Chapter 33 Flashcards
the ovaries:
two glands, one on each side of the uterus
each ovary contains thousands of …, and each of these contains an …
… occurs approximately 2 weeks prior to menstruation
follicles; egg; ovulation
the fallopian tubes:
extend out laterally from the uterus
fertilization usually occurs when a … meets the … inside the fallopian tube
the fertilized egg continues to the uterus where it develops into an …
sperm; egg; embryo
the uterus:
muscular organ that encloses and protects the developing fetus
produces … during labor
helps to push the fetus through the birth canal
birth canal is made up of the … and the lower third of the uterus, called the …
contractions; vagina; cervix
the … is the outermost cavity of the reproductive system
forms the lower part of the birth canal
completes the passageway from the uterus to the outside world
vagina
the breasts produce milk that is carried through … to the nipple to provide nourishment to the newborn once it is born
small ducts
the placenta attaches to the … and provides nourishment to the fetus
uterine wall
placenta keeps the … of the woman and fetus separate but allows substances to pass between them. anything ingested by a pregnant woman has the potential to affect the fetus
circulation
the … connects the woman and fetus through the placenta
the … carries oxygenated blood from the placenta to the fetus
the … carry deoxygenated blood from the fetus to the placenta
umbilical cord; umbilical vein; umbilical arteries
the fetus develops inside a fluid-filled, baglike membrane called the ….–> contains about 500 to 1000 mL of amniotic fluid, which helps … and protect the fetus
amniotic sac; insulate
hormone levels increase to support fetal development and prepare the body for childbirth. pregnant women are at an increased risk for complications from …, …, and some med conditions
uterus is shifted from its normal position
trauma; bleeding;
rapid uterine growth occurs during the …–> as the uterus grows, it pushes up on the … and displaces it
respiratory capacity changes, with … respiratory rates and … minute volumes
blood …. and speed of … increase
… is increased
second trimester; diaphragm; increased; decreased; volume; clotting; cardiac output
in the third trimester, there is an increased risk of … and potential … following trauma
changes in the cardiovascular system and the increased demands of supporting the fetus increase the … of the heart
vomiting; aspiration; workload
weight gain during pregnancy is normal: challenges the heart and impacts the musculoskeletal system
the joints become … or ….
changes in the body’s … increases the risk of slips and falls
“looser”; less stable; center of gravity
… can develop during pregnancy in many women who have not had diabetes previously. usually resolves after delivery. treatment is the same as for any other patient with diabetes
gestational diabetes
… is a common complication:
- pregnancy-induced hypertension
- can develop after the 20th week of gestation
- signs and symptoms include severe hypertension, severe or persistent …, … abnormalities, swelling in the hands and feet, and …
preeclampsia; headache; visual; anxiety
…is characterized by seizures that occur as a result of hypertension.
To treat seizures:
Lie the patient on her …side.
Maintain a patent airway.
Administer supplemental oxygen if necessary.
If vomiting occurs, suction the airway.
Provide rapid transport and call for ALS.
Eclampsia; left
Transporting the patient on her left side can also prevent supine hypotensive syndrome:
Caused by compression of the …and the …by the pregnant uterus when the patient lies supine
descending aorta; inferior vena cava
…:
An embryo develops outside the uterus, most often in a fallopian tubes
Ectopic pregnancy
The leading cause of maternal death in the first trimester is …. following rupture of an ectopic pregnancy.
Consider the possibility in a woman who has missed a menstrual cycle and complains of sudden, severe pain in the lower abdomen.
internal hemorrhage;
Hemorrhage from the vagina that occurs before labor begins may be very serious.
May be a sign of …, or miscarriage.
…: the placenta separates prematurely from the wall of the uterus
…: the placenta develops over and covers the cervix
spontaneous abortion; Abruptio placenta; Placenta previa
abortion:
Passage of the fetus and placenta before …
May be spontaneous or induced
Most serious complications are …and …Treat for shock and transport promptly.
20 weeks; bleeding; infection
Pregnant women have an increased chance of being victims of domestic violence and abuse. Abuse increases the chance of: … … ...
spontaneous abortion
premature delivery
low birth weight
abuse contd:
The woman is at risk from …., …., and ….
