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63 Cards in this Set
- Front
- Back
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Causes of Bradycardia in Fetal Heart Rate
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Maternal Reasons: supine position, hypotension, anesthetics, prolonged hypoglycemia, acute maternal cardiopulmonary compromise, adrenergic-receptor blocking drugs
Fetal Reasons: Umbilical cord occlusion, mature parasympathetic nervous system (big boy), vagal stimulation, acute hypoxemia, cardiac defects |
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Late Decelerations
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Always late with contraction. FHR 10 - 20 Bpm below baseline. Repetitive in nature.
Indicates utero placenta insufficency (bad placenta/eclampsia), or myocardial suppression/depression Could be seen with: maternal hypo/hypertension, post maturity, abruptio, illicit drugs, uterine hyperstimulation, maternal smoking, chronic disease |
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Nursing interventions for late Decelerations
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Change maternal position
Stop Pitocin Hydration LR IV bolus O2 8 - 10 liters Palpate uterus Consider tocolytics Notify MD Continuous monitoring |
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Early Deceleration
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Always with a contraction, tends to mirror the amplitude of the contraction. Benign, result of fetal head compression during the contraction
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Prolonged deceleration causes
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Cord compression / occlusion
Short cord Head compression Uteroplacental insufficiency Can occur spontaneously - even antenatally Repetitive in labor usually progress to more omnious periodic patterm |
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Minor discomforts of pregnancy first trimester
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Nausea and Vomiting
Urinary Frequency Fatigue Breast tenderness Increased vaginal discharge Nasal stuffiness and nosebleed ptyalism (bitter saliva) |
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Minor discomforts of pregnancy, 2nd and 3rd trimesters
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Heart burn (pyrosis), ankle edema, varicose veins, flatulance, hemorrhoids, constipation, backache, leg cramps, faintness, dyspnea, carpal tunnel syndrome
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Pitocin
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Used to induce labor, strengthen labor contractions during childbirth, control bleeding after childbirth
Side effects: irritation at the injection site, loss of appetite, nausea, vomiting, cramping, stomach pain |
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Maternal & fetal risks in Gestational Diabetes
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Maternal: Hydraminos, preeclampsia - eclampsia, hyperglycemia, retinopathy
Fetal: Congenital anomalies (sacral agenesis), macrosomia, increased risk shoulder dystocia, intrauterine growth restriction, respirartory distress syndrome, polycythemia, hyperbilirubemia |
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Subjective/Presumptive Signs of Pregnancy
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Amenorrhea
Breast Changes - tender and fuller Nausea and Vomiting (8 - 12 wks) Quickening UA frequency increased |
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Objective/Probably Signs of pregnancy
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Positive HCG
Reproductive change enlargement of abdomen Braxton Hicks Chadwicks Sign (Blueish cervix) Integument Changes Hyperpigmentation |
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Diagnostic/Positive signs of pregnancy
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Heart FHT
Visualize embryo/fetus U/S Fetal movement |
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Fundal Height
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Measure of the size of the uterus used to assess fetal growth
Measured from the top of the mothers uterus to the top of the mothers pubic bone in cm |
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Chloasma Faciei (Melasma)
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Mask/Glow of pregnancy - hyperpigmented area commonly found on upper cheek, nose, lips, and forehead
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Hydroxyzine
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Tx: preoperative sedation. Anticholinergic, antihistamine, antiemetic properties
Completely metabolized by the liver Contraindicated in OB (teratogen) and lactation Extremely damaging SubQ, must be given deep IM (location ventrolguteal) AE: Dizzy, dry mouth |
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Oligohydraminos
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when amount of amniotic fluid is reduced and concentrated - reflects possible fetal renal dysfunction
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Gravida
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Any pregnancy regardless of duration, including present pregnancy`
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Para
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Birth after 20 weeks gestation regardless of whether the infant was born dead or alive
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GTPAL
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Gravida - # of total pregnancies
Term - Term deliveries Preterm - preterm deliveries Abortions - surgical and miscarriage Living - living children |
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Symptoms of mild Preeclampsia
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Onset after 20 weeks gestation
Bp > 140/90 (or 30 sys/ 15 dia from prepregnancy) Proteinuria: Dip 1-2+, 24 hr protein > 300mg Hyperreflexia Edema - weight gain Labs: H7H, BUN, Placenta, liver enzymes, uric acid |
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Mild Preeclampsia Collaborative Management
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Goal: Health of mother / deliver healthy infant
