus with cocaine buse
small head circumference, cerebral infarctions, shorter body length, altered brain development, malformation of the genitourinary tract and lower Apgar scores, neurobehavioral disturbances, marked irritability, an exaggerated startle reflex, labile emotions, and increased risk of SIDS.
emotional effects of cocaine on neonate
poor interactive behaviors, difficulty responding appropriatley to voices, fail to respond well to consoling behaviors.
Cocaine use after childbirth
Cocaine does cross into the brease milk and may cause such symptoms in the breast feeding infant as extreme irritability, vomiting, diarrhea, dilated pupils and apnea.
Nursing DX for drug addiction
1.Altered Nutrition: Less than body requirements R/T inadequate food intake secondary to stubstance abuse 2. Risk for Infection R/T use of inadequatley cleaned syringes and needles secondary to IV drug use 3. Risk for altered health maintenance R/T a lack of information about the impace of substance abuse on the fetus
Risk of ketoacidosis
can lead to death of mother and fetus if not treated
dystocia
difficult labor
primary goal of controlling maternal insulin
prevent neonatal hypoglycemia
best choice of contraception for diabetic women
barrier method (diaphragm and condom) used with spermicide - oral contraceptives are contraindicated
Nrsg Dx diabetic patients
Risk for Altered Nutrition: More than Body Requirements R/T imbalance between intake and available insulin; Risk for injury R/T possible complications secondary to hypoglycemia or hyperglycemia; Altered Family Process R/T to the need for hospitalization secondary to GDM
which side of the finger is best for a finger stick
sides
Sx of hypoglycemia
sweating, periodic tingling, disorientation, shakiness, pallor, clammy skin, irritability, hunger, headache, and blurred vision
symptoms of hyperglycemia
dry mouth, fatigue, nausea, hot flushed skin, rapid deep breathing, abd cramps, acetone breat, headache, drowsiness, depressed reflexes, oliguria or anuri, stupor, coma
Risks of anemia on the neonate
prematurity, stillbirth, neonatal death in infants with severe anemia in women
Folic acid action
needed for DNA and RNA synthesis and cell duplication
Folic acid deficiency
neural tube defects,- spina befida, anencephaly, meningomyelocele.
Risks of Sickle cell anemia in the pregnant female
increased risk of nephritis, bacteriuria, hematuria and anemic
Dx for pregant woman with sickle cell anemia
pain R/T the effects of siecke cell crisis; Risk of Altered health Maintenance R/T lack of understanding of the need to avoid exposure to infection secondary to the risk of sickle cell crisis
Thalassemia
"Cooley's anemia", is an inherited disease of the red blood cells, classified as a hemoglobinopathy. The genetic defect results in synthesis of an abnormal hemoglobin molecule. The blood cells are vulnerable to mechanical injury and die easily. To survive, many people with thalassemia need blood transfusions at regular intervals.
B-thalassemia and iron
women /c b-thalassemia should not receive iron, it damages the heart and liver
emergency care of tetralogy of fallot
Consequential acute hypoxia may be treated with beta-blockers such as propranolol, but acute episodes may require rapid intervention with oxygen, morphine to reduce ventilatory drive and phenylephrine to increase blood pressure. There are also simple procedures such as the knee-chest position which reduces systemic venous return (to reduce the right-to-left shunting), increases systemic vascular resistance (& hence blood pressure) & and provides a calming effect when the procedure is performed by the parent.
tetralogy of fallot
blue baby syndrome- ventral septal defect, pulmonic stenosis, overriding aorta, ventriculary hypertrophy
Marfan Syndrome
Marfan syndrome is a connective tissue disorder characterized by unusually long limbs. The disease also affects other bodily structures — including the lungs, eyes, heart and blood vessels — in less obvious ways.
