Final Review
Chapter 1
Pages 3-5 Contemporary Issues and Trends
-integrative health care: encompassing complementary
& alternative therapies w/ conventional modalities
-childbirth practices: prenatal care, inc’d c-sections,
dec’d hospital stays, family centered care, childbirth &
parenting classing, midwives
-views of women- holistic view inc’ing physical, mental
& social factors; breastfeeding in workplace; family
leave (1993 FMLA, 12 wks); international concerns
(female genital mutilation, infubulation, circumcision)
-health of women- life expectancy (Caucasian 80, AfAm 75); breast CA & BSE, menopause (inc’ing #
elderly); violence; adolescents; AIDS (perinatal
transmission)
-Healthy People 2010 Goals- inc quality & yrs of
healthy life & eliminate health disparities (focus area of
maternal, infant, child health)
-fertility & birth rate- LBW (morbidity & mortality inc),
infant mortality (factors-education, maternal age,
unmarried status, poverty, lack of prenatal care,
smoking, poor nutrition), maternal mortality
(hemorrhage, PIH, ectopic prego)
-additional: involving consumers & promoting self
care; efforts to reduce health disparities; emphasis on
hi-tech care; community based care; inc high risk
prego; high cost of HC; limited access
term prego; more common in women who smoke & are
obese; assoc’d w/ early menarche, nuliparity, stress;
-tx-heat, massage, effleurage, exercise, diet (low salt &
sugar, inc water), NSAIDS, oral contraceptives
Chapter 5
Pages 94-97 Menstrual Cycle, Breast selfexamination
menstruation- periodic uterine bleeding that begins
~14days after ovulation; controlled by feedback system
of 3 cycles:
-endometrial-menstrual phase, proliferative phase,
secretory phase, ischemic phase
-hypothalamic-pituitary cycle- hypothalamus secretes
gonadotropin-releasing hormones stim’s ant pit to
secrete follicle-stimulating hormone stims ovarian
graafian follicles & estrogen; drop in estrogen LH
release; if fertilization/implantation do not occur,
regression of corpus luteum & progesterone & estrogen
dec GnRH
-ovarian cycle- follicular phase (pre-ovulation), after
ovulation estrogen dec’s midcycle bleeding; luteal
phase from end of ovulation to start of menstruation
Pages 191-194 HIV
-severe depression of immune system; opportunistic
diseases- PCP, candida esophagitis, wasting syndrome,
HSV, cytomegalovirus; s/s- fever, HA, night sweats,
malaise, generalized lymphadenopathy, myalgias,
nausea, diarrhea, wt loss, sore throat, rash;
-tx- counseling, antiretrovirals (AZT, ZDEV, Retrovir);
can be passed to neonate inutero or via breastmilk
Page 100-101 Barriers to Seeking Health Care
-financial issues; cultural issues; gender issues
Chapter 7
Pages 147-151 Dysmenorrhea
-pain during or shortly before menstruation; 1 of most
common GYN problems; improves in most after a full
Pages 151-153 PMS
-complex condition that includes a number of cyclic
symptoms occurring in luteal phase; fluid retention,
behavioral or emotional changes, cravings, HA, fatigue,
backache;
-tx- no smoking, diet (dec sugar, salt, red meat, alcohol
& caffeine), exercise, supplements (Ca, Mg, VitB6),
CAM, NSAIDS
Chapter 8
Pages 175-178 Prevention
-education: risky behavior (unprotected intercourse, any
sex that causes tissue damage or bleeding, multiple
partners, sharing toys, sharing needing), safer sex (avoid
exposure to body fluids, condoms/spermicide, avoid anal
penetration, don’t share toys, use clean needles)
Pages 185-187 HPV
->40serotypes (>20 infective) lesions, cervical CA;
inc risk in smoking & oral contraceptive use>5yrs; can
be passed to neonate; screening w/ PAP;
-tx- does not eradicate, but removal or warts & relief of
s/s; gardasil vaccine
Chapter 9
Pages 207-228 Contraception
-coitus interruptus (withdrawal) ~19% prego rate
-natural family planning/fertility awareness methodscalendar method (aka rhythm method), basal body temp
method, cervical mucus ovulation-detection method,
symptothermal method, predictor test for ovulation,
Marquette method
-barrier methods- spermicides, condoms, diaphragm,
cervical cap, contraceptive sponge
-hormonal methods- oral contraceptives (combined
estrogen-progesterone, progestin only) injections
