Maternity Part 2 Flashcards by Julie Hodgman

TRUE LABOR

How are contractions?
Where is discomfort?
What happens to pain when we change activity?

Contractions: Regular and increasing in duration
Discomfort: Back and radiating to the abdomen
Pain increases

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FALSE LABOR
How are contractions?
Where is discomfort?
What happens to pain when we change activity?

Contraction: Irregular
Discomfort: Abdomen
Pain goes away

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Epidural anesthesia

Position?
What if there is a headache?
Given in what stage?
Major complication?

Lie on left side, leg’s flexed, could be indian style (not too much because we don’t want to get into the CSF)
*HEADACHE = CSF, there usually is no headache

Given in stage 1 @ 3-4 cm dilation

*Major complication: HYPOTENSION

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What to do after an Epidural

Fluids?
Position? What does this position prevent?

How often do we alternate the position from side to side?

BOLUS 1000ml of NS or LR to fight the hypotension

Position: Semi-fowlers on their side to prevent vena cava compression

HOURLY

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What happens if the vena cava is compressed?

It will decrease venous return, decreased CO, decrease BP, and decreased placental perfusion

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Stages of labor

1st stage: Beginning of dilation to 10cm
2nd stage: Delivery of baby
3rd stage: Delivery of placenta

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Phases of labor

Early/latent: Onset of labor to 3 cm
Active: 3 cm - 7 cm
Transition: 7 cm - 10 cm

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Patient on oxytocin needs what?

ONE-on-ONE care

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Complications of Oxytocin

Hypertonic labor (Too much contraction)
Fetal distress
Uterine rupture

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Complete Uterine Rupture

Tear where?
S/S? What if the placenta separates?

What might stop the pain?

Tear through uterine wall AND peritoneal cavity

Sudden sharp/shooting pain
Hypovolemic shock d/t hemorrhage
Absent fetal heart tones if placenta separates

Pain may stop when contractions stop

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Incomplete Uterine Rupture

Tear where?
S/S

Tear through uterine wall

Internal bleeding
Hypertonic contractions, lack of progress
May have pain, late decels, faint, vomit
May lose fetal heart tones

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What patients are at high risk for uterine rupture?

Highest risk?

Vaginal birth after C-section d/t c-section scar opening under stress

Highest risk: When taking oxytocin

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What kind of contractions do we want?

1 every 2-3 minutes, each lasting 60 seconds

Pauses allow more oxygen in

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When would we need to DC the oxytocin?

What if late decals occur?

Contractions are too often
Contractions last too long
Fetal distress

TURN IT OFF

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How is oxytocin hung?

Piggy back to main IV fluid

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How should the oxytocin patient be positioned?

What if the fetus has unreassuring heart tones like bradycardia?

Any position BUT FLAT

Place on left side to enhance uterine perfusion

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Emergency Delivery

Only push when?
Minimize touching what?
Head crowns, what might you have to do?
How to prevent coming out too fast?
What to do when the head is out?
Do you pull at all?
Keep baby's head where?
Why do we have to dry baby?

Only push during CONTRACTIONS
Minimize touching vaginal area
Head crowns, might have to tear the sac
Place gentle pressure on the head
Head is out - feel for cord around neck
NO PULLING, ease each shoulder out
Keep baby's head DOWN
Baby can't regulate T yet

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Emergency delivery

Keep baby at what level?
Place baby on what?
We need to keep baby warm!

PLACENTA
What are we waiting for??
What if it all doesn’t come out? - Need to assess!!!
Can mom push to deliver it?

Keep baby at uterus level to prevent a bolus of blood from the placenta
Place on mom’s abdomen
Cover baby

PLACENTA
Wait for it to separate and deliver
THINK HEMORRHAGE! Need to inspect that thing to make sure it’s all there!

Mom can push it out

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Emergency delivery

How to deal with the cord?
Will it bleed?

Final thing to assess of the uterus?

Tie cord of with a piece of cloth or shoe string

Place 1 knot about 4 inches from baby’s belly button and 2nd knot 8 inches

Cord will bleed

Check for firmness: might need fundal massage to prevent a hemorrhage

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POST-PARTUM

T during first 4 hours might be what?
BP?
HR?

Breasts?
Abdomen?
GI?

T might increase to 100.4
BP - stable
HR- 50-70 common for 6-10 days

Breasts soft for 2-3 days, then engorged
Abdomen soft/loose; diastasic recti
HUNGRY

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TACHYCARDIA POSTPARTUM, THINK WHAT?!?!

HEMORRHAGE

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Uterus after birth

Position–
Immediately:
Few hours:

Want it to be what?
What to do if it’s boggy?

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Immediately: midline 2-3 fingers below umbilicus
Few hours: umbilicus or 1 finger above

Want uterus to be FIRM
Boggy: massage until firm, then check for bladder distention

When is bladder distention suspected?

Complication of this?

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When the uterus is above the expected level or is not midline

Complication: Won’t allow the uterus to contract normally, increasing the risk of hemorrhage

How should the fundal height be?

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Descending 1 FB/day

What is involution?

