1
Q
Presumptive signs of pregnancy
A
- amenorrhea
- N/V
- urinary frequency – one of 1st signs
- breast tenderness (d/t excess hormones in body)
2
Q
Probable signs of pregnancy
A
• (+) pregnancy test (d/t presence of hCG levels)
• Goodell’s sign (softening of cervix; 2nd month)
• Chadwick’s sign (bluish color of vaginal mucosa and cervix; 4th wk)
• Hegar’s sign (softening of lower uterine segment; 2nd/3rd month)
• Uterine enlargement
• Braxton Hicks contractions (occur throughout pregnancy; move blood thru placenta)
• Skin pigmentations
–linea nigra (dark line down the center of abdomen)
–facial chloasma (mask of pregnancy)
–abdomen striae (stretch marks)
–darkening of areola (around nipple)
3
Q
Other condition that can ↑ hCG levels
A
hydatidiform (molar pregnancy) or some medications
4
Q
hydatidiform (molar pregnancy)
• if not malignant?
• if malignant?
A
a benign tumor that develops in uterus as a result of a nonviable pregnancy
• if not malignant? D and C w/ follow-up 6 mos - 1 year
• if malignant? tx based on cancer stage and grade
5
Q
Positive signs of pregnancy
A
• Fetal heartbeat DOPPLER: 10-12 weeks FETOSCOPE: 17-20 weeks • fetal movement • ultrasound
6
Q
Pregnancy Terms • Gravidity (G) • Parity • Viability • TPAL
A
- Gravidity (G) - # of times someone has been pregnant
- Parity - # of pregnancies w/ fetus reaching 20 weeks
- Viability - 24 wks gestation; has ability to live outside uterus
• TPAL T = Term - 37 weeks to 40 weeks P = Preterm - before 37 weeks A = Abortion - spontaneous(miscarriage) and elective abortions L = Living children
7
Q
Nulligravida
A
never been pregnant
8
Q
Primigravida
A
pregnant for 1st time
9
Q
Multigravida
A
2 or more pregnancies
10
Q
Primipara
A
completed 1 pregnancy w/ fetus/fetuses reaching VIABILITY (24 wks)
11
Q
Multipara
A
completed 2 or more pregnancies w/ fetus/fetuses reaching VIABILITY (24 wks)
12
Q
Spontaneous abortion • a.k.a.? • s/sx • hCG • occur when
A
- called Miscarriage
- bleeding, cramping, backache
- hCG drop
- before 20 weeks
13
Q
Naegele’s Rule
A
find first day of LMP
add 7 days
subtract 3 months
add 1 year
14
Q
1st trimester: Nutrition and wt gain
A
- well-balanced diet
- 60 grams per day PROTEIN
- culture: hot vs cold foods; Kosher foods; fasting
• gain 1 - 4 lbs in the 1st trimester
15
Q
1st trimester: Prenatal supplements
• biggest complaints w/ IRON?
• always take iron with? why?
• FOLIC ACID prevents what? daily dose of?
A
- Constipation and GI upset
- take iron w/ VITAMIN C
- neural tube defects – 400 mcg/day
16
Q
1st trimester: Exercise rules
• what exercises are NOT allowed?
• don’t let HR get above ____ – why?
• Do not want them overheated so, no ____ – why?
A
- No high impact (WALKING and SWIMMING are best); no heavy exercise program but CAN continue regular exercise program
- no HR > 140 – ↓ cardiac output
- NO HUT TUBS or HEATING BLANKETS – ↑body temp = body defects
17
Q
Danger signs and Potential Complications
A
- sudden gush of vaginal fluid
- bleeding
- persistent vomiting
- severe headache
- abdominal pain
- ↑ temps
- edema
- no fetal movement ** (sign of adv labor and poor delivery outcomes)
18
Q
1st trimester: Common Discomforts
A
- constipation
- ankle edema
- N/V
- breast tenderness
- urinary frequency
- tender gums
- fatigue
- heartburn
- inc vaginal secretions
- nasal congestion
- varicose veins
- hemorrhoids
- backache
- leg cramps
19
Q
1st trimester:
What are you going to tell the pregnant person about taking medications?
A
NO medications
- unless prescribed by PHP
20
Q
1st trimester: Smoking
• what to tell them?
