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Flashcards in OB ATI Deck (42):
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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

1

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

2

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

3

McDonald's method

Measuring the fundal height in cm between 18-30 wks

4

GTPAL

Gravida-number of pregnancies
Nulli-never
Primi-first
Multi 2 or more
Term 38 wks
Preterm <20 wks or 2 lbs
Living children

5

TORCH

Toxoplasmosis (cat) flu like, fever
infection
rubella joint and muscle pain, rash
cytomegalovirus (member of herpes) droplet, mono like
herpes
These can cross the placenta and effect the fetal development

6

Ambivalence

Conflicting feelings such as having joy and sorrow at the same time

7

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

8

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.

9

Folic acid

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.

10

Iron foods

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

11

Calcium

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.

12

Foods to avoid with PKU

Protein, fish, poultry, meat, eggs, nuts, and dairy products

13

BPP

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

14

Methotrexate

Used to supress cell division in ectopic pregnancy
Avoid alcohol and folic acid.
Avoid sun exposure.

15

Infections

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,

16

Anemia

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

17

Gestational diabetes

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,

18

Gestational hypertension

>140/90 after 20 wks, or >30/15 increase from baseline. No protein or edema, returns 12 wks postpartum.

19

Mild preeclampsia

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

20

Severe preeclampsia

>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

21

Eclampsia

Severe preeclampsia with seizure activity or coma. Usually preceded by headache, severe epigastric pain, hyperreflexia, hemoconcentration.

22

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
Heparin
Avoid foods high in vitamin k
Digoxin to increase CO or for fetal tachycardia

23

Terbutaline

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.

24

Indomethacin

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.

25

Mechanisms of labor. 7

Engagement
Descent
Flexion
Internal rotation
Extension
Restitution and external rotation for shoulders
Expulsion

26

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

27

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.

28

FHR monitoring

Baseline 110-160
Variability: absent is non reassuring
Minimal 25
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,

29

How often to monitor FHR

Low risk: latent 60
Active 30,
2nd stage 15

High risk: latent 30
Active 15
2nd 5

30

Bishop score

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.

31

Cervical ripening

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.

32

Oxytocin

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.

33

Prolapsed cord

Call assistance
Notify doc
Apply pressure with sterile glove
Reposition client
Sterile soaked towel to cord
Monitor FHR
Give o2
IV fluids
Cesarean
Support

34

Fetal distress

< 110 or > 160
No variability
Hyperactivity or no activity
PH<7.2

Reposition
8-10 L O2
Dc oxytocin
Increase fluids
Prepare for cesarean

35

Precipitous labor

< 3 hours

Can result in fetal hypoxia,,asphyxia, or intracranial hemorrhage

36

Lochia amount

Rubra up to 3 days
Serosa 4-10
Alba up to 6 wks

Scant 10cm
Heavy 1 pad saturated in <2 hrs
Excessive less than 15 min

37

APGAR

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

38

New Ballard scale for gestational age

Done in 2-12 hours after birth
Physical:
Skin Texture: thin to wrinkled
Lanugo: present to absent
Plantar creases
Breast tissue: none to 10mm bud
Eyes open
Ear cartilage
Genitals
Neuromuscular
Posture extended to flexed
Square window wrist
Arm recoil
Popliteal angle, knees can extend
Scarf sign
Heel to ear

39

Vitals newborn

Resp, HR, BP, temp

R 30-60 with apnia less than 15 sec
HR 100-160
BP 60-80/40-50
Temp 36.5 37.2, 97.7-98.9

40

Normal newborn labs

Hgb 14-24
Hct. 44-64%
RBC 4800-7100000
Leukocyte s 9000-30000
Platelets. 150-300000
Glucose 40-60
Bilirubin: 0-6 day 1
<12 day 3

41

Newborn nutrition

5-10% wt loss but gain back in 14 days
110-200g wt gain per week for 3 months

100-140ML/kg/24hrs
110cal/kg/day
Milk is 20cal/oz
Breast milk babies may need vit D
Formula needs iron
Flouride after 6 months