1
Q
Calculating due date (Nagele’s Rule)
A
- Take first date of last menstrual period → add 7 days → subtract 3 months
2
Q
Total weight gain during pregnancy
A
- 28 lbs +/- 3 (25-31)
- 1st-trimester weight gain
- 1 lb per month (3 lbs total)
- 2nd/3rd trimester weight gain
- 1 lb per week
- For expected weight gain, take the week of gestation and subtract 9.
3
Q
Fundus (top of uterus)
A
- Not palpable until week 12
- Fundus typically reaches the umbilical at 20-22 weeks
4
Q
Positive signs of pregnancy
A
- Fetal skeleton on x-ray
- Fetal presence on ultrasound
- Auscultation of the fetal heart (doppler)
- Examiner palpates fetal movement/outline
5
Q
Probable/Presumptive signs of pregnancy
A
- All urine and blood pregnancy tests
- Chadwick’s sign (color changes of the cervix to cyanosis)
- Goodell’s sign (cervical softening)
- Hegar’s sign (uterine softening)
- order of Chadwick/Goodell/Hegar alphabetical
6
Q
Discomforts of Pregnancy
A
- Morning sickness
- 1st trimester
- Treatment
- Dry carbs before getting out of bed
- Avoid empty stomach
- Urinary incontinence
- 1st/3rd trimester
- Treatment
- Void Q2H
- Dyspnea
- 2nd/3rd trimester
- Treatment
- Tripod position
- Back pain
- 2nd/3rd trimester
- Treatment
- Pelvic tilt exercises (put foot on stool)
7
Q
Labor
A
- Most valid sign of labor
- Onset of regular contractions
- Dilation
- Opening of cervix (0-10cm)
- Effacement
- Thinning of cervix (thick-100%)
- Station
- Relationship of fetal presenting part to mom’s ischial spine (tightest squeeze for baby’s head)
- Negative = above spine
- Positive = below spine
- Engagement = station 0 at ischial spines
- If numbers don’t go positive, C-section
- Lie
- relationship between spine of baby and spine of mom
- Presentation
- part of baby that enters birth canal first
- most commonly ROA or LOA
8
Q
Patient education
A
- Pattern of office visits
- Once a month until week 28
- Starting at week 28, once every 2 weeks until week 36
- Starting at week 36, weekly until week 42 (induction or c-section)
- Hemoglobin
- normal to fall in pregnant women
- Can fall to 11 in 1st trimester and be normal
- Can fall to 10.5 in 2nd trimester and be normal
- Can fall to 10 in 3rd trimester and be normal
9
Q
Stages of Labor and Delivery
A
- Stage 1: Labor
- Purpose of uterine contractions: Dilate and efface the cervix
- 3 phases
- Latent → Active → Transitional
- Stage 2: Delivery of baby
- Purpose of uterine contractions: push the baby out
- Stage 3: Delivery of the placenta
- Purpose of uterine contractions: push the placenta out
- Stage 4: Recovery
- Purpose of uterine contractions: stop bleeding
- Lasts 2 hours to stop bleeding
- Postpartum begins 2 hours after delivery of the placenta
10
Q
Stage 1: Labor
A
- Latent
- 0-4 cm dilated
- 5-30 minute contraction frequency
- 15-30 second contraction duration
- Mild intensity
- Active
- 5-7 cm dilated
- 3-5 minute contraction frequency
- 30-60 second contraction duration
- Moderate intensity
- Transitional
- 8-10 cm dilated
- 2-3 minute contraction frequency
- 60-90 second contraction duration
- Strong intensity
- Contractions should not be longer than 90 seconds or closer than every 2 minutes
- Stop Pitocin if times exceed 90 seconds and 2 minutes
- Intensity
- Palpate with pads of fingers of one hand over the fundus
11
Q
Stage 2: Delivery of baby
A
- Nursing interventions
- Deliver the head (stop pushing)
- Suction mouth
- Suction nose
- Check for nuchal cord (cord around neck)
- Deliver shoulders and body
- Make sure baby has ID band
12
Q
Stage 3: Delivery of the placenta
A
- Check if intact
- Check vessels
- Should be 2 arteries and 1 vein (AVA)
13
Q
Stage 4: Recovery
A
- Assessments Q15 minutes for first 2 hours after delivery
- Vital signs (assess for s/s of shock - pressures decrease, rates go up, pale, cold, clammy)
- Check fundus (if boggy, massage; if displaced, void/cath)
- Check perineal pads (excessive lochia = pad sat Q15 minutes)
- Roll on to side (check for bleeding under patient)
14
Q
Complications of Labor
A
- Intense back pain during labor (OP position “oh pain”)
- Baby turned around backward
- Low priority
- Position, then push
