Maternity

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selggur29
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Maternity
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2013-02-23 21:24:33
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maternity questions for first year nursing
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  1. Antepartum Period
    (prenatal period) begins w/ conception and ends with the onset of labor
  2. Preconception Health Care
    assessing for risk factors and implementing interventions for current health, future pregnancies.
  3. Anticipatory guidence
    provision of information and guidence to women and their familes that enables then to be knowledgeable andprepared as the process of pregnancy unfold

    Nutrition, PNV, exercise, self-care, contraception cessation, timing of conception, modifying behaviors to reduce risks
  4. Maternal obesity is associated with...
    • LGA (large gestational age)
    • prolonged labor
    • postpartum hemorrhage
    • poor wound healing
    • preeclampsia, hypertension, GDM, thromboembolism, uti
  5. Presumptive signs of pregnancy
    amenorrhea

    N/V

    Breast tenderness

    Fatigue

    Frequency

    Quickening-movement at 18weeks
  6. Probable signs of pregnancy-
    objective signs such as:

    -Chadwick's, Goodell's, Hegar's, & Ballottement

    -Melasma & Linea Nigra

    -Positivie pregnancy test

    All of these changes can also have causes other than pregnancy an are not considered diagnostic
  7. Chadwick's sign
    bluish-purple coloration of the vaginal mucosa, cervix, and vulva seen at 6-8 weeks
  8. Goodell's Sign
    Softening of the cervix and vagina with increased leukorrheal discharge, palpated at 8 weeks
  9. Hegars sign
    Softening of the lower uterine segment, plapated at 6 weeks
  10. Ballottement sign
    a light tap of the examining finger on the cervix causes fetus to rise in the amniotic flud and then rebound to its original position at 16-18 weeks
  11. Melasma (chloasma)

    Linea Nigra
    -mask of pregnancy, brown pigmentation over forehead, temples, cheek and upper lip

    -dark line that runs from the umbilicus to the pubes
  12. Positive signs of pregnancy
    • -ascultation of the fetal heart
    • -observation and palpation of fetal movement by the examiner
    • -sonographic visualization of the fetus w/ cardiac movement (4-8 weeks)
  13. Naegele's Rule
    EDD= First day of period - 3 months + 7 days

    based on 28 day, regular cycle
  14. Term gestation
    5 weeks from 37-42 weeks gestation
  15. Trimesters
    First= first day lmp-12 weeks

    2nd=13-27 weeks

    3rd= 28-40 weeks
  16. 3  part of uterus
    • Fundus-upper portion
    • Isthmus-lower segment
    • Cervix-neck, external posrt of cervix interfaces with the vagina
  17. BMI and how much need to gain in pregnancy
    • underweight < 19.8 (28-40lbs)
    • average 19.8-26.0 (25-35)
    • Overweight 26.1-29 (15-25lbs)
    • Obese > 29 (15lbs)
  18. Gravida
    # of times pregnant, including current pregnancy
  19. Para
    any birth that occured after 20 weeks gestation regardless if baby was born alive

    (pregnancy ending prior to 20 weeks is abortion)
  20. GTPAL
    • Gravida
    • T= term infats born after 37 weeks gestation
    • P= # of preterm infants born b/e 20-37 weeks gestation
    • A= #of pregnanacies ending before 20 weeks
    • L= # of children currently living
  21. Nulligravida
    is a woman who has never been pregnant or given birth
  22. Primigravida
    Woman who has been pregnant for the first time
  23. Multigravida
    someone who is pregnant for at least the 2nd time
  24. First Trimester
    • H & P
    • pelvic exam
    • uterine growth assessment
    • fetal heart tones
    • lab and diagnostc studies
    • education/anticipatory guidence
  25. second trimester
    • confirm EDD
    • Lab and diagnostic studies
    • Rhogam
  26. third trimester
    • focused assessment
    • fetal well-being
    • pelvic exam
    • Leopolds maneuver-baby position
    • group B
  27. implantation
    • day 5,6
    • progesterone stimulates endometrium
    • upper part of posterior wall of uterus
  28. chorion

