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85 Cards in this Set
- Front
- Back
Stages of Labor
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Stage 1: Dilation
*Beginning: onset of regular contractions *End: Complete dilation and effacement Stage 2: Expulsion *Beginning: complete dilation and effacement *End: Birth of baby -Stage 3: Placenta *Beginning: Birth of baby *End: expulsion of placenta -Stage 4: Physical Recovery *Beginning: expulsion of placenta *End: 1-4 hours postpartum |
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Phases of Stage 1: Dilation
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-Latent
-Active -Transition |
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Phase 1
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-Phase 1: Latent
*Cervix: begin - 4cm *Contraction freq: 10-20 then 5" regular *Intensity: Mild to mod *Duration: 30 sec |
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Phase 2
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-Phase 2: Active
*Cervix: 4 - 7cm *Contraction freq: 3 - 5" *Intensity: mod to strong *Duration: 45sec |
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Phase 3
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-Phase 2: Transition
*Cervix: 8 - 10cm *Contraction freq: 2 - 3" *Intensity: strong *Duration: 60 - 90 sec |
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Stages of Labor
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-Dilation (w/3phases)
-Elpulsion -Placenta -Physical Recovery |
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Indications of Pregnancy
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-Presumptive
-Probable -Positive |
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Presumptive
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-Amenorrhea
-N&V -Fatigue -Urinary frequency -Cervical color changes -Brease and skin changes -Quickening |
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Probable
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-Abdominal enlargement
-Braxton-Hicks Contractions -Palpation of fetal outline -Positive pregnancy test -hCG: human chorionic Gonadotropin |
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Positive
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-Auscultation of fetal heart sounds (18-20 wks)
-Doppler 10-12 wks -Fetoscope 18wks -Fetal movement -Visualization of fetus by ultrasound |
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Terms
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-Hegar's Sign: softening of the uterus
-Goodell's sign: softening of the cervix -McDonald's sign: Uterus flexed -Chadwick's sign: color change in the cervix, vagina, and labia (bluish) -Ballottement: during vaginal exam the cervix is tapped, fetus floats upward and then returns to cervical area |
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Routine Lab Tests for Pregnancy
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-CBC, UA, BG
-ABO and Rh typing -Hgb electrophoresis -VDRL/FTA: syphilis -Rubella Titer -TB skin test -Cervical culture -Pap -HIV -Hep B -AFP: alpha fetoprotein to detect for fetal anomalies |
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Luteinizing Hormone
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-Anterior Pituitary Gland
-Target organs: ovaries and testes -Action: Stimulated final maturation of follicle -Causes ovulation -Stimulates transformation of graafin follicle into corpus luteum |
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Follicle Stimulating Hormone
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-Anterior Pituitary
-Ovaries -Stimulates production of estrogens, progesterone -Stimulates growth and maturation of graafin follicles before ovulation |
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Progesterone
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-Ovary, corpus luteum, placenta
-Acts on uterine and breasts -Stimulates secretion of endometrial glands, in preperation for possible embryo -Pregnancy induces growth of cells of fallopian tubes and uterine lining to hourish embryo -Decreases contraction of uterus -Prepares breasts for lactation but inhibits prolactin secretion |
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Prolactin
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-Anterior Pituitary
-Female breasts -Stimulates secreion of milk -Sucking of breast by infant stimulates prolactin production -Estrogen and progesterone from placenta have inhibiting effect on milk production |
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Oxytocin
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-Posterior Pituitary
-Uterus, female breasts -Stimulates in uterus contractions during child birth and postpartum contractions to compress uterine vessels and control bleeding -Stimulates let-down or milk ejection reflex during breast feeding |
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Dip Stick Urine
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-Protein: for PIH
-Glucose: for Diabetes -UTI |
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hCG
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-Used to determine early pregnancies
-Released from the trophoblastic cells |
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Metabolic Changes
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-Average wht gain is 30lbs
-Caloric needs: 2500 a day -Protein: 60g per day -Vitamins: B6, D, E & folic acid |
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Negal's Rule
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-Subtract 3 months and add 7 days to 1st day of last normal menstral period
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Umbelical Cord
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-2 veins
-1 artery |
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GTPAL
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-Gravida, term, preterm, abortions, and live births
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Gravida
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-Number of pregnancies
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Para
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-Number of pregnancies that have progressed past 20 weeks
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Umbilicus Cord
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-Contains:
*2 arteries *1 vein |
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PIH
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-Pregnancy Induced Hypertension
-BP > 140/90 OR > 30 baseline SBP OR > 15 DBP -S/S: *seizures *headaches *spots in front of eyes *pariorbital edema *stroke and other complications |
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Nursing Priorities with PIH
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-PEACE
-P: promote bedrest -E: ensure high protein diet (d/t proteinuria) -A: antihypertensives drug (Apresoline does not cross placenta barrier) -C: convulsion (prevent w/Mg sulfate, antidote calcium gluconate) E: evaluate physical parameter (complications of mg sulfate) |
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Bleeding Conditions
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-Spontaneous Abortion: termination of the pregnancy prior to 20wks gestation
