Explore More/ACE Notes

kegel exercises

pelvic strengthening exercises

start peeing and then stop and hold it

how do you instruct a patient to do kegel exercises

hypotension, tachycardia, diaphoresis, anxiety, pallor, fatigue, cool/clammy skin, tachypnea

what are signs of hypovolemia in a PP patient

first period of reactivity, period of decreased responsiveness, second period of reactivity

what are the three stages that the neonate passes through between birth and the first 10-12 hours of life

first period of reactivity

stage between birth and first 10-12 hours of life that lasts for 30 mins, HR increases to 160-180 beats/min, respiration are irregular and occur at 60-80 breaths/min, baby is alert with spontaneous tremors, is crying, the head moves side to side, and this is the optimal time to initiate BF

period of decreased responsiveness

stage between birth and first 10-12 hours of life that lasts for 1-2 hours, HR falls to 100-120 beats/min, neonate is pink, respiration are 60 breaths/min, bowel sounds are audible, may have sleep or marked decrease in motor activity

second period of reactivity

stage between birth and first 10-12 hours of life that is between 2-8 hours PP and consists of periods of tachycardia and tachypnea and meconium is commonly passed

gravida

what does the G in GTPAL stand for

gravida

total number of pregnancies 

term

what does the T in GTPAL stand for

term

how many pregnancies have gotten to 37 weeks

preterm

what does the P in GTPAL stand for

preterm

pregnancies that lasted from 20 weeks-36 weeks and 6 days

abortion

what does the A in GTPAL stand for

abortion

any loss before 20 weeks

living

what does the L in GTPAL stand for

living

the amount of kids that are currently living

para

the amount of pregnancies that have made it at least 20 weeks 

diabetogenic effect (increased need for insulin in 2nd/3rd trimesters)

what occurs during the 2nd and 3rd trimester of pregnancy that can lead to a high risk pregnancy/pregnancy complications

estrogen

a decrease in what hormone PP is associated with diuresis of excess extracellular fluid accumulated during pregnancy

retained placental fragments, overdistended bladder, long labor with pitocin use, patient on mag, macrosmoia, rapid delivery 

what are the common causes of uterine atony

conduction, convection, evaporation, radiation

what are the 4 modes of heat loss in newborns

conduction

The mode of heat loss that occurs when direct contact with a cooler surface causes loss of heat

convection

The mode of heat loss that occurs when heat flows from the body to a cooler ambient air 

evaporation

the mode of heat loss that occurs when liquid is turned into a vapor

radiation

The mode of heat loss that flows from the body surface to a cooler solid surface that is not in direct contact

3 cm dilation, 80% effaced, 1 cm above the ischial spine, and right occiput anterior

what does 3/80/-1/ROA mean

• DTR, muscle weakness

• respirations

• BP

• edema

• neuro: alertness, HA, LOC, slurred speech

• fetal status

• I&O

what should you assess for a patient on mag

1000 mL of blood loss or hypovolemic S/S

what is the definition of PPH

misoprostol, oxytocin, TXA, methergine, carboprost

what are the 5 meds used for PPH

misoprostol

what PPH med is given rectally

oxytocin

what PPH med is given IV or IM

TXA

what PPH med is given IVPB

HTN, preeclampsia

what is the contraindication for methergine

asthma

what is the contraindication for carboprost

mastitis

inflammation of the breasts that is sometimes caused by infections; pathogenic

breast pain, redness, swelling, warmth, fever, elevated WBCs, flu-like S/S

what are the S/S of mastitis

nasal flaring, grunting, retractions

what are signs of respiratory difficulty

variable → cord compression → move mom (positioning)

early → head compression → initiate delivery

accelerations → okay/oxygenation → no interventions

late → placenta insufficiency → everything (POISON)

what does veal chop mine stand for

24-28 weeks

when are mom’s screened for gestational diabetes

cervical laceration, vaginal laceration, lochia from the placenta

what are 3 sources of PP bleeding

baby blues

what PP mental health issues affects up to 80% of women that peaks at day 5 and can last up to 10 days

brown fat

surrounds the organs and helps insulate/temperature regulate the organs since newborns can’t shiver

they have underdeveloped brown fat

why is temp regulation a concern in preterm babies

position change, oxygen, IV fluids, SVE, oxytocin off, notify the provider

what does POISON stand for

nonreassuring FHR patters, category II/III, variable and late decels

when do you use POISON

bright red vaginal bleeding, no coagulopathy, normal uterine tonicity, absent abdominal tenderness 

what are the s/s of placenta previa

hyperemesis gravidum

severe form of N/V that can cause dehydration, weight loss, and electrolyte imbalances

fluids, antiemetics, BRAT diet, small/frequent meals

how is hyperemesis gravidarum managed

passenger, passageway, powers, positioning, psychological response 

what are the 5 P’s of labor

Preterm babies are expected to be their size for their GA, but IUGR babies are small for their GA due to nutritional deficiencies in the womb

