FINAL EXAM Flashcards
anticipatory signs of labor
Lightening: ability to breathe easier
loss of mucous plug
ROM
Nesting: burst of energy
effacement: thinning of cervix
dilation: opening of cervix
abor Contractions Have the Following Characteristics:
They are regular
They follow a predictable pattern (such as every eight minutes)
They become progressively closer
They last progressively longer
They become progressively stronger
Each contraction is felt first in the lower back and then radiates around to the front or vice versa
A change in activity or body position will not slow down or stop contractions
Your mucus plug may appear
Membranes might rupture
Your health care provider will notice cervical changes, such as effacement (thinning) or dilation
Powers
Purpose: Dilate the cervix + aid in the expulsion of the fetus.
Contractions originate in the fundus and radiate out
Measured by: Frequency: how often are they occurring from start of 1 contraction to the start of the next.
Duration: how long 1 contraction lasts - from start to end of 1
Intensity:
Mild - fundus is able to be pushed feels like the noseo
Moderate: chin
Strong: can’t push in like forehead
Can measure by
IUPC
Mild = <40mmhg
Mod = 40-70mmhg
Strong = >70mmhg
Passageway
Route the fetus must travel
- maternal pelvis
- cervix
Types of Pelvis
Gynecoid: true female - 50% , round, shallow, open
Android: male resemblance, more heart shape - c/s
Anthropoid: narrow + deep
Platypelloid: flat, least common, wide, shallow - egg/oval
Passageway
Route the fetus must travel
- maternal pelvis
- cervix; needs to be ripe –> BISHOP SCORE
- effacement
- dilation
Types of Pelvis
Gynecoid: true female - 50% , round, shallow, open
Android: male resemblance, more heart shape - c/s
Anthropoid: narrow + deep - could do vaginal but it could be a long labor
Platypelloid: flat, least common, wide, shallow - egg/oval c/s
Cardinal Movement of Fetus
- engagement with cervix, flexion, descent
- further descent, internal rotation
- complete rotation, extension
- complete the extension
- restitution - external rotation
- delivery of anterior shoulder
- delivery of posterior shoulder
Passanger
Fetal Attitude: general flexion
Mentum: face presentation, loosely flexed legs. back arched - 13.5cm
Brow: brown at the cervix, sitting like a genie
Sinciput: head is up and not flexed on the chest 10 cm
Vertex/Occiput: fully flexed head to chest, legs flexed up; optimal position - 95% - 9.5cm
Fetal Lie: how the fetus is positioned in the womb
longitudinal: fetus spine running the same direction parallel as mother’s spine; can also be breech
transverse: positioned horizontally - CANNOT HAVE VAGINAL BIRTH
oblique: the head is against the mother’s hip, above the birth canal no parts are against the cervix
Fetal Presentation: the fetus body part that is closest to the cervix; which is presenting first
Frank: buttocks first, legs up
Full: buttocks first but less flexed
Footling: feet first and not flexed
Occiput: head first
Positon
Fetal Position: how the fetus is positioned in the womb and what part of the baby emerges first
1st letter: which way is facing
L: left
R: right
2nd Letter: what part of the body is presenting
O: occiput
S: sacrum
T: transverse
3rd: direction the fetus is facing in relation to mother
A: anterior: facing forward
P: posterior: facing backward
LOA – left, occiput, anterior = fetus is head first, angled to the left of mom’s pelvis and facing mom’s anterior
LOP: sunny side up; back pain –> counter pressure
LOT:occiput isn’t anterior or posterior
Station: relation of the presenting part in relation to the maternal pelvis
0 = engaged at the ishial spines
-5 = higher on the ishial spines
+5 = lower towards cervix
Leopold Maneuvers
To feel the fetal presentation and maneuvers
1. feels the top of the fundus
2. side of the uterus
3. suprapublic
4. only if in cephalic presentation feel for fetal attitude and extension
True Labor
contractions: strong, regular, long and close together, more intense with walking
felt in the lower back and doesn’t stop with comfort measures PAIN RADIATES
Cervix: changes - softening, effacement, dilution
Fetus: presenting parts engage the cervix, easier to breathe (lightening)
show is present
False Labor
Contractions: irregular, stops while walking or comfort measures, felt in the back or above umbilicus; only in groin + lower abdomen
Cervix: may be soft but no significant changes, no bloody show, posterior position - posterior position
Fetus: not engaging cervix
Fetal Heart Tones
Early Dec
VEAL CHOP
Variable Decelerations –> Cord Compression
Early Decelerations –> head Compressio
Accelerations –> ok
Late Decelerations –> placental insufficiency
Accelerations: want to see 2 accelerations >15 bpm for 15s
Early decels: pressure on skull; nothing can be done
Late: hypoxia, need to promote perfusion to fetus. STOP OXY and change position
Variable: change position, fetal or Trendelenburg to relieve pressure.; STIOP INFUSION, O2, amniofusion
Maternal Assessment Before birth
Materal hx: allergies, medications, hx of preg, maternal testing (blood type, Rh, hct/hg, GBS, Hepatitis B, nonstress)
Vital signs
uterine activity
Bladder I&O
Membrane status –> nitrazine (pH strip), amnisure, fern test
Response to labor
discomfort
cultural needs
Fetal Assessment before birth
Fetal presentation and station
HR
Internal: on scalp of baby
External: on top of fundus + on the baby’s spine on the outside
Looking for baseline FHR, variability, accelerations, decelerations
gestational growth + age
Fetal Heart Rate
Goal is to interpret + assess fetal oxygenation
Auscultation use of fetoscope + doppler, internal, external monitoring
Baseline: 110 - 160
Tachy
Mild: 161-180
Severe: >180
Causes: infection, increase metab, hyperthyroid, dehydration, anxiety, stress, fetal hypoxia, corchioamniotesis
Brady
Mild: 100 - 109
Moderate: 70-99
Severe <70
Cause: increase vagal tone, beta blockers, supine hypo, cardiac defects, cord prolapse, CHP
Variability = status of CNS
normal –> 6-25 bpm
Decrease = decrease CNS, alcohol, heroin, hypoxia; if sustained then fetus may need to be immediately delivered
Psyche
The way a woman handles the labor process
influenced by:
Parity
age
culture
coping mechanisms
emotional factors
length + intensity of labor
maternal + fetal position
Pain caused by dilation, pressure on cervix + tissue anorexia
THE SIX CARE PRACTICES THAT SUPPORT NORMAL BIRTH
- labor begins on it’s own
- freedom of movement
- continuous labor support
- minimize intervention
- spontaneous pushing in non supine positions
- no separation of mother and baby
Categories of FHT
Category I: normal; no intervention
2: indeterminate; requires eval + continued monitoring
3: predictive of abnormal fetus acid base, requires prompt eval and interventions
Methods of pain management
Non pharm: moving freely, position change, support system, massage, heat, water immersion, relaxation, aromatherapy, acupuncture, counter pressure, walking, sensory - aroma therapy, breathing, cognitive: hypnosis
Pharm:
Analgeis: partial + full relief from pain: opiates, morphine, stadol, nubain
Anesthesia: loss of sensation
Epidural: blocking neurotransmission —> give bolus for hyptoT
Nitrous oxide
Spinal block
Administration:
Systemic: IV, IM +inhalation; opiates can slow progression + affect fetus
Regional: epidural, spinal - risk of spinal headache, combo
Local block: pupendal + para cervical nerve block
First Stage
True labor contractions –> full dilation of cervix
- Early/Latent Phase: 0-3 cm; irregular contractions 20-40s, 10-30 min apart
woman is excited!
