304 exam 1 -- blue notes

Birth rate

Live births per 1,000 people in population

Maternal mortality rate

Deaths from causes related to or aggravated by pregnancy or the management of pregnancy during the pregnancy cycle (includes 42 days postpartum)

Pregnancy-related death

Death while pregnant or within 1 year of the end of pregnancy (regardless of length)

Infant mortality rate

Deaths of infants under 1 year of age per 1,000 live births

Scope of practice

Limits of nursing practice set forth in state statutes

Standard of Care

Minimum criteria for competent, proficient delivery of nursing care
Designed to protect the public

Clinical Practice Guidelines

Comprehensive interdisciplinary care plans for a specific condition that describe the sequence and timing of interventions that should result in expected client outcomes

Informed Consent

Legal concept that protects a person's right to autonomy and self-determination by specifying that no action may be taken without that individuals' prior understanding and freely given consent

Family Organization

Nuclear
Dual-career/dual-earner
Child-free
Extended/multi-generational
Single-parent
Blended/reconstituted nuclear family
Binuclear
Non hetero-normative

Childbearing Practices of Selected Cultures (table 2-3)

African American: grandmothers, extended family important
Amish: lots of kids, grandparents often care for kids
Appalachian: lots of kids, grandparents often care for kids. strict, physical discipline
Arab American: father is disciplinarian. respect elder

Screening vs diagnostic testing

Screening: wide ranging tests, but can often give false positives
Diagnostics: confirm or deny the initial finding. Can be more invasive.

Criteria for Invasive Diagnostic Testing

Pregnant client age 35 or older
Previous child with chromosomal abnormality
Family history, esp. parents
Positive screening test

Genetic Ultrasound

Assess fetus for genetic or congenital problems
10-14 weeks: fetal nuchal translucency measurement
16-20 weeks: anatomy scan
(when fetal structures have developed completely)
Noninvasive, no documented harm

Genetic Amniocentesis

Diagnostic
goes into amniotic fluid to look at chromosomes shed in the fluid. possible after 15 weeks gestation.
can result in a fetal loss due to infection, rupture of membranes, and spontaneous loss

Ovaries

Ovulation and hormone production

Uterus

Reception, implantation, retention, and nutrition of fertilized ovum and fetus
Expels fetus during childbirth
Cyclic menstruation

Vagina

Passage for menstrual flow, childbirth, and conception

Cervix

Connects vagina and uterus
Opens to facilitate birth and menstruation

Conception

Fertilization - sperm + ovum = new diploid cell aka zygote
Ovum
1 released/cycle
Fertile for 12-24 hours
Sperm
Survive for 48-72 hours, but healthiest for 24 hours

Pre-embryonic period susceptibility to teratogens

Pre-embryonic period: conception to day 14
All or nothing - teratogens either have no effect or the effect results in spontaneous abortion

Amniotic fluid volume is

A measure of fetal well-being
10 weeks: 30 mL
16 weeks: 210 mL
After 20 weeks: 700-1000 mL

Umbilical cord

Connects fetus to placenta
Circulates nutrients and oxygen
1 vein, 2 arteries
Protected by Wharton's jelly

Placental Functions

Transport:
- Simple diffusion: water, O2, CO2, electrolytes, anesthetic gases, certain drugs
- Facilitated transport: glucose, galactose, O2
- Active transport: amino acids, Ca++, iron, water-soluble vitamins, glucose
Hormones:
- hCG maintains pregnancy b

Fetal Development

4 weeks: The fetal heart begins to beat.
8 weeks: All body organs are formed.
8-12 weeks: Fetal heart rate can be heard by ultrasound Doppler device.
16 weeks: Baby's sex can be seen. Although thin, the fetus looks like a baby.
20 weeks: Heartbeat can be

Age of viability

The age (about 22 weeks after conception, 22-25 weeks GA) at which a fetus may survive outside the mother's uterus if specialized medical care is available.
Major determinants: CNS functioning & lung development

Pregnancy Weight Gain Based on Pre-Pregnancy BMI

Underweight woman (BMI <18.5)
- 28 to 40 lb (12.5 to 18.0 kg)
Normal-weight woman (BMI 18.5 - 24.9)
- 25 to 35 lb (11.5 to 16.0 kg)
Overweight woman (BMI 25 - 29.9)
- 15 to 25 lb (7.0 to 11.5 kg)
Obese woman (BMI >30)
- 11 to 20 lb (5.0 to 9.1 kg)

Excessive weight gain/accumulation of fluids after 20th week may signal:

Development of preeclampsia

Most important reason to monitor weight gain during pregnancy is:

To identify potential nutritional problems or complications of pregnancy.