• smoking during pregnancy is associated w/?
A
- STOP SMOKING
* small for gestational age, low birth wt, cleft lip/palate, risk for placental abruption
21
Q
Doctors visits–how often?
• first 28 weeks?
• 28-36?
• after 36 weeks?
A
- once a week
- every 2 weeks/ twice a month
- weekly until delivery
22
Q
Ultrasound
• what should client do before an ultrasound? why?
• what about an ultrasound before a procedure like amniocentesis? why?
A
- drink water to distend bladder – pushes uterus UP closer to abdominal surface = easier to get a good pic
- have them VOID to prevent accidental puncture
23
Q
Amniocentesis?
A
sampling of amniotic fluid using a hollow needle inserted into uterus to screen for developmental abnormalities
24
Q
1ST TRIMESTER
week ___ to ____
A
1 to 13
25
2nd trimester: Nutrition and Weight Gain
* 300 calories/day
* in adolescents -- 500 calories/day
* gain 1 lb per week
26
2nd trimester: Should the client still be experiencing
1. N/V?
2. Breast tenderness?
3. Urinary frequency?
* no
* yes
* no
27
2nd trimester: Quickening
• What is it?
• When?
* fetal movement
| * 16 - 20 weeks
28
2nd trimester: Fetal HR
• normal?
• panic if less than?
* 110 - 160
| * panic if <110
29
2nd trimester: Kegel Exercise
• which muscles to strengthen?
• help stop what?
• keep what from falling out?
* strengthen pubococcygeal muscles
* help stop urine flow
* uterus
30
2ND TRIMESTER
| week ___ to ____
14 to 26
31
3rd trimester:
• weight gain
• normal Fetal HR
* no more than 1 b per week
| * 110 - 160
32
3rd trimester: Monitor BP for Preeclampsia
• what's preeclampsia?
• develops after ___ weeks gestation
• s/sx?
• wt gain of ___ in a week = worry about preeclampsia
• client can have a ____
• drug of choice for preeclampsia? action?
• difference between preeclampsia and eclampsia?
* preeclampsia is BP ≥160/110 documented 6 hrs apart
* 20 weeks gestation
* ↑BP, proteinuria, edema
* 2 or more lbs in 1 wk = watch closely!
* seizure
* Magnesium Sulfate -- anticonvulsant, sedates, vasodilates (↓ BP, ↑ kidney perfusion)
* eclampsia have SEIZURES
33
```
Leopold Maneuvers
• what is it?
• how is it done?
• what should client do first?
• if client is having contractions, should Leopolds be done during or between contractions?
```
* to determine fetal position/presentation
* palpating around abdomen to find the baby's head, back, booty
* void
* between contractions
34
```
Signs of Labor: LIGHTENING
• occurs when?
• what is it?
• what will the client notice?
• what it does to bladder?
```
* 2 weeks before term
* when presenting part of fetus (usually head) DESCENDS INTO PELVIS
* breathe more easily because pressure on diaphragm ↓
* puts more pressure on bladder = urinary frequency is a prob again
35
Signs of Labor: ENGAGEMENT
when the largest presenting part is IN THE PELVIC INLET (hopefully it's fetal head presenting first)
36
If the membranes ruptured and the head is not engaged, what happens? what to do about it?
prolapsed cord! obtain Fetal heart tones to know if baby is stable
37
Signs of Labor: FETAL STATIONS
* in cm
| * measures the relationship of presenting part of fetus to ischial spines of mother
38
Signs of Labor: Other signs
* Braxton Hicks contractions (more frequent and stronger than before)
* softening of cervix
* bloody show
* sudden burst of energy "nesting"
* diarrhea
* rupture of membranes
39
When should the client go to the hospital?
when contractions are 5 MINUTES APART or when MEMBRANES RUPTURE
40
what are we worried about when membranes rupture
prolapsed cord
41
Stages of Labor
1st stage DILATION (0-10 cm)
• Latent (0-5 cm)
• Active (6-7 cm)
• Transition (8-10 cm)
2nd stage BIRTH
• cardinal movement - engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
• push 3x/contraction
• APGAR
3rd stage PLACENTA
• waiting 30 mins max
4th stage RECOVERY/BONDING
42
Non-Stress Test
• what is it? looking for?
• each increase should last how many seconds? recorded how many minutes?