(combined estrogen/progestin, progestins), transdermal,
vaginal ring, implantable progestins; emergency
contraception (w/in 72hrs of unprotected intercourseprevents follicular dev’t)
-IUD- t-shaped device inserted into uterine cavity
(copper or pregestational agent); continuous release for
up to 10 yrs; inc’d risk of PID in first 20 days after
insertion
Chapter 10
Pages 239-253 Care Management of Infertility
factors- female- abnormal genitals, absence of
reproductive structures, anovulation, amenorrhea, early
menopause, inc’d prolactin levels, tubal motility
reduced, absence of fimbriated end of tube or of tube,
inflame w/in tube, tubal adhesions, dev’t uterine
anomalies, endometrial or myometrial tumors,
Asherman syndrome (uterine adhesions or scar tissue)
-male- undescended testes, hypospadias, varicocele, low
testosterone levels, testicular damage 2o mumps,
endocrine genetic or psych disorders, STI’s, exposure to
hazards (radiation or toxic substances), exposure of
scrotum to hi temps, changes in sperm (smoking, heroin,
marijuana, amyl nitrate, butyl nitrate, ethyl chloride,
methaqualone, monoamine oxidase), dec sperm
(hypopituitarism, debilitating or chronic disease, trauma,
gonadotrpic inadequacy), dec libido (heroin, methadone,
SSRI’s, barbiturates), impotence (alcohol, antiHTN),
obstructive lesions of epidyidymis or vas deferens,
nutritional deficiencies
-assess- religious/cultural considerations, insurance, the
woman (age, h/o, US, hormones, biopsy, x-ray), male
(age, h/o, semen analysis, US, labs)
-intervention-psychosocial support, education (lifestyle
changes, medical/surgical options), herbal alternatives
Chapter 11
Pages 255-258 Benign conditions of the breast
-fibrocystic changes- palpable thickenings usually w/
pain & tenderness; unknown etiology, can be uni- or bilateral, dx- US, fine needle aspiration (FNA); txdiuretic, restrict salt, vitE, eliminate caffeine, avoid
smoking & alcohol,
-fibroadenomas- solid, encapsulated, nontender, upper
outer quadrant; unknown etiology; usually solitary
<3cm; dx- h/o, mammography, US, or MRI, FNA; txobservation, surgical removal if suspicious
-lipomas- fatty tumor; often>45yrs, soft mobile,
nontender; dx- mammogram; tx- surgical excision if
desired
-nipple discharge- generally benign, can be r/t endocrine
disorder of malignancy; galactorrhea (bilat spont milky,
sticky discharge) normal in prego, may be result of
thyroid disorder, pituitary tumor, coitus, eating, stress,
trauma, or chest wall surgery
-mammary duct ectasia- inflame of ducts behind nipple;
most often in perimenopausal, characterized by thick
sticky discharge that is white, brown green or purple;
freq w/ burning, pain, itching, or palpable mass; dxmammogram, aspiration, culture; tx- excision of ducts if
not plans to breastfeed, ANX, incision & drainage if inf
-intraductal pailloma- 30-50yrs; too small to be
palpated, serous, serosangiuneous or bloody nipple
discharge, unilateral & spont; tx- surgical excision
-macromastia- very lg breasts; can cause chronic pain in
breast, back, neck, shoulders, sig disruption in
psychosocial fxning & body image; can kyphosis, HA,
paresthesia of upper extremities, shoulder grooving; txreduction
-micromastia- very small breasts; neg influence on body
image; tx- augmentation
Page 263 breast screening practices
-breast self exam (BSE)-monthly
-clinical breast exam- q3yr age 20-39, q1yr >40yrs
-mammography- yearly >40yrs
Chapter 12
Pages 276-281 Structural disorders of the uterus
and vagina
-uterine displacement- posterior or retroversion is most
common, uterus is tilted posteriorly & cervix rotate
anteriorly difficulty in conception; s/s may include
pelvic & low back pain, dyspareunia, exaggeration of
PMS
-uterine prolapsed- inversion of vagina w/ uterus
protruding through; 2o congenital or acquired weakness
of pelvic support structures (childbearing); c/o-pulling,
dragging sensation, pressure, protrusions, fatigue, low
backache, urinary incontinence
-cystocele- protrusion of bladder into vagina 2o injured
support structures (childbearing, obesity, advanced age)
-rectocele- herniation of anterior rectal wall through
vaginal fascia & rectovaginal septum
-urinary incontinence- involuntary leaking of urine, w/
