NRSG 328 Maternity

Gravida

any pregnancy, including the one in progress

Nulligravida

never been pregnant

Primigravida

first pregnancy

Multigravida

given birth to two or more children

Para

the number of pregnancies over 20 weeks

Primipara

a person who has given birth to their first child after 20 weeks

Multipara

person given birth to 2 or more children after 20 weeks

Nullipara

not person who has completed pregnancy past 20 weeks

Abortion

spontaneous or elective

what is the McDonald Sign?

an ease in flexing the body of the uterus against the cervix

creates less than 90 degrees

changes in the anatomy

What is ballottement?

Light tap of examining finger on cervix causes fetus to rise in amniotic fluid & then rebound to original position (16-18 wks)

head is not in the birth canal yet, floating above the uterus

when is the first Ultrasound?

14 weeks

what are the 1st trimester pregnancy discomforts?

Fatigue, nausea, headaches, frequent urination, mood swings, breast changes, constipation

when is the 1st trimester?

0-13 weeks

what are the 2nd trimester pregnancy discomforts?

Nasal congestion & nosebleeds, inflamed/bleeding gums, constipation, changes in pigmentation (face, abdomen), stretch marks

when is the 2nd trimester?

14-27 weeks

what are the 3rd trimester pregnancy discomforts?

Lower backache, fatigue, leg cramps, frequent urination, shortness of breath, heartburn, constipation, swelling of feet, varicose veins, hemorrhoids, insomnia

when is the 3rd trimester?

27-40+ weeks

what is Human Chorionic Gonadotropin?

hCG- the hormone pregnant women release. The test to determine if a woman is pregnant.

what does estrogen do in pregnancy?

Produced first by the corpus luteum (until day 14) and then by the placenta (enlarges uterus, breasts & genitals; promotes fat deposit changes; triggers skin changes; vascular changes, relaxes pelvic ligaments, decreases ability of pancreas to produce insulin) Uterus expands gradually and houses the fetus, the amniotic fluid, and the placenta

what does progesterone do in pregnancy?

Progesterone - produced first by the corpus luteum (until day 14) and then by the placenta (maintains endometrium; inhibits oxytocin & uterine contraction; prepares breasts for lactation; reduces smooth muscle tone - GI (constipation; heartburn) & varicosities)

what does relaxin do?

Produced first by the corpus luteum & placenta (causes connective tissue of symphysis pubis to be more moveable and cervix to soften; inhibits uterine activity)

what does Human Chorionic Somatomammotropin do?

(previously called human placental lactogen hPL) - produced by the placenta (affects glucose & protein metabolism - allows increased glucose to stimulate the pancreas & increase insulin levels; breast development)

what are changes in the vagina and cervix?

Changes in colour (purplish/blueish - Chadwick sign) Cervix becomes softer (Goodell sign) Vaginal pH increases to protect against infection; Vaginal secretions have increased glycogen Risk for yeast infections

what are changes in the breast?

Estrogen and progesterone prepare for breastfeeding Pigmentation increases Colostrum (+++antibodies) can be expressed at the end of pregnancy

what are circulatory changes in pregnancy?

Cardiac output increases by 30-50%; pulse rate may increase

swelling in feet

what are respiratory changes in pregnancy?

thoracic breathing

not the best to try a brand new exercise

dyspnea may occur

what is supine hypotension?

Pressure of baby placed on abdominal vena cava preventing blood return causing drop in BP

could cause fetal hypoxia

what is the safety position?

left side

what are urinary changes in pregnancy?

Filtration rate of kidneys increases; water is retained for increasing blood volume and glycosuria and proteinuria may occur

Progesterone relaxes ureters and bladder à can cause stasis of nutrient rich urine leading to urinary tract infections

what are gastrointestinal changes in pregnancy?

Uterus displaces the stomach & intestines; Mouth tissue may become more tender & bleed (blood vessel development caused by estrogen); Slower digestive system (constipation, bloating); relaxed pyloric sphincter (pyrosis - heartburn)

what are musculoskeletal changes in pregnancy?

