-
ISAM
infants of sub aboue mothere
-
Signs fo maternal substance use in infants
- SGA or IUGR
- Microcephaly
- Neonatal stroke
- lethargy, fever diaphoresis tacfhycardia high pitched cry
- tremaors hypertonicity
- hyperreflexia ineffective suck increased suck
- irriabiltiy jitteriness seizures nasal congestion ravenouse appeitite
- diatthea weight loss abdominal distention
-
Maternal associations with substance use
- Poor or no prenatal use
- Preterm labor–cocaine and crack
- Placental rupture– all
- Precipitous delivery–
- Frequent requests for pain meds–
- Other signs of withdrawal: depression, irritability, nausea, lack of motivation, psychomotor changes
-
Is alcohol a teratogenic?
yes
-
Symptoms for alcohol withdrawl of baby
- sleeplessness
- excessive arousla states
- inconsolable crying
- abnormal refexers
- hyperactivity
- jitteriness
- abdominal distention
- hyperactive rooting
-
Times for baby and mom for start of alcohol withdrawl?
- Babies- 6-12 hours or at least within 3days of life
- Mom's- 24-72 hours
-
Withdrawl symptoms for mom from alcohol
- sedation to decreased irriabiltiy
- tremors
- seizures (12-48hours)
- folic acid and thiamine def
- bone marrow suppressing
- increases infections
- liver disease
- Gi upset
- n&v
- delerus hallucentations
-
Affects 1-5% of newborns
vasoconstriciton for mom and placenta
anorexic effect- malnutitition
metabolites in urine of infant up to 4days of infant
infant withdrawl doesn't need drugs
no breastfeeding, in milk for 60days
3-7x higher risk for sids
Cocaine and crack
-
Baby cocaine and crack
- long term effects infant neurobehavorial problems
- flat apathetic mood
- iugr
- small head
- cerebral infarctions
- shorter body length
- alt brain development
- malforma genitourinary tract
- lower apgar
-
Concaine and crack risks for pregnancy
- increased sab
- abruptio placentae
- preterm
- still birth
-
Signs of cocaine crack dependent mom
- mood swings, app changes
- withdrawl- depression irritability nausea lack of motivation
-
Marijuana withdrawl symptoms for baby. more at risk for what?
- decreased fetal growth and sids
- trembling and excessive crying
-
Risk for mom on heroin
- increased nut defects
- preeclampsia
- anemia
- std
-
Heroin baby risks
- withdrwal usually after 72 hours
- increased IUGR meconium aspiration and hypoxia
- irritablitity and shrill cry
- non consolable for 3 months
- increased risk for abuse
- RDS
-
Methadone risk for mom
- preeclampsia
- placenta abruptio
- placenta previa
-
methadone risk baby
- small head and lbw
- more severe and longer lasting withdrawal symptoms due to longer half-life
- jaundice becuase premature
- withdrawl after discharge
-
NAS
Neonatal abstinece syndrome
-
•Pharmacologic Treatment for ISAM with NAS –
- Neonatal Morphine solution (NMS)-only if tolerating po feeds
- –Neonatal opium solution (NOS)–Paregoric
- –Phenobarbital
- –Lorazepam
- –Methadone-works quickly but takes a long time to wean baby from methadone
- –Clonidine-with very high NAS scores-lcalms baby -long time to wean
-
When Do We Discharge IASM Baby Home?
