NUR 360: Maternity Flashcards
(168 cards)
1
Q
Word that means pregnancy
A
Gravidity
2
Q
A woman who has had 2 or more pregnancies
A
Multigravida
3
Q
A woman who has completed 2 or more pregnancies to 20 weeks or more
A
Multipara
4
Q
A woman who has never been pregnant and is not currently pregnant
A
Nulligravida
5
Q
A woman who has not completed a pregnancy beyond 20 weeks
A
Nullipara
6
Q
Number of pregnancies that have reached 20 weeks
A
Parity
7
Q
A woman who is pregnant for the first time
A
Primigravida
8
Q
A woman who has completed one pregnancy that has reached 20 weeks
A
Primipara
9
Q
Capacity to live outside the uterus, between 22 and 25 weeks
A
Viability
10
Q
A pregnancy from the beginning of week 37 to end of week 40 plus 6 days of gestation
A
Term
11
Q
A pregnancy that has reached 20 weeks of gestation but prior to completing week 36
A
Preterm
12
Q
A pregnancy between 37 snd 38 weeks 6 days
A
Early Term
13
Q
A pregnancy between 39 and 40 weeks 6 days
A
Full Term
14
Q
A pregnancy in the 41st week
A
Late Term
15
Q
A pregnancy after 42 weeks
A
Post Term
16
Q
1st Trimester
A
1 to 13 weeks
17
Q
2nd Trimester
A
14 to 26 weeks
18
Q
3rd Trimester
A
27 to 40 weeks (or until birth)
19
Q
Puerperium
A
Birth to the return of the reproductive system to the pre-pregnant state
(Approx 6 weeks postpartum)
20
Q
Enhancing self-efficacy
A
A person’s belief in their ability to complete a task, and whether or not they can behaviourally do something
21
Q
Factors affecting postpartum psychosocial adaptation
A
- Pregnancy/birth experience
- Physical recovery
- Role attainment
- Binding and attachment
- Infant characteristics
- Fatigue
- Ability to meet needs
- Emotional responses
- Socioeconomics
- Social supports
- Family dynamics
- Cultural considerations
22
Q
Facilitating infant behaviours
A
- Easily consolable
- Enjoys cuddling
- Crying only when hungry/wet
- Smiles
- Lifts arms to parent greeting
- Clings to parent
- Eye contact
- Visually alert
- Tracking parents face
23
Q
Inhibiting infant behaviour for attachment
A
- Ignores parents
- Indifference to parents from others
- Unpredictable sleep and feeding schedule
- Cries for hours
- Inconsolable
24
Q
Facilitating parental behaviours
A
- Naming baby
- Holding baby
- Wanting to sooth baby
- Showing off baby
- Showing similarities of baby to parents
25
Inhibiting parental behaviours for attachment
1. Unwilling to talk about their labour/birth experience
2. Doesn’t want to find infant
3. Identifies infant with someone parent dislikes
26
What are the 3 phases of Postpartum Psychosocial Adaptation?
1. Taking in (dependent)
2. Taking Hold (dependent-independent)
3. Letting Go (independent)
27
Taking In Phase
- first 24hrs
- women more focused on their own self and meeting basic needs
- recovering, exhausted, turned inward
- more indecisive
- wonderment and exciting, talkative about birth
- May not feel entirely maternal yet
- Not receptive to teaching
28
Taking Hold Phase
Day 2-3, often lasts 10 days
- focus on learning
- recovered, feeling more competent
- taking charge, involved and eager
29
Letting Go
Accepting new role, letting go of old self and finding new meaning in life.
- focus on forward movement of family, planning for future
- re-establish relationship with partner
30
Mercer Theory of becoming a mother
1. Commitment, Attachment
2. Acquaintance/Attachment, Learning Infant Care
3. New Normal
4. Achievement of Maternal Identity
31
Becoming a Father
1. New Expectations
2. Set new priorities
3. Balance work
4. Redefine their role
5. Reaping rewards
32
Return to menstrual cycle in nonlactating mother’s
Usually 6-8 weeks, 100% by 6 months
33
Return to menstrual cycle in lactating mothers
12 weeks to 18 months
34
GTPAL
Gravidity (# pregnancies)
Term Births (>37weeks)
Preterm Births (20-37)
Abortions/Miscarriages
Living children
35
GP #
Gravidity (# pregnancies)
Parity (# pregnancies >20 weeks)
- not number of fetuses (ie twins)
36
SVD
Spontaneous vaginal delivery
37
SROM
Spontaneous Rupture of Membranes
38
A&W
Alive and well
39
WNL
Within Normal Limits
40
SA or TA
Spontaneous or Therapeutic Abortion
41
BUBBLLEE
```
Breasts (and nipples)
Uterus
Bladder
Bowels
Lochia
Legs
Episiotomy/Laceratuon/Incision
Emotional status
```
42
Uterine involution
After birth the uterus shrinks back down to normal size.
