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OB > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Pitocin MOA

A

Synthetic oxytocin
Stimulates uterine contraction (CTXN) and milk let-down

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2
Q

When is Pitocin used

A

Induction of labor
Postpartum hemorrhage (PPH)

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3
Q

Pitocin route and dosages

A

IV
Induction: 1-2 milliunits/min, increased every 15-20 mins
PPH: 125-200 milliunits/min or 10-20 units IM

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4
Q

Nursing considerations for Pitocin

A

Monitor FHT and CTXN q 15 mins
Monitor for uterine tachysystole - more than 5 contractions in 10 mins over 30 min window
Decrease Pitocin if uterine tachysystole or baby distress occurs

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5
Q

Cytotec (misoprostol) uses

A

Cervical ripening
Tx for postpartum hemorrhage

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6
Q

Cytotec (misoprostol) routes

A

Oral, vaginal, rectal

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7
Q

Cytotec (misoprostol) adverse effects

A

H/A
N/V/D
Fever/chills

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8
Q

Nursing considerations for Cytotec (misoprostol)

A

For:
Cervical ripening - continuous fetal monitoring
Postpartum hemorrhage (PPH) - monitor vaginal bleeding and uterine tone

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9
Q

Methergine (methylergonovine) uses

A

Tx of uterine atony (soft uterus) and PPH (postpartum hemorrhage)

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10
Q

Methergine (methylergonovine) route and dose

A

0.2 IM q 2-4 hours
Up to 5 doses

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11
Q

Methergine (methylergonovine) adverse effects

A

HTN & hypotension
N/V
H/A
Tinnitus
Dizziness

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12
Q

Contraindications for Methergine (methylergonovine)

A

HTN or pregnancy induced HTN - AE
Preeclampsia
CVD
Lactation

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13
Q

Nursing considerations for Methergine (methylergonovine)

A

Check BP before giving (do not give if >140/90)
Monitor vaginal bleeding and uterine tone (therapeutic effect)

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14
Q

Hemabate (carboprost/15methyl pg f) uses

A

Postpartum uterine bleeding r/t uterine atony

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15
Q

Hemabate (carboprost/15methyl pg f) route and dose

A

0.25 mg (250 mcg) IM q 15-90 mins

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16
Q

Hemabate (carboprost/15methyl pg f) adverse effects

A

Explosive diarrhea
N/V
H/A
Fever/chills
Tachycardia
HTN

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17
Q

Contraindications for Hemabate (carborprost/15methyl pg f)

A

Asthma
HTN
Cardiac, pulmonary, or hepatic disease

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18
Q

Nursing considerations for Hemabate (carboprost/15methyl pg f)

A

Administer with antidiarrhea (adverse effect)
Monitor vaginal bleeding and uterine tone (therapeutic effect)

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19
Q

TXA (Tranexamic acid) use

A

PPH

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20
Q

TXA (Tranexamic acid) route and dose

A

1g slow IV injection
Mixed with 50 or 100 mL IVF
- Administer over 10 minutes

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21
Q

TXA (Tranexamic acid) adverse effects

A

Hypotension
Visual abnormalities
N/V/D
Anaphylaxis

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22
Q

Contraindications for TXA (Tranexamic acid)

A

Hx or risk of thromboembolic disease
Caution with pt with renal impairment

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23
Q

Nursing considerations for TXA (Tranexamic acid)

A

Monitor hemodynamic - assessing for thromboembolic events (contraindication)

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24
Q

Magnesium sulfate MOA

A

CNS depressant
Relaxes smooth muscle - uterus

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25
Q

Magnesium sulfate uses

A

Preterm labor
Pregnancy induced HTN
Preeclampsia

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26
Q

Magnesium sulfate route

A

IV

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27
Q

Magnesium sulfate doses

A

Loading dose: 4-6g over 20-30 mins
Maintenance dose: 1-4 g/hr
- D/c within 24-48 hrs
Limit of 125mL/hr

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28
Q

Magnesium sulfate adverse effects

A

Maternal
- Hot: Flashes, sweating, burning IV site, dry mouth, drowsiness, blurred vision, H/A, weakness, lethargy, dizziness
- Hypocalcemia
- Transient hypotension
- Dyspnea
Intolerable AE
- RR less than 12/min
- Pulmonary edema
- Absent DTR’s
- Chest pain
- Severe hypotension
- Altered LOC
- UOP less than 30mL/hr
- Serum Mg 10 mEq or more
Fetal
- Decreased FHR
- Decreased fetal movement

