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Powers of labor
- the force supplied by the fundus of the uterus
- implemented by uterine contractions
- causes cervical dilation and expulsion of the fetus
- supplemented by the use of abdominal muscles
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Phases of a contraction
- increment: increasing intensity
- acme: strongest intensity
- decrement: decreasing intensity
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Stages of labor
- first stage: latent, active, and transition
- second stage: full dilation to birth
- third stage: birth to delivery of placenta
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Danger signs of labor
(maternal)
- high/low blood pressure
- abnormal pulse
- inadequate/prolonged contractions
- pathologic retraction ring - indentation in abdomen
- abnormal lower abdominal contour - bladder too full
- increasing apprehension
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Danger signs of labor
(fetal)
- high/low heart rate
- meconium staining
- hyperactivity - sign of hypoxia
- oxygen saturation
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Accelerations of FHR
- temporary, normal
- occur with contractions or fetal movement
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Early decelerations of FHR
- normal periodic decreases in HR
- begin when the contraction begins, end when the contraction ends
- normally occurs late in labor
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Late decelerations of FHR
- begin 30-40 seconds after onset of contraction, continue beyond end of contraction
- suggests uteroplacental insufficiency or decreased blood flow
- stop or slow oxytocin, if being used
- change woman's position from supine to lateral
- prepare for possible prompt delivery if continues
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Prolonged decelerations of FHR
- last longer than 2-3 minutes, less than 10 minutes
- generally isolated
- may signify cord compression or maternal hypotension
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Variable decelerations
- unpredictable times in relation to contractions
- indicates cord compression
- change woman's position
- amnioinfusion possible to relieve pressure
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Sinusoidal FRH
- FHR resembles a frequently undulating wave
- occurs with severe anemia or hypoxia
- change of 5-15 bpm every 3-5 minutes
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Analgesia vs. Anesthesia
- analgesia: reduces or decreases awareness of pain
- anesthesia: partial or complete loss of sensation
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Narcotic analgesics during labor
- Demerol, Nubain, Sublimaze, Stadol
- all can cause fetal CNS depression
- can possibly slow labor if given early
- can be givin intrathecal (into spinal cord)
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Regional anesthesia during labor
- Pontacaine or Marcaine
- includes epidurals
- woman does not feel contractions
- counter risk for hypotension by administering fluids
- to administer, positioned on side, back not flexed
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Combined spinal epidural technique during labor
- immediate pain relief
- still allows woman to be ambulatory
- drug in the CSF is a narcotic, not an anesthetic
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Local anesthetics during birth
- injection of lidocaine into perineum
- pudendal nerve block injection close to spine
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General anesthesia during birth
- not preferred
- needs 6 drugs readily available:
- ephedrine: in case BP drops
- atrophine sulfate: dries oral and resp secretions
- thiopental sodium: rapid induction
- succinylcholine: for intubation
- diazepam: control seizures
- isoproterenol: reduce bronchospasms
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Uterine atony
- when the uterus becomes relaxed after birth
- will lose blood very rapidly
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Lochia
- uterine flow of inner layer of decidua
- rubra: red flow from birth to 3 days
- serosa: pink/brown flow from days 4-10
- alba: white/clear flow from day 10-3 weeks
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Nevus flammeus
- port-wine stain
- most often on face, but sometimes on thighs
- does not fade with age
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Telangiectasia
(stork's beak marks)
- a kind of nevus flammeus
- lighter, pink patches at the nape of the neck
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Strawberry hemangioma
- elevated areas formed by immature capillaries and endothelial cells
- will disappear by age 10
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Cavernous hemangioma
- resembles a strawberry hemangioma
- raised dilated vascular space
- do not disappear over time
- can also have additional internal spaces
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Mongolian spots
- pigmented cells
- appear as slate-grap patches across the sacrum or buttocks
- usually appear in Asian, s. European or African children
- disappear by school age
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Vernix caseosa
- a white, cream cheese-like substance on a newborn that protects the skin in utero
- takes on the color of the amniotic fluid
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Lanugo
fine, downy hair that covers a newborn
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Desquamation
- normal drying of skin in 24 hours after birth
- may resemble a sunburn
- no treatment necessary
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Milia
- a pinpoint white papule on the cheek or bridge of nose of a newborn
- disappear by 2-4 weeks
- normal
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Erythema toxicum
- normal newborn rash across face
- lack of pattern
- disappears w/in two days
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Anterior fontanelle
- located at the junction between the two parietal bones and the two fused frontal bones
- diamoned shaped, 2-3 cm
- closes between 12-18 months
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Caput succedaneum
- edema of the scalp of a newborn
- crosses suture lines
- no treatment needed
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Cephalhematoma
- a collection of blood between the periosteum of a newborn's skull bone and the bone itself
- caused by rupture of a periosteal capillary d/t birth pressure
- confined to an individual bone, doesn't cross suture line
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Type I allergic response
- Anaphylaxis - extreme vasodilation -> circulatory shock and extreme bronchoconstriction -> decreases the airway lumens
- Caused by histamine, leukotrienes and SRS-A
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Type II allergic response
Cytotoxic response - attack and destroy foreign cells
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Type III allergic response
Immune complex - initiates inflammatory response
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Type IV allergic response
- Cell-mediated hypersensitivity - inflammatory response 12-72 hours after expsure
- e.g. PPD
- e.g. contact dermatitis
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Allergic rhinitis
- hayfever
- caused by a type I (hypersensitivity)
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Fifth disease
- erythema infectiosum
- bright red rash appears first on cheeks
- a day later, rash appears on the body
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Scarlet fever
- "strawberry tongue"
- rash appears 12-48 hours after high fever, sore throat
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Impetigo
honey-colored crusts on face
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Roseola infantum
after 3-4 days, high fever falls abruptly and then rash appears
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Pityriasis rosea
- begins with the herald patch on the trunk
- then generalized rash appears in Christmas tree shape
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Normochromic, Normocytic Anemias
- impaired production of erythrocytes by the bone marrow or
- abnormal or uncompensated loss of circulating RBCs
- causes: blood loss, acute infection, renal disease, neoplastic disease, hypersplenism, aplastic anemia (bone marrow depression), hypoplastic anemia (bone marrow depression)
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Hypochromic anemias
- hemoglobin systhesis is inadequate
- causes: iron-deficiency, chronic infection
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Macrocytic anemia
- due to nutritional deficiencies
- causes: folic acid deficiency, pernicious anemia (vit B12 deficiency)
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Hemolytic anemia
- destruction of erythrocytes - fundamental abnormalities or extracellular destruction
- e.g. sickle-cell anemia (abnormally shaped RBCs)
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Thalassemia minor
- produce both defective and normal hemoglobin
- no iron supplements
- no other treatment needed
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Purpuras
a hemorrhagic rash or small hemorrhages in the superficial layer of skin
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Thalassemia major
- bone marrow hypertrophies -> bone pain
- heptosplenomegaly due to spleen trying to destroy defective RBCs
- treat with blood transfusions and hematopoietic stem cell transplant
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von Willebrand's disease
- dominant disorder
- factor VIII defect
- inability of platelets to aggregate
- blood vessels cannot constrict to aid in coagulation
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