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145 Cards in this Set
- Front
- Back
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Nagele's Rule
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LMP subtract 3 months add 7 days and a year.
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Physical Changes in uterus
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1: uterus walls thicken,
2: uterine wall begins to thin, braxton-hicks may begin 3: braxton-hicks increase |
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Physical Changes in Cervix
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increased vascularity causes: Softening- Goodell's sign
Blue-purple discoloration- Chadwick's sign Mucus plug formation |
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Physical Changes in Ovaries
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1: hCG maintain corpus luteum (produces hormones until wk 6-8)
2: corpus luteum shrinks |
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Physical Changes of Vagina
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thickening of mucosa, loosening of connective tissue and increase of secretions (white thick and acidic)
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Physical Changes in Breasts
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Increase in size and nodularity
More sensitive Superficial veins (end of 2nd months) Increased pigmentation of areola, and erect nipples stretch marks Colostrum can be manually expressed during 12th week and may leak during last trimester may feel tingling or heaviness |
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Physical Changes in Respiratory System
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oxygen needs increase,
metabolic rate increases (need to add tissue to boobs and uterus) Ligaments of rib cage relaxes Rib cage flare Upper Resp becomes more vascular = nasal stuffiness and nosebleeds |
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Physical Changes in Cardio System
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Blood volumes increase 45%
Heart enlarges and gets pushed up and to the left Systolic Murmur in 90% Blood Volumes increases 45% both in plasma and erythrocytes Hematocrit decreases slightly Hemoglobin should be 12-14 If 11 = anemia More blood flow through kidneys BP decreases than increases in 3rd trimester CO increases 30%-50% |
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Supine hypotensive syndrome
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AKA: vena caval syndrome or aortocaval compression:
Uterus puts pressure on vena cava when woman is supine |
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Physiologic Anemia
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AKA Pseudoanemia
Hematocrit decreases because of the increase in plasma. Making it look like there isn't enough erythrocytes |
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Why do Preggos need more iron?
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Because of increased need of RBCs for both mama and fetus
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Physical Changes in GI system
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Morning sickness: increased levels of hCG
Alters in carb metabolism: increase in hCG and insulin Gums become hyperemic (spongy, swollen, bleeds with mild trauma) Gastric emptying and intestinal motility delayed (bloating & constipation) Smooth muscle become relaxed via progesterone = heartburn. Hemorrhoids from constipation and uterus pressing on intestines May get hypercholesterolemia or gallstones (delayed gastric emptying) |
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Physical Changes in Urinary System
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growing uterus put pressure on bladder = frequency until 2nd trimester when uterus become abdominal organ
When presenting part engages in pelvis = frequency & bladder becomes concave Dilation of kidneys Increased risk of UTI |
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Physical Changes in Skin
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Hyperpigmentation- linea negra, nipples & areola
Chloasma- mask of pregnancy (cheeks, forehead & nose) Striae Vascular spider nevi- small, bright-red elevations (chest, neck, face, arms & legs) |
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Physical Changes in Hair
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rate of growth may increase
number of hair follicles in resting or dormant phase decreases |
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Physical Changes in Musculoskeletal System
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Main hormones- Relaxin and Progesterone
Pelvis relaxes = waddling gait Slight separation of symphysis pubis Center of Gravity changes b/c lumbodorrsal spinal curve accentuates Aches in shoulders, neck, back, and upper extremities Separation of abdominal muscles (diastasis recti) |
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Physical Changes in Endocrine System
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Thyroid: BMR increases 20%-25%
Anterior Pituitary= Prolactin: initiates lactation Posterior Pituitary = Oxytocin : promotes uterine contractions & stimulation of milk projection |
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What is preterm?
