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124 Cards in this Set

  • Front
  • Back
antepartal period
prior to delivery
signs and symptoms of pregnancy:
presumtive- not diagnostic. Amenorrhea, nausea and vomiting, breast tenderness, increased urination, fatigue, abdominal enlargement, quickening
discoloration during first 12 weeks)
s/s of pregnancy:
probable- Goodell's sign (softening cervix)Hegar's sign (uterine isthmus softening)
Chadwick's sign- (vagina, cervix and vulva with purplish discoloration during first 12 weeks), uterine enlargement, palpable fundus, braxton hicks, increased pigmentation(nipples, linea nigra, chloasma, striae gravidarum), pregnancy tests
s/s of pregnancy:
conclusively prove pregnancy. Fetal heartbeat, abdominal ultrasound, fetal movement felt by the examiner
Physiological changes of pregnancy:
reproductive system changes
uterine growth, anemorrhea, suppression of FSH, cervical and vaginal changes, changes in breast size, color and production of colostrum
Physiological changes of pregnancy:
integumentary changes
striae gravidarum or stretch marks, separation of rectus muscles, melasma or chloasma
Physiological changes of pregnancy:
respiratory changes
SOB in late pregnancy
Physiological changes of pregnancy:
temperature changes
increased blood volume 30%, increased cardiac output 25-50%, increased HR by 10
Physiological changes of pregnancy:
gastrointestinal changes
nausea, vomiting, heartburn, and increased saliva
Physiological changes of pregnancy:
urinary changes
fluid retention and change in renal, ureter, and bladder function
Physiological changes of pregnancy:
hormonal changes
increased estrogen and progesterone cause thickening of uterine walls, cervix cells proliferates and secrete a thick, tenacious mucus. The corpus luteum secretes progesterone to maintain the endometrium until the placenta produces enough progesterone to maintain the pregnancy
Physiological changes of pregnancy:
couvade syndrome
the expectant father develops physical symptoms of pregnancy: fatigue, depression, headache, backache, and nausea
Calculating due date:
nagele's rule
first day of last menses, subtract 3 mons. and add 7 days
Calculating due date:
gestation calculator
chart or wheel
14-16 week withdrawl of amniotic fluid through the abdominal wall, carries only a 0.5 % risk of abortion
Calculating due date:
chorionic villi sampling
8-10 week retrieval and analysis of chorionic villi for chromosome analysis. 2-4 % risk of excessive bleeding leading to loss of pregnancy
stress test
oxytocin challenge test evaluates placental function and fetal health. Contractions are induced and monitored by external fetal monitor
nonstress test
does not induce contractions, assesses fetal heart rate related to fetal movement
has a teratogenic effect on the fetus. Immunizations can not take place during pregnancy. Pregnancy should not occur in less than 3 mon after immunization
a pregnant woman needs an additional 300 calories a day (2 milk and 1 protein)Lactating women need 500 cal increase/day
childbirth education
prepares mother and support person for childbirth experience, increases knowledge of obstetric care, helps clients reduce/mangae pain, improves overall enjoyment and satisfaction of child birth. Childbirth exercises may be taught-perineal and abdominal exercises, tailor sitting, squatting, Kegel, abdominal muscle contractions and pelvic rocking
Childbirth pain management methods:
husband coached- abdominal breathing, ambulation and use of a focal point to disassociate the pain of labor and birth
Childbirth pain management methods:
psychosexual method
conscientious relaxation, progressive breathing, flow with contractions rather than struggle
Childbirth pain management methods:
dick read method
fear leads to tension leads to pain. Use of abdominal breathing with contractions
Childbirth pain management methods:
psychoprophylactic- stimulus response conditioning. Controlled breathing is used to reduce pain sensation during labor
Medications of pregnancy:
prenatal vitamins
folic acid prevents neural tube defects
Medications of pregnancy:
magnesium sulfate
CNS depressant halts premature labor
Medications of pregnancy:
ritodrine (Yutopar)tocolytic
relaxes uterine muscle through beta-2 receptor sites. Infusion for 12-24 hours after uterine contractions stop before oral administration
Medications of pregnancy:
Terbutaline sulfate tocolytic
oral dose in quite large to maintain uterine inactivity
Medications of pregnancy:
iron prepartation
60mg recommended. Best absorbed when taken with orange juice
Medications of pregnancy:
docusate sodium (colace)
stool softener that lowers the surface tension of feces. Should be swallowed with a full glass of water
Medications of pregnancy:
Betamethasone sodium phosphate (celestone)
corticosteroid administered to accelerate lung surfactant formation in the fetus. Takes 24 hours to be effective
true labor
contraction intervals are regular and gradually shortened. Intensity and duration increases, may become stronger with ambulation. The cervix softens , effaces and dilates
false labor
contractions are irregular,interval stays the same, no change in intensity or duration and may stop with ambulation. The cervix only softens
Stages and phases of labor:
First stage
begins with contractions and ends with fully dilated cervix.
