Term
| What time frame does the Puerperium or postpartal period refer to? |
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Definition
*It is the period during which a woman adjusts, physically and psychologically, to the process of childbirth.
* It begins immediately after birth and continues for approximately SIX WEEKS, or until the body has returned to a near pre-pregnant state |
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Term
1. Be sure to know where the fundus of the uterus should be located in relation to time of delivery.
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Definition
* Right after the woman gives birth it should be somewhere in the vicinity of the umbilicus.
* It moves one cm per day, completely resolved to its normal location within 10 days. (It contracts itself back down & shrinks in size). |
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Term
| What helps increase the contraction of the uterus? |
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Definition
| • Breastfeeding and ambulation |
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Term
| Processes that slow down contraction of the uterus ? |
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Definition
| difficult birth, twins, triplets, a full bladder or a c-section. |
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Term
| Vanessa wrote the fundus should be where? |
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Definition
* HER FUNDUS SHOULD NEVER BE ABOVE THE UMBILI – 14 HOUR PAST DELIVERY IT WILL MOST LIKELY BE AT THE LEVEL OF THE UMBILICUS…THIS OCCURS B/T 6-12 HOURS POST DELIVERY.
* FUNDUS LOCATION POST BIRTH? 12HRS – UMBILICUS, 28 HRS – 2 CM BELOW UMBILICUS, EVERY 24 HRS FUNDUS GOES DOWN 1 CM (CHECK BOOK). |
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Term
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Definition
• The fundus is in the midline at the umbilicus or 2 fingerbreadths below the umbilicus.
• BP returns to prelabor levels
• Pulse is slightly lower than in label
• Discharge (Lochia) = from the woman should be bright red (rubra!) and with or without clots, small to moderate amt (from spotting on pads to ¼ to ½ of pad covered in 15 minutes). Doesn’t exceed to saturation of one pad in first hour. (if perineal pad becomes soaked in a 15-min period or if blood pools under the buttocks, continuous observation is necessary.
• Bladder is nonpalpable.
• Perineum is smooth, pink, w/o bruising or edema
• Emotional state = wide variation, including excited, exhilarated, smiling, crying, fatigued, verbal, quiet, pensive and sleepy. |
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Term
If the fundus rises and displaces to the right, the nurse must be concerned about 2 factors:
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Definition
1. uterine contractions become less effective and increased bleeding may occur.
2. The most common cause of uterine displacement is bladder distention.
(the bladder fills very quick in women after birth & they also cannot feel it for many reasons… so the nurse needs to assess for bladder distention!) All measures should be taken to enable the mom to void (warm towel on lower abd, warm water on perineum, warm water on hand to facilitate voiding. If the woman is unable, catheterization is necessary.) |
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Term
|
What is the normal progression of lochial change in color?
The color tells healing…
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Definition
Bright red at birth --> Rubra—dark red (first 2-3 days) --> Serosa—pink (3-10 days) --> Alba—creamy white or light yellowish --> Clear
**Once a change has occurred, it should not return to its previous state & if it does you should contact your provider. |
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Term
What are of the physiological changes that occur in the cervix after birth?
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Definition
| Changes from dimple-like os of nullipara (NEVER BEEN PREGGERS) to lateral slit of multipara (MULTIPLE PREGGERS) |
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Term
| what changes occur in the vagina post delivery? |
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Definition
| • Vagina - Decreases in size for 3 weeks in nonlactating woman; Decreases in size slower in lactating woman due to hypoestrogenic state; NEVER RETURNS TO PREPREGNANT STATE. |
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Term
| how much wt loss is expected at birth? at 6-8 wks? |
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Definition
| 10 to 12 pounds at birth; 25 to 30 pounds by 6 to 8 weeks |
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Term
what physiologic changes happen in the abdomen?
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Definition
| Appears loose and flabby, but will respond to exercise. Diastasis recti abdominis (SEPARATION) responds to exercise – THE MUSCLE THAT SEPARATES YOUR ABS. THIS COMMONLY HAPPENS. Diastasis recti abdominis, a separation of the abdominal muscles commonly occurs after pregnancy. |
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Term
| what changes happen in bowels after birth? |
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Definition
Sluggish due to progesterone and decreased abdominal musculature leading to constipation. THEIR MUSCLES ARE WEAK – MAKES BM’S DIFFICULT.
Fear of pain and tearing episiotomy delays elimination. COLACE IS GIVEN BID FOR THIS.
After cesarean section, bowel tone returns in few days and flatulence causes abdominal discomfort/PAIN |
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Term
| what changes happen in the kidneys due to birth? |
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Definition
Puerperal diuresis occurs; Overdistention of bladder caused by rapid filling of bladder – THIS CAN CAUSE HEMORRHAGE TOO;Uterine relaxation occurs causing hemorrhage
Uterus deviates to side and becomes boggy WHEN THE BLADDER IS DISTENDED;
Dilated ureters and renal pelves return to prepregnant state by 6 weeks – YOU ARE MORE PRONE TO UTI’S. TEACH THEM TO REPORT BURNING AND FREQUENCY. |
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Term
| what changes happen in cardiovascular for mom after delivery? |
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Definition
cardio returns to prepregnancy state by 12 weeks. • The Heart will MOVE BACK OVER immediately. There are CHANGES IN HBG & HCT ARE D/T THE BIRTH PROCESS. CBC IS DRAWN 1ST POST PARTUM DAY for baseline. DECREASE OF 2% IN HCT INDICATES LOSS OF 500 CC’S OF BLOOD. Normal Hct for mom is 38-47%. 200-300 CC’S BLOOD LOSS IS NORMAL. C SECTION? AVERAGE IS 600 CC’S.
• The BLOOD VOLUME ALSO DECREASES FROM all the DIURESIS. HEMODILUTION ALSO OCCURS POST BIRTH and can AFFECT CBC. |
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Term
| what are WBC's after birth? |
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Definition
| NORMAL OCCURENCE IS WBC’s UP TO 20,000 D/T THE TRAUMA of BIRTH. |
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Term
| why would a woman start shaking uncontrollably after birth? what is done? |
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Definition
| o Postpartal chill (phase of uncontrollable shaking) may occur after birth & is normal. It’s a vasomotor response. Treat with a warm blanket or warm beverage. |
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Term
| why is there so much postpartal diaphoresis (sweating)? what can the nurse do to prevent chilling? |
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Definition
| Elimination of excess fluids and waste products. To prevent chilling; Assist patient in getting cleaned up and provide fresh change of clothing and bedding; THEY MAY SWEAT A LOT SO PREVENT CHILLING. NIGHT SWEATS CAN OCCUR. THEY MAY NEED A LINEN CHANGE to prevent chilling. |
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Term
| when should a breastfeeding mom expect her period? |
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Definition
| • If breastfeeding, menstruation return depends on length of time breastfeeding and frequency of breastfeeding. |
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Term
| when should a breastfeeding mom expect to be ovulating again? what's it depend on? |
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Definition
| • The return of ovulation for a breastfeeding woman varies. Increased levels of PROLACTIN will cause the ovulation to return. Ovulation may precede menstruation so mom needs to be careful & know breastfeeding is not a reliable birth control method. |
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Term
| when should a non-breastfeeding woman expect her period? |
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Definition
| In NOT breastfeeding (non-lactating) the period will return in 6 to 10 weeks. |
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Term
| when does ovulation return for women who do not breast feed? |
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Definition
| • Ovulation returns in 6 months for women who do not breastfeed. |
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Term
| how long does the risk for thromboembolism last for a woman after birth? why? how do we check? |
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Definition
| Risk of thromboembolism lasts 6 weeks due to the: PRESENCE OF ESTROGEN AND PROGESTERONE. ASSESS FOR DVT. THEY ARE SCREENED FOR RISK FACTORS HERE. Says to do Homan’s sign. Dorsiflex foot back & see if there is pain. |
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Term
Why are postpartum women at risk for UTIs?
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Definition
| Dilated ureters and renal pelvis will not return to normal for 6 weeks & makes the mom more prone to UTI’s Teach them to report burning & frequency. |
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Term
| what is postpartum diuresis? |
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Definition
* ABOUT 12 HOURS after DELIVERY MOM STARTS PEEING A LOT TRYING TO GET RID OF EXTRA FLUID. FOLEY BAGS WILL FILL UP IN LIKE 3 HOURS. THEY ARE PRONE TO UTI’S!! DUE TO ALL THESE CHANGES.
* EPIDURALS PUT YOU MORE AT RISK FOR ALTERATIONS AND PROBLEMS WITH THE BLADDER. ALTERATION IN ELIMINATION, URINARY RETENTION CAN OCCUR. YOU NEED TO STRAIGHT CATH THEM! DON’T GET HER OUT OF BED B/C SHE IS NUMB. |
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Term
| what is postpartum chill? what should a nurse do? |
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Definition
| Nervous response or vasomotor change – THEY SHAKE VIOLENTLY, but it is a NORMAL VASOMOTOR RESPONSE. Treat with warm blanket or warm beverage - COMFORT MEASURES |
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Term
| Is it normal for a postpartum woman to have a temperature elevation up to 100.4 in the first 24 hours? What might this indicate? What interventions can the nurse perform? |
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Definition
| Temperature elevation up to 38°C (100.4°F) is due to normal processes should last for only 24 hours. The high temp is usually due to being NPO & DEHYDRATION. Nurse should PUSH FLUIDS ASAP to reduce temp, then GO BACK AND RECHECK. TEMP CAN ELEVATE IF MOM IS DEHYDRATED. CALL MD IF TEMP IS OVER 100.4. |
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Term
| Why are postpartum women prone to constipation? What nursing interventions can the nurse perform? |
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Definition
• Bowels are sluggish d/t progesterone and decreased abdominal musculature leading to constipation
• The mom just gave birth & fears the pain and tearing of episiotomy delays elimination
• After c section, bowel tone returns in a few days and flatulence causes abdominal discomfort—the gas pain is often more painful than the incisional pain!
• Docusate or colace—is given to help constipation. One in the morning and one in the evening to help keep stool soft |
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Term
Why should postpartum women who are breastfeeding not rely on this as a means of birth control? What should the nurse teach the patient?
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Definition
• In lactating women, ovulation return varies due to increased levels of prolactin
• Ovulation may be happening before menstruation occurs. Breastfeeding is not a reliable means of contraception!
• Nurse should advise patient to utilize other methods of birth control to prevent pregnancy and that you cannot rely on breastfeeding for birth control! |
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Term
| when does the taking in phase occur? what behaviors would you expect to see in the mom? is this the best time for detailed teaching? |
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Definition
o occurs 1-2 days after delivery
o sorting reality from fantasy in birth experience
o mother tends to be passive and focused more on her own needs
o for example, she’s more interested in visiting w/ friends than being w/ baby.