When the funds descends and the uterus goes back to it's normal size

What is common for the first 2-3 days and will keep occurring if mom breastfeeds?

Afterpains - camping of uterus as it goes back to normal; breastfeeding = more oxytocin

Normal days for each Lochia Rubra Serosa Alba Are clots ok?

Rubra: 3-4 days; dark red Serosa: 4-10 days; pinkish brown Alba: 10-28 days ; white or yellow Yes as long as they aren't bigger than a nickel

When does mom start peeing again? | Can mom be dehydrated?

Within 24 hours | YES: Watch for s/s of DVT`

Perineal care What is best especially for mom with an episiotomy, laceration, or hemorrhoids?

Warm water rinses Sit bath 2-4 times a day Anesthetic sprays

Perineal Care Ice? Change pads how often? What to report?

Ice intermittently for the first 6-12 hours to decrease edema Change pads frequently Report foul smell Report loch changes --> MAY NEED 911!!

Peripad rule

NO MORE THAN 1 saturates pad/hour

Bonding is what kind of need? What does it do? How often to do kangaroo care?

Emotional and physiological Stabilizes HR Improves O2 Regulates T Conserves calories At least 1 hr 4 times a week

Breast feeding ``` How to cleanse after feeding? What kind of bra? How to handle soreness? What if you leak? Need to start doing this how soon? Increase calories by how much? How much milk/fluid intake? unless what? ```

Cleanse with warm water (no soap); air dry Support bra Ointment or express colostrum; let air dry Breast pads Need to start ASAP after birth Increased calories 500 8-10 fluid/milk, unless ducts will clog

NON-Breastfeeding engorgement Ice? Put on what? What plant? What does it do? Avoid what?

Ice Breast binders Chilled cabbage leaves cause vasodilation and decrease inflammation Avoid STIMULATION

Post-partum infections Develops when? - What kind? Teaching

Infection within 10 days - E.Coli, Strep Proper hygiene; front to back

Post-Partum hemorrhage Early: 2 things!!!!! Late: Causes?

Early: More that 500mL blood lost in first 24 hours AND 10% from from admission Hct Late: after 24 hours up to 6 weeks causes: Uterine atony, lacerations, retained fragments, forceps used

Meds given to stop postpartum hemorrhage

Oxytocin Methylergonovine Maleate Carboprost Thromethamine

Mastitis Causes? Bacteria? Occurs when?

Caused by not emptying completely, leading to clogged ducts and inflammation Staphylococcus Occurs around 2-4 weeks

How to treat mastitis Activity? Bra? What if they DC breastfeeding? What if they keep breast feeding? Can mom take penicillin? Pain? Heat or cold? How to feed baby?

Bedrest Support bra DC: cabbage, binding BF: frequently or pump YES - feed baby then take it Pain meds Heat to soften the breast Feed baby frequently, giving the hurt booby first because baby will suck harder initially

NEWBORN - Immediate care

Suction Clamp/cut cord Cover baby Do APGAR

When is APGAR done? What does it look at? Good score?

Done at 1 and 5 minutes HR, R, muscle tone, reflex irritability, color Want at least 8-10

What meds are given to newborn?

Erythromycin - in eyes for Neisseria gonococcus, kills chlamydia Phytonadione - Promotes clotting factors

Cord ``` When does it fall off? Clean with what? Fold diaper where? When can you immerse baby? Watch for what? ```

``` 10-14 days Alcohol or NS Below the cord Until it falls off Infection ```

What babies are at highest risk for hypoglycemia?

LGA, SGA, preterm, DM babies

When does PATHOLOGIC jaundice occur? | What does it usually indicate?

1st 24 hours | Rh/ABO incompatibility

When does PHYSIOLOGIC jaundice occur? | What is it due to?

After 24 hours Normal hemolysis of excess RBC releasing bili OR liver immaturity

What combo occurs with Rh sensitization? what causes this?

Rh NEGATIVE mom with Rh POSITIVE baby Blood mixes somehow (placenta, amniocentesis, miscarriage)

What is happen with Rh stage? When does this affect baby?

Mom's body looks at baby's Rh+ as an antigen so mom produces antibodies against baby's blood Affects LATER pregnancies: increased antibodies with each delivery In other pregnancies, the baby will stop growing

What is Erythroblastosis Fettles?

Increase of immature RBC in the fetal circulation resulting in ^bili Anemia, hypoxia HF, neuro damage Hydrous fetalis - severe form

How to diagnose Rh

Indirect Coombs: # antibodies mom has Direct Coombs: # RBC with antibodies attach in baby

What do you do if mom has an Rh+ baby?

Frequent US to watch fetal growth | Early birth

What is RhoGAM given? Who do we urge to give this to?

Within 72 hours after birth - this protects the NEXT pregnancy *May also give at 28 weeks just in case Mom's with abortion, amniocentesis, trauma, ectopic pregnancy (any bleeding episode)

How does RhoGAM work?

It destroys fetal cells that got into mom's blood - but it needs to do this before antibodies form ONCE ANTIBODIES FORM: MOM HAS THEM FOR LIE MUST GIVE RHOGAM BEFORE THEY FORM

Maternity Part 2 Flashcards

(53 cards)