Term
Guidelines for Contraception
Combined Oral Contraceptives, Nuva Ring, Depo-Provera |
|
Definition
| Stop using and have 2-3 normal menses before attempting to conceive. |
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Term
Guidelines for Contraception
IUD |
|
Definition
| Stop using and wait 1 month before attempting to conceive |
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Term
Childbirth Preparation
Lamaze |
|
Definition
Psychoprophylactic
Disassociation relaxation
Controlled muscular relaxation
Breathing patterns |
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Term
Childbirth Preparation
Kitzinger |
|
Definition
Sensory-Memory
Chest breathing in conjunction with abdominal relaxation
Uses elements of Stanislavsky method of acting in a way to teach relaxation |
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Term
Childbirth Preparation
Bradley |
|
Definition
Partner-coached
Working in harmony with the body using controlled breathing and deep abdominopelvic breathing
Promoting general body relaxation |
|
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Term
Childbirth Preparation
HypnoBirthing |
|
Definition
Deep relaxation
Deep breathing
Slow breathing
Breathing the baby down
Maintaining comfort and eliminating pain |
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Term
|
Definition
| Premature dilatation of the cervix usually in the 4th/5th month. |
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Term
|
Definition
Most common hypertensive disorder in pregnancy
An increase in BP AFTER 20 weeks gestation accompanied by proteinuria. |
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Term
|
Definition
| Generalized seizures or coma |
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Term
|
Definition
Hemolysis
Elevated liver enzymes
Low platelet count |
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Term
|
Definition
Few or no symptoms
BP 140/90 or higher
1+ proteinuria
Liver enzymes slightly elevated |
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Term
|
Definition
May develop suddenly
BP 160/110 or higher on two readings at least 6 hrs. apart
Proteinuria of 5g or higher in a 24-hr. collection OR dipstick is 3+ to 4+ on two random samples at least 4 hrs. apart. |
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Term
|
Definition
Bolus 4-6 g. mag sulfate IV over 5 minutes
Antihypertensive agents to keep diastolic between 90-100
Sedative if mag sulfate isn't controlling seizures
Lasix if there is pulmonary edema |
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Term
| Cure for Preeclampsia/Eclampsia |
|
Definition
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|
Term
| Anesthesia precautions in woman with preeclampsia/eclampsia |
|
Definition
| Spinal or epidural contraindicated in the presence of coagulopathy or a platelet count of less than 50,000 |
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Term
Assessment: Preeclampsia
BP |
|
Definition
|
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Term
Assessment: Preeclampsia
Temperature |
|
Definition
| Assess every 4 hours, or every 2 if elevated |
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Term
Assessment: Preeclampsia
FHR |
|
Definition
| Check along with BP OR monitor continuously if the situation indicates |
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Term
Assessment: Preeclampsia
Urinary Output |
|
Definition
Assess with every voiding.
If catheter, every hour.
700 mL or greater in 24 hrs. OR at least 30 mL/hr |
|
|
Term
Assessment: Preeclampsia
Urine Protein |
|
Definition
Assess with every voiding.
If catheter, every hour.
Readings of 3+ or 4+ indicate loss of 5 g. or more in 24 hrs. |
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|
Term
Assessment: Preeclampsia
Urine Specific Gravity |
|
Definition
Assess with every voiding.
If catheter, every hour.
Readings OVER 1.040 correlate with oliguria and proteinuria |
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|
Term
Assessment: Preeclampsia
Weight |
|
Definition
Check daily at same time
May omit if woman is on strict bedrest |
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Term
Assessment: Preeclampsia
Pulmonary Edema |
|
Definition
Observe for coughing
Auscultate lungs for moist respirations |
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Term
Assessment: Preeclampsia
DTR |
|
Definition
Check for hyperreflexia in brachial, wrist, patellar or Achilles'
Patellar is easiest. |
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Term
Assessment: Preeclampsia
Clonus |
|
Definition
Abnormal finding
Vigorous dorsiflexion of foot while knee is held in fixed position: present IF foot "jerks" or taps the examiner's hand.