Fluid needs during pregnancy

Increased
Goal: 2-3 liters/day (8-10 cups)
Max caffeine: 200 mg/day (~2 cups/day)

Folate or folic acid needs during pregnancy

Folate or folic acid: 400 mcg/day
4000 mcg/day if Hx of child with neural tube defects

Iron needs during pregnancy

27 mg/day
- Transfers to fetus and expands maternal RBC
- Almost impossible through diet alone
- Vitamin C helps absorption, take on empty stomach if possible
Avoid coffee, tea, milk, egg yolk, bran
- decreases iron absorption
Side effects: nausea, harmle

Pyrosis (Heartburn)

Small, frequent meals
Fluids separate from meals
Avoid spicy foods
Do not lie down immediately after eating
Seek care when OTC antacids do not relieve pain

Ectopic pregnancy

A pregnancy outside of the womb, usually in a fallopian tube. Must be terminated ASAP.
Characterized by sharp, one-sided pain.
Administer RhoGAM if mother is Rh-

Gestational Trophoblastic Disease signs/symptoms

Vaginal bleeding - often brownish (prune juice) but may be bright red
Passage of hydropic vesicles (grapelike clusters)
Hyperemesis gravidarum (severe N/V)
Administer RhoGAM if mother is Rh-

Spontaneous abortion

Pregnancy terminated before 20 weeks or fetal weight less than 500 grams
Chromosomal abnormalities (cause for ~50% of cases)
Administer RhoGAM if mother is Rh-

Pregnant Clients with Bleeding Disorders

Count and weigh pads to assess amount of bleeding
Save any tissue or clots expelled

Hyperemesis Gravidarum

Excessive vomiting
- 5% weight loss from pre-pregnancy
- Electrolyte imbalance
- Acetonuria (a type of ketonuria)
- Ketosis
Medications:
- Pyroxidone (Vitamin B6)
- Antiemetics

Classifications of Hypertensive Disorders in Pregnancy

Chronic hypertension
- Present before the pregnancy or diagnosed before week 20 of gestation
Gestational hypertension
- Onset of hypertension (140/90 or higher) without proteinuria after the 20th week of pregnancy
Chronic hypertension with superimposed pr

Preeclampsia and Eclampsia Classifications

Preeclampsia
- Gestational hypertension with proteinuria 1+ or higher +/- transient HA and edema
- A vasospastic systemic disorder categorized as mild or severe
- Resolved by birth of placenta
Eclampsia
- Seizure activity or coma in woman diagnosed with p

Signs/symptoms of preeclampsia

Severe HA
Nausea
Vision changes
Hypertension
Epigastric pain
Pitting edema
Hyperreflexia
Oliguria
Proteinuria

Causes of the signs/symptoms of preeclampsia

Vasospasm, decreased organ perfusion
- hypertension, oliguria, seizures, headache, hyperreflexia, blurred vision, hyperlipidemia, N/V, epigastric pain, elevated liver enzymes
Intravascular coagulation
- hemolysis, low platelet count
Increased permeability

Care/medication management for preeclampsia

Low-stimulus environment
Magnesium Sulfate
- goal is to depress CNS
- restrict fluids
Toxicity - low respirations, cardiac dysrhythmias, urine output <30ml/hr. Discontinue and administer calcium gluconate.

Care management for eclampsia

Prevention
- Prenatal care for assessment and early interventions
During a seizure
- Note time
- Call for help, do not leave
- Maintain airway
- Padded railings
- Maintain or initiate an IV
After the seizure
- Evaluate fetal status, ROM, contractions, cer

HELLP syndrome

Hemolysis
Elevated Liver enzymes
Low Platelets
Variant of severe preeclampsia
- Malaise, flu-like illness, epigastric pain
- HELLP caused by liver damage
- Can progress rapidly

Group B Strep

Prevention
- Vaginal-rectal swab at 35-37 weeks
- Intrapartum antibiotic use PRN
Early onset
- Pneumonia, apnea, shock
Late onset
- Meningitis, pneumonia

Rh alloimmunization

Mom RH-, Father RH+
1st baby is RH+
Mom develops antibodies to RH+
Second baby now at risk of mom's antibodies
RhoGAM at 28 wks/PP

