Exam 2 Flashcards by Tori Harwood

Recommended weight gain for a singleton

Underweight: 28-40
Normal: 25-35
Overweight: 15-25
Obese: 11-20

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Emotional impact of a singleton

Accepting pregnancy: ambivalence and mood swings and normal
Preparing for birth and mother role
Establishing attachment to fetus

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Prenatal chromosomal abnormality tests

XX female
XY male 
Normal largo type: 46 chromosomes
Extra or missing chromosomes can occur
Advanced maternal age increases risk of abnormalities

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Psychological effects of high risk pregnancy

Disruption of family roles
Financial strain
Frustration with activity restriction

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Thromboembolic disorders

DVT
Other risk factors of DVT: 
    Advanced maternal age
    Multigravida
    Use of OCPs before 
    Smoking
    Employment with prolonged standing 
S and S:
    Unilateral leg pain
    Swelling and tenderness 
Decrease risk:
    Use SCDs or compressive stockings
    Leg and ankle exercises
    Avoid positioning with sharply flexed knees
    Hydration

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Signs and symptoms of pulmonary embolism

Sob
Tachypnea
Tachycardia

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Gestational HTN

Onset after 20 weeks

No proteinuria

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Preeclampsia

High bp which causes damage to another organ system (usually kidneys)

Causes decreased placental perfusion

Increased risk later in life for cv disease and kidney disease

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Scotoma and HTN

Visual disturbances and HTN in pregnancy

Major red flag

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Eclampsia

Onset of seizures or coma

During seizure: place woman on side if possible
Time the seizure
After: first priority is abc, then fetal assessment

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Magnesium sulfate

Drug of choice to prevent seizure activity
Therapeutic serum level: 4-7 mEq/L
Calcium Gluconate is antidote
Signs of toxicity:
Respiratory depression (rr less than 12)
Slurred speech
Oliguria

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Diabetes and pregnancy

Insulin resistance occurs during 2nd and 3rd trimesters to meet nutritional demands of fetus

If body is unable to produce enough insulin to counteract: gestational diabetes mellitus can occur

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Diabetes screening
Risk factors
Infant

Screening: 24-28 weeks 
    Fasting glucose should be under 95 
Risk factors 
    Previous macrosomic infant 
    Multifetal pregnancy 
    Ethnicity 
Can cause macrosomia in the infant
Mom should be periodically screened for type 2 DM after pregnancy

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Pregnant women with preexisting diabetes

Poor glycemic control before and during early pregnancy can cause congenital anomalies

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Hemorrhagic disorders of pregnancy

Vaginal bleeding is a warning sign that should be further evaluated
Especially if in first trimester

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Placenta previa

Bright red bleeding with no pain
Placenta implanted in lower uterine segment, partially over cervical os

Vaginal exams are contraindicated

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Placental abruption warning signs

Abdominal pain

Dark red bleeding

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Hyperemesis gravidum

Excessive vomiting and loss of 5% of prepregnancy weight

Intractable nausea and vomiting during first trimester
Causes disturbance in nutrition and fluid and electrolyte balance

Meds for nausea
Monitor
Encourage intake of small portions
Monitor urine for ketones

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False vs true labor

True: regular contractions, get closer and stronger over time, don’t change with position or walking

False: irregular contractions, may stop with walking or position change, cervix not effaced or dilated

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Signs preceding true labor

Bloody show
Surge of energy
Lightening
Passing of mucus plug

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Contractions
Purpose
Relaxation phase
Palpation

Purpose
First stage: cervical dilation and
effacement
Second: birth
Third: expulsion of placenta, minimize bleeding

Relaxation phase: important bc contractions can affect fetal oxygenation
Duration longer than 90 sec or interval more frequent than 60 sec can cause fetal compromise

Mom’s BP: will increase at peak of contraction
Mom’s CO: increase during labor

Palpation: evaluate intensity of contractions by pressing fingertips into fundus

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First stage

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Encourage slow and easy breathing
Assess amniotic fluid: should be pale, straw color with small white particles
Kneeling, sitting, or walking will stimulate fetal descent

