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NRS237: Maternity Nursing > Chapters 19 & 21 > Flashcards

Chapters 19 & 21 Flashcards

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1
Q

acoustic stimulation test

A

Antepartum test to elicit fetal heart rate response to sound; performed by applying sound source (laryngeal stimulator) to the maternal abdomen over the fetal head.

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2
Q

alpha-fetoprotein (AFP)

A

Fetal antigen; elevated levels in amniotic fluid and maternal blood are associated with neural tube defects

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3
Q

amniocentesis

A

procedure in which a needle is inserted through the abdominal and uterine walls to obtain amniotic fluid; used for assessment of fetal health and maturity.

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4
Q

amniotic fluid index (AFI)

A

Estimation of amount of amniotic fluid by means of ultrasound to determine excess or decrease.

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5
Q

biophysical profile (BPP)

A

Noninvasive assessment of the fetus and its environment using ultrasonography and fetal monitoring; includes fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate, and qualitative amniotic fluid volume

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6
Q

chorionic villus sampling (CVS)

A

Removal of fetal tissue from the placenta for genetic diagnostic studies.

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7
Q

contraction stress test (CST) (also called oxytocin challenge test (OCT)

A

Test to stimulate uterine contractions for the purpose of assessing fetal response; a healthy fetus does not react to contractions, whereas a compromised fetus demonstrates late decelerations in the fetal heart rate that are indicative of uteroplacental insufficiency.

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8
Q

daily fetal movement count (DFMC)

A

Maternal assessment of fetal activity; the number of fetal movements within a specified time are counted; also called “kick count”

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9
Q

Doppler blood flow analysis

A

use of ultrasound for noninvasive measurement of blood flow in the fetus and placenta.

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10
Q

magnetic resonance imaging (MRI)

A

Noninvaseive nuclear procedure for imaging tissues with high fat and water content; in obstetrics, uses include evaluation of fetal structures, placenta, and amniotic fluid.

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11
Q

nonstress stest (NST)

A

evaluation of fetal response (fetal heart rate) to natural contractile uterine activity or to an increase in fetal activity

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12
Q

percutaneous umbilical blood sampling (PUBS)

A

AKA cordocentesis

procedure during which a fetal umbilical vessel is accessed for blood sampling or for transfusions

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13
Q

uteroplacental insufficiency (UPI)

A

Decline in placental function (exchange of gases, nutrients, and wastes) leading to fetal hypoxia and acidosis; evidenced by late decelerations of the fetal heart rate in response to uterine contractions.

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14
Q

abruptio placentae

A

partial or complete prematures separation of a normally implanted placenta

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15
Q

cerclage

A

use of nonabsorbable suture to keep a premature dilating cervix closed; usually removed when pregnancy is at term

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16
Q

cervical funneling

A

effacement of the internal cervical os

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17
Q

chronic hypertension

A

systolic pressure of 140 mmHg or higher or diastolic pressure of 90 mmHg of higher that is present preconceptionally or occurs before 20 weeks of gestation and/or is persistent after 6 weeks postpartum

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18
Q

clonus

A

spasmodic alternation of muscular contraction and relaxation; counted in beats

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19
Q

couvelaire uterus

A

interstitial myometrial hemorrhage after premature separation (abruption) of placenta; purplish-blue discoloration of the uterus is noted.

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20
Q

disseminated intravascular coagulation (DIC)

A

Pathologic form of coagulation in which clotting factors are consumed to such an extent that generalized bleeding can occur; associated with abruptio placentae, eclampsia, intrauterine fetal demise, amniotic fluid embolism, and hemorrhage.

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21
Q

eclampsia

A

severe complication of pregnancy of unknown cause and occurring more often in the primigravida than in multiparous women characterized by new-onset grand mal seizures in a woman with preeclampsia occurring during pregnancy or shortly after birth.

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22
Q

ectopic pregnancy

A

implantation of the fertilized ovum outside of the uterine cavity; locations include the uterine tubes, ovaries, and abdomen.

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23
Q

gestational hypertension

A

the new onset of hypertension without proteinuria after week 20 of pregnancy

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24
Q

HELLP syndrome

A

A laboratory diagnosis for a variant of severe preeclampsia that incolces hepatic dysfunction, characterized by hemolysis, elevated liver enxymes, and low platelet count

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25
Q

hydatidiform mole (molar pregnancy)

A

gestational trophoblastic neoplasm usually resulting from fertilization of an egg that has no nucleus or an inactivated nucleus.