ABO Incompatability

Mother is type O
Infant is type A or B
Maternal serum antibodies present in serum
Hemolysis of fetal red blood cells
Severe anemia does not generally occur

Managing maternal trauma

If not life-threatening:
Fetal monitoring for 4 hours should be sufficient if there are no contractions, vaginal bleeding, uterine tenderness, or leaking amniotic fluid
Increased uterine irritability may suggest risk for abruptio placentae due to abdomina

Surgery during first trimester

Increased incidence of abortion

Surgery during second and third trimester

Surgery during early second trimester decreases risk of complication
During surgery, wedge placed under mother's hip prevents uterine compression of major blood vessels
Fetal heart rate must be monitored electronically during and after surgery

Gravida

Any pregnancy regardless of duration
Includes current pregnancy

Para

Birth after 20 weeks gestation regardless of outcome of birth
Number of pregnancies, not number of fetuses/babies (e.g. twins still only count as one)

Obstetric History: GTPAL

Gravida
Term births
Preterm births
Abortions/miscarriages (Losses before 20 weeks for any reason)
Living children

Term

Term: 37-42 weeks
Early term: 37.0-38.6
Full term: 39.0-40.6
Late term: 41.0-41.6

Preterm

Labor at 20-36 completed weeks
Late preterm: 34.0-36.6

Postterm

Labor after 42 weeks

Timelines

280 days total
- 9 calendar months
- 10 lunar months of 28 days (280 days total)
Trimesters
- 1st: Weeks 1-13
- 2nd: Weeks 14-26
- 3rd: Weeks 27-40

Nagele's Rule

For estimating delivery date
1st day of last period + 7 days + 1 year - 3 months

Signs and Symptoms of Pregnancy

Presumptive (subjective)
- Pregnant client experiences and reports
- Could be caused by something else
Probable (objective)
- Examiner can perceive
- No other possible causes
Positive (diagnostic)
- Objective
- Can not be confused with pathology
- Conclus

Presumptive signs of pregnancy

Amenorrhea
Nausea and vomiting
Fatigue
Urinary frequency
Breast changes
Quickening

Probable signs of pregnancy

Goodell and Chadwick signs
Hegar and McDonald signs
Enlargement of the abdomen
Braxton Hicks contractions
Skin pigmentation changes
Pregnancy tests

Positive signs of pregnancy

Fetal heartbeat
Fetal movement
Visualization of the fetus

hCG (human chorionic gonadotropin) tests affected by:

Improper collection
Testing too early
Hormone-producing tumors
False positive medications:
- Anticonvulsants
- Tranquilizers
False negative medications:
- Diuretics
- Promethazine

Never ask about intimate partner violence:

with partner present (duh)

Teratogenic Substances

Tobacco, alcohol, many medications
Limit caffeine to 200mg/day (2 cups)

Fetal Heart Tones

Using doppler ultrasound at 10-12 weeks and at each subsequent visit
110-160 beats/min

Weight gain in 1st Trimester

Gain 1.1-4.4 lbs

Nose changes in 1st Trimester

Edema common

Mouth changes in 1st Trimester

Hypertrophy of gingivigal tissue

Breast tissue changes in 1st Trimester

Darkening of areola
Montgomery tubercles more pronounced

Abdomen changes in 1st Trimester

Striae
Linea nigra
Diastesis
Progressive enlargement

Pelvis changes in 1st Trimester

Softening of cervix
Softening of isthmus of uterus
Bluish coloration of cervix
Bony pelvis
- Enlargement of AP(anteroposterior) diameter

Skin changes in 1st Trimester

Spider nevi
Pigmentation changes

Vagina changes in 1st Trimester

Increased estrogen levels
Copious thick discharge
Alteration in connective tissue

Nausea and vomiting in 1st Trimester

Potential causes
- Elevated hCG level
- Smooth muscle relaxation
- Alterations in carbohydrate metabolism
- Emotions
Self-Care
- Ginger
- Vitamin B6
- Avoid strong odors
- Small, frequent meals
When to seek care
- Emesis >1/day
- Signs of dehydration
Typi

Urinary Frequency in 1st Trimester

Potential causes
- Enlarging uterus
Self-care
- Maintain hydration, >2000 mL/day
When to seek care
- Dysuria
- Hematuria

