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# MOTHER BABY
2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. IUP/IUFD ...... Intrauterine pregnancy / intrauterine fetal demise
SAB ............... Spontaneous abortion
TAB ................ Therapeutic abortion
LMP ............... Last menstrual period
ROM .............. Rupture of membranes
SROM ............ Spontaneous rupture of membranes
AROM ........... Artificial rupture of membranes
PROM ............ Prolonged rupture of membranes (>24 hours)
PPROM ......... Preterm premature rupture of membranes
SVD ............... Spontaneous vaginal delivery
FHR ............... Fetal heart rate
EFM ............... Electronic fetal monitoring
US .................. Ultrasound transducer (detects FHR)
FSE ................ Fetal scalp electrode (precise reading of FHR)
IUPC .............. Intrauterine pressure catheter (strength of contractions)
LTV ................ Long term variability
SVE ................ Sterile vaginal exam
MLE ............... Midline episiotomy
NST ............... Non-stress test
CST ................ Contraction stress test
BPP ................ Biophysical profi le
VBAC ............. Vaginal birth after cesarean
AFI ................. Amniotic fluid index
BUFA ............. Baby up for adoption
NPNC ............ No prenatal care
PTL ................ Preterm labor
BOA ............... Born on arrival
BTL ................ Bilateral tubal ligation
D&C / D&E ... Dilation & curettage / dilation & evacuation
LPNC ............. Late prenatal care
TIUP .............. Term intrauterine pregnancy
VMI / VFI ...... Viable male infant / viable female infant
EDB ............... Estimated date of birth
EDC ............... Estimated date of confinement
EDD ............... Estimated date of delivery
ABBREVIATIONS
PREGNANCY DURATION 40 weeks gestational age
The number of completed weeks counting from the 1st day of the last normal menstrual cycle (LMP).
38 weeks fetal age
This refers to the age of the developing baby, counting from the estimated date of conception. The fetal age is usually 2 weeks less than the gestational age.
## TRIMESTERS First Trimester 0 13 WEEKS
Second Trimester 14 26 WEEKS
Third Trimester 27 40 WEEKS Pregnancies that have reached 20 weeks but ended before 37 weeks
Preterm Early Term: 37 38 6/7
Full Term: 39 40 6/7
Late Term: 41 41 6/7 Pregnancies that have lasted between week 37 and week 42
Term
A pregnancy that goes beyond 42 weeks
Postdate/Postterm PRENATAL TERMS
A woman who is pregnant / the number of pregnancies
## Gravida / Gravidity
Never been pregnant
Nulligravida
Pregnant for
VJG TUVVKOG
Primigravida
A woman who has had 2+ pregnancies
Multigravida
The number of pregnancies that have reach viability (20 weeks of gestation) whether the fetus was born alive or not
## Parity
0Zero pregnancies beyond viability (20 weeks)
Nullipara
1One pregnancy that has reached viability (20 weeks)
Primipara
2+ Two or more pregnancies that have reached viability (20 weeks)
Multipara
60 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. GTPAL An acronym used to assess pregnancy outcomes
GRAVIDITY G The number of pregnancies
Includes the present pregnancy Includes miscarriages / abortions Twins / triplets count as one
TERM BIRTHS T The number born at term
> 37th week of gestation Includes alive or stillborn Twins / triplets count as one
PRE-TERM BIRTHS P The number of pregnancies delivered beginning with the 20 th - 36 '(th weeks of gestation
Includes alive or stillborn Twins / triplets count as one
ABORTIONS / MISCARRIAGES A The number of pregnancies delivered before 20 weeks gestation
Counts with gravidity Twins / triplets count as one
LIVING CHILDREN L The number of current living children
Twin / triplets count individually
PRACTICE QUESTION
You are admitting a client to the mother-baby unit. Two hours ago she delivered a boy on her due date. She gives her obstetric history as follows: she has a three-year-old daughter who was delivered a week past her due date and last year she had a miscarriage at 8 weeks gestation. How would you note this history using the GTPAL system?