The taking in phase is NOT the best time for detailed teaching! |
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Term
when does the taking hold phase occur? what behaviors would you expect to see in the mom? is this the best time for detailed teaching?
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Definition
o Occurs 2-3 days after delivery
o Ready to resume control over life
o This is the best time for detailed teaching |
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Term
| what are the 4 stages of maternal role attainment? |
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Definition
1. Anticipatory stage: occurs during pregnancy and mother looks to her role models on how to be a good mother
2. Formal stage: occurs when the baby is born and acts as she believes others expect her to act
3. Informal stage: occurs 3-10 months after delivery and the mother develops her own style of mothering
4. Personal stage: occurs 3-10 months after delivery and the mother becomes comfortable with the role of being a mother
Anticipatory → Formal → Informal --> Personal |
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Term
What does postpartum blues refer to? What contributes to it? What should the nurse teach the patient?
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Definition
• This is a transient period of depression
• Occurs during the first few days after delivery
• Resolves without intervention in 10-14 days
• Manifests as tearfulness, anorexia, difficulty sleeping, and feeling of letdown
• Caused d/t changing hormone levels, psychologic adjustments, unsupportive environment, insecurity, fatigue, discomfort and overstimulation
• Nurse should teach pt and the husband that this is a normal response and assure them that it will pass
• Nurse should also teach that this usually resolves w/in 10-14 days, but if symptoms persist or worsen, the woman may need evaluation for postpartum depression |
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Term
| Why is social support so important for a new mother and her family? |
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Definition
• Life of new mother may change drastically very quick. She may be spending less time with her coworkers and single friends; will have increased contact w/ parents of small children
• Isolation may occur d/t maternity leave or having to quit job to stay home with the new baby; so mother may need to develop new support systems and can go to support groups
• Without proper social support, mother can become stressed and this can contribute to postpartum depression, child neglect and abuse |
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Term
What are some factors that influence maternal infant attachment?
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Definition
• Personal characteristics
• Involvement w/ the family of origin—closer families have more of a support system
• Relationships
• Stability of home environment
• Communication patterns
• Degree of nurturing the mother received as a child |
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Term
| What are some behavioral areas the nurse should assess and observe in the mother if bonding/attachment is occurring? |
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Definition
• Progression of touching activities: from fingertip exploration of the newborn’s extremities toward palmar contact w/ larger body areas and finally to enfolding the infant with the whole hand and arms
• Mother arranges herself or the newborn so that she has direct face to face and eye to eye contact
• Intense interest in having the infant’s eyes open—when they are open, the mother characteristically greets the newborn and talks in high pitched tones to the baby
• Responds verbally to any sounds emitted by the newborn, such as cries, coughs, sneezes and grunts |
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Term
| Why is it so important for bonding/attachment to occur? |
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Definition
• If it doesn’t occur it can affect normal growth and development
• In Donna’s words—baby can be really screwed up if it doesn’t attach
• NOT SURE IF THIS IS CORRECT—CAN’T REALLY FIND ANYTHING ELSE |
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Term
What are three phases of maternal attachment behavior?
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Definition
• Acquaintance phase: fingertip exploration, en face position, responds verbally to sounds of infant
• Phase of mutual regulation: adjustment between needs of mom and needs of infant
• Reciprocity phase: mutually gratifying interaction among mother, infant and father |
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Term
What are some nursing interventions/teaching that will help promote sibling and family member attachments to the newborn?
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Definition
• Social setting and personality influence attachments: open visiting hours, rooming-in
• Siblings can participate in the care in developmentally appropriate ways
• Get grandparents involved |
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Term
What are some cultural influences that impact the postpartum period?
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Definition
• Food, fluid, rest, hygiene, meds like herbs, relief measures, support and advice
• Important for nurse to recognize pt’s cultural practices
• Offer and support individual choices |
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Term
Why is it important to assess for high risk factors when caring for a postpartum mother? What are some of these factors?
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Definition
• It’s important to assess for high risk factors to identify any problems the mother may have and to apply appropriate interventions
• Some high risks are: Preeclampsia, diabetes, cardiac disease, c-section, overdistention of uterus (multiple gestation, hydramnios), abruptio placentae, placenta previa, precipitous labor (<3 hours), prolonged labor (>24 hours), difficult birth, extended period of time in stirrups at birth and retained placenta |
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Term
What are some principles the nurse should follow in performing a postpartum assessment?
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Definition
• Select a time that will provide the most accurate data: have pt void and put head of bed in a flat position prior to checking uterus to evaluate progress of involution
• Perform procedures as gently as possible to avoid unnecessary discomfort
• Record findings as clearly as possible
• Explain the purpose of regular assessments
• Teach pt self care while performing assessment |
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Term
| What are normal vital sign ranges for a postpartum mother? |
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Definition
• Temperature elevation to less than 38° C/100.4° F d/t normal processes and should last no longer than 24 hours
• Blood pressure should remain stable
• Pulse slows, then returns to pre-pregnancy level |
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Term
|
What are normal vital sign ranges for a postpartum mother?
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Definition
TEMP: up to 38 degrees C (100.4 F) may occur after birth as a result of the exertion and dehydration of labor. After the first 24 hrs, the woman should be afebrile, and a temperature of 38 C (100.4 F) or greater suggests infection. Nurse should encourage fluids & recheck temp.
BP: should remain stable after childbirth. A decrease may indicate physiologic readjustment to decreased intrapelvic pressure or it may be related to uterine hemorrhage.
(Teach client how to take her temperature and the infant's temperature and how to
read a thermometer.) |
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Term
| BP elevations, esp when accompanied by headache, suggest?? |
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Definition
| preeclampsia, and the woman should be further evaluated |
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Term
| Puerperal bradycardia with rates of 50 to 70 beats/min after birth indicates what? |
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Definition
| this commonly occurs during the first 6 to 10 days of the postpartal period. (But then returns to prepregnant state.) This may be related to decreased cardiac effort, the decreased blood volume following placental separation and contraction of the uterus, and increased stroke volume. |
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Term
| what does tachycardia after birth indicate? |
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Definition
| Tachycardia occurs less frequently and is related to increased blood loss or difficult, prolonged labor and birth. |
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Term
What does BUBBLEHE stand for?
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Definition
What needs to be assessed:
B = Breast
U = Uterus
B = Bladder
B = Bowel
L = Lochia (discharge)
E = Episiotomy/Laceration
H = Homan's/Hemorrhoids
E = Emotional |
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Term
| What does REEDA stand for? |
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Definition
REEDA—Perineum Assessment:
R = Redness
E = Edema or swelling
E = Ecchymosis or bruising
D = Drainage
A = Approximation of episiotomy or laceration |
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Term
| What is a positive HOMAN’s sign? How does the nurse assess for this? |
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Definition
Assessment for thrombophlebitis
Legs stretched straight with knees flexed, sharply dorsiflex foot, Pain indicates a positive Homan's sign, which needs to be reported. (Describe pain and report to doc), Ultrasound is done if positive Homan's sign. Treatment is low dose heparin therapy. |
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Term
What does a boggy uterus indicate?
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Definition
A boggy uterus, a displaced uterus, or a palpable bladder are signs of bladder distension and require nursing intervention.
A fundus that is above the umbilicus and is boggy (feels soft and spongy rather than firm and contracted) is associated with excessive uterine bleeding. |
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Term
What is the first thing a nurse should do if she finds a boggy uterus?
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Definition
| First thing nurse should do is massage the uterus to get it to contract. |
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Term
Why is patient at high risk for alteration in elimination: urinary retention in the immediate postpartum period after delivery?
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Definition
Alterations in elimination, urinary retention r/t effects of epidural anesthesia
Standing order to straight cath bc she is numb
Epidural takes about 2 hrs to wear off (normally), but can take up to 24 hrs.
The postpartal woman has an increased bladder capacity, swelling and bruising of the tissue around the urethra, decreased sensitivity to fluid pressure, and a decreased
sensation of bladder filling. Consequently, she is at risk for overdistention,
incomplete bladder emptying, and a buildup of residual urine. |
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Term
How does the nurse assess for signs of bladder distention?
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Definition
| Palpate the bladder... look, can "see" signs of distention & do not want to. The nurse should assess the bladder for distention until the woman demonstrates complete emptying of the bladder with each voiding (palpable bladder.) |
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Term
What should the nurse do if she finds the uterus firm but displaced to the right in the abdomen?
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Definition
| Distention of the bladder should be suspected and the bladder should be emptied immediately and the uterus remeasured. If the woman is unable to void, in-and-out catheterization of the bladder may be required. |
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Term
What should the nurse teach a new mom about nutrition?
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Definition
* Nonnursing mom: reduce her caloric intake by about 300 kcal and return to prepregnancy levels for other nutrients.
* Nursing mom: increase her caloric intake by about 200 kcal over the pregnancy requirements or a total of 500 kcal over the nonpregnant requirement.
* Teach patient to take iron supplements for 4 to 6 weeks after delivery to prevent Anemia.
(Class Notes: Will be prescribed to continue taking prenatal vitamins; unless very anemic (any Hgb below 10), will take ferrous sulfate – will take Vitamin C to help it absorb.
* Include dietary teaching with pts – foods rich in iron-liver, leafy greens, etc.) |
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Term
| What are the caloric requirements of a breastfeeding mother and what should the nurse teach her? |
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Definition
| After birth, increase caloric intake by about 200 kcal (a total of 500 kcal over the nonpregnant requirement.) Supply literature on nutrition, so that the woman will have a source of information after discharge. Iron supplementation… |
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Term
What are the caloric requirements of a non-breastfeeding mother and what should the nurse teach her?
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Definition
| Reduction of caloric intake by 300 kcal and return to prepregnancy levels for other nutrients. Again, supply literature on nutrition… Iron supplementation… |
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Term
What are the four physical and developmental tasks that a woman must accomplish during the postpartal period?
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Definition
a. Restoring her physical condition
b. Developing competence in caring for and meeting the needs of her infant
c. Establishing relationship with her new child
d. Adapting to altered lifestyles and family structure resulting from addition of a new family member |
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Term
What are some findings by the nurse that would indicate that a woman is having difficulty adjusting psychologically?
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Definition
a. Excessive continued fatigue (often a highly significant factor in a new mother’s apparent disinterest in her newborn. But need to let mothers rest after long labor bc can be very tired and may wrongly classify them in this category.)
b. Marked depression (if have history of depression, more likely to have postpartum depression)
c. Excessive preoccupation with physical status or discomfort
d. Evidence of low self-esteem
e. Lack of support systems
f. Marital problems
g. Inability to care for or nurture the newborn
h. Current family crises (illness, unemployment)
These characteristics frequently indicate a potential for maladaptive parenting, which may lead to child abuse or neglect and cannot be ignored. Referrals may be needed. |
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Term
|
Know about RHOGAM. Why it is administered, when it should be administered, contraindications, how it is administered, factors to consider before administering, things you should teach the patient before administering, things you should assess for after administering.
