68C course
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Fertilization occurs in this part of the fallopian tube | distal 3rd part
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| QUESTION What is conception? | : Human fertilization occurs when the sperm penetrates an ovum and unites with it.
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| Consists of the first 2 weeks after conception. | Pre-embryonic Period
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| what happens Around the 4th day after conception? | the fertilized ovum, now called a zygote, enters the uterus.
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| Gametogenesis | : the development of ova in the woman and sperm in the man
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| Oogenesis | formation of female gamete
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| Spermatogenesis: | formation of male gamete
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| Implantation in the Decidua | It occurs between the 6th and 10th days after conception.
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| what is HCG? | Human Chorionic Gonadotropin, It is the hormone secreted by the cells that eventually become the placenta.
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| Normal implantation occurs in the upper uterus: | slightly more often on the POSTERIOR wall.
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| Primary chorionic villi | nourish the zygote by diffusion because the circulatory system is not yet established.
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| The villi will eventually form | the fetal side of the placenta.
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| The zygote is fully embedded within the uterus by ___ days | 10 days
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| What is the pre-embryonic period? | The first 2 weeks after conception
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| Zygote | cell formed by union of sperm and ovum.
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| Embryo: | 3rd week to 8th week of development.
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| Fetus: | 9th week until birth.
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| Embryonic Period | extends from the beginning of the 3rd week through the 8th week after conception
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| By the end of the ______ all major organ systems are in place. | 8th week
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| Weekly Embryonic Development, Development pattern: occures spontaniously. | Cephalocaudal
Central-to-peripheral direction
Simple-to-complex
General-to-specific
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| 3 primary cell layers differentiate: Ectoderm | outter layer of embryonic tissue giving skin,nails and hair
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| 3 primary cell layers differentiate: Mesoderm | emryonic middle layers of cells giving rise to all types of muscles connective tissue bone marrow blood lymph and epithelial tissue.
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| 3 primary cell layers differentiate: Endoderm | the innermost of the cell layers, which develope into the lining of the cavities and passages of the bidy and covering of most internal organs.
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| Prenatal Development Week 3 | Ectoderm
Mesoderm
Endoderm
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| fetal gender can be determined | End of 12th week
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| 9 weeks after conception | All major system are present in their basic form
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| Weeks 21 through 24 | Lungs begin to produce surfactant although alveoli capillary network immature
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| What is formed by the union of the sperm and ovum? | Zygote
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| What is an example of teratogenic agent? | Any drug, virus or irradiation that the mother is exposed to can cause malformation of the fetus. An example is the virus Rubella.
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| What is the definition of the embryonic period? | Extends from the beginning of the 3rd week through the 8th week after conception
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| placenta Produces four hormones | Progesterone
Estrogen
HCG
HPL
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| The maternal side of the placenta: "beefy" rough appearance where it attaches to the uterus often referred to as | “Dirty Duncan”
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| Placental Functions:Metabolic: | Produces some nutrients needed by the fetus
Glycogen, cholesterol, and fatty acids are synthesized
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| Placental Functions:Transfer: | Exchange of oxygen, nutrients & waste products across the chorionic villi
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| Placental Functions:Endocrine: |
Produces several hormones necessary for normal pregnancy
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| amnotic fluid Oligohydramnios | an abnormally small amount
< 400 mL
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| Amnotic fluid Hydramnios | an abnormally large amount
> 2000 mL
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| Amniotic Fluid volume | Increases during pregnancy & is approximately 700-800 ml at 40 weeks
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| The entire umbilical cord is protected from compression of a jelly like substance called | Wharton's jelly
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| What is the amniotic sac? | A sac made up of the chorion and the amnion that contains the fetus and amniotic fluid.
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| : Identify 3 parts of the umbilical cord. | Two arteries, one vein, and Wharton's jelly.
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| Which fetal circulatory structure is responsible for blood entering the heart from the vena cava & directed across the right atrium to the left atrium? | The foramen ovale
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| Which twins originate with one fertilized ovum? | Monozygotic twins
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| What are some possible complications from a multigestational pregnancy? | Spontaneous abortions, prematurity, uterine over distention, birth defects and maternal anemia.
