Maternity Final

Folic Acid

a B vitamin that helps prevent neural tube defects in the developing fetus

• lack of folic acid in the diet during pregnancy can also increase the risk of low birth weight and preterm delivery.

• high folic acids food include cereal grains, beans, spinach, kale, broccoli, romaine, lettuce, asparagus, and peanuts. daily allowance is 600 mcg per day.

Chadwick sign

a bluish-purple coloration of the vaginal mucosa and cervix.

complications - Amniotomy

overfilling the uterus, causing high intrauterine pressure, prolapsed cord, placenta abruptio, uterine infection, uterine rupture, maternal chilling & fetal bradycardia (if cold solution is used), fetal tachycardia (if hot solution is used)

medications given to stop labor

Tocolytic medications; Indomethacin & Nifedipine (calcium channel blockers, beta-2 agonists, NSAIDs, magnesium sulfate) to stop preterm labor by decreasing uterine activity.

• side effects - GI upset, hypotension, and tachycardia

Side effects of Magnesium Sulfate

flushing, headache, drowsiness, blurred vision, respiratory depression.

• fetal effects: duration of longer than 5-7 days may cause hypocalcemia in the neonate and possible skeletal abnormalities related to osteopenia.

Expected weight gain in pregnant women

25-35 points if normal weight

Importance on relaxation phase of contraction

The contractions can interfere with fetal oxygenation.

Frank Breech

the hips are flexed and the knees are extended. Presenting part of the fetus is the buttocks.

vertex Presentation

presenting part is the infants head, which is well flexed on the chest.

meconium during labor

fetal distress and risk for meconium aspiration

1st stage of labor; what do contractions do

they dilate and efface the cervix.

VBAC - vaginal birth after cesarean

• major complications of VBAC is ruptured uterus

• contraindications - a large fetus, malpresentation (breech, brow, or transverse lie), cephalopelvic disproportion, more than 2 prior cesarean births, gestational age greater than 41 weeks, gestational diabetes, macrosomia, maternal obesity, short inter pregnancy interval.

uses of Pitocin (oxytocin)

may be given to induce labor, control bleeding, contract the uterus and prevent hemorrhage.

• Contraction parameters - not administered until there are 3 uterine contractions in 10-20 minuses lasting 40 seconds or longer.

possible complications; vacuum extractor

fetal scalp bruising and lacerations, fetal sack injuries that cause either a cephalohematoma or rarely a hematoma. May also cause maternal lacerations of the cervix, vagina, or perineum.

1 and 5 minute Apgar scores

• 1 minute Apgar assessment that scored between 7 and 10 indications that the newborn is adjusting to extrauterine life. A score below 7 indicates that medical or nursing interventions may be needed to improve the newborns cardiorespiratory status.

• if the 5 minute Apgar score is below 7, the newborn should be evaluated every 5 minutes until the score is 7 or above.

the #1 concern for the newborn immediately after delivery

Thermoregulation

Calculating EDD with Naegele’s rule

subtract 3 months from the first day of the menstrual period (LMP) and then add 7 days, which will indicate the approx. date if delivery.

Prenatal visit schedule for uncomplicated pregnancy

• monthly for the first 28 weeks of gestation

• every 2 weeks until 36 weeks of gestation

• weekly after 36 weeks until childbirth.

4th stage of labor

“Recovery”

• bleeding problems may occur

• promote bonding with the infant

• provide a warming blanket

• monitoring blood pressure and pulse every 15 minutes

• palpating the uterus for firmness every 15 mins or more often if needed

• massaging the uterus

• monitoring lochia

• promoting breastfeeding

• providing perineal comfort

use of cold packs in postpartum

to provide perineal comfort.

nurses role if mother is in 2nd stage of labor when pain medication are requested

stay and breathe with her during contractions because she is pass the safe point for the fetus.

interventions for a prolapsed cord

• arrange for an immediate cesarean delivery

• place two fingers in the vagina to elevate the presenting part off the umbilical cord (avoid palpating the cord, which could lead to vasospasm. maintain elevating the presenting part until the uterine incision is made)

• position the mother in the knee-chest or trendelenburg position to allow gravity to assist with elevation of the fetal presenting part

• if there is a delay of more than 30 minutes before delivery, some health-care providers fill the bladder with 500 to 750 mL of fluid to assist with elevation of the fetal presenting part.

• if the cord is outside the mothers body, cover it with wet gauze and replace it gently in the vagina.

• provide oxygen via face mask to increase the oxygen levels for the fetus.

