question

Nutritional needs of lactation vs. nutritional needs of pregnancy

answer

The lactating women needs more CALORIES but the same amount of calcium, protein and fluids are needed.

question

Example two week old full term neonate - normal findings

answer

- regained initial weight loss within 14 days - 1 to 3 BM/day - 6 to 8 wet diapers indicated the baby is well hydrated - breastfed 8x /day

question

Oxytocin

answer

- used to stimulate an active labor pattern - naturally occuring hormone released by POSTERIOR PITUITARY - synthetic form is used to stimulate or augment UC during labor. Therp Class - oxytocic - synthetic hormone Action - acts on uterine myofibrils to contract

question

Oxytocin Nursing Care

answer

Nursing care - admin with infusion pump - closely monitor mom and fetus If contractions occur < 2 min. apart, last longer than 60-90 seconds, or sig change in FHR - STOP INFUSION and turn client to left side

question

Oxytocin Indications

answer

- to induce / augment labor - in pts with PIH, prolonged gestation, maternal diabetes. Rh sensitization, PROM or PPROM, incomplete or inevitable abortion - to control bleeding and enhance UC AFTER the placenta is delivered - rare cases in nonstress contraction test (>31 weeks) if nipple stimulation fails to produce contractions

question

Oxytocin Nursing Implications / Care

answer

Admin IV with infusion pump - starting primary IV line - insert tubing of admin set through infusion pump set drip rate to prescribed dosage and infusion rate - infusion rate: 0.5 to 1.0 ml/minute - labor starting dose: 10 units of oxytocin in 100 mL isotonic solution - maximum dose: 20-40 mU Admin Oxytocin by piggyback method in IV line - always given in piggyback, so if hyperstimulation occurs, the drug can be stopped immed. and IV fluid can continue - also if necessary, drug can be restarted easily to achieve goal

question

Oxytocin Nursing Implications / Care continued

answer

Using external electronic fetal monitoring methods - monitor for FHR decelerations or fetal distress and stop infusion immed. if these occur Be prepared to monitor UC as drug acts immed -regulate infusion rate to achieve contractions that mimic labor Increase oxytocin dose as ordered - DONT increase more than 1-2 mU/min once every 16 to 60 min. Before each increase - assess contraction - maternal VS - fetal HR/rhythm - verify uterine relaxation btw/ contractions by external or internal fetal monitor Monitor maternal HR - if HTN occurs, stop infusion and notify doctor Assist with comfort measure - repositioning pt on her side prn Review infusion rate to prevent uterine hyperstimulation - if hyperstim occurs, D/C oxytocin and admin O2 - increase uterine blood flow by changing the pts position and increasing infusion rate of primary IV line - resume oxytocin infusion, per policy after hyperstim is resolved Monitor I&O, water for signs of water intox (HA/vomitting) - limit IV fluids to 150 mL/hr prepare pt for birth

question

Oxytocin Expected Outcomes

answer

- contractions begin and follow pattern of natural labor - pt suffers NO adverse effects from drug - fetus suffers NO distress - Fetus is delivered successfully

question

Oxytocin Action

answer

- increases UC by increasing circulation of free intracellular calcium - oxytocin receptors increase during preg, esp in 3rd trimester and in LATENT phase of labor due to influence of estrogen, progesterone, prostaglandin - with increased # of receptors, amt of oxytocin needed for labor DECREASES - continuous infusion of oxytocin raises circualting blood level slowly over 20-30 min - half life is only 1-5 min. so stopping infusion results in RAPID DECREASE in effect

question

Oxytocin Adverse Effects

answer

- N/V (water intox) - cardiac arrhythmias - uterine hypertonicity - titanic contractions - uterine rupture (excessive dosages) - severe water intox - fetal BRADYCARDIA

question

If a woman's membranes rupture, what is the nurses FIRST action?

answer

- observe for prolapsed cord or menconium stained fluid these are signs of potentially life threatening complications to the fetus that may require emergency delivery

question

Patient is in labor and appears peaceful and there is an increase in bloody show, what stage of labor is she in?

answer

2nd stage - a short period of peace and an increase in bloody show occur immed. BEFORE the baby is born and at the beginning of 2nd stage of labor

question

Stages of Labor

answer

1st stage - 1 to 10 cm dilitation 2nd Stage - peaceful time, bloody show 3rd Stage - delivery of placenta 4th Stage - 1st 2 hours of delivery

question

Stage 1 of labor

answer

begins with onset of regular contractions and ENDS when cervix is completely effaced and dilated

question

Stage 2 of labor

answer

from complete dilatation of cervix to the birth of the infant

question

Stage 3 of labor

answer

from birth of infant to delivery of placenta

question

Stage 4 of labor

answer

from 1-4 hours post birth

question

How to recognize the onset of labor

answer

- may feel a gush of water at the beginning of labor - may have blood tinged vag discharge - regular UC that become stronger - FM remains UNCHANGED during true labor

question

Gush of water at the beginning of labor indicated what?

answer

- ruptured membranes - labor usually begins within 24 hours of SROM

question

Bloody show is a sing of what?

answer

preceding labor

question

Other signs of preceding labor include

answer

- lightening - urinary frequency - backache - surge of energy - stronger Braxton Hicks contractions

question

Regular uterine contractions that become stronger indicates what?

answer

- true labor discomfort radiates from back to the abdomen contractions dont decrease with rest cervix progressively effaces and dilates

question

cheesy white vaginal discharge indicates what?

answer

candidiasis other Sx - vaginal pruritus Tx with anti fungal prep

question

During labor induction with oxytocin, contractions are observed at 2 min intervals and last > 90 seconds, what should the nurse do?

answer

stop the infusion! its extrem important to continually assess contractions for pt receiving oxytocin drip if contractions occur too freq, (intervals of 90 secs), they may endanger mom and fetus nurse should STOP infusion, and notify doctor

question

Patient is in labor and with regular contractions and her cervix is 9cm dilated, what stage of labor is she in?

answer

1st stage from the beginning of labor until the cervix is completely dilated = 1ST STAGE subdivided into Latent Phase (0-3cm) Active Phase (4-7cm) Transition Phase (8-10cm)

question

Second Stage

answer

from complete dilitation to the birth of the baby Phase 1 = 0 to +2 station Phase 2 = +2 to +4 station Phase 3 = +4 to birth

question

Third stage

answer

delivery of placenta, slight gush of blood and lengthening of umbilical cord

question

Fourth Stage

answer

- 2 hours following birth of baby

question

Normal amount and character of lochia

answer

- bright red and less than a heavy menstrual period

question

12 hours after deliver the fundus should be

answer

1 cm above the umbilicus within 12 hours of birth > 12 hours, the fundus should descend 1-2 cm /day

question

Heredity can be a factor for LGA infants, true or false?

answer

true

question

Macrosomia of insulin dependent diabetic mothers is caused by what

answer

poor maternal control infant has round face, chubby body, flushed complexion

question

What are macrosomia infants at risk for?

answer

hypoglycemia hypocalcemia hyperbilirubinemia

question

Gravida

answer

total number of pregnancies regardless of duration includes - present pregnancy a pregnant woman

question

Parity

answer

number of past pregnancies that have gone beyond the period of viability (capability of fetus to survive outside of the uterus) after 20 weeks gestation or > 500 grams regardless of # of fetuses or whether the infant was born dead or alive

question

Gravid

answer

the state of being pregnant

question

Para

answer

a woman who has carried 1 or more viable offspring to 20 weeks or more

question

Gravida/Parity

answer

- the # of pregnancies a woman had, including the current pregnancy = gravida - the # of children a woman has borne at 20 weeks or later = para - ex. a woman who's preg for the 2nd time and who has 1 child = gravida 2, para 1

question

Primigravida

answer

woman who is pregnant for the 1st time

question

Multigravida

answer

a woman who has previously been pregnant

question

Nulligravida

answer

woman has never been and is not pregnant

question

Primpipara

answer

a woman who has borne 1 child in past 20 weeks

question

Multipara

answer

a woman who has borne 2 or more children in the past 20 weeks

question

GTAL and GTPALM provide more detailed info about a womans preg Hx

answer

G = gravida remains the same T = number of full term infants P = number of preterm infants A = number of abortions L = number of living children M= number of multiple pregs

question

RDS

answer

altered resp state d/t surfactant deficiency in lungs labored resp after several min. or hours of normal respirations initially cyanosis, grunting, nasal flare, retractions, tachypnea

question

Cold stress

answer

- mottled skin and metabolic/resp acidosis - excessive loss of heat that results in increased resp and nonshivering thermogenesis - metabolic acidosis occurs - place in heated environment

question

Perinatal Asphysxia

answer

occurs in utero chronic hypoxia occurs in fetus that is - SGA - maternal Hx of heavy cig smoking Prepare for aggressive ventilatory assistance keep airway open

question

Hypovolemia

answer

low blood volume

question

Cold Stress

answer

excessive heat loss in newborns in order to maintain core temp, infant uses metabolic processes to generate heat Indications include - increased resp - mottling of skin / cyanosis - abnormal blood gases (metabolic acidosis)

question

Nursing Care for Cold Stress

answer

- place infant in heated environ immed after birth - maintain neutral environment - monitor temp - fabric insulated cap for head

question

Gonorrhea can may you unable to have children, true or false?

