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218 Cards in this Set

  • Front
  • Back

What is infertility?

Inability to conceive despite engaging in unprotected sexual intercourse for a period of at least 12 months.
What are the positive signs of pregnancy?
*Fetal heart sounds
*Visualization of fetus by ultrasound
*Fetal movement palpated by an experienced examiner
Nulligravida
A woman who has never been pregnant
Primigravida
A woman in her first pregnancy
Multigravida
A woman who has had two or more pregnancies
GTPAL acronym
Gravidity
Term (38 weeks or more)
Preterm births (from viability up to 37 weeks)
Abortions/miscarriages (prior to viability)
Living children
Normal baseline rate of fetal heart tones
110 to 160/min
Hegar's sign
Softening and compressibility of lower uterus
Chadwick's sign
Deepened violet-bluish color of vaginal mucosa secondary to increased vascularity of the area
Goodell's sign
Softening of cervical tip
Ballottment
Rebound of unengaged fetus
Braxton Hicks contractions
False contractions, painless, irregular, and usually relieved by walking
Nagele's rule
Take the first day of the woman's last menstrual cycle, substract 3 months, and then add 7 days and 1 year
Chloasma
Mask of pregnancy (pigmentation increases on the face)
Linea nigra
Dark line of pigmentation from the umbilicus extending to the pubic area
Striae gravidarum
Stretch marks most notably found on the abdomen and thighs

Probably signs of pregnancy are what?

- Abdominal enlargement related to changes in uterine size, shape, and position
- Cervical changes
- Hegar's sign
- Chadwick's sign
- Goodell's sign
- Ballottement
- Braxton Hicks contractions
- Positive pregnancy test
- Fetal outline felt by examiner

Presumptive signs of pregnancy are what?

- Amenorrhea
- Fatigue
- Nausea and vomiting
- Urinary frequency
- Breast changes - darkened areola, enlarged


- Montgomery's tubules
- Quickening - slight fluttering movements of the fetus felt by a woman, usually between 16 to 20 weeks of gestation
- Uterine enlargement
- Linea nigra
- Chloasma
- Striae gravidarum

True or False

Alcohol causes low birth weight
False

Causes birth defects
True or False

Tobacco causes birth defects
False

Causes low birth weight

What are the danger signs of pregnancy?

- Gush of fluid from the vagina (rupture of amniotic fluid) prior to 37 weeks of gestation
- Vaginal bleeding
- Abdominal pain
- Changes in fetal activity
- Persistent vomiting
- Severe headaches
- Elevated temperature
- Dysuria
- Blurred vision
- Edema of face and hands
- Epigastric pain
- Hyperglycemia
- Hypoglycemia

Dick-Read method

"Childbirth without fear".


Uses controlled breathing and conscious and progressive relaxation of different muscle groups throughout the entire body.

Lamaze

The mission of Lamaze International is to promote a healthy, natural, and safe approach to pregnancy, childbirth, and early parenting by advocating and working with health care providers, parents, and professional childbirth educators.

Leboyer

Method of childbirth that is based on the idea of "birth without violence".


Dim lights, soft voices, warm birthing room. Water baths are based on this method.

Bradley

Stresses the partner's involvement as the birthing coach. Emphasizes increasing self-awareness and teaching the woman to deal with the stress of labor by tuning into her own body.



The mother is encouraged to trust her body and use natural breathing, relaxation, nutrition, exercise, and education throughout pregnancy.

What are ways to relieve heartburn?

- Eat small frequent meals
- Now allow the stomach to get too empty or too full
- Sit up for 30 min after meals
- Check with PCP prior to using any OTC antacids

What are ways to relieve constipation?

- Drink plenty of fluids
- Eat diet high in fiber
- Exercise regularly

What are ways to relieve discomfort from hemorrhoids?

- Warm sitz bath
- Witch hazel pads
- Topical ointments

What are ways to relieve backaches?

