Study guide for Maternity Exam 2 PDF

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Study guide for Maternity Exam 2, all included material...

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N610 Exam 2 Stud tudyy Guide

Healthy PP / Transition to extrau xtrauterine terine life Tran to e xtr life/ Transition sition xtrauterine auterine life/first first breath • Major adjustments at birth – o Institute and sustain respirations o Clear lung fluid o Stabilize alveoli o Redirect blood flow o Close down fetal shunts o Activate all organ systems/metabolic process • Respirations – o Fetus lung fluid:  Term fetus produces 250-400 cc/day  Decreases 35% in days prior to labor  Vaginal squeeze expels 30% o Newborn Lung Fluid:  Change from fluid producer to absorption  Catecholamines produced in labor by fetal adrenal glands decrease production and increase re-absorption of fluid o Surfactant – Fetus:  24-30 weeks – detectable surfactant  30-36 weeks – enough for alveolar stability  Mixture of lipids, proteins, and glycoproteins  Lecithin makes surfactant more effective o Lecithin: sphingomyelin (L/S) ration = 2:1  Ration is either 2.0 or 2:1 --- NOT 2:0  W/ + PG = mature lungs  PG involved in the distribution of surfactants over the surface of alveoli. o Surfactant – Newborn:  Decreases surface tension, reduces collapse of alveoli, allows 40% air to remain as FRC (functional residual capacity) o Newborn Respiratory efforts:  First inspiration generates negative intrathoracic pressure aided by hcest recoil, vaginal squeeze  Must overcome: • Viscosity of lung fluid in respiratory tree • Resistance of airway • Surface tension at the air/water interface Thermoregulation in newborn Loch Lochia ia – • Color, amount (number of pads used - can weigh the pads), first few days is known as rubra d/t it’s dark red to bright red coloration. Smaller clots are normal but lots of large clots are of concern. After this, it will become watery and more serous (pale, transparent) and is then called serosa • Composed of endometrial tissue, blood, and lymph.

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Mean length: 27 days Average blood loss: 240-270 ml Rubra: 1-3 Days o Bright red o Primarily blood & clots Serosa: 4-10 days o Pink/brown tinged o Endometrial tissue & lymph Alba: 10 days-3 weeks o Yellowish-white o WBC’s, cells lymph DANGER: Resumption of bright red bleeding after lochia rubra has ceased (unless scant amount, one-time event) Amount: o Scant: less than 2.5 cm (1”) on pad in 1 hr. o Light: less than 4” on pad in 1 hr. o Moderate: Less that 15 cm (6”) on pad in 1 hr. o Heavy: Saturated pad in 1 hr. o Excessive: saturated pas in 15 min o **Note: always check for presence of clots**

o Laceration treatment – • 1st degree: Skin & mucosa • 2nd degree: Extends to muscle • 3rd degree: extends to anal sphincter • 4th degree: extends to rectal wall • Episiotomy: midline, mediolateral – at least same sutures as 2nd degree laceration o Increased probability of extension to 3rd or 4th degree • Treatm Treatment: ent: o Do:  Sitz bath, shower, reg bath, swimming, gentle exercise  Some MDs will give tub bath restrictions o Don’t:

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 Douche, intercourse, tampons  Nothing in vagina for at least 1 month Peribottle:  Part of PP teaching when first time  Warm water  To clean area  To dilute urine from stinging  Use as long as needed  Blot to dry, no wiping • RN wears gloves when touching bottle  Pelvic arthropathy? Sitz bath:  Brings heat to perineal area  Cleans perineal area  Use 3-4x/day for 20 min (after 1st 24 hours) or until water cold  Warm water (herbs ok too)  Clean well  Tub works too

AP Comp Hyperem Hyperemesis esis gravidaru avidarum m– • (HG) is a pregnancy complication that is characterized by severe nausea, vomiting, weight loss, and possibly dehydration. Feeling faint may also occur. It is considered more severe than morning sickness • Severe N/V that can impact hydration & nutrition status • 0.3 to 2% of all pregnancies • Dehydration, electrolyte imbalances, acidosis, weight loss, ketonuria, hepatic damage (jaundice) & renal damage can occur • Nullips, teens, multiple gestation, obesity, GTD, fetal abnormalities, or previous pregnancies with hyperemesis • Diagnosis: o Intractable vomiting in 1st half of pregnancy, dehydration, ketonuria, weight loss of 5% of pre pregnancy weight • Treatment: o Avoid environmental triggers o Frequent small meals, carbonated or sour beverages o CAM: ginger, acupressure, hypnosis o Vitamin B6 (pyroxidine) PO 10-25 mg BID & 25mg HS? o IV fluids & parenteral nutrition o Phenergan, Reglan, Zofran o Desired urine output 1000ml/24hr Different typ ypes es of abortion – • Spontaneous Abortion: o Termination of pregnancy prior to 20 weeks gestation (35% abruption  FHR changes o Initial compensatory increase in baseline o Decrease variability o Late decelerations o Bradycardia o Absence of FHR Nursing Management: o IV with large bore catheter o Labwork: CBC, type & cross, clotting studies, urinalysis/toxicology o O2 per mask o CVP or Swan-Gantz insertion o Foley catheter o If + FHT, prepare for immediate C-section Nursing Diagnosis: o Alteration in maternal tissue perfusion related to acute blood loss o Alteration in fetal oxygenation and tissue perfusion related to acute blood loss o Anxiety related to perceived threat to self and fetus o Alteration in comfort related to abdominal pain

Tests for gestatio estational nal diab iabetes etes (first scre reen en ening ing vs diagn iagnosi osis test) – st • 1 half of pregnancy (anabolic phase) o ↑ estrogen & progesterone o Leads to pancreatic beta cell hyperplasia & hyperinsulemia o ↑ insulin leads to increase in uptake & storage of glycogen & fat • 2nd half pregnancy (diabetogenic state) o ↑ insulin resistance due to placenta hormones o Hyperglycemia occurs o Deus removes glucose from maternal circulation o Leads to macrosomia o Leads to ↓ in surfactant production • Glucose Load Test (GLT) “GLXP” o Generally, around 28 weeks with 3rd tri labs o 1 Hour Test o 50g sugar loading w/o regard to last meal o Blood glucose test after 1 hour o No exercise, smoking, eating while waiting o If >130-140, then more testing… • Glucose Tolerance Test: o 3 hr. GTT when GLXP >140mg/dl o Includes fasting blood glucose o 100g sugar load o Then blood glucose every 3 hours x 3  Fasting < 105 cuts off at 95  1hour < 190 cuts off at 180  2 hour < 165 cuts off at 155

 3 hour < 145 cuts off at 140 o Diagnosis: 2 or more abnormal values Dif Differe fere ferent nt hype yperte rte rtensi nsi nsion on diag iagnosi nosi nosiss in pregnan egnancy cy – Chronic hypertension Pregnancy induced hypertension (PIH) or Gestational hypertension (GHTN) Preeclampsia (HTN, proteinuria, edema-not used in diagnostic criteria) Eclampsia: (all about preventing seizures) o seizure not attributable to other causes (periods of hypoxia for mother & fetus, risk of aspiration, other risks: CVA, cerebral edema, anoxia, coma, maternal death) • Chronic hypertension with superimposed preeclampsia • Transient (gestational) hypertension • HELLP syndrome: o (Hemolysis - RBCs destroyed, decreased O2; Elevated Liver enzymes - reduced perfusion leads to tissue ischemia/necrosis; Low Platelets - aggregate at damaged vessel wall leads to platelet consumption, thrombocytopenia...