Second stage

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Set up birthing table and radiant warmer close to delivery
Partners should still be present and active
Squatting position will increase pelvic outlet if needed

Third stage

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Lengthening of cord is a sign of placental separation

Nonpharmacologic measures for pain management

Counter pressure against sacrum for back pain Baby probably in occipital posterior Endorphin levels will be higher in a spontaneous natural childbirth

Pharmacologic pain management

Opioids: Can decrease RR and BP Cross the placenta and can affect fetus Assess maternal VS and fetal HR before admin Epidural: Assess for urinary retention and hypotension post procedure

Fetal monitoring

Leopold maneuvers | Determine fetal position and best placement of FHR

Cervical exam

Dilation/effacement/station Station is location in relation to ischial spine 2/50/-2 example Cervix 2cm dilated Cervix 50% effaced Presenting part 2cm above ischial spine

Stage one phases

Latent: 0-3 cm, 6-8 hours Contraction 5-30 min apart, 30-45 sec long Active: 4-7 cm, 3-6 hours Contractions 3-5 min apart, 40-70 sec long Transition: 8-10 cm, 20-40 min Contractions 2-3 min apart, 45-90 sec long

Position of baby

Determined by body part that will lead through birth canal Presenting part: O, S, M, Sc Maternal pelvis: R or L A, P, or T

Abbreviations for fetus position

First letter: R or L Second: presenting part (O, S, M, Sc) Third: maternal pelvis (A, P, T)

CV changes and assessment

Bp increase Supine hypotension Decreased CO when holding breath - leads to decreased bp Wbcs increase Assess bp in between contractions Encourage side lying Encourage open glottis pushing Assess fetal response

Respiratory changes and assessment

RR increases Tingling and numbness in fingers Encourage relaxing and breathing techniques

Renal changes and assessment

Spontaneous voiding may be difficult and/or may occur during contractions Palpate above symphysis to detect full bladder Encourage voiding every 2 hrs Use nitro one to determine urine/amniotic fluid Catheterize if needed

MS changes and assessment

Diaphoresis and fatigue Encourage rest between contractions Positioning and comfort measures

Neuro changes and assessment

Endorphins are relaxed - analgesic effect Ischemia of perineal tissues Behavior changes during labor phases Provide support and encouragement Provide safety

GI changes and assessment

Decreased GI motility - nausea and vomiting Mouth breathing - dry lips and mouth Intake per orders Assess dehydration

Passageway

Birth canal Bony pelvis Soft tissues

Physical exam during first stage of labor

General systems VS Leopold maneuvers Assessment of FHR and pattern

Operculum

Mucus plug | Blood tinged mucoid vaginal discharge indicates passing during first stage

Inadequate weight gain in pregnancy | Excessive weight gain

Less than 2 lbs per month | Over 6 lbs per month

Pattern of weight gain

First trimester 1-5 lbs | Second and third 1-1.5 lbs per week

Nutrition in pregnancy

8-10 glasses of water per day Folic acid intake 0.4 mg in fortified foods Singleton needs around 300 calories more per day

Pica

Eating non foods or non nutritive foods Usually due to low iron - iron deficient anemia

Nitrazine test

Vaginal secretions have ph of 4.5-5.5 | Amniotic fluid has ph of 7-7.5 and turns swab blue

Newborn of a diabetic mother has risk of

``` Hypoglycemia Hyperbilirubinemia RDS Hypocalcemia Congenital abnormalities ```

Gestational diabetes and delivery

Need for c section is more likely

Posterior position of child leads to what?

Back pain/back labor

Severe back pain - nurse expects baby to be in what position

LOP

Doing Leopolds maneuvers. Baby in LOP position, what do you put the Doppler for FHR monitoring?

LLQ

What is first intervention by nurse after the mom suspects her water breaks?

Check fetal heart rate

What is the characteristics of the powers of the first stage of labor?

Controlled by involuntary nervous system Responsible for cervical dilation and effacement Responsive to nursing interventions

Most common and potentially harmful maternal complication of epidural is what?

Hypotension

Exam 2 Flashcards

(53 cards)