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227 Cards in this Set

  • Front
  • Back
Screening assessment
Performed at the first contact
To gather information (baseline data)
Describes client’s status before interventions begin
Forms basis for the ID of strengths and problems
Focused assessment
Used to gather info specific to an actual health problem or a problem the client is at risk for acquiring
Performed at beginning of shift and centers on areas relevant to childbearing
May also reveal strengths that nursing care will enhance
When does Closure of the neural tube occur?
4 Weeks
When does the heart contain 4 chambers?
8 Weeks
When are All abdominal organs are within the abdominal cavity?
10 weeks
When do the Eyes close ? Reopen?
8 weeks; 26 weeks
When does External ear development begins?
6 Weeks
When is Fetal gender apparent by external genitalia?
12 Weeks
When are Fetal movements felt by mother?
20 weeks
When does Surfactant production begin?
24 Weeks
When do the Testes begin entry into the scrotum?
20 Weeks
Vernix caseosa
A thick, white substance that protects the skin of the fetus
Removed when infant is dried at birth or at first bath; remaining is absorbed by skin
Thick covering may indicate preterm infant
None may indicate post-term infant
Yellow tinged may indicate increased bilirubin levels
Green tinged result of meconium staining
Lanugo
Fine, soft hair that covers the fetus during intrauterine life; becomes thinner as fetus nears term
Term infant may have small amount on shoulders, forehead, sides of face, and upper back
Dark skinned infants often have more than lighter colored infants
Brown fat (or brown Adipose tissue) BAT
o Highly vascular specialized fat found in newborn (provides more heat than other fat when metabolized)
o The primary method of heat production in infants is non-shivering thermogenesis; the metabolism of brown fat to produce heat
Brown Fat (facts)
 Contains an abundant supply of blood vessels (causes the brown color)
 Located primarily around the back of the neck, axillae, around the kidneys, adrenals, and sternum, between scapulae, and along the abdominal aorta
 Blood passes through BAT, is warmed and carries heat to the rest of the body
 Intrauterine growth restriction may deplete BAT before birth
 Exposure to prolonged cold stress may cause BAT to be consumed
 Gradually replaced by White Adipose Tissue
 Hypoxia, Hypoglycemia, and Acidosis may interfere with infant’s ability to use BAT to generate heat
Surfactant
Combination of Lipoproteins produced by the lungs of mature fetus to decrease surface tension in alveoli (promotes lung expansion after birth)
Surfactant (facts)
 22 weeks lungs start producing surfactant
 Lines inside of alveoli, allows alveoli to partially open when infant begins to breath at birth
 Without surfactant alveoli collapse when infant exhales and must be re expanded with each breath, increasing work of breathing and possibly resulting in atelectasis
 34-36 weeks sufficient surfactant produced for most newborns to breathe without difficulty
 Increases during labor and immediately after birth to enhance transition from fetal to neonate life
 Steroids given to mother in preterm labor to help increase production and speed maturation of lungs
 Fetus with intrauterine growth restriction, maternal HTN, or prolonged rupture of membranes may have accelerated lung maturation too
 Infants of mothers with Diabetes have slower lung maturation
Fertilization age
Fertilization age is the prenatal age of the developing bay, calculated from the date of conception.
Gestational age
Gestational age is the prenatal age of the developing baby (measured in weeks) calculated from the 1st day of the woman’s last menstrual period (about 2 weeks longer than the fertilization age)
Explain how each of the following mechanisms allows the fetus to thrive in the relatively low oxygen environment of the uterus. (Fetal H&H and Maternal C02 levels)
Average P02 of maternal blood is 50mmHg, average blood P02 in the umbilical vein (after oxygenation) is 30mmHg.
The fetus can thrive in this low oxygen environment because fetal hemoglobin can carry 20-50% more oxygen than adult hemoglobin.
Blood entering the placenta from the fetus has a high PC02, but Carbon Dioxide diffuses quickly to the mother’s blood, where the PC02 is lower, reversing the levels of carbon dioxide in the maternal and fetal blood.
Fetal blood becomes more alkaline and maternal blood becomes more acidic. This allows the mothers blood to give up oxygen and the fetal blood to combine with oxygen readily.
Carbon dioxide is very soluble, allowing it to pass across the placental membrane into maternal blood at this low pressure gradient.
Describe how passage of maternal immunoglobulin G (IgG) antibodies can be beneficial to the fetus. (Passive Temporary Immunity)
Passage of antibodies against disease is beneficial because the newborn does not produce antibodies for several months after birth (they are immune to what the mother has immunity against)
Describe how passage of maternal immunoglobulin G (IgG) antibodies can be harmful to the fetus. (Passive Temporary Immunity)
If maternal and fetal blood types are not compatible mother may already have or produce antibodies against fetal erythrocytes. Antibodies may then destroy fetal erythrocytes, causing fetal anemia or even death. (may occur if mother is Rh-negative and fetus is Rh-positive)
Human chorionic gonadotropin (hCG)
o Causes the Corpus Luteum to persist for first 6-8 weeks of pregnancy and secret estrogens and progesterone
o As placenta develops further, it takes over estrogen and progesterone production and the Corpus Luteum regresses
o Produces a positive pregnancy test
Human placental lactogen (hPL) AKA Human Chorionic Somatomammotropin
o Promotes normal nutrition and growth of the fetus and maternal breast development for lactation
o Decreases maternal insulin sensitivity and glucose use, making more glucose available for fetal nutrition
o Also hPL encourages quick metabolism of free fatty acids to provide energy for the pregnant woman
Estrogen
o Produced the Corpus Luteum for the first few weeks but primarily by placenta (after 6 or 7 weeks of pregnancy)
o Functions during pregnancy:
 Stimulating uterine growth
 Increases blood supply to uterine vessels
 Increases uterine contractions near term
 Aiding in development of glands and ductal system in breast in preparation for lactation
Progesterone
MOST IMPORTANT HORMONE OF PREGNANCY
o Produced first by Corpus Luteum and then by fully developed placenta
o Functions during pregnancy:
 Maintains endometrial layer for implantation of fertilized ovum
 Preventing spontaneous abortion by relaxing smooth muscles of uterus
 Helps prevent tissue rejection of the fetus
 Stimulates development of lobes of lobules in breast in preparation for lactation
 Facilitating deposit of maternal fat store, which provide a reserve of energy for pregnancy and lactation
 Associated with decreased motility of bowel, dilation of uterus, and increased bladder capacity
 Rises the respiratory sensitivity to carbon dioxide C02 and thereby stimulates increased ventilation
State three functions of amniotic fluid
1. Cushions against impacts to the abdomen
2. Maintains a stable temperature
3. Allows room and buoyancy for fetal movement
* Umbilical vein
Carries freshly oxygenated and nutrient-laden blood from the placenta back to the fetus
* Umbilical arteries (two)
Carry deoxygenated blood and waste products away from the fetus to the placenta where substances are transferred to the mother’s circulation
* Wharton’s jelly
A soft substance that cushions the entire cord to prevent obstruction resulting from pressure
10. What substance is the primary energy source for the fetus?
A. Glucose
B. Urea
C. Protein
