Week 1 ● P: preterm <36 weeks
Conception Danger signs of pregnancy, page 71 critical comp box: warning 1st
● What is happening? Fertilization trim + pt education
● Egg and sperm meet. PAGE 47. Sperm enters egg nucleus Pg 88: critical component warning signs 2nd trim + pt ed
oocyte Pg 89 critical component warning signs 3rd trim + pt ed
Menstrual cycle
● Hormones in menstrual cycle, phases, Week 2
● Estrogen, progesterone, follicle stimulating hormone Daily fetal movement count
● Divided into two cycles: ovarian cycle ● Fetal kick counts
○ Ovarian: 3 phases: follicular, ovulatory, luteal ● 10 kicks in 2 hours
○ Follicular phase: LH & FSH ● 4 kicks in 1 hour
○ Ovulatory phase: produce egg/oocyte. Matured graafian True vs false labor
follicle. LH increases 12-36 hours, progesterone ● True labor: cervix dilation and effacement, regular contraction
increases, estrogen decreases Indications of placenta delivery
○ Luteal phase: progesterone and estrogen. ● Signs: umbilical cord lengthens. Chapter 8: pg 273. Rising
Progesterone increases, low estrogen. uterus into ball shape, sudden gush of blood from vagina
○ Pregnancy: corpus luteum releases progesterone and Stages of labor: 4
estrogen 1. Latent: ends with 10 cm dilation pg 258-261
○ No pregnancy, decrease estrogen 2. Ends with delivery of baby
● Endometrial. 3 phases: proliferative, secretory, menstrual 3. Delivery of placenta
phase 4. Post partum and recover
○ Proliferative: estrogen goes up Oxytocin indication
○ Secretory phase: progesterone goes up ● Hang oxytocin/pitocin to prevent postpartum hemorrhage pg
○ Menstrual phase: expulsion of endometrial 274-275
Umbilical cord characteristics ● Uterotonic meds
● 2 arteries, 1 vein page 48-51 ● Uterotonic: contracts uterus, induce contractions
Uterine height measurement chapter 4 page 63, figure 4-2 ○ Hemabate, methylergine, misoprostol, oxytocin
● 20 weeks, fundal height at umbilicus ○ First line: pitocin
● 36 weeks, fundal height below xiphoid process ○ Methylergine not given with high blood pressure
Folic acid ○ Hemabate not given with asthma patients
● Prevent neural tube defects, spina bifida page 71 Intrauterine fetal monitoring
Naegel’s rule: -3 m + 7 d + 1 year page 74 ● Has to be ruptured
GP: gravida & para ● Fetal scalp electrode sit on the head
● 12 weeks pregnant, twins at home born at 35 weeks, 2 ● Measures fetal heart rate
singletons born at 39 weeks and 40 weeks: G4P3 ● Intrauterine pressure catheter: sits in uterus and measures
GTPAL intensity of contractions
● Delivers identical at 36 weeks 6 days, first pregnancy GTPAL: Assessment perform before reporting to doctor:
G1 T0 P2 A0 L2 ● Check vital signs
, ● Dilation ● Procedures cause mixture of blood, if Rh-, need rhogan during
● Fetal heart rate those times. Ex: amniocentesis, trauma
● Labs Fundal massage
● History ● Postpartum nurse, assessing, deviated to the right side, void
APGAR SCORING pg 278 table 8-2 1st because the bladder displaces the uterus
● Memorize signs and scoring ● Massaging, uterus is firm, blood is still trickling, check for
● Crying, kicking, screaming, HR at 160, hands and feet blue, cervical laceration or pg 404-405 clinical judgment, presence of
body pink: APGAR score is 9 d/t blue extremities hematoma
(acrocyanosis) Fundal height
Breech ● Postpartum day 1: expect to be at -1
● Delivered cesarean ● Postop day 2: fundus at -2
● Presenting first: legs, butt, pelvis Episiotomy
EFM strip - practice ● Midline
● Will get 2 strips ● mediolateral
● Chapter 9 ● Doctor opens and cuts to allow baby to pass through
Monitoring newly delivered patient
Week 3 ● Concerns include hemorrhage
● Postpartum blues chapter 13: mood swings, crying, lasts for a ● Monitor: vital signs, blood loss
few weeks after giving birth pg 442-443 can still take care of Difference pg 407-8 box 12-3 engorgement and mastitis
baby ● Mastitis is unilateral, infection, inflammation
● Know priority which patient to see first ○ Treated with antibiotics
a. Nicu mom waiting for discharge orders to go home ○ Can still breastfeed on abx
b. Breastfeeding mom needs help ● Engorgement is excess milk
c. CNA reports mom expelled a huge clot the size of soft Contraception and breastfeeding page 417-420
ball - ANSWER. Hemorrhage. Leftover tissue, placenta ● Methods: barrier, hormonal, natural, sterilization
fragments. Causes of hemorrhage, fundal is firm, laceration, genitourinary, or
■ Smaller than golf ball or egg is okay hematoma
Lochia page 404, table 12-2, figure 12-3 Correct breastfeeding position and latch chapter 16
● Stages, timeframe, expected findings, deviations from normal ● Football or clutch hold - C SECTION MOM because there’s no
● Mom, day 2, expect rubra pressure on abdomen
● Day 5, serosa ● Cradle, cross cradle
● At home day 14, alba ● Side lying
● Foul odor, suspect infection
Rhogam Week 4
● Given because mom is Rh-, prophylaxis to protect mom. Mechanisms of heat loss pg 485
● 28 week gestation 1. Evaporation - loss of heat from water vapors
● Deliver, Rh-, baby is Rh-, mom does not need Rhogan 2. Radiation -cold walls
● Deliver, Rh+, mom needs rhogan within 72 hours of delivery 3. Induction - cold equipment