Count number of taps or beats and record it. |
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Term
Assessment: Preeclampsia
Placental separation |
|
Definition
| Check hourly for vaginal bleeding and uterine rigidity |
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Term
Assessment: Preeclampsia
Headache |
|
Definition
| Ask about existence and location |
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Term
Assessment: Preeclampsia
Vision |
|
Definition
| Ask about changes, blurring. or scotomata. |
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Term
Assessment: Preeclampsia
Epigastric pain |
|
Definition
Ask about this pain.
Differentiate from simple heartburn (familiar feeling and less intense) |
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|
Term
Assessment: Preeclampsia
Lab Blood Tests |
|
Definition
Hematocrit
BUN
Creatinine
Uric acid
Clotting studies
Liver panel
Electrolytes
Mag levels in women receiving mag sulfate |
|
|
Term
Assessment: Preeclampsia
LOC |
|
Definition
Check for:
Alertness
Mood changes
Signs of impending convulsions |
|
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Term
|
Definition
| Marked fetal anemia due to Rh Hemolytic disease |
|
|
Term
Rh Hemolytic Disease
Cascade of effect which leads to:
Erythroblastosis Fetalis |
|
Definition
Hydrops fetalis
CHF
Marked jaundice
Neurologic damage |
|
|
Term
Rh Immune Globulin (RhoGAM)
When to administer in an Rh neg woman who is NOT sensitized: |
|
Definition
|
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Term
|
Definition
Eating raw or undercooked meat
Drinking unpasteurized goat's milk
Contact with cat feces |
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Term
|
Definition
1st trimester: Spiramycin (can be obtained through CDC)
After 1st trimester: Sulfadiazine and pyrimethamine |
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Term
Rubella
VIRUS, also known as: |
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Definition
|
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Term
|
Definition
| Across the placenta to the fetus |
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Term
|
Definition
| Isolation of infants born with this |
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Term
|
Definition
PREVENTION!
Vaccination of all children
Vaccination of women of reproductive age (IF titer is less than 1:8 there is a susceptibility to rubella) |
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Term
|
Definition
Across placenta to fetus OR
Cervical route during birth |
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Term
|
Definition
Fetal infection
Fetal death
Neonatal disorders: Probably most common cause of mental retardation |
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Term
|
Definition
| None exists. Prevention is KEY. |
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|
Term
Herpes Simplex Virus: HSV-1 or HSV-2
Transmission |
|
Definition
Ascending infection during birth: after membranes rupture OR
Transplacental (rare!) |
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|
Term
HSV-1 or HSV-2
Treatment for mom and/or infant |
|
Definition
|
|
Term
| Precaution if there is an active outbreak of HSV at time of labor |
|
Definition
|
|
Term
Group B Streptococcal Infection (GBS)
Transmission |
|
Definition
Vertical from mother during birth OR
Horizontal from colonized medical personnel OR
colonized infants |
|
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Term
|
Definition
| 36 weeks (book says 35-37 weeks) |
|
|
Term
|
Definition
Initial dose of Penicillin G (5 million units)
Follow initial dose with 2.5 million units, IV, every 4 hours until delivery.
Ampicillin may also be used, 2 g. IV initial dose, followed by 1 g every 4 hours until birth. |
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|
Term
|
Definition
Forms bony canal through which fetus must pass
Divided into three sections |
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Term
|
Definition
Inlet- where it curves in
Pelvic cavity - opening in middle
Outlet - where the baby comes out |
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Term
|
Definition
Face
Base of skull
Vault of cranium - top of head |
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Term
|
Definition
| Cranial bones overlap under pressure of labor and demands of unyielding pelvis |
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Term
|
Definition
| Relation of fetal parts to one another |
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Term
|
Definition
Moderate flexion of the head
Flexion of the arms onto the chest
Flexion of legs onto the abdomen |
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Term
|
Definition
Where the head is and relationship of fetal spinal column to mom's spinal column.
Longitudinal
Transverse |
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Term
|
Definition
What is coming through first...
determined by fetal lie and by the body part that enters the pelvic passage first. |
|
|
Term
| Fetal presentation: Types |
|
Definition
|
|
Term
|
Definition
| Largest diameter of presenting part reaches or passes through the pelvic inlet |
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|
Term
|
Definition
Refers to relationship of presenting part to imaginary lines drawn between the ischial spines of the maternal pelvis.