Actions: review plan, reinforce breathing techniques, lab tests per orders - Active: 4-7 cm; intense contractions, every 2-5 min, 45-60 s each, discomfort increases
Actions: monitor FHR, assess pain/admin analgesia, oral fluids - Transition: 8-10cm; shortest but most intense, 1-2 min 60-90 s N/V, diaphoresis
Actions: assess FHR + contractiosn Q15 min, assist with toileting, comfort + support
Second Stage
complete cervical dilation –> birth
INTENSE CONTRACTIONS Q2 min 60-90 s
URGE TO BEAR DOWN (ferguson’s reflex); don’t push until completely effaced and dilated
Actions: instruct when to bear down, monitor FHR Q5-15 / after each contraction, comfort
Third Stage
Birth –> placenta
Uterus contracts until placenta is out ~ 30 mins
You’ll know it’s coming when the uterus gets smaller and there’s a gush of blood.
Actions: assess vitals q15, utertonics as prescribed
Fourth Stage
postpartum –> 4hrs
Chills, pain fatigue,
newborn skin - skin
ASSESS FOR HEMORRHAGE
Preterm Labor
regular contractions occuring between 20-37wks with
- progressive cervical changes
- effacement >80%
- dilation > 1cm
Factors:
Infection + inflammation
decidual hemorrhage
excessive uterine stretch (multiple + polyhydraminos)
maternal or fetal stress
Greatest contributor of infant mortality <32wks
Risks:
Demographic risk: AA highest. Alaskan 11.6%, Hispanic 9.6%
Medical risk in current/ predating preg
environmental/behavioral/ psychosocial
biochemical marker –> fetal fibronectin fFn = protein that acts like a glue attaching sac to the uterine lining.
presence of fFn 24-34 indicated increased risk of preterm labor
absence is a reliable predictor of preg continuing for 2wks
Wouldn’t test if >3cm dilated
there’s vaginal bleeding
ROM
had sex or a vaginal exam 24hrs
gestational age <22wks or >35wks
suspected abruption and previa
Shortened cervix >3cm / 30 mm before 34 wks are less likely to have preterm birth than those who are <3cm
WARNING SIGNS
uterine cramping
backache
pressure on pelvis/ change in vaginal discharge
Abdominal cramping diarrhea
contraction Q10m in 1hr
general sense there is something wrong
change in fetal movement
Management
Assess for infection
restricting activity
hydration
tocolysis - Stop contractions via med
promote lung maturity - corticosteroids
Prevention; progesterone in singleton not multiples
Fetal Reserves
When O2 decreses blood flow is deferred to vital organs.
if placental reserves are depleted fetus may not be able to adapt or tolerate decreased O2 during contraction
Phases of contraction
- increment = begining
- Acme = peak
- decrement = decrease; relaxation
the resting tone is critical to return O2 to baby after contraction - <20 mmHg
Freq: how often
Duration: how long
Initiation of Labor
Must include 1+ regular phasic uterne contraction that increase in freq + intensity + progressive effacement + dilaion.
Factors:
uterine stretching – release of prostaglandins
Oxytocin release - increase contractility
decrease progesterone - inhibits contraction
increase prostaglandin
Cortoisol release inhibit prog and increase prost
placental aging
Tocolytic Therapy
Process of admin of a drug for purpose of inhibiting uterine contractions. Main goal is to stop labor long enough to get steroids to mature lungs
Contradictions:
Severe HT or preeclampsia
fetal compromise
fetal death
anomaly incompatible with life
lungs are mature
Types:
Beta-adrenergic agonist
Mg Sulfate
Ca Channel Blockers –> Nifedipine/Procardia
Prostaglandin inhibitors
Terbutaline
Beta-adrenergic Agonist
Promotion of smooth muscle relaxation
IV or SubQ -> RAPID ONSET
Side Effects:
Maternal + fetal tachy
PE
Hyperglycemia + hypokalemia
hypot
Cardiac insufficiency + arrhythmias
myocardial ischemia
maternal death
Mg Sulfate
Prevents Ca into the myometrial cells –> uterine relax + CNS depressant
USED FOR FETAL NEUROPROTECTION NOT TOCOLYSIS
SE: maternal flushing, headache, nausea, blurred vision
Toxicity
Loss of deep tendon reflexes
loss of consciousness
Respir <7
PE
Hypot
Cardiac arrhythmias
CALCIUM GLUCONATE 1g IV over 3 min
Indomethacin
ANTIINFLAM -> powerful prostaglandin synthesis and readily crosses placenta
adjunt therapy with other tocolytic therapy – Mg - oral or rectal
Prolongs preg for 48-72hrs
could close ductus arterious if admin >32wk, Nectrotizing enterocolitis, hemorrhage + renal failure
Ca Channel Blockers
Nifedipine - smooth muscle relaxer + potent vasodilator
SE: hypot, flushing, headache, tachy, nausea, dizziness, palpitation
Bethamethasone + Dexamethasone
Corticosteroids –> stimulate lung maturity
Only evidenced based rational for tocolysis
Can last 1wk and can be repeated
Nursing Care for Preterm Labor
Stopping contractions
Activity restriction + bed rest —> be aware of DVT and PE
Left side to promote perfusion to uterus
avoid sex
hydration –> dehydration stims pituitary to secrete ADH and Oxytocn
treat infection + have patient report abnormal findings
vitals
monitor FHR and contraction pattern – if tachy for a prolong period could be infection
Risk of PTL
Infections of the urinary tract, vagina, or chorioamnionitis (infection of the amniotic sac)
* Previous preterm birth
* Multifetal pregnancy
* Hydramnios (excessive amniotic fluid)
* Age below 17 or above 35
* Low socioeconomic status
* Smoking
* Substance use
* Domestic violence
* History of multiple miscarriages or abortions
* Diabetes mellitus or hypertension
* Lack of prenatal care
* Recurrent premature dilation of the cervix
* Placenta previa or abruptio placentae
* Preterm premature rupture of membranes
* Short interval between pregnancies
* Uterine abnormalities
Dystocia
Abnromal, long and/or difficult labor as related to the passenger, power, passageway or psyche
Dystocia related to powers
contractions don’t produce progressive dilation, effacement and descent of the presenting part; quantified as the # of contractions in a 10 min window avg over 30 mins
Hypotonic: Arrest of descent/dilation
need to amniotomy –> AROM
Oxytocin augmentation
overdistention – hydaminos + multiparty; must deliver at risk for cord prolapse and infection
Tachysystole: ineffective / erratic contraction pattern
>5 contractions in 10 min time/ 30 mins with less than 60 s of relaxation
–> related to stress + anxiety
Ineffective dilation or pushing
fetal deoxygentation
uterine rupture
Precipitous Labor
rapid labor, is defined as giving birth after less than three hours of regular contractions
Dystocia related to the passenger
abnormal presentation
Malposition: - posterior
Malpresenation:
brow
face
breech
transverse
Dystocia related to the passageway
Cephalopelvic disproportion: fetal head is larger than the maternal pelvic diameter
- lack of descent w. strong contractions
- prolonged labor
Shoulder dystocia –> EMERGENCY!
