OB3 exam

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OB3 exam
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OB 3 exam
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  1. ISAM
    infants of sub aboue mothere
  2. Signs fo maternal substance use in infants
    • SGA or IUGR
    • Microcephaly
    • Neonatal stroke
    • lethargy, fever diaphoresis tacfhycardia high pitched cry
    • tremaors hypertonicity
    • hyperreflexia ineffective suck increased suck
    • irriabiltiy jitteriness seizures nasal congestion ravenouse appeitite
    • diatthea weight loss abdominal distention
  3. Maternal associations with substance use
    • Poor or no prenatal use
    • Preterm labor–cocaine and crack
    • Placental rupture– all
    • Precipitous delivery–
    • Frequent requests for pain meds–
    • Other signs of withdrawal:  depression, irritability, nausea, lack of motivation, psychomotor changes
  4. Is alcohol a teratogenic?
    yes
  5. Symptoms for alcohol withdrawl of baby
    • sleeplessness
    • excessive arousla states
    • inconsolable crying
    • abnormal refexers
    • hyperactivity
    • jitteriness
    • abdominal distention
    • hyperactive rooting
  6. Times for baby and mom for start of alcohol withdrawl?
    • Babies- 6-12 hours or at least within 3days of life
    • Mom's- 24-72 hours
  7. Withdrawl symptoms for mom from alcohol
    • sedation to decreased irriabiltiy
    • tremors
    • seizures (12-48hours)
