question

4 phases of the endometrium

answer

(1) the menstrual phase, (2) the proliferative phase, (3) the secretory phase, and (4) the ischemic phase

question

What happens in the menstrual phase of the endometrium?

answer

-Shedding of the functional 2/3 of the endometrium. -Basal layer is always retained. -Regeneration begins near end of cycle from remaining glandular remnants aka stromal cells.

question

What happens in the proliferative phase of the endometrium?

answer

-Rapid growth from about the 5th day to the time of ovulation (day 14). -The endometrial surface is completely restored from the menstrual phase in about 4 days. - 8 to 10 fold thickening of endometrium occurs and levels off at ovulation. - The proliferative phase depends on estrogen stimulation

question

What happens in the secretory phase of the endometrium?

answer

-Occurs day of ovulation to about 3 days before the next menstrual period. -After ovulation, large amounts of progesterone are produced. -Edematous, vascular, functional endometrium -Fully matured secretory endometrium full of blood and glandular secretions -Protective and nutritive bed for a fertilized ovum implantation

question

What happens during the ischemic phase of the endometrium?

answer

-Blood supply to the functional endometrium is blocked and necrosis develops. -The functional layer separates from the basal layer -Menstrual bleeding begins, marking day 1 of the next cycle.

question

Implantation of the fertilized ovum generally occurs about ___ to ___ days after ovulation

answer

7-10

question

What are the phases of the menstrual cycle?

answer

Follicular phase and luteal phase

question

Dominant hormone of the follicular phase

answer

Estrogen

question

Dominant hormone of the luteal phase

answer

Progesterone

question

Is there a menstrual period at delivery?

answer

YES. Decidua sheds

question

What is the desired pelvic shape/type for child birth?

answer

gynecoid

question

Estrogen

answer

*THE DOMINANT HORMONE FOR THE FOLLICULAR PHASE* -If pregnant, secreted from placenta -Main function: stimulate uterine development to create suitable environment for fetus -Peaks in late follicular phase, towards ovulation -Levels decline after ovulation until baseline, marking the start of a new menstrual cycle -Other functions: thickens hair, thickens skin, enlarged labia - Increases fibrinogen and decreases fibrinolysis? BLOOD THICKENS? risk of clots increase. -Causes linea nigra during pregnancy, epistaxis, swelling in everything above the neck

question

Progesterone

answer

*THE DOMINANT HORMONE FOR THE LUTEAL PHASE* -Produced by corpus luteum, then secreted from placenta if pregnant -Main function: *plays greatest role in maintaining pregnancy* by 1) maintaining endometrium/decidua 2) inhibiting spontaneous uterine contractions by relaxing the smooth muscle 3) helping develop the breast lobules in preparation for lactation -Low, baseline levels in follicular phase -Significant increase in progesterone in the middle of luteal phase -Gradual decrease towards beginning of menstruation

question

FSH (follicular stimulating hormone)

answer

-Secreted by anterior pituitary in response to gonadotropin-releasing hormone (GnRH) -Main function: *stimulates development of ovarian follicles and their production of estrogen* -Peaks during ovulation -Works to develop a mature ovum -Returns to baseline immediately after ovulation

question

LH (luteinizing hormone)

answer

-Secreted by the anterior pituitary in response to gonadotropin-releasing hormone (GnRH) -Main function: *triggers the expulsion of the ovum from the follicle* -Peaks at about day 13 or 14 in cycle, right at ovulation -At baseline for the entirety of the follicular and luteal phase, only having a large peak at ovulation

question

Three signs of ovulation

answer

-Elevation in body temp up to 0.5 degrees F due to release of progesterone after ovulation -Mittelschmerz pain = in German "middle" (of cycle) and "pain". Actual change in the lining of the ovary at the release of the ovum -Cervical mucous increases for sperm transport to the fallopian tube

question

normal sperm life

answer

2-3 days / 72 hours

question

normal ovum life

answer

24 hours

question

presumptive signs of pregnancy (changes felt by woman)

answer

-Amenorrhea (missed period) -Fatigue -Breast changes

question

Probable signs of pregnancy (observed by examiner)

