OB nursing

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busdriverre
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51948
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OB nursing
Updated:
2010-11-28 14:24:37
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OB nursing
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fall semester OB nursing
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  1. How often is APGAR scoring done?
    • 1 minute
    • 5 minutes
    • 10 mins if low score @ 5 minutes
  2. APGAR Scoring
    • Heart rate: (0) absent (1) below 100 (2) 100 or higher
    • Respiratory: (0) no spontaneous effort (1) slow or weak (2) strong lusty cry
    • Muscle tone: (0) limp (1) minimal flexion (2) flexed posture
    • Reflex: (0) no response (1) minimal response (2) responds promptly
    • Color: (0) pallor or cyanosis (1) bluish hands and feet (2) pink
  3. Protective actions for newborn:
    • Eye drops for gonorrhea & chlamydia
    • Vitamin K for blood clotting
    • Hep B if mother is positive
  4. S/S of hypoglycemia
    • jittery & tremors
    • hypothermia
    • difficulty feeding
    • limpness
    • apneic spells
    • weak or high pitched cry
    • sudden pallor
    • eye rolling
    • cyanosis
    • convulsions
    • cardiac arrest or failure
  5. Valves that close after birth:
    • Ductus venosus: in liver
    • Foramen ovale: between rt & left atria
    • Ductus arteriosus: in aortic arch
  6. Newborn temperature
    97-99 F axillary
  7. Newborn male genitalia
    • hypospadias: urethral opening on bottom of penis
    • epispadias: urethral opening on top of penis
    • cryptorchidism: undescended testicles
    • phimosis: end of penis is closed; needs surgery
    • hydrocele: water in scrotum
  8. How often do newborns feed?
    • Breastfed: every 1 1/2 - 3 hours
    • Bottlefed: every 2-4 hours
  9. Calorie needs for newborn
    • need 55cal/pound
    • formula & breast mile have 20 cal/ounce
  10. Polycythemia:
    hematocrit
    signs/symptoms
    • hematocrit over 65-70%
    • tachycardia
    • resp distress
    • poor color (will be bright red)
    • congestive heart failure
  11. Fontanelles
    • anterior - closes at 12-18 weeks
    • posterior - closes at 8 wks
  12. Caput Succedaneum
    • collection of fluid/swollen edematous area, between skull & skin
    • does not cause pressure on the brain: is on outside of skull
  13. Cephalhematoma
    • blood under skin covering bone
    • caused by vessel broken
    • doesn't go into skull
    • look forjaundice from breakdown of RBC's
  14. Newborn Behavioral States
    • deep sleep
    • active sleep
    • drowsy but eyes open
    • quite alert - content, looking around, resting: Best stage for breastfeeding
    • active alert - awake & moving
    • crying
  15. Newborn weight
    • Low birth weight: 5.5 pounds
    • Very low birth weight: 3.3 pounds
  16. Ideal pregnancy weight gain
    27-35 pounds
  17. Terms for weeks of gestation
    • Full term: 38-42 weeks
    • Abortion: before 20 weeks
    • Preterm: 20-37 weeks
    • Postterm: >42 weeks
  18. Gravida & Para
    • Gravida: number of pregnancies
    • Para: number of births
    • - nulli - never carroed a baby over 20 weeks
    • - Primi - 1st pregnancy
    • - Multip - Many births
  19. Nagele's Rule
    1st day of last cycle, minus 3 months, plus 7 days, plus 1 year
  20. McDonald's Method
    measure fundal height in cm from top of pubis to top of fundus. number = weeks gestation
  21. Presumptive Signs of Pregnancy:
    • amenorrhea
    • nausea
    • urinary frequency
    • breast tenderness
    • quickening (at 20 weeks)