-Inevitable abortion: vaginal bleeding with cramping, cervical changes and rupture of membranes (not reversible) -Incomplete abortion: D&C usually needed (<6wks >14wks) -Habitual abortion: SAB in >3 consecutive pregancies |
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Differential Diagnosis
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-Ectopic pregnancy
-Implantation bleeding -Molar pregnancy: hydatidiform mole proliferation of the chorionic villi |
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Placenta Previa
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-Placenta implants in the lower part of the uterus
-S/S: painless. bleeding, sometimes found by ultrasound -Types include: *Total *Partial *Marginal -C-section must be preformed |
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Abruptio Placenta
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-Seperation of the placenta before delivery
-Can be caused by cocaine use, trauma -S/S: sometimes vaginal bleeding, abdominal pain, board-like abdomen, uterine tenderness, concealed bleeding, may be noted by pain, fetal distress and shock symptoms in the mother -DIC: disseminated intravascular coagulation *may occur as a sequela to abruptio -C-section required |
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Toxoplasmosis
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-Protozoan found in cat liter that can cause severe fetal damage
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Amniocentesis
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-Aspiration of amniotic fluid for exam
-Usually done at 15-18wks |
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Midtrimester Amniocentesis
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-To examine fetal cells for any chromosomal abnormalities
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Third trimester Amniocentesis
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-Done to determine fetal maturity or to diagnose fetal hemolytic disease
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Eary Amniocentesis
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-Usually done between 11-14wks
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Non Stress Test
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-To assess fetal well being
-Assess ability of fetal heart to speed up in response to fetal movement -Requires 30 - 40 minutes -Response is a good thing |
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Gestational Diabetes vs DM
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-GD:
*multiple risk factors *FBG > 140 *Obesity, high birth wght, previous preg. or birth -DM: *no oral insulin *Mom Type 1 is at risk for DKA or SAB *Pt education for hyper/hypo glycemia |
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Magnesium Sulfate Toxicity
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-BURP
-B: blood pressure decreased -U: Urine output decreased -R: Respirations decreased -P: Patella reflex absent |
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Danger Signs of Pregnancy
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-CABS
-C: Chills and fever, cerebral disturbances -A: Abdominal pain -B: Blurred vision, blood pressure, bleeding -S: Swelling, sudden escape of fluid |
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Auscultation of Fetal heart sounds
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-18-20weeks
-Doppler: 10-12weeks |
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Preterm Labor
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-Labor that occurs between 20 and 37 weeks of gestation
*may be due to DES exposure which will cause birth defects -Fetal factors: *multiple pregnancy *hydraminos: too much amniotic fluid *fetal infection *plecenta previa *abruptio placenta |
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Tocolysis
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-Medication to stop labor
-Examples: *Mag sulfate *Beta-adrenergic: yutopar *Prostaglandin synthesis inhibitors *Calcium channel blockers - |
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Magnesium Sulfate
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-6-8mg/dl is effective range
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Betamethasone
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-An antenatal corticosteroid
-Used to promote fetal lung maturation |
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Onset of Labor: True
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-**Cervix progressive effacement and dilation (most important sign)**
-Contractions are consistent and increase in intensity and frequency -Discomfort in lower back to abdomen ***Contractions start in the fundus and do down the uterus |
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Dilation
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Cervix progresses from 0-10cm in diameter
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Effacement
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The thinning of the cervix
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S/S of Labor and Delivery
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-WORLD
-W: wgt loss -O: observe change in sensations -R: rupture of membranes (baby should be delivered in 24 hours to prevent infection) -L: lightening: baby droppin -D: dilation & effacement -S: show bloody (mucous plug) |
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Stage 1
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-Latent phase:
*mild and frequent contractions *every 5min lasting 30-40" -Active phase: *increase in FID (freq. inten. dura.) *2-5min frequency *lasting 40-60" -Transition phase: *very strong contractions *1.5-2min frequency *lasting 60" |
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Hypertonic Contractions
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-Contractions that
*have 1-2min frequency *last 90sec -No time for the uterus to relax and allow blood to flow back to the placenta and fetas |
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Lacerations
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-1st degree: vaginal mucousa, skin of perineum
-2nd degree: vagina, perineum, fascia muscle -3rd degree: all perineum, external anal sphincter -4th degree: all perineum, rectal sphincter, some rectal mucus membrane |
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Morphine
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-Can be reversed by 0.4mg narcan via IVP
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Epidural
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-Can only be give during 2nd phase of labor
-Local: for perineum repair and pudendal block for vaginal/forceps delivery -Regional: *Epidural: outside the dura mater *Intrathecal: into the subarachnoid space *Spinal: subarchnoid space with loss of motor and sensory function -General: usually used for life threatening emergencies |
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Anesthesia
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-REGION
-R: respiratory paralysis -E: elimination -G: gastrointestinal -I: inform of procedure -O: observe for hypotension -N: no trauma (prevent trauma to extremeties |
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Mechanics of Labor
