NSG 210 Reproduction and clotting test

Risk Factors for newborn complications

Hemorrhage risk factors

grand muliparity 5+

overdistension of uterus

rapid/prolonged labor

retained placenta

placenta previa, abruptio placentae

tocolytics, Mg sulfate, general anesthesia long use oxytocin

c section, forcep use, vacuum extraction

uterine fibroids

hx postpartum hemorrhage

preeclampsia, diabetes

coagulation defects

cathe

Infection risk factors

c section, forcep use, vacuum extraction

multiple cervical exams

prolonged labor

prolonged rupture of membranes

manual extraction placenta

diabetes

cath

bacterial colonization lower GI

preemie risk factors

low weight

obesity

uterine abnormalities

chronic illness

previous preemie

previous second tri spontaneous abortion

hx prego loss

uterine distension

anemia

uterine bleeding, irritation

dehydration

preeclampsia

PPROM

no prenatal care

Prevent preeclampsia

regular prenatal care

monitor weight gain and BP

low dose asprin, calcium, Mg, fish oil

Mg sulfate

used to manage prego associated HTN related seizures

normal newborn temp

axillae: 36.5°C–37.5°C (97.7°F–99.5°F).

normal newborn HR

120-160

100 sleeping

180 crying

normal newborn respiration

30-60 (avg 40-49)

normal newborn BP

systolic: 65-95

diastolic: 30-60

normal newborn weight

5lbs 8 oz- 8lbs 8 oz

normal newborn posture

flexed extremities, fists clenched, symmetric movements, slight tremors if crying

normal newborn skin

pink/tan with acrocyanosis

small amounts of languno

some crackling and peeling

milia, skin tags, erythema toxicum, mongolian spots

4 Ps of birthing

Powers, passage, passenger, psyche

Powers

Contractions (onset through dilation)

maternal pushing efforts (dilation through birth)

Passage

Consists of maternal pelvis and soft tissues

bony pelvis more important to outcome bc bones + joints do not readily yield

Passenger

Baby

Cephalic

head first

Breech

feet/ butt first

Pysche

state of mother

maternal catecholamines released in response to anxiety and fear which inhibit uterine contractility + placental blood flow

Premonitory labor sx

Braxton hicks (uterus prep for birth)

Lightening (baby drops, peeing all the time)

Increase in clear vaginal secretions

Blood show (mucus plug comes out)

Energy spurt (nesting/prepping)

Small weight loss (loose desire to eat)

True labor vs false

Main difference is progressive effacement and dilation of cervix

some women may not have sx of true

False labor

inconsistent contractions (change in activity does not alter)

Discomfort felt in abdomen and groin more annoying

Cervix no significant changes in effacement/dilation

True labor

Contractions ==consistent pattern. Increased intensity, duration, frequency==. (walking increases intensity)

Discomfort begins at low back and wraps around abdomen (can’t talk through)

Cervix effacement + dilation occurs

Mechanism of labor

descent, engagement of presenting parts, flexion of fetal head, internal rotation, extension of fetal head, external rotation, expulsion of fetal shoulders + body

Stages of labor

latent, active, transition

Latent stage

can last a day 0-4cm

Active stage

4-7cm baby descending

Transition stage

8-10cm urge to push

Ruptured membranes

a gush/trickle of fluid from the vagina (must be eval)

2nd stage

pushing to deliever

3rd stage

deliver placenta

4th stage

recovery, uteral involution

ivolution

shrinking and hardening

stationed baby

top of head at ischial spines

fetal compromise sx

HR outside 110-160

meconium stained amniotic fluid

cloudy/yellow amniotic fluid

increased duration and frequency of contractions

tachysystole

maternal hypo/hypertension

maternal fever >100.4

tachysystole

incomplete uterine relaxation, continuous contractions

often occurs from too much pitocin

what position helps increase moms BP

trendelenbrug

If baby is bradycardic what is mom

low BP

what do you do before admin epidural

preload with fluids bc epidural drops BP

ultrasound transducer

external FHR monitor

secured on mother’s abdomen with straps

less accurate than internal

Toco transducer

external monitor

pressure sensitive area detects changes + abdominal contour

measures uterine activity (how far apart and long contractions are)

