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NRSE-4570 Childbearing Families > Exam 1 Study Guide > Flashcards

Exam 1 Study Guide Flashcards

1
Q

What screening tests are performed during the first trimester to detect congenital anomalies?

A

-First Trimester screening
-triple screen
-quad screen
-MAFP
-Level II ultrasound/ targeted ultrasound

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2
Q

What is the level II ultrasound/ targeted ultrasound? Why is done at 18 weeks

A

complete scan of fetal anatomy ; when fetuses begin to develop at own pace

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3
Q

If something shows abnormal or high risk for a congenital condition on a screening tool, we may recommend our patient get

A

diagnostic tests

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4
Q

What is the first trimester screening?

A

-combination of fetal ultrasound and maternal blood testing to determine risk of genetic defects

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5
Q

What three things does the triple screen assess?

A

-AFP
-hCG
-estriol

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6
Q

What four things does the quad marker screen assess? (done during 16-18 weeks of pregnancy)

A

-hCG
-AFP
-estriol
-Inhibin A

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7
Q

MAFP test assesses (during weeks 15-18 of pregnancy)

A

-only amount of AFP

-abnormal findings may yield the quad marker screening

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8
Q

Low levels of AFP indicate a risk for

A

down syndrome

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9
Q

High levels of AFP can indicate a risk for

A

neural tube defects

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10
Q

Levels higher than expected for hCG and Inhibit A increase risk for

A

down syndrome

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11
Q

Levels lower than expected range for estriol can indicate

A

down syndrome

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12
Q

What is amniocentesis? What does it test for?

A

-transabdominal aspiration of amniotic fluid from the uterus
-performed between 15-20 weeks

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13
Q

Should bladder be empty or full for amniocentesis?

A

empty to prevent risk of puncture

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14
Q

What may be injected during amniocentesis if the mother is RH negative

A

Rho(D) immune globulin

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15
Q

Nursing actions during amniocentesis?

A

-baseline vital signs and FHR
-monitor VS, FHR, and uterine contractions throughout and 30 min after procedure
-allow client to rest for 30 min prior

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16
Q

Complications of amniocentesis include

A

-leakage of amniotic fluid
-maternal or fetal hemorrhage
-infection
-fetal damage or death
-miscarriage and preterm labor

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17
Q

Nursing actions to monitor for complications after amniocentesis

A

monitor VS, FHR, temp, respiratory status, uterine contractions, vaginal discharge

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18
Q

What is chorionic villus sampling?

A

-sampling is the assessment of a portion of the developing placenta

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19
Q

Why is CVS an advantage over amniocentesis

A

-can be done at 10-13 weeks
-results are quicker

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20
Q

The potential for fetal anomalies and death is higher in amniocentesis or CVS?

A

CVS

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21
Q

Should bladder be full or empty during CVS

A

-full bladder

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22
Q

Complications of CVS include?

A

-spontaneous abortion
-fetal limb loss
-miscarriage
-chorioamnionitis an rupture of membranes

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23
Q

What occurs during placenta previa?

A

-placenta implants in the lower segment of the uterus
-may cover all or part of the cervical opening

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24
Q

Partial and complete previa will result in?

A

c-section

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25
Q

Placenta previa will result in bleeding during which trimester?

A

3rd

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26
Q

Expected findings with placenta previa?

A

-painless bright red bleeding
-baby breeched, transverse, etc
-soft non-tender uterus
-fundal height greater than expected
-VS WDL
-reassuring FHR
-decreasing urinary output

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27
Q

Laboratory tests to monitor during placenta previa ?

A

-HGB and HCT
-CBC
-blood type and RH
-coagulation profile
-Kleihauer - Betke test

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28
Q

Nursing care for placenta previa

A

-assess for bleeding, leakage, or contractions
-NO vaginal exams or anything inserted into vagina
-Pt is on BR with oxygen equipment available
-IV fluids, blood products, and medications (betamethasone)

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29
Q

Why is betamethasone given during placenta previa

A

used to develop lungs in the fetus

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30
Q

What is placental abruption?

A

-premature separation of the placenta from the uterus (can be partial or complete detachment)

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31
Q

What is the leading cause of maternal death?

A

placental abruption

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32
Q

When does placental abruption usually occur?