    chorionic villi

    amnion
    • -1st membrane to form. Outermot layer of developing embryo
    • -fingelike projections extend into the endometrium
    • -the inner membrane that surrounds the developing embryo, contains the amniotic fluid
  29. placenta
    • -fully functional 8-10 weeks gestation
    • -produces progesterone, estrogen, HCG and human placental lactogen(hPL)
    • -Metabolic and nutrient exchange b/w maternal and ebryonic circulation: allows for o2/co2 exchange
    • -secretes wastes and hormones
  30. Progesterone

    Estrogen

    hCG

    hPL
    -facilitates implantation and decreases uterine contraction, "maintains pregnancy"

    -stimulates placental blood flow, enlargement of breasts and uterus

    -rises rapidly in first trimester then declines once placenta able to secrete estrogen and progesterone

    -promotes fetal growth by regulating glucose & stimulates bresat development in prep for lactation
  31. Fetal circulatory system
    Maintains blood flow to placenta

    Provides fetus with o2 and nutrients

    Removes co2 and waste

    bypasses fetal lung b/c they dont carry out respiration enchange; placenta does this
  32. Ductus Venosus
    -umbilical vein to inferior vena cava

    -o2 able to enter the rght atrium
  33. Foramen ovale
    -opening b/w the right and left atria

    -o2 blood shunted to the left atrim via this

    -after dleivery closes inresponse to increased blood returning to the left atrium
  34. Ductus Arteriosus
    -connects pulmonary artery with the descending aorta

    -o2 bloodis shunted to the aorta via this with small amounts going to lungs

    -after delivery constricts in repsonse to o2 levels and prostaglandins
  35. amniotic fluid
    • -protection
    • -temp control
    • -symmetrical growth
    • -prevents from adhearing to amnion
    • -promotes movement
    • -wedge for labor
    • -umbilicall free from compression
    • -full term 500-1000ml
  36. umbilical cord
    • -protected by whartons jelly
    • -attaches fetus to placenta
    • -2 arteries: takes blood frm fetus to mother
    • -1 vein: mother to fetus
  37. Pre-embryonic stage

    Embryonic stage

    Fetal stage
    -1st-14 days starting with fertilization

    -day15-end of 8th week

    • -8th week-9 1/2 lunar month
    • (every organ present by 8th week,  remainder of gestation devoted to refining structures and perfecting function)
  38. Maternal Tasks of pregnancy (Rubin)
    • -ensuring that mother & baby emerge from pregnancy healthy
    • -ensure social acceptence of child by significant others
    • -maternal-fetal attachment
    • sacrificing for pregnancy and child
  39. Seven Dimesions of Maternal Role Development (Lederman)
    • -Acceptence of pregnancy: responding to changes
    • -Identification of the motherhood role: woman-with-child
    • -relationship to her mother
    • -reordering relationship with her husband/partner
    • -preparation for labor
    • -prenatal fear of control in labor
    • -prenatal fear of loss of self-esteem in labor
  40. Factors that influence a womans ability to adapt to the maternal role
    • Parity (multiple pregnancies)
    • maternal age
    • sexual orientation
    • single parenting
    • multifetal pregnancies
    • socioeconomic factor
    • abuse
  41. couvade syndrome
    men expirience pregnancy symptoms
  42. 3 phases of fathers (May)
    -announcement phase

    -moratorium phase-emotional distance, resentment, disruption in communiation

    -focusing phase-redefines himself as dad
  43. biophysical factors
    originate from the mother or fetus and impact the development or function of the mother or fetus
  44. Psychosocial factors
    maternal behaviors/lifestyles that have a negative effect on the mother or fetus
  45. Sociodemographic factors
    are vriables that pertain to the woman and her family and place the mother and the fetus at increased risk
  46. Environmental factors
    hazards in the workplace/environment that impact pregnancy outcomes
  47. chorionic villus sampling
    aspiration of a small amount of placental tissue fr chromosomal, mtabolic , or DNA testing

    • -10 to 12 weeks
    • -tests for cystic fibrosis (not neural tube)
  48. Triple and Quad screens
    combines AFP, HCG, and estriol level for detection of trisomies and neural tube defects; quad adds inhibin A to test downs at 80% accuracy
  49. Daily fetal movement count
    to detect hypoxic fetuses: 4 movements in one hour
  50. NST
    records accelerations in the fetal heart rate in relation to fetal actvity. Widely accepted method for evaluation of fetal status.