Medications used in a induction

Oxytocin to produce contractions, Dinoprostone initiates softening, effacement, and dilation of the cervix and stimulates the myometrium to cause contractions, Prostaglandin E1 along (misoprostol) is a synthetic prostaglandin that can be used for cervical ripening.

significant signs of hypoglycemia in newborns

jitteriness or tremors, lethargy, or irritability, hypotonia, weak or high-pitch cry, apnea, hypothermia, poor feeding.

lowest acceptable glucose value in newborn

30 mg/dL

RhoGAM

“Rho(D) immune globulin” administered IM within 72 hours of birth prevent sensitization to the RH factor in an Rh-negative women with an infant who is Rh positive

• this medication will prevent hemolytic disease in subsequent pregnancies.

signs of hypovolemic shock

when a child presents in severe dehydration and the experiences severe vascular volume depletion. urine output is severe compromised.

• decreased blood pressure, increased heart rate, restlessness, confusion.

types of formula

hypoallergenic formula, soy-based.

Ready to feed formula - is available in a can or carton and should not be diluted.

Liquid concentrated formula - is formatted to be diluted with equal amounts of water.

Power formula - should be dissolved in water.

umbilical cord care

the cord will slowly change form whitish blue to black over a period of several days. the stump will fall off within 10 to 21 days.

• keep the stump dry by folding the diaper below the stump so the it is exposed to air.

• sponge bath the baby until the cord falls off

• apply no antimicrobial cream to the stump

• keep the cord cell, if it becomes soiled, clean with warm water and pat dry

• allow the dried cord to fall of on it own, avoid pulling on the cord to dislodge it

• when the cord falls off, small bleeding may occur

• report any signs of infection such as pus or redness around the umbilical stump.

Earliest you can hear the heart beat with a doppler

10 to 12 weeks of gestation.

what is the concern with a sudden weight gain of 10 pounds

possible sounds of preeclampsia, edema, hypertension or heart issues.

intended effect of glucocorticoids in pre-term labor

accelerate fetal lung maturity and reduce the risk of complications.

• stimulate production of surfactant in fetal lungs

Specific lab test for sickle cell

Hemoglobin electrophoresis

• confirms the presence of hemoglobin S (HbS)

Danger of prolonged contractions and coming too close together, “danger stats”

• more than 5 contraction in 10 minutes

• contractions lasting 90-120 seconds

• less than 60 seconds of resting tone between contractions

where is the uterus relative to the umbilicus immediately after delivery

at or slightly below the umbilicus (belly button)

Breastfeeding education points including diet, positioning and a good latch

• 450-500 extra calories/day, 8-10 glasses/day, no more than 200 mg/day, avoid alcohol (wait at least 2 hours per drink breastfeeding), include lean protein, whole grains, fruits, vegetables, and calcium-rich foods.

• cradle-hold, cross-cradle hold, football hold, and side-lying position (tummy-tummy, ear shoulder and hip should be in a straight line, bring baby to the breast not breast to baby)

• (good latch) baby mouth is wide open, baby chin and nose touch the breast, more areola is visible above the upper lip, no pain, audible swallowing.

post delivery concern when you see no lochia after 3 hours

the uterus is not effectively contracting against the cervix, the bladder may be distended, displacing the uterus and preventing proper lochial flow, blood many be pooling in the uterus, raising the risk of postpartum hemorrhage.

• you will likely find a firm fungus that is displaced, usually upward and to the right.

live vaccines for mothers

safe to administer immediately after delivery, even if the mother is breastfeeding.

mastitis parameters for continuing to breast feed

no abscess is present, client is medically stable (even if antibiotics are needed, many are safe to use while breastfeeding), infant is latching well, mild to moderate pain (can be managed with cold compresses and NSAIDs like ibuprofen)

tips to reduce the risk of mastitis

empty the breasts regularly, ensure proper latch and positioning, alternate breasts, avoid tight clothing or pressure on breasts, treat nipple trauma promptly, stay hydrated and well-rested, hand hygiene.

How to assess the funds in a vaginal delivery

position the client supine with knees slightly flexed, support the lower uterus with one hand just above the pbuic bone, use the other hand to palpate the top of the uterus (fungus). check fro location (midline/deviated), height (relative to the umbilicus), tone (firm vs. boggy)

• expected findings - funds is firm, midline, and at the level of the umbilicus, should descend about 1 cm per day, by day 10 it should not be palpable.

how to assess the funds, cesarean delivery

same position but be more gentle (incision pain), support the lower uterus, palpate fundus lightly.

pre-term labor, education needs if they are sent home

report regular contractions, pelvic pressure or low back pain, leaking fluid, vaginal bleeding or spotting, decreased fetal movement, menstrual like cramps or a tightening sensation. limit physical activity, avoid heavy lifting, avoid sexual activity.