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Family NRSG > Week 4: Routine Prenatal Care and Infections (L&D) > Flashcards

Week 4: Routine Prenatal Care and Infections (L&D) Flashcards

(102 cards)

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1
Q

Prenatal care: EDC & EDD

A
  • EDC = estimated date of confinement
  • EDD = estimated date of delivery
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2
Q

Prenatal history includes

A
  • Obstetric history
  • Due date for this pregnancy
  • Monthly/weekly prenatal visits
  • Lab values
  • Maternal medical history
  • Ultrasound results
  • Etc
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3
Q

TPAL –> WILL BE ON QUIZ

A

T = Term birth
P = Preterm births
A = Abortions (spontaneous & therapeutic)
L = Living children

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4
Q

Gravida

A

Number of pregnancies

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5
Q

Parady

A

Number of gestational viable births

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6
Q

Woman pregnant with 4th baby, two children born at term and living, one miscarriage, is:

A
  • G2 P4
  • T2 P0 A1 L2
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7
Q

Cues for risks (MAY SEE IN QUIZ)

A
  • High B/P
  • Hist of previous postpartum hemorrhage
  • Hist of previous shoulder dystocia
  • Rh negative
  • Gestational diabetes
  • More than 5 previous births
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8
Q

Risk factors with STDs

A
  • increased risk of preterm labor and preterm birth
  • Premature rupture of membranes with risk for infection
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9
Q

Routine prenatal lab testing (review)

A
  • Complete blood count
  • Blood type and Rh & antibody screen
  • Past and/or current infections
  • Rubella, HIV, Group B, Hep B, STD/serology, Urinalysis with culture, Syphilis blood test
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10
Q

additional prenatal lab testing (review)

A
  • Not all at first prenatal visit: fetal fibronectin, herpes culture, blood glucose studies, Toxicology screening, TB testing, TORCH titers
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11
Q

Risk factors for group B strep

A
  • Gestation under 37 weeks gestation
  • Ruptured membranes over 18 hours
  • Maternal temp over 100.4
  • GBS bacteriuria this pregnancy
  • Hist of infant with GBS disease
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12
Q

Increased risk for diabetic mothers

A
  • Pyelonephritis
  • Ketoacidosis
  • Preeclampsia
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13
Q

Increased risks for the infants of diabetic mothers

A
  • Macrosomia
  • Birth trauma
  • congenital anomalies
  • Resp. distress syndrome (ARDS)
  • Hypoglycemia
  • Hyperbilirubinemia
  • Fetal malformations
  • Fetal demise
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14
Q

Meds during pregnancy

A
  • The classification system for medications during pregnancy has five categories
  • “Do the risks outweigh the benefits?”
  • Table on slide 22
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15
Q

Cues for maternal substance abuse

A
  • Med hist: cellulitis, hepatitis, Depression/suicide attempt, STDs/HIV/AIDs
  • Placental abruption, unexplained fetal death, Spontaneous abortion, preterm labor/birth, LBW
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16
Q

Domestic violence

A
  • Pregnant women are more likely to die from intimate partner violence (IPV) than from any other cause
  • 11% more homicides occur in pregnant women than in non-pregnant women
  • 22% of pregnant teens are in an abusive relationship
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17
Q

Cues of IPV in pregnancy

A
  • Unplanned pregnancy
  • Delayed or no prenatal care
  • STDs
  • Bleeding, miscarriage
  • Fetal injury, fetal demise
  • PTL, low birth weight
  • Depression, substance abuse
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18
Q

Cues for abuse

A
  • Multiple bruises in various healing stages
  • Extreme anxiety, hesitancy
  • Hovering partner who answers all questions
  • Frequent visits and healthcare utilization
  • Missed appointments
  • Interview patients in private: “Its our policy to interview all patients in private”
  • “do you feel safe at home?”
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19
Q

Teratogens

A
  • agents that can cause congenital anomalies:
  • Smoking: risk for cleft lip/palate or both
  • Alcohol: fetal alcohol syndrome, mental disability, dysmorphic facial features
  • Drugs
  • Occupational hazards
  • Viruses
  • Nutritional deficiencies
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20
Q

When do teratogens affect the fetus?