    -reactive when FHR increases 15 beats above baseline for 15 seconds twice in 20 minutes
  51. Vibroacoustic stimulation
    used in conjuction with NST and EFM, fake larynx that stimulates baby to move
  52. Contraction Stress Test (CST)
    identifies fetus at risk for cmpromise through observation of the fetal response to intermittent resuction in utero placental bloos flow associated with stimulated uterine contractions

    • -monitor fetal activty 20 minutes
    • -if no spontaneous UC's, stimulate UC's with oxytocin via IV until 3 UC's in 10 o 20 minutes lsting 40 seconds
  53. AFI
    abnormal is below 5cm = oligohydramnios

    abnormal is above 24cm = polyhydramnios
  54. BPP
    ultrasund assessment of fetal status with an NST. Evaluation of fetal reflex activities that are CNS controlled; detect hypoxia through fetal breathing movement, gross body movement, fetal tone, amniotic fluid volume, and heart rate reactivity

    score of 8-10 is good, 6 is ?, and 4 or less is non-reassuring

    Modified BPP includes an AFI test
  55. Preterm labor

    Preterm Birth
    labor that occurs b/w 20-36 weeks

    gestational age at birth of less than 37 weeks
  56. late preterm infant

    moderaely preterm infant

    very preterm infant
    -born b/w 34-36 weeks

    -born b/w 32-36 weeks

    -born before 32 weeks 
  57. Low birth weight infant

    Very low birth weight infant

    extremely low birth weight infant
    -weighs less than 2500 grams regardless of gestational age

    -weighs less than 1500 grams at birth

    -weighs less than 1000 grams at birth
  58. Medical Management of Preterm labor
    -Tocolytic drugs-surpress uterine contractions; usually terbutaline or nifedipine

    -bed rest

    -IV hydration

    -Antibiotics

    -Corticsteroid therapy- betamethasone/dexamethasone accelerate feta lung maturity; given 24-34 weeks
  59. when is premature labor allowed to continue?
    • -diation of 4cm
    • -at risk for PIH
    • -lethal fetal anomaly
    • -severe maternal disease
    • -hemorrhage
    • -acute fetal distress
  60. What does fFn do?
    is a protein detected via immunoassay; it is better at predicting if a patient will not go into preterm labor within the next 7-14 days.
  61. Dx of Preterm Labor
    gestational age of >20 weeks and <37 weeks

    UC's >6/hour

    and/or: rupture of membranes, cervix >1cm or 80% effaced
  62. Magnesium sulfate (tocolytic drug)
    • *contraindicated in preterm labor, used for hypertension
    • -turn off excess noise and dim lights
    • -vitals every 5-15 mins.
    • -monitor signs of decreased reflexes, resp. depression, I & O
    • -Keep Calcium gluconate available for toxicity
  63. Prostaglandin synthesis inhibitors:
    Indomethacin
    Naproxen
    Fenoprofen
    -Delays delivery 48+ hours; b/c of fetal sde effects generally used short term and not before 32 weeks

    -fetal side effects heart, hypertension, oligohydraminosis, and hemorrhages

    -oral medication

    -GI upset for mommy
  64. Calcium Channel Blockers:
    Nifedipine
    Nicardipine
    -block calcium available for muscle contraction, delays deliver for 48-72 hours

    -10-20 mg po q 4-6 hours

    -Monitor FHR and UC's, maternal BP and HR (hold if BP <90/50 or HR >120)
  65. Beta-Adrenergic Agonists
    Ritodrine
    Terbutaline
    -surpress uterine activity, delays delivery for 3 days