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| Presumptive Signs of Pregnancy | Amenorrhea
Nausea and vomiting
Breast changes
Urinary frequency
Fatigue
Quickening(movment of fetus)
Change in shape of abdomen
Skin changes
Chadwick’s sign( blueish color of labia)
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| TPAL System | T-term infants
P-preterm infants
A-aborted pregnancies
L-living children now
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| Probable Signs of Pregnancy | Goodell's sign(softening of cervix)
Abdominal enlargement
Hegar's sign
Braxton-Hicks
Ballottement
Fetal outline
Pregnancy tests
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| Only 3 signs are accepted as positive confirmation of pregnancy | Fetal Heartbeat
Fetal Movements
Visualization of Fetus
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| Nagele's Rule: | Identify the first day of the last normal menstrual period
Count backward 3 months
Add 7 days
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| Calculating EDD | THE EDD may also be determined with a gestational wheel, an electronic calculator for this purpose, physical examination, ultrasound, or a combination of these methods.
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| : Which is more accurate in determining a pregnancy, blood test or urine test? | Blood test for HCG
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| Name methods to determine the EDD? | physical examination, ultrasound, or a combination of these methods.
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| Amenorrhea is often the first sign of pregnancy. What are some other signs? | Breast tenderness, N/V, abdominal growth
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| a 25 years old comes into the clinic and says she thinks shes pregnant, last period July 20. what is her expected due date? | April 27
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| a PT reports breast tenderness, N/V and has missed a period. these symptoms are considered to be what type of signs of pregnancy. | presumptive
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| protien per day for a pregnant women | 71g
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| Folic Acid – | 0.6mg (RDA)
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| Fluid intake during pregnancy | 8 to 10 cups of fluid/day, mostly water
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| Name four key nutrients in pregnancy: | Protein-71g
Calcium – 1000mg/day
Iron – 18 mg/day
Folic Acid –0.6mg (RDA)
Fluid intake – 8 to 10 cups of fluid/day, mostly water
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| : How much weight should a normal weight woman gain during pregnancy? | 25-35lbs
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| Holist Methods of Prepared Childbirth Dick-Read Method Bradley Method Lamaze which one is the 1st method? | Dick-read method
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| What are the two broad categories of pregnancy complications? | Those unique to the pregnancy and those that could occur at any time, but when they occur concurrently with pregnancy complicate its course.
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| Ultrasound Examination | Use of high frequency sound waves to visualize structures within the body
Transvaginal or Transabdominal
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| Ultrasound Examination | Confirm/location of pregnancy/survival/compare growth in multi-fetal gestations
Identify abnormalities/Guide needle placement for invasive tests such as amniocentesis
Determine gestational age
Determine location of uterus, cervix and placenta
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| Transvaginal ultrasound |
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| Alpha-Fetoprotein Screening/ | Predominate protein in fetal plasma
AFP screening determines protein level in pregnant woman's serum or sample of amniotic fluid
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| Types of Choronic Villus Sampling Techniques | Transabdominal
Transcervical
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| Non-Stress Test | Noninvasive, 40 min test
Identifies how fetal heart rate responds to fetal movement
Identifies fetal compromise
Adequate accelerations are reassuring
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| Vibroacoustic Stimulation Test | Noninvasive, similar to NST
Fetus stimulated with sound; expected response is acceleration of fetal heart rate, as in NST
Used to confirm a nonreactive NST and shorten time required to obtain high-quality NST data
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| Contraction Stress Test | Evaluation of the fetal heart rate response to mild uterine contractions
Use:
Purposes are the same as the NST
May be done if the NST results are abnormal or questionable.
Done after 32 weeks gestation.
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| Biophysical Profile | 5-fetal assessments:
heart rate and reactivity(interpreted from the NST)Fetal breathing.
Gross fetal body movements
muscle tone (closure of the hand)
amniotic fluid/Used to determine how the fetal /CNS reacts to hypoxemia and fetal acidosis
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| Percutaneous Umbilical Blood Sampling | Aspiration of fetal blood from the umbilical cord for prenatal diagnosis or therapy
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| Percutaneous Umbilical Blood Sampling USE | Use:
Management of Rh disease/
Diagnosis of abnormal blood clotting factors
Acid-base status of fetus/
Clarify questionable genetic testing/
Treat blood diseases and deliver therapeutic/ drugs that cannot be delivered to the fetus in another way
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| 3 fetal movements should be reported. True or False | True
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| : Why is an ultrasound useful in pregnancy? | It has many uses. It can visualize structures in the body, and confirm pregnancy and most fetal anomalies.