assistance: use forcepts or vacuum (unless <34wks)
Dystocia Assitance
Forceps
Vacuum
risk: succedaneum, hematoma, intracranial hemorrhage
Labor Enhancers
Pitocin - stimulates contractions
–> drug med error = injury ; lack of timely recognition
Must be medically necessary; preeclampsia, postterm hemorrhage, prom,
Contra: transverse lie, scarring, cephalopelvic, previa, herpes, cord prolapse
Caution: fetal distress, premature, overdistention
want to make sure that cervix is ripe >8 Bishop score
SE: increase contraction, resting tone, HR, decrease BP, water intoxication ICP increase, fetal tachy
Risk: ftal hypoxia, uterine rupture, abruption, hemorrhage, fetal hyptot
C/S
32% and increasing; performed because of factors related to
mother: diabetes, CD, preeclampsia, infection, dystocia, herpes
fetus: distress, malpresentation, position, anomalies
+ other
Classic: vertical: increased risk of uterine rupture in subsequent pregnancies and labor
Transverse: Pfannenstiel’s most common
Risk: infection, hemorrhage, thrombophlebitis, atelectasis
Post Op care:
pain
respir f(x)
I&O
Incision
bowel f(x)
circulation
psychological response
Shoulder Dystocia
Anterior fetal shoulder is behind the pubic bone of the mother
Risks: Fetal macrosomia >4000
diabetes
obesity
previous shoulder dystocia
McRoberts Postion: pelvis tilt orienting symphaysis more horizontally to facilitate should delivery
Cord Prolapse
umbilical cord drops down alongside or infornt of the presenting part.
This can reduce the circulation to the fetus –> vasoconstriction and resultant fetal hypoxia, which can lead to fetal death or disability if not rapidly diagnosed and managed
Care: Trendelenburg or knee-chest. to relieve pressure, elevate part with STERILE gloved hand.
IF CORD IS VISIBLE DO NOT TOUCH, cover with warm, sterile, saline soacked gauze and continuously assess FHR
Amniotic Fluid Embolism
Amniotic fluid escapes into the maternal circulation –> open sinus of the placental site
Can be fatal to the mother; amniotic fluid has debris, lanugo, vernix, meconium
Signs: dyspnea, chest pain, cyanosis, shock
Interventions: delivery, CV and Respir support
Post partum complications
- Postpartum Hemorrhage
- Complications of breast feeding
- Postpartum Infections
- Endometritis
- UTI
- Mastisis
- Wound Infection
- Thrombophlebitis
- Pulmonary Embolism
- Postpartum Psychiatric disorders
Postpartum hemorrhage
most common - 2.9% ~ 183% increase - 125,000 affected ONE OF THE ONLY COUNTRIES WHERE MATERNAL DEATH + INJURIES ARE INCREASING
* Blood loss >500mL after vag * >1000mL after C/S Early Hemorrhage: first 24hrs after delivery; atony Late: 24hrs - 6wks after; retaining of placental tissue
Causes:
1. Tone: uterine atony; overdistention, infarction, rapid labor, placental abnormality, polyhydraminos, fatigue, Pitocin, NSAIDs, anesthetics, Mg Sulfate + placenta at the lower segment of the uterus (doesn’t contract as well)
2. Tissue: retained placenta; commonly with accreta + previa
3. Trauma: damage to the genital tract spontaneously or manipulation/ cerival laceration - forceps DON’T EVER ATTEMPT WITHOUT THE CERVIX BEING FULLY DILATED
Thrombin/Clotting: clotting abnormalities; hemophilia, Von Willebrand, HELLP, abruption, DIC or sepsis
Hematomas can present as pain or as a change in vital signs disproportionate to the amount of blood loss.
Uterine rupture: most common in women who have significant uterine scarring
Risk factors for PPH
Risk Factors of PPH
* Uterine over-distention - multiple, LGA, polyhydraminos, clots
* Previous PPH
* Anesthesia or MgSO4
* Additional drugs used to make the uterus relax - nifedipine, terbutaline
* Operative birth/ assisstive device - vacuum, forceps
* Trauma
* Grand multiparity
* History of maternal anemia + hemorrhage
* Infection
* Uterine inversion or rupture
* Previa or accreta
* Abnormal labor pattern (hypotonia/hypertonic)
* Retained placenta
* Prolonged labor or fast
* Obesity
* Oxytocin admin during labor
Signs of PPH
Signs of impending Hemorrhage
* Excessive bleeding >2 pads/30-1hr; 1 pad >15mL
* Light headedness, nausea, visual disturbances
* Anxiety, pale/ashen, clammy
* Elevated HR, respir rate and or same/lower BP; you’ll see pulse elevation before BP drop – change in vital signs is a late sign of hemorrhage
=MAP = A MAP of 60 is necessary to perfuse coronary arteries, brain + kidneys; usual = 80-110
* Hematomas - 3-500mL of blood; often feel like they need to have a bowel movement due to the pressure
Interventions + medications for PPH
Interventions
* Risk assessment
* Inspect placenta
* Avoid overmanipulating of uterus - don’t want to tire out
* Active Management: Pitocin @ 3rd stage of labor to promote uterine contraction
* If at risk make sure blood match + have IV access
* Fundal massage if they begin to hemorrhage to firm up the uterus
* Empty bladder to prevent overdistrention
Medications: Oxytocin, Cytotec, Methergine, Hemabate
Oxytocin: Produces uterine contractions, vassopressive + antidiruetic.
