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OB > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Ischial Spines?

A

Smallest area for the baby to pass through in the birth canal. These protrude into the canal.

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2
Q

What is ‘Attitude’?

A

The relationship of fetal parts to each other.

The baby should be in a flexed attitude.

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3
Q

What is ‘Lie’?

A

Relationship of the cephalocaudal axis of the fetus to the cephalocaudal axis of

the mother.

 IE: spine of baby should be parallel to the mom’s spine.

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4
Q

What is the proper Lie and what is an improper Lie?

A

Longitudinal lie

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5
Q

What is ‘Presentation’?

A

Body part of fetus that enters the pelvis first and covers the internal cervical os

(opening).

 IE: Vertex Presentation is what we want, as long as the baby is in a flexed

attitude.

 IE: Shoulder presentation is aka a horizontal lie.

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6
Q

What is ‘Station’?

A

Relationship of the presenting part to the ischial spines of the maternal pelvis.

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7
Q

What station is considered when the baby’s head is even with the ischial spines?

A

0  at this station, the baby is engaged and has to now change positions and

turn head to anterior/posterior to fit through the ischial spines.

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8
Q

What is ‘Position’?

A

Relationship of landmark of presenting fetal part to the front, sides and back of

the mother’s pelvis.

 IE: Occiput left posterior = OLP

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9
Q

What is the preferred position?

A

Occiput anterior

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10
Q

What is the frequency, duration and strength of contractions?

A

Frequency: time from start of one contraction to start of next.

 Duration: length of time a contraction lasts.

 Strength: indentibility on external exam or millimeters of mercury by Intra-uterine pelvic catheter.  If you can easily indent into the Fundus (upper part of the uterus) while they are having a contraction, then they are having a mild contraction.

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11
Q

What is effacement?

A

 Drawing up of the internal os and the cervical canal into the uterine side walls.

 The Fundus contracts and pulls the bottom part of the uterus pushing it down into the canal against the cervix, therefore, thinning it out.

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12
Q

What are some factors that stimulate uterine contractions?

A

Oxytocin, estrogen, fetal cortisol, and prostaglandins.

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13
Q

What is the job of estrogen vs progesterone?

A

 Estrogen is produced by the placenta during the entire pregnancy and causes muscle fibers of the uterus to be active, stimulating contractions.

 Progesterone is also produced by the placenta, but causes smooth muscles to relax and quiet uterine contractions.

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14
Q

What are some signs of labor?

A

 Passing of the mucous plug

 ‘Bloody show’ when there is some blood with the mucous plug

 Surge of energy

 Contractions become regular and rhythmic

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15
Q

What are the characteristics of TRUE vs FALSE labor?

A

 TRUE: Regular/rhythmic contractions, pain moves from back to front, fetal movement is unchanged, fetal descent progresses, pinkish mucous and progressing effusion and dilation!

 FALSE: Irregular contractions, pain is relieved by walking, fetal movement may intensify, no fetal descent, no mucous, no effusion or dilation changes within 1-2 hours.

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16
Q

What is the ONLY way to truly decide if they are in true labor or not?

A

Cervix must show change within two hours

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17
Q

There are 4 stages of labor, the first stage has three phases, what are they and what is the dilation sizes?

A

 Latent slow and early contractions that aren’t close together. They will be dilated from 0-3 cm.

 Active contractions are very active and getting closer. They are dilated from 4-7 cm

 Transition almost to the pushing stage with strong and close contractions. They are dilated from 8-10 cm.

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18
Q

Stage 2 of labor is the pushing stage. When does this stage start and end?

A

At 10 cm. Stage of expulsion. This stage ends with the delivery of the fetus.

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19
Q

What is the 3rd stage of labor and when does it start and end?

A

The placental stage. This begins immediately after fetus is born and ends when the placenta is delivered.

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20
Q

What is stage 4 of labor?

A

‘Recovery’ Maternal homeostatic stabilization stage. Begins after the delivery of the placenta and continues for 1-4 hours after delivery.

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21
Q

What are the critical assessments of the laboring woman?

