maternal nursing part2

MATERNAL NURSING PART 2

MARIE THERESE A. PACABIS, RN, RM, MAN

TESTS TO EVALUATE FETAL WELL BEING

A. Daily Fetal movement count

5 to 10 movements/ hr Lower than 5 movements/ hr may

indicate fetal jeopardy

Assess for fetal sleep patterns


B. Nonstress Test (NST)

Reactive test – 3 accelerations of FHR 15 beats/min above baseline FHR lasting for 15 sec. Or more, over 20 minutes

Non reactive test – no accelerations or acceleration less than 15 beats/ minute above baseline FHR. May indicate fetal jeopardy.


C. Contraction Stress Test (CST) or oxytocin challenge test (OCT)

Corelates FHR response to spontaneous or induced uterine contractions

Indicate interoplacental insuffiency

INTERPRETATION:

Negaative results indicate absence of late decelerations with all contractions

Positive results indicate late FHR decelerations with contractions


D. Biophysical Profile (BPP)

Observation by ultrasound of 4 variables for 30 minutes and results of non stress testing:

FM Fetal tone AFV (Amniotic Fluid Volume) Respiratory movements

Each variable is score 2 if present and 0 if absent

A score below 6 is associated with perinatal mortality.


E. Ultrasound

Non invasive procedure making use of hi frequency sound waves thru uterus to obtain data re: fetal growth, placental positioning and the uterine cavity

Purposes

1. Pregnancy Confirmation2. Fetal viability3. Estimate AOG4. Biparietal Diameter5. Placental location6. Fetal abnormalities7. Fetal death8. Multiple gestation9. AFI


F. Amniocentesis

Invasive procedure for amniotic fluid analysis to assess fetal lung maturity done after 14 weeks gestation

Possible Complications:

1. Onset contractions2. Infections (amnionitis)3. Placental punctures 4. Cord puncture5. Bladder or fetal punture


G. Analysis of Amniotic Fluid

Chromosomial studies to detect genetic abnormalities

Detect inborn errors of metabolism

Determines LS ratio Presence of meconium may

indicate fetal hypoxia.


H. Chronic Villus Sampling (CVS)

Cervically invasive procedure

Removal of small piece of tissue (chronic villus) from the fetal portion of placenta- tissue reflects genetic makeup of fetus

Advantage:

- results can be obtained after 10 weeks gestation due to fast growing fetal cells

Risks:

- spontaneous abortion, infection, IUFD, fetal limb defects etc.

TERMSFetal attitude

-refers to the relation of the fetal parts to the one another

Fetal lie- refers to the relationship of the cephalocaudal axis (of the fetus to the cephalocaudal axis of the woman.

TERMSFetal Presentation

- Is determined by fetal lie and by the body part of the fetus that enters the pelvic passage first.

CLASSIFICATION OF CEPHALIC

PRESENTATIONVertex presentation

– the most common presentation, the fetal head is completely flexed onto the chest, and the most smallest diameter of the fetal head.

Military Presentation

– the fetal head is neither flexed nor extended

CLASSIFICATION OF CEPHALIC

PRESENTATION

Brow presentation- the fetal head is partially extended

Face presentation- the fetal head is completely extended

TERMSStation

- refers to the relationship of the presenting part to an imaginary line drawn between to the ischial spines of the maternal pelvis.

TERMSFetal Position

- refers to the relationship of a designated landmark on the presenting fetal part to the front, sides, or back of the maternal pelvis.

