Ch.1 Oral Contraceptives
• Chest pain, SOB, leg pain (clot), headache, eye problems
• Can cause blood clots
• Hypertension
• Do not use with smokers
• Hx of blood clots, stroke, cardiac, breast or estrogen
• Depro-
...
Ch.1 Oral Contraceptives
• Chest pain, SOB, leg pain (clot), headache, eye problems
• Can cause blood clots
• Hypertension
• Do not use with smokers
• Hx of blood clots, stroke, cardiac, breast or estrogen
• Depro-provera calcium and vitamin D
• IUD= increased risk of pelvic inflammatory disease, ectopic pregnancy
o Change in string length, foul smell, fever/chills, pain with intercourse notify provider
Ch.2 Infertility
• Inability for at least 12 months
• Male first (sperm analysis), then the woman (no hx of dye for test or seafood)
Ch.3
• Presumptive sign: things that can be explained by other means
o Nausea, amenorrhea, N/V, Fatigue
• Probable signs
o Abdominal enlargements, Hagar sign, chad wicks sign, goodwill sign, ballottement, Braxton hick contractions, positive pregnancy test, fetal outline
• Positive sign
o FHR
• Nagele’s rule: add 9 months and a week
• GTPAl: Gravidity (# of times of pregnancy), Term births (38 weeks or more), Preterm births, Abortions/miscarriages, Living children
Ch. 5 Nutrition During Pregnancy
• Normal: 25-30 pounds
• Overweight: 15-25 pounds
• Underweight: 28-40 pounds
• First trimester: no more than 2-4 pounds for entire trimesters.. then 1 lb/week
• 340 calories/day for second trimester…450 for third trimester (even during breastfeeding)
• Folic acid (dark leafy green veggies) fetal neuro tube defects
• 2-3 L of water, limit amount of caffeine
Ch.6 Assessment of Fetal Well being
• Ultrasound want bladder full **non-invasive**
• When poking stomach empty bladder (amniocenteses)
• Biophysical profile: 0-10 score, 8-10 is normal
o Reactive HR (0-2)
o Breathing
o Body movement
o Fetal tone
o Amniotic fluid volume
• Nonstress test: measures fetal well-being in last trimester, response to FHR to fetal movement; reactive if FHR accelerates; non reactive if no FHR acceleration
o YOU WANT REACTIVE
• Contraction stress test
o Want a contraction to occur ocycotcin, nipple stimulation; monitor FHR to see if decelerations occur
o You want late decelerations
• Amniocentesis
o You want an empty bladder
o AT 14 WEEKS
o Levels of AFP (high nuero tube defects; low down syndrome)
o L/S ratio: 2:1 ratio is fetal lung maturity (2:5:1 or 3:1 for a client who has diabetes mellitus)
o Complications: amniotic fluid emboli, hemorrhage, infection
• Chorionic callus sampling
o Taking a piece of placenta
o Can be done earlier to identify abnormalities ( 11 WEEKS)
Ch. 7 Bleeding During Pregnancy
• Ectopic: Unilateral stabbing pain; Lower abdominal quadrant pain
• Molar: bleeding that resembles prune juice
• Placenta previa: lower segment of uterus instead of fundus; PAINLESS bright red during 2nd or 3rd trimester may hemorrhage
o Complete: cervical is completely covered by placental attachment
o Partial
o Incomplete
• Abruptio placentae: sudden onset of intense localized pain with dark red vaginal bleeding
Ch. 8 Infections
• Yeast infection pretty common
Ch. 9 Medical Conditions
• Incompetent cervix cervical cerclage (placed at 12-14 weeks & removed at 37 weeks)
• Hyperemesis: excessive N/V past 12 weeks; IV fluids, pyridoaxine (B6) administrations, antiemetic meds (Zofran)
• Iron deficiency anemia: iron supplements with food rick in vitamin C (orange juice)
• Gestational diabetes: higher risk for developing diabetes after pregnancy, (will likely do biophysiol profile and non-stress test)
o Insulin to control sugar levels
o Test b/w 24-28 wks one-hour glucose (no fasting required) over 140 will proceed with next test OTGG (requires fasting) 3 hours
• Gestational hypertension: caused by vasospasm poor tissue perfusion
o After 20 week; 0ber 140/90 positive
o No protein in the urine
o Mild preeclampsia: 1+
o Severe preeclampsia: 3+
o Eclampsia: seizures
o HELLP syndrome:
o Antihypertensive meds: methyldopa, nifedipine, hydralazine, labetalol
o Magnesium!! to prevent seizures (monitor mg toxicity no reflexes, low urine output, low level of consciousness, low resp)
▪ Magnesium toxicity calcium gluconate (antidote)
