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174 Cards in this Set
- Front
- Back
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Presumptive signs of pregnancy
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Amenorrhea
Fatigue Nausea and vomitting Urinary frequency Darkening areola Quickening Uterine enlargement Linea Nigra- line on stomach darkens Chloasma-pigmentation increases on face Striae gravidarum |
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Probable signs of pregnancy
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Ab enlargement
Cervical changes Hegar's sign - softening of lower uterus Chadwick's sign - deep violet color of vagina Goodell's sign - softening of cervical tip Ballottement - rebound of engaged fetus Braxton Hicks Positive pregnancy test Fetal outlne felt by examiner |
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What does GTPAL stand for?
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Gravidity
Term births Preterm birth Abortion or miscarriages Living Children |
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What happens to vital signs during pregnancy
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Blood pressure decreases 5 to 10 mm Hg in the second trimester
Pulse increases 10 to 15/min Respirations increas by 1 to 2/min |
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Formula to Calculate the delivery date
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1st day of last period subtract 3 months then add 7 days and 1 year
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Danger signs of pregnancy
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Gush of fluid from vagina
Vaginal bleeding Ab pain Decreased fetal movement Persistant vomitting Severe headache Elevated temp Dysuria Blurred vision Edema of face and hands Epigastric pain Hyperglycemia Hypoglycemia |
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Recommended weight gain during pregnancy
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Is between 25 to 35 lbs
3 to 4 lbs during the first trimester and 1 lb a week in the last two trimesters |
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Recommended increase in calories
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Increase by340 calories/day during 2nd trimester
Increase by 450 calories/day during 3rd trimesters Increase by 330 calories/day for first 6 months of breastfeeding |
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Foods high in folic acid
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Leafy vegetable
Dried beans and seeds Orange juice Breads, cereals and other grains that are fortified |
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Iron is best absorbed __.
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Between meals and with vitamin C
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What foods interfere with the absorption of supplements?
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Milk and caffeine
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Good source of iron
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Liver, red meats, fish, poultry, bens, and fortified grains.
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Risk factors to adequate nutrition
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Adolescents
Vegetarians Nausea and vomitting Anemia Eating disorders Excessive weight gain Inability to gain weight Finance problems |
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What are good sources of calcium?
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milk
soy milk fortified orange juice legumes nuts dark green leafy vegetable |
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Why is an increase in folic acid recommended?
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It is crucial for neurological development and the prevention of neural tube defects
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Suggestions for nausea and vomitting
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Eat cracker or dry toast before getting out of bed.
Avoid an empty stomach and spicy, greasy, or gas forming foods |
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Sugesstions for breast tenderness
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Supportive bra
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Suggestions for heart burns
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East small frequent meals, Sit up for 30 min after meals
No empty stomach |
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Suggestions for hemorrhoids
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Warm sitz bath
Witch hazel pads Topical ointments |
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Suggestions for backaches
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Side lying positions
Regular exercise Perform pelvic tilt exercise Proper body mechanics |
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Suggestions for leg cramps
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Massage and apply heat over the affected muscle or a foot masssage while leg is extended
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AFP alpha fetoprotein
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can be measured from the amniotic fluid between 16 and 18 weeks to determine any neural defets or chormosomal disorders
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High levels of AFP
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are associated with neural tube defect such as anencephayly or spina bifida
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Low levels of AFP
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are associated with chromosomal disorders like downs syndrome or gestational trophoblastic disease
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Fetal lung tests
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L/S ratio of 2:1 or Presence of PG
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five variables that a BPP measures
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Fetal breathing
Tone Reactive FHR Amniotic fluid volume Gross body movements |
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If NST is nonreactive....
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anticipate a CST and/or BPP
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When is immune globulin (RhoGAM) indicated?
