OB Exam 2 Study Guide PDF

Hyperemesis Gravidarum - Intervention - KEEP PT NPO UNTIL VOMITING COMPLETELY STOPS - Reintroduce slowly - Monitor I&O, Vital Signs & daily Weight - Hydrate with Lactated Ringers IV - Administer antiemetic medications - Meds - Hydrate with Lactated...

Hyperemesis Gravidarum - Intervention - KEEP PT NPO UNTIL VOMITING COMPLETELY STOPS - Reintroduce slowly - Monitor I&O, Vital Signs & daily Weight - Hydrate with Lactated Ringers IV - Administer antiemetic medications - Meds - Hydrate with Lactated Ringers IV - Give pyridoxine (vitamin B6) - Administer antiemetic medications - Use corticosteroids to treat resistant hyperemesis - TPN (total parental nutrition) for IV nutrition support - Complications (neonate) - IUGR - SGA - Preterm birth Iron-deficiency anemia - Risk factors - Less than 2 years between pregnancy - Heavy period before period - Analysis - Reduced ability to perfuse mom and babies organs (decreased O2 in blood) - Fatigue - Weakness - Pale - PICA - Planning - - Intervention - Increase of dietary intake (beef & green veggies) - Vitamin C with iron - Increase fluid and fiber - Medication : ferrous sulfate or iron infusions - Take iron 1 hr before meals, or 2 hours after GDM - Moms with Hypertension = higher chance for GDM - Weight gain & nutritional requirements stay the same for moms with GDM as they are for moms without it - Planning - Fetal monitoring - Weekly NST - BPP - Daily kick count - Neonatal hypoglycemia (after birth\*\*) - Hyperglycemia - Symptoms: polydipsia, polyphagia, polyuria, nausea, abdominal pain, flushed dry skin, fruity breath - Hypoglycemia - Related to insulin overdosing, skipped meals or increased exercise - Symptoms: nervousness, headache, weakness, irritability, hunger, blurred vision - DKA - 1 hr & 3 hr glucose challenge - Intervention - Primary intervention: Diet and Exercise - Nutrition changes + 80 oz water (remember to consider culture) - 20-30 min of exercise - Monitor blood sugars - Hyper / Hypo glycemia treatment - Meds - Insulin is the 1^st^ line medication - metformin - Evaluation - Resolves after immediately after birth of placenta\* Hypertension - Risk factors (applies to all) - Moms with GDM are more likely to develop htn - First preg - Mom younger than 19, older than 40 - Obesity - Multifetal gestation - Complications (applies to all) - Placental abruption - Preterm birth - End-organ failure - Maternal / fetal mortality - Chronic hypertension - Bp of 140/90 before preg or before 20 weeks - If bp is 160/100 + medication is used - Gestational hypertension - New onset of htn after 20 weeks - Criteria - Sbp 140+ OR dpb 90+ - Occurs on two occasions at least 4 hrs apart - Resolves by 12 weeks postpartum - Preeclampsia - New onset of htn & proteinuria after 20 weeks - Criteria - 140 or higher systolic OR 90 or higher diastolic - PROTEINURIA 1+ or higher - Severe Preeclampsia - Criteria - 160 or higher systolic OR 110 or higher diastolic - Proteinuria 3+ or higher - HYPERREFLEXIA ( 4+, very brisk) - s/s (related to end organ failure of liver, brain, and kidneys. If any of these are seen yk its severe immediately) - Severe headache - Hyperreflexia - Clonus: pt dangles foot, and the foot starts bouncing in your hand when in flexed position - Oliguria - Vision changes - Pitting edema of LE - Epigastric pain - RUQ pain - Nausea - SOB (pulmonary edema) - Only way to resolve is to deliver the baby - If gestation is early on medications may be used to try and prolong pregnancy - Eclampsia - Criteria - 160 or higher systolic OR 110 or higher diastolic - Proteinuria 3+ or higher - Hyperreflexia ( 4+, very brisk) - [SEIZURE] - Again delivering the baby is the only cure - HELLP syndrome - Low hemoglobin, elevated liver enzymes, low platelets - Epigastric pain - Decreased kidney function - Medications - Antihypertensives - Hydralazine - Med of choice during pregnancy - Labetalol - Manage postpartum htn - Anticonvulsant - Mag sulfate - Prevents seizures - Complication: postpartum hemorrhage - Toxicity s/s - Urine output \< 30ml/hr - Absent DTRs - Respirations \< 12/min - Decreased LOC - Cardiac dysrhythmias - If toxicity suspected: - Discontinue infusion - Administer Calcium Gluconate - Methergine - DO NOT GIVE to htn patients\* - Minimal fhr varibility Hypertension medications - antihypertensive - Lower BP - Hydralazine - Drug of choice for HTN disorders in pregnancy - Labetalol - Drug of choice for postpartum HTN management - Given when the mother is discharged home - SAFE for breast feeding - Anticonvulsant - Magnesium Sulfate - Drug of choice to prevent SEIZURES - Complication: risk for postpartum hemorrhage\*\* - DO NOT give Methergine to hypertensive clients\*\* - Expect minimal FHR variability - Toxicity s/s - Urine output \< 30ml/hr - Absent DTRs - Respirations \< 12/min - Decreased LOC - Cardiac dysrhythmias - If toxicity suspected: - Discontinue infusion - Administer Calcium Gluconate Postpartum physiological changes - Hormones - Increased oxytocin - Decreased estrogen, progesterone, & insulinase - Decreased estrogen causes breast engorgement, diaphoresis, & diuresis of excess extracellular fluid from pregnancy - Decreased progesterone causes increased muscle tone throughout the body - Decreased placental enzyme insulinase lowers blood glucose levels immediately after birth - Blood changes - Blood volume - Decreases from bleeding during birth, diaphoresis, and diuresis - Blood loss - Vaginal birth = 300-500 ml - C-section = 500-1000 