@u for first 12 hrs
At 24hrs should be at 20 weeks pregnancy
Then 1-2 cm every 24hrs.
Day 2: u/2
Day 3: u/3
Day 6: halfway between umbilicus and pubis
Day 9-14: completely involuted, unable to palpate
43
Subinvolution
Failure of uterus to return to nonpregnant state. Most commonly due to retains placental fragments and infection.
44
After pains
Contractions after birth facilitate uterine involution.
| Maintains homeostasis by clampingnoff blood vessels to control bleeding in uterus, and less clotting.
45
Oxytocin
Released from the pituitary to stimulate and coordinate uterine contractions.
Stimulated by cervical stretching and breast feeding.
46
Primip vs Multip
Second time moms may experience more severe cramping than first time moms
47
Rubra Lochia
Red.
Blood
Small clots
Tissue debris
3-4 days postpartum
48
Serosa Lochia
Pink-brown
Old blood
Serum
Leukocytes
Tissue debris
22-27 days postpartum
49
Alba Lochia
Yellow-white
Serum
Leukocytes
Mucus
Epithelial cells
4-8 weeks postpartum
50
Scant lochia
<5cm
51
Small/light Lochia
10cm
52
Moderate lochia
15cm (half of peripad)
53
Large/heavy lochia
>15cm (soaking pad in one hour)
54
Lochia blood flow
Trickles, stops when uterus contracts.
Expressed on palparían but then will stop with contraction.
Usually not as bright red as hemorrhagic blood and more mucousy.
55
1st Degree Laceration
Through superficial skin
56
2nd Degree Laceration
Through perineal muscular body
57
3rd Degree Laceration
Perineal and anal sphincter torn (but not completely)
58
4th Degree Laceration
Involves entire rectal wall
59
Episiotomy
Incision into perineal wall to prevent 3rd or 4th Degree Lac.
60
Perineum Assessment (REEDA)
```
Redness
Ecchymosis
Edema
Discharge/Discomfort
Approximation
```
61
Vital signs postpartum
Opioid medications can cause respiratory depression, drop in BP
62
Legs Postpartum Assessment
Slight increase risk of DVT due to laying down for longer after operation or
63
Lochia post C-section
Slightly less
64
C/S Assessment
1. Breath sounds (resp depression from anesthesia)
2. Bowel sounds
3. Bloodwork (CBC in 2 hours)
4. Signs of infections
65
Postpartum Hemorrhage (PPH)
Hemodynamics instability, life threatening
Vaginal Birth: >500mL blood
C/S: >1000mL blood loss
66
Early PPH
After 24 hrs due to poorly contracted uterus (uterine atony)
67
Uterine atony
Poorly contracted uterus
68
Late PPH
After 24hrs but less than 6 weeks postpartum. Usually due to subinvolutions, infection, placental remnants.
69
PPH Management
1. Call for help
2. Fundal massage
3. O2 mask and BP cuff on
4. Meds to contract uterus
70
Risk Factors for PPH
1. Uterine Atony
a) high parity
b) big baby or twins
c) trauma, forceps assisted birth
d) prolonged labour/oxytocin
2. Infection (chorioamnionitis)
3. Retained placental products
4. Uterine subinvolution
71
PPH Etiologist - 4 Ts
Tone - poor tone or atony
Tissue - retained or abnormal placental implantation
Trauma - Laceration in genital tract, sgx, instrumental delivery
CloTting - hemophilia or Willebrand disease
72
What are the 3 categories of Venous Thromboembolic Disorders?
1. Superficial Venous Thrombosis
2. DVT
3. Pulmonary Embolism
Formation of blood clot in BV. Leading cause of death in Canada.
73
Venous stasis
Pregnant women 4-5x more likely to develop clot due to hypercoagulation
74
Risk Factors for Venous Theomboembolic Disorders
1. C/s or forceps delivery
2. History of VTE, PE, varicositiws, blood clots
3. Obesity
4. Maternal age over 35
5. Multiparity, multiple gestation, twins.
6. Smoking (causes hypercoagulability)
7. Bed rest or immobility
75
Endometritis
Infection of endometrial lining of uterus (most common postpartum infection).
Higher risk with C/S.
