Fall Semester 2009

Student Nurse SCC

NUR 251

OB Lecture Series

Alison Harding OB Lecture Series ‘09 Block 3, SCC Nursing Program T (623) 234.0472 E katali@me.com
OB Lecture: Pregnancy

Prep 211 ry

Nutrition:
hiatlequate maternal intake — fetal deprivation
&ads to treterrn, stilik—n, congenital birth dcfccIs
Daily requirements:

Ca:bs/Grans: 6 servinuslday
Dairy: 4 servings/day
Fnirts: 2/day le deep yellow FOLIC ACID also V1T
Vegetables: 3/day deep green FOLIC ACID
Weight Cain:
2s-35 lbs
10
1- lb per wk aller that
Felus:
13 11 lbs
Uterus:
lb
Blood
2s ibs volume: 4 lbs
Breast
% tissue: 3 lbs
O
Mama] stores: 5-10 lbs Moms gaint"1•') 'HI 4, Lwa 1

cr '§
Eating disorders:
PICA abnormal craving ror Min l'uud substanceb
ICE CUBES
AAA iron to diet
Anemia issues
OTC Medleatiolis:
ONLY PRENATAL VITAMINS
Smoking:
Bad
Growth retardation
IVCrR! inta-uteri no growth retardation
Nc calcitic; de.crezes binh wt
Folic Acid:
Increase RBQ;
Lots of 02 on RBCs good for fetils's brain
Reduces r:sk of Neural Tube Detects

Pregnancy Hormones:
Estrogen:
"—lutes uterine deycloprocni tD provide environment for fowl growta
Prepares breast for lactation
EICC Owned Chorionic Gonaciotropiu:
Urine pregnancy lost e,I'
LStimulatc3
hormone)progesterone/estrogen pruluction to ma
HIPL
; Hillan
n Pincental
Lutain the pregritine:y
1.911:
WWI] :

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OB Lecture: Pregnancy
•••

Breast Chancy,:
Fullness I tingling !endemessl darkened areola / prominent blue veins secretion of
cologrum by len wk

Psycholoocal Changes:
First trimester (1-12 w ks)
Acceptance NCLEX
Ann ouneement
Ambivalence
Second trimester (13-24 wks)
Differentiation
Fetal embodiment
Visualization ulaasound
Mom feels the baby move the quickening (16
Acueptine,
- the baby is real
Third trimester
20 wks) NCLEX(25
Preparfng
- for parenthood
Mom is self absorbed with the baby
40 wla)
Separation of baby
Concerned with sage delivery
Childbirth education
Nesting:
Baying clothe, baby's mane, baby's room
Couvade: NCLEX
When date; experience sympathetic preEnancy symptoms
Wt gains, mom sick pop sick

Signs of Pregnancy: NCLEX

Presumptive (subjective):
Findirgs reported by the mother that sugges:s present of a pregnancy
Examples: atrenorrhea, niv, fatigue, breast changes, quickening (16
Probable (objective): 5k-in A
-
Pelvischange
20 wks) _Rra Si
Heger s sign
Goodell's sign,
, 5 0144 n u pet Cv
4
Chadmick's sign, .0 tt.0 s-
k co lo in pigmentation, n .; Eff
W•• t,trika ., rT ttAto LLJ
Changs rt
Ja
Pod live (diagnostic): r
POSA ti VC pregnancy test
Yi
Three things ONLY /,ʻ
,A)
1_ iletai heart teniz: 110-160
2. Fetal mow:Amin that HCP 0,1,c
can feel 20-24 wks
3. 'Ultrasound visual S
- )
Don't have o(brain
6wks vaginal Subject Title for This:
and heart beats Ilwks) 1
1
'
tr 45
i
m 07---: c,23
0 '''''
e
s
2
1 t
e
r
d
OB Lecture: Pregnancy

releasc of imulirl
Frees fatty acids available for maternal metabolic use
Also decrease maternal metabolism of glucose
Progesterone;
Maintains thn endontetimim and inhibib uterine contractions
Hormone of pregnancy lactation
Prevents abortions
Itc built;
Ittl""ts uterine contractionsisoftens colvix
Maternal serum from time of 1 missed menses