coughing, laughing, exercise
-genital fistulas- perforations between genital tract
organs; most occur between bladder & genital tract
(vesicovaginal), urethra & vagina (urethrovaginal) or
sigmoid colon & vagina (rectovaginal); s/s- presence or
odor of urine, flatus, feces in vagina, irritation of vaginal
tissues
Pages 284-288 Surgical Management
-severe prolapsed- hysterectomy
-cystocele/rectocele- anterior repair (shortening of pelvic
muscles to provide better support for bladder), often
done w/ hysterectomy
-incontinence- insertion of bladder neck support
prosthesis or bladder suspension
-fistulas- depends on location but may not be successful
Pages 306-309 Cancer and Pregnancy
-breast (3-7% of prego or lactating), cervix (3-7%
pregos), leukemia, Hodgkin Disease, melanoma, thyroid,
bone tumors, other GYN CA’s (vulva, vagina, uterus,
uterine tube, ovary)
-tx- type & timingcomplex medical judgments &
intense emotional responses; chemo & radiation risk
fetus death, miscarriage, teratogenesis, alterations in
G&D, fxn & genetic mutation; surgery offers least risk
to fetus but inc’s risk of miscarriage & preterm labor; no
chemo first trimester; radiationdeath or deformity
Chapter 13
Pages 328-330 Milestones in Human Development
-8wks- heartbeat, skeletal mvmt,
-12wks- bile secreted, marrow forming blood, kidney
secrete urine, sex recognizable
-16wks- blood formation in spleen, sense organ
differentiated
-20wks- vernix caseosa & lanugo appear, mvmt strong
enough for mom to feel, primitive resp mvmt’s
-24wks- alveolar ducts & sacs present, ability to hear
-28wks- lecithin forming on alveolar surfaces, sleepwake cycle, suck reflex, light receptive
-30-31wks- taste present, aware of outside sounds, testes
descend
-36wks-can turn & elevate head, L/S ration >2:1
-40wks-good tone, brain myelination begins
Chapter 14
Page 334 Gravidity and Parity
Gravidity- pregnancy, parity- # or preg’s in which fetus
reached viability (22-24wks)
G/T/P/A/L- pregs/term/preterm/abortion/living
Page 336 Signs of Pregnancy
Presumptive: s/s pt reports-inc’d basal temp,
quickening, breast changes, N&V, amenorrhea,
constipation, urinary frequency, fatigue
Probable: s/s leads practitioner to believe pregoChadwick’s sign (violet color of vaginal mucous
membrane & cervix), Goodell’s sign (softening of
cervix), Hegar’s sign (softening of lower uterine
segment), preg test (serum or urine), Braxton Hicks,
Ballottement
Positive: can only be from prego- US, fetal heart rate,
fetal mvmt
Page 349 Pregnancy effects on GI system
-appetite- N&V early, change in tastecravings (picanonfood cravings; clay, starch)
-mouth- hyperemic, spongy, swollen, bleed easily,
ptyalism (excessive salivation)
-esophagus, stomach, intestines- upward displacement
of stomach, dec’d hydrochloric acid peptic ulcers;
regurg, slower emptying, reverse peristalsis heartburn;
inc’d water absorption constipation; hemorrhoids
-gallbladder & liver- gallbladder distended 2o dec’d
muscle tone, inc’d emptying time, thickening of bile,
slight hypercholesterolemia gallstones; intrahepatic
cholestasis
-abd discomfort- pelvic heaviness, round ligament
tension, flatulence, distention, bowel cramping, uterine
contractions
Chapter 15
Page 353-355 Nutrition Needs before conception
-folate or folic acid to minimize risk of neural tube
defects- fortified foods, green leafy vegs, whole grains,
fruits; legumes, peas, beans, lentils, asparagus, spinach,
papaya, wheat germ, broccoli, avocado, orange (OJ),
pasta, rice
Pages 355-359 Weight gain during pregnancy
Weight gain guidelines
Underwt (BMI<19.8): 28-40lbs (12.5-18kg)
Normal (BMI 19.8-26.0): 25-35lbs (11.5-16kg)
Overwt (BMI>26): 15-25lbs (7.0-11.5kg)
BMI= wt(kg)/ht2 (meters); 3.281ft/m or 39.37inches/m
Rate of wt gain
Healthy: 3-5lbs/wk 1st, 1-2lbs/wk 2nd & 3rd
Underwt: 5-6lbs/wk 1st, 1-2lbs/wk 2nd & 3rd
Overwt: 1-2lbs/wk 1st, 1lb/wk 2nd & 3rd
Page 360 Protein in pregnancy
-60g (50 non prego, 65 lactation)- milk, meat, eggs,
cheese, legumes, whole grains, nuts; needed for maternal
tissue and blood volume expansion
Chapter 16
Page 381 Nagel’s Rule
-first day LMP-3mos+7days=EDD
Page 381-388 Adaptation to pregnancy
-maternal/paternal-accepting the preg (emotional
