Pregnancy Risk: Infections TORCH - TOToxoplasmosis Transmitted Through Raw Meat Or Cat Litter Can Cause Spontaneous Abortion In 1st Trimester

Pregnancy Risk: Infections TORCH - RRubella (German Measles) Teratogenic (Causing Malformations) In 1st Trimester Congenital Defects Of Eyes, Heart, Ears, And Brain If Not Immune (Titer Less Than 1:8), Vaccinate In Postpartum Wait 1 - 3 Months Before Becoming Pregnant

Pregnancy Risk: Infections TORCH - CCytomegalovirus Low Birth Weight Intrauterine Growth Restriction Enlarged Liver And Spleen Jaundice Blindness Hearing Loss Seizures

Pregnancy Risk: Infections TORCH - HHerpes Simplex Virus Vaginal Examinations If Active Herpes Lesions Are Present C-Section If Lesions Are Visible Contact Precautions

Maternity: Once Membranes Have Broken...The Baby Should Be Delivered Within 24 Hours, Otherwise Chorioamnionitis Can Occur.

Process Of Labor: Four P'sFour Major Factors That Interact During Normal Childbirth; They Are Interrelated And Depend On Each Other For A Safe Delivery Powers Passageway Passenger Psyche

Process Of Labor: Four P's - Powers Uterine Contractions 1. Forces Acting To Expel The Fetus 2. Effacement: Shortening And Thinning Of The Cervix During The 1st Stage Of Labor 3. Dilation: Enlargement Of Cervical Os And Canal During 1st Stage Of Labor 4. Pushing Efforts Of Mother During 2nd Stage

Process Of Labor: Four P's - PassagewayThe Mother's Rigid Bony Pelvis And The Soft Tissues Of The Cervix, Pelvic Floor, Vagina, And Introitus (External Opening To The Vagina)

Process Of Labor: Four P's - PassengerThe Fetus, Membranes, And Placenta

Process Of Labor: Four P's - PsycheA Woman's Emotional Structure That Can Determine Her Entire Response To Labor And Influence Physiological And Psychological Functioning; The Mother May Experience Anxiety Or Fear.

Process Of Labor: AttitudeNormal Intrauterine Attitude Is Flexion, In Which The Fetal Back Is Rounded, The Head Is Forward On The Chest, And The Arms And Legs Are Folded In Against The Body. The Other Attitude, Extension, Tends To Present Larger Fetal Diameters.

Process Of Labor: Lie Relationship Of The Spine Of The Fetus To The Spine Of The Mother Longitudinal/Vertical- Fetal Spine Is Parallel To Mothers And In Breech Or Cephalic Presentation Transverse/Horizontal - Fetal Spine Is At A Right Angle/Perpendicular, To Mother's Spine, Presenting Part Is The Shoulder, Delivery By C-Section Is Necessary

Process Of Labor: Presentation Portion Of Fetus That Enters The Pelvic Inlet First Cephalic: Head First, Most Common, And Has Four Variations (Vertex, Military, Brow, And Face) Breech: Buttock's First, C-Section May Be Required, Three Variations (Frank, Full "Complete", And Footling) Shoulder: Fetus In Transverse Lie, Or Arm, Back, Abdomen, Or Side Could Present, C-Section May Be Required If Fetus Does Not Turn Or Cannot Be Manually Turned

Process Of Labor: Position ROA (Facing Left Of Mothers Spine) LOA (Facing Right Of Mother Spine) ROP (Facing Left Side Of Mothers Stomach) LOP (Facing Right Side Of Mothers Stomach)

Process Of Labor: Station Station 0: At Ischial Spine Minus Station: ABOVE Ischial Spine (Still Up There) Plus Station: BELOW Ischial Spine (On Its Way Out) Engagement: Widest Diameter Of Presenting Part Has Passed The Inlet; Usually Corresponds To A 0 Station

Mechanisms Of Labor: KNOW THE ORDER!!!KNOW THE ORDER!!! ED FIEREE (Think Of How The Scottish Would Say Fury) E-Ngagement D-Escent F-Lexion I-Nternal Rotation E-Xtension R-Estitution E-Xternal Rotation E-Xpulsion