answer

-Urine test, uterine enlargement, positive pregnancy test for the presence of HCG -Braxton Hicks Contractions (uterus strengthening) occur after 20 weeks -Chadwick's sign (bluish coloring of vagina and cervix) occurs at week 4 -Hegar's sign (softening of the uterine isthmus/segment): occurs at about week 6 -Goodell's sign (softening of the cervix) occurs at beginning of 2nd month -Ballottement (rebounding of fetus against the examiner's fingers on palpation)

question

What are Braxton Hicks contractions

answer

-Occur when the uterus gets thicker and heavier, so it practices contractions that do not dilate the cervix. -Normal. Starts after 20 weeks gestation. -Abnormal if more than 4 contractions in 1 hour.

question

Positive signs of pregnancy (can only be attributed to presence of a fetus)

answer

-Fetal heart tones -Visualizing the fetus with ultrasound -Palpating fetal movements

question

blood during pregnancy

answer

1500 extra mL of fluid - 1000 of plasma and 500 of RBCs

question

mothers should be put on what supplements to combat anemia from the increased blood volume?

answer

prenatal vitamins and iron

question

Is it normal to hear a systolic murmur (S3) during pregnancy?

answer

yes, it is caused by a turbulent flow of the extra blood

question

Never take a pregnant pts BP while they are flat on their back because

answer

it could result in a false low BP

question

BP should remain the same during the pregnancy except for

answer

decreasing slightly during the second trimester

question

What is good to teach pregnant pts about relaxin and it's effects?

answer

-That it effects all joints -No heavy lifting or exercises that could injure compromised joints

question

There is an increased risk of UTIs due to the

answer

growing uterus pushing against the bladder and causing urine to stagnate

question

fetal heart rate

answer

120-160

question

Human Chorionic Gonadotropin (HCG)

answer

-Detected in pregnancy tests -Peaks in very beginning of pregnancy (around day 50 and 70) and doubles everyday to maintain pregnancy -Stimulates the secretion of estrogen and progesterone from the corpus luteum until the placenta is developed (about 20 weeks) -Glycoprotein -Secreted by the trophoblast early in pregnancy

question

Human Chorionic Somatomammotropin (HCS) aka HumanPlacental Lactogen (HPL)

answer

-Produced by the placenta *INSULIN ANTAGONIST* -Increases mother's resistance to insulin --> increases blood sugar levels -Facilitates the transport of glucose across the placental membrane so that the fetus grows -Stimulates breast development to prepare for lactation -Peaks at 40 wks gestation -Mother stops receiving when placenta is delivered

question

If a mother is already heavy and insulin resistant before pregnancy, then she could be predisposed to develop

answer

gestational diabetes

question

Relaxin

answer

-Secreted by placenta ONLY -Inhibits uterine activity, diminishes the strength of uterine contractions, softens the cervix -Relaxes ligaments --> pelvis stretches to allow baby to put its head down into the pelvic cavity -Long term of effect of remodeling collagen -NOT SPECIFIC to pregnancy so it stretches ALL ligaments, which is why some mothers go up a shoe size

question

Relaxin can be dangerous because

answer

Mothers can accidentally pull a muscle or damage their ligaments without knowing because relaxin is still in their system

question

Estrogen during pregnancy

answer

-Secreted originally by the corpus luteum -Produced by the placenta as early as the 7th week -Stimulates uterine development to provide a suitable environment for the fetus -Helps develop the ductal system of the breasts in preparation for lactation

question

Prostaglandins during pregnancy

answer

-Lipid substances in high concentrations in the female reproductive tract -Exact functions are unknown: believed to play a role in the initiation of labor -Late term mothers are suggested to have sex to induce labor because the prostaglandin head of a sperm may be able to break through barrier

question

Progesterone during pregnancy

answer

-Produced originally by the corpus luteum and then by the placenta -Plays greatest role in maintaining pregnancy? maintains the decidua; inhibits spontaneous uterine contractility -Helps develop the lobules of breasts in preparation for lactation -Smooth muscle relaxant? prevents uterus from contracting

