OB nursing

• 1 minute
• 5 minutes
• 10 mins if low score @ 5 minutes

• 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

• Eye drops for gonorrhea & chlamydia
• Vitamin K for blood clotting
• Hep B if mother is positive

• jittery & tremors
• hypothermia
• difficulty feeding
• limpness
• apneic spells
• weak or high pitched cry
• sudden pallor
• eye rolling
• cyanosis
• convulsions
• cardiac arrest or failure

• Ductus venosus: in liver
• Foramen ovale: between rt & left atria
• Ductus arteriosus: in aortic arch

97-99 F axillary

• 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

• Breastfed: every 1 1/2 - 3 hours
• Bottlefed: every 2-4 hours

• need 55cal/pound
• formula & breast mile have 20 cal/ounce

• hematocrit over 65-70%
• tachycardia
• resp distress
• poor color (will be bright red)
• congestive heart failure

• anterior - closes at 12-18 weeks
• posterior - closes at 8 wks

• collection of fluid/swollen edematous area, between skull & skin
• does not cause pressure on the brain: is on outside of skull

• blood under skin covering bone
• caused by vessel broken
• doesn't go into skull
• look forjaundice from breakdown of RBC's

• deep sleep
• active sleep
• drowsy but eyes open
• quite alert - content, looking around, resting: Best stage for breastfeeding
• active alert - awake & moving
• crying

• Low birth weight: 5.5 pounds
• Very low birth weight: 3.3 pounds

27-35 pounds

• Full term: 38-42 weeks
• Abortion: before 20 weeks
• Preterm: 20-37 weeks
• Postterm: >42 weeks

• Gravida: number of pregnancies
• Para: number of births
• - nulli - never carroed a baby over 20 weeks
• - Primi - 1st pregnancy
• - Multip - Many births

1st day of last cycle, minus 3 months, plus 7 days, plus 1 year

measure fundal height in cm from top of pubis to top of fundus. number = weeks gestation

• amenorrhea
• nausea
• urinary frequency
• breast tenderness
• quickening (at 20 weeks)
• fatigue
• weight gain

• Chadwick's sign: bluish color vagina & cervix
• Goodell's sign: cervical softening
• Hegar's sign: softening between cervix & uterus

• fetal heart heard
• seen during ultrasound
• movement felt

• increased O2 demands
• ligaments of rib cage relax
• increased vascularity of respiratory
• thoracic breathing

• 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

• hyperpigmentation
• - chloasma
• - linea nigra
• - striae gravidarum
• increased hair growth

• posture changes with center of gravity shift
• increased lumbosacraql curve
• waddling gait

• 300 more cal/day
• 60 gms protein daily
• 1200 mg/day calcium & phosphorus
• folic acid

• intervillar spaces
• more villa = better exchange
• decrease in mothers BP -> decreased blood flow
• diabetes = decreased blood flow

• Occiput - preferred-smallest part
• Mentum - chin
• Sacrum - breech
• Scapula - shoulder (c-section needed)

• turning the baby with hands on mothers belly
• cord becomes tied or pinched
• rupture of membranes
• rip cord off

• 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

• 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

• 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

• push on upper stomach to determine head or butt
• feel sides for back
• feel for head at pubic pone

• 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

• effacement - thinning of uterus
• dilation - size of opening

• cushions baby
• protects baby
• regulates babys temp
• protection from infection

fetal heart rate to determine is cord is around neck or pinched

• 1st: cervic effaces and dilates
• 2nd: complete dilation to birth of baby
• 3rd: delivery of placenta
• 4th: immediate 4 hours after delivery (recovery period)

• latent or early - 0-3 cm dilated
• active - 4-7 cm dilated
• transition - 8-10 cm dleated

• 1. descent
• 2. flexion
• 3. internal rotation
• 4. extension
• 5. restitution
• 6. external restitution
• 7. expulsion

• 1st degree - just skin
• 2nd degree - skin & tissue
• 3rd degree - tear to anus
• 4th degree - tears thru anus

stretch receptors in the pelvis floor which may determine the mother's urge to push

• Fundal pressure-pushing on fundus - dangerous
• Suprapubic pushing - when shoulders are caught - pushing straight down on suprapubic area

• 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

• progressive form of PIH
• symptoms: high blood pressure, edema and proteinuria
• presence of grand mal seizures with any of the symptoms is called eclampsia

• pO2 - 101 to 108
• pCO2 - 27 to 32
• pH - 7.40 - 7.45
• HCO3 - 18 to 21

• 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

• active labor: low risk every 30 min / high risk every 15 min
• stage two - low risk every 15 min / high risk every 5 minutes

• external uses ultrasound
• intenal uses an electrode that is attached to the presenting part

• where the fetal HR spends most of the time between contractions for 2 minutes
• normal range is 110 - 160
• measured in increments of 5

• fluctuations in the baseline
• line looks jagged on the monitor

• 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

• baby sleeping
• meds to treat pre-eclampsia and preterm labor
• narcotics
• gestational age

• 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

visible decreases from baseline

• 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

• 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

• 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

• 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

• fundus
• lochia
• vitals
• perineum
• bladder
• skin

• lateral separation of the two halves of the rectus abdominis muscle
• usually heals on its own

• rubra - dark red
• serosa - pinkish to brownish
• alba - creamy or yellowish discharge

• Taking-In: recognize reality of labor and birth
• Taking-Hold: teachable reachable phase focuses on infant
• Letting-Go: relinquishment of fantasies and accept reality

persistent uncontrolled vomitting

weak - can't hold the weight of the fetus

• 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

Rh negative mothers get Rhogam at 28 weeks and w/in 72 hours of birth and anytime there's a mixing of blood

• Elevated results: open neural tube, anencephaly, gastroschesis, fetal demise
• Decreased results: down's syndrome, trisomy 18

• mom pushes a button when baby moves & compare to fetal monitor
• looking for accelerations

• looking for late decels and watching baby's reactions
• looking for 3 contractions/10 minutes

• 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

• done at 10 wks
• identifies chromosomal abnormalities

• 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

• lecithin to spingomyelin
• detects lung maturity
• done at 30 weeks
• want to be 2:1 or 3:1

• overweight before pregnancy
• previous gestational diabetes
• previous newborn over 8.5 pounds
• family history of diabetes
• >25 years old

• <140 negative
• >140 positive
• if positive then GTT is done

• fasting >95
• 1 hr >180
• 2 hrs >155
• 3 hrs >140