- Exercise regularly
- Perform pelvic tilt exercises
- Use proper body mechanics using the legs to lift rather than the back
- Use side-lying position

What is the increased amount of calories should be consumed in the second trimester?
340 calories/day
What is the increased amount of calories should be consumed in the third trimester?
452 calories/day
How many additional calories is recommended during the first 6 months of breastfeeding?
330 calories/day
How many additional calories is recommended during the second 6 months of breastfeeding?
400 calories/day
Caffeine intake should be limited to how much?
300 mg/day
What is maternal phenylketonuria (PKU)?
A maternal genetic disease in which high levels of phenylalanine pose danger to the fetus.
When should the female client resume the PKU diet?
At least 3 months prior to pregnancy and continue the diet throughout pregnancy
What foods should be avoided for the PKU diet?
Foods high in protein, such as fish, poultry, meat, eggs, nuts, and dairy products.
What is the biophysical profile (BPP)?
Uses a real-time ultrasound to visualize physical and physiological characteristics of the fetus and observes for fetal biophysical responses to stimuli.
What are the five variables measured in biophysical profile?
Reactive FHR (reactive nonstress test)
Fetal breathing movements
Gross body movements
Fetal tone
Amniotic fluid volume
What is amniocentesis?
Aspiration of amniotic fluid for analysis by insertion of a needle transabdominally into a client's uterus and amniotic sac under direct ultrasound guidance locating the placenta and determining the position of the fetus.
When can an amniocentesis be done?
After 14 weeks of gestation
Alpha-fetoprotein (AFP) can be measured from the amniotic fluid when?
Between 16 and 18 weeks of gestation.
What are the indications for the use of an Amniocentesis During Pregnancy?

- Maternal age greater than 35 years
- Previous birth with a chromosomal anomaly
- A parent who is a carrier of a chromosomalnomaly
- A family history of neural tube defects
- Prenatal diagnosis of a genetic disorder or congenital anomaly of the fetus
- Alpha fetoprotein level for fetal abnormalities
- Lung maturity assessment
- Fetal hemolytic disease diagnosis
- Meconium in the amniotic fluid

High levels of AFP are associated with what?
Normal multifetal pregnancies

Neural tube defects such as....

anencephaly - incomplete development of fetal skull and brain
Spina bifida - open spine
Omphalocele - abdominal wall defect
Low levels of AFP are associated with what?

Chromosomal disorders (Down syndrome)



gestational trophoblastic disease (hydatidiform mole)

What are the fetal lung tests?

- Lecithin/sphingomyelin (L/S) ratio - a 2:1 indicating fetal lung maturity (2.5:1 or 3:1 for a client who has diabetes mellitus)



- Presence of phosphatidylglycerol (PG) - absence of PG is associated with respiratory distress

What is the importance of Kleihauer-Betke test?

Ensures blood obtained is from the fetus

What is percutaneous umbilical blood sampling (PUBS)?
Most common method used for sampling a fetal blood transfustion.
What is chorionic villus sampling (CVS)?
Asessment of a portion of the developing placenta (chorionic villi) is aspirated through a thin sterile catheter or syringe through the abdomen or intravaginally through the cervix under ultrasound guidance and analyzed.
When can a chorionic villus samplying (CVS) be done?
10 to 12 weeks of gestation
What is the quad marker screening?
A blood test done that will ascertain information about the likelihood of fetal birth defects. It does not diagnose the actual defect. It may be performed instead of the maternal serum alpha-fetoprotein yielding more reliable findings. The test screens for the presence of hCG, AFP, estriol, and Inibin-A.
Human chorionic gonadotropin (hCG)
Hormone produced by the placenta
Alpha-fetoprotein (AFP)
Protein produced by the fetus
Estriol
Protein produced by the fetus and placenta
Inhibin-A
Protein produced by the ovaries and placenta
When can a Quad Marker screening be done?
Between 15 to 20 weeks of gstation
What is a nonstress test (NST)?

Noninvasive procedure that monitors response of the FHR to fetal movement.



A Doppler, transducer, used to monitor the FHR, and a tocotranducer, used to monitor uterine contractions, is attached externally to a client's abdomen to obtain paper tracing strips. The client pushes a button attached to the monitor whenever she feels a fetal movement, which is then noted on the paper tracing.



This allows a nurse to assess the FHR in relationship to the fetal movement.

When can a nonstress test be performed?
During the 3rd trimester.
What does a nonreactive NST indicate?
The fetal heart rate doe snot acceerate adequately with fetal movement.
What does Indirect Coombs' test do?
Detect Rh antibodies in the mother's blood.
What is spontaneous abortion?
When a pregnancy is terminated before 20 weeks of gestation (the point of fetal viability) or a fetal weight less than 500 g
What is ectopic pregnancy?
Abnormal implantation of a fertilized ovum outside of the uterine cavity. The implantation is usually in the fallopian tube, which can result in a tubal rupture.
What is gestational trophoblasic disease?

