NCM 109- Care of the Mother, Child at Risk or with

Problems (Acute or Chronic)

NCM 109- Care of the Mother, Child at Risk or with
SUMMARY- REVIEW
 Fetal movements = begins at 28 weeks
 Fetal kicks = happen during 2nd tri
 Quickening = 16th - 22nd week
 Z- tract injection = Adults: 22-25 g (23g)
 Fetal distress = occurs most likely in pregnancies that last 42 weeks or longer
 Vaginal delivery = 500 ml of blood loss (single baby)
 Cesarean delivery = 1000 ml loss (single baby)
 Placenta Previa = bleeding without pain during 3rd trimester.
 3 stages of labor last = 6- 18 hours
 Rapid labor or Precipitous labor = 3-5 hours
 
 STAGES OF LABOR
1. First stage "CERVICAL STAGE"
Ends when the cervix is fully dilated.
A. Latent phase "prodroma stage"
 0-3 cm
 20-40 sec every 5-20 min
 Primi = 6 hours
 Multi = 4-5 hours.
B. Active labor
 4-7 CM
 40-60 sec every 3-5 min
 Primi = 3hrs
 Multi = 2hs
C. Transition phase
 8-10 cm
 60- 80 sec every 2-3 min
 Primi = 1 hr
 Multi = 30 min
 
2. Second stage "EXPULSION STAGE"
 Fully dilated cervix ------> expulsion of the baby.
 
3. Third stage "PLACENTAL STAGE"
 Explusion of the baby -----> placental expulsion
 15-20 after delivery ni baby tsaka tatanggalin si placenta.
 
4. Fourth stage
 
 Shockable rhythm = defibrillate 2-4 J/kg
 Synchronized Cardioversion = 0.5 - 1 J/kg
 Supraventricular Tachycardia = Paroxysmal supraventricular tachycardia
 If uterus cannot remain contracted the physician or the nurse-midwife probably order:
 Dilute IV infusion of oxytocin.
 Carboprost tromethamine (hemabate)
 Rectal misoprostol ( effective treatment for postpartum hemorrhage)
 Dilatation and curettage (d & c) (a procedure to remove tissue from inside your uterus)
 NCM 109- Care of the Mother, Child at Risk or with
Problems (Acute or Chronic)
NCM 109- Care of the Mother, Child at Risk or with
 Disseminated Intravascular Coagulation (DIC) - deficiency in clotting ability caused by
vascular injury, usually associated with premature separation of the placenta.
 Removing more than 750 - 1000 ml of urine = create extreme pressure changes in the
bladder and lower abdomen.
 Although sulfa drugs are normally prescribed for urinary tract infection they are
contraindicated for breastfeeding women they can cause neonatal jaundice.
 Amoxicillin or ampicillin will be prescribed to treat a post partal urinary tract infection.
 At least 4 antenatal visits with a skilled health care provider.
 Antihypertensive meds and magnesium sulfate for severe pre-eclampsia
 Administer antenatal steroids to all patients who are at risk for preterm delivery (between
24-34 weeks of AOG)
 Antenatal Steroids
 Betamethasone 12 mg IM q 24hrs x 2 doses or
 Dexamathasone 6 mg IM q 12 x 4 doses.
 Limit total number of IE to 5 or less.
 Amniotomy (also referred to as artificial rupture of membranes [AROM])
 Medication for RDS in children: antibiotic or bronchodilator.
 First indication that the child RDS is worsening: tachypnea, or retractions.
 Term newborns are generally scheduled for phototherapy when the total serum bilirubin
level rises to 10 -12 mg/dl at 24 hours of age
 Lights are placed 12 to 30 inches above the newborn's bassinet or incubator
 THERAPEUTIC DOSAGE OF MAGENESIUM SULFATE = 4-7 mEq/L, 8 mEq/L is toxic
 HELLP :Hemolysis, elevated liver enzymes and low platelets.
 Severe Preeclampsia treated with HYDRALAZINE -adverse effect = Tachycardia
 Magnesium Sulfate is used to treat Gestational Hypertension and severe preeclampsia.
 Magnesium sulfate may cause sweeting
 Severe preeclampsia is characterized by blood pressure over 160/110 mm Hg, urine protein
levels greater than 500 mg/24 hours and hyperreflexia.
 As with any seizure,
 the priority is to clear the airway and maintain adequate oxygenation both to the
mother and the fetus.
 Fluids and control of hypertension are addressed once the airway and oxygenation
are maintained.
 Transvaginal ultrasound is especially useful for obese women whose thick abdominal layers
cannot be penetrated adequately with the abdominal approach.
 Because of the possibility of fetomaternal hemorrhage, administering RhoD
immunoglobulin to the woman who is Rh negative is standard practice after an
amniocentesis.