A
  • About 10 - 14 days after conception
  • Once the fertilized egg is attatched to the uterus, toxins in the mother can pass to the embryo/fetus
  • The neural tube closes in the first 3 - 5 weeks of the pregnancy. During this time, teratogens can cause neural tube defects such as spina bifida
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21
Q

Some organs are sensitive to teratogens during the whole pregnancy

A
  • This includes the baby’s brain and spinal cord
  • Alcohol affects the brain and spinal cord, so it can cause harm at any time during pregnancy. This is why a woman should not drink alcohol if she’s pregnant.
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22
Q

Infectious diseases in pregnancy

A
  • Common complication of pregnancy
  • May affect only the mother, only the fetus or neonate, or cause serious problems for both mother and infant
  • Infections may be acquired transplacentally, may ascend in the birth canal, or be acquired during passage through the vagina at birth.
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23
Q

TORCH

A

toxoplasmosis, other, rubella, cytomegalovirus, herpes, syphilis

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24
Q

Neonatal viral infections

A
  • Transferred transplacentally or around time of delivery
  • Infants may be initially asymptomatic, yet later develop disabling sequelae
  • Infant can present a few days after birth with:
  • Fever
  • Sepsis
  • Disseminated intravascular coagulation (DIC)
  • ARDS
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25
Toxoplasmosis
- Mode of transmission: transplacental, eating or handling raw meat, exposure to cat feces - Prevention: cook meat thouroughly, wash hands and food prep areas, avoid cat poo
26
Hep B
- Transmission: Direct contact with infected blood/body fluids - Infants with HBsAg positive mothers are given HBIG (immune globulin) and hepatitis B vaccine within 12 hours of birth, 2 more doses within the 1st year.
27
Maternal effects of hep B
- No specific treatment - Breastfeeding is not contraindicated unless nipples are cracked and bleeding
28
Rubella (German Measles)
- Rubella antibody titer of 1:8 or more indicates immune status - reassuring - If woman is non-immune: should be immunized before becoming pregnant or prior to hospital discharge postpartum - Rubella during pregnancy is the most common cause of congential deafness
29
Herpes simplex virus (HSV)
- Approx. 20% to 30% of childbearing women - Most do not have a hx of genital lesions - Neonatal HSV infection can be devastating - Most infections acquired during delivery or by ascendig infection - Postnatal infection occurs rarely
30
Maternal effects of HSV
- Painful cervical, vaginal, or genital lesions - Virus sheds until lesions are completely healed - Tx: oral antiviral therapy
31
Neonatal effects of HSV
- Mortality of 50-60% if neonatal exposure to active primary infection - Protect the neonate from exposure at delivery: - C-section if active genital lesion when presenting in labor
32
Group B Streptococcus (GBS)
- Most common cause of neonatal infectious morbidity and mortality in the U.S. - Prevention approach is risk and screening based: - Urine culture at prenatal visit - Vaginal/anal culture at 35 weeks - If positive, treatment with penicillin starts when in labor - At least 2 doses before the birth can be protective for baby
33
Gonorrhea
- More common in teenage population - Fetal & neonatal effects: - Premature rupture of membranes (PROM) --> Allowing for infection of fetus - Preterm delivery - Chorioamnionitis - Neonatal sepsis
34
Syphilis
- Infection can be transmitted to the fetus at any stage of the disease - With untreated maternal disease, around half of pregnancies results in: - Miscarriage - Fetal death - Newborn death
35
HIV or AIDS
- Perinatal exposure can be transplacental, intrapartum, or from breastmilk - Breastfeeding is contraindicated
36
Summary
- Infectious disease during pregnancy can have a significant impact on maternal/fetal morbidity - Patient education and prompt recognition and treatment of maternal infection during pregnancy can optimize maternal neonatal outcomes
37
Initial evaluation in labor