A. 2-2-1-0-2
B. 3-2-1-0-1
C. 3-2-1-0-2
D. 3-2-0-1-2
1 PRACTICE QUESTION 2
A prenatal clients obstetric history indicates that she has been pregnant 3 times previously and that all her children from previous pregnancies are living. One was born at 39 weeks gestation, twins were born at 34 weeks gestation, & another child was born at 38 weeks gestation. She is currently 38 weeks pregnant. What is her gravidity & parity using the GTPAL system?
A. 4-1-3-0-4
B. 4-1-2-0-3
C. 4-2-1-0-4
D. 4-2-2-0-4
> Q#1 is (D) 3-2-0-1-2
> Q#2 is (C) 4-2-1-0-4
> ANSWER KEY
61
2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. PREGNANCY SIGNS & SYMPTOMS
# PRESUME
Period Absent (Amenorrhea) Really tired Enlarged breasts Sore breasts Urination increased (urinary frequency) Movement perceived (quickening) Emesis & nausea
# FETUS
Fetal movement palpated by a doctor or nurse Electronic device detects heart tones The delivery of the baby Ultrasound detects baby Seeing visible movements
# PROBABLE
Positive (+) pregnancy test (high levels of the hormone: hCG) Returning of the fetus when uterus is pushed w/ fingers (ballottement) Objective Braxton hicks contractions A softened cervix (Goodell's sign) Why is a positive pregnancy test not a positive sign?
High levels of hCG can be associated with other conditions such as certain medications or hydatidiform mole (molar pregnancy).
Bluish color of the vulva, vagina, or cervix (Chadwick's sign) Lower uterine segment soft (Hegar's sign) Enlarged uterus Why is quickening not a positive sign?
Quickening can be difficult to
distinguish from peristalsis or gas so it can not be a positive sign.
SUBJECTIVE OBJECTIVE OBJECTIVE
These are changes felt by the women that are subjective. Can be associated with other things.
NOT a defi nite diagnosis for pregnancy!
Can only be attributed to a fetus Think Baby
Defi nite diagnosis for pregnancy!
q
Pregnancy signs that the nurse or doctor can observe Think Doctor Think Mom PRESUMPTIVE POSITIVE PROBABLE
62 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. PREGNANCY PHYSIOLOGY
HORMONES Prolactin: Allows for breast milk production
Estrogen: Growth of fetal organs & maternal tissues
Progesterone & Relaxin: Relaxes smooth muscles
hCG: Produced by placenta, prevents menstruation
Oxytocin: Stimulates contractions at the start of labor
RESPIRATORY
Basal metabolic rate (BMR) O2 needs Respiratory alkalosis (MILD)
CARDIOVASCULAR
Cardiac output ( Heart rate + stroke volume) Blood pressure stays the same or a slight decrease in plasma volume q Enlarges
(May develop systolic murmurs)
RENAL
GFR from plasma volume Smooth muscle relaxation of the uterus = risk of UTIs! Urgency, frequency & nocturia EDEMA!!