Latent phase: (preparatory)- onset to rapid cervical dilation
Active phase: cervical dilation 4 centimeters to 7. Stronger contractions lasting 40-60 seconds and occuring 3-5 minutes
Transitional phase: maximum dilation of 8-10 centimeters. Contractions reach their intensity peak, full dilation, complete cervical effacement. Phase ends with an irreversible urge to push.
Stages and phases of labor:
second stage
full dilation to birth of infant. Crowning to pushing the fetus out of the birth canal.
Stages and phases of labor:
third stage
placental stage
placental separation- approx. 5 minutes after birth of the infant
placental expulsion- placenta delivered by bearing down or gentle exterior pressure
fetal presentation-
1.most common position
2. second monst common position
1.is LOA (Left,occipital-anterior)
The first letter indicates Left or right of the mother.
The middle letter is for presenting part/fetal landmark: O for occiput, M for mentum, Sa for sacrum and A for acromion process. The last letter defines where the landmark points: A-anterior, P-posterior and T-transverse
Labor complications:
increased risk of infection, dangerous to both mother and infant. Must avoid tub bathing, coitus, and douching. Report fever > 100.4, uterine tenderness, or odorous vaginal discharge.
Labor complications:
viewed ad normal,normally occurs late in labor when the head is fairly low represent pressure on the fetal head during contractions
Labor complications:
deceleration- late
delayed 30-40 seconds after contraction onset and continue after the contraction. Suggests uteroplacental insufficiency or decreased blood flow. Maternal position should be changed to lateral, oxytocin should be stopped or slowed, O2 and fluid admin should be considered. Prompt delivery should be prepared for
Labor complications:
unpredictable, indicates compression of the cord. Position should be changed to lateral or trendelenburg, O2, fluids and possible anmioinfusion with NS or lactated ringer's
Labor complications:
can occur with PROM, placenta previa, small fetus, hydramnios, cephalopelvic disproportion and multiple gestation. Compression and resulting anoxia must be relieved
Labor complications:
sluggish contractions, dysfunctional labor.
Primary- occurs at the onset of labor
Secondary- occurs late in labor
Interventions during labor:
artificial rupturing of membranes with womanin dorsal recumbent position
Interventions during labor:
surgical incision of perineum (taint)done to allow fetal head to pass, preventing a tear to the perineum. Shortens the last portion of 2nd stage of labor
Interventions during labor:
artificially starting labor at term. Hygroscopic suppositories of seaweed and prostaglandin get can be used to ripen cervix. Oxytocin induces contractions
Interventions during labor:
steel instrument used to assist delivery
Interventions during labor:
disk-shaped cup pressed against the fetal scalp to help pull the fetus out. Procedure usually caused marked caput. Contraindicated in preterm infant births
Interventions during labor:
birth through a surgical abdominal incisioninto the uterus. Indications include cephalopelvic disproportion, active genital herpes or papilloma, previous c-section, PIH, heart disease, placenta previa, premature separtation of the placenta, transverse fetal lie, low birth weight, fetal distress
Medications for labor:
cervical softening to prepare for labor induction
Interventions during labor:
synthetic form of posterior pituitary hormone used ot initiate uterine contractions
Interventions during labor:
epidural anesthesia
narcotic injected into the epidural space
Interventions during labor:
narcotic analgesics
analgesic effect by may cause fetal CNS depression. Demerol, morphine, nubain, Fentanyl, and Stadol
postpartal period
after birth
return of reproductive organs to prepregnancy size and condition.