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When the mother is RH-negative and baby if RH-positive
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Nursing care for spontaneous abortion
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-Avoid vaginal exam
-Place client on bedrest -Save tissue passed -Use lay terms like miscarriage -Perform a pregnancy test -Observe bleeding amount and color |
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Causitive Factors for spontaneous abortion
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-Chromosomal abnormalities
-Maternal Illness -Advance age -Premature cervical dilation -Chronic maternal infection -Trauma or injury -Abnormalities of fetus or placenta -Substance abuse |
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Signs and symptoms of spontaneous abortion
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bleeding, uterine cramping, expulstion of tissue, backache, fever, dilation of cervic
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What is spontaneous abortion?
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Pregnancy terminated before 20 weeks
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discharge instructions for spontaneous abortion
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-Avoid vaginal exam
-Take antibiotics -No sex for 2 weeks -Call provider if heavy, bright red blood -Might have discharge for 1 to 2 weeks -Avoid pregnancy for 2 months |
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What is ectopic pregnancy?
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Fertilized ovum is implanted outside of the uterus usually on in the fallopian tube
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Risk factors for ectopic pregnancy
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Anything that blocks tube patency ie IUD or PID
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S & O data for ectopic preg
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-Shoulder pain
-1 or 2 missed periods -Frequent nausea and vomitting -Unilateral stabbing pain and tenderness in lower ab |
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Lab tests for ectopic preg
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Elevated hCG and progesterone
Elevated WBC |
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Surgical care for ectopic preg
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Linear salpingostomy
Laparoscopic salpingostomy (removal of tube) |
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Med for ectopic preg
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Methotrexate used to inhibit cell division and enlargement of the embryo. Prevents rupture of the fallopian tub
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If client is on Methotrexate advise them ...
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-To protect themselves from sun exposure
-Avoid alcohol and vitamins containing folic acide to prevent toxic response |
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Gestational trophoblasstic disease
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trophoblastic villa in the placenta become swollen, fluid filled, and takes on the appearance of grape like clusters
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Risk factors for trophoblastic disease
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Low protein intake
Under 18 Over 35 |
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S & O data for trophoblatic disease
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Vaginal bleeding
Excessive vomiting b/c increase hcg uterine growth larger than expected blood can be bright red and dark brown symptoms of pregnancy induced hypertension |
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How often does the hcg levels have to be tested for someone with trophoblastic disease?
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every 1 to 2 weeks until normal then every 2 to 4 week for 6 months
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Nursing actions for trophoblastic disease
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Measure fundal height
assess bleeding and discharge Assess GI status and appetite Asess the extremities and face for edema |
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Client education for trophoblastic disease
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No pregnancy for 12 months so hcg levels can be monitored
importance of follow ups |
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What is placenta previa?
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The placenta implants at the bottom of the uterus instead of at the top
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Risk factors for placenta previa
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Previous placenta previa
Utering scarring Over 35 Multifetal gestation Closely spaced pregnancies |
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S&O data for placenta previa
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Painless bright red bleeding
Soft, relaxed, nontender uterus Fundal height greater than expected Fetus in brech |
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Medication for placenta previa
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Corticosteriods such as Betamethosone for fetal lung maturity
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Discharge instructions for placenta previa
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Bed rest
No sex |
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What is Abruptio Placenta?
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Premature seperation for the placenta from the uterus after 20 weeks
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Risk factors for Abruptio placenta
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Maternal hypertension
Trauma Cocaine Previous incidents cigarettes Premature rupture of membranes Multifetal pregnancy |
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S&O data for Abruptio placenta
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Sudden onset of intense uterine pain with bright red bleeding
board like ab Rigid uterus with contractions fetal distress signs of hypovolemic shock |
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What is vasa previa?
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the presence of fetal blood vessels crossing the amniotic membranes over
the cervical os |
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S&O data for Vasa Previa
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Painless heavy bleeding upon rupture of membranes
Fetal bradycardia Hgb and Hct decreased |
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Nursing care for Vasa Previa
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Assess bleeding rate, amount, and color.
Administer IV fluids. Administer oxygen 8 to 10 L via face mask. Prepare for an emergency cesarean birth. |
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S&O data for HIV
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Fatigue
Weight loss Anemia Diarrhea |
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Medication for HIV
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Retrovir-an antiretroviral agent
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Timing for administering retrovir
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-Administer retrovir at 14 weeks of gestation, throughout the pregnancy, and before the onset of labor or cesarean birth.
