Maternity

Initial lochia: 1-3 days and is bright red, fleshy odor. Numerous large clots.  Saturation in 1 hour or less.

Days 4-9. Pinkish brown.  Saturation of pad in 1 hour or less

Day 10 - approx 6 weeks. Creamy white

• 1. Anticipatory -during pregnancy.  Looks @ role models on how to be a mother.
• 2. Formal -  birth and on. Still influenced by others
• 3. Informal -  when mother starts to make her own choices and find own style
• 4.  Personal - Does what she is comfortable with 3-10 mo after delivery

• Prolactin
• Oxytocin (also stimulates uterine contractions)

Within 3 days

Diuresis (↑ pee)

Diaphoresis (↑ sweating)

no more than 2 hours

Smallpox

Improper mouth position and requires repositioning

• Hindemilk - milk produced at the end of feeding. Contains more fat
• Foremilk -  milk produced at the beginning

500

• prolonged labor
• Incomplete expulsion of placenta
• Anesthesia
• Previous labors
• Full bladder

• postpartum check
• Breasts
• Uterus
• Bladder
• Bowel
• Lochia
• Episiotomy
• Homan's sign
• Emotional status

• HIV
• HTLV 1 &2
• You can breastfeed - Hep A, Hep B (must receive HPV vaccine first) and TB

• Can store in glass or hard plastic
• Do not microwave
• Store in fridge up to 5 days and freezer 2 weeks

Failure of uterus to return to pre-pregnancy size and mostly caused by retained placental fragments

• Uncomplicated labor
• Breastfeeding
• Early, frequent ambulation

• Temp may raise to 100.4°
• Pulse often ↓ to 50-60 bpm for 6-8 days

BP should remain the same

• Fundus above umbillicus
• Fundus over to the side
• Excessive lochia

Lactoferrin

• (In 1 hour)
• Scant -  < 2" stain
• Light -  < 4"
• Moderate - < 6"
• Large -  > 6" or pad saturated in 2 hours 
• Excessive -  Saturation w/in 15 min

Separation of abdominal muscles at midline

• Avoid forceful retraction
• Wash with water only during infancy
• Whiteish limps (smegma) are normal

• Hypoxia
• Acidosis
• Hypogylcemia
• ↓ surfactant production
• Collapse of alveoli
• Reopening of foramen ovale & ductus arteriosus

• Flat-purple lesion that doesn't blanch
• Can be assoc. with genetic disorders

• Splotchy erythema with firm yellow-white papules
• No interventions

• Heat producing tissue
• Located at the nape of the neck, armpits, between shoulder blades, abd aorta and around kidneys
• Not rewable

• Swelling of soft tissues of the scalp that is caused by pressure on head during labor
• No intervention needed

• Bulging- can indicate intracranial pressure
• Depressed -  Late sign of dehydration

• Anterior closed by 18 mo
• Posterior closed by 2-3 mo
• 3rd fontanelle may indicate down syndrome

• Vitamin K -  newborns cannot synthesize Vit K because they have no bacterial flora, deficient in clotting factors
• Erythromycin -  prophylaxis against opthalmia neonatorum
• Hep B

• Check umbilical clamp for tight closure
• Keep dry and exposed to air
• Clean around cord with alcohol every diaper change
• If moist, red or foul odor report immediately

• Stork bites
• Gradually fade

Heat production without shivering by oxidation of brown fat

• Easily awakened
• The best time to test hearing

Ballard scale

• Preserve the skins PH
• Avoid: alkaline soaps, oils, powder, lotions

For 1-2 weeks, water only

• 1 - Birth - 1 hour (in delivery room)
• 2 -  1-4 hours
• 3 - 4 hours - discharge.  Nursing interventions and family teaching

97.7 - 99.5

• Failure of the two eyes to direct their gaze at the same object simultaneously.
• Estropia - when one eye moves toward the other eye
• Extropia -  turning out of one eye
• Surgery or eye exercises to treat

The amount of air that remains in the lungs after normal expiration

• Bluish pigmentation over lower back and buttocks
• Common in dark skinned newborns

• Ductus Venosus -  diverts blood away from liver.  Closes when cord is cut
• Foramen Ovale -  diverts blood from right atrium directly to left atrium. 
• Ductus Arteriosus -  Diverts blood from pulmonary artery into aorta after birth - closes w/in 15 hours and perm by 3 weeks