D. Fatty Acids
A. Glucose
Ballottement
Fetal rebound in the amniotic fluid when the cervix is tapped
Hyperemia
Excess blood in a body part
Lightening
Descent of the fetus into the pelvis, reducing pressure on the diaphragm
Melasma
Brownish discoloration of the face
Physiologic anemia of pregnancy
Fall in hematocrit that occurs because plasma volume expands more than RBC volume
Primipara
Woman who has given birth once after a pregnancy of at least 20 weeks
Striae gravidarum
Irregular reddish streaks caused by tears in connective tissue – stretch marks
When during pregnancy is the fundal height at the symphysis pubis?
8 weeks
When during pregnancy is the fundal height Halfway between the symphysis pubis and the umbilicus?
16 weeks
When during pregnancy is the fundal height at the umbilicus?
20 Weeks
When during pregnancy does the fundal height start and stop measuring equal to weeks of pregnancy?
20 weeks and 36 weeks
When during pregnancy is the fundal height equal to the xiphoid process?
36 weeks
When during pregnancy is the fundal height below the xiphoid process?
After lightening has occurred
Chadwick’s sign (Color)
Bluish purple discoloration of cervix, vagina, and labia during pregnancy as a result of increased vascular congestion. It is one of the earliest signs of pregnancy. In response in increasing levels of estrogen the cervix becomes congested with blood (hyperemia).
Goodell’s sign (Consistency)
Softening of the cervix during pregnancy. Pre-pregnancy cervix consistency is like the tip of the nose, after conception it is the consistency of the ear lobe. The cervix is largely composed of connective tissue that softens when collagen fibers decrease in concentration.
Hegar’s sign
Softening of the lower uterine segment that allows it to be easily compressed by the 6th week of pregnancy.
Mucus plug
The endocervical tissue resembles a honeycomb that fills with mucus secreted by the cervical glands. The mucus forms a plug in the cervical canal. The plug blocks ascent of bacteria from the vagina into the uterus during pregnancy and protects the fetus and membranes from infection. It remains in place until the onset of labor. Effacement and dilation cause expulsion of the mucus plug.
Bloody show
Mixture of cervical mucus and blood from ruptured capillaries in the cervix; often precedes labor and increases with cervical dilation
What breast changes occur during pregnancy?
Breasts change in both size and appearance during pregnancy. Estrogen stimulates the growth of mammary ductal tissue. Progesterone promotes the growth of lobes, lobules, and alveoli. Breasts become highly vascular. The nipples increase in size and become more erect. The areola becomes larger and more pigmented. Sebaceous glands (tubercles of Montgomery) become more prominent and secret a substance that lubricates the nipples. Colostrum is present beginning in the 2nd trimester and can readily be expressed by 3rd trimester.
Describe changes in maternal heart size and position that may occur during pregnancy.
Muscles of the heart enlarge slightly because of the increased workload during pregnancy. The heart is pushed upward and toward the Left as the uterus elevates the diaphragm during the 3rd trimester.
Changes in the pregnant woman’s blood:
Plasma volume (30-45 ml/kg)
Increases 50%
Changes in the pregnant woman’s blood:
Red Blood Cell Mass (20-35 ml/kg
Increases 25%
Changes in the pregnant woman’s blood:
White Blood Cell Count
Rises during labor and early postpartum
Changes in the pregnant woman’s blood:
Fibrinogen
Increased fibrinogen levels offer protection from excess blood loss but also predispose women to thrombus formation
What factors contribute to a pregnant woman’s sense of dyspnea?
The growing uterus eventually lifts the diaphragm and reduces lung expansion and because the respiratory center becomes more sensitive to carbon dioxide, the minute volume increases and the partial pressure to C02 falls
What causes the heartburn that often occurs in pregnancy?
Heartburn occurs when reverse peristaltic waves cause regurgitation of acidic stomach contents into the esophagus. Underlying causes are diminished gastric motility and displacement of the stomach by the enlarging uterus. Improper diet and nervous tension may be precipitating factors.
Why are pregnant women more likely to develop urinary tract infections?
Higher levels of Progesterone decrease the muscle tone of the uterus, causing them to dilate and slowing urine flow. As the uterus enlarges it may compress the ureters making it that much more difficult for urine to flow through them as quickly and as freely as usual. The bladder also loses tone during pregnancy. It becomes more difficult to completely empty your bladder, and your bladder becomes more prone to reflux (when some urine flows back up the ureters toward kidneys).
What changes in carbohydrate metabolism and the production, utilization, and breakdown of insulin occur during pregnancy? Why do these changes occur? How does the woman’s body normally respond to these changes?
More insulin is required as pregnancy progresses because hormones (hPL, prolactin, estrogen, progesterone, and cortisol) cause maternal tissue resistance to insulin. The decrease in the mother’s ability to use insulin is a protective mechanism that allows an ample supply of glucose for transfer to the fetus. However, the mother’s pancreas produces more insulin so that she can continue to metabolize enough glucose to meet her own energy needs and prevent hypoglycemia. Hypoglycemia occurs when blood glucose levels exceed available insulin, which is needed to transport glucose into cells. In the woman that cannot produce increased insulin, they become hyperglycemic or have gestational diabetes mellitus.
At what point is possible to hear fetal heart sounds?
10-12 weeks with a Doppler transducer
How do you use Nagele’s rule to calculate estimated dates of delivery (EDDs)?
Subtract 3 months, add 7 days, correct the year
What is the significance of a pregnancy risk assessment and why is it done more than one time during pregnancy?
Risk assessment begins at the initial visit when the health care provider Identifies factors that put the expectant mother or fetus at risk for complications and that require specialized care. Risk factors change as pregnancy progresses and must be updated throughout pregnancy. Gestations categorized as low risk at the initial assessment may later become high risk and many women identified as high risk give birth to healthy full term infants.
What routine urine testing is done during prenatal visits and why?
Bacteriuria – If left untreated, increases risk of kidney infection and is associated with preterm labor and low birth weight (asymptomatic)
Protein – May indicate contamination by vaginal secretions, kidney disease, or preeclampsia
Glucose – Small amounts may indicate physiologic “spilling” that occurs during normal pregnancy, larger amounts require glucose screening of blood
Ketones – May be found in urine post heavy exercise or as a result of inadequate intake of food
What process should the nurse expect the expectant father to go through during pregnancy?
The response of the expectant father is dynamic, progressing through phases that are subject to individual variation. There are 3 developmental processes that an expectant father must address:
• Grappling with the reality of pregnancy and the new child\
• Struggling for recognition as a parent from his family and social network
• Making an effort to be seen as relevant to childbearing
List three major consequences that are associated with inadequate weight gain during pregnancy and excessive weight gain during pregnancy.
Inadequate weight gain:
1. Low birth weight
2. Preterm labor
3. Increased risk of fetal and newborn mortality and morbidity

