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2013-12-09 13:52:50
OB Maternity RN45

Reall OB Maternity RN45
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    • author "me"
    • tags "OB final"
    • description "OB final study guide"
    • fileName "OB study"
    • freezingBlueDBID -1.0
    • Organ that houses the Fetus?
    • Uterus
  1. Top uppermost part of the uterus
  2. Lowest part of the uterus
  3. What is the main portion of the uterus called? and what tissue is it mostly made of
  4. What are the uterine changes postpartum?
    -100g, Spongey layer of decidua sloughed off
  5. What/when: lochia: rubra? Serosa? Alba?
    • Rubra= red 2-3 days
    • Serosa= pink 3-10 days
    • White = continues until cervix is closed
  6. What to assess lochia for?
    Color, fleshy odor, clots (nickel size are fine), amount (240-270 ml) [pad: 1in/h=scant, 4in=light, 6in=moderate, heavy=saturates pad in 1 hour or less], pooling, exertion
  7. Where is fundus immediately after delivery? Where is fundus 6-12 hours after? What happens every day?
    Midline between symphasis pubis and umbilicus; 6-12: at umbilicus. Height of fundus Lowers 1 cm each day for 10 days
  8. Postpartum changes in vital signs
    • Temp 38/100.4 for 24 hours post
    • Temp may be increased for 24 hours after milk comes in
    • BP rises early and then returns to normal
    • Bradycardia occurs during the first 6-10days
  9. Postpartum changes in lab values
    • Non pathologic leukocytosis occurs early
    • Blood loss average 200-500ml (vaginal) 700-1000 (cesarean)
    • Plasma levels rack the pre-pregnant state 4-6weeks postpartum
    • Platelet levels return to normal by week 6
    • Diuresis
    • Cardiac Output Returns to normal Week 6-12
  10. postpartum weight loss
    • 10-12 lbs, initially
    • diuresis=5 lbs, lost
    • Prepregnant weight 6-8 weeks
  11. What should you monitor client for post partum
    • infection
    • respiratory difficulty
    • Constipation
    • voiding problems
    • circulatory problems
    • Breasts
    • uterus
    • Bowel
    • Bladder
    • Lochia
    • Episiotomy / lacerations
    • Homan's/ Hemorrhoids
    • Emotions
  13. Breast assessment
    Size and shape, abnormalities, reddened areas, engorgement, presence of breast fullness due to milk, assess nipples for cracks fissures, soreness, or inversion
  14. What do you note for abdominal assessment?
    • position of fundus related to umbilicus
    • position of fundus to midline
    • firmness
    • Assess incision for bleeding , approximation, and signs of infection
  15. Assessments for extremities , bowel , bladder
    • Homan's sign
    • Assess calf for redness and Warmth
    • Adequacy of Urinary elimination
    • Bladder distention and pain during urination
    • intestinal elimination
    • Maternal Concerns regarding bowel move­ments
  16. Post partum Pain meds
    • Motrin (Ibuprofen) PO
    • Anaprox DS (Naproxen Sodium)
    • Toradol (Ketorolac tromethamine)
    • Given PO, IM, IV
  17. Signs and symptoms of labor
    • • Cervical softening 7-month to 1 hour before
    • •lightening: the fetus descends into maternal pelvis another breathes easier , but waddles primips z-3 weeks before, multips @ initiation
    • • Bloody show: Loss of mucous plug
    • • increased energy from hormones
    • • Braxton Hicks (need to distinguish from Contractions)
    • • SROM -1-in 4 women w experience prior to labor
  18. effacement
    Thinning of cervix
  19. Dilation
    How much cervix is opening
  20. Contraction characteristics
    Frequency, duration, intensity
  21. Cervical assessment
    Dilation, station, effacement
  22. Characteristics of true labor
    Contractions are at regular intervals.

    Intervals between contractions gradually shorten

    Contractions increase in duration and intensity

    Discomfort in back and radiate around to abdomen.

