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NSG 211 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

what are the 5 factors that affect the process of labor and birth?

A

Passageway
Passenger
Passage and passenger relationship
Physiological forces of labor
Psychologic response

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2
Q

what is the favorable shapes of the pevic inlet during birth?

A

Gynecoid and Anthropoid

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3
Q

what are the unfavorable shapes of the pelvic inlet during birth?

A

Android and Plataploid

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4
Q

what are fontanelles?

A

intersections of cranial sutures

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5
Q

what is the posterior fontanelle?

A

back of head, forms a triangle, and closes in 8-12 weeks

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6
Q

what is the anterior fontanelle?

A

front of head, forms a diamond, and closes by 18 mon

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7
Q

what can closed sutures with no fontanelle cause?

A

Skull fractures

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8
Q

what is a fetal lie?

A

relation of the fetal spine to maternal spine

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9
Q

what is a longitudal fetal lie?

A

fetus is vertical

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10
Q

what is a transverse fetal lie?

A

fetus is perpendicular to maternal spine (right angle, laying from side to side)

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11
Q

what is attitude?

A

relation of fetal parts to one another
-flexion is normal

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12
Q

what is presentation r/t the fetus/passenger?

A

the part of the fetus that enters the pelvis first and leads through the birth canal

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13
Q

what is a cephalic presentation?

A

fetal head is presenting

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14
Q

what is a breech presentation?

A

buttock or feet is presenting

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15
Q

what is a shoulder presentation?

A

acromium process of scapula is presenting

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16
Q

which presentation is the only one who can result in a natural birth?

A

Cephalic
- vertex presentation is normal and most common

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17
Q

what is engagement?

A

when largest transverse diameter of fetus has passed through pelvic inlet
“0 station”

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18
Q

when does engagment occur in a primigravida mother?

A

before labor

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19
Q

when does engagement occur in a multipara?

A

not until labor is established

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20
Q

what is the station?

A

location of the fetus in relation to an imaginary line btwn maternal ischial spines

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21
Q

what are the number ranges of a station?

A

-5 is high towards belly button
0 is in middle of ishical spines
5 is at bottom of ischial spines ready to be birthed

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22
Q

what is a primary power?

A

involuntary uterine contractions

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23
Q

what is a secondary power?

A

mothers bearing down efforts

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24
Q

what is a hypertonic uterus and what can it cause?

A

uterus does not relax between contractions
- can cause fetal distress

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25
Q

what does progesterone do for the labor process?

A

relaxes smooth muscle

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26
Q

what does estrogen do for the process of labor?

A

stimulates uterine contractions

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27
Q

what are the possible causes of labor onset?

A

Progesterone withdraw hypothesis
Prostoglandin hypothesis
Corticotropic releasing hormone hypothesis

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28
Q

what is the progesterone withdraw hypothesis?

A

at the end of term progesterone decreases which makes estrogen stimulate contractions

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29
Q

what is the prostoglandin hypothesis?

A

inducing of labor after vaginal application of prostaglandins (semen)

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30
Q

what is the corticotropin releasing hormone hypothesis?

A

CRH increases at end of term which stimulates prostaglandins

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31
Q

what is lightning and what does it cause?

A

baby drops which causes return of urinary frequency

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32
Q

what is a bloody show and what can you expect ?

A

mucous plug is expelled causing pink secretions
labor in 24-48 hours

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33
Q

if mom has a rupture of membranes, what do you assess?

A

COAT color odor amount time

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34
Q

what can you use to differentiate amniotic fluid with urine?

A

Nitrozen paper (amniotic fluid is alkaline and urine is acidic)

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35
Q

what is the most accurate way to differentitate amniotic fluid and urine after a ROM?

A

microscope test
- fernning pattern is amniotic fluid

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36
Q

if a mom’s membrnaes have been ruptured for 24 hours and the baby hasnt been birthed, what do you give?

A

prophalactic ATB to prevent infection

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37
Q

when does stage 1 of labor begin and end?

A

begins at onset of true labor and contractions
ends when cervix is completely dialated and effaced

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38
Q

when does stage 2 of labor begin and end?

A

begins when cervix is fully dialated/effaced
ends with birth of baby

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39
Q

when does stage 3 of labor begin and end?