- •On once daily dose of Methadone-only drug generally discharged home on–Only given 2 week supply at a time
- •Finnegan score < 5
- •+ weight gain
- •Tolerates po feeds easily
- Parents have been educated
-
Nursing care with ISAM
- RDS- vs
- Jaundice- trancut or serum bilirubin
- Behaviour- quiet dim room, swaddling, mittins to protect face
- congnitive
- Withdrawl- neonatal absinence socring (finnegan score) , administer meds
- Feeding problems- extra time and small frequent feeds
-
Insulin need for 1st 2nd 3rd trimester
- 1st- decreased need
- 2nd and 3rd- insulin increases double or quadruple for growth
-
Insulin need intrapartum and post
- I:increase
- P: decrease immediately
-
antagonist to insulin , frees up moms glucose allows more glucose for baby
HPL
-
Vascular changes in preexisting diabetes
- retinopathy
- nephropathy
- gestational hypertension
- greater risk for preeclampsia
-
Maternal risk in diabetes
- hydraminos
- preclampsia and elclampsi
- hyperglycemia to ketoacidosis
- worsening retinopathy
- increase uti and yeast infection
-
Fetal risks for diabetic mom
- congentital abomalies 5-10%
- 50% fetal death with untreated ketoacidosis
- Large for gestational age/macrosomia- birth trama
- neonatal hypoglycemia
- IUGR
- Polycythemia/hyperbilirubinema- decrease o2 amounts , A1c takes o2
- RDS- surfactant decrease because of fetal insulin
- hypoglycemia
-
-
Screening for diabetes
- 24-28 1hr ogtt
- 50grams of carbs
-
High risk screening for diabetes
- immediate screening wth fasting or random serum glucos
- flooled by repeat glucose and 3 hr oggtt - npo at midnight, 100g carbs 0-1-2-3 test 2 out of the 4 positive
- tretest 24-28 weeks or prn
-
what puts women high risk of diabetes
>40, history of gd, positive family history, hypertension, obese, poor ob outcome
-
Dietary for diabetes mom
- increase calories 300/day
- 3meals/3snacks
- 40-50% complex carbs, 15-20% protein, 35% fats
-
glucose monitoring
- weekly fasting glucose
- 1-2 psot prandial glucose checks by self monitoring
- self check 4 times a day
- fasting <- 90
- 2hrs after meals <-120
-
Fetal evaluation of GD
- maternal serum afp 16-20
- ultrasounds 18 week and 28week ( iugr and macro)
- bpp
- nst 28 weeks weekly and 32 weeks 2xweekly
- maternal daily activity checks 28 weeks
-
Laboring management for GD
- monitor glucose qhr
- 2 lines- iv fluids ns and d5
-
GD postpartum
- increase calorie 500-800 daily
- no oral hypoglycemics
- reasses 6wks and then every year x3
-
s&s of hypoglycemia of newborn
- tremors, cyanosis, apnea, temp instability, poor feeding, hypotonia
- plycythemia
- rds- whites a-c, not d-f
- hyperbili- 48-72hours
-
Newborns with hypoglycmeia monitoring
- at risk should be monitored 30-60 min after birth, before feedings, or whenever s&s
- IDM should be monitiored within 30 of birth
- monitor qhr 1st 4 hours and then 4hr intervals for 48 hours
- titrate iv fluids when po by decreaseing the concentration of parental glucose gradually to d5w, the reducing the rate of infulsion slowly discontinue if ofver 4-6 hours
-
Therapy that reduces the risk of hiv transmission to fetus
zidovudine (ZDV)
-
HIV Maternal risks
- intrapartal or postpartal hemorrhage
- postpardal infection
- poor wound healing
- infrections of the genitoruinary tract
-
Neonatal risks for hiv
- will usually have a positive antibody titier
- often premature
- low birthd weight
- SGA
-
Testing for hiv neonate
- PCR
- 1st 1-24hrs of life
- 2nd- 1-2months
- 3rd- 2-4 months
-
Treatment for hiv
AZT 8-12hrs--->6weeks
-
Heart disease check ups
- q2weeks 1st half of pregnancy
- qweek 2nd half
- special attention 28-30weeks
-
heart diseas
class I
II
II
IV
- I- asymptomatic no limits
- II asymptomatic at rest slight limit of physical activity
- III- symptomatic at less than ordinary activity- moderate to marked limitiation
- IV sever symptoms at rest DONT GET PREGNANT
-
Causes scarring on valves- mitral most common
increases risk of congestive heart failure
rheumatic heart disease
-
Symotoms of mitral valve prolapse
treatment?