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26
Q

hyperemesis gravidarum

A

abnormal condition of pregnancy characterized by protracted vomiting, weight loss, and fluids and electrolyte imbalance.

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27
Q

miscarriage

A

loss of pregnancy that occurs naturally without interference or known cause; also called spontaneous abortion.

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28
Q

placenta previa

A

placenta that is abnormally implanted in the thin, lower uterine segment. The condition is further classified as complete placenta previa, marginal placenta previa, or low-lying placenta according to gestational age and placental location in relation to the internal cervical os.

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29
Q

preeclampsia

A

disease encountered after 20 weeks of gestation or early in the puerperium; a vasospastic disease process characterized by hypertension and proteinuria.

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30
Q

premature dilation of the cervix

A

cervix that is unable to remain closed until a pregnancy reaches term because of a mechanical defect in the cervix; also called incompetent cervix

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31
Q

superimposed preeclampsia

A

new-onset proteinuria in a woman with hypertension before 20 weeks for gestation, sudden increase in proteinuria if already present in early gestation, sudden increase in hypertension, or the development of HELLP syndrome

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32
Q

TORCH infections

A

infections caused by organisms that damage the embryo or fetus; acronym for toxoplasmosis, other (e.g., syphilis), rubella, cytomegalocirus, and herpes simplex virus.

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33
Q

Risk Factors for Polyhydramnios

A
  • Diabetes mellitus

- Fetal congenital anomalies

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34
Q

Risk Factors for IUGR

A
  • Maternal Causes: Hypertensive disorders, diabetes, chronic renal disease, collagen vascular disease, thrombophilis, cyanotic heart disease, poor weight gain, smoking, alcohol/drug use, living at high altitude, multiple gestation.
  • Fetoplacental causes: chromosomal abnormalities, congenital malformations, intrauterine infection, genetic syndromes, abnormalplacental development.
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35
Q

Risk factors for Oligohydramnios

A
  • renal agenesis (potter syndrome)
  • PROM
  • Prolonged pregnancy
  • Uteroplacental insufficiency
  • Maternal hypertensive disorders
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36
Q

Risk factors for chromosomal abnormalities

A
  • maternal age 35 years or older

- balanced translocation (maternal and paternal)

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37
Q

Common maternal and fetal indications for antepartum testing.

A
  • Diabetes
  • Chronic hypertension
  • preeclampsia
  • fetal growth restriction
  • multiple gestation
  • oligohydramnios
  • preterm PROM
  • postdate or postterm gestation
  • previous still birth
  • decreased fetal movement
  • systemic lupus erythematosus
  • renal disease
  • cholestasis of pregnancy
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38
Q

Fetal alarm signal

A

fetal movements cease entirely for 12 hours. A kick count lower than 3 movements an hour warrants further evaluation

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39
Q

Indications for standard ultrasonography

A

detect fetal viability, determine presentation of fetus, assess gestational age, locate the placenta,examine the fetal structure for anomalies, and determine amniotic fluid volume

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40
Q

Limited examination ultrasound indications

A

ID fetal presentation during labor or evaluating FHR activity when its not detected by other methods

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41
Q

Specialized or target examinations indications

A

woman is suspected of carrying ananatomically or physiologically abnormal fetus

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42
Q

Indications for comprehensive ultrasound

A

abnormal clinical exam, polyhytramnios, oligohydramnios, elevated AFP, history of offspring with anomalies

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43
Q

When can Fetal heart activity first be seen and heard?

A

as early as 6-7 weeks by Echo scanners, and 10-12 weeks by doppler

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44
Q

nuchal translucency

A

screening tool using ultrasound measurement of fluid in the nap of the fetal neck between 10 and 14 weeks of gestation to ID possible fetal abnormalities. Fluid greater than 3mm is considered abnormal

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45
Q

What does an elevated NT (nuchal translucency) indicate.

A

Increased risk of fetal cardiac disease. Genetic testing is recommended.
When combined with a low maternal serum marker, increased risk of chromosomal abnormalities occurs (trisomy 13,18,21)

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46
Q

Placenta previa diagnosed during 2nd trimester. (facts)

A

more than 90% of cases diagnosed during the 2nd trimester will have resolved by term, primarily because of elongation of the lower uterine segment.