Mechanisms Of Labor: Order With ExplanationEngagement This Is Also Called Lightening Or Dropping The Fetus Nestles Into The Pelvis Descent This Process Starts From The Time Of Engagement Until Birth And Is Assessed By The Station. The Fetal Head Undergoes As It Begins Its Journey Through The Pelvis. Flexion The Fetal Head's Nodding Forward Toward The Fetal Chest While Descending Through The Pelvis, The Fetal Head Flexes So That The Fetal Chin Is Touching The Fetal Chest. This Functionally Creates A Smaller Structure To Pass Through The Maternal Pelvis Internal Rotation With Further Descent, The Occiput Rotates Anteriorly And The Fetal Head Assumes An Oblique Orientation. In Some Cases, The Head May Rotate Completely To The Occiput Anterior Position. Extension It Begins After The Head Crowns This Means That The Fetal Chin Is No Longer Touching The Fetal Chest. It Enables The Head To Emerge When The Fetus Is In A Cephalic Position The Extension Of Labor Is Completed When The Head Passes Under The Symphysis Pubis And Occiput And The Anterior Fontanel, Brow, Face And Chin Pass Over The Sacrum And Coccyx And Are Over The Perineum Restitution After The Head Emerges, The Fetal Head Becomes In A Realignment External Rotation The Shoulder Of Fetus Externally Rotates After Head Emerging And Restitution The Shoulder Is In The Anteroposterior Diameter Of The Pelvis. Expulsion This Is The Birth Of Entire Body.

Mechanisms Of Labor: Engagement - Expulsion Engagement: Lightening Or Dropping Descent: Assessed By The Station Flexion: Nodding Of The Fetal Head Forward Toward The Fetal Chest Internal Rotation: Internal Rotation Of The Fetus From The LOT Or ROT Position At Engagement Extension: Begins After The Head Crowns And Is Complete When The Head Passes Over The Perineum Restitution: Realignment Of The Fetal Head With The Body After The Head Emerges External Rotation: Shoulders Externally Rotate So That They Are In The Anterioposterior Diameter Of The Pelvis Expulsion: Birth Of The Entire Body

Mechanisms Of Labor: Nesting, True Labor, And False Labor Nesting: Sudden Burst Of Energy 24 - 48 Hours BEFORE Onset Of Labor True Labor: Contractions Occur Regularly, Become Stronger, Last Longer, And Occur Closer Together; May Manifest As Back Pain And Resemble Menstrual Cramps; Dilation, Effacement, And Descent Occur False Labor: Dilate, Efface, Or Descend; Contractions Are Irregular, Without Progression; Walking Often Stop Contractions Or Pain

Leopold's ManeuversPalpation To Determine Presentation And Position Of The Fetus And Aid In Location Of Fetal Heart Sounds. Head=Hard, Round, Movable Object Buttocks=Soft And Irregular Shape Back=Smooth, Hard Surface Felt On One Side Of The Abdomen Irregular Knobs And Lumps On Opposite Side Of Abdomen May Be Hands, Feet, Elbows, And Knees

Fetal Monitoring Baseline FHR Is Measured Between Contractions Normal FHR Is 120 - 160 Bpm Internal Fetal Monitoring: Client Must Be Dilated 2 To 3 Cm To Perform Fetal Bradycardia: FHR 160 Bpm For 10 Minutes Or Longer If Fetal Bradycardia Or Tachycardia Change The Position Of The Mother, Give O2, And Assess The Mothers Vital Signs, Then Notify The Physician

Variability Decrease Variability Can Result From Fetal Hypoxemia, Acidosis, Or Certain Medications Absent Or Undetected Variability Is Nonreassuring A Temporary Decrease May Occur If Fetus Is In A Sleep State (Does Not Usually Last Longer Than 30 Minutes)

AccelerationsBrief, Temporary Increases In FHR Of At Least 15 Beats More Than Baseline And Lasting At Least 15 Second- (Same Parameters As Nonstress Test)

Early Decelerations Decreases In FHR Below Baseline; The Rate At The Lowest Point Of The Deceleration Usually Remains Greater Than 100 Bpm Occur During Contractions As The Fetal Head Is Pressed Against The Mothers Pelvis Tracing Shows A Uniform Shape And Mirror Image Of Uterine Contractions NOT Associate With Fetal Compromise And Requires No Intervention

Late Decelerations Nonreassuring Patterns That Reflect Impaired Placental Exchange Or Uteroplacental Insufficiency Interventions Include Improving Placental Blood Flow And Fetal Oxygenation

Variable Decelerations Restrict Flow Through The Umbilical Cord The Shape, Duration, And Degree Of Decline Below The Baseline FHR Are Variable; These Fall And Rise Abruptly With The Onset And Relief Of Cord Compression

VEAL CHOP FLOPV-Ariable Decels C-Ord Compression E-Arly Decels H-Ead Compression, Okay A-Ccelerations O-Kay!!! L-Ate Decels P-Lacental Insufficiency Placental Insufficiency: F-Luids L-Ateral Position O-Xygen, O2 On P-Itocin Off

Four Stages Of Labor: Stage 1 Effacement And Dilation Of Cervix Three Stages - Latent, Active, And Transition Mother Is Talkative And Eager In Latent Phase, Becoming Tired, Restless, And Anxious As Labor Intensifies And Contractions Become Stronger Assess FHR Before, During, And After Contractions, Noting That The FHR Is Between 120-160 Bpm Assess The Color Of The Amniotic Fluid If The Membranes Have Ruptured Because Meconium Stained Fluid Can Indicate Fetal Distress