- primarily palpatations
- chest pain
- dyspnea
- Treat with limiting caffine
- needs prophylactic antiboitotics at delivery
-
peipartun cardiomyopathy
- dysfucntional left ventrical
- last month of preg-5 months postp
- symptoms dyspnea orthopna fatigue cough chest pain
- edema palpitations
- may resolve with bed rest
- no more pregnancies
- treatment is supportive: digitalis diuretics vasodilators anticoagulants sodium restriction STRICT BEDREST
-
Antepartunm cardiac management
- education
- diet high protein, iron, low sodium
- 8-10 hours of sleep
- restrict activites
-
Intrapartum management cardiac
- evaluate vs frquently
- demi folwers or side lying position with head and shoulders elevated
- o2 diuretics analgesics prophylactic abx digitalis
- calm
- cont efm
- epidural
- forceps and vacum... no valsva manuver
-
Management cardiac postpartum
- first 48 hours critical all extra fluid becomes intravascular
- hospital 1 week
- progressive activity
- diet and stool softeners
- encourage bonding
- no breastfeeding if on coumading, hep and lovenox ok
-
Risk factors for etopic pregnacy
- tubal factors
- previous ectopics
- endometriosis
- smoking
- progesterone only contraceptives
- des
- iud in placw
-
signs and symptoms of ectopic
- initially normal feelings of pregnancy
- lower levels of hCG
- sonogram adnexal mass -area between tubes and overies
- pe- tenderness andnexa
- with rupture: one sided shapr abdominal pain, referred shoulder pain because irritates the diaphram and vag bleedng
-
Etopic diagnosis
- lmp
- serum progesteron <5 (>25 viable pregnancy)
- quantitive beta hcg - intial and 48hrs 2000!
- vs for shock
-
treatment etopic
if unrupted, less that 3.5 mass and no fetal cardiac activity, stable with no intraabdomial bleeding:
- Methotrexate- 2doses IM
- avoid sun exposure, mild abdominal pain for only 24-48hrs
-
Treatment etopic surgical
- Salpingostomy - open tube and take out
- Salpingectomy- take out with tubes and ovary if ruptured
-
Gestational trophoblastic disease (gtd or molar preg)
abnormal development of placent
-
Hydatodoform mole complete
ovam is fertilized , no genetic, no chromosomes, choriocarcinoma
-
Hydatitdiformform mole parital
triploid karyotype, 2 sper,s . 69 chromo, villi only fluid in portions of placent
-
Invasive mole
Same as comple hydatitdiforom mole but uterine mymetrium
-
Choriocarcinoma
associated with complete hydatitdiform
-
Monitoring for hydratoform moles
- hcg is monitored q1-2 weeks until 2 negative consecutive tiems then q month or 2 for a year
- DONT GET PREGO FOR A YEAR
-
Cause of placenta abruptio and risk factors
- hypertension and cocaine
- hydraminos
- multiples
- alcohol
- smoking
- ama
- trama
-
types of palcenta abrupto
- marginal - seperates at edges - blood
- central- seperates in the middle - concealed blood
- complete- total seperation -hemorrhage
-
Grade of placenta abruptio
- 1- mild seperation (FHR, maternal bp)
- 2. partial seperation, uterin inablitlit increase mom pulse bp stable. decrease fhr
- 3- large and complete seperation with mod-severe bleeding maternal shock and painful uterin contractions present fetal death
-
assessments placenta abruptio
- FHR
- Painful bleeding
- PTT Fibrinogen
- abdominal girth
- c-section
- shock s/s
-
Placenta previa catagories
- Total- os completely covered
- Paritial - os partially covered
- Marginal - edge of placenta is covering
- low lying the palcenta in lower uterine segment in close proximit to but not covering os
-
Placenta previa causes
- prior orevia
- multiparity
- increasing age
- large placenta
- smoking and cocain
- prior c/s
- defective vessels
- palcenat accrete
-
Major symptom of placenta preiva
painless bleeding
-
hypermesis gravidarum
peak
8-12weeks
-
hypermesis gravidarum
things that can go wrong
- dehydration-electrolyte imbalance-alkalosis from loss of hcl acid-
- hypovolemia
- hypotension
- tachycardia
- increase hematocrit
- increase bun
- decrease output
-
hypermesis gravidarum
possible ---- if untreated
- Metabolic acidosis
- k+ muscle wasting sever protien and vit def fetal and mom death
-
hypermesis gravidarum
treatment
- 1st- avoid crap that make sick
- 2- iv fluid kcl+added
- gi rest for 48 hours then advance slowly brat diet with out the bannanas, avoid greasy and fresh food
- antimetics