A

begins with birth of baby
ends when placenta is delivered

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40
Q

when does stage 4 of labor begin and end?

A

begins after placenta delivery
last for 2 hours
immediate recovery period

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41
Q

what is a mother and babys job during stage 1 of labor?

A

mother dialate baby rotate

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42
Q

what is the cervical dialations for the 3 phases of stage 1 of labor?

A

Latent: 0-3cm
Active: 4-7cm
Transition: 8-10cm

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43
Q

when does nursing care begin for the 1st stage of labor?

A

when mom reports:
- progressive, regular contractions that increase in frequency, strength, and duration
- blood tinged mucoid discharge
- fluid discharge

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44
Q

what are the laboring characteristics for the latent/early stage during stage 1 of labor?

A

last 6-8 hours
contractions can be 5-30min apart lasting 30-40 dec (mild/moderate)
station is -2 to 0
mom is excited and thoughts are centered towards baby

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45
Q

what are the laboring characteristics of the active phase during stage 1 of labor?

A

last 3-6 hours
contractions can be 2-5 min apart and last for 40-60 seconds (moderate/strong)
station is 1 to 2
mom becomes more seriou, apprehensive, and irritable

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46
Q

what are the laboring characterisics of the transition phase during stage 1 of labor?

A

last 20-40 min
contractions will be 1-2 min apart and last 60-90 seconds (very strong)
station is 2 to 3
mom is fearfull of loss of control and extremely agitated and may feel like she has to poop

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47
Q

what are the 7 cardinal movements?

A
  1. descent
  2. flexion
  3. internal rotation
  4. extension
  5. resitution
  6. external rotation
  7. expulsion
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48
Q

what side of the placenta is grey?

A

fetal side

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49
Q

what can happen to mom in the 4th stage of labor?

A

shaking chills or hypotonic bladder (unable to urinate)

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50
Q

what can make a pregancy high risk?

A

abnormal presentation
multiple gestation
meconium staining
PROM
abruptio placenta
Placenta previa

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51
Q

what is an amniotomy?

A

artifical rupture of membranes (AROM) to induce labor

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52
Q

what are the characteristics of amnitic fluid?

A

pale, straw colored
white flecks of vernix, lanugo and hair
no strong odor
alkaline

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53
Q

what can happen when membranes rupture and what do you assess?

A

umbillical cord could prolaspe
assess FHR and pattern immediatly

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54
Q

what are the 2 types of external monitoring?

A

Transducers for FHR
Tocodynometer for UC

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55
Q

what are 2 types of internal monitoring?

A

Spiral Electrode
B.O.W. rupture

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56
Q

what can cause FHR changes?

A

periodic changes with UC
Episodic (non-periodic) changes are not associated with UC
accelerations
decelerations

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57
Q

what can cause fetal tachycardia?

A

early fetal hypoxia
maternal fever, dehydration, or hyperthyroidism
fetal anemia

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58
Q

what can cause fetal bradycardia?

A

late fetal hypoxia
maternal hypotension or hypothermia
umbillical cord compression
fetal arrythmia
uterine hyperstimulation or rupture
abruptio placenta

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59
Q

what is the single best indicator of fetal well being?

A

FHR variability

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60
Q

what is an absent FHR variability?

A

undetected

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61
Q

what is a minimal FHR variablity?

A

greater than undetected but less than or equal to 5bpm

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62
Q

what is a moderate FHR variability?

A

6-25 bpm

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63
Q

what is a marked FHR varability?

A

greater than 25 bpm

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64
Q

what is reassuring FHR patterns?

A

FHR 110-160
moderate variabliity
accelerations with UC

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65
Q

what is an early deceleration r/t FHR?

A

baby is okay
- head could be compressed during a UC

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66
Q

what is a late deceleration r/t FHR?

A

baby bad
-decreased blood and o2
-placental insuffencicy

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67
Q

what is a variable deceleration r/t FHR?

A

baby bad
- decreased blood and 02
-cord compression

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68
Q

what is the nursing care managment for late or variable deceleration FHR patterns?

A

notify HCP immediatly
stop oxytocin
change maternal position
increase IV fluids
administer 02
prepare for delivery

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69
Q

what are the FHR patterns and their causes?

