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OB

OB

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Published by 08abigael14

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Published by: 08abigael14 on Apr 10, 2009
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09/30/2012

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OB
Probable sign of pregnancy…Goodell’s sign (softening of thecervix)…enlargement of uterusPositive sign of pregnancy…fetal movement…quickening…fetal heart beatChloasma / melasma – brownspots on faceStriae gravid arum – stretch markon abdomenLinea nigra – dark vertical line onabdomenChadwick’s s/ - discoloration of vaginaAmniocentesis – detects maturityof the fetusUTZ – gender of the fetusChorionic villus sampling –detects presence of genetic d/oor fetal abnormalityLMP – 3 months + 7 days =EDP/EDCUrine samples in p-test = (+)chorionic gonadotropinRich in Hgb thus iron (livers,tomato, dried apricots, peas,prune juice)Chloasma – mask of pregnancyIncreased vaginal discharge /bleeding – danger sign of pregnancy, due to uterineatony or lacerationColostrums – (+) in 4th monthPregnant woman’s breast -colostrums, tingling sensation& darkening of areola; noincreased in sizeBreast tenderness on firsttrimesterSafe to give antibiotics during thefirst trimesterConstipation if best treated withincreased bulk and fluid in dietNormal glycosuria, abnormal witholiguriaRelease of ovarian folliclehappens on the 14
th
or 15
th
dayof cycleQuickening and fetal heart beat –20
th
weekIf vaginal bleeding occurs, callthe physician first and reportthe amount and type of bleeding Toxoplasmosis – risk factor ishaving a cat in one’s house True labor – increasing infrequency and durationChildbirth education – to have anemotionally satisfying birthexperienceIn birthing center, if both parentsare anxious, demonstratecomfort measures the fathermay useWhen a 2-yr old sibling of theborn child seems interested,this is just his part of developmental levelNormal = lower abdominal painmay be experienced at thetime of rupture of the follicleCervix 2 cm dilated, moderatebright red vaginal bleeding =inevitable abortionInitial nursing mgt = examineperineal pads for tissues andclotsBaby is no longer alive but thebody has not expelled it yet =missed abortionMcDonald’s procedure = will besutured temporarily, to beremoved at term. Important torecognize the s/sx of laborEctopic pregnancy – spotting,lower abdominal pain radiatingto shouldersHigh risk factor is having 3consecutive spontaneousdeliveriesPlacenta previa – small amount of bright red bleeding, painless,caused by abnormalimplantation of the placentaInitial action is to estimateamount of blood loss, thenkeep on bed rest and limitphysical activityAbruption placenta – bright redblood, painfulPredisposing factor – multiplepregnancyFurther assessment – abdominalexamination for s/sx of tenderness or rigidityInitial nursing mgt – administerO2Complication – DIC (disseminatedintravascular coagulationsyndrome)S/sx – venipuncture site continuesto bleed for 15 mins(+)meconium staining in vaginaldischarge – check fetal hearttome and apply external fetalmonitor first before callingphysicianPrevent convulsion – keep roomdimly litBed rest with PIH – reducepressure by lowering bodymetabolismAntagonist for MgSO4 – CaGluconateHas a minor effect to the babyInsulin needs will vary throughoutthe pregnancyDiabetic baby – (+) tremorsBreastfeeding predisposes themother to infectionPotential problem for pregnantwith a hx of heart d’se –reduced tolerance of activity(+) pubertal acceleration ingrowth of pregnantadolescents – basicconsideration in pregnantadolescentsHazard – increased mortality rate,increased incidence of anemia,vaginitis, UTI, and PIHIncreased demand in iron duringpregnancy is due to anexpansion in total blood cellvolume and Hgb mass byapprox 25-50% duringpregnancyMost impt ax when ROM occurs-color of amniotic fluidRectal pressure – transitionalphase of laborVariable deceleration - due tocord compressionN – early deceleration and goodvariabilityLate deceleration is AbnFetal heart rate drops duringcontraction and returns tobaseline at the end of contraction is NORMALFetal heart rate drops duringcontraction and returns tobaseline a minute aftercontraction is ABNORMALLate deceleration is observed –turn off the oxytocinimmediately, then determinethe extent of cervical dilatationImpt ax for mother given withepidural anesthetic – monitorBPMost impt discharge instruction –family planning informationWeight gain:1
st
trim = 1 lb/wk = 12 lb2
nd
trim = 1 lb/wk = 12 lb3
rd
trim = 2 lb/mo = 6 lb Total = 30 lbsSome:1
st
trim = 3 lb2
nd
trim = 12 lb3
rd
trim = 12 lb Total = 27 lbsNormal FTHR = 120 – 160 bpm Teratogen – causes px defects onthe fetusPlacenta – carry nourishment,empty waste, provide severalhormonesAmniotic fluid – prevents fetusfrom external injury ToxoplasmosisOther infection (hepa a and b)RubellaCytomegalovirusHerpes simplex Torch – group of d’se that harmsfetusUmbilical vein – pathway of O2Ampulla – fertilizationIsthmus – tied in tubal ligationMeconium stain in breechpresentation = N…in cephalic is abnormal = fetaldistress To determine nutritional needs –assess first what she eats nowHigh in calcium – green veggiesesp. broccoliMilk – 4 servings daily, 1L, 4 cupsIron is most impt in 2
nd
trimBraxton hicks – painlesscontractionsCI when having vaginal bleeding –vaginal examCauses of vaginal bleeding(ectopic or abortion, Hmole,abruptio, previa)
Nursing care during the 1
st
stage of labor
 