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20 wks - completion of 37 Weeks
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Antepartum
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Time between conception and onset of labor
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Intrapartum
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Onset of labor to birth of placenta
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Postpartum
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Birth to prepregnant condition at 4-6 wks
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Gestation
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Number of weeks between LMP and birth
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Abortion
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birth before 20 wks
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Term
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Normal duration of pregnancy 38-42 weeks
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Preterm
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Labor occurs after 20 wks and before 38 wks
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Gravida
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G
Any pregnancy no matter the duration |
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Nulligravida
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never ever preggo with an eggo
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Primigravida
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Preggo for first time ever
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Multigravida
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2 + pregnancies
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Para
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P
# of births (dead or alive) |
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Primipara
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One birth at more than 20 wks
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Multipara
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2 + births at morethan 20 wks
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Stillborn
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dead baby, fetal demise
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TPAL
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term births
preterm births abortion living children |
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Quickening
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18- 20 wks
Feels baby move |
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Symptoms of Preterm Labor
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Abdominal pain
Back pain Pelvic pain Menstrual-like cramps Vaginal Bleeding Increased vaginal discharge Pelvic Pressure |
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Criteria for Diagnosis of Preterm Labor
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Uterine contractions are 4/20 minutes or 8/60 minutes
80% effacement or dilation of 1 cm Advances to point where it wont respond to meds |
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Adverse Reactions of Terbutaline
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Maternal/fetal tachycardia
Palpitations Restlessness Flushing |
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Tocolysis
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Using medications to stop labor
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Drugs to Stop Labor
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Terbutaline sulfate (Brethine)
uterine relaxation (smooth muscles) bronchodilation Magnesium Sulfate |
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Magnesium Sulfate
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"The Big Guns"
MgSO4 CNS Depressant Relaxes smooth muscles |
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Side Effects of MgSO4
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hot flushes, sweating, drowsiness, decreased respirations, decreased DTR, decreased UO, decreased BP
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4 Ps of Labor
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Passenger
Passageway Powers Process Of Labor |
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Passenger
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a) size of fetal head
b) fetal presentation (cephalic- normal, military- straight neck, brow, face, breech & shoulder) c) fetal lie (the relationship of the long axis of the fetus and the long axis of the mother) d) fetal attitude- (relationship of fetal body parts to each other) e) fetal position f) station |
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Fetal Position
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Position the relationship of the presenting part to the 4 quadrants of the mothers pelvis
The first letter is the location of the presenting part to the mothers pelvis: either an R or L The second letter is the specific presenting part: either occiput O, mentum (chin) M, sacrum S, acromium (shoulder) A The third letter is the presenting part to the mothers pelvis: anterior A, posterior P, transverse (turning) T |
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Station
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The relationship of the presenting part of the fetus to an imaginary line drawn between the maternal ischial spines. It is a measure of the degree of descent of the presenting part of the fetus through the birth canal.
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Engagement
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Corresponds to station 0
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Passageway
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Gynecoid- favorable for vaginal birth (rounded)
Android- not favorable for vaginal birth (heart shaped) Anthropoid- favorable for vaginal birth (oval) Platypelloid- not favorable for vaginal birth- (outlet capacity inadequate) |
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Powers
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Uterine Contractions
Frequency- the time from the beginning of one UC to the beginning of the next Duration- the length of the UC, 30 sec to 90 sec Intensity- the strength of the UC. Chart using toco (external monitor on top of uterus) signals during contraction- doesn’t really get the intensity. To tell intensity you just palpate. Mild feels like chin, Moderate feels like nose, Strong feels like forehead |
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Effacement and Dilation in Primigravida
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Cervix will be effaced then begin to dilate
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Effacement and Dilation in Multigravida
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Both will happen at same times
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Process of Labor
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Early Signs
lightening bloody show cervix ripens amniotic fluid n/v burst of energy |
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When does lightening occur?
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primi - 2 weeks before labor
multi - right before labor |
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How long do you have after ROM and why?
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18 - 24 hours
Prevent infection |
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What size is the uterus at week 10?
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the size of an orange, twice the size nonpregnant size
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Where is the fundus at week 22-24
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The umbilicus
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Where is the fundus at week 38?
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xyphoid process
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Where is the fundus around week 38-40?