fundal descent
descends @ 1cm/day for 10 days after birth. Breastfeeding and an empty bladder facilitate fundal descent and involution
regainsits shape by 18 hrs after birth
uterine/vaginal discharge after birth
lochia rubra
1st three days,mostly blood with pieces of decidua and mucus
locia serosa
fourth day amount decreases and color changes to pink/pinkish
locia alba
after 10th day discharge becomes yellowish white. May last for 6 weeks or more
milk production is sustained wiht frequent breastfeeding sessions. Lactation will cease within a week if breastfeeding never begun
Body system changes:
bladder/ureters return to prepregnant size. Urine increases to diureses excess fluid from pregnancy
phychosocial adaptation:
taking in phase
mother's need for food, fluid and sleep. Phase of nurturing and protective care. Integraiton of labor/birth experience
phychosocial adaptation:
taking hold phase
becomes more independent and takes responsibility for her care and shifts focus to the care of the infant. Lasts @ 10 days
phychosocial adaptation:
letting-go phase
role change from carefree lifestyle of being only a couple. The parents move forward as a unit with a new member
postpartum blues
mild, transient condition. Lasts about 2 weeks with crying for no apparent reason, fatigue, anxiety, restlessness, letdown feeling, headache and sadness
postpartum depression
(PPD) serious, intense, persistent. Characterized by inability to feel love, irritability, guilt, shame, unworthiness,loss of self, spontaneous crying, insomnia/hypersomnia, fatigue, decreased concentration. Negative feelings may be directed to the infant like disinterest, annoyance with care demands and thoughts of harm to the infant
Postpartum complications:
Postpartum complications:
puerperal infection
infection between birth and 6 weeks postpartum with a temp of 100.4 or more on 2 consecutive days during the first 10 after birth.
Postpartum complications:
Common postpartum infxns:
wound, metritis (inflammation of the uterus), mastitis (tender, hot, swollen wedge shaped area of the breast), and UTI
Postpartum complications:
of the birth canal, cervix, vagina or perineum. Perineal are classified from the fourth degree dependant on depth and extent of tissue involvement
Postpartum complications:
cardiac decompensation
postpartal PIH. Easier to tx with antihypertensive therapy because fetal risk is no longer present(pregnancy induced hypertension)
Postpartum complications:
can be caused by staphylococcus aureus or candida albicans. A crack or fissure in the nipple of the portal of entry
Medications after birth:
is given within 72hrs of birth to prevent semsitization of Rh negative moms who have given birth to Rh positive infants
is used to contract the uterus if extensive bleeding is evident due to uterine atony, retained placental fragments, or laceration of the birth canal
Postpartum complications:
can be caused by staphylococcus aureus or candida albicans. A crack or fissure in the nipple of the portal of entry
(Nurses Assoc of the American College of Ob/Gyn) formed in 1969 to improve women and newborn health. Name change in 1993 AWHONN (Association of Women's Health, Obstetric and Neonatal Nurses)
Venal Caval syndrome
uterus compresses the aorta and vena cava when mother is supine decreasing fetoplacental blood flow. Tx is changing position of mother, elevating one hip in a side-lying position, providing oxygen and IV fluids
Care of the Fetus and neonate:
"A love story"
sperm and ovum unite to form a zygote in the distal thrid of the fallopian tube. After 5 days of impact they become a trophoblast and implant in their first apartment, the endometrium
3 stages of fetal development
1 preembryonic/germinal; first 14 days
2. embryonic: day fifteen through week 8
3. fetal: week nine to full term (38-40 weeks)
1st trimester: 0-12 weeks
2nd trimester: 13-27 weeks
3rd trimester: 28-40 weeks
describe the umbilical cord
@ 21 inches long. Contains 2 umbilical arteries that carry unoxygenated blood from the fetus to the mother and 1 vein carrying oxygenated blood. All vessels are surrounded and protected by Wharton's jelly. The umbilical cord functions to eliminate waste and carbon dioxide from the infant and deliver nutrients, hormones, antibodies etc to the fetus
develops in response to progesterone secreted by the corpus luteum. It has three major functions: transport, endocrine, and metabolic. The placenta secretes five hormones that are essential to pregnancy
human chorionic gonadotropin: responsible for positive pregnancy tests
human placental lactogen
The placenta also produces fatty acids, glycogen, and cholesterol for fetal use and hormone production
Transition to extrauterine life:
during birth the fetal chest is compressed and fluid is squeezed from the lungs and intrathoracic pressure increases. Chest recoil at birth creates negative intrathoracic pressure which stimulates air movement into the lungs and fluid movement into the interstitial tissue. Change in temperature from intrauterine to extrauterine stimulates breathing too
Transition to extrauterine life:
lower pulmonary resistance aids blood flow to the lungs to be oxygenated. Ductus arteriosus has a reversal of blood flow because of increased aortic pressure and increased O2 in the blood. Pressure in the R artium decreases and the L atrium increase. Blood flow to the liver begins and filtration of the blood begins
Transition of extrauterine life:
heat is generated through metabolism, muscular activity and nonshivering thermogenesis (metabolism of brown fat). Heat is lost through four mechanisms.