- Position knee/chest on hands and knees
- Push fist into the sacrum
- Prolapsed cord
- High priority
- Push, then position
- Push head back in off cord
- Position in knee/chest or trendelenburg
- Prep for C-section
- For all other complications of labor and birth
- LION PIT
- Left side/lateral
- IV increase rate
- Oxygen increase rate
- Notify PCP
- PIT (stop Pitocin)
- LION PIT
15
Q
Fetal Heart Tracing
A
- Low FHR (<110)
- bad
- LION Pit
- High FHR (>160)
- not a problem
- document
- Take mother’s temp
- Low baseline variability (FHR does not change)
- bad
- LION Pit
- High baseline variability (FHR always changing)
- good
- document
- Late decelerations (FHR slows at end of contraction)
- bad
- LION Pit
- Early decelerations (FHR slows at beginning of contraction)
- document
- normal
- Variable decelerations
- very bad
- prolapsed cord
- Push, position
- VEAL CHOP
- Variable = Cord compression
- Early = Head compression
- Accelerations = OK
- Late = Placental insufficiency
16
Q
Postpartum Assessments
A
- Q4-8 Hours
- BUBBLE HEAD
- Breasts
- Uterine fundus
- firm and midline (massage if boggy, cath if displaced)
- height = day postpartum
- by pubis by 24 hours
- Bowel
- Bladder
- Lochia (vaginal drainag)
- Color
- Rubra - red (first few days)
- Serosa - pink (1 week postpartum)
- Alba - pale
- Amount
- 4-6 inches on pad in one hour is ok
- excessive is pad saturation in 15 minutes
- Color
- Episiotomy
- Hgb/Hct
- Extremity check
- Assess for thrombophlebitis
- bilateral calf circumference
- Assess for thrombophlebitis
- Affect
- Discomfort
17
Q
Abruptio Placenta vs. Placenta Previa
A
- Abruptio Placenta
- Premature separation of the placenta from the uterine wall
- Primarily seen in multigravida over 35 y/o (w/ hx of HTN, trauma, cocaine)
- Painful
- Assessments
- 5-15 minutes for bleeding, maternal VS
- Continuous FHR monitoring, deliver baby at earliest sign of fetal distress
- Babies usually delivered by C-section
- Higher risk of fetal death
- 3rd trimester
- Placenta Previa
- Not painful
- more voluminous than abruptio
18
Q
Cardiac disease in Mothers
A
- # 1 cause - rheumatic heart disease
- S/s
- JVD
- Murmurs
- Crackles/rales
- SOB
- Palpitations
- Treatment
- Rest
- bedrest for one week after delivery
- Diuretics, heparin, digoxin
- can be given analgesics (morphine ok)
- Dietary modifications (decreased Na, decreased water)
- Increase iron and folic acid
- Rest
- Interventions
- Assess lung sounds Q30-10 minutes during the stages of labor
- Limit client’s effort to bear down
19
Q
1st Trimester findings
A
- Increased leukorrhea (vaginal secretions
- Nasal stuffiness
- Urinary frequency increases
- Fatigue
- Epistaxis
- N/V
- Breast changes (tenderness, pain, tingling, fullness)
- Pytalism (increased salivation)
- Gingivitis
20
Q
2nd Trimester findings
A
- Accepting fetus as being distinct from self
- Heartburn
- Striae gravidarum
- Linea nigra
- Urinary frequency lessens
- Pruritis
- Joint pain and mobility
- Pelvic pressure
- Chloasma “Mask of pregnancy”
- begins after week 16 and lasts until delivery
- Supine htn
- Hemorrhoids
- Backache
- Varicose veins appear
- Round ligament pain
- Carpal tunnel syndrome
- Oily skin and acne
- Constipation
- Palpitations
- HA
- Faintness
- Food cravings (pica)
21
Q
Third Trimester
A
- Preparing for birth and parenting
- Fear defects in the baby
- Pregnant women fears labor and delivery
- SOB and dyspnea
- Urinary frequency returns to normal
- Insomnia
- Braxton-Hicks contractions
- irregular, false contractions
- Ankle edema (non-pitting)
- Leg cramps
- Perineal pressure
22
Q
Discomforts and Dangers in pregnancy
A
- Ambivalence
- Spider nevi on neck, thorax, face, arms (2nd or 3rd)
- Danger signs
- Severe HA
- UTI
- Epigastric pain
- severe abdominal pain
- Seizures
- Decreased fetal movements or absent fetal movements
- movements first felt around 16 to 20 weeks
- Blurry vision (pre-eclampsia)
- Vaginal bleeding
- Persistent, severe vomiting
- Edema of face or fingers (possible HTN, pre-eclampsia)
23
Q
Endometriosis
A
- Treatment
- Androgens (Danazol)
- No tampons
- Diagnostics
- Laparoscopy
Mark Klimek
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