Ch. 10 Early onset of Labor
• Preterm labor: 20-37 weeks
o Swab of vaginal secretions (fetal fibronectin)
o Administer nifidepine (calcium channel blocker) block calcium to suppress contractions
o Magnesium sulfate- relax smooth muscle (watch for mg toxicity)
o Indomethacin
o Betamethasone (steroids) promote fetal lung maturity
• Premature rupture of membrane
o Nitrazine paper test (should turn blue) *yellow would be just urine*
o Positive ferning test to conduct on amniotic fluid to verify rupture
o May put on an antiobiotic (infection can cause rupture) (betamethasone)
Ch.11 Labor and Delivery Processes
• Back ache, weight loss (1-3 lbs), lightening (fetal to pelvis), contractions (Braxton hicks), increased vaginal discharge or bloody show, energy burst, GI changes
• Labs: Group B streptococcus, urinalysis
• Stages of labor:
o Onset-complete dilation (10 cm):
▪ Latent: irregular (mild-moderate); every 5-30 min lasting 30-45 sec
▪ Active: regular (moderate-strong); every 3-5 min lasting 40-70 sec
▪ Transition: (strong-very strong); every 2-3 min lasting 45-90 sec (feeling of needing to poop)
o Fully dilates-birth:
o Birth-delivery of placenta:
o Delivery to placenta-normal vital signs:
Ch. 12 Pain management
• Effleurage: light gentle circular stroking of the clients abdomen with fingertips in rhythm with breathing during contractions (cutaneous stimulation)
• Resp. depression, decreased FHR, hypotension, sedation with opioid or sedative
• Epidural: lack of sensations from umbilicus to thighs; dilated to 4cm or aboce; AE: hypotension fetal bradycardia, (IV bolus to counteract) avoid supine hypotension **do not lay on back
Ch. 13 Fetal Assessment During Labor
• 110-160 BPM; want moderate variability (NO LATE DECELERATIONS) **early ones are ok
• Fetal bradycardia (due to epidural) disco oxytocin, place on side, provide oxygen
• Fetal tachycardia (over 160) maternal infection (antipyretic and oxygen)
• Late declaration (uteral placental insufficiency): side lying position, increase fluid, admin oxygen, disco oxytocin
• Variable decelerations (umbilical cord compression): reposition clients side to side, knee
chest position
Ch. 16 Complications related to labor process
• Prolapsed umbilical cord: displaced preceding the presenting part of the fetus or through the cervix
o Use a sterile-gloved hand, insert two fingers into the vagina and apply finger
pressure on either side of the cord to the fetal presenting part to elevate it off the cord
o Reposition in a knee-chest, Trendelenburg or a side lying position with a rolled towel under the clients right or left hip to relive the cord
o Apply warm sterile saline soaked towel to the visible cord
Ch.17 Postpartum physiological adaptions
• RhoGaM admin 72 hours after giving birth who are RH neg and baby is RH positive to prevent issues with next pregnancy
• Fundus
o 3rd stage of labor: palpable at midline and 2cm below to halfway b/w umbilicus and symphysis pubis
o 12 hr postpartum: 1 cm above umbilicus
o Every 24 hours after should descend 1-2 cm
o 6 post partum halfway
o By 10 day you shouldn’t be able to palpate
• Lochia: discharge after birth
o Rubra bright red color, some clot (1-3 days)
o Serosa pinkish brown color (4-10 days)
o Alba yellowish white creamy discharge with flush order (4-8 weeks)
• Ice packs at perineum for first 24 to 48 hr, sitz baths at 100-104 degrees at least 2x a day
• Milk 2-3 days after birth (before that is the colostrum)
• Uterine atony: retaining urine (uterine to be displaced)
o Have her go to the bathroom
Ch. 18 Baby friendly Care
• Phases of maternal role attainment
o Dependent (taking in); 24-48 hr
o Dependent-independent (taking-hold); 2-3 days
o Interdependent (letting-go)
Ch. 19 Discharge Teaching
• Breast engorgement cold/warm compresses b/w feedings, warm shower prior to breastfeeding (increase milk flow and promote the let down reflex)
• For non lacting patients fresh cold cabbage leaves
Ch.20 Postpartum Disorders
• Deep vein thrombosis: unilateral swelling in legs; postpartum at higher risk
• Pulmonary embolism: chest pain, difficulty breathing
• Postpartum hemorrhage: Uterine atony, retained placenta fragments; increase change in lochia pattern