• want this test to be reactive or non-reactive?
* 2 or more accelerations of 15 beats/minute with or without fetal movement---Looking for ACCELERATION
* each increase should last 15 SECONDS; recorded for 20 MINUTES
* want this test to be REACTIVE
43
```
Biophysical Profile Test (BPP)
• done when?
• how often in high risk pregnancy?
• measurements are obtained by what?
• each parameters count as how many points? what's a perfect score?
• what are the parameters?
• observation time is? by what?
• results: good? worrisome? ominous (immediate delivery)?
```
• in 3rd trimester
• every week or twice a week in 3rd trimester
• ultrasound
• 2 points each parameter---10/10 is perfect score
• Parameters
----HR, Muscle tone, Movement, Breathing, Amount of Amniotic Fluid around the baby
• 30 mins by sonogram
• 8-10 is good --- 6 is worrisome --- <4 is ominous
44
Contraction stress test- oxytocin challenge
• Looking for?
• performed on which high risk pregnancies?
• determines if baby can handle what?
• what's deceleration?
• we do NOT want to see ____ decelerations--means what?
• do we want positive or negative test? negative test mean what?
• rarely performed before how many weeks? why?
• results are only for ___ week
* late decelerations in HR
* preeclampsia, maternal diabetes, any suspected placental insufficiency conditions
* if baby can handle the stress of a uterine contraction
* if blood flow decreases enough to cause hypoxia in fetus, then FHR will decrease from baseline
* LATE decelerations---means uteroplacental insufficiency = placenta is wearing out
* negative test---it means no late decels
* 28 weeks --- induces delivery of premature baby
* 1 week
45
```
VEAL CHOP -- what is it? interventions?
Variable
Early
Accelerations
Late
```
Variable → Cord compression -- (BAD) put client in Trendelenburg or knee-chest position
Early decelerations → Head compression -- not bad
Accelerations → Okay
Late decelerations → Placental insufficiency -- (BAD) put on left side, Administer O2
46
True labor
| contractions? frequency and duration? discomfort where? pain level with change in activity?
regular contractions
↑ in frequency and duration
discomfort in back and radiates to abdomen
↑ pain level
47
False labor
| also called? contractions? discomfort where? pain level with change in activity? what activities?
```
"Braxton Hicks"---
irregular contractions
discomfort in abdomen (just front)
pain decreases w/ change of activity;
walk, drink water, roll in bed
```
48
```
Premature Labor
• contractions occur with? between ____ weeks
• goal?
• treat what to stop preterm labor?
• client placed on?
• Medications prescribed?
```
* occur w/ dilation, 20 and 37 weeks
* stop labor!!
* treat vaginal/UTI infection and hydrating mom
* bedrest
Medications
• Magnesium Sulfate (IV) - relaxes uterus
• Betamethasone (IM) - steroid; helps fetal lungs mature
STOP contractions w/
• Terbutaline (SQ)
• Indomethacin (PO)
• Nifedipine (PO)
49
Epidural Anesthesia
• position?
• given in stage when ___ cm dilation
• major complication? what to monitor? treatment? positioning? to prevent what? alternate position how and how often?
• don't forget to check ____ and assess ____
* Lie on LEFT side, legs flexed, prop up over bedside table
* 3 to 4 cm dilation
• Major complication--Hypotension
- -monitor BP
- -tx: IVFs bolus 1000 mL NS or LR
- -semi-fowlers, tilted on their side to prevent vena compression (↓ venous return = ↓ cardiac output and BP = ↓ perfusion of placenta)
- -alternate position from side to side HOURLY
• check URINE OUTPUT, assess BLADDER
50
Oxytocin: Nursing Considerations
1. need what type of care?
2. be alert for what kind of complications?
3. want a contraction rate of ___ every _____ minutes, each lasting _____ seconds
4. discontinue oxytocin when?
5. when you discontinue oxytocin, make sure you do not turn off what?
6. What position when receiving oxytocin?
7. What should be done w/ the infusion if late decelerations occur?
1. one on one care
2. hypertonic labor, fetal distress, uterine rupture (d/t rupture of scar from prev CS; or VBAC moms)
3. 1 contraction every 2-3 minutes, each lasting 60 seconds
4. contractions are TOO OFTEN, LAST TOO LONG, or w/ any sign of fetal distress (late decels)
5. main IV fluid (oxytocin is piggybacked into a main IVF)
6. anything but FLAT on their back (NOT supine b/c of vena cava compression)
7. Turn it off
51
Oxytocin Medication Alert
• always label what?