lability, ambivalence); id’ing w/ mother/father role;
reordering personal relationships; establishing
relationship w/ fetus (attachment); preparing for
childbirth
Page 399 Signs of potential complications
1st trimester-severe vomiting-hyperemesis gravidarum
-chills, fever, burning on urination, diarrhea-infection
-abd cramping, vag bleeding-miscarriage, ectopic preg
2nd or 3rd-persistent, severe vomiting- hyperemesis gravidarum,
PIH
-sudden discharge of fluid from vag<37wks- PROM
-vag bleeding, severe abd pain- miscarriage, placenta
previa, abruption placentae
-chills, fever, burning on urination, diarrhea- infection
-change in fetal mvmts- fetal jeopardy or intrauterine
fetal death
-uterine contractions, pressure, cramping <37wkspreterm labor
-visual disturbances (blurring, double vision, spots),
swelling of face, fingers, sacrum; HA (severe, frequent
or continuous); muscular irritability or convulsions;
epigastric or abd pain (perceived as severe
stomachache)- hypertensive conditions, PIH; last one
can also be abruption placenta
-glycosuria- gestational diabetes
Chapter 18
Page 450 Fetal Position
fetal position- position in relation to mom’s pelvis
1st letter- position in relation to mom (left, right or none)
Middle letter- part of baby (o-occiput, s-sacrum, mmentum chin, sc-scapula)
Last letter-opposite where baby is facing (p-posterior, aanterior, t- to the side)
True- contractions regular, become stronger, last
longer, occur closer together, more intense w/ walking,
lower back radiating to lower abd, continue despite
comfort measures; cervix progressive change (softening,
dilation, effacement), anterior; fetus engaged
False- contractions irregular or temporary, stop w/
walking or position change, felt in back or abd above
naval, stopped through comfort measures; cervix soft but
no significant effacement or dilation, still posterior
position; fetus not engaged
Page 535 Assessment of Uterine contractions
-frequency, intensity, duration, resting tone
Chapter 22
Pages 577-578 Lochia
-rubra- bright red, lasts 3-4days
-serosa- pinkish-brownish, 3-4wks
-alba- whitish, up to 6 wks
Scant- <2.5cm
Mild- <10cm
Mod- >10cm
Heavy- 1 pad saturated w/in 2 hrs
Page 579 Endocrine system
-placental hormones- expulsion of placenta dec’s
estrogen, cortisol, insulinase
-pituitary hormones- prolactin stays elevated in
breastfeeding women;
Chapter 19
Pages 471-473 Childbirth preparation
-Dick-Read- “natural childbirth” & “childbirth w/o
fear”, deep abd breathing during early contractions,
shallow for later, sustain pushing w/ breath holding;
taught relaxation
-Lamaze- “psychopropholactic method”, controlled
muscular relaxation & breathing techniques; tense only
involved muscles while keeping other relaxed
-Bradley-“natural” childbirth w/o anesthesia/analgesia
& w/ husband/coach & breathing techniques; emphasize
environmental variables such as darkness, solitude, quiet
Pages 487-488 Epidural
-injection of local anesthetic (bupivacaine, ropivacaine)
&/or analgesic (fentanyl, sufentanil) into epidural space
@L4-5
-disadvantages & s/e- limited mvmt, orthostatic
hypotension, dizziness, sedation, weakness of legs,
excitation, tinnitus, disorientation, paresthesia,
convulsions, resp depression, higher rate of fever,
questionable negative effects on neonate (less muscle
tone)
Chapter 21
Page 520 True Labor vs False Labor
Page 597 Episiotomy Care
-cleansing-wash hands, wash perineum w/ mild soap &
warm water at least daily, cleanse front to back, change
pad w/ each void or defecation or at least 4 per day,
assess amt & character of lochia w/ each change
-ice pack- first 2 hr to dec edema, after first 2hrs
anesthetic effect
-squeeze bottle- warm tap water, squirt perineum to
cleanse, blot dry
-sitz bath- pad w/ towel before filling, encourage BID
for 20min, teach to tighten gluteal muscles while
entering & relax after in bath
-surgi-gator- sit on toilet w/ legs apart w/ nozzle past
perineum, adjust as needed
-topical applicants- anesthetic cream or spray 3-4times
daily, witch hazel pads for hemorrhoids
Chapter 24
Page 631 Grandparent adaptation
-grandparents can be source of knowledge & support &
can have positive influence on postpartum family.
