Flashcards in Exam 1 Deck (158):
Why is supplemental iron usually prescribed during antempartum?
to meet the hemoglobin needs of the expanded RBC volume.
How much does plasma volume increase by during antepartum?
plasma volume increases by 50% (is greater than RBC increase)
Physiologic anemia of pregnancy
Hct is slightly lower in pregnancy. Anemia is defined as <10.5 mg/dL during 2nd trimester
Effects of pregnancy on WBC count
WBC increases 5-12,ooo during pregnancy, and gets as high as 30,000 during labor and postpartum
When does CO peak during pregnancy?
CO peaks at about 25-30 weeks at about 30-50% above prepregnant levels
Why does n/v happen during first trimester?
increased hCG secretion and changes to carb metabolism
cholestasis of pregnancy
intense itching could signal a serious disorder called cholestasis of pregnancy which requires medication and/or delivery of baby at 37 weeks. Characterized by generalized itching starting with palms of hands and soles of feet. No long term sequelae for mom, but can cause sudden fetal death.
Why do gums bleed more during pregnancy?
increased saliva production
mask of pregnancy
how does pregnancy affect metabolism?
BMP increases by 20-25% due to increased oxygen consumption.
weight gain recommendations
25-35 lbs overall
1-4 lbs in first trimester
1 lb/week during second and third trimesters
**sudden, rapid weight gain is a concern
underweight weight gain recommendations
if BMI <18.5, then recommend 28-40 lbs
overweight weight gain recommendations
if BMI 25-29.9, 15-25 lbs
obese weight gain recommendations
BMI >30 then 11-20 lbs
What happens to T4 during pregnancy?
vascularity and hyperplasia of thyroid cause T4 to increase
What happens to the pituitary gland during pregnancy?
Pituitary gland enlarges and prolactin supports initial lactation while oxytocin supports uterine contractility and milk ejection from the breasts. Insulin needs increase (hormones of pregnancy cause insulin resistance). DONT TREAT HYPERTHYROIDISM DURING PREGNANCY-BAD FOR BABY. ok to treat hypothyroidism with synthroid.
What hormone causes insulin resistance during pregnancy?
Human placental lactogen produced by the placenta. If the woman is diabetic, she will need more insulin as the pregnancy progresses.
naegles rule aka LMP to calculate EDB
first day of LMP, subtract three months, add 7 days. Ultrasound to date EDB is GOLDSTANDARD
when do you screen for gestational diabetes?
between 24-28 weeks. retest a CBC and an indirect Coob's (if Rh neg) at this time as well.
when do you screen for syphylis?
RPR between 32 and 33 weeks
When do you screen for GBS?
between 35-37 weeks. swab vagina, if present, treat with Abx during labor to prevent infection of the fetus.
crown, rump length during ultrasound 6-12 weeks accurate +/-3 to 5 days
bipareital diameter measured during ultrasound 14-26 weeks and accurate +/- 7-14 days
accurate during 22-34 weeks
when can you perform a Maternit21 blood test?
as early as 10 weeks. Do this if quad screen comes back positive. Safer than amniocentesis
what might visual disturbances or dizziness indicate during pregnancy?
what might a severe headache indicate during pregnancy?
What might seizures or convulsions indicate during pregnancy?
preeclampsia turning into eclampsia
what might epigastric pain indicate during pregnancy?
preeclampsia, or just acid reflux due to progesterone and upward pressure on ABD from large uterus
What is the best indicator of fetal well-being?
KICK COUNTS!! start counting everday at 28 weeks. count to 10. if it takes longer and longer to count 10 movmts, that is a BIG RED FLAG. (Count after a meal-that's when baby is most likely to be active).
why might a women experience SOB during pregnancy?
