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OB Pedi
Material from Nursing 210
| Question | Answer |
|---|---|
| The post-partum non lactating woman should expect menstruation to return in what period of time? | 6-10 weeks |
| Size decreases and normal rugae returns to normal size in _____________ | 3 weeks |
| Abdominal waqll is relaxed an stretched and takes ____ weeks to return to shape. | 6 |
| Postpartum diuresis begins within ___ hours of birth. | 12 |
| cardiac hemodynamic levels remain elevated for at least ____ hours after birth | 48 |
| Stages in development of mothers (Rubin) Taking in (1-2) days | Mother very concerned about herself and is preoccupied with her own needs and is dependent. Concerned with food sleep and talking about her labor |
| Postpartum nursing assessment: | 1. All vital signs q15 minutes |
| 8 B's of postpartum assessment: | 1.Breasts 2.Breath Sounds 3.Belly (uterine fundus) 4.Bladder & Bowel 5.Bottom (episiotomy, lacerations) 6.Blood clots 7.Brain 8.Bonding |
| How do you treat afterpains: | massage, keeping bladder empty, pain medications (1hr before feeding) lying prone on small pillow. |
| Indirect Coombs test is performed on________? | Indirect Coombs test is performed on mother's blood. Direct Coombs is the test done on baby's blood |
| Principles of breast feeding: | 1. babies and mothers must learn to breast feed 2. babies will not starve before the milk comes in 3. Successful breast feeding is a matter of supply vs demand. 4. If infant doesn't latch on in 24 hrs mother will bottle feed |
| ____________ is responsible for the milk ejection reflex or let-down reflex. | Oxytocin |
| Compostition and volume of milk depends on __________ ? | Stage of lactation |
| The ideal time to start breast feeding is? | Within the first hour after delivery |
| New babies need _______ feedings within a 24 hrs period. | 8-12 |
| How long is the transition period for a newborn? | 6-8hrs |
| What is expected during the first period of transition? (first 30 minutes) | rapid increase in heart rate 160-180 bpm. Decreases to 100-120 bpm in 30 minutes. |
| What is the most critical and immediate adjustment a newborn must make? | Respiratory system- breathing |
| What kind of vasculature should you see in the umbilicus? | two arteries and 1 vein |
| What is the average heart rate at birth? | 140 bpm |
| Signs of respiratory distress: | 1.nasal flaring 2.sternal retractions 3.grunting with respirations 4.see-saw respirations 5.rate <30 or >60 should be reported |
| If you see signs of jaundice in the first ___hrs it is considered pathological. | 24 hrs |
| True / false? Shivering is rarely seen in a new born. Why? | True. Babies use brown fat for thermogenesis |
| ****make questions for circulatory system of newborn | save for circulatory |
| save for fetal circulation | save for fetal circulation |
| What are the two kinds of swelling you might see in a newborn's head? | 1.Caput succednaneum- collection of blood between the skull bone and periosteum. 2.cephalohematoma-does not cross suture line |
| What are some of the neurological reflexes you look for in a newborn? | Moro (startle) stepping babinski rooting suck |
| What range does a newborn have the clearest vision? | 17-20 cm |
| How quickly is the apgar score assessed on a newborn? | 1-5 minutes |
| How is the apgar score calculated? | 1. Heart Rate (0=absent,1=<100, 2=>100) 2. Respirations (0=absent, 1=slow/week, 2- good cry) 3. Muscle tone (0=flacid, 1=some flexion, 2=well flexed) 4. Reflex irritability (0=no response, 1=grimace, 2-cry) 5.Color(0=blue, 1=pink with blue extrem. 2=p |
| Define: Preterm | born before completion of 37 weeks of gestation, regardless of of birth weight. |
| Define: Term | Born btwn the beginning of the 38th week and the end of the 42nd week of gestation. |
| Define:Postterm | Born after the 42nd week of gestation. |
| define: Gravidity | Gravidity= the number of pregnancies |
| GTPAL | pregnancies, term, preterm, abortions, living children |
| Parity= | the number of pregnancies in which the fetus has reached viability (not the number of fetuses) |
| viability | capacity to live outside the uterus (22-24 since lmp) |
| What are the 4 phases of the menstrual cycle | 1.Menstrual phase (days 1-5) 2.Proliferative phase 3.secretory phase (days 14-24) 4.Ischemic phase |
| True or False? The ovaries are connected to the fallopian tube. | False |
| Describe Pre-embryonic development: | first 14 days- cell multiplication begins as zygote moves through fallopian tubes rapid mitotic division forms solid ball of 12-16 cells (morula) -morula enters the uterus forms central cavity -inner solid mass= blastocyst -outer cell layer=trophob |
| Describe Embryonic development: | From day 15 until 8 weeks most critical time of development at the end of 8 wks all organ systems and external structures are present |
| chorion | chorion= outer memberane (trophoblast) |
| amnion | amnion=inner membrane (blastocyst) |
| umbilical cord | during 3rd week, blood vessels develop during 5th week embryo curves in on itself from both ends so that the stalk is attached to its ventral side -two arteries, one vein |
| Placenta | -begins to form at implantation -trophoblast invades the decidua basalis -burrows into maternal blood vessels -divided into sections- cotyledons -chorionic villi project from cotyledons and from fetal blood vessels |
| Placental functions: | 1.hCG 2.hPL 3.Progesterone 4.Estrogen |
| Placental functions: Metabolic | Metabolic – produces and stores glycogen, cholesterol and fatty acids for fetal use and hormone production; also numerous enzymes essential for fetoplacental transfer |