Four Stages Of Labor: Stage 1, 3 Phases3 Phases: Latent, Active, Transition Latent: Longest Phase, Dilation 1-4 Cm, Contractions Every 15 To 30 Min, 15 To 30 Sec In Duration, Mild Intensity Active: Dilation 4-7 Cm, Contractions Every 3 To 5 Min, 30 To 60 Sec In Duration, Moderate Intensity Transition: Dilation 8-10 Cm, Contractions Every 2 To 3 Min, 45 To 90 Sec In Duration, Strong Intensity

Four Stages Of Labor: Stage 2 Expulsion Of Fetus Pushing Stage Mother Has Intense Concentration On Pushing With Contractions; May Fall Asleep Between Contractions

Four Stages Of Labor: Stage 3 Separation Of Placenta Expulsion Of Placenta Mother Is Relieved After Birth Of Infant; Mother Is Usually Very Tired Contractions Occur Until The Placenta Is Expelled

Four Stages Of Labor: Stage 4 Physical Recovery 1-4 Hr After Expulsion Of Placenta Mother Is Tired, But Eager To Become Acquainted With Her Newborn BP Returns To Prelabor Level HR Is Slightly Lower Than During Labor Fundus Remains Contracted, In The Midline, 1 Or 2 Fingerbreadths BELOW The Umbilicus Monitor Lochia Discharge. Lochia May Be Moderate In Amount And Red In Color

Anesthesia: Lumbar Epidural Block Injection In The Epidural Space At L3 To L4 May Cause Hypotension, Bladder Distention, And A Prolonged Second Stage

Anesthesia: Subarachnoid (Spinal) BlockInjection In The Spinal Subarachnoid Space At L3 To L5 May Cause Postpartum Headache, Hypotension Mother Must Lie Flat For 8 To 12 Hrs After Spinal Injection

External Version Turning Of Fetus From An Abnormal Position Into A Normal Presentation Indicated For An Abnormal Presentation That Exists After Week 34 IV Fluids And Tocolytic Therapy To Relax The Uterus And Permit Easier Turning Of Fetus US Is Used During Procedure Abdominal Wall Is Manipulated To Turn And Direct The Fetus After Procedure: Nonstress Test, Assess For Bleeding, Rupture Of Membranes

Episiotomy Relieve Pain Ice Packs During First 24 Hrs Sitz Baths Analgesic Spray Or Ointment Perianal Pad Perineal Care, Using Clean Technique, Wipe Front To Back, And Blot/Pat Area Rather Than Wipe

Cesarean Delivery Postoperative Vital Signs Pain Relief Encourage Turning, Coughing, And Deep Breathing Ambulate Burning And Pain On Urination May Indicate Bladder Infection A Tender Uterus And Foul-Smelling Lochia May Indicate Endometritis A Productive Cough Or Chills May Indicate Pneumonia Pain, Redness, Or Edema Of An Extremity May Indicate Thrombophlebitis

Problems With L&D: Prolapsed Umbilical CordFetal Heart Monitor Shows: Variable Decelerations Or Bradycardia After Rupture Of Membranes. Place In Trendelenburg, Modified Sims, Or Knee-To-Chest Position Give O2 Stay With Client And Ask Other Nurse To Get Physician Use Two Gloved Fingers To Apply Pressure To The Cervix And Lifting Upward On The Presenting Part If Umbilical Cord Is Felt DO NOT Remove Fingers Until Physician Says To, Which May Be While Baby Is Being Delivered

Problems With L&D: Placenta PreviaPPP=Placenta Previa Painless Placenta Is Partially Disconnected From The Uterine Wall And The Fetus Is Not Getting Enough Oxygen Or Circulation Sudden Onset Of Painless, Bright Red Vaginal Bleeding That Occurs In The Last Half Of Pregnancy Uterus Is Soft, Relaxed, And Nontender Prepare For US To Confirm The Diagnosis Do Vaginal Examinations Or Any Other Actions That Would Stimulate Uterine Activity

Problems With L&D: Abruptio Placentae Dark Red Vaginal Bleeding PAIN PAIN PAIN Uterine Tenderness And Rigidity Causes: Using Cocaine, 35 Years Or Older, And/Or Having Twins Or Triplets

Problems With L&D: Placental Abnormalities Placenta Accreta - Abnormally Adherent Placenta (A Placenta That Remains Attached To The Uterine Wall Beyond The Normal Time After Birth Of The Fetus) Placenta Increta - Occurs When The Placenta Penetrates The Uterine Muscle Itself Placenta Percreta - When The Placenta Goes All The Way Through The Uterus Assessment: HEMORRHAGE Immediately After Birth Because The Placenta Does Not Separate Cleanly. Intervention: Hysterectomy If A Large Portion Of The Placenta Is Still There And Monitor For Hemorrhage And Shock.