S/S: fever, increased HR, chills, anorexia. Nausea, fatigue, lethargy
76
UTI
Not uncommon
Fever, elevated WBCs, dysuria, increased frequency of urination, pain, foul smelling urine I
77
Mastitis
Breast infection, usually unilateral
78
What are the 3 types of postpartum mood disorders?
1. Postpartum blues
2. Postpartum Depression (non-psychotic)
3. Postpartum Depression (psychotic)
Effects almost half of women
79
Postpartum Blues
Heightened sense of joy followed by blue period, peaking around day 5-10 then subsiding.
Transient, with NO FUNCTIONAL IMPAIRMENT
80
Postpartum Depression (PPD)
Insomnia/Hypersomnia, fatigue, appetite changes, feelings of worthlessness, guilt, hopelessness, irritability, decreased concentration, inability to cope, despondency, intense irrational fears, suicidality
FUNCTIONAL IMPAIRMENT
81
Risk Factors for Postpartum Depression
1. Prenatal depression/anxiety, life stress, lack of social support, personal/family hx of depression
2. Low self esteem
3. Stress of child care
4. Low SES
5. Marital relationship problems
6. Difficult child temperament
82
Postpartum Psychosis
Onset 2-8weeks. Same S/S as PPD but with delusions, hallucinations, thoughts of harm to self or infant, agitation, poor judgement, irrational, overactive, disorganized behaviour, inability to care for infant
PSYCHIATRIC EMERGENCY
83
What are the 3 phases of the “Transition Period”?
1. Period of reactivity
2. Period of Decreased Responsiveness
3. Second Period if Reactivity
84
Period of Reactivity
Up to 3 hours
HR: increases to 160-180 bpm
Gradual decline to baseline 100-160 bpm, irregular
RR: irregular, 60-80 breaths/min
Alert, startles, cries
85
Period of decreased responsiveness
60-100 minutes
HR: normal baseline (100-160 bpm)
RR: rapid, shallow, up to 60 breaths/mi
Sleep or marked decreased in motor activity
86
Second Period of Reactivity
4-8 hours to one day
HR: brief periods of tachycardia
RR: brief periods of tachypnea
Increased muscle tone
87
APGAR Score
HR, Respiratory effort, muscle tone, reflex/irritability, colour
0-3 (Severe Distress)
4-6 (moderate distress)
7-10 (minimal effort and difficulty)
88
APGAR Scores
HR > 100bpm
RR - good, crying, no gasping or nasal flaring
Muscle tone - well flexed, active movements of extremities
Reflex - good cry (moderate= grimace or weak cry)
Colour - pink all over (moderate = cyanosis in extremities)
89
Newborn apnea
Lasting <20 seconds WNL
90
Reasons for apnea
Rapid increase in body temp or hypothermia, speaks, neuro problem, hypoglycaemia, junk in mouth, crying
91
Factors that trigger newborn’s first breath
- cutting umbilical cord
- reflex triggered by pressure changes
- crying from cool air temperature, noise, light, and other sensations
- chemoreceptors in aorta and carotid bodies initiate reflex when arterial oxygen pressure and pH falls and CO2 pressure rises
92
Foramen ovale
Shunt blood from R atrium to L atrium, bypassing the lungs in utero
Permanently closed by 1 year of age.
93
Ductus arteriosus
Shunts blood from pulmonary artery tonaorta, bypassing lungs.
Closes in presence of oxygen in blood. Permanently closed by 3 weeks.
First breath inflated lungs/cord cutting, pressure drops, foramen ovale and ductus arteriosus close
94
Newborn Vital Signs
HR: 110-169 bpm
RR: 30-60
T: 36.5 - 37.5 degrees C
BP: 60/40 to 80/50
95
Baby’s weight
2500-4000g
SGA < 2500g (small gestational age)
LGA >4000g
96
Acrocyanosis
Cyanosis in hands and feet
97
Erythromycin ointment
Eye prophylaxis 1-2cn ribbon 0.5% within 2 hours of birth.
Adverse reaction 24-48hrs: conjunctivitis temporary blurry vision
98
Vitamin K Prophylaxisis
Prevention/tx of hemorrhagic disease in newborns. Promoted clotting factors.
0.5-1mg IM injection within 6 hours after birth.
Adverse reactions: edema, erythema, discomfort/pain at site
99
What are the 2 sleep states?
1. Deep sleep
| 2. Light sleep
100
What are the 4 awake states?
1. Drowsy
2. Quiet alert
3. Active alert
4. Crying
101
What are the 12 newborn reflexes?