answer

TRUE - bc it causes pelvic inflamm disease which is one of the most common causes of sterility

question

How is Gonorrhea treated?

answer

with antibiotics

question

Gonorrhea can cause

answer

- preterm labor - premature ROM - PP endometriosis May cause the following the infant: - sepsis - conjunctivitis - preterm birth

question

How to care for the newborns umbilical cord

answer

- clean the cord and skin around it with water - contact doctor if there's white or yellow discharge from cord DO NOT - bathe baby in tub (until it falls off) - cover the cord with diaper (fold diaper below umbilicus to maintain dry area) - will on cord when it becomes loose (allow it to fall off) - apply petroleum jelly to base of cord

question

Newborn Cord Care

answer

- umbilical cord surrounding the skin need be kept clean, dry and open to air until it falls off (usually 7-14 days after delivery) - cord is left clamped (to prevent oozing of blood) until it dries, usually 24 hours post delivery - clean cord with WATER - no bath tubs allowed - diapers folded below base to facilitate drying - report redness, edema, purulent drainage which may indicate infection Once cord falls off, remaining stump needs another 3-5 days of care

question

Newborn Cord Care expected outcomes

answer

- shriveled and blackened umbilical cord falls of in 7-10 days and the umbilicus heals completely

question

Newborn Cord Care Implementation

answer

- assess area freq for blood / signs of infection - follow facility policy on cleansing and applying any appropriate agent at every diaper change - ensure edge of diaper is BELOW the cord area to prevent irritation and promote drying - remove cord clamp ONLY AFTER CORD IS FULLY DRY

question

Newborn Cord Care - Patient Teaching

answer

- apply alcohol or recommended solution to cord site at each diaper change - monitor for bleeding, redness, drainage, or foul odor - dont give infant a tub bath until cord has fallen off or healed - fold diapers below stump - observe color change from yellow to brown to black - allow cord to fall off on its own

question

Newborn Cord Care Unexpected Outcomes and Associated Interventions

answer

Hemorrhage - ensure cord is clamped securely until after thrombosis obliterates the umbilical vessels Infection - keep cord stump dry and clean and dont use creams, lotions, oils near cord Ulcerous area remaining 1 week after the cord falls off - may require cautery with silver nitrate to speed healing

question

FHR during labor is 59bpm, what should the nurse do?

answer

turn the mom onto her left side admin oxygen by nasal cannula start IV

question

Bradycardia in fetus indicates what

answer

- fetal distress persistent bradycardia may indicate - cord compression / separation of placenta

question

When is a woman most likely to become pregnant?

answer

10-14 days after the onset of her menstrual period this is the time of ovulation (around 14th day) if pt has intercourse 2-3 days before this time or 2-3 days after this time, its possible that she will become pregnant, since the sperm lives for about 48 hours.

question

Secretory phase occurs when

answer

between the day of ovulation and about 3 days prior to next menstrual period large amounts of progesterone are produced

question

Implantation of fertilized ovum occurs when

answer

7-10 days after ovulation

question

Ovulation

answer

periodic ripening and rupture of mature graafian follicle and discharge of ovum occurs approx 14 days prior to next menstrual period

question

Fertilization occurs when?

answer

approx 24 hours after ovulation usually in outer third of fallopian tube

question

Ovulation

answer

rupture of mature follicle, which releases an ovum - occurs at about 14 days BEFORE menstruation - low levels of estrogen and progesterone stimulate secretion of gonatotropin releasing hormone which stimulates the secretion of LSH which spurs the development of follicle LH surges, leading to ovulation within 48 hours

question

gonadotropin releasing hormone

answer

this hormone stimulates the anterior pituitary to secrete FSH and LH goes to the anterior pituitary gland and makes it release FSH and LH, prolactin responsible for sex maturation

question

Follicle stimulating hormone

answer

WOMEN: initiates growth of ovarian follicles each month and stimulates ovulation; MEN: stimulates sperm production

question

Lutenizing Hormone

answer

stimulates the formation of corpus luteum, estrogen and progesterone in females and testosterone in males

question

Sex intercourse within 72 hours of ovulation aids in what?

answer

conception

question

Ovulation Assessment

answer

- menstrual history, to determine regularity and length of cycle - evaluation of hormone levels (serum progesterone, FHS, LH, prolactin - Progesterone test to confirm ovulation - Eval of thyroid hormones to determine thyroid functioning and pituitary glands Hypothyroid condition can interfere with - pituitary feedback cycle and disrupt secretion by pituitary of FSHand LH Cervical mucus assessment - at ovulation peak, mucus is thin, watery, transparent and stretches when pulled Measurement of women's BBT - temp rises with ovulation

question

Painless vaginal bleeding indicates what? for example at 29 weeks gestation

answer

placenta previa

question

placenta previa

answer

placenta thats abnormally implanted in the lower uterine segment pt will be Tx with - bedrest - no vag exams - IVs to restore blood volume - monitor FWB

question

Severe abdominla cramps and PAINFUL bleeding indicates what?

answer

abruptio placenata - premature separation of a normally implanted placenta

question

Placenta Previa

answer

- implanted near or over the cervical opening Indications - PAINLESS bright red vaginal bleeding accompanied by soft uterus usually in 3rd trimester btw 29-30 weeks Caused by - scarring of uterus from preg - tumor

question

PLacenta Previa Tx

answer

- bedrest - US to locate placenta - no vag/rectal exams before fetal viability - amniocentesis for lung maturity - daily Hgb and Hct - 2 U of cross matched blood avail

question

Diabetes S/S

answer

- fatigue/weakness - irritability - polyuria - polydipsia - polyphagia - nocturia - blurred vision - slowly healing lesions - numbness of hands and feet - weight loss - dry skin

question

Type 1 DM TX

answer

-strict diet to meet nutrient needs, control bg levels, recduce acidosis - injected insulin, implantable insulin pumps, inhaled insulin

question

Type 2 DM

answer

- meal planning to control blood glucose levels - weight loss to decrease insulin resistance - reg exercise to lower bg, increase insulin effectiveness, reduce cardiovasc risk - injected insulin

question

Gestational Diabetes Tx

answer

- diet modification - blood glucose monitoring - insulin if necessary (oral antidiabetic agents arent used in women)

question

Diabetes Nursing Care

answer

- monitor pts blood glucose freq during insulin infusion - plan pts usual insulin regimen after any crisis - monitor pts electrolyte levels closely and admin K+ replacement if needed - design meal plan - monitor insulin complications (hypo/hyper glycemia) - check for history for conditions such as pregnancy, breastfeeding stress or illness, which can increase insulin requirements - check pts urine for ketones, esp if he is ketosis prone with type 1 dm - show pt how to check their own glucose - monitor A1C

question

Gestational Diabetes

answer

- insulin resistance results from SECRETION OF PLACENTAL HORMONES - in most instances, blood glucose levels return to normal after delivery, but these women are at risk for Type 2 DM later in life

question

The baby's anterior fontanelle should close after how long?

answer

about a year and a half 18 months - diamond shaped, 3x2 cm - junction of saggital, coronal and frontal sutures

question

Posterior Fontanelle

answer

triangular n shape jx of sutures of the 2 parietal bones and 1 occiptal bone closes 6-8 weeks post delivery

question

when is the most critical time for fetal development?