    • fatigue
    • weight gain
  22. Probable Signs of Pregnancy
    • Chadwick's sign: bluish color vagina & cervix
    • Goodell's sign: cervical softening
    • Hegar's sign: softening between cervix & uterus
  23. Positive Signs of Pregnancy
    • fetal heart heard
    • seen during ultrasound
    • movement felt
  24. Respiratory changes during pregnancy
    • increased O2 demands
    • ligaments of rib cage relax
    • increased vascularity of respiratory
    • thoracic breathing
  25. Renal changes during pregnancy
    • relaces muscle tone can lead to UTI
    • increased bladder tone leads to urgency/frequency
    • increased glomerular filtration rate & renal blood flow
    • increase sodium retention may lead to clucosuria or proteinuria
  26. Skin changes during pregnancy
    • hyperpigmentation
    • - chloasma
    • - linea nigra
    • - striae gravidarum
    • increased hair growth
  27. Muscular skeletal changes during pregnancy
    • posture changes with center of gravity shift
    • increased lumbosacraql curve
    • waddling gait
  28. Dietary needs of pregnant woman
    • 300 more cal/day
    • 60 gms protein daily
    • 1200 mg/day calcium & phosphorus
    • folic acid
  29. Where does O2/CO2 exchange take place?
    • intervillar spaces
    • more villa = better exchange
    • decrease in mothers BP -> decreased blood flow
    • diabetes = decreased blood flow
  30. Fetal Landmarks
    • Occiput - preferred-smallest part
    • Mentum - chin
    • Sacrum - breech
    • Scapula - shoulder (c-section needed)
  31. External Version/Possible Complications
    • turning the baby with hands on mothers belly
    • cord becomes tied or pinched
    • rupture of membranes
    • rip cord off
  32. Ballotable vs Engagement
    • ballotable - not engaged - in pelvic inlet but if the baby's head is touched it will float up
    • engagement - 0 station or more - mother can breathe easier but pressure on bladder causes frequent urination
  33. Presentation & Position
    Best Position for delivery
    • Presentation - part of the baby's body that enters the birth canal first
    • Position - where the baby is located relative to the maternal pelvis
    • Best position: LOA - facing left, occiput presenting, anterior position
  34. Types of Presentation
    • vertex: baby is head down and in full flexion
    • breech: complete - feet and buttocks present together
    • : footling - one or both feet come first
    • : frankling - buttocks present and feet/legs are up
  35. Leopold's Maneuvers
    • push on upper stomach to determine head or butt
    • feel sides for back
    • feel for head at pubic pone
  36. True vs False Labor
    • True:
    • regular contractions
    • increase in duration
    • discomfort begins in back, radiates to abdomin
    • intensity increases with walking
    • False:
    • irregular contractions
    • no change in duration
    • discomfort in abdomin
    • walking has no effect
  37. Effacement and Dilation
    • effacement - thinning of uterus
    • dilation - size of opening
  38. Purpose of amniotic fluid
    • cushions baby
    • protects baby
    • regulates babys temp
    • protection from infection
  39. First assessment when water breaks?
    fetal heart rate to determine is cord is around neck or pinched
  40. Stages of Labor
    • 1st: cervic effaces and dilates
    • 2nd: complete dilation to birth of baby
    • 3rd: delivery of placenta
    • 4th: immediate 4 hours after delivery (recovery period)
  41. Phases of first stage of labor
    • latent or early - 0-3 cm dilated
    • active - 4-7 cm dilated
    • transition - 8-10 cm dleated
  42. Cardinal Movements
    • 1. descent
    • 2. flexion
    • 3. internal rotation
    • 4. extension
    • 5. restitution
    • 6. external restitution
    • 7. expulsion
  43. Degrees of tearing
    • 1st degree - just skin
    • 2nd degree - skin & tissue
    • 3rd degree - tear to anus
    • 4th degree - tears thru anus
  44. Ferguson's Reflex
    stretch receptors in the pelvis floor which may determine the mother's urge to push
  45. Fundal Pressure vs Suprapubic Pushing
    • Fundal pressure-pushing on fundus - dangerous
    • Suprapubic pushing - when shoulders are caught - pushing straight down on suprapubic area
  46. Supine Hypotensive Syndrome
    • occurs when the mother is lying supone and the weight of the uterus and the fetus compresses the vena cava and aorta
    • placing a wedge under one hip or turning mother onto her side reduces this
  47. Pre-eclampsia
    • progressive form of PIH
    • symptoms: high blood pressure, edema and proteinuria
    • presence of grand mal seizures with any of the symptoms is called eclampsia
  48. Pregnancy blood gas values
    • pO2 - 101 to 108
    • pCO2 - 27 to 32
    • pH - 7.40 - 7.45
    • HCO3 - 18 to 21
  49. Obstretic Emergencies
    • abruptio placenta - premature separation of the placenta
    • placenta previa - placenta is over all or part of the cervical opening
    • prolapsed cord - umbilical cord presents before the baby
    • fetal distress - demonstrated through non-reassuring fetal heart rate