    • folic acid and thiamine def
    • bone marrow suppressing
    • increases infections
    • liver disease
    • Gi upset
    • n&v
    • delerus hallucentations
  8. Affects 1-5% of newborns
    vasoconstriciton for mom and placenta
    anorexic effect- malnutitition
    metabolites in urine of infant up to 4days of infant
    infant withdrawl doesn't need drugs
    no breastfeeding, in milk for 60days
    3-7x higher risk for sids
    Cocaine and crack
  9. Baby cocaine and crack
    • long term effects infant neurobehavorial problems
    • flat apathetic mood
    • iugr
    • small head
    • cerebral infarctions
    • shorter body length
    • alt brain development
    • malforma genitourinary tract
    • lower apgar
  10. Concaine and crack risks for pregnancy
    • increased sab
    • abruptio placentae
    • preterm
    • still birth
  11. Signs of cocaine crack dependent mom
    • mood swings, app changes
    • withdrawl- depression irritability nausea lack of motivation
  12. Marijuana withdrawl symptoms for baby. more at risk for what?
    • decreased fetal growth and sids
    • trembling and excessive crying
  13. Risk for mom on heroin
    • increased nut defects
    • preeclampsia
    • anemia
    • std
  14. Heroin baby risks
    • withdrwal usually after 72 hours
    • increased IUGR meconium aspiration and hypoxia
    • irritablitity and shrill cry
    • non consolable for 3 months
    • increased risk for abuse
    • RDS
  15. Methadone risk for mom
    • preeclampsia
    • placenta abruptio
    • placenta previa
  16. methadone risk baby
    • small head and lbw
    • more severe and longer lasting withdrawal symptoms due to longer half-life
    • jaundice becuase premature
    • withdrawl after discharge
  17. NAS
    Neonatal abstinece syndrome
  18. •Pharmacologic Treatment for ISAM with NAS –
    • Neonatal Morphine solution (NMS)-only if tolerating po feeds
    • –Neonatal opium solution (NOS)–Paregoric 
    • –Phenobarbital
    • –Lorazepam
    • –Methadone-works quickly but takes a long time to wean baby from methadone
    • –Clonidine-with very high NAS scores-lcalms baby -long time to wean
  19. When Do We Discharge IASM Baby Home?
    • •On once daily dose of Methadone-only drug generally discharged home on–Only given 2 week supply at a time
    • •Finnegan score < 5
    • •+ weight gain
    • •Tolerates po feeds easily
    • Parents have been educated
  20. Nursing care with ISAM
    • RDS- vs
    • Jaundice- trancut or serum bilirubin
    • Behaviour- quiet dim room, swaddling, mittins to protect face 
    • congnitive
    • Withdrawl- neonatal absinence socring (finnegan score) , administer meds
    • Feeding problems- extra time and small frequent feeds
  21. Insulin need for 1st 2nd 3rd trimester
    • 1st- decreased need
    • 2nd and 3rd- insulin increases double or quadruple for growth
  22. Insulin need intrapartum and post
    • I:increase
    • P: decrease immediately
  23. antagonist to insulin , frees up moms glucose allows more glucose for baby
    HPL
  24. Vascular changes in preexisting diabetes
    • retinopathy
    • nephropathy
    • gestational hypertension
    • greater risk for preeclampsia
  25. Maternal risk in diabetes
    • hydraminos
    • preclampsia and elclampsi
    • hyperglycemia to ketoacidosis
    • worsening retinopathy
    • increase uti and yeast infection