Excessive weight gain:
1. Greater risk for higher birth weight (macrosomia)
2. Prolonged labor
3. Birth trauma
4. C-section
Why is the nutritional value of the diet more important than the actual weight gained during pregnancy?
Weight gain from a diet lacking in essential nutrients is not as beneficial as weight gain from a balanced diet.
A general guideline for pregnancy weight gain is _____kg (_____lb) during the first trimester and _____kg (_____lb) per week thereafter.
1.6 kg/3.5 pounds

0.44kg/1 pound
List the kilocalorie content for the following food types.
a. Carbohydrates _______/g
b. Protein____________/g
c. Fat______________/g
a. Carbohydrates ___4____/g
b. Protein______4______/g
c. Fat_______9_______/g
Why is folic acid important before and during pregnancy?

What are some of its food sources?
Folic acid can decrease the occurrence of neural tube defects in newborns.

Black beans, kidney beans, pinto beans, peanuts, OJ, asparagus, peas, broccoli, spinach
Why is calcium important in pregnancy?

List some high-calcium foods other than dairy foods.
Calcium is necessary for bone formation, maintenance of cell membrane permeability, coagulation, and neuromuscular function. It is transferred to the fetus, especially in the last trimester and it important for mineralization of fetal bones and teeth.

Dairy, legumes, nuts, dried fruits, dark green leafy vegetables, and broccoli
32. The recommended fluid intake during pregnancy is ____glasses (____ounces) daily.

Which fluids should be limited?
8 glasses/64 ounces

Those high in calorie with no nutritional value
Alpha-fetoprotein (AFP)
Fetal substance used to screen for specific abnormalities
Amniocentesis
Withdrawing amniotic fluid for laboratory examination
Bilirubin
Waste product of erythrocyte (red blood cell) breakdown
Chorionic villus sampling
Procedure to obtain tissue from fetal side of the developing placenta
Hydramnios
More amniotic fluid than normal
Oligohydramnios
Less amniotic fluid than normal
Percutaneous umbilical blood sampling
Sampling fetal blood with the aid of ultrasound
Ultrasonography
Imaging technique that uses high-frequency sound waves to visualize internal body structures
List typical purposes for an ultrasound examination during the First Trimester
• Detect multiple fetal gestation
• Determine gestational age with measures such as crown-rump length, head measurements
• Confirm number and viability of fetus
• ID markers such as nuchal translucence that suggest chromosome or other abnormalities
• Determine location of uterus, cervix, and placenta for procedures such as chronic villus sampling
32. The recommended fluid intake during pregnancy is ____glasses (____ounces) daily.

Which fluids should be limited?
8 glasses/64 ounces

Those high in calorie with no nutritional value
Alpha-fetoprotein (AFP)
Fetal substance used to screen for specific abnormalities
Amniocentesis
Withdrawing amniotic fluid for laboratory examination
Bilirubin
Waste product of erythrocyte (red blood cell) breakdown
Chorionic villus sampling
Procedure to obtain tissue from fetal side of the developing placenta
Hydramnios
More amniotic fluid than normal
Oligohydramnios
Less amniotic fluid than normal
Percutaneous umbilical blood sampling
Sampling fetal blood with the aid of ultrasound
Ultrasonography
Imaging technique that uses high-frequency sound waves to visualize internal body structures
List typical purposes for an ultrasound examination during the First Trimester
• Detect multiple fetal gestation
• Determine gestational age with measures such as crown-rump length, head measurements
• Confirm number and viability of fetus
• ID markers such as nuchal translucence that suggest chromosome or other abnormalities
• Determine location of uterus, cervix, and placenta for procedures such as chronic villus sampling
List typical purposes for an ultrasound examination during the Second and Third Trimesters:
• Confirm fetal viability
• Evaluate fetal anatomy including the umbilical cord, its vessels, and its insertion
• Determine gestational age
• Assess serial fetal growth over several scans
• Compare growth of fetuses in multi fetal gestations, and evaluate quantity of fluid in each amniotic sac
• Evaluate amniotic fluid volume
• Locate placenta when Placenta previa is suspected
• Determine fetal presentation
• Guide needle placement for amniocentesis or percutaneous umbilical blood sampling (PUBS)
What is the purpose of checking alpha-fetoprotein levels?

When is it done?

What conditions are suggested by abnormally high and low levels?
To Identify Chromosomal Abnormalities

DONE AT 16-18 WEEKS

* Low – Down Syndrome
* High – Spina Bifida
What is chorionic villus sampling and when is it done?

List three risk associated with this test.
Chorionic villi are microscopic projections from the outer membrane (chorion) that develop and burrow into endometrial tissue as the placenta is formed. The villi are fetal tissues and reflect the Chromosomal and genetic makeup of the fetus (includes gender of the fetus as well).

CVS is usually performed BETWEEN 10 AND 12 WEEKS of gestation to diagnose fetal chromosomal, metabolic, or DNA abnormalities.
Can be performed by either the transcervical or the transabdominal approach. Risks:
1. Miscarriage
2. Infection
3. Immune system reaction in mothers who are Rh+
Fewer fetal movements than expected suggest possible:
Intrauterine fetal growth restriction

Inaccurate gestational age dating

Rapid intrauterine fetal maturation

Reduced placental perfusion with fetal hypoxia
What is the purpose of a Birth Plan
To help women and their partners examine their options and to take an active part in planning their birth experience. The plan may be simple or it may be a list of specific items to be included in the child birth experience. Cultural preferences can be incorporated. It is a tool for expanding communications with health professionals. It ensures that the couple’s wishes are known before labor begins.
What are the two “powers” of labor?

When during labor do they come into play?
The 2 powers of labor are uterine contractions and maternal pushing efforts.

Uterine contractions are the first force that moves the fetus through the maternal pelvis during the first stage of labor (onset to full cervical dilation).