Nurse must acknowledge wide range of dynamic issue
that enhance or mitigate experiences of intergenerational
support
Chapter 25
Pages 641-643 Newborn GI System
-Epstein’s pearls- small whitish cysts on gum margins
-stomach capacity 30-90ml
-amylase not produced until ~3mo (salivary glands) &
lipase (pancreas) ~6mos
-meconium- intestinal secretions & cells; greenish black,
viscous, contains occult blood; generally pass w/in first
12hrs; breastfed infants 3 stools/day after 3-4days
-stools- breast fed are yellow & pasty w/ odor like sour
milk; formula fed are pale yellow to light brown, firmer,
more offensive odor
Page 657 Sleep-wake states
During first 6wks inc in wakefulness, dec in REM,
initially wakefulness dictated by hunger, newborns sleep
approx 17hrs/day
Chapter 29
Page 772 BPP (biophysical profile)
-assess w/ US: fetal breathing mvmts, fetal mvmts, fetal
tone, FHR patterns, amniotic fluid volume
-determine physical & physiologic characteristics
Pages 774-776 Amniocentesis
->14wks w/ US, needle inserted transabd into uterus,
amniotic fluid withdrawn for assessments
-indications- prenatal dx of genetic disorders or
congenital anomalies, ass pulm maturity, dx fetal
hemolytic disease
-complications- maternal hemorrhage, Rh
isoiummunization, infection, labor, abruption placentae,
inadvertent damage to intestine or bladder, amniotic
fluid embolism; fetal death, hemorrhage, infection, direct
injury from needle, miscarriage or preterm labor, leakage
of amniotic fluid
Pages 777-778 MSAFP
-screen for neural tube defects
-low levels assoc’d w/ Down’s & other autosomal
trisomies
Page 765 Specific problems and related risk factors
Preterm labor- <16 or >35, low socioeconomic status,
maternal wt <50kg, poor nutrition, previous preterm
birth, incompetent cervix, uterine anomalies, smoking,
drug addiction/alcohol abuse, pyelonephritis,
pneumonia, multiple gestation, anemia, abnormal fetal
presentation, PROM, placental abnormalities, infection,
abd surgery in current prego, h/o cervical surgery
Polyhydramnios- diabetes mellitus, multiple gestation,
fetal congenital anomalies, isoiummunization (Rh or
ABO), nonimmune hydrops, abnormal fetal presentation
IUGR- multiple gestation, poor nutrition, maternal
cyanotic heart disease, prior preg w/ IUGR, maternal
collagen diseases, chronic HTN, PIH, recurrent
antepartum hemorrhage, smoking, maternal diabetes w/
vascular problems, fetal infections, fetal CV anomalies,
drug addiction/alcohol abuse, fetal congenital anomalies,
hemoglobinopathies
Oligohydramnios- renal agenesis (Potter’s syndrome),
prolonged ROM, IUGR, intrauterine fetal death
Postterm preg- anencephaly, placental sulfatase
deficiency, perinatal hypoxia, acidosis, placental
insufficiency
Chromosomal abnormalities- maternal age >35,
balanced translocation
Chapter 31
804-808 Miscarriage
-aka spontaneous abortion- preg ends before 20wks or
fetus <500g
-1/2 from chromosomal abnormalities, majority before
8wks
-2o endocrine imbalance, immunologic factors,
infections, systemic disorders
-late (12-20wks) usually result from maternal causesadvanced age & parity, chronic infections, premature
dilation of cervix, anomalies of reproductive tract,
chronic debilitating diseases, inadequate nutrition,
recreational drug use
-s/s-uterine bleeding, contractions, pain
-threatened- spotting, cramping but cervix is closed; txavoid intercourse, dec activity, rest
-inevitable- cervix is open, cannot be stopped
-incomplete-mod bleeding, more severe cramping, fetus
delivers but placenta does not, needs D&C
-complete- fetus & placenta delivered, no intervention
required
-missed- fetus dies but no labor, delivery required
(prostaglandins for <8wks, pitocin or D&C or
D&E>8wks
811-815 Ectopic pregnancy and Hydatidiform
Mole
Ectopic preg- preg other than uterus; spotting, unilateral
pain; tx- methotrexate if before rupture to remove
