Maternity

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sfaltynski
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21053
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Maternity
Updated:
2010-06-03 13:09:46
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Maternity
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Maternity
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  1. Fetal Alcohol Syndrome
    Caused by maternal alcohol use during pregnancy which causes mental & physical retardation.

    • -Facial Changes: thin upper lip, low nasal bridge, short upturned nose, hypoplastic philtrum (above lips), flat midface, short palpebral (eyelid) fissures, undeveloped cheek bones
    • -Abnormal palmar creases
    • -Respiratory Distress (cyanosis, apnea)
    • -Congenital heart disorders
    • -Irritability, hypersensitivity to stimuli
    • -Tremors
    • -Poor feeding
    • -Seizures
    • -Small head circumference
    • -Low Birth Weight

    • -Monitor for respiratory distress & poistion newvborn on side to facilitate drainage of secretions
    • -Monitor for hypoglycemia
    • -Assess suck & swallow reflex; administer small feedings
    • -Decrease environmental stimuli
  2. Placenta Previa
    Abnormal implantation of placenta in lower uterine segment.

    MEDICAL EMERGENCY

    • Sudden Onset Painless Bright Red Vaginal Bleeding
    • No Pain
    • FHR Normal
    • Soft Uterus
    • S/S of Shock

    • TX--> br, side lying position
    • u/s to diagnose; NO abd/vag manipulation
  3. Abruptio Placentae
    Partial or complete premature detachment of placenta from uterus.

    MEDICAL EMERGENCY

    • Dark Red Bleeding
    • Rigid, Board-Like Abdomen
    • FHR abnormalities

    Tx--> br, side-lying, NO vaginal stimulation, Monitor for s/s of DIC
  4. Mild Preeclampsia
    • HTN
    • Generalized Edema
    • Proteinuria

    • BR and place client in left lateral position
    • Monitor BP and weight
    • Monitor neuro status b/c changes can indicate cerebral hypoxia or impeding seizure
    • Monitor deep tendon reflexes & for clonus- hyperreflexia can indicare incr. CNS irritability
    • Monitor I & O (30mL/hr indicates adequate renal profusion)
    • Increase dietary protein & carbs with NO added salt
  5. Severe Preeclampsia
    • Severe HTN (SBP>160, DBP >110)
    • Massive Generalized Edema & Weight Gain
    • Proteinuria 3+, 4+
    • Oliguria ( <400-500mL/24hr)
    • Altered level of consciousness/visual disturbances
    • HA or Blurred Vision
    • Epigastric Pain, N/V
    • Thrombocytopenia
    • HELLP syndrome (H hemolysis, EL elevated liver enzymes, LP low platelets)

    • Maintain BR
    • Administer Mg Sulfate to prevent seizures
    • Monitor of signs of Mg toxicity (flushing, sweating, hypotension, depressed deep tendon reflexes, CNS depression, including respiratory depression) ANTIDOTE @ bedside= Calcium Gluconate
    • Administer anti-HTNives & Prepare for induction of labor
  6. Eclampsia
    Seizures

    • Maintain patent airway and administer O2
    • Protect client from injury
    • Montiro FHR and contractions
    • Administer meds to control seizures (Mg)
    • Prepare for delivery after stabilization of client
  7. Gestational HTN
    onset of HTN without proteinuria or edema after 20 weeks of pregnancy ; resolves after delivery
  8. Cesarean Section
    • Vertical Incision--> more blood loss/rapid delivery
    • Low-Segment Transverse Incision--> less blood loss/vaginal birth after cesarean a possibility (VBAC)

    • Medication usually lower narcotic dose than normal
    • Priority to prevent fluid & electrolyte imbalnce d/t bleeding
  9. Stage 1
    Beginning to Complete Cervical Dilation (0-10cm)

    • Latent Phase--> talkative & eager to be in labor
    • Ambulation
    • Active Phase--> feelings of helplessness, restlessness and anxiousness as contractions become stronger
    • Encourage maintenance of effective breathing patterns
    • Provide quiet environment
    • Promote comfort with backrubs, sacral pressure, pillow support, and position changes

    • Transition Phase--> tired, restless, irritable and feels out of control
    • Encourage rest btn contractions. Instruct mother to pant with pursed lips.
    • Throughout Stage 1:
    • Assist with comfort measures
    • Changes of position
    • Encourage voiding every 1-2 hours
    • Offer fluids & ice chips and ointment for dry lips
    • Keep mother and partner informed of progress
    • Monitor FHR before, during and after contractions (120-160 normal)
    • Assess cervical dilitations & effacement
  10. Stage 2
    • From Complete Dilation to Birth of BABY
    • Cervical Dilation is complete.
    • Mother feels urge to bear down

    • Assist mother in pushing efforts
    • Provide mother with encouragement and praise
    • Provide rest btn contractions
    • Assist mother in positions that promote comfort & assist pushing efforts (lithotomy, semisitting, kneeling, side-lying, or squatting)
    • Prepare for birth.
  11. Stage 3
    • From Birth to Delivery of Placenta
    • Contractions occur until Placenta is Born. Placenta separation & expuslion occur.