First stage of labor – dilatation of the cervix 8 – 10 cm andcervical effacementStation – degree of descent of thefetal head or presenting partBack lying – hypotensiveSemi sitting – venacavacompressionSim’s position – best andpreferredFHR normally slows at the onsetof a contractionFHR is abnormal if it slows at thepeak of the contraction, orremains unchanged, or slowsimmediately after a contraction(late deceleration) Transitional phase – mostencouragement and support iseffective when givenEnd of first stage of labor(encouraging voiding,breathing deeply, and lying onleft side; least appropriate is tohave client push withcontraction – 2
nd
stage of labor)Nitrazine test – differentiate b/wurine and amniotic fluid; blue –af; red – bloodDistended bladder prevent thedescent of the fetusOffer bedpan in frequent intervalEnema is ordered to preventcontamination of feces when itis expelled during deliveryBeginning of contraction until endof it – durationEnd of contraction until anotherbeginning – intervalDuration count in specified time –frequency To feel the contraction – placehands just above the umbilicusFeel the FHR during thecontraction and immediatelyafter the contractionPrepare vaginal exam – cleanvulvaVery early stage of labor – offerwater or clear liquid becausesolid foods result to vomitingPosition – presenting fetal bodypart in relation to mother’spelvisPrimary reason for episiotomy –prevent prolonged pressure onfetal headPrimipara is taken into thedelivery room when theperineum is bulgingMultipara is taken into thedelivery room when the cervixis dilated 6-8 cm
ACTIVE
- cont q15-20 mins, 10-30 sec duration, mild intensity,cervix 3 cm dilated
LATENT –
cont q3-5 mins, 30-45sec duration, mod intensity,cervix 6 cm dilated; ambulate
TRANSITIONAL -
cont q1-2mins, 45-60 sec duration,strong intensity, and cervix 8cm dilated
Nursing care during the 2
nd
stage of labor
Begins when cervix is fully dilatedEncourage to push downNarcotic analgesic given late inthe first stage of labor – mayresult in respi depression of thenewborn To lessen discomfort – assumesim’s pos’nPant b/w contractionsObserve for s/ of hyperventilation– blurred vision and tingling of extremitiesHave the client breathe into asmall paper bagSaddle block (subarachnoidblock) – take effect almostimmediately
Nursing care during the 3
rd
stage of labor
Delivery of the newborn untildelivery of placenta andmembranesRelax in b/w contractions –delivery of the babyDelivery of the placenta – pushwith contractionClamp the cord after the cordstops pulsatings/e of oxytocin – water retentionand water intoxicationOxytocin – strengthenscontractions of the uterusBonding b/w newborn andparents – during first hour afterdeliveryPrevent of loss of body heat –placing under radiant source of heatApply in lower conjunctival sac –silver nitrateApgar – ax of physical conditionof the newborn0-3 = immediate resuscitation4-6 = guard the baby7-10 = free from immediatedistressPlacental separation – suddengush of blood from the vagina,lengthening of the umbilicalcord, upward rise in the uterus
Nursing care during the 4
th
stage of labor
 Time when placenta is deliveredupto 2-4 hours after delivery of the placentaFundus should be firmlycontracted in b/w navel andsymphisis pubisAfter 12 hrs – level of navelAfter 24 hrs – 1 cm belowumbilicusFundus should be checked for thefirst hour every 15 minutes;fundus should be massaged if it feels soft and boggyOne hand on the fundus, other just over the pubic bone
Nursing care duringpostpartum
Delivery of newborn until 6 wksafter birthLochia:1-3 rubra (bright red)4-9 serosa (pink)10-15 albaHematoma s/sx - swelling anddiscoloration of the skin aroundperineum, painEncourage ambulation to preventcirculatory system problemComplain of discomfort due toepisiotomy – place heat lamp18-24 inches from theperineum (as prescribed)At home – sitz bath1
st
24 hr – coldAfter 24 hr – hotPropoxyphene HCL (Darvon) –relieves painPerineal care – front to backBreast engorgement – occurs onthe 3
rd
postpartum day
Taking in phase
– 1-2
nd
day,passive
Taking hold phase
– holdsresponsibility; 2-4
th
day
Postpartum blues
– 1
st
2 weeks,withdrawal of maternalhormones, hypothyroidism ,lack of family support, decprogesterone and estrogen andinc prolactin
Postpartum depression
– 6mosto 1 yr
Postpartum psychosis
requires hospitalization
Chronic sorrow –
prolongedgrief 
Complications of pregnancy
Bleeding1
st
trim – abortion, ectopic2
nd
trim – hmole, incompetentcervix (weight of the fetuscauses the cervix to dilate)3
rd
trim –
apruptio
(painful, hardboard like – couvelaire’suterus, premature separationof normally implantedplacenta, in severe AP, observefor shock)
previa
(painless,check for decreased BP andincreased PR, abnormalimplantation)Abundant vaginal dischargeduring prenatal – infection, std,protozoan flagellateHyperemesis gravid arum –vomits 4 times / day,emergencyCause of PIH – unknown, commonamong the poorHEP (HPN, edema, proteinuria)Convulsion – eclampsia, providesafe env’t (dimly lit room)Prepared drug – Mg SO4, 4-7mEq/LNursing resp – check for RR,reflexes (tendon and patellar),and urine output (measureshourly)Ectopic – outside uterus, WOFhemorrhageSpontaneous abortion – occurswithout the client having doneanything to cause it Threatened SA – observe foruterine cramping and loss of amniotic fluidGlucose – 70 to 150 mg/dlProblems – macrosomic baby,larger than averageConstipation – increase fluid, highfiber, exercise
 
