Maternity terminology
Terms
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- Fundus
- upper body of the uterus
- if the uterus is firm and the mom is still bleeding what do you do?
- look for bleeding somewhere else~ lacerations etc
- FB or F
- Fingerbreadth (assuming that each finger is a centimeter)
- U
- Umbilicus
- BF
- Breastfeeding
- Boggy
- Soft and “squishy†(use in describing uterus tone) [not good]
- Lochia
- Drainage from the uterus and vagina after delivery of a baby
- Lochia Rubra
- First 3 days after child birth, blood
- Lochia Serosa
- Fourth day lochia changes to pink or brown-tinged
- Lochia Alba
- white or cream colored by the 11th day may persist to the 6th week after childbirth
- Lochia Amount
-
-Scant: les than 1 inch stain on pad
-Light: 1 - 4 inch stain
-Moderate: 4 - 6 inch stain
-Large: Saturated peripad in 1 hour
-Excessive: saturated pad in 15 minutes
-A constant trickle of lochia indicates excessive bleeding and requires immediate attention
-Foul odor can suggest endometrial infection - Perineal Assessment
-
-REEDA
-R: redness
-E: edema
-E: ecchymosis (bruising)
-D: discharge
-A: approximation (should be closed as if they were stuck or glued together) - Fundal Height
-
-Immediately following delivery the fundus can be found midway between the symphysis pubis and the umbilicus
-Then the fundus rises to the level of the umbilicus and remains at this level for 24 hours
-After 24 hours the fundus begins to desend by approximately 1cm, or 1 fingerbreadth per day
-By 10th day it is back in the pelvic cavity - Postpartum Vital Signs
-
-HR: 50-60 is normal as large amounts of blood return to the maternal circulation after the placenta is born
-B/P: hypotension may indicate a hemorrhage
-Resp: 16-20
-Temp: 100.4 is common during the first 24 hours after birth - Newborn Vital Signs
-
-Temp:
*Axillary: 97.7 - 99.5
*Rectal: 97.7 - 99.7
-HR: 120-160
-Resp: 30-60
-BG: 40-45 - Newborn Measurments
-
-Weight: 2500-4000g
-Length: 48-53cm
-Head Cir: 33-35.5cm
-Chest Cir: 30.5-33cm - Signs of Delayed Bonding
-
-Using negative terms to describe infant
-Discussing infant in impersonal or technical ways
-Failing to give the infant a name or to use name
-Visiting or calling infrequently or not at all
-Decreasing number & length of visits
-Showing interest in other infants
-Refusing offers to hold and learn to care for infant
-Showing decrease in or lack of eye contact - Mastitis
-
-A painful infection of the breast usually caused by the entry of germs, often from the baby's mouth, into a milk duct through a crack or fissure in the nipple.
-Symptoms include fever, soreness, and swelling. It occurs in about one in 20 breastfeeding mothers at some time during lactation, most commonly between the tenth and 28th days postnatally. - Breast Feeding Health teaching tool
-
-Latch within the first 2hrs of birth
-Offer breast every 2-3hrs
-Feed 20min or longer ea side
-Position: football, cross, cradle, side lying
-Stimulate baby's lower lip
-Support baby's head
-Listen for swallows
-Avoid artificial nipples
-Avoid formula or glucose H2O
-Offer encouragement
-Est. care plan if problems
*begin pumping as soon as problem arises
-Not wanting to breast feed:
*do not take hot showers
*No stimulation of breasts
-Tight fitting bras - S/S Mastitis
-
-Temp up to 40c
-Hard irregular warm red spot on breasts
-Pain in breasts
-Feel like flu-like symptoms - Avoiding Mastitis Health teaching
-
-Alternating breasts
-Allow breasts to air dry
-Avoid soap or alcohol
-Proper positioning of baby
-Avoid stasis with warm soaks, freq feedings - SVD
- spontaneous vaginal delivery
- C/S
- Cesarean section – C-section~ opening into the uterus to take the baby out
- FP
- Family planning
- SBE
- self breast exam
- EBL
- estimated blood loss
- HNV
- has not voided
- DTV
- due to void
- Episiotomy
- incision on perineum to assist delivery of infant
- Mediolateral
- a placement of episiotomy
- Cervix
- Structure between uterus and vagina
- Striae
- Stretch marks
- Cholasma
- mask of pregnancy – darkened area on woman’s face~ around the eyes especially, may darken with sun exposure
- Linea nigra
- dark line on Mom’s abdomen due to pregnancy~ due to hormones, may also be on the baby
- Tubal ligation
- cutting of the Fallopian tubes for sterilization
- Lochia Health teaching
-
-Amount should decrease each day.