ml - Blood values - Vitals - Bp - hr Postpartum assessment - Bubblehee - Breast - Promote early breast feeding (1-2 hrs after birth) - Educate on latch techniques (baby should have part of areola in mouth) - Nipple assessment: cracks, bleeding, redness, blisters, raw - Milk suppression - Wear supportive bra for 72 hrs - Do not stimulate breasts (no running warm water over of having baby breast feed) - Ice 15 minute on 45 off for engorgement - Fresh cold cabbage leaves in bra may also help - Tylenol & ibuprofen for pain - Uterus - Midline, firm uterus - If uterus is boggy = MASSAGE the fundus - Encourage pt to empty bladder to prevent uterine displacement & atony - Uterus goes down 1 finger breath/ cm per day - Shouldnt be palpable 1-2 weeks after birth - Should be at umblicus 1 hr after birth - Bladder - Excessive diuresis is normal after birth for 2-3 days - Empty bladder every 2-3 hrs - If pt is retaining insert catheter to prevent uterine atony - Perform kegels to strengthen pelvic floor - Bowel - May not have a bm 2-3 days after birth - Hydrate & stool softeners to ease bm after birth - c-section \--\> ambulate - Lochia - Rubra: day 3-4 - Serosa: day 4-10 - Alba: day 10-week 8 - Redness - Edema - Ecchymosis - Discharge - Approximation - Need to weigh all pads that discharge on them to get QBI - Bright red blood = tear - Epissiotomy / laceration - Episiotomy - ICE PACKS for the first 24 hrs \* - Use a warm peribottle to clean after using the bathroom, blot dry! - Change pad every 2/3 hrs - Topical spears, tux pads, witch hazel, and pain medication to ease discomfort - Ensure tear is approximated - Insicion / c-section - Look for erythema, edema, burning, drainage, dehisvence, & approximation - Stool softeners to ease bm - Ice pack on incision - Cotton underwear, keep clean and dry, blot dry - Hemrrhoids - Assess by turning pt completely on side - Hydrate & stool softeners - Tucks pads - Side lying positions are key! - Edema / dvt - Educate about s/s of dvt - Redness, pain, warmth - Early ambulation and scds\* - Emotional status - Skin to skin - Rooming in, baby with mom at all times - Musculoskeletal - Less progesterone = better muscle tone - Always assist mom to the bathroom for the first time after birth\* - Diastasis recti resolves 6 weeks pp - Pain - Assess location, type, and quality of the pain to guide nursing interventions and client education - Administer pain medications as prescribed - Teach nonpharmacological measures [(distraction, heating pads, position changes, cold packs, tucks, lanolin)] Baby-friendly care - Immediate skin to skin to promote bonding - Phases - The taking-in phase focuses on the client meting personal needs - the taking-hold phased focuses on baby care and improving caregiver abilities, - The letting-go phase focuses on the family as a unit. Postpartum client education PPH complications - Primary vs secondary - Primary - Happens within the first 24 hours - Secondary - Happens up to 12 weeks after birth - Assessment - Hypovolemic Shock Signs & Symptoms - Persistent significant bleeding -- soaking peripad within 15 minutes - Woman states she feels weak, light-headed, funny, vision changes - Skin color turns ashen or grayish - Skin feels cool & clammy - HR increases - BP declines - - Analysis - Uterine atony is main cause of pph - Planning - Give a second IV site - Intervention - MASSAGE THE FUNDUS\*\* - Assess for source of bleeding - evaluation PPH Medications - Pitocin - Contracts the uterus - Methergine - Do not give to HTN moms\*\*\*\*\* (preeclamptic pt) - Dont give to someone thats taking mag sulfate - Hemabate - Do not give to pt with asthma - Side effects - Main one = diarrhea (explosive, shitting an insane amount) - Cytotec - Must be given rectally or orally - TXA DVT complications Postpartum infections - Endometritis: infection of the uterine lining (typically starts where placenta was attached) - Assessment - Uterine tenderness & enlargement - Dark, profuse lochia - Malodorous lochia - Temperature greater than 100.4o F - Tachycardia - Planning - Vagina & blood cultures - Iv abx - Pain meds - Mastitis : inflammation of breast cause by blocked duct - Assessment - Painful / tender, warmth, redness, and swelling unilateral - Flu like symtpoms - Planning - Continue breast feeding - Abx - Ice / heat packs - Interventions - NO UNDERWIRE BRAS, but make sure theyre supportive - Proper latching techinque - Completely empty breast at every feeding Postpartum affective disorder - Blues - (mood swings that resolve within 2 weeks) - Depression - ongoing mood disorder that causes sleep disturbances, lack of interesting in self-care and caring for the infant - Psychosis - hallucinations, thoughts of harming self and/or infant Review session notes - Hormones - Decreased estrogen - Increased oxytocin -- to contract uterus - Sweating and peeing will occur after birth - WBC will be increased after birth - Mom may have a fever 24 hrs after birth, after 24 hrs is abnormal - Rubella vaccine : dont get preg 4 weeks after getting it - Breast feeding - No underwire bra - Milk suppression - Ice packs for engorgement - Hematomas - Main s/s = pain - Traumatic birth is main risk - Pp Infections - Endometritis - Infection or uterine lining - Dark perfuse lochia - Tender enlarged uterus - Mastitis - Clogged milk duct - No underwire bra - CONTINUE BREAST FEEDING\* - Flu like symtpoms - Psych - Blue - Lasts 2 weeks - Crying, mood swings, anxious - Depression - Excessive guilt - - psychosis