A

 VS –make sure they’re WNL

 What is the strength/duration/frequency of the contractions?

 Vaginal exam Universal precautions? Dilation/effacement/station of the baby.

 Viewing history of the mom from the GYON of problems, and look at the labs (hgb, WBC’s).

 Fetal status  palpating the abdomen of the woman (LEOPOLDS MANEUVERS)

 Any cultural/psychosocial considerations needed?

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22
Q

What positions should the laboring woman be in?

A

Ambulatory as long as possible, squatting, side lying, semi/high fowlers, left pelvic tilt (wedging R hip when lying on back to keep the abdominal aorta and the vena cava from being occluded).

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23
Q

How can the nurse help prevent bladder distention?

A

Have the pt void every 2 hours, watch for the bladder to be distended.

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24
Q

What helps the uterus to contract POST delivery?

A

Breast feeding causes a release of oxytocin, if mom is not breast feeding, IV oxytocin is used.

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25
Q

What should be closely monitored after birth in the mother?

A

Hypotension, impaired elimination due to trauma to neck of bladder/urethra, uterine displacement, uterine atony (1st intervention is to massage the uterus) and tremors/shivering (this is normal, get warm blanket.)

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26
Q

What are the main points to a precipitous birth? (4)

A

-Gentle pressure against fetal head to prevent tearing in mom.

 Check for nuchal/umbilical cord after birth of head.

 Clear mouth and nasal passages

 Dry newborn, place on mom’s abdomen, lower head to facilitate mucous drainage and initiate breastfeeding.

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27
Q

What is the gate control theory of pain?

A

 Premise that pain can be blocked. A non-painful input closes the “gates” to painful input preventing the sensation from traveling up the CNS.

 IE: sterile water papules placed intra-dermally around the sacral area.

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28
Q

Pain stage one (labor stage) is caused by what?

A

Dilation of the cervix, hypoxia of uterine muscle cells during contractions, stretching of the lower uterine segment, and pressure on the adjacent structures (urethra/neck of the bladder).

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29
Q

Pain stage two (pushing stage) is caused by?

A

Hypoxia of the uterine muscle cells (contractions), distention of vagina and perineum, and pressure on adjacent structures.

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30
Q

During systemic analgesia is the first level a woman may experience any type of pain relief after non-pharmacologic therapies. (Fentanyl, butorphanol, nalbuphine) what do these do?

A

Decrease the perception of pain, although still feel contraction, they can tolerate them better.

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31
Q

There are also adjunct meds to the analgesics (promethazine and diphenhydramine) for what?

A

Decrease nausea and anxiety

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32
Q

What are the AE’s and nursing considerations of the systemic analgesia?

A

Dizzy (we don’t want mom to get up out of bed to walk after getting these). The drugs do go to the baby but we aren’t worried about the baby being dizzy, we are worried about respiratory depression if baby is delivered shortly after these medications are given. If baby comes quickly after mom gets these medications,
Naloxen is given to reverse those drugs and prevent respiratory depression.

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33
Q

When would Barbitruates be given to a laboring mom?

A

Latent phase to decrease anxietyanxiety/induce sleep. Usually these are used only when mom is not in true labor, and is exhausted and getting no
sleep due to the painful Braxton Hicks contractions to help her sleep. Once she wakes up she is usually in true labor.

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34
Q

Two ways to give regional analgesia/anesthesia for labor?

A

 Epidural  spae outside of the subarachnoid space (spinal column)

 Intrathecal “subarachnoid space)  done quick for c-section, gives immediate pain relief.

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35
Q

What are some AE’s and nursing considerations with regional analgesia/anesthesia?

A

Sensory/motor block, vasodilation (maternal hypotension)  fluid preload/bolus to help prevent vasodilation. Left uterine displacement by wedging R hip, check platelet count (has to be above 100,000 or your putting them at risk for a hematoma during the administration.

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36
Q

There are 4 things that occur to help baby take his first breath. What are they?

A

 Mechanical: when the baby pushing through the canal, it squeezes him and pushes that fluid out but 80-100 cc’s does still remain afterwards.