Adaptations to Pregnancy:
PhysiolOgic Changeg
Psychological Chasges

Physiologic Changes;

Cardiovascular Sygtera:
Physiologic anemia plasma vultulie increme 50%
Vona
- cava syndrome:
',Items crimps/presses vemi, cava
7
Decreases blood flow to right atria
0
NI:
/0 decrease in heTriatoerit
Do not put moms on her bnek KNOW
Pia mom on her left side (light side is ok)
Hypercoagalation;
Blood vut increasus 45%,
RBCs increase 1 H%
-Cardiac
30 output increases 3040%
4Heart rate inereasm
?/0
Mom's bpin increase 10
-Blood pressure changes:
Uterus presses on pelvis
15
Postural IFIN
14090 max no hiGher

Respiratory System:
NCLEX
1%4asopharyngealedema:
The hormone estrogen = nasal stuffiness
Shortness of breath

Renal System;
GlyeosuriS:
Raises plasma glucose levels far above normal
Kidneys can't reabsorb all the glucose
violet mom fur gestational diabetes

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OB Lecture: Pregnancy

G !omen' lar filtration rate (CFR):

Urinary frequency;
tJtorms pressc,-s on tile bladdel — a lot of pee. I trinicstel
trimesler relieved by uterus moving into abdnrninal area
Tti
Reappears in the 3 - trimester

Endocrine System:
Thyroid gland;
Enlarged due to iracrcase in nictaL')oliu rate
Parathyroid:
Slight enlargement allows for better use of calcium and vitamin])
Pancreas: NCLEX

Pituitary gland:
Increase secretions of Prolactin to prepare breas:s for lactation
D r.sw,r1
A ...bi-:wp
trIA 1,11
,

m. em 4,1A
Uterus:
rim cob
jaLt..m•

Palpable
awn n by iterease of size by I 2
11LA, re • NCI.EX
Flaby'b 'mud t!usucitila imp pclvib (2 wks bcfbic birth)
' wk of gestation
Hewer's Sign! NCLEX
61h 8
'TV-Ien the area boAreen the cervix and •uterus softens
Ih
An I Idjc4..v.L cot
mks
Itmxton
- Hicks Con tractinn NCI ,EX
softe
False
catty labor
plcgiluticy
ning
Contractions
of don't elcser together.
Contractions don't get stronger_
lower
Contractions don
uterin
1
e
1 last longer
air
••••-•1•1 T

segm
Coodelt's
n••
•r;• Sign: NCLEX
ent
••

Effacement: Thinning of the cervix.

Significant softening of the cervix
Due to the inc.-mod blood now to II Ie vaginal aL-ea
Mucus Plug:
Barrier to protect baby from Lnfection (estrogen', NCLEK

%•• •El meA. a

4161.1 la2 •

Chadwick's Sign: NCI.EX

A Iuish
congestion
,
Iliercast:
purplis in vaginal discliarAc:
h
discol
oratio
n of
the
cervix,
4
1 vagina
and
vulva
OB Lecture: Pregnancy

'
Subtract
t 3 months
Add
t 7 days
Example:11/7/07
h go back Oct, Sept, Aug, add 7 days - Aug. 14, 07
Don't
y forget to change the year if necessary
Obstetrical
o History:
Gravida = # of times pregnant
f
Parity = A of infants delivered > 20 wks
l
FPAL or TPA L:
a full term = 38 wks and up
Ps- pi
- t= Ahcntinn <M wks
A
L o- living
comi
csi
Multiple births count as 1 gavida
Medical
t DX Pat Medical DX;
up to
Surgeries
n
uom
Chromosomal
L abnormalities
plete
Prior inkctions
di 37
S'iDs
v
wks
GYN
ora Pap smear normal or abnormal
Last
i
>20
Follow up prenatal visits NCLEX
p
wks
Every 4 wks until 28 wks
c
Even
abort
2l
,ion
Every wk until deli very
wksi
o
Laboratory
until Screening:
Initial
36 d I a ha
Riff i WBC
wks
Blood type and Cross R1-1
Rubella
VSRL Syphilis
GC: Gonorrhea, Chlamydia
MSAFP: blood, otwal tube defeuLs (SP)
lf tesulls are low Downs Syndrome
Diabetes screen: neirqive if BSL <: 140 KNOW
Genetic Screening