Class I: individual with heart disease
Individuals /c cardiac disease but /c no resulting limitation of physical activity and no symptoms of cardiac insufficiency
Class II: individual with heart disease
individuals with cardiac disease that results in slight limitation of physical activity
Class III: individual with heart disease
individual /c cardiac disease that results in marked limitationof physical activity
Class IV: individual with heart disease
individuals /c cardiac disease that results in the inability to carry on any physical activity /s experiencing discomfort, even at rest experience symptoms
Nursing dx of heart diseased pregnant patient
Decreased Cardiac Output: easy fatigability; Impaired Gas Exchange R/T pulmonary edema secondary to cardiac decompensation; Fear R/T the effects of the maternal cardiac condition on fetal well-being
symptoms of CHF in the pregnant patient
cough (freq. /c or /s hemoptysis); dyspnea, (progressive , upon exertion, edema, (progressive, generalized, including extremities, face, eyelids; heart murmurs (heard on ausculation, palpitations, rales (auscultated in lung bases)
Main causes of bleeding in pregnancy in the 1st and 2nd trimester
abortion/miscarraige; ectopic pregnancy and gestational trophoblastic disease
gestational trophoblastic disease
GTD) includes hydatidiform mole (HM), invasive mole, choriocarcinoma (CCA) and placental site trophoblastic tumor (PSTT), epithelioid trophoblastic tumor (ETT), exaggerated placenta site (EPS) and placental site nodule (PSN).
threatened abortion
unexplained bleeding, cramping or bachache indicate that the fetus may be in jeopardy
Nursing Dx for lost pregnancy
Fear R/T the risk of pregnancy loss; Pain R/T abdominal crampin secondary to threateened abortion; Anticipatory Grieving R/T expected loss of unborn child
Nursing Dx for ectopic pregnancy
Anticipatory grieving R/T the loss of the pregnancy; Pain R/T abdominal bleeding secondary to tubal rupture; Health seedking behavior: information about the tx of ectopic pregnancy R/T an expressed desire to gain better understanding of the condition & its longterm implications
tocolysis
use of medication to stop labor. (premature labor)
Iv hydration in preterm labor
Iv hydration /c lrg amt.s of hypertonic fluids increases the risk of pulmonary edema and should be used /c caution
Sx & Sx of preterm labor
1.contractions 10/< with or without pain, 2.Mild menstrual like cramps felt low in the abd,3. Constant/intermittent feelings of pelvic pressure that may feel like the baby pressing, 4. ROM, 5.Low dull backache,constant/intermittent,6.Change in vaginal discharge, clear and watery - pinkish.7.abdominal cramping with out without diarrhia
Maternal risk of preeclampsia
abruptio placenta, subcapsular hematoma of the liver, thrombocytopenia, acute tubular necrosis
scotoma
spots before the eyes
intravascular
within the blood vessels -The blood vessels are part of the circulatory system and function to transport blood throughout the body. The most important types, arteries and veins, are so termed because they carry blood away from or towards the heart, respectively
extravascular
Located or occurring outside a blood or lymph vessel.
gestational hypertension
transient hypertension- occurs when transient elevation of bp occurs for the first time after midpregnancy without proteinuria
Sentization Rh most commonly occurs
when a Rh(-) woman carries an Rh(+) fetus, also occurs ehn an Rh(-) nonpregnant woman recieves an Rh(+) transfusion, experiences Rh(+) tubal pregnancy, has an amniocentesis or any other traumatic event
erythroblastosis fetalis
hemolytic disease of the fetus and newborn
hemolysis
Hemolysis (or haemolysis)—from the Latin Hemo-, Greek Αἷμα meaning blood, -lysis, meaning to break open— is the breaking open of red blood cells and the release of hemoglobin into the surrounding fluid (plasma, in vivo).
hydrops fetalis
Hydrops fetalis is a blood condition in the fetus characterized by an edema in the fetal subcutaneous tissue, sometimes leading to spontaneous abortion.
risks of rubella on the neonate
congenital cataracts, sensorineural deafness, and congenital heart defects (patent ductus arteriosus), mental retardation, cerebral palsy.
Antiphospholipid syndrome
Antiphospholipid syndrome is a disorder of coagulation which causes thrombosis in both arteries and veins, as well as recurrent miscarriage
hemoglobinopathy
Hemoglobinopathy is a kind of genetic defect that results in abnormal structure of one of the globin chains of the hemoglobin molecule. Most common hemoglobinopathies include sickle-cell disease and thalassemia.
Biophysical Profile- NST
an assessmentof 5 fetal biophysical variables, feta HR acceleration, fetal breathing, fetal movements, fetal tone, amniotic fluid volume
fetal tone
flexion of the extremities
one of the first indications of fetal compromise is
a nonreactive NST
Risk of poorly functioning placenta
results in diminished fetal renal perfusionk leading to oligohydramnios
Intrauterine growth restriction (IUGR)
used to describe any fetus that falls below the 10th percentile in ultrasonic estimation of weight at a given gestational age.