  26. Fetal risks for diabetic mom
    • congentital abomalies 5-10%
    • 50% fetal death with untreated ketoacidosis
    • Large for gestational age/macrosomia- birth trama
    • neonatal hypoglycemia
    • IUGR
    • Polycythemia/hyperbilirubinema- decrease o2 amounts , A1c takes o2
    • RDS- surfactant decrease because of fetal insulin
    • hypoglycemia
  27. hbg for polycythemia
    >65
  28. Screening for diabetes
    • 24-28 1hr ogtt
    • 50grams of carbs
  29. High risk screening for diabetes
    • immediate screening wth fasting or random serum glucos
    • flooled by repeat glucose and 3 hr oggtt - npo at midnight, 100g carbs 0-1-2-3 test 2 out of the 4 positive
    • tretest 24-28 weeks or prn
  30. what puts women high risk of diabetes
    >40, history of gd, positive family history, hypertension, obese, poor ob outcome
  31. Dietary for diabetes mom
    • increase calories 300/day
    • 3meals/3snacks
    • 40-50% complex carbs, 15-20% protein, 35% fats
  32. glucose monitoring
    • weekly fasting glucose
    • 1-2 psot prandial glucose checks by self monitoring
    • self check 4 times a day
    • fasting <- 90
    • 2hrs after meals <-120
  33. Fetal evaluation of GD
    • maternal serum afp 16-20
    • ultrasounds 18 week and 28week ( iugr and macro)
    • bpp
    • nst 28 weeks weekly and 32 weeks 2xweekly
    • maternal daily activity checks 28 weeks
  34. Laboring management for GD
    • monitor glucose qhr
    • 2 lines- iv fluids ns and d5
  35. GD postpartum
    • increase calorie 500-800 daily
    • no oral hypoglycemics
    • reasses 6wks and then every year x3
  36. s&s of hypoglycemia of newborn
    • tremors, cyanosis, apnea, temp instability, poor feeding, hypotonia
    • plycythemia
    • rds- whites a-c, not d-f
    • hyperbili- 48-72hours
  37. Newborns with hypoglycmeia monitoring
    • at risk should be monitored 30-60 min after birth, before feedings, or whenever s&s
    • IDM should be monitiored within 30 of birth
    • monitor qhr 1st 4 hours and then 4hr intervals for 48 hours
    • titrate iv fluids when po by decreaseing the concentration of parental glucose gradually to d5w, the reducing the rate of infulsion slowly discontinue if ofver 4-6 hours
  38. Therapy that reduces the risk of hiv transmission to fetus
    zidovudine (ZDV)
  39. HIV Maternal risks
    • intrapartal or postpartal hemorrhage
    • postpardal infection
    • poor wound healing
    • infrections of the genitoruinary tract
  40. Neonatal risks for hiv
    • will usually have a positive antibody titier
    • often premature
    • low birthd weight
    • SGA
  41. Testing for hiv neonate
    • PCR
    • 1st 1-24hrs of life
    • 2nd- 1-2months
    • 3rd- 2-4 months
  42. Treatment for hiv
    AZT 8-12hrs--->6weeks
  43. Heart disease check ups
    • q2weeks 1st half of pregnancy
    • qweek 2nd half
    • special attention 28-30weeks
  44. heart diseas
    class I
    II
    II
    IV
    • I- asymptomatic no limits
    • II asymptomatic at rest slight limit of physical activity
    • III- symptomatic at less than ordinary activity- moderate to marked limitiation
    • IV sever symptoms at rest DONT GET PREGNANT
  45. Causes scarring on valves- mitral most common
    increases risk of congestive heart failure
    rheumatic heart disease
  46. Symotoms of mitral valve prolapse
    treatment?