    -Give IV or SQ

    -Monitor FHR and UC's, I & O for overload, Auscultate lungs for pulmonary edema, HR >120, maternal blood glucose

    -contraindicated in women with cardia disease

    *can tx COPD
  66. Premature Rupture of membranes
    rupture of the chorioamniotic membranes before the onset of labor
  67. Preterm premature rupture of membranes (PPROM)
    rupture of membranes with a premature gestation of < 37 weeks
  68. Prolonged rupture of membranes (PROM)
    >24 hours
  69. AROM

    SROM
    -Artificial Rupture of membraes; MD

    -Spontaneous Rupture of membranes
  70. Risk factors for PPROM
    • -previous PPROM
    • -Previous preterm delivery
    • -bleeding during pregnancy
    • -multiple gestation
    • -STD's
    • -cigarette smoking
  71. Fern test

    Nitrazine paper
    Confirms the rupture of membranes
  72. Incompetent cervix
    -mechanical defect in the cervix that results in painless cervical dilation and ballooning of the membranes into the vagina followed by epxpulsion of a premature fetus during the second trimester

    -short cervical length, hx fetal loses in 2nd trimester, live fetus w/ intact membranes

    -us or cervical length and funneling, cerclage (purse string)
  73. Multiple gestation pregnancies

      Monozygotic & Dizygotic Twins
    pregnancies with more than one fetus

    -one zygote that divides in 1st trimester (always same gender)

    -fertilization of two eggs

    -maternal risks include: preterm labor, PPROM, HTN, Preeclampsia, Gestational Diabetes, Anemia, SOB, Pulmonary edea and c-section
  74. Hyperemesis Gravidrum
    -vomiting during pregnancy that is so sever it leads to dehydration, electrolyte and acid-base imbalance, and starvation ketosis

    -r/t rising levels of HCG in 1st trimester

    -dry mucous membranes, poor skin turgor, malaise, low BP

    -Vitamin B and antiemetics, IV hydration, Labs to monitor kidney and liver function
  75. Diabetes Mellits 

      Type 1 vs. Type 2
    type 1- autoimmunity of beta cells in the pancrease, insulin deficiency, managed w/ insulin

    tpye 2-insulin resistence & inadequate insulin production, obesity, managed w/ diet, exercise, meds
  76. Hormones that antagonize insulin production for developing fetus
    placenta produces-Human placental lactogen,Progesterone, Growth Hormone, and Corticotropin-releasing hormone
  77. pregestatinal diabetes rsik factors for woman
    • -hypoglycemia
    • -Diabetic Ketoacidosis
    • -hypertension & preeclampsia
    • -polhydraminos/ oligohydraminos
    • -infection
    • -c-section
    • -induction of labor
  78. pregestational diabetes risk for new born
    • -hypoglycemia r/t fetal hyperinsulinemia
    • -hypocalcemia and hypomagnesmia
    • -IUGR
    • -asphyxia
    • -hyperbilirubinemia r/t polycythemia and RBC   breakdown (jaundice)
    • -macrosomia
  79. 4 stages of hypertensive disorders:
    Chronic Hypertnsion

    Pre-eclampsia-eclampsia

    Pre-eclampsia superimposed on chronic

    hypertensionGestational Hypertension
  80. Chronic Hypertension
    hypertension before conception or before 20th week of gestation; may put  the woman at high risk for developing preeclampsia
  81. preeclampsia-eclampsia
    systemic disease with hypertension accompanied by proteinuria after the 20th week of gestation

    eclampsia =seizure
  82. preeclampsia superimposed on chronic hypertension
    hypertensive women who develop new-onset proteinuria; proteinuria before the 20th week gestation; r sudden uncontrolled hypertension
  83. gestational hypertension
    high BP detected for the 1st time after mid-pregnancy w/o proteinuria.
  84. preeclampsia

    mild vs severe
    • mild-
    • bp > 140/90
    • proteinurea 1+ 2+
    • generalized edema of face, hands, ankles