CRITICAL FACTORS IN LABOR

The birth passage

Size of pelvis(diameters of the pelvic inlet, midpelvic or pelvic cavity, and outlet)

Type of pelvis (gynecoid, android, anthropoid, platypelloid, or a combination)

Ability of the cervix to dilate and efface and ability of the vaginal canal and the external opening of the vagina (the introits) to distend


The Fetus

1. fetal head(size and presence of molding)

2.Fetal attitude(flexion or extension of the fetal body and extremeties

3.Fetal lie


The Fetus

4.Fetal presentation (the part of the fetal body entering the pelvis first in a single or multiple – gestation pregnancy)

5.Placenta (implantation site)


The relationship between the passage and the fetus

1.Engagement of fetal presenting part

2.Station (location of fetal presenting part within the maternal pelvis)

3.Fetal position (relationship of the presenting part to one of the four quadrants of the maternal pelvis


Primary forces of labor

1.Frequency, duration, and intensity of uterine contractions as the fetus moves through the birth passage

2.Effectiveness of maternal pushing effort

3.Duration of labor


Psychosocial consideration

1.Physical preparation of childbirth

2.Support from significant others

3.Emotional status

FIRST STAGE OF LABOR

Phases of first stage

Assessment: Expected Maternal Behavior

Nursing Care Plan/ Implementation

1. Time: multipara 5-6 hr; nullipara 8-10hr, average

Usually comfortable, euhpric, excited, talkative, and energetic, but may be fearful an withdrawn

Provide encouragement, feedback for relaxation, companionship, hydration, nutrition

0 – 4 cm: Latent Phase and Early Active Phase





2.Contractions:

regular, mild, 5-10min apart, 20-30seconds duration

Relieved or apprehensive that labor has begun

Coach during contractions





3. Low back pain and abdominal discomfort with contractions

Alert, usually receptive to teaching, coaching, diversion, and anticipatory guidance

Comfort measures: position change of comfort; praise; keep aware of progress; maintain hydration





5. Cervix thins: some bloody show

6. station: Multipara (-)2 to (+)1; nullipara 0





1. Average Time:

Nullipara 1-2 hr

multipara 1 ½ - 2 hr

Tired, less talkative, and less energetic

Coach during contractions

4 – 8 cm: Midactive Phase, Phase of Most Rapid Dilation

FIRST STAGE OF LABORPhases of first stage



2.Contractions:

2-5 min apart, 30-40 seconds’ duration, intensity increasing

More serious, tendency to hyperventilate, may need analgesia, needs constant coaching

Position for comfort; encourage relaxation, keep aware of progress; offer analgesics and anesthetics, provide hygience: mouth care, ice chips, clean perineum; warmth.




3. Membranes may rupture now

Monitor progress of labor and maternal / fetal response, color of fluid, time of rupture of membranes (PROM)

4. Increased bloody show

5. Station: 1 to 0





1. Average Time:

Nullipara 40min-1hr

Multipara-20 min.

If not under regional anesthesia, more introverted; may be amnesic between contraction

Stay with woman

8-10cm: Transition, Deceleration Period of Active Phase





2.Contractions:

1 ½-2min apart, 60-90sec duration, strong intensity

Feeling she cannot make it; increased irritability, crying, nausea, vomiting and belching; increased perspiration over upper lip and between breasts; leg tremors; and shaking

Continue to coach with contractions: coach panting or “ he-he” respirations to prevent pushing





3. Increased vaginal show; rectal pressure with beginning urge to bear down

May have uncontrollable urge to push at this time

Comfort measures, offer ice chips




4.Station:

regular, mild, 5-10min apart, 20-30seconds duration

Monitor contactions, FHR, vaginal discharge, perineal bulging

Assess for bladder filling

DIFFERENCTIATION OF FALSE/ TRUE LABOR

False Labor True Labor

Contractions: Braxton, Hicks intensify

(more noticeable at night); short, irregular, little change

Contractions: Begin in lower

back, radiate to abdomen

(“ girdling”), become reglar, rhytmic; frequency, duration, intensity increase

DIFFERENCTIATION OF FALSE/ TRUE LABORFalse Labor True Labor

Discomfort: Mostly abdominal and

groin

Discomfort: Mostly low back

Relieved by change of position or activity(e.g.walking)

Unaffected by change of position, activity, drinking two glasses of water, or moderate analgesia

