1. What are the psycological adaptations to the transition stage of the first phase of labor?
    • Withdrawal.
    • doubts ability to cope.
    • apprehensive and irritable
    • terrified of being alone
    • NO TOUCHY!
  2. What is responsible for an ^ in n/v during pregnancy?
    ^hCG levels.
  3. What hormone is repsonsible for sm motility?
    • Progesterone decreases sm contractility sustaining preganncy. At end of term, progesterone levels v-->estrogen as dominant hormone and allows for oxytocin to have full effect when it comes time to expel baby.
    • v in SM motility-->constipation during pregancy.
  4. What hormone is responsible for mother's ^ in insulin resistance?
    HPL-->v sensitivity to insulin in mother and preserves blood sugar to ensure fetus has enough. This may cause gestational onset diabetes.
  5. What hormone is responsible for "hot flashes in the pregant mother?
  6. What are the fxn's of estrogen during pregnancy?
    • v GI motility
    • facilitates uterine and breast developement
    • ^ vascularity
    • alters metabolism and fluid/e-lyte balance.
    • *also causes hyperpigmentation
  7. What are the main fxn's of oxytocin during pregnancy?
    • stimulates uterine contractions
    • triggers milk let-down reflex when breastfeeding.
  8. What are the fxn's of HPL?
    • facilitates breast developement
    • alters carb, protein, and fat metabolism
    • facilitates fetal growth by altering maternal metabolism, acts as an insulin antagonist.
  9. What is couvade?
    Pregnancy-like symptoms in the father. Typically indicates ^paternal involvement in pregancy and child.
  10. Which vaccination should a woman get before becoming pregnant?
    • Rubella.
    • It's a live attenuated virus so it can be passed to the fetus. If fetus contracts-->birth defects.
  11. What is Naegele's Rule?
    • Way of determining delivery date for baby.
    • First day of last missed period - 3mo + 7 days.
  12. What are the danger signs of pregnancy?
    • Gush of fluid from vagina-->possible labor. If not, at least ^risk nfxn.
    • Bleeding
    • Abd pain
    • Fever/chills
    • Visual abnormalities
    • Persistent vomiting
    • Pretibial edema-- possible sign of preeclampsia.
    • muscular irritiablity/convulsions
    • Epigastric pain (RUQ)
    • Headaches unrelieved by tylenol
    • Oliguria-scant, dark, consentrated urine
    • Dysuria
    • absence of fetal movement
  13. T/F It is normal for a pregnant mother to have a systolic murmur.
  14. What is the cause of physiologic anemia in the pregant woman?
    an increase in RBC's with an even greater ^in plasma volume.
  15. How should a woman take her pregnancy iron suppliment?
    With OJ between meals.
  16. What can preggers do to relieve constipation?
    • Drink more fluid
    • Eat more fiber
    • walk it off/out.
  17. What can preggers to do relieve pain of hemarrhoids?
    • Heat
    • Cold
    • sitz bath
  18. FHR should be...
  19. Why would you measure estriol levels in a pregnant mom?
    v estriol levels indicate NTD.
  20. What is the "gold standard" test for fetal health and development?
    • NST
    • FHR monitored.
    • --reactive >2 accelerations (^15BMP for 15 sec) in 20 min.
    • --non-reactive <2 accelerations over 40min.
  21. What is a contraction stress test
    • Measures FHR in response to uterine contractions
    • Positive if late decelorations in response to >49% of UCs. Indicates poor oxygenation of fetus. Negative if not.
    • **If positive CST and non-reactive NST, C-Section if >32wks.
  22. What is a biophysical profile?
    • Ultrasound, NST, and amniotic fluid index
    • Used to predict risk of decreased fetal movement, IUGR, preterm labor, gestational diabetes, post term preganncy, premature ROM.
  23. What is the prefered anatomy of the pelvic bones for the birthing mother?
    • Gynecoid=best
    • Anthropoid is next best.
    • Platypelloid is worst.
  24. What are primary powers of contraction?
    • Involuntary UCs.
    • measured in frequency, duration, and intensity
    • responsible for
    • --decent
    • --effacement
    • --dilation
  25. What is the Furgeson Reflex?
    • Upon engagement, vagina-->oxytocin-->increadible urge to push.
    • **According to Ali, like vomitting out your vagina.
  26. What are the stages of labor?
    • First stage: begining of dilation to fully effaced/dilated.
    • --latency: 0-3cm.
    • --active: 4-7cm.
    • --transition: 8-full
    • Second stage: Active pushing-->birth of baby.
    • 3rd: Ends with passage of placenta/uterine sac.
    • 4th: Up to 4th hour after birth. Mother recoups.
    • --*Uterus needs to contract to achieve hemostasis.