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47
Q

Calculating AFI

A

Take the largest pocket of amniotic fluid in each quadrant and measure their vertical depth in cm and add all 4 together.

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48
Q

Normal AFI

A

10 cm or greater, with the upper range of normal around 25 cm

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49
Q

Low normal AFI

A

5 - 10 cm

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50
Q

Oligohydramnios

A

AFI less than 5 cm

Associated with congenital anomalies (renal agenesis), grown restriction, and fetal distress during labor

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51
Q

Polyhydramnios

A

AFI >25 cm
associated with neural tube defects, obstruction of the fetal gastrointestinal tract, multiple fetuses, and fetal hydrops.

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52
Q

Biophysical profile scoring categories

A 
Fetal breathing movements
Gross body movement
Fetal tone
Reactive fetal heart rate
Qualitative amniotic fluid volume
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53
Q

Normal Score for Biophysical Profile

A

2 Pts per category
Fetal breathing: at least 1 episode of >30 sec in 30 mins
Gross body: 3 discrete body movements in 30 mins
Fetal tone: at least 1 episode of active extension with return to flexion
Reactive FHR: 2 accelerations in 30 mins
Fluid volume: at least 1 pocket measuring 2 cm in 2 planes

54
Q

Abnormal Biophysical Categories

A

Fetal breathing: absent or no episodes > 30 sec
Gross body: up to 2 episodes of movement
Fetal tone: absent movement, slow extension, or no return
Reactive FHR: less than 2 accelerations
Fluid volume: either no fluid pockets or less than <2cm in two planes

55
Q 
Score 10 
(biophysical profile interpretation and management)
A

Normal infant; low risk of chronic asphyxia.

Repeat testing at weekly intervals; repeat twice weekly in diabetic patients and patients at 41 weeks of gestation.

56
Q 
Score 8
(biophysical profile interpretation and management)
A

Normal infant; low risk of chronic asphyxia
Repeat testing at weekly intervals; repeat testing twice weekly in diabetic patients and patients at 41 weeks gestation; oligohydramnios is an indication for delivery

57
Q

Score of 6

BPP interpretation & management

A

Suspect chronic asphyxia
If 36 weeks of gestation and conditions are favorable, deliver; if at > 36 weeks and L/S <2.0, repeat rest in 4-6 hours; deliver if oligohydramnios is present

58
Q

Score 4

BPP Interpretation and Management

A

Suspect chronic asphyxia

If 36 weeks of gestation, deliver; if <32 weeks of gestation repeat score

59
Q

Score 0-2

BPP interpretation and management

A

Strongly suspect chronic asphyxia

Extend testing time to 120 minutes; if persistent score of <4, deliver, regardless of gestational age.

60
Q

presence of ______ almost always indicates a fetal defect

A

acetylcholinesterase

61
Q

MSAFP can be performed when?

A

Between 15 - 22 weeks (16 - 18 weeks is ideal)

62
Q

Triple marker tests for

A

MSAFP, unconjugated estriol, and HCG

63
Q

Quad screen test for

A

the same as triple screen + inhibin A

64
Q

Oxytocin contraction tests (looks for what kind of contractions)

A

3 uterine contractions of good quality, lasting 40 - 60 seconds within a 10 minute period.

65
Q

Four most common types of hypertensive disorders during pregnancy

A
  1. gestational hypertension
  2. preeclampsia
  3. chronic hypertension
  4. preeclampsia superimposed on chronichypertension
66
Q

Mild Preeclampsia

A
  • BP>or = 140/90 x2 at least 4-6 hrs apart but within a week
  • proteinuria >= 1+or 300mg in 24 hour
  • Output matches intake
  • No visual problem, epigastric pain, or pulmonary edema
  • Transient irritability/ changes in affect
  • normal liver function
  • reduced placental perfusion.
67
Q

Severe preeclampsia

A
  • BP rise >= 160/110 on 2 separate occasions 6 hrs apart while on BR
  • Proteinuria >= 3+ dip, >= 5g 24 hour
  • <400-500 mL in 24 hrs
  • persistent severe headache
  • blurred vision, photophobia
  • severe irritability
  • epigastric pain, thrombocytopenia, impaired liver function, pulmonary edema may be present.
  • decreased placental perfusion expressed as IUGR
68
Q