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Definition
Mother must be Rh-, not previously sensitized to Rh factor. Infant must be Rh+, direct antiglobulin negative. Rhogam is given to prevent mom from forming antibodies that will attack future fetus'(may cause hemolytic disease of NB in future pregnancies). Given at 28 weeks & within 72 hours of birth.
Rhogam is given IM or as a drip called Rhofilac (IV) given slow IV push. If it says RhoGam on it, cannot give IV; if Rhofilac, can give IV or IM. If given IM, give it in the deltoid b/c needs to get in the muscle or mother will get sensitized; need to be 100% sure it gets in the muscle.) |
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Term
|
Know about RUBELLA. Why it is administered, when it should be administered, contraindications, how it is administered, factors to consider before administering, things you should teach the patient before administering, things you should assess for after administering.
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Definition
Dose/Route: Single-dose vial, inject subQ in outer aspect of the upper arm.
Indication: Stimulate active immunity against rubella virus.
Adverse Effects: Burning or stinging at the injection site; about 2-4 weeks later may have rash, malaise, sore throat, or headache.
Nursing Implications: Determine whether woman has sensitivity to neomycin (vaccine contains neomycin); is immunosuppressed, or has received blood transfusions (not to be administered within 3 months of blood transfusion, plasma transfusion, or serum immune globulin). To be given at discharge.
Client Teaching: Name of drug, expected effect, possible adverse effects, possible comfort measures to use if adverse effects occur; rubella titer will be assessed in about 3 months. Instruct woman to AVOID PREGNANCY FOR 3 MONTHS following vaccination. Provide information regarding contraceptives and their use.
(Class notes: Rubella – looking at prenatal records from OB office, if had prenatal care; if it says equivocal-still need vaccine. A live attenuated virus. Given subq in the back, fatty part of the arm. How much - .5 mL. Need to fill out and sign a consent form; need to be advised of potential probs. Need to be informed that if they get pregnant in 3 mos, could cause congenital probs – need to make them promise to use a back up form of birth control. Contraindications-pregnant women, if allergic to neomycin or eggs. Given on day of discharge; can cause low grade fever, some redness and bump on arm.) |
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Term
| when can a woman get pregnant after receiving Rubella vaccination? |
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Definition
| • After the vaccination is given, they must avoid pregnancy for 3 months. ← very important. |
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Term
| a prenatal lab screen for Rubella is done on a new mom. what results indicate succeptibility and immunity? |
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Definition
| . The presence of a positive titer (1:16 or greater) is evidence of immunity. A negative titer (less than 1:8) indicates susceptibility. A pregnant woman who is not immune must avoid anyone with the virus and be vaccinated soon after delivery. |
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Term
|
What are some warning signs and symptoms the nurse should teach the patient about during discharge teaching to report to her physician?
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Definition
When to contact the primary care provider:
• sudden, persistent or spiking fever
• change in the character of the lochia-foul smell, return to bright-red bleeding, excessive amount, passage of large clots
• evidence of mastitis, such as breast tenderness, reddened areas, malaise
• Evidence of thrombophlebitis, such as calf pain, tenderness, redness
• Evidence of UTI, such as urgency, frequency, burning on urination
• Continued severe or incapacitating postpartal depression (past 10-14 days) |
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Term
| What are “after pains”? What nursing interventions can help alleviate these? |
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Definition
| Afterpains are intermittent uterine contractions. These are more common in multiparas than in primiparas. The uterus of the primipara usually remains continuously contracted, the lost tone of the multiparas uterus results in alternate contraction and relaxation. Often occur when the infant is breastfeeding because release of hormone, oxytocin. Nursing mom may benefit from mild analgesic about an hour before breastfeeding. |
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Term
| class notes, interventions for "afterpains" --> |
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Definition
• position prone with small pillow under lower abdomen
• warm sitz bath
• warm K-pad to abd
• Ambulation
• Anelgesic agents such as Ibuprofen or Naproxen Sodium (prostaglandin inhibitors) |
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Term
| what are some common physiologic nursing diagnoses after birth for the mom? |
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Definition
• Risk for hemorrhage related to uterine atony (highest priority?)
• Risk for alteration in elimination related to effects of anesthesia, perineal edema
• Acute Pain related to perineal edema, episiostomy lacerations, cesarean incision. |
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Term
| what are some common nursing diagnoses for the family? |
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Definition
• Family coping: potential for growth related to successful adjustment to new baby.
• Educational needs
• Health-seeking behaviors related to lack of info about infant care, lack of parenting experience |
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Term
What factors can influence learning in the postpartal period?
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Definition
* There is LOTS of education in the postpartal period. The educational needs will be based on varying: age, background & culture, educational level (do they have any learning disabilities? Do they read?), experience, expectations (is there anything specific your pt wants to learn more about?), barriers to learning (language).
* Remember that you are the expert, times change and do not assume that they know what is going on because they have experience. |
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Term
| How should the nurse go about assessing, planning, implementing and evaluating patient and family learning needs? |
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Definition
• Nurse should plan the teaching program based on needs, cultural values, and beliefs.
• Implement the teaching plan when family members are available and ready to learn. |
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Term
What are some instructional methods the nurse can utilize in teaching during the postpartum period?
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Definition
• Handouts & discharge manuals
• Formal classes – start prenatal (may have demonstrations/classes on the unit or in the hospital)
• Videotapes
• Individual Interaction & demonstration
• Closed circuit educational TV shows for new mothers of a variety of topics for around the clock viewing while in the hospital |
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Term
| What are some ways the nurse can evaluate if learning has occurred during the postpartum periord? |
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Definition
• Return Demonstration (one of the best ways to know probably!)
• Question & answer session
• Formal evaluation tool
• Sometimes a follow-up phone call or home health visit is ordered |
|
|
Term
What are some areas the nurse should include in teaching about postpartum self care?
|
|
Definition
• Perineal care: after every bowel/urination squirt on the “peribottle” – it’s warm water to cleanse. Can use a moist antiseptic towel or toilet paper. Wipe from front to back. “pat to dry” Apply perineal meds and pad.
• Teach good hand washing.
• Expect emotional liability. There is a transient period of depression (not the same as postpartum depression) for 10-14 days that usually resolves without intervention. Usually d/t rapid drop in hormone levels, occurs during the first few days after delivery. If it lasts longer than 2 weeks, let someone know… |
|
|
Term
What are some nursing interventions to relieve perieneal discomfort?
|
|
Definition
• Ice pack is best immediately after delivery on perineum.
• On 20 minutes, off 10 minutes. Use for 24 hours. |
|
|
Term
What is a sitz bath? What should the nurse teach about this?
|
|
Definition
• Sitz bath keeps the episiotomy clean and promotes healing
• Best after the first 24 hours. Set a towel down in the bottom of the bath.
• Temp of bath should be 102-105 F for 20 minutes three times a day and PRN.
• A cool sitz bath is fine too, whatever the pt prefers.
• The heat/warmth promotes circulation in area & helps healing.
• Helps with relief of afterpains too |
|
|
Term
What are kegal exercises? What should the nurse teach about this?
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|
Definition
• Kegel’s = 80/day. Do 8 reps of 10 to be effective.
• Start while on the birthing unit & continue exercises at home.
• Your body will let you know if you’re doing too strenuous of activity postpartum. There will be pain! Increased bleeding, increased lochia…. |
|
|
Term
What are some nursing interventions aimed at relieving discomfort from muscle strain?
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|
Definition
• Early ambulation will help the discomfort of muscle strain
• Monitor for dizziness & weakness though (especially if the patient has low Hgb and Hct)
• 1st time they want to stand or go to restroom after delivery? Tell them to call you to go to the bathroom for the first couple times. Their cardiac is very unstable & many women pass out. |
|
|
Term
Why is early ambulation so important in the postpartum period?
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|
Definition
• Helps decrease afterpain & muscle strains.
• “Early ambulation is encouraged to help reduce the incidence of complications such as constipation and DVT.
• Also helps promote a feeling of general well-being.
• Nurse should provide info about ambulation and the importance of monitoring any signs of dizziness and weakness. |
|
|
Term
What should the nurse teach her patient who plans to suppress lactation (does not plan to breastfeed?
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|
Definition
• Wear a supportive well-fitting bra until lactation is suppressed, usually for 5-7 and remove only for showers.
• Ice packs to axillary areas for 20 minutes four times a day.
• Avoid stimulation to breasts until sensation of fullness has passed (usually about 5-7 days).
• Avoid heat (let warm shower water go on back, not breasts)
• Analgesic agents (such as Tylenol or Ibuprofen) will help decrease pain
• Suppression medications/pharmacological treatments are no longer used to suppress breast milk, just the mechanical methods mentioned are now what is used. |
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Term
What is engorgement? What can the nurse teach the patient to possibly prevent this and to promote comfort if she does experience this?
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Definition
• Engorgement is swelling of the breasts caused by expanding veins and the pressure of new milk. Common at 2-6 days when colostrum switches to mature milk.
• Best way to prevent engorgement is to nurse often. Some suggest not going more than 3 hours without nursing and not skipping night feedings.
• Pumping or manually expressing some breast milk can help reduce engorgement, warm showers before feeding, massaging breasts while feeding, applying ice packs after feeding to reduce swelling.
• The mom can take acetaminophen (Tylenol) or ibuprofen (Advil) to relieve pain. Neither will affect the baby. |
|
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Term
| What is IBUPROFEN? Why it is administered, when it should be administered, contraindications, how it is administered, factors to consider before administering, things you should teach the patient before administering, things you should assess for after administering. |
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Definition
| Ibuprofen helps control release of PROSTAGLANDINS which helps relieve the pain of CRAMPING IN THE UTERUS as it returns to the original size. Ibuprofen is given PO when the patient is complaining of cramping in the abdomen and is also given 30 minutes before breastfeeding to prevent cramping. Always have the pt rate their pain before administering it and then about an hour after giving the med. |
|
|
Term
What are some risk factors for suboptimal breastfeeding?
|
|
Definition
Maternal obesity, Primiparity – more than one baby to breastfeed, Use of formula supplementation and pacifiers
Cesarean birth, Second stage greater than one hour, Low birth rate, Flat or inverted nipples |
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|
Term
What are some common breastfeeding concerns of new moms and what should the nurse teach the patient?
|
|
Definition
Nipple soreness- peaks on days 3-6, then recedes.
Cracked nipples
Breast engorgement – on next slide
Plugged ducts – continue breast feeding every 2-3 hrs. massage breast before feeding. Apply ice compress to breasts between feeding for 20-30 min. Alternate feeding positions, positioning of infant’s chin toward obstructed area.