Hyperventilation of pregnancy caused by increased VC and TV due to increased oxygen needs and mild resp alkalosis. reaasure mom its normal.
elective or spontaneous delivery that occurs before 20 weeks gestation or birth of a fetus weighing less than 500 grams.
birth after 20 weeks but before 37 weeks
birth after 42 weeks
any pregnancy, regardless of duration, including the current one
a woman who has never been pregnant
a woman who is pregnant for the first time
a woman who is in her second or any subsequent pregnancy
birth after 20 weeks gestation, regardless of whether the infant is born alive or death
a woman who has had one birth at more than 20 weeks gestation, regardless of whether the infant is born alive or death
a woman who has not given birth at more than 20 weeks gestation
a woman who has had two or more birhts at more than 2 weeks gestation
Term (deliveries at 37 weeks or after)
Preterm (deliveries between weeks 20-37)
Living (the # of currently living children to whom the woman has given birth).
purple/bluish discoloration of cervix; increased vascularization thanks to estrogen
softening of cervix
fetal mvmts felt by mother: 18-20 weeks for most primigravidas, but as early as 16-22 weeks for multigravidas.
estimated date of birth
estimated gestational age
softening of the isthmus of uterus
fetal heart rate can doppler at 10-12 weeks
Pregnancy affects on the heart
systolic murmur can be heard in 90% of women.
CO increases by 30-50% by 25-30 weeks (BP should remain less than 135/85
erythrocytes volume increases (due to increased need to transport add'l oxygen)
Plasma volume increases by 50%
Hct is slightly lower during pregnancy (relative anemia of pregnancy)
Certain blood clotting factors increase resulting in a hypercoagulable state
venous stasis in late pregnancy places the pregnant woman at increased risk for venous thrombosis
Why do you perform AROM
artificial rupture of membranes to induce or accelerate labor (AROM aka amniotomy). Cervix must be dilated 1 cm at least. Allows internal fetus and uterine monitoring. Allows provider to assess color of amniotic fluid. If umbilical cord prolapses-->emergency c- section!!
Nuchal cord around neck
cephalopelvic disproportion is a condition where the baby's head or body does not fit through the mother's pelvis. CPD is often diagnosed when a woman's labor fails to progreess to delivery, the cervix has stopped dilating, or the baby does not descend through the pelvis. In cases of actual CPD, a C-section is usually indicated.
estimated date of confinement: due date
estimated date of delivery
electronic fetal monitoring.
Fetal Scalp electrode
group B strep
intrauterine growth retardation: fetus who is at or below the 10th percentile in weight for its gestational age. There are two factors necessary to define an IUGR: Fetal weight is bottom 10% AND there is a pathological process present that prevents expression of normal growth potential.
intrauterine pregnancy=normal pregnancy
intrauterine pressure catheter: placed into the amniotic sac during labor in order to measure the strength of uterine contraction
large for gestational age (at risk for perinatal morbidity and potentially long term metabolic complications) LGA is >90%. Common causes include gestational diabetes or prolonged pregnancy
premature rupture of membranes: when the membranes break before labor. Most women will then go into labor within 24 hours
preterm premature rupture of membranes. If the water breaks before the 37th week of pregnancy. Infection usually precedes PPROM, so strict sterile technique should be used in any vaginal exam
small for gestational age: low birth weight. A developing baby with intrauterine growth restriction will be small in saze and can have problems such as increased RED (polycythemia) low blood sugar (hypoglycemia), and low body temp (hypothermia)
spontaneous rupture of membranes. often happens after active labor has started. Your contractions may get stronger after membranes rupture. If engagement has not occurred, there is a risk that the umbilical cord may be expelled with the fluid (prolapsed cord)
trial of labor after C-section; the attempt to deliver vaginally after a c-section. carries some risk of rupture of the uterine scar.
termination of pregnancy
vaginal birth after c-section
why do an amnioinfusion?
warm, sterile NS infused through an IUPC into the uterus to increase the volume of fluid around the fetus to prevent or treat variable decelerations by relieving pressure on the umbilical cord. **Amniotic membranes must be ruptured and cervix must be open enough to allow insertion of IUPC
the inner of the two membranes that form the sac containing the fetus and amniotic fluid
What do you need to assess before and after an amniotomy?
FHR, inspect the amniotic fluid for color, amount, odor and the presence of meconium or blood.