answer

the first 3 months

question

1st 2 weeks of pregnancy

answer

preembryonic stage lasts from conception to 14 days initial development of embryonic membranes and establishment of primary germ layers occur

question

The first 3 months of pregnancy

answer

- 1st trimester aka first 3 months - all major systems of the fetus are developed - exposure of mother to noxious environmental agents can interfere with proper development of fetus

question

The 4th-6th months of pregnancy

answer

the systems are all developed at this time

question

The last month of preg

answer

fetus increases in weight at 36 weeks, able to adjust to extrauterine life

question

Fetal Development at 4 weeks

answer

- fetal heart begins to beat

question

Fetal Development at 8 weeks

answer

- all body organs are formed

question

Fetal Development at 8-12 weeks

answer

fetal heart rate can be heard by doppler device

question

Fetal Development at 16 weeks

answer

baby's sex can be seen fetus looks like a baby

question

Fetal Development at 20 weeks

answer

- heartbeat heard with fetoscope - mom feels movement - baby develops regular schedule of sleeping, sucking, kicking - vernix/lanugo present

question

Fetal Development at 24 weeks

answer

- increased activity, weighs 1lb 10oz - resp movement begins

question

Fetal Development at 28 weeks

answer

- eyes open and close - can breathe at this time - surfactant needed for the baby to breath at birth is formed - 2/3 final size

question

Fetal Development at 32 weeks

answer

- has fingernails, toenails, subcut fat formed

question

Fetal Development at 38-40 weeks

answer

fills uterus

question

Fetal Development begins with conception and continues until birth, its typically divided into 3 periods:

answer

1. Pre-embryonic Period (fertilization to week2) 2. Embryonic Period (weeks 3-7) 3. Fetal Period (week 8 - birth)

question

Pre-embryonic Period

answer

fertilization to week 2 - fertilized ovum advances through the fallopian tube toward the uterus and undergoes miotic division, becoming a ZYGOTE - zygote reaches the uterus about day 3 after fertilization Called a blastocyst when it reaches the uterus, - trophoblast layer develops into fetal membranes and the placenta - inner cell mass then forms the embryo By the end of the 1st week of fertilization, the blastocyst attaches to the ENDOMETRIUM - During the next week, the invading blastocyst sinks below the endometrium's surface - the penetration site seals, restoring the continuity of the endometrial surface

question

Embryonic Period

answer

weeks 3-7 - blasotcyst becomes an embryo

question

Embryonic Period - ectoderm develops into the

answer

Epidermis Nervous system Pituitary gland Tooth enamel Salivary gland Optic lens Lining of the lower portion of anal canal Hair

question

Embryonic Period - Mesoderm develops into

answer

- connective tissue and supporting tissue - the blood and vasc system - musculature - teeth - mesothelial lining of pleural, and peritoneal cavities - kidneys / ureters

question

Embryonic Period - Endoderm develops into

answer

- epithelial lining of pharynx and trachea - auditory canal - ailmentary canal - liver - pancreas - bladder and urethra - prostate

question

Embryonic Period - at the end of the month

answer

the head, trunk and tiny buds that will become arms, legs = are discernible CV system has begin to function umbilical cord is visible in its primitive form

question

Embryonic Period - during the 2nd month,

answer

it grows to 1 and 1 gram head and facial features develop arms / legs take shape external genitalia are present CV function is complete umbilical cord has a definite form

question

Fetal Period

answer

week 8-birth - during the 3rd month, the fetus is 3 and 1 ounce - teeth and bones begin to appear - kidneys start to function - fetus opens mouth - grasps with fully developed hands - preps for breathing by inhaling and exhaling gender is distinguishable by THE END OF THE 3RD MONTH

question

Growth and development of fetus follows what type of pattern?

answer

cephalocaudal (head to toe) proximal to distal pattern

question

Implantation occurs where?

answer

the upper uterus

question

Embryo develops into a fetus, which grows and develops at a predictable rate

answer

- heart beats regularly by week 5 - resembles a human being at the end of week 8 - weight quadruples during the 4th month - FM detected by mother during the 4th month - Fetal heart sounds can be detected by stethoscope during 5th month - muscles are well developed by week 20 - lungs begin to produce surfactant during the 6th month - fetus reaches 15 inches in length during the 7th month - increased CNS control over body fx occurs during the 8th month - fetus is considered full term at 38 weeks - fetus fills uterus during 9th month

question

Adequate amounts of amniotic fluid

answer

- maintain a consistent body temp - protects fetus from trauma - promotes symmetric growth and development - protects from umbilical cord compression - allow for FM to enhance MS development

question

The placenta

answer

- forms the trophoblasts - attaches to the uterus & provides the following functions: - acts as a transfer organ btw mom and fetus - produces hormones necessary for a normal preg (hCG, hPL, estrogen, progesterone, relaxin) - protects fetus from mom's immune system - removes waste products from fetus - triggers mom's body to provide more food to placenta - produces hormones that mature fetal organs in prep for birth

question

The umbilical cord is formed from amnion and is made of how many veins / arteries?

answer

1 large vein 2 small arteries surrounded by Whartons jelly to protect the blood vessels from compression - acts as a lifeline from fetus to mom - approx 22 inches long and 1 in wide at term

question

Oligohydraminos

answer

< 500 mL of amniotic fluid associated with - utero-placental insufficiency - fetal renal abnorms

question

Hydraminos

answer

> 2,000 mL of amniotic fluid at term Associated with - maternal diabetes - neural tube defects - chromosomal deviations - malformations of CNS/GI that prevent fetus from swallowing amniotic fluid

question

Teratogens, infections, radiation, nutrient deficiencies

answer

are the most dangerous during embryonic period bc of rapid growth, and forming of organs / structures

question

Chromosomal abnorms

answer

- numeric or structural abnroms Downs, fragile X syndrome

question

Autosomal Dominant inherited disorders

answer

- abnormal gene pair causes disease even if the matching pair from the other parent is normal - familial hypercholesterolemia - breast and ovarian cancer r/t BRCA genes -

question

Autosomal Recessive inherited disorders

answer

- both gene pairs are mutated, causing disease sickle cell, cystic fibrosis

question

mom addicted to narcotics gives birth to day, when is the most likely time to observe symptoms of narcotic withdrawal?

answer

within 24-72 hours after birth infant wil be jittery, hyperactive, high pitch cry, diaphoresis, tachypnea

question

if mom is taking methadone, infant demonstrates signs of withdrawal when

answer

about 7 days after birth

question

Toxoplasmosis

answer

protozoan infection caused by eating infected undercooked meat or after handling infected kitty litter infection can cross placenta and infect the fetus preg woman shouldnt clean cat liter box, if she must, wear latex gloves and wash hands after

question

How should the nurse palpate uterine contractions?

answer

place one hand on the abdomen over the fundus and with the fingertips, pressgently

question

Mild Contractions

answer

fundus is easy to indent with fingertips

question

Moderate contractions

answer

feels like touching the tip of nose

question

Fundus is difficult to indent

answer

- feels like touching your chin

question

Fundus boardlike and almost impossible to indent

answer

feels like touching your forehead

question

Menconium stained amniotic fluid should alert the nurse to the possibility of what?

answer

fetal distress and perinatal asphyxia

question

Hyperbilirubinemia

answer

- elevation of unconjugated serum bilirubin concentrations - caused by hemolytic disorder (patho) - or bc of rapid destruction of RBCs (physio)

question

Abruptio Placenta

answer

premature separation of normally implanted placenta pt complains of painful vaginal bleeding

question

Placenta previa

answer

painless vaginal bleeding d/t placenta thats implanted over or near the cervical os

question

Fetal Monitor purpose

answer

to determine if the fetus is receiving adequate amounts of oxygen

question

How to evaluate progress of labor

answer

determined by effacement and dilitation of cervix

question

External monitors can measure what?

answer

frequency regularity and duration of UCs but not intensity of UCs

question

Advantages of breastfeeding include

answer

- nutrients are easier for infant to absorb - breast milk contains immune factors - provides protections against allergies - antibody responses to parenteral and oral vaccines are greater - breast milk contains immune factors that contribute to lower incidence of diarrheal illness - lower incidence of SIDS

question

When a mother breastfeeds, the addition of solid foods (cereal) begins at around what months?

answer

4-5 months

question

When mom chooses to breast feed, how many times per day does she need to feed to ensure adequate weight gain?

answer

8-10x /day

question

Breastfeeding - successful lactation depends on what?