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a little lower than week 38 due to lightening
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How do you measure uterine contractions
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Start at the beginning of one UC and end at the beginning of the next UC
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Lightening
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When the presenting part becomes engaged in the pelvis
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Stages of Labor (just their time frames)
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Stage 1: beginning of true labor until the cervix completely dilated
Stage 2: Dilation through the birth of the baby Stage 3: Birth of the baby until expulsion of placenta Stage 4: Begins with expulsion of placenta and lasts about 4 hours (recovery period) |
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Stage 1 of Labor
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beginning of true labor – cervix completely dilated
3 Phases Latent: Cervix 0-3 cm. UC mild 20-40 sec and 5 min apart. Station: -2 to 0. Woman excited, relatively comfortable. Active Phase: cervix 4-7cm, UC moderate 40-60 sec 2-5min apart, Station +1 to +2. Fetal descent. Uncomfortable, up to walk for gravity assistance. No talking through contractions Transitional Phase: Cervix from 8 – 10cm. UC 2-3min apart, 60-90sec. Personality changes, anxious, losing control, irritable, STAY positive. Hardest part of labor |
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Stage 2 of Labor
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complete dilation – birth of baby
Contractions 2-3 minutes apart and 60-90 sec long Can take up to 2 hours for prima and 15 minutes for the multi If the patient involuntarily pushes while the baby is descending have her “blow out the candle” or when the baby is being born and is stressed and has a bowel movement- right when the head is born she’ll blow out the candle while the doctor suctions the nose and mouth |
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Stage 3 of Labor
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Birth of baby - expulsion of Placenta
Can take Up to 30 minutes. Usually by 5 min. If longer than 30 worry about bits and pieces being left behind |
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Shiny Shultz
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Shiny side of the placenta is out first. This is the side that is in contact with amniotic fluid
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Dirty Duncan
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Rougher looking red part of the placenta comes out first. This is the side that is attached to the uterus.
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Stage 4 of Labor
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Expulsion of placenta for about 4 hours
Physiologic Readjustment Begins Average Blood loss 250-500 ml of blood loss Check uterus for bleeding May have chills- warm blanket right next to skin Once you know all placenta is out she can start to eat Make sure she can void |
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Average Blood Loss
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250-500 mLs
If more it's considered postpartum hemorrhage |
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Postpartum definition
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The time after birth- continues approximately 6 weeks or until the body has returned to a near prepregnant state.
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What important to know about assessing the uterus?
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Very important
Uterus should be firm. Feel fundus and massage it Boggy- if feels soft, it should firm up with a little massage Teach the woman how to do it. If it’s off to the side then that bladder is full. If it’s not midline than it won’t contract |
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how much blood loss is there during a C-section?
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During a C-section theres about 1000 ml lost
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Involution of the Uterus
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6-12hrs post birth, fundus should be at level of umbilicus.
1 day post birth fundus is 1cm (finger width) below umbilicus, continues to decrease 1cm/day. u/u if fundus at umbilicus, 1/u if 1 cm above umbilicus. u/2 if 2 cm below umbilicus. Cramping after birth b/c uterus is shrinking, oxytocin helps this process. Encourage breastfeeding to release oxytocin. |
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Compare False Labor to True Labor
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True: progressive dilation and effacement of cervix. Contractions occur regularly and increase in duration, time and intensity. Pain is not resolved by positional changes.
False: no dilation/effacement. Irregular contractions, discomfort relieved by ambulation, postional changes, rest, heat. |
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8 Factors that Affect Involution
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Prolonged labor (30 hrs) muscles tend to relax so more chance of bleeding too much,
Anesthesia (muscle relax), Difficult birth (ex: large baby), Grandmultiparity (lots of babies, 4-8) because stretched muscles lead to less tone, Full bladder- uterus cant contract, Retained placenta (interferes with uterine contractions), Infection (due to inflammation), Overdistention of uterus- from multiple gestation or hydramnios (too much amniotic fluid), or a HUGE KID |
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3 types of Lochia
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It's the discharge following delivery
rubra- dark red may have clots serosa- pinkish to brownish alba - light, almost white- pinkish |
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Time frame for Lochia Rubra
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2-3 days after
If comes back after day 10 then the mother may be overdoing it. |
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Time frame for Lochia Serosa
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3-10 days after
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Time frame for Lochia Alba
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After day 10
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Guidelines to assessing lochia
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Heavy- peripad saturated within 1 hour
Moderate- peripad has less than a 6 inch stain within 1 hour Light- peripad has less than a 4 inch stain within 1 hour Scant- peripad has less than 1 inch stain within 1 hour or a little bit on toilet paper |
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Comfort measures for postpartum
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Clean sheets and gowns
Ice to perineum Sitz baths Tucks- for hemorrhoids Warm blanket Lost of ibuprofen for cramping |
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Maternal Role Attainment
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learns mother behaviors and is comfortable as new role of mother. 3-10 mnths after birth.
4 stages – Anticipatory Stage (during pregnancy) Formal Stage (child is born) Informal Stage (mom makes own choices) Personal Stage (comfortable with notion of being mother) |
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Postpartum Blues
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in 70% of all women, mood swings, anger, weepiness, anorexia, difficulty sleeping, feeling let down. Resolves naturally 10-14 days after
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Rh immune globulin (RhoGAM)
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All Rh - women who have a baby with Rh +blood are given RhoGAM within 72 hours of birth.