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| What is it called when the mother counts the number of fetal movements in a prescribed period of time? | Maternal Assessment of Fetal Movement (Kick Counts)
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| : What is the most common indication for an amniocentesis during the third trimester? | : Assess if fetal lungs are mature enough to adapt to extrauterine life.
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| How can a nurse facilitate communication with a client undergoing fetal diagnostic procedures? | : By providing clear, simple explanations of what the test measures and its purposes.
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| : How can we help families cope? | By helping them set realistic goals and encouraging them to express their concerns.
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| Hyperemesis Gravidarum | Persistent, uncontrollable vomiting
Begins in first weeks of pregnancy
HEG can have serious consequences
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| Hyperemesis Gravidarum Manifestations | Loss of 5% or more of prepregnancy weight
Dehydration
Metabolic imbalances
Elevated ketones
Vitamin K &Thiamine deficiency
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| Hyperemesis Gravidarum Therapeutic Management | Exclude other causes/
Lab studies/
Home therapy (first)/
Drug therapy /
Correct dehydration and imbalances/
IV fluids/
TPN if severe/
Enteral nutrition/
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| What is it called when a female is pregnant has excessive nausea and vomiting, which significantly hinders nutritional status and causes electrolyte and metabolic imbalances? | : Hyperemesis gravidarum
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| Name a nursing intervention that can be provided to a person with hyperemesis gravidarum? | : Encourage bland, low fat diet; intake & output; daily weights; Monitor urine for ketones; meals every 2-3 hours
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| List appropriate nursing care for a patient experiencing a bleeding disorder of early pregnancy. | : Assess for shock, pain control, and provide emotional support.
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| List signs and symptoms of hypovolemic shock. | Fetal heart changes, rising weak pulse, rising respiratory rate, shallow irregular respirations, falling blood pressure, decreased urine output, pale skin, cold clammy skin, faintness and thirst
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| what are Teratogenic agents? | any drug, virus, or irritant that can cause harm to the fetus.
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| Define zygote | cell formed by 2 reproductive cells.
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| Define Morula | develomental stage of the fertilized ovum in which there is a solid mass of cells resembling a mulberry.
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| Define Blastocyst | the embryonic form, a spherical mass of cells having a central fluid filled cavity surrounded by two layers of cells.
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| Define Villi | short vascular processes or protrusions growning on certian membranous surfaces.
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| Define Chronic Villi | tiny vascular protrusions on the chronic surface that project into the maternal blood sinuses of the uterus and help form the placenta.
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| Ectopic Pregnancy Therapeutic Management;Unruptured tube | Methotrexate(prevents cells division)
Surgery
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| Ectopic Pregnancy Therapeutic Management:Ruptured tube Goal: | control bleeding/
prevent hypovolemic shock/
Salpingectomy
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| Disseminated Intravascular Coagulation definition | A life-threatening defect in coagulation that may occur with several complications of pregnancy
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| What is it called when all products of conception are expelled from the uterus? | Complete abortion
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| What is it called when the fertilized ovum is implanted outside the uterus? | Ectopic pregnancy
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| Why is the patient placed on her left side while on bed rest? | It helps improve the blood flow to the placenta and more effectively providing oxygen and nutrients to the fetus
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| What drug is administered to mom's who are RH negative | RhoGAM
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| hypertension medications given during child in pregnancy | Nifedipine (calcium channel blocker)
Labetolol (beta-adrenergic blocker)
Hydralazine (Apresoline): major advantage over other antihypertensives
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| HEELP Syndrome: : acronym that refers to a life-threatening occurrence that complicates about 10% of pregnancies | HE: hemolysis
EL: elevated liver enzymes
LP: low platelet count
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| Why is the patient placed on her left side while on bed rest? | It helps improve the blood flow to the placenta and more effectively providing oxygen and nutrients to the fetus
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| What compound is present in urine with a person who has preeclampsia? | Protein
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| What drug is administered to mom's who are RH negative? | RhoGAM
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| What is the disease that occurs when anti-Rh antibodies cross the placenta and destroy fetal erythrocytes? | Erythroblastosis fetalis
(Erythroblastosis fetalis is a condition that causes the mother's red blood cells attack those of the baby as they would any foreign invaders.)
