NSG 401 OB EXAM ONE NOTES
May 5, 2016
OB class notes
How to take care of the laboring patient:
▪ Three stages of labor:
1. 0-10cm – first stage is divided into three phases (Early latent 0-3,
active 4-7, trans 8-10cm)
2. Pushing (could take a couple of hours)
3. Placenta needs to be delivered (10-20mins- worried about
hypovolemic shock)
4. Recovery stage (takes about 2 hours to make sure they are safe)
▪ Go through triage first-how do we know if they are in labor? Contractions
(don’t go away)- helps cervix dilate.
o Definition of labor: contraction that dilates the cervix.
▪ If water breaks doesn’t mean you’re in labor, but need to go to the hospital
because the baby is at risk for infection. If the water breaks you may induce
labor.
▪ SRON/AROM
▪ Benefits of breaking the water
▪ Is your baby moving? –Baby moving is good. Not moving could mean
something is wrong.
▪ FIRST THING TO ASSESS on the pregnant women: baby’s heart rate/fetal
monitor. RLQ/LLQ (you are listening to the baby's back)
▪ Safety for mom and baby (#1 goal)
▪ BURP your patient → breathing, urinate, relax, and position.
▪ Keep her out of bed→ Helps rotate the baby.
▪ Rocking chair
▪ After contraction take a cleansing breathe in and let it out (give baby more
oxygen and save her strength).
▪ Vena Cava supplies blood to baby, therefore educate the patient to NOT lie on
their back, this could decrease blood flow to the baby.
▪ The lady will lay on her back. The patient usually needs about four pillows.
▪ IV med (get an order for saline lock to help with movement)
o Lactated ringers→ hydration/ 200ml/HR
o Gauge 18 (if you need blood)
o Forearm
o Labs (type and cross, CBC –H&H, white blood cell, platelets less than
100, RPR (syphilis),
o Narcotic- Push it slow. Is it safe for my baby? The best time to give it
during the active stage of labor, so its not depressing the baby or
getting rid of the contractions completely.
, o Bolus of lactated ringers prior to epidural so the blood pressure
doesn’t become extremely low.
▪ Epidural
▪ Questions?
o Am I going to paralyzed?
o It will hurt, but not as much as contractions.
o Take her blood pressure often now
▪ Water breaks→ color? Clear, maybe yellow from baby’s urine.
o TACO
o Clear or meconium stain?
▪ Peanut baby—helps transition the baby (peanut ball).
▪ Bladder full? Always empty the bladder→ after epidural? Straight cath.
▪ Place baby on moms abdomen
▪ Baby on skin-skin (golden hour)-BONDING
▪ Stage 3? Starts oxytocin, make sure she’s not bleeding, breast feed!
▪ Breast feed the first hour.
▪ Erthromycin, vitamin k, HEP B (meds for baby).
May 5, 2016
OB class notes
▪ Maternity of childbearing women and families through all stages of
pregnancy→ OR, NICU, labor, birth, recovery, antepartum.
▪ Maternal Mortality→ What actually causes it? What kills women in the
US and world? ***
o Hemorrhage (#1 U.S and world)
o Hypertensive disorders (#3 in US and world)
▪ Preeclampsia
o Infection (#1 in world)
o Pulmonary embolism (#2 in the U.S) – Why are they prone to it?
▪ The body increases the blood factors to increases clotting to
prevent hemorrhage, but that increases chance.