- 3. alternative - tpn possible, ginger
-
Preeclampsia risks factors and diagnosisi
- Hypertension (140/90) 1+ proteinuria
- Teens >35 gtd multiple rh incompatibility, diabetes hx preeclampsia
-
Risks of preeclampsia Mom
- Hyperreflexia, headache, seizures
- renal failure
- abruptio placenta
- dic
- rupture liver
- pulmonary embolism
- thrombocytopeina, platelet count less than 100
-
Risks preeclampsia baby
- SGA- fetal hypoxia and malnutrition
- prematurity 10% mortality with pre and 20% with eclampsia
- oversedated at birth
- hypermagnesia
-
Mild preeclampsia
- >140/90
- protienuria 1g or less in 24 hours (2+ dipsitck)
-
Home care for preeclampsia mild
- daily bp
- weight
- protein uria
- fetal montitor
- 2x week nst
- weekly Bpp
- weight gain 3lbs in 24hours or 4 lbs in 3 day periodi
-
preeclampsia severe
- 160/110 or greater @ least 6hrs apart
- 24 hour urine proteinuria >5g
- 3-4+ protein uria on 2 random samples 4hrs apart
- oliguria less than 500ml in 24hrs
- ruq epigastric pain
- headach blurred vision spots iugr impaired liver function
- thrombocytopeina hyper reflexia
- edema
-
HELLP
- Hemolysis
- Elevated Liver enzymes
- Low Platelet count
-
s&s of hellp
n&v, flu like symptoms, epigastric symptoms
-
normal platelet for prego
150-400
-
Antibody screens for rh sensitation
1st and 28 weeks
-
indirect coombs
- done on mom
- indicates whether the woman is sensitized to the rh antigen
-
Direct coombs
- done on baby
- maternal antibodies in baby
- hyperbilirubia anemic
-
ABO incompatibility for baby
- pathologic jaundice
- hyperbilirubia
-
Side effects for toxoplasmosis
- most sever fetal problems of contratcted 1st trimester
- death, blind. deaf, or retarted if survives
-
Treatment of toxoplasmosis
- mom-spiramycin
- baby- pyrimehamin, folinic acid, and sufonamide after 18th week
-
How do you contract toxoplasmosis?
How do you diagnose
- raw meat, cat liter, gardening, unpasturized goat milk
- antibody titers, IgG and IgM
-
Rubella german measles for baby
- greatest risk if contracted the 1st trimester
- congential heart disease and cataracts, mental retardation, cerebral palsy
-
Expanded rubella syndrome
- may develp for years after infection,
- insulin dependent diabetic
- sudden hearing loss
- glacoma
- slow progressive encephalitits
-
Cytomegalovirus
How many people have it
how is it transmitted
diagnosis
- 50-80% of all adults by age 40
- in all body fluids, close contact
- cmv in urine or serum and igm levels
-
Cytomegalovirus
effects on baby
treatment
- no treatment
- sheds virus for years, dormant
- most common problems are hearing loss, vision imparment, and mental retardation
- Blood brain and liver
- PRIMARY INFECTION DURING PREGNANCY IS MOST SERIOUS
- WASH HANDS!
-
HSV
transmitted to baby?
- After membranes rupture and virus ascends OR through infected birth canal
- neonate transmission is usually form mouth (cold sore) or HANDS of caregiver
-
If primary infection for mom what is babies chances of contracting hsv?
Reactivations ?
- gential infection form women with vaginal lesions
- 33-50%
of herpetic infection for womean with vaginal lesions less thand 5%
-
Treatment of HSV in pregnancy
- Antiviral (acyclovir, valocyclovir, famciclovir) may be used with first episode or severe recurrent disease
- Acyclovir not absorbed as well as other two
-
HSV symptoms of infected infant
often asymptomatic at birth , then 2-12 days later fever and more likely hypothermia, jaundic, seizures and poor feeding
-
Treatment with HSV infant
What if no treatment?
- Treat with acyclovir
- -50% with die
- 35-40% will develop microcephaly, mental retardation, seizures, apnea and coma (refers to congential and infections accquried at birth)
-
Early onset Group B baby
within 7 days- pnemonia and spticemia, apnea and shock
-
Late onset Group b baby
after 1 week - menigitis or pneumonia
-
Risk factors for baby with group b
- preterm
- intrapatrum fever
- prolonged rupture of memebranes
- previous infected kid
- gbs urine
-
treatment with Group B
- Treat with prophylaxis at onset of labor or ruptured membranes
- Penicillin G 5 million units, then 2.5 milllion units q4hr until delivery
- 3 doses in 24 hours
-
Screening for gbs done what weeks
35-37 weeks
-
Human b19 parovirus
slapped cheek
fifth's disease
How often does it cross the placenta?