SE: water intoxication - ADH like behaviors, NV
Conta: none if for PPH
10-49u/500-1000mL >500mL/hr titrated; 10-20mL IM
WATCH FOR BLEEDING + TONE
Methergine: sustained tetanic uterotonic effect that reduces bleeding and shorten the 3rd stage of labor.
SE: HT, Hypot, NV headache
Contra: HT, cardiac, preeclampsia
.2mg IM up to 5 doses 2-4hrs
CHECK BP Before giving don’t give if >140/90 watch bleeding
Misoprotol/Cytotec: Synthetic prostaglandin analog. Mixed results for uterine atony but used for reducing risk of GI ulcers by NSAIDs
SE: headache, NVD, fever, chills
Contra: allergies to prostaglandins
100 - 200mcg tabs – 600 - 1000mcg rectally or sublingually
Monitor bleeding + tone
Hemabate: prostaglandin similar to F2-alpha but has a longer duration. Produces myometrial contractions
SE: headache, NVD, fever, tachy, HT, fever
Contra: Asthma, HT
.25mg IM or intrauterine
Monitor
Caregivers underestimate blood loss by 50%
Most woman are healthy can tolerate blood loss - since most patients give birth doral recumbent need a lot of blood loss before the effects are felt.
Postpartum infections
Puerperal sepsis: any infections of genital canal within 28 days after abortion or birth
* occurs within 28 days after and 6 wks, on 2 successive days within the first 10 days postpartum not including the first 24hrs
* Commonly in C/S
* Leading cause of maternal morbidity + morality worldwide
Pathogens: normal vaginal, cervical or bowel organisms - GBS or E.Coli
Characterized by
* Temperature >100.4 at least 2/10 days post birth
* >101 within first 24hrs
Common infections:
1. Endometritis
2. Wound infections
3. UTI
4. Mastitis
5. Respir
Prevention:
1. Handwashing
2. Perineal hygiene
3. Antibiotic administration
4. Wound management
5. Breast care
Risk Factors Preconception
* History of previous venous thrombosis, UTI, mastitis, infection
* Diabetes
* Alcoholism
* Drug abuse
* Immunosuppression
* Anemia
* Malnutrition
Risk Factors Intrapartum
* Prolonged labor
* Poor aseptic technique
* Birth trauma
* C/S
* Prolonged ROM
* Chorioamnionitis
* Bladder catheterization
* Internal fetal/uterine pressure monitoring
* Vaginal examinations after ruptured membranes
* Epidural anesthesia
* Retained placental fragments
* PPH
* Episiotomy + lacerations
* Hematomas
Endometris/metris
- most common cause of postpartum infection
- Begins as localized infection but can spread – outside uterine cavity
Higher risk if C/S
- Begins as localized infection but can spread – outside uterine cavity
Symptoms
1. Lower abdominal tenderness + pain
2. >100.4 temp + Chills
3. Foul smelling lochia
4. Tachycardia
5. Subinvolution
Treatment
* Broad spectrum antibiotic - take cultures
* Analgesia
* Emotional support
Incidence: <3% Vag; 10-50% C/S
Interventions:
* Monitor vitals q4h
* Assess for abdominal pain
* Monitor lab values, CBC, blood cultures, sed rate
* Antibiotics
* Increase fluid intake
SEMI FOWLERS + AMBULATION = uterine drainage
Wound Infection
- Most commonly at site of incision
- Episiotomy + laceration infections occur less often; symptoms 24-48 hrs
- Aseptic wound management
- Frequent perineal pad changes
- Good handwashing
Admin antibiotic + analgesics
Complications involving breasts
Engorgement, cracked nipples + blocked ducts are increased risk of mastitis
* A sign of engorgement = poor feeding -> good latching best form of prevention of engorgement
= warmth/ warming pad and ice after breastfeed, breast massage
* Cracked nipples = poor latch, baby should feed on other nipple
=lanolin, hydrogeal disks, education on proper latch
* Plugged ducts = inadequate removal of milk from underwire bra, clothing baby should feed on other side
Mastitis: influenza like symptoms
* It can happen any time, most commonly with lactating
* Happens in the upper outer quadrant, can be both breasts most commonly unilateral
* Caused by S.aureaus, can enter through cracked nipples, engorgement + stasis of milk come before
Treatment: antibiotics, continue to breastfeed, warm compress
UTI
straight cath > indwelling = avoid CAUTI
* Frequent cervical exam in labor
* Anesthesia can cause urinary retention = stasis
* GU injury
* C/S
* Atonic bladder + urethra post delivery
Lower UTI
* Dysuria
* Urgency + Frequency
* Suprapubic pain
* Low grade fever
* Hematuria
* Cloudy + smelly urine
Upper UTI
* Pyelonnephritis
* Develops 3-4 days
* Chills + fever
* Costovertebral angle tenderness
* Nausea + vomiting
Symptoms + Treatment
* Burning + pain urination
* Lower adnominal pain
* Low grade fever
* Flank pain
* Proteinuria, hematuria, bacteriuria nitrates + WBC
Assess vitals Q4H
>fluids + I&O
Antibiotics, antipyretics, antispasmodics, antiemetics
Rest
Thromboembolic Disease
formation of blood clots inside blood vessel
1. Superficial thrombosis: involves the veins of the superficial saphenous system
2. Deep thrombosis: lower extremities
3. PE: complication of DVT
Causes: venostasis + hypercoagulation
Declining due to early ambulation
Risks: >fibrinogen, hx of DVT, increased parity, obesity, >35, immobility, C/S, tissue trauma, blood other than O, dehydration
Thrombophlebitis
Assess for hot, red painful, edematous areas of lower extremities + groin >100 temp
HOMAN CONTRA BECAUSE YOU CAN DISLODGE CLOT
Treatment: analgesics rest + elevation superficial
DVT: heparin + coumadin
PE
SS: dyspnea, sweating, pallor, chest pain, cyanosis, confusion, tachypnea, cough, temp, sense of impending death
Treatment: elevate head of bed, O2 8-10L, clot busters
Psychological Complications
- Have implications for mother, newborn + family, can interfere with the attachment + integration, can threaten the safety/ well being
Postpartum Depression - 10 -20%; first 3 mo - 1 yr- Intense, pervasive sadness
- Labile mood swings
- Intense fear, anger, anxiety
- Unable to care for self or infant
- Irritability –> violent outburst
- Rejection of infant
- Obsessive thoughts
Treatment: Edinburgh Scale, Postpartum depression scale - Depression responds best to a combo psychotherapy, medication, social support
Postpartum Psychosis - rare but immediately needs to be treated, psychiatric emergency - Depression, delusion, bizarre + irrational behavior, thoughts of harming self + infant
- Predictors = hx of bipolar or postpartum psychosis
- Risk of homicide + suicide is high
Antipsychotics + mood stabilizers = lithium
Discuss the use of illegal substances or over the counter medications and how they may affect pregnancy
Alcohol - most common
Abnormalities in brain and neuron development
LBW
Prematurity
Fetal alcohol syndrome
Leading cause of mental retardation
Cocaine
maternal cardiac events
Abruption of Placenta**
Fetal effects = vasocon + neuroexcitation
Opioids
Withdrawal - NAS
*should not immediately give narcan as infant will immediately go into withdrawal
Tobacco
Decreased fertility
Increased risk of miscarriage
Placenta Previa
IUGR
long term cognitive function + risk of brain damage
Describe how diabetes affects the pregnant woman and her fetus; identify nursing interventions
The primary concern for any woman with this disorder is controlling the balance between insulin and blood glucose levels to prevent hyperglycemia or hypoglycemia. Women with gestational diabetes are at an increased risk of complications during pregnancy and delivery.