How far down is the baby? |
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Term
|
Definition
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|
Term
| Station: Negative numbers |
|
Definition
Presenting part is higher than the ischial spines
-5 = at the pelvic inlet |
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|
Term
| Station: Positive numbers |
|
Definition
Presenting part has passed the ischial spines
+4 = pelvic outlet |
|
|
Term
|
Definition
| Uterine muscular contractions |
|
|
Term
|
Definition
| Use of abdominal muscles to push |
|
|
Term
|
Definition
| the time between the beginning of one contraction and the beginning of the next contraction |
|
|
Term
|
Definition
| measured from the beginning of a contraction to the completion of that same contraction |
|
|
Term
|
Definition
refers to the strength of the contraction during acme.
Estimated by palpating fundus or measured directly by intrauterine catheter |
|
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Term
|
Definition
| build-up of the contraction |
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Term
|
Definition
|
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Term
|
Definition
| Letting up of the contraction |
|
|
Term
|
Definition
Causes relaxation of smooth muscle tissue.
Toward the end of gestation, availability to myometrial cells decreases making it easier to stimulate contractions. |
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Term
|
Definition
| Causes stimulation of uterine muscle contractions |
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|
Term
|
Definition
Pressure of fetal head causes cervical dilation
Rectum and vagina are drawn upward and forward with each one.
During 2nd stage: anus everts |
|
|
Term
Premonitory Signs of Labor:
B,B,C,D, L, M, N, W |
|
Definition
Bloody show
Braxton-Hicks
Cervical changes
Diarrhea
Lightning
Membrane rupture
Nesting
Weight loss of 1-3 lbs. |
|
|
Term
| Braxton-Hicks Contractions |
|
Definition
Intermittent contractions
Irregular
Cause more discomfort closer to onset of labor |
|
|
Term
|
Definition
Regular intervals
Longer, stronger, closer together
Discomfort begins in back and radiates around to front
Walking intensifies contractions!
Resting or relaxing in warm water doesn't decrease intensity
Contractions produce cervical dilatation |
|
|
Term
|
Definition
Irregular contractions
Lessened by walking, rest or warm water
Discomfort felt primarily in abdomen
Contractions do not dilate cervix |
|
|
Term
|
Definition
3 phases:
Latent
Active
Transition |
|
|
Term
|
Definition
Beginning of regular, usually mild contractions
May begin: Duration: 30 seconds/Frequency: 10-30 min.
Progress to: Duration: 30-40 seconds/Frequency: 5-7 min.
0-3 cm. |
|
|
Term
Latent
Nullipara:
Multipara: |
|
Definition
Nullipara: averages 8.6 hours, not exceeding 20
Multipara: averages 5.3 hours, not exceeding 14 hours |
|
|
Term
|
Definition
Fetal descent is progressive
4-7 cm. |
|
|
Term
|
Definition
Nullipara:1.2 cm/hr
Multipara: 1.5 cm/hr |
|
|
Term
|
Definition
More frequent contractions
Duration: 60-90 seconds
Frequency: 1.5-2 minutes
8-10 cm. |
|
|
Term
Transition
Nullipara
Multipara |
|
Definition
Nullipara: 3 hours
Multipara: 1 hour |
|
|
Term
|
Definition
Stage of Expulsion
Begins with complete dilation and ends with delivery of baby |
|
|
Term
|
Definition
Placental stage
Begins immediately after baby is born and ends when the placenta is delivered |
|
|
Term
|
Definition
Maternal Homeostatic Stabilization
Begins after the delivery of placenta and continues for 1-4 hours after delivery.
