Flashcards in OB ATI Deck (42):
Presumptive signs of pregnancy
objective or subjective signs that make a woman think she is prego
amenorrhea, fatigue, nausea and vomiting, urinary frequency, breast changes, Quickening-Feeling the baby move, uterine enlargement, Linea Nigra, chloasma-mask of pregnancy, striae gravidarum
Probable signs of pregnancy
Changes that make the examiner suspect a woman is pregnant. Abdominal enlargement, cervical changes, Hegars sign which is softening and compressibility of the lower uterus, Chadwicks sign which is a deep purple blue color of the vaginal mucosa, Goodells sign which is softening of the cervical tip, Ballotement which is rebound of the fetus, Braxton Hicks contractions, positive pregnancy test, fetal outline felt by examiner
Positive signs of pregnancy
Signs that are only explained by pregnancy they include fetal heart cells, visualization by an ultrasound, fetal movement felt by the examiner
Measuring the fundal height in cm between 18-30 wks
Gravida-number of pregnancies
Multi 2 or more
Term 38 wks
Preterm <20 wks or 2 lbs
Toxoplasmosis (cat) flu like, fever
rubella joint and muscle pain, rash
cytomegalovirus (member of herpes) droplet, mono like
These can cross the placenta and effect the fetal development
Conflicting feelings such as having joy and sorrow at the same time
Types of birthing plans
Dick-read: Childbirth without fear. Control breathing and relaxation. Completely relax between contractions.
Lamaze: is to promote a healthy, natural, safe approach with early parenting
Leboyer: Births without violence stress is decreased. Dim room soft voices, warm room, Waterbirth
Bradley: Partners involvement as a coach. Natural breathing, relaxation, nutrition, exercise
Weight gain during pregnancy
3 to 4 pounds during the first trimester, 1 pound a week after that. A total of 25-35 pounds.
increase of 340 cal a day during the second trimester.
Increase 452 a day during the third trimester.
If breast-feeding take an additional 330 The first six months and 400 the second six months.
Leafy vegetables, dried peas and beans, seeds, orange juice, and other foods that are fortified such as breads, cereals, grades. 600 µg during pregnancy and 500 while lactating.
Take between meals and with vitamin C. Milk and caffeine interferes with the absorption. Liver, red meat, fish, poultry, dried peas and beans, fortified cereals and bread. May need a stool softener
Milk, fortified soy milk, fortified orange juice, nuts, legumes, dark green leafy vegetables. 1000 mg per day. If under 19 take 1300 mg per day.
Foods to avoid with PKU
Protein, fish, poultry, meat, eggs, nuts, and dairy products
5 things measured.
Score 2 is normal, 0 abnormal. 8-10 normal, 6 equivocal. < 4 abnormal
Reactive fetal heart rate
fetal breathing movements at least one episode of 30 seconds in 30 minutes
gross body movements at least three extensions in 30 minutes fetal tone at least one episode of extension and flexion
amniotic fluid volume
Used to supress cell division in ectopic pregnancy
Avoid alcohol and folic acid.
Avoid sun exposure.
Group b, test 35-37 wks, Trt pcn G in labor
Chlamydia, Trt zithromax ro erythromycin
Erythromycin given to babies eyes for ophthalmia neonatorum
Gonorrhea. Rocephin or zithromax
Erythromycin to baby
Candida albicans, diflucan,
Risk factors include less than two years between pregnancies, heavy periods, Diet low in Iron.
Signs and symptoms include fatigue, irritability, headache, shortness of breath, palpitations, pica, pallor, brittle nails, decreased H and H
60 mg iron
Glucola screening test done at 24 to 28 weeks. Greater than 140 needs further testing
3 hr test: Overnight fasting, avoid caffeine, no smoking. 100 g glucose given and retested at one, two, three hours.
Daily kick counts, diet and exercise, insulin admin,
>140/90 after 20 wks, or >30/15 increase from baseline. No protein or edema, returns 12 wks postpartum.
Gestational hypertension with 1 to 2 protein urea, weight gain more than 4.4 pounds per week in the second and third trimester, mild edema
>160/100, 3 to 4 protein urea, oliguria, elevated creatinine greater than 1.2, cerebral or visual disturbances such as headache and blurred vision, hyperreflexia, ankle clonus, pulmonary or cardiac involvement, extensive Edema, liver dysfunction, epigastric and right upper quadrant pain, thrombocytopenia
Severe preeclampsia with seizure activity or coma. Usually preceded by headache, severe epigastric pain, hyperreflexia, hemoconcentration.
Heart disease with pregnancy
Class-1 exhibits no symptoms with activity.
Class 2 have symptoms with ordinary exertion.
