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 q2!–!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
• 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