A

-after 20 weeks gestation

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33
Q

Risk factors for placenta abruption

A

-maternal HTN
-MVA or other traumas
-cocaine and smoking
-multifetal pregnancy
-premature rupture of membranes

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34
Q

Expected findings of placenta abruption

A

-sudden onset of intense localized uterine bleeding with dark vaginal bleeding
-uterine board-like tenderness
-fetal distress
-findings of hypovolemic shock
-hypertonicity contractions

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35
Q

Laboratory tests used with placental abruption

A

-Hgb and Hct (decreased)
-coagulation factors decreased
-clotting defects (DIC)
-Kleihauer -Betke tests

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36
Q

What may be used to test fetal well-being during placental abruption

A

Biophysical profile and fetal well-being

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37
Q

Nursing care for placental abruption

A

-palpate uterus for tenderness and tone
-perform serial monitoring of fundal height
-assess FHR pattern
-provide emotional support

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38
Q

What is the treatment for placental abruption

A

Immediate birth

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39
Q

What is an ectopic pregnancy?

A

the abnormal plantation of a fertilized ovum outside of the uterine cavity usually in the fallopian tube

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40
Q

What is the second most common cause of bleeding in early pregnancy and a leading cause of infertility

A

ectopic pregnancy

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41
Q

Risk factors for ectopic pregnancy?

A

STI’s, reproductive technologies, tubal surgery, IUDs

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42
Q

Expected findings for ectopic pregnancies

A

-unilateral stabbing pain
-tenderness in lower quadrant
-scant dark red or brown vaginal spotting
-radiating shoulder pain
-hemorrhage and shock findings

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43
Q

Rapid treatment for ectopic pregnancy includes?

A

-medical management is rupture has not occurred and tube preservation desired
-methotrexate: inhibits cell division and embryo enlargement
-salpingostomy: done to salvage fallopian tube if not ruptured
-laparoscopic salpingectomy: performed when the tube is ruptured

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44
Q

Nursing care during ectopic pregnancy?

A

-replace fluids, maintain electrolyte balance
-client education: do not take vitamins with folic acid and avoid sun exposure

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45
Q

Presumptive signs of pregnancy

A

amenorrhea, fatigue, nausea and vomiting, urinary frequency, breast changes, uterine enlargement

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46
Q

Best way to remember presumptive signs

A

-think they could be caused by something else

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47
Q

Probable signs of pregnancy

A

-abdominal enlargement
-Positive pregnancy test
-Hegar’s sign: softening and compressibility of lower uterus
-Chadwick’s sign: deepened violet-blueish color of cervix and vaginal mucosa
-Braxton-hicks contractions
-fetal outline felt by examiner

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48
Q

Positive signs of pregnancy

A

-auscultaion of fetal heart sounds
-fetal movements felt by examiner
-visualization of the embryo or fetus

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49
Q

What is a non-stress test?

A

most widely used technique for antepartum evaluation of fetal well-being performed during the third trimester

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50
Q

What does the non-stress test evaluate

A

-relationship between FHR and fetal movement during a 20-30 minute period

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51
Q

Reactive non-stress test results will show

A

-two or more accelerations within a 20 minute period

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52
Q

Nonreactive stress test results will show

A

fewer than two accelerations in a 40 minute period

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53
Q

What can we do to stimulate fetal movement during the non-stress test

A

-give juice, ice water, or leave on for longer

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54
Q

A disadvantage of the non-stress test includes

A

high rate of false nonreactive strips

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55
Q

If a non stress test shows to be non-reactive, the patient will then have to have

A

a contraction stress test or BPP

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56
Q

What is a Biophysical Profile test (BPP)

A

-a real time ultrasound to visualize physical and physiological characteristics of the fetus and observes for fetal biophysical responses to stimuli

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57
Q

Essentially, a BPP is a combination of

A

FHR monitoring and fetal ultrasound

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58
Q

Indications of a BPP include

A

-nonreactive stress test
-suspected oligohydraminos (not enough) or polyhydraminos (too much) amniotic fluid
-suspected fetal hypoxemia or hypoxia

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59
Q

What is being assessed during a BPP

A

-FHR, fetal breathing, body movements, fetal tone, amount of amniotic fluid

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60
Q

A score of 8-10 with a BPP indicates?

A

normal

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61
Q

A score of 4-6 on the BPP indicates

A

abnormal, suspect chronic fetal asphyxia

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62
Q

A score of less than 4 on the BPP indicates

A

abnormal, strongly suspect chronic fetal asphyxia

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63
Q

How is the nipple-stimulated contraction stress test performed

A

-lightly brushing palm on nipples for two minutes which stimulates the release of oxytocin, and then stopping the nipple stimulation when a contraction begins. The same process is repeated after a 5 minute rest period

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64
Q

What pattern of contractions must be completed to use as assessment data during the nipple stimulating stress test?

A

-3 contractions within a ten minute time period
-duration must be 40 to 60 seconds

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65
Q

What should be avoided to prevent pre-term labor with a contraction stress test?

A

tachysystole of the uterus: uterine contractions of 90 seconds or 5 contractions in 10 minutes

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66
Q

what is a oxytocin stimulated contraction test?