-Color should progress from bright red to pinky red to brownish-red/white
-Should not go back in color or amount
-Fleshy odor – not foul smelling
Lochia –changes in amount
-when getting OOB and standing up
-with breastfeeding- uterus clamps down better and that is cause
-with massage –dark = pooled. Red=fresh
-with exertion – esp. when goes home
-with C/S and Pitocin use the flow is little to none - Perineum – Health teaching
-
a. Wash hands before and after BR
b. Peri bottle q void
c. Change pad q void
d. Apply pad front to back
e. Report any foul drainage
f. Kegals exercises - Newborn Tests
-
-heel stick for
*B/G
*PKU (Phenal Ketone Uria)
*bilirubin test
*Coomb's test
-Auditory test - Bilirubin
-
-With breakdown of RBCs, bilirubin is an usable product that needs to be excreted
-it can be toxic at high levels
-it is fat soluble so it can be absorbed by the SQ fat
Causes yellowish discoloration of skin and scolera (white) of eye - Teratogenic
-
-Any substance that is capable of interfering with normalembryonic development and can produce non-heritable birth defects
-teratogenic substances are most often radiation or chemicals
-drugs given to the mother that can cross the placental barrier to the unborn child. they are capable of interfering with the development of the fetus, thus causing birth defects - Acrocyanosis
-
Bluish discoloration of the hands and feet due to reduced peripheral circulation
-normal in the newly born infant
should go away after the first couple of hours of life to 1-2 days after birth - Umbilical cord care
-
-cord should be check for bleeding and oozing
-cord clamp should be securely fastened
-parents should clean the cord with alcohol at least TID
-fold diaper below the cord
-clamp can be removed 24 hours after birth if the cord is dry - Involution
- Retrogressive changes that returns the reproductive organs, particularly the uterus, to their prepregnancy size and condition
- Signs of respiratory distress
-
-tachypnea: >60
-retractions: sternal, substernal, suprasternal, intercostal
-flaring of the nares
-cyanosis: generalized
-grunting: end expiratory pressure against a closed glottis
-seesaw respiration
-decreased breath sounds
-crackles - Nursing postpartum care for a C-Section
-
*VS q5 min then q15 min when stable
*o2 status, pulse ox, and tdbc, I&O, NPO, IV and foley
*the IV will be 10-20U of pitocin used to help cause involution of the uterus
*incision and dressing: if bleeding, circle, date and time
*fundus and lochia checks
*assess post anesthesia state, epidural and general - Subinvolution
-
-This is the failure of the uterus to shrink according to normal progression
-caused by retained fragments or infection
-S&S
*fundus that does not shrink one cm/day
*lochia that deviates from rubia-serosa-alba, varies in amt
*uterine tenderness, heaviness, bachache - Physiologic Jaundice
-
-occurs when bilirubin reaches 5-7
-never present during he first 24 hours of life
-appears on day 2 or 3
-normal in newborns
-levels begin to fall about a week after birth
-phototherapy may be used - pathologic jaundice
-
-occurs during the first 24 hours of life
-a bilirubin level above 1 or a total bilirubin concentration that increases by more than 5 per day or is higher than 12 or persists after the second week
-due to abmormalities causing excessive destruction of RBCs
-can be due to incompatable blood (mothers/infants), infection, metabolic disorders - cephalhematoma
-
-does not cross the suture line
-check for jaundice
-does not appear until 24-48 hours after birth
-gone within a few weeks - meconium aspiration
-
may be caused by:
-hypoxia- creating a relaxation of the anal sphincter
-vagal stimulation possible from cord compression
-GI motility, norm for term or post-term infant
->38 weeks, less amniotic fluid, increased cord compression
-can cause pnemonia, asphyxia, pneumothorax, distress - Newborn Reflexes
