HESI 11-15 tres

Clomiphene (Clomid) and Pergonal Act by inducing ovulation Major side effect is multiple births

Just before ovulation basal body temperature dips Just after ovulation basal body temperature rises a half a degree Woman should avoid sexual intercourse for 3 days before and 2 days after ovulation

Definition: Endometrial tissue is growing outside the uterus; frequently on the ovary
Manifestations: severe dsmenorrhea, dyspareunia, infertility
Managed: OC, sx

1st day of LMP minus 3 months (or forward 9 months) plus 7 days

Presumptive (subjective): amenorrhea, NV, fatigue, urinary frequency, breast changes, quickeninig
Probable (objective): chadwicks sign (coloration), goodells sign (softening), Hegars (softening), + preg test, BH contractions, pigmentation changes
Positive: fetal HR (doppler 8 wks), FM,

Reactive: fetal heart rate increases with movement Nonreactive: no increase in fetal heart rate with movement

Goal is to cause three contractions, 40-60 seconds long, in a 10-minute period Contractions can be induced with nipple stimulation or oxytocin Negative: No late decelerations Positive: Late decelerations with more than one half of the contractions Suspicious: Late decelerations with less than one half of the contractions

Painless, bright red bleeding after the 7th month Bleeding, sometimes intermittent, bed rest, observe for hemorrhage, no vaginal exams
-abruptio: bleeding, board-like abd, severe pain, absence of FHR, late decels

-first preg, very young, very old, protein deficiency, DM, chronic HTN,
-Manifestations: proteinuria (1 gm-5 gm/ 24 hrs). oligiuria, edema in upper body, wght gain, headache, hyperreflexia

Drug: Magnesium sulfate (MgSO4)
Check reflexes before giving and at intervals after: loss of knee jerk reflex indicates drug toxicity Check respirations: hold drug if resp. <14 Calcium gluconate at bedside to treat magnesium sulfate toxicity

-mothers insulin doesn't cross placenta, but glucose does, and acts as a GH.

Dilating stage. contractions to 10 cm 1. Latent phase; effacement 0-4 cm Mild contractions q 10 - 20 min. X 10 - 30 seconds 8 - 9 hours in primipara; 5 - 6 hours in multipara; not to exceed 20 hrs in primipara or 14 hrs in multipara Abdominal cramps, backache, rupture of membranes, and/ or bloody show Mother is talkative, cheerful, excited 2. Active phase 5 - 7 cm Moderate contractions q 3 - 5 minutes X 30 - 60 seconds Mother less talkative; rests between contractions; needs reassurance and coaching 3. Transitional phase 8 - 10 cm Intense contractions q 2-3 min X 60 - 90 seconds Most difficult phase of labor May have amnesia between contractions Dark, heavy show Feels like pushing but should not until full dilatation Irritable "Don't touch me." 2 hrs for primipara; less for multipara

1. Early decelerations a.Fetal heart rate starts to slow down (decelerate) early in the contraction b.Lowest fetal heart rate at peak of contraction c.Associated with head compression d. Usually benign 2. Late decelerations a. Fetal heart rate does not begin to slow until contraction is well under way b.Fetal heart rate reaches lowest point near end of contraction c. Associated with uteroplacental insufficiency d.An ominous sign e. Prepare for cesarean delivery 3.Variable decelerations a.Associated with cord compression b.Watch and wait c.Change maternal position

Sign 0 1 2 Heart Rate 0 <100 >100 Respirations 0 Slow, irregular Weak cry Strong cry Muscle Tone Flaccid Some flexion Well flexed Reflex Irritability No response Grimace Cough, sneeze, cry Color Blue, pale Body pink, extremities blue All pink

Assess position of uterine fundus 1. One hour after delivery: level of umbilicus 2. 12 hours after delivery: 1 cm above umbilicus 3. Descends at least 1cm/day 4. Day 5: 4-5 cm below umbilicus 5. Day 10: below symphysis pubis 6. Six weeks: involution complete