• only administer oxytocin with its own bag and __________ before you remove the tubing from the pump
• attach the oxytocin at the IV port _____ to the site
• when you discontinue oxytocin, remove what?
* label both IV bag w/ oxytocin sticker and IV tubing and ports
* close all clamps
* closest
* remove IV bag and all tubing from the room
52
Emergency delivery/Precipitous Delivery
a. Tell client to pant/blow to ↓ urge to push --SHOULD NOT PUSH BETWEEN CONTRACTIONS--ONLY PUSH DURING!
b. Wash hands
c. Elevate HOB
d. Place something clean under butt
e. ↓ touching of vaginal area
f. As head crowns, tear the amniotic sac
g. Place hand on fetal head and apply gentle pressure
h. When head is out, feel for cord around the neck
i. Ease each shoulder out
j. The rest will deliver fast
k. Keep baby's head down
l. Dry baby (b/c cannot regulate its temp)
m. Place baby on mom's abdomen
n. Cover baby (Skin to skin contact w/ mom--great way to keep baby warm)
o. Wait for placenta to separate/deliver
p. Can push to deliver placenta (want it out in 30 MINUTES)
q. Inspect placenta for intactness --worry about hemorrhage
r. Tie the cord off w/ something (clean shoestring, narrow strip of cloth) --place know no closer than 4 in to baby's navel and a second knot about 8 in from baby's navel
s. Check firmness of uterus
53
Postpartum
Vitals
• temp? BP? HR?
• TACHYCARDIA + POSTPARTUM...THINK ____
Breast
• soft for ______, then the dreaded engorgement occurs
Abdomen
• how does it feel?
GI
• is hunger common?
Vitals
---temp? may ↑ to 100.4 F (38 C) during first 4 hrs
--- BP? STABLE
--- HR? 50-70 is COMMON for 6-10 DAYS after delivery
•THINK HEMORRHAGE
Breast
• soft for 2-3 DAYS, then the dreaded engorgement occurs
Abdomen
• SOFT/LOOSE
GI
• is hunger common? YES
54
Postpartum: Uterus
• fundus is midline ____ finger breadths (FB) below umbilicus
• a few hrs after birth, it rises to level of umbilicus or ___ FB above
• want fundus to be firm or boggy?
• What is the FIRST thing to do if fundus is boggy?
• Fundal height will descend ___ FB/day
• Proper term used when fundus descends and uterus returns to its pre-pregnancy size?
• Afterpains are common for first 2-3 days and will continue to be common if mom chooses to what?
* 2 to 3
* one FB above
* FIRM
* MASSAGE fundus until it's FIRM, then check for BLADDER DISTENTION
* one FB/day
* Involution
* breastfeed
55
```
Lochia
• Rubra -- how many days? color?
• Serosa -- how many days? color?
• Alba -- how many days? color?
• can have ALBA up to ___ weeks
• Clots are okay as long as no larger than a ____
```
* 3-4; dark red
* 4-10; pinkish brown
* 10-28; whitish-yellow
* 6 wks
* nickel
56
Perineal care
• intermittent ice pack for first ____ hrs to decrease ___
• rinse with?
• sitz baths ____ times per day
• _____ sprays --ease pain, promote healing, provide hygiene
• change ____ frequently -- what's the rule?
• teach to report what?
* first 24 hrs; edema
* warm water
* 2-4 times per day
* Anesthetic sprays
* change PAD -- no more than 1 peripad/hour (=hemorrhage)
* foul smell and any lochia changes (alba to rubra)
57
Bonding
• bonding between mother/father and baby develops ____ in infant
• in infant, ____ is not only an emotional need but also a _____
• How does the new born benefit _____ from bonding? ____
* trust
* trust, physiological
* physiologically; skin to skin contact
58
Bonding: Skin to Skin Contact
• what is it?
• how often?
• benefits?