INCREASED PULSE
DECREASED BP
Uterus should be located below umbilicus |
|
|
Term
|
Definition
Relief that labor has begun
High excitement with some anxiety |
|
|
Term
|
Definition
Fear of loss of control
Anxiety increases |
|
|
Term
|
Definition
increased feelings of anxiety
irritability
eager to complete the birth process
need to have support person or nurse at bedside |
|
|
Term
|
Definition
Globular-shaped uterus
Rise of fundus in the abdomen
Sudden gush or trickle of blood
Further protrusion of cord from vagina |
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|
Term
|
Definition
| Acid/Base: Result of hyperventilation during labor |
|
|
Term
| Mild metabolic acidosis compensated by respiratory alkalosis |
|
Definition
| Acid/BaseL End of 1st Stage |
|
|
Term
| Mild respiratory acidosis |
|
Definition
| Acid/Base: During pushing in 2nd stage, PaCO2 levels may rise |
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|
Term
| Metabolic acidosis uncompensated for by respiratory alkalosis |
|
Definition
| Acid/Base: End of second stage |
|
|
Term
| Electronic Fetal Monitoring - placement |
|
Definition
| Most accurate when it is placed where baby's back is located. |
|
|
Term
| Assessing Cervical Dilatation |
|
Definition
| Index finger and middle finger placed against sides of cervix to determine size of opening |
|
|
Term
|
Definition
| Progressive thinning of cervix measured in percentages |
|
|
Term
|
Definition
| Systematic way to evaluate the maternal abdomen |
|
|
Term
| Prep for Leopold's Maneuvers |
|
Definition
Empty bladder
Lie on back with feet on bed
Knees bent |
|
|
Term
|
Definition
Book says: 110-160 (p. 400)
PP Slide says: 120-160 |
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|
Term
|
Definition
|
|
Term
| Causes of fetal tachycardia |
|
Definition
Early fetal hypoxia
Maternal fever
Maternal dehydration
Amnionitis
Maternal hyperthyroidism
Beta-sympathetic drugs (e.g. terbutaline, atropine)
Fetal anemia |
|
|
Term
| OMINOUS sign if fetal tachycardia is accompanied by: |
|
Definition
Late decelerations
Severe variable decelerations
Decreased variability |
|
|
Term
| Causes of fetal bradycardia |
|
Definition
Profound hypoxia in fetus
Maternal hypotension
Prolonged umbilical cord compression
Fetal arrhythmias
Uterine hyperstimulation (turn the PIT down!)
Abruptio placentae
Uterine rupture
Vaginal exam in second stage of labor |
|
|
Term
|
Definition
Transient increases in FHR normally caused by fetal movement
Normally a reassuring sign of fetal well-being when it occurs during a contraction.
Acme of 15 bpm above baseline with duration > 15 seconds but < 2 minutes |
|
|
Term
|
Definition
| Periodic decreases in FHR from baseline |
|
|
Term
|
Definition
Nadir of decel matches peak of contraction
Anticipated response to contraction
The uterus is squeezing the head.
Occurs before a contraction and usually requires no interventions.
Onset to nadir is greater than or equal to 30 seconds |
|
|
Term
|
Definition
Onset, nadir, and recovery of decel FOLLOW beginning, peak, and end of contraction.
Non-reassuring sign.
Onset to nadir is greater than or equal to 30 seconds
The concern is that the squeezing of the uterus is NOT causing this.
Transmission of 02 isn't good - possibly a placental issue. |
|
|
Term
|
Definition
Not definitive
Abrupt onset to nadir is less than 30 seconds with drop of 15 bpm below baseline for greater than or equal to 15 seconds but < 2 minutes.
The relationship to the contraction is variable.
Usually due to umbilical cord compression and require further assessment. |
|
|
Term
|
Definition
No periods of normal fetal heart rate.
Associated with Rh problems, fetal anemia, severe fetal hypoxia, or a chronic fetal bleed. |
|
|
Term
|
Definition
Normal baseline
Accelerations with fetal movement
3-5 cycles of long-term variability per minute
Early decels may be present |
|
|
Term
| Non-reassuring EFM Tracings |
|
Definition
Severe variable decels (FHR < 70 for longer than 30-45 sec along with a rising baseline OR decreasing variability OR slow return to baseline)
Late decels
Absent variability
Prolonged decels (> 60-90 sec)
Severe (marked) bradycardia (FHR baseline < 70 bpm) |
|
|
Term
| Nursing Interventions for Non-reassuring FHR |
|
Definition
Maternal positioning
Maternal VS - hypotension?