Proliferation and degeneration of trophoblasitic villi in the placenta that becomes swollen, fluid-filled and takes on the appearance of grape-like cluster.



The embryo fails to develop beyond a primitive state and these structures are associated w/choriocarcinoma, which is a rapidly metastasizing malignancy.

What is placenta previa?

Occurs when the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus.

What is abruptio placenta?
Premature separation of the placenta from the uterus, which can be a partial or complete detachment. Occurs after 20 weeks of gestation which is usually in the 3rd trimester.
What is vasa previa?
Presence of fetal blood vessels crossing the amniotic membranes over the cervical os.
What are the signs and symptoms of spontaneous abortion?

- Vaginal bleeding
- Uterine cramping
- Partial or complete expulsion of products of conception

What are the signs and symptoms of ectopic pregnancy?
Abrupt unilateral lower-quadrant abdominal pain with or without vaginal bleeding

What are the signs and symptoms of gestational trophoblastic disease?

- Uterine size increasing abnormally fast
- Abnormally high levels of hCG
- Nausea and increased emesis
- No fetus present on ultrasound
- Scant or profuse dark brown or red vaginal bleeding

What are the signs and symptoms of placenta previa?
Painless vaginal bleeding

What are the signs and symptoms of abruptio placenta?

- Vaginal bleeding
- Sharp abdominal pain
- Tender rigid uterus

What are the signs and symptoms of vasa previa?
Fetal vessel cross over the cervix abrupt bright red vaginal bleeding following rupture of membranes
TORCH acronym

- Toxoplasmosis
- Other
- Rubella (German measles)
- Cytomegalovirus (member of herpes virus family)
- Herpes simplex virus (HSV)

Toxoplasmosis is caused by what?
Consumption of raw or undercooked meat
Handling cat feces
How is rubella contracted?
Through children who have rashes or neonates who are born to mothers who had rubella during pregnancy
How is cytomegalovirus transmitted?
By droplet infection from person to person, a virus found in semen, cervical and vaginal secretions, breast milk, placental tissue, urine, feces, and blood.
What are the medication for streptococcus B-hymolytic, Group B?
Penicillin G or ampicillin (Principen)
What are the medications for chlamydia?

- azithromycin (Zithromax)
- amoxicillin (Amoxil)
- erthromycin (Ery-Tab)

What are the medications for gonorrhea?

- ceftriaxone (Rocephin)
- azithromycin (Zithromax)

What is the medication fro candia albicans?
fluconazole (Diflucan)
What is hyperemesis gravidarum?
Excessive nausea and vomiting that is prolonged past 12 weeks of gestation.
What are the results of hyperemesis gravidarum?
5% weight loss from prepregnancy weight, electrolyte imbalance, acetonuria, and ketosis
What is the ideal blood glucose level during pregnancy?

Between 70 to 110 mg/dL

HELLP acronym

- Hemolysis
- Elevated Liver enzymes
- Low Platelets

What is eclampsia?
Severe preeclampsia symptoms along with the onset of seizure activity or coma.
What are signs and symptoms of eclampsia?

- Headache
- Severe epigastric pain
- Hyperreflexia
- Hemoconcentrations

Hemolysis is a result of what?

Anemia
Jaundice

Elevated liver enzymes results from what?

- Elevated alanine aminotransferase (ALT) or aspartate transaminase (AST)
- Epigastric pain
- Nausea and vomiting

Low platelets results from what?

- Thrombocytopenia
- Abnormal bleeding and clotting time
- Bleeding gums
- Petechiae
- Possibly DIC

What medication is used for signs and symptoms of severe preeclampsia?
Magnesium sulfate - anticonvulsant
What is magnesium sulfate used for?
Lower blood pressure
Depress the CNS
What is Class I for heart disease?
Client exhibits no symptoms w/activity
What is Class II for heart disease?
Client has symptoms with ordinary exertion
What is Class III for heart disease?
Client displays symptoms w/minimal exertion
What is IV for heart disease?
client has symptoms at rest.
What is propranolol (Inderal) used for?
Treat tachyarrhythmias
Lower maternal blood pressure

It is a beta blocker
What is gentamicin (Garamycin) used for?
Prevent endocarditis