What is the desired birth presentation?
cephalic (LOA=left occiput anterior is the most common position)
fetal membrane closest to the intrauterine wall that gives rise to the placenta and continues as the outer membrane surrounding the amnion.
When is augmentation necessary?
when there are less than 3 contractions in a 10 minute period or if the intensity of the contraction is less than 25 mm Hg as indicated by internal uterine pressure catheter during active phase of labor.
we dose Pitocin in mu/min, but deliver it in mL/hr. Administer 2 mu/min increasing 1-2 mu/min q15-30 mins until contractions occur q2-3 mins.
relationship of the presenting fetal part to an imaginary line drawn between the pelvic and ischial spines. The ischial spines are zero station. If the presenting part is higher than the ischial spines, a negative number is assigned, noting cm above zero station. Station -5 is at the inlet, and station +4 is at the outlet. When the fetus is engaged, the largest diameter of the presenting part (biparietal diameter) passes through the pelvic inlet and the station of the fetal head will be 0
Three phases of contractions
Increment (the building up and is the longest phase)
decrement (letting up of the contraction)
what happens during the rest period between contractions?
the rest period between contractions restores the uteroplacental circulation.
the time between the beginning of one contraction and the beginning of the next contraction. frequency is every 2-3 mins when labor is progressing
early durations are 30-40 s but as labor continues, duration increases to 30-90s.
strength of the contraction at the acme.
Favorable for vaginal birth:
Gynecoid (50% of female pelves): rounded, wide deep sacral curve, wide and round pubic arch, all inlet and outlet diameters adequate
Anthropoid (25%): oval, long anteroposterior diameter, adequate but short transverse diameter, inlet and outlet adequate. Favors occiput posterior.
Unfavorable for vaginal birth:
Android (20%): heart shaped, male-type pelvis, anteroposterior and transverse diameters are adequate, but other measurements make both inlet and outlet inadequate. Favors occiput posterior.
Platypelloid (5%): flat, transverse oval shape, short anteroposterior diameter, wide pubic arch, both inlet and outlet inadequate.
when does effacement begin?
at 4 cm. Effacement: The drawing up of the internal os and the cervical canal into the uterine side walls (starts at 4 cm long)
stages of labor
1st Stage—contractions until 10cms
2ndStage —complete dilation until birth
3rd Stage—birth until placenta
4thStage —placenta until1-4 hours later; uterus contracts, bleeding is controlled at the placental site
Characteristics: Beginning of cervical dilatation and effacement, no evident fetal descent, uterine contractions increase in frequency
Contractions : irregular, Q 3-30 minutes, duration 20-40 seconds, mild intensity
Maternal behaviors: able to cope, happy that labor has started, energetic, nesting
Typically lasts: 8.6 hours in nulliparas, 5.3 hours in multiparas
Characteristics: dilatation from 4 to 7 cms; fetal descent (1.2-1.5 cm/hr)Contractions: Q 2-5 minutes, lasting 40-60 seconds, moderate intensity, firm to palpation
Maternal behaviors: anxiety, decreased ability to cope, time to go to the hospitalTypically lasts: 4.6 hours in nulliparas, 2.4 hours in multiparas
Characteristics: dilatation from 8 to 10 cms, progressive fetal descent increases 1-2cm/hrContractions Q 1.5-2 min, lasting 60-90 seconds, strong intensity
Maternal behaviors: withdraws, terrified of being alone, but does not want to be touched or talked to—BUT DON’T LEAVE HER!, may lose focus, or beg for drugs, may have urge to push but should control through panting/blowing—important NOT to push against an incompletely dilated cervix—can lead to cervical tears and hemorrhage!