When are the severe effects?
What are the effects?
- 40% of the time
- if infection prior to 20 weeks of gestation
- rash, fever, fetal anemia, spontaneous abortion, fetal hydrops, and still birth
-
Infection of newborn
WBC in first 24hrs
if less then what number will indicate sepsis
-
If serum IgM levels are elevated what will it indicate?
normal?
- transplacental infection
- normal igm is <20 mg/dl
-
Signs and symptoms of infant with infection
- behavior changes- "not doing well" lethargic, irritable, cool and clamy, color changes
- Temp instability -mostly hypothermia
- Feeding intolerance- abdominal distention, vomiting , poor sucking
- hyperbilirubinemia
- tachycardia initally, followed by spells of apnea or bradycardia
-
PROM
spontaneous ruputure of the membranes before the onset of labor
-
PPROM
Preterm PROM, rupture of membranes occcuring before 37 weeks gestation
-
Whatr is PPRom associated with
- infection
- previous history of pprom
- hydramnios
- multiple pregnancy
- uti
- amniacentesis
- placenta previa
- abruptio placente
- trauma
- incompetent cervix
- blleeding during pregnancy
-
Complications of PROM
- Infection
- abruptio placentae
- retained placenta and hemorrage
- maternal sepisis
- maternal death
-
Fetal complications of PROM
- RDS (pprom)
- fetal spsis
- malpresentations
- prolapse of cord
- nonreassuring fhr
- premature birth and increased perinatal and morbidity and mortality
-
If PPROM and no infection what should you expect for clinical management
- assess fetal wellbeing - nst, bbp, avoid vag exams
- labs- cbc, c-reactive protein, u/a, cultures
- Bedrest
- continuous efm at beginning
- maternal corticosteriods for surfactant
-
Nursing implications for PPROM
- determine duration of prom
- assess gestational age
- ss of infection
- hydration status
- fetal status
- rest on l
-
Nursing conciderations for administration of betamethasone?
- assess contractions
- provide education of side effects
- deep im
- bp, weight, edema
- assess glucose and electrolytes
-
when is the latest you can use betamethasone
34 weeks
-
Signs and symptoms of preterm labor
- Uterine contrations thta occer every 10 min or less with or without pain. 6 OR MORE IN ONE HOUR
- midle menstral like cramps felt low in the abdomen]
- constant or intermittent feeling of pelvic pressure that feel like the baby pressing down
- rupture of membranes
- constant or intermitent low dull backache
- a change in vaginal discharge ( an increase in amount, a change ito more clear an dwatery, or a pinkish tinge
- abdomial cramping with or withoug diaherra
-
What is the goal of preterm labor management
- prevent preterm labor from advancing to the point that it no longer responds to medical treatment.
- stop in latent phase
-
How is PTL diagnosed
- 20-37 weeks
- 6 or more contractions in one hour
- cervical changes
-
Predictors for preterm labor
- Presence of infection
- Cervicovaginal fibromectin protein found in the fetal membrane and decidua- NOT PRESENT 22-37 WEEKS
- Very reliable if negative not going into labor for 7 days
- Cervical length less than 25mm
- History of preterm labor
-
Medications commoly used for tocolytics to stop contraction
- B-adrenergic agonists- Brethine
- Mag Sulfate
- Cyclooxygenase ( prostaglandin synthetase inhibit)-Indocin
- Calcuim Channel blocker - procardia
-
Side effects for Brethine
- Tachycardia
- Maternal pulmonary edema
-
Side effects for mom for mag
- warmth
- headach
- nystagmus
- nausea
- dizziness
-
Side effects for baby mag
- Hypotonia
- lethargy after birht
- Respiratory depression
-
Side effects of Indocin
Fetal
- Constriction of ductus arterious
- NEC
- IVH
-
Side effects for Procardia
- Not to be used with Mag
- tachycardia
- hypotension
- facial flushing
- headache
-
Nursing care standard for mag sulfate
- BO q 10-15 min during administration
- Mag levels- theraputic 4-8. q6-8hrs
- Respiration if <12 reevaluate
- Reflexes
- Urinary output, <30 accumulation of mag
- Calcium gluconate is antagoist 1g in 3 min