It is an aminoglycoside antibiotic.
What is ampicillin (Polycillin) used for?
Prevent endocardiits

It is an antibiotic.
Definition of preterm labor
Uterine contractions and cervical changes that occur between 20 and 37 weeks of gestation.
What is chorioamnionitis?
Infection of the amniotic membranes.
What is premature rupture of membranes (PROM)?
The spontaneous rupture of the amniotic membranes 1 hr or more prior to onset of true labor.
What is Leopold maneuvers?
Abdominal palpation of the maternal uterus through the abdominal wall to determine:

Number of fetuses
Presenting part
Fetal lie
Fetal attitude
Degree of fetal descent into the pelvis
Probable location where fetal heart tones may be best auscultated on the woman's abdomen or point of maximal impulse (PMI)
Latent phase begins and ends with what?
Begins - Cervix 0 cm

Ends - Cervix 3 cm
Active phase begins and ends with what?
Begins - Cervix 4 cm

Ends - Cervix 7 cm
Transition phase begins and ends with what?
Begins - Cervix 8 cm

Ends - Complete dilation at 10 cm
Second stage begins and ends with what?
Begins - Full dilation

Ends - Birth
Third stage begins and ends with what?
Begins - Delivery of the neonate

Ends - Delivery of placenta
Fourth stage begins and ends with what?
Begins - Delivery of placenta

Ends - Maternal stabilization of vital signs
What are the characteristics of contractions in true labor?

- May begin irregularly, but become regular in frequency
- Stronger, last longer, and are more frequent
- Felt in lower back, radiating to abdomen
- Walking can increase contraction intensity
- Continue despite comfort measures

What are the characteristics of contractions in false labor?

- Painless, irregular frequency, and intermittent
- Decrease in frequency, duration, and intensity with walking or position changes
- Felt in lower back or abdomen above umbilicus
- Often stop with sleep or comfort measures such as oral hydration or emptying the bladder

What are the characteristics of the cervix in true labor?

- Progressive change in dilation and effacement
- Moves to anterior position
- Blood show

What are the characteristics of the cervix in false labor?

- No significant change in dilation or effacement
- Often remains in posterior position
- No significant bloody show

What are the characteristics of the fetus in true labor?
Presenting part engages in pelvis
What are the characteristics of the fetus in false labor?
Presenting part is not engaged in pelvis
When can opioids be given?
First stage - active phase
When can the client get an epidural at the earliest?
First stage - active phase
When can the client get a spinal block at the earliest?
Second stage
When can the client get a pudendal at the earliest?
Second stage
When can the client get a local infiltration at the earliest?
Second stage
When can the client get sedatives?
First stage - latent phase
What will an epidural block do?

- Eliminates all sensation from the level of the umbilicus to the thighs
- Relieving the discomfort of uterine contractions, fetal descent, and pressure and stretching of the perineum

What will a pudendal block do?
Provide local anesthesia to the perineum, vulva, and rectal areas during delivery, episiotomy, and episotomy repair.
What will a spinal block do?
Eliminates all sensations from the level of the nipples to the feet.
Which regional block is used commonly for cesarean births?
Spinal Block
What are the opioid analgesics used to provide pain relief without causing significant respiratory depression in the mother and fetus?

- butorphanol (Stadol)
- nalbuphine (Nubain)

What is effluerage?
Light, gentle circular stroking of the client's abdomen with the fingertips in rhythm with breathing during contractions.
What is sacral counterpressure?
Consistent pressure is applied by the support person using the heel of the hand or fist against the client's sacral area to counteract pain in the lower back.
What is hydrotherapy?
Whirlpool or shower
Why is hydrotherapy used to promote relaxation and pain relief?
Increases maternal endorphin levels
When would naloxone (Narcan) be administered?
To correct neonatal depression caused by maternal opioids.
What are the opioid analgesics used to act in the CNS to decrease the perception of pain without the loss of consciousness?

- hydrochloride (Demerol)
- fentanyl (Sublimaze)
- butorphanol (Stadol)
- nalbuphine (Nubain)

What is the purpose of the fetal scalp blood sampling?
Obtained to assess the fetal blood gases consisting of the pH, PO2, and PCO2.
What is the normal fetal scalp blood pH?
7.25
What would cause the fetal scalp blood pH to decrease?
Fetal hypoxia
What is considered fetal bradycardia?
FHR <110 beats/min for 10 min or more
What is considered fetal tachycadia?
FHR >160 beats/min for 10 min or more
What are the nursing interventions for fetal bradycardia?