Typically, transition is not longer than 3 hours in nulliparas, 1 hour in multiparas
second stage characteristics
Characteristics: Nulliparas: up to 3 hrs, Multiparas: 0-30 mins
Contractions q 1.5-2 mins, lasting 60-90 seconds, extremely strong intensity
Latent phase and active phases of second stage—should not start pushing until cervix is completely dilated and baby’s head is low (at least +1 station)
Urge to push as fetal head presses on pelvic floor—comes from activation of Ferguson’s reflex
Maternal behaviors: pushing feels good, sense of control, ring of fire
activation creates an urge to push. Mom should NOT push until fetal head is at least +1 station and cervix is completely dilated
third stage characteristics
Placental delivery usually occurs within 5 - 30 minutes after the delivery of the infant
Signs of impending placental delivery: gush or trickle of blood, lengthening of the umbilical cord, a rise of the fundus in the abdomen
Pitocin via IVF and vigorous fundal massage will be given as soon as placenta delivers to aid in uterine contraction to prevent/minimize bleeding (active management of the 3rd stage of labor)
Maternal behaviors: recovering, may bear down to aid in placental expulsion
fourth stage of labor
Characteristics: 1 to 4 hours after birth, Physiologic readjustment phase, Mother may experience shaking chill (“Postpartum Chill”), bladder is often hypotonic, uterus remains contracted (midway between the symphysis pubis and the umbilicus)
Maternal behaviors: relief that process is over, exhausted, excitement about baby, thirsty and hungry
monitoring in labor
Q 15-30 min during active phase; q 5-15 min during 2nd stage
Review/documentation of continuous:
Uncomplicated pregnancy/labor: review/document q 30 minutes during 1st stage and q 15 minutes during 2nd stage
Complicated pregnancy/labor: review/document q 15 minutes during 1st stage and q 5 minutes during 2nd stage
what is preferred anesthesia for preeclampsia patients?
nursing mgmt for regional anesthesia
Monitor maternal and fetal vital signs
Assess for hypotension
Take corrective measures for hypotension
Left lateral-side lying position, oxygen
Administer anti-emetics as needed
Monitor respiratory rate
Assess bladder and catheterize if unable to void
usually associated with cord compression usually not concerning unless deceleration is less than 70 beats/min and lasts more than 60s. If the variable is slow to return to baseline, may indicate hypoxia and warrants intervention
what do you assess before increasing oxytocin flow rate?
fetal heart tones. to determine effect of oxytoxin, measure mom's BP and pulse
signs of labor
braxton hicks, lightening (engagement), weight loss, sudden burst of energy, ROM, bloody show, n/v/d, backache
what is a contraindication for pictocin?
CPD (cephalopelvic disproportion)
when should you d/c pitocin (oxytocin) or decrease flow rate?
dc IV oxytocin infusion when nonreassuring fetal status is noted (bradycardia or variable decelerations), uterine contractions more frequent than q2mins, duration of contractions >60s, or insufficient relaxation of the uterus between contractions or a steady increase in resting tone is noted. In addition to discontinuing oxytocin infusion, turn patient to her side, and if nonreassuring fetal status is present, administer oxygen by tight face mask at 7-10 L/min and notify physician.
most common side effect of epidural anesthesia?
hypotension; prevent by preloading with a fluid bolus prior to delivery of epidural.
what is the nursing care related to an epidural?
maternal BP and HR q5mins for at least 30 mins, then at least 30 mins thereafter while the block is present. The FHR is monitored and assessed by continuous EFM.
UA with proteinuria of +1
may indicate preeclampsia
promotes fetal lung maturity. 12mg IM q24h X2doses
used with fentanyl in epidural infusions for pain relief; monitor for cardiovascular collapse. 0.125% @ 8-12 mL/hr
labor pain analgesic; 1-2 mg IV or IM q4h
GBS prophylaxis; 1-2 grams q8h
*only need one dose preop if c-section
labor induction or abortion. (10mg intravaginally). stimulates uterine contractions
preeclampsia (anticonvulsant) preterm labor (smooth muscle relaxant). 4-6 grams loading dose over 15-20 mins, followed by 2g/hr continuous infusion.
labor induction, abortion, postpartum hemorrhage. 23 mcg vaginally q3hrs for induction. 800-1000 mcg rectally for postpartum hemorrhage
labor induction, postpartum bleeding, and adjunctive therapy in abortion. Labor induction: 0.5-1 mu/min, increase in increments of 1-2 mu/min. Postpartum bleeding 10 units IM or 10-40 units IV in 1000 mL IVF
intrapartum antibiotic therapy for GBS+ patients.
preterm labor 0.25 mg SC q20mins for three doses (hold for HR >120)
analgesic, anesthetic; 100 mcg IV, 2-4 mcg/ml in epidural infusions
demerol has an active metabolite and can cause respiratory depression in neonate after birth. It is not recommended to give this to women in active labor.