A

IV administration of oxytocin to induce uterine contractions

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67
Q

Why is the oxytocin-stimulated contraction test not used as first line?

A

-contractions started with oxytocin can be difficult to stop and can lead to preterm labor

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68
Q

Contraindications of oxytocin stimulated contraction test?

A

-placenta previa, vasa previa, preterm labor, multiple gestations, previous classic incision from a cesarean birth, reduced cervical competence

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69
Q

What is a positive result of the stress test?

A

-abnormal finding
-consistent late decelerations with 50% or more of the contractions

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70
Q

Late decelerations on the contraction stress test is indicative of

A

uteroplacental insufficiency

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71
Q

Variable decelerations during the contraction stress test is indicative of

A

cord compression

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72
Q

Early decelerations on the stress tests may indicate

A

fetal head compression

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73
Q

A negative (normal finding) on the CST presents as

A

-in a 10 minute period, with 3 uterine contractions, there are no late decelerations of the FHR

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74
Q

Complications of the contraction stress tests include

A

potential for preterm labor

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75
Q

What is quickening?

A

slight fluttering movements of the fetus felt by the client

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76
Q

When is quickening felt?

A

16 - 20 weeks

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77
Q

What are monozygotic twins?

A

‘identical’ from one ovum and one sperm

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78
Q

What are dizygotic twins?

A

‘fraternal’ from two ova and 2 sperm

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79
Q

Do identical twins usually have one or two placentas?

A

one common placenta

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80
Q

Do fraternal twins have one or two placentas

A

two placentas

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81
Q

the formation of dizygotic twins

A

two ova, two sperm –> two blastocysts –> two amnions and two chorions

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81
Q

the formation of monozygotic twins

A

-one sperm, one ovum –> one blastocyst –> one chorion and two amnions

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82
Q

How long does gestation last

A

280 days, 40 weeks, 10 lunar months, 9 calendar months

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83
Q

When is the first day of pregnancy considered

A

1st day of LMP

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84
Q

what is the embryonic stage?

A

day 15 through 8 weeks gestation

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85
Q

The embryonic stage is the most critical time in

A

the development of organ systems

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86
Q

What stage are embryos most vulnerable to malformations caused by environmental teratogens

A

embryonic stage

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87
Q

What is the fetal membrane in the embryonic stage?

A

amnion and chorion

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88
Q

The amnion is the ____ membrane and the chorion is the ______ membrane

A

inner ; outer

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89
Q

What does the amniotic fluid do?

A

cushions against impact, maintains a stable temp, allows symmetric development, prevents membrane from adhering to developing fetal parts, allows room and buoyancy for fetal movement

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90
Q

The placenta prevents direct contact between

A

fetal and maternal blood

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91
Q

What are the functions of the placenta

A
  1. transfer oxygen and nutrients
  2. remove waste products and carbon monoxide into maternal blood
  3. make hormones
  4. transfer antibodies from mother to fetus
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92
Q

What hormones are produced by the placenta?

A
  1. chorionic gonadotropin
  2. prolactin
  3. estrogen
  4. progesterone
  5. relaxin
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93
Q

the umbilical cord is comprised of

A

two arteries and one vein

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94
Q

The arteries in the umbilical cord carry _____ blood from fetus to mother whereas the vein carries _____ blood from mother to fetus

A

deoxygenated ; oxygenated

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95
Q

Vessels in the umbilical cord are surrounded by

A

Wharton’s jelly

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96
Q

All organ systems are present by

A

the end of week 8

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97
Q

When is the fetal stage?

A

9 weeks gestation until pregnancy ends

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98
Q

Amniotic fluid during the fetal stage may be made of

A

-fetus’ urine, diffusion from maternal blood

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99
Q

During the fetal stage, amniotic fluid increases

A

weekly to about a quart

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100
Q

Heart beat is detectable by doppler at

A

8 weeks

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101
Q

eyes, ears, nose, and mouth recognizable at

A

8 weeks

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102
Q

Quickening is first felt at about

A

20 weeks

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103
Q

Primitive breathing movements are noticed at about

A

20 weeks

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104
Q

Vernix caseosa is noticeable at

A

20 weeks (cheesy skin cream)

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105
Q

Lanugo is seen first at about

A

20 weeks

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106
Q

What week is the embryo in a c-shaped body and has a rudimentary tail?

A

5

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107
Q

What week is the head rounded and nearly erect with eyes that have shifted forward and closer together. Eyelids are also beginning to form?

A

7

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108
Q

What area is most likely to be damaged during childbirth?

A

perineum (between vagina and anus)

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109
Q

What is an episiotomy?

