Which of the following doses of Rh immune globulin

RhoGAM is appropriate for a pregnant client at 28 weeks

gestation?
1. 50 mcg in a sensitized client
2. 50 mcg in an unsensitized client
3. 300 mcg in a sensitized client
4. 300 mcg in a unsensitized client
4. 300 mcg in a unsensitized client
An Rh negative unsensitized woman should be given 300 mcg
of RhoGAM at 28 weeks after an indirect Coombs test is done
to verify that sensitization hasn't occurred.
For a 1st trimester abortion or ectopic pregnancy, 50 mcg of
RhoGAM is given.

Common difficulties in the first trimester

-Polyurea
-Nausea and vomitting
-Breast pain/tingling/tenderness
-Weakness and fatigue

Common difficulties in the second trimester

-Constipation
-Heartburn
-Leg cramps

Common difficulties in the third trimester

-Hemorrhoids
-Varicose veins
-Leg cramps
-Braxton hicks contractions

First stage of labor

-begins with the first true contraction and ends with full dilation
-amniotic sac usually ruptures in this stage
-true contractions are generally regular and lasting between 515 mins. They also increase in pain and intensity as labor
progresses.
-can last up to 18hrs

Second stage of labor

-begins with full dilation of the cervix and ends with the
delivery of the baby
-labor pains are described more as a 'bear down' feeling
-contractions are more intense and frequent (about 2-4mins)

-crowning begins
-this stage can progress very rapidly in women who have had
many deliveries
-for first time mothers, this can last 1-2hrs

Third stage of labor

-begins at the end of the delivery of the baby and ends at the
delivery of the placenta
-usually lasts no longer than 30mins
-expect copious amounts of blood loss as the placenta
delivers
-don't pull on the cord to expedite this stage, and definitely
don't let go of the cord
-don't delay transport of the baby and mother for the delivery
of the placenta

Stages of Labor
a) The fetus moves into the birth canal
b) The cervix completes dilation
c) The placenta seperates from the uterus

Equipment for delivery

-BSI
-Warm clean towels to dry and then wrap infant
-Umbilical crod clamps (2)
-Scalpel or sterile scissors to cut umbilical cord
-Bulb syringe to suction infant's mouth and nose

Appearance
1st A (APGAR)

Pulse
P (APGAR)

Grimace
G (APGAR)

Activity
2nd A (APGAR)

Respirations
R (APGAR)

APGAR
Done at 1 and 5 minutes post delivery

<6
APGAR score that requires immediate resuscitation

<60bpm
if HR ____bpm newborn requires PPV with 100% oxygen and
chest compressions

>60bpm, <100bpm
if HR _________bpm newborn requires PPV with 100%
oxygen for 60 seconds then reassess pulse

>100
if HR _____bpm give newborn blowby oxygen and supportive
care

Appearance (color)
0 - blue
1 - Pink with blue extremeties
2 - Completely Pink

Pulse (HR)
0 - Absent
1 - <100bpm
2 - >100bpm

Grimace (response to stimulation)

0 - No response
1 - Grimace
2 - Vigorous cry

Activiy (flexion of extremities)

0 - Limp
1 - Some flexion of extremities
2 - Flexed limbs

Respirations
0 - Not breathing
1 - Weak respirations
2 - Crying

Neonate
A baby in the first 28 days of life
Neonate Inverted Pyramid
Dry, warm, position, suction, stimulus
Oxygen
BVM, ETT

Chest Compressions
Medications
Care of Neonate
- Temperature (warm and dry)
- Airway (position and suction)
- Breathing (stimulus to cry)
- Circulation (heart rate and color)
breast feeding, oxytocin
Once placenta has been delivered, encourage ____________
to release ______________ hormone to reduce bleeding.
massaging
If postpartum bleeding is excessive, manage the bleeding by
_____________ the mother's abdomen.
Meconium Aspiration
occurs when meconium is present in their lungs during or
before delivery
Meconium
is the earliest stools of an infant