  27. What are the psycological adaptations to the transition stage of the first phase of labor?
    • Withdrawl.
    • doubts ability to cope.
    • apprehensive and irritable
    • terrified of being alone
    • NO TOUCHY!
  28. What are the 7 cardinal movements of labor?
    • 1. Descent
    • 2. Engagement: 0 station
    • 3. Flexion: should present vertex, ie OA
    • 4. Internal rotation
    • 5. Extension
    • 6. External rotation: to square with shoulders
    • 7. Expulsion
  29. When is the most critical time for the neonate?
    • 6-8hrs after birth
    • Risk of morbidity highest because cardio/pulmonary system adjusting to life extrauterine.
  30. Neonate's BP should be...
  31. Why would you clamp the umbilicord late?
    • Late clamping-->
    • --^blood volume
    • --^HR
    • --^systolic BP
    • --^respiration
  32. Neonates temp should be...
    • 36.4-37.2C
    • 97.5-99.0F
    • **Fever >100.5 = immature immune system
  33. Factors negatively affecting thermoregulation
    • v sq fat
    • v brown fat, esp in preterm neonates
    • large body surface area
    • loss of body heat from various mechanism
  34. mechanisms of heat loss
    • convection: loss of heat from the warm body surface of cool air.
    • Radiation: heat lost to cooler objects but not in direct contact.
    • Conduction: heat lost to cool object in direct contact
    • Evaporation: heat lost when surface moisture is converted to vapor.
    • **Maintain neutral thermal environment to reduce risk of cold stress.
  35. When do the periods of activity occure after birth?
    • 1st: lasts up to 30 min after birth.
    • --HR ^ and gradually decline.
    • --RR^--> 60-80/min.
    • --period is followed by sleep/v motor activity for 60-100 min.
    • 2nd: 4-8hrs after birth.
    • --lasts 10min - several hrs.
    • --another period of tachycardia/pnea
    • --^muscle tone
    • --should pass meconium.
  36. What is Kernicterus?
    • Most severe form of hyperbilirubinemia
    • >25mg/dcL
    • Will manifest as bilirubin encephalopathy, lethargy, poor suck rflx.
  37. How many more cal/day does mom need to breastfeed?
    • +200/day post pregnancy
    • +500/day over prepregnancy
  38. How do you go about pharmacologically ripening a cervix?
    • prepidil PGE2 (Dinoprostone gel)
    • -- add oxytocin 6-12 hours later
    • Cervidil (Dinoprotone insert)
    • --add oxy 30-60min after removal of insert
    • Misoprostil PGE1 (Cytotec)
    • --add oxy 4 hours later.
    • ***All ^risk for tachysystole
  39. What must you always do when administering oxytocin?
    • DILUTE!
    • Admin at site most proximal to venous site
    • Always infuse with pump
    • Decrease or d/c when UCs too close
    • Once in active labor, d/c.
  40. What is tachysystole?
    • Excessive uterine activiy
    • Defined as 5 or more UC's in 10 min over 30 min period or...
    • a series of single uc's lasting 2 min or longer.
  41. Nursing intervensions for tachysystole?
    • Reposition mom
    • IV bolus lactated ringers of 500mL
    • v oxy by half or d/c altogether if persists
    • 10L O2 by mask
    • Notify provider
    • Terbutaline?
  42. What is an amniotomy?
    • Artificial ROM used to induce or shorten labor
    • Need before and after FHR because fetus is at risk for pinching umbilical cord and FHR is vital for determining health if this happens.
    • Doc time, color, odor, and amount.
  43. When and why do you have mom stop pushing?
    • During delivery after internal rotation when entire head has presented.
    • Pause to suction mouth and nose to prevent aspiration of meconium which -->chemical PNA in neonate.
  44. what are some indications and concerns for vaginal hematoma?
    • pt c/o severe pain that cannot be controlled with Rx
    • May appear as hard grey-white area
    • May d/c as much as 1L/day blood.
    • Very painful. Persistent high rated pain may indicate vaginal hematoma.
  45. What happens to estrogen levels PP and why does it matter?
    It v-->breast engorgement and diuresis of excess fluid.
  46. T/F The effect of prolactin during breastfeeding supressess ovulation and is therefore an effective means of b/c while nursing.
  47. What are some normal vital sign finds after delivery?
    • small, transient rise in BP that lasts about 4 days.
    • Resp fnxn normalizes in 6-8wks.
    • May have spike in temp for vaginal delivery.
  48. When is RhD Ig given?
    • Within 72 hours post delivery
    • Done with Rh negative mother who delivered an Rh positive child.
    • Prevents sensitization to Rh-positive erythrocytes that may have entered the mother's bloodstream when infant was born
Card Set
fetal development , assessment, maternal changes, etc.