 Chemical: when the cord clam is put on, there is an increase in the PCO2 and a decrease in O2 levels which sends a negative feedback signal to the medulla oblongata to make baby breath.

 Thermal: baby comes from the warm amniotic fluid to the cold delivery room.

 Sensory: drying the baby off with the towel is stimulating as well as the noise in the room and us tapping his feet to stimulate him.

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37
Q

What are normal newborn respirations for the first 2 hours after birth?

A

60-72 breaths per minute.

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38
Q

What are normal newborn respirations after the first 2 hours of life?

A

30-60 breaths per minute.

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39
Q

All newborns have periodic breathing with periods of apnea. How long is apnea okay for as a new born and how long do you take newborn resp. rate?

A

 Okay apnea 5-15 seconds, longer than 20 is bad. Take RR for 1 whole minute.

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40
Q

What are some of the first things the nurse should do after birth?

A

Clear the nares, assess RR 1 min, skin color perfusion (capillary refill), heart rate, and lung sounds.

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41
Q

What is a normal heart rate for a newborn?

A

110-160

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42
Q

Factors that oppose the first breath? (3)

A
  1. Alveoli need a phospholipid called “surfactant” to keep them from collapsing, so without adequate surfactant produced, gas exchange cannot occur. To produce surfactant LS is needed to be at a ratio of 2:1 to support life.

 Alveoli need correct amount of surface tension as well.

 2. Viscosity of lung fluid within the respiratory tract has to be correct. If in the amniotic fluid when water breaks there is meconium, then the baby has most likely ingested this and it will change the viscosity of the lung fluid and trap the alveoli from exchanging gas.

 3. The degree of the lung compliance.

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43
Q

When is wall suction for meconium aspiration done?

A

Heart rate

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44
Q

What cardiovascular adaptations occur after birth?

A

Shunts in the heart that close shortly after birth because of changes in pressure. In fetus pressure is higher on the R side and in an adult the pressure is greater
on the L. The shunts keep the blood from going to the lungs and the liver because they don’t need those organs to work in the mother.

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45
Q

When listening to the newborns heart, you may hear murmurs, these should always be reported to pediatrician although usually they are physiologic until the shunts close. What is average mean BP in the newborn?

A

50-55 mmHg should be done all four extremities and they should all be equal.

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46
Q

What is a normal body temperature for newborn? How long are they put under the radiant warmer if their temp is not WNL?

A

97.8-99.4 degrees F  axillary

 Until temp is 98.6 degrees F

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47
Q

What are some reasons that a newborn has a hard time maintaining body heat?

A

 Large body surface compared to body mass.

 Inability to generate heat from shivering.

 Thin layer of sub-q fat making blood vessels closer to the surface of the skin.

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48
Q

What occurs if the baby’s temperature drops below 97.8?

A

Their oxygen consumption will decrease, they become tachypneic and then use their glucose stores and become hypoglycemic which leads to seizures.

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49
Q

What are the 4 ways a baby can lose heat?

A

 Convection  air drafts can make him lose heat.

 Radiation  placing the crib by a cold window.

 Evaporation  dry baby quickly so he isn’t losing heat while fluid is evaporating.

 Conduction  naked baby on cold surface like the weight scale.

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50
Q

When babies are cold stressed what can they suffer from?

A

Respiratory distress, hyperbilirubinemia, hypoglycemia

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51
Q

Neonatal hypoglycemia level

A

below 40. Start protocol at 45

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52
Q

First S/S of neonatal hypoglycemia? (4)

A

Jitteriness, lethargy, feeding problems, temperature instability.

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53
Q

What is a baby’s heat production since they can’t shiver?

A

Non-shivering thermogenesis  break down their brown fat into heat energy, if they are pre-mature, they don’t have as much brown fat so they go to incubator.

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54
Q

A new born must conjugate their bilirubin which means what?

A

Turn it from a fat soluble to water soluble form of bilirubin so they can pass it out of the body.

 If they can’t pass it out of their body, it builds up in the skin and causes jaundice.

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55
Q

When is it normal to see jaundice in a new born in first 24 hours?