Pay attention to the environment for any signs of abuse.
Talk to the patient in a private area, away from the potential abuser if possible.
bleeding; infection; uterine rupture
Effects of addiction on the fetus include:
…
Low …
Severe …. distress
….
….describes the condition of infants born to women who have abused alcohol.
in cases of substance abuse, newborn will probably need immediate resuscitation
prematurity birth weight respiratory death fetal alcohol syndrome
Pregnant women have an increased amount of overall total blood volume and a 20% increase in ….
May experience a significant amount of blood loss before you will see signs of …Uterus is vulnerable to penetrating trauma and blunt injuries.
heart rate; shock
In a motor vehicle crash, severe hemorrhage may occur from injuries to the pregnant uterus.
Trauma is one of the leading causes of ….
Common symptoms include vaginal bleeding and severe abdominal pain.
abruptio placenta
Improper positioning of the … can result in injury to a pregnant woman and the fetus.
Cardiac arrest
Focus is the same as with other patients.
Perform CPR and provide transport.
Compressions may need to be applied …on the sternum.
seat belt; higher
Scene safety
Take standard precautions.
… and … and … protection are a minimum if delivery is already begun or is complete.
If time allows, a … should also be used.
Consider calling for additional resources.
gloves; eye; face; gown
Mechanism of injury/nature of illness
- You will encounter pregnant patients who are not …, so it is important to determine the MOI or NOI.
- Do not develop tunnel vision during a call.
Form a general impression:
- Whether the patient is in active labor or whether you have time to assess and address other possible life threats
- Perform a …
in labor; rapid examination.
Transport decision
If delivery is …, prepare to deliver at the scene.
If delivery is not …, prepare the patient for transport.
imminent; imminent
Transport decision (cont’d) Provide rapid transport for pregnant patients who: Have significant ...and pain Are ... Are having a ... Have an...
bleeding
hypertensive
seizure
altered mental status
Obtain a thorough obstetric history: Her expected … Any … that she is aware of If she has been receiving … care A complete medical history
due date
complications
prenatal
Obtain a SAMPLE history.
Determine the due date, frequency of …, a history of previous pregnancies and deliveries, the possibility of …, and if she has taken any drugs or medications.
If her water has broken, ask whether the fluid was … (due to meconium).
contractions; multiples; green
Secondary Assessment- Physical examinations
Assess the major body systems as needed.
Emphasis on the chief complaint
If the patient is in labor, focus on … and possible delivery.
If you suspect that delivery is imminent, check for …
contractions; crowning
stages of labor:
- Dilation of the …
- Delivery of the ..
- Delivery of the …
cervix
fetus
placenta
first stage:
Begins with the onset of …and ends when the cervix is fully …
Usually the longest stage, lasting an average of … hours
Frequency and intensity of contractions increase
contractions; dilated; 16;
Labor is generally longer in a … than in a … .
A woman may experience preterm or false labor, or …
Some women experience a premature rupture of the …
primigravida; multigravida; Braxton-Hicks contractions; amniotic sac
Second Stage:
Begins when the fetus begins to encounter the …
Ends when the newborn is born
Uterine contractions are usually … together and last longer.
The … will bulge significantly, and the top of the fetus’s head will appear at the vaginal opening (…).
birth canal; closer; perineum; crowning
Third Stage:
Begins with the birth of the newborn and ends with the delivery of the … The placenta must completely separate from the …
This may take up to …minutes.
placenta; uterine wall; 30;
To determine if delivery is imminent, ask the patient: How ...have you been pregnant? When are you due? Is this your ...baby? Are you having ...? How far apart? How ...do they last?
long
first
contractions
long
To determine if delivery is imminent, ask the patient (cont’d):
Have you had …or …?
Has your …?
Do you feel as though you need to have a ….?
Do you feel the need to push?
spotting; bleeding
water broken
bowel movement
To determine potential complications, ask:
Were any of your previous deliveries by …?
Have you had problems in this or any previous pregnancies?