Three ways to describe a small fetus
low birth weight, small for gestational age, and intrauterine growth restriction
trisomy 13
Patau syndrome, also known as trisomy 13, is a chromosomal aberration, a disease in which a patient has an additional chromosome 13 due to a non disjunction of chromosomes during meiosis. Most cases of Patau syndrome result from trisomy 13, which means each cell in the body has three copies of chromosome 13 instead of the usual two copies
trisomy 18
a genetic disorder. It is the second most common trisomy after Down Syndrome. It is caused by the presence of three — instead of two — chromosomes 18 in a fetus or baby's cells
trisomy 21
Down syndrome (also Down's syndrome) or trisomy 21 is a genetic condition resulting from the presence of all or part of an extra 21st chromosome. Down syndrome is characterized by a combination of major and minor abnormalities of body structure and function. Among features present in nearly all cases are impairment of learning and physical growth, and a recognizable facial appearance usually identified at birth.
L/S ratio
lecithin/sphingomyelin ratio
Diseases detected by Chorionic Vill Sampling (CVS)
sickle cell anemia, alpha & some beta thalassemias, phenylketonurea, alpha antitrypsin deficiency, Down syndrome, Duchenne muscular dystrophy and factor IX deficiency
Risks of Chorionic Ville Sampling (CVS)
spontaneous abortion as well as ROM, leakage of amniotic fluid, bleeding, intrauterine infection, maternal tissue contamination of the specimen and RH isoimmunization
Rh isoimmunization
Incompatibility between an infant's blood type and that of its mother, resulting in destruction of the infant's red blood cells (hemolytic anemia) during pregnancy and after birth by antibodies from its mother's blood.
percutaneous umbilical blood sampling (PUBS)
aka cordocentesis used to obtain pure fetal blood from the umbilical cord while the fetus is in utero
percutaneous umbilical blood sampling (PUBS) is used to diagnose
hemophilias, hemoglobinopathies, fetal infections, chromosome abnormalities, nonimmune hydrops, and isoimmune hemolytic disorders as well as fetal hemoglobin and hematocrit calculation of transfusion requirements in the 2nd and 3rd trimester
Fetal fibronectin (fFN)
presence of fFN between 20 and 34 weeks, major indicator of preterm delivery due to spontaneous preterm labor or premature rupture of membranes
lecithin/sphingomyelin ratio
1:1 equal amounts of each; 2:1 lecithin is 2 times greater than sphingomyelin (RDS is very unlikely with this ratio)
Phosphatidylglycerol (PG)
available in surfactant, just the mere presence of this substance is assoc. /c very low risk of RDS
fetal attitude
refers to the relation of the fetal parts to one anotehr. the normal attitude of the fetus is one of moderate flexion of the head, flexion of the arms onto the chest, and flexion of the legs onto the abd.
fetal lie
refers to the relationship of the cephalocaudal axis (spinal cord) of the woman
Longitudinal lie
Fetus long axis in line with mother long axis
transverse lie
If the baby is lying across the womb rather than head-down, and continues to do so up to labour, then the lie of the baby is referred to as transverse. If this is the case at the beginning of labour, the baby is found to be a shoulder presentation, which would make vaginal delivery impossible and a caesarean section unavoidable.
The body part that enters the maternal pelvis first is referred to as
the presenting part
malpresentations are
breech and shoulder presentations.
Vertex presentation (cephalic)
fetal head is completerly flexed onto the chest, the occiput is the presenting part
Military presentation
the fetal head is neither flexed nor extended, the top of the head is the presenting part
Brow presentation
the sinciput is the presenting part, fetal head partially extended
Face presentation
the fetal head is hyperextended, the face is the presenting part
Engagement
occurs when the largest diameter of the presenting part reaches or passes through the pelvic inlet (baby drops)
station
How far the baby is "down" in the pelvis. Measured in negative and positive numbers. -3 is a floating baby, 0 station is said to be engaged in the pelvis, and +4 is crowning.
Occiput Cephalic
Sometimes the baby is presenting head down as it should be, but it is facing the mother's abdomen. This increases the chance of painful "back labor" and prolonged delivery.
Occiput anterior
Ideally for labor, the baby presents head-down, facing the mother's back, with its chin tucked to its chest and the back of the head ready to enter the pelvis.