Conception Danger signs of pregnancy, page 71 critical comp box: warning 1st
● What is happening? Fertilization trim + pt education
● Egg and sperm meet. PAGE 47. Sperm enters egg nucleus Pg 88: critical component warning signs 2nd trim + pt ed
oocyte Pg 89 critical component warning signs 3rd trim + pt ed
Menstrual cycle
● Hormones in menstrual cycle, phases, Week 2
● Estrogen, progesterone, follicle stimulating hormone Daily fetal movement count
● Divided into two cycles: ovarian cycle ● Fetal kick counts
○ Ovarian: 3 phases: follicular, ovulatory, luteal ● 10 kicks in 2 hours
○ Follicular phase: LH & FSH ● 4 kicks in 1 hour
○ Ovulatory phase: produce egg/oocyte. Matured graafian True vs false labor
follicle. LH increases 12-36 hours, progesterone ● True labor: cervix dilation and effacement, regular contraction
increases, estrogen decreases Indications of placenta delivery
○ Luteal phase: progesterone and estrogen. ● Signs: umbilical cord lengthens. Chapter 8: pg 273. Rising
Progesterone increases, low estrogen. uterus into ball shape, sudden gush of blood from vagina
○ Pregnancy: corpus luteum releases progesterone and Stages of labor: 4
estrogen 1. Latent: ends with 10 cm dilation pg 258-261
○ No pregnancy, decrease estrogen 2. Ends with delivery of baby
● Endometrial. 3 phases: proliferative, secretory, menstrual 3. Delivery of placenta
phase 4. Post partum and recover
○ Proliferative: estrogen goes up Oxytocin indication
○ Secretory phase: progesterone goes up ● Hang oxytocin/pitocin to prevent postpartum hemorrhage pg
○ Menstrual phase: expulsion of endometrial 274-275
Umbilical cord characteristics ● Uterotonic meds
● 2 arteries, 1 vein page 48-51 ● Uterotonic: contracts uterus, induce contractions
Uterine height measurement chapter 4 page 63, figure 4-2 ○ Hemabate, methylergine, misoprostol, oxytocin
● 20 weeks, fundal height at umbilicus ○ First line: pitocin
● 36 weeks, fundal height below xiphoid process ○ Methylergine not given with high blood pressure
Folic acid ○ Hemabate not given with asthma patients
● Prevent neural tube defects, spina bifida page 71 Intrauterine fetal monitoring
Naegel’s rule: -3 m + 7 d + 1 year page 74 ● Has to be ruptured
GP: gravida & para ● Fetal scalp electrode sit on the head
● 12 weeks pregnant, twins at home born at 35 weeks, 2 ● Measures fetal heart rate
singletons born at 39 weeks and 40 weeks: G4P3 ● Intrauterine pressure catheter: sits in uterus and measures
GTPAL intensity of contractions
● Delivers identical at 36 weeks 6 days, first pregnancy GTPAL: Assessment perform before reporting to doctor:
G1 T0 P2 A0 L2 ● Check vital signs
, ● Dilation ● Procedures cause mixture of blood, if Rh-, need rhogan during
● Fetal heart rate those times. Ex: amniocentesis, trauma
● Labs Fundal massage
● History ● Postpartum nurse, assessing, deviated to the right side, void
APGAR SCORING pg 278 table 8-2 1st because the bladder displaces the uterus
● Memorize signs and scoring ● Massaging, uterus is firm, blood is still trickling, check for
● Crying, kicking, screaming, HR at 160, hands and feet blue, cervical laceration or pg 404-405 clinical judgment, presence of
body pink: APGAR score is 9 d/t blue extremities hematoma
(acrocyanosis) Fundal height
Breech ● Postpartum day 1: expect to be at -1
● Delivered cesarean ● Postop day 2: fundus at -2
● Presenting first: legs, butt, pelvis Episiotomy
EFM strip - practice ● Midline
● Will get 2 strips ● mediolateral
● Chapter 9 ● Doctor opens and cuts to allow baby to pass through
Monitoring newly delivered patient
Week 3 ● Concerns include hemorrhage
● Postpartum blues chapter 13: mood swings, crying, lasts for a ● Monitor: vital signs, blood loss
few weeks after giving birth pg 442-443 can still take care of Difference pg 407-8 box 12-3 engorgement and mastitis
baby ● Mastitis is unilateral, infection, inflammation
● Know priority which patient to see first ○ Treated with antibiotics
a. Nicu mom waiting for discharge orders to go home ○ Can still breastfeed on abx
b. Breastfeeding mom needs help ● Engorgement is excess milk
c. CNA reports mom expelled a huge clot the size of soft Contraception and breastfeeding page 417-420
ball - ANSWER. Hemorrhage. Leftover tissue, placenta ● Methods: barrier, hormonal, natural, sterilization
fragments. Causes of hemorrhage, fundal is firm, laceration, genitourinary, or
■ Smaller than golf ball or egg is okay hematoma
Lochia page 404, table 12-2, figure 12-3 Correct breastfeeding position and latch chapter 16
● Stages, timeframe, expected findings, deviations from normal ● Football or clutch hold - C SECTION MOM because there’s no
● Mom, day 2, expect rubra pressure on abdomen
● Day 5, serosa ● Cradle, cross cradle
● At home day 14, alba ● Side lying
● Foul odor, suspect infection
Rhogam Week 4
● Given because mom is Rh-, prophylaxis to protect mom. Mechanisms of heat loss pg 485
● 28 week gestation 1. Evaporation - loss of heat from water vapors
● Deliver, Rh-, baby is Rh-, mom does not need Rhogan 2. Radiation -cold walls
● Deliver, Rh+, mom needs rhogan within 72 hours of delivery 3. Induction - cold equipment