A

Never in the first 24 hours. After that, some babies get it in the face but when levels go over 20 and it goes down their stomach and arms/legs it’s a problem.

56
Q

How can we help to prevent jaundice?

A

 Keep them warm

 Adequately hydrated

 Monitor skin color

 Monitor output and stools

 Assess for any signs of infection

 Assess for risk factors

57
Q

Any baby born to a mom with blood type O have to have what test done?

A

Coombs. Because if baby is A/B blood then she will produce antibodies to destroy the RBCs of baby.

58
Q

What is the APGAR scoring for? When is it done? What does it look at?

A

 APGAR scores need for resuscitation.

 It is done at 1 min, 5 min, and 10 min post birth.

 It looks at HR, RR, Muscle tone, reflex irritability and color of baby

59
Q

What is a perfect APGAR test? Anything below ___ needs some type of resuscitation?

A

 10 perfect

60
Q

What screen helps us to estimate gestational age? What does this contain?

A

Ballard Exam get a score for gestational age.

 Physical characteristics: skin, sole creases, amount of breast tissue,

 Neuromuscular: posture, square window sign, arm recoil, popliteal, amount of lanugo (hair), cartilaginous development of ear, testicular descent, scrotal rugae or labial development, angle, scarf sign, heel to ear.

61
Q

What is a term baby, post term, and premature baby?

A

 Term: 37 weeks complete gestation

 Post: >42 weeks

 Pre:

62
Q

Go over the tests for the neuromuscular checks:

A

Posture: full term babies will be flexed and when you try to but their shirt on, you have to straighten out their arms, premature babies are more limp.

 Square window sign: measures the angle at the wrist when the hand is flexed. Term babies have more fat so the angle will be smaller.

 Scarf sign: arm and wrap around neck, checking to see if elbow crosses the midline. Term babies cannot cross the midline.

 Heel to ear: term babies have too much muscle tone to touch their heel to their ear, but premature babies can.

 Ankle dorsiflexion: same as square angle, in term babies they have more fat so angle will be smaller.

 Arm recoil: term babies will recoil their arms to less than 90 degrees quickly, premature babies don’t recoil as quick and angles more than 90 degrees.

63
Q

What should the ratio of head circumference to chest circumference be?

A

Head should be 2 cm larger than chest in the newborn.

64
Q

What are the labs that should be assessed after birth?

A

Mother and newborn’s blood type, coombs if mom is type O, (watch for jaundice if baby is A and mom is O), if mom is Rh negative we do a fetal screen for antibodies that could be attacking babies RBCs, bilirubin levels, blood sugar (only high risk babies), Group Beta strep (done during pregnancy, vaginal culture taken at 36 weeks. Lives in the GI tract of all of us but if in vaginal tract, can cause sepsis in babies).

 If mom is positive for group beta strep, when mom goes into labor, she gets high doses of antibiotics.

65
Q

Where is the babies first temp taken and why?

A

Rectally for patency

66
Q

When assessing the skin in a new born look at:

A

 Color:

 Acrocyanosis: foot/hand cyanosis (normal)

 Jaundice

 Texture: should be smooth

 Turgor

 Pigmentation:

 Milia: white sebaceous glands on nose (normal)

 Mongolian spots: concentrated pigmented melanin

 Erythema toxicum: newborn rash. DO blanch, will go away.

 Telangiectatic nevi: ‘stork bites’ on eye lid of nape of neck, raised DO

 Vernix Caseosa: white cheese-like substance

67
Q

What is cephalohematoma?

A

Blood between skull and scalp occurs from ruptured blood vessels. Unilateral does not cross the midline suture. Watch for jaundice because extra red blood
cells are being destroyed within the hematoma.

 Too large hematoma can lead to hypotension and anemia.

68
Q

What is caput succedaneum?

A

 Collection of fluid on the head (edema) resulting from a long difficult labor or

vacuum extraction. This will cross the midline suture line.

69
Q

If a baby’s nares are flaring what is this a sign of?