During the second stage of labor (full cervical dilation to birth of the baby) the mother adds voluntary pushing efforts to the force of uterine contractions.
Fetal lie is Orientation of the long axis of the fetus to the long axis of the women, what are the variations?
Longitudinal Lie– Either the head or the butt of the fetus enters the pelvis first

Transverse Lie – Long axis of fetus at right angle to moms long axis

Oblique Lie – Same angle between Longitudinal and transverse
Fetal attitude is The relation of fetal body parts to one another.
Normal is flexion with head flexed toward the chest and the arms and legs flexed over the thorax. The back is curved in a convex C shape.
• Flexion is Normal
• Extension is Abnormal
Fetal presentation

The fetal part that first enters the pelvis is the presenting part. Presentation falls into 3 categories:
• Cephalic (most common) Has four variations:
o Vertex, Military, Brow, and Face

• Breech (Associated with prolonged labor, likely to require C-section) Has 3 variations:
o Frank, Full, and Footling

• Shoulder (Associated with prolonged labor, likely to require C-section)
What is the importance of fetal position/presentation?
The position is the relation of a fixed reference point on the fetus to the quadrants of the maternal pelvis and the presentation is the fetal part/presenting part that enters the pelvic inlet (presenting part). The fetal position is not fixed but changes during labor as the fetus moves downward and adapts to the pelvic contours. Abbreviations indicate the relationship between the fetal presenting part and maternal pelvis. The first letter describes whether the fetal reference point is to the Right or Left of the mother’s pelvis. If neither, the letter is omitted. The second letter of the abbreviation refers to the fixed fetal reference point (varies with presentation). The third letter describes whether the fetal reference point is in the anterior or posterior quadrant of the mother’s pelvis, if neither, it is described as transverse.
Right, Left or Omitted (R, L)
Occiput, Mentum, or Sacrum (O,M,S)
Anterior, Posterior, or Transverse (A,P,T)
How can nursing measures help increase a woman’s sense of control during labor?
The nurse’s supportive attitude strengthens positive psychological elements (psyche) and enhances the processes of birth. The nurse can act as an advocate for the laboring woman and her support person to increase their sense of control and mastery of labor, which often reduces anxiety and fear and helps them achieve their desired birth experience.
Descent
Mechanism of labor that accompanies all others, without decent, none of the other mechanisms will occur. Decent describes the descent of the fetal presenting part through the true pelvis
Engagement
engagement of the fetal presenting part as its widest diameter reaches the level of the ischial spines of the mother’s pelvis
Flexion
flexion of the fetal head allows the smallest head diameter to align with the smaller diameters of the midpelvis as it descends
Internal rotation
occurs to allow the largest fetal head diameter to align with the largest pelvic diameters
Extension
extension of the fetal head as the neck pivots on the inner margin of the symphysis pubis, allowing the head to align with the curves of the pelvic outlet
External rotation
external rotation of the fetal head allows for aligning of the head with the shoulders during expulsion
Expulsion
expulsion refers to expulsion of the fetal shoulders and fetal head
Labor is divided into _____ stages. The first stage has 3 phases (Latent, Active, and Transition).
4 Stages
• First Stage of Labor

(Effacement and Dilation of Cervix)
Latent
Contractions (mild and infrequent progresses to moderate strength)
Dilation (0-3 cm)

Active
Contractions (increase in frequency duration and intensity)
Dilation (4-7 cm)

Transition
Contractions (strong)
Dilation (8-10 cm)
Second Stage of Labor

(Expulsion of Fetus)
o Dilation (10 cm)
o Contractions (Maybe slightly less intense during transition phase of first stage; may briefly pause as second stage begins.
o Nullipara (Avg 50 mins)
o Multipara (Avg 20 mins)
Third Stage of Labor

(Separation of Placenta)
o Uterus Firmly Contracted
o 5-10 minutes up to 30 minutes for both
Fourth Stage of Labor

(Physical recovery and bonding with Newborn)
o Uterus Firmly Contracted
o 1-4 hours after birth
What is the nurse’s role in each stage of labor?
The nurse’s role during labor includes pain management measures to promote comfort and specific measures to relieve pain such as breathing techniques and meditation. Ordinary measures reduce irritating surroundings that impair woman’s ability to relax and use coping skills.
List two signs that suggest that the placenta has separated

(Abruptio Placentae)
Depending on the location and amount of separation, vaginal bleeding varies in amount (scant to heavy) and color (bright to dark red). Light vaginal bleeding does not necessarily indicate a minor problem. In some cases, a large amount of blood can be pooled between the placenta and the uterine wall, resulting in little or no vaginal bleeding.

Uterine tenderness or pain. The uterus may feel hard or rigid (localized at the site of abruption).
Why is it important that the uterus remain firmly contracted after birth?
Because the relaxed muscle fibers allow rapid bleeding from the endometrial arteries at the placental site. Bleeding continues until the uterine muscle fibers contract to stop the flow of blood.
List some important nursing assessments after the membranes rupture.

Describe normal and abnormal findings.
FHR assessed for 1 minute after spontaneous rupture. Umbilical cord could be displaced in a large fluid gush, resulting in compression and in interruption of blood flow through it (prolapsed cord)

Fluid should be clear, may include bits of vernix. Cloudy, yellow, and foul smelling fluid suggests infection; green fluid indicates that the fetus has passed meconium.

Quantity should be described in approximate terms; “large” is more than 1000 mls and scant is a trickle.

Several maternal assessments also relate to the health of the fetus, such as vital signs and contractions.
What are Leopold’s maneuvers?
Leopold’s maneuvers provide a systematic method for palpating the fetus through the abdominal wall during the latter part of pregnancy.

These maneuvers provide valuable information about the location and presentation of the fetus.
Describe fetal nursing assessments associated with oxytocin infusion.

What are signs of problems?
FHR and Fetal heart pattern every 15 minutes during first stage and every 5 minutes during second stage of labor

• Nurse remains alert for fetal heart patterns that suggest reduced placental exchange secondary to hypertonic contractions, examples are:
o Fetal bradycardia, tachycardia, late decelerations, and decreased FHR variability
Describe maternal nursing assessments associated with oxytocin infusion.
• Uterine activity for Hypertonus (contributes to rupture)
• Contractions for frequency, duration, and intensity
• Uterine resting tone is assessed for relaxation of at least 30 seconds
• Uterine activity observations are charted at the same intervals as the FHR
• BP and P are taken every 30 mins or with each dose change, temp checked every 2-4 hrs to ID infection
• Stimulated contractions often increase in intensity more quickly so pain management should be assessed frequently
• Recording Intake and Output identifies fluid retention, which may precede water intoxication
List nursing interventions if fetal or maternal assessments are not reassuring when oxytocin induction or augmentation of labor is being done.
If nonreassuring patterns occur in the fetus or contractions are hypertonic in the mother, the nurse takes steps to reduce uterine activity and increase fetal oxygenation.
o Reduce or stop the oxytocin infusion and increase the rate of the primary nonadditive infusion
o Keep the woman in a nonsupine position (sidelying) to prevent aortocaval compression and increase placental bloodflow
o Give 100% oxygen by facemask at 8-10 L/min to increase the women’s oxygen saturation, making more available to the fetus
o Doctor may order a drug to reduce uterine activity, such as terbutaline and magnesium sulfate
Nonstress test
A method for evaluating fetal status during the antepartum period by observing the response of the fetal heart rate to fetal movement indicating adequate oxygenation.

