NURS 330 FINAL Flashcards
(576 cards)
1
Q
Genetic Disorders
A
Disease caused by a genetic mutation that is either inherited or arises spontaneously
2
Q
Autosomal Dominant
A
Each child has a 50% chance of showing the disease (Huntington’s, braca breast cancer gene)
3
Q
Autosomal Recessive
A
Each child has 50% chance of being a carrier and 25% chance of showing (Cystic fibrosis)
4
Q
X-Linked Recessive
A
Males at risk - Each male has 50% risk of showing (color blindness, hemophilia a, duchene muscular dystropyh)
5
Q
Numerical Chromosome Abnormality
A
Entire single chromosome added or missing
6
Q
Structural Chromosome Abnormality
A
Part of chromosome missing or added OR abnormal rearrangement of material within the chromosome
7
Q
Trisomy
A
Extra copy of one chromosome (47)
8
Q
Trisomy 21
A
Down Syndrome = most common
8
Q
Trisomy 13
A
Less common, severe (don’t live past infancy)
8
Q
Klinefelter’s Syndrome
A
Boys have an extra X chromosome (XXY)
8
Q
Turner’s Syndrome
A
Only monosomy compatible with life (girls - single X)
8
Q
Monosomy
A
Missing chromosome (45)
8
Q
Bowlby’s Attachment Theory
A
- Pre-attachment (birth-6wk)
- Attachment in making (6wk - 6-8mos)
- Clear-Cut attachment (6-8mos - 18-24mos)
- Formation of Reciprocal Relationships (24mos +)
9
Q
Erickson’s Psychosocial Theory
A
- Trust vs Mistrust (infant - 18mos)
- Autonomy vs Shame/Doubt (18mos - 3yrs)
- Initiative vs Guilt (3-5yrs)
- Industry vs Inferiority (5-13yrs)
10
Q
Piaget’s Theory of Cognitive Development
A
- Sensorimotor (infant - 18/24mos)
- Preoperational (2-7yrs)
- Concrete operational (7-13yrs)
- Formal Operation (adolescence - adulthood)
11
Q
Freud’s Theory of Psychosexual Development
A
- Oral stage (birth-1yr)
- Anal stage (1-3yrs)
- Phallic stage (3-6yrs)
- Latency stage (6yr-puberty)
12
Q
Kohlberg’s Theory of Moral Development
A
- Pre-Conventional
a) obedience & mortality
b) individualism & exchange - Conventional Mortality
a) good interpersonal relationships
b) social order - Individualism & Exchange
a) social contract & individual rights
b) universal principles
13
Q
Respiratory Differences in PEDS
A
Nose breathers
Larger tongue
Decreased lung capacity and IC muscles
Increased RR and O2 demand
Short airway
Barrel-chested
Rely on diaphragm
Prone to retractions
14
Q
Asthma
A
Chronic airway inflammation (infiltration of T cells, mast cells, basophils, macrophages, and eosinophils)
15
Q
Characteristics of Asthma
A
- Bronchial (airway) hyperresponsiveness
- Airway edema
- Mucous production
16
Q
Silent Asthma
A
coughing at night when mucous settles
17
Q
Prevalence of Asthma in Canadian children
A
10-20%
18
Q
Most common cause of asthma exacerbation
A
Respiratory viral infections
19
Q
S&S of Asthma
A
Wheezing, increased RR and air entry, increased work of breathing, coughing/sputum
20
Pediatric Respiratory Assessment Measure (PRAM)
O2 sats, use of accessory muscles, air entry in both longs
Mild = 0-3
Mod = 4-7
Severe = 8-12
21
SABA
Ventolin - Rescue Med
22
LABA
Salmeterol - Pre-exercise
23
Anticholinergic
Ipratropium or atrovent - inhibits bronchoconstriction and decrease mucous production
24
Inhaled Corticosteroid
Budenoside and fluticasone
25
Oral Corticosteroid
“Bursts” for uncontrolled asthma
26
Treatment for mild PRAM
Keep O2 > 92%, salbutamol, consider oral steroids
27
Treatment for mod PRAM
Keep O2 > 92%, salbutamol, oral steroids, consider ipratropium
28
Treatment for severe PRAM
Keep O2 > 92%, salbutamol & ipratropium, PO steroids, IV methylprednisolone, continuous SAB, IV mag sulf
29
Respiratory Syncytial Virus (RSV)
Most common lower resp tract infections in children, leading cause of pneumonia and bronchitis in infants
29
S&S of RSV
Coughing, rhinorrhea, wheezing, irritability, low fever, nasal flaring & retractions, palpable liver & spleen
30
Management of RSV
Airway = #1, position/O2/Suction, ventolin & ribovarin
31
Influenza/Parainfluenza
Virus that can cause upper/lower resp infection (bronchitis, croup & pneumonia)
32
S&S of Influenza
Fever, cough, runny nose, sore throat, SOB, wheezing
33
Croup-Laryngotracheobronchitis
VIRAL - swelling in trachea and larynx
34
S&S of Croup
Tachypnea, stridor, seal-like barking cough
35
Management of Croup
O2, racemic epinephrine, corticosteroids
36
Pertussis-Whooping Cough
Bacterial
37
S&S of Pertussis-whooping cough
Runny nose, fever, mild cough, high-pitched whoop/crowing sound & gasp for air, vomiting after coughing spell
38
Necrotizing Enterocolitis (NEC)
Most common and serious GI disorders in hospitalized preterm neonates - bowel dying
39
S&S of NEC
Vomiting, bloody diarrhea, ABD distention, feeding intolerance, irritability OR lethargy
40
Management of NEC
Surgical resection
41
Long-Term complications of NEC
Malabsorption, short bowel, scarring/narrowing of bowel, scarring in abdomen
42
S&S of Dehydration
Irritable, sunken fontanels, sunken eyes, no tears, tenting of skin, bradycardia, hypotension, urine output < 1ml/kg/hr
43
Dehydration Management
IV fluids - NS bolus, then D5NS for sugar
44
Hirschsprung (Congenital anianglionic megacolon)
Absence of autonomic parasympathetic ganglion cells of the colon that prevent peristalsis
45
S&S of Hirschsprung
Vomiting, ABD distention, constipation, no MEC
46
Management of TEF
Surgery to close fistula
46
Management of Hirschsprung
Surgical resection of dysfunctional portion
46
Tracheoesophageal Fistula (TEF)
Abnormal opening between trachea and esophagus
46
Diagnosis of TEF
Barium Swallow test
46
Imperforate Anus
Passage of fecal material obstructed
46
Management of imperforate anus
Surgery to create anal opening
47
Intussuseption
One portion of bowel slides/invaginates into next
48
S&S of Intussuseption
vomiting, currant jelly, pain
49
Management of Intussuseption
Barium Enema
50
Pyloric Stenosis
Hypertrophy of circular pyloris muscle - stenosis of passage between stomach and duodenum
51
S&S of Pyloric Stenosis
Projectile vomiting, FTT, dehydration, appears hungry
52
Nissen Fundoplication
For bad acid reflex to tighten stomach
53
Formation of Cavity
Bacteria + sugar = acid
Acid + tooth = cavity
54
Early Lesions
White/chalky, seen at gum line
55
Progressing/Advanced lesions
Light brown, wet
56
Inactive/Arrested Lesions
Dark brown/black, leathery
57
Extra-oral exam
general appearance, asymmetry/swelling
58
Intra-oral exam
count teeth, note dark staining (D), fillings (F), broken (B), swellings (A)
59
Diabetes in Children
Most common metabolic disease in children
60
Type 1 Diabetes
Autoimmune destruction of insulin producing cells (beta-cella) resulting in COMPLETE INSULIN DEFICIENCY
61
Type 2 Diabetes
Obesity - biggest risk factor - insufficient production of insulin causing high blood sugar
62
Complications of Type 2 Diabetes
Kidney disease, retinopathy, neuropathy, dyslipidemia, HTN
63
Hemoglobin A1C
Objective measurement of glycemic control
64
Diabetic Ketoacidosis (DKA)
Complex metabolic state of hyperglcemia, ketosis and acidosis
65
HYPERglycemia