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| Abruptio Placentae | Definition: premature separation of a normally implanted placenta from the uterine wall
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| Therapeutic Management Severe Preeclampsia | When antihypertensive meds are given to a woman receiving magnesium sulfate, HYPOTENSION may result, reducing placental perfusion
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| Therapeutic Management Anticonvulsants | Magnesium Sulfate: most common
CNS depressant
Not an antihypertensive, but relaxes smooth muscle
Administer IVPB
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| Hypertensive Disorders of Pregnancy; Preeclampsia | SBP > or = 140
DBP > or = 90
Significant proteinuria
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| Hypertensive Disorders of Pregnancy;Eclampsia | Progression of preeclampsia to generalized seizures
Seizures CAN occur postpartum
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| Gestational Hypertension | BP elevation after 20 weeks that is NOT accompanied by proteinuria
May progress to preeclampsia
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| Hypertensive Disorders of Pregnancy: Four categories of disorders exist: | Gestational Hypertension
Preeclampsia
Eclampsia
Chronic Hypertension
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| List some examples of teratogens that are harmful to the fetus. | Infections/
Ionizing Radiation/
Maternal Hyperthermia/
Pollutants/
Effects of Maternal Disorders/
PKU/Diabeties
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| Mechanical Disruption:Forces that interfere with normal prenatal development include: | Oligohydramnios:small amount of amniotic fluid reduces the cushion surrounding the fetus and may result in deformations.Can interfere with fetal lung develop.Fibrous amniotic bands:tears in the inner sac of fetal membranes,can result in fetal deformations
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| Tabacco:fetal development | Fetal effects:
Prematurity
Low birth weight
Fetal demise
Developmental delays
Increased incidence of SIDS
Neurologic problems
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| Infant with Fetal Alcohol Syndrome (FAS) | Prenatal and postnatal growth restrictions/
CNS impairment/
Recognizable combination of facial features
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| fetal effects:Marijuana | Fetal effects: unclear, more study needed.
Irritability
Tremors
Sleep problems
Sensitivity to light
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| Cocaine: fetal effects | intracranial/bleeding/Stillbirth/Prematurity/IUGR/Irritability/
inability to interact with environmental stimuli/
Poor feeding reflexes/
N/V/diarrhea/
Decreased intellectual development/
Prune-belly syndrome from absence of abd. muscles
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| Amphetamines: fetal effects | Fetal effects:
Withdrawal symptoms:
Lethargy
Depression
IUGR
Fetal death
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| Opioids: fetal effects | Fetal effects:
IUGR(Intrauterine growth restriction condition of the unborn being smaller than normal.)
Perinatal asphyxia/
Intellectual impairment/
Neonatal abstinence syndrome/
Neonatal infections/
Neonatal death (SIDS, child abuse and neglect)
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| FDA Pregnancy Risk Categories:Category A: | No evidence of risk to the fetus exists.
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| FDA Pregnancy Risk Categories:Category B | animal reproduction studies have not demonstrated a risk to the fetus. No adequate and well-controlled studies have been done in pregnant women.
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| CURRENT SETTINGS FOR CHILDBIRTH:Traditional |
Small functional room for labor
Moved to delivery area
Transferred to recovery area
To postpartum unit
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| CURRENT SETTINGS FOR CHILDBIRTH:Labor, Delivery, and Recovery Rooms (LDR) | One setting for labor, delivery and recovery
Remain in LDR for 1 to 2 hours/Labor, Delivery, Recovery, and Postpartum
Rooms (LDRP)
Similar to LDR
Not transferred to a postpartum unit after recovery
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| CURRENT SETTINGS FOR CHILDBIRTH:Birth Centers | Designed to provide maternity care to low-risk women outside the hospital setting.
Birth midwife
Advantage: less expensive, safe and home-like setting for the low risk women
Disadvantage: Not equipped for major obstetric emergencies.
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| CURRENT SETTINGS FOR CHILDBIRTH:Home Births |
Advantage: keeps family together in own environment
Disadvantage: Long transfer time to hospital in an emergency
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| Guidelines for Reporting to a Birthing Facility | Contractions:
5 minutes apart for 1 hour for first labor.
10 minutes apart for 1 hour for second and subsequent labors.
Ruptured membranes.
Bleeding other than bloody show.
Decreased fetal movements.
Other concerns.
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| What is the primary advantage of the traditional hospital setting? | : It is safe. All emergency equipment and personnel are readily available.