question

Relief for nausea and vomiting during the first 1-12 weeks

answer

dry crackers/toast; avoid odors/causative factors; small, frequent dry meals

question

relief for urinary frequency

answer

avoid drinking a lot of fluid in the evening

question

presence of nitrites in the urine indicates

answer

a UTI

question

UTIs are caused by

answer

urine stagnation during pregnancy

question

asymptomatic bactiurea (asymptomatic UTI) can lead to

answer

pyelonephritis if left untreated

question

what causes nocturnal diuresis

answer

swelling in feet that builds during the day? lie down ? fluid leaves lower body/ 3rd space and makes it's way back to the bladder ? pee it all out at night Don't drink fluids after 5 pm

question

relief for breast tenderness

answer

wear a well fitting supportive bra

question

what is leukorrhea

answer

-normal white vaginal discharge -Maintain good hygiene, avoid douching bc it puts you at risk for yeast infection

question

relief for epistaxis (nosebleeds)

answer

-Cool air vaporizer may help -Avoid nasal sprays and decongestants -Sea spray

question

what is pytalism

answer

the tali glands that secrete saliva to help chew food produce very thick saliva in pregnant women causing them to spit it out or else they cannot swallow

question

what can help relive pytalism

answer

-Astringent mouthwashes -Chew gum or suck hard candy -Drink more water (at risk for dehydration)

question

what can help relive pyrosis (heartburn)?

answer

-Small, frequent meals -Low sodium antacids/tums -Avoid overeating, fatty and fried foods

question

What is dependent edema and how can it be helped?

answer

swelling in feet due to additional 1500 mL of blood volume leaking out of capillaries To help relieve -Foot exercises -elevate feet and legs

question

how can varicose veins be prevented

answer

-Elevate legs frequently -Support hose -avoid standing for prolonged periods -avoid crossing legs

question

why is constipation a problem during pregnancy and how can it be relieved

answer

Due to baby and uterus pushing on intestines and obstructing bowel movements. Peristalsis has decreased! -Increase fluids, fiber and exercise -Eat your veggies -Regular bowel habits

question

what are hemorrhoids and how can they be helped

answer

swollen veins around the anus -Avoid constipation -Ice packs, topical ointments, tucks pads -Warm soaks or sitz baths

question

what causes physiologic anemia and how can it be helped

answer

The initial 1000 ml plasma/ 500 ml RBC increase from pregnancy causes the mother to have more plasma in the blood than RBCs, thus causing anemia. -Fe supplements but S/E is constipation

question

relief for backaches

answer

-Don't sleep on back -Proper body mechanics -Pelvic tilt exercises/ pelvic rock -Comfortable, low heeled shoes

question

relief for abdominal discomfort and round ligament pain

answer

-Avoid stretching -Flex knee and hip on affected side -Heat

question

why does dyspnea occur and how can it be helped

answer

need more oxygen bc total lung capacity has decreased due to fundus pushing against diaphragm To help -Elevate for severity -Posture -Pillows for sleeping

question

supine hypotension/vena caval syndrome

answer

-caused when mother is lying flat on her back -the aorta and/or inferior vena cava becomes compressed -can result in pallor, tachycardia, sweating, nausea, hypotension and dizziness

question

McDonald's rule

answer

the length of the uterus, from the pelvic bone to the fundus in cm is the approximate gestational age of the baby (+/- 2 wks)

question

Leopold's maneuvers

answer

a systemic way in order to determine the position of the fetus in the uterus. It is comprised of 4 maneuvers.

question

What are the 4 maneuvers that make up Leopold's maneuver?

answer

1- feeling the top of the fundus to determine the structure located there. Desired: bottom of baby; grab it? soft? moves whole body when moved 2- feel for the sides of the baby in order to determine where the spine of the baby is and which side the arms and legs are on. Desired: spine on one side- hands/feet on other 3- feel for the pelvis and determine what structure is in the pelvis. Desired: head- firm- moves independently 4- feel in the pelvis of the mother to see if the baby has dropped down into it. The fetus' head is the preferred structure in the pelvis.

question

longitudinal lie

answer

baby's spine is parallel to mom's spine (can be in breech or cephalic) *preferred lie of the fetus

question

oblique lie

answer

baby lying diagonally (breech or cephalic)

question

transverse lie

answer

Mom and baby's spines are perpendicular to each other; horizontal

question

underweight women should gain how many pounds?

answer

28-40 lbs

question

Normal weight women should gain how many pounds?