Hot & dry, sugar high - polyphagia, polydipsia, polyuria, dry skin, blurred vision
66
HYPOglycemia
Cool & clammy, need a candy
Tachycardia, Irritability, Restlessness, Excessive hunger, Dizziness, pallor/clammy
67
Insulin
Anabolic hormone made in beta cells of islets in pancreas - allows entrance of glucose into cells
68
Spinal Cord Injury (SCI)
Mechanism of injury & direction of forces determines the type of lesion that occurs
69
Complete SCI
Total loss of all motor/sensory function below level of injury
70
Incomplete SCI
Some function below level of injury
71
SCI at C3
Ventilator required
72
SCI at C5
No wrist/hand control, diaphragm function present
73
SCI at C6-C7
Quadriplegia, some function of upper extremities
74
SCI at T1-T8
Hand control, poor trunk control, lack of ABD muscles
75
SCI at T9-T12
Good trunk and ABD muscle control
76
Concussion
Most common head injury
77
S&S of Concussion
Confusion, N/V, dizziness, unusual emotions, slurred speech, headache, slow response, decreased coordination, loss of consciousness
78
Post-concussive Syndrome
2-12 hours after concussion
79
Causes of Increased Intracranial Pressure
Meningitis, encephalitis, trauma
80
Prevalence of Post-Traumatic seizures
10% of head injuries
81
Head injury complications
Ischemia, death of tissues, deficits, hearing/vision problems, speech and learning problems, behavioral changes
82
Epidural hematoma
Bleeding between dura and cranium -fast onset
83
Subdural hematoma
Bleeding right against the brain - slow onset
84
Nociceptive Pain
Damage to underlying soft & bone tissues by disease
85
Somatic Pain
Well localized, sharp, throbbing, squeezing, aching
86
Visceral Pain
Diffuse, poorly localized, dull, crampy, colichy
87
Neuropathic Pain
Invasion of or traction on nerves arising from injury to CNS and PNS - burning, stinging, lancinating, tingling, stabbing, prickly, shock-like
88
Pain Assessment tools for Neonates
CRIES
89
Pain assessment tools for FLACC
Face
Legs
Activity
Cry
Consolability
2mos-7yrs
90
Wong-Baker FACES
> 3-4yrs
91
Nervous system at birth
Complete, but immature
Myelination incomplete until 4 years and brain 1/4 size of adult (full mass by age 7-10)
92
Pediatric Coma Scale
1. Eye opening
2. Best motor response
3. Best response to auditory and/or verbal response
93
S&S of increased ICP
Bradycardia, wide pulse pressure, irregular resps, irritability, bulging fontanels, increased head circ, seizure, vomiting
94
Most important indicator of neurologic dysfunction
Level of Consciousness!
95
Meningitis
Inflammation of the meninges
96
S&S of Meningitis
Headache, fever, lethargy, rashes, seizures
97
Most common source of Meningitis
Resp Infection
98
Diagnosis of Meningitis
Brudzinski’s sign = neck stiffness
Kernig’s sign = hamstring stiffness
1. LP
2. BW
3. Antibiotics
99
Bacterial Meningitis
Less common, more severe
100
Aseptic Meningitis
Headache, fever, and inflammation - usually viral
101
Encephalitis
Inflammation of the brain caused by infection or toxin - edema and neuro dysfunction
102
S&S of Encephalitis
headache, fever, N/V, stiff neck, dizziness, ataxia, convulsions (seizures), sensory disturbances, drowsiness
103
Causes of Encephalitis
HSV, ticks, mosquitoes, measles, mumps, chickenpox, rubella, mononucleosis
104
Herpes Encephalitis
Untreated infants with HSV have 85% mortality rate
105
Prevention of Herpes Encephalitis
C/S, contact dressing, secretion precautions
106
Treatment of Herpes Encephalitis
Antiviral meds, corticosteroids (decrease head growth), anticonvulsants PRN, antipyretics
107
Seizures
Involuntary contraction of muscle caused by abnormal electrical brain discharges
108
Status Epilepticus
Prolonged and clustered seizures in which consciousness does not return between
109
Intractable Seizures
Seizures that continue to occur even with optimal medication management
110
Epilepsity
Recurring seizures that have no immediate underlying cause/problem that cannot be corrected
111
Partial (focal) seizures
Electrical disturbance is limited to a specific area of one cerebral hemisphere (with or without loss of consciousness)
112
Partial Seizures WITH loss of consciousness
with or without aura, tonic clonic movement on one side, followed by confusion and lethargy
113
Partial seizures without loss of consciousness
motor, autonomic, or sensory symptoms - aware and conscious
114
Generalized Seizure
Affect both cerebral hemispheres - impair consciousness
115
Absence Seizures
Lapses of awareness that begin and end abruptly, lasting a few seconds (<30 seconds)
116
Atonic Seizures
Abrupt loss of muscle tone - head drops, loss of posture, sudden collapse, loss of consciousness
117
Myoclonic Seizures
Rapid, brief contractions of muscles - both sides of the body (may or may not lose consciousness)
118
Tonic Clonic Seizures
Most common - begin with stiff limbs (tonic phase) and then jerking of limbs and face (clonic phase)
119
Infantile Spasms
Starts at 3-12mos, increase in intensity and duration with age
120
Causes of Infantile Spasms
Fever, genetics, cerebral lesions, brain disease, trauma, infection
121
Treatment of Infantile Spasms
meds, ketogenic diet (90% fat and low carb), extratemporal cortical resection, functional hemospherectomy
122
Spina Bifida
Any congenital defect involving insufficient closure of the spin - neural tube defect
123
Meningomyelocele
Spine damage (sac breaks skin)
124
Meningocele
No damage to spinal cord (75%)
125
S&S of Spina Bifida
Paralysis, lack of sensation, hydrocephalus, visible protrusion in the back
126
Treatment of Spina Bifida
Surgical repair
127
Hydrocephalus
Result of imbalance between production and absorption of CSF - Increased CSF in brain causes abnormal enlargement of brain ventricles
128
S&S of Hydrocephalus
Large head, rapid growth of head, bulging anterior fontanels, N/V, sleepiness, irritability, seizures, eyes fixed down, blurred/double vision
129
Causes of Hydrocephalus
Obstructive (noncommunicating) - prevents CSF flow and Non-obstructive (communicating) - problem with producing or absorbing CSF
130
Types of Shunts
Ventricular Peritoneal (VP) - drains into peritoneal cavity
Ommaya Reservoir - can give meds and drain come
External Ventricular Device (EVD) - stay laying at all time
131
Cardiopulmonary bypass (CPB)
Artificial blood pump continuously propels blood forward into artificial oxygenator then to patient tissues
132
Cardioplegia pump
Introduce a high potassium solution directly to the heart to induce and maintain cardiac arrest
133
Cardiac Hemodynamic Parameters
Systole, diastole, ESV, EDV, CO
134
Systole
Heart contracts with ejection of blood
135
Diastole
Heart relaxes and fills with blood
136
End-Systolic Volume (ESV)
Volume of blood left in heart after contraction
137
End-Diastolic Volume (EDV)
Volume of blood in heart after filling
138
Preload
Volume of blood in ventricles at end of diastole
139
Afterload
Resistance left ventricle must overcome to circulate blood
140
Contractility
Force of contraction
