final exam 3 Flashcards
(40 cards)
Why is Oxytocin given?
- given for induction, can titrate up to 20
- for uterus to contract after labor–> to prevent bleeding
What are the differences between boluses?
LR bolus → Before epidural, intrauterine resuscitation, for nonreassuring FHR
1st intervention for PP hemorrhage? NO – would prefer oxytocin bolus (already sitting in bag nearby from induction - faster method)
Normal Saline bolus → given before epidural placement to prevent hypotension (pt on side or sitting for epidural)…
Magnesium Sulfate bolus → to control seizure activity
Dextrose bolus → symptomatic hypoglycemia
Why do you have a pap smear?
detect abnormal cervical cells
what’s the purpose of family planning?
to plan for a family…
How do you help a patient who wants to get pregnant?
- Ovulation window (Stringy, mucus discharge, increased basal temperature, keeping track of menstrual cycle
Know GTPAL
G (# of pregnancies in a lifetime (including miscarriage, abortion), twins/triplets count as 1)
T (# of pregnancies that end at TERM (37 weeks+), includes stillborns)
P (All pregnancies that make it to/delivered at pre-term [20-37 weeks], a viable pregnancy)
A (abortion – spontaneous or planned)
L (living kids, if you have twins counts as 2 here)
Understand gender sensitivity + mindful about responses, biologic identification
respect pronouns, etc.
Rh + blood types and incompatibilities
- Mom to worry about? Rh negative mom, need to worry if she’s had or has an Rh+ baby, if we know dad is Rh+ – then it’s a tossup, Rh+ mom and Rh- dad – 50/50 chance, med given → Rhogam, and if not sure we give it as well, given during pregnancy and postpartum
Measurement of belly
Should match in cm the week of gestation +/- 2 is okay, anything less or more tunes us into potential problem
Know a reactive strip, and what constitutes a reassuring strip + category tracings
- Reactive strip = have done impromptu or informal non stress test, saying i looked at strip and have seen 2 accelerations in a 20 minute period – tells me baby is well oxygenated + developing as baby should
- Reassuring = tells us everything is ok, like to look at variability (moderate is good), tells us about baby perfusing, don’t have to have accelerations to say it’s reassuring, but they support it – can be reassuring w early decelerations alone because it tells us head is coming down for delivery
- ->Saw early decelerations – check to see if ready for labor, if they aren’t position change
Category Types
- Category 1 – good variability, reassuring
- Category 2 – decreased variability, decelerations
- Category 3 – serious decelerations, need to consider intrauterine resuscitation but also do we need to get baby out immediately with vaginal surgery or c-section
what is normal bleeding vs. abnormal bleeding
Bloody show normal when term and cervix is showing…buuuuut saturating a pad in an hour is too much
- Know when bleeding is normal vs not
- Bright red very different than dark lochia looking
What to monitor during mag sulfate administration
- DTR, BP – looking for s/s of CNS depression – mag may cause HYPOreflexia
- +1/+2 OK, +2 or more = hyperreflexia, less than +1 or absent = hyporeflexia
- Indications : preeclampsia (may see hyperreflexia) and as a tocolytic
Know how to interpret a sterile vaginal exam
- Dilation, station (based upon where baby is in pelvis in relation to ischial spine – engaged baby at 0 station, then goes up to +5 = crowning), effacement (% of shortening that has happened w cervix)
What to do for a patient who wants to labor without an epidural?
- Breathing techniques – open glottis breathing, one where you hold breath + bear down (WHEN actually pushing), panting if mom shouldn’t push, grunting can help mom bear down + push
Assessing a postpartum mother’s bladder
bladder can distend
- Worry about uterine atony
- Bladder fills quickly from bolus and fluids, and mom diuresis – kidneys go into overdrive, blood volume begins to shift, body starts letting go of fluid
- Can also have diaphoresis to let go of fluids
what happens during baby adaptations?
- circulatory system:
- Cardiac adaptations: understand order → 1. Baby born, 2. Pulmonary blood flow increases first (lungs squished – then take first breath and they recoil and blood flow to lungs increases), 3. Foramen valley duct closes first, 4. THEN ALVEOLAR CORD is clamped → CAUSING SYSTEMIC PRESSURE increases, 5. then ductus arteries closes
Know reflexes
-tonic-neck (fencing baby)
- babinski (toe fans out)
sucking reflex
Babies lose 10% of weight at first…
postpartum fundus
- Massage fundus : to prevent bleeding, hemorrhage,
- It’s the same as after c-section
Know thermoregulation
Transient tachypnea of the newborn
- a respiratory disorder usually seen shortly after delivery in babies who are born near or at term. Transient means it is short lived (usually less than 24 hours) and tachypnea means rapid breathing
- Supportive tx
- Grunting, nasal flaring, etc
- Kept in thermoneutral environment
Know gestational diabetes baby
- BIG baby, macrosomic, 4,000g or >
- When baby is born, looking for hypoglycemia
baby
Withdrawal, when to worry about this?
- 24-72 hrs
- Takes time to show up…
