1	Oxygenation Across the Life Span
2	Physiologic Alterations During Pregnancy O2 uptake increases by 15-20% Tidal volume increases by 30-40% Minute volume increases by 20% Decreased concentration of CO2 by alveoli with compensated resp. alkalosis Increased respiratory rate by 2/minute
3	Prenatal Changes
4	Anatomical Changes During Pregnancy Shape of thorax widens by 6 cms. Breathing changes from abdominal to thoracic with SOB in 3rd trimester Estrogen increases vascularity to nasal mucosa
5	Placenta
6	Fetal development of respiratory system 11 wks.- breathing observed via ultrasonography 20-24 wks- breathing movements dx 25-28 wks- surfactants produced, alveoli forming 32 wks.- lecithin production incr. 35 wks.-Lecithin/Sphingomyelin = 2/1 Phosphatidyl Glycerol (PG) is present
7	L/S Ratio The L/S ratio is predictive of lung maturity in low risk newborns. Mature lungs=2/1 Lung cell differentiation: Type 1 lung cells are for gas exchange while Type 2 lung cells are for surfactant production.
8	Amniocentesis
9	Oxygenation During Intrapartum To evaluate fetal O2 needs we analyze the fetal heart rate tracing External vs. Internal monitoring Periodic Changes in the heart rate: Early, Late and Variable decels and accelerations Baseline variability Tachycardia and Bradycardia
10	Potential for Fetal injury Remember with preterm labor: Steroids and tocolysis to help buy time for fetal lung maturation. Tocolyze uterus or shut off Pitocin Amnioinfusion for variables Fetal scalp Ph Stat Cesarean Section Specific nursing measures to improve oxygenation.
11	O2 Needs of Mom During Labor Controlled breathing More O2 for fetus and uterine muscle Open Glottis vs, Closed Glottis for pushing Panting to prevent a rapid delivery and associated trauma during end of 2nd stage.
12	Oxygenation Needs PostPartum C-Section birth has a lot of O2 considerations both intrapartally and postpartally Cesarean birth - maternal mortality is 2-4x’s greater than vaginal deliveries due to anesthesia accidents or underlying medical conditions.
13	Cesarean Birth Complications- hemorrhage; bladder, intestine or ovarian trauma; endometritis; infection of the incision; urinary tract infection. Aspiration- When did you eat last Post-Op assessment: Repro, lungs, bowel Duramorph precautions
14	C/S Indications Presentation/position Fetal distress Dysfunctional labor CPD prolapsed cord Intrauterine Growth retardation Prolonged ROM Herpes Fetal malformation
15	C/S vs. V-BAC Transverse Classical
16	Embolism Pulmonary Amniotic fluid
17	First Breath
18	Cold Stress Non-Shivering Chemical Thermogenesis Brown fat Competition of protein binding sites as with jaundice and infection Modes of heat loss/cold gain Nursing measures.
19	Newborn Respiratory Assessment Obligate nose breathers Rule out distress Preterm vs. Postterm needs Transient Tacchypnea