OB NUR SING BULLE TS
Sexual intercourse OK anytime during pregnancy except for: (+) PROM, pre-term labor, incompetent cervix and (+) vaginal spotting HUMAN CHORIONIC GONADOTROPIN (HCG) – responsible for a positive pregnancy test FLUID RETENTION caused by elevated estrogen and progesterone and also fatigue OXYTOCIN – produced by posterior pituitary gland for uterine contractions FUNDAL PRESSURE – aids in placental delivery if mother is anesthetized GLOBULAR – – uterus in 3rd stage of labor CORD TRACTION AND FUNDAL PRESSURE DANGER – – inversion of uterus and avulsion of cord AFTERCARE post PLACENTA DELIVERY – comfort, dry clothing, perineal pads and linens CHECK 4 TH STAGE OF LABOR q15 – lochia, fundus, hematoma AVOID SEX if cervical mucus is clear and elastic (for contraception) INTRAFALLOPIAN TRANSFER – – for low sperm count IN-VITRO – for tubal occlusion ANOVULATION ANOVULATION – tx of Clomid or Parlodel CERVICAL CAP – (-) spermicide pre-intercourse, can stay up to 24-48h, durable, contraindicated if with abnormal pap smear IUD doesn’t protect against STDs PROFUSE BLOOD LOSS – saturation of peripad within 15 minutes and with pain sensation sensation uterine DISTENDED BLADDER inhibits contraction contraction with increased risk of blood loss FOR IMPENDING HEMORRHAGIC SHOCK massage fundus if boggy, elevate legs from hips, IV line, oxygen at 8-10 l/min, stay with patient PRE- LM – void FHR – – priority post rupture of membranes FHR FREQUENCY – – beginning to beginning ENDOMETRIOSIS – growth of endometrial tissue outside the uterus; dx: lap and biopsy DANOCRINE – menses stop, edema, weight gain, anovulation BBT – drop 0.2 F pre ovulation, increase 0.4 F post ovulation MOST ACCURATE BBT READING – immediately after awakening and before arising STRIAE GRAVIDARUM – abdominal stretches
s pine DIPPING – descending but not at ischial spine IMPENDING DELIVERY – increase in bloody show, rectal pressure, rupture of membranes, regular and long contractions contractions RITGEN’S MANEUVER at crowning FUNDAL HEIGHT AT UMBILICUS at 20 weeks or 5 months gestation HEMORRHAGE AND INFECTION – most important to check 24 postpartum COMPLETE CERVICAL DILATATION – termination of first stage of labor PLACENTAL DELIVERY – end of third stage of labor VITAMIN K – 1.0 mg for full terms, 0.5 mg for preterms CLINIC VISITS 12 TO 24 MONTHS – monthly ROOMING IN – for maternal-infant bonding HCG PRIMARY FUNCTION – maintain corpus luteum during 1st trimester DODERLEIN’S BACULLUS – maintains acidic vaginal pH BTL – no lifting activities post surgery BSE SCHED – 5-7 days post menstruation MAMMOGRAPHY – dx of breast CA; yearly for 40s, biannual for 50y above RADICAL MASTECTOMY – removal of breast/s, pectoral muscle, pectoral fascia, nodes VITAL SIGNS – most important 2 h postpartum IUD INSERTION – done during menstrual days 1-4 pre-ovulation OVULATION PERIOD – 24-48 hours pre-ovulation to 48 hours post ovulation OCPs – prevent ovulation CLOMID – stimulates oogenesis LIGHTENING - decrease in fundal height due to a change in shape of the abdomen a few weeks before onset of labor HOME VISIT – for continuity of care ABORTION – loss of fetus before viability (20 weeks) INEVITABLE ABORTION – with dilated cervix THREATENED ABORTION – closed cervix, spotting and uterine cramping HABITUAL ABORTION – consecutive abortions THREATENED ABORTION – complete bed rest, check vaginal bleeding and observe uterine contractions OVULATION – 14 days before menstruation (for a 28 day cycle); increased pH of cervical secretions, (+) MITTLESCHMERZ; increase in BBT PROLIFERATIVE – LH surge from anterior pituitary gland – at 5th month or 20-24 weeks AGE OF VIABILITY VIABILITY – OSSIFICATION OF BONES – at 10th lunar month FHT – Doppler at 3 weeks, fetoscope at 18-20 weeks MC DONALD’S RULE – fundic ht in cm x 8/7 = aog 1