-Administer retrovir to a neonate following delivery and for 6 weeks following. |
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Can clients with HIV breastfeed?
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NO
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TORCH stands for:
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TOxoplasmosis
Reubella Cytomegalovirus Herpes |
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What is TORCH?
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TORCH is an acronym for a group of infections that can negatively affect a woman who is pregnant.
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Toxoplasmosis is caused by...
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Toxoplasmosis is caused by consumption of raw or undercooked meat or handling cat feces.
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Rubella (German measles) is contracted by...
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children who have rashes or neonates who are born to mothers who had rubella during pregnancy.
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The herpes simplex virus (HSV) is spread by...
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direct contact with oral or genital lesions.
Transmission to the fetus is greatest during vaginal birth if the woman has active lesions. |
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Cytomegalovirus (member of herpes virus family) is transmitted by...
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droplet infection from
person to person, a virus found in semen, cervical and vaginal secretions, breast milk, placental tissue, urine, feces, and blood |
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Nursing care for Placenta previa
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Assess for bleeding and contractions
Assess fundal height Perform Leopold maneuvers Refrain from vaginal exam Have o2 available for fetal distress |
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Nursing care for Abruption placenta
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Monitor vitals q 5 to 15 min
Monitor FHR and pattern Observe all area for bleeding q hr Assess for pain, palpate fundal tone and tenderness, and measure girth q hr Maintain lateral position Fluid volume replacement Admin IV Admin oxygen 8 to 10 L C sect reserved for fetal distress |
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Gate control theory
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Suggests that the pathway that pain sensations travel can only hold a limited amount of sensation so by sending other signals through the pathway, the pain sensation can be blocked
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Sensory stimulation strategies
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Aroma therapy
Breathing techniques Imagery Music Use of focal points |
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Cutaneous strategies
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Back rub and massage
Effleurage Sacral counterpressure Heat or cold therapy Hydrotherapy Intradermal water block Hypnonsis Accupressure |
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Reasons why FHR may be tachy during labor:
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Fetal hypoxia
Maternal Fever Meds Infection Fetal anemia Maternal hyperthyroidism |
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Reasons why FHR may be brady during labor:
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Late hypoxia
Meds Maternal hypotension Prolonged umbilical cord compression |
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If FHR variation are absent or undetectable it may be because of:
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Meds
Hypoemia CNS abnormalities Infant sleeping |
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Interventions for absent FHR variation:
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Stimulate the fetal scalp
Assist with scalp electrodes Position client on left side |
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How many beats is considered a moderate amount of variation?
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6 to 25 bpm
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Interventions for late decelerations
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Immediately report
Change maternal position Discontinue oxytocin Increase IV fluids Admin oxygen 8 - 10 L Prepare for C section |
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What are common reasons for accelerations
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Fetal movement
Contractions-response to decreased blood flow |
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What are common reasons for decelerations:
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Vagal response from fetal head compressions during contractions
umbilical cord compressions |
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After a fetal blood sampling, a pH of what is indicative of fetal distress?
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7.20
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What is considered tachy for a fetus?
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> 160 bpm for 10 min
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What is considered brady for a fetus?
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< 110 bpm for 10 min
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What is being assessed during a vaginal exam?
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If membranes are ruptured
Dilation Effacement Fetal station |
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When there is a membrane rupture or suspected what should be done?
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FHR monitored for distress
Nitrazine test Assess the fluid |
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How often for bp, pulse and resp during latent phase?
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q 30 to 60 min
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How often for bp pulse and resp during active phase
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q 30 min
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How often for bp pulse and resp during transition phase?
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q 15 to 30 min
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How often is temp assessed
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q 4 hours or 1 to 2 if membranes have ruptured
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How often to monitor FHR during latent phase?
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q 30 to 60 min
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How often to monitor FHR during transitional phase?
