Maternal/newborn

s/s chorioamnionitis

FUTA
fever
uterine tenderness
tachycardia (fetal/mom)
Amniotic abnormalities (Green, odorous fluid)

risk factors chorio

chlamydia/gbs
frequent vag exams
internal devices
prolonged rupture of membranes (ABOVE 18 HRS)

chorio management

FIRST: CBC/cultures
give iv abx
prepare for c section

s/s neonatal sepsis

TEMP INSTABILITY
RESP DISTRESS
POOR FEEDING AND LETHARGY
SHOCK: HYPOTONIA MOTTLED SKIN

risk for neonatal sepsis

INFECTED MOM (GBS/CHORIO)
ROM ABOVE 18 hrs
PREMATURITY
INVASIVE PROCEDURES (CENTRAL LINE/IV)

neonatal sepsis prevention/monitoring

NEOSAFE

Newborn vitals (Track unstable temperature, fast breathing, or low heart rate).

E – Energy & feeding (Watch for poor sucking, lethargy, or sudden sleepiness).

O – Output & skin (Monitor for pale/mottled skin, jaundice, or poor wet diapers).

S – Sterile technique (Wash hands strictly and keep the umbilical cord clean).

A – Antibiotics early (Give maternal/neonatal antibiotics promptly when risked).

F – Fluid balance (Maintain hydration to support blood pressure and perfusion).

E – Environmental control (Keep the baby warm to prevent cold stress).

neonatal sepsis nursing interventions

FIRST: CBC/cultures
give iv abx
then IV fluids if shock
o2 as needed

ectopic pregnancy risk factors

prior tubal surgery
STDs
intrauterine device

ectopic pregnancy s/s

MISSED PEROID
POSITIVE HCG
UNILATERAL LOWER ABD PAIN
confirmed via vaginal ultrasound

ectopic pregnancy treatment (unruptured)

give methotrexate
NO FOLIC ACID (methotrexate antidote)
track hcg levels (down is good)
OPIOIDS MASK RUPTURE

ectopic pregnancy rupture s/s

sudden, sharp abdominal pain
referred shoulder pain
cullen’s sign: bruise on umbilicus
signs of shock

ectopic pregnancy treatment (ruptured)

SURGERY TIME
2 VADs for fluid
Rh and type and screen

ectopic preg teaching

PREGNANCY IS POSSIBLE
GIVE RH IF RH NEGATIVE

Molar pregnancy

pregnant with trophoblastic cells instead of regular cells
body thinks ur pregnant

Molar Pregnancy s/s

dark brown vaginal bleeding (prune juice)
hyperemesis gravidarum
higher than expected fundal height
preeclampsia before 24 wks (s/s are proteinuria/HTN)

Molar Pregnancy treatment

vacuum it out
NO UTERINE STIMULANTS UNTIL AFTER SURGERY
give stimulants after surgery

Molar Pregnancy teaching

monitor for neoplasia (cancer) FOR A YEAR

Increasing hcg levels = CANCER (yay)!
TREAT NEOPLASIA WITH METHOTREXATE
NO PREGNANCY/IUD

use oral contraceptives

Types of FHR Monitoring and requirements

external monitoring: ultrasound + toco
internal: fetal scalp electrode + iu pressure catheter
INTERNAL REQUIRES ROM AND DILATION ABOVE 2 CM

contractions

40-90 seconds every 2-5 min
if over 5, or under 2: lowers placental reperfusion
give terbutaline to slow/stop contractions

fhr

110-160
tachy: fever/dehydration
brady: hypoglycemia
treat cause
if minimal/absent: fetal sleep/hypoxia
wake up fetus

What acronym is for minimal/absent FHR?

Stop oxytocin
Tocolytic
Oxygen
Position left lateral
Increase iv
Notify healthcare

Gestational Diabetes patho

border control - placenta lets glucose in, keeps insulin out

gestational diabetes risk factors

overweight
history of GDM
above age of 25
minority
IMMEDIATE family history

GDM clinical manifestations

hyperglycemia
3 Ps

increase in fundal height from polyhydramnios/macrosomia (big baby)

Polyhydramnios

caused by fetal polyuria
increases fundal height

Macrosomia

increased fetal insulin

gdm diagnostics

screened from 24-28 wks gestation
1 hr glucose - if positive, then 2 hr

gdm treatment

first, start with diet/exercise
then insulin
teach signs of hypoglycemia
rule of 15 - 15 grams of carbs, check every 15 minutes

gdm complications

think viscous blood
preeclampsia, underdeveeloped baby, big baby, hypoglycemia after delivery
HEEL WARMER FOR BABY
if baby is aware, give oral feedings
if not, iv dextrose

newborn hypoglycemia symptoms

persistent jitters
respiratory distress