* mom/dad places baby "skin to skin" on their chest--baby is wrapped inside the parent's shirt or covered w/ a blanket
* held for 1 HOUR at least 4 TIMES A WEEK
```
Benefits:
• stabilizes HR
• improves O2 sats
• regulates infant's temp
• conserves calories
• breasts can change in temp to warm or cool the infant
```
59
Breast care: Breastfeeding Mothers
• cleanse w/ ____ after each feeding
• let it ____
• wear ____
• ____ for soreness
• express some ____ and let it ____
• breast pads absorb ____
• mother needs to initiate breastfeeding ASAP after ____ and alternate breasts
• if breastfeeding interrupted: mom can ____
• increase caloric intake by ____ calories per day
• Fluid/milk intake: ______ glasses of fluid a day
• Massaging breasts during feeding can help with ____
• breastfeeding helps uterus ____
* cleanse w/ WARM after each feeding
* let it AIR DRY
* wear SUPPORT BRA
* OINTMENT for soreness
* express some COLUSTRUM and let it DRY
* breast pads absorb MOISTURE
* mother needs to initiate breastfeeding ASAP after BIRTH and alternate breasts
* if breastfeeding interrupted: mom can PUMP
* increase caloric intake by 500 calories per day
* Fluid/milk intake: 8-10 8oz glasses of fluid a day
* emptying
* contract
60
Breast care: Non-breastfeeding Mothers
• how to reduce engorgement?
• how to decrease inflammation and engorgement?
* ice packs, breast binders/ ACE wrap
* Chilled cabbage leaves
* no STIMULATION of the breast
61
Complications: Postpartum infection
• occurs when? caused by?
• teach ____ and good
• dx and treat how?
* infection within 10 DAYS after birth; E. coli/Beta hemolytic strep
* teach proper hygiene (front to back cleansing) and good hand washing
* get cultures, treat w/ abx
62
```
Complications: Postpartum hemorrhage
• early?
• late?
• causes?
• Medications used to halt excessive postpartum hemorrhage?
```
* >500 mLs of blood lost in first 24 hrs with 10% drop from admission Hct (must have both)
* after 24 hrs and up to 6 weeks postpartum
* uterine atony, lacerations, retained fragments and forceps delivery
```
MEDS
• oxytocin (Pitocin)
• methylergonovine maleate (Methergine)
• carboprost tromethamine (Hemabate)
• misoprostol (Cytotec)
```
63
Complications: Mastitis
• what is it? major bacteria? occurs when?
• causes?
• S/SX
```
Treatment
• bed ____
• support ____
• nonbreastfeeding moms?
• if mom's continuing breastfeeding?
• drug of choice? if allergic? when to take it?
• pain meds?
• heat?
• feed the baby ____; always offer the affected breast ____
```
• inflammation of breast tissue caused by Staphylococcus bacteria; occurs 2-4 weeks
Causes
• poor hygiene, not breastfeeding properly
S/SX
• rapid onset fever and chills, breast swollen and hard and tender to touch, malaise
Treatment
• bed rest
• support bra
• binding chilled cabbage leaves (nonbreastfeeding moms)
• if mom's continuing breastfeeding --initiate breastfeeding frequently or pump
• Penicillin (DOC) --if allergic? erythromycin--take after feeding baby
• Pain meds depends what it is and if still breastfeeding
• heat to relieve pressure--breast will leak; help let-down of milk
• frequently; first
64
```
Newborn care: Immediate care
• maintain what?
• APGAR? wants a score of?
• erythromycin use for?
• Phytonadione (Vit K, Aquamephyton) promotes what?
```
• Maintain BODY TEMPERATURE
APGAR
• Activity (muscle tone) -- Pulse (HR) -- Grimace (reflex irritability) -- Appearance (color) -- Respiration
--want 8 - 10 score
* erythromycin (eye ointment) to kill Neisseria gonococcus and Chlamydia
* Phytonadione (Vit K, Aquamephyton) promotes formation of clotting factors
65
```
Newborn care: Cord care
• dries and falls off in how many days?
• cleanse with each diaper change using what?
• fold diaper ____ the cord
• NO _____ until cord falls off
• Watch for ____
```
* 10 - 14 days
* alcohol or NS
* below
* immersion
* infection
66
Newborn complications: Hypoglycemia
• why do babies sometimes experience hypoglycemia after birth?
• who's at greatest risk?
