OB-Peds
Terms
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- Duvall's Stages of Family Life
- Looks at family over time and addresses their universal tasks: married couples, w/ kids up to mos., w/ preschoolers ^6 yrs, w/ schoolage kids ^13, w/ adolescents ^19, launching young adults, middle age parents (empty nest), retired and old age (to death of spouse)
- Birth rate definition
- Number of births per 1000 women of childbearing age
- Maternal mortality def.
- Number of maternal deaths per 100 000 live births from complications of l and d and postpartum
- Neonatal mortality
- Infant deaths per 1,000 live births of 20 wks. gest. to 28 days
- Infant mortality
- Infant deaths from 1 mo. to 1 yr. per 1,000
- gravity
- pregnancy w/o regard to outcome
- parity
- fetus reaches viability (20-24 wks gest.)
- mulligravida
- never been pregnant
- primagravida
- pregnant for the first time
- Multigravida
- woman has experienced two or more pregnancies
- primipara
- one pregnancy w/ fetus reaching viability
- multipara
- completed two or more pregnancies which have reached viability
- fundic souffle
- Fetal heart rate of 115-160
- ballotment
- mov't of unengaged head 16-18 wks ^, probable sign of pregnancy (could be a tumor)
- quickening
- first recognition of fetal mov't, 18 wks w/ primipara, 14-16 w/ multipara, sooner w/ twins
- Pregnancy tests measure
- HCG (human chorionic gonadotroipin hormone)
- EDD/EDC
- Estimated date of delivery/ end date of confinement. Nagele's rule: last period plus seven days minus three months, plus one year
- v-vac
- Vaginal delivery after having a c-section
- What to include in a pregnant woman's hx
- Current and past pregn. char., gyn. hx, current medical hx, family hx, cultural/religious background, personal data
- Uterine changes during pregn.
-
Enlargement (due to incr. in estrogen and progesterone), increase in vascularity and dilation of b.v., incr. in tissue
Grows and elevates out of the pelvic area, can be palpated above symphysis by 12-14 wks, pushes on bladder, can hold 5-10 L - Chadwick's sign
- 5-8 wks, purple blue vagina and cervix
- Braxton-Hicks contractions
- Not in everyone, occur after 4 mos. Painless and normal
- Uterine souffle
- Bruit, sound of blood going to placenta, synchronous w/ maternal pulse
- McDonald sign
- Easy flexion of the fundus over the cervix
- Hegar sign
- Softening of the lower uterine segment
- Goddell sign
- Softening of the cervix
- Cardiovascular changes w/ pregnancy
- Cardiac hypertrophy, diaphragm displaces up and left, pulse inc. by 10-15 bpm by 20 wks, BP decr. 1 and 2 trimester, 3 normal (should NEVER increase). Blood volume incr. by 1500 cc, CO incr. by 30-50 % by 32 wk
- leukorrhea
- White mucous discharge, musty odor, normal variation, fills cervical canal forming mucus plug, barrier against bacterial invasion in pregnancy
- Hormonal changes w/ placental detachment
- Estrogen decr, stimulates prolactin and oxytocin (uterus contracts to prevent hemorrhage)
- Neuro changes w/ pregnancy
- Numbness and tingling in hands, compression of pelvic nerves-leg pain, lightheadedness (hypoglycemia b/c of infant), leg cramps or tetany-hypocalcemia
- Lab exams associated w/ pregn.
- Clean catch urine, PPD, pap, cervical, and vaginal smears, VDRL (syphillis), herpes, chlamydia, and gonorrhea, CBC, blood type, aby screening, HIV and hep. CAN'T have vaginal delivery w/ herpes outbreak
- Prenatal exam
- Nutritional info, health maint. q4wks to 28 wks, q2wks 29-36 wks, qwk >36
- Danger signs during pregnancy
- HA, visual disturbance, muscular irritability, epigastric pain, vomiting, discharge...htn? decr. fetal movt for at least 24 hours
- S/S of preterm labor
- Uterine contractions q10min or less, esp. if getting harder or more freq, menstral like cramps, low dull backache, pelvic pressure, incr. vaginal discharge
- Effleurage
- massage over abdomen w/ fingers to reduce pain
- Theories for what causes labor
- Don't know: uterine distension, incr. uterine pressure, age of placenta, incr. sensit. to oxytocin, changes in barometric pressure or hormone conc. (estrogen and prostaglandins increase, progesterone decreases)
- Intrapartum
- During the process of birth, includes 1-4 hours after birth, when mother/baby leave delivery area
- Preliminary signs of labor
- Lightening (baby drops-first baby: 1 wk before labor), increase in vaginal mucus/secretions, persistent low back pain, incr. in Braxton-Hicks contract., ripening, ROM (may be spontaneous), nesting syndrome, diarrhea
- True labor
- Contractions have a regular pattern, shortening interval, inr. intensity and duration, start from back to front, intensified by walking
- Internal exam reveals this for true labor:
- Progressive effacement and dilation, position and presentation of fetus, pelvic station and descent, status of membranes.