A

Respiratory distress

70
Q

Next check the mouth for clef pallet and teeth. Ears no drainage, if the ears are low set

to the outer canthus of the eyes what is this a sign of?

A

Renal problems

71
Q

What is the Moro Reflex?

A

Slightly lift baby off table with arms, when released, hand dropping should be symmetrical and arms should pull back in. If the baby has fractured a clavicle or brachial plexus, this dropping reflex will be asymmetrical.

72
Q

What is ortolani sign looking for?

A

Knees to chest then moving out, if you feel a give or a click it is a sign of hip dysphasia. (needs to be reported)

73
Q

Look for plantar reflex/Babinski reflex.

A

Flaring of the toes when you stroke bottom of foot

74
Q

Assessment of newborn neuromuscular:

A

Reflexes, blink, pupillary reflex, moro, rooting/sucking, palmar grasp, plantar grasp, stepping reflex, Babinski, tonic neck.

75
Q

What immunizations/treatments do we give to the newborns immediately following birth?

A

 Prophylactic injection of vitamin K to prevent hemorrhage, given in the vastus lateralis.

 Hepatitis B vaccination (transferred through bodily fluids) is started.

 Prophylactic eye treatment for Ophthalmia Neonatorum (eye ointment) (in case the baby comes into contact with gonorrhea or chlamydia.)

76
Q

What are the new safety measures for newborns?

A

 ID bands (2 on baby, 1 mom, 1 dad) check every time

 Security band on baby

 Teach never to leave baby unintended

 Transfer baby in crib, can’t just walk down the hall carrying baby.

 Keep baby in crib between bed and wall, rather than between bed and door.

 Closed units

 Scrubs have to have that hospital/floor logos on them

 Have to change into and out of scrubs on the floor.

 Staff ID badges at top of scrubs chest level.

77
Q

What are the nursing goals during the first 4 hours post birth for newborns?

A

 Maintain clear airway

 Maintain neutral thermal environment

 Prevent hemorrhage and infection

 Initiate oral feedings

 Facilitate attachment

78
Q

 First period of reactivity:

A

 30 min post birth when newborn is awake, alert, strong sucking reflex, great time to bond! Then they go to sleep/inactivity phase for 2-4 hours. They are difficult to wake and get baby to nurse. Best time for breastfed
babies to feed.

79
Q

Second period of reactivity:

A

 After 4 hours they go into second phase of reactivity lasting 4-6 hours. Digestive juices start flowing and waking up, and mucous production increases, watch for choking. Best time for bottle-fed babies to first
feeding.

80
Q

When breastfeeding, how long should the newborn nurse?

A

 10-15 min each breast, separated with a period of burping. (20-30 min total, every 1.5-2 hours)

81
Q

How can a mom know if baby is getting breast milk?

A

 Latch

 Audible swallowing

 Type of nipple

 Comfort (shouldn’t hurt mom)

 Holding

82
Q

How should we teach bottle feeding?

A

 feed every 2-3 hours

 No more than ½ oz (15 cc) at first

 Every 5-10 cc’s burp, then feed some more

 No more than 45 cc before discharge

83
Q

After discharge, what is the normal output and stool patterns?

A

 6-10 wet diapers per day

 1-2 stools per day for formula fed baby

 6-10 small, loose yellow stools per day for breastfed baby

84
Q

What teaching should be taught for care of circumcision?

A

 Watch for active bleeding

 Watch for patency and force of the stream

 Clean penis with water during diaper changes and with bath

 Do not force foreskin back over penis as an infant!!!!

85
Q

Two types of circumcision procedures:

A

 Gomco/Sheldon/Logan: Surgically removed foreskin with scalpel

 Plastabell: (foreskin tied tight to cause the skin to necrose and fall off.

86
Q

We use a neonatal infant pain scale (NIPS) to judge for infant pain from birth to 1 year.

What is this scale?

A

 Facial expression

 Relaxed muscles – 0

 Grimace – 1

 Cry

 No cry – 0

 Whimper – 1

 Vigorous cry – 2

 Breathing patterns

 Relaxed – 0

 Change in breathing – 1

 Arms and then legs

 Relaxed – 0

 Flexed/extended – 1

 State of arousal

 Sleeping/awake peaceful – 0

 Fussy – 1

87
Q

NIPS pain levels?