SKIN
Striae
Stretch marks (abdomen, breasts, hips, etc) Chloasma
Mask of pregnancy Brownish hyperpigmentation of the skin Linea Nigra
Pregnancy line dark line that develops across your belly during pregnancy Montgomery glands / Tubercles
Small rough / nodular / pimple-like appearance of the areola (nipple)
MUSCULOSKELETAL
Lordosis : center of gravity shifts forward leading to inward curve of spine Low back pain Carpal tunnel syndrome Calf cramps
PITUITARY
FSH/LH due to Progesterone Prolactin Oxytocin
THYROID
Thyroxine May have moderate enlargement of the thyroid gland (goiter) Metabolism & appetite
GASTROINTESTINAL
Pyrosis
Progesterone = LOS to relax = heartburn Constipation & hemorrhoids
Progesterone = gut motility Pica
Non-food cravings such as ice, clay, and laundry starch
HEMATOLOGICAL
Plasma volume is greater than the amount of red blood cell (RBC) = hemodilution = physiological anemia
ANEMIA ANEMIA PLASMA VOLUME RBC VOLUME
White blood cells Platelets Pregnant women are
HYPERCOAGULABLE
(increased risk for DVTs)
Non-pregnant levels: 200-400 mg/dL
Pregnant levels: up to 600 mg/dL FIBRINOGEN Blood pressure should not be increased! This could indicate preeclampsia
63
2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. NAEGELE'S RULE WHAT TO AVOID DURING PREGNANCY
Date of Last Menstrual Period 3 Calendar Months + 7 Days + 1 Year
q Bases calculation on a woman who has a 28-day cycle (most women vary)
q The typical gestation period is 280 days (40 weeks)
q First-time mothers usually have a slightly longer gestation period
FACTS ABOUT NAEGELE'S RULE
1st day of last period: September 2, 2015 Minus 3 calendar months: June 2, 2015 Plus 7 days: June 9, 2015 Plus 1 year: June 9, 2016
> EXAMPLE
"30 days hath September, April, June & November. All the rest have 31, except February alone (28 days) "
Used for estimating the expected date of delivery (EDD ) based on LMP (last menstrual period)
TERATOGENIC DRUGS TERATOGENIC DRUGS TORCH INFECTIONS TORCH INFECTIONS T Thalidomide
e Epileptic medications (valproic acid, phenytoin)
r Retinoid (vit A)
a Ace inhibitors, ARBS
T Third element (lithium)
0 Oral contraceptives
w Warfarin (coumadin)
a Alcohol
s Sulfonamides & sulfones TORCH infections are a group of infections that cause fetal abnormalities. Pregnant women should avoid these infections!
T Toxoplasmosis
o Virus-B19 (fifth disease)
r Rubella
c Cytomegalovirus
h Herpes simplex virus Parv
TERA-TOWAS TORCH
(EDD) MNEMONIC MNEMONIC MNEMONIC MNEMONIC
How many days are in each month?
REMEMBER:
64 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. STAGES OF LABOR THE BABY IS DELIVERED
## STAGE 2
q Provide ice chips & ointment for dry lips
q Provide praise & encouragement to the mother
q Monitor uterine contractions & mothers vital signs
q Maintain privacy & encourage rest between contractions
q Encourage effective breathing patterns & rest between contractions
q Monitor for signs of birth (perineal bulging or visualization of fetal head)
> INTERVENTIONS
Starts when cervix is fully dilated & effaced
Ends after the baby is delivered
RECOVERY!
## STAGE 4
RECOVERY: fi rst 1-4 hours after delivery of the placenta
q Assessing the fundus
q Continue to monitor vital signs & temperature for infection
q Administer IV fluids
q Monitor lochia discharge (lochia may be moderate in amount & red).