    Intensity usually increases with changing activity

    Cervical dilation and effacement are progressives

    Contractions do not decrease with rest or warm tub bath
  23. characteristics of false labor
    Contractions are irregular

    Usually no change in intervals between contractions

    Usually no change in intensity discomfort is usually in abdomen

    Change it activities has no effect on contractions

    No change in cervical dilation

    Rest and warm tub lesson contractions
  24. What can cause Braxton Hicks
    A lot of activity from mother. Moms can walk out Baxton Hicks or false contractions
  25. How many phases are there in the first stage of labor
    3 the latent phase the active phase and the transition phase
  26. latent phase characteristics
    Cervical dilation: 0 to 3 cm

    contraction frequency every 10 to 30 minutes

    Contraction duration: 30 seconds

    Contraction intensity begin as mild and progresses to moderate. 25 to 40 mmHg
  27. Active phase characteristics
    Cervical dilation 4 to 7 cm

    Contractions every 2 to 5 minutes

    Duration of contraction 40 to 60 seconds

    Intensity began as moderate and progressed a strong 50 to 70 mmHg
  28. Transition phase characteristics
    Cervical dilation 8 to 10 cm

    Contraction frequency: 90 to 120 seconds

    Contraction duration: every 60 to 90 seconds

    Intensity strong by population; 70 to 90 mmHg
  29. What happens in second stage of labor?
    Mothers pushing baby out
  30. Emotions of each phase in the first stage
    Latent phase: excited relief in control

    Active phase need to focus and work, increased anxiety

    Transitional phase, they sell loss of control, anxious, Restless, often desirse a break from labor
  31. What are the 5 P's of labor
    • 1 passenger, the fetus and placenta
    • 2. Passageway, birth canal
    • 3. Power, contractions
    • 4. Position, position of the mother
    • 5. Psychological response
  32. How often do you document fetal heart rate and uterine contractions during active phase
    Every 15 to 30 minutes
  33. How often should mother void during latent and active phase
    Void every 2 hours
  34. During transition phase how often do you document the FHR and the uterine contractions
    FHR every 15 to 30 minutes and contractions every 10 to 15 minutes
  35. During second stage of labor how often do you monitor maternal vital signs . How often do you document the SHR and contractions during this time
    Every 5 to 30 minutes . Every 5 minutes
  36. What happens in the fourth stage of labor
    delivery of placenta and four hour maternal stabilization
  37. What are admission procedures for newborn
    Give vitamin K, eye prophylaxis, observation for the stress, initiate feeding, newborn bath, facilitate parental-infant attachment
  38. What is the point of the new Ballard scoring system. When is this inaccurate
    Estimates gestational age. Less accurate for neonates less than 28 weeks are greater than 43 weeks
  39. When is the neonate period
    From birth to the 28th day of life
  40. At the time of the first birth what happens in the lungs, in the heart, in the placenta?
    • • Compression of Filth chess quizzes fluid from lungs creating negative pressure, air is sucked into the lungs and thorax recoils
    • • where in a quart is clamped pH and carbon dioxide increase and oxygen decrease stimulating baby to take a breath
  41. How many pregnancies experience postpartum hemorrhage. What is postpartum hemorrhage considered. How many ladies is it kill
    10 to 15 percent of all pregnancies. Blood loss greater than 500 cc's. Is one of the leading causes of maternal mortality
  42. What are the risk factors of postpartum hemorrhage
    • Over to standard uterus
    • Hematological disorders
    • Lacerations to the birth canal
    • Infection
    • Hematomas
  43. What factors retard uterine involution
    Prolonged labour, anaesthesia, difficult labor, grand multipara, full bladder, incomplete expulsion of the placenta, infection, over distended uterus
  44. What is subinvolution.
    Failure of the uterus to return to its pre pregnancy state
  45. What are postpartum hemorrhage is caused by
    Uterine atony, genital tract lacerations, hematomas
  46. uterine atony
    Relaxation of the uterine muscles following delivery. Accounts for 80 to 90 percent off early postpartum hemorrhages
  47. nursing interventions for uterine atony
    • Massage fundus immediately and frequently falling delivery
    • • empty bladder a full bladder impedes uterine contraction
    • • increase IV fluids
    • • may need to add potatoes into IV if not in bag already
    • • prepare for IM administration of either methergine (vasoconstrictor) or hemabate (bronchoconstrictor)
  48. Signs of postpartum hemorrhage
    • Vaginal bleeding persists even though fundus is firm
    • • steady trickle of vaginal bleeding
  49. Predisposing factors for postpartum hemorrhage
    • No parity: no pregnancies
    • Precipitous delivery: less than 3 hours
    • Macrosomia LGA
    • Forcep or vacuum-assisted delivery
    • Epidural anesthesia