12 Pregnancy: Stages and Complications of Labor.pdf
Transcript
10. Maternity -Be able to calculate a due date (Nagele’s Rule ): First day of last menstrual cycle Add 7 days Subtract 3 months Add a year -Total weight gain during pregnancy: 25-31 pounds Ideal weight gain: [Week of gestation] - 9 (+ a couple lbs) ○ If more than 3...
10. Maternity -Be able to calculate a due date (Nagele’s Rule ): First day of last menstrual cycle Add 7 days Subtract 3 months Add a year -Total weight gain during pregnancy: 25-31 pounds Ideal weight gain: [Week of gestation] - 9 (+ a couple lbs) ○ If more than 3 lbs, you need to assess, something could be wrong -Fundus: Top of the uterus; not palpable until week 12 Fundus typically reaches the umbilical (naval) level at week 20-22 1st trimester (1-12 weeks): 1 lb/month weight gain, total: 3 lbs ○ Fundus not palpable. Mother is Priority ○ If you can palpate the fundus or she gains 10lb, she might have a hydatidiform mole, or not really be in the 1st trimester ○ You can palpate the fundus at the end of the 1st trimester 2nd trimester (13 - 27 weeks): 1lb/week weight gain ○ Fundus at umbilicus or below it. ○ Mother is Priority ○ At 20-22 weeks the fundus is at the umbilicus 3rd trimester (28 - 40 weeks): 1lb/week weight gain ○ Fundus above umbilicus. ○ Baby is Priority -Signs of pregnancy : 4 Positive Signs: Fetal skeleton on an X-ray; Fetal presence on ultrasound; Auscultation of the fetal heart (doppler); Examiner palpate fetal movement/outline HR begins to beat at 5 weeks, but you can hear it at 8-12 weeks, and when the examiner palpates fetal movement Quickening (when the baby kicks): 16-20 weeks *NCLEX TIP: 3 Different Questions for OB Q’s: ○ “When would you first auscultate a fetal heart?” - 8 weeks “First”: pick earliest part of range ○ “When would you most likely auscultate a fetal heart?” - 10 weeks “Most likely”: pick mid part of range ○ “When should you first auscultate a fetal heart by?” - 12 weeks “Should”- pick end of range -Probable/Presumptive “The Maybes”: Positive Pregnancy Test Chadwick, Goodells, Hegar signs (Alphabetical in that order) ○ Chadwick: Cervical color change to cyanosis ($4 blue candle) ○ Goodells: Cervical softening (good when your cervix softens, 2 ll’s =2 month) ○ Hegar: Uterine softening (upside down g for 6 months) -Patient Teaching: Come once/month until week 28 (3rd trimester) Week 28 → come once every 2 weeks until week 36 Week 36 → every week until delivery until week 42. Hemoglobin will fall ○ Normal hemoglobin for females → 12-16 ○ 1st trimester → can fall to 11 and be normal ○ 2nd trimester → can drop to 10.5 and be normal ○ 3rd trimester → can drop to 10 and be normal ○ Acceptably low can be as low as 9 When does morning sickness start and how to treat it? ○ It happens during the first trimester ○ Treatment: eat dry carbohydrates (crackers) before getting out of bed and avoid having an empty stomach When does urinary incontinence happen and how to treat it? ○ It happens during the first and third trimester ○ Not a problem during the second trimester because the baby is up high off the bladder ○ Treatment: void every 2 hours all the way through 6 weeks postpartum Dyspnea (difficulty breathing): ○ 2nd & 3rd trimester ○ Treatment: Tripod position ⇒ Feet flat, arms on table/knees leaning forward Back pain: ○ 2nd & 3rd trimester ○ Treatment: Pelvic tilt exercises **NCLEX TIP: Pregnancy is a healthy state. If you don’t know the answer, think “What would be good for anybody?” and that is usually the answer. -Labor & Birth : Valid sign of labor: Onset of regular progressive contractions Dilation: Opening of cervix ○ 0-10 cm → 0 is closed, 10 fully dilated Effacement: Thinning of the cervix. From thick to 100% Station: relationship of fetal presenting part to mom's ischial spine (tightest squeeze) ○ Negative station: above spine Presenting part is above the tight squeeze (-1, -2) → BAD ○ Positive stations: below spine Presenting part is below the tight squeeze (+1, +2) → GOOD ○ Engagement is station zero; at the ischial spine Lie: Relationship between the spine of mom & spine of baby ○ Vertex lie (longitudinal): Compatible for natural vaginal birth; uncomplicated Mom’s spine and baby’s spine are parallel (Good) ○ Transverse lie (shoulder presentation): Trouble Presentation: Part of baby that enters the birth canal first ○ Most common is: ROA or LOA -Stages of Labor : Stage One: The purpose of uterine contractions in 1st stage: dilate & efface the cervix ○ Phase 1 (Latent): Dilation: 0-4 cm Contraction Frequency: 5 - 30 mins apart, lasts 15-30 secs Intensity → mild ○ Phase 2 (Active): Dilation: 5-7 cm Contraction Frequency: 3-5 mins apart, lasts 30-60 secs Intensity → moderate ○ Phase 3 (Transition): Dilation: 8-10 cm, Contraction Frequency: 2-3 mins, lasts 60-90 secs Intensity → strong **Only memorize phase 2. 1st 3 letters in latent tell u the order of phases** MUST KNOW!!! ○ Signs of uterine tetany/ uterine hyperstimulation/ stop Pitocin: Contractions should not be longer than 90 seconds or closer than every two minutes!! *NCLEX TIP: ****PAY ATTENTION TO THE Q: PHASES ARE NOT STAGES! **** How to time contractions: Frequency ⇒ beginning of one contraction to the beginning of the next contraction (A → C) Duration ⇒ beginning to end of one contraction (A → B, C → D) Intensity ⇒ strength of the contraction; palpate with pad of fingers of one hand over the fundus Complications: Painful back labor: LOP, ROP ○ Low priority ○ What do you do? Position than Push: Position → knee chest: on hands and knees with butt and head up This brings the baby down off the sacrum and coccyx Push → take fist & push into sacrum Provides counter pressure and relieves some pain Prolapsed Cord: Bad, OB emergency ○ When the cord is the presenting part, which wraps around baby’s neck, ○ High priority ○ What do you do? Push than Position: Push head back up off the cord Keep your hand there until the baby is delivered Position her in knee chest Interventions for all other complications of birth: ○ **LION → turn on left side, increase IV , O2 , notify doc ○ In a crisis: if Pitocin is running, stop the Pitocin first! & then do LION***** Pain MGMT: ○ Do not administer a systemic pain medication to a woman in labor IF the baby is likely to be born when the pain med peaks. (Respiratory depression) ○ Example: You have a primigravida at 5 cm who wants her IV push pain med. Will you give it to her or not? Is it likely that she will deliver the baby in the next 15-30 minutes? ○ No → give her the pain med You have a multigravida at 8 cm who wants her IM pain med. Will you give it to her? Is it likely that she will deliver the bay in the next 30-60 minutes? ○ Yes → do not give pain med