Contractions are described as
frequency, duration, and intensity
Frequency
time between the beginning of one contracion and the befinning of the next contraction
Duration
measured from the beginning of the contraction to the completion of contraction
Intensity
strenth of the uterine contraction during acme (peak of contraction)(mild moderate or strong)
Two physiological forces of labor
primary force-uterine contractions and secondary force is abdominal muscles to bear down
Three phases of contractions
increment-building up, acme-peak and decrement - letting up of the contraction
One action of indomethacin
inhibits prostaglandin synthesis to prevent preterm labor
Effacement
Effacement is the shortening, or thinning, of the cervix before or during early labor
Lightening
describes the effects that occur when the fetus begins to settle into the pelvic inlet (engagement)
The uterine muscle remains shorter and thicker and does not return to it's original length
brachystasis
Sign of impending labor
bloody show- pink-tinged secretions
Three phases in the first stage of labor
Latent, Active, Transition
Latent phase
Contractions begin, mild, smiles, anxious, copes better, able to talk
Active phase
Contractions intensify, anxiety increases, Loss of control, dilation from 4- 7cm
Transitional Phase
Dilation up to 10cm, contraction duration longer, less coping ability, irritable, not wanting to be touched, but still fearful and anxious, stomach feels like its about to burst, desire to bear down intense, may feel like tearing
Second stage of labor
begins with complete dilation ends with birth of infant
cardinal movements
mechanisms of labor
Decidua
Decidua is the term for the uterine lining (endometrium) during a pregnancy. It is formed under the influence of progesterone and serves to support and interact with the gestation. The decidua represents the maternal portion of the placenta.
Leopold's maneuvers
systematic way to evaluate the maternal abdomen
Causes of fetal braydycardia
late fetal asphyxia, maternal hypotension, prolonged umbilical cord compression, fetal arrhythmia
Accelerations
transient increases in the FHR
Accelerations in fetal HR are caused by
periodic accelerations accompany contractions, fetal movement, mild compression of the umbilical cord; non-periodic accelerations are normally cause by fetal movement eg when an adult excercises the HR increases.
Decelerations
are periodic decreasesin FHR from normal baseline
Early decelerations
due to pressure on the fetal head as it progresses down the birth canal, early decelerations are generally benign and are seen in active labor
Late decelerations
due to uteroplacental insufficiency, result of decreases in blood flow that impede oxygen transfer to the fetus through the intervillous space during uterine contractions
Variable decelerations
vary in onset, occurrence, duration, intensity and waveform, due to umbilical cord compression, when membranes rupture
How often should vaginal exams be done
infrequently to prevent infections
When should cord clamping take place
should not be clamped if above the vagina,blood may be transferred from the neonate to the placenta fluid overload may produce polycythemia,
what level should the neonate be held immediately /p birth
regardless of the presentation at birth the newborn is held at the level of the uterus to facilitate blood flow through the umbilical cord
Why is the oral route for medication not used when giving medication to the postpartum woman
oral routes are poorly absorbed because of delayed gastric emptying, choice is IV, IM, SC
regional anesthesia
the temporary and reversible loss of sensation produced by injecting an anesthetic agtent into an area that will bring the agent into direct contact with nervous tissue
epidural block
involves injection of a local anesthetic agent into the edpidural space.
Contraindications for epidural block
maternal refusal, local or systemic infection, coagulation disorder, actual or anticipated hemorrhage, low platelet count ,100,000, hypovolemia, allergy to a specific class of local anesthetic agetn, suspiction of neurological disease and lack of trained staff.