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q 15 to 30 min
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Signs of true labor:
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Contractions are:
Regular in frequency Stronger and more frequent Felt in the lower back and ab Continue despite comfort Progressive dialation and effacement Bloody show Fetus at station 0 |
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First Stage of labor includes:
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Latent, active, and transition stages
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Latent Phase
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Cervix dialates 0 - 3 cm
Frequency q 5 - 30 min Duration 30 to 45 sec |
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Active Phase
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Cervix dialates 4 - 7 cm
Frequency q 3 - 5 min Duration 40 to 70 sec |
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Transition
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Cervix dilates 8 - 10 cm
Frequency q 2 to 3 min Duration 45 to 90 secs Urge to push and increased rectal pressure |
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Second stage of Labor
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Full dilation
Intense contraction q 1 to 2 min Birth |
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Third stage of Labor
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Delivery of placenta
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Fourth stage of labor
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Maternal stabilization of v/s
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Nursing interventions for Fourth stage of labor
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Assess v/s q 15 min
Assess fundus q 15 min Massage the fundus and admin oxytocics to prevent hemorrhage Encourgage voiding Encourage bonding |
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Adverse effects of spinal anesthesia
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Hypotension
Fetal bradycardia Loss of bearing down reflex Headache from CSF leak Higher incidence of bladder and uterine atony |
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Interventions for post dural headaches:
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Supine posiiton
Bed rest in dark room Analgesics Caffeine Fluids Autologous blood patch |
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Nursing actions for the administration of epidural
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Administer a bolus of IV fluids to offset hyptotension
Position in sitting or side lying Monitior vitals Assess FHR Raise side rails |
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Nursing interventions for a prolapsed cord
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Call for assistance immediately
Notify provider Try and elevate cord of fetus neck Reposition client in Trendelenburg, knee chest, or side-lying position Apply sterile saline soaked towel to the cord Monitor FHR |
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Beta Methasone
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Glucocorticoid
Is administered 24 hr prior to delivery to promote fetal lung development and increase surfactant |
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Warning for Beta Methasone
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Taper off of drug
Decreased immunity Restlessnesss, trouble sleeping Weight gain |
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Bupivicaine
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Local anesthetic such as Lidocaine
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Fetanyl
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Powerful Opiod Analgesic
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Fentanyl side effects
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diarrhea
nausea constipation dry mouth abdominal pain anxiety, nervousness apnea asthenia (weakness) confusion dizziness dyspepsia (indigestion) fatigue, somnolence flu-like symptoms hallucinations headache hypoventilation shortness of breath urinary retention |
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Secobarbital
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Sedatives (barbiturates)
Can be used during the early or latent phase of labor to relieve anxiety and induce sleep. |
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Adverse effects of sedatives
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Neonate respiratory depression
Unsteady ambulation of the client Inhibition of the mother’s ability to cope with the pain of labor. Sedatives should not be given if the client is experiencing pain, because apprehension can increase |
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When breastfeeding you should:
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Wear well fitting bra
Adequate fluid intake |
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What to do for sore nipples?
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Apply breast milk to breast and let let it air dry
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What to do for irritated/ cracked nipples?
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Apply cream
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How do you relieve engorgement?
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Nurse every 2 hrs
Feed for 20 min/ breast Cool compresses betwn feedings Warm compresses before feedings |
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Can pregnancy occur while breastfeeding?
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Yes, it can happen before menses return
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What is uterine atony?
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Inability of the uterine muscle to contract adequately after birth. This can lead to postpartum hemorrhage
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S&O of uterine atony
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Irregular or excessive bleeding
Uterus larger than normal and boggy Prolonged lochia discharge Tachy or hypotension |
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Nursing care for uterine atony:
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Ensure empty bladder
Perform fundal massage If uterine atony persists, anticipate surgical intervention Express clots if uterus is firmly contracted Monitor vitals IV fluids Provide O2 |
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Discharge instructions for uterine atony
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Plenty of rest and increase in iron and protein to promote rebuilding of RBC volume
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What is post partum hemorrhage?