Gestational: If glucose cant get into the cell
Note signs of hyperglycemia (confusion, increased thirst, frequent urination, changes in visual acuity) or hypoglycemia (dizziness; tremors; lethargy; excessive sweating, pale, cool, moist skin).
Discuss hyperemesis gravidarum including causes, symptoms, treatment, and nursing care
Severe NV that causes dehydration, electrolyte imbalance + acid/base imbalance, starvation ketosis + weight loss.
-hypokalemia + natremia
- decrease urea
Peaks @ 9-20wks
Cause: increase of HCG, prog, + E, h.pylori, ambivalence towards preg.
Findings:
● Vomiting that may be prolonged, frequent, and severe
● Weight loss, acetonuria, and ketosis
● Signs and symptoms of dehydration including:
● Lightheadedness, dizziness, faintness, tachycardia, or inability to keep food/fluids down for more than 12 hours
● Dry mucous membranes
● Poor skin turgor
● Malaise
● Low blood pressure
Management:
IV Hydration
B6 or vitamin B6 plus doxylamine
Laboratory studies to monitor kidney and liver function
Correction of ketosis and vitamin deficiency should be strongly considered. Dextrose and vitamins, especially thiamine, should be included in the therapy when prolonged vomiting is present
Discuss hydatidform mole including risk factors, causes, symptoms, treatment, and nursing care
hydatidiform mole is a benign proliferating growth of the trophoblast in which the chorionic villi develop into edematous, cystic, vascular transparent vesicles that hang in grapelike clusters without a viable fetus.
hydatidiform moles are benign, but they sometimes become cancerous. Having one or more of the following risk factors increases the risk that a hydatidiform mole will become cancer.
Partial: may have some fetal tissue
Complete: no fetal tissue
Risk
<20 yrs >35 yrs
Previous molar preg
Risk for woman
increased risk of choriocarcinoma
Assessment:
bleeding + uterine enlargement (big for gestational age)
Anemia
NV
Ultrasound to diagnose
Treatment:
immediate evacuation with aspiration + suction
Nursing actions
no preg for 1 yr, monitor for malignancy
Discuss hypertension in pregnancy, including risk factors, causes, symptoms, treatment(especially Magnesium sulfate) , and nursing care
Hypertension is identified as systolic pressure 140 mm Hg or greater or diastolic pressure 90 mm Hg or greater. Hypertensive disorders of pregnancy are the most common complication of pregnancy, affecting 10 percent of pregnant women, and are the second leading cause of maternal death and a significant contributor to neonatal morbidity and mortality.
● Preeclampsia is a multisystem hypertensive disease unique to pregnancy, with hypertension accompanied by proteinuria after the 20th week of gestation. Eclampsia is the onset of convulsions or seizures that cannot be attributed to other causes in a woman with preeclampsia.
●Chronic hypertension with superimposed preeclampsia includes the following scenarios:
Women with hypertension only in early gestation who develop proteinuria after 20 weeks of gestation.
Women with hypertension and proteinuria before 20 weeks who develop a sudden exacerbation of hypertension,
● Gestational hypertension: Systolic BP ≥ 140/90 for the first time after 20 weeks, without other signs and systemic finding of preeclampsia
● Chronic hypertension: Hypertension (BP ≥ 140/90) before conception. High blood pressure known to predate conception or detected before 20 weeks of gestation
Treatment:
● Magnesium sulfate, a central nervous system depressant, has been proven to help reduce seizure activity without documentation of long-term adverse effects to the woman and fetus.
● Antihypert
● Assess CNS changes, visual, reflexes
Risks for Woman
● Cerebral edema/hemorrhage/stroke
● Disseminated intravascular coagulation (DIC)
● Pulmonary edema
● Congestive heart failure
● Maternal sequelae resulting from organ damage include renal failure, HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), thrombocytopenia and disseminated intravascular coagulation, pulmonary edema, and eclampsia (seizures), hepatic failure
● Abruptio placenta
● Women with a history of preeclampsia have a 1.5 to 2 times higher risk of developing heart disease later in life
● obesity
● Chronic HT, kidney disease, lupus, diabetes
Fetal Risk:
● Fetal/neonatal morbidity and mortality are consequences of intrauterine growth restriction (IUGR), prematurity, and placental abruption.
● Fetal intolerance to labor because of decrease placental perfusion
● Stillbirth
At Risk: Cardiac Disease
Increases the demand for cardiac output
Demand on the heart increases – 50%
Signs cardiac issues are worsening
Progressive generalized edema
Crackles at bases of lungs
Rapid, weak irregular pulse (100 bpm or higher)
Difficulty catching breath
Cough
Increased fatigue
Care:
EKG + FHR
Anticoag: warfarin + heparin
O2 + Pulse Ox
Pain management
Make sure placenta is properly perfused
AVOID FLUID OVERLOAD
NO METHERGINE
Treatment for Heroin
Methadone: Most common in pregnancy
Buprenorphione: less side effects than methadone
Naltrexone: opioid antagonist
Diabetes
Type1 : body isnt making insulin - body attacks destroys insulin producing cells.
