OB & Pediatric Nursing Vocabulary Review

Skills, Abbreviations & Terminology

• TPAL: Term, Pre-term, Abortions, Living children – rapid obstetric résumé
• LMP / PMP / EDC (EDD) – dating acronyms
• GP or GTPAL five-digit gravidity/ parity system
• Gyn/procedural terms
  • CKC, LEEP, BTL, D\&C, TVH, TAH, LAVH, TLH, BSO
• Word roots & suffixes (oligo-, hyper-, hypo-, meno-, ‑rrhea, ‑ect omy, ‑otomy…)
• Common perinatal abbreviations: PROM, PPROM, SVD, LTCS, VBAC, VAVD, SAB, EAB, IUFD, ASCUS, LGSIL, HGSIL

Routine Post-Partum Assessment – BUBBLE-HEE

• Breast
  • Condition of nipples, engorgement, colostrum/ milk “coming-in”
• Uterus
  • Tone: firm vs boggy (atony)
  • Position/ fundal height: $@U$, $@U \pm 1$ finger-breadths each PP day
• Bowel
  • BS present? BM/ flatus; no stool required before discharge but flatus must pass
• Bladder
  • Voiding pattern; ensure empty to prevent uterine deviation/ hemorrhage
• Lochia
  • COCA (color, odor, clots, amount)
  • Rubra $\sim 4$ d ➔ Serosa $\sim 10$ d ➔ Alba $4!–!6$ wk
  • Scant < 2.5 cm; Light < 10 cm; Mod 10 cm; Heavy pad ≈ saturated in < 1 h
• Episiotomy/ laceration (REEDA), peri-bottle usage, hemorrhoids
• Extremities – pulses, edema, DVT, SCDs
• Emotional status – Taking-in, Taking-hold, Letting-go phases

Newborn Basics

• Vitals order: Resp ($30!–!60$, ≤ $20$ s apnea), Pulse $110!–!160$, Temp $98!–!99$ °F (fever $\ge 100.4$)
• Injections first yr
  • Site: Vastus lateralis; 25 G $5/8$ in; 90°; separate multiple shots $\approx 1$ in
• Medications @ birth
  • Vit K $1$ mg IM, Erythromycin OU, Hep B vaccine (+ HBIG if mom $H\,BsAg^+$)

Contraception & Pre-Conception Counseling

• Natural: FAM, BBT (drop $0.5$ °F pre-ovulation then rise $1$ °F), cervical mucus, LAM, coitus interruptus
• Barrier: spermicide, condoms, diaphragm/cap
• Hormonal: pill $99.9\%$, implant, Depo $q12$ wk (Ca$^{++}$ loss), patch/ring
• IUD: Paragard $10$ yr (Cu), Mirena $5$ yr (levonorgestrel)
• Surgical: Vasectomy, BTL

Fetal Development Highlights

• Pregnancy length $40$ wk / $280$ d
• Pre-embryonic $0!–!2$ wk; Embryonic $2!–!8$ wk (all organs); Fetal $\ge 8$ wk
• Placenta functions – metabolic, gas exchange, excretory, endocrine; optimal perfusion at rest; compromised by HTN, contractions, Vena-cava compression, smoking
• Amniotic fluid: $\approx 800$ mL @ $34$ wk ➔ $600$ mL at term
  • Oligo < $300$ mL; Poly > $2000$ mL

Diagnosis of Pregnancy

• Presumptive: amenorrhea, N/V, quickening (16-20 wk)…
• Probable: Goodell, Chadwick, Hegar signs; +hCG; ballottement
• Positive: FHT (Doppler $10!–!12$ wk), US visualization $\ge 4$ wk

Prenatal Care Schedule & Tools

• Visits: q4 wk (to 28 wk) ➔ q2 wk (28-36) ➔ weekly (≥ 36)
• Leopold maneuvers, McDonald fundal height (cm ≈ wk 18-34), Naegele EDD: LMP − 3 mo + 7 d
• Labs 1st visit: CBC, type & Rh, Ab screen (Coombs), HbsAg, HIV, RPR/VDRL, Rubella titer, GC/CT, +/- Sickle, TORCH
• 24-28 wk: $50$ g GCT (fail ≥ $140$ → $100$ g GTT), H/H
• 36-37 wk: GBS culture, GC/CT repeat, H/H