Effect of alcohol and medications – ask dr. before taking anything
Return to work
Weaning – gradually wean the infant from bottle or breast, night time feeding should be the last feeding to be weaned. The infant should be ready to wean at 1 & 1/2. Usually time if they bite your breast, she said! |
|
|
Term
| What should nurse teach to help reduce engorgement |
|
Definition
| manually express small amount of milk; pump may be beneficial, use warm compresses or a warm shower before breastfeeding; for severely engorged breasts, cold compress may be helpful to reduce vascularity after feeding. Compress areola with fingers to facilitate infants grasp (c-hold). Use well fitting nursing brassiere and wear 24hr/day. For excessive discomfort take aspirin, ibuprofen, or actaminophin 30 minutes before feeding. Massage breast; vary position of infants mouth on nipple and areola. |
|
|
Term
What are some nursing interventions aimed at providing emotional support to new moms?
|
|
Definition
| Emotional lability – explain mood swings, tearfulness, and postpartum blues, Help them cope with feelings about birth experience, Coping with feelings about infant, Ability to care for self and infant, Reassurance for successful parenting |
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Term
How can the nurse promote maternal rest?
|
|
Definition
| Organize nursing care to avoid frequent interruptions, Encourage rest period while baby is napping or 1 to 2 naps per day, Encourage rest to decrease problems of establishing breastfeeding pattern, Put sign on mother’s door for visitors to check at nurse’s station before entering |
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Term
What should the nurse teach the new mother about resuming activity once she goes home?
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|
Definition
Gradually increase ambulation and activity over 6 weeks after delivery. Teach pt. to avoid: Heavy lifting (nothing heavier than baby), Excessive stair climbing, Strenuous activity.
Return to work after final postpartal examination |
|
|
Term
What nursing interventions promote family wellness?
|
|
Definition
* Mother-baby, or couplet care:
Allows time to bond with baby
Allows time to learn and practice care of infant
* Sibling visitation/grandparent visitation:
Reassurance of mother’s love and well-being
Opportunity to become familiar with infant
* Interventions at home:
Father carry baby to allow mother to greet siblings
Doll for siblings to care for
Involve siblings in infant care
One-on-one time with siblings and parents |
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Term
|
What should the nurse teach the new mother and her spouse or significant other about resumption of sexual activity?
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Definition
Resume sexual intercourse once episiotomy is healed and lochia flow has stopped – defer to MD or NP. Measure to decrease discomfort: Use water-soluble lubricant only, Female superior or side lying positions help. Breastfeeding mom: breastfeed prior to sexual intercourse to reduce milk flow with orgasm.
Factors that inhibit sexual experience: Baby crying, Body unattractive to mother or partner, Sleep deprivation, Physiologic responses due to hormonal changes, Decreased libido.
Provide anticipatory guidance! Many Dr's recommend resuming sex at around 4-6 weeks. |
|
|
Term
What contraceptive method is best for most new moms especially until after the first postpartum check?
|
|
Definition
|
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Term
|
Why might it be important to use a water based lubricant?
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|
Definition
| The vaginal vault is dry d/t lacking estrogen, some form of water-soluable lubrication such as K-Y jelly or Astroglide may be necessary during intercourse. |
|
|
Term
What are some contraceptive options for breastfeeding moms?
|
|
Definition
1. IUD
2. No estrogen containing birth control pills – PROGESTIN only
3. Condom |
|
|
Term
What are some interventions to prevent infection in new moms including perineal (vag deliveries) and breast as well as incisional and pulmonary in C/S moms?
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|
Definition
| Cough and deep breathe Q2-4hrs, C-section birth moms may have an incentive spirometer ordered to use while awake, Ambulate |
|
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Term
What are some interventions to help prevent abdominal distention (seen commonly in C/S moms)?
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|
Definition
Leg exercises
Ambulation
Avoid carbonated or very hot or cold beverages
Avoid use of straw
Rectal suppositories, enemas
Lie on left side
Cesarean birth moms must have bowel sounds before liquids may be given. Should be passing flatus before solid foods given. |
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|
Term
Know normal lab values for a postpartum mother? i.e. WBC, Hct, Hgb, Platelets
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|
Definition
WBC: 6,000-10,000 (usually return to normal after the first postpartum week)
Hct and Hgb – are difficult to interpret in the first 2 days after birth because of the changing blood volume. A decrease in 2% points for Hct counts as about 500mL of Hgb lost. Hemodilution occurs after 72-96 hrs leading to a decrease in Hgb, Hct, & plasma. Nonpregnant levels are reached by 4 to 6 weeks.
Platelet levels typically fall as a result of placental separation, then they begin to increase by the 3rd or 4th postpartum day, gradually returning to normal by the 6th postpartum week.
I couldn’t find exact numbers for Hct, Hgb, and Platelets |
|
|
Term
Why do postpartum mothers get a first day after delivery CBC drawn?
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|
Definition
| To get a baseline for Hgb and make sure it isn't dropping too much.. signifying hemorrhaging. |
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Term
What would a Hgb below 10 indicate? What nursing interventions might the nurse consider?
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|
Definition
| Call the Dr., Assess for signs of shock and figure out where she is bleeding from (laceration or uterus), Give transfusion, Give iron supplement |
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|
Term
What are some factors/interventions the nurse needs to consider in planning care for an adolescent mother?
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|
Definition
The nurse should consider the maturity and support system, Assess maternal-infant interaction, Roles of support people
Plans for discharge, Knowledge of childrearing, Plans for follow-up care, Contraception counseling is an important part of teaching, If the father is present he should be included in much of the teaching along with the grandparents if they are going to have an active role in caring for the child. Demonstrate positions for handling the baby, Educate about infant behavior, infant care skills, taking it’s temp, clearing the nose and mouth, growth & development, infant feeding, well-baby care, and danger signals if the ill newborn. Give positive feedback about her newborn and her developing maternal responses. Praise and encouragement will increase her confidence and self-esteem. |
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Term
What are some factors/interventions the nurse needs to consider in planning care for a mother who plans to give her baby up for adoption?
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Definition
The mother usually experiences intense ambivalence and several things contribute to this. (Social pressure against giving up one’s child, The woman has made considerable adjustments in her lifestyle to carry and give birth to this child, and may be unaware of her growing bond with her child
Her attachment feeling may peak when seeing the baby, She may not have told friends and family about the pregnancy and lack social support).
After childbirth the mother needs to complete a grieving process to work through her loss and its accompanying grief, loneliness, guilt, and other feelings.
The nurse needs to respect any special requests for the birth and encourage the woman to express her emotions.
Tell the mother that relinquishment is often a painful act of love when she is feeling that she may have made the wrong decision. |
|
|
Term
| no sex or anything in vagina for how long after delivery? |
|
Definition
|
|
Term
| Every woman gets a baseline CBC after birth. If lab indicates a decrease of 2% Hct what does this mean? How much is normal blood loss of vag delivery? c-section? |
|
Definition
| decrease of 2% Hct = 500 cc blood loss. Vag delivery: loss is 200-300 cc's average. C-section: more blood loss, about 700 cc's. |
|
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Term
| what meds help afterpains (intermittent uterine contractions)? |
|
Definition
| PROSTAGLANDIN INHIBITORS... Ibuprofen or Naproxen Sodium. Also, warmth on abdomen helps alleviate cramping. Ibuprofen is a prostaglandin inhibitor & that is what is causing the cramping. |
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|
Term
| what position must the bed be in for fundal assessment? |
|
Definition
|
|
Term
| can oral narcotics be given after epidural? |
|
Definition
|
|
Term
| how long can it take for a BM after delivery? |
|
Definition
| can take 2-3 days. if can't remember though... may need milk of magnesia. |
|
|
Term
| how is Rhogam given? how is Rhofilac given? |
|
Definition
| Rhogam is IM ONLY! (NOT IV!) Rhofilac is Slow IV push & IM. |
|
|
Term
| 14 hours after baby midline episiostomy (usual in US, cut from vaginal opening straight down to anus)... where should the fundus be? |
|
Definition
| It should never be above the umbilicus. Right after delivery it is right at the umbilicus & then descends slightly. Expect: Lochia Rubera (first very red discharge). Teach self care measures (prevent infection & good hand washing, how to use big undies, teach perineal care & to spray warm water after every bladder & bowel movement. |
|
|
Term
| after epidural, need to assure ________. |
|
Definition
|
|
Term
| If the urine is dark for the void? |
|
Definition
| push fluids! should already be doing this, but this indicates pretty severe dehydration. Mom should be getting 2,000 mL fluid/day. |
|
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Term
| What tell pt for the 1st time they get up to go to the bathroom after delivery? |
|
Definition
| tell them to call you for the first couple times... their cardiac is unstable & MANY women pass out. They need to sit up slowly & let legs dangle on side of bed for awhile. Walk slowly with assistance. |
|
|
Term
| how often are VS assessed postpartum? |
|
Definition
| assess q 15 min's for first hour after delivery. 2nd hour: can check every 30 minutes. Hourly for 2 more hours. Then usually every 4 hours for the first 24 hours. We're monitoring for any complications. |
|
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Term
| postpartum we're medicating to promote contractions, decrease bleeding. (give _____ ) |
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Definition
|
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Term
| ________ helps the uterus to firm up. If you can't get it to firm up, what med helps? |
|
Definition
| 1st massage uterus to firm up. Then give IV LR with petossin. (This drug is a vasoconstrictor so watch BP!) |
|
|
Term
| What perineal care is imp to teach? |
|
Definition
| Use "peribottle" with warm water to cleanse after every urination & BM. Use moist antiseptic towelette or toilet paper... always wipe front to back. Apply perineal meds and pad. |
|
|
Term
| What is best immediately upon delivery on the perineum? |
|
Definition
| an ICE PACK. Put on 20 min's, off 10 min's for 24 hrs. The warm sitz bath is best after the first 24 hours. 102-105 degree F water for 20 minutes 3 times a day & PRN too... cool sitz baths are also used. topical meds, anesthetic sprays, witch hazel compresses, ointments all used on perineum... |
|
|
Term
| What are magnesium sulfate soaks over ice? |
|
Definition
|
|
Term
| how much activity after birth? |
|
Definition
| Key is to GRADUALLY increase ambulation & activity over 6 weeks. Avoid heavy lifting (nothing heavier than the baby) esp with c-section. Excessive stair climbing needs to be avoided. Stairs at home are fine, but no carrying heavy groceries up them. Avoid strenuous activity for 6 weeks. There is no driving for the first couple weeks. |
|
|
Term
| is vaseline ok to use after birth with sex? |
|
Definition
| no!!! water based lubricant only |
|
|
Term
| how do we increase circulation in mom's? |
|
Definition
| SCDs/Ted hose is likely on. Do leg exercises every 2 hours until ambulating. Tightening of abd muscles. Until ambulatng, cesarean moms may have special AV boots or stockings ordered to promote circulation esp if high risk for DVT. |
|
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Term
| what helps to manage pain? |
|
Definition
| epidural, PCA (pt controlled anelgesia), analgesic agents. Non-pharm measures that help promote comfort & prevent abd distention: leg exercises, ambulation, avoid carbonated or very hot or cold beverages, avoid use of straws (swallow more air & increase gas), rectal suppositories/enemas can help expel air if it's pretty bad, lying on left side in SIMS position helps bowels expel gas. C-Section moms MUST have bowel sounds before liquids are given. Should be passing gas (flatus) before solid goods are given. |
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Term
| The ______ spine could cause some slowing and may make birth difficult due to the diameter which the fetus must pass. |
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Definition
|