Sodium Thiopental (Pentothal)
short acting barb for general anesthesia-used as an adjunct to initiate unconsciousness
intermediate acting barb used for induction of general anesthesia-effects last 20-60 mins
what about a woman in labor with aortic stenosis?
consider general anesthesia instead of epidural
What is important to know about Nitrous Oxide and oxygen?
can increase uterine blood flow and uterine relaxation--risk for hemorrhage!!
uterus returns to prepregnant state (usually takes 6 weeks)
when are the baby blues the worst?
third or fourth day following delivery due to hormone levels drop. If not resolved within two weeks, consider referral for postpartum depression
blood loss averages during labor
vaginal birth 200-500 mL (>500 mL = hemorrhage)
C-sections: 700-1000 ml (>1000mL = hemorrhage)
How does blood volume reach pre-pregnant state by 1 week?
why do you have an increased risk for UTI for up to six weeks after birth?
dilated ureters and renal pelves
fourchette, perineal skin, and vaginal mucous membrane involvement
involves perineal skin, vaginal mucous membrane, underlying fascia, muscles of the perineal body (central tendon of the perineum that lies between the vagina and anus)
involves above plus the anal sphincter; may extend up the anterior wall of the rectum
involves above plus the anal sphincter; may extend up the anterior wall of the rectum but extends through the rectal mucosa into the lumen of the rectum
when may a woman expect to return to her pre-pregnant weight?
6-8 weeks after delivery
what amount is considered a heavy amount of lochia?
saturated peripad within one hour
drugs that control postpartum bleeding?
Hemabate or Cytotec
assess BP and allergies!!
newborns generally have blue extremities and the rest of the body is pink. This is present in 85% of normal newborns 1 minute after birth. When this occurs, the newborn is given a merit score of 1 on the apgar .
localized swelling of tissues of scalp resulting from long or difficult labor. crosses sutures, present at birth or shortly thereafter. Conehead
collection of blood between cranial bone and periosteal membrane. doesn't cross suture lines. Horns
Erythema toxicum **
newborn rash or fleabite; innocuous pink, papular rash of unknown cause with superimposed pustules; appears with a 24-48 hours after birth and resolves spontaneously within a few days. Usually from harsh detergents in hospital
small glistening white specks that feel hard to touch, usually disappear in a few weeks and are of no significance.
port wine stain
strawberry mark; capillary hemangioma
most common of the group of metabolic errors. newborn with this lacks ability to convert phenylalanine to tyrosine-musty odor in urine; accumulation and abnormal metabolites in brain tissue leads to progressive intellectual disability
stork bites; usually fade by second birthday
normal birth weight
5 lbs, 8 oz-8 lbs, 13 oz
normal birth length
48-52 cm (18-22 in)
normal chest cirumference at birth
30-35 cm (12-14 in)
normal head circumference at birth
32-37 cm (12.5-14.5 in)
Normal HR at birth
110-160 bpm, count 1 full minute
normal RR rate at birth
30-60/min for 1 full min
Temp at birth
rectal 36.6-37.2 C (97.8-99F)
Axillary 36.4-37.2 (97.5-99.4)
7-10 is good (do twice at 1 minute then again at 5 mins)
activity: absent 0, some motion, flexion, resistance to extension 1, active, spontaneous mvmt with good flexion 2
Pulse: absent 0, below 100 1, above 100 2
Grimace: no response 0, grimace, frown 1, sneeze, cough, pull away, cry 2
Appearance: blue-gray, pale all over 0, normal except for extremities 1, normal over entire body 2
Respiration: absent 0, slow, irregular 1, good, crying 2