A

VEAL and CHOP

Variable to cord compression
Early to head
Acceleration to okay
Late to placental insufficency

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70
Q

when should a pregnant women reprt to a birthing unit?

A

if her membranes have ruptured
regular frequent contractions
vaginal bleeding
decreased fetal movements

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71
Q

what are considered regular frequent contractions for a nullipara?

A

5 min apart for 1 hour

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72
Q

what are considered regular frequent contractions for a multipara?

A

6-8 min apart for 1 hour

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73
Q

why is a urine sample taken on admission and what can it indicate?

A

to assess for proteinuria
-can indicate preclampsia

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74
Q

if mom is excessivly bleeding, what assessment do you NOT do?

A

Cervical examination
-notify HCP

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75
Q

what are the nursing actions (Vitals) during the latent phase of stage 1?

A

Maternal BP and RR every hour
Maternal temp every 4 hour unless over 99.6 or membranes have ruptures then every hour and if contractions have started then every 30 min

FHR every 30-15 min

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76
Q

what are the nursing actions (vitals) during the active phase of stage 1?

A

Maternal BP, RR, and HR every hour
Palpate contractions every 15-30 min

FHR every 30-15 min

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77
Q

what are the nursing actions (vitals) during the transition phase of stage 1?

A

Maternal BP, RR, and HR every 30min
Palpate contractions every 15 min

FHR every 30-15 min

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78
Q

what are the nursing actions (vitals) during stage 2?

A

Maternal BP, RR, and HR every 5-15 min
Maternal temp every 2 hour
Palpate contractions continuously

FHR evert 15-5 min

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79
Q

what are the nursing actions (vitals) during stage 3 of labor?

A

Maternal BP, RR, and HR every 5 min
Palpate contractions intermittenly to assess for placental seperation

Fetal newborn assessment, gestational age, and neurological assessment within 1st hour
APGAR at 1 and 5 min
Assesss umbillical cord for 3 vessells

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80
Q

what are the nursing actions (vitals) during stage 4 of labor?

A

Maternal BP, RR, HR, and temp every 15 min for first hour
Maternal assessment of fundus, lochia, perineum, laceration, bladder and rectum every 15 min

Fetal assessment needs to be complete in 1-4 hours post birth
After inital 8 hours, do vitals and assessment every 8 hours
Fetal skin assessed every 4 hours

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81
Q

what are the nursing responsibilities during stage 1 of labor?

A

determine true/false labor
establish rapport
orient family
position changes
provide ice chips
assist to void every 1-2 hours
rest between contractions
breathing techniques
keep couple informed

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82
Q

what are the nursing responsibilities during stage 2 of labor?

A

assist with pushing efforts
provide support
patient advocate

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83
Q

what are the nursing responsibilities during stages 3 and 4 of labor?

A

Inital care of newborn (APGAR, care of umbillical cord, physical assessment, and newborn identification)
Delivery of placenta
Enchancing attatchment
Maternal stabilization

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84
Q

what is a 1st degree laceration?

A

ectends through skin and structures superficial to muscles

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85
Q

what is a 2nd degree laceration?

A

extends through muscles of perinuem

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86
Q

what is a 3rd degree laceration?

A

extends through anal sphincter

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87
Q

what is a 4th degree laceration?

A

extends through anterior rectal wall

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88
Q

why are episiotomies not often performed?

A

bc they increase risk for a 4th degree laceration

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89
Q

how can you prevent a laceration?

A

Use counter pressure
Lubricate periunuem
use warm compress

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90
Q

what are the nonpharmalogical managements of discomfort while in labor?

A

guided imagery, massage, position changing, and effleurage

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91
Q

what is effleurage?

A

gently use the tip of funger ti touch or massage abdomen

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92
Q

what pharmalogical management us used for emergency c sections?

A

general anesthsia

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93
Q

what are the systemic analgesia medications used for discomfort in labor?

A

Opiod agonist (Demerol, Morphine)
Opiod agonist-antagonist (Nubain) *narcotic
Opiod antagonist (Ultram) *narcotic
Ataractics (Xanax)

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94
Q

what is Nalbuphine Hydrochlorids (Nubian) and its advantages?

