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HURST > Maternity > Flashcards

Maternity Flashcards

1
Q

Name of hormone that induces amenorrhea

A

progesterone

increased temp when ovulating

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2
Q

Presumptive Signs of Pregnancy

A

amenorrhea
N/V
Urinary frequency (can be one of first signs)
breast tenderness (bc of excess hormones)

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3
Q

Probable Signs of Pregnancy

A 
positive pregnancy test (based on presence of hCG levels)
     - hydatidiform (molar pregnancy) and meds can increase hCG
Goodell's sign 
Chadwick's sign
Hedgar's sign
Uterine enlargment
Braxton Hicks contractions
pigmentation changes of skin
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4
Q

Goodell’s sign

A

softening of cervix (2nd month)

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5
Q

Hydatidiform

A

Molar Pregnancy

benign neoplasm of grape-like vesicles that CAN become malignant
if not malignant, DNC required w close follow-up
if malignant, treatment based on stage and grade of cancer

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6
Q

Chadwick’s sign

A

bluish color of vaginal mucosa and cervix

4th week

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7
Q

Hegar’s sign

A

softening of lower uterine segment

2nd / 3rd month

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8
Q

Pigmentation changes of skin

A 
linea nigra (dark line down abdomen)
facial chloasma (mask of pregnancy)
abdomen striae (stretch marks)
darkening of areola
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9
Q

Positive Signs of Pregnancy

A 
fetal heartbeat
     - doppler --> 10 to 12 weeks
     - fetoscope --> 17 to 20 weeks
fetal movement
ultrasound
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10
Q

Gravida

A

number of times someone has been pregnant

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11
Q

parity

A

number of pregnancies in which fetus reachs 20 wks

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12
Q

viability

A

24 wks gestation

infant has ability to live outside of uterus

20 wk is not viable

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13
Q

TPAL

A

term
preterm
abortion
living children

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14
Q

bleeding, cramping, backache, think

A

miscarriage

hCG levels drop with miscarriage

most before 20 wks

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15
Q

Naegele’s Rule

A

add 9 months and 7 days

accurate plus or minus 2 weeks

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16
Q

First trimester

A

Week 1 -13

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17
Q

Second Trimester

A

week 14-26

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18
Q

Third Trimester

A

Week 27-40

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19
Q

Nutrition in First Trimester

A

increase protein to 60 grams/day
- normal protein is 40-45 g/day

culture (hot v. cold / kosher foods / fasting)

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20
Q

First Trimester Wt Gain

A

1 to 4 pounds in first trimester

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21
Q

Biggest complains with iron?

A

constipation and GI upset

always take iron with vitamin C

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22
Q

Folic acid

A

prevents neural tube defects

daily dose = 400 mcg/day

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23
Q

First Trimester Exercise

A

no high impact (walking / swimming are best)
no heavy exercise but can continue regular

DON’T LET HEART RATE GO OVER 140
- if it does, CO and uterine perfusion are decreased

don’t want them to get overheated so no hot tubs, heating blankets
- overheating can cause birth defects

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24
Q

Danger Signs and Potential Complications of Maternity

A
  • most commonly occurs in 3rd trimester but we teach it in 1st
sudden gush of vaginal fluid
bleeding
persistent vomiting
severe headache
abdominal pain
increased temps
edema
no fetal movement
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25
Q

Common Discomforts in Pregnancy

A 
constipation
ankle edema
N/V
breast tenderness
urinary frequency
tender gums
fatigue
heartburn
increased vaginal secretions
nasal congestion
varicose veins
hemorrhoids
backache
leg cramps
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26
Q

Smoking during pregnancy is associated with…

A

small for gestational age, low birth weight babies, cleft lip or palate, risk for placental abruption doubles w smoking

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27
Q

How often should a pregnant client visit the primary HCP?

A

first 28 weeks = once a month

28-36 weeks = every 2 weeks or twice a month

after 36 weeks = weekly until delivery

high-risk = more prenatal visits

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28
Q

What do you do before an ultrasound?

A

drink water to distend bladder to push uterus up for better imagining

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29
Q

Second Trimester Nutrition

A

increase by 300 calories a day

adolescent = increase by 500 calories a day

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30
Q

Second Trimester Weight Gain

A

1 lb per week

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31
Q

Does a pregnant lady still experience N/V in second trimester? Breast tenderness? Urinary frequency?