- FHR
-
Respiratory effects on preterm baby
- Lacks surfactant
- ductus arteriosus may remain open- because of decreased o2 levels and prostagladin e levels
-
Nursing care for preterm respiratory effects of preterm baby
- Position
- airway pateny
- HR and RR
- Montior resp function befor and during feeding
-
Signs of patent ductus arteriosis
increase blood volu to the lungs, causing pulmonary conjestion, increased resp effort, co2 retention and bounding femoral pulses
-
Adequate output for baby
1-3 ml/kg/hr
-
calorie needs for baby
95-130 kcal/kg/day
-
Nursing implications of preterm gastrointestinal baby
- evaluate hydration status
- observe for signs of fetal intolerance
- measure abdominal girth
- ausulate bowel sounds
- aspirate and measure residual
- v&d
- lactose or blood in stool
- daily weights
- Place on right side or stomach after meal
-
First signs of sepsis in baby
- lethargy
- increased episodes of apnea and bradycardia
-
Why is immune system weaker in preterm baby
- Lack of passive IgG antibodies- last trimester
- Skin is easily excoriated
-
Big powerful contractions, not doing anything, stops in lanent phase, increased frequency but decreased intensity of contractions
Hypertonic labor patterns
-
Labor that is stopped in active phase
<2-3 contractions in 10 minutes
Hypotonic labor pattern
-
Possible reasons for hyptonic labor
- Overstretched form twins, large fetus
- hydramnis
- fetal malposition
- prematurity or grandmultiparity
- bladder or bowel distention
- cpd associated
- anegia/anasthia
- full bladder
- pelvis too small
-
Dystocia risks for mom
- increased discomfort, unproductive (hyper)
- fatigue/exhaustion
- stress on coping abilites
- dehydration and possible infection if labor prolonged
- increased risk for postpartal hemorrhage - from insufficient uterin contractions following birth (hypo)
-
Dystocia Fetal-Neonatal risks
- Nonreassuring fetal status
- increase incidence of caput succedaneum, cephlahematoma, and molding
- increased risk of sepsis from prolonged membrane
-
Early PPH
- 1st 24hours
- uterine atony most common cause
- loss of 500ml+ vaginal or 1000+ c/s
-
Late PPH
- 24hours- 6weeks
- Retained placenta products
-
4 "T"'s for PPh
- Tone
- tissue
- trauma
- thrombin
-
Tone - 70-80% causes
- Uterine over-distention:
- multiple birth
- polyhydram
- macrosomia
- prolonged labor
- oxytocin
- grand multiparity
- anathesia
- prolonged 3rd stage
- operative -forceps and vacum
- previa
- Uterine Muscle Fatigue:
- Uterine infection/chorioamnionitis:
- Uterine distortion/ abnormality:
- Uterine relaxing durgs:
- epidural
- general
- spinal
- anthsia
- mag
- procardia
- brethaline/terbtine
-
Tissue PPH
- Retained placenta/membranes - from masage fundus before placenta seperation
- Abnormal placenta- placenta implanted on the muscle of uterus
- C/s near scar
-
Trama PPH
- Gentital tract tears:
- cervical, vaginal and perineal ( big baby, fast delivery, episotomy, primagravida, forcepts , vacum, oxytocin
- Extended tear at C/S incision
- Uterin rupture- V-back removal of fibroids past surg
- Uterine inversion- turning insid out, pulling on cord before seperation
-
Thrombin PPH
- Pre-existing clotting abnormality
- anticoagulation- history of pe dvt
- acquired complications in pregnancy
-
Nursing interventions of PPH
- 2 sat pads in 15 min
- dont leave
- call help
- call dr
- notify anesthesia
- explain what is happening
- MASSAGE FUNDUS
- Obtain v/s q5 min
- pulse ox continuous
- o2 @ 8-10 L min via face mask
- insert foley
- initiat 2 iv sites with 16-18 gauges
- order a pp hemorrage order set- CBC, CMP, PT,PTT, Fibrinogen
- Type and cross for 2 units of packed RBC's
- Order trama blood if necessary
- elevate patient legs
- monitor i and os
- auscultat lungs before and after infustions
-
Treatment TONE
- uterine massage
- 1. oxytocin- 20 units per liter of LR- 10 units im if no iv
- 2. Methergine 0.2mg IM q 2-4hours UNLESS HYPERTENSIVE
- 3. Hemabate 0.25 mg IM repeat Prn q15-90 min with max of 8 doses
