Labor & Delivery

Preeclampsia

S/S of this condition include:

• Proteinuria (albumin)

• Weight gain of 5 lbs in the past two weeks

• Elevated blood pressure

Vasectomy and Tubal Ligation

The only two forms of permanent contraception are…

(one male and one female)

Blood glucose level

When a newborn is admitted and is small for gestational age (SGA), what is the priority intervention?

• due to low subcutaneous fat or glycogen stores

Cervical Dilation and curettage

This procedure is often done for cases of infertility and heavy bleeding

Apply an electronic fetal monitor

A client at 37 weeks’ gestation is in the emergency department after a motor vehicle accident. Vital signs upon admission are BP 110/72 mm Hg, HR 98 beats/min. The client begins complaining of sudden, sharp abdominal pain, and repeated vital signs are BP 90/60 mm Hg, HR 108 beats/min. Which nursing intervention is the priority at this time?

Contraction Stress Test

This test is contraindicated in pregnant patients who have a history of preterm labor, placenta previa, cervical insufficiency, and premature rupture of membranes

• Can lead to preterm labor and bleeding

Infection

S/S of this in a pregnant client include:

• Chills

• Fever

• Diarrhea

• Flank pain

• Burning on urination

Ortolani Test

Test in which an audible clunk may be heard or felt as the femoral head relocates into the acetabulum after being dislocated in an infant

Fetal anomalies

Chorionic villus sampling is performed between the 10th and 12th weeks to avoid…

2

Apgar Score Criteria:

• Greater than 100 bpm

• Good, strong cry

• Well-flexed muscle tone

• Crying, sneezing

• Completely pink skin

1

Apgar Score Criteria:

• Less than 100 bpm

• Irregular, slow, weak cry

• Some muscle flexion

• Grimacing response

• Acrocyanosis

0

Apgar Score Criteria:

• Absent HR

• Absent respirations

• Limp/flaccid muscle tone

• No response to stimuli

• Blue, pale skin

Nonstress test

Risk factors that indicate this test include:

• Advanced maternal age (greater than 35)

• Risk for placental insufficiency

• History of stillbirth from her last pregnancy

• Hypertension

• T1DM

First Stage of Labor

• Lasts from onset of regular uterine contractions to full effacement and dilation of the cervix

• Lots of variability, broken into three phases

  • Latent phase involves more progress in effacement

  • Active and transition phases have more rapid dilation of the cervix and increased rate of descent of presenting part

Second Stage of Labor

• Lasts from fully dilated cervix to the birth of the fetus; birth is now imminent

• Two phases, latent and active (greater urge to push in active phase)

Third Stage of Labor

• Lasts from birth of fetus to delivery of placenta

Fourth Stage of Labor

• Delivery of placenta and includes at least two hours after birth

• Physical recovery from birth, important to monitor for complications

Cord Compression, Maternal repositioning

What are variable decels caused by and how do you intervene?

Head Compression, identify labor progress

What are early decels caused by and how do you intervene?

Nothing

What do you do about fetal accelerations?

Placental insufficiency, immediately (stop pitocin, give oxygen, reposition, possible c-section)

What are late decelerations caused by and how soon should we intervene?

Candida (yeast infection)

Infection that manifests as a white, thick, odorless discharge from the vulva along with inflammation

Vaginosis

Infection that manifests as a thin, white, fishy-smelling discharge from the vulva along with irritation

Trichomonas

Infection that manifests itself as a frothy green or yellow-colored malodorous discharge from the vulva

Chlamydia

Infection that manifests itself as a blood discharge from the vulva

Normal

Is yellow exudate around the incision site of a circumcision normal or abnormal?

Preeclampsia

Risk factors include:

• Nulliparity

• Familial history

• Preexisting conditions

  • Advanced maternal age ( > 40)

Cerebral edema

What is the underlying cause of headaches and elevated DTRs in preeclampsia?

Decreased H&H with burr cells, elevated liver enzymes, and decreased platelets

What lab values are indicative of HELLP syndrome?

Prolpased Cord

Event in which the umbilical cord precedes the baby, possibly cutting off the fetus’s blood supply

Medical emergency that is a top priority

Placenta previa

Condition in which the placenta is sat too low in the uterus and is covering the cervix, causing spotting

• Painless vaginal bleeding

Mag sulfate

CNS depressant used to prevent seizures

Urine output

Measurement that is important to take note of in mag sulfate administration (other than respiratory rate)

Calcium gluconate

Reversal agent for mag sulfate toxicity

Early decelerations

Decelerations that mirror the mothers contractions, caused by head compression

Late decelerations

Happens after the contraction has occurred, caused by placental insufficiency

Variable decelerations

May occur at any time, caused by cord compression

Postpartum hemorrhage

Along with oxytocin, carboprost tromethamine is used to treat what?

Methylergonovine

Drug used to treat low maternal blood pressure

Hyporeflexia and respiratory depression

Two main complications of mag sulfate to watch for in newborns (toxicity)

Stillbirth

What can happen as a result of maternal alcohol abuse?