Routine screenings at initial visit

CBC
Blood type (A/B/O, Rh)
Rubella titer
HIV
Syphilis/Gonorrhea/Chlamydia
Urine culture
HBsAg

Ultrasound in 1st Trimester

Transvaginal
Indications
- Confirm pregnancy
- Gestational age
- Number/size/location of gestational sac
- Fetal cardiac activity
- Uterine anatomy
- Nuchal translucency

Choronic villus sampling timing

10-12 weeks or after

Braxton Hicks contractions

Irregular, painless contractions
Throughout pregnancy, palpable externally at ~16weeks

Cardiovascular System changes in 2nd trimester

Increased estrogen and progesterone
- Increased cardiac output
- Increased blood volume 40-50%
+ Physiologic anemia of pregnancy
- Increased RBC -> O2 to cells
- Increased clotting factors
- Decreased blood return from extremities
+ Supine hypotensive syn

Physiologic Anemia of Pregnancy

Apparent anemia that results because during pregnancy the plasma volume increases more than the erythrocytes increase.
Most often in second trimester

GI and GU changes in 2nd trimester

Decreased peristalsis, gastric emptying
Increased risk of hemorrhoids
Increased risk for UTI (dilation, alkalination)

Backache

Potential causes
- Lordosis r/t growing uterus
Self-care
- Change positions frequently
- Good posture, body mechanics
- Hip tilts
- Yoga
- Support garments
- Use pillows for support when lying/reclining
- Avoid high heel shoes
When to seek care
- Unable t

Psychological changes in pregnant woman

1st trimester
- Disbelief and ambivalence
2nd trimester
- Quickening
- Fetus as separate from self
3rd trimester
- Anxiety about labor/birth
- Nesting

Psychological changes in partner

1st trimester
- Disbelief
- May feel left out
- Confused by partner's mood changes
- Resentful
2nd trimester
- Decide which behaviors of own partner to imitate or discard
3rd trimester
- Anxiety about labor and birth
Couvade: Partner develops physical sym

Rubin's 4 Tasks

Ensuring safe passage
Seeking acceptance of this child by others
Seeking acceptance of self as mother
Learning to give of oneself on behalf of one's child

Timing of Visits

<24 weeks - once a month
24-36 weeks - once every two weeks
>36 - once a week

Danger signs

Gush of fluid from vagina
Vaginal bleeding
Abdominal pain
Fever above 101.0�F (38.3�C) and chills
Dizziness, blurred vision, seeing spots, severe headache
Persistent vomiting
Edema of hands, face, legs, and feet
Muscular irritability, convulsions
Epigastr

Ultrasound: 2nd and 3rd Trimesters

Drink 1-1.5 quarts of water beforehand to help visualize
Indications
- Fetal anatomy and growth
- Genetic disorders
- Placental location and function
- Amniotic fluid volume
- Guide additional testing

Doppler Blood Flow Analysis often called for because of:

Suspected IUGR (Intrauterine growth restriction)

Quad Screen

Four parts:
- Maternal serum alpha-fetoprotein (MSAFP)
- hCG
- Unconjugated estriol (UE3)
- Dimeric inhibin-A
Screens for trisomy 21, trisomy 18, and neural tube defects (NTD)
Indicated for all pregnant women at 15-20 (16-18) weeks GA
Less accurate and hi

Amniocentesis

Ultrasound guided removal of amniotic fluid to examine fetal cells
>14 weeks
Indications
- Genetic concerns
- Neural tube defects
- Fetal pulmonary maturity testing
Rh negative women must receive Rhogam after procedure

Labs at 26-28 weeks

CBC
Rh (RhoGAM if negative)
1 hour glucose tolerance test
- Gestational Diabetes Mellitus screen
- 3 hr GTT if positive
VRDL or RPR as needed

Labs at 35-37 weeks

GBS culture
- Vaginal rectal swab
- Valid for 5 weeks
- IV Abx in labor if positive
VRDL or RPR as needed
CBC PRN

Nonstress Test (NST)

Begin at 30-32 weeks in high risk pregnancies
Reactive NST (good result)
- ?2 accelerations in 20 minutes
- ?32weeks: acceleration = ^15 bpm for >15 seconds
- <32 weeks: acceleration = ^10 bpm for >10 seconds
Nonreactive NST (bad result)
- <2 qualifying a

Effects of Fetal Hypoxia

In order:
Decreased heart rate reactivity
Decreased/absent fetal breathing movements
Decreased/absent gross fetal movements
Decreased fetal tone
Prolonged hypoxemia - reduced amniotic fluid volume
Fetal acidosis

