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Flashcards in maternity Deck (45)
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1

hormone that induces amenorrhea

progesterone

2

presumptive signs of pregnancy

amenorrhea
n/v
urine frequency
breast tenderness

3

probable s/s of pregnancy

positive test (based on hCG levels)
Goodell's sign (softening of cervix)
chadwick's sign (bluish color of vaginal mucosa and cervix)
Hegar's sign (softening of lower uterine segment)
uterine enlargement
braxton hicks contractions throughout pregnancy

pigmentation changes:
linea nigra (dark line down the center of the abdomen)
facial chloasma (mask of pregnancy)
abdomen striae (stretch marks)
darkening of the areola

4

positive signs of pregnancy

fetal heartbeat:
doppler (10-12wk)
fetoscope (17-20wk)

fetal movement
ultrasound

5

gravidity

number of times someone has been pregnant

6

parity

number of pregnancies in which fetus reaches 20wks

7

viabililty

24 wks gestation
infant can live outside uterus

8

TPAL

T: term
P: preterm
A: abortion (includes spontaneous and elective)
L: living children

9

spontaneous abortion

AKA miscarriage:
bleeding, cramping, backache-- think miscarriage
hCG levels will drop

10

Naegele's rule for EDD

first day of LMP
add 7 days
subtract 3 months
add 1 year

11

first trimester nutrition & supplements

increase protein to 60g/day
weight gain of 1-4pounds

biggest complaint of iron (constipation and GI upset)
always take iron with vitamin C (enhances absorption)
folic acid prevents neural tube defects

12

first trimester exercise

no high impact
walking
swimming
no heavy exercise program
dont let HR get above 140 (can decrease CO/perfusion to baby)
don't overheat (no hot tubs or heating blankets--increase body temp and cause birth defects)

13

danger signs and potential complications of maternity

sudden gush of vaginal fluid
bleeding
***persistent vomiting
severe headache
abdominal pain
increased temp
edema
*** no fetal movement

14

common discomforts

constipation
ankle edema
n/v
breast tenderness
urinary frequency
tender gums
fatigue
heartburn
increased vaginal secretions
nasal congestion
varicose veins
hemorrhoids
backache
leg cramps

15

1st trimester meds, smoking, HCP visits, ultrasounds

no meds unless approved by HCP

stop smoking
can have small gestational age, low birth weight babies, cleft lip or palate, placental abruption

first 28wks = once a month
28-36wks = every 2 wks/twice a month
after 36wks = weekly

drink water before ultrasound to distend the bladder and push uterus up closer to abdominal surface so it's easier to get a picture
ultrasound before procedure (amniocentesis): void

16

2nd trimester nutrition

wk 14-26

increase 300cals
adolescent can increase 500cal

1 pound weight gain/wk

should not experience n/v and urinary frequency
can still have breast tenderness

17

quickening

fetal movement (16-20wks)

18

fetal HR

110-160
less than 110=panic!!!

19

kegel exercise

strengthen pubococcygeal muscles
help stop urine flow
keep uterus from falling out

20

3rd trimester assessment

wk 27-40

term if advances to 40 weeks

no more than 1lb weight per week

monitor BP:
pre-eclampsia develops after 20wks:
they will have high BP
proteinuria
edema
BP 160/110 or greater documented 6 hours apart

***two or more pounds of weight gain in a week, watch close and worry about possible pre-eclampsia:
can have a seizure
magnesium sulfate is drug of choice:
given IV
close supervision
anticonvulsant
sedates
vasodilator
***it is called eclampsia when they have a seizure

FHR: 110-160

fetal position determined by leopold maneuvers:
have them void
if having contractions, do it between contractions

21

signs of labor

lightening:
2wk before term
presenting part (head) descends into the pelvis
abe to breath easier
urinary frequency

engagement:
largest presenting part in pelvic inlet (head)

fetal station:
measured in cm

braxtion hicks (more frequent and stronger than before)
softening of cervix
bloody show
sudden burst of energy called nesting
diarrhea
ruptured membranes

when should they go to the hospital:
contractions are 5minutes apart
membranes rupture
worried about prolapsed cord when membranes rupture

22

non stress test

two or more accelerations of 15beats/min or move with or without fetal movement

acceleration:
FHR has an abrupt increase
increase is greater than 15beat/min
lasts for 15 seconds
should come back to baseline within 2minutes

each increase should last for 15 seconds and recorded for 20minutes

***want it to be reactive

23

biophysical profile test

commonly done in last trimester
measured by ultrasounds and each of the parameters count 2 points
10/10 = perfect score

parameters:
HR
muscle tone
movement
breathing
amount of amniotic fluid

BPP test:
observation time is 30minutes by sonogram
8-10 = good
6 = worrisome
less than 4 = ominous (deliver)

24

contraction stress test

oxytocin challenge test
for high risk pregnancies
determines if baby can handle the stress of contractions

deceleration:
blood flow decreases & causes hypoxia then FHR will decrease

*** do not want to see late decelerations (uteroplaental insufficiency = placenta is wearing out)

** want a negative test

25

types of decelerations

early:
not bad
benign
caused by physiological hypoxia from fetal head compression

late:
bad
caused by uteroplacental insuffiency

variable:
bad
caused by umbilical cord compression

26

true vs false labor

true:
regular contractions
increase in frequency and duration
discomfort in back and radiates to abdomen
pain increases with activity

false:
irregular contractions
discomfort in abdomen (front)
pain decreases/goes away with activity

27

premature/preterm labor

contractions occur with dilation between 20-37 weeks
stop the labor
treat any existing vaginal/UTI
hydrate the mom will often stop preterm labor
bedrest

Meds:
magnesium sulfate (IV relaxes uterus)
betamethasone (IM, steroid helps fetal lungs mature)
terbutaline (SQ)
indomethacin (PO)
nifedipine (PO)

28

epidural anesthesia

lie on L side
legs flexed
prop up over the bedside table
given at 3-4cm dilation
usually no headache
major complication (hypotension)
IVFs (bolus with 1000ml of NS/LR to fight hypotension)
monitor BP close
semi-fowlers
tilt on side to prevent vena cava compression
vena cava compression will decrease venous return (reduces CO and BP)
if BP decreases perfusion to baby goes down
alternate position from side to side hourly
check urine output and assess bladder

29

client receiving oxytocin

considerations:
one-on-one care

complications:
hypertonic labor
fetal distress
uterine rupture
contraction rate of 1 every 2-3 minutes with each lasting 60seconds

discontinue oxytocin when:
contractions are too often
contractions last too long
fetal distress

oxytocin is piggly backed into a main IV fluid so when you turn off turn off IV fluids too

any position except flat
put on L side with any fetal distress

turn it off with any late decelerations

30

emergency delivery/precipitous delivery

pant/blow to decrease the urge to push only during contractions
wash hands
elevate HOB
place something under butt
decrease touching vaginal area
tear amniotic sac as head crowns
place hand on fetal head and apply gentle pressure
when head is out, feel for the cord around he neck (nuchal cord)
ease each shoulder out
keep baby's head down
****dry baby (cannot regulate temp)
place on mom's abdomen
cover baby (skin to skin)
wait for placenta to separate/deliver
can push to deliver placenta
****want placenta out wihtin 30minutes
check firmness of uterus