Varicose – avoid crossing legs,knees, and ankle…gentle massage on affectedarea…elastic bandage…contact physician if soreness,redness, or warmth develops inthe veins (life threatening, cancause embolism)Skin itches – use of lotion onareas of drynessEdema on late pregnancy –pressure of an enlarged uteruson pelvic veinsLower daily intake of salt – 3g/dayAlso elevate legs and feet forshort periods during the dayDyspnea is often normal duringthird trimesterUrinary frequency during late inpregnancy – enlarging uterus iscausing pressure on thebladder2
nd
month – less frequencybecause uterus rises into theabdominal cavityBackache /pelvic rock – wear lowheeled shoesNausea / Heat5burn – sff Calcium tabs – for leg crampsFetal alcohol syndrome – joint andlimb abnormalities,microcephaly, abn cnsNewborns of mothers addicted tonarcotic such as heroin – sufferwithdrawal sxSmoking – newborn is smaller
CS
Apply gel before fetal transducerto improve conduction of soundCatheter – keep bladder emptyduring the procedureCS delivery – care is most likely of that who undergone abdominalsurgeryShock – hypo tachytachyINC ICP – hyper bradybradyPatient controlled analgesia –device gives a larger thannormal dose of the drug toprovide instant pain relief Postop abdominal distention –ambulationMultigravida, past babies camefast..when shouts THA BABY ISCOMING!, provide immediatelya clean field for deliveryIt head continues to crown, allowhead to emerge slowly anddeliver it between contraction.NEVER push back firmly on thehead. NEVER place pressure onthe vaginal meatus. NEVER letthe legs close. NEVER slidefinger into the vagina anddelivers the head duringcontractionsMost common fetal complicationin elective cs – prematurityMajor indication –disproportionate is the fetalhead to birthing canal
Care for the young family
Crede’s prophylaxis – preventopthalmia neonatorum; silvernitrate 1% sol’n, penicillin,erythromycin (occurs incontact with gonoccocus)Inappropriate agent – mycostatin(fungus)Don’t rinse eyes after instillationAdminister within 2 hrs after birthVitamin K – antihemorrhagic;anterior/lateral thigh; IM; beingadministered because of lacking bacterial flora in colonRectal temp – check for patency(these days, not beingpracticed)F – 32 / 1.8C x 1.8 + 32Regurgitation of small amount of mucus – suctions andconsiders it normalHexacholorophene soap – cancause neurologic damageHealing of cord stump – 7
th
dayInitial ax – includes pxappearance, neurologicreflexes, gestational age
Babinski
– stroking foot fromheal to toe
Moro
– providing sudden changein equilibrium
Plantar
– infant’s feet to touchsurface
Tonic neck reflex
– flexion of left arm and leg and extensionof the right arm and leg whenthe head is turned toward theright
Moro reflex