Do you use drugs, drink alcohol, or take any medications?
Is there a chance of …?
Does your physician expect complications?
cesarean section; multiple deliveries
once labor has begun, don’t let the woman …
go to the bathroom
Patient position
Preserve the patient’s privacy.
Place the patient on a …surface that is padded with blankets, sheets, and towels.
Support the …, …, and …
Have her keep her legs and hips flexed, with her feet flat and her knees spread apart.
place … or … on the floor around the delivery area
open OB kit carefully
use sterile sheets and drapes from OB kit to make a sterile delivery field
firm; head; neck; upper back; towels; sheets
Your partner should be at the patient’s head to comfort, soothe, and reassure.
Continually check for …
Some patients experience …labor and birth.
Position yourself so that you can see the …area at all times.
…the contractions.
crowning; precipitous ; perineal; Time
Delivering the head
Observe the head as it exits the vagina.
Support the head with your gloved hand as it ….
Do not poke your fingers into the newborn’s eyes or fontanelles.
rotates
Unruptured amniotic sac
If the amniotic sac does not rupture by the time the head is crowning, it will appear as a fluid-filled sac emerging from the vagina.
It will …the fetus if not removed.
You may puncture the sac with a .. or tear it by twisting it between your …
Clear the newborn’s mouth and nose immediately.
suffocate; clamp; fingers
Umbilical cord around the neck
As soon as the head is delivered, use one finger to feel whether the umbilical cord is .. (…cord).
Usually, you can slip the cord gently over the delivered head.
If not, you must cut it.
wrapped around the neck; nuchal
Delivering the body
Once the head is born, the body usually delivers easily.
Support the … and … as the shoulders deliver.
Do not pull the fetus from the birth canal.
The newborn will be slippery and covered in …
head; upper body; vernix caseosa
If the mother is able and willing, place the newborn on her abdomen so … contact can begin immediately.
Dry off the newborn and wrap him or her in a blanket or towel.
Place the newborn on one side, with the head slightly …than the rest of the body.
skin-to-skin; lower
postdelivery care:
… and … the cord.
Obtain the 1-minute….
Delivery of the placenta
The placenta delivers itself, usually within a few minutes of the birth.
You can help to slow bleeding by gently …the woman’s abdomen with a firm, circular, “kneading” motion.
clamp; cut
Apgar score
massaging
Record the time of birth in your patient care report.
The following are emergency situations:
More than …minutes elapse and the placenta has not delivered
There is more than …mL of bleeding before delivery of the placenta.
There is significant …after the delivery of the placenta.
30; 500; bleeding
Follow standard precautions.
Always put on gloves before handling a newborn.
Newborn will usually begin breathing spontaneously within …to …seconds after birth.
Heart rate will be …beats/min or higher.
If you do not observe these responses:
Gently tap or flick the … or ….
Many newborns require some form of stimulation, including:
Positioning the airway, drying, warming, suctioning, or tactile stimulation
15; 30; 120
soles of feet; rub the back
Neonatal assessment and resuscitation:
Position the newborn on his or her …with the head … and the neck slightly ….
If necessary, suction the mouth and then the nose.
back; down; extended
Observe the newborn for spontaneous …, skin …, and movement of the ….
Evaluate the heart rate at the base of the …or the … or listening to the newborn’s chest with a stethoscope.
respirations; color; extremities
umbilical cord; brachial artery
If chest compressions are required, use the … technique for two-person resuscitation.
Perform BVM ventilation during a pause after every third compression, using a ratio of…
hand-encircling; 3:1.
If you see …in the amniotic fluid and the newborn is not breathing adequately, quickly suction the newborn’s mouth and then nose before providing rescue ventilations.
meconium
Apgar score: Standard scoring system used to assess the status of a newborn Assigns a number value to five areas: … … ...or ... … or … … calculate the apgar score at 1 minute and 5 minutes after birth
appearance pulse grimace; irritability activity; muscle tone respirations
Assessing a newborn
Calculate the Apgar score.
Stimulation should result in an immediate increase in ….