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Term
| The ______ pelvis is the flaring aspect of the predominant bone. |
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Definition
|
|
Term
| the _____ pelvis: an imaginary line separating the flaring aspect from the more narrow line into the syphisis pubis. |
|
Definition
|
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Term
| The fetal head has important sutures w/ membranous areas surrounding. The _________ diameter is the part that must pass through the ischial spine. Passing through involves some molding of the head. |
|
Definition
|
|
Term
| Fontanels & suture lines do what during delivery? |
|
Definition
| they're important landmarks during vaginal exam that can be identified with fingertips and identifies the position of the fetus. |
|
|
Term
| cephalic means _______ first. |
|
Definition
|
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Term
| ________ is the relation of the fetal parts to each other. The fetus is expected to be flexed: chin upon chest, arms upon chest. Extension causes problems with vaginal labor. Extension causes a face forward delivery (accompanied by bruising) |
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Definition
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Term
| ____ is the relationship of the cephalocaudal axis of the fetus to the cephalocaudal axis of the mom. There is longitudinal = which is the best. There is transverse = which requires a c-section. and Oblique = which needs a c-section. |
|
Definition
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|
Term
| ______________ is the body part of the fetus that presents first through the pelvis and covers the internal cervical os. There is cephalic = head first. Breach = buttocks first. |
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Definition
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Term
| ____________ of the presentation occurs when the largest diameter of the presenting art reaches or passes through the pelvic inlet - causes "lightening". The mother breaths easier once baby is into the pelvis and feels lighter. No pressure on the diaphragm. |
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Definition
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Term
| _____________ is the relationship of the presenting part to the ischial spines of the maternal pelvis. The may say "I think my baby dropped". |
|
Definition
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|
Term
| How is stationing (where the presenting babies part is in relationship to the ischial spine of mom's pelvis) determined? |
|
Definition
| Stationing must be determined through a vaginal exam to feel the ischial spines through the wall. When you feel the ischial spines you move your fingers to the center to determine where is in relation to the spine. |
|
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Term
| What is zero station? what is five station? |
|
Definition
| zero station: when you feel the tip of the babies head at the ischial spine (also called engagement) the baby has descended into the true pelvis. five station: baby is delivered. |
|
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Term
| How might the baby be positioned? How is this determined? |
|
Definition
| Positioning can be "ORP"=occiput right posterior or "OLP"=occiput left posterior. This is determined via vaginal exam and also by palpating maternal abdomen. Position involves picking a landmark on the fetus. Relationship of the presenting fetal part to the front, sides and backs of the mothers pelvis. |
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Term
| ___________ is from the beginning of one contraction to the next. |
|
Definition
|
|
Term
| _________ is from the beginning to the end of one contraction. |
|
Definition
|
|
Term
| How is the intensity of contraction known? |
|
Definition
| done by palpating on the maternal abdomen. 2 fingers placed on the fundal area (upper uterus). ** MOst of contractile activity occurs here and pushes down fetus ** If the fundal area is easily indented=mild. If there is no indention=strong contraction. If it is inbetween=moderate contraction. |
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Term
|
Definition
| This is drawing up of the internal os and the cervical canal into the uterine walls. the cervix becomes thinner. |
|
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Term
|
Definition
| cervical os and cervical canal widen to 10 cm |
|
|
Term
| What hormonal changes happen during birth? _________ relaxes smooth muscles. It is given to miometrial cells of uterus and pauses contractions. What happens when the stores are used up? |
|
Definition
| Progesterone. When it's used up, Estrogen takes place (happens about 1/2 term) and estrogen causes contractions in uterus. |
|
|
Term
| Women who have repeated miscarriages will often get a progesterone suppository to prevent preterm labor. |
|
Definition
|
|
Term
| "Tocolitic medications" do what? |
|
Definition
| decreases contractions & prevent preterm labor (like Progesterone). |
|
|
Term
| What factors stimulate contractions? |
|
Definition
| oxytocin, fetal cortisol, prostaglandins |
|
|
Term
| What are premonitory signs of labor? |
|
Definition
| lightening, braxton hicks contractions, cervix changes, "bloody show", ROM=rupture of membranes, sudden burst of energy, other weight loss, diarrhea, indigestion, N/V and backage. |
|
|
Term
| "Bloody show" is triggered by... |
|
Definition
| the break in capillaries at the maternal Os. |
|
|
Term
| What is the difference between true vs. false labor? |
|
Definition
| True labor has progression of cervical effacement and dilitation. True contractions are regular & rhthmic (false are irregular), true pain moves form back to front (whereas false is relieved by walking), in true labor the fetal movement remains unchanged (where it may intensify in false labor), pinkish mucus presents in true labor, but does not show in false labor. |
|
|
Term
| What are the 4 stages of labor? |
|
Definition
| 1. Stage of cervical dilitation 2. Stage of expulsion: complete cervical dilatation & deliver of fetus. 3. Placental Stage: begins immediately after fetus is born & ends when fetus is delivered. 4. maternal homeostatic stabilization stage begins after the delivery of the placenta and continues for one to four hours after delivery. |
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|
Term
| What assessments are done for laboring patient? |
|
Definition
| maternal hx & high risk factors are assessed, critical assessments: VS (normal to do every 1/2 hour, but every fifteen minute if critical or high risk). labor status: (the dilitation and effacement is assessed via vaginal exam). Fetal status is determined using Leopolds maneuver. |
|
|
Term
| What is Leopolds Maneuver? (assesses fetal status & determines where to put FHR-fetal heart monitor) |
|
Definition
| Feeling the sides of the maternal abdomen. 1st maneuver: feeling for buttocks (feeling about umbilicus). 2nd maneuver: feel for back & stomach of baby (both hands across midline of uterus), 3rd maneuver: feel just above symphisis pubis to confirm findings. Base of uterus should feel FIRM LIKE A BASKETBALL (if the baby is cephalic)!! 4th maneuver: another confirmation of cephalic and firther determination for why baby is facing. This is performed to identify back of the baby for location to place fetal monitor. |
|
|
Term
| What should Hgb & WBC labs be? |
|
Definition
|
|
Term
| What are some common nursing diagnoses for birth? |
|
Definition
| Knowledge deficit, fear & anxiety: it is a priority to make sure that mom understands what will happen if a new mom. Acute Pain, Impaired elimination, Impaired fetal gas exchange (TOP PRIORITY) |
|
|
Term
| When is informed consent done with birth? |
|
Definition
| Always done BEFORE the nurse touches or assesses the patient. This REQUIRES a signed informed consent. |
|
|
Term
| What position is the mom in for birth? |
|
Definition
| side lying, semi fowlers, pelvic tilt to prevent vena cava compression. If the pt is sitting at 45 degree angle or above no compression will occur. Pelvic tilt should be to the the left. Prop right hip with towel or blanket. |
|
|
Term
| What about activity during labor?? |
|
Definition
| Ambulation is encouraged in LATENT labor stages. Once active labor is initiated the patient will not want to be as ambulatory. |
|
|
Term
| What does mom intake during labor? |
|
Definition
| Ice chips is usual. The prevention of aspiration (although most studies show eating could probably be done without aspiration). The risk is smaller for aspiration now in emergency c-sections than it used to be with anesthesia, but they still stick to NO food or drink - just ice chips. |
|
|
Term
| What is done for comfort during labor? |
|
Definition
| pillows, dry & clean the perineum |
|
|
Term
| How often should the patient be encouraged to void? why? |
|
Definition
| Encourage peeing every 2 hours! A distended bladder is very visible. The babies descending head causes pressure & edema... resulting in desensitization. |
|
|
Term
| The fetus should be ________ and should descend with force of contraction. |
|
Definition
|
|
Term
| For entering inlet, the ____ diameter should be transverse with mom. |
|
Definition
|
|
Term
| Pressure felt will cause the chin to do what? |
|
Definition
|
|
Term
| The baby at ischial spine: |
|
Definition
| AP diameter will not fit. The baby adjusts by turning AP to symphisis pubis & sacrum. Baby will be w/ occipital area pressing against the sacrum = BACK LABOR = UNCOMFORTABLE. A baby with occipital area forward = IDEAL. |
|
|
Term
| When the head crowns & the baby will extend their head (delivery). The shoulders have not yet delivered. What happens in the last External Rotation of the head "Turtle Maneuver"? |
|
Definition
| Head turns to realign with the shoulders, anterior delivers first, posterior second and then body follows. |
|
|
Term
| What is "Gate Control Theory" for pain? |
|
Definition
| based on the premise that pain can be blocked by a "gating mechanism." |
|
|
Term
| Pain control has a continuum. There can be non pharm (childbirth classes) to pharm (narcotics/regional anesthesia)... as you move along the continuum from non pharm to pharm the potential for ________ & ___ ________ increases. |
|
Definition
| complications & side effects |
|
|
Term
| What is the goal of childbirth education classes? |
|
Definition
| to break the pain cycle! (They address fear, anxiety, muscle tension, pain). |
|
|
Term
| What is an additional therapy done by midwives (not usually in hospital) to break pain cycle (one step from non-pharm methods). |
|
Definition
| instilling normal saline around the dermal layer or sacrum. It is just 1/10 of a cc. This is a non-pharm method for pain used by midwives. |
|
|
Term
|
Definition
| dilitation of the cervix, hypoxia of uterine muscle cells during contractions, stretching of lower uterine segment, pressure on adjacent structures. |
|
|
Term
|
Definition
| Hypoxia of uterine muscle cells (occurs in both), distention of vagina & perineum, pressure on adjacent structures. |
|
|
Term
| Systemic analgesia's include the natrcotic opioid analgesics that decrease perception of pain. The 3 most common are Fentanyl, Stadol & Nubain. How much Fentanyl (SUBLIMAZE) is given? what are the side effects? |
|
Definition
| 50-100 mcg q hour IV or PCA. Respiratory depression and ambulation risks, especially for the baby. |
|
|
Term
| how much Stadol is normally given? |
|
Definition
| 0.5-2 mg Q 3 hrs IV (peaks at 30 minutes) |
|
|
Term
| how much nubain is normally given? |
|
Definition
|
|
Term
| What kind of narcotic delivery puts the baby at highest risk? |
|
Definition
| When the narcotics are delivered quickly (within 1.5-2 hrs) of eachother. If they can hold off on delivering more pain meds for 4 hours, the drug will have peaked & the baby will not be at risk. |
|
|
Term
| If the baby is showing signs of respiratory depression, what drug reverses the effects of opioid analgesics? |
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Definition
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Term
| Why would sedatives (barbiturates) be given in the latent phase? (* sedatives are ONLY given in the latent phase * ) |
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Definition
| to decrease anxiety & induce sleep. THey may be given if the mom is progressing really slowly & has not dilated, she really needs rest. Will give Secobarbital (Seconal) |
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Term
| how many hospitals use regional analgesia/anesthesia for labor? <--rate of epidurals... |
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Definition
| rate of use if more than 60% in most hospitals. Some as high as 90%. |
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Term
| Again, what are some characteristics of false labor? |
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Definition
| irregular contractions, pain is relieved by walking, fetal movement may intensify, fetal descent does not change or progress, shows NO pink mucus, the cervix remains unchanged after 1-2 hours. If there is no change in the dilitation after 2 hrs = false labor. |
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Term
| What are some characteristics of true labor?? |
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Definition
| contractions are regular & rhythmic, pain moves back to front, fetal movement is unchanged, fetal descent is progressing, shows pink mucus, cervix is effacing & dilatation. |
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Term
| The first stage of labor is the LABORING stage. what happens & what are the 3 phases within the first stage of labor? |
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Definition