* Because they're NOT getting glucose from the mom
| * Large for gestational age, Small for gestational age, Babies of diabetic moms
67
Newborn complications:
- Pathologic Jaundice
• occurs when? means what?
- Physiological Jaundice (hyperbilirubinemia)
• occurs when?
• because of what?
• first 24 hours; Rh/ABO incompatibility
* after 24 hours
* d/t normal hemolysis of excess RBC releasing bilirubin and immaturity of liver
68
Newborn complications: Jaundice Phototherapy
• feed every _____ hours
• make sure newborn's eyes are ______when applying ______
• Genital should be _____
• expect ____ stools and _____ urine
* 2-4 hours
* eyes covered; eye patches
* genitals covered
* green stool; dark urine
69
Rh sensitization/Rh factor:
• Rh sensitization, what is it?
1st pregnancy
• occurs when?
• mother's body looks at baby's Rh+ blood as a ____
• Rh- mom produces _____ against the Rh+ blood
--is the first offspring aftected by them? why?
2nd pregnancy
• Chances of Rh- mom forming antibodies to Rh+ blood increases w/ each pregnancy. why?
• what happens if Rh- sensitized mom gets pregnant again?
• what's the name for increase of immature RBCs in fetal circulation?
• occurs when you have an Rh- mother w/ Rh+ baby
1st pregnancy
• placenta separates at birth, during a miscarriage, amniocentesis, trauma to mom's abdomen
• foreign body
• antibodies -- no,it takes time to develop antibodies
2nd pregnancy
• w/ every pregnancy of an Rh+ baby, there's a risk for mom's Rh- blood coming in contact w/ the baby's Rh+ blood
• mom's antibodies enter baby's bloodstream thru placenta → baby's RBCs breakdown ("Hemolysis") → baby compensate by releasing lots of immature RBCs
• erythroblastosis fetalis = FATAL!
70
Rh sensitization/Rh factor:
Diagnosis
• Inderect Coombs
• Direct Coombs
Treatment
• frequent ____
Prevention
• what to give?
• when is it given?
Diagnosis
• Inderect Coombs - done on mom; measures # of antibodies in blood
• Direct Coombs - done on baby; tells if there's antibodies stuck to RBCs
Treatment
• frequent ULTRASOUNDS
Prevention
• RHOGAM
• Given to mom at 28 wks gestation (for baby in utero) and WITHIN 72 HRS after birth (for next baby); also when there's any bleeding episode during pregnancy
71
How RhoGAM works
• destroy what?
• must do this before when?
* Destroys positive fetal blood cells that get into mom's negative blood
* RhoGAM must do this before antibodies are formed
72
Acrocyanosis
purple hands and feet
73
```
Miscarriage
• patho, causes
• s/sx
• dx
• treatment--if imminent?
• notes
```
* pregnancy termination w/o action taken by woman or another person -- congenital abnormalities incompatible w/ life and maternal infections/disorders
* spotting, bleeding, cramping
* hCG levels, Vaginal ultrasound
* no sex, restrict physical activity; psychological support -- IV, blood, D and C (dilatation and curettage) if needed
* may expel spontaneously; early miscarriage in 1 st trim scheduled D and C; induction if fetus is large
74
```
Hydatiform mole (Molar pregnancy)
• patho
• s/sx
• dx
• treatment
• notes
```
* a benign tumor that develops in uterus as a result of a nonviable pregnancy (no fetus)
* absence of FHTs; large uterus for gest age; excessive N/V; bleeding
* ultrasound; abnormally elevated hCG
* small mole: D and C (empty uterus) -- if malignant, it's "choriocarcinoma" -- CXR to determine metastasis -- measure hCG weekly until normal, then q2-4 weeks; then qq1-2 months for 6 months to a year; don't get pregnant during 1 year f/u time