q Monitor for respiratory depression, vomiting, & aspiration if general anesthesia was used
q Great time to watch for complications such as bleeding (postpartum hemorrhage)
q Soft
q Boggy
q Displaced
q FIRM
q Midline
THE PLACENTA IS DELIVERED
## STAGE 3
The PLACENTA is expelled (5 - 30 min after birth)
q Assessing mothers vital signs
q Uterine status (fundal rubs every 15 minutes)
q Provide warmth to the mother
q Promote parental-neonatal attachment
q Examine placenta & verify it's intact - Should have 2 arteries & 1 vein
> INTERVENTIONS
q Lengthening umbilical cord
q Gush of blood
q Uterus changes from oval to globular shape
SIGNS OF A PLACENTA DELIVERY
"Shiny Schultz"
Side of baby delivered 1st
DELIVERY MECHANICS
"Dirty Duncan"
Side of mother delivered 1st
2 " A" for Arteries
1 " V" for Vein
CERVIX DILATES FROM 0-10 CM
## STAGE 1
q Promote comfort - Warm shower, massage, or epidural
q Offer fluids & ice chips
q Provide a quiet environment
q Encourage voiding every 1 - 2 hours
q Encourage participation in care & keep informed
q Instruct partner in GH GWTCIG (light stroking of the abdomen)
q Encourage effective breathing patterns & rest between contractions
> INTERVENTIONS
q Cervix dilates : 4 - 7 cm
q Intensity : Moderate
q Contractions : 3 -5 min (30-60 sec in duration)
Active
q Cervix dilates : 8 - 10 cm
q Intensity : Strong
q Contractions : Every 2-3 min (60-90 sec in duration)
Transition
q Cervix dilates : 1- 3 cm
q Intensity : Mild
q Contractions : 15 - 30 mins
Latent (early)
Longest Longest Stage Stage Labor
actively
transitioning >30 min = Retained placenta looks like a smiley face!
> MEMORY MEMORY TRICK TRICK
pushing! pushing! MNEMONIC MNEMONIC
65
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# TRUE VS. FALSE LABOR
# FALSE LABOR TRUE LABOR
Irregular Stops with walking / position change Felt in the back or the abdomen above the umbilicus Often stops with comfort measures Occur regularly
Stronger
Longer
Closer together More intense with walking Felt in lower back radiating to the lower
portion of the abdomen Continue despite the use of comfort measures May be soft NO signifi cant change in....
Effacement
Dilation No bloody show In posterior position (baby's head facing mom's front of belly) Presenting part is usually not engaged in the pelvis Presenting parts become engaged in the pelvis Increased ease of breathing (more room to breathe) Presenting part presses downward & compresses the bladder = urinary frequency
> CERVIX CONTRACTIONS FETUS
Progressive change
Softening
Effacement
Dilation signaled by the appearance of bloody show
Moves to an increasingly anterior position (baby's head facing mom's back)
## SIGNS OF LABOR LABOR
Moving the fetus, placenta, & the membranes out of the uterus through the birth canal
Lightening Increased vaginal discharge (bloody show) Return of urinary frequency
Cervical ripening Rupture of membranes "water breaking" Persistent backache Stronger Braxton Hicks contractions Days preceding labor
Surge of energy
Weight loss (1- 3.5 pounds) from a fl uid shift
## Signs of Preceding Labor
66 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. FETAL HEART TONES
Cause:
q Uteroplacental insufficiency
Intervention:
q D/C oxytocin
q Position change
q Oxygen (nonrebreather)
q Hydration (IV fluids)
q Elevate legs to correct the hypotension
> NON-REASSURING
LATE DECELERATIONS
> mom's contractions fetal heart rate
Cause:
q Cord compression
Intervention:
q D/C Oxytocin
q Amnioinfusion
q Position change
q Breathing techniques
q Oxygen (nonrebreather) Side-lying or knee chest will relieve pressure on cord
> NON-REASSURING
VARIABLE DECELERATIONS
> mom's contractions fetal heart rate
Cause:
q From head compression
Intervention:
q Continue to monitor
q No intervention needed
> NORMAL!
EARLY DECELERATIONS
> mom's contractions fetal heart rate
Normal fetal heart rate: 120 - 160 BPM "Mirror" image of mom's contractions (They don't technically come early)
> MEMORY MEMORY TRICK TRICK
Literally comes late after mom's contraction MEMORY MEMORY TRICK TRICK
*Variable: Looks "V" shaped MEMORY MEMORY TRICK TRICK
67
2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. Overview of Hypertensive disorders during pregnancy PREECLAMPSIA OVERVIEW
1st Trimester CHRONIC HTN:
Before pregnancy or before 20 weeks!