Cervical changes – none; no effacement or dilation progress

Cervical changes – progressive effacement and dilation

CARE OF THE WOMAN AT BIRTH

Position - any comfortable position - squat – ideally

Vital signs – BP= every 5-15min - FHR= every 5(High Risk)

= every 15(Low Risk)

Uterine Contraction- Monitored- continuously


Episiotomy may be done – when indicated- Median- Mediolateral

Check illimination


Nutrition – ice chips & clear liquids(as needed)

MedicationsAnesthetic – for suturingOxytocics – methergin/

- syntocinon

Main Goals

Relax the woman

Relieve her discomfort-without having a significant effect on her contractions, pushing efforts or the fetus.

PHARMACOLOGICAL PAIN RELIEF

Opiods are commonly used because they significantly reduce pain

Common drugs used:- meperidine (Demerol)- nalbuphine(Nubain)- butorphanol(stadol)


Additional effects in labor:- relaxes the cervix

Disadvantage:depress the CNS of the fetus w/c leads to respiratory depression

if a neonate is born with respiratory depression,

*Naloxone(Narcan)- is given to counteract the effects of the opiod.


Drug of choice:

Meperidine- sedation & antispasmodic actions- gives the mother feelings of well being

& euphoria- relaxes cervixit is a “labor’s feel good drug”

Route:IM, IV or intrathecally (subarachnoid space of the spinal cord)


EPIDURAL ANESTHESIA- Infection of a narcotic medication such as fentanyl, bupivacaine or lidocaine like drug, thru a needle or catheter into the epidural space.

- women with pre existing medical conditions such as heart disease, diabetes, PIH choose this method because it makes labor almost pain free, w/c reduces physical & emotional stress


EPIDURAL ANESTHESIA

Effect: Lowers blood pressure that can lower

blood flow to uterus & the placenta

Before anesthesia, woman should receive 500-1000ml of IV fluid such as D5LR to prevent hypohension

Avoid glucose solution because of the risk of hypoglycemia in the neonate


IMMEDIATE CARE OF THE NEWBORN

Maintain body temperature- conserve energy & O2 needs, prevent chills

- dry quickly, minimize exposure

- apply hat/ bonnet, keep warm

- take temperature hourly until stable


Prevent eye infection (gonorrheal & chlarrydial Opht. Neonatorum)

- apply within one hour of birth


Give Vitamin K to facilitate clotting1 mg =.1cc of Vit.K or Aquamyphyton

Vaccines- BCG, Hepa B


Ensure patent airway- suction mouth first, then nose may cause aspiration of mucus

- avoid prolonged, vigorous suctioning

*may traumatize tissue, cause edema bleeding,

laryngospasm & cardiac arrythmia

PUERPERIUM- period where reproductive organs return to its pre gravida stage

1.B-reasts *engorged breasts, may elevate temperature

*prepare for Lactation- add 500 calories

PHYSIOLOGICAL STATUS:

COLOSTRUMyellowish fluid, 2-3 days has

immunologic & nutritive value

Encourage first feeding w/in one hour after giving birth

Encourage emptying of both breasts at each feeding & before engorgement ot stimulate milk production, prevent mastitis

R.A. 7600 – Rooming In Law

2.Uterus Immediately after birth, uterus below

navel

Midline, contracted like a firm grapefruit

Descends one fingerbreath daily until day 10

Day 10 – behind symphysis pubis, non palpable


3.Lochia Bloody discharge from the uterus during

puerperium

*Day 1-3: rubra (red)*Day 3-7: serosa(pink to brown)*Day 10: alba(creamy white)

Amount:- Moderate flow- Fishy odor- Clots, few small clots


4.Perineum

Immediately after birth – edematous

Check for hematoma, complains of pain, perineal distention, painful, tense


5. Cardiovascular system

Immediately after birth, increased cardiac load due to:

Return of uterine blood flow to general circulation

Blood volume – returns to prepregnant state in about 3 weeks. Major reduction-during 1st week due to diuresis & diaphoresis


5. Cardiovascular system

Blood values

High WBC during labor & 1st few days postpartum

Blood coagulationhypercoagulability maintained during 1st few days postpartum, predisposes to thrombophlebitis & pulmonary embolism


6. Urinary Tract

Output, increased due to diuresis daily output 3000ml.