141
Ductus Venosus
Gradually closes after birth
142
Ductus Arteriosus
Gradually constricts after birth
143
Foramen Ovale
Increased BF to lungs closes this after birth
144
Causes of Heart defects
Teratogenic, chance, familial link, chromosomal abnormalities
145
DiGeorge
Deletion at 22
146
S&S of CHD
Cyanosis, resp distress, CHF, decreased CO, abnormal cardiac rhythms, cardiac murmur, FTT
147
Cardiac Catheterization Monitoring
1. Pressures within the heart
2. O2 sats
3. BF patterns
4. Structural info (valves , chambers, great vessels)
148
Tetrology of Fallot
1. Ventricular septal defect
2. Pulmonary stenosis
3. Overriding aorta
4. Right ventricular hypertrophy
149
S&S of TOF
Clubbing, central cyanosis
150
Treatment of TOF
Beta blockers, morphine, prostaglandin EI, surgery, +/- BT shunt, subclavian artery to PA
151
Tricuspid Atresia (TA)
Absent of imperforate tricuspid valve
152
S&S of TA
Cyanosis, acute resp failure, hypoxemia, acidosis
153
Treatment of TA
Creation of shunts
154
Complications of Catheterization
Arrhythmias, bleeding, cardiac perforation, CVA, hypercyanotic spells, vascular complications, infection
155
Post-Cath nursing care
1. Arterial perfusion: pallor, mottling, decreased pulses, cool skin, decreased cap refill
2. Venous obstruction: edema,infection
156
Components of Blood
Plasma (55%), WBC & Platelets (4%) and RBC (41%)
157
Plasma
For coagulation (clotting)
158
WBC and Pletelets
Fight infection, stop bleeding
159
RBC
Carry oxygen
160
RBC count
Actual RBC count
161
Hemoglobin (Hgb)
Measure of heme & globin protein
162
Hematocrit (Hct)
Indirect measure of RBC’s
163
Mean Corpuscular Volume (MCV)
Size of RBC’s
164
WBC count
Actual number of WBCs
165
166
Differentials
WBC types
167
Platelet Count
Number of platelets per blood volume
168
Anemia
Decreased production and increased destruction/blood loss, sequestration
169
Sizes of RBC’s
Microcytic (small)
Normocytic (normal)
Macrocytic (large)
170
Anemia r/t decreased production
Marrow infiltration/injury, nutritional deficiency, erythropoietic deficiency, ineffective erythropoiesis
171
Hemolysis - Extrinsic
Acquired
172
Hemolysis -- Intrinsic
Inherited
173
Iron Deficiency Anemia
Excessive blood loss, inadequate intake, increased demand, impaired absorption
174
Management of Anemia
Dietary education - iron rich foods, decrease milk intake
Iron supplementation
175
Sickle Cell Anemia
Qualitative defect of Hgb that is insoluble at low O2 concentration and forms “sickles” that are sticky and cause hemolysis and vasoocclusion in vessels
176
Manifestation of Sickle Cell Anemia
Acute pain, stroke, acute-chest syndrome, chronic infection, splenic infarction, renal impairment, dactylitis, priapism, retinal damage
177
ABCDEF of Sickle Cell
A) Assess and reassess pain
B) Believe child’s report of pain
C) Complications/Cause of pain
D) Drugs and distraction
E) Environment
F) Fluids - avoid overload
178
Decreased WBC’s
Increased risk of infection
179
Increased WBC’s
Infection, inflammation, tissue damage, leukemia
180
S&S of decreased Platelets
Bruising, nose bleed, bleeding gums, petichiae, purpura
181
Causes of decreased platelets
Infection, idiopathic thrombocytopenia purpura, DIC, meds, platelet disorders
182
Hemophilia a and b
X-linked recessive
183
Von WIllebrand Disease
Autosomal recessive/dominant
184
Common Sites for Childhood Cancers
CNS, bone, muscles, endothelial tissue, connective tissue, blood, lymph tissue
185
Leukemia
WBC grow out of control
185
Prevalence of Leukemia
32% of childhood cancer
186
Lymphoma
Tumour of the lymph tissue
- Hodgkins and Non-Hodgkins
187
S&S of Pediatric Brain Tumours
Headaches, N/V, visual/hearing problems, seizures, slurred speech, dysphagia, memory problems, difficulty concentrating
188
Posterior Fossa
60%
- Medullablastoma
- Astrocytoma
- Ependymoma
- Diffuse intrinsic pontineglioma
- atypical teratoid rhabdoid tumour (ATRT)
189
Cerebral Hemisphere
40%
- Astrocytoma
- ganglioma, craniopharyngiomas
- Supratentioal primitive neuroectodermal tumors (PNET)
190
Osteosarcoma
Increased risk in males, near growth plates, in long bones
191
Rhabdomyosarcoma
Soft-tissue tumour, increased head and neck, increased risk in males
192
Wilm’s Tumour (nephroblastoma)
In kidney cells - can grow out of it!
193
S&S of Wilms
“dancing eyes”, diarrhea
194
AE of Chemotherapy
Kills healthy cells, bone marrow suppression, mucositis, N/V, wt loss, constipation, diarrhea, immunosuppression, myelosuppression, alopecia, organ dysfunction
195
AE of Alkylating
Hemorrhagic cystitis, nephrotoxicity, neurotoxicity
196
AE of Antiometabolites
Hepatotoxicity, dermatitis, neurotoxicity, fever
197
AE of Steroids
Immune suppression, mood changes, diabetes, HTN
198
AE of Asparginase
Clots, pancreatitis
199
AE of antitumour antibiotics
Heart issues
200
Radiation
Breaks bonds within cells to damage/kill
201
AE of Radiation
Fatigue, memory loss, decreased development/grotwh, N/V, skin burning, myelosuppression, organ dysfunction
202
Stages of Grief
1) Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance
203
Underweight BMI for children
< 18.5
203
Normal BMI for children
18.5-24.9
203
Overweight BMI for children
25-29.0
204
Obese BMI in children
>30
205
How much physical activity should children get
1 hour per day
206
Wellness Assessment for Children
Social, psychological, spiritual, physical
207
Preconception care
Wt/nutrition/exercise, modifiable risk factors, folic acid & iron, oral health, immunizations, screening for diseases/STI’s, genetic counselling, family planning, social risk factors, optimize mental health
208
Routine screening in pregnancy
Blood group, Rh and Hgb, infectious diseases, gestational diabetes, perinatal serum, group B strep (35-37wk), asymptomatic bacteriuria
209
Non-Routine Screening in pregnancy
more ultrasounds, doppler flow studies, marker tests, nuchal translucency, amniocentesis, chorionicvillus, non-stress test, biophysical profile (BPP), measurement of amniotic fluid
210
Role of Amniotic Fluid
Cushions fetus, temp control, infection control, lung & GI development, muscle & bone development, umbilical cord support
211
Oligohydramnios
Too little amniotic fluid
212
Polyhydramnios
Too much amniotic fluid
213
1st Trimester Screening
11-14wks. PAPP-A, BetahCG, r/o chromosome disorders
214
2nd Trimester Screening
15-20wks. Quad screen - AFP, E3, Inhibin A and Betahcg
215
5 P’s of Labour
1. Passage(way)
2. Passenger
3. Powers
4. Position
5. Psychosocial
216
Passage(way)
Ability of pelvis and cervix to accommodate passage of fetus
- Optimal Pelvis = gynecoid, arthropoid
- Less Optimal = android & platypelloid
217
Passenger
Ability of fetus to complete birth process
218
Molding
Cranial bones overlap under pressure of the powers of labour and demands unyielding pelvis
219
Suboccipitobregmatic
Smallest diameter of fetus’ head
220
Passenger Characteristics
a) Attitude
b) Lie
c) Presentation
d) Position
e) Station
221
Fetal Attitude
