Matenal Infant Final

1. Stages of Labor
Ÿ First Stage-Onset of labor, 0-10 cm dilated. 0-3cm Latent
(prodromal), 4-7cm active (primip will progress at about 1cm/hr and
can last 8 hours), 8-10 cm Transition (30-60 minutes), Nulliparous
will seek admission during latent phase, multifarious will not come
until active phase
Ÿ Second Stage-delivery 10cm to delivery of infant (pushing-can last
few minutes up to 4 hours). Three phases 1) latent: relatively calm
with passive descent of baby through birth canal 2) descent active
pushing and urges to bear down 3) transition: presenting part is on
perineum and bearing down efforts are most effective for promoting
birth
Ÿ Third Stage-baby delivery to expulsion of placenta
Ÿ Fourth Stage-1-4 hours postpartum until she is stable (recovery)
2. Major event and interventions-
3. S/S of pregnancy- changes in breast, no menstruation, N/V. Headaches,
uterus changes in size, shape, and position, cervical changes, quickening
4. Presumptive-What he mom feels or perceives, nausea, tenderness of
breast. Missed period, quickening,
5. Probable- Can be observed but may not be from pregnancy ( a positive
pregnancy test, uterine enlargement, uterine souffle, goodell sign, heager
sign, ballottment,
6. Positive- Things that can only be caused by the fetus/pregnancy (fetal
heart tones) fetal movement, visualization with ultrasound.
7. Gravita and Para G F P A L- G ( # of pregnancies) F (# of full term
38-42 weeks) P ( # of preterm 20-37 weeks) A (# of abortions) L (# of
living children)
8. Estimating Gestational Age - ask about LMP, morning sickness occurs
weeks 4-15, changes in breast week 3-4, measure fundal height, use
ultrasounds, fetal movement is felt around weeks 16-20. 5%
of women have births on their estimated due date. ( EDB = date of birth,
EDD= date of delivery, EDC= date of confinement) In
the 1 and 2 trimester doctor visits are monthly, 3 trimester = more
st nd rd