A

 0-2 no/mild pain

 2-3 mild/moderate pain

 >4 severe pain

 Anything above 3 needs some sort of intervention

88
Q

What are some signs of illness in the newborn?

A

 Axillary temp above 100.4 or continuous rise in temp

 More than one episode of forceful/frequent vomiting over 6 hours

 Refusal of 2 feedings in a row

 Lethargy, difficulty in awakening  911

 Cyanosis with or without a feeding  911

 Absence of breathing longer than 20 seconds  911

 Inconsolable infant (continuous high pitch cry)

 Discharge bleeding from umbilical cord/circumcision or other opening

 2 consecutive green watery stools

 No wet diapers 18-24 hours or fewer than 6 wet diapers per day

 Development in eye drainage

 Projectile vomiting

 Increasing jaundice

89
Q

When discharging what are some of the labs/screening that is done?

A

 PKU – checks to make sure they can break down protein

 Bilirubin levels

 Hearing screen

 Congenital hypothyroidism screened for (can cause MR if not caught early)

 Congenital heart defect screening

90
Q

How long is the postpartum period?

A

Begins immediately and then continues for about 6 weeks or until the body has returned to a near pre-pregnant state.

91
Q

What is the leading cause of postpartum maternal death in this country?

A

hemorrhage

92
Q

When doing our assessment on the postpartum mom, what pneumonic can we use to get every area?

A

o BUBBLEHE

o Breast, uterus, bladder, bowel, lochia, episiotomy, Homan’s/hemorrhoids, and emotional

93
Q

How should the breast look on the first pp day, 2nd pp day, and 3rd pp day?

A

o 1st: soft non-tender, non-red instruct her to pump and wear supportive nursing bra.

o 2nd: slightly firm non-tender

o 3rd: firm ad some tenderness

94
Q

How much calories should she increase by while pregnant and then if nursing?

A

o During pregnancy: 300 additional cal/day

o Nursing: an additional 200 cal per day (for a total of 500 additional cal/day)

95
Q

If a woman is not breast feeding, what are some nursing interventions?

A

o Instruct them to wear a well-fitted bra that is supportive.

o If she becomes engorged, wrap ice packs in a towel and place on breasts 20 min on and

20 min off  standing order for Tylenol. Tell her this is 24-48 hours and it will get

better.

o Do not express any milk this will continue milk production.

o Cut back 300 cal/day

96
Q

What is involution of the uterus?

A

Healing of the uterus back to the original size, shape and position, also the place where the placenta detached heals as well.

97
Q

Fundus positioning:

A

o Starts in the midline immediately after birth between the symphysis pubis and the umbilicus.  point A

o 6-12 hours after birth the fundus rises to point B, due to the blood/clots that remain in the uterus.

o After this it starts to descend 1 cm every 24 hours until day 10 when it should be back down to the normal position (9)

o **Fundus should be rock hard, not boggy!

98
Q

If fundus is displaced to the right it could indicate what?

A

Bladder is full, displacing the fundus.

99
Q

When assessing the uterus, what are things the nurse must do?

A

Have mom empty her bladder, lower the head of the bed, locate fundus and determine the tone (firm/boggy), measure the distance between the fundus and the umbilicus, and determine position (should be midline).

100
Q

What is the protocol for a boggy uterus?

A

o Risk for hemorrhage.

o Massage uterus (deep), if uterus does not respond, start IV oxytocin, and notify physician or midwife. If she has a full bladder, have her void!

101
Q

What is Puerperal diuresis and when does it start?

A

o Urinating extra fluid that has accumulated for pregnancy. This usually starts by hour 12.

o On this, even though we learned to always assess, the right answer for our patient was to tell her that the sweating is normal

102
Q

What are some complications of puerperal diuresis?

A

Bladder distention and bladder infections (cystitis)

103
Q

What are some nursing interventions aimed to reduce complications of the bladder?