  50. Monitoring fetal heart rate
    • active labor: low risk every 30 min / high risk every 15 min
    • stage two - low risk every 15 min / high risk every 5 minutes
  51. Continuous fetal monitoring
    • external uses ultrasound
    • intenal uses an electrode that is attached to the presenting part
  52. Baseline heart rate
    • where the fetal HR spends most of the time between contractions for 2 minutes
    • normal range is 110 - 160
    • measured in increments of 5
  53. Baseline Variability
    • fluctuations in the baseline
    • line looks jagged on the monitor
  54. Absent Variability
    • indicates there are no detectable fluctuations
    • flat line on the monitor strip
    • anything below 2 beats from baseline
    • minimal: 2-5 beats from baseline
    • average: 5-25 beats from baseline (preferred)
    • marked: more than 25 beats from baseline
  55. Causes of decreased variability
    • baby sleeping
    • meds to treat pre-eclampsia and preterm labor
    • narcotics
    • gestational age
  56. Accelerations
    • visible increases above the baseline
    • must be at least 15 beats above baseline for 15 seconds
    • considered a reassuring sign and may be associated with fetal movement
  57. Decelerations
    visible decreases from baseline
  58. Early decelerations
    • gradual decrease that starts with a contraction and returns to baseline at the end
    • mirrors contraction - start and end together
    • caused by head compression
    • not treated
  59. Variable decelerations
    • visible abrupt drop in heart rate
    • decreased rate is at least 15 bpm below baseline
    • may or may not be associated with contractions
    • ** most commonly associated with cord compression
    • looks like V or U on monitor strip
  60. Late decelerations
    • decrease that starts after teh peak of the contraction and returns well after the contraction is over
    • results in minimal blood flow thru placenta
    • ** placental reserve is inadequate for the fetus and the heart rate drops before contraction is over
    • ** indicates inadequate placental support during a contraction
  61. Reassuring/Non-Reassuring Heart Rate
    • reassuring: when fetal heart rate is in the normal baseline rate with variability and accelarations present
    • non-reassuring: persistent late or variable decelarations or prolonged baseline bradycardia and absence of variability. Fetus is at risk
  62. 1st hour after delivery critical assessments
    • fundus
    • lochia
    • vitals
    • perineum
    • bladder
    • skin
  63. Diastasis Recti
    • lateral separation of the two halves of the rectus abdominis muscle
    • usually heals on its own
  64. Lochia: Names & Colors
    • rubra - dark red
    • serosa - pinkish to brownish
    • alba - creamy or yellowish discharge
  65. Rubin's Psychological Adjustment Phases
    • Taking-In: recognize reality of labor and birth
    • Taking-Hold: teachable reachable phase focuses on infant
    • Letting-Go: relinquishment of fantasies and accept reality
  66. Hyperemesis Gravidarum
    persistent uncontrolled vomitting
  67. Incompetent cervix
    weak - can't hold the weight of the fetus
  68. Molar Pregnancy
    • cells that would become the fetus grow too rapidly
    • grapelike cysts grow really fast
    • S/S: n/v, dark red bleeding, edema
    • high risk to develop cancer
  69. Rh sensitization
    Rh negative mothers get Rhogam at 28 weeks and w/in 72 hours of birth and anytime there's a mixing of blood
  70. Alphafetalprotein testing
    • Elevated results: open neural tube, anencephaly, gastroschesis, fetal demise
    • Decreased results: down's syndrome, trisomy 18
  71. Non Stress Test (NST)
    • mom pushes a button when baby moves & compare to fetal monitor
    • looking for accelerations
  72. Contraction Stress Test
    • looking for late decels and watching baby's reactions
    • looking for 3 contractions/10 minutes
  73. Biophysical Profile
    • done under ultrasound
    • looking for: resp movements, body movement, fetal position, amniotic fluid volume
    • Scoring: 0-2 deliver baby
    • 4: >36 deliver <36 repeat w/in 24 hours
    • 6: repeat in 4-6 hours
    • 8-10: good
  74. Chorionic Villus Sampling
    • done at 10 wks
    • identifies chromosomal abnormalities
  75. Amniocentisis
    • done in 2nd trimester
    • detects open neural tube defects by high AFP level
    • identify Rh factor
    • identify intrauterine infections
    • fetal lung maturity
    • detect bilirubin present
  76. L/S Ratio
    • lecithin to spingomyelin
    • detects lung maturity
    • done at 30 weeks
    • want to be 2:1 or 3:1
  77. Gestational Diabetes Risks
    • overweight before pregnancy
    • previous gestational diabetes
    • previous newborn over 8.5 pounds
    • family history of diabetes
    • >25 years old
  78. Glucose Challenge Test
    • <140 negative
    • >140 positive
    • if positive then GTT is done
  79. Glucose Tolerance Test levels
    • fasting >95
    • 1 hr >180
    • 2 hrs >155
    • 3 hrs >140

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