1. Rooting
2. Sucking
3. Swallowing
4. Grasp - Palmar and Plantar
5. Extrusion
6. Glabellar
7. Tonic Neck or “Fencing”
8. Moro (or startle)
9. Stepping or Walking
10. Deep Tendon
11. Crawling
12. Babinski
102
Newborn reflex that forced tongue toward when touch or depress tip of tongue
Extrusion
103
Newborn reflex to blink first 4-5 taps on forehead, bridge of nose, or maxilla
Glabellar
104
Newborn reflex of supine infant turning head to one side and arm and leg on that side extend while opposite limbs flex.
Tonic Neck or “Fencing”
105
Newborn reflex of symmetrical abduction and extension of arms when loud or abrupt sound
Moro or Startle Reflex
106
Newborn reflex to hyperextend toes into dorsiflexion when touch moves from sole of foot up and across ball of foot
Babinski Reflex
107
What are the 4 mode did heat loss?
1. Radiation
2. Evaporation
3. Conduction
4. Convection
108
What are contributing factors to newborn thermogenesis?
1. Less subQ
2. Larger body surface to body mass
3. Larger head
4. Higher metabolic rate with limited stores
5. Poor shivering response
109
Cold Stress
1. Increased O2 consumption
2. Increased RR
3. Pulmonary vasoconstriction
4. Decreased O2 uptake
3. Peripheral vasoconstriction
4. Decreased O2 to tissues
5. Increased anaerobic glycolysis
6. Decreased PO2 and pH
7. Metabolic acidosis
110
Signs of cold stress
- crying/restlessness, cool to touch
- increased RR initially
- pronounces acrocyanosis
- resp distress
- circumpolar cyanosis
- hypoglycaemia
111
Brown fat
Superficial deposits along scapula, anilla, around kidneys, and thoracic inlet. Activated by cold, run lipids through mitochondria to create HEAT (instead of ATP).
112
Bones on baby’s head are not secured and move to fit through vago al cavity
Moulding
113
Fine hair covering baby’s body
Lanuga
114
Swelling of head due to pressure of delivery, usually disappears in 3-4 days.
Capital succudaneum
115
Fontanelles
Anterior (diamond) stays open until 18 months
| Posterior (triangle) closes by 6-8 weeks
116
Collection of blood within skull bone and periosteum due to sheering force. Does not cross suture lines, spontaneously resolves in 3-6 weeks.
Cephalhematoma
117
Bluish black area of pigmentation
Mongolian spot
118
Odourless, skin cells and sebaceous cells moisturizer baby’s skin
Vernix
119
Distended small white sebaceous glands on newborns face
Milia
120
Respiratory Red Flags
- Tachypnea
- Bradypnea
- Nadal flaring
- Retractions/I drawing
- Grunting
- unequal bilat breath sounds
- cyanosis
- apnea
121
Cardiovascular Red Flags
- tachycardia (sustained)
- bradycardia (sustained)
- abnormal heart sounds
- abnormal location of heart sounds (dextrocardia=opposite side)
- weak, absent or unequal pulses
- cyanosis
122
Newborn Neuro Red Flags
Jitteriness/tremors (bilateral, not stopped when held)
- Lethargy
- irritability
- bulging fontanelles
- hyper or hypotonia
- seizure activity
123
Hyperbilirubinemia
Jaundice
= elevated UNconjugated bilirubin
Due to:
- more RBC breakdown
- immature liver
- lower albumin
124
Physiological Jaundice
60% newborns
| >24hrs old
125
Pathological Jaundice
<24hrs old, or longer than 2 weeks
Hemolytic anemia (breaks down RBCs too fast)
Septic, hyperthyroidism, G6PD Deficiency
126
Breastfeeding Jaundice
2-5 days old, due to ineffective breastfeeding, decreased hepatic clearance
127
Contraindications for infant breastfeeding
- Galactosemia
| - Metabolic disorders
128
Mother contraindications for breastfeeding
- chemotherapy
- TB or Varicella
- HIV
- Herpes
- Substance abuse
- Human T-Lymphotrophic Virus
- Select meds
- Chagas Disease
129
BFI step most correlated with long- term breastfeeding
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospital
130
What are the 3 stages of Lactogenesis?
1. Differentiation
2. Activation
3. Maintenance
(DAM)
131
Lactogenesis 1 - Differentiation
Occurs mid pregnancy, Prolactin stimulates cells to differentiate. Progesterone inhibits the onset of copious milk secretion.