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29
Q

Antidote for magnesium sulfate overdose

A

Calcium gluconate

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30
Q

Nursing considerations for Magnesium sulfate

A

Monitor DTR’s
- Increased = low Mg, Decreased = high Mg
Foley for strict I/O’s
D/c infusion if intolerable AE occur

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31
Q

Contraindications for Magnesium sulfate

A

Myasthenia gravis
Hypocalcemia
Renal failure

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32
Q

Brethine (terbutaline) MOA

A

Relaxes smooth muscle
Inhibits uterine activity
Causes bronchodilation

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33
Q

Brethine (terbutaline) uses

A

Tx of preterm labor

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34
Q

Brethine (terbutaline) route and doses

A

SQ
0.25 mg q 4 hours
Not for more than 24 hours

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35
Q

Contraindications for Brethine (terbutaline)

A

Dilated to over 4 cm
Suspected heart disease (AE)
Pregestational or gestational diabetes (AE)
Preeclampsia/eclampsia
Hyperthyroidism
Glaucoma
Seizure disorder

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36
Q

Brethine (terbutaline) adverse effects

A

Maternal
- Tachycardia, palpitations, chest discomfort
- Tremors, dizziness, nervousness
- H/A
- N/V
- Hypokalemia, hyperglycemia, hypotension
Intolerable
- Tachycardia over 130
- BP lower than 90/60
- Chest pain (not just discomfort)
- Cardiac arrhythmias/MI
- Pulmonary edema
Fetal
- Tachycardia
- Decreased FHR variability

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37
Q

Nursing considerations for Brethine (terbutaline)

A

Notify provider of intolerance adverse effects
Typically continuous fetal monitor is required

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38
Q

Procardia (nifedipine) MOA

A

Relaxes smooth muscle (uterus) by blocking calcium entry

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39
Q

Procardia (nifedipine) route and dose

A

PO
Initial dose: 10-20mg q 3-6hrs - until contractions are rare
Maintenance dose: 30-60mg q 8-12 hrs

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40
Q

Procardia (nifedipine) adverse effects

A

Maternal
- Hypotension
- H/A
- Flushing, dizziness, nausea
Fetal
- Hypotension

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41
Q

Contraindications for Procardia (nifedipine)

A

Intrauterine infection
HTN, cardiac disease
Do not give with magnesium sulfate (calcium is the antidote)
Do not give with or immediately after Brethine (terbutaline)
Do not give sublingual

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42
Q

Betamethasone or Dexamethasone MOA

A

Glucocorticoid
Stimulates fetal lung maturity by promoting the release of enzymes that produce lung surfactant

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43
Q

Betamethasone or Dexamethasone use

A

Prevent/reduce respiratory distress syndrome (RDS) in infants 24-34 weeks gestation
- Off label use

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44
Q

Betamethasone or Dexamethasone route and dose

A

IM
Betamethasone: 12mg in 2 doses, 24 hours apart
Dexamethasone: 6mg in 4 doses, 12 hours apart

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45
Q

Nursing consideration for Betamethasone or Dexamethasone

A

Must be given IM (ventral gluteal or vastus lateralis)
Assess BG in pt with gestational/pregestational diabetes

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46
Q

Narcan (naloxone hydrochloride) use

A

Reverse opioid induced respiratory depression in mother or newborn

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47
Q

Narcan (naloxone hydrochloride) routes

A

IV, IM, or SQ

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48
Q

Narcan (naloxone hydrochloride) doses

A

Adult: 0.4-2 mg q 2-3 min until 10mg
Infant: 0.1 mg/kg for infants over 5 kg

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49
Q

Narcan (naloxone hydrochloride) adverse effects

A

Hypotension or HTN
Tachycardia, hyperventilation
N/V
Sweating, tremors

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50
Q

Nursing considerations for Narcan (naloxone hydrochloride)

A

Delay breastfeeding for 2 hrs after last dose
Do not use if mother or baby is opioid dependent

51
Q

Rhogam (rhophylac) MOA

A

Concentrated immunoglobulin
Suppresses immune response in nonsensitized Rh-negative women who may have infant with Rh-positive blood