PRENATAL CHECKUPS – 1-7 mo once a month, 8th mo 2/month, 9th q wk PREGNANCY AS A MATURATIONAL CRISIS – due to hormonal and physiological changes occurring PROM – prone to infections TAKING HOLD PHASE – focus is the infant POST PARTUM BLUES – 4-5 days post partum ZYGOTE – cell that results from the fertilization of the ovum by a sperm MITOSIS – cell division of the fertilized ovum OVULATION – rupture of the ovum from the graafian follicle MORULA – mulberry-like ball of cell that results from cleavage FUNDUS – where zygote normally implants IMPLANTATION – 7-10 days post fertilization EFFACEMENT – cervix becomes thinner GDM – carbohydrate intolerance induced by pregnancy ADVERSE EFFECTS OF GDM – morbidity common in newborn, infant may inherit a predisposing to DM, higher perinatal death GDM NURSING INTERVENTIONS – liberal exercise, acceptable diet at 30-35 kcal/kg of IDBW/day, insulin as ordered, CBG monitoring GLUCOSE – 18.02 mg/dl = 1 mmol BREAST ENGORGEMENT – doesn’t last for greater than 24 hours MEFENAMIC ACID – anti-inflammatory PASSAGEWAY – structure of maternal pelvis NITRAZINE PAPER TEST – urine vs. amniotic fluid; yellow vs blue PROM – check temperature NONPREGNANT UTERUS – lined by endometrium VULVA – externally visible structure of the female reproductive system extending from the symphysis pubis to the perineum AMPULLA – fertilization site ISTHMUS – site of sterilization VAS DEFERENS – conduit for spermatozoa EJACULATORY DUCT – seminal fluid LEYDIG’S CELLS – synthesize testosterone PROGESTERONE – increased activity of endometrial glands during luteal phase; increased basal metabolism, increased placental growth, development of acinar cells in the breast ROUND LIGAMENT – (+) hypertrophy during pregnancy SPERM MOTILITY – best criterion for sperm quality HYSTEROSAPINGOGRAPHY – introduction of radiopaque material into uterus and fallopian tubes to assess for tubal patency
TETANIC CONTRACTIONS – brought about by the overstimulation by oxytocin DYSTOCIA – due to mechanical factors POSTPARTUM HEMORRHAGE – greater than 500 ml of blood loss CORTEX OF OVARIES – where developing follicles and the graafian follicles are found LABIA MINORA – forms the frenulum and prepuce of the clitoris FOURCHETTE – formed by the labia minora tapering and extending posteriorly RUGAE – thick folds of membranous stratified epithelium on the internal vaginal wall capable of stretching during the birth process to accommodate delivery of fetus EXTERNAL OS – location where squamocolumnar junction is, pap smear location MYOMETRIUM – largest portion of uterus CORPUS – upper triangular portion of uterus LH – testosterone production ESTROGEN – secreted by graafian follicle associated with spinnbarkeit and ferning AUTOSOMAL RECESSIVE – cystic fibrosis, taysach’s disease, sickle -cell anemia CHORIONIC VILLI SAMPLING – detects trisomy 21, cystic fibrosis and tay sach’s MATERNAL AGE – indication for chorionic villi sampling RHOGAM – essential post-CVS or RH (-) mom; refrain from sex 48h post-CVS NEEDLE INSERTION SITE – most important factor affecting amniocentesis MORNING AFTER PILL – prevent implantation of the fertilized ovum; taken within 12h post-intercourse, (+) slight nausea post-2d; not given to those with hx contraindications to OCPs COMBINED OCPs – inhibit FSH and LH production ESTROGEN – causes sodium retention PARITY – indication for IUD use HX OF PRETERM LABOR – contraindication for IUD use HYSTEROSALPINGOGRAM – done 2-6 days after menses COVADE’S SYNDROME – way in which an expectant father can explore his feelings RhOGAM – should be administered within 72h; destroys fetal RBCs to prevent antibody formation LEUPROLIDE – tx for endometriosis AMPICILLIN – safest antibiotic for pyelonephritis HYPOTONIC DYSTOCIA – monitor contractions MAGNESIUM TOXICITY – first sign is disappearance of knee-jerk reflex IUD SIDE EFFECT – excessive menstrual flow 2