TORCH:
Toxoplasmosis:
Protozoal in leetion horn undercooked meats or cat feces/litter
Other Infections;
111WhenatitisIGBS/SvphillisNarieella
Rubella
Cytomegalovims 1:CMV):
Mental retardation

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OB Lecture: Pregnancy

Nil! (stops by 2'

'1Breast tenderness
trimester)
Saliva big time
2" and 3
Heartburn
rd
Ankle edema
trimetter
Varicose
discomf veins
Hemorrhoids
ort:
Constipation
Backache
Leg cramps (drink a quart of milk a day)
SOB
Difficaltv sleeping

Warning Signs or Pregnancy:

Report these 1 m mcdiatcly
1. Bleeding: bright rtal
Abruptio placentae! Emergency
The premature separation of the placenta from the uterus
Placeutne L'mergeney
A condition in
-11. Decreased fetal movements
Baby Inows
which the everyday
3.Headache
placental
4. Edcma
tissue lies of bind. and face
5. VisJal changes
abnormally
3,4 to the
close
Et.ni
internal
5
M. 1.1111

7.
anSymptoms
cervical es of infection;
Fever
d 5 > 104
ITT
all
Chest or abdominal path
ar
PersiKent vomiting
e
ind
Prenatal Screenings:
ica
..11AL Lel. idsa cum d 1 gappy...1, yv not 1,p0Trii evy yi3111.
tiv
e
Wt,
or
Fundus ht (r
Fetal
prand 3 tunes.,
d heint
I irillP dipstiel (ellic.oge and prctiein)
eg
rd
Edema
na
trimester),
Gestational age: KNOW THESE NCLEX
nc D.I.
y
Baby's expected date of birth / liDC. or EDD
ind
uc
ed
HT
N

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OB Lecture: Pregnancy

ITerrAs Simplex:
If active out break at birth then C-Section

Diagnostic Tests:
Ultrasound;
Confirms preptanoy and geslational age
CvS - Chorio rt lc ViIlus Sampling (10-12 weeks)
Chorionie villas sampling is a diagnostic tos: for identifying oltf(Pulosolne abnormalities
and ot'ler inherited di3orders
Usually not done
Determines fetal karvoty
21)
-
Sickle cell
pe
PKIJ(detection of
chromosomal
ikinnicceritcsis:
anet.ploidy, especially
ASSCSS US ratio normar iN 2:1 this is for lung maturity (1,
MSA FP:
Trisomy
—
Maternal serum alpha feta protein spinal bifida
Longs) NCLEX
PUBS:
Percutaneous Umbilical Blood Sampling
EPP — Biophysical Profile (3rd tri)
Fetal breathing movement, teial movemeat, fetal tone (extension & flexion), amniotic
fluid volume, non stross test that has lo be loactive
Placenta last only 40 licks
NST:
Nos Stress Tegt NCLEN
Fetal RR, fetal movement, monitors 2 intervals 2•) inaluts each & has to have - in fetal
HR >15
7:40trnal is :10-160
B PM
sustain
ed for at
least
15,
second
s (2 or
mon
acceler
ations
per
interval)

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OB Lecture: Delivery

CHILDBIRTH
THEORIES ONTHE ONSETOFLABOR

increase in es
-
trogen vs.
thinning and1stretching of cervix to get ready for
, decrease in
increase in prostaglandins4eauscs smooth musok contractility and is
progesterone
vasodilator.
a potent
uterine distension-)causes cervical pressure, irritability and contractibility due to
hormonal role in action
4, decrease in relazin3causes mom's intravertebral joints relax

preparing lungs to breath

In order for labor co start, we need hormones! Labor starts from balancing of hormones.

