L10&11 Maternal and newborn, Med tips, Piaget development,

calculating due date

first day of last period + 7 days - 3 months = estimated due date

total weight gain in pregnancy

28lbs +-3lbs

calculating expected weight gain throughout pregnancy

week of gestation age - 9, within 2 lbs is ok

T1: 1lb a month (3 months)

T2&3: 1lb every week

when is uterus palpable

@12w (end of T1)

when is fundus at belly button

22 weeks (palpable at 12w)

when is fhr heard

8-12w

positive signs of pregnancy

-skeleton on x ray

-visual of fetus on ultrasound

-auscultation of fhr on monitor (8-12w)

-Provider feels fetal movement (mom doesnt count)

presumptive signs of pregnancy

• Chadwick's sign - cervix looks purple/blue from cervical cyanosis

• goodelles - cervical softening

• hegars - uterus softening

when does mom need checkups

1xm till week 28 (T1&2) then 1×2weeks till week 36, then 1xweek until delivery

Hemoglobin in pregnancy

decreases to 10 (normal)

when does mom have urinary incontinence

T1 and 3, should void q2hrs

define labor

progressive contractions with cervical softening

what is maternal station

the babys presenting part in relation to moms ISCIAL spine (ischial spine= smallest opening in pelvis)

graded -3,-2,-1,0,1,2,3 as baby moves down, 0 is at spine, positive numbers are positive news to moms in labor

fetal lie

babys spine in relation to moms

transverse is perpendicular- bad

fetal presentation

ROA (right occipital anterior) most common

stage 1 of L&D

all of labor, includes phases a,b,c for latent, active and transition

stage 2 of labor

goal push out baby

• head first then suction mouth then nose, check for nucal cord, deliver body

stage 3 of labor

delivery of placenta, make sure its all there with 2 arteries and 1 vein

stage 4 of labor

recovery (2hrs after delivery of placenta)

• q15min for 1hr check vitals, fundus, bleeding quantity

• if fundus is not midline she needs to pee

• if fundus is boggy she needs a massage

• saturation of a pad in 15min is danger sign of hemorrhage

phase 1 of labor

latent phase

phase 2 of labor

active phase

• 5-7cm dilation

• 3-5min frequency of contractions

• 30-60sec duration

• moderate intensity

uterine tetany

contractions for 90+ sec and/or closer together than 2min frequency

• stop pitocin to slow/calm contractions

interventions for back pain in labor

position then push

position on floor on hands and knees, push sacral area to relieve pressure

prolapse cord interventions

do NOT push cord, push HEAD up to take pressure off of the cord

position mom with legs up in Trendelenburg position

when do you NOT give pain meds to mom

when med peak is likely during delivery

• IV meds peak 15-30min

• IM meds peak 30-60min

low fhr

• Bad

• less than 110

• stop pitocin

• L for LION

• Left side, IV, O2 and notify provider

high fhr

• more than 160

• not a big deal, mom may have temp

high fhr baseline variability

• good! lots of changes in hr

low fhr baseline variability

• danger

• L for lion

• Left side, IV, O2 and Notify provider

late fhr decelerations

• bad, when fhr decreases at the end of contractions

• L for LION (left side, IV, O2, notify provider)

early fhr deceleration

• good! sign of head compression (normal)

variable fhr decelerations

VERY BAD

• cord compression → prolapse cord

  • push baby head up, do NOT press cord

  • LION

what does a nonstress test measure

• fhr

• fetal breathing movements

• amniotic fluid volume

• fetal movements

• fetal tone

bleeding postpartum

500ml+ for vaginal birth is hemorrhage

1000+ml for c birth is hemorrhage

pad saturated in 15 min is warning sign

fundal height measurements on postpartum

starts at umbilicus, sinks 1cm per day pp, takes 6w to return to normal

rubra

bright red lochia

day 1-3

serosa

phase 2 lochia, pink/brown

day 4-10

alba

phase 3 lochia

white/yellow

d11-6w

thrombophlebitis

monitor with calf circumference

capt succedaneum

CS→ crosses sutures is symmetric

normal finding, swelling of the head after birth

cephalohematoma

normal finding, bruise from labor, normally vacuum

non-symmetrical, does not cross sutures

tocolytic

drug class, slows labor

give to premature labor moms

• terbutaline - gives maternal high hr

• mag sulfate - hyper mag= decreased hr, bp, reflexes, rr, loc *keep rr >12 and reflexes at a 2+

terbutaline

tocolytic med (slows labor)

will give mom high hr

magnesium sulfate

tocolytic med - slows contractions

high mag levels will decrease hr, bp, loc, rr, reflexes

• nurse should keep rr >12 and reflexes at or higher than 2

pitocin

• stimulates uterine contractions

• watch for uterine tetony when contractions last longer than 90sec with a frequency less than 2m

• if baby is in distress, stop pitocin

methergine

increases uterine strength/contractions by vasoconstricting, will cause increased bp

betamethasone

steroid given to mom to increase fetal lung maturation

given IM

Servanta

given to baby transtrachial (blown into lungs) to help prevent alveolar lung collapse