- Cervix changes (3)
-
Ripening: softening
Effacement: thins out
Dilatation: opens, must be 10 cm. for ALL vaginal deliveries (incl. premies) - Engagement
- Fetus descends to level of ischial spine (Station 0), Above is - below is + (closer to delivery a good thing). Negative station: baby floating
- Bloody show
- Impending labor: cervical secretions mixed w/ blood from ruptured capillaries, mucus plug expelled
- Window of safety after ROM
- 24 hours, after that, increased risk of infection for mother and baby
- Nsg interventions after ROM
- Check fetal monitor for change in FHR and pattern, check for possible cord prolapse, note and record: exact time, color, odor, clarity, and amt.
- Test for presence of amniotic fluid
-
Blue: positive
Yellow: negative - Shape of fontanelles
-
Ant. is diamond, remains open 18 mos.
Post. triangle, smaller, closes 12 wks - Fetal lie
- Relation of fetus to mother, only longitudinal a vaginal birth candidate
- Stages of Labor
-
Stage I: Early phase-7-8 hrs, 0-3 cm, 30-45 sec, 5-20 min. interval. Active Phase-3-5 hrs, 3-7 cm, 60 sec, 2-4 min. intervals. Transition Phase: 7-10 cm, .5-1.5 hrs, 70-90 sec., .5-1 min. intervals (VERY HARD phase)
Stage II: Expulsion, pushing stage, complete/complete
Stage III: Placental (5min-1hr), after delivery of infant, ends w/ deivery of placenta
Stage IV: Recovery 1-4 hrs after birth, physiological readjustment, fudnal firmness, v.s., bonding, hemorrhage, food and fluids, output, baby to breast - Number of b.v. in umbilicus
- 3: AVA
- Signs of placental delivery
- Uterus contracts firmly, separation of placenta from uterine wall. Globular shaped uterus, rise of fundus in abdomen (should be firm) sudden gush or trickles of blood, increase descent of cord
- Retained placenta
- more than 30 minutes after delivery, placenta does not detach
- Nursing intervention for intrapartum
- VS, fetal monitoring, change position (off back, on left side), keep bed and pt. clean and dry, breathing, back rub, adequate oxygenation, monitor fluids (up to 500 cc blood loss reasonable), urinalysis to monitor for infection.
- Fever causes fetal...
- tachycardia, give IV antibiotics stat
- V-vac can be performed when this type of incision used
- Low transverse
- Nursing considerations w/ epidural
- Monitor for hypotn, IV wide open w/ pressure
- Degree of lacerations w/ delivery
-
1st degree: vaginal mucosa and perineal skin
2nd degree: above plus underlying fascia and muscle
3rd: all of above and anal sphincter
4th: All w/ tear extending up into rectal wall - Indications for labor induction
- After 40 wks, deteriorating placenta, fetal death, prolonged ROM, facilitate labor
- C/I for induced labor
- Reasons to perform a C-section: fetal distress, placenta previa, abruptio placenta, CPD(cephalopelvic disproportion), predisposition to uterine rupture, grand-multiparity, past hx of traumatic delivery
- major stressor to infants in the hospital
- Interrupted routine, parental separation, lack of stimulation, and delayed response to crying/needs
- Behaviors exhibited by stressed infants in the hospital
- Poor feeding, irritability, crying, altered sleep patterns
- Interventions for stressed infants and children in the hospital
- Encourage parent participation, consistent nursing care, promote home routine, provide stimulation, respond promptly to cry, arrange for volunteers to hold, rock, play
- Major stressors for toddlers in hospital setting
- Interrupted routine and rituals, separation from parents, loss of control, fear of being hurt
- Behaviors exhibited by toddlers in hospital
- Protest, Despair, Detachment, Developmental regression, refusing to eat/sleep disturbance
- Preschool age stressors in hospital
- Pain/bodily injury, separation from parents, loss of control
- Behavior exhibited by preschoolers in hospital
- Passive withdrawal, poor appetite, sleep disturbances, magical thinking, fantasy, enuresis, aggression
- School age child stressors
- Guilt, fear of pain, loss of control, body image changes, missing school and friends, falling behind in school
- QUESTT
-
Question child
Use pain rating scale
Evaluate behavior and physiologic state
Secure patient's involvement
Take cause of pain into account
Take action - BSA
- Body surface area, method of prescribing medication to peds...more common in oncology and critical care
- Body weight method
- convert lbs. to kg, round to .01
- Calculating daily fluid requirements
-
100 mL/kg/day first 10 kg
50 mL/kg/day next 10 kg
20 mL/kg/day for each kg above 20 - Complications w/ viral nasopharyngitis
- Pain in ear, increased respirations (>50-60), fever, cough (persistent 2+ days), wheezing, poor sleeping, listlessness, increased irritability
- Complications w/ strep
-
18 days after->rheumatic fever
10 days after->glomerular nephritis - Complications w/ mono
- hepatic and spleen involvement->jaundice
- Bronchiolitis
- Caused by RSV, major cause of hospitalization in infants. Affects lowre respiratory tract. Tx w/ croup tent, clear liquids, clear nasal secretions,
- Hallmark of epiglottitis
- Dyspnea, dysphagia, drooling and dysphonia. Have trach set ready, NO TONGUE BLADES, decreased incidence since H. influenzae vaccine
- Laryngotracheobrinchitis
- LTB: caused by virus but can have secondary bacterial infection, inspiratory stridor, gradual onset, lowgrade fever,
- Etiology of CF
- Commonly manifests as pancreatic deficiency and pulmonary disease