Small white papules that are harmless

• When ductus arteriosus fails to close after birth
• May lead to CHF if not corrected
• High occurance in preemies
• Contributing factors - Congenital rubella

a substance formed in the lungs that reduces surface tension and helps keep the alveoli expanded and not collapsed

lack of oxygen at the tissue level will depress respirations

• 30-60 breaths/min
• Periodic breathing with 5-15 second pauses
• Breathe through the nose

• Accumulation of blood under the periosteum of newborns skull
• Caused by trauma to blood vessels during birth
• More common in long or difficult labor
• May take up to 3 weeks to go away

• Small, white blebs found on the gums and junction of soft & hard palates
• You just need to distinguish between them and thrush

• Eyes are open, minimal body activity
• Best time for parent/newborn interaction and to test responses and reflexes

• bluish discoloration of hands and feet
• Normal

• If newborn has phimosis, should be circumcised, otherwise it's elective
• Preterm infants should not, must be stabilized first
• A&D or petroleum jelly applied at every diaper change
• Usually heals in 3-5 days.  Do not remove yellow crust

5 days

Fingerlike projections at the end of fallopian tube

• a gland that surrounds the urethra that contributes to semen secretion
• Adds alkaline fluid to semen
• Helps neutralize acidity of vagina

• 2 saclike structures
• produces milky secretion that protects sperm
• empties into urethra

• Stimulates uterine growth
• Increases blood flow to uterine vessels
• Stimulates development of breast ducts

• Protection
• Nutrition
• Respiration
• Excretion
• Hormone production

• The cells on the outer ring of blastocyst
• Will become placenta
• The cells secrete enzymes that enable it to implant into uterus

Outer membrane of amniotic sac that is formed from trophoblast

Haploid # of chromosomes

The process of mitosis in the sperm & ovum

• Type of cell division in which each daughter cell contains the same # of chromosomes as the parent cell
• The process by which the body grows and cells are replaced

• Spiral structures found within nucleus of each cell
• They control heredity
• Occur in pairs. One member from mother, one from father.
• Each cell contains 46 chromosomes

• Less than 300 mL of amniotic fluid
• (associated with renal abnormalities)

• Excessive amniotic fluid (more than 2L)
• Assoc w/malformations of CNS and GI tract

Fluid that surrounds the fetus and permits fetal movement, absorbs shock and prevents heat loss

root-like, branching projections of chorion containing capillaries that substances are exchanged between mother and fetus

• Maintains uterine lining
• Reduces uterine contractions
• Prepares glands of breasts for lactation
• Stimulates testes to produce testosterone (male fetus)

• Undelivered baby after embryonic period
• 8th week-birth

17 weeks

body cells

• agent or substance that causes abnormal development of embryo
• Most likely to cause damage during first 8 weeks

• Amnion - Inner layer that contains amniotic fluid and embryo
• Chorion -  outer layer that encloses amnion

Segments of DNA that control heredity

"sex cells" which determine the sex of the fetus

• Hypoglycemia
• Respiratory distress
• Jaundice
• Lanugo
• Less body fat
• Enlarged clitoris
• Less activity

Diploid number of chromosomes

Reduction cell division in ova and sperm that halves the # of chromosomes in each cell

• in the sperm before traveling to fallopian tube
• and
• in ovum after ovulation if fertilized

50% of offspring will carry that trait

the outer third of the fallopian tube

• XX = female
• XY = male

5 days

6-24 hours

• stage that follows morula
• Outer layer of trophoblast attached to an inner cell mass.  Contains: fluid filled cavity, trophoblast, inner cell blast

Stage of zygote where there is solid mass of cells (approx 3 days)

Thick substance that is physical buffer to prevent kinking of umbilical cord

• Progesterone
• Estrogen
• HCG
• HPL

• Mono -  identical twins splitting of one fertilized egg before 15th day. If splitting is incomplete = conjoined twins
• Dizy -  2 ova, 2 sperm. Each fetus has own amniotic sac and placenta

Consumption of substances ordinarily considered inedible.  