Primary danger of general anesthesia
fetal depression
dystocia
at risk or difficult labor
psychological disorders
characters by alterations in thinkin, mood or behavior
what causes depression
impalance of serotonin and other neurotransmitters in the CNS
precipitous labor
occurrs when the entire process of labor and virth occurs within 3 hours
accommodation
the ability to focus and refocus
rods and cones
are long, narrow cells shaped like rods or cones, rods are mainly responsible for night vision or vision in low light, cones provide the best vision for bright light, color vision or fine detail
optic nerve aka
Cranial nerve II (CN II)
physiologic blind spot in the eye
optic disc/optic nerve head
OD
Right Eye
OS
Left Eye
OU
Both eyes
digitalis toxicity with the eye
may cause color vision deficit
macular degeneration and color
macular degeneration -central vision --difficulty identifying colors because central vision identifies color
neovasculariztion
growth of abnormal new blood vessells in aged-related macular degeneration
Tonometry
measures IOP
Gonioscopy
visualizes the angle of the anterior chambers to identiy abnormalities in appearance and measurements
Color fundus photography
used to detect and document retinal lesions
Flourescein angiography
evaluates clinically significant macular edema, documents macular capillary nonperfusion and identifies retinal and choroidal neovascularixation (abnormal growth of new vessels0
Ultrasonography
direct visibility of lesions int the globe or orbit
Tonometry
measures IOP
Gonioscopy
visualizes the angle of the anterior chambers to identiy abnormalities in appearance and measurements
Color fundus photography
used to detect and document retinal lesions
Flourescein angiography
evaluates clinically significant macular edema, documents macular capillary nonperfusion and identifies retinal and choroidal neovascularixation (abnormal growth of new vessels0
Ultrasonography
direct visibility of lesions int the globe or orbit
emmetropia
normal vision
retinitis pigmentosa
night blindness
intraocular pressure (IOP)
Intraocular pressure (IOP) is the fluid pressure inside the eye. It may become elevated due to anatomical problems, inflammation of the eye, genetic factors, as a side-effect from medication, or during exercise
miotics
cause pupiliary constriction
mydriatics
medications causing pupiliary dilation
Characteristics of cataracts
Painless, blurry vision
diplopia
double vision
Characteristics of cataracts
Painless, blurry vision
bullous keratopathy
formation of blisters that cause pain and discomfort on rupturing
diplopia
double vision
bullous keratopathy
formation of blisters that cause pain and discomfort on rupturing
Persistent edema of the cornea leads to
bullous keratopathy
strabismus
diviation in ocular alignment
Persistent edema of the cornea leads to
bullous keratopathy
strabismus
diviation in ocular alignment
Aphakia
Aphakia is the absence of the lens of the eye, due to surgical removal, perforating wound or ulcer, or congenital anomaly; causes a loss of accommodation, hyperopia, and a deep anterior chamber. Complications include detachment of the vitreous or retina, and glaucoma.
keratoconus
condition characterized by conical protuberance of the cornea with progressive thinning or protrusion and irregular astigmatism
keratoplasty
corneal transplantation or corneal grafting
Refractive surgeries
cosmetic, elective procedures performed to reshape corneal tissue and correct refractive errors so that eye glasses or contact lens are no longer needed.
Rhegnomatogenous detachment
most common form of retinal detachment, - a hole or tear developsi n the sensory retina, allowing some of the liquid vitreous to seep through the sensory retina and detach
Clinical manifestation of retinal detachment
pt may report the sensation of a shade or curtain coming across the vision of one eye, cobwebs, bright flashing lights, or the sudden onset of a great number of floaters. No c/o pain
aged macular degeneration
yellowish spots called drusen
angiogenesis
abnormal blood vessel formation
proptosis
downward displacement of the eyeball
Management of soft tissue damage that does not threaten vision
Cold compresses used early, then warm compresses later
corneal abrasion with contacts
pt experiences severe pain and photophobia
photophobia
ocular pain on exposure to light
Treatment for chemical burns
irrigation with normal saline or tap water immediately
ocular trauma from foreign body
no attempt should be made to remove the foreign material, or apply pressure or a patch
splash injuries are irrigated with
normal saline
Caution in topical eye drops and corneal abrasions
topical anesthetic eye drops are not given to a pt. for repeated use /p corneal injury because their effects mask further damage, delau healing, and can lead to permanent corneal scarring.
hemorrhagic chemosis
edema of the conjunctiva
hyphema
hemorrhage within the chamber
MRI is contraindicated in most DX of eye from trauma or foreign bodies because
most foreign bodies are metallic and magnetic
involution
used to describe the rapid reductio in the size of the uterus
Puerperium
aka postpartal period, immediately after birth and into 6 weeks or until body returns to prepregnant state
excessive uterine bleeding is associated with
a fundus that is above the umbilicus and boddy (soft and spongy rather than firm and well contracted)
Bladder distenstion is suspected when
the fundus is generally deviated to the right, (a full bladder can move the uterus)
The uterus decends about
one finger breadth or 1 cm per day (2 weeks on avg)
Tocolytic therapy
drug therapy for preterm labor, decreases uterine muscle contractions, (beta-adrenergic agent-terbutaline, (Brethene), Mg sulfate is used as well
SE of terbutaline
tremors, malaise, weakness, dyspnea, tachcardia (maternal and fetal), increased Sustolic pressure and decreased diastolic pressure, chest pain, nausea, vomiting, diarrhea, constipation, erythema, sweating, hyperglycemia and hypokalemia.
