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OB > Exam 1 : lecture 1 > Flashcards

Exam 1 : lecture 1 Flashcards

complications of pregnancy GBS cord prolapse fetal monitoring maternity nursing Pain management during labor Cervical Ripening Agents Augmentation/Induction of labor Glossary of terms

1
Q

Leopold’s maneuver

A

-checking felt position by external palpation

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2
Q

Vertex

A

baby’s head is down

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3
Q

Breech

A

baby’s buttocks or feet are presenting first

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4
Q

Gravida

A

how many times pregnant

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5
Q

Para

A

how many times delivered after 20 weeks

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6
Q

PROM

A

premature rupture of membranes

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7
Q

PPROM

A

-preterm premature rupture of membranes (amniotic fluid)

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8
Q

SROM

A

spontaneous rupture of membranes (on its own)

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9
Q

AROM

A

artificial rupture of membranes (use of amniotic hook by HCP)

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10
Q

Meconium

A

baby’s first BM

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11
Q

Amninoinfusion

A

normal saline infused into uterus while in labor

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12
Q

Amniocentesis

A

withdrawing amnio fluid through the mother’s abdomen

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13
Q

Cervical Ripening Agents

A
  • Prostaglandin E1, (PGE1): Misoprostol (Cytotec)
  • Prostaglandin E2 (PGE2): Dinoprostone (Cervidil Insert; Prepidil Gel)
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14
Q

Augmentation/Induction of labor

A

Oxytocin / Pitocin

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15
Q

Two most reported medical risk factors w/pregnancies

A

-hypertension
-diabetes

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16
Q

What does GTPAL stand for?

A

G = gravidity: # of pregnancies
T = term births: 37weeks to 42 weeks gestation
P = preterm births: 20 to 37 weeks gestation
A = abortions: pregnancy that ends prior to 20 weeks
L = living children

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17
Q

what is GBS?

A

Group B streptococcus (GBS) is a
naturally occurring bacterium found in
approximately 50% of healthy adults.
- Women who test positive in pregnancy
are considered carriers.

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18
Q

GROUP B STREP INFECTIONS
IN NEWBORNS

A
  • Early onset disease- occurs the first week
    of life
  • Early onset causes sepsis, pneumonia, and
    meningitis of newborns
  • Approximately one out of every 100-200
    newborns born to mothers who are GBS
    positive develop signs and symptoms of
    disease.
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19
Q

Assessments- complications of pregnancy: risk factors

A
  • Prematurity
  • Prolonged ROM of >18 hours
  • Maternal fever during labor
  • Previous infant with GBS
    infection
  • GBS during pregnancy
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20
Q

GBS screenings done when and how

A
  • Screen women at 35-37 weeks with vaginal
    and rectal culture
  • If no culture treat if: < 37 weeks, prolonged
    ROM>18 hours, maternal temperature of
    100.4 or greater
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21
Q

prevention of transferring GBS (positive mom) to baby

A
  • Can be prevented by giving pregnant women
    antibiotics (ABXs) IV during labor usually penicillin
  • ABs can only be taken during labor, not before,
    because bacteria grows quickly
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22
Q

what is cord prolapse?

A

emergency
-when the umbilical cord comes out before the baby

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23
Q

How does cord prolapse happen?

A

when the mother’s water breaks BEFORE the baby has moved into the birth canal

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24
Q

cord prolapse causes what?

A

cord is at high risk for cord compression, blocking oxygen, and blood flow to the baby = fetal distress
emergency C/S

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25
Q

Risks for cord prolapse

A

-SGA = Small baby (for gestation age)
- unengaged fetal part (head isnt well applied against the cervix)
-AROM
-Polyhydramnios (too much amniotic fluid)
Multiple gestation (if have twins or triplets)

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26
Q

cord prolapse medical management

A

Pt’s BOW breaks
1st: Look @ FHR, water, if cord is there

If cord prolapse has occurred
1st: call for help
2nd: w/sterile glove, elevate the presentation part off the cord
3rd: reposition (knee chest or trendelenburg) to relieve pressure
4th: educate/emotioinal support while staying calm
5th: call physican
6th: Prepare for c/s delivery - call for charge nurse, OR, NICU

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27
Q

What does CORD stand for in a cord prolapse situation?