A

No N/V
Yes breast tenderness
No urinary frequency - uterus rises and relieves pressure on bladder

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32
Q

Quickening

A

fetal movement

15-20 weeks

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33
Q

FHR

A

110-160 in second trimester

less than 110 = panic

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34
Q

Kegel Exercise

A

strengthens pubococcygeal muscles (these stop urine flow and keep uterus from falling out)

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35
Q

Third Trimester Weight Gain

A

no more than 1lb a week

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36
Q

Third Trimester Assessment for Pre-E

A 
monitor BP and report ANY increases from baseline
Pre-E develops after 20 weeks gestation
     - increased BP
     - proteinuria
     - edema

watch for 2 or more lbs gain in a week

Magnesium Sulfate

Defined as BP of 160/110 or greater that lasts for 6 hrs or more

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37
Q

Magnesium Sulfate

A

acts like anticonvulsant
sedates
vasodilates (decreases BP)
pre-e means they haven’t had a seizure yet

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38
Q

Normal FHR

A

110-160

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39
Q

How do you determine position / presentation of a fetus?

A

leopold maneuvers (palpating the uterus)

they should void first and they need to be done in between contractions

40
Q

Signs of Labor

A

lightening
engagement
fetal stations

Other signs:

 - braxton Hicks contractions become more frequent and stronger
 - softening of cervix
 - bloody show
 - sudden burst of energy called nesting
 - diarrhea
 - rupture of membranes
41
Q

Lightening

A

usually happens 2 weeks before term

lightening is when presenting part descends into pelvis

client will be able to breathe easier, but there is more pressure on bladder so urinary frequency is a problem.

42
Q

Engagement

A

largest presenting part is in the pelvic inlet

poor engagement during rupture of membranes can lead to prolapsed cord

43
Q

fetal stations

A

measured in cm

  • means still in mom
    + means really low in pelvic inlet
44
Q

When should the client go to the hospital?

A

when contractions are 5 minutes apart or when membranes rupture

when ROM occurs, we are worried about prolapsed cord

45
Q

Non-Stress Test

A

NST

  • when two or more accelerations of 15 bpm (or more) with or without fetal movement passes the NST
  • each increase should last for 15 seconds and be recorded for 20 min
  • you want the test to be reactive
46
Q

Acceleration

A

increase from baseline by at least 15 bpm for at least 15 seconds and return to normal within 2 min

47
Q

Biophysical Profile Test

A

BPP

commonly done in last trimester but can be done at 28 wks in high-risk pregnancy

high-risk may have BPP every week or twice a week in 3rd trimester

measurements are obtained by ultrasound and each parameter counts as 2 points. (10/10 is perfect score)

parameters: HR, muscle tone, movement, breathing, amount of amniotic fluid around baby

observation time is 30 min by sonogram

8-10 = good
6 = worriesome (repeat test in 24 hrs)
less than 4 = immediate delivery

48
Q

Contraction Stress Test

A

CST / also called oxytocin challenge test

performed on high-risk pregnancies: pre-E, maternal diabetes, placental insufficiency

tests if baby can handle stress of contraction (they decrease blood flow to uterus and to placenta)

decelerations - mean hypoxia

late decels mean that placenta is wearing out / uteroplacental insufficiency

you want NEGATIVE CST = no late decels

rarely performed befroe 28 wks

results only good for 1 wk

49
Q

Early Decelerations

A

not bad / benign

caused by physiological hypoxia from fetal head compression

50
Q

Late decelerations

A

bad

caused by uteroplacental insufficiency (UPI)

51
Q

variable decelerations

A

bad

caused by umbilical cord compression (CC)

52
Q

True Labor

A

regular contractions

increase in frequency and duration

discomfort in back and radiates to abdomen

pain increases with activity

53
Q

False Labor

A

irregular contractions

discomfort in abdomen

pain decreases / goes away with activity

54
Q

Premature Labor

A

contractions occur w dilation between 20 to 37 weeks

goal is to stop labor

treat vaginal or urinary infections and hydrate mom

place on bedrest

Meds

55
Q

Medications to stop Preterm Labor

A

magnesium sulfate (relaxes uterus)

betamethason (IM / steroid that helps fetal lungs mature)

terbutaline (SQ)