answer

25-35 lbs

question

Overweight women should gain how many pounds?

answer

15-25 lbs

question

Obese women should gain how many pounds?

answer

11-20 lbs

question

Women of all weights should gain how many pounds during the 1st trimester?

answer

3-5 lbs

question

How do you calculate how much a mother should gain in the remaining 2nd and 3rd trimester?

answer

divide the remaining weight they should gain after the 1st trimesters 3-5 lbs, then divide it by 2

question

what should mothers in each weight class be gaining during the remaining 2nd and 3rd trimester?

answer

underweight- 17.5 lbs each sem normal weight- 15 lbs each sem overweight- 10 lbs each sem obese- 7.5 lbs each sem

question

A pregnant woman should consume ___ kcal extra per baby she is carrying

answer

300

question

A gain of greater than 6.6 lbs in a month, especially after the 20th week of gestation can lead to

answer

preeclampsia

question

The first 8 weeks of development are crucial for

answer

organogenesis

question

It is extremely important for mothers to stay away from teratogens during

answer

the first 8 weeks of development

question

Teratogens

answer

substances that adversely affect the normal growth and development of the fetus. Examples= tobacco, alcohol, caffeine, cocaine, and medications with the FDA categories of D or X

question

Why do babies of mothers who smoke usually have a low birth weight?

answer

the vasoconstricting and calcifying nature of tobacco on the placenta

question

Cocaine can lead to

answer

an abruption of the placenta

question

Alcohol use can lead to

answer

fetal alcohol syndrome

question

FDA drug category A

answer

-Controlled human and animal studies show no risk -Adequate and well controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters)

question

FDA drug category B

answer

-Animal studies show no risk, but there are no human studies OR -Animal studies show risk but there were controlled human studies -Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well controlled studies in pregnant women

question

FDA drug category C

answer

-Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. -Benefits outweigh risks.

question

FDA drug category D

answer

-BAD, dont give -There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans -Potential benefits may warrant use of the drug in pregnant women despite potential risks.

question

FDA drug category X

answer

-Demonstrated fetal risks clearly outweigh any possible benefit! BAD! -Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience -Risks involved in use of the drug in pregnant women clearly outweigh potential benefits

question

Equation to calculate a due date (EDD, EDC, EDB)

answer

-3 months, + 7 days, + 1 year

question

Rules in calculating the due date

answer

-mother must have a normal menses (assume 28 day cycle) and fertilization occurred on the 14th day. -If the mother has an abnormal cycle, she must get an ultrasound to determine her due date (equation will not apply to her) -We must also assume that there are 30 days to every month -Need the FIRST day of her last normal menses. -calculation is -3 months +7 days +1 year from the first day of her last normal menses.

question

Gravida (G) is

answer

-the number of pregnancies, including the current one

question

Parity (P) is

answer

-the number of pregnancies past 20 weeks gestation (age of viability) -refers to the number of pregnancies and not the number of fetuses.

question

What does GTPAL stand for

answer

Gravida (G): number of pregnancies Term (T): number of pregnancies terminating 37 wks or further gestation Preterm (P): number of pregnancies terminating 20-36 wks gestation. Abortion (A): number of pregnancies terminating before 20 wks gestation Living (L): number of living children

question

Initial tests on the mother during her first check up

answer

CBC, platelets, white count, CF (cystic fibrosis screen), Blood type and Rh, Rubella titer, Hep B antigen, HIV STDs: VDRL/RPR (blood for syphilis), gonorrhea and chlamydia culture Urine: for drugs, protein, RBC, WBC, Nitrites, glucose, protein, ketones

question

15-20 week screening tests

answer

msafp/quad screen to test for Downs syndrome if too low or Spina Bifida if too high, amniocentesis and ultrasound

question

24-28 weeks test

answer

1 hour glucose tolerance test if >130- we do 3 hour gtt if 2 of 4 values (fasting, 1 hr, 2 hr, or 3 hr) are elevated- diagnosed with gestational diabetes IF RH neg (O neg, A neg, B neg, AB neg) do indirect coombs test- if positive- you are done, this patient goes to high risk and you will not be giving any medication. If indirect coombs is negative- you will give rhogam to prevent antibody formation over the next 12 weeks (rhogam works for 12 weeks).