A

For cord prolapse situation
C: call for help
O: organzine delivery
R: receive pressure on the cord
D: deliver

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28
Q

meds to use if cord prolapse were to happen

A

Tocolytic agents (terbutaline)
- to stop contractions
-route:SQ
-assess HR and lungs (bc this med increases HR)

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29
Q

Cord prolapse delivery

A

-in most cases emergency c/s
-if birth is imminent (baby right there) deliver vaginally immediately

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30
Q

Types of fetal monitoring

A

Electronic fetal monitoring
-hospital setting

Intermittent Auscultation
-Dr. office, or at homes/birthing settings

31
Q

Intermittent monitoring

A

low risk
-hand held dropper
-fetoscope
-intermittent auscultation (not continuous)

32
Q

Electronic fetal monitoring -types

A
  • external monitoring
  • internal monitoring
33
Q

External monitoring- placed where + indications

A

less invasive
external ultrasound (US) transducer
- for FRH
- placed in lower quadrants of mom; below umbilicus
- only this (round) US gets US jelly

external TOCOtransducer
- for uterine contractions
- placed above umbilicus

34
Q

Internal monitoring- placed where + indications

A

most invasive+ more accurate than external monitoring
internal fetal scalp electrode (FSE)
- measures the FHR

intrauterine catheter
(IUPC)
-measures strength of uterine contractions internally

35
Q

What must be done PRIOR to do internal monitoring

A

Membranes must be ruptured + cervix dilated at least to 2cm

36
Q

Guidelines for assessing FHR

A

-Initial 10–20-minute continuous FHR assessment

-Intermittent auscultation every 30 minutes during labor for low risk and every 15 minutes for high-risk woman.

-During second stage, every 15 minutes for
low risk and every 5 minutes for the high risk during pushing

37
Q

how to count contractions

A

Duration: beginning to end of one contraction (how long they are lasting)

Frequency: beginning of one contraction to the beginning of the next one (how far apart they are)

38
Q

Normal: baseline FHR

A

110-160 for 10 mins

39
Q

Abnormal: baseline Tachycardia FRH

A

FHR>160 for >10 mins

40
Q

Abnormal: baseline Bradycardia FRH

A

FRH<110 for >10 mins

41
Q

Normal Variability

A

Moderate variability
FHR goes up and down

42
Q

Abnormal Variability

A

Minimal to absent variability

43
Q

Tachycardia FHR-usually a sign of..

A

*early sign of fetal hypoxemia (baby not getting enough oxygen)
-is mom dehydrated?
- is mom any BP meds?
- does mom have a fever?
- infx?
abnormal and provider should be contacted

44
Q

3 key aspects to determine if FHR is normal + good

A

Rate
variability
any periodic change

45
Q

Nursing interventions if FHR is tachycardia

A

-take mom’s temp, any elevation? (report everything to dr)
-is she @ risk for infx / PROM ?
-dehydrated/ SOB? (PRN orders for a IV bolus)
- usage of drugs or drug abuse?

46
Q

FHR-Bradycardia: causes

A

-Maternal supine position (laying on back)
- Hypoxia
- Medications
- Maternal hypotension
- Cord prolapse ( cord compression )
- Rapid fetal descent (mom delivers v fast _ in response the baby’s FHR will fall)

47
Q

FHR-Bradycardia: nursing interventions

A

-Maternal supine position: change position/to side
-Maternal hypotension: Prior to epidural 1 L bolus LR given via IV

48
Q

Baseline Variability significance

A

Most important characteristic bc it is the paramount indicator of a well oxygenated fetus

49
Q

What is absent variability

A

ABNORMAL!!!!
0 BPM + is a straight line
needs immediate attention

50
Q

what is minimal variability

A

ABNORMAL!!!!
5 or less BPM
*can result from fetal hypoxemia

51
Q

what is moderate variability

A

NORMAL!!WANT!!
6-25 BMP

52
Q

What makes up periodic changes?