Maternal assessment Labs Medication Diet - moderate protein Monitor fetus closely - FM, US, BPP, serial NST Delivery - vaginal delivery, electiveCS if severe and determines stress to much for mother |
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Mild Preeclampsia: Nursing Interventions
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Outpatient: Activity, monitoring, self-assessment teaching, fetal activity, labs
Inpatient: Positioning, Decrease CNS stimulation, monitor as ordered or high risk (VS, I&O / Weight qd, assessments, DTRs/Clonus, Labs, Daily NST) Postpartum risk continues for 6 weeks |
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Severe Preeclampsia
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BP 160 - 180 / 110 (twice)
Proteinuria: 5g/L 24hr, 3 - 4 dip Oliguria (<30cc/hr) Fetal growth restriction Oligohydramnios CNS Symptoms: visual anomalies, hyperreflexia/clonus, HA, altered LOC Epigastric or RUQ pain Increase ALT/AST |
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Meds for severe preeclampsia
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Anticonvulsant: magnesium sulfate
Antihypertensives: Hydralazine (Apresoline) Chronic HTN: Methyldopa (Aldomet) |
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Developmental tasks of pregnancy
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Ensuring safe passage through pregnancy, labor, and birth
Seeking acceptance of child by others Seeking commitment and acceptance of self as mother to the infant Learning to give of oneself on behalf of ones child |
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Magnesium Sulfate
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Mineral/electrolyte
Tx: hypertension, anticonvulsant, HELLP (eclampsia) use cautiously in patient with decreased renal function A/E: diarrhea, resp depression, loss of reflexes one of first signs of toxic levels |
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Maternal causes of fetal tachycardia
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Fever
Infection Dehydration Anemia Medications: atropine, vistaril, asthma meds, epinephrine, positive intropes, decongestants, stimulants |
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Fetal causes of fetal tachycardia
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Infection
Activity or stimulation Compensation after hypoxia Fetal hyperthyroidism Tachyarrhythmias Prematurity Anemia Cardiac anomalies |
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Hydralazine
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Antihypertensive / vasodilator
Used in treatment of moderate to severe hypertension/preecclampsia - eclampsia A/E: tachycardia, sodium retention, drug induced lupus syndrome Nurse should monitor BP and pulse frequently |
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Nubain (Nalbuphine)
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Opioid analgesic - analgesia used in labor (IV)
Can cause resp depression in neonate if it close to delivery - therapeutic effect has a ceiling (not effective past certain dosage) A/E: dizziness, headache, sedation, dry mouth, nausea, vomiting, clammy, sweating Nurse to assess BP, pulse, resp |
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Tocolysis
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Process of using medications to stop preterm labor
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Deceleration
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Decrease in fetal heart rate that can indicate problems or be a normal part of physiology.
Late = Placental Insufficiency Early = Head compression (Benign w/ contractions) Variable = Cord compression |
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3 stages of human development
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Fertilized Ovum: Zygote
Embryo: Day 15 to 8 weeks Fetus: 8 to 40 weeks |
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Hyperemesis Gravidarum
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Excessive Vomitting characterized by:
Weight loss 5% of pre pregnant weight Dehydration (low Bp, Inc Pulse, poor skin turgor) Abnormal Labs (electrolyte imbalance, inc Hct) |
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Collaborative Management of Hyperemesis Gravidarum
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NPO 48hr after vomiting ceases
Hydration - PO, IV, ET, TPN small meals + potassium IV Antiemetics Monitor labs Education/Prevention |
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Nagele's Rule
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EDD/EDB/EDC
Begins with the first day of last menstrual period, subtract 3 mo and add 7days |
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Potential teratogenic substances/vaccines/microorganisms
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Rubella
Toxoplasmosis Salmonella Hepatitis Varicella Cytomegalovirus cocain HIV ALcohol Measles Lead Methamphetamine Radiation Mercury Herpes virus Listeria Insulin dependent diabetes maternal hyperthermia herbs (except ginger) Syphilis |
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Harmful (not or not always teratogenic but may cause fetal harm)
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Salmonella
Varicella Cigarettes Marijuana Group B Strep Cocain Lead Methamphetamine Heroine Mercury Listeria Processed meats Gestational Diabetes Domestic Violence |
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NonStress Test
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Done at 28 weeks gestation + (often after 32)
Normal test will show normal base line FHR, two accelerations with in 20 minutes, and good variability Gross fetal movement should be associated with accelerations |
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Trimesters by week
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1st 1 - 13 weeks
2nd 14 - 26 weeks 3rd 27 - 40 weeks Term 38 - 42 weeks |
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Cervidil
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Prostaglandin analogue - used during labor
Helps dilate the opening of the uterus (cervix) in a pregnancy woman. A/E: Chest pain, tightness, rash, itching, labor pains, arrhythmia, N&V, back/stomach pain, fever, HA |
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Terbutaline