IV fluids as needed
02 as needed
Stop PIT
Continuous monitoring
Vaginal exam to look for prolapsed cord
Fetal blood sampling
Prep for expeditious birth
Explain to mom and partner
Give tocolytic as ordered (relax the uterus from putting pressure on the baby.) |
|
|
Term
|
Definition
Transcervical instillation of 250 mL of warmed sterile saline followed by a continuous infusion rate of 100-200 mL/hr.
May decrease frequency and severity of variable decels during labor.
May also be used in cases of thick meconium to decrease the consistency and incidence of meconium below the infant's vocal cords. |
|
|
Term
|
Definition
Her Rapid Response Made Sense
H - heart rate
R - respiratory effort
R - reflex irritability
M - Muscle tone
S - skin color |
|
|
Term
| Heart Rate scoring (APGAR) |
|
Definition
> 100 = 2
< 100 = 1
Absent = 0 |
|
|
Term
| Respiratory Effort scoring (APGAR) |
|
Definition
Vigorous cry = 2
Slow irregular effort = 1
Absent = 0 |
|
|
Term
| Muscle Tone scoring (APGAR) |
|
Definition
Knees normally positioned up toward abdomen = 2
Some flexion = 1
Flaccid = 0 |
|
|
Term
| Reflex Irritability scoring (APGAR) |
|
Definition
Cry = 2
Grimace = 1
No response = 0 |
|
|
Term
| Skin Color scoring (APGAR) |
|
Definition
Totally pink = 2
Acrocyanosis = 1
Totally cyanotic = 0 |
|
|
Term
| IV Narcotics for Laboring Mom in 1st Stage of Labor |
|
Definition
|
|
Term
|
Definition
SLEP
Spinal block
Local infiltration
Epidural block
Pudendal block |
|
|
Term
|
Definition
Excellent pain relief
No neonatal respiratory depression
Provides relief during prolonged labor and for a few hours postpartum |
|
|
Term
Epidural Block
Disadvantages |
|
Definition
Anesthesiologist or CRNA must insert
Numbness of lower extremities
Decrease in contractions
Little or no urge to push
Relaxation of musculature below injection site can result in fetal internal rotation.
May have elevated maternal temperature |
|
|
Term
|
Definition
Itching
Maternal Hypotension
Fetal bradycardia
Urinary retention
Spinal headache |
|
|
Term
| Nursing Interventions for Maternal Hypotension |
|
Definition
1. Left side-lying position. (LEFT is BEST)
2. Increase rate of IV fluids
3. 02 by face mask as ordered |
|
|
Term
|
Definition
Used primarily for C-Sections
Local anesthetic directly into spinal canal |
|
|
Term
|
Definition
More than 2000 mL of amniotic fluid
1 % of all pregnancies
Causes: major congenital anomalies (esp. neural tube defects), maternal diabetes, large placenta, Rh sensitization |
|
|
Term
| Polyhydramnios Signs and Symptoms |
|
Definition
Shortness of breath
Edema
Fundal height greater than gestational weeks
Difficulty palpating fetus using Leopold's |
|
|
Term
|
Definition
Less than normal amount of amniotic fluid (around 500 mL is considered normal)
Largest vertical pocket is 5 cm. or less.
Causes: Post-maturity, renal malformation of fetus (baby isn't urinating appropriately)
May see a 2-vessel cord as opposed to a 3-vessel cord |
|
|
Term
| Oligohydramnios Signs and Symptoms |
|
Definition
Fundal height small for dates
Variable decels
Reduced amniotic fluid on ultrasound
Fetus easily palpated and outlined |
|
|
Term
|
Definition
| Flexed with occiput in the right or left anterior quadrant of the maternal pelvis |
|
|
Term
Fetal Malposition
POP -Persistent Occiput Posterior |
|
Definition
Most common malposition
Fetus doesn't rotate but is born in the occiput posterior position. |
|
|
Term
|
Definition
Intense back labor pain caused by fetal occiput compressing the sacral nerves.