Adverse reactions to terbutaline
Pulmonary edea, dysrhythmias, ketoacidosis and anaphylactic shock
Action of Mg sulfate
relaxes the smooth muscle of the uterus, CNS depressant, calcium antagonist,
SE of Mg Sulfate
maternal-flush, feeling of warmth, perspiration, dizziness, nausea, HA, lethargy, slurred speech, sluggishness, nasal congestion, heavy eyelids, blured vision, decreased GI action, increased pulse rate, hypotension.
Adverse reactions of Mg sulfate
depressed reflexes, confusion, and , respiratory depression and arrest, circulatory collapse, cardiac arrest
SE in fetus of Mg sulfate
depressed fetal HR variability,
SE in neonate with Mg sulfate
hypotonia with diminished reflexes and lethargy for 24-48hours
Corticosteroid therapy
accelarates lung maturation with resultant surfactant development in the fetus in utero, decreasing the incidence of RDS
Betamethsone (corticosteroid)
When premature labor occurs /a the 33rd wk of getation, this is prescribed
SE of betamethasone (corticosteroid)
HA, seizures, vertigo, edema, HN, increased sweating, petechiae, ecchymoses, facial erythema
Drug treatment for severe Preeclampsia
Mg sulfate and Hydralazine
SE of hydralazine
HA, N/V, nasal congestion, dizziness, tachycardia, palpitations and angina pectoris
Non-pharmacological interventions for pain relief
ambulating, positioning supportive of the gravid uters and promoting uterine perfusion, using hygiene and comfort measures, involving support persons, using breathing and relaxation techniques, using hydrotherapy
ataractic effect
they potentiate the analgesic action of a low-dose narcotic in addition to decreasing anxiety and apprehension
Eg of ataratic drugs
phenergen,- a sedative antihistamine, hydroxyzine (Vistaril, Atarax) a sedative hypnotic
SE of ataractic drugs
Promethatzine :confusion, disorientation, excess sedation, dizziness, hypotension, tachycardia, blurred vision, HA, restlessness, weakness and urinary retension.
Spinal block
used in C-section delivery, blocks umbilicus to toes
Epidural block
used in first and second stages of labor, blocks entire pelvis
SE of spinal block
hypotension, occasional spinal HA
Considerations of epidural block
may cause loss of bearing down reflex(vacuum or forceps delivery),
Potential complications
hypotension, convulsions, coma, respiratory arrest, dural puncture with leak of spina fluid
caudal block
given in first and second stages of labor, blocks perineum, masks uterine contractions
Paracervical block
given for pain in 1st stage of labor, blocks uterus, cervix and vagina, does not block lower vagina and perineum
Pudendal block
for outlet forceps, episiotomy and repair, given emmediatley before birth, blocks perineum and pudendal nerves
uterine inertia
inability or unwillingness to move- oxytocin is prescribed
True/False
oxytocin (pitocin, Syntocinon) can be administered intranasally
true
Contraindications to Oxytocin
cephalopelvic disporportion, fetal intolerance of labor, hypersensitivity, anticipated nonvaginal delivery,
hypersensitivity
Type 1 hypersensitivity is an allergic reaction provoked by reexposure to a specific antigen. Exposure may be by ingestion, inhalation, injection, or direct contact
ergot alkoloids
used to prevent postpartum hemorrhage and to promote uterine involution
Examples of Ergot alkaloids
(Ergotrate) ergonovine maleate, (Methergine) methylergonovine maleate
True/false Methergine cannot be given IV
true only IM or PO
SE of Methergen and Ergotrate (Ergot alkaloids)
uterine cramping, N/V, dizziness, HTN, with IV administration, sweating, tinnitus, chest pain, dyspnea, itching and sudden severe HA
Ergotism
sign of ergot alkaloid toxicity
Signs of ergot alkaloids toxicity
pain in arms, legs and lower back, numbness, cold hand and feet,muscular weakness, diarrhea, hallucinations, siezures and blood hypercoagulability