question

36 weeks tests

answer

group beta strep- if positive, must report to hospital as soon as water breaks for antibiotic treatment (ampicillin or clindamycin) to prevent exposure to the neonate which can cause fever all the way to bacterial meningitis and death. Also, gonorrhea, chlamydia, urine and cbc

question

Tests done at birth

answer

Direct Coombs test to determine if any hemolysis occurred between the mother and baby due to the crossing of antibodies over the placenta. A bilirubin test is also done

question

Bilirubin levels in baby and interventions

answer

The amount of bilirubin is scored from +1 to +4. +1 is the least severe, and we just need the baby to excrete the bilirubin out in urine and poop. +4 is the most severe, and requires phototherapy to change the structure of bilirubin into something that can be excreted through waste.

question

First stage of labor

answer

Begins with the onset of regular uterine contractions and ends with full cervical effacement and dilation

question

What are the 3 phases of the 1st stage of labor

answer

Latent Phase - thru 3 cm of dilation Active Phase - 4 to 7 cm of dilation Transition Phase - 8 to 10 cm of dilation

question

Second stage of labor

answer

The stage where the infant is born! Stage begins with full cervical dilation at 10 cm and complete effacement (100%) Stage ends with the birth of the baby

question

What are the 2 phases of the 2nd stage of labor

answer

-Latent Phase - a period of rest and relative calm where the fetus continues to descend passively down the birth canal and rotate to an anterior position as a result of ongoing contractions -Active Pushing (Descent) Phase the woman experiences strong urges to bear down and the fetal station is usually +1 with anterior position, changing positions frequently to find a more comfortable pushing position

question

Third stage of labor

answer

-Lasts from the birth of the baby until the placenta is expelled -Generally the shortest stage of labor -The goal of this stage is the prompt separation and expulsion of the placenta and *SHOULD be completed within 20-30 minutes* -After the birth of the fetus, strong contractions cause the placental site to shrink and the placenta detaches itself

question

Fourth stage of labor

answer

-First four hours postpartum -Focuses on the hemodynamic stability of the mother

question

what does cephalic occiput mean

answer

-the baby's head is the presenting part at the cervix -The occiput is the back of the baby's head. When the position of the head is occiput anterior, this means that the baby's face is facing the mother's spinal cord. This is the desired position. -If the baby is occiput posterior, this means the baby is "sunny-side up." -The intervention: have the mother get on her hands and knees. This makes the baby uncomfortable (laying face-down in a hammock). This will hopefully initiate position change of the baby. *Side note: occiput posterior causes back labor pains

question

Effacement

answer

Thinning of the cervix. Must occur prior to dilation.

question

Dilation of the cervix

answer

Diameter of the cervix increases from being closed to to full dilation (approximately 10cm). Full cervical dilation marks the end of the first stage of labor. Dilation is caused by strong uterine contractions.

question

Station of baby

answer

The placement of the presenting part of the fetus is measured in centimeters above or below the ischial spines. Measured from -5 (5 centimeters above the ischial spines) to +5 (5cm below the ischial spines) with 0 station being when the presenting part is at the level of the ischial spines/against the cervix opening. Birth is imminent when station is +4 or +5.

question

non-medicated pain relief

answer

-Transcutaneous Electrical Nerve Stimulation -Acupuncture and/or acupressure -Application of heat or cold -Touch and massage -Hypnosis

question

medicated pain relief

answer

-Sedatives -Analgesia and anesthesia Systemic analgesia Opioid (narcotic) agonist analgesics Opioid agonist-antagonist analgesics Opioid antagonists Local perineal infiltration anesthesia Pudendal nerve block Spinal anesthesia (block)-(Postdural puncture headaches & Epidural blood patch)

question

Epidural Anesthesia Nursing Interventions/Responsibilities

answer

-Evaluate history for previous spinal surgeries -Evaluate skin for lesions (do not want MRSA in your spinal column) -Evaluate CBC for platelet count (should be >100,000 platelets... any less could cause bleeding in the spinal column which would put pressure on the spine, possibly resulting in paralysis) -Obtain consent for all anesthesia -Preload patient with 1-2 liters of NS/LR (Hypotension is a common side effect of epidural anesthesia and can cause decreased O2 in baby) -Monitor heart rate during test dose (*If the HR elevated during the test dose, you know that the catheter placement is in a blood vessel (not good)* -Monitor HR/BP/O2 -Bladder Care -Ensure the side rails are up x3 and the bed is in the lowest position