Increase

Iron needs in pregnant women require an…

Negative

These numbers in fetal station refer to being above the ischial spines

0

Fetal station number that represents the presenting part being level with the ischial spines

Positive

Fetal station numbers that represent the presenting part being below the ischial spines

Dinoprostone and misoprostol

Cervical ripening meds used for softening the cervix and improving uterine muscle tone to further induce labor

Lateral (left side)

What position allows for greater placental perfusion by taking pressure off of the vena cava?

Nifedipine

Calcium channel blocker used to inhibitor myometrial acitivty

Indomethacin

Common drug used to treat preterm labor

Mother and fetus

When a pregnant patient takes ANY medication, this may affect…

Oxytocin (pitocin)

Med used to induce labor by stimulating contractions

Raloxifene

Med used to prevent postmenopausal osteoporosis caused by bleeding

Clomiphene

Med used to cause ovulation in women who don’t produce ova (eggs)

Breech

Fetal presentation in which the feet will come out first

• Tones heard just above hte umbilicus

12 to 18 months

At what point should the anterior fontanelle close?

Subtract 3 months and add 7 days

Naegele’s rule calculation

2 cm below the umbilicus

Where is the fundus after birth before it slowly rises?

Empty the bladder

If the fundus is firm and displaced, what should the patient do?

Massage

Boggy fundus, intervention?

300 calories

What calorie increase should pregnant mothers take to meet metabolic demands of pregnancy?

10% or less

Appropriate weight loss for newborns? If greater the HCP should be notified

Convective Heat Loss

Drying the infant after birth under a radiant warmer helps in reducing…

Molding

Normal occurrence after birth in which a babies head is asymmetric

Erythromycin

Prophylactic eye treatment to prevent ophthalmia neonatorum that can be caused by Neisseria gonorrhea that can be acquired from the birth canal of the mother

• Typically given 1 to 2 hours after birth into the lower conjunctival sac of each eye

Talc-based powders

Avoidance of this kind of powder is good to reduce risk of pneumonia

PKU

Condition related to a problem in converting the protein phenylalanine which can lead to a buildup leading to brain damage and intellectual disability

Lateral heel

Where should blood be collected from a neonate?

At the umbilicus

Where should the fundus be located 24 hours after birth?

Rubra

Bright red lochia, 1-3 days after birth

Serosa

Pinkish-brown lochia, 4-10 days after birth

Alba

Whitish-yellow lochia, 10-14 days after birth but can last 3 to 6 weeks

Counterpressure

Cutaneous stimulation exercise to ease back discomfort; includes back massage

Effleurage

Light massaging of the abdomen

In the second hour after the client gives birth, her uterus is firm, above the level of the umbilicus, and to the right of midline. Which nursing action is an appropriate response to this situation?

Empty the bladder

HIV

Condition that can be passed on via breastfeeding

Postmaturity

S/S include:

• Profuse scalp hair

• Parchmentlike skin

• Creases covering the entire soles

Knee-chest

Positioning to perform with heavy bleeding associated to placenta previa to prevent shock?

Toxoplasmosis

Prevention measures include avoiding cat feces and fully cooking pork and beef

Placenta

When a sudden gush of blood appears after birth of the fetus, what is being ready to get expelled?

Increase in estrogen and progesterone

What causes the expected occurrence of increased nasal congestion during pregnancy?

Upward displacement of the diaphragm

What physiologically makes it more difficult for pregnant clients to breathe?

Cervical cancer

What does a pap smear screen for?

Cullen Sign

Ecchymotic blueness around the umbilicus that indicates blood in to peritoneal cavity

Ectopic Pregnancy

Risk factors include:

• Smoking

• Alcohol

• Recreational drugs

• STI’s

• Birth control use

• History of ectopic pregnancy

Ectopic pregnancy

When a fertilized ovum is outside of the uterus and cannot survive

Folic acid

What food is to be avoided when taking methotrexate for ectopic pregnancy?

Fallopian Tube Rupture

S/S include:

• Severe shoulder pain unrelieved by position change

• Severe pain in the lower quadrant of the abdomen

6 to 9 lbs

Average newborn weight? (in lbs; otherwise 2700 to 4000 grams)

33 to 35 cm

Normal newborn head circumference? in cm

Bland foods

What diet to follow to reduce vomiting in pregnant patients?

Lima beans

Best source of folic acid?

Supine, wedge under right hip

Positioning for Cesarean delivery?

Dystocia

Term for slow, non-progressing labor

2 to 4 weeks

When to resume sexual activity after birthing?

12 weeks

When are fetal heart sounds audible via a Doppler ultrasound?

Adjusting well

Apgar of 7 to 10 indicates…

Some intervention

Apgar score 4 to 6 requires…

Vigorous resuscitation

Apgar score 0 to 3 requires…

Kegel exercises

What is done to strengthen the pelvic floor?

Edema at the base of the cord

What indicates umbilical cord infection?