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| Traditional Practices of Various Cultural Groups:Southeast Asia (China, Japan, Korea): | Father usually is not present.
Stoic response to pain.
Side-lying position preferred
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| Traditional Practices of Various Cultural Groups:Laos | Squat for birth.
Prefer female attendants.
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| Traditional Practices of Various Cultural Groups:India | Natural childbirth methods used.
Female relatives present as caregivers
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| Traditional Practices of Various Cultural Groups:Iran | Father not present.
Female caregivers and support people present at birth.
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| Traditional Practices of Various Cultural Groups:Mexico | Stoic about pain until second stage.
Father and female relatives present.
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| Traditional Practices of Various Cultural Groups:American Indian | Bury placenta for good luck.
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| When should a woman report to the birthing facility? | Contractions: 5 minutes apart for 1 hour for first labor. 10 minutes apart for 1 hour for second and subsequent labors.
Ruptured membranes.
Bleeding other than bloody show.
Decreased fetal movements.
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| Four Ps: Components of the Birth Process | Powers.
Passage.
Passenger.
Psyche.
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| Four Ps: Components of the Birth Process: Powers | Involuntary uterine contractions :
Primary powers: Responsible for effacement and dilation of the cervix.
Secondary powers: Bearing down efforts of the woman which add to the power of the expulsive forces but have no effect on cervical dilation.
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| Four Ps: Components of the Birth Process: Passage. | Bony pelvis and the soft tissues of the pelvis and perineum.
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| Hypertonic (tachysystole) contractions | Less than 2 mins apart.
Longer than 90-120 secs.
Intervals shorter.
Incomplete relaxation of the uterus.
Report immediately
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| Four Ps: Components of the Birth Process: Powers:The Psyche | Crucial part of childbirth.
Marked anxiety and fear decrease a woman’s ability to cope with pain in labor.
Catecholamines inhibit uterine contractions and divert bloodflow from the placenta
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| How are dilation and effacement estimated? | Effacement is the thinning of the cervix, described as a percentage of the original length of the cervix from 0 -100%.. Dilation is the enlargement or widening of the opening of the cervix and the cervical canal from 1cm – 10 cm.
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| What is used to describe how the head is oriented if the fetus is head down? | Fetal presentation. Designated as cephalic or vertex.
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| what is True labor? | Contractions:
Regular.
Closer together.
Stronger.
Last longer.
The cervix softens, effaces and dilates.
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| what is False labor? |
Rarely follow a pattern.
Vary in length and intensity.
Contractions frequently stop with ambulation and position changes and eventually stop with relaxation interventions
The cervix does not change.
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| Nursing Care r/t False Labor: | Focused Assessment:
Fetal heart tones.
Maternal vital signs.
Presence and frequency of contractions.
Observation.
Discharge.
Review guidelines for returning.
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| Which kind of labor is characterized by change in cervical dilation and effacement? | True labor
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| : Which kind of labor is characterized by contractions which subside with relaxation and breathing interventions? | False
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| Fetal condition upon admission | The fetal heart rate (FHR), regular rhythm.
The normal average FHR is 110-160 beats/min with 6-25 beat fluctuations.
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| Status of Amniotic Membranes: water breaking/admission. | Ruptured Membranes:
SROM.
AROM.
Observe time, amount, color and odor.
Confirm ruptured membranes with:
Nitrazine paper.
Fern test.
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| Maternal Condition: L/D admission | Assess vital signs:
BP
Assess for hypertension.
Goal is BP less than 140/90.
Temperature
Assess for signs of infection.
Temp above 38 C (100.4 F) should be reported.
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| Admission Procedures for mother | Notification of attending provider:Consent forms:
Anesthesia.
Vaginal delivery and/or cesarean section.
Blood transfusion.
HIV testing.
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| Admission Procedures: lab tests | Blood for hematocrit (CBC usually sent) and midstream urine specimen for glucose and protein are obtained.
HIV status, ABO and Rh type.
Women with no prenatal care will have additional labs drawn such as drug screen.
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| If the amniotic membranes are ruptured, what is the fluid assessed for? | Observe time, amount, color and odor
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| Impending Labor: Includes | Braxton-Hicks contractions.
Increased vaginal discharge.
Bloody show.
Rupture of membranes.
Energy spurt.
Small weight loss.
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| Mechanism of Labor: in the infant | Descent.