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Client loses more than 500 ml of blood after a vaginal. Client loses more than 1000 ml of blood after c sect
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Risk factors for postpartum hemorrhage:
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Uterine atony
Complications Preciptous delivery Magnesium sulfate therapy Lacerations and hematomas Subinvolution Retain placental fragments Coagulpathies |
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Nursing care for postpartum hemorrhage
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Monitor vitals
Assess for source of bleeding Assess bladder for distention IV fluids or blood expanders Admin uterine stimulants O2 Elevate legs to a 20 or 30 degreen angle |
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Uterine stimulant meds
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Oxytocin
Methergine |
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drugs for thrombophlebitis
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Heparin
Warafin |
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meds for pulmonary embolism
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activase and streptase, used to break up blood clots
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What is subinvolution?
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Uterus remains enlarged with continued lochial discharge
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what is inversion of the uterus?
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uterus turns inside out.
THIS IS AN EMERGENCY SITUATION |
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Teaching plan for mastitis when mom is breastfeeding
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Continue to breastfeed especially on affected side
feed on unaffected side first to encourage let down completely empty breast you do not have to stop breastfeed well fitting bra |
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findings for a TORCH infection
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Toxoplasmosis symptoms similar to flu or lymphadenopathy
Malaise, muscle aches, (flu-like symptoms) Rubella joint and muscle pain Cytomegalovirus has asymptomatic or mononucleosis-like symptoms Signs of rubella include rash, mild lymphedema, fever, and fetal consequences, which include miscarriage, congenital anomalies, and death. Herpes simplex virus initially presents with lesions. Signs of toxoplasmosis include fever and tender lymph nodes. |
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Nursing care for TORCH infections
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Administer antibiotics
For rubella, vaccination of women who are pregnant is contraindicated because rubella infection may develop. These women should avoid crowds of young children. Women with low titers prior to pregnancy should receive immunizations. no treatment for cytomegalovirus exists, so tell client to prevent exposure by frequent hand hygiene before eating, and avoiding crowds of young children. Emphasize the importance of compliance with prescribed treatment. |
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three stages of lochia
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Lochia rubra
lochia serosa lochia alba |
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lochia rubra
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bright red blood
fleshy odor may have clots flow increases during breastfeeding and in morning |
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lochia serosa
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days 4 - 10
pinkish brown serosanguineous |
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lochia alba
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day 11 - week 6
yellowish white creamy fleshy odor |
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pad saturation
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scant - < 2.5 cm
light - < 10 cm moderate - > 10 cm heavy - 1 pad in 2 hrs excessive - 1 pad in 15 min |
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Methergine
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uterine stimulant
controls postpartum hemorrhage |
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adverse reactions for oxytocin
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water intoxication ie light headed, nausea, vomiting, headache, and malaise
seizures comas |
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terbautaline
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tocolytic
to relax uterus for procedures |
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what is used to assess the gestational age of an infant at birth
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a newborn maturity rating scale that assesses neuromuscular and
physical maturity |
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components of neuromuscular maturity as it relates to gestational age
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Posture ranging from fully extended to fully flexed Square window
Arm recoil Popliteal angle Scarf sign Heel to ear, |
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components of physical maturity as it relates to gestational age
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Skin texture
Lanugo presence Plantar surface Breast tissue amount Genitalia development |
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action of surfactant therapy
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lowers surface tension and increases pulmonary compliance
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indication for suractant therapy
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prevents or treats RDS in pretern newborns
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How is surfactant therapy administered
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intratracheal
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possible side effects of surfactant therapy
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bradycardia
oxygen desaturation possible increased hospital infection |
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preprocedure assessment of circumcision
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bleeding disorders
hypospadias or epispadias hermaphidite illness or infection |
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post procedure assessment of circumcision
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assess q 15 min for the first hour and every hour for at least 12 hr
assess for first voiding |
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before the procedure, inform parents of
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newborn will not be able to be bottlefed for up to 4 hr prior but can nurse until the procedure
anesthetic will be administered newborn will be restrained on a board consent form need to be signed |
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after circumcision the nurse will need to teach:
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fan fold diapers to prevent pressure
tub bath not given until wound is healed notify if ny signs of infection yellowish mucus may form, do not wash off no premoisted toilettes |
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s & o data for FAS newborns
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increased wakefulness,
high pitched, shrill cry incessant crying irritability tremors hyperactive increased deep tendon reflexes increased muscle tone deafness convulsions developmental delays growth retardation sleep disturbances facial anomolies |
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complications of FAS
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feeding problems
cNS problems behavioral difficulties ie hyperactive language abnormalities future substance abuse poor maternal newborn bonding |
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what to look for in an infant whose mother has untreated GBS infection?
