OB Final Exam Review Topics Fall 2024 PDF

Final Exam Review Topics Fall 2024 Antepartum Antepartum nutrition and weight gain: Ideal weight gain 24-30 pounds ​ overweight: 16-20 pounds ​ 3-12-12 ​ 300 more calories a day Danger signs of pregnancy ​ Vaginal bleeding-during all trimesters ​ Abdominal pain-all trimesters ​...

Final Exam Review Topics Fall 2024 Antepartum Antepartum nutrition and weight gain: Ideal weight gain 24-30 pounds ​ overweight: 16-20 pounds ​ 3-12-12 ​ 300 more calories a day Danger signs of pregnancy ​ Vaginal bleeding-during all trimesters ​ Abdominal pain-all trimesters ​ Temperature > 101 degrees- all trimesters ​ Dizziness, blurred vision, headache-any time ​ Edema of face and hands-any time ​ Absence of fetal movement-after quickening happens ​ Don't lay flat no supine hypotension Fetal Assessment- non stress ​ Look for 2 accelerations in 15 minutes ​ Non reactive: not enough accelerations noticed test/Biophysical profile  ​ Tells us fetal well being and identifies any fetal compromise ​ Below 6 requires follow up, below 4 requires emergency intervention ​ Hemodilution of pregnancy/Normal CBC ​ Decreased hematocrit and hemoglobin ​ Increased white blood cells ​ Increased fibrinogen High Risk Antepartum PIH, Diabetes, ​ Patient safety is priority ​ Patients may have lower insulin needs the first trimester ​ Insulin requirements may increase as pregnancy goes on ​ How well mom manages glucose directly affects baby ○​ Diabetes complications: still birth, macrosomia, shoulder dystocia, hypoglycemia ○​ A good glucose level 45-60 Hyperemesis ​ Excessive vomiting that surpasses first trimester ​ Serious situations require Patient teaching: Eat crackers, small frequent meals, drinks fluids before or after meals, small fluids throughout the day PTL and betamethasone ​ Preterm labor is anywhere between 20 and less than 37 weeks ​ Betamethasone: promotes fetal lung maturity enhances storage and secretion of surfactant , IM injection to mother ​ Risk for IGR ​ Poverty, abuse, and smoking can contribute Placenta Previa ​ Painless bleeding, Bright red blood ​ Soft abdomen  ​ V/S changes, Hypotension ​ Predisposing factors- surgical procedures of uterus, multiparity, older age ​ Diagnosed via ultrasound ​ Cautions: NO vaginal exams or pitocin ​ Intervention: C Section Placental abruption ​ Sudden, painful Dark blood Bleeding, Board like abdomen ​ V/S changes, Hypotension ​ Predisposing factors- trauma, HT, substance abuse (cocaine ​ External or internal hemorrhage ​ Uterine irritability Management: maintain bedrest, monitor FHR, assess blood loss, prepare pt for C section Rh/ABO incompatibility ​ RH antibodies created in response to a an rh+ fetus ​ Rhogam stops the production of maternal antibodies and reduces complications. Given at 28 weeks to RH- woman and within 72 hours after birth ​ Could be given for trauma, spontaneous abortion, and amniocentesis Infections, GBS/ TORCH ​ GBS should be treated during labor with antibiotics during labor ​ Why is GBS a risk? Imbalances or low body temperatures if infected with GBS Magnesium toxicity ​ Lethargy ​ Decreased bp ​ Absent DTR ​ sLOWED RESPIRATION 12 ​ Anti Tide is calcium gluconate Intrapartum VEAL CHOP, nursing actions V- Variables → cord compression E- Early→ Head compression A- Accelerations → okay L - Late → Placental insufficiency →Interventions: Left side, discontinue pitocin, o2 Labor anesthesia/analgesia ​ Epidurals reduce pain. Main complication is hypotension, manage this by giving IV fluid bolus before Priority nursing actions High risk intrapartum Prolapsed cord ​ Can happen if baby is high and not engaged, small baby, breech presentation, transverse lie ​ Intervention: Put trendelenburg, push presenting part upwards relieving pressure off cord, Prepare for rapid delivery Shoulder dystocia ​ Shoulders are stuck, macrosomic babies at risk ​ Do neonatal assessment of arms and clavicle Postpartum Fundal assessment/ priority nursing actions ​ Fundus should be firm, round, and midline ​ Boggy = bleeding ​ Involution: reduction of fundus to pre pregnancy fundus ​ Lochia rubra, serosa, alba ​ After pains: uterine contractility. Pitocin and breastfeeding help with this. Give NSAIDS​ Pitocin use ​ Promotes uterine contractility, helps us control our bleeding postpartum Postpartum assessment B- Breasts U - uterus B - bladder B - bowel L - lochia E- episiotomy H- homans sign E - Emotional support Postpartum complications/ bleeding/ hematoma ​ >500 for vaginal > 1000 is hemorrhage for C section ​ Pp for vaginal delivery note lacteration, hematoma ​ 4ts: Can cause postpartum hemorrhage 1.​ Tone/uterine atony, 2.​ tissue, 3.​ trauma 4.​ Thrombin Postpartum Infection ​ Mastitis: Keep breastfeeding ​ endometritis Newborn Maternal role adaptation Thermogenesis/ hypoglycemia ​ Thermoregulation, maintenance of body temperature ​ #1 priority is maintaining body temp. Keep the baby dry and warm! Risk for heat loss via evaporation from fluids on skin ​ Thermogenesis: Physiological mechanism that increases heat production ie using brown fat ​ Cold stress: increased metabolism increases need for o2 and glucose Newborn assessment findings ​ Normal vs abnormal findings Normal: slight weight loss in first week, blue acrocyanosis, lanugo, Newborn reflexes ​ Babinski  ​ Rooting ​ moro Macrosomic infant ​ Tremors, hypoglycemia, jittery resp distress Hyperbilirubinemia ​ Excessive levels of bilirubin ​ First 24 hrs: pathological ​ s/s: jaundice, lethargy, poor feeding, vomiting, bulging fontanelles Newborn nutrition/ breastfeeding ​ Breast vs bottle feeding, education ​ Cold compress for bottle feeding ​ Warm compress for breastfeeding ​ Discharge instructions/Danger signs to report to pediatrician ​ Concerns: inconsolable crying, lethargy, poor feeding, ​ Note normal vitals temp, hr, Cephalohematoma/caput ​ Caput: soft ill defined enlargement area of edema over fetal head, result from pressure against the cervix. Cross suture line. May last days. ​ Cephalohematoma: does not cross suture line, bleeding between periosteum and skull usually by using forceps or VBAC. May last weeks Family Planning Permanent methods ​ Tubal ligation Risk reduction/ hormonal Early signs of complications from hormonal bc A- abdominal pain C- chest pain H- headache E- eye problems S- severe leg pain Natural method/ BBT ​ Slight elevation of basal body temperature can indicate ovulation Definations Dilation Effecacment Stations Amniotomy Nursing interventions