These are candidates for a normal pregnancy and delivery.
Class III display symptoms with minimal exertion and maybe bedrest during pregnancy.
Class IV is the client has symptoms at rest and is not a candidate for pregnancy.
Restrict NA and follow cardiac diet.
Inderal to lower BP and treat tachycardia
Gentamicin prophylactic abx
Ampicillin prophylactic abx
Avoid foods high in vitamin k
Digoxin to increase CO or for fetal tachycardia
Relaxes uterine smooth muscles to prevent contraction. Should be discontinued if there are signs of pulmonary edema which includes chest pain, shortness of breath, respiratory distress, wheezing in crackles, productive cough. Restrict oral and IV fluids to reduce risk of pulmonary edema. Withhold if heartrate is above 120 to 140.
An anti-inflammatory that blocks prostaglandins and suppresses uterine contractions. Discontinue if signs of pulmonary edema. Should not exceed 48 hours. Only used for gestational age less than 32 weeks. Monitor for postpartum hemorrhage. Given with food or rectally.
Mechanisms of labor. 7
Restitution and external rotation for shoulders
Stages of labor
Stage 1: 12 1/2 hrs, onset labor, complete dilation, 1cm per hr for first time, 1 1/2 for others
Latent: 4-6 hrs, 0-3, contractions 30-45 sec, 5-30 min apart
Active: 2-3 hrs, 4-7, 40-70 sec, 3-5 min, some decent
Transition: 20-40 min, 8-10 sec, 45-90, 2-3 min,
Stage 2: 5-120 min, intense contractions 1-2 min, birth
Stage 3: placenta delivery; shiny Schultz, dull duncan(maternal side)
Stage 4: 1-4 hrs, stabilization, lochia scant to moderate
Pain meds for labor
Stadol and Nubian do not cause resp depression, IM IV
Demerol, fentanyl, are also used.
Labor should be at least 4 cm dilated and well established.
Variability: absent is non reassuring
Periodic changes are with contractions, episodic are not
Category 1: normal baseline, moderate variability, possible accelerations, possible early decels, no variable or late decels
Category 2: tachy or Brady baseline, absent, minimal, or marked variability, decels >2<10, late decels, no accelerations with stimulation
Category 3: sinusoidal pattern, absent variability with recurrent variable or late decels, bradycardia,
How often to monitor FHR
Low risk: latent 60
2nd stage 15
High risk: latent 30
Used to determine readiness for labor by evaluating the cervix. Score of 0 to 3 is assigned to cervical dilation, cervical effacement, cervical consistency such as firm medium or soft, cervical position such as posterior mid position or anterior, presenting part station. Score of nine for first time or five for the second time indicates readiness.
Cytotec, Cervidil, Prepidil
Use with caution for clients that have glaucoma, asthma, cardiovascular, or renal disease. It can cause hyperstimulation which is treated with terbutaline. It can cause fetal distress in which oxygen is needed, repositioning, IV fluids.
6 to 12 hours after prostaglandin administration. Should be engaged at 0 station. Use the port closest to the client for IV administration. Reassessed every 30 minutes. FHR and contractions every 15 min. I&O.
Increase until contraction pattern established and then maintain
Dc if hyperstimulation: >2 min frequency, lasting >90sec, intensity >90, resting >20, no relaxing.
Terbutaline to counteract it.
Apply pressure with sterile glove
Sterile soaked towel to cord
< 110 or > 160
Hyperactivity or no activity
8-10 L O2
Prepare for cesarean
< 3 hours
Can result in fetal hypoxia,,asphyxia, or intracranial hemorrhage
Rubra up to 3 days
Alba up to 6 wks
Heavy 1 pad saturated in <2 hrs
Excessive less than 15 min
0-3 severe distress
4-6 moderate distress
7-10 no distress
Appearance: color 0 blue, 1 acrocyanosis, 2 pink
Pulse: 0 absent, 1 100
Grimace reflex irritability. 0 none, 1 grimace, 2 cry
Activity muscle tone. 0 flaccid, 1 some flexion, 2 well flexed
Respiratory 0 absent, 1 weak slow cry, 2 good cry
New Ballard scale for gestational age
Done in 2-12 hours after birth
Skin Texture: thin to wrinkled
Lanugo: present to absent
Breast tissue: none to 10mm bud
Posture extended to flexed
Square window wrist
Popliteal angle, knees can extend
Heel to ear
Resp, HR, BP, temp
R 30-60 with apnia less than 15 sec
Temp 36.5 37.2, 97.7-98.9
Normal newborn labs
Leukocyte s 9000-30000
Bilirubin: 0-6 day 1
<12 day 3