| The 1st stage starts when contractions start & ends with complete dilation. So ends when at 10 cm. 3 phases are: 1) LATENT: 0-3 cm dilation. 2) ACTIVE: 4-7 cm dilation 3) TRANSITION: 8-10 cm dilation |
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Term
| Just name the 3 phases within the first stage? in order... |
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Definition
| Latent, Active, Transition |
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Term
| What happens during the 2nd stage of labor? |
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Definition
| This is the PUSHING stage (or the stage of expulsion). It begins with complete cervical dilation (10 cm) & ends with delivery of the fetus. The fetus is delivered in the 2nd stage of labor! |
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Term
| what happens during the 3rd stage of labor? |
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Definition
| This is the time the PLACENTA DELIVERS. 3rd stage begins when fetus is delivered & ends when the placenta is delivered. |
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Term
| What happens in the 4th stage of labor? |
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Definition
| This is the RECOVERY stage (aka "the maternal homeostatic stage") It begins after the delivery of the placenta & continues for 1-4 hrs after delivery. There is nothing delivered in the 4th stage. |
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Term
| What do oxytocin, estrogen, fetal cortisol & prostaglandins do for contractions? |
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Definition
| These will stimulate contractions |
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Term
| What factor quiets contractions? |
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Definition
| progesterone. as long as progesterone is dominant, there are no contractions. At 40 weeks though, estrogen takes over. |
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Term
| The "drawing up" of the internal os (opening/passageway) and the cervical canal into the uterine side walls is ______________. |
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Definition
| Effacement. It is the drawing up of the cervix into the lower uterine segment. usually 50% effaced, 100% effaced.. can't feel the cervix at all. Just the uterus. It's been drawn up into the uterine wall. |
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Term
| has the fetus entered the pelvis? _____________ is the fetal head entering the inlet & reaches the ischial spine. Another term is "lightening". It takes pressure off the diaphragm & the mom can breath easier. |
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Definition
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Term
| What does "Strength" refer to when talking about the force of labor? |
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Definition
| Strength = Intensity. Strength is the identibility on external exam or millimeters of mercury by IUPC (intrauterine pressure catheter) |
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Term
| what is the #1 concern post delivery? |
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Definition
| uterine atony or a boggy uterus. So assess the fundus (uterus)! Things like: massaging the uterus helps. IV oxytocin & breastfeeding will cause a release of endogenous oxytocin which helps the uterus. |
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Term
| What do you do if you feel the fundus is "dextroverted" off to the right side after delivery? |
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Definition
| Get this finding if the bladder is full. Bladder fills quickly & needs to be emptied! |
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Term
| What should be done if you are present at a "Precipitous Birth" (coming fast & unattended by a HC provider who is licensed to do deliveries... an RN is NOT!) This is a Wal-mart delivery.. |
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Definition
| 1. Put gentle pressure against the fetal head 2. Check for nuchal cord after birth of head (use 2 fingers & unwrap if possible around neck) 3. Clear mouth & nasal passages - prob do not have a suction, so wipe them clean. 4. Dry the newborn, place on the mom's abd. Want babies head lower than its body to facilitate mucus drainage. 5. at some point, initiate breast feeding. There is no reason to cut/tie off cord, ok to leave for awhile. Keep the placenta with the baby. If membranes have not ruptured, you have to break the sack or baby will aspirate fluid. |
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Term
| Pain in stage _______ is related to: 1. dilatation 2. hypoxia of the uterus 3. stretching of the uterus (effacement) 4. pressure on other structures |
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Definition
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Term
| pain in stage _____ is related to: 1. hypoxia of the uterus 2. distention of the vagina (change in stage 2) 3. pressure on structures |
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Definition
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Term
| What drugs are given if the mom to decrease her anxiety & especially nausea? |
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Definition
| 1. Promethazine (Phenergan) 12.5 - 25 mg & 2. Diphenhydramine (Benadryl) 10-50 mg. They will help decrease anxiety & nausea. |
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Term
| What narcotic (opidoid) analgesics help decrease the perception of pain? |
|
Definition
| Fentanyl (Sublimaze) 50-100 mcg q 1 hour IV or PCA. (Does not last long, given every hour) Butorphanol (Stadol) 0.5-2mg q 3-4 hours IV (peak is at 30 minutes for Stadol, it is the most commonly used). Nalbuphine (Nubain) 10 mg q 3-6 hours IV. |
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Term
The drugs are given for the mom, not the baby. If Stadol is given & 30 minutes later she pushes & has her baby. Are you worried about Respiratory Depression? |
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Definition
| Stadol peaks in 30-60 minutes & lasts 2-4 hrs. There is less risk for respiratory depression if the baby is born shortly after giving the med (within 30 minutes) or after 2-4 hrs. If the baby is born in 1-1.5 hours after giving - then worry about respiratory depression. |
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Term
| What drug should be kept on hand to reverse the effects of respiratory depression on the NB due to excess opioid analgesics? |
|
Definition
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Term
| Is it ever too early to give an epidural? Will it slow labor? |
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Definition
| No, it is NEVER TOO EARLY. It will not slow labor. We give an epidural whenever the mom asks for one. Denying the woman an epidural is what may actually lengthen the labor. |
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Term
| What is the advantage of an Intrathecal catheter vs. an Epidural? |
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Definition
| Intrathecal advantage is you can give less medication than an epidural. Both can be given in continuous mode via catheter. Intrathecal is for c-sections usually. |
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Term
| What drugs go into an epidural or intrathecal catheter? |
|
Definition
| fentanyl, sufentanil or morphine plus local anesthetic agent (bupivacaine) |
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Term
| What sd effects does the epidural or intrathecal anesthesia cause? |
|
Definition
| Sensory/motor nerve block & vasodilation --> maternal hypotension (therefore affects baby & get decreased HR in baby). We are worried about MATERNAL HYPOTENSION |
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Term
| What's Nursing Implications are done before an epidural or intrathecal cath is done? |
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Definition
| 1. Fluid preload/bolus will decrease the vasodilation (prophylactic 500 mL bolus fills vascular space & there is not a lot of space) 2. Left Uterine Displacement 3. Check Platelet Count (doctors will not start epidural without |
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Term
| What did early general anesthesia do to laboring mom's? how much is given now? |
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Definition
| Used to leave mom's with no motor control & we do not want to do that anymore. It is a balancing act between how much anesthetic & how much narcotic is given. Some of the best epidurals relieve all pain, but mom can still walk. Usually done in hospitals where the anesthesia team is on the OB unit. |
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Term
| IV is standard protocol for most deliveries in the hospital. Immediately after delivery, the pt will get a bolus of oxytocin & should be encouraged to breastfeed. what will oxytocin help with? |
|
Definition
| This causes uterine contraction that will prevent hemorrhage. Uterine atony (boggy uterus) >>> vessels dilate and blood is allowed to exit the body. If bladder fills postpartum it may push the uterus from the midline, risking uterine atony b/c it can't contract fully. Assess & empty that bladder in postpartum mom!!! |
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Term
| Tremors, shivering and uncontrollable shaking after delivery can happen after receiving an epidural or delivery. why? what is done? |
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Definition
| not exactly sure why. Possibly b/c of a vasomotor response related to changing blood levels and pressures. It is NOT related to thermogenesis!!! This happens after an epidural b/c the pt's BP drops ad have a period of hypotension that starts the vasomotor response. Nurse needs to REASSURE THE MOM & FAMILY THAT IT IS NOT ABNORMAL. Just give a WARM BLANKET COULD COMFORT THEM. Do NOT give demerol postpartum! |
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Term
| Oxytocin bolus + breastfeeding will decrease _________. |
|
Definition
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Term
| What breathing techniques are used with Stage I labor if prepared? |
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Definition
| first level = slow paced. begin with a cleansing breath, inhale slowly through the nose, lift chest up & out during inhalation, exhale through pursed lips, maintain 6-9 breaths/min, end w/ cleansing breath. second level= "one and two and one and ... " begin with cleansing breath & then push out short breath at the end of this inhalation, 4 breaths every 5 seconds, keep jaw relaxed b/c breathing in & out of mouth, end with a cleansing breath 3. cleansing breath at beginning & end, begin rapidly & slowly w/ forced exhalation, begin pattern of 4 breaths "hee hee hee hoo". |
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|
Term
| breathing techniques for stage I of labor, if unprepared... |
|
Definition
| Want conscious relaxation (a gentle, but firm touch by the nurse or significant other. followed by verbal directions to relax). use a focal point to maintain a state of relaxation. use deep chest breathing, slow & deep breaths. Also shallow chest breaths (panting type of breathing) and pushing. |
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|
Term
| What is the main cause of maternal mortality in pregnancy? |
|
Definition
| Ectopic Pregnancy (means a tubal pregnancy... the egg has implanted in the wrong place) |
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|
Term
| What obstetric events may cause maternal mortality during pregnancy? |
|
Definition
| hemorrhage, pulmonary embolism (DVT), pregnancy-induced hypertension (PIH) |
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Term
| What is the major cause of perinatal mortality (events around the birthing experience)... why do new babies (less than 28 days) old often die? |
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Definition
| PREMATURITY or Low birth weight |
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Term
| Risk factors for having pregnancy complications are: |
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Definition
| age (too young or too old), SES, Primiparity... 1st time pregnant (preeclampsia is more common), Multiple pregnancies |
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|
Term
| What can be done to prevent pregnancy problems? |
|
Definition
| get adequate prenatal care |
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Term
| What are pregestational disorders? |
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Definition
| health problems prior to being pregnant, then get pregnant. So, disorder affects the pregnancy & vice versa. |
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Term
| One cardiovascular disease is rheumatic heart disease. This used to be common, but is not anymore. Why? |
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Definition
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|
Term
| Why do we see more of congenital heart disease in pregnant moms now? |
|
Definition
| these women did not used to make it to childbearing age even. Technology & advancements have lengthened the life span of people with congenital heart disease. |
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Term
| Mom's may have "mitral valve prolapse"... what does this mean? what do we do? |
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Definition
| It is not a significant problem & may have palpitations. A prophylactic antibiotic is given during labor. Same as when these people receive prophylactic antibiotics before going to dentist. |
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|