question

Fentanyl and Stadol

answer

-First medication to give is usually fentanyl then stadol -These medications should not be given an hour before the birth because of the respiratory depression they cause in the newborn -Reversal agent is narcan

question

Uncomplicated 3rd stage of labor

answer

-Birth of the baby until the placenta is expelled -Firmly contracting fundus -Change in uterus -Sudden gush of dark blood from the introitus -Apparent lengthening of the umbilical cord -Vaginal fullness -Placental examination and disposal

question

4th stage of labor

answer

-First 4 hours after birth -Assessment of maternal physical status (Physiologic changes to pre-pregnancy status) -Signs of potential problems Excessive blood loss Alterations in vital signs and consciousness -Care of the new mother -Care of the family

question

Check pad under mother for

answer

bleeding, noting the character, quantity, presence of clots, and odor. Lochia rubra is typical 1 to 3 days following delivery, and small clots are common. -Determine the amount of saturation as scant, light, moderate, heavy, or excessive. -Be sure to check under the patient's buttocks to be sure blood is not pooling beneath her. -Lochia typically increases with breastfeeding and ambulation. If bleeding is excessive, the patient will soak an entire perineal pad within 15 minutes or so. For that finding as well as for numerous large clots or a foul odor, notify the provider immediately.

question

breastfeeding- hormones

answer

-The post birth drop in progesterone triggers the anterior pituitary to release prolactin. -During pregnancy, prolactin prepares the breasts to secrete milk and during lactation it works to synthesize and secrete milk. -Prolactin levels are maintained by infant suckling and emptying the breasts (supply and demand system). -Oxytocin is essential to lactation. The suckling prompts production and it's responsible for the milk ejection reflex (MER, or let-down reflex).

question

What does oxytocin do

answer

-Stimulates uterine contractions during labor -Contracts uterus after birth to control bleeding -Causes milk ejection reflex

question

How often should the infant breastfeed

answer

They should be breastfed within the first hour after birth and q2-3 hours after that. During the first 24 hours, most babies do not wake up often enough to feed. Parents should wake baby every 3 hours during the day, and every 4 hours at night to feed

question

What are cluster feedings

answer

baby feeds every hour or so for 3 to 5 feedings then sleeps for 3 to 4 hours between feedings.

question

Benefits of breastfeeding

answer

•Long-term health benefits for both mom and baby. •Human milk provides the best nutrition for infants. •Uniqueness of human milk •Contains many immunologically active, protective components: •Main immunoglobulin: IgA •IgG, IgM, IgD, and IgE are also present. •Colostrum: more concentrated than mature milk and extremely rich in immunoglobulins •Higher concentrations of protein and minerals but less fat than mature milk •Enhanced bonding and attachment •Convenient, inexpensive •Environmental benefits

question

What is an incorrect latch and how does the mother know?

answer

Incorrect latch is when the baby does not take the breast correctly and in turn doesn't get as much milk, while also leading to sore nipples for the mom. Pain = incorrect latch. Breastfeeding should be painless.

question

nursing interventions for sore nipples

answer

-To make initial sucks less painful the mother can express a few drops of colostrum/milk to moisten the nipple and areola before latch. -Continued pain? consultant/nurse will evaluate latch? repositioning mom or baby may help. -The baby's mouth should be wide open before latching the breast -Limiting time at the breast does NOT prevent sore nipples

question

sore nipple treatment

answer

-Start the feeding on the least sore nipple -Assess for cracking and skin integrity -If break in the skin? mother advised to wipe nipple after finished breastfeeding to remove baby's saliva -A thin coating of topical antibiotic may help reduce the risk of infection and promote healing (remove cream before breastfeeding) -Keep sore nipples open to air as much as possible -Wear comfortable bra? breast shells are devices that allow air to circulate while keeping clothing off sore nipples -Application of lanolin or hydrogel pads -Electric breast pump (that effectively empties the breast) for 24-48hr if extremely damaged and need time to heal