Posture changes as fetus grows - low back pain, rounding of the shoulders Pelvic joints relax - "waddling" gait as symphysis pubis slightly separates (relaxin)

What is isoimmunization?

Isoimmunization is when the Rh-positive blood leaks into the Rh- negative mother's circulation, resulting in her body producing antibodies that would destroy Rh-positive erythrocytes.

what is RhoGAM?

give for Neg mother and pos baby

What is gestational hypertension?

goes away after birth

occurs after 20 weeks of gestation

what is pre-clampsia?

Increase in blood pressure with proteinuria

what is eclampsia?

seizure occurs

need C-section

what are the HELLP syndrome signs?

Right upper quadrant or epigastric pain Nausea

Vomiting

Malaise

Abnormal enzyme levels

what is the HELLP Syndrome?

Preeclampsia with thrombotic microangiopathy involving the liver

HELLP = Hemolysis, Elevated Liver Enzymes, and Low Platelets

what are the effects of pregnancy on glucose metabolism?

the hormones: estrogen and progesterone cause inc resistance of cells to insulin and inc speed of insulin breakdown

what is the gestational diabetes mellitus?

Impaired tolerance to glucose with the first onset or recognition during pregnancy

what is the diagnosis of GDM?

50g oral glucose challenge test

If result is 7.8-11.0, this is a positive screen

what is the GDM treatments?

diet: high protein, healthy fats, vegetables

exericse

insulin

What is a TORCH infection?

Toxoplasmosis

Other

Rubella-make sure mom had the vaccine

Cytomegalovirus-hearing loss

Herpes-making sure that it is under control (chronic viral infection)

what is BUBBLEEE

Breasts Uterus Bowel Bladder Lochia Episiotomy Extremities Emotional Status

What is mastits?

occurs when there is a block in the milk duct

this is complication

needs antibiotics to clear it to prevent sepsis

can still cont. breastfeeding and pumping

apply heat and massage

breast engorgement?

use a warm compress

cold compress to dec swelling

engorgement around day 3

warm water on breast to dec engorgement, express some milk to loosen milk ducts

cracked/damaged nipples

get a good latch, want to get the baby to latch onto the areola.

tummy to mommy

nose to nipple

if nipple comes out of the mouth circular-good latch

if it is oval-not a good latch

how to break a latch

use pinky finger to hook onto the baby's mouth

what is colostrum?

A milk-like substance secreted right after delivery

What is lanolin?

emollient with moisturizing properties for nipples

what is the fundus?

top of uterus

post delivery is at the umbilicus

cont. to go down by 1 cm

by two weeks: should not be able to palpate it anymore

an uncomfortable assessment

what is boggy?

soft uterus

massage to dec boggy uterus.

Antepartum period

period before the onset of labor

how often do we want the person to urinate?

every 4 hours

"pee before you breastfeed everytime"

what is induction in postpartum?

what is the lochia assessment?

rubra-red

serosa-pink

alba-yellow and white

do not want pad to be completely saturated in one hour

what size clot do you start to assess?

toonie size

what is the rescue position?

left

what is the perineal care?

peri-spray bottle

ice

warm and sanitize after initial 24 hours

keeps the tear or episiotomy clean

what are the 1st to 4th degree tears?

1st: superficial no sutures, no repairs tend to be done

2nd: common as well, may require a couple sutures

3rd: same a second degree plus the anal sphincter

4th: extends through the anal sphincter into the rectal mucosa (OR)

why would an episiotomy be performed?

shoulder dystocia

before a forcep delivery

when the baby is stuck

what are C-section considerations?

considered an abdominal surgery

baby is pushing from the top to get the baby out

make sure they have analgesic beforehand

use REEDA to assess the site

GU: catheter

GI: NPO if it is elective C-section

pain management: opioid prescription: dilaudud/morphine, its okay for the mom to BF

what might we see in terms of lochia after C-section?

less

what are the rx factors for DVT?

•Coagulation disorders, heart disease

•Age >35, multiple gestation, obesity, immobility

•Postpartum infection

•Caesarean birth

how to prevent DVT?