7. Legs

Homan’s sign – should be negativeno calf pain when knee is extended & gentle pressure applied to dorsiflex foot


8. Menstruation

First menstrual cycle maybe unovulatory

Non Nursing-ovulation=4-6weeks 6-8

wks.menstruation begins

Nursing/Lactation An ovulatory period No menstruation up to 6 mos. LAM


HIGH RISK PREGNANCY

Mother prone to Fetus morbidity

and mortality

RISKS FACTORS1. Maternal Age

- below 18 & above 35 yearsAdolescents – Higher PIH

LBW-Preterm Labor & delivery -Anemia-Labor dysfunctions-CPD

- above 35 years – placenta previaH- MoleCHVDsBabies with chromosomial

abnormalities

RISKS FACTORS2. Maternal Parity

- risk to hemorrhage- abortion

3. OB & Gynecologic HX- 2 or more premature deliveries or abortions- stillbirths- cervical incompetency- malposition- malpresentation- multiple pregnancies- previous dystocia- placental abnormalities etc.

4. Maternal Medical Hx- cardiac disease- CHVD- Renal disease, diabetes, asthma- TB- Family history- STDs

RISKS FACTORS

5. Lifestyle- lifestyle & Occupation- What she consumes & what she is exposed to can seriously afect her pregnancy

Ex. OTC drugs Cigarette Smoking Alcohol Substance abuse

RISKS FACTORS

GENERAL CAUSES OF MATERNAL MORTALITY

Hemorrhage

Hypertension

infection

SELECTED STDS AND PREGNANC

Y

STD Causative organism

Assessment findings Treatment Special considerations

Candidiasis

•Thick, cheesy like vaginal discharge

•Intense pruitus•Vaginal redness and irritation

•Wet mount slid positive for organism

Antifungal agent, such as micronazole cream (Monistat) or oral fluconazole (Difucan)

•Common during pregnancy because increased estrogen levels cause changes in vaginal pH

•Most commonly occurs in women receiving antibiotic therapy for another infection and women with gestational diabetes or human immunodefieciency virus infection

•Possible neonatal infection if infection is present at the time of delivery

STDCausative organism Assessment

findingsTreatment

Special considerations

Trichomoniasis

Single-cell protozoan infec-tion

•Yellow-gray, frothy, odorous vaginal discharge

•Vulvar itching, edema, and redness

•Vaginal secretions on a wet slide treted with potassium hydoxide positive for organism

•Topical clotrimazole (Gyne-lotrimin) instead of metronoida•zole(flagyl)because of its possible teratogenic effects if used during the first trimester of pregnancy

•Possible associated with preterm labor, premature rupture of membranes, and postcesa•rean infection

•Treatment of partner required, even if asymptomatic

STDCausative organism Assessme

nt findings

TreatmentSpecial

considerations

Bacterial vaginosis

Gardnerella vaginalis infection

(most commonly

)

•Thin, gray vaginal discharge with a fish like odor

•Intense pruiritus

•Topical vaginal metronidazole after the first trimester, usually late in pregnancy

•Rapid growth and multiplicaion or organisms, replacing the normal lactobacilli organisms that are found in the healthy woman’s vagina

•Treatment goal of reestablishing the normal balance of vaginal flora

•Untreated infections associated with amniotic fluid infections and possibly, preterm labor and premature rupture of membranes


findingsTreatme

nt


Chlamydia

Chlamydia trachomatis

•Commonly produces no symptoms; suspicion raised if partner treated for nongonococcal urethritis