If the newborn is breathing well, assess the …
Assess oxygenation via … and observe for ….
respirations; pulse; pulse oximetry; central cyanosis
Apgar score:
Request a …if the newborn is in distress and will require resuscitation.
In situations where assisted ventilation is required, use a newborn BVM.
If the newborn does not begin breathing on or does not have an adequate heart rate, continue CPR and rapidly transport.
second unit ;
Most infants are born headfirst.
Occasionally, the buttocks are delivered first.
Called a…
Breech deliveries usually take longer, so you will often have time to transport the pregnant woman to the hospital.
If the buttocks have passed through the vagina, the delivery has ….
breech presentation; begun
Preparing for a breech delivery is the same as for a normal childbirth.
Allow the buttocks and legs to deliver spontaneously, supporting them with your hand.
The head is almost always …and should be allowed to deliver spontaneously.
Make a “V” with your gloved fingers and position them in the vagina to keep the walls from …
facedown; compressing the fetus’s airway.
On rare occasions, the presenting part of the fetus is a single arm, leg, or foot.
Called a …
A fetus with a limb presentation cannot be delivered in the field.
Transport immediately.
If a limb is protruding, cover it with a …
Never try to push it in or pull on it.
limb presentation; sterile towel
..of the umbilical cord must be treated in the hospital.
The umbilical cord comes out of the vagina before the fetus.
Do not push the cord back into the vagina.
Keep the fetus’s head from …the cord.
Insert your gloved hand into the vagina and push the fetus’s head away from the umbilical cord.
Transport rapidly.
Prolapse; compressing
….: Developmental defect in which a portion of the spinal cord or meninges may protrude outside of the vertebrae
Cover the open area of the spinal cord with a …. dressing.
Maintenance of .. is important when applying moist dressings.
spina bifida; sterile, moist; body temperature
multiple gestation:
Twins occur once in every …births.
Twins are … than single fetuses, and delivery is typically not difficult.
After …minutes after the first birth, contractions will begin again, and the birth process will repeat itself.
The procedure is the same as that for a single fetus.
Record the time of birth of each twin separately.
Twins may be so small that they look premature.
30; smaller; 10
premature birth:
Any newborn who delivers before ….(36 weeks) or weighs less than … at birth is considered premature.
A premature newborn is smaller and thinner, and the head is proportionately ….
8 months; 5 lb; larger
postterm pregnancy:
Pregnancies lasting longer than … weeks
Fetuses can be larger, sometimes weighing …or more.
Can lead to problems with the woman and fetus:
A more difficult labor and delivery
42; 10 lb
postterm pregnancy contd: Problems (cont’d): Increased chance of injury to the fetus Increased likelihood of ... Woman is at risk for ... and .... Postterm newborns have increased risks of ..., ..., and being ....
cesarean section;
perineal tears; infection
meconium aspirations; infection; stillborn
fetal demise:
Onset of labor may be premature, but labor will progress normally in most cases.
If an intrauterine infection caused the demise, you may note a foul odor.
Do not attempt to resuscitate an obviously dead neonate.
foul odor
delivery without sterile supplies:
You should always have eye protection, gloves, and a mask with you.
Carry out the delivery as if sterile supplies were available.
Use ….
freshly laundered sheets and towels
delivery without sterile supplies contd:
Carry out the delivery (cont’d)
Wipe the inside of the newborn’s …with your finger.
Do not cut or clamp the umbilical cord.
As soon as the placenta delivers, wrap it in a … and transport.
Keep the placenta and the newborn at the…, and keep the newborn ….
mouth
clean towel
same level; warm
postpartum complications:
If bleeding continues after delivery of the placenta:
Continue to ..the uterus.
Check your technique and hand placement if bleeding continues.
Cover the vagina with a …
Administer oxygen, monitor vital signs, and transport the patient immediately.
massage; sterile pad
Postpartum patients are at an increased risk of an ….
Most commonly, a pulmonary embolism
Results from a clot that travels through the bloodstream and becomes lodged in the …
Consider when a woman complains of sudden difficulty breathing or shortness of breath following delivery
embolism; pulmonary circulation