appts. Starting week 28 appointments are every 2 weeks until the 36th
week when they are weekly. Nagele’s Rule
9. Baby Blues - appears after childbirth, involves sudden mood swings such
 as being very happy or depressed, the new mother may suddenly cry for
no reason. May last a few days or a couple weeks.
10.Post Partum Depression - more severe than baby blues, often needs
medications, can last 6 months to 1 + years
11.Psychosis - when the mother wants to hurt the baby or themselves, they
hear voices and require medications or hospitalization.
Treatment: Encourage expression, provide rest, give reassurance, may
not require medication (meds= self limiting), food + hygiene
12.Normal Blood Loss - 500cc is normal, anything above that is
hemorrhaging. A mother can lose up to 40% of blood w/o having s/s
13.Episiotomy- incision made in the perineum to create a vaginal opening
for birth, it is a/w with higher incident rate of a 3rd or 4th degree
laceration. Mediolateral episiotomy is used in operative births, a 4th
degree laceration may be preventable but is 3rd degree is likely to occur.
14.Laceration ( A&P and interventions) 1st degree lacerations involve skin
and superficial components to muscle. 2nd = skin and muscle, 3rd= skin,
muscle, and anal sphincter, 4th = tearing of skin, anal sphincter, vaginal
mucosa, anterior rectal wall, and facia of muscle. No BM 2-3 days post
delivery is normal. Mother will be at risk for constipation, infection,
acute pain, and maybe incontinent stool.
15.What a non-stress test is ( + or - , reassuring or not) -
16.Contraction Stress Test (Positive CST = bad, NST reactive = good) -
CST = 3 contractions over 10mins with no late dcells, a negative CST is
good
17.Biophysical Profile - score 0 or 2 in each category, aka BPP, looks at
five items = 1) NST, accelerations times 2/ 10mins = good, it is a
nonstress test 2) amniotic fluid 3) gross movement 4) breathing motions
5) muscle tone, a score of 6 or below requires immediate delivery, also a
score of 8 with a decrease in amniotic fluid
18.Indications for inducing labor- induction may be elective or for
medical, obstetric, fetal reasons. Obstetric reasons include HTN, diabetes
mellitus, choriominoitis, and suspected fetal danger. Also is the MultiP
lives far from the hospital and has a history of rapid labor. Decreased
variability ( normal is 5-25 beats per min, compare with baseline) Also if
fetal heartbeat cannot be found (trouble asculating) , if there is brady or
tachy cardia
19.Fetal monitoring ( 3 types of DeCells, accelerations, Tachycardia,
Bradycardia) Nonreassuring FHR included baseline <110 or >160
beats/min. Normal range is 110-160
20.Amino infusion- adds normal saline into the uterus after membranes
 have ruptured. It may be for variable decelerations because the umbilical
cord is being squeezed due to the decrease in fluid.
21.Ruptured membranes (what is good, TACO and nursing care)
TACO( Time, Amount, Color, Odor) of amniotic fluid
When the water breaks > listen to baby and monitor maternal
temperature
22.Pros and Cons of fetal monitoring: normal heart rate is 110-160,
variability is 5-25, evidence does not show better outcomes.
Pros( reassures mother, watches signs of stress, visual and permanent
record, allows early interventions, decreases nurse/ patient ratios)
Cons ( false alarms, increases rate of C- Section, decreases mobility of
mother, increases labor discomfort, causes needless anxiety).
Umbilical compression with show variable deceleration (sudden onset)
when the mother is pushing, the contractions will square off.
Acceleration is a good sign 15 beats by 15 seconds, has to be ½ boxes
long and wide. Decceleration means distress.
23.Breastfeeding two children- the mother should increase her calorie
intake, she should feed the newborn before the older child. Breastfeeding
may cause uterine contractions as it produces oxytocin and prolactin. The
breast milk may contain colostrum which changed the taste of the milk
and may create a laxative effect on the older child.
24.Having children in the delivery room - the parents should not force this
upon the child and should come a caretaker present if the child needs to
leave the room.
25. 5th disease - Some fetuses may develop severe anemia if the mother is
infected while pregnant, especially if the infection occurs during the first
half of pregnancy. In some cases this anemia is so severe that the fetus
does not survive. Fortunately, about half of all pregnant women are
immune from having has a previous infection with parvovirus, serious
problems occur in less than 5% of women. A blood test will determine if
the mother is infected
26.Factors of satisfaction in delivery Mothers feel satisfied with delivery
when they have control over that the outcome and process will be like.
Birthing centers have more satisfaction due to home like feeling.
27.Pain relief in labor: relaxation, imagery and visualization, conscious
breathing, biofeedback, massage and acupressure, hydrotherapy, music,
spinal anesthesia, Epidural
28.S/S of potential complications in labor
29.Breastfeeding vs. Bottle feeding
30.Newborn Assessment (APGAR and Vitals)
31.Variations of Normal
32.Placental Abruption and S/S: can be painful, does not have bright red
blood, on fetal monitor if you see pressure go up ( ^ 25) = hemorrhage,
you will see late deceleration on fetal monitor and very little variability,
you can see the abruption on an ultrasound. Abruptio placentae is the
detachment of part of all of the placenta from its implantation site.
Seperation occurs in the area of the decidua basalis after 20wks of
pregnancy of before child birth. Clinical manifestations include 1000-
1500mm blood loss in grade II, abdominal pain, port wine amniotic fluid,
uterine contraction, uterine tenderness, abnormal heart rate of fetus or
death, and boardlike abdomen. Monitor mother for 24hrs after trauma.
Risk factors include HTN, cocaine use = vasospam, abdominal trauma,
smoking and women who have already had one before.
33.Placental Previa and S/S : placenta covers opening of uterus, can be
complete, partial, low line depending on patient. S/S is bright red vaginal
bleeding, not painful usually, never do a vaginal exam
In a C-Section you do a manual placenta removal.
34.Blood Loss and Shock: Vital signs may be normal even with heavy
bleeding because the women can lose up to 40% of blood volume w/o
showing signs, clinical presentation and a decrease in urine production
are a more accurate indicator of acute blood loss. The mother may go
through hypovolemic shock, blood pressure may drop and plus rate will
rise. There will be tachycardia, decrease in BP, clamy skin, sweaty pale .
35.Left Tilt : done for CPR,
Patient has late vital changes in shock due to the 30-50% increase in
blood volume. In shock you will see fetal distress before you see
maternal changes
36.Medications from Clinical List
37.Nursing Diagnosis for various complications and what priority
38.What is the APGAR score (in detail) done with the baby is born and 5
minutes later 0 1 2
Respiratory: absent slow/weak lusty
Heart Rate: absent < 100 >100
Color: pale, blue body pink all pink
Muscle Tone: flaccid some flexion well flexed
Reflex : none grimace cry, pull away
39.Position and Presentation of the baby
40.Station of the baby ( ROA, LOA, ROP, LOP) - 0 station = the babies
head is even with the Ischial spine. Above the level of the Ischial spine
are negative #s (-1 is a little higher, -4 is way higher = far from delivery)
 below the Ischia spine are positive #s, if the babies head floats away there
is no station because the head is not fixed into the Ischia and it is known
as balautable. Once the babies head is seen it is called crowning.
41.Where is the occiput in relation to the mother

42.Ortoloni’s Maneuver.
43. BUBBLE Breast, Uterus, Bowel, Bladder, Lochia, Episiotomy.
The uterus should be firm or boggy = soft, or firm with massage. Bowel
(sounds, distention, and flatulence) Bladder ( check for distention atleast
300 cc x 2. A full bladder will displace up/ right)
Lochia heavy, moderate, or scanty. Heavy saturation of pad in an hour or
less is not normal.
Homan’s Sign: of DVT in calf (report is positive for clots) push their toes
towards them, if they feel pain in calf its positive.