If fetal heart does not accelerate with movement fetal hypoxia and acidosis are concerns.
Epidural block or sedative
Epidural block is a popular regional block that provides analgesic and anesthesia for labor and birth without sedation of the woman and fetus

Used for both vaginal and cesarean births
Tocolytic drug
Drug that inhibits uterine contractions
Rh immune globulin
Given to Rh- moms who are carrying an Rh+ fetus and who subsequently become pregnant to prevent maternal antibodies from attacking fetal RBC’s.
Electronic fetal monitoring
Consists of the bedside monitor unit and sensors for FHR and uterine activity

Sensors for each function maybe either internal or external

It processes the information and provides output in the form of a numeric display and a printed strip

Data about FHR and uterine activity are printed on a paper strip having a horizontal grid for the FHR and another for the uterine activity
How many points are given in each area of the Biophysical profile?

What are the components of a Biophysical profile?
2 POINTS PER COMPONENT

•Fetal Breathing Movements
>1 lasting >30 sec within 30 min

•Gross Body Movements
>3 in 30 min (body or limb)

•Fetal Tone
>1 episode of extension of extremity w/ rtn to flexion or opening or closing of hand

•Amniotic Fluid Volume
>2cm single vertical pocket

•Nonstress Test
>2 accelerations of >15 BPM for >15 sec in 20-40 mins
Explain the rationale for the intervention associated with cesarean birth:

Maintaining NPO status
Risk for aspiration with anesthetic
Explain the rationale for the intervention associated with cesarean birth:

Placing a wedge under one hip
To displace uterus laterally to prevent compression which causes decreased placental perfusion
Explain the rationale for the intervention associated with cesarean birth:

Complete blood count, coagulation studies, blood type and crossmatch
Ordered to establish baseline data and to compare and contrast mom and baby’s blood types, It is possible that an emergency could occur and a transfusion might required
Explain the rationale for the intervention associated with cesarean birth:

Intravenous antibiotics
Prophylaxis and the postoperative mother is at risk for infection
Explain the rationale for the intervention associated with cesarean birth:

Indwelling catheter
keeps the bladder empty to prevent unnecessary pain, urinary status, and infection
What is an episiotomy and describe the care/teaching the patient will need?
Episiotomy is an incision of the perineum to enlarge the vaginal opening.

The patient will need self-care measures such as sitz baths, perineal care, use of topical anesthetics, cooling astringent pads, and ordered analgesics to help make physical activity or bowel elimination easier during the postpartum period.
Describe postpartum changes in the uterine muscle
The uterine muscle goes through Involution postpartum and depends on 3 processes:

1) Contraction of muscle fibers
2) Catabolism
3) Regeneration of uterine epitelium
What is lochia and how does it change during post-partum (color, amount etc….)?
Lochia is vaginal drainage after birth

Lochia begins as Lochia Rubra (reddish vaginal discharge that occurs immediately after childbirth;

changes to lochia serosa (pink or brown-tinged vaginal discharge that follows lochia rubra and precedes lochia alba);

changes to Lochia Alba (white or cream-colored vaginal discharge that follows lochia serosa. Occurs when the amount of blood is decreased and the number of leukocytes is increased).
What are normal findings during a post-partum assessment (vital signs)?
Vital Signs

BP 120/80
P 60-90
RR 12-20
T up to 100.4 (common up to 24h after birth)
What are some normal and abnormal findings during a post-partum assessment (Fundus)?
Normal – Firmly contracted, level of umbilicus, midline

Abnormal – Boggy, above umbilicus, displaced from midline
What are some normal and some abnormal findings during a post-partum assessment (Bladder)?
Normal – Clear, yellow, odorless urine with unobstructed flow. 2-3 voidings after birth or removal of a catheter. Voidings of 300 to 400mls each.

Abnormal – Bulging bladder above symphysis, frequent voidings of <150mls which may indicate retention, bladder discomfort
What are some normal and some abnormal findings during a post-partum assessment (Breasts)?
Normal – soft, nontender

Abnormal – engorgement, dimpling, thickening, flat or retracted nipples
What are some normal and some abnormal findings during a post-partum assessment (Lower Extremities)?
Normal – Palpable pedal pulses

Abnormal – redness, heat, edema, tenderness
What are causes of early and late post-partum hemorrhage?
• EARLY – 2 major causes are uterine atony and trauma to the birth canal during labor and delivery. Hematomas and retention of placental fragments are other causes.

• LATE – most common causes are subinvolution (delayed return to non-pregnant size and consistency) and fragments of placenta that remain attached to the myometrium when the placenta is delivered.
What are the benefits of breast feeding for the infant?
o Does not cause allergic reaction
o Species specific (meets nutritional needs)
o Nutritional and immunological needs change according to need
o Easily digested and absorbed
o Protein, fat, and carbs occur in most suitable proportions
o Improper dilutions not possible
o Contamination not possible
o Less likely to result in overfeeding
o Unlikely to cause constipation
What are the benefits of breast feeding for the mother?
o Enhances uterine involution
o Loses less blood due to delayed return of menses
o More likely to rest while breastfeeding
o More likely to eat a balanced meal while breastfeeding
o Enhancing bonding
o Convenient, economical
o Infant less likely to be ill, reducing medical care costs
o Traveling is easier
o May reduce risk of some cancers
What nursing measures help the mother cope with breast engorgement?
Teach her about the application of cold packs after feedings to reduce edema and pain.

Heat can be applied just before feedings to increase vasodilation and milk flow. Massage of the breasts causes release of oxytocin and increases the speed of milk release.

A well-fitting bra may be worn both day and night to help support the breasts.

If the areola is too engorged for the infant to compress it the nurse should help the mother express milk by hand or with a breast pump to soften to areola.

Mothers with engorgement may need medication for discomfort so that they can relax while breastfeeding. (Acetaminophen, ibuprofen)
What are some of the expected maternal behaviors the nurse is assessing for during the postpartum period?
Attachment, Bonding, Enface, Engrossment, Entrainment, Fingertipping, Letting-Go, Reciprocal Bonding Behaviors, Taking-hold, Taking-In
What is the significance of the APGAR?

What does the score mean to the nurse?
The Apgar score is a method for rapid evaluation of the infant’s cardiorespiratory adaptation after birth.

The nurse scores the infant at 1 and 5 minutes in each of 5 areas. The assessments are arranged from most important (heart rate) to least important (color). The infant is assigned a score of 0 to 2 in each of the 5 areas and the scores are totaled.

Resuscitation should not be delayed until the 1-minute score is obtained. However, general guidelines for the infants care are based on three ranges of 1-minute scores.

<4 Resuscitation may be needed
5-7 need for stimulation
8-10 satisfactory adaptation
Identify some characteristics that predispose newborns to heat loss

What are nursing interventions that can be implemented to prevent heat loss?
Thin skin, vessels close to the surface, little subcutaneous or white fat is present to serve as barrier to heat loss. Heat is transferred from the warmer internal areas of the body to the cooler skin surfaces to their surrounding area (loss by evaporation).