PREECLAMPSIA: HTN after 20 weeks gestation with systemic features
GESTATIONAL HTN: HTN after 20 weeks without systemic features
2nd Trimester 3 rd Trimester
> 20 WEEKS
> WH
ATISHYPERTENSION?WHATISHYPERTENSION?SYSTOLIC > 140
OR
DIASTOLIC > 90
Hypertension may be abbreviated "HTN"
HELLP SYNDROME
Variant of preeclampsia Life-threatening complication Hemolysis Elevated liver enzymes Low platelet count
HEL LP THERAPEUTIC RANGE : 4 7 mg/dL
TOXICITY! MAGNESIUM SULFATE ANTIDOTE: calcium gluconate
*because magnesium sulfate can cause respiratory depression
RX given to prevent seizures during & after labor.
*Remember : magnesium acts like a depressant
RR <12 DTR's UOP <30 mL/hr EKG Changes
*Mag is excreted in urine
UOP Mag levels
RISK FACTORS
q HX of preeclampsia in previous pregnancies
q Family history of preeclampsia
q 1st pregnancy
q Obesity
q Very young (<18) or very old (>35)
q Medical conditions (Chronic HTN, renal disease, diabetes, autoimmune disease)
PATHOLOGY
q Defective spiral artery remodeling
q Systemic vasoconstriction & endothelial dysfunction Pathology isn't completely known
PLACENTA
is the root cause
SIGNS & SYMPTOMS
"PRE" eclampsia
q Severe headache
q RUQ or epigastric pain
q Visual disturbances
q Urine output
q Hyperrefl exia
q Rapid weight gain Proteinuria Rising BP Edema
PE
> Triad Signs
AMA (advanced maternal age)
ECLAMPSIA
(seizures activity or a coma)
Immediate care:
Side-lying Padded side rails with pillows/blankets O2 Suction if needed Do not restrain Do not leave
68 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. VEAL CHOP A tool to help interpret fetal strips
Lasts 45 - 80 seconds
Should not exceed 90 seconds
BEGINNING of the contraction to the END
of that same contraction Only measured through external monitoring
2 - 5 contractions every 20 minutes
Should not be more FREQUENT then every 2 minutes
Only measured through external monitoring
Number of contractions from the BEGINNING of one contraction to the
BEGINNING of the next
25 - 50 mm Hg
Should not exceed 80 mm HG Mild - nose
Moderate - chin
Strong - forehead Can be palpated
Strength of a contraction at its PEAK
Frequency Intensity Resting Tone Duration Average: 10 mm HG
Should not exceed 20 mm HG Soft = good
Firm = not resting enough Can be palpated
TENSION in the uterine muscle between contractions (relaxation of the uterus = fetal oxygenation between contractions)
# ASSESSMENT OF UTERINE CONTRACTIONS
## Variable
## Decelerations V C Cord Compression
## Early Decelerations E Head Compression H
## Accelerations A OK (normal fetal oxygenation) O
## Late Decelerations L Placental Insufficiency P
69
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# LABOR & BIRTH PROCESSES
Fetus & Placenta The Birth Canal Position of the Mother Contractions Emotional Response 5 factors that affect the process of labor & birth
# 5 P's PASSENGER PASSAGEWAY POSITION POWERS PSYCHOLOGY PASSENGER Fetus & Placenta
ANTERIOR POSTERIOR
SIZE OF THE FETAL HEAD FONTANELS
Space between the bones of the skull allows for molding Anterior (larger)
- Diamond-shaped
- Ossifies in 12-18 months
Posterior
- Triangle shaped - Closes 8 - 12 weeks
MOLDING
Change in the shape of the
fetal skull to "mold" & fit
through the birth canal
FETAL PRESENTATION
Refers to the part of the fetus that enters
the pelvic inlet first through the birth canal
during labor
FETAL LIE
Relation of the long axis (spine) of the fetus to the long axis (spine) of the mother
LONGITUDINAL OR VERTICAL
The long axis of the fetus is parallel with the long axis of the mother Longitudinal: cephalic or breech