NON-Stress Test:
-This simple, painless procedure is done during pregnancy to evaluate your baby's
condition. During the test, your healthcare practitioner or a technician monitors your
baby's heartbeat, first while the baby is resting and then while he's moving. Just as your
heart beats faster when you're active, your baby's heart rate should go up while he's
moving or kicking.

-The test is typically done if you've gone past your due date, or in the month leading up to
your due date if you're having a high-risk pregnancy. Here are some reasons you might
have a nonstress test:
-You have diabetes that's treated with insulin, high blood pressure, or some other medical
condition that could affect your pregnancy., You have gestational hypertension., Your
baby appears to be small or not growing properly., Your baby is less active than normal.
,You have too much or too little amniotic fluid., You've had a procedure such as an
external cephalic version (to turn a breech baby) or third trimester amniocentesis (to
determine whether your baby's lungs are mature enough for birth or to rule out a uterine
infection). Afterward, your practitioner will order a nonstress test to make sure that your
baby's doing well., You're past your due date and your practitioner wants to see how your
baby is holding up during his extended stay in the womb.,You've previously lost a baby in
the second half of pregnancy, for an unknown reason or because of a problem that might
happen again in this pregnancy. In this case, nonstress testing may start as early as 28
weeks.
The Cradle Hold
This classic breastfeeding position requires you to cradle your baby's head with the crook
of your arm. Sit in a chair that has supportive armrests or on a bed with lots of pillows.
Rest your feet on a stool, coffee table, or other raised surface to avoid leaning down
toward your baby. Hold her in your lap (or on a pillow on your lap) so that she's lying on
her side with her face, stomach, and knees directly facing you. Tuck her lower arm under
your own.

If she's nursing on the right breast, rest her head in the crook of your right arm. Extend
your forearm and hand down her back to support her neck, spine, and bottom. Secure her
knees against your body, across or just below your left breast. She should lie horizontally,
or at a slight angle.

Best for: The cradle hold often works well for full-term babies who were delivered
vaginally. Some mothers say this hold makes it hard to guide their newborn's mouth to
the nipple, so you may prefer to use this position once your baby has stronger neck
muscles at about 1 month old. Women who have had a cesarean section may find it puts
too much pressure on their abdomen.

The Cross-Over Hold

Also known as the cross-cradle hold, this position differs from the cradle hold in that you
don't support your baby's head with the crook of your arm. Instead, your arms switch
roles. If you're nursing from your right breast, use your left hand and arm to hold your
baby. Rotate her body so her chest and tummy are directly facing you. With your thumb
and fingers behind her head and below her ears, guide her mouth to your breast.

Best for: This hold may work well for small babies and for infants who have trouble
latching on.

The Clutch or Football Hold

As the name suggests, in this position you tuck your baby under your arm (on the same
side that you're nursing from) like a football or handbag. First, position your baby at your
side, under your arm. She should be facing you with her nose level with your nipple and
her feet pointing toward your back. Rest your arm on a pillow in your lap or right beside
you, and support your baby's shoulders, neck, and head with your hand. Using a C-hold
(see below), guide her to your nipple, chin first. But be careful — don't push her toward
your breast so much that she resists and arches her head against your hand. Use your
forearm to support her upper back.

Best for: You may want to try this hold if you've had a Cesarean section (to avoid having
the baby rest on your stomach). And if your baby is small or has trouble latching on, the
hold allows you to guide her head to your nipple. It also works well for women who have
large breasts or flat nipples, and for mothers of twins.

Reclining Position
To nurse while lying on your side in bed, ask your partner or helper to place several
pillows behind your back for support. You can put a pillow under your head and
shoulders, and one between your bent knees, too. The goal is to keep your back and hips
in a straight line. With your baby facing you, draw her close and cradle her head with the
hand of your bottom arm. Or, cradle her head with your top arm, tucking your bottom
arm under your head, out of the way. If your baby needs to be higher and closer to your
breast, place a small pillow or folded receiving blanket under her head. She shouldn't
strain to reach your nipple, and you shouldn't bend down toward her.

Best for: You may want to nurse lying down if you're recovering from a cesarean or
difficult delivery, sitting up is uncomfortable, or you're nursing in bed at night or during
the day