    • severe-
    • b/p 160-100
    • preoteinurea 3+ 4+
    • oliguria- urine output < 500ml in 24 hrs, generalized edema
    • headache
    • blurred vision
    • n/v
    • epigastric pain= convulsion
  85. How do you treat mild preeclampsia
    • -bedrest
    • -left lateral recumbent position
    • -monitor bp
    • -diet of 80-100 mg protein
    • -limit sodium and salt
    • -weekly nst's
  86. eclampsia
    -occurence of seizure activity in the presence of preeclapsia. Eclampsia is triggered by cerebral: vasospasm, hemorrhage, ischemia, edema

    -symptoms of headsches, n/v, spigastric pain, hyperreleca w clonus, restlessnedd
  87. How do you care for a pt on magnesium sulfate
    -Assess vitals before and q 5-15 minutes p during loading dose, then 30-60 minutes until pt stablizes

    -assess DTR's deep tendon reflexes

    -I&O (renal disease and oligo at risk for toxicity)

    -Sob or RR <24

    -Chest Pain

    -If toxicity suspected, discontinue and notify Dr. (calcium gluconate available)
  88. Hemolysis, Elevated Liver Enzymes and Low Platelets (HELLP Syndrome)
    -variant chages in lab values that can occur as a complication of severe eclampsia

    • -Hemolysis is a result of RBC destruction as they travel through constricted vessels
    • -Elevated Liver Enzymes results from decrased blood flow and damage to the liver
    • -Low platlets result from platelets aggregating at the site of damaged cascular endothelium causing platelet consumption and thrombocytopenia

    -only tx is dleivery
  89. Lab values of HELLP syndrome
    • platelets <100,000/mm
    • Liver enzymes: AST >70, ALT>50
    • Bilirubin >1.2
    • LDH >600
  90. Risk for woman and fetus from HELLP syndrome
    • -abrupto placenta
    • -renal failure
    • -liver hematoma and possibl rupture
    • -death
    • preterm birth and infant death
  91. What are some presenting symptoms to HELLP syndrome
    • -epigastric pain
    • -unexplained bruising, mucosal bleeding
    • -petechiae
    • -bleeding from IV site
  92. what is placenta previa
    placenta attaches to the lower uterine segment of the uterus, near or ver the internal cervialooos, instead of in the body of fundus of the uterus
  93. Total placenta previa

    Partial Placenta previa

    Marginal Placenta previa

    Low-lying placenta
    -the placenta completely covers the internal cervical os

    -the placenta partially covers

    -pacenta is at the margin

    -implanted in the lower uterine segment in close proximity to the cervix
  94. Abruptio Placenta
    seperation of the placenta

    grade 1-3
  95. Placenta Accreta
    abnormality of implantation defined by degree of invasion into uterine wall of trophblast of placenta
  96. placenta accrete

    placenta increta

    placenta percreta
    -invasion of the trophoblast beyond the normal boundary

    -invasion of the trophoblast extends into uterine myometrium

    -invasion of th etrophoblast extends into the uterine musculature and can adhere to to other pelvic organs
  97. Induced abortion

    Elective abortion

    Therapeutic abortion

    Spontaneous Abortion
    -medical/surgical termination of pregnancy before fetal viabilit

    -termination at the request of the woman, but not for impaired health of mother or fetus

    -termination of pregnancy fo serious maternal medical condition or serious fetal anomalies