- Presenting complaint: Contractions, bleeding, headache - EDD/EDC - Pregnancy hist - frequency, duration, and intensity of contractions - Membrane status - prescence/absence of bleeding - Cervical status - Thoroughly review prenatal record - blood type, platlets, etc - Any complications of pregnancy
38
Cues that warrant closer focus
- Bleeding -Post dates (more than 40 weeks gestation) - Fever, HTN (MAY BE ON QUIZ) - Hist of genital herpes and current sx - Ruptured membranes (GBS) - Advanced cervical dilation - FHR minimal variability or deceleration - Large or small for gestational age - Previous complications
39
Performing leopolds manuevers
- May be on NCLEX - Determine fetal lie: up and down, or across (transverse lie) - Presentation: head or buttocks, shoulder, face, brow coming first? - Position: Engaged in the pelvis or not - Assists in determining best site for FHR auscultation
40
Performing a vaginal exam with sterile gloves, assess cervix for:
- Dilation: how open is the cervix? - Effacement: How thin is the cervix? - Station: How low is the presenting part?
41
Effacement: How thin is the cervix?
- Effacement: The gradual thinning, shortening and drawing up of the cervix measured in percentages from 0 - 100%
42
Fetal station - How low is the presenting part?
- station = relationship of presenting part to the ischial spines "Will the bby fit through the pelvis?" - Likely will have a question about this on NCLEX
43
Station = Minus 1 or Minus 2,3,4,5, means:
Presenting part is above zero station and higher than the ischial spines
44
Plus 1 or pluse 2,3,4,5, means
- Presenting part has descended lower than the ischial spine - Positive (+) is at the outlet
45
Stage 1 of labor
- pre-labor - phase 1: latent behavior - phase 2: active labor - Phase 3: transition
46
2nd stage
pushing
47
3rd stage
birth + placenta
48
Hormonal theories of labor
- Progesterone inhibits uterine contraction - Labor begins when progesterone's inhibition is overcome by an increase in the levels of estrogen
49
Positive feedback loop responsible for progression of labor
- Uterine contractions... - Push fetus against cervix (stretch) - Oxytocin secreted through neuroendocrine reflex - Prostaglandin produced
50
Labor pain is unique
its the only pain that does not indicate something is going wrong
51
True vs false labor
- flase labor produces pain at irregular intervals (braxton hicks) but there is no cervical dilation - True labor begins when contractions occur at regular intervals and there is cervical change:
52
Description of pain from contractions
- tight metal belt from back around to below uterus - Heat and tightness with each contraction - Back pain increases with walking - Dilation of cervix with a discharge of blood containing mucus in the cervical canal
53
Five P's of labor
- Power - passenger - Passageway - Position - Psychology
54
Bedside nurse
- Support maternal and family birth plan - Monitor, assess, intervene, educate - Provide safe environment
55
Power: uterine contractions
- Duration - Frequency - Intensity (palpation): Mild = nose, moderate = chin, strong = forehead - Resting tone: soft or firm
56
Timing contractions
beginning of one to the beginning of the other
57
Tachysystole (probably on NCLEX)
- Too many contractions. More than 5 contractions in 10 minutes (closer than 2 min apart) for 30 minutes - Has to be stopped
58
Passenger (fetus)
- Fetal descent through the birth canal is determined by: - Size of fetal head - Fetal lie - Fetal presentation - Fetal attitude - fetal position - Leopolds - We want baby facing the moms spine (we don't want bone to none) - We want baby to be "flexed"
59
Fetal lie (may be on NCLEX)
- Relationship of long axis (spine) of the fetus too long axis of the mother - Two primary lies: - Longitudinal - Transverse or oblique
60
Attitude
Flexion of the head toward the chest
61
Fetal presentation
- Determined by the portion of the fetus that first enters the pelvic inlet: - Cephalic - Breech - Shoulder - Compound
62
Picture of face presentation
May have brusing and swelling
63
Labor
- Regular frequent contractions, leading to progressive cervical effacement and dilation - Labor dx usually made in retrospect - Avg. 1st labor is 15 hours from 4 cm dilation
64
Active phase labor