| Placental functions: Transport | actively controls transfer of a wide range of substances by simple diffusion, facilitated transport, active transport and hydrostatic and osmotic pressure |
| save for physiologic changes of pregnancy | save |
| save | save |
| save | save |
| save | save |
| save | save |
| Presumptive signs of pregnancy | (subjective signs the woman experiences and reports) breast changes, amenorrhea, faigue, urinary frequency, quickening |
| Probable signs of pregnancy | Goodell's, Chadwick's, Hegar's, McDonalds + pregnancy test |
| Dating pregnancy: Nagele's Rule | LMP-3 months + 7 days |
| What laboratory tests are performed for prenatal care? | cbc hemoglobin electrophoresis blood type, Rh type Rubella titer serology urinalysis and culture/sensitivity pap, gc culture, chlamydial culture, gbs |
| What is the schedule for follow up prenatal visits | 1-28 weeks= monthly 28-36 weeks=biweekly 36 weeks til birth= weekly |
| What is the minimum expected weight gain during pregnancy? | 25 lbs |
| The most frequent need for supplementation in pregnant woman is? | Iron |
| The first few hours in which the newborn stabilizes respiratory and circulatory functions is known as _____________? | neonatal transition |
| During fetal development surfactant production peaks at ____ weeks? | 35 |
| The peak fetal production of surfactant clinically corresponds to? | a marked decrease in respiratory distress syndrome |
| immediately after birth two radical changes must take place for the lungs to function. What are these two changes? | 1.pulmonary ventilation must be established through lung expansion. 2.A marked increase in pulmonary circulation must occur |
| What two pelvic types (shape) are favorable for vaginal birth? | Gynecoid (inlet rounded with all inlet diameters adequate) Anthropoid (inlet oval in shape, with long anteroposterior diameter) |
| What two pelvic types (shape) are not favorable for vaginal birth? | Android (inlet heart-shaped with short poisterior sagittal diarmeter) Platypelloid (inlet oval in shape with long transverse diameters) |
| What is the term for the overlapping of cranial bones that a fetal skull might experience in the birthing process? | molding |
| what is fetal attitude? | Fetal attitude refers to the the relation of the fetal parts to on another. The normal attitude of the fetus is of moderate flexion of the head. |
| What is fetal lie? | Fetal lie refers to the relationship of the spinal column of the getus to the spinal column of the mother. A fetus may assume either a longitudinal or transverse lie. |
| What are the three fetal presentations? (presenting part) | Cephalic Breech Shoulder |
| What is the most common cephalic presentation ? | Vertex presentation- the fetal head is completely flexed onto the chest and the smallest diameter of the fetal head. |
| When does Engagement occur? | When the largest diameter of the presenting part reaches or passes though the pelvic inlet. |
| What does Station refer to? | Station refers to the relation ship of the presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis (usually the narrowest diameter through which the fetus must pass) |
| If the presenting part is higher than the ischial spines a ______________ number is assigned. | negative |
| Effacement | the drawing up th the internal os and the cervical canal into the side walls of the uterus. |
| Lightening | describes the effects that occur when the fetus begins to settle into the pelvic inlet (engagement) |
| Signs of lightening | Leg cramps increased pelvic pressure increased venous stasis, leading to edema increased vaginal secretions |
| Bloody show | occurs when the mucus plug is expelled. Bloody show is considered a sign that labor will begin within 24 hrs |
| What are some signs and symptoms of impending labor? | Lightening Braxton HIcks contractions Cervical changes Bloody Show Rupture of membranes (ROM) Sudden burst of energy Weight loss of 1-3 lbs Diarhhea, indigestion or nausea and vomiting |
| The first stage of labor is divided into three phases. What are they? | latent active transition |
| Latent phase (stage 1) | Starts with the beginning of regular contractions which are usually mild. Contractions may start lasting 15-30 sec with a freq of 10-20 min and progress to moderate ones lasting 30-40 sec with freq of 5-7 min. |
| Active phase (stage 1) | a woman's anxiety tends to increase as she senses the intensification of contractions and pain. During this phase the cervix dilates from about 3-4cm to 8cm |
| Transition phase (stage 1) | Woman may show significant anxiety, restlessness. Frequent changing of position inner directed Contractions have freq of 2 minutes duration of 60-90 sec and strong intensity Cervical dialation 8-10cm |
| transition phase (stage 1) More characteristics: | increasing bloody show hyperventilation generalized discomfort increased need for partner's support restlessness apprehension & irritability hiccuping, belching, nausea, vomiting increasing rectal pressure and urge to bear down |
| Second stage of labor: | Begins with complete cervical dilation and ends with the birth of the infant. Usually completed within 2 hrs. |
| Positional changes of the fetus: | 1. Flexion 2. Internal rotation 3. Extension 4. Restitution 5. External rotation 6. Expulsion |
| Third stage of labor: | Placental separation & placental delivery |
| Fourth stage of labor: | This is the time from 1-4 hours ofter birth, during which physiologic readjustment of the mother's body begins. The fundus is usually midway btwn the symphysis pubis and umbilicus. |
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goodwinnursing
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