IUD COMMON PROBLEM – spontaneous expulsion of device IUD – provides contraception by setting up a nonspecific inflammatory cell reaction in the endometrium OVULATION – occurs when LH is high OCPs – causes breakthrough bleeding POST COITAL TEST – best timed within 1-2 days of presumed ovulation TUBAL DEFECTS – are most often related to past infections INFERTILITY – inability to become pregnant after a year of trying SIMS HUHNER (POST COITAL TEST) – determine the number, motility and activity of sperm HYATIDIFORM MOLE – be alert for unusual uterine enlargement ECTOPIC PREGNANCIES – sudden lower right or left abdominal pain radiating to the shoulders TUBAL RUPTURE – sudden knifelike, lower quadrant pain GERM PLASMA DEFECTS – causes most spontaneous abortions INCOMPLETE ABORTION – fetus is expelled but part of the placenta and membranes are not FUNIS – umbilical cord AMNION – inner membrane that encloses the fluid medium for the embryo FETUS – 8th week to birth 12th WEEK – uterus becomes an abdominal organ QUICKENING – first fetal movement felt by the mother GREATEST WEIGHT GAIN – in third trimester; 2nd trimester: height and length PLACENTA – chief source of estrogen and progesterone after the first 3 months DUCTUS VENOSUS – has the highest oxygen content DIAGONAL CONJUGATE – A-P diameter of pelvic inlet BLOOD VOLUME INCREASE – 30-50% is normal CHADWICK’S SX – purplish discoloration of vaginal mucosa PHYSIOLOGIC ANEMIA – result of increased plasma volume of the mother CHORIONIC GONADOTROPIN – causes nausea and vomiting PITUITARY GLAND – increase in melanotropin hormone causing dark nipples and linea nigra RH DETERMINATION - routinely performed on expectant mothers to predict whether the fetus is at risk for acute hemolytic anemia LEUKORRHEA – caused by elevated estrogen
TX FOR FLUID RETENTION - adequate fluids and elevation of lower extremities FULL BLADDER – pre UTZ NORMAL AMNIOTIC FLUID – clear, almost colorless, containing little white specks RESTRICT MOVEMENT – when an external fetal monitor is being used EARLY DECELERATION – FHT decreases just before acme due to head compression LATE DECELERATION – FHT decreases just after acme caused by uteroplacental insufficiency; may lead to distress VARIABLE DECELARATION – due to cord compression LOCATION OF FUNDUS AFTER PLACENTAL DELIVERY – halfway between the symphysis pubis and the umbilicus SLOW DEEP BREATHING – alleviates discomfort during contractions PANTING – during crowning OCCIPUT POSTERIOR – causes low back pain APPLICATION OF BACK PRESSURE – during contractions to increase comfort NPO – during second stage of labor because undigested food and fluid may cause nausea and vomiting, limiting the choice of anesthesia client TRANSITIONAL PHASE – help retain/remain in control POSITIONING DURING DELIVERY – legs elevated simultaneously to prevent trauma to the uterine ligaments UTERINE TETANY – observe carefully for this during the induction of labor PUSH WITH GLOTTIS OPEN – when fully dilated but (-) crowning EPISIOTOMY is done to prevent lacerations PUERPERAL INFECTIONS – 2 most important predisposing factors to its development is hemorrhage and trauma during birth PROLACTIN - stimulates secretion of milk from the mammary glands SITZ BATH – promotes vasodilation, relieves hemorrhoids INFANT FEEDING – on demand; baby will soon develop a feeding schedule CLOSURE OF FORAMEN OVALE – after birth is caused by an increase in the pulmonary blood flow DUCTUS ARTERIOSUS – becomes the ligamentum arteriosum HEART RATE – primary critical observation in apgar scoring MECONIUM CHECK Q SHIFT – to keep limit development of hyperbilirubinemia ASSYMETRICAL MORO REFLEX – associated with brachial plexus, cervical or humerus injuries 3