    • primarily palpatations
    • chest pain
    • dyspnea
    •  Treat with limiting caffine
    • needs prophylactic antiboitotics at delivery
  47. peipartun cardiomyopathy
    • dysfucntional left ventrical
    • last month of preg-5 months postp
    • symptoms dyspnea orthopna fatigue cough chest pain
    • edema palpitations
    • may resolve with bed rest
    • no more pregnancies
    • treatment is supportive: digitalis diuretics vasodilators anticoagulants sodium restriction STRICT BEDREST
  48. Antepartunm cardiac management
    • education
    • diet high protein, iron, low sodium
    • 8-10 hours of sleep
    • restrict activites
  49. Intrapartum management cardiac
    • evaluate vs frquently
    • demi folwers or side lying position with head and shoulders elevated
    • o2 diuretics analgesics prophylactic abx digitalis
    • calm
    • cont efm
    • epidural
    • forceps and vacum... no valsva manuver
  50. Management cardiac postpartum
    • first 48 hours critical all extra fluid becomes intravascular
    • hospital 1 week
    • progressive activity
    • diet and stool softeners
    • encourage bonding
    • no breastfeeding if on coumading, hep and lovenox ok
  51. Risk factors for etopic pregnacy
    • tubal factors
    • previous ectopics
    • endometriosis
    • smoking
    • progesterone only contraceptives
    • des
    • iud in placw
  52. signs and symptoms of ectopic
    • initially normal feelings of pregnancy
    • lower levels of hCG
    • sonogram adnexal mass -area between tubes and overies
    • pe- tenderness andnexa
    • with rupture: one sided shapr abdominal pain, referred shoulder pain because irritates the diaphram and vag bleedng
  53. Etopic diagnosis
    • lmp
    • serum progesteron <5 (>25 viable pregnancy)
    • quantitive beta hcg - intial  and 48hrs 2000!
    • vs for shock
  54. treatment etopic
    if unrupted, less that 3.5 mass and no fetal cardiac activity, stable with no intraabdomial bleeding:
    • Methotrexate- 2doses IM
    • avoid sun exposure, mild abdominal pain for only 24-48hrs
  55. Treatment etopic surgical
    • Salpingostomy - open tube and take out
    • Salpingectomy- take out with tubes and ovary if ruptured
  56. Gestational trophoblastic disease (gtd or molar preg)
    abnormal development of placent
  57. Hydatodoform mole complete
    ovam is fertilized , no genetic, no chromosomes, choriocarcinoma
  58. Hydatitdiformform mole parital
    triploid karyotype, 2 sper,s . 69 chromo, villi only fluid in portions of placent
  59. Invasive mole
    Same as comple hydatitdiforom mole but uterine mymetrium
  60. Choriocarcinoma
    associated with complete hydatitdiform
  61. Monitoring for hydratoform moles
    • hcg is monitored q1-2 weeks until 2 negative consecutive tiems then q month or 2 for a year
    • DONT GET PREGO FOR A YEAR
  62. Cause of placenta abruptio and risk factors
    • hypertension and cocaine
    • hydraminos
    • multiples
    • alcohol
    • smoking
    • ama
    • trama
  63. types of palcenta abrupto
    • marginal - seperates at edges - blood
    • central- seperates in the middle - concealed blood
    • complete- total seperation -hemorrhage
  64. Grade of placenta abruptio
    • 1- mild seperation (FHR, maternal bp)
    • 2. partial seperation, uterin inablitlit increase mom pulse bp stable. decrease fhr
    • 3- large and complete seperation with mod-severe bleeding maternal shock and painful uterin contractions present fetal death
  65. assessments placenta abruptio
    • FHR
    • Painful bleeding
    • PTT Fibrinogen
    • abdominal girth
    • c-section
    • shock s/s
  66. Placenta previa catagories
    • Total- os completely covered
    • Paritial - os partially covered
    • Marginal - edge of placenta is covering
    • low lying the palcenta in lower uterine segment in close proximit to but not covering os
  67. Placenta previa causes
    • prior orevia
    • multiparity
    • increasing age
    • large placenta
    • smoking and cocain
    • prior c/s
    • defective vessels
    • palcenat accrete
  68. Major symptom of placenta preiva
    painless bleeding
  69. hypermesis gravidarum
    peak
    8-12weeks
  70. hypermesis gravidarum
    things that can go wrong
    • dehydration-electrolyte imbalance-alkalosis from loss of hcl acid-
    • hypovolemia
    • hypotension
    • tachycardia
    • increase hematocrit
    • increase bun
    • decrease output
  71. hypermesis gravidarum
    possible ---- if untreated
    • Metabolic acidosis
    • k+ muscle wasting sever protien and vit def fetal and mom death
  72. hypermesis gravidarum
    treatment
    • 1st- avoid crap that make sick
    • 2- iv fluid kcl+added
    • gi rest for 48 hours then advance slowly brat diet with out the bannanas, avoid greasy and fresh food
    • antimetics
    • 3. alternative - tpn possible, ginger
  73. Preeclampsia risks factors and diagnosisi
    • Hypertension (140/90) 1+ proteinuria
    • Teens >35 gtd multiple rh incompatibility, diabetes hx preeclampsia
  74. Risks of preeclampsia Mom
    • Hyperreflexia, headache, seizures
    • renal failure
    • abruptio placenta
    • dic
    • rupture liver
    • pulmonary embolism
    • thrombocytopeina, platelet count less than 100
  75. Risks preeclampsia baby
    • SGA- fetal hypoxia and malnutrition
    • prematurity 10% mortality with pre and 20% with eclampsia
    • oversedated at birth
    • hypermagnesia
  76. Mild preeclampsia
    • >140/90
    • protienuria 1g or less in 24 hours (2+ dipsitck)