Relationship of fetal parts to one another
- optimal = flexed
- less optimal = extended or brow
222
Fetal Lie
Relationship fetal spine to maternal spine
- Optimal = longitudinal
- less optimal = transverse, oblique
223
Fetal Presentation
Determined by fetal lie and body part of fetus that enters pelvic passage first (presenting part)
224
Cephalic presentation
Head
225
Breech presentation
buttocks
226
Shoulder presentation
Dystocia - requires C/S
227
Compound presentation
> 1 fetal part presenting (ex. hand on head)
228
Fetal Position
Position of fetus in relation to the pelvis
- Optimal = ROA or LOA
- less optimal = ROT, ROP, OP, LOP, LOT, OA
229
Fetal Station
Relationship of presenting part to imaginary line drawn between ischial spines of pelvis
230
Engaged station
“0” = engaged OR largest diameter of presenting part passes through pelvic inlet
231
Powers
Contractions and effectiveness of expulsion methods
232
Primary Powers
Uterine muscular contractions
233
Secondary Powers
Abdominal muscles used to push during 2nd stage
234
Assessing Contractions
Frequency
Duration
Intensity
Resting Tone
235
Position
Maternal - reposition is helpful
236
Premonitory Signs of Labour
Lightening, Braxton hicks, increased vaginal mucous, cervical changes, bloody show, rupture of membranes, sudden burst of energy, loss of 0.5-1kg, diarrhea/indigestion/NV
237
Braxton Hicks
Contractions that don’t progress, “tight” feeling, intermittent
238
1st Stage of Labour
a) Early or latent phase (0-3cm)
b) Active phase (4-7cm)
c) Transition phase (7-10cm)
239
2nd Stage of Labour
Pushing - up to 3hrs
240
3rd Stage of Labour
Delivery of Fetus to delivery of placenta
241
4th Stage of Labour
1-4 hours after placental delivery
242
Baseline Assessment in Labour
FHR, VS, cervix, membranes, bleeding, edema, weight change, urine (glucose, ketones, protein, UTI), other anomalies
243
Lab Test Pre-Labour
CBC, infection/blood dyscrasia/coags, serologic testing, blood type/Rh/antibodies, HIV/Hep B&C, Ultrasounds, GBS/diabetes
244
Tachysystole
Frequency = >6 in 10, duration > 90sec, <30 sec resting tone
245
How to Determine Dilation and Effacement
Sterile Vaginal Exam (SVE)
246
SROM
Spontaneous Rupture of Membranes
247
AROM
Artificial Rupture of Membranes
248
PROM
Premature Rupture of Membranes
249
PPROM
Preterm Premature Rupture of Membranes
250
What to Assess for ROM
Time, amount, color, odor
251
Characteristics of amniotic fluid
800-100mls
Clear/white
Earthy smell (not foul)
252
Green Amniotic fluid
Meconium (thick, thin or particulate)
253
Blood Amniotic fluid
Streaks/brown/pink = normal
Bright red is NOT normal
254
Nitrazine Test
To confirm ROM
Yellow = negative
Blue = positive
255
Fetal Health Surveillance
1. Intermittent Auscultation (IA)
2. Electronic Fetal Monitoring (EFM)
256
FHR basline
110-160bpm
257
Fetal tachycardia
>160bpm for >10mins
258
Fetal bradycardia
<110 for >10mins
259
Variability
Fluctuations in FHR/min
Absent = A
Minimal = MN = <5bpm
Moderate = MD = 6-25bpm
Marked = MK = >25bpm
260
Normal Variability in FHR
Moderate (6-25)
261
Sinusoidal FHR pattern
Smooth, repetitive sine wave like pattern that persists for > 20mins , amplitude is 5-15, and 3-5cycles per min
262
Accelerations
Increase in FHR at least 15bpm above BL for at least 15 seconds (if <34 weeks, 10x10)
263
Decelerations
Decrease in FHR, abrupt or gradual
264
Variable Decelerations
Cord Compression - periodic or episodic, uncomplicated or complicated
265
Early Decelerations
Head compression (gradual decrease) that mirrors contraction pattern
266
Late Decelerations
Uteroplacental Insufficiency (gradual decrease) AFTER contraction - always ATYPICAL (intermittent) or ABNORMAL (recurrent)
267
Prolonged Decelerations
Profound Changes - apparent decrease lasting > 2min but <10min
268
Normal EFM Patterns
Normal Contraction Pattern
Rate: 110-160bpm
Moderate Variability
Accelerations Present (not required)
Decelerations absent, early, or variable (if uncomplicated)
269
Umbilical Cord
Delay clamping for 60 sec
2 arteries, 1 vein
270
5 Categories of Labour Comfort Measures
Physical, Emotional, Instructional/Informational, Advocacy, Partner/Coach care
271
Spinal Block
Local anesthetic injected into spinal canal, quick onset, longer duration - for C/S or vag
272
Pudenal Block
Injected into pudenal nerve near end of labour
273
Local Infiltration
Injected into Perineum
274
General Anesthetic
Used in emergent situations, increase risks
275
BUBBLEES
Breasts, Uterus, Bowels, Bladder, Lochia, Episiotomy, Emotions, Signs
276
(B)UBBLEES
Breasts - BF or formula?
Nipples - cracking, soreness, latch
Breasts - filling, engorged, softness
NOT BF - avoid stimulation
277
B(U)BBLEES
Uterus - involution
- firmness
- position
- incision
- musculature
- interventions
278
Involution
Rapid decrease in size of uterus to non-pregnancy stage
1. Sealing off placental site
2. Return of uterus to pre-pregnancy state
279
Involution is Impeded by:
Overdistenstion, exhaustion, retained placental fragments
280
Involution is Enhanced by:
Oxytocin, fundal massage, placental expulsion, breastfeeding
281
BU(B)BLEES
Bladder - assess r/o retention
- Color, Odor, Consistency, Amount
282
BUB(B)LEES
Bowels
- Last BM, increased risk of complication
- hemorrhoids, constipation, flatulence
283
BUBB(L)EES
Lochia
- Rubra: 1-3days (red & bloody, small clots)
- Serosa: 3-10days (pink/brown)
- Alba: 10-24 days (yellow/white)
Type, quantity, odor, clots, hygiene, interventions
284
BUBBL(E)ES
Episiotomy/Perineum
4H - Healing, Hemorrhage, Hematoma, Hemorrhoids
- intact, episiotomy, laceration, hemorrhoids, hematoma, hygiene, interventions
285
BUBBLE(E)S
Emotions
- Taking-in (1-2days)
- Taking Hold (3-4 days)
- Letting Go
Assess for PP blues and depression screening
286
BUBBLEE(S)
Signs
- VS, pain, 5P’s r/t DVT
287
C Section monitoring includes all BUBBLEES but adds...
Foley, IV, DB&C, early ambulation, sedation score, analgesia
288
WinRho
If mom is Rh negative and baby is Rh positive
289
How many calls to add to diet when BF
200cals
290
Newborn Care Immediately after birth
Term gestation, breathing/crying, muscle tone
291
APGAR scoring
1, 5 and 10 mins
HR: >100 = 2, <100 = 1, absent = 0
Resp: good cry = 2, slow/irregular = 1, absent = 0
Muscle Tone: well-flexed = 2, some flexion = 1, flaccid = 0
Reflex Irritability: vigorous cry =2, grimace = 1, none = 0
Color: Completely pink = 2, acrocyanosis = 1, pale/blue = 0
292
Umbilical Artery
2 - Unoxygenated
293
Umbilical Vein
1 - Oxygenated
294
Venous pH
7.30-7.35
295
Arterial pH
7.24-7.29
296
Venous PO2
28-33mmHg
297
Arterial PO2
12-20mmHg
298
Venous PCO2
38-42mmHg
299
Arterial PCO2
45-50mmHg
300
Venous Base Deficit
5mEq/L
301
Arterial Base Deficit
10mEq/L
302
Normal Newborn VS
T: 36.5-37.5
HR: 110-160bpm
RR: 30-60rpm
BP: 50-75/30-45
303
Signs of Neonatal Resp distress
tachypnea, cyanosis, grunting/cooing, nasal flaring, retraction/indrawing, accessory muscle use
304
Why are newborn at risk for inadequate thermoregulation?