TRANSVERSE, HORIZONTAL, OR OBLIQUE
Long axis of the fetus is at a right angle to the long axis of the mother Transverse: vaginal birth CANNOT occur in this position Oblique: usually converts to a longitudinal or transverse lie during labor
CONTINUED
2 BREECH
Buttocks, feet, or both first Presenting part: Sacrum
> Most Most Common Common
1 CEPHALIC
Head fi rst
Presenting part: Occipital (back of head/skull)
3 SHOULDER
Shoulders first Presenting part: Scapula
70 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. LABOR & BIRTH PROCESSES PASSENGER PASSAGEWAY
FETAL ATTITUDE
TYPES OF PELVIS GENERAL FLEXION
Back of the fetus is rounded so that
the chin is flexed on the chest, thighs are fl exed on the abdomen, legs are fl exed at the knees
BIPARIETAL DIAMETER
9.25 cm at term, the largest transverse diameter and an important indicator of fetal head size
SUBOCCIPITOBREGMATIC DIAMETER
Most critical & smallest of the anteroposterior diameters
FETAL POSITION SOFT TISSUE FETAL STATION
Where the baby's presenting part is located in the pelvis Measured in centimeters (cm)
Find the ischial spine = zero
Above the ischial spine is (-)
Below the ischial spine is (+)
+4 / +5 = Birth is about to happen
ENGAGEMENT
Fetal station zero = baby is " engaged " Presenting parts have entered down into the pelvis inlet & is at the ischial spine line (0)
When does this happen?
First-time moms: 38 weeks
Already had babies:
can happen when labor starts
LOWER UTERINE SEGMENT
Stretchy
CERVIX
Effaces (thins) & dilates (opens) After fetus descends into the vagina, the cervix is drawn upward and over the first portion
PELVIC FLOOR MUSCLES
Helps the fetus rotate anteriorly
VAGINA INTROITUS
External opening of the vagina
CONTINUED
The Birth Canal: |Rigid bony pelvis, soft tissue of cervix, pelvic floor, vagina & introitus
GYNECOID
Classic female type Most common
ANDROID
Resembling the male pelvis
ANTHROPOID
Oval-shaped Wider anteroposterior diameter
PLATYPELLOID
The flat pelvis Least common
LIGHTENING
When the baby "drops" into the mother's pelvis
I'm (+) that I'm getting this baby out
> MEMORY MEMORY TRICK TRICK
Head, foot, butt (closest to exit of uterus)
> -5 +1 -4 +2 -3 +3 -2 +4 -1 +5 0
71
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# LABOR & BIRTH PROCESSES POSITION POWERS
UPRIGHT POSITION
Sitting on a birthing stool or cushion
"ALL FOURS" POSITION
On all fours: putting your weight on your hands & feet
Position of the mother during birth Contractions: Primary & Secondary
Frequent changes in position helps with:
Relieving fatigue Increasing comfort Improving circulation
## PRIMARY POWERS
Involuntary uterine contractions Signals the beginning of labor
## SECONDARY POWERS
Does not affect cervical dilation but helps with expulsion of infant once the cervix is fully dilated When the presenting part reaches the pelvic
fl oor, the contractions change in character
& become expulsive. Laboring women start to feel an involuntary urge to push & she uses secondary powers to aid in the expulsion of the fetus
FERGUSON REFLEX
When the stretch receptors release oxytocin, it triggers the maternal urge to bear down
EFFACEMENT
Shortening & thinning of the cervix during the first stage of labor Cervix normally:
2 -3 cm long
1 cm thick
The cervix is "pulled back / thinned out" by a shortening of the uterine muscles
Degree of
EFFACEMENT
is EXPRESSED in %
(0-100%) PSYCHOLOGY Emotional Response
Anxiety can increase pain perception & the need for more medications (analgesia & anesthesia)
## THINGS TO CONSIDER:
SOCIAL SOCIAL SUPPORT SUPPORT PAST PAST EXPERIENCE EXPERIENCE KNOWLEDGE KNOWLEDGE DILATION