Problems With L&D: Preterm Labor After 20 Weeks, But Before The 37th Week Focus On Stopping Labor Bedrest And Lateral Position Ensure Hydration

Problems With L&D: Precipitous Labor And DeliveryLabor Lasting 20 - All 50 States Require Routine Screening Of All Newborns For Phenylketonuria

Peds - Metabolic & Endocrine: Phenylketonuria S/SS/S: All Children - - Musty Odor Of The Urine - Mental Retardation Older Children - - Hypopigmentation Of The Hair, Skin, And Irises - Hyperactive Behavior

Peds - Metabolic & Endocrine: Phenylketonuria InterventionsInterventions: - Screening Of Newborn Infants: The Infant Should Have Begun Formula Or Breast Milk Feeding Before Specimen Collection - If Initial Screening Is Positive, A Repeat Test Is Performed, And Further Diagnostic Evaluation Is Required To Verify The Diagnosis - Rescreen Infants By 14 Days Of Age If The Initial Screening Was Done Before 48 Hours Of Age - If Diagnosed Restrict Phenylalanine Intake; High-Protein Foods ( Meats And Dairy Products) And Aspartame Are AVOIDED Because They Contain Large Amount Phenylalanine

Peds - Renal & Urinary: Glomerulonephritis Description And CauseDescription: - Functioning Units Of Kidneys - Loss Of Kidney Function Develops Cause: - Antecedent Group A Beta-Hemolytic Streptococcal Infection Of The Pharynx Or Skin - History Of Pharyngitis Or Tonsillitis 2 To 3 Weeks Before Symptoms

Peds - Renal & Urinary: Glomerulonephritis S/SS/S: - Cloudy, Smoky, Brown-Colored Urine (Hematuria) - DX Feature - Azotemia (Waste Products) - BUN - Creatinine - Antistreptolysin O Titer (ASO)

Peds - Renal & Urinary: Glomerulonephritis InterventionsInventions: - Foods High In Potassium Are Restricted During Periods Of Oliguria - Urinary Output - Report Signs Of Bloody Urine, Headache, Or Edema - Do The Appropriate Treatment For Infections, Specifically For Sore Throats, Upper Respiratory Infections, And Skin Infections

Peds - Renal & Urinary: Nephrotic Syndrome Description- Kidney Disorder Characterized By Massive Proteinuria, Hypoalbuminemia (Hypoproteinemia), And Edema - Objectives Of Therapeutic Management Are To Reduce The Excretion Of Urinary Protein, Maintain Protein-Free Urine, Reduce Edema, Prevent Infection, And Minimize Complications

Peds - Renal & Urinary: Nephrotic Syndrome S/SClassic Signs: - Massive Proteinuria - Hypoalbuminemia - Edema Others Are: - Leg, Ankle, Labial, Or Scrotal Edema - Protein (Hypoproteinemia) - Lipid Level

Peds - Renal & Urinary: Nephrotic Syndrome Interventions- Monitor Urine Specific Gravity And Protein - Monitor For Edema - Diet: Regular W/O Added Salt, Sodium Is Restricted During Periods Of Massive Edema (Fluids May Also Be Restricted) - Plasma Expanders Such As Salt-Poor Human Albumin May Be Prescribed For A Severely Edematous Child Albumin = Plasma Volume Expander, If Plasma Volume Is Then Cardiac Output Is

Peds - Renal & Urinary: EnuresisBed Wetting At Night

Peds - Renal & Urinary: Cryptorchidism*Higher Risk For Testicular Cancer* - Testes Fail To Descend - Testes Are Not Palpable Or Easily Guided Into The Scrotum - Surgical Correction, If Needed, Is Done By ORCHIOPEXY Before The Child's 2nd Birthday (Between 1 And 2 Years Of Age) If The Testes Do Not Descend Spontaneously

Peds - Renal & Urinary: Epispadias & HypospadiasEpispadias: Urethral Orifice (Opening) On The Dorsal Surface Of The Penis (On The Top) Hypospadias: Urethral Orifice (Opening) Below The Glans Penis Along The Ventral Surface (Underneath/On The Bottom Of The Penis) ***WATCH FOR INFECTION*** - Surgery Is Done Before The Age Of Toilet Training, Between 16 And 18 Months ***Circumcision Is NOT Performed Because The Foreskin May Be Used In Surgical Reconstruction*** - The Child Has A Pressure Dressing And May Have Some Type Of Urinary Diversion Or A Urinary Stent (Used To Maintain Patency Of The Urethral Opening) While The Meatus Is Healing

Peds - Integumentary: Eczema- Associated With Family History Of The Disorder, Allergies, Asthma, Or Allergic Rhinitis S/S: - Itching - Minute Papules (Firm Elevated Lesions