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asthma management and tocolytic - given to prevent preterm labor
AE: tachycardia, nervousness, HA, hyperglycemia, hypokalemia, and pulmonary edema |
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Leopold Maneuver
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Used to determine fetal position inside uterus - may also be done by ultrasound
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Asynclitic
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When head of baby presents first but is tilted towards the shoulder - often spontaneously corrects itself
if persistent may cause dystocia or need for c-section |
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Dystocia
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Abnormal or complicated birth (obstructed birth)
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SInusoidal FHR
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Associated with highly anemic baby or complications from Rh antibodies
Emergency - call MD, asap c section Assess for bleeding, possible causes of anemia Pseudo sinusoidal occurs after narcotic administration |
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Nursing Interventions for nonreassuring fetal heart rate
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Change Position
Increase maternal blood volume (IV fluids) Stop Pitocin Administer oxygen per NRB mask at 8 - 10 liters/min Assessment Call primary care giver |
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3 primary causes for Dystocia of labor
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Passage - narrow birth canal etc
Passenger- large baby, poor positioning Power - weak uterine contractions (may also include maternal position and psyche) |
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Nursing responsibilities during dystocia of labor
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Assess UC, progress, dilation, and descent
Enhance progress of labor (pt ambulation, positioning, empty bladder) Relaxation - Psyche Directed position at 2nd stage Monitor augmentation, notify MD of progress or lack there of Assist with operative delivery Document |
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Umbilical Cord Prolapse
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Fetal bradycardia with variables
Palpate for the cord Keep head of cord Adjust positioning Ongoing assessment Prep for C - section or expedited delivery Call for help |
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Fetal lie
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relationship to the long axis of the baby to the long axis of the mom. May be longitudinal or transverse
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Fetal attitude
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Relation of the fetal body parts to eachother. Flexion of the head is best
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Fetal Station
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Relates to where the presenting part is in relation to the pelvis at the ischial spines. Above the spines is negative, below is positive by cm.
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Premonitory Signs of Labor
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LIghtening
Stronger Braxton Hicks contractions Nesting (Increased endorphines/burst of energy) Increased mucous discharge Bloody Show Weight loss Bachache Loose stools or regular (prostaglandins) Heightened response to stimuli |
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Labor Stage 1: Latent/Early Phase
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Latent/Early Phase: 0 - 3 cm, effacement. Contractions > 10minutes apart, gradually changing to 5 min apart. Usually mild, can walk/talk through contractions
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Labor Stage 1: Active Phase
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Active phase: 4 - 7 cm. More rapid dilation. UC 3 - 5 min apart, moderate intensity. Usually lassts 3 - 5 hrs.
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Labor Stage 1: Transition Phase
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Regarded as the most uncomfortable phase. 8 - 10 cm, descent has started. UC strongest they will get. Contractions 1.5 to 3 minutes apart, lasting 60 to 90 seconds. .5 to 2 hours.
Women may have urge to push, be restless, throwing up, burping, hiccups, hot and cold flashes, sleepy, bachache, trembling legs, thirsty |
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Labor Stage 2
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Pushing. Strong bearing down and fetal station advancing through the pelvis. Average 20 minutes to one hour (up to 2 for first time moms). Contractions have 1 minute duration every 3 to 5 minutes.
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Labor Stage 3 and 4
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Stage 3: Separation and delivery of placenta, may take up to 30 minutes
Stage 4: after placenta delivery until recovered. Initial recovery about 4 hours |
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Stadol
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Opioid angonist/antagonist
Has therapeutic ceiling AE: Confusion, tachycardia, irregular heartbeat, urinary hesitancy, Seizures, Resp depression, Blurred vision, Nausea, vomiting, or constipation |
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Calcium Gluconate
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Treats magnesium over dose (think to much magnesium sulfate during eclampsia/preeclampsia episode)
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Nifedipine
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Calcium channel blocker used to treat high blood pressure - may also be used as tocolytic to treat preterm labor
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Folic acid
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400 mcg (0.4 milligrams) daily prior to conception and during early pregnancy reduce the risk of a serious neural tube defect by up to 70%.
spina bifida, an incomplete closure of the spinal cord and spinal column anencephaly, severe underdevelopment of the brain encephalocele, when brain tissue protrudes out to the skin from an abnormal opening in the skull |