PELVIS

Passage4 this is maternal pelvis and soft tissue that baby must pass through, going
through the birth canal.
pelvis: this is
border,
-
a mid
Fake Leivis;you
you do not want this, as be baby cannot deliver, re(iuires C-section.
what
Directs the presenting part into the true pelvis. False pelvis is the part above the
pelvis,
brim want,
and docs regLitur
not aid in childbirth
und the
pelvicvabinal Nal;
Poweit+ these are the
pelvic
0.tite., contractions;
ialct iin
• primary powers are involuntary uterine contractions, responsible for effacement
upptx of the cervix and descent
an
andodilation of the fetus
FilICI r
• secondary powers are voluntary bearing down efforts (diaphragm and abdominal
baby to
muscles)
cnmebaby and how the baby is rmitioned; refers to the fetus.
Passenger-)
Psych->through
ail about the mom and what she goes through.

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OB Lecture: Delivery

Pelvis Types: The type of pelvis influence the fetal descent into pelvis, progression of
labor and the type of labor to expect. *I* Look these up***

Android Pe1vi54 Heart shaped pelvis. Most men have this shape, but if mom has this, she
would most likely need a C-Section, use of forceps or vacuum ex
-
Gynocold Pelvis (50%) the elassie female pelvis, resulting in very cominwn and nonral
indica
vaghlat detiveriegwtth more found shape,

Platypellold Pelvis (3i) 4 a Rai oval shaped pelvis (less common)

Anthropoid (20%)
4 resembles the
pelvis
ofantbropoidape3
(less common)
2

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OB Lecture: PostPartum

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OB Lecture: Infant

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OB Lecture: Infant

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OB Lecture: Infant
o Simian Creases in the palm or hand indicates Down Syndrome (occasionally seen
in normal neonates)
o Syndactyly: webbed fingers or toes
o Polydactyly: extra digits or exlra fingers
Ortolani's Maneuver - method ol
clunk ol click is
. essessine torsometimes heardoror felt. If hip dysplairia is present, head of Ctail Lli can
hip dysplasia
be felt to slip 1I)LVLLU
dislocation - audible in inxtubultun f
.rele;Ised Erna ieLmnre renirned to the F r originni poqition NCT t"
-hp Nockf,i) alai ilip back when
3- SKIN - softismoothiwarm
jpressure is to touch

O Lanugo: fine downy hair; oremies have this hair growth

o Mongolian Spots - hregalar area ofdeep pigmenta7ion, bluish-black areas of pigmentation

most commonly notes on back and buttoAs of dark skin ethnicity peopk
Mediterranean,
( irrieao, Latin American or Asian).
o Erythmema Toxicun - "newborn rash" reddish rash
o Acrocyanosis - bluish-purplish skin discoloration
Stork Dile
- Wine Stain - pale red to deep purple, strawberry mark - capillary hemangloma,
c Port
may remain ontil 5-6 years Or longer
Telangleet
C- yanosts
ie Nevi - blue or dusky appearance of skin (extremely emergent sign)
Jaundice
- fiat deep
-pink
yellow
or
skin
11. Prophylactic
red Meds administration and Screening
- birth:discolorat
n Ikel
given toioninjection
due
all to of vitamin
babies within K (thigh)
O Erythromycin
ineffectiv
I hoar after ointmot
e liver
E) 01.11,xpsu
functionin 5c1 VCiling , is alit IOU nal reading cOr 1310t Id glucose- done 30 -60 minutes after
birth if diabetic mom, prrin h I re baby or has had signs of asphyxia.

Reflexes Provides an indirect evaluation of cranial nerve function:

o Rooting_ turning race from side to side to find breast

c; Coughing
o Sneezmg
- Gagging
L..; 'Ionic Neck - normal reaction, site bead is turned to, arms and ,egs will extend and other arm is
flexed
Moro/startle:infant annuctairctendel arms anti lingers fanned out, makes a "C" shape with
thumb and forefi ugee
o Prirnative
- NCI ,EXreflexes:
Q
• Paimar Grasp - NCLEX
- Plantar Grasp
• Stepping
0 Babinski: toes open when foot is stroked

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