• usually performed at 16-18 weeks gestation
• High levels assoc with spina bifida

• done in 1st trimester 
• alternative to amniocentesis
• Higher abortion rate than amnio
• Checks for chromosome defects

Used to determine the presentation and position of fetus

• 2nd - 8th week after conception
• When most basic organ structures are formed

Number of births after 20 weeks gestation regardless if infants survived

Gestational hypertension

• hearing fetal heart sounds
• palpating fetal movements
• visualizing the fetus via ultrasound

Lower BP and pulse in supine position resulting from compression of the inferior vena cava by pressure of the uterus

A deep breath taken at the beginning and end of each labor contraction

• Method to calculate expected DOB
• Count back 3 months from first day of last period and add 7 days

• A slight stroking movement of fingertips over abdomen during labor
• Used as a distraction for pain relief during contractions

• Fundus - upper rounded portion
• Corpus - middle
• Cervix - lower potion (known for its elasticity)

• 18" tube that ends at seminal vesicle
• Carries sperm from testes to urethra

Hormone produced by posterior pituitary that stimulates uterine contractions and milk

• testes open into and becomes vas deferens.
• Provide reservoir for sperm
• Can be maintained for up to 3 weeks

• Upper portion of pelvis
• Supports growing uterus and directs head of baby to true pelvis

Stimulates development of corpus luteum

Dorderlein's bacilli

Vaginal opening

• (Outer) Perimetrium
• (middle) Myometrium
• (Inner) Endometrium

Stimulates development of graafian follicle

• (external reproductive organs)
• Mons pubis
• Labia majora and minora
• Vestible
• Fourchette
• Perineum
• Clitoris

• Menstrual
• Proliferative - post menstrual. Lining repairs
• Secretary -  Premenstrual. Lots of progesterone. Thick lining

Distance between sacral promontory and lower border of symphysis pubis

• Gynecoid -  female type - Normal/round
• Android - male type - heart shaped outlet
• Anthropoid - long anterposterior
• Platypelloid - wide transverse outlet.  Not favorable for vaginal delivery

• Vaginal opening
• Urethral meatus
• Skene's ducts
• Ducts of Bartholin's glands

• Solid, yellow body that develops within ruptured follicle
• Secretes progesterone

Increases maternal insulin resistance

• Relaxes symphysis pubis and other pelvic joints
• Softens the cervix

• Inhibits uterine contractions
• Promotes duct developement
• Stimulates sodium secretion
• Reduces smooth muscle tone

• Slow Paced breathing -  starts and ends with cleansing breath, then breathes slowly
• Modified Paced breathing -  begins and ends with cleansing breath, then rapid/shallow breaths
• Patterned Paced breathing -  during later part of cervical dilation. Cleansing breaths, rapid breaths, pant blow

• Doubles
• 40% increase in blood volume

• G - gravida (# of pregnancies)
• T -  # of term pregnancies
• P -  # of pre-term pregnancies
• A -  # of abortions
• L -  # of live births
• M -  # of multiple births

• Chorionic villi of placenta. 
• Present as early as 1 week after conception

Any pregnancy, including present one

• Used to maintain fitness, not improve
• Mild to moderate is beneficial
• Strenuous or prolonged may cause hypoxia in baby

110 - 160 bpm

When fetal head is flexed

• Decreases in fetal heart rate
• Indicate an interruption of oxygen transfer to fetus

Face

• time from beginning of contraction until the beginning of the next
• Contractions more than every 2 min may decrease fetal O² supply

• Increment -  period of increasing strength
• Acme -  peak - period of greatest strength
• Decrement - period of decreasing strength

Relation of presenting fetal part to the front, sides and back of maternal pelvis

• Sagittal
• Frontal
• Coronal

• Vital signs every 30 minutes
• Provide support
• Assess membrane status
• Dilation
• Position changes

• Decrease in fetal HR before, during and after contraction
• r/t compression of umbilical cord
• Change mothers position

• Latent phase -  when regular contractions start up to dilated 4 cm
• Active phase -  dilation from 4-7 cm
• Transition phase -  dilation completes to 10 cm
• 1st stage ends when fetal head can be seen

Fetus is flexed with head on chest, arms and legs folded and legs drawn up onto abdomen

• Passageway (Pelvis size and shape)
• Passenger ( fetus size and position)
• Powers (effectiveness of contractions)
• Psyche (preparation and previous experience)

• Relation of presenting fetal part to the pelvic ischial spines of the birth canal
• How far fetal presenting part has descended into mothers pelvis
• Measured in cm above or below ischial spine
• Above = minus 1-5
• At 0 = head is engaged

• HR
• Respiratory effort
• Muscle tone
• Reflex irritability
• Color

• Increased pigmentation of the face during pregnancy
• aka - "mask of pregnancy" or melasma