- 4. Cytotec 800-1000mcg rectally q2hrs
- surgical procedures
-
Treatment Tissue
- Manual removal of placenta
- curettage of retain tissue
- ultrasound evaluation of uterus and retained tissue
-
Treatment Trama
- suture laceration
- drain hematomas
- replace inverted uterus
-
Treatment Thrombin
- Hematology consult
- Replace factors
- Platelet transfusion
- fresh frozen plasma
- Recombiant factor - manmade activated protein that promotes thrombosis
-
Signs of PPH
- excessive or bright bleeding (sat of more than 1 pad in 1hr)
- Boggy fundus not responding to massage
- abnormal clots
- increased temp
- unusual pelvic or back pain
- persisitent pain with firmly contracted fundus
- rise fundus
- hematoma formation or bulging/ shiny skin in the perineal area
- decreased level of consciousness
-
Things to remember with hemabate for pph
- avoid with asthma
- do not give if the paient has actvit cardiac, pulmonary, renal or hepatic disease
-
antagonist of heperain
protomine sulfate
-
preventive measures for decrease thormboembolic disease
ambulate, scds, avoid dehydartion, no smoking , no leg crossing
-
Labs for coumadin
pt and inr
-
-
Adjustment reatction with depressed mood "Baby Blues"
incidence
s&s
onset
causes
nursing care
- 50-80%
- Tearful without being sad
- day 2ish but gone by 2-3 weeks
- Hormones
- Bring family in!
-
Postpartum major mood disorder
incidence
onset
risk factors
risk for suicide
- up to 30%
- about 4 wks out and come anytime within the first year
- impoverish, birthplan not met, last postpardum depression, exhaustion, fatigued
- Yes! infantcide uncommon
-
Signs and symptoms of adjustment reatction with depressed mood
- overwhelmed
- unable to cope
- fatigued
- anxious
- irritable
- oversensitive
- episodic tearfulness
-
Risk factors for PPD Postpartum major mood disorder
- all women
- primaparity
- prior history of depression
- anciety
- hx of other mental illentss
- family hx
- social risks
- fatigue
-
S&S of PPD
- Depressed mood
- tearfulness
- sleep or appetite disturbances
- nervousness or anxiety
- irritabliltiy
- weight gain or loss
- loss of interest or pleasrue
- low energy
- loss of concentration
- guilt hopelessness
- thoughts of harming self or baby
-
screening for ppd
- edinburgh postnatal depression scal
- 1st prenatla visit, 20weeks gestation, immediately pospartum, 6 weeks postpartum, regular intervals during 1st year
-
Treatments of PPD
- Non pharm
- complementry
- anti depressants
- anti psychotics
- hospitalization
-
Postpartum psychosis
evident when
s&s
- within 1st 3 months postpartum
- agitation
- hyperactivity
- insomnia
- mood lability
- confusion
- irrationality
- poor concentration and judgetment
- delusions and hallucinations
-
Treatment of postpartum psychosis
- hospitalixation
- antipsychotics
- ect
- removal of infant
- psychotherapy
- improvement in 95% of all cases
-
SGA
how big?
What age?
- below 10th percentile
- preterm, term, postterm
- doubets and ballard score then compare size
-
IUGR
Symmetric
- head doesn't apperar abnormally large or the length excessive in relation to other bodyparts
- never catch up to peers
- vigorous
- body parts in proportion
- below normal size for gestational age
-
IUGR
Asymmetric
- Appear long, thin, emaciated, loss of fat, and muscle mass, head appears large
- Head is really in the normal percentile
- loose skin folds
- vigourous cry
- appear wide eyed and alert
- chest size and abdominal girth decreased
- catches up to peers
-
Common complications for SGA
- asphyxia- rds
- aspirations syndrome - tachynpea, ng feeding, hypoxic, gasp aspirat amniotic fluid
- hypothermia
- hypoglycemia - most comon with iugr
- polycythemia
-
Complications of LGA
- Birth trama- cpd, aphexia, clavical, ect.
- Increased C/S
- hypoglycemia, polycythemia, hyperviscocity
- More difficult to arouse to a quiet alert state
-
When do test for pku and metabolism disorders?
24hrs after po feedings
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