52
Q

Rhogam (rhophylac) use

A

Prevents the production of anti-Rho(D) antibodies in Rh-negative mothers

53
Q

Contraindications for Rhogam (rhophylac)

A

Rh positive moms
Sensitized moms (have anti-Rho(D) antibodies)

54
Q

Rhogam (rhophylac) route

A

IM - deltoid or gluteal muscle

55
Q

Rhogam (rhophylac) administration considerations

A

All Rh-negative moms receive dose 28 wks antepartum
All Rh-negative moms with Rh-positive baby receive 2nd dose within 24 hrs of delivery
Rh-negative moms with invasive testing or could mix blood with fetus receive it

56
Q

Nursing considerations for Rhogam (rhophylac)

A

Observe for 20 mins after administration for reaction
Document lot and expiration date
Made from human plasma - Jehovah’s Witness

57
Q

Rubella vaccination uses

A

Provides immunity to non-immune mothers

58
Q

Nursing considerations for Rubella vaccination

A

Do not give to pregnant pt
Give postpartum
Do not get pregnant for 28 days after administration
Breastfeeding is ok (does not pass through breast milk)
If given with Rhogam check titer after 3 months
Do not give if living with immunocompromised person

59
Q

Congenital Rubella Syndrome (CRS) birth defects

A

Hearing loss
Eye defects
Heart defects
Developmental delays
Neurological defects
- Also miscarriage if rubella is contracted in early pregnancy

60
Q

Rubella infection effects on the mother

A

Mild illness
Arthritis/Arthralgia
Rare - encephalitis or thrombocytopenia

61
Q

Risks of rubella infection across each trimester

A

1st: Highest risk for severe fetal effects
2nd: Risk of CRS decreases, but still significant
3rd: Risk is lower, but can still cause late-onset issues

62
Q

Antepartum

A

During pregnancy

63
Q

Nagele’s rule

A

How to determine due date
Last menstrual period - 3 months + 7 days = Estimated date of confinement (EDC)

64
Q

Gravida

A

Number of pregnancies, regardless of outcome

65
Q

Para

A

Term: After 37 wks
Preterm: 20-36 6/7 wks
Abortion: Spontaneous (miscarriage/SAB) or elective (EAB)
Living: Living children

66
Q

What does G1 P2 mean

A

Twins

67
Q

Fundus

A

Top of uterus

68
Q

Fundal height

A

Should measure in cm how many wks pregnant you are
18 cm = 18 wks

69
Q

Intrapartum

A

During labor

70
Q

Tocodynamometer (toco)

A

External monitoring during labor
Measures uterine activity
Strapped directly over fundus
Records activity on bottom line of strip

71
Q

Where are FHT best heard

A

Posterior chest wall of fetus

72
Q

How often are cervical assessments done

A

q1-2h
Sterile vaginal exam
Assessing for: Dilation, effacement, station (baby head placement), membrane status

73
Q

First Leopold’s maneuver

A

Palpate upper abd with both hands
Head = firm
Butt = soft
- Feeling if baby is head down or breach

74
Q

Second Leopold maneuver

A

Move hands towards pelvis
Back = smooth
Feet/arms = Bumpy

75
Q

Third Leopold maneuver

A

Palpate symphis pubis to see if fetal head is engaged

76
Q

Fourth Leopold maneuver

A

Face towards woman’s feet, at their head
Move hands from upper to lower abd, feeling for fetal head

77
Q

Post partum assessment acronym

A

Breasts
Uterus
Bowels
Bladder
Lochia (discharge after birth)
Episiotomy/laceration/C section

78
Q

Involution

A

The rapid reduction of uterus size and return to similar prepregnancy state
- Takes ~6wks

79
Q

What should the fundal position be immediately after birth

A

Midway between symphysis pubis and umbilicus

80
Q

What happens to fundal position 6-12 hrs after delivery

A

Fundus rises back to the level of the umbilicus

81
Q

When does fundus start to descend

A

Descends 1cm or 1 fb per day on the first postpartal day

82
Q

Boggy fundus

A

Fundus rises as it fills with blood and clots
When the uterine muscles fail to contract properly, the fundus becomes boggy instead of firm