* complications - bleeding and infection after molar pregnancy -- assess for emotional loss and anxiety
75
```
Ectopic pregnancy
• patho
• s/sx
• dx
• treatment
• notes
```
* gestation outside of uterus; usually in Fallopian tube
* Pain (1st) -- then pain, spotting, maybe bleeding into perineum -- if fallopian tubes rupture = vaginal bleeding present
* ultrasound
* Methotrexate (stop growth of embryo) --- if it doesn't work, incision to remove embryo (entire tube may be removed), done if tube ruptures or advanced pregnancy
• hx of it = at risk for another;
if tube ruptures, assess for hemorrhage
76
```
Placenta previa
• patho
• s/sx
• dx
• treatment
• notes
```
* placenta has implanted abnormally in lower uterus and covers all or part of the cervix → prematurely separate when cervix begins to dilate and efface → baby doesn't get O2 ---placenta may deliver first; most common cause of bleeding in later months (7 mos)
* painless (spot/profuse) bleeding in 2nd half of pregnancy
* ultrasound
* bedrest if no active bleeding;
- -complete previa - hospitalization to prevent blood loss and fetal hypoxia if client goes into labor and fetal monitoring;
- -if there's not much bleeding - bedrest and watch closely
- -monitor blood count, FHTs, contractions (call PHP)
- -C-section
- -NO VAGINAL EXAM
• Fetal complications: preterm; intrauterine growth retardation; fetal distress; anemia
- -maternal complications: hemorrhage, DIC
- -corticosteroids speeds maturation of fetal lungs, ↑ maturity and birth wt until delivery
77
```
Abruptio placenta
• patho
• s/sx
• dx
• treatment
• notes
```
* premature separation of placenta from uterus abnormally (partial or complete)
* Rigid, board-like abdomen, w/ or without vaginal bleeding, abdominal pain, uterine tenderness at site of separation, ↑ uterine tone, can't palpate fetus, dull back pain
* ultrasound
* hospitalization, bedrest, fetal monitoring, tocolytics
- - C-section
- -NO VAGINAL EXAM
- -manage fetal status and maternal shock
• causes: unknown but ↑ risk with MVA, domestic violence, hx of C-section, PIH, smoking, COCAINE USE
78
```
Incompetent cervix
• patho
• s/sx
• dx
• treatment
• notes
```
* cervix dilates prematurely; have hx of repeated, painless 2nd trim miscarriages
* may be none; painless and premature cervical dilation in 2nd trim; mild discomfort, spotting
* transvaginal ultrasound, pelvic exam having a hx of 2nd trimester deliveries
* Cerclage at 14-18 wks--reinforces cervix
- -C-section to preserve suture
- -PHP may clip suture so client can deliver vaginally
• causes: weight of baby puts pressure on cervix = premature dilation
--risk factors: cervical trauma/surgeries; repeated ultrasounds to monitor for dilation in subsequent pregnancies
79
```
Hyperemesis gravidarum
• patho
• s/sx
• dx
• treatment
• notes
```
* starts like regular morning sickness before 20th week but becomes persistent and excessive
* excessive vomiting and dehydration = starvation and death;
- - ↓ BP, weight, UO
- - ↑ H/H
- - ↓ Potassium
- - + ketones in urine
• med hx of N/V; standard physical exam
• NPO 48 hrs; IVFs 3000mL for 1st 24hrs; Antiemetics;
Vitamins;
Quiet environment;
Frequent oral hygiene;
Don't talk about food and keep basin out of sight;
6-8 small dry feedings then clear liquids;
foods/liquid should be icy cold or hot;
well-ventilated room
• common in unmarried, wypipo in 1st pregnancies, multiples gestational pregnancies; H-pylori associated w/ H.G.