132
Colostrum
- 2-20 mls/feed
- lower in fat and sugar than mature milk
- high protein and minerals
- contains IgA
- laxative effect
133
Decreased in progesterone, estrogen, placental Lactogen
| Increased in oxytocin and prolactin
Lactogenesis 2 - Activation
134
Feedback inhibitor of lactation (FIL)
Small whey protein acts as local negative feedback mechanism to signal sloe or stop milk production and visa versa
135
Milk Production feedback loop
1. Suckling causes hypothalamus to signal anterior pituitary to release prolactin
2. Alveoli in breast make milk in response to the release of prolactin
3. Oxytocin contracts muscle cells causing “let down”
136
Inverted nipple
Pinch test = if areola and nipple goes in
137
What are the 6 P’s that affect labour?
```
Passenger
Passageway
Powers (contractions and pushing)
Position
Psychological Response
People
```
138
Primary contractions
Involuntary, every 2 minutes in labour
139
Secondary contractions
Pushing, mostly voluntary
140
What are the 4 Fetal Presentations?
1. Occiput
2. Brow
3. Breach
4. Shoulder
141
What are the 3 Fetal Lies?
1. Longitudinal = vertex or breach
2. Transverse
3. Oblique
142
Fetal attitude
Fetal body parts related to each other. Well-flexed.
143
Fetal Positions
```
O = occiput
R = right
L = left
A = occiput facing anterior
P = occiput facing posterio
T = transverse (occiput facing sideways)
D = direct
```
144
Fetal station
0 at ischial spine of ischial tuberosity
145
What are the 4 stages of labour?
1st stage = onset of uterine activity to complete effecement and dilation (100% and 10cm)
Latent (0-4cm) and Active (4-10cm)
2nd stage = full dilationto birth of fetus (pushing stage)
3. Birth of fetus to birth of placenta
4. 2hrs post birth
146
Latent Labour
```
0-3cm dilated
75% effaced
6-8 hrs
Contractions = mild to moderate, irregular, q5-30min, 30-45 sec
Station: 0 to -2
Bloody show: Brownish-pale pink, scant
```
147
Active & Transition Labour
```
4-10cm dilated
75-100% effaced
3-6hrs
Contractions: Moderate-Strong, regular, q2-4 min, 45-90secs
Bloody pink mucous, scant-copious
```
148
Amniotic Membranes (COAT)
Colour
Odour
Amount
Time
Nitrizine to test presence
149
PROM
Premature Rupture of membranes
(Without labour)
Often administered oxytocin
150
PPROM
Preterm Premature ROM (less than 37wks without labour)
| Hook to tear sac
151
Labour dystocia
Delayed, arrests or not progressing.
Stress response releases cortisol which release catecholamine secretions, reducing contractions.
152
Spinal Block
Between L3 and L4 in subarachnoid space. No catheter left in, usually during C/S.
153
Epidural Block
Between L5 and L6 in epidural space. Catheter to continuos pump.
154
What is a risk of an increased length of 3rd stage of labour?
Increased risk of hemorrhage
155
When is fetal heart rate present?
12-13 weeks
156
Positive Goodall Sign
Softening of cervix, increased vascularity
157
Positive Chadwick Sign
Deepening colour of vagina mucosa
158
Beta hCG
Rise until day 60-70, number amount in bloodwork, pos or neg in urine
Low levels = miscarriage
High levels = ectopic pregnancy, multiples, or Down Syndrome
159
Nazgele’s Rule
```
Lunar months (28 days)
280 days, 40 weeks gestation
```
LMP - 3 months + 7 days + 1 year = EDB (by dates)
LMP +7 days + 9 months = EDB
160
Parental Development for mothers
1. Accepting the pregnancy
2. Identifying with role of mother
3. De-ordering personal relationships
4. Establishing relationship with fetus
5. Preparing for childbirth
161
Fatherhood stages
1. Announcement Stage
2. Moratorium (often philosophical)
3. Focussing Phase (active involvement in pregnancy)
4. Relationship with fetus
5. Identifies as father
162
GBS Test
35-37 weeks
163
Pregnancy Red Flags
1. Severe Headaches (preeclampsia)
2. Visual disturbances (preeclampsia)
3. Fever
4. Accidents/falls/injuries
5. Vaginal bleeding/discharge
6. Contractions
7. Pain
8. Decreased Fetal Movement
9. SOB, Chest pain
164
Fundal height
20-22 weeks = umbilicus
18-32 weeks = equals GA
38-48 weeks = May drop in preparation
165
Where would the nurse expect to palpate the fundus 24hrs postpartum?
At umbilicus, same as 20 weeks
166
What is the reason for a sitz bath?
Helps promote episiotomy/Laceration healing and comfort
167
Characteristics of contractions
1. Frequency
2. Resting tone
3. Intensity
4. Duration
168
When is uterine involution expected to start?
Immediately after birth of placenta