83
Q

What is the intervention if fundus is high and deviated to the right

A

Have pt empty bladder

84
Q

Rubra

A

Type of Lochia
Bright red
First 2-3 days

85
Q

Serosa

A

Type of Lochia
Light pink or brown
Days 4-10

86
Q

Alba

A

Type of Lochia
Creamy yellow
Days 11 - 4 wks

87
Q

Normal RR for newborns

A

30-50 breaths per min
60-70 during delivery

88
Q

Acrocyanosis

A

Peripheral cyanosis, normal finding

89
Q

Abnormal findings for newborns

A

Retractions, grunting, nasal flaring
- Indicate respiratory distress

90
Q

Normal types of breathing for newborns

A

Diaphragmatic (diaphragm breathing)
Shallow/irregular
Synchronous chest movement
Short episodes of apnea
Nose breathers

91
Q

Normal neonatal HR

A

120-130
100 when sleeping
120-160 when awake
180 when crying

92
Q

What does vitamin K injection do for babies

A

Activates coagulation factors
Without it babies have risk of bleeding - no surgery/procedures

93
Q

What babies are at risk for bleeding

A

Moms who took:
Dilantin or Phenobarbital
Heparin
Aspirin

94
Q

Meconium stool

A

Thick, tarry stool formed in utero
Consists of amniotic fluid and mucus cells
Released in utero with fetal distress

95
Q

Transition stools

A

Thin, brown green
Day 2-3
Breastfed: Yellow
Bottle: Pale brown

96
Q

How many stools/day is normal

A

2-3, up to 10 stool per day

97
Q

How often is Apgar score done

A

1 min and 5 mins

98
Q

Normal neonatal length

A

18-22 inches

99
Q

Normal BPD (biparietal diameter) for neonates

A

32-37 cm

100
Q

Normal head measurement for neonate

A

2cm more than chest

101
Q

Normal chest measurement for neonates

A

30-35 cm

102
Q

Neonatal temperature

A

97.7-98.6
Q15mins for first hour, then Q1H for 4hrs

103
Q

What does a decreased temp indicate in babies

A

Infection

104
Q

What does increased temp indicate in babies

A

Dehydration/overheating

105
Q

Normal BP for newborns

A

80-60/45-40 at birth
100/50 at day 10

106
Q

Mottling (newborn)

A

Lacy pattern of blood vessels due to circulation fluctuations

107
Q

Harlequin sign

A

Deep red color on one side
Lasts 1-20 mins
Due to vasomotor instability
No clinical significance

108
Q

Erythema toxicum

A

A perifollicular eruption of skin lesions
Firm, vary in size white/yellow papules
“newborn rash” no tx

109
Q

Vernix

A

White, cheesy substance lubricates the skin and provides protection

110
Q

Milia

A

Sebaceous glands
White spots
No tx necessary

111
Q

Telangiectactic nevi

A

“stork bites”
Pink/red spots
Found on nose, eyelids, neck, occipital bone
Disappears by 2nd birthday

112
Q

Mongolian spots

A

Areas of blue/black pigment on buttock
Common in darker skin
Disappears by age 2

113
Q

How many arteries and veins does umbilical cord have

A

2 arteries, 1 vein
(2 areolas, 1 vagina)

114
Q

When does the cord start to dry

A

Within 1-2 hours

115
Q

When does cord start to slough off

A

7-10 days

116
Q

Hypospadius

A

Newborn male
Urinary meatus on ventral side

117
Q

Epispadias

A

Newborn male
Urinary meatus on dorsal side

118
Q

Phimosis

A

Newborn male
Foreskin cannot be pulled over glans

119
Q

Hydrocele

A

Collection of fluid surrounding testes in the scrotum

120
Q

When is circumcision performed

A

After 24 hrs of birth, day of discharge
After vitamin K
Stable temperature

121
Q

Potential side effects of circumcision

A

Hemorrhage
Infection
Difficulty voiding
Discomfort
Adhesions
Entrapment and urethral damage

122
Q

Comfort measure for circumcision

A

Sucrose water on pacifier

123
Q

Signs of distress in neonates

A

Respirations under 60
Sternal retractions
Cyanosis
Abd distention
Failure to pass meconium - increased bilirubin
Temp below 97.7
Glucose below 40
Vomiting green
Jaundice within 24 hrs

124
Q

Wharton jelly

A

Mucoid connective tissue that surrounds the two arteries and one vein of the umbilical cord

OB (6 decks)

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