what is the difference between preterm and IUGR

prolonged birth and ROM, poor hygiene, excessive SVE, CAUTIs, C/S, lacerations/episiotomy, retained placental fragments, epidural anesthesia

what are causes of PP infections

chorioamnioitis 

common PP infection that causes greena nd smelly amniotic fluid  

clotting factors and fibrinogen are elevated in pregnancy and in the immediate PP period

why are women at risk for DVT and VE during and after pregnancy

grape-like clusters, enlarged uterus, no actual fetus, brown or bright red bleeding, anemia from blood loss, excessive N/V or hyperemesis, abdominal cramping, preeclampsia, D&C

what are the S/S of hydatidiform molar pregnancy

don’t get pregnant for a year, risk of cancer, HCG labs weekly for a year, D&C, Rhogam

what is the management for a hydatiform molar pregnancy 

rubella and varicella

what vaccines are live vaccines and cannot be given if planning to get pregnant (Must wait a month after receiving them) or if currently pregnant

clotting issues

what are the contraindications for TXA

high-pitched/abnormal cry, irritability, yawning, sneezing, wants to be held but difficult to console, jittery

what are the S/S of opioid withdrawal

uterus involution

when the uterus goes back to normal shape, occurs immediately after the placenta is born 

subinvolution

Failure of the uterus to go back to normal, which can occur from retained placental parts or infection, is a risk for PPH

engorgement

occurs when milk comes in around 72-96 hours after delivery but will go away, breasts are hard, full, and can hurt

do not BF or pump, avoid warm water compress which stimulates the nipple, do cold compress, wear a supportive sports bra, cabbage leaves

What should moms who are non-breastfeeding do when engorgement occurs, because milk comes in regardless of whether they are planning to BF or not

oxytocin

what hormone is related to milk letdown and milk ejection reflex

prolactic

what hormone is responsible for milk production

Insert a catheter to drain the bladder

what do you do if the fundus is shifted to the side

striae gravidum (stretch marks)

what skin changes during pregnancy will not go away

linea nigra, melasma (mask of pregnancy)

what skin changes go away after pregnancy is over

lordosis, center of gravity shifts forward (fall risk), hypermobility of joints

what MSK changes occur during pregnancy that should go away PP

rubra

what type of lochia occurs from days 0-3

bright red, small clots

what does rubra lochia look like

serosa 

what type of lochia occurs from days 4-10

brown, red, or pink

what does serosa lochia look like

alba

what type of lochia occurs from days 10+ up until 2/6 weeks

yellow and white

what does alba lochia look like

call HCP for concern of infection

what should be suspected/done if lochia has a foul odor

hand hygiene before and after changing a pad

what are ways to prevent infection PP

rooming in

what helps with bonding and attachment for baby and parents PP

pink period

the first 2 days after birth in which the mom is really happy

PP depression

what should be expected if baby blues last more than 10 days

overstretched uterus, high parity, grandpariety, polyhydramnios, fetal macrosomia

what are RF for uterine atony

fundal massage immediately and educate mom how to do (after stable) as well, continuous oxytocin, PPH meds

what are interventions for PPH

decreased HR and RR, hypotension (late)

what are the S/S of hypovolemic shock which is a sign of PPH

IV fluids and stop the bleed

what is the treatment of hypovolemic shock due to PPH

U/L edema, pain, tenderness

what are the S/S of DVT

bipolar disorders

who is at risk for PP psychosis

Edinburgh postnatal depression scale

used to screen for PPD/PP psychosis

the 10th: do you want to harm yourself or your baby

what is the most important question of the Edinburgh postnatal depression scale

fatigue, mood swings, flat affect, doesn’t want to bond with the baby

what are signs of PPD which is not normal and different than baby blues

respiratory and circulatory because they were controlled by the placenta

what are the biggest system that change after delivery for infants

shallow, irregular, periods of apnea for around 20 seconds, RR of 30-60 bpm (listen for a whole minute)

what do respirations sound like for the newborn

nasal flaring, grunting, chest retractions

what are signs of respiratory distress that are concerning if present after the first hour

Rhogam

give within 72 hours PP to the mom is positive baby and negative mom

physiological jaundice 

jaundice that occurs 24 hours after birth, is normal, and usually resolves

pathologic jaundice

jaundice that occurs within 24 hours after birth and is abnormal (can lead to permanent brain damage)

hypoglycemia, increased O2 consumption, respiratory distress (nasal flaring, grunting, retractions), acidosis

what are s/s of hypothermia in a newborn

put a hat on them

what should a nurse do to prevent convection heat loss in a newborn

keep the bassinet away from a cold window or draft

what should a nurse do to prevent heat loss from radiation in a newborn

dry off the baby after birth and after baths completely

what should a nurse do to prevent heat loss from evaporation in a newborn

put a blanket on the bassinet and the scale

what should a nurse do to prevent heat loss from conduction in a newborn