Maternity Test 1

False Labor

No cervical change, contractions are irregular, varied length, not as painful (Braxton-Hicks)

False Labor Interventions

REST, HYDRATE, MEDS

False Labor Causes

Stress, Dehydration, and Fatigue

True Labor

Cervix dilates, effaces, and contractions become more frequent, stronger, and regular duration

Dilate

cervix opens

Effaces

Cervix thins

Stage 1 of Labor

Cervical dilation 0-10cm, early, latent, and active

Early

0-5 cm, lasts about 20hrs, contractions are still irregular at every 5-30 minutes lasting about 30 seconds

Latent

0-5cm, regular contractions about every 3-5 minutes and lasting about 60 seconds

Active

6-10cm, regular contractions lasting 60-90 seconds

Stage 2 of Labor

pushing and birthing of neonate, ends when the baby is delivered

power

contractions

passenger

fetus

passage

route through the bony pelvis

psyche

mom's mental status

passage factors

fetal head size, fetal attitue, fetal lie, presentation

Fetal Lie

Longitudinal, transverse, oblique

Fetal lie: longitudinal

vertical

fetal lie: transverse

horizontal

Fetal lie: oblique

fetus at slight angle

Presentation

Cephalic/Vertex, Breech, Shoulder

Presentation: Cephalic

head first

Presentation: Breech

fetal pelvis is the presenting part

Presentation: shoulder

shoulder first

Stage 3 of Labor

delivery of the placenta

Stage 3 Consideration

MUST NOT EXCEED 20 MINUTES, due to dilate uterine veins/hemorrhage risk if it does

Stage 4 of Labor

1-4 hours post op, hemodynamic stability is highest priority due to hemorrhage risk

Stage 4 Monitoring

Monitor BR, Hr, fundus firmness, lochia, promote bonding and helps with breastfeeding

Fundus Firmness Assessment

the fundus should decrease 1cm a day till day 10 then it should no longer be palpable

Lochia

vaginal discharge after birth

Stage of Labor Treatments

Narcotic/ Morphine and/or Anticholinergic/ Vistaril. Morphine + Vistaril may be prescribed during latent labor to provide therapeutic rest.

Morphine

provides pain relief

Vistaril

promotes relaxation and sedation

FHR monitoring at..

beginning, peak (acme), and end of each contraction

duration

length of each contraction from beginning to end

Frequency

beginning of one contraction to the beginning of the next (3-5 must be measured for accurate number)

intensity

measure by internal uterine monitoring after amniotic membrane has been ruptured, ranges from 30-70 mmHG at peak

Internal monitoring

used for high risk but amniotic sac must be ruptured, RISK FOR FETAL AND UTERINE INFECTION

Internal Monitoring: Spiral Electrode

placed on baby's scalp, cardiotachometer moitors baby HR

Internal Monitoring: Intrauterine Pressure Catheter (IUPC)

monitors uterine contraction, frequency, duration, and strength (Montevideo Units (MVUs) avg is 280

External Monitoring

belly band monitors with two parts to monitor fetal HR and uterine contractions

External Monitoring: Tocotransducer

monitors the frequency and duration of contractions, placed at the top since contractions start at the fundus

External Monitoring: Ultrasound Transducer

monitors fetal HR, better heard when placed on the baby's back so typically placed at the bottom of the stomach

Doppler

provides closer proximity to auscultate the fetal HR for women who are obese or earlier in gestation

Normal Fetal HR

110-160 bpm

Fetal Bradycardia

FHR < 110, late manifestation of fetal hypoxia, fetal cardiac problems, maternal hypoglycemia, prolonged umbilical cord compression or head compression

Fetal Tachycardia

FHR > 160, THINK MOM HAS A FEVER, early sign of fetal hypoxia, fetal infection, maternal infection, maternal fever, maternal hyperthyroidism, medication or drug induced (mild tachycardia can be normal in less than 28 weeks gestation)

Fetal Bradycardia Interventions

NOTIFY HCP, change maternal position to side laying, stop oxytocin, administer maternal oxygen, fluid bolus with LR

Fetal Tachycardia Interventions

NOTIFY HCP, IV fluid bolus, reduce maternal fever, administer antipyretics (Tylenol), administer maternal oxygen

FHR Variability

Absent, minimal, moderate, or marked

FHR Variability: Absent

amplitude range is undetectable (EMERGENCY)

FHR Variability: Minimal

amplitude range detectable up to and including 5 beats/min (monitor)

FHR Variability: Moderate

amplitude range of 6-25 beats/min (goal)

FHR Variability: marked

amplitude range greater then 25 beats/min (EMERGENCY)

Normal Contractions

cause the cervix to change, duration between 45-90 seconds, frequency 3-5 minute (you don't want more than 5 contractions in 10 minute window) allow for fetal relaxation and oxygenation

Bad Contractions

duration longer than 90 seconds or frequency less than 30 minutes cause decreased O2 and increased CO2 risking fetal acidosis and brain damage, not enough causes o cervical change and prolongs labor

VEAL CHOP

V- Variable Decelerations, E- Early Decelerations, A- Acceleration, L- Late Decelerations