Normal Maternal Adaptations

• Cardiovascular: ↑ blood vol $30!–!50\%$; systolic murmur $\approx 90\%$; BP mild ↓ 2nd tri – rise baseline 3rd (rise = danger)
• Respiratory: diaphragm ↑ $4$ cm; mild ↑ RR
• Musculoskeletal: lordosis; relaxin-mediated ligament laxity
• Skin: linea nigra, melasma, striae
• Endocrine: Estrogen (growth), Progesterone (smooth muscle relax), Prolactin (milk), Oxytocin (labor–letdown), Relaxin (cervix/joints)

Danger Signs of Pregnancy

• Vaginal bleeding, severe HA, visual changes, epigastric pain, ↓ fetal movement, fever, ROM < 37 wk, persistent vomiting (hyperemesis)

Prenatal Screening & Diagnostics

• NST reactive: ≥ $2$ accels $15\times15$ in $20$ min (>32 wk)
• CST negative = good (no late decels with 3 ctx/10 min)
• BPP components (FBM, movement, tone, AFI, NST) – score $8!–!10$ normal
• Amniocentesis $14!–!20$ wk (karyotype, AFP); L/S ratio $2:1$ = mature (diabetic $3:1$)
• CVS $10!–!12$ wk (chromosomes; not NTD)
• Quad screen (AFP, hCG, Estriol, Inhibin-A) $15!–!20$ wk – ↑AFP → NTD, ↓ AFP/↑ hCG/↑ Inhibin → Down’s

Rh & ABO Considerations

• Rh − mother + Rh + fetus ➔ sensitis­ation ⇒ erythroblastosis fetalis/kernicterus
• Rho(D) Ig (Rhogam) $300$ µg IM @ $28$ wk, anytime bleeding/invasive proc, and ≤ $72$ h PP if baby Rh +

Teratogens & Infections (TORCH)

• Most vulnerable period: ≤ $8$ wk (organogenesis)
• Alcohol → FAS; ACE-I, warfarin, AEDs (valproate), isotretinoin = category X/D
• TORCH: Toxoplasmosis (cat litter/undercooked meat), Other (syphilis, varicella), Rubella, CMV, HSV
• Other perinatal infections:
  • GBS: screen 36-37 wk; intrapartum PCN G $q4$ h ×3 doses
  • BV, Candidiasis, Trich, GC/CT – treat to reduce preterm birth
  • HIV: maternal ART + infant ZDV, avoid breastfeeding in high-income settings

High-Risk Antepartum Conditions

Spontaneous Abortion (<$20$ wk)

• Threatened, Inevitable, Missed, Incomplete, Complete – monitor bleeding, Rhogam prn, emotional support

Hyperemesis Gravidarum

• Excess N/V → >$5\%$ wt loss, ketonuria; Tx = IV LR + B6, antiemetics (metoclopramide), NPO → advance diet, TPN severe

Gestational Diabetes

• Patho: placental hormones ↓ insulin sensitivity ≥24 wk
• Dx 100 g GTT: fasting ≥$95$, 1 h ≥$180$, 2 h ≥$155$, 3 h ≥$140$ (≥ 2 values)
• Mgmt: diet ($30!–!35$ kcal/kg), SMBG (fast <$95$, 1-h <$140$), exercise, insulin (gold), fetal surveillance; watch neonatal hypoglycemia

Ectopic Pregnancy

• Unilateral pain, +hCG but empty uterus on US; MTX if unruptured; salpingectomy if rupture; Rhogam

Gestational Trophoblastic Disease (Molar)

• High hCG, prune-juice bleed, “snow-storm” US; D&C, serial hCG ×1 yr, no pregnancy \& contraception

Cervical Insufficiency

• Painless dilation @ $\sim 16!–!20$ wk ➔ cerclage $12!–!14$ wk; remove $37$ wk; pelvic rest

Placenta Previa vs Abruption

• Previa: painless bright red 3rd tri bleed, uterus soft; NO digital exams; plan CS if complete/partial
• Abruption: painful dark bleed, rigid uterus, ↑ fundal height → emergency CS, risk DIC

Hypertensive Spectrum

• Gestational HTN $\ge 140/90$ after $20$ wk w/o proteinuria
• Preeclampsia: HTN + $\ge 300$ mg/24h protein OR severe feat. (BP $\ge 160/110$, ↑ creat 3.1, platelets <$100K$, epigastric pain, vision changes)
• MgSO$_4$ seizure prophylaxis (loading $4$ g IV, maint $1!–!2$ g/h); monitor reflexes, RR ≥$12$/min, UO ≥$30$ mL/h; antidote = $10$ mL $10\%$ Ca gluconate IV
• Eclampsia = seizure – maintain airway, Mg bolus, deliver
• HELLP: Hemolysis, ↑ LFT, ↓ Plt – deliver, manage DIC risk