answer

infant sucking maternal production / delivery of milk

question

Nurses should instruct breastfeeding mom to

answer

- clean nipples with water, no soap, and dry well - expose breast to air - position nipple so infants mouth covers large portion of areola and release infants mouth from nipple by inserting finger to break suction - rotate breastfeeding positions - educate that most drugs cross through breast milk to baby - check with doc b4 taking any meds

question

Breastfeeding Purpose

answer

- provides optimal nutrition to infant - helps build infants immunity - stimulates hormones that help uterine involution and reduce uterine cramping - gives the mom and infant opportunity to bond - protects against breast cancer in mom

question

Samples of Associated Nursing Diagnoses for Breastfeeding

answer

- Anxiety - Deficient Knowledge - Health Seeking Behaviors

question

Breastfeeding Implementation - Initiating Breastfeeding, including latching on:

answer

- teach mom how to position baby's mouth over the areola so the baby can take the whole areola into mouth - demonstrate how stroking the infants cheek can stimulate rooting reflex - show mom diff ways of holding baby to facilitate the babys latching on (cradle, side lying, football positions) - teach mom how to position baby so it can breathe freely thru the nose - feed baby as freq as he/she wants, usually 8-12x in 24 hours for 1st few months, 10-20 min per session - when feeding complete, teach mom to break suction by inserting finger btw gums and cheek - then gently pull newborn away from breast (tissue damage can occur if suction not carefully broken)

question

Breastfeeding Implementation - Nipple Care

answer

- teach mom to clean breasts / nipples with water and fingertips and to let nipples air dry - avoid soap and washcloth - advise the mother to wear breast pads and to replace the pads often to reduce risk for infection - advise mom to lubricate the nipples with few drops of expressed breast milk before feeding

question

Breastfeeding Implementation - Nutrition Education (including drugs in milk)

answer

- explain that most substances the mother ingests are secreted into breastmilk - teach mom that if she ingests drugs, prescription meds, alcohol, caffeine, her infant will also be ingesting these through breast milk - encourage mom to follow good nutrition practices - drink plenty of fluids

question

Explain initiation of breastfeeding

answer

- should begin within ONE HOUR of delivery of healthy infant

question

Physiology of milk production

answer

- delivery stimulates production of PROLACTIN, which stimulates production of MILK - colostrum comes in first, for 3 or 4 days post birth, and confers moms antibodies to infant - oxytocin causes LET DOWN REFLEX or forcing of fore milk through nipples - HIND MILK forms after let down reflex and contains more fat than FORE MILK - breast milk contains all nutrients the infant needs - substances mother ingests are secreted into breastmilk and also consumed by infant

question

Instruct proper technique for breastfeeding - Promote successful feeding by maintaing comfortable position for both mom and baby

answer

- baby should be supported, nose free for breathing, able to take in areola into mouth - mom should be relaxed and free from pain - mom can hold baby in positions that dont put stress on C-section

question

Instruct proper technique for breastfeeding - Help baby latch onto nipple by holding breast to present to infant

answer

- if nipple is cracked or raw, or if breast is engorged, infant may have trouble latching on - signs of successful latching on = wide open mouth position, audible sucking noise, tongue and jaw movement indicates swallowing

question

Switch breasts when feeding

answer

- begin feeding on opposite breast from previous feeding

question

Feed baby as freq as he/she wants,usually 8-12x in 24 hours for first few months. signs of hunger include

answer

- crying / squirming - sucking / rooting action with mouth - grasping / nuzzling breasts - sucking on own fist - smacking lips

question

Ensure adequacy of feeding by monitoring what?

answer

- number of wet diapers (6 / day) - number of loose yellow stools (2/ day) - color of urine (pale yellow, not dark) - steady weight gain - signs of contentment (sleep well, health looking, alert when awake)

question

Discuss breastfeeding self care - Maintain Nipple Integrity

answer

- avoid soap or wash cloth - break suction - let nipple air dry after feeds - massage drop of breastmilk into nipple to lubricate - wear breast pads and replace pads often

question

Discuss breastfeeding self care - Minimize Breast Engorgement

answer

- ice compress / cool compress - wear snug, support bra - use good latching on technique - take warm shower before feeds

question

Discuss breastfeeding self care - Monitor Nutritional Intake Similar to during pregnancy

answer

- BreastF requires extra energy - anything mom eats, drinks, ingests, is secreted into breast milk and can cause allergic / adverse reaction in baby

question

Unexpected Outcomes and Interventions - Mother is experiencing pain

answer

- ensure mom is free from infection (from cracked nipples or resulting from delivery) - implement good nipple hygiene and techniques for diminished breast engorgement - check method for latching on

question

Unexpected Outcomes and Interventions - Poor nutrition or inappropriate ingestions in mom

answer

- educate mom in principles of good nutrition - ensure she understands passage of ingestion

question

Neonates can lose up to what % of birth weight due to low levels of intake and excretion of fluids through lungs, bladder bowel. when should neonates regain weight by?

answer

10% by 10-14 days old

question

During a c-section, how does the anesthesia affect the baby?

answer

the amount of narcotic given is decreased in a client undergoing c- section - the dose of sedatives / hypnotics usually remains the same lower level of narcotic given to prevent RESP DEPRESSION in infant and drowsiness at birth reversal narcotics can be acheived by admin Narcan to mom 15 min. before delivery

question

Low birth weight infants are at GREATEST RISK for developing what?

answer

RDS - caused by underdeveloped lungs and lack of surfactant

question

Hydrocephalus

answer

- accumulation of fluid in subdural or subarachnoid spaces - freq occurs in infants with myelomeningocele - bulging anterior fontanelle and head circumference that increases at an abnormal rate

question

Warning signs that pregnancy is in danger include - swelling of face and fingers may indicate what in a pregnant woman?

answer

HTN condition gush of fluid / bleeding from vagina reg UC severe HA visual disturbances abdominal pain persistent vomit/fever, chills

question

Post newborn circumcision, nurse action

answer

- apply petroleum gauze and observe carefully for bleeding - change diaper at least every 4 hours - observe for bleeding hourly during 1st 12 hours - observe that infant is voiding - wash penis gently with WATER and apply petroleum around glans - yellow exudate SHOULD NOT be removed

question

Circumcision

answer

removal of foreskin of glans penis Jews - perform on 8th day of life RISKS - hemorrhage - infection - dehiscence - meatitits - adhesions admin prophylactic antibiotics

question

PP patient states shes urinating large amounts of urine, why?

answer

the body is getting rid of increased fluid - diaphoresis occurs for the first 2-3 days PP in order to decrease the retained fluid during pregnancy - diaphoresis is due to decreased estrogen levels and decreased venous pressure in lower extrems

question

pt receiving mag sulfate IV has decreased DTR, what should nurse do?

answer

D/C IV infusion of mag sulfate

question

What is magnesium sulfate given for?

answer

to prevent and treat convulsions

question

decreased DTR indicates what?

answer

magnesium toxicity - so does resp depression keep calcium gluconate at bedside as well as intubation equipment

question

Magensium Sulfate

answer

anticonvulsant when given IV, saline cathertic when given orally - electrolyte replacement agent SE - weak, absent DTR - hypotension - resp paralysis - depressed cardiac fx - hypocalcemia nursing considerations - respirations should be > 16 / min before med given iV - test knee jerk and patellar reflexes before each dose - monitor VS and I&O

question

Gestational Diabetes

answer

disorder that results in abnormally high glucose levels in blood - cause is absence or decrease insulin from pancreas and/or decrease ability of body to respond to insulin (insulin resistance, decreased sensitivity of tissue to insulin) Tx - insulin injection / oral hypoglycemic agents - diet (total cals, carbs, timing of food) - pt should lose weight if obese / maintain ideal weight - high intake of COMPLEX CARBS - low intake of FAT - high intake of FIBER - some protein Meal planning - meals with complex carbs, fat, protein - insulin as pancreatic hormone that controls blood glucose levels, lowering them by promoting uptake and use of glucose by cells - inhibiting conversion of glycogen and amino acids to glucose - admin by injection

question

NB circulatory system after birth

answer

- 2 hours post birth, infant begins pulmonary ventilation lung inflation causes pressure in the right atrium to DECLINE pressure is INCREASED in the left atrium and FORAMEN OVALE closes Ductus arteriosus occludes and becomes a ligament

question

Fundus during 3rd stage of labor should feel

answer

firm and globular

question

Diaphragm should remain in place for how many hours after intercourse?

answer

at least 6 hours to be effective in preventing pregnancy can be inserted up to 6 hours PRIOR to intercourse, but spermicide must be inserted into vagina with every intercourse

question

when does the diaphragm have to be refitted?

answer

if client gains/loses significant amount of weight

question

Diaphragm

answer

soft dome shaped contraceptive barrier covers the cervix and prevents sperm entry nursing considerations - inspection - care application - removal

question

Prenatal Care Purpose

answer

- estab BASELINE data for pregnant pt - eval maternal / fetal well being - assess risk factors for preg realted disorders, fetal anomalies, genetic disorders - assess fetal growth / development - provide nutrition / health info - minimize maternal discomforts / anxieties - prep pt / partner for labor / delivery / parenthood

question

Nursing Care - Prenatal

answer

obtain bio info - age - culture consids - marital status - occupation / education level asses nutrition, obtain 24 hr diet recall take med hx - OTC/prescription drugs, smoking, alc, illicit drugs, previous/current medical coniditons, dm, htn, rubella, herpes, cardiac / resp disorders, STD, endometriosis, phlebitis, epilepsy, gallbladder disorders, cancer, mental health - mom/dad family history - gyno hx OB hx - # preg, births, outcomes, preg related difficulties, length/quality of labor, infant conditions, mom PP probs, pts blood type, use of RhoGam phys exam, height, weight, VS

question

How often should prenatal visits be conducted?