absent anddiminished within first 24 hrs –normal due to temporaryvariation in CNS conditionsSterile water for first feeding – if it was aspirated due to GIanomaly, sterile water is lessirritating to the lungsIntercostal retractions – abnormalComfortable position inbreastfeeding the baby – lyingon your sideSore nipples – expose nipples toair after feeding To break suction of the baby –place finger in the corner of the mouth To alert baby to grab and hold –brush the nipple against themouth To make nipple more prominent –hold it b/w 2 fingersPhysiologic weight loss – 5-10%of its weightPregnant mother – additional 300kcalLactating mother – additional 500kcalMaturational crisis- disequilibriumrelated to anticipateddevelopmental taskBe directive and offer clientspecific guidelines for reducingstressMilk production – prolactin; APTLet down of milk – oxytocinIn 3
rd
trim where maternalantibodies are transferred tothe fetusIgG – most abundant, 80%,crosses placentaIgA – 15 %IgM – largest macrophage, obesememberIgA – colostrumsBlack and sticky stool –meconium stool; normalBrick dust – normal; pinkish, brickcolored, powder stain stoolOpponent of circumcision – penileulceration and meatal stenosisProponent of it – physical hygieneCord care – wipe with alcohol onand around it a couple times aday; when it falls off, I can putthe baby down in bath waterPKU – for inherited cause of mental retardation; early dxBaby 3 day old, (+) jaundice –physiologic; inability toconjugate indirect bilirubin;normal in 2
nd
to 3
rd
day;disappears in 4
th
or 5
th
dayPathologic – 1
st
24 hrsPreterm – born before 38
th
weekPreterm, posterm, sga, and lga –all prone to hypoglycemiaSGA – 13 inches head (13.5), 11inches chest (13), 21 and half inches length, 6 and half lbs(7); skin dry, desquamation,loose folds, abdomen appearssunkenPreterm and sga – highest risk formortalityPreterm 30 weeks – thick layer of vernix, no palpable breasttissue, soft pinna folded,smooth soles without creases,lanugo entirely, prominentclitoris, widely separated labia,no arm recoilHypothermia (immature cnsregulatory mechanism, tightlyflexed position, decreasedstores of brown fat andglycogen)Cold stress – compromised heatproduction ability due todecreased brown fat storageHumidified O2 is warmed toprevent cold stressOther problem that may occurwith cold stress – increasedmetabolic rateBrown fat – abundant vascularand nerve supplyRespi distress – head slightlyelevated and neck slightyhyperextended to open airway…due to decreased surfactantAlveolar collapse – leads to respiacidosis and metabs alkalosisRetrolental fibrolpasia –administer O2 at 40%concentration or lessDextrosix – detects presence of hypoglycemiaRationale: an IDM (infant of diabetic mother) hashyperinsulinemia anddecreased gluconeogenesisProne also to polycythemia –increased RBCSafe rule of thumb – offer 2 to 4cc the first 24 hrs, then

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