Engagement.
Internal rotation.
Extension.
External rotation.
Expulsion
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| Stages of Labor: 1ST STAGE: | Dilation.
Begins with the onset of contractions until full dilation of the cervix (10cm).
This is the longest stage for both the nullipara and multipara
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| Early Latent Phase | Contains 3 Phases:
Early Latent.
Mild/Active.
Transitional.
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| Stages of Labor: 1ST STAGE:Early Latent Phase: | 0 - 3 cm.
Contractions mild and infrequent.
Gradually increased strength & intensity.
Woman sociable & excited; cooperative but anxious.
Pain is usually mild at this phase
Duration 30 to 40 seconds.
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| Stages of Labor: 1ST STAGE:Mild/Active Phase: | 4 - 7 cm.
Complete effacement.
Contractions moderate to firm every 2-5 mins
Duration 40-60 seconds.
Contraction intensity & frequency increase.
Woman less sociable, turns inward.
May ask for pain medication
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| Stages of Labor: 1ST STAGE:Transitional Phase: | 8 - 10 cm.
Shortest phase.
Contractions firm; q 1.5 to 2 min. & lasting 60 to 90 seconds.
Woman may become uncooperative & hostile; feeling of losing control.
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| Process of Childbirth:Second stage: | Full dilation to birth.
53 to 57 minutes or 79 minutes with epidural for nullipara;17-19 minutes with no epidural or 45 with it for multiparas.
Contractions firm;less frequent & shorter duration.
Urge to push with each contraction.
Regains control.
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| Process of Childbirth:Third Stage |
Begins with delivery of baby and ends with delivery of the placenta.
Average time is 5 to 30 minutes.
Uterine contraction controls bleeding.
Oxytocin & breastfeeding stimulate contractions.
Minimal pain; cramping.
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| Post third stage of delivery( of the placenta) what should be done at every vital sign interval? | Massaging the uterus to firm it up and compress open vessels at the placental site.
Assess uterine tone with each set of vital signs.
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| Process of Childbirth: Fourth stage: | : stabilization.
1-4 post birth.
Monitor physiologic changes.
V/s, uterine tone, vaginal drainage and assessing perineal tissue are important during this time.
Assess bladder for fullness.
s/s of hemorrhage by assess lochia.
Promote comfort/analgesi
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| Nursing Interventions/post partum/baby |
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| Nonpharmacological Pain Management | Application techniques
Relaxation
Environmental
Cutaneous
Hydrotherapy
Mental Stimulation
Breathing Techniques
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| what are the five sources of labor pain in most labors? | It is normal pain but it expected/
preparation time exists/ it is time limiting, labor pain has a foreseeable end./labor pain is intermittent/ labor ends with birth of baby.
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| Childbirth pain is 2 types of pain: | Visceral and Somatic
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| What is Visceral pain during childbirth? | this pain is slow,deep,poorly localizedpain that is often described as dull or aching. this pain dominated during first stage of labor as uterus contacts and cervix dilates.
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| What is Somatic pain during childbirth. | this pain is quick,sharp pain that can be precisely localized. this pain dominates during the late first stage of labor and during second stage of labor as the descending fetus puts direct pressure on maternal tissue.
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| Pharmacological Pain Management | Includes:
Systemic drugs
Regional pain management
General anesthesia
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| Regional Pain Management include: | Epidural Block
Intrathecal Opioids Analgesics
Subarachnoid (spinal) Block (SAB)
Systemic Drugs
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| General Anesthesia | Produces loss of sensation & consciousness
Not recommended for uncomplicated vaginal birth
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| General Anesthesia;Reduces risk of maternal aspiration: name meds and intervention | Reduce/restrict intake
Pre-op Meds:
Citric acid (Bicitra)
Ranitidine (Zantac)
Glycophyrrolate (Robinul)
Metoclopramide (Reglan)
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| Maternal Physiological changes: CV | compression of the aorta and inferior venacava by the uterus can occure when the women lies supine. displacment is often to the Left.
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| Maternal Physiological changes: Respritory | Full uterus reduces respritory capacity.more rapid and deep breaths, may reduce arterial oxygenation during induction of general anesthesia. normal edem is also present and may make it difficult to intubate.
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| Maternal Physiological changes: GI | progestrone slows peristalsis and reduces the tone of the spincter at junction of the stomach and esophogus. more vulnerable to regurgitation/aspiration of gasteric content when anesthesia is given.