- Discontinue oxytocin (Pitocin) if it is being infused
- Help the client into a side-lying position
- Administer oxygen (8 to 10 L/min by mask)
- Start an IV line if one is not in place
- Administer a tocolytic medication as prescribed
- Notify the primary care provider

What are the nursing interventions for fetal tachycardia?

- If maternal fever exists, administer antipyretics as prescribed
- Administer oxygen (8 to 10 L/min by mask)
- Give bolus of IV fluis

What are the nursing interventions for accelerations (variable transitory increase in the FHR above baseline)?

- Reassuring
- No interventions required
- Indicative reactive nonstress test

What are the nursing interventions for decrease or loss of FHR variability (decrease or loss of irregular fluctuations in the baseline of the FHR)?

- Stimulate the fetal scalp
- Assist primary care provider with application of scalp electrode or fetal blood pH sampling
- Position the client into a left-lateral position

What are the nursing interventions of early deceleration of FHR (slowing of FHR with start of contraction with return of FHR to baseline at end of contraction)?
No intervention required.
What are the nursing interventions for late deceleration of FHR (slowing of FHR after contraction has started with return of FHR to baseline well after contraction has ended)?

* Change the client to a side-lying position
* Start an IV line if not in place or increase the IV rate
* Discontinue oxytocin (Pitocin) if being infused
* Administer oxygen 8 to 10 L/min per mask
* Notify the PCP
* Prepare for an assisted vaginal birth or cesarean birth

What are the nursing interventions for variable deceleration of FHR (transitory, abrupt slowing of FHR <110 beats/min, variable in duration, intensity, and timing in relation to uterine contraction)?
* Change the client's position
* Discontinue oxytocin (Pitocin) if it is being infused
* Administer oxygen at 8 to 10 L/min per mask.
* Perform or assist with a vaginal examination
* Assist with an aminoinfusion if ordered
What are the risk factors of premature rupture of membranes and preterm premature rupture of membranes?
* Infection
* Chorioamnionitis - the infection of the amniotic membranes