o Meds: oxytocin (uterine stimulant), methylergonovine , misoprostol
o Uterine atony Massage fundus
Ch. 21 Postpartum infections
• Mastitis: infections in breast; painful or tender localized hard mass and reddened area usually on one breast; Chills, fatigue
o Enlarged tender axillary lymph nodes with an area of inflammation that can be
red, swollen, warm and tender
• Hygiene: wash hands prior to breastfeed, air dry nipples, baby taking nipple and areola area when feedings, breast emptied during each feeding to prevent mastitis
Ch.22 Postpartum depression
• Blues: tearfulness, lack of appetite
• Depression: within 6 mo of delivery,
• Psychosis: hx of bipolar disease, hallucinations, obsessive behavior, paranoia
Ch. 23 Newborn assessment
• APGAR (0-2) total of 10; 0-3 severe distress; 4-6 moderate difficulty; 7-10 minimal to no difficulty
o Heart Rate=- greater than 100/min is 2
o Resp rate
o Muscle tone
o Reflex- grimace is a 1
o Color- completely pink is 2
• New Ballard Scale- newborn maturity scale (neuromuscular and physical maturity)
o Neuromuscular: square window, arm recoil, scarf sign, popliteal angle, heel to ear **they should be well flexed
o Physical:
▪ Preterm: thinner skin, sticky skin, lanugo, flat smooth scrotum, flat labia
▪ Full term: thicker, plantar creases, breast tissue (5-10 mm breast buds)
▪ Late term: wrinkle, leather skin
• Normal deviations
o Milia: raised white spots
o Mongolian spots: bluish purple spots
• Head
o Should be 2-3 cm larger than chest circumference
o Anterior (diamond shape) and posterior fontanel (smaller and triangle shape) present
o Caput succedaneum
o Cephalohematoma
• Eyes are blue at grey at first
• Grey white patches on tongue indicate thrush a fungal infection (Candidiasis)
• Reflexes
o Sucking rooting reflex
o Palmar grasp
o Plantar grasp
o Moro reflex
o Tonic neck (fencer position)
o Babinski reflex
o Stepping
Ch. 24 Nursing Care of Newborn
• Thermoregulation
o Conduction
o Convection
o Evaporation: drying newborn off
o Radiation
• Meconium- should be passed after 24 hours after birth (abnormal if it doesn’t happen)
• Erythromycin ointment in eye to (gonorrhea, chlamydia)
• Vitamin K needed to prevent hemorrhaging until they start producing their own
• Hep B at birth, 1 mo, 6 mo
• Hypoglycemia (jittery, twitching, weak high pitched vcy, cyanosis, lethargy, seizures, under 40 glucose level, irregular resp)
Ch. 25 Newborn nutrition
• Lose 5-10% body weight after birth
• Breast feeding
o Decrease risk of SIDS
o First food introduced – iron
o Start right after birth (uterine cramps release of oxytocin)
o 15-20 min per breast (try to empty breast with each feeding)
o Best indicator if they are eating right is based on diaper (6-8 diapers per day)
o Stored at room temp for up to 8 hours, refrigerated must be used within 8 days, If frozen up to 6 mo, deep freezer, 12 mo.
o Thaw milk in refrigerator
o DO NOT microwave milk
o DO NOT refreeze thaw milk
o Used portions should be discarded (DO NOT use again)
o Formula up to 48 hours
Ch. 26 Nursing Care and Discharge teaching
• Place baby on back (to prevent SIDS)
• Newborns sleep 17 hours out of 24
• Cord care
o Keep dry and above diaper
o Give sponge baths only until it comes off (10-14 days after birth)
o Makes sure it is NOT moist or red, foul odor, purulent drainage
• Circumcision Care
o Petroleum jelly
o DO NOT wash yellowish mucus off
o Give baby acetaminophen
• Car safety
o Rear end facing
o Middle back seat until age 2
Ch. 27 New born complications
• Hypoglycemia (less than 40)
• Preterm: resp distress, bronchopulmonary dysplasia, aspiration, apnea,
• Macrosonic newborn: born to mom with diabetes, hypoxia, hypoglycemia, hypocalcemia (tremors)
• Post term: cracked, leather skin, long hair and nails
• Hyperbilirubinemia
o Jaundice (monitor time it set in)
o Kernicterus (untreated)
o Phototherapy primary treatment (greater than 15)
▪ Eye mask over baby
▪ Keep newborn undress
▪ Cover genital
▪ Avoid applying lotion
▪ Remove from phototherapy every 4 hours and check eyes
▪ Reposition every 2 hours
▪ Bronze/rash is not serious
▪ Monitor dehydration!!! (sunken fontanel); check diaper (feed frequently)
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