products of conception; surgery if rupture, removal of
ectopic preg by salpingostomy if before rupture
Gestational trophoblastic disease (hydatiform mole,
chorlocarcinoma, molar preg)- inc Hcg, HTN,
hyperemesis gravidarum; tx- D&C, D&E; no preg for 1
yr after, monitor Hcg wkly(can develop into CA that
inc’s Hcg) & diligent f/u care; risks Oriental, <20 or
>40, low protein/folic acid diet, hx previous
815-823 Placenta Previa and Abruption
Placenta previa- placenta covers cervical opening (can
be low lying, partial, total); painless bright red bleeding
that inc’s w/ preg; do NOT do cervical exam if pt
presents w/ vag bleeding
Abruption placentae- placenta separates from uterus; #1
cause is cocaine use; also trauma, PIH, age, gran
multiparity, pitocin w/o relaxation periods, smoking,
short umbilical cord
-Grade 1: ~20% detachment; bleeding, tenderness,
uterine tetany, no maternal or fetal distress
-Grade 2: 20-50%; tetany, no maternal but fetal distress
-Grade 3: >50%; uterus does not relax, maternal shock,
fetus prol expired
-Grade 4: complete detachment; most likely lost mom &
fetus
Tx-delivery if severe, considered medical emergency
Chapter 32
Pages 827-828 DM Metabolic changes associated
with pregnancy
-fetal glucose proportional to maternal; glucose crosses
placenta, insulin does not;; 1st tri insulin production inc’d
& fasting glucose dec’d by ~10%; diabetics prone to
hypoglycemic; 2nd & 3rd diabetogenic, dec’d tolerance to
glucose, inc’d insulin resistance, dec’d hepatic glycogen
stores, inc’d hepatic production of glucose; at birth,
prepreg insulin bablance returns in 7-10days,
breastfeeding insulin requirements remain low while
nursing
Page 832-837 Antepartum Planning and Care for
IDDM
-preconception counseling- glucose control, some oral
agents have teratogenic effects
-risks & complications-poor control inc’d preg loss,
fetal macrosomia (40-50%), hypertensive disorders,
preterm labor/birth, hydramnios (10x more), infections,
ketoacidosis
-fetal risks- stillbirth, congenital anomalies (6-10%),
macrosomia, hypoglycemia, resp distress, polycythemia,
hyperbiloirubinemia
-diet, exercise, monitoring blood glucose levels, insulin
therapy, fetal surveillance, intrapartum care (no fluids w/
glucose, FHR,), postpartum care
Pages 842-844 Hyperemesis gravidarum
Hyperemesis gravidarum- excessive vomiting; can lose
up to 5% of pre preg wt; NPO til under control then slow
progression; antiemetics, IV fluids, f/u care
Chapter 33
Pages 861-865 Anemia in pregnancy
Anemias- 20-30% of preg, iron requirements double
-iron deficiency, folic acid deficiency (leads to neural
tube defects, cleft lip, cleft palate); sickle cell (SGA,
IUGR, skeletal changes); thalassemia (infertility
problems, stillbirth, IUGR, preeclampsia, preterm birth)
Page 865-866 Asthma and pregnancy
-severity of symptoms peak 29-36wks;
-tx- relief of acute attack, prevention or limitation of
later attacks & adequate maternal & fetal oxygenation;
eliminate triggers, drug therapy (most asthma meds are
preg safe), client education, treat infections
-avoid morphine & meperidine
-inc’d risk for postpartum hemorrhage- tx w/ oxytocin
Chapter 33
Page 356 Cardiac decompensation- inability of heart
to maintain sufficient cardiac output
CV disease- most common complication is CHF
(edema, SOB, rales, fatigue, moist cough)
Chapter 36
Pages 936-938 PPROM- preterm PROM (<37wks)
-strict sterile technique required (high risk inf), freq
BPP, prophylactic ABX
-complications- infections, cord prolapsed,
oligohydramnios
Pages 950-951 Oxytocin
-stimulates uterine contractions- used to induce or
augment labor
-indications- suspected fetal jeopardy, inadequate uterine
contractions; dystocia, PROM, postterm preg,
chorioamnionitis, maternal medical problems, PIH, fetal
death, multiparous w/ h/o precipitate labor or who live
far from hospital
-contraindications- CPD, prolapsed cord, transverse lie,