**There is an increased risk of infection if there is a lag period over the 24-hr period from when the membranes rupture to delivery.
What are the risk factors of preterm labor?
* Infections of the urinary tract, vagina, or chorioamnionitis (infection of the amniotic sac)
* Previous preterm birth
* Multifetal pregnancy
* Hydramnios (excessive amniotic fluid)
* Age below 17 or above 35
* Low socioeconomic status
* Smoking
* Substance
* Domestic violence
* History of multiple miscarriages or abortions
* Diabetes mellitus or HTN
* Lack of prenatal care
* Incompetent cervix
* Placenta previa or abruptio placentae
* Preterm premature of membranes
* Short interval between pregnancies
* Uterine abrnomalities
* Diethylstillbestrol (DES) exposure in utero
What is the antidote for magnesium sulfate toxicity?
Calcium gluconate
What are the contraindications for magnesium sulfate?
* Active vaginal bleeding
* Dilation of the cervix greater than 6 cm
* Chlorioamnionitis
* Greater than 34 weeks of gestation
* Acute fetal distress
What are the adverse effects of magnesium sulfate?
* Loss of deep tendon reflexes
* Urinary output less than 30 mL/hr
* Respiratory depression less than 12/min
* Pulmonary edema
* Chest pain
What is the criteria for fetal oxygen saturation?
* Nonreassuring FHR
* Used in single fetus gestation
* At least 36 weeks gestation
* Vertex presentation
* Ruptured membranes
* Cervix dilated to at least 2 cm
* Fetal station at least -2
What is the description of precedure for a fetal oxygen saturation?
Performed by inserting a specifically designed sensor next to the fetal cheek or temple area to assess fetal oxygen saturation (FSpO2).
What is considered normal FSpO2?
30 to 70%
What are the nursing interventions during first stage, active phase of labor?
* Provide client/fetal monitoring
* Encourage frequent position changes
* Encourage voiding at least every 2 hr
* Encourage deep cleansing breaths
* Encourage relaxation
* Provide nonpharmacological comfort measures
* Provide pharmacological pain relief as prescribed
What are the nursing interventions during first stage, transition phase of labor?
* Continue to encourage voiding every 2 hr
* Continue to monitor and support the client and fetus
* Encourage a rapid pant-paint-blow breathing pattern if the client has not learned a particular breathing pattern prenatally
* Discourage pushing efforts until the cervix is fully dilated
* Listen for client statements expressing the need to have a bowel movement. This sensation is a sign of complete dilation and fetal descent
* Prepare the client for the birth.
What are the nursing interventions during the second stage?
* Continue to monitor the client/fetus
* Assist in positioning the client for effective pushing
* Assist in coaching pushing efforts and in encouraging bearing down efforts during contractions
* Promote rest between contractions
* Provide comfort measures such as cold compresses
* Cleanse the client's perineum as needed if fecal material is expelled during pushing
* Provide feedback on labor progress to the client
What are the nursing interventions during the third stage?
* Instruct the client to push oncd signs of placental separation are indicated
* Promote bonding between the family and the newborn, which facilitates the release of endogenous oxytocics.
* Administer analgesics as prescribed
* Administer oxytocics once the placenta is expulsed to stimulate the uterus to contract and thus prevent hemorrhage.
* Gently cleanse the vulvar area with warm water or 0.9% sodium chloride and apply a perineal pad or ice pack to the perineum.
What are the nursing interventions during the fourth stage?
* Assess maternal vital signs every 15 min for the first hour and then according to facility protocol
* Assess fundus and lochia every 15 min for the first hour and then according to facility protocol.
* Massage the uterine fundus and/or administer oxytocics as prescribed to maintain uterine tone and prevent hemorrhage.
* Encourage voiding to prevent bladder distention
* Promote an opportunity for maternal-infant bonding
What ist he pH of amniotic fluid?
6.5 to 7.5 - Nitrazine paper will turn blue
What is external cephalic version (ECV)?
The attempt to manipulate the abdominal wall to direct a malpositioned fetus into a normal vertex cephalic presentation after 37 weeks of gestation.
What is bishop score?
Determine the maternal readiness for labor by evaluating if the cervix is favorable by rating the following:

* Cervical dilation
* Cervical effacement
* Cervical consistency (firm, medium, or soft)
* Cervical position (posterior, midposition, or anterior)
* Presenting part station

Score of 9 for nulliparas and 5 or more for multiparas indicates readiness for labor induction
What is the vacuum-assisted delivery?
Involves the use of a cuplike suction device that is attached to the fetal head. Traction is applied during contractions to assist in teh descent and birth of the head, after which, the vacuum cup is released and removed preceding delivery of the fetal body.
What are the indications for a vacuum-assisted delivery?
* Maternal exhaustion and ineffective pushing efforts
* Fetal distress during second stage of labor
What is an amnioinfusion?
An amnioinfustion of 0.9% sodium chloride or lactaed Ringer's solution, as prescribed, is instilled into the amniotic cavity through a transcervical catheter introduced into the uterus to supplement the amount of amniotic fluid. The instillation will reduce the severity of variable decelerations caused by cord compression or dilute meconium-stained amniotic fluid.
What are indications for amnioninfusion?
* Oligohydramnios - caused by uteroplcental insufficiency, premature rupture of membranes, or postmaturity of the fetus
* Fetal cord compression secondary to postmaturity of fetus (macrosomic, large body) which places the fetus at risk for variable deceleration from cord compression
What are the indications for an episiotomy?
* Shorten the second stage of labor
* Facilitate forceps-assisted or vacuum-assisted delivery
* Prevent cerebral hemorrhage in a fragile preterm fetus
* Facilitate birth of a macrosomic (large) infant
Signs and symptoms of fetal distress
* FHR is below 110/min or above 160/min
* FHR shows decreased or on variability
* There is a fetal hyperactivity or no fetal activity
* Fetal blood pH is less than 7.2
What is dystocia (dysfunctional labor)?
Difficult or abnormal labor related to the first powers of labor (powers, passenger, passageway, psyche, and position)
What is precipitous labor?
Labor that lasts 3 hr or less from the onset of contractions to the time of delivery
What is the Trendelenburg position?
Supine position
What is the lithotomy position?
Supine position with knees elevated
What are the risk factors for dystocia?
* Short stature, overweight status
* Age greater than 40 years
* Uterine abnormalities
* Pelvic soft tissue obstruction or pelvic contracture
* Cephalopelvic disproportion (fetal head is larger than maternal pelvis)
* Fetal macrosomia
* Fetal malpresentation, malposition
* Multifetal pregnancy
* Hypertonic or hypotonic uterus
* Maternal fatigue, fear, or dehydration
* Inappropriate timing of anesthesia or analgesics
What are the risk factors for amniotic fluid embolus?
* Multiparity
* Tumuluous labor
* Abruptio placentae
* Oxytocin (Pitocin) administration
* Fetal macrosomia
* Hydramnios
* Fetal demise
* Meconium-stained amniotic fluid
What is the main goal during the immediate postpartum period?
Prevent postpartum hemorrhage
Postpartum physical assessment -