  77. Home care for preeclampsia mild
    • daily bp
    • weight
    • protein uria
    • fetal montitor
    • 2x week nst
    • weekly Bpp
    • weight gain 3lbs in 24hours or 4 lbs in 3 day periodi
  78. preeclampsia severe
    • 160/110 or greater @ least 6hrs apart
    • 24 hour urine proteinuria >5g
    • 3-4+ protein uria on 2 random samples 4hrs apart
    • oliguria less than 500ml in 24hrs
    • ruq epigastric pain
    • headach blurred vision spots iugr impaired liver function
    • thrombocytopeina hyper reflexia
    • edema
  79. HELLP
    • Hemolysis
    • Elevated Liver enzymes
    • Low Platelet count
  80. s&s of hellp
    n&v, flu like symptoms, epigastric symptoms
  81. normal platelet for prego
    150-400
  82. Antibody screens for rh sensitation
    1st and 28 weeks
  83. indirect coombs
    • done on mom
    • indicates whether the woman is sensitized to the rh antigen
  84. Direct coombs
    • done on baby
    • maternal antibodies in baby
    • hyperbilirubia anemic
  85. ABO incompatibility for baby
    • pathologic jaundice
    • hyperbilirubia
  86. Side effects for toxoplasmosis
    • most sever fetal problems of contratcted 1st trimester
    • death, blind. deaf, or retarted if survives
  87. Treatment of toxoplasmosis
    • mom-spiramycin
    • baby- pyrimehamin, folinic acid, and sufonamide after 18th week
  88. How do you contract toxoplasmosis?
    How do you diagnose
    • raw meat, cat liter, gardening, unpasturized goat milk
    • antibody titers, IgG and IgM
  89. Rubella german measles for baby
    • greatest risk if contracted the 1st trimester
    • congential heart disease and cataracts, mental retardation, cerebral palsy
  90. Expanded rubella syndrome
    • may develp for years after infection,
    • insulin dependent diabetic
    • sudden hearing loss
    • glacoma
    • slow progressive encephalitits
  91. Cytomegalovirus
    How many people have it
    how is it transmitted
    diagnosis
    • 50-80% of all adults by age 40
    • in all body fluids, close contact
    • cmv in urine or serum and igm levels
  92. Cytomegalovirus
    effects on baby
    treatment
    • no treatment
    • sheds virus for years, dormant
    • most common problems are hearing loss, vision imparment, and mental retardation
    • Blood brain and liver
    • PRIMARY INFECTION DURING PREGNANCY IS MOST SERIOUS
    • WASH HANDS!
  93. HSV
    transmitted to baby?
    • After membranes rupture and virus ascends OR through infected birth canal
    • neonate transmission is usually form mouth (cold sore) or HANDS of caregiver
  94. If primary infection for mom what is babies chances of contracting hsv?
    Reactivations ?
    • gential infection form women with vaginal lesions
    • 33-50%

    of herpetic infection for womean with vaginal lesions less thand 5%
  95. Treatment of HSV in pregnancy
    • Antiviral (acyclovir, valocyclovir, famciclovir) may be used with first episode or severe recurrent disease
    • Acyclovir not absorbed as well as other two
  96. HSV symptoms of infected infant
    often asymptomatic at birth , then 2-12 days later fever and more likely hypothermia, jaundic, seizures and poor feeding
  97. Treatment with HSV infant
    What if no treatment?
    • Treat with acyclovir
    • -50% with die
    • 35-40% will develop microcephaly, mental retardation, seizures, apnea and coma (refers to congential and infections accquried at birth)
  98. Early onset Group B baby
    within 7 days- pnemonia and spticemia, apnea and shock
  99. Late onset Group b baby
    after 1 week - menigitis or pneumonia
  100. Risk factors for baby with group b
    • preterm
    • intrapatrum fever
    • prolonged rupture of memebranes
    • previous infected kid
    • gbs urine
  101. treatment with Group B
    • Treat with prophylaxis at onset of labor or ruptured membranes
    • Penicillin G 5 million units, then 2.5 milllion units q4hr until delivery
    • 3 doses in 24 hours
  102. Screening for gbs done what weeks
    35-37 weeks
  103. Human b19 parovirus
    slapped cheek
    fifth's disease
    How often does it cross the placenta?
    When are the severe effects?
    What are the effects?
    • 40% of the time
    • if infection prior to 20 weeks of gestation
    • rash, fever, fetal anemia, spontaneous abortion, fetal hydrops, and still birth
  104. Infection of newborn
    WBC in first 24hrs
    if less then what number will indicate sepsis
    • 30000-40000
    • <5000-7500
  105. If serum IgM levels are elevated what will it indicate?
    normal?
    • transplacental infection
    • normal igm is <20 mg/dl
  106. Signs and symptoms of infant with infection
    • behavior changes- "not doing well" lethargic, irritable, cool and clamy, color changes
    • Temp instability -mostly hypothermia
    • Feeding intolerance- abdominal distention, vomiting , poor sucking
    • hyperbilirubinemia
    • tachycardia initally, followed by spells of apnea or bradycardia
  107. PROM
    spontaneous ruputure of the membranes before the onset of labor
  108. PPROM
    Preterm PROM, rupture of membranes occcuring before 37 weeks gestation
  109. Whatr is PPRom associated with
    • infection
    • previous history of pprom
    • hydramnios
    • multiple pregnancy
    • uti
    • amniacentesis
    • placenta previa
    • abruptio placente
    • trauma
    • incompetent cervix
    • blleeding during pregnancy
  110. Complications of PROM
    • Infection
    • abruptio placentae
    • retained placenta and hemorrage
    • maternal sepisis
    • maternal death
  111. Fetal complications of PROM
    • RDS (pprom)