▪ Healthy People 2020 Mission – know OB stuff
o To make sure postpartum relapse of smoking among women who
quit smoking with pregnancy
o Benefits of breast feeding→ Decrease the percentage of breast-
fed newborns who receive formula supplementation within the
first 2 days of life
o Reduce preterm birth
o Reduce the rate of fetal and infants death
▪ Issues with the U.S Health Care System
▪ Foreign object retained after surgery (to prevent we count everything)
▪ Blood incompatibility (We are worried about that because hemorrhaging)
May 5, 2016
OB class notes
How to take care of the laboring patient:
▪ Three stages of labor:
1. 0-10cm – first stage is divided into three phases (Early latent 0-3,
active 4-7, trans 8-10cm)
2. Pushing (could take a couple of hours)
3. Placenta needs to be delivered (10-20mins- worried about
hypovolemic shock)
4. Recovery stage (takes about 2 hours to make sure they are safe)
▪ Go through triage first-how do we know if they are in labor? Contractions
(don’t go away)- helps cervix dilate.
o Definition of labor: contraction that dilates the cervix.
▪ If water breaks doesn’t mean you’re in labor, but need to go to the hospital
because the baby is at risk for infection. If the water breaks you may induce
labor.
▪ SRON/AROM
▪ Benefits of breaking the water
▪ Is your baby moving? –Baby moving is good. Not moving could mean
something is wrong.
▪ FIRST THING TO ASSESS on the pregnant women: baby’s heart rate/fetal
monitor. RLQ/LLQ (you are listening to the baby's back)
▪ Safety for mom and baby (#1 goal)
▪ BURP your patient → breathing, urinate, relax, and position.
▪ Keep her out of bed→ Helps rotate the baby.
▪ Rocking chair
▪ After contraction take a cleansing breathe in and let it out (give baby more
oxygen and save her strength).
▪ Vena Cava supplies blood to baby, therefore educate the patient to NOT lie on
their back, this could decrease blood flow to the baby.
▪ The lady will lay on her back. The patient usually needs about four pillows.
▪ IV med (get an order for saline lock to help with movement)
o Lactated ringers→ hydration/ 200ml/HR
o Gauge 18 (if you need blood)
o Forearm
o Labs (type and cross, CBC –H&H, white blood cell, platelets less than
100, RPR (syphilis),
o Narcotic- Push it slow. Is it safe for my baby? The best time to give it
during the active stage of labor, so its not depressing the baby or
getting rid of the contractions completely.
, o Bolus of lactated ringers prior to epidural so the blood pressure
doesn’t become extremely low.
▪ Epidural
▪ Questions?
o Am I going to paralyzed?
o It will hurt, but not as much as contractions.
o Take her blood pressure often now
▪ Water breaks→ color? Clear, maybe yellow from baby’s urine.
o TACO
o Clear or meconium stain?
▪ Peanut baby—helps transition the baby (peanut ball).
▪ Bladder full? Always empty the bladder→ after epidural? Straight cath.
▪ Place baby on moms abdomen
▪ Baby on skin-skin (golden hour)-BONDING
▪ Stage 3? Starts oxytocin, make sure she’s not bleeding, breast feed!
▪ Breast feed the first hour.
▪ Erthromycin, vitamin k, HEP B (meds for baby).
May 5, 2016
OB class notes
▪ Maternity of childbearing women and families through all stages of
pregnancy→ OR, NICU, labor, birth, recovery, antepartum.
▪ Maternal Mortality→ What actually causes it? What kills women in the
US and world? ***
o Hemorrhage (#1 U.S and world)
o Hypertensive disorders (#3 in US and world)
▪ Preeclampsia
o Infection (#1 in world)
o Pulmonary embolism (#2 in the U.S) – Why are they prone to it?
▪ The body increases the blood factors to increases clotting to
prevent hemorrhage, but that increases chance.
▪ Healthy People 2020 Mission – know OB stuff
o To make sure postpartum relapse of smoking among women who
quit smoking with pregnancy
o Benefits of breast feeding→ Decrease the percentage of breast-
fed newborns who receive formula supplementation within the
first 2 days of life
o Reduce preterm birth
o Reduce the rate of fetal and infants death
▪ Issues with the U.S Health Care System
▪ Foreign object retained after surgery (to prevent we count everything)
▪ Blood incompatibility (We are worried about that because hemorrhaging)