A

when a cut is made at the vagina to help with tearing (no longer common practice)

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110
Q

What hormone is produced during pregnancy?

A

human chorionic gonadotropin hormone (HCG)

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111
Q

How to calculate GTPAL

A

G = gravidity
T = # term deliveries 37 weeks or greater
P= # preterm deliveries less than 37 weeks
A = # abortuses < 20w or < 500 g
L = # living children

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112
Q

The patient is in her 3rd pregnancy. She has had 2 previous pregnancies, delivered at term, and has 2 living children. Calculate GTPAL

A

G3T2P0A0L2

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113
Q

this patient is not currently pregnant. she had 4 previous pregnancies, 2 delivered at term, 1 preterm, and 1 abortion, and has 3 living children. Calculate GTPAL

A

G4T2P1A1L3

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114
Q

this patient is not currently pregnant. she’s had 1 previous pregnancy, delivered preterm, and her child has deceased. Calculate GTPAL

A

G1T0P1A0L0

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115
Q

What is Naegele’s rule?

A

-take the first day of the last menstrual cycle
-subtract 3 months
-add 7 days (ADJUST THE YEAR!)

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116
Q

What is gravidity?

A

total number of times a patient has been pregnant

-nulligravida = 0
-primigravida = 1
-multigravida = 2nd or more

117
Q

What is parity?

A

number of pregnancies that reached > 20 w or fetus 500g or more

118
Q

Nullipara means

A

-never had pregnancy greater than 20 weeks or fetus 500g

119
Q

Primipara means

A

had pregnancy before, delivered at 20 w or greater or fetus was 500g or more

-fetus could have been born alive or dead

120
Q

Multipara means

A

2 or more pregnancies before, delivered at 20w or more or fetus 500g or more

121
Q

What is fundal height?

A

the distance between your pubic bone and the top of your uterus (measured in cm)

122
Q

When does fundal height begin being used in pregnancy?

A

20 - 24 weeks

123
Q

How do we know if fundal height is on track?

A

After abut 20 weeks of pregnancy, fundal height should be almost equal to gestational age

ex: @ 28 weeks, fundal height should be 28 cm

124
Q

What is urinary frequency during pregnancy?

A

When the woman feels she has to go more often because of the pressure exerted on the bladder

125
Q

Does the amount of urine being produced increase in pregnancy?

A

No –> just the amount of times they go

126
Q

When does urinary frequency begin in pregnancy?

A

first trimester

127
Q

During the second trimester, does urinary frequency increase or decrease?

A

may decrease because the baby is moving up in the abdomen

128
Q

Does urinary frequency increase or decrease during the third trimester?

A

increases again when baby begins effacement

129
Q

Facial edema, blurred vision, seeing floaters, edema in the hands, severe headaches, and epigastric pain are danger signs during pregnancy that may indicate

A

hypertensive condition or preeclampsia

130
Q

Burning during urination is a danger sign during pregnancy which may indicate

A

UTI

131
Q

severe vomiting is a danger sign during pregnancy and may indicate

A

hyperemesis gravidarum

132
Q

Diarrhea is a danger sign during pregnancy and may indicate

A

DHD, fluid and electrolyte imbalances

133
Q

Are fever and chills considered a danger sign with pregnancy?

A

yes

134
Q

Are abdominal cramping and vaginal bleeding considered danger signs of pregnancy?

A

yes

135
Q

After 38 weeks, a gush of fluid from the vagina may indicate

A

beginning of labor

136
Q

Before 38 weeks, a rush of fluid from the vagina may indicate

A

a pregnancy danger sign

137
Q

Abdominal pain and changes in fetal activity (I.e no fetal movement) may indicate

A

danger sign of pregnancy

138
Q

Flushed dry skin, fruity breath, rapid breathing, increased thirst, increased urination, and headache are danger signs of pregnancy. What may they indicate?

A

hyperglycemia

139
Q

Concurrent occurrence of clammy pale skin, tremors, irritability and lightheadedness are danger signs of pregnancy. What do they indicate>

A

hypoglycemia

140
Q

Dehydration of a pregnant mother may increase risk of

A

pre-term labor

141
Q

If a client experiences one of the danger signs of pregnancy, what should they do?

A

-at least contact the provider immediately

142
Q

Danger signs should be discussed with the client at what time?

A

At each pre-natal visit. Focus on danger signs most common in their current point of pregnancy

143
Q

What is supine hypotension?

A

-when a pregnant client lays on their back, the vena cava is compressed by the uterus which reduces blood supply to the fetus

144
Q

Symptoms of gestational hypotension

A

lightheadedness and faintness, pallor, clammy skin

145
Q

What may happen to the fetus during supine hypotension?