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-4Ps
-Power of uterine contraction -Passenger: size, lie, presentation, attitude, postion, station -Passage: pelvic inlet, midcavity and outlet -Pstchy of mother |
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Active Phase
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-4-7cm dilated
-Contractions every 3-5min -Lasting 30-60" -MAD -M: medication (can only be given in this phase -A: assess and anticipate needs -D: dry lips (ointment) and dry linens |
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Transition Phase
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-8-10cm dilated
-Contractions every 2-3min -Lasting 45-90" -TIRED -T: Tires (needs support) -I: Inform of progress -R: Restless -E: Encourage and praise -D: Discomfort (no pain meds) |
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Dysfunctional Labor
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-Problems with: power, passage, passenger, psyche
-Problems of: presentation, position, effacement, dilatoin, and descent |
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PROM
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-Prolonged premature rupture of membranes
-Hypovolemic shock??? -Nitrazine or fern test on fluid (will be blue if amniotic fluid is present) |
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Preterm labor
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> 20th week but < 38th week
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Prolapse Cord
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Compression of cord can happen after water breaks
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Uterine Rupture
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Hypertonic dysfunction
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Amniotic fluid embolism
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-in baby's circulatory system
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Early Decelerations
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-Fetal head compression
-Intracranial pressure -Cause vagus nerve to slow HR -HR > 100 BPM -Return to baseline at end of contraction -Mirror images of contractions -Are not associated with fetal compromise and require no added interventions |
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Late Decelerations
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-Decrease in oxygen
-Less water exchange -Indicates danger d/t uterus/placenta insufficiency -Variable HR due to stimuli are ok -Late decelerations are not good -Begin well after the contraction begins (right shift) -Return to baseline after contraction ends -Reflect impaired placenta exchange -Placenta blood flow and fetal oxygen supply needs to be addressed |
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Variable Decelerations
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-Shape like a v or flat u
-can occur at any time and may be non-repetitive -Cause: cord compression -Nursing care: change position of the mother -Mother may need oxygen to help the fetus |
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Nursing Intervention for Late Deceleration
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-COIL
-C: change position (left lateral position) -O: oxygen (admin oxygen to morther to correct fetal insufficiency, if oxytocin is infusin stop infusion) -I: IV fluids (will increase the maternal blood pressure and the uteroplacenta circulation) -L: lower head of bed (to encrease perfusion to uterus) |
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Side Effects of Pitocin
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-PITOCIN
-P: pressure elevated -I: intake and output (watch) -T: Tetanic contractions -O: Oxygen decrease in fetus -C: Cardiac arrhythmia -I: Irregular fetal HR -N: N&V -Stop the pitocin drip |
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hCG
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-Human chorionic gonadotropin
-Causes the corpus luteum to persist and secrete estrogens and progesterone |
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H&H
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-RBC mass and Plasma volume increases during pregnancy
-The resulting dilution of RBCs (d/t greater and earlier increase in plasma volume) causes a decline in maternal hematocrit -Hmg: >10.5 -Hct: >33% |
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Nausea and Vomiting Causes
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-Generally beginning about 6wks after last period
-Believed to be caused by the increased levels of hormones hCG, estrogen..., decreased gastric motility and relative hypoglycemia |
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Rhogam
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-Admin to women who are Rh- at 28 wks gestation and 72 hours after delivery
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Chorionic Villus Sampling
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-Removal of a small sample of chorionic tissue
-Dx for genetic disorders -9-ll wks optimal time -Indications: *family history of genetic abnormalities *Advanced maternal age *mother is carrier for x-linked disease *parents known carriers of autosomal recessive disorders *History >3 successive SAB |
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Precipitate Labor
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Labor that lasts <24 hours???
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Macrosomia
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Unusually large fetal size, infant birth > 4000g
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Shoulder Dystocia
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-Delayed or difficult birth of the fetal shoulders after the head is born
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Ritodrine
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-Beta-adrenergic drug
-Yutopar -S/S: tachycardia (M and F), decreased BP -May be given: IV, SC, oral |
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Betamethasone
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-Corticosteroid
-Acceleration of fetal lung maturation -12mg IM for 2 doses, 24 hours apart -Up to 34wks |
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Nitrazine Paper
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-Paper to determine pH
-Helps to determine whether the amniotic sac has ruptured |
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Fern Test
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-Microscopic appearance of amniotic fluid that resembles fern leaves when the fluid is allowed to dry on slide
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Fetal Heart Rate
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110-160 BPM
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Fetal head engagement
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-Descent of the widest diameter of the fetal presenting part to at least zero station
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Fundal Height
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-22wks roughly when fundus reaches the umbilicus
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