A

Assess voiding amounts during first 24 hours, frequency/urgency/burning, assist woman to bathroom encouraging her to void within 6 hours of birth or if she begins experiencing s/s of bladder distention. Instruct woman to increase fluid intake and Kegel exercises.

104
Q

When assessing the bowel/GI tract postpartum, what should the nurse look for?

A

o Constipation/flatulence (normal should return 1-2 weeks), hemorrhoids (sitz baths), appetite, wt loss.

o Encourage ambulation, and stool softeners, have them lay left lateral side. NO HEAT with epidural!

105
Q

Lochia

A

vaginal discharge after birth

106
Q

What are the color changes with lochia?

A

o Bright red at birth

o Rubra – dark red (first 3 days)

o Serosa – pink (4-10 days)

o Alba – creamy white or light yellowish

o Clear

o Should never go back to a before color! Instruct them to call if this happens hemorrhage.

107
Q

Assess the episiotomy for REEDA which stands for what? What else is assessed?

A

o Redness, edema, ecchymosis, discharge, approximation of edges.

o Assess for discomfort (1-10), provide comfort measures: ice 20/20, witch hazel, donut pad, sitz bath, Tylenol 3, hydrocodone.

o Use infection prevention protocols!

108
Q

What is Homan’s sign used for?

A

DVT caused by hormone drop

109
Q

When does the postpartum blues occur and when do these usually resolve?

A

Occur in the first few days after delivery, and usually resolve without intervention in 10-14 days.

110
Q

Explain the psychological adaptation phases: (2)

A

Taking-in: 1-2 days after delivery. Sorting reality from fantasy in birth experience. Tends to be passive, focused more on her own needs. (IE calling friends after delivery and describing what happened and how their labor went.)

o Taking-hold: 2-3 days after delivery. Ready to resume control over life and care of baby and herself.

111
Q

What are the phases of bonding and attachment? (3)

A

o Acquaintance phase (fingertip exploration, En face position, listening to sounds of infant)

o Phase of mutual regulation (adjustment between needs of mother and needs of infant)

o Reciprocity (mutually gratifying interaction among mother, infant and father.)

112
Q

VS should all be WNL after delivery! What would we think if the mom had tachycardia and a low BP after delivery?

A

o Internal bleeding

o Side note: They can also have pregnancy induced HTN after birth, this needs to be reported.

113
Q

What is the average blood loss in the vaginal and c-section procedures?

A

o Vaginal: 400-500 cc

o C-section: up to 1000 cc

114
Q

Cardiac output ________in the first few hours postpartum and then returns to normal in

_____hrs after delivery.

A

increases, 48 hours

115
Q

A Hemoglobin less than ___ is considered anemia in the postpartum woman.

A

less than 1o-11

116
Q

What is postpartum chill what can we do for it?

A

Immediately after delivery they feel cold/shaky due to vascular instability, this is normal, give them a warm blanket this helps to calm them down.

117
Q

What can the WBC count be after delivery? When should this return to normal?

A

Up to 20,000 is WNL. Will return to normal limits within 7 days

118
Q

What is considered a normal temperature after delivery and why?

A

Up to 100.4 degrees F. This is normal because she is dehydrated.  GIVE FLUIDS for her to drink.

119
Q

What immunizations should mom have pre-birth?

A

o Rubella can cause fetal blindness

 If they are not, post-discharge they get MMR shot. If they get the shot they have

o Rh immunization

 Iso-imunization can occur with an Rh+ fetus and an Rh- mom, meaning mom will

 Have to have Rogam shot within 72 hours post birth in order to not be iso-

o Tdap

o Influenza  ask about egg allergy, they can still have it but we need to watch for AEs to sign a consent that they won’t get pregnant within first month. make antibodies to attack future babies RBC’s (not that baby but future). immunized.

120
Q

What is the newborn caloric/fluid needs per day?

A

o Caloric intake: 120 cal/kg/day

o Fluid: 160 ml/kg/day

121
Q

How much weight should a formula fed baby gain compared to breastfed babies?