answer

1st 28 weeks = every 4 weeks until 26th week = every 2 weeks until delivery = every week

question

PreNatal Care appointments

answer

- measure pts weight, assess VS - perform head to toe exam - pelvic exam (asses ovaries/uterus) - pap as ordered - palpate abdomen/ measure fundal height - assess pelvic size - asses for PTL Sx, FHT, edema - ask about FM - assess L&D understanding, expectations

question

1st Prenatal Visit

answer

- usually initiated bc pt suspects that she is pregnant - covers maternal Hx, repro Hx, phys exam, lab tests, preg confirmation

question

Follow up Prenatal Visits

answer

- tracks progress of preg, development of fetus - assess pt health status - monitors fetal health - provides prep, education, guidance for L&D

question

Prenatal Visit Complications

answer

- discovery of risk factors for preg related maternal or fetal difficulties - discovery of fetal chromosomal abnorms, fetal anomaly, disruption of growth and developmental - developmental of maternal conditions unique to or directly r/t preg - development of fetal distress

question

During what phase are narcotics contraindicated during labor?

answer

Transition Phase

question

The 1st stage of labor is divided into what 3 phases

answer

Phase One: Latent - cervix dilated 0-3cm contrax 10-30 seconds long, 5-10 min. apart - mild to moderate Phase Two: Active - cervix dilated 4-7cm contractions 30-40 seconds long, 3-5 min. apart - moderate to strong Phase Three: Transition - cervix dilated 8-10cm - contractions 45-90 seconds, 2-3 min. apart - strong, impending delivery marked by increase in dark red bloody show - increased urgency to bear down

question

True Labor begins when?

answer

the woman has bloody show membranes rupture painful contractions that cause effacement and dilatation of cervix

question

Labor ends when?

answer

after the birth of the baby and placenta after immediate PP period

question

Preliminary S/S of labor

answer

- lightening - increased activity - braxton hicks - cervix ripening

question

Signs of true labor

answer

UC show SROM

question

1st Stage of Labor

answer

Cervix effaces/dilates Begins w/ onset of true UC Ends when cervix fully dilated Subdivided into 3 phases - LATENT - ACTIVE - TRANSITION

question

Latent Phase

answer

- contractions are mild and last 20-40 seconds, recur 5-30 min. - lasts for about 6 hours in primipara - lasts for about 4.5 hours in multipara - cervix dilates from 0-3cm - becomes fully effaced - contractions may vary in intensity / duration but become consistent w/in a few hours

question

Active Phase

answer

- release of show increases - membranes may rupture spontaneously - contractions are stronger, last about 40-60 seconds - recur about every 3-5 min. - cervical dilation occurs more rapidly, increasing from 3-7cm - fetus begins to descend thru pelvis at an increased rate - lasts about 3 hours in primp - lasts about 2 hours in mulipara

question

Transition Phase

answer

- contractions reach max intensity, last about 60-90 seconds, occur every 2-3 min. - cervix dilated from 8-10cm - 100% effaced - peaks when cervical dilatation slows slightly at 9cm and signifies the end of the first stage of labor

question

2nd Stage of Labor

answer

- starts w/ full dilation / effacement of cervix - ends with delivery of neonate - lasts about 1-3 hours in primp - lasts about 30-60 min. in multipara - freq of contractions slows to 1 every 3-4 min. - duration of contractions continues to be 60-90 seconds - contractions are accompanied by uncontrollable urge to push or bear down

question

2nd stage: Cardinal movements of labor occur during this stage to help the fetus move through the birth canal

answer

1. Engagement 2. Descent 3. Flexion 4. Internal Rotation 5. Extension 6. External Rotation 7. Expulsion

question

Engagement

answer

involves movement of fetal presenting part to the level of the ischial spines

question

Descent

answer

downward movement of fetus

question

Flexion

answer

occurs when the resistance of the fetal head against the PELVIC FLOOR combines with uterine and abdominal muscle contractions to force head of the fetus to bend forward so that the chin is pressed to the chest.

question

Internal Rotation

answer

allow the shoulders to top pass through pelvic inlet

question

Extension

answer

occurs when descent is temp. halted bc the fetus' shoulders are too wide to pass through the pelvis or under the pubic arch the head extends, and the brow, nose, mouth, and chin are born

question

External Rotation

answer

necessary bc the shoulders, which previously turned to fit through the pelvis inlet, must now turn again to fit through the pelvic OUTLET and under the pubic arch

question

Expulsion

answer

occurs as the rest of the body is delivered quickly and easily

question

3rd Stage of Labor

answer

- occurs after delivery of neonate - ends with delivery of placenta - consists of 3 phases 1. placental separation 2. placental expulsion 4th stage of labor - occurs immed after placenta delivery - usually lasts 1-4 hours - initiates PP period

question

Labor Interventions

answer

- cervical ripening - induction of labor by oxytocin - augmentation of labor by oxytocin - active management of labor - forceps birth - vacuum - Cbirth

question

Complications of Labor

answer

- dysfx labor - contraction rings - precipitate labor - uterine rupture - inversion of uterus - amniotic fluid embolism - prolapase cord - multiple gestation - occipito posterior position of fetus - breech, face, brown positions - transverse lie - macrosomia - shoulder dystocia - fetal anomalies - inlet/outlet contraction

question

to listen to the apical pulse on a newborn, do you use the diaphragm or bell of the stethescope?

answer

bell place btw 4th and 5th intercostal space

question

Nurse Patient Relationship (for psych too) Pre-Interaction Phase

answer

- review patient data (medsurg) - anticipate concerns / issues that may arise

question

Nurse Patient Relationship - Orientation Phase

answer

Intro to patient, usually at patient's bedside once she's admitted - talk to patient, get to know her using verbal and nonverbal communication skills to ease her fears - discuss fears - express genuine concern that pt will receive Tx she needs

question

Nurse Patient Relationship - Working Phase

answer

Team building phase btw you, patient and entire health care team - encourage patient, help her understand her condition and how to set and accomplish goals. - expect patient to be willing to participate in her healthcare - patient provides accurate info, asks questions about Tx, participates in Tx procedures Understand that the patient expects healthcare needs will be met by you - patient is kept informed about her condition - provided with correct Tx/procedures

question

Nurse Patient Relationship - Terminiation Phase

answer

- remind patient that the termination of the relationship is near - verify that d/c planning occurs - make necessary referrals for home care nurse visits / rehab - ensure smooth transition to home

question

Why is the newborn given Vitamin K at birth?

answer

bleeding due to newborns inability to produce vitamin K the 1st 3-4 days vitamin K produced in GI tract after microorganisms introduced able to produce vitamin K by day 8

question

Why does physiological jaundice occur in the newborn?

answer

immature hepatic function unable to deal with bili production due to rapid breakdown of RBCs

question

During ovulation, a woman's basal body temp rises or lowers?

answer

rises slightly

question

BBT lowers or increases PRIOR to ovulation

answer

lowers prior to ovulation rises at the time of ovulation

question

Temperature should increase or decrease 2-4 day prior to menstruation?

answer

DECREASE if temp remains elevated, pregnancy has occured.

question

Just prior to ovulation, a woman's BBT _____ about 1 degree. at the time of ovulation, the body temp ______ about 1-2 degrees

answer

lowers increases

question

4cm dilated 60% effaced means what?

answer

the opening of the cervix = 4cm wide cervical canal = 60% shorter than normal

question

Dilatation

answer

stretching of the external os from an opening a few mm in size to an opening large enough to allow passage of the infant (0-10cm)

question

Effacement

answer

thinning and shortening or obliteration of the cervix

question

Most common in preterm infant

answer

- red, wrinkled skin, lanugo, hypotonic muscles red wrinkled skin d/t lack of subcut fat that accumulates during 3rd trimester lanugo - downy fine hair found on shoulders, forehead and cheeks floppy, poor head control and limp extrems indicate hypotonia

question

Vernix

answer

white cheesy substance that acts as a protective covering for the infants skin, describes full term infant

question

depressed fontanells indicates what?

answer

fluid volume deficit

question

Mottled skin is a symptom of what?

answer

cold stress

question

hypertonia is not seen in

answer

preterm infants

question

Preterm Infant

answer

infant born before 37 weeks gestation - use aseptic technique to prevent infection - maintain body temperature - maintain patent airway - administer TPN or gavage feedings - small freq feedings - prevent fatigue by not handling infant excessively or allowing infant to cry for prolonged periods of time - cuddle several times per day

question

To measure the FREQUENCY of UC, which method should you use?