nonreassuring FHR, placenta previa, prior classic uterine
incision, active genital herpes, invasive cervical CA,
multifetal presentation, breech, presenting part above
pelvic inlet, abnormal FHR, polyhydramnios, grand
multiparity, maternal cardia disease, HTN
Pages 966-967 Postterm pregnancy, labor and birth
->42wks; maternal wt loss, dec’d uterine size, meconium
in amniotic fluid, advanced bone maturation of fetus
-risks- dysfunctional labor, birth canal trauma, pp
hemorrhage, infection; fetal- prolonged labor, shoulder
dystocia, birth trauma, asphyxia from macrosomia; aging
placenta dec’s fxn, amniotic fluid vol declines risk cord
compression; meconium aspiration, dysmaturity
syndrome, hypoglycemia, polycythemia, resp distress
Chapter 37
Page 977-983 Care Management of postpartum
hemorrhage
Postpartum hemorrhage-nursing process
Definition- >1000ml w/ c section, >500ml vag; the most
common & most serious type of excessive obstetric
blood loss
Predisposing factors- previous hemorrhage, previa,
MgSO, clotting disorders, multiple gestations, abruption,
uterine atony (most frequent cause), polyhydramnios,
macrosomic baby, poor uterine tone,
rapid/prolonged/precipitous labor,
induction/augmentation, chorioamnionitis, anesthesia,
over massage
Causes- early: retained placental fragments,
tears/lacerations, hematoma, inversion of uterus, DIC
(seen in PIH, HELLP, & stillbirths); late: subinvolution
from infection, retained placental parts, excessive
vigorous massage of uterus
s/s- inc’d lochia, >1pad/hr; boggy uterus (tx fundal
massage, notify PCP if not corrected), u/a to locate
fundus (sign of atony); tachycardia, dec BP
classification- early/acute/primary (w/in first 24hr of
delivery); late/secondary (after 24hr to 6wks)
interventions- may need to cath to empty bladder &
monitor I/O, fundal massage, inc Pitocin, Metergine (do
not give if HTN), Hemabate (not ok for asthmatics); VS
& SpO2, O2, labs (H/H, pt, ptt, fibrinogen), surgery
(vessel repair, hysterectomy)
herbal remedies- witch hazel & lady’s mantle
(homeostatic), blue cohosh & cotton root bark
(oxytocic), motherwort & sheperd’s purse (promotes
uterine contraction), alfalfa leaf & nettle (inc avail of vit
K, inc Hgb), red raspberry (homeostatic, promotes
uterine contraction)
Hemorrhagic Shock- perfusion of body organs may
become severely compromised, leading to significant
morbidity or mortality of mom; emergency situation
-s/s- persisten significant bleeding (pad soaked in
<15min); dec BP, pale, cool/clammy, tachycardia,
anxiety, air hunger
-interventions- notify PCP, fundal massage for atony,
O2 8-10via mask, I/O, VS, lung sounds, maintain IV
site, determine cause, fluid mngmnt (blood, IV
crystalloids 3ml/L loss)
Medications utilized in caring for the patient with
postpartum hemorrhage- Pitocin inc to promote
uterine contractions, Metergine (do not give if HTN),
Hemabate (not ok for asthmatics)
Pages 988-989 Postpartum Infections
Postpartum (Puerperal) Infections-any inf w/in 28
days of delivery; strep most common
s/s- temp >38 (100.4) on 2 or more occasions after 24h
pp; in pain, malaise, dysuria, subinvolution, foul odor
-prevention most effective & inexpensive tx; strict
aseptic technique; standard precautions
Endometritis- lining of uterus; *most common pp inf;
seen more in c-sections; s/s- inc’d tenderness; fever
(>38), inc HR, chills, anorexia, Nausea, fatigue,foul
smelling profuse lochia; tx- ABX, encourage fluids,
analgesics, fowler’s to promote drainage
Wound/lacerations- s/s REEDA; tx- ABX, analgesics,
sitz bath, hot/cold
UTI’s- esp w/ freq caths, pelvic exams & w/ epidurals;
s/s- dysuria, frequency, urgency, lowgrade fever,
retention, hematuria, pyuria, plank pain tx- fluids,
hygiene (front to back), ABX
Mastitis- staph from infants mouth 2o to improper
latching, missed feeding, improper fitting bra; usually 56wks pp, s/s-unilateral, reddened tender area, flu-like