A

hypoxia

146
Q

How to alleviate supine hypotension

A

-lay on left side
-semi sitting position with the knees slightly flexed
-if on back / supine, place pillow under the hip

147
Q

What is polydramnios?

A

presence of too much amniotic fluid

-dx with a BPP test

148
Q

What is oligohydramnios?

A

not enough amniotic fluid

-dx with a BPP test

149
Q

A mom may present with these sx if she has polyhydramnios?

A

shortness of breath, abdominal pain, swelling in the legs

150
Q

What may polyhydramnios cause in the fetus?

A

-increased preterm births
-fetal malpresentation
-cord prolapse
-upper GI obstruction, neural tube defects, trisomy 13 and 18, abdominal wall defects

151
Q

What may oligohydramnios cause in the fetus?

A

-reduces cord compression –> fetal death and hypoxia
-birth defects
-miscarriage
-preterm birth
-still birth

152
Q

What is a neural tube defect?

A

when the neural tube does not close properly

(the neural tube closes to form brain, skull, back, and spine)

153
Q

What are the three most common neural tube defects

A

spina bifida, anencephaly, myelomeningocele, meningocele, and encephalocele

154
Q

What happens during Spina Bifida?

A

the spine does not develop completely

155
Q

What happens during anencephaly?

A

the brain and skull does not develop properly

156
Q

How can neural tube defects be prevented?

A

the intake of folic acid

157
Q

How much folic acid should clients of childbearing age take when not pregnant. How much should they take when pregnant?

A

400 mcg, 600 mcg

158
Q

What foods are high in folate?

A

-leafy vegetables, dried peas and beans, seeds, orange juice. Breads, cereals, and other grains sometimes contain folic acid

159
Q

If monozygotic twins implant in the womb and then split immediately, what will we see

A

shared placenta and separate inner sacs

160
Q

are monozygotic twins of the same sex?

A

yes

161
Q

If monozygotic twins separate before implanting in the womb, what will we see

A

separate placentas and separate inner sacs

162
Q

If monozygotic twins implant in womb and then split after, what will we see?

A

shared placenta and shared inner sac

163
Q
A
164
Q

Risks associated with twins include?

A

-high risk for preterm labor
-polyhydramnios
-hyperemevis gravidarum
-anemia
-preclampsia
-postpartum hemorrhage

165
Q

Fetal/newborn risks of twins?

A

-prematurity and intrauterine growth restriction
-respiratory distress
-birth asphyxia
-congenital anomalies
-twin to twin transfusion syndrome
-conjoined twins

166
Q

What is twin to twin transfusion syndrome?

A

transfusion of blood from one twin (Donor) to the other twin (recipient)

167
Q

Systolic blood pressure throughout preganncy

A

-slight or no increase from pre-pregnancy levels

168
Q

diastolic blood pressure throughout pregnancy?

A

-slight decrease around 24-32 weeks, but will gradually return back

169
Q

Gestational hypertension is commonly caused by

A

vasospasm contributing to poor tissue perfusion

170
Q

Factors of gestational hypertension

A

-occurs after week 20
-BP 140/90 on two separate occasions, 4 h apart
-no proteinuria, no edema
-BP back to base line 12 weeks after postpartum

171
Q

Factors of preeclampsia

A

-GH with addition of proteinuria 1+ or more
-transient headaches, irritability, edema

172
Q

Factors of severe preclampsia

A

-BP greater than 160/110
-3+ proteinuria
-oliguria
-creatinine elevated (1.1)
-headaches and blurred vision
-hyperreflexia with clonus
-extensive peripheral edema
-epigastric and RUQ pain
-thrombocytopenia
-hepatic dysfunction
-heart failure

173
Q

Factors of eclampsia:

A

-severe preclampsia
-new onset of seizures or coma
-preceded by: headache, severe epigastric pain, hyperreflexia

174
Q

What is HELLP syndrome?

A

-severe preeclampsia involving hepatic dysfuntion

175
Q

What is the acronym for HELLP sydrome

A

hemolysis –> anemia and jaundice
Elevated liver enzymes –> associated with lab tests, nausea, and vomiting
Low Platelets –> less than 10,000 , thrombocytopenia , s/s of bleeding

176
Q

what can we expect to see in clients with preeclampsia

A

severe continuous headache, nausea blurring of vision, flashes of lights or dots behind the eyes

177
Q

Risk factors for hypertension, preeclampsia, and eclampsia

A

-maternal age < 19 or > 40
-first pregnancy or multi fetus gestation
-DM, obesity
-autoimmune disorders
-chronic HTN

178
Q

Nursing care during gestational HTN

A

-assess LOC
-I and O’s, DW
-monitor VS
-perform NST, kick counts

179
Q

When patients have a history of early onset preeclampsia , what may be started?