• Immediately dry newborn
• Place baby in radiant warmer
• Place cap on newborn to prevent loss though head
• Place towel on scale to prevent heat loss to cooler surface
• Place baby skin to skin with mother
Cold stress causes many body changes
The increase metabolic rate and metabolism of brown fat that results from cold stress increase the need for oxygen.

Glucose is also necessary in larger amounts when the metabolic rate rises to produce heat when glycogen stores are converted to glucose, they may be quickly depleted, causing hypoglycemia. Infants who use glucose for temperature maintenance have less available for growth.

Putting it together

Metabolism of Brown fat and of glucose in the presence of insufficient oxygen causes increased production of ACIDS.

Elevated Fatty Acids in the Blood stream can interfere with transport of bilirubin in the liver, increasing the risk of Jaundice.
The normal values for fetal erythrocytes, hemoglobin and hematocrit.
HCT - Normal Newborn Range: 49 - 61

HGB - Normal Newborn Range: 14 - 20

RBC – Normal Newborn Range: 5.8
What is a meconium stool and when should the baby have one?
Meconium is the first stool excreted by the newborn. It consists of particles from amniotic fluid, such as vernix, skin cells, and hair, along with cells shed from the intestinal tract, bile, and other intestinal secretions.

The baby usually has the first one within 12 hours of birth, but 99% have the first stool within 48 hours.
When should you expect a newborn to void after delivery?
After birth, the newborn will usually urinate within the first 24 hours of life
What are normal vital signs for a neonate?
Apical Pulse
120-160 beats/minute
(100 sleeping) (180 crying)

Respirations
30-60 breaths/minute

Temperature
97.7-99.5 F Axillary
What are the Normal newborn measurements at term?

Head, Chest, Length, Weight
Head 13-14 inches

Chest 12-13 inches

Length 19-21 inches

Weight 7.5 pounds
Moro Reflex
Let infants head drop back approx. 30 degrees

Sharp extension and abduction of arms w/ thumbs and forefingers in C position. Followed by flexion and adduction to “embrace” position. Legs follow similar pattern

Absent: CNS dysfunction.
Asymmetry: brachial plexus injury, paralysis, or fractured bone or extremity.
Exaggerated: maternal drug use

6 months
Rooting Reflex
Touch or stroke from side of mouth toward check

Infant turns to side touched. Difficult to elicit if infant sleeping or just fed.

Weak or absent: prematurely, neurologic deficit, depression from maternal drug use

3-4 months
Sucking Reflex
Place nipple or finger in mouth, rub against palate

Infant begins to suck. Weak If recently fed.

Weak or absent: prematurity, neurological deficit, maternal drug use.

Disappears by 1 year
Swallow Reflex
Place fluid on the back of the tongue Infant swallows fluid. Should be coordinated with sucking.

Coughing, gagging, chocking, cyanosis: tracheoesophageal fistula, esophageal atresia, neurologic deficit.

Present throughout life.
Palmar Grasp Reflex
Press finger against base of finger Fingers curl tightly

Weak or absent: neurologic deficit or muscle damage

Lessons by 3 months
Plantar Grasp Reflex
Press fingers against base of toes Toes curl forward

Weak or absent: neurologic deficit or muscle damage

Lessons by 8 months
Babinski Reflex
Stroke lateral sole of foot from heel to across base of toes
Toes flare with dorsiflexion of the big toe

No response, Bilateral: CNS deficit. Unilateral: local nerve damage.

12 months
What is the normal blood sugar for a neonate?
Normal blood glucose during first day of life is 40-60 and 50-90 there after
Describe the different types of jaundice in a neonate.

What are some nursing interventions to address this diagnosis?
Jaundice in newborns is caused by Physiological Jaundice or Breast feeding Jaundice.

Physiologic jaundice develops between 1 and 5 days after birth because baby’s organs are not yet able to get rid of excess bilirubin effectively.

Breast feeding Jaundice is caused by mild dehydration which prolongs and intensifies physiologic jaundice. Dehydration contributes to jaundice because it makes removing bilirubin from the body even harder for babies immature systems.

A baby is less likely to develop significant breastfeeding jaundice when fed frequently. Frequent feeding increases the production of colostrum and breast milk which ensures that bay gets enough nutrition and fluid to get rid of the extra bilirubin.

Nurses can wake sleepy babies to feed and instruct moms to feed wit in 12 hours of birth and every 2-3 hours thereafter.
What is Preeclamsia?

What are some Nursing Interventions?
A condition in which HTN develops during the last half of pregnancy in a woman that previously had normal BP. In addition to HTN, renal involvement may cause proteinuria, may also experience generalized edema. Only known cure is delivery.

Interventions:
• Daily weights
• BP
• RR, Pulse Ox
• Breath sounds
• Deep tendon reflexes
• Edema
• I&O’s
• Urine protein
• LOC
• Epigastric pain, visual problems
• Fetal HR, baseline variability
• Laboratory data
What is Eclampsia?

What are some Nursing Interventions?
Eclampsia is a Progression of preeclampsia to generalized seizures that cannot be attributed to other causes

Nursing Interventions:
• Perform actions that minimize the risk of seizures and prevent injury if seizure should occur
• Monitor for signs of impending seizures
• Consult with the physician if signs of impending seizure are observed
• Support the family of the women with eclampsia
Placenta Previa

Placenta location
Character of bleeding
Presence of pain
Uterine activity
Diagnosis
In the lower uterus – depends on how much of the internal os is covered by the placenta (total, partial, or marginal)

May be scanty or profuse and may be spontaneously, only to reoccur later. Bleeding may not occur till labor starts when cervical changes disrupts placental attachment

None

Placenta is implanted low in uterus

Ultrasound
Abruptio Placentae

Placenta location
Character of bleeding
Presence of pain
Uterine activity
Diagnosis
In normal location

Vaginally or may be concealed

May be sudden and severe when bleeding occurs into the uterine muscle or it is intermittent and difficult to distinguish from labor contractions

Blood clot is formed on the maternal side of the placenta (may be apparent or concealed), may become board like and tender making palpation of the fetus difficult.