-
-Moro: allow the head and trunk of newborn to fall backward (arms and legs should extend and abduct)
-Palmer grasp: when infant's hand is touched at the base of the fingers the hand should close into a tight fist
-Plantar grasp: same as above except on the feet
-Babinski: stroking the sole of the infant's foot causing the toes to flare
-Rooting: when infant's check is touched near the mouth the head turns toward that side
-Sucking: when the mouth or palate is touched the infant should begin to suck
-Tonic neck: arm and leg should extend on the side of the body in which the head is turned (fencing reflex)
-Stepping: when infant is held upright w/their feet touching a hard surface they should lift one foot then the other as if they were walking - Moro Reflex
- allow the head and trunk of newborn to fall backward (arms and legs should extend and abduct)
- Palmar grasp
- when infant's hand is touched at the base of the fingers the hand should close into a tight fist
- Plantar grasp
- same as palmar except on the feet
- Babinski reflex
- stroking the sole of the infant's foot causing the toes to flare
- Rooting reflex
- when infant's check is touched near the mouth the head turns toward that side
- Sucking reflex
- when the mouth or palate is touched the infant should begin to suck
- Tonic neck reflex
- arm and leg should extend on the side of the body in which the head is turned (fencing reflex)
- Stepping reflex
- when infant is held upright w/their feet touching a hard surface they should lift one foot then the other as if they were walking
- Signs of neonatal hypoglycemia
-
-Jitteriness
-Poor muscle tone
-Diaphoresis
-Poor suck
-Tachypnea
-Dyspnea
-Cyanosis
-Apnea
-Low temp
-High-pitched cry
-Irritability
-Lethargy
-Seizures, coma
-Some infants may be asymptomatic - Respiratory Distress Syndrome
-
-Increases w/decreased gestational age, multiple gestation and uncontrolled DM
-A deficiency of surfactant production
-Surfactant keeps the aveoli surface tension down to prevent aveoli from collapsing at the end of expiration - gravid
- pregnant, the state of being pregnant
- gravida (g)
- a pregnant woman
- Primigravida
- a woman who is pregnant for the first time
- multigravida
- a woman who has been pregnant more than once
- nulligravida
- a woman who has never been pregnant
- para (p)
- a woman who has delivered a viable infant (over the age of 20 weeks gestation), whether alive or stillborn~ refers to the number of deliveries not infants
- parity
- the number of times a woman has delivered a viable infant or infants
- nullipara
- one who has never borne a viable child
- Primipara
- a woman who has had one delivery of a viable infant or infants
- multipara
- a woman who has had two or more deliveries of viable infants
- puerperium
-
the 6 week postpartal period. It nds with the resumption of ovulatory menses. It is broken down into three phases:
*immediate~ first 24 hours
*early~ second to seventh day
*late~ seventh day through the sixth week - rate of involution
- Faster in primip than in multip due to better muscle tone in the primip. this is also faster in breast feeding mothers than non-breast feeding due to stimulation of oxytocin. slower when the uterus is overdistended (ex~ polyhydraminos, twins, large baby)
- gestation
- period of fetal development from conception to birth
- trimester
- refers to a period of 3 months. pregnancy is divided into a 1st, 2nd and 3rd trimesters
- term
- beginning of the 38th week to the end of the 42nd week
- pre-term
- 20th week to the end of the 37th week
- abortion
- Spontaneous or therapeutic cessation of pregnancy before 20 weeks (ab or ETP)
- Ectopic pregnancy
- development of an embryo outside the uterine cavity. Not viable. Removed surgically approximately 6-8 weeks of pregnancy (usually in fallopian tubes could also present in the abdominal cavity)