BUBBLEVT - acronym
Breasts
Uterus (fundal height uterine placement, & consistency)
Bowel and GI function
Bladder function
Lochia (color, odor, consistency, & amount [COCA])
Episiotomy (edema, ecchymosis, approximation)
Vital signs to include in the pain assessment
Teaching needs
What is postpartum chill?
Occurs in the first 2 hr puerperium, and is an uncontrollable shaking chill experienced by the client immediately following birth.
What are the nursing interventions for postpartum chill?
* Provide the client w/warm blankets and fluids
* Assure the client that these chills are a self-limiting common occurrence that will only last a short while
When should the uterus lie within the true pelvis and not be palpable?
By day 10 postpartum
Where should the fundus be immediately after delivery?
It should be firm, midline with the umbilicus, and approximately at the level of the umbilicus.
Characteristics of lochia rubra
* Bright red color
* Bloody consistency
* Fleshy odor
* May contain small clots
* Transient flow increases during breastfeeding and upon rising
* Lasts 1 to 3 days after delivery
Characteristcs of lochia serosa
* Pinkish brown color
* Serosanguineous consistency
* Lasts from approximately day 4 to day 10 after delivery
Characteristics of lochia alba
* Yellowish, white creamy color
* Fleshy odor
* Lasts approximately day 11 up to and beyond 6 weeks postpartum
Scant - Lochia
< 2.5cm
Light - Lochia
< 10cm
Moderate - Lochia
> 10cm
Heavy - Lochia
One pad saturated within 2 hr
Excessive blood loss - Lochia
One pad saturated in 15 min or less or pooling of blood under buttocks
What is considered abnormal lochia?
* Excessive spurting of bright red blood from the vagina, possibly indicating a cervical or vaginal tear
* Numerous large clots and excessive blood loss (saturation of one pad in 15 min or less) which may be indicative of a hemorrhage
* Foul odor, which is suggestive of an infection
* Persistent lochia rubra in the early postpartum period beyond day 3, which may indicate retained placental fragments.
* Continued flow of lochia serosa or alba beyond then normal length of time may indicate endometritis, especially if it is accompanied by a fever, pain, or abdominal tenderness.
How often should the client be checked after the delivery of the infant?
15 min X4
30 min X2
Hourly X2

Which equals to 4 hours
What are the behaviors that indicate mother-infant bonding?
* Considers the infant a family member
* Holds the infant face to face (en face) maintaining eye contact
* Assigns meaning to the infant's ehavior and views positivitely
* Identifies the infant's unique characteristics and relates them to those of other family members
* Touches the infant and maintains close physical proximity and contact
* Provides physical care for the infant such as feeding and diapering
* Response to the infant's cries
* Smiles at, talks to, and sings to the infant
What are the behaviors that indicate a lack of mother-infant bonding?
* Apathy when the infant cries
* Disgust when the infant voids, stools, or spits up
* Expresses disappointment in the infant
* Turns away from the infant
* Does not seek close physical proximity to the infant
* Does not talk about the infant's unique features
* Handles the infant roughly
* Ignores the infant entirely
What are nursing interventions to facilitate sibling acceptance of the infant?
* Take the sibling on a tour of the obsteric unit
* Encourage the parents to:

1. Let the sibling be one of the first to see the infant
2. Provide a gift from the infant to give the sibling. Arrange for one parent to spend time with sibling while the other parent is caring for the infant
4. Allow older siblings to help in providing care for the infant.
5. Provide the preschooler with a doll to care for.
What are ways to relieve breast engorgement?
* Apply cool compresses between feedings and apply warm compresses
*Take a warm shower prior to breastfeeding
* Cold cabbage leaves
What can the client do to regain pelvic floor muscle control?
- Performing Kegel exercises 8-10 times a day
What are the behavior characteristics of postpartum depression?
*Intense mood swings
* Anxiety
* Irritability
* Feeling of loss
* Sleep pattern disturbances
* Fatigue persisting beyond a reasonable amount of time
* Persistent feelings of sadness
* Feelings of guilt and inadequecies
What is uterine atony?
Inability of the uterine muscle to contract adequately after birth. This can lead to postpartum hemorrhage.
What is retained placenta?
When the placenta or fragments of the placenta remain in the uterus which prevents the uterus from contracting.
What is the blood glucose level that is considered hypoglycemia for an infant?
Preterm = < 25 mg/dL

Term = < 40 mg/dL
What is the normal weight for an infant?
Between 10-90th percentile
What is considered LGA?
Birth weight above 90th percentile or more than 4,000 g (8 lb, 12 oz)
What is considered SGA?
Birth weight is at or below the 10th percentile
How should the car seat be positioned?
Rear-facing in the middle
How often should the newborn who are formula fed be burped?
15 to 30 mL
How often should the newborn be fed?
8 to 12 feedings (Every 3 to 4 hours and on demand)
When can a newborn be submerged in water?
Until the cord falls off. At the mean time sponge baths are appropriate.
What is triple dye?
Topical antimicrobial may be used for umbilical cord care.
What reflex is elicited by stroking the newborn's cheek or edge of his mouth? When this is done, the newborn turns his head toward the side that is touched and starts to suck. Expected age is from birth to 4 months.
Sucking and rooting reflex
What reflex is elicited by placing an object in the newborn's palm? The newborn will grasp the object. Expected age is from birth to 6 months.
Palmar grasp
What reflex is elicited by touching the sole of the newborn's food? The newborn responds by curling his toes downward. Expected age is from birth to 8 months.
Plantar grasp
What reflex is elicited by striking a flat surface that the newborn is lying on, or allowing the head and trunk of the newborn in a semisitting position to fall backward to an angle of at least 30 degrees? The newborn's arms and legs symmetrically extend and then abduct while his fingers spread to form a "C". Expected age is from birth to 4 months.
Moro reflex (startle)
What is the reflex that the newborn will extend his arm and leg on the side when his head is turned to that side with flexion of his arm and leg of the opposite side? Also, the newborn will turn his head to one side. The newborn will respond by extending his arm and leg on that side, and flex his arm and leg on the opposite side. Expected age is birth to 3 to 4 months.
Tonic neck reflex (fencer position)
What reflex is elicited by stroking the outer edges of the newborn's sole of his foot, moving up toward his toes? His toes will fan upward and out. Expected age is from birth to 1 year.
Babinski's reflex
What reflex is elicited by holding the newborn upright with his feet touching a flat surface. The newborn will respond with stepping movements? Expected age is from birth to 4 months.
Stepping
What is intrauterine growth restriction (IUGR)?
Growth rate doe snot meet expected norms.
What are the 5 categories for an APGAR score?
* Heart rate
* Respiratory rate
* Muscle tone
* Reflex irritability
* Color
What are the characteristics of postpartum blues?
* Feelings of sadness
* Lack of appetite
* Sleep pattern disturbances
* Feeling of inadequacies
* Intense mood swings
What are the characteristics of postpartum psychosis
* Pronounced sadness
* Disorientation
* Confusion
* Paranoia
* Hallucinations
* Delusional thoughts of self harm or harming the infant
What organism usually causes mastitis?
Staphylococcus aureus
What are the risk factors for endometritis?
* Cesarean birth
* Retained placental fragments and manual extraction of the placenta
* Prolonged rupture of membranes
* Chorioamnionitis
* Internal fetal/uterine pressur emonitoring
* Multiple vaginal examinations after rupture of membranes
* Prolonged labor
* Postpartum hemorrhage
What are the risk factors for mastitis?
* Milk stasis from a blocked duct
* Nipple trauma and cracked or fissured nipples
* Poor breastfeeding technique with improper latching of the infant onto the breast, which can lead to sore and cracked nipples
* Decrease in breastfeeding frequency due to supplementation with bottle feeding
* Poor hygiene with inadequate hand hygiene between handling perineal pads an breasts.