answer

timing the contraction from the BEGINNING of 1 contraction to the beginning of the NEXT contraction

question

flow of lochia increases during

answer

ambulation and breastfeeding

question

PP nursing care

answer

- check lochia (color, volume) every 15 min. - lochia (endometrial sloughing) DAY 1-3 = rubra (bloody with fleshy odor, may have clots) DAY 4-9 = serosa (pink/brown with fleshy odor) DAY 10 = alba (yellow/white) foul odor should never occur - indicates infection - check VS (BP, pulse) every 15 min - follow protocol til stable - check fundus every 15 min, position should be at or 1 cm ABOVE umbilicus for the first 12 hours, then descends by 1 finer each succeeding day - pelvic organ usually by day 10 - check urinary output - measure 1st void - may have urethral edema, urine retention

question

PP Assessment - Check med records for info on

answer

- problems encountered during preg - time of labor onset / admission to l&d - types of analgesia / anesthesia used - length of labor - time of delivery - time of placenta expulsion, appearance of it - sex, weight, status of infant

question

PP Assessment: Ask patient

answer

1. to describe delivery experience 2. about home life, family structure, support system, community, socioeconomic level

question

PP Physical Exam - General

answer

- VS - general appearance - skin - eyes, color of conjunctiva - energy level, activity/fatigue - pain, location, severity, aggravating factors - GI elimination, bowel sounds, flatus passage, hemorrhoids - fluid intake - urinary elimination (time/amt of 1st void) - peripheral circ

question

PP Physical Exam - Breasts

answer

- inspect/palpate breasts - note size, shape, color - observe for colostrum secretion

question

PP Physical Exam - Uterus

answer

- palpate fundus to determine size, degree of firmness, rate of descent (measured in fingerbreds or cm below umbilicus) perform fundal assessments every 15 for 1st hour after delivery

question

PP Physical Exam - Lochia

answer

- help patient to Sims position - check under buttocks to ensure blood isnt pooling - remove perineal pad and assess discharge for character, amount, color, odor, consistency (clots), be sure pad isnt sticking to stitiches and remove carefully to avoid tear perineum - ask pt about pain / tenderness, note response - inspect skin for tears - observe for hemorrhoids - inspect episiotomy for signs of infection, ecchymoses, hematoma, erythema, edema, drainage, bleeding from sutures, foul odor

question

PP Normal FIndings - General

answer

- low grade fever in 1st 24 hours bc of dehydration - VS WNL w/ possible relative bradycardia that resolves w/in 10 days

question

PP Normal FIndings - Breasts

answer

- initial colostrum secretion - by 3rd day - firm and warm - eventually large and red with taut, shiny skin bc of engorgement

question

PP Normal FIndings - Uterus

answer

- fundus is midline, feels firm - fundus is located btw/ umbilicus and symphysis 1-2 hours after delivery @ level of umbilicus 6-12 hours after delivery - fundus progresses downward at rate of 1cm per day after delivery

question

PP Normal FIndings - Perineum

answer

- early PP edema and slight bruising

question

PP Abnormal FIndings - General

answer

- elevated temp lasting >24 hours, infection - increased pulse, high or low BP, may indicate hemorrhage, infection, late onset preeclampsia - absent or decreased bowel sounds, may indicate paralytic ileus - hemorrhoids

question

PP Abnormal FIndings - Breasts

answer

unrelieved engorgement

question

PP Abnormal FIndings - Lochia

answer

- scant or absent (may be scant with c birth) - saturates pad in < 1 hour, indicates excessive flow - clots or tissue, send to lab for exam - foul smelling = infection - suddent color change or increase in amt

question

PP Abnormal FIndings - Uterus

answer

- fails to contract/heavy bleed occurs - higher position than expected, retained tissue - boggy feeling - displaced to 1 side, indicated uterine atony secondary to distended baldder or retained placental fragment

question

PP Abnormal FIndings - Perineum

answer

- tearing of tissues - signs of infection at episiotomy site: redness, swelling, increasing discomfort, purulent drain, white along episiotomy - irritation, ecchymoses, tenderness, hematoma, hemorrhoids - severe intractable pain

question

Amenorrhea and FM are what type of pregnancy signs?

answer

presumptive as well as - breast changes - N/V - urinary freq - fatigue

question

Auscultating FHT, visualization of fetus by US OR x-ray or FM palpated by examiner are what types of pregnancy signs?

answer

positive pregnancy signs

question

positive preg test, braxton hicks, chadwicks, hegars sign are what type of pregnancy signs?

answer

positive pregnancy signs

question

fatigue is what type of pregnancy sign?

answer

presumptive

question

If the client has preeclampsia, what instructions would be most important for the nurse to teach?

answer

- must ensure adequate protein in diet - bedrest lying on left side - maintain adequate intake of fluids and proteins bc proteins restore osmotic pressure

question

Preeclampsia - complication of pregnancy

answer

- proteinuria - edema - occurs btw 20-40th week of preg

question

Indications of preeclampsia include:

answer

- BP 140/90mmHg or increase of 30/15mmHg 2+ to 3+ proteinuria slight generalized edema

question

Nursing care of preeclampsia includes:

answer

- bed rest in left lateral position - well balanced diet - daily weights

question

Indications of severe preeclampsia

answer

BP 150-160/100-110 mmHg 4+ proteinuria headache epigastric pain NURSING CARE - bedrest, monitoring I&O, seizure precaution, VS, FHT, admin mag sulfate, Apresoline, Valium, Procardia

question

Pregnancy Induced Hypertension

answer

HTN that develops during after the 20th week of preg has 2 forms - preeclampsia - eclampsia

question

S/S of PIH

answer

- sudden weight gain of 3lbs (1.4kg) in 2nd tri or > 1 lb (0.4kg) per week in 3rd tri BP >140/90 BP increase, measured on 2 occasions 6 hours apart, of 30/15 over normal - proteinuria >300mg in 24 hour urine or more >1+ protein by chem reg strip or dipstick in 2 or more random urine samples taken at least 6 hours apart (in absense of urinary tract infection )

question

Preeclampsia characterized by

answer

generalized vasospasm decrease in circ blood volume activation of coag system manifested as hypertension and decrease perfusion to placenta, kidneys, liver, brain

question

Mild Preeclampsia

answer

- diastolic BP < 100mmHg - proteinuria 1or2+ - edema of face and hands, weight gain - can proceed rapidly to severe preeclampsia

question

Severe Preeclampsia

answer

- diastolic BP 110+ - proteinuria 5mg/24 hour urine or 2+/3+ by dipstick - raised Hct, creatinine, uric acid levels - thrombocytopenia, platelet count < 100,000 - oliguria < 400mL/24 hours - blurred vision caused by retinal arterioral spasms - epigastric pain / heartburn - irritable, emo tension - altered LOC, HA, scotomata (blind spots)

question

As conditions worsens, risk for

answer

- eclampsia - abruptio placenta - DIC - liver / renal failure - pulm edema - cerebral hemorrhage

question

With onset of eclampsia, what symptoms occur

answer

- hyperreflexia on DTRs - sudden, severe increase in BP - systolic BP 180/200 mmHg - seizure - coma

question

PIH Tx

answer

- complete bed rest, left lateral position to enhance venous return - AntiHTN drugs (methyldopa, hydralazine) - if above 2 fail - mag to promote diuresis, reduce BP, prevent seizures - if condition doesnt improve or fetus's life is endangered, delivery by labor induction with oxytocin or c-sec if seizures begin: - immediate IV mag - oxygen therp - fetal monitoring

question

PIH Nursing Care

answer

-monitor for changes in BP, pulse rate, RR, FHR, vision, LOC, DTR, HA unrelieved by medication - assess these before admin meds

question

If ordered, admin MAg sulfate

answer

- piggyback infusion so it can be stopped immed in case of toxicity - obtain BL mag level 1st and monitor levels frequently - serum mag levels should be maintained btw/ 5-8 mg/dL

question

Monitor patient during magnesium admin

answer

assess serum levels - 8mg/dL or above = toxicity and admin must be stopped assess patellar reflex, biceps or triceps reflex if patient has received epidural anesthesia - diminished/hypoactive reflex suggests TOXICITY - assess ankle clonus by rapidly dorsiflexing pts foot 3x, if foot continues to move 3-5x, moderate toxicity is present, if foot continues 6 or more times, severe toxicity is present

question

Antidote to magnesium sulfate

answer

calcium gluconate

question

monitor extent and location of edema

answer

- elevate affected extrems and avoid constrictive clothing/bedding

question

- measure intake / output and body weight daily to monitor fluid balance - insert indwell cath prn for accurate output measurement