•Heavy, gray-white vaginal discharge

•Painful urination

•Positive vaginal culture using special chlamydial test kit

•Amoxicillin (Amoxil)

•Possible premature rupture of the membranes, preterm labor, and endometritis in the postpartum period resulting from infection

•Possible development of conjunctivitis or pneumonia in neonate born to mother with infection present in the vagina

STDCausative organism Assessmen

t findingsTreatment


Syphilis Treponema pallidum

•Painless ulcer on vulva or vagina (primary syphilis)

•Penicillin G benza-

thine (Bicillin L-

A) I.M. (single dose)

•Possible ransmission accross placenta after approximately 18 weeks’ gestation, leading to spontaneous miscarriage, preterm labor, stillbirth, or congenital anomalies in the neonate


findingsTreatme

nt


Genital herpes

Herpes simplex virus, type 2

•Painful, small vesitcles witherythematous

•Acyclovir (Zovirax) orally or in ointment form

•Primary infection transmission possible across the placenta, resulting in congenital infection in the neonate

•Cesarean delivery recommended if patient has active lesions

•Associated with spontaneous miscarriage, preterm birth, and endometritis in the postpartum period


findingsTreatm

ent


Gonorrhea

Neisseria gonorrhoeae

•Yellow-green vaginal discharge

•Cefixime (Suprax) as a one-time I.M. Injection

•Associated with spontaneous miscarriage, preterm birth, and endometritis in the postpartum period

•Major cause of pelvic infectious disease and infertility

•Severe eye infection leading to blindness in the neonate(ophthamia neonatorum) if infection present at birth


findingsTreatmen

t


Condyloma acuminate

Human papillomavirus

•Discrete papillary structures that spread, enlarge, and coalesce to form large lesions; increaseing in size during pregnancy

•Topical application of trichloroacetic acid or bichloroacetic acid to leasions

•Lesion removal with laser therapy, cyyocautery, or knife excision

•Serious infections associated with the development of cervical cancer later in life

•Lesions left in place during pregnancy unless bothersome and removed during the postpartum period

STDCausative organism Assessmen

t findingsTreatmen

t


Group B streptococci infection

Spirochete

•Usually no symptoms

•Broad-spectrum penicillin such as ampicillin

•May lead to urinary tract infection, intra-amniotic infection leading to preterm birth, and postpartum endometritis

Threatened:

Spotting, vaginal bleeding cervix closed, (+) BOW

20% of women have spotting during pregnancy of these 50% abort

Mother is made to rest Save pads for further assessment, Note amount ,

color, odor Administer drugs as ordered

antibiotics in IV fluid Vital signs, no Administer blood as ordered

BLEEDING IN PREGNANCY

Incomplete Abortion

1. cervix open, BOW ruptured2. Placental parts retained3. Mother bleeds until, D&C is

done

Habitual abortion1. 3 or more abortions2. 2nd trimester, cerclage is done

until term, sutures may be removed so NSD is possible. If sutures remain, C/S is performed

Inevitable abortion

1. Open cervix, BOW ruptures2. As contractions continue,

products of conception are expelled

Missed abortion1. uterus retains the products of

C for 2 months or more & the fetus is dead

2. Uterus AOG3. Prolonged retention of dead

products may cause coagulation defects, like DIC (disseminated intravascular coagulation

Inevitable abortion

1. Open cervix, BOW ruptures2. As contractions continue,

products of conception are expelled

Management- D&C

Bleeding will continue for several days

Report bleeding that lasts more than one week

Watch for signs of infection – T=37˚C up and foul discharge

Abstain from sexual intercourse for approximately 2 weeks

use contraception when you resume coitus

follow up visit after one month

A Rh (-) female should receive RhoGam to prevent future hemolytic disease

ECTOPIC PREGNANCY

- Inplantation of a fertilized ovum outside the uterine cavity.

Sites: cervix, fallopian tube, abdominal cavity

Causes: - PID- IUD, STDs- Tumors- Previous FT surgery,

tubal ligation etc.