RhoGAM promotes lysis of fetal Rh+ RBC before maternal body can make antibodies against them. Fetal blood crosses into maternal circulation during childbirth. The Rh negative mother will make antibodies against blood. Will effect the next baby. |
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Rubella Vaccine
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Tested during prenatal visits to see if they’ve had rubella.
The vaccine may have a teratogenic effect Give right after birth |
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Causes of Postpartum Blues
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Hormonal changes, psychological adjustment, lack of sleep, over-stimulation, discomfort
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Postpartum Depression
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Much more severe.
If the woman has had a Hx of depression, more likely to have an issue. |
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What's should be included in the care of a post c-section patient?
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Assess incision- should be clean and dry
Will have less lochia Needs to get out of bed. Checking for homan’s sign- pull back on toes and assess for pain in calf and leg- r/t thrombophlebitis |
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Newborn Vitals
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BP At birth 70-50/45-30 mmHg Day 10: 90-60/50-44 mmHg
Pulse: 120-160 Respirations: 30-60 breaths/min; synchronization of chest and abdominal movements. Diaphragmatic and abdomina breathing. Crying: strong and lusty, moderate tone and pitch Temperature: Axilla 36.4-37.2 C |
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5 Apgar Parameters and good score
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All are rated 0-2
Heart Rate Respiratory Effort Muscle Tone Reflex Irritability Color A good score is 7-10 |
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At what times do you do the Apgar test?
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1 minute and 5 minutes
unless baby needed resuscitation, then its @ 2 min. |
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Newborn Respirations
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Normal respirations are between 30 - 60 per minute
Diaphragmatic breathing (the abdomen goes rises and falls) Always count for a full minute Signs of distress: grunting, restractions (skin is pulled in because newborn is using accessory muscles), nasal flaring, tachypnea (>60) Retrations: types > substernal, intercostal, subcostal, suprasternal, clavicular, The closer to the head the retraction the more serious |
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Newborn Heart Rates
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120-160 bpm
If post dates, HR is lower 110-120 If premature, HR is faster 150-160 Best place for apical pulse on newborn is right over left nipple (its easier to count if tap finer along with it) count for a full minute |
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Newborn Temperature
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Must keep the baby warm
Do rectal only once at first. Can cause damage to mucosa, but also want to check for patency of the rectum Then do auxiliary Norms 36.5-37.0 C 97.7-98.6 F |
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Newborn Weight
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Average 7.5 lbs
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Newborn Length
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Average 20 in
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Newborn Head Circumference
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average circumference is 35 cm. Take it at the widest diameter of the head.
(worry about hydrocephalus) |
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Newborn Chest Circumference
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32 cm across nipple line
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Caput Succedaneum
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(caput): when there is swelling of the head. Cross the suture line. Generalized edema all over the head. Resolves itself soon after birth
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Cephalhematoma
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Collection of blood between the periosteum and the cranium,
Does not cross the suture line. Generally appears on day one or two. Can last as long as a few weeks. Often associated with jaundice (high bilirubin level) Occurs with trauma (forceps, vacuum extractor, a big head/small pelvis) |
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Vernix
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cheesy substance on the newborn's skin. It is protection. As it matures in utero, it begins to absorb it.
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Milia
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overactive sebacous glands. should go away in about a month
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Acrocyanosis
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Hands & feet bluish color due to poor peripheral circulation. Better to assess face & mucous membranes for hypoxia
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Jaundice
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Immature liver cant convert bilirubin into a form which can be excreted through stool. Seen in preemies, cerebral hematomas, bruising, blood incompatibilities. Breastmilk jaundice & patho jaundice
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Mongolian Spots
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Birthmark
lower back, buttocks, upper thighs. More common in African or Asian background but also Native American. Can happen in Looks like bruising. |
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Strawberry Mark
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Birthmark
enlarged capillaries in the dermal layer of the skin. Very dens. Doesn’t blanch. Most disappear during childhood |
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Port Wine Stain
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Birthmark
reddish to purple, non-elevated area of dense capillaries. Doesn’t blanch. Doesn’t fade |
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Stork Bites
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Birthmark
on eyelids, nose, neck. Red spots. On babies with light complexion. Last for about 2 years and then go away |
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Polydactyly
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extra digits on hands or feet. Sometimes one hand, sometimes both. Most often extra tissue, no bone. Physician can tightly suture tissue so it falls off.
