MATERNITY / NEWBORN – Flashcards
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What is the name of the rule used to expected date of birth (EDB)?
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NAEGELE'S RULE
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Explain Naegele's rule?
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Find the last menstrual period (LMP). Add 7 days, deduct 3 month = EDB (expected date of birth) or due date
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How long is typical gestation period?
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280 days / 40 weeks
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If clients first day of last menstrual period was January 17, when is her EDP?
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Count forward 7 days: January 24 / Back 3 months: October 24 / EDP: October 24
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chemical markers associated with pregnancy. These markers are found in urine and blood, and pregnancy tests require sampling one of these substances. produced by the trophoblast cells of the fertilised ovum (blastocyst). What is it?
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HUMAN CHORIONIC GONADOTROPIN (hCG)
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After about a week after implatation, the ovum (ZYGOTE) has reach over 100 cells is known then as a?
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BLASTOCYST
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How long after fertilization, the blastocyst will be called a FETUS?
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8 weeks after fertilization: FETUS
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Signs of pregnancy can be generally categorized as?
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1. Presumptive 2. Probable 3. Positive signs of Pregnancy
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What is the definition of Presumptive signs?
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Signs that suggest but do not positively confirm pregnancy and could be due to other conditions
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What are the Presumptive signs?
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Absence of menstruation / N&V / Breast changes / Urinary frequency / Fatigue / Quikening
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What is the definition of Probable signs?
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Strong indicators of pregnancy, not likely but still possibly due to other conditions
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What are the Probable signs?
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Abdominal enlargement / Chadwick's sign (Bluish tinge of vulva and vagina) / Hegar's sign (softening of lower uterine segment) / Goodell's sign (softening of cervix) / Ballotement (rebound mvt of floating fetus) / Braxton-Hicks contractions (irregular painless contractions) / Palpation of fetal outline / Positive pregnancty test (hcG)
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What is the definition of Positive signs of Pregnancy?
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Signs definately confirming pregnancy
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What are the Positive signs of Pregnancy?
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Fetal Heart tones / Fetal movement felt by examiner / Ultrasound evidence of fetus
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How long is the Embrionic stage?
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The first 8 weeks
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When does the heart appear and begins to beat?
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By the 4th week
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When do the lungs begin to develop?
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By the 6th week
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All organs are formed by?
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The end of the 8th week
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Since the first 8 weeks is dividing cells that form the embrio, what should the mother most watch out for?
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The embrio will be susceptible to Teratogenic effects of substances such as OTC meds, caffeine, drugs, smoke... The first 8 wks are the most dangerous
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When can the fetus be born at the earliest with a good chance of survival?
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By the 35th week
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Fundal height is a measure of the size of the uterus used to assess fetal growth and development. It is measured from the top of the uterus to the top of the pubic bone in centimeters. It should match the fetus' gestational age in weeks within 1 to 3 cm, e.g., a pregnant woman's uterus at 26 weeks should measure 23 to 29 cm. This is valid from 24 weeks. What is the name of this method?
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MCDONALD'S rule or method
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What is amniocentisis used for?
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(bet 15 to 17 wks) to rule out genetic defects, neural tube defect
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What is the most common way to assess fetal lung maturity?
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THE LECITHIN-SPHINGOMYELIN RATIO (l/s)/ A result of 2:1 indicates lung maturity
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Amniocentisis is also sometimes done late in pregnancy to assess?
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Fetal lung maturity by finding a substance called phosphatidyl glycerol (pg) which means fetal lung maturity
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When do you administer RhoGam?
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If client is Rh negative, administer RhoGam / for instance after an amniocentisis (post procedure) as prescribed because of the possibility of maternal Rh isoimmunization.
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What is Hyperemesis Gravidarum?
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Severe persistent nausea during pregnancy with and unknown cause.
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Symptoms of Hyperemesis Gravidarum?
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Persistent vomiting / rapid pulse / decreased urinary output / low grade fever / weight loss
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What is PIH?
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Pegnancy Induced Hypertension or PIH also called Pre-eclampsia
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S/s of PIH or mild preeclampsia?
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BP is 140/90 or above / Edema is 1+ pitting / Proteinuria is 1+ or 2+ or higher / Swelling of face, hands, and feet
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What to implement for precautions in a hopitalized woman with PIH?