Large head, increase SA, less adipose tissue, brown fat, decreased ability to shiver
305
BAT
Brown Adipose Tissue
Primary source of heat in hypothermic newborn
306
Example of Evaporation
Wet with amniotic fluid
307
Example of Convection
Body heat moves to cold air
308
Example of Radiation
Cold objects near bed absorb heat
309
Example of Conduction
Cold stethoscope
310
Risks for altered thermoregulation
8-12hrs old, prematurity, SGA, CNS problems, sepsis.
311
S&S of Cold stress
acrocyanosis, pallor, tachypnea, tachycardia, fussiness, hyperactive, irritable
312
Risks of Neonatal Hypoglycemia
no glucose = neuro complications
313
Normal Blood glucose in newborns
2.2-6mmol/L
314
When to test newborn for hypoglycemia
SGA (decreased glycogen stores), LGA (hyperinsulinism), diabetic parent, premature, stressed/sick/cold
315
S&S of Hypoglycemia in newborn
tremor, apathy, cyanosis, apneic spells, tachypnea, weak cry, limpness/lethargy, difficulty feeding, eye rolling, sweating
316
Treatment for hypoglycemia in newborns
if asymptomatic - increase feeds
if symptomatic or <2 - infuse glucose
317
Vitamin K
Give 1mg IM within 6hrs of birth due to risk of hemorrhage (low prothrombin levels)
318
Erythromycin
Give ointment into eyes within 1 hour to prevent opthalmia neonatum from gonorrhea, clamydia, etc.
319
Newborn Regular Behavior
1. Pd of reactivity for 30-120mins
2. pd of sleepiness after the 30-120mins
3. 2nd pd of reactivity
320
Overall Assessment of Newborn
Color, skin, tone, cord, fontanelles & sutures, hip dysplasia, reflexes
321
Cephalohematoma
Blood between cranial bone and periosteal membrane - does not cross suture lines
322
Caput Seccedaneum
Fluid and edema on scale from trauma or pressure, crosses suture lines
323
Vernix Cerosa
NORMAL - white fluid, especially in creases
324
Lanugo
Hair, normal
325
Milia
White dots - sebaccious glands
326
Erythema toxicum
Newborn rash - normal
327
Dermal Melanocytosis
Mongolian spots, normal
328
Telangietctatic nevi
Stork bite
329
Newborn EYE assessment
Placement, tears, follow stimuli, decreased muscle control
330
Newborn MOUTH assessment
Palate, tongue (frenulum - ankyloglossia, TOT), teeth/epstien’s pearls, response to tastes
331
Newborn EARS assessment
Cartilage recoild, skin tags, react to stimuli, hearing screen
332
Newborn NOSE assessment
Nose breather, patency, identify people by smell
333
Normal Progression of newborn stools
Meconium - 48hrs
Transitional - thin, brown-green
334
Breast fed baby stools
yellow, gold, seedy, soft/mushy
335
Formula fed baby stool
pale yellow, formed, pasty
336
Brick urine
urine crystals, normal for 1week
337
Normal newborn urine
6 times per day after day 6, pale/clear
338
Plagiocephaly
Flat Head
339
Induction
Initiation of contraction of client NOT in labour
340
Augmentation
Enhancement of contractions in client already in labour
341
Cervical Ripening
Use of pharmacological means to soften, efface, and/or dilate cervix to increase likelihood of vag delivery
342
Indications for induction
Postterm, HTN, DM, maternal disease, antepartum bleeding, chorioamnionitis, oligohydramnios, fetal compromise, Rh, IUGR, PROM (if GBS positive), IU death, Increased maternal age
343
Post dates
>40 weeks
344
Post term
>42 weeks
345
Maternal Risks for Post term
Placental “expiry date”
346
Fetal Risks for post term
large baby, complicated labour
347
Cautions for Induction
grand multiparity, vertex not fixed, unfavourable/unripe cervix, brow/face presentation, overdistension of uterus, lower segment uterine scar, pre-existing hypertonus, history of difficult labour, availability of C/S
348
Contraindications for Induction
Complete placental previa
Cord presentation/prolapse
Fetal malpresentation (transverse lie, breech)
Hx of uterine surgery, pelvic abnormalities, genital herpes, medical conditions
349
Optimal Bishops score
7-8
350
Unfavourable Bishops score
<6
351
Bishops Score
Dilation, Cervix position, effacement (%), Station, Consistency
352
Bishops - Dilation
0 = closed
1 = 1-2cm
2 = 3-4cm
3 = 5-6cm
353
Bishops - Cervix position
0 = posterior
1 = mid position
2 = anterior
354
Bishops - Effacement
0 = 30%
1 = 40-50%
2 = 60-70%
3 = 80%
355
Bishops - Station
0 = -3
1 = -2
2 = -1,0
3 = +1, +2
356
Bishops - Consistency
0 = firm
1 = medium
2 = soft
357
Stripping/Sweeping of Membranes
Mechanical separation of membranes from cervix to uterus
358
Mechanical Dilation
Foley, cervical ripening balloon (CRP), amniotomy
359
Prostin Gel
Into posterior fornix of vaginal
360
Cervidil
Into posterior fornix of vaginal to continuously slow release
361
Misoprostol/Cytotec
Oral or Vaginal - can go home with it inserted
362
Prostaglandin Advantage
Minimal invasion, simple admin, induction (not augmentation)
363
Oxytocin Infusion
Syntocin/pitocin
Induction & Augmentation
Gradual increase in 30 min increments
364
Tachysystole Risks
Uterine hyperstimulation - can cause placenta abruption, fetal hypoxia, precipitous delivery, PP hemorrhage, uterine atony
365
Oxytocin Complications
Failture establishing labour, tachysystole, chorioamnionitis, uterine rupture, PPH, hysterectomy, placenta implantation abnormalities in future pregnancy, longer hospital stay, risk of assisted birth or C/S, adverse neonatal outcomes
366
Causes of Dystocia
P - Problems with powers
P - Problems with passageway
P - Problems with passenger
P - Problems with Psyche
367
Labour Dystociaa
non-progression in active labour
368
HTN disorders in pregnancy
Pregnancy induced HTN (PIH)
Gestational HTN (GH)
Pre-eclampsia
Toxemia
369
Risks factors that increase HTN in pregnancy
Nullipara, hx of HTN, SLE or CKD, poor nutrition, obesity, advanced maternal age, multiples, pre-gestational diabetes, hx of stillbirth or IUGR
370
Chronic HTN
Develops before pregnancy or > 20weeks gest
371
Gestational HTN
Sys >140 and/or dias >90 - After 20wks and up to 12 weeks PP
372
Severe HTN
Sys > 160 and/or dias >110
373
Preeclampsia
Sys > 140 and/or Dias >90 + proteinuria (2+) and other adverse conditions
374
Eclampsia
Seizure
375
Maternal Consequences of preeclampsia
Stroke, pulmonary edema, hepatic failure, jaundice, seizures, placental abruption, acute renal failure, HELLP, DIC
376
Fetal Consequences of preeclampsia
IUGR, oligohydramnios, prematurity, fetal compromise, IU death
377