A

It is comparable to Morphine
-works within 5 min
-minimal nausea and fetal effects

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95
Q

What can Nubian cause?

A

Drowsiness

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96
Q

what is Dutorphanol Tartrate (Stadol) and its advantages?

A

It is a narcotic and sedative
-works within 5 mun
-minimal nausea and fetal effects

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97
Q

what stage of labor is Stadol given?

A

first stage

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98
Q

what can Stadol cause?

A

Maternal hypotension, drowsiness, and dizziness

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99
Q

what can nerve block anesthsias cause?

A

Maternal hypotension
Ineffective breathing
Medication reactions
Spinal HA

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100
Q

What do you use for a spinal HA?

A

use a blood patch

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101
Q

what is a pudendal block?

A

injection into perineum

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102
Q

what is a pudendal block used for and what stages is it given in?

A

repair episiotomies
-stages 2 and 3

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103
Q

when is an epidural given?

A

when active labor begins

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104
Q

when is an epidural block used and what is it used for?

A

all stages of active labor and for the repair of episiotomies

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105
Q

what are the characteristics of an epidural block?

A

they dont wear off
gravity activated so change maternal positions if it is not effective on one side
administered continuously VIA pump

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106
Q

what can an epidural cause?

A

Longterm back pain
maternal hypotension
delay of bladder function

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107
Q

what can a hypotonic bladder increase the risk for?

A

postpartum hemmorage
*so make sure momma is urinating

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108
Q

what are the contradictions of an epidural?

A

Infection
Blood coagulation *monitor platelets
Increase ICP
Allergies
Hypovolemic shock

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109
Q

what type of anesthsia is used in C-section deliveries?

A

spinal block

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110
Q

what is a low spinal block?

A

Used in csection dele=iveries to numb nipple to feet

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111
Q

what can a spinal block cause?

A

delayed bladder control for 8-12 hours

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112
Q

what do you administer before an epidural and what do you do?

A

IV fluid blous 500-1000ml
*make sure momma empty bladder before epidural is given

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113
Q

what is given for hypotension during labor?

A

Ephedrine

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114
Q

how often should blood pressure be checked after administration of an epidural?

A

every 3-5 min for the 1st 30 min

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115
Q

when is the newborn period?

A

birth to 28 days

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116
Q

what is the neonatal transition?

A

1st few hours of life when newborn stabalixes respiratory and circulatory functions

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117
Q

what is surfactant required for and when does it peak?

A

it is required for lung expansion and peaks at 35 weeks gestation

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118
Q

what is the rate of breaths for a newborn?

A

shallow and iregular
30-60 BPM
short periods of apnea (no more than 20 seconds)

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119
Q

what type of breathers are newborns and what is the main nursing action?

A

obligatory nasal breathers
* make sure nasal passages are clear

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120
Q

Is acrocyanosis normal for a newborn?

A

yes, but only for the 1st 24 hours

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121
Q

what happens to the cardiovascular system of a newborn after birth?

A

their 1st breath inflates the lungs and decreased pulmonary vascular resistance to the pulmonary blood flow
increased pulmonary blood flow returns to left side of heart and increases pressure in left atrium
3 shunts close and chnage to maternal circulation

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122
Q

what does a newborns blood contain and what happens to it?

A

fetal hemoglobin
-will decreaase by 55% in 5 weeks
-will reduce to 5% by week 20

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123
Q

what is most critical to a newborns survival?

A
  1. respiration
  2. circulation
  3. heat regulation
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124
Q

what is convection heat loss?

A

loss of heat from warm body to cool air currents

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125
Q

what is radiation heat loss?

A

baby loses heat when heat transfers from warm body surface to cooler objects not in direct contact with body

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126
Q

what is evaporation heat loss?

A

baby loses heat when water is converted to vapor
- immediatly after birth when wet with amniotic fluid

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127
Q

what is conduction heat loss?

A

baby loses heat to a a cooler surface by direct contact with body
- chilled hands, cold tables, cold stethascopes

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128
Q

what is physiological jaundice also known as?

A

hyperbilirubinemia

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129
Q

what is physiological jaundice or hyperbilirubinemia?