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Syndactyly
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webbing of the fingers and toes. Common with Down syndrome (also has palmar crease: one line that goes across palm)
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Brachial Palsy
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Partial or complete paralysis of arm because of damage to brachial plexus during birth, which affects nerve in shoulder. Make sure they move both arms equally. Seen in large babies who get stuck. Usually temporary, repairs itself. Feel clavicles for break, usually large babies, traumatic birth. Repairs self quickly, use sling.
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Club Foot
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The affected foot appears rotated internally at the ankle. May involve 1 or both feet
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The umbilical cord should contain which vessels?
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1 vein
2 arteries |
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Pseudomenstration
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From the withdrawal of mom’s hormones
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Hypospadius
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the urethra come out underneath the penis
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Cryptorchidism
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the testes do not descend into scrotum
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Swollen Labia on newborn
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Normal on lady babies, caused by hormones
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Bruised Scrotum on newborn
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Normal to be bruised and swollen, especially if the baby was breech
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Newborn rectum
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Chart with bowel movement. Want a BM within 24 hrs to ensure patency
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Newborns back should be ________
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straight and flat.
Must assess base of the spine- worry about spinal bifida (nerves come out lower area of the back) assess for pilonidal dimple- make sure it’s not open. May have little tuft of hair |
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Vitamin K for Newborns
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to prevent hemorrhagic disorders. Helps coagulate blood. Don’t make their own Vit K until 8 days after birth
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Eye Prophylaxis
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Manditory in nurseries.
Erythromyacin is used. Not so much silver nitrate. To prevent ophthalmianeonatorum- inflammation of the eyes caused by Chlamydia or Gonorrhea Thick sticky paste so hold off on it for up to 2 hours to allow for bonding first Squeeze in lower eye about 1/4 inch then dab eye with 4 x 4 to clean it a bit |
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Periods of Reactivity
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First period of reactivity: 30- 60 min after birth, best for bonding and breast feeding
Sleep phase: can last up for 4 hours, difficult to awaken, HR and resp. decrease and have no interest in sucking Second period of reactivty: are alert and awake good for feeding and interaction, lasts 4-6 hours. Often when they void and have first BM. |
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Tonic Neck Reflex
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AKA Fencer Reflex
newborn on back, turn head to one side, the arm and legs on side their looking extend, other contract |
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Grasping Reflex
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finger to palm and grasp it
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Moro Reflex
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drop the bassinet and the baby’s arms and legs flail and the arms and legs come to center like a ‘c’
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Rooting Reflex
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touch side of mouth and baby will turn towards it
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Sucking Reflex
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stick gloved finger in mouth and baby will start sucking
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Babinski Reflex
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stroke heel to little toe- should hyperextend
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Galant Reflex
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trunk incurvation: stroke side of spine and baby should curve to that side
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Stepping Reflex
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hold baby upright just so their feet are barely touching surface, should take little stepping motions
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A baby is premature when born between ______
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20 wks and completion of 37th week
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7 Characteristics of a Premature Baby
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Translucent, thin skin because very little adipose tissue
Lanugo: fine hair covering body, which decreases with gestational age. Plantar creases: bottoms of feet are smooth (mature baby has increased amount of creases). Breastbud is flat (mature baby has budding breast) Ear: cartilage is not developed (be careful of bending) Genitals: male: scrotum is smooth & flat (maturity = rugae). Female: labia majora & minora are very small, underdeveloped, so clitoris is very prominent. Flexion: There will be little to no flexion of the extremities |
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TRICHOMONIASIS
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Most are acquired through sexual intimacy. Fomite transmission may be through shared bath facilities, wet towels or wet swimsuits.
S & Sx: yellow-green, frothy, odorous discharge and vulvar itching, dysuria, & dyspareunia. Maybe subepithelial hemorrhages on the cervix (strawberry-like red spots.) Women are often asymptomatic or have mild symptoms Pregnant women are at increased risk of premature rupture of membranes, pre-term birth and low birth weight |
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CHLAMYDIA
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, the most common STI in the US. Most frequent in sexually active adolescents and young adults. Acquired through vaginal sex.