A

-low dose aspirin therapy

180
Q

What antihypertensive medications may be used in preeclampsia/ G HTN

A

-methyldopa
-nifedipine
-hydralazine
-labetalol

181
Q

what type of antihypertensive drugs should pregnant women avoid

A

-ACE inhibitors (-pril) and Angiotensin II receptor blockers (ARBs, -sartan)

182
Q

What medication is given in ecampsia and severe preeclampsia to perform CNS depression and reduce risk of seizures

A

magnesium sulfate

183
Q

Sx of magnesium sulfate toxicity

A

B blood pressure decreased
U urine output less than 30 mL/hr
R respirations less than 12/min
P patella reflex absent

184
Q

Magnesium sulfate toxicity and how it affects the heart

A

causes dysrhythmias

185
Q

Magnesium sulfate toxicity and how it affects DTR/s

A

absence of deep tendon reflexes

186
Q

if magnesium toxicity is expected, the nurse should?

A

-discontinue the infusion
-administer calcium gluconate

187
Q

What should we monitor while our clients is on magnesium sulfate?

A

-VS, I & O (may use indwelling catheter), presence of headache and visual disturbances, fetal HR and activity

188
Q
A
188
Q

What is hyperemesis gravidarum?

A

-excessive N and V extending past 16 weeks
-can lead to weight loss, DHD, electrolyte imbalances, and ketonuria

189
Q

Expected findings with hyperemesis gravidarum

A

-excessive vomiting
-DHD, electrolyte imbalance
-increased pulse rate, decreased BP
-poor skin turgor, dry mucous membranes
-weight loss

190
Q

The most important initial laboratory test for hyperemesis gravidarum is

A

-urinarlysis for ketones and acetones
-may have elevated urine specific gravity

191
Q

Will Na, K, and Cl be elevated or decreased in hyperemesis gravidarum

A

decreased due to poor intake

192
Q

Will those with hyperemesis gravidarum develop metabolic acidosis

A

yes (secondary to starvation)

193
Q

Will those with hyperemesis gravidarum develop metabolic alkalosis?

A

yes (secondary to excessive starving)

194
Q

Patients with hyperemesis gravidarum will have increased or decreased levels of thyroid hormones

A

increased (most have hyperthyroidism)

195
Q

Will HCT be increased or decreased with hyperemesis gravidarum

A

-increased due to inability to retain fluid

196
Q

Nursing care for hyperemesis gravidarum?

A

monitor I & O, assess skin turgor and mucous membranes, monitor VS, monitor weight, have client remain NPO until vomiting stops

197
Q

Why is IV lactated ringers given for hyperemesis gravidarum?

A

replenish hydration

198
Q

What is another name for vitamin B6?

A

-folic acid
-pyridoxine

199
Q

Other than IV lactated ringers, what may also be given to treat hyperemesis gravidarum

A

Vitamin b6 and other supplements as needed /tolerated

200
Q

What antiemetic can be prescribed but used cautiously to treat hyperemesis gravidarum

A

metoclopramide

201
Q

Are liver enzymes elevated in hyperemesis gravidarum?

A

yes

202
Q

Discharge teaching for hyperemesis gravidarum?

A

advanced clear liquids and bland foods –> start with crackers/toast/cereal –> soft diet normal diet

203
Q

In severe cases of hyperemesis gravidarum, what may be considered to increase nutrition

A

feeding tube or TPN

204
Q

What is the ideal blood glucose level during pregnancy?

A

60-99 mg/dL fasting, less than or equal to 120 2 hr after meals

205
Q

What are increased risk to fetus from gestational diabetes

A

-macrosomia, birth trauma, electrolyte imbalances, neonatal hypoglycemia

206
Q

Why may urinal and vaginal infections occur in a fetus whose mom had GDM

A

increased glucose in the urine

207
Q

is polyhydramnios a risk factor in GDM?

A

yes (can lead to placental abruption, preterm labor, pp hemorrhage)

208
Q

Hyperglycemia can lead to excessive fetal growth known as

A

macrosomia

209
Q

Can ketoacidosis occur with GDM?

A

yes

210
Q

What four things will gestational hypertension lead to?