Ultrasound (but may not always be evident on Ultrasound)
What are some nursing interventions associated with placenta previa?
•Assess Vital signs
•Maintain bed rest or chair when indicated
•Provide frequent rest periods and uninterrupted night sleeps
•Monitor amount and types of bleeding
•Position mother on her Left side
•Restrict vaginal Exams
•Monitor uterine contractions and fetal heart rate by external monitor
•Maintain positive attitude about fetal outcome
•Administer 02 as indicated
What are some nursing interventions associated with abruptio placentae?
•Monitor amount of bleeding by weighing all pads
•Investigate pain reports, noting location, duration, intensity (0-10 scale) and characteristics (dull, sharp, constant)
•Monitor maternal vital signs and fetal heart rate through continuous monitoring
•Measure and record fundal height
•Position mother in the Left Lateral position, with the HOB elevated
•Provide comfort measures like back rubs, deep breathing, instruct relaxation or visualization exercises. Provide diversional activities.
•Administer 02 as indicated
Describe how diabetes impacts pregnancy

(Major effects of Diabetes Mellitus on Pregnancy): Increased maternal risk -
HTN
preeclampsia
UTI’s
ketoacidosis (both mom and baby) labor dystocia
c-section birth
uterine atony with hemorrhage after birth
birth injury to maternal tissues (hematoma, lacerations).
Describe how diabetes impacts pregnancy

(Major effects of Diabetes Mellitus on Pregnancy): Increased fetal risk -
congenital anomalies
perinatal death
macrosomia
intrauterine fetal growth restriction
premature labor
premature rupture of membranes
premature birth
birth injury
hyperglycemia
polycythemia
hyperbilirubinemia
hypocalcemia
respiratory distress syndrome
What is the care for a mom that develops gestational diabetes?
• Diet
• Exercise
• Blood Glucose Monitoring
• Fetal Surveillance
• Insulin Administration if Prescribed
How is gestational diabetes diagnosed?
• Screened by identification of a history or risk factors that are consistent for GDM or by blood glucose testing

• Glucose Challenge Test (GCT) 24-28 Weeks

• OGTT (More Advanced Test) - Fasting, 1hr, 2hr, 3hr
What is the care for a mom that is HIV positive?
To reduce the vertical transmission of the virus to the infant, zidovudine (ZDV) is recommended for the pregnant who are HIV-positive.
What are the care considerations for her infant based on the mother's diagnosis of HIV?
A slight anemia appears to be the main adverse effect for the baby

The HIV virus has been found in breast milk so although breast milk is usually ideal for infants, formula is best in this case.

Nurses need to respond honestly that testing will be required but most infants do not get the virus if the medication regimen is followed carefully.

Nurses must reinforce information about medications that both slow the progression of the disease for the mother and decrease the incidence of the vertical transmission.
How can toxoplasmosis be prevented?
PREVENTION:
•Cook meats thoroughly
•Avoid touching mucous membranes of the mouth and eyes while handling raw meats
•Wash all kitchen surfaces that come in contact with uncooked meat
•Wash the hands thoroughly after handling raw meat
•Avoid uncooked eggs and unpasteurized milk
•Wash fruits and vegetables before consumption
•Avoid contact with materials that are possibly contaminated with cat feces (such as cat litter boxes, sand boxes, garden soil)
What are the fetal and neonatal effects of Group B streptococcus infection?
(This disease can be life threatening without prompt treatment)

• Sepsis
• Hypoglycemia
• Pneumonia…Respiratory failure
• Meningitis

*Permanent neurological consequences are more likely in infants who survive meningeal infections
Identify and explain the essential components of a post-partum assessment. (BUBBLE)
BREAST: gentle palpation – soft, non-tender

UTERUS: for consistency and location, should be firmly contracted and at or near the level of the umbilicus

BOWEL: bowel sounds, are they sluggish? Reduced muscle tone?

BLADDER: bladder distended? Increased lochia? Displaced uterus? Retention? Should be non-palpable.

LOCHIA: amount, color, and odor

EPISIOTOMY/EXTREMITIES/EMOTIONS/EDUCATION:
Episiotomy –REEDA (redness, edema, ecchymosis, drainage, approximation)
Extremities- swelling, edema, homans?
Emotions – Post-partum, Bonding?
Education – Teaching
Where does newborn jaundice first appear?

How would the nurse know that the newborn he/she is taking care of jaundice is so bad that the baby will need phototherapy (bilirubin level greater than what)?
Jaundice first appears in the face of the newborn (the eyes).

Phototherapy may be considered if the TSB exceeds the 95th percentile for the infant's age. This is approximately 8mg/dl at 24 hours, 13 mg/dl at 48 hours, and 16 mg/dl at 72 hours.
Hepatitis B During Pregnancy
If you test positive for hepatitis B, your newborn will be given two shots immediately after birth: the first dose of the hepatitis B vaccine (which is routine at birth anyway) and one dose of the hepatitis B immune globulin (HBIG). If these two medications are given within the first 12 hours of life, a newborn has more than a 90 percent chance of being protected against a lifelong hepatitis B infection.

The second dose of vaccine should be given at one to two months of age and the third dose at six months of age (again, these are routine immunizations).

If you know you're infected, you should not breastfeed your baby since hepatitis B can be passed along in breast milk.
Symptoms of hepatitis B include:
• jaundice (yellow skin or eyes)
• fatigue
• abdominal pain
• nausea, vomiting, loss of appetite
• one-third of infected people will show no symptoms
Mongolian Spots
Deep blue pigments on back and buttocks (usually not found on Caucasians)
Stork bites
Back of neck, eye lids, or between eye brows (No need to treat)
Caput succadaneum
(pressure on head during birth)
common scalp lesion
swelling extends beyond the bone (Crosses suitors)margins
(no treatment needed)
goes away in a few days
Cephalolhematoma
(caused by head pushing on cervix)
Forms when blood vessels rupture during delivery and most often associated with vaccum assisted delivery.

Swelling minimal at birth and increases in a day or 2.

Does not extend beyond the limits of the bone.

No treatment needed - 2-3 weeks to resolve
Milia
Cause by distended subatious glands

Seen on nose, chin, and forehead
Caput succedaneum should be reported to the doctor?
No
Rales are commonly heard, particularly if a newborn was delivered by c-section.
True
Fracture of clavicle is the most common birth injury
True
Factors that may slow involution after delivery:
Prolonged labor (excessive anesthesia)
Rapid or difficult delivery
Pelvic Infection
Grand multiparity
Full bladder
Incomplete expulsion of the placenta
What could be the cause of increased pulse and decreased BP postpartum?
Hemorrhage
Formula for working out flow rates
Volume (ml) x Drop Factor (drops/ml)/Time (min) = gtts/min

V x DF / T = gtts/min
How to calculate Fluid dosages

(oral, IM, IV, SQ)

UNITS for required dose and stock dose must be the same!
Dose ordered / Dose on hand x stock volume = volume to be given

DO / DOH x Stock Vol = Vol to b Given
How to calculate tablet dosages

Units for required dose and stock dose must be the same
Dose ordered / Dose on hand = #tabs

DO / DOH = #tabs
How to calculate flow rate when using a pump
Volume (ml) / Time (hr) = ml/hr

V / T = ml/hr
Calculating the total time of an infusion
Volume (ml) x DF (gtt/ml) / Rate (gtt/min) = Time (min)

V x DF / R = T (min)