answer

- enforce complete bed rest, provide quiet, dark room, limit visitors til condition stabilizes

question

Advise patient that Preterm delivery may be necesary with preeclampsia and infant may be small but

answer

these infants typically do better than other small premature infants bc they've developed adaptive responses to stress in utero

question

Encourage patient to eat what type of diet with PIH occurs

answer

- well balanced, high protein - limit sodium intake - high fiber - drink 8 glasses of 8 ounce water of noncaff bevs each day

question

Teach patient worsening condition preeclamp S/S

answer

- HA - visual disturbance, blurring, flashes of light, spots before eyes - GI NAUSEA/PAIN - worsening edema, esp face / fingers - noticeable decrease in urine output

question

PIH Causes/Risk Factors

answer

unknown cause risk factors - 1st preg - preeclampsia in prev preg - excess placenta tissue (multiple gest, gest trophoblastic disease) - mom/sister of pt had preeclamp - lower socioecon status - Hx of DM, HTN, renal disease - poor nutrition - AA - Young, younger than 17 > 35y.o. - obese

question

PIH Dx tests

answer

- BP MEASUREMENT - meausrement of urinary protein - 300mg or more urianry protein in 24 hours or 1+ protein by chem reg strip

question

Complications of PIH

answer

progression to eclampsia HELLP (hemolysis, elevated liver enzymes, low platelets) risks to fetus - poor placenta perfusion - IUGR

question

Colposcopy

answer

magnifies tissue for examination - exam of vagina/cervix

question

1st nursing action immed post normal vag delivery

answer

- check lochia flow!

question

Amniotic Fluid function

answer

- maintains constant body temp - provides oral fluids - cushions fetus

question

ROM

answer

the breaking or tearing of amniotic sac check FHT to assess fetal distress assess for prolapsed cord

question

If prolapse occurs - nurse actions:

answer

call for help place in Trendelenberg or Knee to chest position - Tx successful if FHT remain unchanged

question

Rupture of membranes Types - SROM

answer

membranes rupture on their own with labor: - during labor or before onset of true labor (water breaking) without labor - can occur before onset of labor in preg of at least 37 weeks gest (PROM) - can occur prematurely before 27 weeks (PPROM)

question

Rupture of membranes Types - AROM

answer

- amniotomy - membranes are ruptured with use of instrument (amniohook or hemostat) to induce, augment or facilitate labor

question

S/S of ROM

answer

- gushing or leaving of amniotic fluid from vagina

question

ROM Patient Teaching

answer

- inform patient early in preg S/S of ROM - ensure pt knows fluid may leak instead of gush - stress impt of reporting rupture right away for prompt Tx to avoid infection - warn pt not to have sex, douche, or take a tub bath after membranes break - advise pt to refrain from orgasm and breast stim to avoid stimulating UCs, in case of premature ROM - tell pts to report temp over 100.4 = infection - advise pt that ROM doesnt mean dry delivery and may infact shorten labor bc it wil cause fetal head to settle into pelvis

question

SROM with labor at home

answer

Typically pt is at home and calls dr - ask pt to describe color, should be clear - yellow tinge indicates bili staining, blood type incompat btw/ mom and fetus - green tinged indicates menconium staining, fetus requires immed assessment, infant will require monitoring bc of possible menconium aspiration - advice patient to report to hospital

question

SROM with labor in hospital

answer

- verify that membranes have ruptured by verifying the fluid is amniotic - explain diagnostic tests and clarify misunderstandings - obtain sample of vaginal fluid with sterile cotton tip applicator - test fluid with strip of Nitrazine paper, amniotic fluid is alkaline (vag secretions are usually acidic) - test fluid by fern test ( exam under microscope) amniotic fluid will show a fern like pattern when dry (urine will not) - while assessing fluid, check cervical effacement/dilatation and fetal presentation and station - check for prolapse cord, monitor contractions and FHR

question

PROM or PPROM

answer

- verify fluid is amnioic by Nitrazine test or fern test - assess VS, FHR, UC, Uterine tenderness - check for prolapse cord - if labor starts, observe contractions and monitor VS every 2 min. watch for s/s of maternal infection - fever, abdom tenderness, amniotic changes such as purulence or foul odor, fetal tachycardia, report s/s immed. Tell pt to count fetal kicks and to report fewer than 10 kicks in 12 hour period, as this may indicate fetal distress If patient is prescribed bed rest for hospitalization, - assess pts support system, help pt communicate - monitor temp every 8 hours - assess for chorioamnionitis (intraamniotic infection): WBC every other day, uterine tenderness, tachycardia - corticosteroids may be admin if preg btw 23-34 weeks and viable - fetal lung maturity will be assessed if preg is btw 32-36 weeks

question

AROM

answer

- explain procedure to pt, including why its needed - prep or vag exam - stay with patient during exam and provide reassurance - provide perineal care post exam - inspect fluid, assess w/ Nitrazine strip or fern test - be ready to admin prophylactic antibiotics to protect neonate if test results GBBS+ - monitor VS, FHR, contractions - assess for umbilical prolapse

question

SROM

answer

- normal in most cases, experienced by 1 in 4 woman - amniotic fluid continues to be produced, so fetus continues to be protected - PROM incidence is approx 10% of preg - period of time btw rupture and labor = latent period - under no circumstance is digital exam performed after rupture to avoid infection

question

AROM

answer

- performed if membranes dont rupture spontaneously during labor - allows fetal head to contact cervix more directly and may increase efficiency of contractions - cervix must be dilated at least 3 cm b4 procedure can be carried out

question

Causes/Risk Factors for PROM and PPROM

answer

- lack of proper prenatal care - poor maternal nutrition / hygiene - maternal smoking - incompetent cervix - increased intrauterine tension from hydraminos or multiple gestation

question

PROM Diagnostic Tests

answer

Nitrazine Test - sample of vaginal fluid is obtained by sterile cotton tipped swap - fluid is applied to Nitrazine paper, color of paper is compared to color guide to determine pH of fluid - colors in blue-green area = amniotic fluid Microscopy - fluid sample's collected and applied to slide, viewed under microscope to visualize ferning apperance indicative of high estrogen content of amniotic fluid

question

PROM Complications

answer

- possible infection bc protective barrier of amniotic sac is lost - umbilical cord prolapse if engagement hasnt happend yet - abruptio placenta - preterm labor

question

Apgar score, performed at 1 & 5 min components:

answer

0-2 points = cardiac tone, respirations, muscle tone, reflexes, color 0-3 = indicates severe distress (poor) 4-6 = indicates moderate difficulty (fair) 7-10 = indicates good adjustment to extrauterine life (excellent)

question

1 min 5 min

answer

1 min - indicates initial adaptation 5 min - indicates picture of overall status

question

Apgar HR

answer

- count HR for 1 min: place fingers at junction of umbilical cord and skin (if cord still pulsates) or place fingers or stethescope over 5th intercostal space 0 = absent 1 = 100 bpm

question

Apgar Resp Effeort

answer

- listen to infants cry for volume / vigor - auscultate lungs 0 = absent 1 = slow and irregular 2 - good, crying

question

Muscle TOne

answer

- extend limbs and observe return to flexion 0 = flaccid 1 = flexion of extrem 2 = active motion

question

Reflex Irritability

answer

listen to cry for presence, vigor, pitch if not crying, elicit cry by flicking soles 0 = no response 1 = grimace / weak cry 2 = vigorous cry

question

Color

answer

observe skin / mucous membranes for color 0 = pallor, cyanosis 1 = pink body, blue extrems 2 = completely pink

question

Apgar Normal Findings

answer

- patients apgar score is: 1 min = 7 to 10 5 min = 7-10 pt has a HR > 100bpm good cry active motion vigorous cry normal skin color over body and extrems

question

Apgar Abnormal Findings

answer

pts score is 0-3 at 1 min pt status = poor immed, intervention / resuscitation is needed patients score < 7 at 5 min. assessment is repeated at 10 min. patient may need airway cleaned out and o2 administered

question

C-section

answer

performed bc of - dystocia - repeat c-section - breech presentation - fetal distress - active maternal gonorrhea - herpes type 2 infection - placenta previa - abruptio placenta

question

C-section Nursing Considerations

answer

PREOP - obtain type cross and match - urinalysis - CBC - emo support - admin preop med - insert retention catheter POSTOP - check fundus - check skin incision for signs of excessive bleed - freq VS - splint incision with CDB - give mom her infant asap