A

-placental abruption, kidney failure, preterm birth, fetal and maternal death

211
Q

s/s of hypoglycemia

A

shaking, weakness, hunger, blurred vision, nervousness, headache, cool and clammy skin

212
Q

s/s of hyperglycemia

A

3 P’s, nausea, abdominal pain, dry skin, flushed skin, fruity breath

213
Q

Physical assessment findings of GDM

A

-s/s of hypo and hyper, shaking, rapid pulse, shallow respirations, vomiting, excessive weight gain

214
Q

What is the glucose screening/ 1 hr glucose tolerance test

A

-50 g oral glucose –> assess glucose levels one hour later (done at 24-28 weeks)

215
Q

Is fasting necessary during the one hour glucose tolerance test

A

no

216
Q

A positive 1 hr glucose tolerance test will have a blood glucose of

A

130 to 140

217
Q

If a client tests positive for the 1 hr glucose tolerance test, they must go for

A

oral glucose tolerance test

218
Q

is fasting indicated for the 3 hr oral glucose tolerance test?

A

yes
-must fast overnight, avoid caffeine, and avoid smoking 12 hr before test

219
Q

How is the 3 hr oral glucose tolerance test performed?

A

-fasting glucose obtained –> give 100 g glucose –> serum levels drawn at 1, 2, and 3 hr

220
Q

What diagnostic procedures are done during GDM to asses the fetus?

A

BPP, amniocentesis to determine fetal lung maturity, non-stress test

221
Q

Initial treatment for GDM is?

A

-diet and exercise (if levels remain high, insulin is begun)

222
Q

what oral hypoglycemic agent may be used to treat GDM?

A

glyburide (most others are contraindicated)

223
Q

Client education with GDM?

A

-perform daily kick counts
-adherer to diet
-exercise
-self - administration of insulin
-understand need for postpartum laboratory testing to include blood glucose levels

224
Q

risk factors for cervical insufficiency?

A

-cervical trauma, short labors, early pregnancy loss, early dilation

224
Q

What is cervical insufficiency?

A

expulsion of the products of conception occur (premature cervical dilation and effacement)

225
Q

Expected findings with cervical insufficiency?

A

-pink- stained vaginal discharge or bleeding
-possible gush of fluid (membrane rupture)
-uterine contractions with the expulsion of the fetus

226
Q

What is the treatment for cervical insufficiency?

A

cerclage (best results if done before 12-14 weeks) and removed at 36 weeks

227
Q

What signs and symptoms do patients with cerclage/ cervical insuffiency need to report?

A

-rupture of membranes, infection, strong contractions less than 5 minutes apart, urge to push, severe pressure,

228
Q

Why do clients with cervical insuffiency need to increase fluids

A

help relax uterus and prevent contractions

229
Q

Should intercourse be avoided with cervical insuffiency? should activity be limited?

A

-intercourse must be avoided
-activity restrictions and BR may be common

230
Q

What is a spontaneous abortion?

A

-when pregnancy ends before age of viability (20 weeks)

231
Q

What type of abortion has sx of mild cramps, slight spotting, no tissue passed, and cervix remains closed

A

threatened

232
Q

what type of abortion has mild to moderate cramps, moderate bleeding, no tissue passed, and the cervix is usually dilated?

A

inevitable

233
Q

What type of abortion has severe cramps, heavy bleeding, tissue passed, and a dilated cervix (which may contain tissue in the cervical canal)

A

incomplete

234
Q

what type of abortion contains mild cramps, minimal bleeding, passed tissue, and a closed cervix

A

complete (cervix closed after tissue passed)

235
Q

What type of abortion has no cramps, no bleeding/ minimal spotting, no tissue passed, and cervix closed

A

missed

236
Q

what type of aboriton is characterized by varied cramps, malodorous discharge, varied tissue passing, and a dilated cervix

A

septic

237
Q

what type of abortion is characterized by varied cramps, varied bleeding, tissue passed, and dilated cervical opening?

A

recurrent

238
Q

Risk factors for spontaneous abortions includes?

A

chromosome abnormalities, maternal illness, advanced maternal age, premature dilation, chronic maternal infections (STI), malnutrition, trauma, substance

239
Q

Expected findings with spontaneous abortion

A

abdominal cramping, rupture of membranes, dilation of the cervix, fever, manifestations of hemorrhage (hypotension and tachycardia)

240
Q

Why must an ultrasound be done for spontaneous abortion

A

-see if pregnancy is still viable/ assess FHR

241
Q

What do we consider viable pregancy?

A

-placenta attached to uterus, FHR present

242
Q

Do we do cervical exams for threatened spontaneous abortions?

A

no

243
Q

What is a dilation and curettage (D&C) for spontaneous abortions?

A

-used to dilate uterine walls and scrape out uterine contents for inevitable and incomplete abortions

244
Q

What is a dilation and evacuation (D&E)

A

dilation and evacuation of uterine contents after 16 wks gestation

245
Q

Prostaglandin and oxytocin treatment may be used for what type of spontaneous abortion?