Hemoglobin

normal

A

12 - 16

69
Q

Hematocrit

normal

A

37 - 47%

70
Q

Platelets

normal

A

150,000 - 400,000

71
Q

PT

normal

A

12-14 sec

72
Q

PTT

normal

A

60 - 70 sec

73
Q

Fibrinogen

normal

A

200 - 400

74
Q

Fibrin split products

normal

A

Absent

75
Q

BUN

A

10 - 20

76
Q

Creatinine

normal

A

0.5 - 1.1

77
Q

LDH

normal

A

45 - 90

78
Q

AST

normal

A

4 - 20

79
Q

ALT

normal

A

3 - 21

80
Q

Creatinine clearance

A

80 - 125

81
Q

Burr cells or schistocytes

normal

A

Absent

82
Q

Uric acid

normal

A

2 - 6.6

83
Q

Bilirubin (total)

normal

A

0.1-1

84
Q

Preeclampsia lab value changes

A

Hgb, Hct: may increase
Plt:normal or 5
Bili: unchanged or slightly increased

85
Q

HELLP lab value changes

A 
HGB, HCT, PLTs: decreased
Fibrinogen: decreased
Fibrin split products: present
BUN, Creat, AST, ALT: increased AST and ALT very increased
Creat Clear: decreased
Burr cells: present
Uric acid: >10
Bili: increased
86
Q

HELLP acronym

A

Hemolysis
Elevated Liver
Low Platelets

87
Q

Assessing Deep Tendon Reflexes

A

0 - No response
1+ - Sluggish or diminished
2+ - Active or expected response
3+ - More brisk than expected, slightly hyperactive
4+ - Brisk, hyperactive, with intermittent or transient clonus

88
Q

Pitting Edema grades

A

+1 - 2mm
+2 - 4mm
+3 - 6mm
+4 - 8mm

89
Q

Therapeutic serum magnesium for preeclampsia

A

4 - 7 mEq/L

90
Q

Expected side effects of magnesium sulfate

A

feeling of warmth, flushing, and burning at IV site

91
Q

Symptoms of mag toxicity

A

Mild: lethargy, muscle weakness, decreased or absent DTRs and slurred speech.
Increasing toxicity:maternal hypotension, brady cardia, bradypnea, and cardiac arrest.

92
Q

Reversal agent for Mag Sulfate

A

Calcium gluconate

93
Q

Treatment of patient after seizure

A

Suction food and fluid from glottis, and administer 10 L of oxygen by non-rebreather. Insert 18G IV, replace old IV because its likely displaced. Loading dose of 6G mg over 15-30 mins followed by 2G hourly

94
Q

types of miscarriage

A

threatened, inevitable, incomplete, complete, and missed

95
Q

threatened miscarriage

A

include spotting of blood but with the cervical os closed.
-mild cramping
-No passage of tissue, no cervical dilation
Management: bed rest, sedation, avoidance of stress, sexual stimulation and orgasm usually recommended

96
Q

Inevitable miscarriage

A 
Moderate bleeding
mild to severe cramping
No passage of tissue
Cervical dilation
Treatment: acetaminophen, further treatment depends of woman's response to treatment, bedrest if no pain, fever or bleeding. If ROM bleeding, pain, or fever is present, the prompt termination of pregnancy is accomplished usually by D&C
97
Q

Incomplete Miscarriage

A 
Heavy, profuse bleeding
Severe uterine cramps
Passage of tissue
Cervical dilation with tissue in cervix
Management: May or may not require additional cervical dilation before curettage.
98
Q

Complete miscarriage

A

Slight bleeding
Mild uterine cramping
Passage of tissue
No cervical dilation (cervix already closed after tissue passed)
Management: Suction curettage may be performed to ensure no retained fetal or maternal tissues

99
Q

Missed miscarriage

A 
No bleeding, possible spotting
No cramps
No tissue passed
No dilation
Management: If spontaneous evacuation of the uterus does not occur within 1 month, uterus is emptied by method appropriate to duration of pregnancy.
100
Q

Septic miscarriage

A 
blood amount varies, usually malodorus
cramps vary
tissue passage varies
cervical dilation usually passes
Management: The uterus is emptied immediately by a method appropriate for the gestational age
101
Q

Recurrent miscarriage

A 
bleeding varies
cramping varies
passage of tissue
dilation is usually present 
management: Varies depending on type. Prophylactic cerclage may be performed if premature cervical dilation is the cause.
102
Q

cerclage placement

A

offered if the cervical length falls to less than 20 to 25 mm before 23 to 24 weeks. Risks of the procedure include PROM, preterm labor, and chorioamnionitis.