Indomethacin (PO)

Nifedipine (PO)

56
Q

Epidural Anethesia

A

lie on left side, legs flexed, prop on bedside table

given in stage 1 at 3 to 4 cm dilation

usually no headache

major complication is hypotension

Bolus with 1L of NS or LR to fight hypotension

put in semi-fowlers tilted on their side to prevent vena cava compression (which decreases venous return, CO, and BP)

hypotension leads to decreased perfusion of placenta

alternate position from side to side hourly

check UOP and assess bladder

57
Q

Oxytocin Patient

A

need one-on-one care

Complications: hypertonic labor, fetal distress, uterine ruptrue

want contraction every 2 to 3 minutes with each lasting 60 seconds

Oxy is piggybacked into main IV fluid

place in any position except flat on back
- if there’s any unreassuring fetal heart tones, put on left side to enhance uterine perfusion

if late decels occur, turn off infusion

58
Q

Discontinue oxytocin when

A

contractions are too often

contractions last too long

any sign of fetal distress

59
Q

Emergency Delivery / Precipitous Delivery

A

pant / blow to decrease urge to push
* don’t push between contractions

wash hands / elevate HOB

something clean under booty

decrease touching vaginal area

as head crowns, tear amniotic sac

place hand on fetal head and apply gentle pressure

when head is out, feel for cord around neck (nuchal cord)

ease each shoulder out / rest will deliver fast

keep baby’s head down

dry baby / place on mom’s abdomen

covery baby (skin to skin)

wait for placenta to separate / deliver

can push to deliver placenta (want out in 30 min)

inspect placenta for intactness

tie cord off with something clean like shoestring or strip of cloth
- no ccloser than 4 in to baby’s navel and second about 8 inches from baby’s navel

check firmness of uterus

60
Q

Post-Partum Assessment: VS

A

temp - 100.4 is normal for first 4 hours
BP - stable
HR - 50-70 common for 6 to 10 days after

  • tachycardia + postpartum = think hemorrhage
61
Q

Post-Partum Assessment: Breasts

A

soft for 2 to 3 days then engorgement comes

62
Q

Post-Partum Assessment: Abdomen

A

soft / loose

63
Q

Post-Partum Assessment: GI

A

hungry af

64
Q

Post-Partum Assessment: Uterus

A

fundus midline 2 to 3 fingers below umbilicus

few hours after birth, rises to level of umbilicus or to one finger above

FUNDUS SHOULD BE FIRM

Fundus is boggy? Massage until firm and then check for bladder distention.

fundal height will descend one finger /day

65
Q

Involution

A

fundus descends and uterus returns to its pre-pregnancy size

66
Q

Afterpains

A

common for first 2 to 3 days and will continue if breast feeding due to oxytocin

67
Q

Post-Partum Assessment: Lochia

A

Rubra (3 to 4 days) - dark red
Serosa (4 to 10 days) - pinkish brown
Alba (10 to 28 days) - whitish yellow

can have alba for up to six weeks

clots are okay as long as they are no larger than a nickel

68
Q

Post-Partum Assessment: Urine Output

A

diuresis the excess fluid around 24 hours after delivery

dehydration is possible

inspect for DVT

69
Q

Perineal Care Post-Partum

A

intermittent ice packs for first 24 hours to decrease edema

warm water rinses

sitz baths 2 to 4 times per day

anesthetic sprays

change pads frequently

don’t want more than 1 saturated peripad/hour

teach to report foul smell and any lochia changes

70
Q

Bonding - How does baby benefit from skin-to-skin?