    • fetal spsis
    • malpresentations
    • prolapse of cord
    • nonreassuring fhr
    • premature birth and increased perinatal and morbidity and mortality
  112. If PPROM and no infection what should you expect for clinical management
    • assess fetal wellbeing - nst, bbp, avoid vag exams
    • labs- cbc, c-reactive protein, u/a, cultures
    • Bedrest
    • continuous efm at beginning
    • maternal corticosteriods for surfactant
  113. Nursing implications for PPROM
    • determine duration of prom
    • assess gestational age
    • ss of infection
    • hydration status
    • fetal status
    • rest on l
  114. Nursing conciderations for administration of betamethasone?
    • assess contractions
    • provide education of side effects
    • deep im
    • bp, weight, edema
    • assess glucose and electrolytes
  115. when is the latest you can use betamethasone
    34 weeks
  116. Signs and symptoms of preterm labor
    • Uterine contrations thta occer every 10 min or less with or without pain. 6 OR MORE IN ONE HOUR
    • midle menstral like cramps felt low in the abdomen]
    • constant or intermittent feeling of pelvic pressure that feel like the baby pressing down
    • rupture of membranes
    • constant or intermitent low dull backache
    • a change in vaginal discharge ( an increase in amount, a change ito more clear an dwatery, or a pinkish tinge
    • abdomial cramping with or withoug diaherra
  117. What is the goal of preterm labor management
    • prevent preterm labor from advancing to the point that it no longer responds to medical treatment.
    • stop in latent phase
  118. How is PTL diagnosed
    • 20-37 weeks
    • 6 or more contractions in one hour
    • cervical changes
  119. Predictors for preterm labor
    • Presence of infection
    • Cervicovaginal fibromectin protein found in the fetal membrane and decidua- NOT PRESENT 22-37 WEEKS
    • Very reliable if negative not going into labor for 7 days
    • Cervical length less than 25mm
    • History of preterm labor
  120. Medications commoly used for tocolytics to stop contraction
    • B-adrenergic agonists- Brethine
    • Mag Sulfate
    • Cyclooxygenase ( prostaglandin synthetase inhibit)-Indocin
    • Calcuim Channel blocker - procardia
  121. Side effects for Brethine
    • Tachycardia
    • Maternal pulmonary edema
  122. Side effects for mom for mag
    • warmth
    • headach
    • nystagmus
    • nausea
    • dizziness
  123. Side effects for baby mag
    • Hypotonia
    • lethargy after birht
    • Respiratory depression
  124. Side effects of Indocin
    Fetal
    • Constriction of ductus arterious
    • NEC
    • IVH
  125. Side effects for Procardia
    • Not to be used with Mag
    • tachycardia
    • hypotension
    • facial flushing
    • headache
  126. Nursing care standard for mag sulfate
    • BO q 10-15 min during administration
    • Mag levels- theraputic 4-8. q6-8hrs
    • Respiration if <12 reevaluate
    • Reflexes
    • Urinary output, <30 accumulation of mag
    • Calcium gluconate is antagoist 1g in 3 min
    • FHR
  127. Respiratory effects on preterm baby
    • Lacks surfactant
    • ductus arteriosus may remain open- because of decreased o2 levels and prostagladin e levels
  128. Nursing care for preterm respiratory effects of preterm baby
    • Position
    • airway pateny
    • HR and RR
    • Montior resp function befor and during feeding
  129. Signs of patent ductus arteriosis
    increase blood volu to the lungs, causing pulmonary conjestion, increased resp effort, co2 retention  and bounding femoral pulses
  130. Adequate output for baby
    1-3 ml/kg/hr
  131. calorie needs for baby
    95-130 kcal/kg/day
  132. Nursing implications of preterm gastrointestinal baby
    • evaluate hydration status
    • observe for signs of fetal intolerance
    • measure abdominal girth
    • ausulate bowel sounds
    • aspirate and measure residual
    • v&d
    • lactose or blood in stool
    • daily weights
    • Place on right side or stomach after meal
  133. First signs of sepsis in baby
    • lethargy
    • increased episodes of apnea and bradycardia
  134. Why is immune system weaker in preterm baby
    • Lack of passive IgG antibodies- last trimester
    • Skin is easily excoriated
  135. Big powerful contractions, not doing anything, stops in lanent phase, increased frequency but decreased intensity of contractions
    Hypertonic labor patterns
  136. Labor that is stopped in active phase
    <2-3 contractions in 10 minutes
    Hypotonic labor pattern
  137. Possible reasons for hyptonic labor