question

Explain mastitis and the medical/nursing interventions including continuance of breastfeeding

answer

-inflammation of the breast as a result of infection. May occur at any time during lactation. -Assessment: localized heat and swelling, pain, tender axillary lymph nodes, elevated temperature, complaints of flu-like symptoms. -Interventions: instruct the client in good hand washing ; breast hygiene techniques, promote comfort, apply heat or cold to the site as prescribed, maintain lactation in breast-feeding mothers, encourage manual expression of breast milk or use of a breast pump q4 hours, encourage the client to support the breasts by wearing a supportive bra (avoid wearing an underwire bra), administer analgesics as prescribed, administer antibiotics as prescribed.

question

average variability of fetal heart rate

answer

6-25 bpm

question

Synthetic form of oxytocin that causes contraction

answer

pitocin

question

Contractions and fetal oxygen

answer

During contractions, blood flow to fetus is cut off, inhibiting O2 and nutrient flow. If contractions are too frequent or too long, hypoxia and acidosis can occur in the fetus.

question

what is a non stress test

answer

No stress is placed on the maternal/placental/fetus unit (no contractions). Used to see how well the placenta transfers oxygen to the fetus as it moves from the non-constricted maternal endometrial arteries? to the placenta? then to the fetus.

question

reactive non stress test

answer

GOOD 2 accels (15 beats x 15 secs) in a 10-20 min tracing

question

non-reactive non-stress test

answer

Fetus did not meet acceleration requirements. -Potential causes: fetal sleep- continue to monitor up to two hours, and give juice (glucose/caffeine to the baby to cause movement), fetal hypoxia (due to placenta not functioning)? need further testing with contraction stress test and/or biophysical profile

question

variable deceleration

answer

u, v, or w shaped which are an ABRUPT decrease in the baseline of 15 beats lasting 15 seconds and returns to baseline within 2 minutes from the time of onset Each deceleration looks different caused by? manual cord compression

question

Contraction and variable deceleration have __ relationship/pattern

answer

NO

question

Interventions for variable deceleration

answer

-Change positions to remove the force (usually baby) which is compressing the cord -O2 per 10L non rebreather -If variables are severe and mom is dilating adequately- Amnioinfusion: to float the cord away from the mechanical force (fluid delivered into pressure catheter) Discontinue the pitocin to allow the fetus to rest prior to becoming acidotic

question

Early decelerations

answer

Start BEFORE the peak of the contraction. Indicates fetal head compression, which is generally a good sign. This means the fetus is moving down for vaginal delivery. Head compression at vaginal squeeze? vagal response? fetal HR decrease There are NO interventions!!

question

Late decelerations (Uteroplacental insufficiency)

answer

consistent and persistent decelerations starting AFTER the peak of the contraction. Indicate the presence of fetal hypoxemia from the inability of the placenta to perfuse the fetus. Common causes: vascular problems of the placenta (calcified from smoking, aging, postdates, drugs, GDM, PIH) and hypotension (secondary to epidural). At peak of contraction, baby has no oxygen? HR decrease ? late deceleration. Epidural? hypotension? mom O2 drop? late deceleration

question

Interventions for late decels

answer

-Change maternal position? takes pressure off the cord and placenta which allows more oxygen to get to the fetus -Turn off the pitocin (stop closing the endometrial arterioles? allows O2 to get to the fetus) ? stops the squeezing of the placenta and allows more blood flow through the arterioles -O2 per 10L non rebreather? when you give mom 10L of oxygen via a nonrebreather mask, it hypersaturates her cells with oxygen -LR/fluid bolus to increase pressure at the placental site? when you give a fluid bolus of lactated ringers to the mother, it increases blood pressure and increases how fast the hypersaturated cells arrive at the uterus and intervillous gap. This provides increased oxygen at the gap which can be delivered to the fetus -Notify Doc ? if unable to correct? C-section because don't want hypoxic/acidotic brain damage

question

orange juice helps with the absorption of

answer

iron should drink with iron supplements

question

contractions should occur

answer

every 3-5 min and last for 45-90 secs

UNF nursing OB test 1 – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards