Nursing Care in Maternal Health

Test 2 OB/GYN Study Notes

• Dysmenorrhea: Significantly painful menstruation
• Dysmenorrhea Treatment: NSAIDs, oral contraceptives (reduce bleeding), heat packs, rest, hydration
• Third Stage of Labor: Placental delivery
• Third Stage Duration: 5-30 minutes
• Placental Separation Indication: Firmly contracting fundus, changing uterus shape (discoid to globular), gush of dark blood, lengthening of the umbilical cord
• Nursing Interventions (Placental Delivery): Instruct pushing, administer oxytocin as ordered, position comfort, provide warmth, apply ice (if episiotomy), explain assessments to come, monitor the mother's physical status. Record birth statistics
• Ice vs. Heat (Postpartum): Ice immediately after lacerations or episiotomies. Heat after 24 hours for pain relief.
• Episiotomy/Laceration Comfort Measures: Ice packs (24 hours), warm water rinses, witch hazel pads, steroid hemorrhoid cream, benzocaine spray, pain medications (NSAIDs), positioning.
• Alpha-Fetoprotein Analysis: Measures mother's blood to screen for neural tube defects or chromosomal abnormalities (high = neural tube defect suspicion, low = trisomy 21 or 18 suspicion). Test at 16-18 weeks.
• Amniocentesis: Collection of amniotic fluid to diagnose chromosomal or neural tube defects and metabolic defects. Performed at 15-20 weeks for abnormalities; 35 weeks for fetal lung maturity.
• Pre-Amniocentesis Nursing Actions: Explain procedure, obtain informed consent, have client empty bladder, obtain vitals and FHR, reduce risk of inadvertent puncture.
• Amniocentesis Nursing Actions (during): Supine position with wedge, drape client, cleanse abdomen, use antiseptic solution, local anesthetic administration.
• Post-Amniocentesis Nursing Actions: Monitor vitals, FHR, uterine contractions (30 minutes), rest for 30 minutes, Rh negative evaluation and Rhogam injection as needed.
• SAVE Model (Domestic Violence): Screen all clients, ask direct non-judgmental questions, validate the client by believing them, evaluate, educate, and refer if necessary.
• Abuse Assessment Screening: 4-question test for Intimate Partner Violence (IPV); any "yes" result is positive for abuse.
• Goal of Interventions (Abused Women): Empower them and improve their self-esteem to regain control of their lives.
• Gestational Diabetes: Glucose intolerance and insulin resistance during pregnancy (around 24 weeks)
• Diabetes Screening (High-Risk): First prenatal visit.
• Diabetes Screening (No Risk Factors): During 24-28 weeks of pregnancy.
• Abnormal 2-Hour Glucose Tolerance Test: Greater than 120
• Gestational Diabetes Diagnosis: Abnormal 2-hour AND 3-hour glucose tolerance test required.
• Fetal Complications (Gestational/Pre-gestational Diabetes): Congenital abnormalities, cardiac issues, IUGR, stillbirth, macrosomia, birth trauma, polyhydramnios, hyperbilirubinemia, and neonatal hypoglycemia.
• Maternal Complications (Gestational/Pre-gestational Diabetes): Hypotonic labor, shoulder dystocia, gestational hypertension, ketoacidosis, preterm labor, and postpartum hemorrhage.
• Prenatal Diabetic Dietary Recommendations: 3 small meals and 3 small snacks including a bedtime snack. 40% calories from complex carbs, 35% from protein, and 25% from unsaturated fats.
• HIV Transmission to Fetus: During pregnancy, labor, delivery, and breastfeeding (depends on viral load).
• HIV-Positive Delivery Methods: Depends on viral load.
• HIV-Positive Labor Precautions: Avoid instrumentation (episiotomy), internal monitoring (FSE and IUPC) reduce fetal exposure to bodily fluids, and avoid vacuum-assisted delivery, forceps.
• Most Common Pregnancy Anemia Type: Iron deficiency anemia
• Iron Deficiency Anemia Risks: Preterm labor, low birth weight, and perinatal mortality. Postpartum depression, and hemorrhage.
• Iron Deficiency Anemia Symptoms: Fatigue, malaise, anorexia, headaches, susceptibility to infection, pica, pale mucous membranes, tachycardia, restless leg syndrome, and low hemoglobin (<11), low hematocrit (<35%), low serum iron (<30)
• Iron Deficiency Anemia Treatment: Encourage taking iron with vitamin C (ascorbic acid) with meals to promote absorption
• Neonatal Abstinence Syndrome Symptoms: Irritability, hypertonicity, seizures, jitteriness, fever, high pitched cry, vomiting, diarrhea, feeding disturbances, disturbed sleep, respiratory distress, diaphoresis
• Maternal Risks (Older Pregnancy): Infertility, pregnancy loss, chromosomal abnormalities, stillbirth, obstetrics complications, chronic HTN, gestational diabetes, and postpartum hemorrhage.
• Cardiac Decompensation Assessment: Every visit, but most commonly at 28-32 weeks
• Rubella: A viral infection spread through droplets or direct contact; complications for fetus include congenital cataracts, glaucoma, cardiac defects, microcephaly, hearing loss, and intellectual disabilities.
• Cytomegalovirus: A common viral infection that can be transmitted through droplets. Greatest risk to fetus is in the first trimester or early second trimester.
• Herpes Simplex Virus Management: Prophylactic antiviral at 36 weeks, Cesarean section if active lesions
• Hepatitis B Positive Mothers: Vagainal delivery is possible
• Hepatitis B Treatment Recommendations (Baby): Hep B vaccine and Hep B immunoglobulin within 12 hours of birth—breastfeeding is okay.
• Cardiovascular Changes Exacerbating/Exposing Diseases: Increased cardiac output
• ABO Incompatibility: Usually occurs in type O mothers with type A or B fetuses, not harmful to the mother. May cause jaundice and anemia in the fetus
• Rh Incompatibility: Mother's antibodies cross the placenta if mother is Rh negative and fetus is positive, causing erythroblastosis fetalis (hydrops) in the fetus, not harmful to the mother.
• Polyhydramnios: Excess amniotic fluid (>2000 mL); risk factors: gestational diabetes, fetal genetic disorders or GI obstructions, and multiple fetuses.
• Oligohydramnios: Insufficient amniotic fluid (<500 mL); risk factors: fetal urinary obstruction, reduced blood flow from maternal HTN or diabetes, or leakage of fluid)
• Chronic Hypertension: Onset of hypertension (above 140/90) before pregnancy or before 20 weeks gestation—antihypertensive meds are recommended for these patients.
• Superimposed Pre-eclampsia: Pre-eclampsia occurring in a woman with existing chronic hypertension.
• Gestational Hypertension: Onset of hypertension without proteinuria after 20 weeks of pregnancy, doesn't usually persist longer than 12 weeks postpartum
• Pre-eclampsia: Hypertension and proteinuria after 20 weeks gestation, mild (>/=140/90,>/= 1+ proteinuria) and severe (>/=160/110, >/= 3+ proteins).
• Mild Pre-eclampsia Treatment: Bed rest, BP monitoring, fetal movement counts, IV magnesium sulfate during labor
• Severe Pre-eclampsia Treatment: Hospitalization, antihypertensive medications, oxytocin to induce labor if necessary and magnesium sulfate.
• Increased DTRs (Deep Tendon Reflexes): Indicates possible impending seizure in pre-eclamptic mothers
• Antihypertensive Medications (PO/IV for preeclampsia): Labetalol, hydralazine, and nifedipine (procardia).
• Therapeutic Magnesium Level (Pregnancy): 8-10 mg/dL.
• Magnesium Toxicity Signs: Decreased BP, decreased urine output, decreased respiratory rate, decreased DTRs
• Magnesium Toxicity Treatment: Calcium gluconate
• Eclampsia: Seizure activity or coma in a woman with pre-eclampsia with no prior history of seizures
• HELLP Syndrome Symptoms: Severe epigastric or right upper quadrant pain, abdominal pain, and altered LOC.
• Dystocia of Labor Causes: Pelvic/birth canal issues, excessive size of the fetus; abnormal positions of the fetus and uterine contractions issues
• Precipitous Labor: Completion of labor (contraction to delivery) in less than 3 hours.
• Preterm Labor: Labor between 20 and 37 weeks gestation
• Indomethacin: A tocolytic (labor stopping) drug with contraindications in patients with less than 32 weeks gestation—can cause premature closure of the PDA.
• Contraction Pattern (Preterm Labor): 4 contractions every 20 minutes or 8 contractions in 1 hour
• Fetal Fibronectin Test: Determines if labor is imminent. Negative results are a strong indicator that preterm labor is unlikely in 2 weeks.
• Reliable Preterm Labor Prediction: Measurement of the cervix(e.g., transvaginal ultrasound).
• Postterm Labor: Labor after 42 weeks gestation.
• Labor Induction Methods: Mechanical (e.g., balloon catheter, stripping membranes), alternative methods and herbal supplements (e.g., hot baths, intercourse, evening primrose oil), and pharmacologic (e.g., misoprostol, dinoprostone).
• Bishop Score (≥8): Indicates a good candidate for induction or augmentation of labor.
• Bishop Score: Measures cervical ripeness.
• Indications (Forceps/Vacuum Assisted Birth): Maternal heart disease, dense epidurals, fetal distress, membranes ruptured, cervix dilated, fetus is vertex and engaged, maternal pelvis size is adequate.
• Amnioinfusion Indications: Severe variable decelerations due to cord compression, oligohydramnios due to placental insufficiency, postmaturity, or rupture of membranes, preterm labor with premature ROM, thick meconium, or fluid.
• Contraindications for Vaginal Birth after Cesarean: Classic incision, previous myomectomy.
• Rationale for Prostaglandin Use before Induction: Soften and efface the cervix.
• Shoulder Dystocia: Fetal shoulder obstruction of vaginal delivery.
• Cord Prolapse Indications: Presenting part of the fetus is above the cervix.
• Uterine Rupture Indications: Tear in the uterus.
• Amniotic Fluid Embolism Factors: Placental abruption, uterine overdistension, fetal demise, uterine trauma, amnioinfusion, or ROM.