Prevention of Vasospasms and Hypoperfusion
ASA if increase risk starting at 16wks until delivery
Calcium supplements
378
Management of Vasospasms and hypoperfusion
decrease stress, treat BP, wt loss, NST’s, hourly I&O, BP, pulse, resp, BW (Liver, platelets, Hct), fetal movement and blood flow
379
Meds for vasospasms and hypoperfusion
labetolol, nifedipine, hydralazine, aldomet
380
What HTN meds are NOT allowed in pregnancy
ACE - inhibitors
381
Magnesium Sulfate
Anti-convulsant
382
Magnesium toxicity
CNS depression (RR <12, oligouria = <30ml/hr, decreased DTR)
383
Mag sulf monitoring
tachycardia, NB reflexes, urine output, slow labour, muscle weakness, decreased energy, resp depression, low BP
384
What to do if suspected eclampsia
Bolus of mag sulf - possible dilantin, lasix (for edema), digitalis (for circulatory failure)
385
What to do if early delivery is required for preeclampsia
Give corticosteroids to increase fetal lung maturity
386
HELLP Syndrome
Hemolysis Elevated Liver enzymes Low Platelets
387
DIC
Disseminated Intravascular Coagulation - overactivation of normal clotting mechanism - mini clots develop and EXCESS BLEEDING
388
DIC causes
Preeclampsia, hemorrhage, IU fetal demise, fluid embolism, sepsis, HELLP
389
Gestational Diabetes Prevalence
3-20%
390
Causes of Gest Diabetes
1. Fetus continually takes glucose from mother
2. Placenta creates hormones which alter effects of resistance to insulin and glucose tolerance
391
Carbohydrate Metabolism in pregnancy - 1st trimester
increased hormones stimulate insulin production and tissue response (sensitivity)
392
Carbohydrate Metabolism in pregnancy - 2nd trimester
Placenta secretes hPL and increases resistance to insulin
393
Pregnancy/Maternal Effects of Gest diabetes
Preeclampsia risk increases due to vascular changes
Polyhydramnios, PROM, PPROM
Preterm labour risk increases, increased risk of dystocia and C/S
Worsening myopathies (vascular, renal, retinal)
Increased risk of HTN and T2DM later in life
394
Fetal Effects of Gest diabetes
Macrosomnia/LGA, IUGR, fetal demise, congential anomalies
395
Neonatal Effects of gest diabetes
hypoglycemia, hyperbilirubinemia, RDS
396
Normal result of non-fasting glucose test
24-28wks
<7.8mml/L
397
Abnormal result of non-fasting glucose test
7.8-11 = fasting glucose required
>11.0 = gest diabetes diagnosis
398
Multiples birth risks
Increase risk of preterm labour, anemia, HTN, abnormal presentation, twin-twin transfusion syndrome, uterine dysfunction, abruptio placenta/placenta previa, prolapsed cord, PPH
399
Singleton Stats
Gest age - 38.7wks, 6.3% weigh < 2500g, 7% < 34wks, mortality 4.1/1000
400
Twin Stats
Gest age - 35.2wks, 56.6% weigh < 2500g, mortality 25.7/1000
401
Triplet Stats
Gest age - 32.1wks, 94.1% weigh <2500g, mortality 62.2/1000
402
Twin-to-Twin Transfusion Syndrome
Blood in umbilical cord flows unequally between twins that share a placenta
403
Complications of Obesity in Pregnancy
Spontaneous abortion/stillbirth, HTN, diabetes, preterm or postterm
404
Complications of Obesity in Intrapartum
Still birth, macrosomia/shoulder dystocia
405
Complications of Obesity in Neonatal
Macrosomia, hypoglycemia, BF issues, congenital anomalies
406
Complications of Obesity in Post Partum
Depression, PPH, Infection, Thrombosis
407
Risks of Adolescent Pregnancy
Physical: preterm birth, LGA, CPD, anemia, HGTN
Psychosocial: Interruption of development, substance use, poverty, interruption or cessation of education, less prenatal visits
408
Risks of Advanced maternal age in pregnancy
>35
Decline in fertility, increased chronic diseases, increased difficulty in pregnancy, increased risk of C/S and induction, increased genetic conditions, congenital anomalies
409
Methadone
Most commonly used for women dependent on opioids - heroin
- blocks withdrawal symptoms
- reduces cravings for narcotics
- crosses placenta
410
Methadone use in pregnancy
Associated with pregnancy complications and abnormal fetal presentation
411
Prenatal exposure to methadone
Reduced head circumference and low birth weight, withdrawal symptoms
412
Cannabis in Pregnancy
Can negatively impact fertility, crosses placenta (can harm fetus - birth defects, preterm delivery, cognition and behavioral problems), passes into breastmilk
413
Teratogens
Alcohol, drugs, prescribed medications, pathogens
414
CHEAP TORCHES
C: Chickenpox and shingles
H: Hepatitis B/C/D/E
E: Enteroviruses
A: AIDS
P: Parvovirus B19
T: Toxoplasmosis
O: Other (GBS, listeria, candida)
R: Rubella
C: Cytomegalovirus
H: Herpes Simplex Virus
E: Every STI (gonorrhea, chlamydia)
S: Syphilis
415
Syphilis problems in newborn
Issues with eyes, ears, teeth, bones and may cause death
416
Urinary, vaginal, sexually transmitted infections, PID, Bacterial vaginosis (BV)
10-25% of all women, 50% asymptomatic
May cause spontaneous abortion, preterm delivery, maternal and fetal morbidity and mortality
417
COVID in pregnancy
May cause preterm delivery and infant morbidity
418
Group B Streptococcus (GBS)
Common bacteria which are often found in the vagina, rectum, or bladder of 15-40% of people
- screen at 35-37wks
419
HIV and AIDS in pregnancy
Modes of pregnant client client to child:
- in utero (placenta)
- during childbirth and delivery
- PP through BF
420
HIV Chance of transmission
WITHOUT treatment = 25% chance
WITH treatment = <2% chance
421
Treatment of HIV in pregnancy
Combination anti-retroviral therapy (cART) (pregnancy)
Add IV ZDV during labour until birth/3hrs before C/S
Infant - ZDV oral suspension for 6wks, no BF
422
HIV care following birth
Positive antibody titer, reflects passive transfer of maternal antibodies rather than HIV infection
NO BF
423
Biggest risk of preterm labour
PREVIOUS PTB
424
Common symptoms of preterm labour
Low ABD pain/cramps/backache, bleeding/spotting/show/ROM, pelvic pressure, increased amount/changes in vag delivery, contractions every 10 mins
425
Fetal Fibronectin fFN
Glycoprotein released into cervical/vaginal fluid in response to inflammation or separation of amniotic membranes
Normal until 22wks gest and reappears before labour
426
Negative fFN
pregnancy is likely to continue for at least another 2 wks (95-98%)
427
Positive fFN
Present 24 through 34 wks gest indicates high risk of preterm delivery
428
Management of preterm labour
Should it be stopped?