• ID bracelet
• Vitals
• Fetal HR
• SROM?
• Assess contractions
• Allergies
• Last food intake?
• Recent illness or meds?
• Consent sigs
• Review lab tests and document
• RH status
• Orient to unit
• Care preferences

Fetal HR because prolapse of umbilical cord is most likely to occur at that time

• Slowing of FHR caused by head compression
• Mirrors contraction
• No interventions

• Begin at peak of contraction and end after contraction ends
• Assoc with uteroplacental insufficiency
• Repetitive decelerations are bad

• Lengthening of umbilical cord
• Gush of blood from vagina
• Elevation of fundus

• The relation of the fetal parts to one another
• Normal attitude is flexion

• Irritability
• Restlessness
• Amnesia
• Cramps in legs
• Belching/hiccups
• nausea
• Sweating
• Wants meds
• Feels out of control

• Can displace uterus and inhibit uterine contraction
• Woman may not be able to sense the need to void

Mouth then nose

Every 15 min for at least 1 hour

• Maintain thermoregulation
• Maintain cardiorespiratory function
• ID
• Look for anomalies
• Meconium & Urine
• Bonding

• Relational longitudinal axis of the fetus to the longitudinal axis of the mother
• Ideal is parallel with eachother

• Body part that is lowest in the mother's pelvis
• Cephalic is most common

Back part of the head

• Descent
• Flexion
• Internal rotation
• Extension (when crowning occurs)
• External rotation - after head is delivered
• Expulsion - when baby is delivered (end of 2nd stage of labor)

ROA - Right occiput anterior, engaged

Thinning and shortening of cervix before and during labor

• Movement of the fetus and uterus downward into the pelvic cavity
• Physical changes in mother are: easier breathing, increased urination, leg cramps, edema

• Zygote
• Morula
• Blastocysts
• Embryo
• Fetus

• Umbilical arteries carry deoxygenated blood to placenta
• Umbilical vein carries oxygenated blood from the placenta

Increased pressure in the left atrium

By the end of the seventh week

20 weeks

Each parent must contribute an abnormal gene

• Amenorrhea
• Nausea
• ↑ urination

• Fatigue
• Quickening
• Breast tenderness

• Uterine enlargement
• Hegar's sign
• Positive pregnancy test

Increased saliva production

When woman feels quickening, the fetus becomes distinct and separate. Daydreams and speaks of baby

Rule out fetal abnormalities

L/S ratio

Neural tube defects

Fetal oxygenation and autonomic functions

Woman brushes palm across nipple for 2-3 minutes

Stand with feet flat on the floor

To prevent aspiration

• #1: Urinary Bladder
• #2: Vas Deferens

• #1: Pectoralis major muscle
• #2: Alveoli
• #3: Areola
• #4: Nipple

• #1: Fallopian tube
• #2: Ovary
• #3: External Illiac Vessels
• #4: Infundibulopelvic Ligament

• #1: Seminal Vesicle
• #2: Ejaculatory Duct
• #3: Prostate Gland

• #1: Round Ligament
• #2: Corpus of Uterus
• #3: Bladder
• #4: Symphysis Pubis

• #1: Mons Pubis
• #2: Clitorus
• #3: Prepuce
• #4: Labia Minora

• #1: Orifice of Urethra
• #2: Labia Majora
• #3: Opening of Bartholin's Gland
• #4: Perineal Body

• #1: Hymen
• #2: Orifice of Vagina
• #3: Vistibule
• #4: Fourchette
• #5: Anus

• #1: Vaginal Orifice
• #2: Urogenital Diaphram
• #3: Vagina
• #4: Anus

• #1: Epididymis
• #2: Testes
• #3: Scrotum

• #1: Urogenital Diaphram
• #2: Glans of Clitoris
• #3: Urethra
• #4: Labium Minus
• #5: Labium Majus

• #1: Bulbourethral Gland
• #2: Anus

• #1: Urethra
• #2: Penis
• #3: Glans Penis
• #4: Foreskin

• #1: Ureter
• #2: Sacral Promontory
• #3: Uterosacral Ligament
• #4: Posterior cul-de-sac of Dougles

• #1: External Anal Sphincter
• #2: Lavator Ani Muscle
• #3: Fornix of Vagina
• #4: Rectum
• #5: Cervix