A

-accelerations (visually abrupt increase but are cherry on top; normal)
-decelerations (normal; early) (abnormal;variable, late, prolonged)

53
Q

periodic changes: accelerations

A

-fetal movement
-contractions
-accelerations are positive

54
Q

periodic changes: what makes an accelerations

A

Transient increases above the FHR baseline
an acceleration last >15-20secs bpm before going back to baseline

55
Q

Periodic changes: types of decelerations

A

-early (normal + could be an expected finding)
-late (abnormal)
-variable (abnormal)
-prolonged (abnormal)

56
Q

Periodic changes: when do early decelerations occur?

A

when fetal head is compressed; usually around 8 cm dilated
-called transition period; when pt is almost ready to start pushing
-occurs ONLY at the same time as contractions on strip

56
Q

Periodic changes: early decelerations - how do they look on the monitor

A

-early decelerations mirror contractions

57
Q

Periodic changes: early decelerations- nursing interventions

A

cervical exam to check for size of dilation

58
Q

Periodic changes: Variable deceleration- what is caused by?

A

caused by cord compression
ABNORMAL

59
Q

Periodic changes: Variable deceleration- what do they look like on the strip

A

can occur w or w/out contractions
-are very abrupt and look like Vs + Ws
-crowed + not spread out on the strip

60
Q

Periodic changes: Variable deceleration- Nursing interventions

A

change position (to side)

61
Q

Periodic changes: Late deceleration- what is it?

A

ABNORMAL
-due to uteroplacental insufficiency = baby not getting enough oxygen

62
Q

Periodic changes:Late deceleration- what does this indicate?

A

indicates presence of fetal hypoxemia stemming from insufficient placental perfusion during contractions

63
Q

Periodic changes:Late deceleration- what does it look like?

A

the deceleration in the heart rate comes AFTER the contraction
-Late onset + HR doesn’t go back to normal baseline UNTIL contraction is OVER/HAS PAST

64
Q

Periodic changes: nursing interventions on all ABNORMAL FRH/variability/periodic changes on strips

A

intrauterine Resuscitation shorter than POISON but same interventions
1. change maternal position (on side)
2. increase IV rate (250-500 ml bolus bolus of LR solution)
3. O2 8-10 L/min via mask
4. notify provider
5. start planning delivery

65
Q

Periodic changes: Prolonged decelerations- what is it?

A

ABNORMAL
-decrease in FHR of at least 15 bpm BELOW the baseline + lasting MORE than 2 mins BUT LESS THAN 10 mins (if >10mins = bradycardia)

66
Q

Periodic changes: Prolonged decelerations- what does it indicate ?

A

indicates there is a disruption in fetal oxygen supply

67
Q

what does POISON stand for + used for?

A

for decelerations
P: position change
O: oxytocin/Pitocin off
I: IV (increase fluids)
S: sterile vaginal exam
O: oxygen 8-10 L/min via mask
N: notify provider

68
Q

FHR patterns: normal and abnormal categories

A

normal = category 1
abnormal = category 3

69
Q

FHR patterns: category 1- what is it?

A

NORMAL
-baseline rate 110-160 bpm
-moderate variability
-early decelerations either present OR absent
-accelerations either present OR absent
-late or variable decelerations ARE ABSENT

70
Q

category 2 FHR patterns??

A
71
Q

FHR patterns: category 3 - what is it?

A

ABNORMAL
Absent baseline variability with
-recurrent late decelerations
-recurrent variable decelerations
-bradicardia
-sinusoidal pattern (severe fetal anemia)
ALL indicate hypoxemia

72
Q

What is VEAL CHOP

A

Place here

73
Q

Nursing interventions for treatment of non-reassuring FHR patterns (aka fetal distress) in addition to POISON

A

-Amnioinfusion (through internal monitoring; indicated for cord compression)

-Stimulation; scalp or fetal acoustic stimulation (Buz abdomen or touch baby’s head for cervical exam to see for any activity; indicated to look for accelerations)

OB (8 decks)

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