Term
| What is peripartum myopathy? |
|
Definition
| Around the time of delivery there is a rapid onset of SEVERE cardiac symptoms when there was NO prior problems. this is RARE. |
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Term
| What are physiologic changes of pregnancy that cause stress on the heart? |
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Definition
| Increased blood volume, increased preload... all cause increased work for the mom's heart. |
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Term
| Many signs of cardiac decomposition can be normal responses of pregnancy (like fatigue, dyspnea, palpitations, tachycardia, having a heart murmur, edema in the 3rd TM...) what key sign differentiates & is NOT a normal sign during pregnancy? |
|
Definition
| Complaints of a COUGH. There is fluid build-up, causing pulmonary edema... get a COUGH. |
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Term
| If you are classified as having Class I & II heart disease, what can you expect during pregnancy? |
|
Definition
| Most likely have a normal pregnancy, this is less severe (III & IV are difficult) May have s/s of cardiac decompensation, but should have a normal pregnancy. A c-section is not assumed for someone with these heart problems. Do want to avoid a "closed glottis" which is holding breath & pushing... do NOT want them to do this. |
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Term
| If you are classified as having Class III & IV, what can you expect in pregnancy? |
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Definition
| More complicated & may be counseled to avoid pregnancy. |
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Term
| The primary goal for people with heart disease (class I to IV) is to get enough ________. |
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Definition
| REST. Management may include quitting work for people w/ class 3 & 4 heart problems. |
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Term
| What needs to be prevented for pregnant who have heart disease? |
|
Definition
|
|
Term
| what do we monitor pregnant women who have heart disease for? |
|
Definition
| signs of cardiac decompensation (fatigue, dyspnea, palpitations, tachycardia, heart murmurs, edema before 3rd TM, COUGH) |
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|
Term
| What happens for labor & delivery in people who have heart disease? |
|
Definition
| The risks must outweigh the benefits to get a c-section, goal is to manage a vaginal delivery, do not closed glottis push/valsalvas maneuver (hold breath & push which is ok for 80%, but not for these b/c it can adversely affect maternal hemodynamics & fetal oxygenation) want open glottis pushing (allows mom to exhale while bearing down & leads to minimal increase in BP, maintains blood flow & decreased fetal hypoxia) |
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Term
| Endocrine Disorders like Diabetes during pregnancy will further alter _____ metabolism. Pregnancy is already a "_______________" state. |
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Definition
| CHO (carbohydrate) metabolism is more altered during pregnancy. Pregnancy is already a DIABETOGENIC STATE so if you're diabetic already? control is really haywire. |
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Term
| What is Type III diabetes? |
|
Definition
| gestational diabetes. It is "subclinical". There were no problems until pregnancy. There is a test at 26 weeks to screen for. Gestational diabetes goes away after pregnancy. |
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Term
| However, women who have gestational diabetes are at higher risk for... |
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Definition
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Term
| Why do diabetics & gestational diabetics have big babies that are 9+ lbs? |
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Definition
| They're big because of INSULIN in the fetus is a growth factor. They are not big because of excess glucose. |
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Term
| What influences on pregnancy, does diabetes cause? |
|
Definition
| 1. There are changes in CHO metabolism & control of blood glucose. 2. Vascular Disease may increase & cause decreased blood supply to periphery & to placenta. The blood becomes STICKY BLOOD, clogs up when it is trying to get through & causes nephropathy & retinopathy. |
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Term
| What are the maternal complications due to diabetes? |
|
Definition
| ketoacidosis. Glucose breaks down into Fats which breaks down into Ketones. |
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Term
| What fetal/neonatal complications can diabetes cause? |
|
Definition
| increase in developmental anomalies. when diabetic the BIG concern is intrauterine death though. Diabetic women have higher risk for still birth. |
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Term
| Why is managing health difficult for a diabetic during pregnancy difficult. especially dietary control & insulin control. |
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Definition
| There is an increased need for calories, but insulin control is difficult. During the last TM these are both really critical, may come in every week for tests, if not before. |
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Term
| If mother is diabetic, what is checked after birth on the baby? what is the baby at risk for? |
|
Definition
| check blood glucose, baby is at risk for hypoglycemia w/o mom's BG. New babies will really need their BG monitored early & closely if mom was diabetic. Neonatal Hypoglycemia is a problem we see. |
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Term
| Early in pregnancy there is an increased incidence of insulin coma (____glycemia) due to increased n/v & not eating.. don't need same insulin as before. So, decrease insulin/monitor closely in first 1/2 pregnancy. Second 1/2 pregnancy there is increased risk of diabetic coma (______glycemia). In the 2nd half get massive fetal growth, tremendous need for glucose & mom's giving to baby. if mom's glucose is antagonized she is giving to baby. So, increase insulin during the 2nd half of pregnancy/monitor closely. |
|
Definition
| 1st half=hypoglycema (decrease insulin). 2nd half=hyperglycemia (increase insulin). |
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Term
| Pregnancy management for diabetics involves: |
|
Definition
| N/V -> watch for bottoming out, might improve a bit in first TM, increases risk & problems last 1/2 of pregnancy, insulin demands are 3-5x the normal later in pregnancy. |
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Term
| Are oral antidiabetic agents used to control BG in pregnancy? |
|
Definition
| oral antidiabetic agents are NOT used, they're teratogenic to the fetus & cause anomalies. Occasionally have to use insulin. Really want to control via diet, exercise... often recommended to keep diaries. |
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Term
| When does still birth often occur for diabetic women who are pregnant? What test is done at this time b/c of this? |
|
Definition
| 36 weeks. A nonstress test is done at this time. |
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Term
| _________ disorders are health alterations associated with pregnancy. They were not present before, but just happen with pregnancy. Most disappear after delivery. |
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Definition
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Term
| With 'premature rupture of membranes' (PROM) we are worried about ___________!!! |
|
Definition
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Term
|
Definition
| premature rupture of membranes is a spontaneous rupture of the membranes and/or leakage of amniotic fluid prior to the onset of labor. This may be preterm. |
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Term
| The primary concern of PROM is with infection b/c the barrier is gone. What is the membrane called? |
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Definition
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Term
|
Definition
| nitrazine paper and ferning test for pH of amniotic fluid (high>>alkaline) |
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Term
| With PROM what is being monitored? |
|
Definition
| temperature (it is going to be high or it's going to spike), WBC's and the fetus is being watched within 24-48 hrs of rupture. |
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Term
| How is Premature Rupture of Membranes managed? |
|
Definition
| It depends on the presence of infection... gestational age. |
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Term
| Preterm Labor (PTL) is a gestational disorder. This is labor that occurs between 20 & __ weeks. |
|
Definition
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Term
| What is the main concern for a woman having preterm labor? |
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Definition
| premature delivery is the main concern. Prematurity & Low birth weight are the # 1 cause of neonatal mortality. |
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Term
| For the woman to be having preterm labor, what must be happening? |
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Definition
| It must be 20-37 weeks. Have DOCUMENTED uterine contractions (4 per 20 minutes or 6-8 per hour). You cannot just go on the mom's word. There is cervical dilation of 1 cm+ or 2 cm+. OR there is positive fFN level. Checking this correlates with higher incidence of being in preterm labor. |
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Term
| What are the risk factors for having pre-term labor? |
|
Definition
| Having had a previous preterm labor, drug use... especially stimulants like amphetamines, cocaine. Genital tract infections (like bacterial vaginosis or Group B Strep - this is not a problem for mom, but only baby during delivery. Hyperemesis Gravidum = too much N/V, this is severe n/v though. |
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Term
| other risk factors for pre-term labor that were in the book: |
|
Definition
| multiple gestation, DES exposure, known cervical incompetence, polyhydramnios, uterine anomaly, cervix is dilated > 1 cm at 32 weeks, 2nd TM abortion, fetal abnormality, bleeding after 12 weeks, febrile illness, history of pyelonephritis or other maternal infection, maternal medical disease, previous preterm birth, previous labor with term birth, abd surgery during 2nd or 3rd TM, hx of cone biopsy, uteralplacental ischemia, stress, inadequate prenatal care, cervical shortening < 1 c, uterine irritability, age (<18 or >35), low SES, more than 10 cigarettes a day, substance abuse, low maternal weight, poor weight gain, more than 2 first-TM abortions, non-white race, cervical cerclage in situ, in vitro fertilization (singleton or multiple gestation), STDs (trichomoniasis, chlamydia), Anemia, abd trauma, foreign body (IUD), bacterial vaginosis, E.coli (ascending intrauterine infection), peridontal disease |
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Term
| If the mother is having uterine irritability? IF she's feeling contractions preterm what should you do? |
|
Definition
| It could be dehydration. Need to get her off her feet & have her drink LOTS of water. Also want to keep the bladder empty though... so urinate every 2 hours to decrease uterine irritability. |
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Term
| What is "Hyperemesis Gravidum"? |
|
Definition
| This is excessive, severe N/V. They're not keeping anything down (no foods or fluids) this is much more severe than morning sickness. Severe & often lasts beyond the first TM. Can result in dehydration... F & E imbalances, weakness, fatige, scant dark urine. |
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Term
| How is Hyperemesis Gravidum managed? |
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Definition
| Dry carbohydrate snacks.. small, frequent meals, antiemetics, hospital admission... IV therapy, correct electrolyte & acid base balance (eg Potassium), potentially TPN (if SO severe), Zofran is OK, psychological component? for having to deal with this during pg. also women w/ problems may previously may experience this more. NOT the cause, but a component. |
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Term
| Bleeding disorders can occur in Early pregnancy (1st & 2nd TM) and also Late pregnancy (placenta previa & abruptio). Spontaneous abortion or "miscarriage" generally occur in the ________ trimester. |
|
Definition
| first (within 8-10 weeks) |
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Term
| What are the s/s of spontaneous abortion or "miscarriage". |
|
Definition
| BLEEDING (can be spotting to gushing) there is a range. There is CRAMPING. BACKACHE. "FEELING OF FULLNESS" in pelvic area. |
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Term
| The diagnosis of spontaneous abortion is related to what "type" it is. One type is a _____________ abortion where there is bleeding out, but the cervix is not dilated, it is open and the placenta is attached, but the pregnancy MAY be okay with this type. |
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Definition
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Term
| There is ___________ abortion where the cervix is dilated & the pregnancy cannot be saved. |
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Definition
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Term
| ___________ abortion is when some parts are lost, but some remain. Need to rid the pt's uterus of pregnancy (via scraping out uterus of conception & collect any tissue that is passed) to stop hemorrhaging. This is how women died. Watch woman closely b/c lots of hemorrhaging. give her an IV. |