Biophysical Profile (BPP)

Dynamic assessment based on acute and chronic markers of fetal disease
Ultrasound:
1.AFV
2.Fetal breathing movements
3.Fetal movements
4.Fetal tone
Fetal heart rate reactivity (nonstress test)
2 points for each positive sign, 0 points for negative
Normal

Contraction Stress Test (CST) Interpretation

Negative (good result):
- 3 contractions of >40 seconds in 10 minutes with no late or significant variable decelerations
= Fetal oxygenation is adequate, placenta functioning well, likely to tolerate labor
Positive (abnormal):
- Late decelerations with ?5

5 P's (factors affecting labor)

Passageway
- i.e. birth canal. gynecoid is preferable type of pelvis
Passenger
- i.e. fetus and placenta
- engagement: when the largest part of baby has entered the pelvis
- station: Relationship of the presenting part to the ischial spines
- fetal positi

Contractions terms

Frequency
- Beginning of 1 contraction to the beginning of the next
Duration
- Beginning to end of 1 contraction
Strength (via palpation or IUPC)
- Baseline to peak
Resting tone (via palpation or IUPC)
- Baseline

Effacement

Shortening and thinning of the cervix

True vs false labor

True Labor ? contractions w cervical dilation and shortening, back pain
False labor ? irregular contractions (not progressively stronger), w/out cervical changes., lower abdomen/groin pain
*SEDATION helps (key to distinguish)! Can reassure and d/c home.

Stages of Labor

First stage
- Onset of regular contractions to 10 cm dilation
Second stage
- 10 cm (or onset of pushing) to birth of fetus
Third stage
- Birth of fetus to birth of placenta
Fourth stage
Return to homeostasis (about 2 hours after birth of placenta)

First stage of labor (three phases)

Onset of regular contractions to 10 cm dilation
latent phase (6-8hrs)
- excited, communicative
active phase (3-6hrs)
- inwardly focused, serious, fatigue, pain
transition phase (20-40min)
- vague communication, severe, pain, irritable, loss of control

Second stage of labor (two phases)

10 cm (or onset of pushing) to birth of fetus
Nullip: 2 hours (3 with epidural)
Multip: 1 hour (2 with epidural)

Mechanisms of labor

Descent
Engagement
Flexion
Internal rotation
Extension
External rotation
Expulsion

Signs of placental separation

Firmly contracting fundus
Change in shape of uterus
Sudden gush of dark blood from introitus
Apparent lengthening of umbilical cord
Sensation of vaginal fullness

Admission interview (during intrapartum assessment)

Presenting symptoms
- FM
- Contractions
- LOF, vaginal bleeding
- Pain
Prenatal data
Psychosocial factors
Stress in labor
Cultural factors

Cultural preferences (during intrapartum assessment)

Support people in the labor/birth room
Garments
Labor preferences
Birth position
Temperature of fluids
Privacy

Physical assessment (during intrapartum assessment)

Vital signs, weight
Lungs
Fundus
Edema
Hydration
Perineum
Fetal movement
Fetal heart rate
Presentation
Position
Uterine contractions
Cervical dilation
Cervical effacement
Fetal descent
Membranes

Uterine contractions - methods of assessment

Palpation
- Not quantitative or continuous
Internal monitoring
- Continuous
- External
- Provides timing, not strength
- Internal
- Provides timing AND strength

Leopold maneuver

First maneuver
- Which part occupies the fundus?
- Am I feeling buttocks or head?
Second maneuver
- Where is the fetal back?
- Where are the small parts or extremities?
Third maneuver
- What is in the inlet? Does it confirm what I found in the fundus?
- I

Indications for Continuous External Fetal Monitoring (EFM)

Hx stillbirth at term
Presence of high-risk factors (Table 17-2)
Induction of labor
Preterm labor
Decreased FM
Non-reassuring fetal status
Meconium
Hx of C/S

Fetal heart rate baseline

Average rate during a 10 minute period, rounded to closest 5 bpm
Normal: 110-160 bpm

Fetal heart rate variability

Irregular waves or fluctuations in the baseline FHR measured in peak to trough
- Excludes accelerations and decelerations
Absent/minimal: undetectable to ?5 bpm
- Abnormal or indeterminate
Moderate: 6-25 bpm
- Normal
Marked: ?25 bpm
- Unclear significance