Dysfunctional labor pattern
Hypotonic labor b/c fetal head doesn't put enough pressure on the cervix
Dilatation or fetal descent slowed or stopped |
|
|
Term
| Fetal Normal Presentation |
|
Definition
| Occiput is presenting part |
|
|
Term
|
Definition
Breech
Brow
Compound
Face
Shoulder (transverse lie) |
|
|
Term
| Nursing Interventions for POP |
|
Definition
Encourage mom to lie on her side opposite from the fetal back to help with rotation
Knee-chest position
Sacral counter-pressure with heel of hand to relieve back pain. |
|
|
Term
| Bleeding in a pregnant woman: may mean... |
|
Definition
| Placenta previa or a placental abruption |
|
|
Term
|
Definition
| Premature separation of a normally implanted placenta from the uterine wall. |
|
|
Term
|
Definition
Placenta separates at edges.
Blood passes between the fetal membranes and the uterine wall and escapes vaginally. |
|
|
Term
|
Definition
Placenta separates centrally and blood is trapped between the placenta and the uterine wall.
Concealed bleeding |
|
|
Term
|
Definition
|
|
Term
Placental abruption: S/S
Onset |
|
Definition
|
|
Term
Placental abruption: S/S
Bleeding |
|
Definition
|
|
Term
Placental abruption: S/S
Color of blood |
|
Definition
|
|
Term
Placental abruption: S/S
Anemia and Shock |
|
Definition
| Greater than apparent blood loss |
|
|
Term
Placental abruption: S/S
Toxemia |
|
Definition
|
|
Term
Placental abruption: S/S
Pain |
|
Definition
|
|
Term
Placental abruption: S/S
Uterine tenderness |
|
Definition
|
|
Term
Placental abruption: S/S
Uterine tone |
|
Definition
|
|
Term
Placental abruption: S/S
Uterine contour |
|
Definition
| May enlarge and change shape |
|
|
Term
Placental abruption: S/S
Fetal heart tones |
|
Definition
|
|
Term
Placental abruption: S/S
Engagement |
|
Definition
|
|
Term
|
Definition
C-Section
3rd or 4th degree laceration or episiotomy |
|
|
Term
|
Definition
Forehead is presenting part
Usually converts to vertex or face presentation |
|
|
Term
|
Definition
Fetal scalp electrodes should not be used
Prepare parents for facial bruising |
|
|
Term
|
Definition
| Vaginal delivery is NOT an option |
|
|
Term
|
Definition
Complete: butt first with knees flexed
Frank: butt first with legs extended
Incomplete (footling): 1 or both feet presenting, increased risk for cord prolapse. |
|
|
Term
|
Definition
| Fetus is not firmly engaged allowing room for the cord to move beyond the presenting part. |
|
|
Term
| Factors that contribute to cord prolapse |
|
Definition
ROM before presenting part engages
Small fetus
Breech, esp. footling
Transverse lie (shoulder presentation) |
|
|
Term
| CPD - Cephalopelvic Disproportion |
|
Definition
| Fetal head is too large to pass through the bony pelvis |
|
|
Term
|
Definition
| Fetal head never descends into pelvis, even with strong contractions. |
|
|
Term
|
Definition
Obstetric emergency
Difficulty or inability to deliver the shoulders |
|
|
Term
|
Definition
Gestational diabetes
Increased fundal height
Maternal obesity
"Turtle" sign - baby stretching and getting stuck. |
|
|
Term
| Nursing Interventions for Shoulder Dystocia |
|
Definition
McRobert's Maneuver
Woman flexes thighs to abdomen which changes angle of pelvis and increases the pelvic diameter. |
|
|
Term
|
Definition
C - cervical ripening
A - amniotomy
P - pitocin
S - stripping of membranes |
|
|
Term
|
Definition
AROM - artificial rupture of membranes
2 cm. of dilation required
use amniohook
Causes release of natural prostaglandins that stimulate contractions.
Always assess color and composition of amnio fluid |
|
|
Term
|
Definition
Softening and effacing of cervix
Cervidil - prostaglandin
Cytotec - synthetic prostaglandin |
|
|
Term
|
Definition
| Practitioner inserts a gloved finger into the internal os and rotates is 360 degrees twice, separating the amniotic membranes that are lying against the lower uterine segment. |
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|