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| Maternal Physiological changes:Nervous system | Endorphines and enkephalins are high. this will reduce the need for pain medications.
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| Common Opioid Analgesics: | Meperidine (Demerol)
Fentanyl (Sublimaze)
Butorphanol(Stadol)
Nalbuphine(Nubain)
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| Obstetric Procedures:Amniotomy: | Definition: (aka AROM) artificial rupture of the membranes (amniotic sac) by using a disposable plastic hook (Amnihook).
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| Amniotomy purpose; | Purpose: usually performed to allow internal electronic fetal monitoring.
Technique:
Vaginal exam
The hook snag the membrane.
The opening is enlarged with the finger, allowing fluid to drain.
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| Amniotomy Nursing Considerations:Identifying Complications: |
Fetal heart rate (Baseline and after procedure)
Record the color, odor, and amount of the amniotic fluid
Report the patient’s temperature if it >100.4 F
Green fluid means that the fetus passed meconium
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| Induction of labor: artificial initiation of labor include Cervical assessment, this includes knowlege of what? | Dilation, the opening of the cervix (measured in cm), and effacement, the thinning of the cervix (measured in %)
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| Induction / Augmentation Techniques:Amniotomy. and Cervical Ripening; | Medical Methods of cervical ripening:
Prostaglandin gel (Prepidil)
Cytotec (Misoprostol)
IV Oxytocin
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| most common drug used to induce labor. | Pitocin (oxytocin): most common
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| Oxytocin is discontinued or rate is reduced if the_____ _____ is out of the normal _____. | fetal heart rate is out of the normal range.
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| Oxytocin is discontinued or rate is reduced if the fetal heart rate is out of the normal range what drugs might the Physician order to reduce uterine activity? | terbutaline and magnesium sulfate.
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| Observe the Fetal Response when induction is proformed. | Monitor fetal heart rate
every 15 minutes 1st stage
Every 5 minutes 2nd stage
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| Observe Maternal Response when induction is proformed: | Assess uterine activity
Vital signs q 30 minutes or each dose increase
Temperature q 2 to 4 hours
Intake and output
May need pain management
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| External Cephalic Version Technique | Done after 37 weeks gestation
The procedure begins with a nonstress test or biophysical profile and fetal age confirmation
The woman receives a tocolytic medication (terbutaline) to relax the uterus
Using ultrasound to guide the procedure
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| ____ forceps are used for breech presentation | breech delivery using Piper forceps
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| no vacum used before ___ weeks | 34 weeks
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| 1st and 2nd degree laceration: | are usually uncomplicated and heal quickly because they don’t affect the rectal sphincter.
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| 3rd degree laceration | extend to the rectal sphincter.
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| 4th degree laceration: | extends completely though the rectal sphincter.
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| a large fetus, generally weighing over 4000 gm (8 lb 13 oz). | Macrosomia:
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| Hypertonic Labor Dysfunction | Definition: contractions that are uncoordinated and erratic in their frequency, duration and intensity
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| Hypotonic Labor Dysfunction | Definition: uterine contractions are too weak to be effective during labor
Most likely to occur in women with an over-distended uterus
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| Occiput posterior position may causes pain in what area? | may cause intense back and leg pain in the woman
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| placenta previa | Placenta previa occurs when a baby's placenta partially or totally covers the opening in the mother's cervix
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| Hydrocephalus | : fluid collection on the brain, causes enlargement of the fetal head.
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| hernial protrusion of the meninges of the spinal cord. Hernial sac contains CSF and sometimes nervous tissue. | Spina bifida
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| Gynecoid | 1.Pelvic brim is a transverse ellipse (nearly a circle)
2.Most favorable for delivery
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| Anthropoid | 1.Pelvic brim is an anteroposterior ellipse 1.Gynecoid pelvis turned 90 degrees
2.Narrow ischial spines
3.Much more common in black women
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| Android | 1.Pelvic brim is triangular
2.Convergent Side Walls (widest posteriorly)
3.Prominent ischial spines
4.Narrow subpubic arch
5.More common in white women
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| Platypelloid | 1.Pelvic brim is transverse kidney shape
2.Flattened gynecoid shape
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| Hyperemesis Gravidarum Medication classification Categories: | Antiemetics
Antiulcer
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|
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