- at least 4 cm dilated - Regular, frequent, usually painful contractions - Dilate at least 1.2-1.5 cm/hr - Are not comfortable with talking or laughing during their contractions
65
1st stage of labor (3-10 cm) nursing care
- when in bed, side lying or semi-fowlers position only - Contractions: frequency, intensity, duration - Fetal heart tones: variability, baseline rate, decels or acels.
66
SROM, AROM
- SROM = Spontaneous rupture of membranes - AROM = Artificial rupture of membranes - Ruptured membranes increase risk of infection - Spontaneous rupture of membranes occurs at the height of the contraction with a gush of fluid out of vagina - Artificial rupture of membranes called amniotomy - Monitor throughout AROM and for 30 min afterwards to confirm no prolapse
67
1st stage nursing care cont.
- Maternal vital signs - Fetal heart rate - Subsequent vaginal examinations: - No standard, approx q 2 hours unless ruptured - Assess fetal descent and cervical change
68
What is the fetus doing during labor?
- Cardinal movements of labor - Engagement (0 station) - Descent (continous) - Flexion - Internal rotation - Extension - External rotation - Expulsion
69
(Slide 80) LOA is the best position
- L = left side of mom - O = occiput is reference point - A = Anterior facing occiput
70
What does coping look like? Active labor
- Relaxation between contractions - Rhythmic activity-rocking ___
71
When does she need help?
- Early labor: Tensing at peak of contraction - __ _
72
Pain relief
___
73
Supportive care
- Your presence! - Counter-stimulation:
74
Nitrous oxide
75
Pharmacological pain relief
- IV analgesia: systemic - ___
76
Nursing considerations for labor
- Assess womans___
77
Epidural analgesia
78
Nursing care after placement
- Position patient in semi-reclining position with lateral tilt ___
79
Side effects of epidural
- Hypotension - Itching: give Naloxone (Narcan) - ___
80
Contraindications (may be in NCLEX)
81
2nd stage of labor (10 cm to delivery) Pushing stage
- Cues: FHR variables, increase in vaginal show, suprapubic pain if epidural present, grunting if no epidural, "Im going to poop!" - Actions______
82
Coach pushing
- Midwives might suggest open glottis pushing - ____
83
Document
84
After the birth
85
Delivery of placenta
86
"Assisted delivery" "instrumented delivery" "Operative delivery"
- All mean use of vacuum extractor or Forceps
87
Forceps pros and cons
- Pros: more likely to achieve vaginal birth, less likely to cause cephalohematoma - Cons: increased risk of anal sphincter injury _____
88
Vacuums pros and cons
89
Recovery time
In first hour of life, babies can crawl and self attach to breast
90
Slide 99
91
Prolapsed cord
- About 1 in every 300 births -Umbilical cord slips out thorugh the vagina before the babyy when the bag of waters breaks and head is not engaged - Potentially fatal complication
92
Risk factors
- Multiples - Preterm labor - Low birth weight - Breech presentation - transverse lie - Ruptured membranes with unengaged fetal head
93
What if the baby is "stuck" (shoulder dystocia)
- One or both of the baby's shoulders may get stuck behind the pubic bone during childbirth - _____
94
Risk factors include:
95
Nursing interventions for shoulder dystocia (Likely will be on NCLEX)
- Lower mom's head - Mcrobert's maneuver: - At least two people - Flex mom's knees and hips toward her chest - perform supra pubic pressure side ways or up and down pressure jusst above pubic bone to rotate fetus - Never pres on uterine fundus
96
Old midwives' trick
Turn patient on all fours in crawling position
97
Be prepared
- Discuss Mcrobert's and suprapubic pressure with mom well in advance of delivery - Have stool at bedside - Know where the bab's back is, if possible - Stool already to go
98
Common reasons for c/s
- Multiples - Breech presentation - Previous uterine surgery ____
99
C-section Recovery
- About 2 hours - Mom may breastfeed
100
TOLAC
A trial of labor for vaginal birth. Trying vaginal birth after she has previously had a c-section.
101
VBAC
Essentially that the TOLAC was successful. The mom delivered vaginally after she had had a c-section before
102
C-section recovery
- About 2 hours - Mom may breastfeed - Fundal checks just as for vaginal birth - ____

Family NRSG (8 decks)

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