Autoimmunity of beta cells of the pancreas resulting in absolute insulin deficiency and is managed with insulin. About 5%-10% of patients diagnosed with diabetes are type I
Type 2: body is producing enough insulin but not properly produced overweight can’t stop insulin production. fat deposits on cell can’t open. Characterized by insulin resistance and inadequate insulin production. This is the most prevalent form of diabetes and is linked to increased rates of obesity and sedentary lifestyle. It is managed primarily with diet and exercise; the addition of oral antihyperglycemic or insulin may be indicated if hyperglycemia continues.
- glucose can’t get into cells + trys to get rid of extra w. kidney
Challenge to manage because of
HPL
P
HgH
Corticotropin-releasing hormone
Shift energy source from ketone -> free fatty acid
Treatment:
Euglycemic control
minimize complication
prevent prematurity
-> keep the lowest possible glycosylated hemoglobin w/o going into hypoglycemia
Cardinal Signs
Polyuria
Polydipsia
Weight Loss
Polyphagia
Changes of insulin during pregancy
1st Tri: decreases
2nd-3rd: rises
HPL + Somatropin - hormones from the placenta create insulin resistance
Fetal Risk with Diabetes
Macrosomia – BIG baby >5000g
- baby is big but isnt as mature
IUGR
RDS
Preterm Labor
Regular contractions of uterus resulting in changes in the cervix before 37 wks
PTB = 20 -36 wks
Leading cause of neonatal mortality
Spontaneous: unintentional/planned delivery before 37wks –> can be caused from inflam + infection
Medically Indicated: Provider recommends preterm birth – preecalmpsia
Nonmedically indicated: Elective (NOT RECOMMENDED)
Risks:
Multiple gestation
Uterine/cervical abnormalities
Fetal anomalies
Hydramnios + Oligohydraminos
Infection
Premature rupture of membranes
HT, Diabetes, clotting disorders
<17yrs or >35 yrs
Obesity
Smoking + illicit drug use
Contradictions:
Intrauterine fetal demise
Lethal fetal anamoly
nonreassuring fetal status
Severe preeclampsia + eclampsia
Chorioamnionitis
Warning signs:
Water breaks
decrease fetal movement
Increase vaginal discharge
Fever
Preterm Classifications
Late Preterm: Born 34-37wks
Very Preterm: <32wks
Viability: @ 25wks
Perviability: 40% of infant deaths 20-25wks
Cervical insufficiency
describe the inability of the uterine cervix to retain a pregnancy in the absence of the signs and symptoms of clinical contractions, or labor, or both in the second trimester
Preeclampsia
Preeclampsia is a kind of high blood pressure some women get after the 20th week of pregnancy or after giving birth. s high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working normally. Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy.
Imbalance of vasodilator hormones (prostacyclin) and vasoconstrictor hormones (thromboxane)
- Leading cause of maternal death
- 20wks 140/90 @ least 4 hrs apart + proteinuria >300mg or new systemic disease.
“PREECLAMPSIA WITHOUT SEVERE FEATURES” (MILD)
“PREECLAMPSIA WITH SEVERE FEATURES” (SEVERE)
Diagnosis Criteria
>140/>90 mmhg after 20 wks
proteinuria
thrombocytopenia <100,000
renal insufficiency
impaired liver f(x)
PE
Visual symptoms
High Risk:
>35 yr
AA + low socioeconomic
previous preeclampsia with another preg
pregnant w. multiples
have diabetes + HT, kidney disease, AI
obese
GTD
SS
Headache that doesnt go away
Blurred vision
Epigastric pain
trouble breathing
NV
swelling in face + hands
weight gain - 2-5lbs per week
Proteinuria
Thrombocytopenia
Renal insufficiency
Impair live function
Pulmonary edema
Visual symptoms
Risk for fetus
Morbidity
intolerance of labor
still birth
placenta abruption
IUGR
Low birthweight
Treatment
Early detection
Delivery monitor
Hydra Liz one
Mg sulfate
Oral nifedipine
Labetalol
Consequences Maternal
w. eclampsia 20% morality rate – can occure up to 48hrs post
increase risk of
- abruptio placenta
- retinal detachment
- acute renal failure
- cardiac failure
- hemorrhage + stoke
Consequences Fetal
Fetal growth retardation
Hypoxia
Death
Multiple Gestations
+1 fetus - either from the fertilization of one zygote that subsequently divides (MONOZYGOTIC) or fertilization of multiple ova.
● Monozygotic twins are from one zygote that divides in the first week of gestation. They are genetically identical and similar in appearance and always have the same gender.
● Dizygotic twins result from fertilization of two eggs and may be the same or differing genders. If the fetuses are of differing gender, they are dizygotic and therefore dichorionic.
● Either of these processes can be involved in the development of higher order multiples.
In neonatal abstinence syndrome- which of the following potential symptoms are measured by the Finnegan scale?
Temperature
Tone
Tremors
Excoriation
Nasal Stuffiness
https://www.thecalculator.co/health/Finnegan-Score-For-Neonatal-Abstinence-Syndrome-(NAS)-Calculator-1025.html
Whats the rationale for using Eat, Sleep, Console?
- Supports infants and mothers rooming in together during
infant hospitalization - Focuses on non pharmacologic treatments
- Increases breastfeeding rates of opioid exposed newborns (OEN)s
- Decreases pharmacologic treatment and duration of
treatment for OENs - Decreases the average length of stay (LOS) for OENs.