C- Cord Compression, H- Head compression, O- Ok, P- uteroPlacental insufficiency

Variable Decelerations

U, V, and W shape, caused by cord compression

Variable Decelerations Interventions

change maternal position to get pressure off the cord, consider late deceleration interventions if they continue

Early Decelerations

mirror the contraction, deceleration starts early or before the peak of the contraction

Early Decelerations Interventions

normal- no interventions needed

Acceleration

good blood flow to the baby to be considered a true acceleration it must go up by 15 beats and last 15 seconds

Acceleration Intervention

normal

Late Decelerations

VERY BAD, indicated fetal acidosis which can lead to brain damage and death, starts late or after the peak of the contraction caused by uteroplacental insufficiency

Late Decelerations Interventions

Turn the pt, turn off oxytocin, give oxygen 10L non rebreather, give fluid bolus, call the provider

Neonate Vitals

Temp: 97.8-99 F

HR: 110-160

Resp: 30-60

Tone

Normal: flexed

Abnormal: Flaccid (acidotic and compromised due to decreased O2 and increased CO2)

Skin

Normal: Stork Bite, Milia, Erythema Toxicum, Congenital Dermal Melanocytosis

Abnormal: Breaks/lesions, Jaundice

Head

Normal: Molding, Caput, Open Fontanels

Abnormal: Bruising, Cephalohematoma, Closed Fontanel, Cleft Lip

Stork Bites

Telangiectatic nevi

Salmon colored patches on back of neck, eyelids, or between eyes seen in whites

Blanched, generally disappear within first year of life

Milia

small raised white spots on nose, chin, and forehead

Erythma Toxicum

newborn rash, seen in about half of all babies in the first few days of life. There are white or yellowish vesicles on an erythematous base, and the lesions come and go rapidly. It can look frightening to parents, but is normal. Again, treatment is not necessary or indicated. "baby acne"

congenital dermal melanocytosis

bluish-black areas of hyperpigmentation often found on the lower back or buttocks of darker-skinned neonates

Molding

Shaping of the fetal head during movement through the birth canal.

Caput

dependent edema/ baby upside down contracting on head for hours

Cephalohematoma

Swelling caused by bleeding between the osteum and periosteum of the skull. This swelling does not cross suture lines.

Fontanels

Gaps between a baby's skull that slowly close up during the first 18 months of life

Cleft Lip

a birth defect in which there is a deep groove of the lip running upward to the nose as a result of the failure of this portion of the lip to close during prenatal development

Eyes

Normal: white sclera, aligned with the top of the ears

Abnormal: drainage (sign of conjuctivitis)

Ears

Abnormal: dimpling

Oral Exam

Normal: symmetrical lips, intact palate

Abnormal: Tongue Tied

Tongue Tied

a physical medical condition where a short band of tissue restricts tongue movement

Clavical

Abnormal: bump of infant crying upon palpation indicates injury or fracture

Lungs

Inspect the chest wall for configuration and Lung sounds in the apices and bases. Assess for adventitious sounds and tachypnea. (lungs curve so you only need to assess anterior)

Cardiovascular

Auscultate the heart in all 5 (APETM) auscultatory areas using both the bell and the diaphragm; note rhythm, rate, murmurs, and extra sounds and Assess brachial and femoral pulses should be palpable

Abdomen

Inspect for contour and distention, bowel sounds (right and left), and evaluate the cord for three vessels/AVA

Genitals Male

Male- two descended testicles and a center meatus - term

Genitals Female

Majora completely covers the minora and clitoris

Back

Normal: spinal closure, alignment, sacral bump

Abnormal: bulging (sign of spina bifida), uneven gluteal folds (hip dysplasia)

Rooting Reflex

an infant's response in turning toward the source of touching that occurs anywhere around his or her mouth

Sucking Reflex

Reflex that causes a newborn to make sucking motions when a finger or nipple if placed in the mouth

Extrusion Relfex

When you touch or press the tip of a baby's tongue, they automatically push their tongue outward. This helps protect them from swallowing unsafe things

Palmar Grasp Reflex

When you put a finger or object into the open palm of a baby's hand, they close their fingers and grip it tightly.

Plantar Grasp Reflex

When you press or stroke the skin right under a baby's toes, the toes curl downward to grab your finger

Stepping reflex

When you hold a baby upright with their feet touching a flat surface, they move their legs like they are trying to walk or dance

Moro/Startle Reflex

When a baby hears a loud noise or feels a sudden drop, they throw their arms and legs out wide, spread their fingers, and then pull them back inward while crying

Tonic Neck Reflex

When a baby lies on their back and turns their head to one side, the arm on that side straightens out straight, while the opposite arm bends up at the elbow like a fencer

Babinski Reflex

When you firmly stroke the bottom of a baby's foot from the heel to the toes, the big toe pulls upward and the other toes fan out wide

Normal Newborn Medications

Erythromycin ophthalmic ointment 0.5%, Vitamin K (AquaMEPHYTON) 0.5 mg IM, and Hepatitis B Vaccine and HBIG if the mom is positive for Hepatitis B

Erythromycin ophthalmic ointment 0.5%

a. Recommended to prevent ophthalmia neonatorum

b. Administer within first hour of birth. If parents desire an open-eye bonding period, may delay eye prophylaxis for up to 2 hours.