103
Q

removal of the entire tube

A

salpingectomy

104
Q

“cleaning”of the fallopian tube after tubal pregnancy

A

salpingostomy

105
Q

How long should the woman wait to get pregnancy after miscarriage?

A

At least 3 menstral cycles to allow for healing.

106
Q

What medication can be given to dissolve an ectopic pregnancy

A

methotrexate

107
Q

How long should pregnancy be postponed after a molar pregnancy

A

6 months - 1 year to ensure no cancer cells are forming.

108
Q

GTD

A

gestational trophoblastic disease

ex. molar pregnancy

109
Q

types of molar pregnancies

A

complete or partial mole

110
Q

complete mole

A

fertilization of an egg in which the nucleus has been lost or inactivated. It resembles a bunch of white grapes.
Usually contains no fetus, placenta,amniotic membranes, or fluid.
Maternal blood has no placenta to receive it; therefore hemorrhage into the uterine activity and vaginal bleeding occur.

111
Q

Partial mole

A

two sperm fertilizing 1 egg.
often have embryonic or fetal parts and an amniotic sac.
Congenital anomalies are usually present.
Potential for malignant transformation if 5 - 10%

112
Q

Abruptio placentae

Grade 1 mild seperation

A
  • minimal bleeding, dark red blood
  • <500 mL blood loss
  • shock rare
  • tenderness usually absent
113
Q

abruptio placentae

grade 2 - moderate seperation

A

Absent to moderate bleeding

  • dark red
  • 1000-1500 mL
  • mild shock
  • increased uterine tonicity
  • pain present
114
Q

abruptio placentae

grade 3 - severe

A 
absent to moderate bleeding
>1500 blood loss
dark red blood
Shock is common
pain - agonizing
tetanic, persistent uterine contractions
115
Q

placenta previa

A

minimal to severe and life threatening bleeding

  • amount varies
  • bright red blood
  • Normal uterine tonicity
  • absent pain.
116
Q

Chlamydia

effects on mother and baby

A

Maternal: PROM, preterm labor, postpartum endometritis, miscarriage
Fetal: Low birth weight

117
Q

Gonorrhea

affects on mother/baby

A

Maternal: miscarriage, preterm labor, PROM, amniotic infection syndrome, chorioamnionitis, postpartum endometritis,postpartum sepsis
Fetal: Preterm birth, IUGR

118
Q

Group B Strep

Affects on Mom/baby

A

Maternal: UTI, chorioamnionitis, postpartum endometritis, sepsis, meningitis (rare)
Fetal: preterm birth

119
Q

HSV

effects on Mom/Baby

A

Maternal: Intrauterine infection (rare)
Fetal: Congenital infection (rare)

120
Q

HPV

affects on mother/baby

A

Maternal: Dystocia from large lesions, excessive bleeding from lesions after birth trauma

121
Q

Syphilis

affects on Mom/baby

A

Maternal: Miscarriage, Preterm labor
Fetal: IUGR, Preterm birth, Stillbirth, Congenital Infection

122
Q

Chlamydia

treatment

A

Azithromycin

Amoxicillin

123
Q

HSV

treatment

A

Acyclovir

124
Q

Gonorrhea

treatment

A

Ceftriaxone

Cefixime + Azithromycin or Amoxicillin

125
Q

Group B Strep

treatment

A

Penicillin G

126
Q

Syphillis

treatment

A

Penicillin G

127
Q

Trichomonas

treatment

A

Metronidazole

128
Q

Candidiasis

treatment

A

butoconazole, clotrimazole, miconazole, or terconazole

129
Q

Bacterial vaginosis

treatment

A

metronidazole

130
Q

CABS

A

compressions, airway, breathing, and defibrilation

NRS237: Maternity Nursing (5 decks)

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