question

C-section purpose

answer

- to deliver a fetus that cannot be delivered vag - to avoid risks to health of fetus or mom due to probs involving l&d Used in case of maternal factors - CPD - active infection with gonorrhea, genital herpes, papollomavirus, HIV - previous c birth - disabling conditions such as sever PIH, and heart disease that prevent pushing - complete placenta previa - abruption placentae - malignant rumors - HIV positive - active herpes lesions - chronic diseases in mom in which delivery in indicated before term

question

C-section Used in case of fetal factors such as:

answer

- transverse fetal lie - extremely low fetal size - fetal distress - compound conditions such as macrocosmic fetus in breech lie - living fetus with prolapsed cord - fetal hypoxia - abnormal FHR patterns - unfavorable intrauterine environment such as from infection - moderate to severe Rh factor isoimmunization

question

Nursing Care C-section PreOp - Planned C-section

answer

- asses maternal and fetal status freq until delivery - if ordered, ensure ultrasound has been obtained - explain c-birth to pt and partner - provide reassurance and emo support - be brief, clear, essential points scheduled c-birth - discuss procedure with both parents observe mom for signs of imminent delivery - demonstrate use of incentive spirometer and have pt CDB, splint - restrict food/fluids after midnight if genera anesthetic is ordered to prevent aspiration Prepare patient - operative skin site prep as ordered - inform pt that anestesiologist will interview her to explain planned anesthesia and induced risks - verbal consent ensure bladder empty , indewll cath as ordered preop med antacid to help neutralize stomach acid start IV for fluid replacement therp using pts nondom hand 18 gauge or larger cath to allow blood admin thru IV if needed ensure CBS, type and cross blood match and 2 units of blood are ordered

question

Nursing Care C-section PreOp - Emergency C-section

answer

- explain procedures - reinforce positive aspects during procedure (FHR good, etc) - explain sensations and what to expect

question

Nursing Care C-section PreOp - Emergency C-section - Postop Care

answer

- asap promote infant mom bonding - check perineal pad and incision dressing freq every 15 min for 1 hour - then every half hour for 4 hours - then every 4 hours for 24 horus

question

Lochia will be present but not in the same amt as for vag delivery

answer

- perform fundal checks at same intervals - check dressing for bleeding and incision site for signs of infecton - monitor VS - monitor IV patency, if one is ordered admin oxytocin - monitor urinary cath patency, flow and urine quality - maintain patent airway for mom and infant - encourage mom to CDB for adeq resp fx general anesthetic - remain with her til responsive regional anesthetic - return of leg sensation - help mom turn from side to side every 1-2 hrs - if ordered, show pt how to admin PCA - admin pain meds as ordered, comfort for breast engorgement - if mom wants to breast feed, offer encourgaement/help - monitor effects of pain med, time admin adainst breast feed scheledue - promote early amb - warn mom of lochia flow freely when she moves from supine to upright position

question

C-section incision is made thru the abdomen and uterus

answer

- vertical incision classic - or low transverse incision (more common)

question

C section complications

answer

- abdominal surgery - infection - hemorrhage - aspiration - pulm embolism - urinary tract trauma - thrombophlebitis - paralytic ileus - atelectasis complications in infant - resp depression secondary to anesthetic - transient tachypnea

question

Insulin requirements of a Type I DM increase or decrease during pregnancy/after delivery

answer

increase during pregnancy decrease after delivery

question

Placental hormones increase or decrease insulin resistance during pregnancy?

answer

increases insulin resistance

question

diabetes increases maternal risk for what

answer

infections PIH hydraminos macrosomia prematurity RDS

question

Pregnancy and Type 1 Diabetes nursing care includes:

answer

- reinforce need for careful monitoring throughout pregnancy - eval clients understanding of modifications in diet/insulin coverage - instructions to eat prescribed amt of food daily at the same time and perform home glucose monitoring - instruct about insulin dosage - stress reduction - closely monitor fetus

question

Appropriate weight gain during 1st tri, 2nd tri and 3rd tri

answer

1st tri = 2-4 lbs 2nd tri = 12-14 lbs 3rd tri = 8-12lbs

question

increase recommended daily intake of nutrients during pregnanct

answer

protein -25 grams during last 2 trimesters and more for multiple births - water: at least 2.3 liters in bevs - fiber: 28g - iron: 30 mg - zinc 11-12 mg - iodine 220mcg - magnesium 350-400 mg - vitamin A 750-770 mcg - Vitamin B6 1.9 mg - Vitamin b12 = 2.6 mcg - vitamin c = 80-85mg - folate 600 mcg vits d and e are same as for prepreg

question

fencing position

answer

lying on back, head turned to one side, arm and leg on that side of body will be in extension while extrems on opposite side will be flexed disappears at 3-4 months

question

moros

answer

startle reflex disappears 3-4 months

question

babinksis

answer

stroking sole of foot from heel upward across ball of foot will cause ALL toes to fan out - reverts to usual adult reponse by 12 months

question

rooting

answer

turns toward any object touching/stroking cheek / mouth

question

Indications for genetic counseling

answer

1) AMA; 2) multiple fetal losses; 3) previous child --> neonatal death, mental retardation, aneuplody, known genetic disorder; 4) family history: genetic diseases, birth defects, mental retardation; 5) abnormal prenatal tests: triple screen, US; 6) parental aneuploidy

question

Aneuploidy

answer

numeric chromosome abnormalities in which cells do not contain 2 complete sets of 23 chromosomes

question

Most common cause of aneuploidy:

answer

nondisjunction

question

What is the most common aneuploidy?

answer

trisomy

question

What is the optimal GA for IDing fetal anatomic structural anomalies by US?

answer

18-20 wks

question

What is the accuracy of gestational dating at GA < 12 wks?

answer

+/- 5 days

question

Chorionic villous sampling

answer

aspiration of placental tissue precursors under sonographic guidance for fetal karyotyping

question

At what GA is CVS performed?

answer

between 9 and 12 wks

question

What is the pregnancy rate loss with CVS?

answer

0.7%

question

Name the main advantage of CVS:

answer

karyotyping available at a very early age (earlier than amniocentesis)

question

Amniocentesis

answer

transabdominal needle withdrawal of amniotic fluid under sonographic guidance

question

Name 3 general indications for amniocentesis:

answer

1) genetic testing; 2) Rh isoimmunization; 3) fetal lung maturity studies

question

At what GA is amniocentesis peformed when for genetic testing

answer

15-20 wks

question

At what GA is amniocentesis peformed when for Rh isoimmunization testing?

answer

after 24 wks

question

At what GA is amniocentesis peformed when for fetal maturation testing

answer

after 34 wks

question

Pregnancy loss rate of amniocentesis:

answer

0.5%

question

Percutaneous umbilical blood sampling (PUBS)

answer

sonographically guided transabdominal aspiration of fetal blood from the umbilical vein

question

4 Indications for PUBS:

answer

1) fetal karyotyping; 2) IgM antibody detection; 3) blood typing; 4) intrauterine blood transfusion

question

When is PUBS performed?

answer

after 20 wks

question

Pregnancy loss rate of PUBS

answer

1-2%

question

2 indications for fetoscopy

answer

1) fetal tissue biopsy; 2) coagulation of placental vessels in twin twin transfusion syndrome

question

Pregnancy loss rate of fetoscopy:

answer

3-5%

question

What 3 levels are measured in a triple screen?

answer

1) MS-AFP; 2) bHCG; 3) estradiol

question

High levels of AFP on triple screen

answer

suggest increased risk of neural tube defects

question

What findings on triple screen suggest increased risk of Down's syndrome?

answer

high bHCG and inhibin levels with low AFP and estradiol

question

What is the triple screen?

answer

it is a SCREENING test (not diagnostic) for genetic abnormalities (esp. trisomy 21) and neural tube defects

question

What is added to the triple screen in the quad screen?

answer

dimeric inhibin A (DIA)

question

Twin twin transfusion syndrome

answer

complication of pregnancy with high morbidity and mortality that occurs when two or more fetuses share a common (monochorionic) placenta; the connection in circulatory systems results in the donor twin pumping blood to the recipient twin without receiving blood in return

question

Polyploidy

answer

numeric chromosome abnormality in which cells contain complete sets of extra chromosomes

question

Name a common polyploidy

answer

incomplete molar pregnancy in which an egg is fertilized by 2 sperm (--> triploidy, 69 chromosomes)

question

Mosaicism

answer

presence of 2 or more cytogenetically distinct cell lines in the same individual

question

What is the genetic defect associated with cri du chat syndrome?

answer

deletion of short arm of chromosome 5 (del 5p)

question

Karyotype associated with Turner's syndrome

answer

45,X

question

Karyotype associated with Klinefelter syndrome

answer

47,XXY

question

2 findings of Turner's syndrome on US

answer

1) nuchal skin fold thickening; 2) cystic hygroma

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