ECTOPIC PREGNANCY

Management:

1.If ruptured- sharp abdominal pain radiating to the shoulder- salphingoopherectomy

ECTOPIC PREGNANCY

Management:

2.If detected earlyNon surgical management- Methotrexate (FOLEX) that

stops cell production. Destroys trophoblasts

GESTATIONAL TROPHOBLASTIC DISEASE

- H. Mole, rapid deterioraion of trophoblastic Villi cells

As they deteriorate, they are filled wih fluid, grapelike clusters as a result, the embryo dies


Causes: - chromosomial abdnormalities - deficiencies in protein & folic

acid

Signs: - brownish red spotting to bright red bleeding

- passes grapelike clusters - uterus that is larger than

size - No FHB


UTZ: - done on 3rd month shows grape clusters

Management: - D& C

Complications: - hemorrhage - infection - Perforation - Choriolarcinoma

GESTATIONAL TROPHOBLASTIC DISEASEDischarge Management: - monitor HCG levels - weekly for 3 weeks at 2 mos for 6 mos, then monthly for 6 months until HCG levels & Chest X-Ray (-)

- no pregnancy for one year

- prophylaxis is methotrexate to prevent malignancy

ABRUPTIO PLACENTA

VS. PLACENTA

PREVIA

PATHOLOGY ETHIOLOGY

ASSESSMENT Nursing Care Plan/Inplemetation

Placenta Previa

Types:Marginal – low-lying

Partial – partly covers internal cervical os

Complete- covers internal cervical os

•Fibroid tumors

•Endometriosis

•Old uterine scars

•Multiple gestatio

Painless, bright red vaginal bleeding

Bedrest

PATHOLOGY ETHIOLOGY ASSESSMENT Nursing Care Plan/Inplemetation

Abruptio Placentae

Types:Partial – small part separates from uterine wall

Complete – total placenta separates from uterine wall

Retroplacental –bleeding (concealed

Marginal – occurs at edges; external bleeding

•Preeclampsia/ eclampsia

•Traction on cord

•Cocaine use

Pain: sudden, severe

Monitor: vital signs, blood loss, fetus

Prepare for surgery

Fluid, blood replacement

Types:1. Type 1 diabetes (absolute insulin

insufficiency)*usually occurs before 30years. Requires insulin

2. Type 2 diabetes (insulin resistance)*occurs after age 40*treated with diet & exercise in combination with antidiabetic drug

DIABETES

Types:3. Gestational diabetes

*emerges during pregnancy, usually middle part when insulin resistant is most apparent

Causes: Heredity Environment (diet, infection, virus), lifestyle

DIABETES

Risk factors:

Obesity Hx of delivery large babies Family history of diabetes Age older than 25

DIABETES

Tests:

24-28wks - OGCTG=501 hr glucose testcut off- 140mg/del

OGTT-3 hr glucose test

1˚=1902 ˚=1653 ˚=145

2 abdominal levels mean positive for diabetes

DIABETES

Management:

More frequent PNC

Adequate nutrition & exercise

Insulin may be given (parenteral) since oral hypoglycemic drugs aretogenic

Insulin – 1st trimester is reduced - 2nd & 3rd trimester increased

DIABETES

Fetal monitoring:

AFP test – done between 16-18 weeks

- detect neural tube defects

DIABETES

UTZ – 18-20 weeks detect gross anomalies

Bioprofile = 36-38 weeks

Amniocentesis= for LS ratio

Effects:

Maternal FetalPIH Macrosomia

Infection (cardiasis) Congenital anomalies

Polyhydramnios(higher urine production caused by hyperglycemia)

Stillbirths

Spontaneous abortion

Method of delivery: NSD

PREGNANCY INDUCED HPN

Potentially life threatening disorder that develops after the 20th week of pregnancy.