    -abortion occurring w/o medical or mechanical means, miscarriage
  98. ectopic pregnancy
    blastocyst implanting somewhere other than the endometrial lining of the uterus; occur in the fallopian tube
  99. hydatiform mole (molar pregnancy)
    benign proliferating growth ofte trophoblast in which the chrionic villi develop into endomatous, cystiv vascular transparent vesicles that hang in grapelike clusters w/o a viable fetus
  100. what are risk of std in pregnancy
    leadto PTL, PROM, and uterine infection

    can also lead to PID, infertiltiy, chronic hepatitis, and cervical cancer
  101. TORCH
    (Toxoplasmosis, Other (hep B), Rubella and Cytomegalovirus, and Herpes)
    torch infection are teratogenic to a developing fetus
  102. Trauma During pregnancy
    is the leading cause of maternal death during pregnancy and is more likely to cause maternal death than any other compliation of pregnancy
  103. toxoplasmosis
    avoid eating raw meat and contact with cat feces
  104. Hepatitis B
    Infant recieves HBIG and hepatitis vaccine at delivery
  105. Rubella
    woman recieved immunity injection p delivery
  106. Cytomegalovirus
    virus of herpes group transmitted by contact droplet and transplacetally; no tx
  107. Herpes Simplex Virus (HSV)
    acyclovir to suppress outbreak of lesions; c-section in having aan active outbreak
  108. anemia in pregnancy
    catorgorized as hemoglobin < 10g and hematocrit < 30%
  109. The 4 "p's"
    • Powers- the contractions
    • Passage- the pelvis and birth canal
    • Passenger-the fetus
    • Psyche-the response of the woman
  110. Uterine Contractions
    frequency-begining of one to begining of another

    duration-time from the beginning of a contractin to the end of the contraction

    • Intensity- strength of the contraction
    •   Mild-easily indented during contraction
    •   Moderate- resistant to indentation
    •   Strong-cannot be indented
  111. 3 phases of a contraction
    Increment- ascending/buildup of the contraction that begins in the fundus and spreads throughout the uterus

    acme- peak of intensity

    Decrement- descending/relaxation of the uterine musce
  112. effacement
    precedes dilation in a first time pregnancy; effacement and dilation preogression of the cervix occurs together in subsquent pregnancies
  113. passage
    the maternal pelvis is the greatest determinate in the vaginal delivery of the fetus

    includes te bony pelvis and the soft tissues of the cervix, pelvic floor, vagina, and introitus(external opening to the vagina)
  114. Types of boney pelvis
    • Gynecoid-most common
    • Android
    • anthropoid
    • Platypoid
  115. station
    refers to the relationship of the ischial spine to the presenting part of the fetus and assists in assessing for fetal descent during labor. 0 is the narrowest diameter the fetus must pass through + is outside the pelvis
  116. Molding
    -ability of the fetal head to change shape to accomodate/fit throuh the maternal pelvis

    -membranous space b/w bons is the sutures; intersections of these sutures are fontanels
  117. fetal attitude or posture
    relationship of fetal parts to one another; flexion/extension of the fetal joints
  118. fetal lie
    -long axis (spine) of the fetus in relationship to the long axis (spine) of the woman

    -longitudal (yes) and transverse (no)
  119. fetal presentation: presenting part
    cephalic-head, breech-pelvis, shoulder

    • right/left occiput anterior
    • right/left occiput posterior
  120. psyche
    satisfaction during labor and birthing process is enhanced with coordination of collaborative goals

    selfesteem, self confidence, relationship to others and general view she holds of life
  121. lightening
    refers to the descent of the fetus into the true pelvis that occurs approximately w weeks before term in first time pregnancies
  122. nitrazine paper

    ferning
    -is placed in a visble pool of fluid around the cervix. the paper turnsblue when in contact with amniotic fluid

    -a sterile speculum exam may be performed to confirm rupture of membranes; fluid is viewed under microscope "ferning pattern"
  123. stages of labor
    • stage 1: onset of labor through 10cm dilitation
    • stage 2: complete dilitatio of cervix through delivery of baby
    • stage 3: begins after delivery of baby and ends with delivery of placenta
    • stage 4: begins after delivery of the placenta and is completed 4 hours later, it is the immediate postpartum period
  124. phases of labor
    • latent 0-3
    • active 4-7
    • transistion 8-10
  125. apgar score
    done at 1 and 5 minutes

    • hr
    • RR
    • muscle tone/flexion
    • reflex irritability/tactile stimulation
    • color

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