NURS 333 OB clinical

Edwards

acetaminophen

Brands: Tylenol, Abenol, Panadol

1. Classification- Analgesic (nonopioid), antipyretic; not an NSAID bc it lacks anti-inflammatory action

2. Indications- Tx of pain and fever

3. Contraindications / Precautions- allergy to acetaminophen; severe hepatic impairment or chronic alcoholism

4. Adverse Reactions / Side Effects- Hepatic toxicity, nephrotoxicity; GI upset; anaphylaxis

5. Nursing Considerations- Check allergies, assess pain/fever, evaluate liver/renal function. Regularly evaluate pain relief and fever control; monitor liver enzymes (AST/ALT), BUN/creatinine in at-risk patients; monitor CBC if prolonged use

6. Patient/Family Teaching: Avoid taking multiple acetaminophen- containing products; adhere to maximum daily dose; avoid alcohol; report symptoms like jaundice, rash, bleeding; measure dose accurately

Overdose Management: Antidote: N‑acetylcysteine (NAC)

aldomet

(Methyldopa)

Indication: Chronic hypertension in pregnancy.
Contraindications: Liver disease; MAOIs.
Side effects: Sedation, depression, hemolytic anemia, liver dysfunction.
Nursing: Monitor BPs, LFTs, mental status.
Teaching: May cause drowsiness; avoid alcohol; report jaundice or unusual fatigue.

APGAR scoring

Done at 1 min and 5 mins

• 0-3= severe distress

• 4-6= moderate difficulty adjusting

• 7-10= good adjustment

focused assessment for MOTHER

BUBBLE-REEDAH

(get vitals first!)

• B- breasts- firmness (soft, filling, or engorged); condition of nipples; breast or bottle feeding

• U- uterus- with HOB flat & empty bladder, palpate the fundus (top of uterus). It should be firm & midline, right above umbilicus. If it’s “boggy” (soft), perform a gentle fundal massage

• B- bladder- assess voiding patterns, look for retention/distention. Foley for 6-8 hrs after birth. Should void minimum 30ml / hr

• B- bowels- Patterns/flatus/ bowel sounds. Colace= common stool softener; Symproic= helps relieve gas

• L= Lochia = Normal discharge from vagina after delivery (blood, mucus, tissue). If the pt fills a peri pad every hour, that is too much! (scant, minimal, moderate, heavy). Document color, amt, odor (normal fleshy), clots

• E= episiotomy = During a vaginal delivery, the doctor may cut the perineum (bottom of the vagina) if the baby is too large to exit the birth canal

  • REEDAH assesses episiotomy/ C-section incision

• R- redness

• E- edema- may see initially, should decrease daily

• E- ecchymosis- bruising

• D- discharge from episiotomy- should be NONE (can signify infection, esp. if odor is present)

• A- approximation= all skin edges should be together

• H- Homan’s sign- checks for deep vein thrombosis / DVT / blood clot in leg! Mothers are at high risk after delivery. Dorsiflex pt’s foot (bend toes up & back) - if they have calf pain, they may have a DVT in that leg. Also check for unilateral pain, warmth, swelling, tenderness)

normal vital signs for full term newborn

(40 weeks gestation)

• Heart Rate- 110-160 bpm

• Respirations- 40-60 breaths per min

• bp- 80-60 s / 60-40 d mm Hg

• Temp- 97.7 ͦF - 99.6 ͦF (36.5 ͦC- 37.5 ͦC)

• SpO2- > 95% in right hand. with 3% or less difference in O2 sat between the right hand and r/l foot.

• Head Circumference- 13-15 inches (33 to 37 cm)

• Length- 19-21 in (48 to 53 cm)

• Weight

  • Females= 2.8 - 4.0 kg (6lb, 3 oz to 8 lb, 14 oz)

  • Males= 2.9 - 4.2 kg (6 lb, 7 oz to 9 lb, 5 oz)

  • LBW = <2500g

ankyloglossia

assess for this in a newborn

when a short frenulum attaches the tongue to the floor of the mouth, limiting its mobility

• interferes with breastfeeding

Ballard assessment

determines a newborn’s gestational age - if it was preterm or unknown

• length, weight, & head circumference can then be placed on Growth Chart

Placenta complications: previa, abruptio, accreta

Previa- placenta covers the cervix

• Painless vaginal bleeding

• C section is required

• no vaginal exams

Abruptio- placenta detaches from uterus

• Abrupt painful bleeding

• Baby is deprived of oxygen and nutrients

• Third trimester

Accreta- placenta grows too deeply in the uterine wall

• Does not spontaneously separate & deliver after birth

Moro

“Startle reflex”

• Newborn moves symmetrically in response to loud noise or sudden movement

• Disappears at 3-4 months

Babinski reflex

Stroking sole of infant’s foot upward in a J shape elicits a hyper extension of toes

• disappears at 1 year

Rooting

When cheek or mouth of newborn is stroked, they turn toward that side

• usually disappears at 3-4 months but can last up to 1 year

Tonic neck

“Fencing position”

• newborn reflex

• Neck turns sharply to that side, arm and leg on that side extend while arm and leg on opposite side are flexed

• Disappears in 3-4 months

Lochia

Normal discharge after childbirth

• blood, mucus, uterine tissue

• Can “gush” out when standing up bc it pools while sitting or lying down

• Continues for 4-6 weeks after birth

How body temp changes during menstrual cycle

Basal Body Temp (BBT) rises slightly after ovulation

• can prevent conception

Why do newborns bleed after birth?

Absence of intestinal bacteria & LACKING VITAMIN K.

• viramin K is produced by bacteria in the stomach which haven’t grown yet

• Newborn gets a Vit K shot

Jaundice

Newborns sometimes have immature hepatic function (liver not functioning properly). It can’t break down Bilirubin in the bloodstream- causes yellow appearance

Colposcopy

Magnifies vagina and cervix for examination

• looks for precancerous lesions

• Biopsy taken

• Light bleeding may occur after

Culdoscopy

Views structures in the pelvic cavity

• after the procedure, lay client on stomach with pillow underneath to expel air that entered the abd.

• Checking Under Lady parts thru the CUL De sac of Douglas

Primigravida

A woman pregnant for the first time

• after delivery, they’re a primipara

Rh incompatibility

Occurs when the mother is Rh negative and is carrying a Rh positive fetus.

• Mom’s body doesn’t recognize Rh positive cells and attacks the baby’s cells

• Firstborn babies are not affected usually bc the mom’s body takes time to build antibodies (unless mom had a previous miscarriage)

• If mom and dad are Rh positive, incompatibility is not possible

• Moms/babies at risk need given RhoD immune globin

Depressed fontanels in newborns

Indicate fluid volume deficit

Preeclampsia

Pregnant mother’s arteries constrict, causing increased bp

• report decreased fetal movement, urine output, or persistent and severe Headache

Vernix caseosa

Cheesy substance covering a full-term newborn

Characteristics of a preterm newborn

• bright pink / translucent skin

• Lanugo present (fine hair on body)

• Soft ear cartilage

• Meconium stool

Treating/ preventing heartburn

when the lower esophageal sphincter is weak and stomach acid back flows into throat

• sit up after meals

• Eat small, frequent meals

• avoid gassy, fatty, spicy, fried food

• Myth: drink milk (this can temporarily reduce burning but later causes reflux again bc of fat)