Key Pharmacology (Ob & Newborn)

• MgSO$_4$ – tocolysis & pre-eclampsia; therapeutic $4!–!8$ mg/dL
• Betamethasone $12$ mg IM ×2 $24$ h apart (<$34$ wk) – lung maturity
• Terbutaline $0.25$ mg SQ $q4$ h (HR <$120$) – tocolysis
• Dinoprostone (Cervidil) & Misoprostol (Cytotec) – cervical ripening; monitor uterine tachysystole
• Oxytocin: induction & PPH control; must be IV pump piggyback; antidote = terbutaline
• Uterotonics for PPH: Pitocin, Methergine (hold if BP >$140/90$), Carboprost (Hemabate) (CI asthma), Misoprostol PR $800$ µg
• Rhogam $300$ µg IM
• PP analgesia: Ibuprofen, Acetaminophen ± Codeine, Fentanyl (labor IVP $50$ µg q1h)

Intrapartum Essentials

4 P’s

• Passage, Passenger, Powers, Psyche

Labor Stages

1. Dilation (Latent $0!–!3$ cm, Active $4!–!7$, Transition $8!–!10$)
2. Birth (complete ➔ delivery)
3. Placenta (~$5!–!30$ min)
4. Recovery $0!–!4$ h PP

Fetal Heart Monitoring

• Baseline $110!–!160$; variability Absent/Min/Mod/Marked
• VEAL CHOP
  • Variable = Cord, Early = Head, Accel = OK, Late = Placenta
• Intrauterine resuscitation for late/variable: Reposition, IV bolus, O$_2$ 10 L NRB, d/c Pitocin

Induction/Augmentation

• Bishop score $\ge 8$ favorable
• AROM risks: prolapse cord, infection, abruption

Obstetric Emergencies

• Prolapsed cord: knee-chest, hand lift presenting part, O$_2$, stat CS
• Shoulder dystocia: McRoberts + suprapubic pressure; anticipate brachial plexus inj
• Uterine rupture: sudden pain, loss of station, fetal distress → laparotomy CS

Post-Partum Period $0!–!6$ wk

• Lochia progression, fundal descent $1$ cm/day; uterus non-palpable day $10$
• Return of ovulation: non-lactating $6!–!10$ wk; lactating ≥ $3$ mo (LAM not reliable)
• PP Blues $50!–!80\%$ <$10$ d; PPD $10!–!15\%$ w/in $1$ yr; Psychosis emergency
• PPH definitions: Vag >$500$ mL, CS >$1000$ mL; 4 T’s – Tone, Tissue, Trauma, Thrombin
• Bakri balloon tamponade option

Infant Feeding

• Breastfeed q$2!–!3$ h; newborn output ≥$6$ wet/$3$ BM/day by day 4
• Formula $q3!–!4$ h; discard unused after $1$ h; iron-fortified till $12$ mo

Common Neonatal Conditions

• Cold stress → hypoglycemia ++; manage with warm, dry, skin-to-skin
• Physiologic jaundice after $24$ h; pathologic <$24$ h or >$13$ mg/dL – phototherapy (cover eyes, hydrate)
• Neonatal Abstinence: high-pitched cry, tremors; Finnegan scoring; morphine/ methadone PRN; low-stim environment

Selected Pediatric Topics

Iron-Deficiency Anemia

• Daily need $11!–!15$ mg; treat Fe $3!–!6$ mg/kg/d × $4!–!6$ wk (straw, Vit C)

Croup (LTB)

• Barky cough + stridor @ night; cool mist, nebulized racemic epi & dexamethasone

RSV Bronchiolitis

• Supportive: suction, O$_2$, hydration; contact/droplet iso; Synagis prophylaxis high-risk

Dehydration

• Mild <$5\%$ wt loss; mod $6!–!9\%$; severe ≥$10\%$. ORS $50!–!100$ mL/kg over $4$ h

Congenital Cardiac Lesions

• Acyanotic (↑-pulm flow): VSD, PDA; COA (obstruction)
• Cyanotic (R→L): TOF (VORP – VSD, Overriding aorta, RV hypertrophy, Pulm stenosis), TGA
• PDA closure: Indomethacin IV; keep open (PGE$_1$) for TGA, TOF until surgery
• TOF “tet spell”: knee-chest, O$_2$, morphine, fluids