Pre gestational diabetes
Blood glucose is elevated but below clinical threshold
Components:
Central adiposity > 35 in
Dyslipidemia
Hyperglycemia
HT
Maternal Risk:
DKA - 2nd tri
HT
Spontaneous Abortion
Polyhydramnios
Induction of Labor
UTI, Hypergly, Postpartum, post hemorrhage
exacerbation of diabetes symptoms
Fetal Risk:
Congenital defect
Prematurity
Hypogly, cal + mag
asphyxia
respir distress
Still birth
hyperbilirubinemia
polycythemia
● Development of metabolic syndrome, prediabetes, and type II diabetes
● Impaired intellectual and psychomotor development
Gestational Diabetes
hormone made by the placenta prevents the body from using insulin effectively. Glucose builds up in the blood instead of being absorbed by the cells. insulin less effective, a condition referred to as insulin resistance
Two main contributors to insulin resistance are:
● Increased maternal adiposity
● Insulin desensitizing hormones produced by the placenta
risk:
<25 yr
HT, PCOS
Increase in maternal adiposity
insulin desensitizing hormone
Family history/ age/ race/ obesity history of macrosomia
Diagnosis: glucose testing 24-28 wk
Complications:
Macrosomia
Shoulder dystocia
HT + preeclampsia
preterm birth + stillbirth
C-section
Risks for baby
excessive birth weight
preterm
breathing difficulties
hypoglycemia
obesity + type 2 later in life
stillbirth
hyperbilirubinemia
birth trauma
RDS
Prevention:
maintain healthy lifestyle, keep active, don’t gain more weight than recommended
Findings:
Glucose screening 24-28 wks of gestation
Management:
For most women with GDM, the condition is controlled with a well-balanced diet and exercise.
● Up to 40% of women with GDM may need to be managed with insulin.
● Oral hypoglycemic agents may be used, but there is not agreement on their recommended use during pregnancy.
● Cesarean birth is recommended for estimated fetal weight >4,500 g.
● Women with GDM need to be monitored for type 2 diabetes after the birth.
Nursing Actions:
Teach the woman to test glucose four times a day, one fasting and three postprandial checks/day (suggested glucose control is to maintain fasting glucose less than 95 mg/dL before meals, and between 120 to 135 mg/dL after meals)
HELLP Syndrome
HELLP syndrome is a serious pregnancy complication that affects the blood and liver. HELLP stands for these blood and liver problems:
H–Hemolysis. This is the breakdown of red blood cells. Red blood cells carry oxygen from your lungs to the rest of your body.
EL–Elevated liver enzymes. High levels of these chemicals in your blood can be a sign of liver problems.
LP–Low platelet count. Platelets are little pieces of blood cells that help your blood clot. A low platelet count can lead to serious bleeding.
HELLP may develop in women who do not present with the cardinal signs of severe preeclampsia.
Risk for woman:
Abruptio placenta
Renal failure
liver hematoma / rupture
Death
Risk for fetus
Preterm birth
Death
Assessment:
general malaise, nausea, and right upper gastric pain.
unexplained brusing, mucosal bleeding, petechaie
Treatment:
Delivery of fetus + placenta — resolve 48hrs post partum
Eclampsia
occurrence of seizure activity in the presence of preeclampsia
- can be ante, intra + post partum
It can be triggered by cerebral vasospasm, hemorrhage, ischemia, edema
Warning:
persistent headaches
epigastric pain
NV
hyperreflexia w. clonus
restlessness
Treatment
Mg sulfate + hypertensive
Placenta Previa
1/200
The placenta attaches to the lower uterine segment near/over cervix vs. on the body of the fundus
Painless intermittent bleeding
Confirmed by ultrasound
Risk Factors:
scarring
large placenta
infertility, nonwhite, low socio, short interpreg
diabetes, smoking cocaine use
Painless bleeding
Large placenta, Multiple gestation
>35 yrs
Maternal risk:
Hemorrhagic + hypovolemia shock
Blood loos
Fetal Risk:
Disruption of blood flow
Morbidity + morality
Fetal:
Malpresentation
IUGR fetal anemia
Management:
Avoid vaginal exam
Monitor fetal vitals
Check Amniocentesis + BPP - lung maturity
When active bleeding:
* Large bore IV access
* Measure I&O
* Weigh pads — counting or visual estimate is not sufficient (1gm=1ml)
* CBC, coagulation studies, T&X
* Oxygen to keep pulse ox > 95%
* Anticipate possible emergent cesarean birth
Bright red bleeding
Placenta Abruption
Partial complete detachment of placenta
- hematoma forms + destroys the placenta around it
dark red bleeding
The major clinical findings are vaginal bleeding and abdominal pain, often accompanied by hypertonic uterine contractions, uterine tenderness, and a nonreassuring fetal heart rate (FHR) pattern
Grade:
1(mild) least amount of separation
2 (moderate)
3 (Severe) more separation + blood
Risk Factor
decreased placenta perfusion
HT
Seizure
Blunt trauma to the maternal abdomen
history of abruption
smoke/cocaine use
Risk for Fetus:
LBW, asphyxia, still birth
SS
Sudden onset of intense pain
board-like rigidity to the abdomen
uterine irritability
tachystole
vaginal bleeding
port wine stain amniotic fluid
Management
assess fundal height
girth measurement
shock
weigh pads
Restoring blood loss
Anticipation and prepare for emergency delivery.
check for DIC
Partial abruption: concealed bleeding – retroplacental
Partial abruption: marginal bleeding placenta is halfway torn - bleeding is apparent
Complete abruption: bleed could be concealed or apparent
Placenta Accreta
The partial/complete placenta invades and becomes inseparable from the uterine wall.
0 leads to hemorrhage + may need a hysterectomy
- 3000 - 5000 mL blood loss
As many as 90% of patients with placenta accreta require blood transfusion, and 40% require more than 10 units of packed red blood cells
Risk factors
myometrial damage caused by C/S
Advanced maternal age
Multiparity
Risks for woman
Hemorrhagic + hypovolemic shock ~ 25-30% morbidity
Increase risk of infection, thromboembolism, pyelonephritis, pneumoia, ARDS + renal failure
Surgical complications
Risk for Fetus
Preterm ~ normally 34-36wks
Assessment: Ultrasound
Treatment:
Planned c/s + hysterectomy
Actions:
Monitor CBC + clotting
emotional support
Abortion
Spontaneous or elective termination of pregnancy <20wks
Induced: medical/surgical abortion before fetal viability
Elective: at the request of the woman but not for a medical reason
Therapeutic: abortion because of abnormalities
Spontaneous: nonviable intrauterine preg w. either empty gestational sac or gestational sac containing embryo/fetus w/o heart activity 126/7 wks —> miscarriage
Termination of preg done transcervical by dilation of the cervix, evacuation, fetus out by cuttage, scrapping + vacuum
Meds: mifepristone +misoprostol
Ectopic Preg
Fertilized egg grows outside uterus as a result in blastocyst implanting itself other than endometrial lining
- stunted growth + will be nonviable.