Divide time by 60 to get hours
Colasma
Mask of Pregnancy
Abdominal wall changes in Pregnancy
Muscle changes d/t pressure of enlarging uterus - can cause diastase rectis (separation of stomach muscles)
Normal weight gain in pregnancy?
25-35 pounds, if started out at normal weight
Pregnancy Symptoms (the 3 P's)

Presumptive
Probable
Positive

List the Presumptive signs:
Amenorrhea
Morning sickness
Breast tenderness
Urinary frequency
Fatigue
Quickening
Pregnancy Symptoms (the 3 P's)

Presumptive
Probable
Positive

List the Probable signs:
Physical changes of the uterus
(Abd enlargement, cervical softening, ballottment)
Braxton hicks contractions
Positive Pregnancy Test
Pregnancy Symptoms (the 3 P's)

Presumptive
Probable
Positive

List the Positive signs:
Fetal Heart Tone
Palpable Movement by Doc
Visible Movement by Doc
Ultrasound Confirmation by Doc
Probable signs of pregnancy include the following signs (define them):

Hegar sign
Chadwick sign
Goodell sign
Hegar - softening of lower uterine segment

Chadwick - color chg of vagina

Goodell - softening of cervical lip
List some Warning Signs during pregnancy that need to be reported:
Vaginal bleeding
Leakage of fluid from vagina
Fevers
Abd pain
Persistent vomiting
Blurred vision
Severe HA
Epigastric Pain
Number of Pregnancies and the outcomes of those pregnancies (GTPAL)
G - # of Pregnancies
T - # of Term Pregnancies (>37)
P - # of Preterm Pregnancies (20-37wks)
A - # or Abortions
L - # of Living Children
What test is performed at 28 weeks gestation?

What is given at 28 weeks gestation, if necessary (based on mom's blood type)?
GTT (glucose tolerance test

RhoGAM to Rh-negative women
When is the Group B Streptococcal infection (GBS) test performed on pregnant women?

When is it treated?
36 weeks

Treated after admitted to the labor and delivery unit for child birth
Define Ectopic Pregnancy

What are the risk factors for ectopic pregnancy?
Ectopic Pregnancy is any pregnancy outside of the uterus.
Ectopic pregnancy usually occurs in the outer 1/3 of the fallopian tube

PID, infertility, tubal ligation, reversal of tubal ligation, and smoking
Use of an IUD, low progesterone levels, multiple elective abortions, and previous ectopic pregnancies
Signs and symptoms for Ectopic Pregnancy

Medical Management

Nursing Implications
Before Rupture - Missed Period, Abd pain, tenderness, and fullness, and dark red vaginal bleeding
After rupture - Abd pain, syncope, shoulder pain, shock out of proportion to the noted blood loss, cullen sign

Testing (blood-work, Ultra Sound)
Can be surgical or non surgical

Assess abd for pain, type, location, intensity, and amt and type of vaginal bleeding
Monitor VS, menstrual pad count, and syncope
Control Pain
Obtain labs
Prepare for surg/post op procedures
What is HELLP Syndrome?

This happens in severe preeclampsia. Recognition is important because only cure is delivery...Can have hellp without HTN and proteinuria.

Symptoms of HELLP?
H - Hemolysis
E - Elevated
L - Liver Enzymes
L - Low
P - Platelets

Symptoms:
RUQ Epigastric Pain
N&V
HA
Elevated BP
Flulike sumptoms
Biophysical Profile Score
Fetal breathing
Gross Body Movement
Fetal Tone
Normal Amniotic Fluid Volume
NST reactive heart rate
Apgar Score (0,1,2) Max score of 10

Done at 1 and 5 minutes...

Heart Rate
Respiratory Rate
Muscle tone
Reflex Irritability
Color

Max scores for each area are:
Heart Rate >200 = 2
Resp Rate Good Cry = 2
Muscle Tone Well Flexed = 2
Reflex Irritability Cry = 2
Color Pink = 2
What is Rh incompatibility (also referred to as isoimmunization)?

When is RhoGAM given?
Rh incompatibility occurs when an Rh-negative mother has an Rh-positive fetus

An Rh-negative fetus is in no danger because the fetus is the same Rh factor as the mother

Only the Rh-positive fetus of the Rh-negative mother is at risk

RhoGAM is given at 28 weeks gestation and within 72 hours of giving birth.
What are symptoms of Respiratory Distress Syndrome (RDS)?

Occurs most often in premature infants r/t deficiency in surfactant production to lubricate the lungs.
Retractions
Grunting
Nasal Flaring
Infants of Diabetic Mothers need frequent Blood Sugar Tests, the first one should be done...

What is the normal BS for a newborn?
Within 30 minutes of birth

40-60
When and why is an Amniocentesis done?
15 to 20 Weeks gestation

Chromosomal Information
When and Why is Chorionic Villus Sampling Done?
10-12 Weeks

To detect congenital anomalies and problems
When is the GTT (Glucose Tolerance Test) done?
20-24 weeks
What medication is used to treat Eclampsia?
Mag Sulfate
Name 4 Hemorrhagic Conditions of Early Pregnancy:
ABORTION

DIC

ECTOPIC PREGNANCY

GESTATIONAL TROPHOSBLASTIC DISEASE
What are all the types of Abortions? Define them.
Spontaneous - Before 24 weeks

Threatened - Mild cramping/bleeding (cervix still closed)

Inevitable - Cramping Bleeding (Cervix opened)

Incomplete - Bleeding (passes somethg but somethg remains in uterus)

Complete - Bleeding (Passes everthg)

Missed - Fetus detected but no heaertbeat

Recurrent spontaneous - More than 2 early pregnancy losses
What is Disseminated Intravascular Coagulation (DIC) in pregnancy?
When a woman uses up all of her clotting factors (oozing)
What is Gestational Trophoblastic Disease?
Empty Sac, No fetus, Molar Pregnancy - Uterus is growing, looks pregnant further than should be...

Passes grape like clusters and brown blood
Vitamin K (Aquamephyton) 1 mg. IM x1 is given within 1 hour of birth to newborn babies for
Prevention of hemorrhagic disease of the newborn
What is the use of Terbutaline sulfate
0.25 mg subcutaneously (discuss off-label use as a tocolytic, not as an asthma medication)
Stops Premature Labor, reduce or stop hypertonic labor contractions, whether natural or stimulated

Hold if pulse >120 bpm
What is the use for Procardia (nifedipine) 10-20 mg q4-6 h prn (discuss use as tocolytic NOT antihypertensive)
Preterm Labor

Watch for maternal pulse rate greater than 110
What is Magnesium Sulfate
4-6 gram bolus, then
1-2 Grams/hour continuous IV used for?
Prevention and control of seizure in severe preeclampsia. Prevention of uterine contractions in preterm labor.
Rubella Virus Vaccine is given after birth of the baby for what?
Immunization from rubella virus

Do not become pregnant for at least 4 weeks after vaccination