1. convection
2. conduction
3. radiation
4. evaportation
1. convection
2. conduction
3. radiation
4. evaportation
1. heat flows fromt the body surface to cooler surrounding air
2. heat transfers to a cooler solid object in direct contact
3. body heat transfer to a cooler solid object not in contact
4. evaportation heat loss through conversion of a liquid to vapor
Transition of extrauterine life:
gastrointestinal system
sterile at birt, does not provide necessary bacteria to synthesize vitamin K. Limited ability to digest fat and starch. Immature cardiac sphincter allow for easy regurgitation. First stool is meconium, thich, sticky, and tar-like
Newborn reflexes:
infant turns head to side when corner of mouth is stroked
Newborn reflexes:
elicited by touching the newborn's lips
Newborn reflexes:
infant forces the tongue outward when the tip is depressed or touched. Disappears at 4 months allowing for easier feeding
Newborn reflexes:
palmar grasp
fingers flex and grasp a finger placed across their palm
Newborn reflexes:
tonic neck
fencing reflex. Flexing and extension of limbs of turning of the head
Newborn reflexes:
moro reflex
startle reflex. Response may be asymmetrical due to injury of the clavicla, humerus, or brachial plexus
Newborn reflexes:
gallant reflex
an infant lying prone will trun shoulder and pelvis to the stimulated side when skin near the spine is stroked
stepping reflex
Newborn reflexes:
babinski's reflex
stroking to plantar surface of an infant's foot upward causes great toe dorsiflexion and fanning out of the other toes
Newborn reflexes:
crossed extension reflex
stimulation the foot of the held down leg will elicit flex, adduct and extension of the other foot
Newborn reflexes:
placing reflex
backward step onto a firm surface when one foot is already resting there
Complications of the neonate:
excessive bilirubin in the blood. Can cause yellow staining in the brain (kernicterus)at levels of 20mg/dl. Commone cause of Rh incompatibility. Phototherapy and fluid intake are used to treat jaundice
Complications of the neonate:
respiratory distress
transient tachypnea that is the result of the newborn's failure to clear the airway of fluid and mucus or aspiration of amniotic fluid. Tx is supportive and may include humidified O2, CPAP, or mechanical ventilation
small for gestational age
large for genstational age
preterm infant
higher risk for respiratory distress syndrome, hypoglycemia, and intracranial hemorrhage
Complications of the neonate:
post-term infants
beyond 42 weeks the placenta loses its ability to effectively cary nurtients to the fetus
Complications of the neonate:
(GBS) group B streptococcal organism. Symptomatic infants (lethargy, fever, loss of appetite increased ICP) receive antibiotics (ampicillin, gentamicin or penicillin)
serum glucose less than 40 mg/dl. Infants at risk include born to diabetic mothers, large for gestational age infants. Tx feed early with formula or admin IV glucose, bolus not recommended
Complications of the neonate:
cold stress
keep in warm environment to prevent increased O2 needs due to increased metabolism to stay warm
Complications of the neonate:
growth restriction, CNS depression, cognitive impairment etc. demonstrated with tremors, fidgetiness, irritabilty. Weak sucking reflex and sleep disturbances
Neonate's immunizations and meds at birth:
vitamin K
intestine is sterile and can not synthesize initially after birth. Needed for clotting process. Most newborns produce enough by day 8. Given within first hour of birth to prevent hemorrhagic disorders
Neonate's immunizations and meds at birth:
Hep B
vaccine should be given within 12 hours of birth
Neonate's immunizations and meds at birth:
erythromycin et al
is administered as a prophylactic opthalmic ointment. It is mandatory in the US. May be delayed to promote bonding and attached
birth through the first 28 days of life
Brazelton Neonate Behavior
behavioral capacity and ability to respond to set stimuli
blood between the periosteum of the skull bone and bone itself due to rupture capillaries at birth. May take weeks to absorb
Caput succedaneum
edema of scalp at the presenting part of the babies head. Edema crosses the suture lines and usually disappears in the third day of life
assessment of wellness of newborn at 1 minute and repeated at 5 minutes
HEART RATE -0-absent, 1-slow(<100), 2 >100
RESPIRATORY EFFORT- 0-absent,1-slow, irregular, weak cry, 2- good, srong cry
MUSCLE TONE- 0-flaccid, 1- some extremity flexion, 2- well flexed
REFLEX IRRITABILITY-sx nostrils with catheter, or slap soles of feet- 0-no response, 1-grimacing, 2-infant coughs, sneezes or cries and withdraws feet
COLOR-0- blue or pale, 1 body pink, extremities are blue, 2-completely pink