- 95% happen in fallopian tube, 5% other ovary, abdominal cavity, cervix
- most are tubual + tube lacks submucosal layer but can’t support the growth of the tropoblast
Risks:
Pelvic inflam disease
infertility
endometriosis
STI
smoking
Management:
* SALPINGOSTOMY/SALPINGECTOMY
* METHOTREXATE
* MONITOR FOR BLOOD LOSS
* EMOTIONAL SUPPORT
Hydatiform Mole
Grape Like Cysts
1. complete: fertilization of empty ovum (no embryonic tissue found)
2. Partial: some fetal tissue; normal ovum but 2 sperm 1/1500birth
1/1500 pregnancies
* WOMEN WITH LOW PROTEIN INTAKE
* >35 YEAR-OLDS
* ASIAN WOMEN
* EXPERIENCED PRIOR MISCARRIAGE
* UNDERGONE OVULATION STIMULATION (CLOMID)
SS:
Rapidly growing uterus, vaginal bleeding, NV.HT. Abnormally high hcg
* NAUSEA/VOMITING
* HYPERTENSION
* ABNORMALLY HIGH HCG LEVELS
* NO FETAL HEARTBEAT
* ULTRASOUND: NO FETUS (ONLY CYSTS)
Management:
no preg for 1 yr, monitor for malignancy
Monitor of malignancy
20% BECOME MALIGNANT
Polyhydraminos
excessive amniotic fluid >2000mL
associated with fetal GI anomalies + maternal diabetes
Treatment:
remove amniotic fluid
Oligohydramnios
scanty amniotic fluid <500mL
risk: fetal adhesion + malformations
Treatment: amniofusion
Infant Danger Signs
Tachypnea
retraction of chest wall
grunting/ flaring
lethargy
abnormal temp
hypogly
abdominal distension
failure to pass meconium in 48 hrs
failure to void in 24 hrs
convulsions
jaundice <24hrs
jitteriness
cant keep constant temp
Newborn Vitals
Pulse 110 - 160 bpm (sleep <70)
Respiration 30 -60
BP: 70-50mmHg - 90/60 @ day 10
Temp: Ax 97.7-99
skin 96.8 - 97.7
97.8 - 99
Caput succedaneum
swelling under the skin of the scalp - fluid filled
crosses suture lines
Cephalhematoma
collection of blood from broken blood vessels that build up under scalp `doesnt suture line
Craniosynostosis
premature closure of suture
- restricts growth perpendicular + compensatory overgrowth in unrestricted regions
List the critical elements of performing a neonatal assessment
APGAR
Birth Weight
Measurements: Head, chest + length
Vitals: temp, pulse, respiration
Gestational assessment
Physical maturity: Ballard exam + Dubowitz
Points are given for each area of assessment. A low of -1 or -2 means that the baby is very immature. A score of 4 or 5 means that the baby is very mature (postmature). These are the areas looked at:
Skin textures. Is the skin sticky, smooth, or peeling?
Soft, downy hair on the baby’s body (lanugo). This hair is not found on immature babies. It shows up on a mature infant, but goes away for a postmature infant.
Plantar creases. These are creases on the soles of the feet. They can be absent or range up to covering the entire foot.
Breast. The provider looks at the thickness and size of breast tissue and the darker ring around each nipple (areola).
Eyes and ears. The provider checks to see if the eyes are fused or open. He or she also checks the amount of cartilage and stiffness of the ears.
Genitals, male. The provider checks for the testes and how the scrotum looks. It may be smooth or wrinkled.
Genitals, female. The provider checks the size of the clitoris and the labia and how they look.
Physical exam
General appearance. This looks at physical activity, muscle tone, posture, and level of consciousness.
Skin. This looks at skin color, texture, nails, and any rashes.
Head and neck. This looks at the shape of head, the soft spots (fontanelles) on the baby’s skull, and the bones across the upper chest (clavicles).
Face. This looks at the eyes, ears, nose, and cheeks.
Mouth. This looks at the roof of the mouth (palate), tongue, and throat.
Lungs. This looks at the sounds the baby makes when he or she breathes. This also looks at the breathing pattern.
Heart sounds and pulses in the groin (femoral)
Abdomen. This looks for any masses or hernias.
Genitals and anus. This checks that the baby has open passages for urine and stool.
Arms and legs. This checks the baby’s movement and development.
Describe reflexes present in a neonate
Moro: startle reflex - lifts arms and legs curl them back toward body and throw head back
abnormal Moro reflex which only involves one side of the body. Other babies may have no Moro reflex at all. Some causes of an abnormal or absent Moro reflex may include infections, muscle weakness, injuries from childbirth, peripheral nerve damage and spastic cerebral palsy. disappear around 6 mo.
Rooting: when you touch the cheek of an infant baby turns head
The rooting reflex in babies usually lasts for about four months. After that, rooting becomes a voluntary response rather than a reflex
Sucking: 32 weeks inside the mother’s womb. roof of the mouth is stimulated or when you place the mother’s breast or a bottle in his/her mouth, the baby will place the lips over the nipple and squeeze it between the tongue and roof of the mouth. Next, the baby will move his/her tongue to the nipple to suck and milk the breast. The sucking reflex usually lasts until the baby is four months old.
Tonic Neck: fencing reflex, the tonic neck reflex happens when the baby’s head turns to one side. This is triggered when you stroke or tap the side of the baby’s spine while the baby lies on his/her stomach.
Tonic neck reflex may last until the baby is around five to six months old.
Grasp: stroking or touching the palm of a baby may cause the baby to automatically close his/her hands. The grasp reflex may last until the baby is about five to six months old.
Babinski: firmly stoke the sole of the baby’s foot. The baby’s big toe moves upward or toward the top of the foot and the other toe fans out. until the child is about two years old, but for some, it goes away after a year.
Stepping: walking or dancing reflex. Stepping reflex happens when you hold the baby upright with his/her feet touching a flat surface. You will notice that the baby will move his/her legs as if he/she is walking or trying to take steps although the baby is still too young to actually walk. lasts for about two months.
Defensive reflexes
Blinking
Cough
Gag
Sneeze
Yawn
Extrusion
Define APGAR and its indication
Test checks a baby’s heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed. Babies usually get the test twice: 1 minute after birth, and again 5 minutes after they’re born. tells the health care provider how well the baby is doing outside the mother’s womb
heart rate
0- absent
1 -60-100
2 >100
Respir
0-absent
1- slow irregular weak
2 cry
Reflex
0-no response
1-grimace
2-cry
Color
0 cyanotic
1pink and blue
2 pink
Muscle tone
0flaccis
1some flexion
2active motion
Identify critical adjustments the newborn makes in the transition to extra uterine life
EXTRAUTERINE PHYSIOLOGIC TRANSITIONS
* RESPIRATORY, CIRCULATORY, THERMOREGULATION