•Mobilization, compression devices, low-molecular weight heparin

what are normal postpartum emotions?

crying, frustration, stress

what is rubin's psycological changes of postpartum?

Taking-in: first 24 hrs, mother is passive and lets the other do things for them

Taking-hold: 1-3 days to weeks, mother initiates actions and becomes interested in caring for the newborn

Letting-go: parents starts reflecting on birthing experience

what are postpartum blues?

•50-80%

•Up to 10 to 14 days postpartum

related to hormones changes

now there is an infant you need to take care of

new identity: having a baby be codependent on you.

look at how this presents in the partner as well. nap while partner takes care of the baby

what is anxious attachment?

demand closeness, less trusting, more emotional, jealous, and possessive

what is avoidant attachment?

the child shows no preference between a stranger and the caregiver. the caregiver has little or no response to a distressed child

what is avoidant attachment?

the child shows no preference between a stranger and the caregiver. the caregiver has little or no response to a distressed child

What is disorganized attachment?

no clear pattern of behavior in response to the caregiver's absence or presence

inc rx of mental health challenges

following delivery: vital signs

VS q15min for one hour

check again in one hour

and then 1 shift

what is Precipitous labour?

give birth quick, inc rx of bleeding

what happens when you find PPH?

call for help and do the aggressive massage to fundus

what are the 4Ts of PPH?

Tone

Tissue

Trauma

Thrombin

what is puerperal infection?

-bacterial infections after child birth

-occurs within 28 days of abortion or delivery

-found inside or outside of vagina

prevent: hygiene, handwashing

what is PROM?

premature rupture of membranes

What does the placenta do?

supplies fetus with blood, nutrients

what chemical stimuli stimulate resp/cardiac for extra-uterine life?

•Cessation of umbilical cord flow (↓O2, ↑CO2, ↓pH)​

•These changes stimulate aortic and carotid chemoreceptors​

what mechanical stimuli stimulate resp/cardiac for extra-uterine life?

•Compression of the chest during birth removes fluid from the neonate's lungs​

•Air replaces fluid in lungs during re-expansion at birth​

•Further lung expansion occurs with cries​

•↑intrathoracic pressure helps to open and fill alveoli with air

how long do we do umbilical cord clamping?

2 minutes

sometimes in OR after C-section: for 1 minutes

what are the benefits of skin-to-skin?

- Bonding

- Increased success in breast feeding

- Thermoregulation

- Pain control

- Decreases anxiety

-stables vitals

What is normothermia?

36.5-37.5 C

what helps maintain normothermia?

-skin to skin

-warm blanket

-wear a hat

-increase temp in room

-baby is not under a cooling vent

When do we do APGAR scores?

1 min, 5 min, reflects the condition of the baby at that time,

7 or below apgar at 10 min

How many fontanelles are there? What are they?

2 (anterior and posterior)

When does the anterior fontanel close?

12-18 months

what is the shape of posterior fontanelle?

triangle

When does the posterior fontanel close?

2 months

what are the newborn head assessment?

molding

hematoma

sunken fontanelle

buising

when does umbilical cord usually fall off?

5-14 days

care: use soap and water, don't need to use alcohol

clean to make sure nothing is building up

What is the Galeazzi sign?

Knee is lower in position of the affected side when patient is supine and knees are flexed.

What is hypospadias?

opening of the urethra on inferior surface of penis

Due to failure of the urethral folds to close

what are the newborn medications?

vitamin K:

erythromycin eye prophylaxis

ophthalmia neonatorum

What is purple crying?

The time period when babies cry and they are inconsolable.

what were birth alerts?

Nurses/physicians would flag parents to service services so that they can watch them when having children and their child can be taken away at birth. would not tell parents that their file has been flagged. MCFD. child was apprehended. birth alerts occurred up until 2019.

what are some colonial history that controlled mothers?

Indian act

Sixies scoop

birth alerts

drug poisoning occured more in indigenous motheres

why do we want to keep mothers and babys together?

mitigate toxic stress in newborn

enhance bonding

increase family unity

cost reduction