A

o Formula fed baby: 1 oz/day for first 6 months

o Breastfed baby: 0.5 oz/day for first 6 months

122
Q

What is the difference between colostrum, transitional milk and mature milk?

A

o Colostrum is present at 1st pp week, it is thick and yellow and increases in volume in parous women.

o Transitional milk: present 7-10 days pp, not as yellow in color

o Mature milk: present after first 2 weeks pp, whiter and thinner than transitional milk

123
Q

How do you store breastmilk?

A

o Clean container with a label containing name, date and time

o Placed in refrigerator within 30 min of expressing

o Can be stored in fridge for 48 hours

o Can be stored in freezer for 3-4 months

o Can be stored in deep freezer for 6 months

124
Q

A baby girl weighs 3,000gms. She is being fed a 20cal/oz formula. In order to meet her caloric requirement of 120kcal/kg/day, how many oz of formula would you instruct her parents to feed her q 4 hours?

A

o 3000gms 3 kg

o 120 * 3kg = 360kcal/day

o 360 / 6 feedings = 60

o 60 / 20 = 3 oz/feeding!

125
Q

How long can contractions last without being worrisome to medical staff?

A

A contraction causes hypoxia in the fetus. A contraction of 60 seconds is still okay and the fetus should have enough reserve to get through the contraction, but anything much longer is worrisome.

126
Q

What is variability of the FHR?

A

A fluctuation in the FHR of 2 cycles per minute or more, and is irregular in amplitude and frequency.

127
Q

What are the types of variability, and which is normal?

A

o Absent: amplitude undetectable (very bad)

o Minimal: amplitude detectable but less than 5 bpm

o Moderate: (normal) amplitude 6-25 bpm looks like blades of grass!

o Marked: amplitude greater than 25 bpm (worrisome)

128
Q

What is acceleration and deceleration of the FHR?

A

Accelerations: Transient increases in the FHR normally caused by fetal movement. At 15 bpm for at least 15 seconds. They usually accompany uterine contractions.

Decelerations: periodic decreases in FHR from normal baseline, categorized as early, late and variable.

129
Q

What is an early deceleration?

A

Occurs when fetal head is being compressed and cerebral blood flow is decreased leading to vagal stimulation and reduces HR. The fetal HR will decelerate at the same time and recover at the same time as mom’s contractions.

130
Q

What is late deceleration?

A

This is caused by decreased blood flow and oxygen transfer to the fetus during contraction. The fetal HR will decelerate mid-way through mom’s contraction.

131
Q

What is variable deceleration?

A

This occurs if the umbilical cord becomes compressed, reducing blood flow between the placenta and the fetus.

132
Q

Fetal monitoring basics

A

When looking at the graph paper, each little box is 10 seconds, and each dark line reports 1 min.

The top is always fetal HR, the bottom is always contractions.

133
Q

Category 1 FHR tracings

A

(normal) normal fetal acid-base status and the tracings may follow a routine manner with no action required. These are the normal characteristics:

 Baseline FHR between 110-160

 Moderate FHR variability

 No late, or variable decelerations

 Present, absent or early decelerations

 Present, or absent accelerations (if fetus is awake)

134
Q

Category 2 FHR tracings

A

(intermediate) not predictive of abnormal fetal acid-base status. Can’t be classified as I or III so they are intermediate. Continued surveillance:

 Bradycardia not accompanied by absent variability.

 Tachycardia

 Minimal variability (etc)

135
Q

category 3 FHR tracings

A

(abnormal) abnormal fetal acid-base status and require prompt evaluation.

Abnormal FHR must be resolved!

 Recurrent late decelrations

 Recurrent variable decelerations

 Bradycardia

 Sinusoidal pattern (just know this is related to abnormal oxygenation of fetus)

136
Q

What are the ways we can help an abnormal FHR?

A

o Lateral maternal repositioning

o Oxygen at 10 L/min via non-rebreather facemask

o IV 500 mL fluid bolus of LR (tx of maternal hypotension)

o Decrease/discontinue oxytocic agent

o Vaginal exam to rule out prolapsed cord

o Notify charge nurse/ physician.

OB (2 decks)

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