symptoms; prevention- handwashing, proper breast care
& feeding, good/clean bra; tx-ice pack after feeding,
cont feeding (start on unaffected side), ABX; assess for
abscess- if found, no feeding on this breast, pump &
dump until healed (ABX, drained, heat)
Chapter 38
Page 994 Skeletal Injuries
-clavicle (most common) r/t dystocia; humerus & femur
Page 997 Macrosomia
-50% of women w/ gestational diabetes, 40% of type 1
diabetics
-infant is LGA, round, cherubc face, cubby body,
plethoric or flushed complexion, enlarged internal
organs, inc’d body fat, placenta & umbilical cord are
larger than average
-high incidence of c-section
Pages 998-1003 Neonatal sepsis
-risk factors- maternal-low socioeconomic status, poor
prenatal care, poor nutrition, substance abuse;
intrapartum- PROM, maternal fever, chorioamnionitis,
prolonged labor, premature labor, maternal UTI;
neonate- twins, male, birth asphyxia, meconium
aspiration, congenital anomalies of skin or mucous
membrans, galactosemia, absence of spleen, LBW or
prematurity, malnourishment, prolonged hyospitalization
-tx-IV ABX, support other problems, wt &
measurements, dx (cultures, xray, urinalysis, lumbar
puncture, etc), VS q1-2hr first 4 hr then q4hr, advance
oral feeds as tol’d, teaching
Pages 1003-1010 TORCH p210
TORCH- Toxoplasmosis (cat liter, raw meat; txabortion if <20wks), Other (STD’s, GBS, varicella),
Rubella (droplet/contact, titre<1-8), Cytomegalovirus
(herpes family mental retardation, deafness, seizures),
Herpes virus Type II (genital herpes, active lesions
require c-section)
Chapter 40
Page1067-1068 Environmental concerns
-maintain neutral thermal environment (temp at which
O2 consumption is minimal but adequate to maintain
body temp)
-prevention of infection
-appropriate stimulation- kangaroo care, quiet
environment
Chapter 41
Pages 1098-1105 Care Management for loss of
newborn
Loss and Grief
Maternal or fetal/neonate death, loss of what was hoped
for (natural birth, girl/boy, etc), perception of loss of
control during birthing (more common in Bradley pts),
birth of child w/ handicap
Plan of care- actualize loss, provide time to grieve,
interpret normal feelings, allow for individual
differences, cultural & spiritual needs, physical comfort,
options for parents (seeing/holding, bathing/dressing,
privacy, visitations, religious rituals/funeral
arrangements, special memories, pictures)
Math calculations:
IV drip rate
Fluid and calorie calculations for newborn (page 714)
Fluids: 100-140mo/kg/24hrs
First 24hrs most only need 60-80ml/kg/hr
Calories: 110kcal/kg/day for first 3 mos, 95 from 69mos, 100 from 9mo-1yr
Breast milk provides 67k cal/100ml or 20kcal/oz
Newborn weight loss (page 1063)
Birth wt – current wt / birth wt = %
15% in premie, 10% in term is acceptable during first
week.
Fetal Heart Rate Patterns pp. 502-513
Baseline- rounded to 5’s; brady<110, tachy>160(#1
cause is maternal temp)
Variability- fluctuations in baseline (absentundetectable; minimal </=5; moderate 6-25bpm;
marked>25bmp)
Accelerations- abrupt inc from baseline (15bpmx15sec,
<2min from onset to return to baseline for >32wks;
10x10<32wks)
Early decels- occur w/ peak of contraction; 2o head
compression’ “U” shaped
Late decels- occur after peak of contraction; 2o
uteroplacental insufficiency; non reassuring, need to be
treated
Variable decels 2o cord compression; “V” shaped;
reposition mom
Prolonged decels- 15bpm<baseline, at least 2 in
<10mins, tx-intrauterine rescusitation
Reassuring- normal baseline & variability
Reactive- HR inc in reaction to fetal activity; normal
Non-Reactive- not HR change in relation to fetal
activity; not normal
Non-Reassuring- “warnings”, fetus not tolerating
contractions, needs intervention
Intrauterine Resuscitation (IUR)- reposition side to
side, knee chest; O2 per mask 8lpm, inc IV wide open,
dec or turn off pitocin