OB Nursing Bullets


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OB Nursing Bullets

  1. 1. DIPPING – descending but not at ischial spine OB NURSING BULLETS IMPENDING DELIVERY – increase in bloody show, rectal pressure, rupture of membranes, regular and long contractions RITGEN’S MANEUVER at crowning FUNDAL HEIGHT AT UMBILICUS at 20 weeks or 5 months gestationSexual intercourse OK anytime during pregnancy except for: HEMORRHAGE AND INFECTION – most (+) PROM, pre-term labor, incompetent cervix and (+) important to check 24 postpartum vaginal spotting COMPLETE CERVICAL DILATATION – HUMAN CHORIONIC GONADOTROPIN termination of first stage of labor (HCG) – responsible for a positive pregnancy test PLACENTAL DELIVERY – end of third stage of FLUID RETENTION caused by elevated estrogen labor and progesterone and also fatigue VITAMIN K – 1.0 mg for full terms, 0.5 mg for pre- OXYTOCIN – produced by posterior pituitary gland terms for uterine contractions CLINIC VISITS 12 TO 24 MONTHS – monthly FUNDAL PRESSURE – aids in placental delivery if ROOMING IN – for maternal-infant bonding mother is anesthetized HCG PRIMARY FUNCTION – maintain corpus GLOBULAR – uterus in 3rd stage of labor luteum during 1st trimester CORD TRACTION AND FUNDAL PRESSURE DODERLEIN’S BACULLUS – maintains acidic DANGER – inversion of uterus and avulsion of cord vaginal pH AFTERCARE post PLACENTA DELIVERY – BTL – no lifting activities post surgery comfort, dry clothing, perineal pads and linens BSE SCHED – 5-7 days post menstruation CHECK 4TH STAGE OF LABOR q15 – lochia, MAMMOGRAPHY – dx of breast CA; yearly for 40s, fundus, hematoma biannual for 50y above AVOID SEX if cervical mucus is clear and elastic (for RADICAL MASTECTOMY – removal of breast/s, contraception) pectoral muscle, pectoral fascia, nodes INTRAFALLOPIAN TRANSFER – for low sperm VITAL SIGNS – most important 2 h postpartum count IUD INSERTION – done during menstrual days 1-4 IN-VITRO – for tubal occlusion OVULATION PERIOD – 24-48 hours pre-ovulation ANOVULATION – tx of Clomid or Parlodel to 48 hours post ovulation CERVICAL CAP – (-) spermicide pre-intercourse, can OCPs – prevent ovulation stay up to 24-48h, durable, contraindicated if with abnormal pap smear CLOMID – stimulates oogenesis IUD doesn’t protect against STDs LIGHTENING - decrease in fundal height due to a change in shape of the abdomen a few weeks before PROFUSE BLOOD LOSS – saturation of peripad onset of labor within 15 minutes and with pain sensation HOME VISIT – for continuity of care DISTENDED BLADDER inhibits uterine contraction with increased risk of blood loss ABORTION – loss of fetus before viability (20 weeks) FOR IMPENDING HEMORRHAGIC SHOCK INEVITABLE ABORTION – with dilated cervix massage fundus if boggy, elevate legs from hips, IV line, THREATENED ABORTION – closed cervix, oxygen at 8-10 l/min, stay with patient spotting and uterine cramping PRE- LM – void HABITUAL ABORTION – consecutive abortions FHR – priority post rupture of membranes THREATENED ABORTION – complete bed rest, FHR FREQUENCY – beginning to beginning check vaginal bleeding and observe uterine contractions ENDOMETRIOSIS – growth of endometrial tissue OVULATION – 14 days before menstruation (for a outside the uterus; dx: lap and biopsy 28 day cycle); increased pH of cervical secretions, (+) MITTLESCHMERZ; increase in BBT DANOCRINE – menses stop, edema, weight gain, anovulation PROLIFERATIVE – LH surge from anterior pituitary gland BBT – drop 0.2 F pre ovulation, increase 0.4 F post ovulation AGE OF VIABILITY – at 5th month or 20-24 weeks MOST ACCURATE BBT READING – OSSIFICATION OF BONES – at 10th lunar month immediately after awakening and before arising FHT – Doppler at 3 weeks, fetoscope at 18-20 weeks STRIAE GRAVIDARUM – abdominal stretches MC DONALD’S RULE – fundic ht in cm x 8/7 = aog 1
  2. 2. PRENATAL CHECKUPS – 1-7 mo once a month, TETANIC CONTRACTIONS – brought about by8th mo 2/month, 9th q wk the overstimulation by oxytocinPREGNANCY AS A MATURATIONAL CRISIS – DYSTOCIA – due to mechanical factorsdue to hormonal and physiological changes occurring POSTPARTUM HEMORRHAGE – greater thanPROM – prone to infections 500 ml of blood lossTAKING HOLD PHASE – focus is the infant CORTEX OF OVARIES – where developingPOST PARTUM BLUES – 4-5 days post partum follicles and the graafian follicles are foundZYGOTE – cell that results from the fertilization of LABIA MINORA – forms the frenulum and prepucethe ovum by a sperm of the clitorisMITOSIS – cell division of the fertilized ovum FOURCHETTE – formed by the labia minoraOVULATION – rupture of the ovum from the tapering and extending posteriorlygraafian follicle RUGAE – thick folds of membranous stratifiedMORULA – mulberry-like ball of cell that results from epithelium on the internal vaginal wall capable ofcleavage stretching during the birth process to accommodateFUNDUS – where zygote normally implants delivery of fetusIMPLANTATION – 7-10 days post fertilization EXTERNAL OS – location where squamocolumnar junction is, pap smear locationEFFACEMENT – cervix becomes thinner MYOMETRIUM – largest portion of uterusGDM – carbohydrate intolerance induced bypregnancy CORPUS – upper triangular portion of uterusADVERSE EFFECTS OF GDM – morbidity LH – testosterone productioncommon in newborn, infant may inherit a predisposing ESTROGEN – secreted by graafian follicle associatedto DM, higher perinatal death with spinnbarkeit and ferningGDM NURSING INTERVENTIONS – liberal AUTOSOMAL RECESSIVE – cystic fibrosis, tay-exercise, acceptable diet at 30-35 kcal/kg of IDBW/day, sach’s disease, sickle-cell anemiainsulin as ordered, CBG monitoring CHORIONIC VILLI SAMPLING – detects trisomyGLUCOSE – 18.02 mg/dl = 1 mmol 21, cystic fibrosis and tay sach’sBREAST ENGORGEMENT – doesn’t last for MATERNAL AGE – indication for chorionic villigreater than 24 hours samplingMEFENAMIC ACID – anti-inflammatory RHOGAM – essential post-CVS or RH (-) mom;PASSAGEWAY – structure of maternal pelvis refrain from sex 48h post-CVSNITRAZINE PAPER TEST – urine vs. amniotic NEEDLE INSERTION SITE – most importantfluid; yellow vs blue factor affecting amniocentesisPROM – check temperature MORNING AFTER PILL – prevent implantation of the fertilized ovum; taken within 12h post-intercourse,NONPREGNANT UTERUS – lined by (+) slight nausea post-2d; not given to those with hxendometrium contraindications to OCPsVULVA – externally visible structure of the female COMBINED OCPs – inhibit FSH and LHreproductive system extending from the symphysis productionpubis to the perineum ESTROGEN – causes sodium retentionAMPULLA – fertilization site PARITY – indication for IUD useISTHMUS – site of sterilization HX OF PRETERM LABOR – contraindication forVAS DEFERENS – conduit for spermatozoa IUD useEJACULATORY DUCT – seminal fluid HYSTEROSALPINGOGRAM – done 2-6 days afterLEYDIG’S CELLS – synthesize testosterone mensesPROGESTERONE – increased activity of COVADE’S SYNDROME – way in which anendometrial glands during luteal phase; increased basal expectant father can explore his feelingsmetabolism, increased placental growth, development RhOGAM – should be administered within 72h;of acinar cells in the breast destroys fetal RBCs to prevent antibody formationROUND LIGAMENT – (+) hypertrophy during LEUPROLIDE – tx for endometriosispregnancy AMPICILLIN – safest antibiotic for pyelonephritisSPERM MOTILITY – best criterion for spermquality HYPOTONIC DYSTOCIA – monitor contractionsHYSTEROSAPINGOGRAPHY – introduction of MAGNESIUM TOXICITY – first sign isradiopaque material into uterus and fallopian tubes to disappearance of knee-jerk reflexassess for tubal patency IUD SIDE EFFECT – excessive menstrual flow 2
  3. 3. IUD COMMON PROBLEM – spontaneous TX FOR FLUID RETENTION - adequate fluidsexpulsion of device and elevation of lower extremitiesIUD – provides contraception by setting up a non- FULL BLADDER – pre UTZspecific inflammatory cell reaction in the endometrium NORMAL AMNIOTIC FLUID – clear, almostOVULATION – occurs when LH is high colorless, containing little white specksOCPs – causes breakthrough bleeding RESTRICT MOVEMENT – when an external fetalPOST COITAL TEST – best timed within 1-2 days monitor is being usedof presumed ovulation EARLY DECELERATION – FHT decreases justTUBAL DEFECTS – are most often related to past before acme due to head compressioninfections LATE DECELERATION – FHT decreases justINFERTILITY – inability to become pregnant after a after acme caused by uteroplacental insufficiency; mayyear of trying lead to distressSIMS HUHNER (POST COITAL TEST) – VARIABLE DECELARATION – due to corddetermine the number, motility and activity of sperm compressionHYATIDIFORM MOLE – be alert for unusual LOCATION OF FUNDUS AFTERuterine enlargement PLACENTAL DELIVERY – halfway between theECTOPIC PREGNANCIES – sudden lower right or symphysis pubis and the umbilicusleft abdominal pain radiating to the shoulders SLOW DEEP BREATHING – alleviates discomfortTUBAL RUPTURE – sudden knifelike, lower during contractionsquadrant pain PANTING – during crowningGERM PLASMA DEFECTS – causes most OCCIPUT POSTERIOR – causes low back painspontaneous abortions APPLICATION OF BACK PRESSURE – duringINCOMPLETE ABORTION – fetus is expelled but contractions to increase comfortpart of the placenta and membranes are not NPO – during second stage of labor becauseFUNIS – umbilical cord undigested food and fluid may cause nausea andAMNION – inner membrane that encloses the fluid vomiting, limiting the choice of anesthesiamedium for the embryo TRANSITIONAL PHASE – help clientFETUS – 8th week to birth retain/remain in control12th WEEK – uterus becomes an abdominal organ POSITIONING DURING DELIVERY – legsQUICKENING – first fetal movement felt by the elevated simultaneously to prevent trauma to themother uterine ligamentsGREATEST WEIGHT GAIN – in third trimester; UTERINE TETANY – observe carefully for this2nd trimester: height and length during the induction of laborPLACENTA – chief source of estrogen and PUSH WITH GLOTTIS OPEN – when fullyprogesterone after the first 3 months dilated but (-) crowningDUCTUS VENOSUS – has the highest oxygen EPISIOTOMY is done to prevent lacerationscontent PUERPERAL INFECTIONS – 2 most importantDIAGONAL CONJUGATE – A-P diameter of predisposing factors to its development is hemorrhagepelvic inlet and trauma during birthBLOOD VOLUME INCREASE – 30-50% is PROLACTIN - stimulates secretion of milk from thenormal mammary glandsCHADWICK’S SX – purplish discoloration of vaginal SITZ BATH – promotes vasodilation, relievesmucosa hemorrhoidsPHYSIOLOGIC ANEMIA – result of increased INFANT FEEDING – on demand; baby will soonplasma volume of the mother develop a feeding scheduleCHORIONIC GONADOTROPIN – causes nausea CLOSURE OF FORAMEN OVALE – after birth isand vomiting caused by an increase in the pulmonary blood flowPITUITARY GLAND – increase in melanotropin DUCTUS ARTERIOSUS – becomes the ligamentumhormone causing dark nipples and linea nigra arteriosumRH DETERMINATION - routinely performed on HEART RATE – primary critical observation in apgarexpectant mothers to predict whether the fetus is at scoringrisk for acute hemolytic anemia MECONIUM CHECK Q SHIFT – to keep limitLEUKORRHEA – caused by elevated estrogen development of hyperbilirubinemia ASSYMETRICAL MORO REFLEX – associated with brachial plexus, cervical or humerus injuries 3
  4. 4. STERILE INFANT INTESTINES – lack bacteria NEONATAL MORBIDITY - with low apgar scorenecessary for the synthesis of prothrombin at 5 minutes post deliveryPKU SCREENING – measures protein metabolism HIV/AIDS INFANT – microcephalic, craniofacialNORMAL REGURGITATION – in infants is features, persistent diarrheacaused by an underdeveloped cardiac sphincter CHLAMYDIA INFECTIONS – purulentAMNIOCENTESIS – done to detect presence of conjunctivitis and pneumonia in infantneural tube defects RETROLENTAL FIBROPLASIA – caused by highPREMATURITY – contraindication for oxytocin oxygen concentration administered in prematurechallenge test infantsUTEROPLACENTAL INSUFFICIENCY – (+) SYPHILIS – asymptomatic newborn, VDRL testCST HIP DYSPLASIA – asymmetric gluteal foldsPREGNANT ADOLESCENT – emphasize ERB’S PALSY – complication of breech delivery;importance of consistent care flaccid arm with elbows extended; ROM exercisesPERINATAL MORTALITY – is 2-3 times greater in PRECIPITATE DELIVERY – increased risk formultiple gestation than in single gestation intracranial hemorrhage and elevated ICPHYPOTONIC UTERINE DYSTOCIA – is PATHOLOGIC JAUNDICE – appearance ofoftentimes caused by multiple gestation jaundice during the first 24 hoursPYELONEPHRITIS – observe for signs of PTL; DECREASED INFANT GFR – inability of theantibiotic tx should be administered until urine is infant to concentrate urine and conserve watersterile—2 (-) C/S RESPIRATORY DISTRESS – most commonCONCEALED HEMORRHAGE – causes preterm complicationabdominal pain associated with abruption placenta INFANT HYPOGLYCEMIA SX - tremors, periodsDIC/HYPOFIBRINOGENEMIA – causes of apnea, cyanosis and poor suckingbleeding following sever abruptio placenta LARGER DM NEWBORNS – due to increasedABRUPTIO PLACENTA – is most likely to occur in somatotropin and increased glucose utilizationwomen with pregnancy induced hypertension UTERINE AND OVARIAN ARTERIES – mainPLACENTA PREVIA – painless vaginal bleeding blood supply of the uterusPAIN MEDS – are kept at minimum during PTL to ENDOMETRIOSIS – is characterized by painfulprevent respiratory depression menstruation and backacheATONY OF THE UTERUS – due to overstretching RETROCOELE – is brought about by overstretchingis commonly caused by multiple gestation of perineal supporting tissues as a result of childbirthOVERDISTENED BLADDER/HYDRAMNIOS COLUMNOSQUAMOUS JUNCTION OF THE– may cause uterine atony INTERNALAND EXTERNAL OS – common sitePOSTPARTAL HEMORRHAGE – rarely occurs as of cervical CA growtha complication of uncomplicated gestational DIETHYLSTILBESTROL – management forhypertension infertilityPIH – BP elevation of 30/15 mmHg from baseline on RADIUM REACTION – pain and elevated2 occasions 6 hours apart temperatureEPIGASTRIC PAIN – subjective symptom of an DOXORUBICIN – inhibits RNA synthesis byimpending seizure binding DNAROLLING OF EYES TO ONE SIDE WITH A ESTROGEN RECEPTOR PROTEIN (ERP) –FIXED STATE – objective sign of an impending evaluates potential response to hormone therapyseizure BILATERAL OOPHORECTOMY – surgicalDANGER OF SEIZURE – ends in 48h postpartum menopausein a woman with eclampsia CESSATION OF MENSES – is due to the inabilityCORD COMPRESSION - birth hazard associated of the ovary to respond to gonadotropic hormonewith breech delivery BARTHOLOMEW’S RULE – via location ofGRAVIDOCARDIAC PT - cardiac acceleration in fundusthe last half of pregnancy; most compromised during HAASE’S RUELE – first 5 months: month2 = aog;the first 48 hours after delivery; forceps delivery second half: month x 5 = aogGDM DIET – balanced, to meet the increased dietary NAGELE’S RULE – LMP minus 3m +7d + 1y =needs with insulin adjusted as necessary EDCRENAL AGENESIS - funis with only two vessels DECIDUA BASALIS – placentaDRUG WITHDRAWAL IN INFANT - irritabilityand nasal congestion 4