STERILE INFANT INTESTINES – lack bacteria necessary for the synthesis of prothrombin PKU SCREENING – measures protein metabolism NORMAL REGURGITATION – in infants is caused by an underdeveloped cardiac sphincter AMNIOCENTESIS – done to detect presence of neural tube defects PREMATURITY – contraindication for oxytocin challenge test UTEROPLACENTAL INSUFFICIENCY – (+) CST PREGNANT ADOLESCENT – emphasize importance of consistent care PERINATAL MORTALITY – is 2-3 times greater in multiple gestation than in single gestation HYPOTONIC UTERINE DYSTOCIA – is oftentimes caused by multiple gestation PYELONEPHRITIS – observe for signs of PTL; antibiotic tx should be administered until urine is sterile — 2 (-) C/S CONCEALED HEMORRHAGE – causes abdominal pain associated with abruption placenta causes DIC/HYPOFIBRINOGENEMIA – bleeding following sever abruptio placenta ABRUPTIO PLACENTA – is most likely to occur in women with pregnancy induced hypertension PLACENTA PREVIA – painless vaginal bleeding PAIN MEDS – are kept at minimum during PTL to prevent respiratory depression ATONY OF THE UTERUS – due to overstretching is commonly caused by multiple gestation OVERDISTENED BLADDER/HYDRAMNIOS – may cause uterine atony POSTPARTAL HEMORRHAGE – rarely occurs as a complication of uncomplicated gestational hypertension PIH – BP elevation of 30/15 mmHg from baseline on 2 occasions 6 hours apart EPIGASTRIC PAIN – subjective symptom of an impending seizure ROLLING OF EYES TO ONE SIDE WITH A FIXED STATE – objective sign of an impending seizure DANGER OF SEIZURE – ends in 48h postpartum in a woman with eclampsia CORD COMPRESSION - birth hazard associated with breech delivery GRAVIDOCARDIAC PT - cardiac acceleration in the last half of pregnancy; most compromised during the first 48 hours after delivery; forceps delivery GDM DIET – balanced, to meet the increased dietary needs with insulin adjusted as necessary RENAL AGENESIS - funis with only two vessels DRUG WITHDRAWAL IN INFANT - irritability and nasal congestion
NEONATAL MORBIDITY - with low apgar score at 5 minutes post delivery HIV/AIDS INFANT – microcephalic, craniofacial features, persistent diarrhea purulent CHLAMYDIA INFECTIONS – conjunctivitis and pneumonia in infant RETROLENTAL FIBROPLASIA – caused by high oxygen concentration administered in premature infants SYPHILIS – asymptomatic newborn, VDRL test HIP DYSPLASIA – asymmetric gluteal folds ERB’S PALSY – complication of breech delivery; flaccid arm with elbows extended; ROM exercises PRECIPITATE DELIVERY – increased risk for intracranial hemorrhage and elevated ICP PATHOLOGIC JAUNDICE – appearance of jaundice during the first 24 hours DECREASED INFANT GFR – inability of the infant to concentrate urine and conserve water RESPIRATORY DISTRESS – most common preterm complication INFANT HYPOGLYCEMIA SX - tremors, periods of apnea, cyanosis and poor sucking LARGER DM NEWBORNS – due to increased somatotropin and increased glucose utilization UTERINE AND OVARIAN ARTERIES – main blood supply of the uterus ENDOMETRIOSIS – is characterized by painful menstruation and backache RETROCOELE – is brought about by overstretching of perineal supporting tissues as a result of childbirth COLUMNOSQUAMOUS JUNCTION OF THE INTERNALAND EXTERNAL OS – common site of cervical CA growth DIETHYLSTILBESTROL – management for infertility RADIUM REACTION – pain and elevated temperature DOXORUBICIN – inhibits RNA synthesis by binding DNA ESTROGEN RECEPTOR PROTEIN (ERP) – evaluates potential response to hormone therapy BILATERAL OOPHORECTOMY – surgical menopause CESSATION OF MENSES – is due to the inability of the ovary to respond to gonadotropic hormone BARTHOLOMEW’S RULE – via location of fundus HAASE’S RUELE – first 5 months: month 2 = aog; second half: month x 5 = aog NAGELE’S RULE – LMP minus 3m +7d + 1y = EDC DECIDUA BASALIS – placenta
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