80
```
Preeclampsia
• patho
• s/sx
• dx
• treatment
• notes
```
• ↑ BP, proteinuria, edema after 20 wks
• sudden wt gain; face and hand swelling;
headache, blurred vision, spots, hyperreflexia; clonus seizure;
proteinuria; altered liver and renal labs (hepatic dysfunction)
* ↑ BP with proteinuria, low PLT count, impaired LFT, pulmonary edema, new onset heaches or visual disturbances, brisk DTRs
* mild - bedrest, ↑ protein in diet, quiet private room, dim lights, no TV
- -Magnesium Sulfate (DOC); anticonvulsant, sedative, vasodilator, avoid renal failure, ↑palcental perfusion --- if kidney function impaired or shift occurs too fast, high risk for pulmonary edema --- also used for preterm labor
- -Monitor q1-2hrs for Mag toxicity; check BP, RR, DTRs, LOC, UO hourly, serum magnesium; common SE ↑ HR
- -- if Magnesium sulfate is used, labor will stop unless augmented w/ oxytocin
- -- if dia >100 apresoline in combo w/ magnesium sulfate
- --may add bethametasone 24-34 wks to reduce infant mortality--stimulates surfactant production to help w/ breathing
• mild: BP 30/15 off baseline, recorded 6 hrs apart; 2 or more lbs of wt gain in 1 wk worry PIH
- -severe: BP 160/110 recorded 6 hrs apart; sedation to delay seizures
- -never lay on BACK
- -preterm delivery = fetus risk for immature lungs and ↓ blood flow to placenta
81
Eclampsia
• patho
• s/sx
• treatment
* progression of preeclampsia w/ generalized seizures
* ↑BP with SEIZURES
• tx - monitor FHTs and labor progression; bedrest; antihypertensives, anticonvulsant (magnesium sulfate DOC)
--monitor for s/sx of HF, stroke, heart attack, renal failure, DIC, HELLP syndrome, neuro damage, multisystem organ failure
82
```
Premature labor
• patho
• s/sx
• dx
• treatment
• notes
```
* labor that occurs between 20-37 wks
* uterine contractions (may/may not be painful), constant low back pain, pain in vagina/thighs, change/increase in vaginal discharge (Spotting)
* gentle cervical exam w sterile speculum or transvaginal ultrasound
* tocolytics: terbutaline, Magnesium Sulfate
- -bethametasone given IM to mom (stimulate maturation of baby's lungs)
- -hydrate mom; treat vaginal/UTI
• limit activity; hydration therapy
83
```
Prolapsed Cord
• patho
• s/sx
• dx
• treatment
• notes
```
* umbilical cord falls thru cervix when presenting part not engaged and membranes rupture
* visible vaginal opening;
- -palpation vaginal exam - cord will pulsate in sync w/ FHTs
- -occult prolapse - suspected b/c FHT changes, not palpated/seen
* assessment and palpation, ultrasound
* lift head off cord until provider arrives
- -place client in Trendelenburg or knee-chest position
- -administer O2
- -monitor FHTs, Check FHTs when membranes rupture
- -cord compression = variable decels = C-section ASAP!
• if cord ceases to pulsate = fetal death
- -if still pulsating = fetus is being oxygenated to some degree
- -DO NOT push cord in
84
```
Shoulder dystocia
• patho
• s/sx
• dx
• treatment
• notes
```
• fetal head is out but anterior fetal shoulder is stuck w/ maternal pelvis
--risk factors: LGA or >4000 grams macrosomic infants; gestational diabetes; hx of it; postdate delivery = large fetus
* delay in birth of shoulders once head is delivered
* "Turtle Sign" - fetal head after it's delivered retracts back against the perineum
• McRoberts maneuver (hyperextend legs) or Mazzanti technique (suprapubic pressure)
--NEVER apply fundal pressure, only HCP
• risks to fetus - hypoxia, brachial plexus injury (Erb's palsy), broken clavicle, Bell's palsy
--maternal risks: traumatic delivery, bruised bladder, extension of episiotomy, rectal tear, torn cervix and/or uterus
85
```
Group B strep
• patho
• s/sx
• dx
• treatment
• notes
```
* leading cause of neonatal morbidity
* no s/sx
* vaginal and rectal cultures 35-37 weeks and on admit to L and D
* prophylactic abx during L and D (IV Penicillin; Cephazoline or Clindamycin)
* risk factors: preterm <37 wks
- - not an STI
- - (+) prenatal cultures in current pregnancy
- - premature rupture of membranes
- - + hx for early-onset neonatal GBS
- - intrapartum maternal fever >100.4 F (38 C)
- -prev infant w/ GBS
NCLEX
flashcards
Decks in class (24)
# Cards
-
Normal Lab Values62
-
Insulins & IV Solutions14
-
Analgesics4
-
Common drugs (suffixes)59
-
Stages: Freud, Erikson, Maslow18
-
Infection Control42
-
Leadership/Community44
-
Fluid & Electrolytes91
-
Acid Base Balance31
-
Burns53
-
Oncology46
-
Endocrine78
-
Cardiac76
-
Psych19
-
Renal9
-
GI15
-
Respiratory9
-
Ortho63
-
Neuro40
-
Maternity85
-
Pediatrics67
-
Management of Care38
-
Asthma5
-
Immunization (peds)9