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signs of sepsis which include,
poor feeding inability to maintain body temp inability to maintain blood glucose level over 60 lethargy seizure activity |
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Hgb for newborns
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14-24 g/dl
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Hct for newborn
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44 to 64%
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RBC count for newborn
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4,800 to 7,100,000
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WBC count for newborn
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9,000 to 30,000
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Platelets count for newborn
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150,000 to 300,000
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glucose read for newborn
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40 to 60 mg/dl
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bilirubin count newborn
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6 mg/dl or less on day 1
8 mg/dl or less on day 2 12 mg/dl or less on day 3 |
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Infertility assessment
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Over 35
More than one year without conceiving Pelvic or Ab surgery Past spontaneous abortions Gynecologic history Sexual history-ie history of STD, number of partners Environmental exposure Weight |
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S&O data for Pregnancy induced hypertension
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Severe continuous headache
Nausea Blurred vision Flashes of lights or dots before the eyes Hypertension Proteinuria Face, hand, and ab edema vomiting oliguria hyperreflexia epigastric pain right upper quad pain dyspnea diminished breath sounds seizures jaundice |
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What is Preterm Premature rupture of membranes?
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Spontaneous rupture of membranes after 20 weeks but before 37 weeks
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Risk factors of PPROM
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Infection to mother and baby
Infection of the amniotic membrane called Chorioamnionitis |
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Risk factors for uterine rupture
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prevvious c section scar
trauma uterine abnormality attempted fetal version overdistention of uterus for a big baby forceps assisted birth hyperstimulation of the uterus spontaneously or with oxytocin |
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hypertonic contractions
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Strong and painful but not effective in dialation and effacement
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Hypotonic contractions
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Contractions are weak in frequency and intensity and inefficient
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hyper/hypotonic labor impact on fetus
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may need forceps assisted or vacuum assisted or c sect birth
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Indication for amniofusion
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Variable FHR decelerations caused by cord compression or to dilute meconium in the amniotic fluid
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Reasons for a cesarean
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Malpresentation, particularly breech presentation
Cephalopelvic disproportion Fetal distress Placental abnormalities ie placenta previa and Abruptio placenta HIV status Hypertensive disorders Maternal diabetes mellitus Active genital herpes Previous cesarean birth Dystocia Multiple gestations Umbilical cord prolapse |
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Assessment findings for SGA
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Weight below 10th percentile
Normal skull, but reduced body dimensions Hair is sparse on scalp Wide skull sutures from inadequate bone growth Dry, loose skin Decreased subcutaneous fat Decreased muscle mass, particularly over the cheeks and buttocks Thin, dry, yellow, and dull umbilical cord rather than gray, glistening, and moist Drawn abdomen rather than well-rounded Signs of respiratory distress and hypoxia Wide-eyed and alert, which is attributed to prolonged fetal hypoxia Signs of meconium aspiration Signs of hypoglycemia Signs of hypothermia |
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Nursing interventions for SGA
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Support respiratory efforts and suction the newborn as necessary to maintain an open airway.
Provide a neutral thermal environment for the newborn Initiate early feedings (An infant who is SGA will require feedings that are more frequent). Administer parenteral nutrition if necessary. Maintain adequate hydration. Conserve the newborn’s energy level. Prevent skin breakdown. Protect the newborn from infection |
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Bottle feeding teaching
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Awaken newborn every 3 hrs during day and every 4 hrs during night
Use tap water to mix formula Formula can be refrigerated up to 48 hrs Hold close at a 45 degree angle Place nipple on top of newborn's tongue Keep nipple filled with formula Burp after ea 1/2 oz to 1 oz of milk Place newborn supine after feeding 6 to 8 diapers a day |
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do meds
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bottom of study guide
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