Assess and monitor VS, contractions and fetus
Avoid stimulation (no vag exams, no sex, no nipple stimulation)
429
Tocolytics for preterm labour: Indomethacin
anti-prostaglandin inhibits uterine activity, effective in delaying delivery for 48 hrs - NOT for long term
430
Tocolytics for preterm labour: Calcium channel blockers
nifedipine (adalat) - not very effective
431
Tocolytics for preterm labour: Vaginal Progesterone
May prevent and reduce incidence of PTB if previous hx of PTB or short cervical length
432
Cervical Insufficiency
Premature painless dilation of cervix (20-28wks)
- 2nd trimester abortions because cervix can’t handle the weight
433
Cervical Insufficiency Treatment
Bedrest, pelvic rest, avoid heavy lifting
Cervical cerclage (suture)
434
Risks of cervical cerclage
Infection, blood loss, PPROM, preterm labour, damage to cervix
435
Corticosteroids in Preterm Labour
All pregnant clients between 14-34 weeks gestation who are at risk of preterm delivery within 7 days
- single course reduces perinatal mortality, resp distress syndrome, and intraventricular hemorrhage
436
MgSO4 for Fetal Neuroprotection
Prevent seizures in newborn
Use if preterm <31+6weeks (active labour <4cm dilation, planned preterm)
437
Abortion
Expulsion of fetus before 20wks gestation OR expulsion of fetus < 500g
438
Spontaneous abortion
occur naturally
439
Therapeutic/induced abortion
medical or surgical means
440
If minimal bleeding in spontaneous abortion
bed rest and abstinence from sex
441
If persistent/heavy bleeding/pain/fever in spontaneous abortion
Cytotec (misoprostol)/cervidil
WinRho
IV therapy
Surgical dilation and currettage (D&C) or suction evacuation (D&E)
442
Ectopic Pregnancy
Implantation of fertilized ovum outside the uterus
443
S&S of ectopic pregnancy
rupture and bleeding into abd cavity: sharp unilateral pain and decreased BP and syncope, referred shoulder pain, vaginal bleeding, hypovolemic shock
444
Gestational trophoblastic disease
RARE (1/1000) pathologic tumour of childbearing age client
- abnormal development of placenta
- trophoblastic cells that obliterate in pregnancy
445
S&S of Gestational trophoblastic disease
Uterine enlargement greater than gest age, vaginal bleeding, passage of clots, hyperemesis gravidarum, preeclampsia before 24 wks
446
Antepartum hemorrhage
Vaginal bleeding > 20wks -delivery
447
Causes of antepartum hemorrhage
- Placenta previa
- Abruptio Placentae
448
Placenta previa
Implantation of the placenta - total/complete, partial, marginal, low-lying placenta
449
Placenta previa detection
routine ultrasound, ultrasound at start of bleeding, frequent monitorig
Goal: 36-37wks
450
Placenta previa risk factors
previous placenta previa
uterine abnormalities/endometrial scarring
impeded endometrial vascularization
large placental mass
451
Abruptio placentae
Premature separation of normally implanted placenta from uterine wall
Total/complete - hemorrhage, fetal death
Partial - fetus can tolerate 30-50% abruption
452
Abruptio placentae risk factors
Previous abruption, HTN blunt abdominal trauma, overdistended uterus, PPROM, previous C/S, cocaine/crack use, smoking, short umbilical cord, uterine abnormalities (fibroids at implantation site), advanced age in pregnancy or high parity
453
Implications of abrupto placentae in pregnant client
antepartum/intrapartum hemorrhage, PPH, DIC, hemorrhagic shock
454
Implications of abrupto placentae in fetal-neonate
Sequelae of prematurity, hypoxia, anemia, brain damage, fetal demise
455
Manifestation summary of placenta previa
insidious, visible bleeding, bright red blood, no pain, soft and relaxed uterine tone, FHR normal, may be breech or transverse, no engagement
456
Manifestation summary of abruptio placentae
sudden onset, concealed or visible bleeding, dark red blood, constant pain in uterus, firm to rigid uterine tone, fetal distress or absent
457
Placenta accreta
Placenta attaches itself too deeply into surface of the myometrium
458
Placenta increta
Penetrates into the myometrium
459
Placenta percreta
WORST - placenta through myometrium and into tissues or organs
460
Velamentous insertion of cord
Vessels of umbilical cord divide some distance from placenta in placental membranes
Torn vessels lead to fetal hemorrhage
461
Uterine Rupture
Spontaneous rupture or rupture of previous scar
462
Risk factors for uterine rupture
Previous uterine surgery or C/S, short inter delivery interval (less than 18 months), grand multiparity, trauma, IU manipulation, midforcep rotation of fetus
463
Presentation of Uterine Rupture
ABD pain, decreased uterine activity, N/V, vaginal bleeding, fetal tachycardia, pallor, shape of abdomen changes, fetal parts palpable through ABD wall
464
Primary (early) PPH
birth to 24 hours
465
Secondary (late) PPH
24hours - 6wks
466
EBL
Estimated blood loss
467
PPH blood loss
>500mls vaginal
>1000 C/S
468
Prompt recognition of PPH
Rise in level of fundus, boggy fundus, abnormal clots, persistent lochia rubra, bright red bleeding, increased pulse, decreased BP, bleeding with firmly contracted uterus, pelvic discomfort, decreased LOC
469
4 T’s of PPH
Tone (70%)
Trauma (20%)
Tissue (10%)
Thrombin (<1%)
470
Tone - Uterine Atony
Lack of uterine muscle tone
- overdistended uterus
- exhausted
- infection
- abnormalities
471
Trauma - Uterine atony
Cervical, vaginal, perineal lacerations suspected when BRIGHT RED BLEEDING with contracted uterus, hematoma, uterine inversion, uterine rupture
472
Tissue - Uterine atony
Common in LATE PPH
Retained placental lobes, membranes
Retained blood clots
473
Retained placenta
Retention of placenta beyond 30 mins after birth - requires manual removal
474
Thrombin - uterine atony
Pre-existing or acquired bleeding disorders
475
Treatment for PPH
Prompt attention to resuscitation (ABC’s), identify cause of bleeding, appropriate based on etilogy, multidisciplinary approach, fundal assessment massage, empty bladder, admin uterine stimulus, admin antifibrinolytic
476
If PPH persists after initial treatment
Large bore IV - crystalloid bolus
foley and oxygen
477
Interventions/Thrombosis prevention
Avoid: smoking, sitting/standing in one position, oral contraceptives
encourage: early activity, leg exercises
consider: compression devices, anticoags
478
Metritis
Inflammation of the uterus
479
S&S of Metritis
ABD pain, fever, foul lochia, N/V, fatigue, increased WBC
480
Wound infection
Surgical, laceration, episiotomy
481
S&S of wound infection
REEDA, pain/tenderness at site, fever, increased WBC
482
Mastitis
Inflammation of breasts
483
Post partum danger signs
fever >38 degrees
foul odor to lochia/unexpected change
large blood clots or saturating >1pad per hr
visual changes or severe headaches
calfe pain
swelling, redness, discharge at site
dysuria, burning on voiding
SOB or difficulty breathing
depression or mood swings
484
Risk factors for PP mental health problems
Female, hx of depression/dc of antidepressants, low income/education, single, age, relationship issues (IPV), lack of social support, stress, substance use, ethnic minority, unplanned pregnancy, difficult and delivery
485
S&S of PP mental health problems
Depressed mood, anhedonia, wt changes, insomnia/hypersomnia, restless, agitated, slowed, low energy, guilt
486
Antenatal depression
Melancholia in pregnancy: in 20 % of women
487
PINKS in PP
elation after, happy and excited, early dc, sleep, bipolar, expectations of pregnancy
488
Postpartum Blues
“normal” transient, emotional response, up to 85%
489
Postpartum Psychosis
0.1-0.2% - insomnia, agitation, hallucinations, self-hard, infanticide, homicide, mood swings
490
PP Anxiety
24% in pregnancy, fearful/phobic, over-concerned, high expectations, panic attacks
491
Obsessive Compulsive disorder (OCD)
Intrusive, repetitive thoughts, guilt, worry, shame, hypervigilant
492
T-ACE
Problems with Alcohol
T- tolerance (2pts)
A - annoyed (1 pt)
C - cut down (1pt)
E - Eye opener (1pt)
At-risk = 2-5
493
Preterm infant resp
lack of surfactant, RDS, BPD
494
Preterm infant Cardio
patent ductus arteriosis (PDA), increased resp effort, CO2 retention
495
Preterm infant GI
Small stomach, immature feeding reflexes, NEC
496
Preterm infant Renal
Decreased ability to concentrate urine, decreased ability to excrete drugs
497
Preterm infant hepatic/hematologic
immature liver (decreased ability to conjugate bilirubin - increase jaundice)