A

-missed abortions
-induces uterine contractions to expulse products of conception

246
Q

clients at risk for spontaneous abortion (i.e they have a threatened abortion) must be kept on

A

bed rest

247
Q

What should nurses do with pads after spontaneous abortion

A

-observe the color, amount of bleeding, and amount of pads gone through

248
Q

what are danger signs of spontaneous abortion

A

heavy, bright red vaginal bleeding, elevated temperature, foul smelling vaginal discharge

249
Q

Clients that have had spontaneous abortions should do these to prevent infectoin

A

take abx, refrain from tub baths/sexual intercouse/ placing anything into vagina for 2 weeks

250
Q

What should clients with a threatened abortion avid

A

tub baths, sexual intercourse, placing anything into the vagina for two weeks

251
Q

What does pregnancy category A mean?

A

-no risk to fetus and was tested on pregnant women

252
Q

What does pregnancy category B mean?

A

no risk to fetus when tested on animals

253
Q

what should we advise clients to do regarding medications while pregnant?

A

-avoid all OTC medications, supplements, and prescription medications unless the provider supervising their care has knowledge of this practice

254
Q

What are normal kick counts that our client should observe to minimize fetal risk

A

-clients should count fetal activity 2-3 times a day for 2 hr after meal or at bedtime
-feal movements of less than 3/h or movements ceased entirely for 12 h indicate a need for further evaluation

255
Q

What is a fetal demise?

A

fetal death that occurs 20 weeks after gestation but before birth

256
Q

How is fetal demise diagnosed?

A

-ultrasound with no fetal heart beat or fetal cardiac activity

257
Q

The menstrual phase of the cycle lasts from days

A

1-6

258
Q

the proliferative phase of the cycle lasts from days

A

7-14

259
Q

the secretory phase of the cycle lasts from days

A

15-26

260
Q

Uterine bleeding usually begins ____ days after ovulation

A

14

261
Q

What days are considered a full menstrual cycel

A

1st day of period to the first day of the next period

262
Q

what happens during the proliferative phase of the menstrual cycle?

A

-estrogen increases enlarging endometrial glands
-edometrium begins to thicken
-cervical mucous becomes thin, clear, stretchy, and alkaline

-think of proliferative as ovaries using estrogen to prepare for ovulation

263
Q

What days are the proliferative phase

A

7-14 (ends day before ovulation)

264
Q

What happens during the secretory phase?

A

-progesterone stimulates a thickened endometrium to become vascularized and filled with glycogen and lipids
-this is to prepare for implantation if it is to occur

265
Q

If there is no fertilized egg by day 23 of the menstrual cycle, what happens during the secretory phase

A

estrogen and progesterone levels decrease and the corpus luteum begins to degeneratw

266
Q

What happens during the menstrual phase

A

-blood is released into the uterus and sloughing of endometrial linginh begins

267
Q

What is the fertile period?

A

-ova only fertile for 24 hours after ovulaton

268
Q

How long do sperm remain viable

A

2-3 days

269
Q

How long does it take for an egg to implant?

A

6 days

270
Q

The role of estrogen in the menstrual cycle?

A

-maturing egg follicle to prepare for ovulation (during proliferative phase)
-peaks again during secretory stage to prepare for implantation
-drops off for menstrual phase if no pregnancy

271
Q

The role of progesterone in the menstrual cycle??

A

-thicken endometrium to prepare for zygote
-relaxes uterus to maintain pregnancy

272
Q

What stage of the menstrual cycle does progesterone peak

A

secretory

273
Q

Both of these hormones drop off right before menstruation?

A

progesterone and estrogen

274
Q

what is the role of prostaglandin hormones

A

-help release of egg in ovulation
-increases labor contractions and opening of the cervix for birth

275
Q

What structure secretes progesterone during the menstrual cycle?

A

corpus luteum

276
Q

A drop in basal body temperature predicts

A

ovulation

277
Q

after ovulation, BBT spikes up

A

1/2 degree

278
Q

Mucous changes during ovulation?

A

-mucous thins to allow sperm to reach ovum

279
Q

what is spinnbarkeit

A

thin, clear, egg white sign of ovulation

280
Q

Fertilization occurs in the outer 1/3 of the tube and forms

A

zygote

280
Q

What is a cleavage?

A

-the splitting of the zygote as it travels the length of the tube (3-4)

281
Q

What is the morula?

A

-16 cell morula gives rise to blastocyst with a hollow cavity

282
Q

The blastocyst becomes what two structures?

A

-embryoblast –> embryo
-trophoblast –> becomes placenta

283
Q

The blastocyst imbeds into the placenta how many days after conception?

A

6-10 days

284
Q

What is the fundus?

A

the top of the uterus and where the t

284
Q
A
285
Q
A

NRSE-4570 Childbearing Families (4 decks)

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