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Seizure precautions such as side rails up / lights dimmed down / padded environment / encourage woman to lie of left side to reduce BP
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S/s of severe preeclampsia?
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BP of 160/110 or higher / Extensive generalized edema / Proteinuria of 3+ or 4+ or higher / Headache, visual disturbance, abdominal pain
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With worsening of PIH, the classic s/s of headache, blurred vision, epigastric pain, decreased urine output, and n/v, the women might be in a seizure state or eclampsia and will be at risk for?
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Fatal pulmonary edema / organe failure / Cardiac failure / cerebral hemorrhage
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What is the first line of drug therapy for PIH?
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Magnesium Sulfate
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Magnesium sulfate signs of toxixity to watch for?
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Dereased resp rate of less than 8 to 10 / absenses of reflexes / decreased urinary output (less than 30ml/hr)
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What to do in case of Magesium sulfate toxixity?
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Admister the antidote Calcium Gluconate
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abnormal implentation of pacenta near, partially covering, or completely covering the cervical os or cervix?
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PLACENTA PREVIA,usually detected after onset of painless vaginal bleeding / Placental Previa can be marginal, partial or total
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Main S/S of Placenta Previa?
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Painless vaginal bleeding
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A major concern is where the placenta seperates from the uterus. Ofter a life threatening emergency?
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ABRUPTIO PLACENTA
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Most common risk factor for ABRUPTIO PLACENTA?
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HIGH BP during pregnancy / others are previous hx, smoking, drinking, trauma fr car accidents for instance.
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Unlike Placenta Previa, ABRUPTIO PLACENTA is?
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EXTREMELY PAINFUL as blood is released into the uterus and abdominal cavity.
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What is a complication of Abruptio placenta?
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placenta detachment of more than 50% usually leading to hemorrhage and fetal death
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What is a complication of both Abruptio placenta and Placenta previa?
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Disseminated Intravascular Coagulopathy or DIC / S/S of DIC include bleeding of gums and injection sites, rapid pulse, skin may have purple areas or purpla.
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What is DYSTOCIA?
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A difficult or abnormal labor
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What is MOLDING?
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Molding is the process of when the skull of fetus overlaps on itself in order to pass through birth canal. It is possible cos' of flexible sutures in the skull. Baby will have conehead for a while.
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What does the 1st stage of labor include?
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1. LATENT PHASE (O to 4cm cervix dilation) / 2. ACTIVE PHASE (4 to 8cm) / 3. TRANSITION PHASE, contraction coming q min and 1/2 to 2 mns and lasting 60 to 90 sec (8 to 10cm)
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What is the 2nd stage of labor?
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THE EXPULSION STAGE: full cervical dilation and ends with birth of baby, most dangerous phase for fetus, contractions are intense and frequent
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What is the 3rd stage of labor?
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PLACENTAL STAGE, begins after fetus is delivered and ends with placenta expulsion.
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What is the 4th stage of labor?
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THE RECOVERY STAGE: 1st 4hrs after delivery of placenta.
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What should be done before performing LEOPOLD'S MANEUVER (manual maneuvers)?
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Ask pt to empty bladder / Place small rolled towel under right hip
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What are late decelarations? and are they normal?
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Late decelarations (occur after a contraction begins and continues after contraction is over) are when the fetal heart rate slows down during movement or contractions and is NOT NORMAL
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What are the interventions for late decelarations?
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Turning pt on her left side / Admister Oxygen at 8 to 10liters per min / IV fluids for blood volume
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What is an healthy fetal reaction to movement?
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An accelaration of 15 beats per minute in response to movement and is a reasuring sign
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What do late decelerations suggest?
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Fetal Anoxia / Uteral placental insuficiency
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When are late decelarations usually noted?
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In pts with PIH / Pts w DIABETES / Pt got an over stimulation from OXYTOCIN / Past due date / Abuse of drugs / Placenta Previa / Abruptio placenta
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Complications of Ruptured Membranes?
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Infection (esp after 24hrs) / Fetal Distress / Cord Prolapse
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Preterm Labor is onset of contractions and dilations prior to?
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37 weeks of gestation
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What are TOCOLYTICS?
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Medications used to suppress preterm labor (anti-contraction medications or labour repressants)
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What is BETAMETHASONE used for in preterm labor?
