NR 327 final maternal exam download for an A+

Postpartum Hemorrhage (PPH) • From delivery up to 6wks postpartum • SVD Spontaneous vaginal delivery: greater than 500ml (considered PPH) o Estimated blood loss o Quantitative blood loss (weighing everything) • CS C-Section: greater than 1000ml Two main reasons for PPH • Full bladder • Retained placenta What you will assess when you walk into a patient’s room for PPH 1. Assess Fundus -should always be right at umbilicus If it feels like your cheek: boggy; (massage it) Don’t stop unless it firms up 2. Call for help 3. Call Dr. 4. Meds 5. VS and O2 stat 6. Weigh under pads (add this amount of blood loss to what she lost at delivery 7. Change under pads 8. Empty bladder (foley) 9. Start 2nd IV; may need to give patient blood o Once you start to feel the fundus firm up you can stop massaging o Only thing that can misplace the fundus is a full bladder • The uterus has to contract to stop bleeding Meds (all usually standing orders) • Pitocin: usually IV sometimes IM every patient after they deliver will get this drug (immediately) o If there is a fetus in the uterus; has to be on pump and is piggybacked o If not given wide open • Methergine: given IM; if patient has HTN CANNOT be given this drug • Hemabate: given IM; CANNOT give if patient has asthma (can cause explosive diarrhea) • Cytotec: rectally; given 800-1000 mcg *Methergine and Hemabate: work within 2-3 minutes If all of this doesn’t work then back to the OR • Should be dark brown • Firm w/ Bright red blood- laceration • After delivery check every 15 minutes x 4 • Every 30 minutes x 4 Oxygen • 8-10L • Non-rebreather mask • Never nasal cannula Menstrual cycle • 28, 32, or 36-day cycle • 36-day cycle, go back 14 days, she will ovulate on day 22 (can get pregnant on this day) • Have sex on the 17th and the 27th • Ovulation: go back 14 days from very last day of cycle • Sperm lives 3-5 days (200,000,000-800,000,000 per ejaculation) • Ova can only be penetrated for the first 24 hrs • If you want to get pregnant start intercourse 5 days before or 5 days after ovulation • Should have sex every 6 hrs during that time period • Progesterone levels decrease signals hypothalamus to anterior pituitary gland to stimulate the follicle stimulating hormone and luteinizing hormone; which increase estrogen and progesterone (~36 hours) • Corpus luteum: hole where egg left. increases/produces progesterone; you need increase in progesterone to carry a pregnancy • Progesterone levels have to go up in order to hold a pregnancy • Placenta takes over hormone level regulation after 6 - 7 weeks * Naegele’s Rule (estimated due date) • 1st day of last period (minus) 3 months (plus) 7 days -3 months + 7 days 30 days has September, April, June & November 1st Trimester • Conception – 13 6/7 weeks (13 weeks & 6 days) 2nd trimester • 14 weeks -26 6/7 weeks (26 weeks & 6 days) 3rd Trimester • 27 weeks-40 6/7 weeks (40 weeks & 6 days) Term: 37 weeks or greater 20 weeks gestation when the organs are done being formed G- # of pregnancies T- # of term deliveries P- # of preterm deliveries (20- 36 6/7 weeks) A- # of abortions (less than 20 weeks) L- # of living children Fetus cannot survive before 20 weeks Antepartum o fetus in uterus Prenatal Visit (1st things that need to be checked) • Vital signs • Estimated Date of Confinement (Estimated Due Date) • Medical hx • CBC • Hep B • HIV • VDRL- STI • Blood type- Rh factor • Rubella titters; drawn at prenatal visit (if nonimmune she needs Rubella titters w/in 72hrs after delivery) • TB skin test • Pap smear • Weight • UA- urinalysis • Fetal heart tones (can be heard at 6 weeks) If mother is Rh-(negative), she needs Rhogam (26-28wks), she needs that because negative antigens may try to fight off pregnancy • If mom is negative and baby blood positive; mom needs Rhogam within 72hrs after delivery to protect next pregnancy *Only run babies cord blood to find out blood type if moms blood type is negative Next visits • VS • Weight • UA • Fetal heart tones • Measure abdomen Office Visits- doctor for normal pregnancies • 1 week (conception) - 28 6/7 weeks: o Mom will visit Dr. every 4 weeks • 29 weeks- 36 6/7 weeks: o Mom will visit Dr. every 2 weeks • 37 weeks and greater: o Mom will visit Dr. every week Changes in Body Systems: Reproductive • Uterus o F • Cervix o Chadwick signs: bluesish/purplish o Goodell’s sign: cervix softening o Mucus plug: keeps the uterus safe from any germs getting into uterus; can cause some spotting as separating from cervix wall o Hrg’s sign: softening of lower segment of the uterus • Vagina and vulva o Increased vascularity o Vaginal mucosa thickens o Vaginal rugae becomes prominent o Increased roiduction • Breast o Grow larger o Areola gets darker o Colostrum- thick yellow discharge; body getting ready for breast home • Heart • Blood o Blood volume increase o Plasma volume increases: o Cardiac output increase • Relaxin: o body releases during pregnancy; smooth muscle relaxer; keeps BP normal - Has clotting factors in it • Oxygen needs increase o RR will go up about 20%