Fetal scalp electrode

internal monitor detects FHR

Intrauterine pressure catheter

internal monitor strength of contraction

VEAL CHOP

Variables. Cord compression

Early. Head compression

Accelerations. Okay

Late. Placental insufficiency

FHR decel

caused by decreased blood flow through umbilical cord

fall and rise abrupt

Early FHR looks like

upside down (n)

Variable FHR looks like

V

Interventions for nonreassuring FHR

ID cause

Increase placental perfusion

Increased maternal O2 sats

decrease cord compression

Amniotomy purpose

often done in conjunction w/ induction

enables internal and external fetal monitor

Amniotomy

rupturing the membrane

Amniotomy risks

prolapse/compression of umbilical cord

increased risk infection longer the membranes been ruptured

abruptio placentae

Induction + augmentation indications

fetal compromise

spontaneous rupture of membranes near term

post term prego

chorioamnionitis (uterus infection)

HTN assoc. w/ prego

maternal medical conditions

fetal death

Induction + augmentation contra

placenta previa

vasa previa

abnormal presentation (not head)

umbilical cord prolapse

previous uterine surgery (no Pitocin (pressurize rupture)

non-reassuring FHR (no Pitocin (worsen fetal status)

Cervical ripening (induction technique)

prostaglandins

mechanical (transcervical cath, laminaria)

oxytocin diluted in isotonic solution 2ndary infusion

transcervical cath

foley bulb

laminaria

seaweed that expands +dilates

Induction nursing considerations

observe for fetal brady tachy late decels (cant starr unless 30 min + strip of FHR)

observe mother for tachysystole

cervedil

placed in vagina ripens cervix (prostaglandin) can hyperstimulate on cause tachysystole can be removed

Cytotec

dissolves cannot be taken out

same purpose as cervedil

tachysystole sx

contractions >90-120

contractions

Nursing actions tachysystole

reduce/stop oxytocin

increase rate primary nonadditive infusion

keep laboring woman in left lateral

give O2 via snug facemask 8-10L

notify physician/nurse/midwife

external version

promotes vaginal birth by changing fetal presentation from a breech or transverse to cepahlic

internal version

typically used for twins, change position of second after first is born

infant trauma w/ operative delievery

ecchymosis

lacerations

abrasions

facial nerve injury

intercranial hemorrhage

subgaleal hematoma

Episiotomy

incision of perineum just b4 birth

episotomy indications

fetal shoulder dystocia

forceps/vaccum assisted birth

fetus occiput position

preferred incision for c sections

low transverse

uterine fundus descent

1 cm per day

14 days after child birth, fundus should no longer be palpable

Afterpains/intermittent uterine contractions

cause discomfort for women (esp w/ multiparas and breast feeding)

lochia rubra

1-3 days, red, small clots

lochia serosa

pinkish brown days 4-10

lochia alba

white/yellow days 11-12

how long does it take for vagina to regain size and contour

6-12wks

healing of perinuem

4-6 months

1st degree perineal tear

superficial vaginal mucosa + perineal skin

2nd degree tear

vaginal mucosa pernieal skin deeper tissue

3rd degree tear

same as 2nd but involves anal sphincter

4th degree tear

extended through anal sphincter into rectal mucosa

sx distended bladder

displaced fundus

excess lochia

discomfort

frequent voiding <150ml

when does prolactin start prod

2-3 days after birth

how much weight is lost during birth

10-13 lbs

another 4kg/9lbs lost over the next 2 wks

2.5kg/5lbs 6 mnths after

post partum assessment

Breath sounds +<3

Breasts

Uterus

Bladder

Bowels

Lochia
Episiotomy

Homan’s sign DVT

Edema'/emotion

immediate post partum care

comfort (ice, sitz bath, perineal care, meds, position)

peeing

fluids + food

prevent thrombophlebitis

Taking in phase

all about mama

taking hold

my babt

letting go

show off baby

Fundus firm midline @ umbillicus - 2 fingers

FFM@U-2

postpartum blues

starts 1st week

>2wks needs eval

gynecoid pelvis

preferred pelvis for birth

PROM

premature rupture of membranes

PPROM

preterm premature rupture of membranes b4 37 wks

preterm labor

after 20 wks b4 37 wks

placenta acreta

attached to uterine wall

placenta increta

attached to uterine wall

placenta percreta

attached through uterine wall to other organs

placenta increta and perceta require

hysterectomy

Bishops scale >7

inducible

peripartum

last few weeks of prego

what percentage of women experience peripartum depression

6-20%