Occurs commonly in the nulliparous below 18-35 years above women& low socio economic groups


Types:1. Preeclampsia Mild2. Preeclampsia Severe3. Eclampsia

Signs:1. Edema- sudden weight gain2. HPN – 140/90 – 16/100 up3. Preteinuria - +1 - +5 up


management:

Diet – lower F, moderate salt, higher protein

Activity – frequent rest periods Medication – hydralazine methyldopa

If condition persists, MgSO4 – IVLD – 4-6grms over 20 minutes

maintain at 1 G/hr.


management:

Hospitalization may be indicated Provide quiet, dark room Enforce complete bed rest Follow safety measures

Higher padded rails O2 by the bedside Suction

Calcium gluconate by the bedside


management:

if measures fail to improve condition, then an emergency C/S is done

COMPLICATIONS

BRAIN KIDNEYS

LUNGS EYES

HEART BLOOD VESSELS

LIVER

HELLP SYNDROME

Stands for hemolysis, elevated liver enzymes & low platelets.

12% of women with PIH develops this ailment

Maternal & infant mortality is high

Approximately ¼ of women & 1/3 of infants die from this disorder.

HELLP SYNDROME

Management:

MgSO4

Transfusion of fresh frozen plasma or platelets

Immediate delivery

Caesarean birth may be a planned or an emergency procedure. Factors that lead to cesarean birth may be maternal, placental, or fetal in nature.

CESAREAN FACTORS

CESAREAN FACTORSMaternal: Cephalopelvic disproprotion

Active genital herpes or papilloma

Previous cesarean birth by classic incision

Disabling conditions, such as severe pregnancy-induced hypertension and heart disease, that prevent pushing to accomplish the pelvic division of labor

CESAREAN FACTORS

Placental:

Placenta previa

Premature separation of the placenta

CESAREAN FACTORS

Fetal :

Transverse fetal lie

Extremely low fetal size

Fetal distress

Compound conditions, such as macrosomic fetus in a breech lie

INFECTIONS

Puerperal infection is a common cause of child related death.

Fever of 38˚C

Lasts 2 consecutive days

Occurs 1st 10 days postpartum

Accompanied by chills, headache malaise, anxiety

INFECTIONS

Predisposing factors:

Prolonged laborInterventionsRetained products of conceptionBleedingC/SEpisiotomies/ lacerationsFrequent IEPROM

INFECTIONS

COMMON INFECTIONS:

Endometritis

Wounds

Mastitis

thrombophlebitis

INFECTIONS

TESTS:

CulturesUBC

30% above baseline data over a 6 hr.period.

MANAGEMENT:

Antibiotics

SAMPLE QUESTIONS

1. Maternal factors indicating the need fo c/s include:

a) Breech presentationb) Previous c/s with bikini incisionc) Active genital herpesd) hypotension

SAMPLE QUESTIONS

2. Nenita, a G1P1, just delivered 10min ago. The doctor ordered an oxytocin to be given to Nenita. She is a PEM, with BP of 140/100. which oxytoxin would you choose?

a) Syntocinonb) Ergotratec) Methergind) estriol

SAMPLE QUESTIONS

3. Luisa is admitted at 9am. Data upon admission –G2P1 32 yrs old, ceph presentaion FHB=140/min. Effacement=7-%=cx=4cm. Approximately, at what time would you expect Luisa to be wheeled into the DR?:

a) 12 pmb) 1pmc) 2pmd) 3pm

SAMPLE QUESTIONS

4. If she presents the ff. uterine contraction pattern-moderate intensity, 40-45sec duration, every 5min interval, at what phase of labor is she in now?

a) Latentb) Activec) Transitionald) Birthing phase

SAMPLE QUESTIONS

5. Which among the ff. nursing procedures should not be done to Luisa at this stage?:

a) Pain medication can be administeredb) Bladder elimination is encouraged

more oftenc) Breathing exercises are coached

when contractions occurd) Hot soup can be offered to increase

energy

maternal nursing part2

Documents