Dilation of the cervix is the gradual enlargement or widening of the cervical opening & canal once labor has begun Pressure from amniotic fluid can also
apply force to dilate
closed
0 -
full dilation
10 measured measured in cm in cm
cm
Voluntary bearing-down efforts by the women once the cervix has dilated
LITHOTOMY POSITION
Supine position with buttocks on the table
LATERAL POSITION
Laying on a side
> Most Most Common Common
72 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. NEWBORN ASSESSMENT
# APGAR 7 - 10 supportive care
4 - 6 moderate depression
< 4 aggressive resuscitation
Blood flow from umbilical vessels & placenta stop at birth
Acrocyanosis : Blueness of hands & feet
( >`}iw {vvi
Closure of:
q Ductus arteriosus
q Foramen ovale
q Ductus venosus
Transient murmurs are normal
CIRCULATORY SYSTEM GENERAL CHARACTERISTICS INITIAL GOALS INITIAL GOALS INITIAL GOALS
Suction with bulb syringe / deep suction *Newborns are obligatory nose breathers
1ST PRIORITY = AIRWAY 2ND PRIORITY = WARMTH
Dry with a blanket or place in warmer
HEAD Molding:
Abnormal head shape
that results from pressure ( normal )
Fontanelles:
Bulging = increase ICP or hydrocephalus
Sunken = dehydration
Fontanelles Fontanelles may be may be bulging bulging when when the newborn cries, the newborn cries, vomits, or is lying down. vomits, or is lying down. This is normal. This is normal.
score 0 points 1 point 2 points ACTIVITY
(Muscle tone) Absent Flexed arms & legs Acrive
PULSE 0 < 100 > 100
GRIMACE
(Reflex irritability) Floppy Minimal response to stimulation Prompt response to stimulation
APPEARANCE
(Skin color)
Blue / pale all over Pink body Blue extremities (acrocyanosis) Pink
RESPIRATION
(Effort)
No breathing Slow & irregular Vigorous cry
# APGARUMBILICAL CORD
looks like a smiley face! MEMORY MEMORY TRICK TRICK
Should have
2 arteries & 1 vein
Should be dry, no odor & no drainage 2 arteries 1 vein
VITAL SIGNS Cephalohematoma:
Birth trauma (collection of blood)
Does not cross the suture lines
Like a baseball cap MEMORY MEMORY TRICK TRICK Caput Succedaneum:
Edema (collection of fluid)
Crosses the suture lines
Blood Pressure (bp) Systolic 60 -80 mmHg
(Not done routinely) Diastolic 40 - 50 mmHg
Heart Rate (hr) 110 - 160 bpm can be 180 if crying can be 100 if sleeping
Respiratory rate (rr) 30 - 60 breaths/min
temperature (t) (Auxiliary ) 97.7 99.5F (36.5 - 37.5C) Map Equal to the # of weeks gestation or higher
TEMP HEAT LOSS DUE TO:
>
Evaporation:
Moisture from skin & lungs
Convection:
Body heat to cooler air
Conduction:
Body heat to a cooler surface in direct contact
Radiation:
Body heat to a cooler object nearby
Take Take apical pulse apical pulse for 1 full min for 1 full min Breathing pattern is IRREGULAR.
Newborns are Abdominal breathers. Count for a full minute! To count breaths, place your hand on their abdomen
Retractions Nasal flaring Grunting
Signs of Respiratory Distress Signs of Respiratory Distress
expected 44 - 55 cm
length 17 - 22 in
expected 2,500 - 4,000 g
weight 5 lb, 8 oz - 8 lb, 14 oz Length & Weight
head 32 - 39 cm
circumference 14 - 15 in *measure above eyebrows
chest 30 - 36 cm
circumference 12 - 14 in *measure above nipple line Head & Chest Circumference 73
2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. POSTPARTUM ASSESSMENT
# B BREASTS
May be sore after breastfeeding Breastfeed every 2 - 3 hours (15 - 20 minutes each breast) Position newborn "tummy to mummy" Latch should be completely around the areola
+PHGEVKQPKP COOCVKQPQHDTGCUVVKUUWG
Continue breastfeeding Warm compress Hydration Rest Analgesics Wash hands!