R/O hypoglycemia
Limited iron stores - anemia
498
Preterm infant neurological
IVH, hydrocephalus, hearing loss, ROP
499
Preterm infant temp regulation
no subcutaneous fat, poor muscle tone, thin skin, no adipose tissue (brown fat only), no liver glycogen, resuscitation efforts, LDR or ambient temps
500
Preterm infant minimize heat loss
<28 weeks placed in food grade polyethylene bag
501
Late preterm infant
brain size only 60% compared to normal fetus
Largest proportion of preterm births
502
common causes of neonatal resp distress
RDS, Meconium aspiration (MSAF, MAS), transient tachypnea of the newborn (TTN)
503
RDS risk factors
Prematurity, C/S without labour, males, hx of RD, cold stress, maternal diabetes, perinatal asphyxia
504
RDS protective factors
Prolonged ROM, GHTN, donor twin, physiological stress, use of corticosteroids
505
Management of RDS
Antenatal corticosteroids, exogenous surfactant, continuous positive airway pressure (CPAP), positive end-expiratory pressure (PEEP)
506
Meconium-Stained Amniotic Fluid (MSAF)
12% of live births
can cause fetal compromise
507
Care with Mec aspiration
Prevent: avoid postmaturity, amniotic infusion, endotracheal suction by trained individual
Assisted ventilation
Surfaxin (exogenous surfactant), steroids
Close observation
508
Transient Tachypnea of Newborn
Excess fluid in the lungs or delayed re-absorption of fetal lung fluid (“wet lung”)
resolves self in 72hrs
509
Perventricular hemorrhage
occurs in 50% of neonates <1500g and/or <35 wks
Due to weak ventricular capillaries, immature cerebral vascular development
510
Hyperbilirubinemia
Excessive concentration of bilirubin in the blood
511
Jaundice
Bile pigment deposited in the skin, mucous membranes, and sclera
512
Kernicterus
Bilirubin levels rise > accepted levels at a given age or rate of rise is high enough - deposits in brain and causes encephalopathy
513
Physiological jaundice
most common cause
increase in RBC, short life span of RBC and RBC hemolysis after birth
Resolves by day 8
514
Pathological jaundice
excessive erythrocyte destruction, increased extravascular blood, polycythemia
within first 24 hours of life = pathological
515
TcB
Transutaneous Bilirubin
516
TSB
Total Serum Bilirubin
517
Critical hyperbilirubinemia
>425 in first 28 days
518
Severe hyperbilirubinemia
>340 at any time in the first 28 days
519
Coomb’s test
For ABO incompatibility
520
Phototherapy
Additional light helping to breakdown bilirubin
Naked (except diaper)
Eye protection
Phototherapy blankets
Continue BF
521
Neonatal abstaining/withdrawing from drugs
Eat, sleep, console
Look for signs of withdrawal
Decrease stimulation, swaddle, c-position
522
Cocaine in pregnancy
Risk of placental problems, risk of miscarriage, risk of preterm labour, risk of SIDS
523
Meds to treat withdrawal
Opium, morphine, methadone, phenobarbital
524
Naloxone (narcan)
for resp depression, can cause rapid withdrawal and seizures
525
Neonatal sepsis
Infection = major cause of neonatal illness and death
526
S&S of Neonatal sepsis
SUBTLE behavior changes, temp instability, tachycardia, seizures - hypotonia, poor peripheral circulation, resp distress, hyperbilirubinemia
527
IPV during pregnancy
Increase up to 7-11% in pregnancy
528
Impact of domestic violence on pregnancy
delayed/less prenatal care, increased stress & depression, financial effects, inadequate weight gain, complications
529
Impact of domestic violence on fetus
direct physical trauma causing injury or miscarriage, negative behavioral effects, preterm labour/birth, low birth weight/SGA
530
Impact of domestic violence postnatal
decreased likelihood of BF, maternal mental health issues, r/o aggression and hyperactivity in child, increased r/o child abuse
531
Complications in L&D
Dystocia
Precipitous L&D
Malpresentation/position (POP, breeach, ECV)
Operative and assisted deliveries (C/S, Forceps/vacuum), TOLAC/VBAC, obstetrical emergencies (shoulder dystocia, cord prolapse)
532
Breech presentation
3-4% of all term pregnancies
Frank 50-70%
Footling 10-30%
Complete 5-10%
533
Diagnosis of Breech
Maternal perception of movement, leopold’s maneuver’s, FH auscultated above umbilicus, vag exam, ultrasound, passage of thick mec
534
characteristics for breech delivery
Vaginal delivery is optimal if uncomplicated TERM, frank or complete breech, singleton, >2500 and <4000g with flexed head
535
External Cephalic version
Flipping baby from breech to cephalic
536
Indiction of C/S
non-reassuring FHR findings, active genital herpes, multiple gestation, umbilical cord prolapse, pelvic size, lack of labour progression/failed induction, maternal infection, placenta previa, previous C/S, fetal anomalies or extremities in size
537
Inta-operative risk for C/S
Aspiration, difficult airway management, PPH
538
Post-op risk for C/S
Endometritis/infection, hemorrhage, poor bladder emptying, paralytic ileus, thrombophlebitis
539
Trial of Labour After Cesarean Section (TOLAC)
Depends on indication and type of 1st section and maternal heatlh
540
Risks of TOLAC
Hemorrhage, uterine rupture, infant death or neuro complications
541
Successful TOLAC
VBAC
542
TOLAC Care
Continuous EFM - uterine contractions, avoid oxytocin if possible (increases risk of rupture), avoid cervical ripening methods, have C/S available
543
Indications for Vacuum and Forceps
Fetal indications (+4 but not coming out, decreased FHR)
Maternal - inability to push, lack of rotation, disease
544
Vacuum Extractor
Suction applied to fetal head (occiput)
Pull with contractions
Should be progressive descent with first two pulls (with contractions)
545
Common complications of vacuum or forceps delivery (newborn)
bruising, laceration, edema (caput)
546
Uncommon complications of vacuum or forceps delivery (newborn)
Retinal hemorrhage, nerve injury, cephalohematoma, cerebral hemorrhage, skull fracture, intracranial pressure, subgaleal hemorrhage
547
Complications of vacuum or forceps delivery (maternal)
genital tract trauma, increased bleeding (risk for PPH), bruising and edema, shoulder dystocia
548
Obstetrical emergencies
shoulder dystocia
Cord prolapse
549
Shoulder Dystocia Interventions
Ask for help
Lift/hyperflex legs (mcroberts manoeuvre)
Anterior shoulder disimpaction (subrapubic pressure)
Rotate posterior shouldre
Manual removal of posterior arm
Episiotomy
Roll over onto all fours
550
Shoulder Dystocia complications maternal
Episiotomy, extended lacerations, hematomas, uterine atony, hemorrhage, bladder injury, rectal injury
551
Shoulder dystocia complications fetal
Clavicle or humerus fracture, brachial plxus injury or spinal nerve damage, erb’s palsy, asphyxia, death
552
Cord prolapse
sudden, severe, variable decels or no FHR
553
Cord prolapse causes
polyhydramnios, long cord, malpresentation, premature ROM, amniotomy before engaged vertex
554
Cord Prolapse interventions
check FHR, get help and prepare for C/S
Hold presenting part OFF cord (trandelnburg, knee-chest, keep gloved hand in vagina, decrease contractions
555
Perinatal Loss - Early Loss
Ectopic pregnancy, miscarriage/abortion, medical interruption of pregnancy, infertility/multi-fetal reduction
556
Perinatal loss - late
Stillbirth, newborn death, loss of baby (adoption, relinquishment or apprehension)
557
Attachment during pregnancy and childbirth
planning, confirming and accepting pregnancy, feeling fetal movements, seeing US, accepting fetus as individual, giving birth, hearing and seeing baby, touching and holding baby, caring for baby
558
4 Tasks of Mourning
Accept reality of the loss
Work through pain and grief
Adjust to a world without the deceased
Find an enduring connection while moving forward with life
559
Breaking Bad news to Paretns
Provide “warning shot”
Allow support to be present
Use private setting
Sit down near family and maintain eye contact
Be unhurried
Be specific
560
Guidelines for intervention during fetal loss delivery
provide optimal analgesia while in labour, respect privacy and time with baby (unrushed), support of and for family, take lead from parents, provide information, care of the infant), provide PP information, follow up
561
Providing memories for loss of baby
memory boxes, lock of hair, footprints, photos, ultrasound pictures, fetal monitor strips, crib card with wt and measurement, items of significance
562