A 
stabilizes HR
improves O2 sats
regulates temp
conserves calories
breasts regulate temp
71
Q

kangaroo care

A

skin to skin

held for 1 hour at least 4 times a week

72
Q

Breastfeeding moms –> breast care

A

cleanse with warm water after each feeding (soaps = drying)

let air dry

supportive bra

ointment for soreness

express some colostrum and let it dry

breast pads - absorb moisture (change frequently)

mother needs to initiate breastfeeding ASAP after birth and alternate breasts

mom can pump if needed

increase caloric intake by 500 calories per day

fluid / milk intake - 8 to 10 glasses of fluid / day

73
Q

Non-Breastfeeding moms –> breast care

A

ice packs

breast binders (ACE wraps / tight bras)

chilled cabbage leaves (decreases inflammation and engorgement)

no stimulation of breast

74
Q

Post Partum Infection

A

infection within 10 days after birth (E. Coli / Beta hemolytic strep)

teach proper hygiene (front and back cleansing)

cultures and antibiotics

75
Q

Postpartum Hemorrhage

A

early –> more than 500 mLs of blood lost in first 24 hours accompanied by 10% drop from admission hematocrit

late –> after 24 hrs and up to 6 wks postpartum

76
Q

Causes of Postpartum Hemorrhage

A

uterine atony

lacerations

retained fragments and forceps delivery

77
Q

Meds to Stop Postpartum Hemorrhage

A

oxytocin

methylergonovine maleate

carboprost tromethamine

misoprostol

78
Q

Mastitis

A

poor hygiene / improper breastfeeding

staphylococcus

usually occurs around 2 to 4 wks

79
Q

Mastitis S/sx

A

rapid onset of fever and chills

the breast will be swollen and hard and tender to touch

malaise

80
Q

Mastitis Treatment

A

bed rest

support bra for engorgement

binding and chilled cabbage leaves
- only use if breastfeeding is being discontinued

breastfeed / pump frequently
- affected breast first

penicillin / erythromycin

pain meds

heat

81
Q

Newborn Care Immediately post delivery

A

maintain body temp / dry / skin to skin

APGAR - assessed at 1 and 5 min

erythromycin (eye ointment) to kill Neisseria gonococcus and Chlamydia

Phytonadione (Vit. K) promotes formation of clotting factors (IM - give in vastis lateralis)

82
Q

Newborn Care - Cord Care

A

dries and falls off in 10 to 14 days

cleanse with each diaper change using alcohol or NS

fold diaper below cord

no immersion until cord falls off

watch for infection

83
Q

APGAR

A

assessed at 1 and 5 min

looks at HR, Respiration, muscle tone, reflex irritability, color

want score of at least 8 to 10

84
Q

Newborn Complications

A

Hypoglycemia

Pathologic Jaundice

Physiological Jaundice

Rh Sensitization or Rh Factor

85
Q

Hypoglycemia in Newborns

A

no longer getting glucose from mom

babies at greatest risk are large for gestational age, small for gestational age, babies of diabetic moms

86
Q

Pathologic Jaundice in Newborns

A

occurs first 24 hrs

usually means Rh/ABO incompatibility

87
Q

acrocyanosis

A

purple hands and feet

88
Q

Physiological Jaundice Newborns

A

after 24 hours

due to normal hemolysis of excess RBCs releasing bilirubin and immaturity of liver

89
Q

Rh Sensitization

A

occurs when you have Rh- mom and Rh+ baby

baby from first pregnancy is not affected, but second pregnancy the mom’s antibodies will breakdown babies RBC (hemolysis)

90
Q

when does babies and mom blood mix?

A

placenta separates at birth, during miscarriage, amniocentesis, trauma to mom’s abdomen

if mom is Rh - and baby is Rh + then give Rhogam

91
Q

When Rh - mom’s antibodies attack Rh + baby, what happens?

A

Hemolysis

baby compensates by releasing immature RBCs

this is called erythroblastosis fetalis

92
Q

Diagnosis of Rh Sensitization

A

Indirect Coombs - done on mom; measures antibodies in blood

Direct Coombs - done on baby; tells if there are any antibodies stuck to RBCs
- done on cord

93
Q

Treatment of Rh Sensitization

A

frequent ultrasounds

94
Q

Prevention of Rh Sensitization

A

RhoGAM

95
Q

RhoGAM

A

prevents Rh Sensitization

given to mom within 72 hours after birth

most HCP give RhoGAM twice

 - once at 28 wks
 - again 72 hrs after birth

it’s also given with any bleeding episode

*RhoGAM destroys Rh+ fetal blood cells that are in mom’s Rh- blood before antibodies are formed

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