    • Shiny Schultze
    • Dirty Duncan

    • Examine placenta for cotyledons & membranes to verify that it is intact.
    • Following birth of placenta, uterine fundus remains firm & located 2 fingerbreadths below umbilicus
    • Promote mother-neonatal attachment
  12. Stage 4
    The period of time from 1-4 hours after delivery of Placenta

    • Fundus should be contracted, midline and located 1-2 fingerbreadths below umbilicus
    • Lochia is moderate or scant and is red.
    • Massage uterus if needed and teach mother to massage it.
    • Apply ice packs as needed to perieum and warm blankets
  13. Apgar Score
    • 0-3 Poor
    • 4-6 Fair
    • 7-10 Excellent

    • Heart Rate
    • Respiratory Effort
    • Muscle Tone
    • Reflexes
    • Color
  14. Accelerations
    15bpm above baseline followed by a return; usually response to fetal movement or contractions; indicates fetal well-being!!
  15. Early Decelerations
    Occurs before the peak of contraction associated with HEAD COMPRESSION, benign pattern
  16. Late Decelerations
    • Onset after contraction is established with slow return to baseline.
    • Indicative of fetal hypoxia b/c of deficient placental perfusion NON REASSURING

    Caused by: PIH, Maternal Diabetes, Placenta Previa, Abruption Placentae

    • Position mother L side lying
    • Administer O2
    • Stop Oxytocin
    • Administer IV Fluids
    • Prepare for C-Section
  17. Variable Decelerations
    • Transient U/V shaped reduction occuring anytime during contraction
    • Indicative of Cord Compression


    • Change mother position
    • Administer O2 and Discontinue Oxytocin if repetitive, severe or slow return to baseline.
  18. Lecithin/Sphingomyelin (L/S) Ratio
    Amniocentesis done at 30 weeks to determine lung materity
  19. Fetal Positions
    RSA LSA

    ROP LOP

    ROA LOA**


    • Left Occiput Anterior- Most Common- indicating Fetal Occiput on Mother's L side toward the front of her pelvis
    • Occiput Posterior
    • Sacrum Anterior
  20. Recommended Weight Gain & Caloric Increase during Pregancy
    25-35lbs for women with normal prepregnancy weight

    Increase of 300 calories during pregnancy

    Increase of 500 calories during lactation

    Diet high in folic acid with folic acid supplements to prevenbt neural tube defects
  21. Boggy Uterus
    Massage or breast feeding causes a natural surge of oxytocin that results in uterus contractions
  22. Rh Factor
    If mother is Rh-, should recieve Rh immune globulin(RhoGAM) at 28 wk's gestation.

    RhoGAM promotes lysis of fetal Rh+ RBCs circulating in maternal bloodstream before Rh- mother develops her own antibodies to them.

    • Example:
    • Mom Rh- =no Antigen
    • Dad Rh+ = has Rh Antigen

    Baby Rh+ = has Rh Antigen, mother's body could create antibodies to attack Rh Antigen in baby's blood. RhoGAM kills Rh antigens in mother's blood stream before mother can develop antibodies.
  23. Naegele's Rule
    Subtract 3 months and Add 7 days
  24. Weight Gain
    1st Trimester: 2-5lb

    2nd Trimester & 3rd Trimester: 1/2- 1 lb/week

    Total 25-35 pounds
  25. Ectopic Pregnancy
    Pain d/t implantation of egg outside of uterus. Potentially life-threatening to mother d/t hemorrhage.

    • S/S:
    • Missed Period
    • Unilateral, dull lower quadrant pain after 4-6wks of normal pregnancy
    • Rigid, tender abdomen
    • Referred shoulder pain can occur
    • Bleeding- gradual oozing to frank bleeding

    • Tx:
    • Prepare for sx.
    • Monitor for shock
    • Provide emotional support and expression of grief
    • Administer RhoGAm to Rh- women
  26. Effect of Mag Sulfate on Newborns
    Can cause decreased RR (normal 30-60).
  27. STOP Pitocin
    if contractions occur 2 minute intervals and last > 90 seconds.
  28. Prenatal Vitamins
    Instruct mother to take at bedtime (nausea) with OJ (help increase absorption of Iron).
  29. Fetal Movements
    Primigravada= 18 weeks

    Multigravada= 20 weeks

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