S & Sx: thin or mucopurulent discharge, cervical ectopia, friable cervix (bleeds easily) burning and frequency of urination and lower abdominal pain. Women and men are commonly asymptomatic It can infect the fallopian tubes, cervix, urethra, and Bartholin’s glands. Can cause PID, infertility, and ectopic pregnancy. Newborn exposure in the birth canal is most common cause of ophthalmia neonatorum but responds to erythromycin ophthalmic ointment |
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GONORRHEA
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Second most common STI in U.S. Acquired through vaginal, anal and oral sex.
S & Sx: PID, : greenish-yellowish discharge, dysuria, and urinary frequency. Some get inflammation of vulva. Cervix may be swollen, eroded. Pelvic pain as well. If pregnant women becomes infected after 3rd month the mucus plug will help infection from ascending beyond cervix. Exposed newborn is at risk for developing ophthalmia neonatorum (eye prophylaxis for all newborns.) |
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HERPES GENITALIS
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recurrent lifelong infection. Mostly spread through vaginal, anal and oral sex, can be through skin to skin contact.
S & Sx: single/multiple blister-like vesicles, inflammation, pain, urinary retention, genital itching/tingling If present in tract during birth can have real bad effects/fatal. |
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SYPHILIS
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Acquired through vaginal, anal or oral sex.
S & Sx: slight fever, loss of weight, & malaise. 6 weeks to 6 months- secondary symptoms: condylomata lata (infectious wart like plaques on vulva) acute arthritis, enlarged liver & spleen, enlarged lymph nodes, iritis, chronic sore throat May transmit through placenta Transplacental transmission @ 95% in early but then drops to 10% in late. May cause intrauterine growth restriction, preterm birth and stillbirth. Testing for every woman. |
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HPV/CONDYLOMATA ACUMINATA
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aka genital warts. Acquired through vaginal, anal or oral sex.in 15% of population. Linked to cervical and anal cancers.
S & Sx: single or multiple soft grayish pink cauliflower-like lesions. May cause itching, friable (bleeds easily) or pain. Most infections are asymptomatic Treatment is different if preggo |
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PEDICULOSIS PUBIS (CRABS)
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caused by parasite Phthirus that attaches eggs to hair shaft. Acquired through sexual contact or possible shared towels and bed linens. Symptoms: itching. Wash all clothes and linens in hot dryer.
The typical shampoo used to treat cannot be used on pregnant or lactating women |
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SCABIES
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Female burros under skin and lay eggs. Acquired by intimate sexual contact in adults. In kids, other ways. Symptoms: itching (worse at night or when hot.) may see little red bumps. Certain treatments not recommended for pregnant women.
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VIRAL HEPATITIS
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inflammatory process of liver from virus A, B, C, D or E. Only can immunize for A & B. A Symptoms: jaundice, anorexia, n/v, malaise & fever. Self limiting. Not chronic. B C & D symptoms: similar to A w/ arthralgias, arthritis, skin eruptions or rash. Theses are chronic. E- usually in South Central Asia. Symptoms: like A, not chronic
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AIDS
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fatal caused by HIV. Acquired sexually. Can be passed to fetus through placenta or to baby via breastmilk
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Summarize the health teaching that a nurse needs to provide to a woman with an STI
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Provides information about infection, methods of transmission, implications for pregnancy or fertility, importance of treatment. Stress importance of treating partner if needed. Should abstain from sex during treatment. Some are easily treated with medications. Some can only be controlled. Help the women explore her feelings relating to the infection.
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PID
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Can cause a woman to become infertile caused by postinfection tubal damage
More common in women with multiple sexual partners, history of PID, early onset of sexual activity, those who douche regularly or those with a recent intrauterine device IUD. Clinically defined as syndrome of inflammatory disorders of upper female genital tract. Includes any combination of endometritis, salpingitis, tubo-ovarian abscess, pelvic abscess and pelvic peritonitis. May be associated with bacterial infections S & Sx: bilateral sharp cramping pain in lower quadrants, fever higher than 101, chills, mucopurulent cervical discharge, irregular bleeding, cervical motion tenderness during sex, malaise, n/v. may also be asymptomatic |
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4 Pelvic Shapes
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Gynecoid: round, most common (FAVORABLE)
Anthropoid: oval (FAVORABLE) Android: heart-shaped (UNFAVORABLE) Platypelloid: inadequate outlet capacity (UNFAVORABLE) |