    • Overstretched form twins, large fetus
    • hydramnis
    • fetal malposition
    • prematurity or grandmultiparity
    • bladder or bowel distention
    • cpd associated
    • anegia/anasthia
    • full bladder
    • pelvis too small
  138. Dystocia risks for mom
    • increased discomfort, unproductive (hyper)
    • fatigue/exhaustion
    • stress on coping abilites
    • dehydration and possible infection if labor prolonged
    • increased risk for postpartal hemorrhage - from insufficient uterin contractions following birth (hypo)
  139. Dystocia Fetal-Neonatal risks
    • Nonreassuring fetal status
    • increase incidence of caput succedaneum, cephlahematoma, and molding
    • increased risk of sepsis from prolonged membrane
  140. Early PPH
    • 1st 24hours
    • uterine atony most common cause
    • loss of 500ml+ vaginal or 1000+ c/s
  141. Late PPH
    • 24hours- 6weeks
    • Retained placenta products
  142. 4 "T"'s for PPh
    • Tone
    • tissue
    • trauma
    • thrombin
  143. Tone - 70-80% causes
    • Uterine over-distention:
    • multiple birth
    • polyhydram
    • macrosomia
    • prolonged labor
    • oxytocin
    • grand multiparity
    • anathesia
    • prolonged 3rd stage
    • operative -forceps and vacum
    • previa
    • Uterine Muscle Fatigue:
    • Uterine infection/chorioamnionitis:
    • Uterine distortion/ abnormality:
    • Uterine relaxing durgs:
    • epidural
    • general
    • spinal
    • anthsia
    • mag
    • procardia
    • brethaline/terbtine
  144. Tissue PPH
    • Retained placenta/membranes - from masage fundus before placenta seperation
    • Abnormal placenta- placenta implanted on the muscle of uterus
    • C/s near scar
  145. Trama PPH
    • Gentital tract tears:
    • cervical, vaginal and perineal ( big baby, fast delivery, episotomy, primagravida, forcepts , vacum, oxytocin
    • Extended tear at C/S incision
    • Uterin rupture- V-back removal of fibroids past surg
    • Uterine inversion- turning insid out, pulling on cord before seperation
  146. Thrombin PPH
    • Pre-existing clotting abnormality
    • anticoagulation- history of pe dvt
    • acquired complications in pregnancy
  147. Nursing interventions of PPH
    • 2 sat pads in 15 min
    • dont leave
    • call help
    • call dr
    • notify anesthesia
    • explain what is happening
    • MASSAGE FUNDUS
    • Obtain v/s q5 min
    • pulse ox continuous
    • o2 @ 8-10 L min via face mask
    • insert foley
    • initiat 2 iv sites with 16-18 gauges
    • order a pp hemorrage order set- CBC, CMP, PT,PTT, Fibrinogen
    • Type and cross for 2 units of packed RBC's
    • Order trama blood if necessary
    • elevate patient legs
    • monitor i and os
    • auscultat lungs before and after infustions
  148. Treatment TONE
    • uterine massage
    • 1. oxytocin- 20 units per liter of LR- 10 units im if no iv
    • 2. Methergine 0.2mg IM q 2-4hours UNLESS HYPERTENSIVE
    • 3. Hemabate 0.25 mg IM repeat Prn q15-90 min with max of 8 doses
    • 4. Cytotec 800-1000mcg rectally q2hrs
    • surgical procedures
  149. Treatment Tissue
    • Manual removal of placenta
    • curettage of retain tissue
    • ultrasound evaluation of uterus and retained tissue
  150. Treatment Trama
    • suture laceration
    • drain hematomas
    • replace inverted uterus
  151. Treatment Thrombin
    • Hematology consult
    • Replace factors
    • Platelet transfusion
    • fresh frozen plasma
    • Recombiant factor - manmade activated protein that promotes thrombosis
  152. Signs of PPH
    • excessive or bright bleeding (sat of more than 1 pad in 1hr)
    • Boggy fundus not responding to massage
    • abnormal clots
    • increased temp
    • unusual pelvic or back pain
    • persisitent pain with firmly contracted fundus
    • rise fundus
    • hematoma formation or bulging/ shiny skin in the perineal area
    • decreased level of consciousness
  153. Things to remember with hemabate for pph
    • avoid with asthma
    • do not give if the paient has actvit cardiac, pulmonary, renal or hepatic disease
  154. antagonist of heperain
    protomine sulfate
  155. preventive measures for decrease thormboembolic disease
    ambulate, scds, avoid dehydartion, no smoking , no leg crossing
  156. Labs for coumadin
    pt and inr
  157. Labs for heparin
    ptt
  158. Adjustment reatction with depressed mood "Baby Blues"
    incidence
    s&s
    onset
    causes
    nursing care
    • 50-80%
    • Tearful without being sad
    • day 2ish but gone by 2-3 weeks
    • Hormones
    • Bring family in!