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Definition
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|
Term
| If there is common cause of 2nd TM abortion (14-16 weeks) is ___________ cervix. The cervix begins to dilate & efface too early. |
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Definition
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Term
| What is the Cerlage Procedure? Done to help incompetent cervix. |
|
Definition
| often described as a "purse string" There are sutures placed in cervix and pull it up like a purse. They need to know to COME IN AT THE 1st SIGNS OF LABOR!! The sutures need to be clipped. This works & can often carry to term. |
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|
Term
| What is an ectopic pregnancy? what are some s/s? |
|
Definition
| VERY LIFE THREATENING, #1 cause maternal mortality with pregnancy. It is Implantation in a site other than the endometrium. Fertilization happens at a site that is not the uterus. There is often some sort of a tubal obstruction that causes this to occur. S/S: LOWER QUADRANT PAIN with OCCASIONAL SPOTTING, INTERNAL HEMORRHAGE. The dx is difficult & can happen before she even knows she is pregnant. If a woman present to ER with LQ pain... tubal pregnancy is a possibility. The pg test may or may not be helpful b/c it may give a false negative. |
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Term
| What is a big risk factor for having a tubal obstruction and then an ectopic pregnancy? |
|
Definition
| PELVIC INFLAMMATORY DISEASE (PID) |
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Term
| What is the worst situation for a tubal pregnancy? what is done to prevent? |
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Definition
| The worst situation is not identifying that the woman has a tubal pregnancy. A tubal pregnancy can NOT continue b/c baby grows and the tube can rupture and cause internal bleeding. This is why it is the highest risk for maternal mortality. |
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Term
| For a pt with bleeding disorders, what needs to be done? what's priority? |
|
Definition
| Priority is to assess for amount of vaginal bleeding!! Check the pad count. |
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|
Term
| What are the signs of hemorrhagic shock? <-- Due to internal bleeding. |
|
Definition
| Diaphoresis (lightheaded), increased HR (tachycardic), decreased BP, N/V, THIRST (having a dry mouth) |
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Term
| Gestational Trophoblastic Disease/Hyatidiform Mole/Molar Pregnancy are all the same thing & fairly rare |
|
Definition
| benign overgrowth of trophoblastic tissue. There is abnormal tissue growth in the uterus. Embryo does not get adequate blood. Usually baby is lost, but want to check for FHR (fetal heart tones). Run an hCG & it will be sky high. There is potential for cancer (Choriocarcinoma), but for now it is benign. |
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Term
| s/s of trophoblastic disease/hyatidiform mole/molar pregnancy are: |
|
Definition
| excessive N/V, GREATER THAN EXPECTED FUNDAL HEIGHT, Discharge --> vesicles. |
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|
Term
| What is the management for gestational trophoblastic disease/molar pregnancy/hyatidiform mole? |
|
Definition
| Serial hCG levels for 1 year. Management is to remove the tissue. DO NOT GET PREGNANT FOR A YEAR!!! The reason for serial hCG test for a year is looking for choriocarcinoma bc it's very fast growing. After the year, they can get pregnant again. |
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Term
| Preeclampsia/eclampsia is what? |
|
Definition
| Pregnancy induced hypertension or "Toxemia" (same thing). This is HTN resulting in seizures. Need to ID high BP early. |
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Term
| What are the 3 main signs of preeclampsia/eclampsia? |
|
Definition
| Increased BP, edema (it is in hands, fingers, face) & proteinuria. Need ALL 3 of these for dx of preeclampsia-eclampsia though. |
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|
Term
| What is considered high BP for PIH? |
|
Definition
| 140/90. Or an increase of 30 in systolic or increase of 15 in diastolic from baseline. Diastolic may be more prognostic. |
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|
Term
| what is considered edema for PIH dx? |
|
Definition
| WEIGHT GAIN of 2 lbs. per week!! This is a sudden, excessive weight gain. Know that edema is going to be normal dependent in the lower extremities due to the decreased VR. You want to assess for: lower extremity edema on arising and edema on face & hands. |
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Term
| There is also presence of _______ in urine for preeclampsia-eclampsia. This is not necessarily related to the severity of it. |
|
Definition
| preoteinuria (albuminuria) |
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|
Term
| Other signs of preeclampsia-eclampsia are: |
|
Definition
| hyperreflexia! brisk reflexes to clonus... clonus may happen just prior to convulsions & you will know they are near. Clonus=pull back on foot & it twitches (hyperreflexia). Cerebral symptoms are headaches, blurred vision, scotoma (spots in front of eyes). May show this persistently & means convulsions are near. |
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Term
|
Definition
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Term
| If there is oliguria (less than 400 mL/24 hr output), pulmonary edema, RUQ pain, PERSISTENT headache, scotoma, blurred vision, BP > 160/110, edema & proteinuria at 3+, 4+. These are all signs of what? |
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Definition
|
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Term
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Definition
| 140/90+, but <160/110 OR increase of 30 in systolic or 15 in diastolic. Proteinuria & edema are 1+, 2+, occasional headaches, scotoma, blurred vision, oliguria is NOT present, pulmonary edema is NOT present, RUQ pain is NOT present for MILD PIH |
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Term
| What are SIGNIFICANT signs of severe PIH b/c close to convulsing? |
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Definition
| Oliguria of <400 mL/24 hrs, pulmonary edema is present & epigastric RUG pain is present - often reported as severe heartburn. An increase in severity of PIH will see a decrease in renal function & may monitor hourly, if there is less than 30 cc's/hr, that's decreased urinary output. |
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Term
| Women who ARE childbearing & having right upper quadrant pain? what are you thinking... |
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Definition
| be worried... sign of severe PIH |
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Term
| who do we see an increased incidence of PIH in? (what women?) |
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Definition
| primigravidas, teens & women > 35 years-ld, history of preelampsia, multiple gestation, GTD, Rh incompatibility, Diabetes |
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Term
| PIH is more common in first pregnancies with new partners or moms who have had a few kids? |
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Definition
| 1st pregnancies with new partner... primipara |
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Term
| when do s/s of PIH occur? |
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Definition
| do not occur until 20-24 weeks generally. Though they may occur in labor or up to 48 hrs AFTER delivery... potential for diagnosis for up tot a week after delivery! |
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Term
| What are the risks of PIH for the mom? |
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Definition
| convulsions... coma. Renal failure, abruptio placentae, DIC, ruptured liver, and pulmonary embolism. |
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Term
| what are the risks for the fetus from PIH? |
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Definition
| SGA (Small for gestational age) related to intrauterine growth restrictions (IUGR). There is a 10% perinatal mortality with preeclampsia (HTN).... 20% with eclampsia (convulsions will increase the mortality) |
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Term
| What BV increase is normal in pg? what happens to BV in mild PIH? what about BV in severe PIH? |
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Definition
| normal BV increase is 30-50%. Mild PIH causes no change or slight decrease in circulating BV. Severe PIH causes decrease in BV, often to non-pregnancy levels. |
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Term
| Cardiac Output normally increases in pregnancy. What will happen to CO if PIH is present? |
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Definition
| There is no change from the normal |
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Term
| Peripheral resistance normally __________ in pregnancy, but with PIH the peripheral resistance _____________. this is the main key to the patho... |
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Definition
| peripheral resistance normally DECREASES (blood flows easier), but PIH causes INCREASE in resistance. |
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Term
| What happens to BP normally in pregnancy? PIH causes BP to ... ? |
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Definition
| BP normally unchanged or slightly decreased. PIH causes BP to RISE though. |
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Term
| What happens to Hematocrit normally during pregnancy? Hct with PIH? |
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Definition
| Hct normally falls, but with PIH is RISES. (Since the blood volume is low, there is more hemodilution) |
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Term
| What normally occurs during pregnancy? |
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Definition
| increase blood volume, increase in CO, decrease in peripheral resistance, decrease in BP |
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Term
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Definition
| no change or decrease in Blood volume, no change in CO, increase in peripheral resistance, BP rises & Hct Rises too |
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Term
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Definition
| VASOSPASM. The increase in blood volume must "fit" into the space & leaves the circulation, moves to interstitial spaces. Woman looks like she has EDEMA due to the decrease in blood volume. |
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Term
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Definition
| BEDREST on the LEFT LATERAL or EITHER SIDE! Do this for 30 minutes 6 times/day. Just lay down! Often can maintain & do not have to be hospitalized. The same medications do not work for this type of HTN. |
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Term
| What are the benefits of laying down for woman with PIH? |
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Definition
| the placenta, kidneys (promotes diuresis.... decreases blood pressure) |
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Term
| What diet should woman with PIH be on? |
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Definition
| Need to assure adequate proteins! Assure adequate fluids! LOTS of fluids, push fluids! Do NOT put PIH on low sodium diet. |
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Term
| What should be closely monitored with PIH? |
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Definition
| BP, weight, proteinuria, reflexes, urine output. (these can be hourly or daily like weights!) |
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Term
| Are antihypertensives given for PIH? |
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Definition
| No they're generally not used prior to delivery. May be used in an emergency situation however. |
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Term
| What is the drug of choice for PIH? |
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Definition
| Megnesium Sulfate is best to treat preeclampsia. The MOA is it stops impulse at the motor plate & so no firing & no muscle reacting. |
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Term
| What needs to be watched closely if on Magnesium Sulfates? Remember, it is decreasing muscle reactions. |
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Definition
| Watch BLOOD PRESSURE & RESPIRATIONS b/c it is a CNS depressant!!! Watch their reflexes, if their reflexes go, next is respirations. Watch Resp Rate after giving Magnesium Sulfate. |
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Term
| What is the antidote for decreased respirations due to magnesium sulfate? |
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Definition
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Term
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Definition
| H=hemolysis EL=elevated liver enzymes LP=low platelets |
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Term
| What is the patho of HELLP syndrome? |
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Definition
H = RBC's are lysed. EL = intraarterial lesions, platelet aggregation, fibrin accumulation, microemboli in hepatic vasculature, ischemia. LP = platelet consumption.
*She said HELLP was not on test, it's just for awareness. |
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