Fetal heart rate accelerations

Abrupt increase in FHR (onset-peak<30 seconds) of >15 bpm lasting >15 seconds but <2 minutes
- If <32 weeks GA: increase of 10 bpm for >10 seconds
Indicates fetal wellbeing

Decelerations acronym (VEAL CHOP)

Variable = Cord compression
Early = Head compression
Accelerations = Okay
Late = Placental insufficiency

Early decelerations

Gradual (?30 seconds) decrease in and return to baseline FHR
MIRRORS UC
Indicates fetal head compression (normal, benign)
Cause
- Head compression

Nursing interventions for early decels

None indicated

Late Decelerations

Gradual (?30 seconds) decrease in and return to baseline FHR
Begins AFTER the contraction has started, reaching lowest point after peak of contraction
Indicates disruption in fetal oxygenation
Cause
- Uteroplacental insufficiency
- Maternal hypotension

Nursing Interventions for late decelerations

Lateral position
Increase IV rate
D/C oxytocin PRN
O2 @ 8-10L/min via face mask
Elevate legs
Notify provider
Assess for tachysystole
Prepare for possible internal monitoring or immediate birth (C/S or assisted vaginal)

Variable decelerations

Abrupt (<30 seconds) decrease in FHR below baseline of >15 bpm for >15 seconds but <2 minutes
Causes
- Umbilical cord compression
- Occasional variables are typically benign
- Recurrent variables may result in hypoxemia

Nursing Interventions for recurrent variable decels

Change maternal position
D/C oxytocin PRN
O2 @ 8-10L/min via face mask
Notify provider
Prepare for possible SVE, amnioinfusion, C/S

Prolonged deceleration

Gradual or abrupt decrease in FHR of >15 bpm below baseline lasting 2-10 minutes
- If >10 minutes, this is a baseline change

Nursing interventions for prolonged decels

Notify provider
Vaginal exam
Lateral position
Increase IV rate
D/C oxytocin (if using)
O2 @ 8-10 L/min via face mask
Prepare for possible internal monitoring or immediate birth (C/S or assisted)

FHR tracing evaluations

Category 1 (normal)
Category 2 (indeterminate)
Category 3 (oh shit)

FHR category 1

Normal
FHR 110-160 beats/min
Normal FHR variability in the moderate range
No variable or late decelerations
Accelerations present or absent
Early decelerations present or absent
No specific action required

FHR category 2

Indeterminate
Baselines include bradycardia with continued variability or tachycardia
Baseline changes in variability
No accelerations with scalp stimulation
Episodic decelerations
Variable decelerations
Requires evaluation, continued surveillance, and re

FHR category 3

Abnormal
Absent variability in baseline FHR
Recurrent late decelerations, recurrent variable decelerations, and/or bradycardia
Sinusoidal FHR patterns may be present
Requires prompt evaluation and likely urgent birth

Amniotomy

Artificial Rupture of Membranes (AROM)
Induce or augment labor

Cervical ripening

Prostaglandins (see ATI pharm section)

Oxytocin (Pitocin) - given IV

Therapeutic use
- Induces or augments labor
- Prevents or treats PPH
Complications
- Uterine hyperstimulation
- Hypertensive crisis
- Water intoxication
Contraindications
- Cervix unripe
- Fetal distress
- Malpresentation
- Prolapsed umbilical cord
Intera

Preventing Episiotomies

Perineal massage during pregnancy
Guided vs directive 2nd stage
Side-lying position for 2nd stage
Warm compresses on perineum
Firm counterpressure on perineum
Gradual expulsion of neonate

cesarean section risks

Maternal mortality is higher
Perinatal mortality is higher
Infection, bleeding, clots, etc.

Preparation for c section

Establishing IV lines
Placing urinary indwelling catheter
Performing abdominal prep
Good communication
Therapeutic touch and eye contact, if culturally appropriate for client

Care After C section

Routine postpartum care including
- Fundal checks
- Care of incision
- Monitoring intake and output and maintaining IV access
- Administer and teach about postoperative medications
- Assessment of respiratory system
- Assessment of bowel sounds

TOLAC and VBAC

Trial of labor after cesarean/ Vaginal birth after cesarean
Most common risks are:
- Hemorrhage
- Infection
- Operative injuries
- Thromboembolism
- Hysterectomy
- Death
- Uterine rupture
- Infant death or neurologic complications
Nursing management
- Con