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Betamethasone is used to accelerate fetal lung maturity (corticosteroid)
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What is MAGNESIUM SULFATE given for?
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To depress uterine contractility / monitor urine output, BP, reflexes and respirations with magnesium sulfate
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What orther medications are used to suppress labor?
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CALCIUM CHANNEL BLOCKERS like: NEFEDIPINE and PROSTAGLANDINS INHIBITORS
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3 complications for the fetus in preterm labor?
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Respiratory Distress / Hyperbilibirunimia / Infection
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What is the definition of POST TERM LABOR?
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Over 42 weeks gestation
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What happens to the placenta in porst term babies?
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Placenta stop working efficiently
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Risks of port term babies?
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Asphyxia / Meconium aspiration / Dysmaturity syndrome / Respiratory distress
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What happens to the amnioatic fluid between 40 and 42 wks gestation?
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Amniotic fluid declines dramatically (OLYGOHYDRAMNIOS)increasing likelihood of hypoxia from fetal cord compression
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Medication used to induce labor?
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OXYTOCIN
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Neonatal complications of post term labor and delivery?
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HYPOGLYCEMIA / POLYCYTHEMIA / HYPERBILIRUBINEMIA / IMPAIRED THERMOREGULATION
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What happens to the HR of fetur during a cord prolapse?
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Bradycardia to the fetus / Prolapse cord is a medical emergency / give mother oxygen to supply fetus / be prepared for emergency caesarian
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Ways to stimulate labor?
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1. Amniotomy (rupture of amniotic sac with amnihook) 2. Insertion of either prostaglandin gel or laminaria for cervical ripening 3. IV oxytocin to initiate or intensify contractions
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Oxytocin has some antidiuretic properties, so watch for the followint signs of water intoxication?
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Headache / blurred vision / Increased BP, RR / Rales / Wheezing / Coughing
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In the porstpartum time (6wks after delivery), what do u call the shrinking of uterus back to its prepregnancy state?
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INVOLUTION
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How many days after delivery should we see lochia rubra? lochia serosa? and lochia alba?
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LOCHIA RUBRA: 2-3 days after del / LOCHIA SEROSA (pink/brownish): 3-10 days / LOCHIA ALBA (yellow/white): 10 days to 6 weeks
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Why is diaphoresis or heavy perspiration is to be expected for the first few days after delivery?
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Because she is expelling the extra fluid she accumulated during the pregnancy.
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What is PPH?
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Pospartum Hemorrhage or PPH is a complication after birth. PPH is losing 500ml after a vaginal delivery or 1000ml after a caesarian delivery.
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Most common cause for PPH? and intervention?
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Uterine Atony from retained placental tissue / Intervention includes manual fundal massage squeezing uterus to stop hemorrhage (one fist in vagina) ouch..
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Medications to control PPH?
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IV Oxytocin (produced uterine contractions)
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Apart from PPH, what is common possible postpartum complication?
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Infection (mastitis, endometritis, UTI, wound infections..)
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S/s of postpartum infection?
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Fever above 100.4 (38C) / Chills / Tachycardia / N&V / Anorexia / Fatique / Headache
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Apart from PPH, Infection, what is the 3rd most common pospartum complication?
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THROMBOPHLEBITIS: venous inflammation, clot formation in vein lumen, usu in legs, superficial or deep veins, DVT
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List the 5 areas of the Apgar Score and possible scores?
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1. Heart rate 2.Respirations 3.Muscle Tone 4.Reflex Irritability 5.Color / Each area is scored a 0 or 1 or 2 / The whole Apgar score can be between 0 and 10 / Apgar is considered good if between 8 to 10 / A score bet 5 and 7 indicates newborn needs further stimulation / A score of 4 or below indicates serious circulatory pbs or respiratory depression
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What are the firs medications the nurse will give the infant?
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Vitamin K in the thigh IM (so the infant has clotting factors right away) / Erythromycin (prevents blindness if exposed to gonorrhea) / First immunization (Hep B)
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What is Convection?
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Heat loss to cool air
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What is Radiation?
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Heat loss to cool objects without touching
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What is Evaporation?
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Heat loss by fluid on newborn that turns to vapor
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What is Conduction?
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Heat loss to cooler surfacs by direct contact
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What is Milia?
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Tiny white bumps or small cysts on skin, usu face, will disappear on their own.