  159. Postpartum major mood disorder
    incidence
    onset
    risk factors
    risk for suicide
    • up to 30%
    • about 4 wks out and come anytime within the first year
    • impoverish, birthplan not met, last postpardum depression, exhaustion, fatigued
    • Yes! infantcide uncommon
  160. Signs and symptoms of adjustment reatction with depressed mood
    • overwhelmed
    • unable to cope
    • fatigued
    • anxious
    • irritable
    • oversensitive
    • episodic tearfulness
  161. Risk factors for PPD  Postpartum major mood disorder
    • all women
    • primaparity
    • prior history of depression
    • anciety
    • hx of other mental illentss
    • family hx
    • social risks
    • fatigue
  162. S&S of PPD
    • Depressed mood
    • tearfulness
    • sleep or appetite disturbances
    • nervousness or anxiety
    • irritabliltiy
    • weight gain or loss
    • loss of interest or pleasrue
    • low energy
    • loss of concentration
    • guilt hopelessness
    •  thoughts of harming self or baby
  163. screening for ppd
    • edinburgh postnatal depression scal
    • 1st prenatla visit, 20weeks gestation, immediately pospartum, 6 weeks postpartum, regular intervals during 1st year
  164. Treatments of PPD
    • Non pharm
    • complementry
    • anti depressants
    • anti psychotics
    • hospitalization
  165. Postpartum psychosis 
    evident when
    s&s
    • within 1st 3 months postpartum
    • agitation
    • hyperactivity
    • insomnia
    • mood lability
    • confusion
    • irrationality
    • poor concentration and judgetment
    • delusions and hallucinations
  166. Treatment of postpartum psychosis
    • hospitalixation
    • antipsychotics
    • ect
    • removal of infant
    • psychotherapy
    • improvement in 95% of all cases
  167. SGA
    how big?
    What age?
    • below 10th percentile
    • preterm, term, postterm
    • doubets and ballard score then compare size
  168. IUGR
    Symmetric
    • head doesn't apperar abnormally large or the length excessive in relation to other bodyparts
    • never catch up to peers
    • vigorous
    • body parts in proportion
    • below normal size for gestational age
  169. IUGR
    Asymmetric
    • Appear long, thin, emaciated, loss of fat, and muscle mass, head appears large
    • Head is really in the normal percentile
    • loose skin folds
    • vigourous cry
    • appear wide eyed and alert
    • chest size and abdominal girth decreased
    • catches up to peers
  170. Common complications for SGA
    • asphyxia- rds
    • aspirations syndrome - tachynpea, ng feeding, hypoxic, gasp aspirat amniotic fluid
    • hypothermia
    • hypoglycemia - most comon with iugr
    • polycythemia
  171. Complications of LGA
    • Birth trama- cpd, aphexia, clavical, ect.
    • Increased C/S
    • hypoglycemia, polycythemia, hyperviscocity
    • More difficult to arouse to a quiet alert state
  172. When do test for pku and metabolism disorders?
     24hrs after po feedings

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