MASTITIS B BOWELS
Constipation is common after birth. Increasing FLUIDS & FIBER may help! May see blood in the stool Should begin to shrink following birth Tucks / witch hazel Ice pack Squeeze bottle Sitz Bath
HEMORRHOIDS B BLADDER
Postpartum urinary retention is common - In-and-out catheterization may be needed - Bladder distention can cause a displaced & boggy uterus! Foul smelling or purulent lochia Fever (>100.4 F ) Abdominal tenderness Tachycardia
SIGNS OF INFECTION
# U UTERUS
Enlarged Soft Poorly contracted uterus Boggy Not midline
SYMPTOMS
Fundal massage Assist to void or use in-and-out catheter
INTERVENTIONS
Retained placenta Chorioamnionitis (infection) Uterine fatigue Full bladder
RISK FACTORS
UTERINE ATONY S SECTION (c-section incisions) / Episiotomy
Promote proper wound healing Report to the health care provider: >Uy >>U`}>V
# E EMOTIONAL STATUS
Postpartum depression (PPD) is common for women following childbirth As the nurse ask about feelings of...
depression hopelessness self-harm harm to the newborn
Crying Irritable Sleep disturbances Anxiety Feelings of guilt
INTERVENTIONS
# L LOCHIA
"Really Sore After"
bright red
1 - 3 days RUBRA pinkish/brown
4 - 10 days
SEROSA whitish-yellow
10 - 14 days
*Can last up to 6 weeks
ALBA
> MEMORY MEMORY TRICK TRICK MNEMONIC MNEMONIC
""BUBBLES BUBBLES ""
74 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. The uterus is often called the
LIVING LIGATURE
The uterus is like a
BASKET WEAVE OF MUSCLE FIBERS
that crimps off vessels
protecting mom from hemorrhage.
If the uterus is not doing this crimping off, it causes bleeding!
PATHOLOGY SIGNS & SYMPTOMS
q Hypotonia of the uterus
q Atony / boggy uterus
q Deviated to the right
q Uncontrolled bleeding
RISK FACTORS
q Multiple gestations
q Polyhydramnios
q Macrosomic fetus (> 8 lbs)
q Multifetal gestation
> overdistended uterus
# POSTPARTUM HEMORRHAGE
## DRUGS
# "OH MY HEMORRHAGE" This is a way to remember the order in which the drugs are used
VAGINAL BIRTH: loss of >500 ml of blood
CESAREAN BIRTH: loss of >1,000 ml of blood
A CHANGE IN HEMATOCRIT BY 10% Postpartum Hemorrhage
is defined as:
## HEMABATE
## #3
CONTRAINDICATIONS
Contraindicated in people with asthma
ACTION
Hemabate is a prostaglandin! Hemabate helps control blood pressure and muscle contractions (uterine contractions).
## METHERGINE
## #2
ACTION
Vasoconstriction
CONTRAINDICATIONS
Contraindicated in people with hypertension *Remember vasoconstriction causes blood pressure to rise
"Methylergonovine "
## OXYTOCIN
## #1
ACTION
Stimulates contraction of the uterine smooth muscle "Pitocin "
## MISOPROSTOL
given rectally
ACTION
Stimulates contraction of the uterine smooth muscle
Another medication that can be used:
MEMORY MEMORY TRICK TRICK
#1 cause of #1 cause of uterine atony is uterine atony is
a full a full bladder bladder
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# Today I will
# not stress over
# what I cant
# control .
# NOTES
2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.