A

inmatture liver is not able to get rid of all billirubin produced by breakdown of RBC
so billirubin seeps out of blood into skin coloring them yellow the 1st three days of life

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130
Q

when do signs of psychological jaundice appear?

A

24 hour after birth

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131
Q

if signs of psychological jaundice appear before 24 hours what does it mean?

A

something could be wrong the liver

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132
Q

what can decrease billirubin levels?

A

frequent feedings, maintain tempreture of 97.8 and monitor stool for excretion of billi

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133
Q

what is the normal fetal billirubin level?

A

less than 3

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134
Q

what are the nutritional needs of a newborn for the first three months?

A

110/115 kcal/kg/day

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135
Q

how much nutrition does breastmilk provide?

A

67 kcal/100ml

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136
Q

what are the changes in output requirements for a newborn that indicate a change in nutritional needs?

A

less than 6-8 wet diapers per day AND OR less than 3 stools every 24 hours

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137
Q

what is the urine output of a newborn at birth and days 1 and 2?

A

small quanity (40ml) is present at birth in newborns bladdar
Day 1-2: 2-6 diapers a day

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138
Q

what indicates adequate fluid intake?

A

6-8 voids a day of pale straw colored urine

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139
Q

what is meconium?

A

newborns first BM
black, tarry, and sticky

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140
Q

when should a baby show meconium?

A

within 12 hours of birth

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141
Q

what are the characteristics of a newborns immune system?

A

for the first 3 mon the baby has some immunity from mom
*if breastfed they will recieve immunity from colostrum and breastmilk

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142
Q

what is mongolian spot?

A

Bruise like spot /appearance

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143
Q

if a baby has a magolian spot what does the nurse do?

A

document well due to appearance could be mistaken for abbuse

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144
Q

how long should vernix caseosa be kept on baby?

A

1st 4-6 hours

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145
Q

what do increased estrogen levels cause on a newborn?

A

swelling of breast tissue
vaginal discharge (pseudomenstruation)
witchs milk: thin discharge from nipple

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146
Q

what is an ortolani test?

A

assessment of developmental dysplasia of the hips
* newborn girls

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147
Q

what is the palmar grasps?

A

when you touch babies palm and they grasps tightly

148
Q

what is a moro reflex?

A

baby is startled by loud noise so they extend arms and legs and then pull tightly back to body

149
Q

what is the stepping reflex?

A

infant is held uprught with feet touching ground and baby moves feet

150
Q

what is the babinski reflex?

A

when you stroke the babies sole of foot and they fan out toes and turn foot inward

151
Q

what is the rooting reflex?

A

when you stroke the side of babies cheek and baby turns toward source, opens mouth and suck

152
Q

by the 5th day, what can a newborn do?

A

recognize mothers smell and distinguish breast milk of other lactating moms

153
Q

when must the gestational age be established?

A

within 1st 4 hours after birth

154
Q

what is an accurate newborn weight?

A

10-90th percentile 5.5-9 pounds

155
Q

for the first 6 months what does a babies weight do?

A

increase by 7oz weekly and grow 2.5 cm monthly

156
Q

if a mom has had alot of IV fluids during labor, what will happen?

A

baby will be larger but lose more weight after birth due to fluid shifts

157
Q

what is the approximate head circumference of a newborn?

A

2cm larger than their chest circumference

158
Q

what helps gaurd against heat loss?

A

a flexed position

159
Q

what is cold stress considered?

A

an emergency

160
Q

if no heat conservation measures are started, what happen to body tempreture?

A

decrease 0.2 pper min

161
Q

how often is tempreture monitored on a newborn?

A

every 30 min until stable for 2 hours

162
Q

when should a babies tempreture stabalize?

A

within 8-12 hours after birth

163
Q

what is mottling?

A

lacy pattern of dialated blood vessells under skin
-results from circulation flucuations

164
Q

what is harlequins sign?

A

deep red color develops on one side of body, while other side remains pale
- results from vasomotor disturbance in vessells

165
Q

what is erythema toxicum?

A

eruption of lesions in area surrounding a hair follicule that are firm and consist white/yellow papules with a red base
- not on palms or feet

166
Q

what is milia?

A

exposed sebaceous glands
-raised white spots on face or nose

167
Q

what is a telangiectatic nevi birthmark?

A

stork bite
pale pink or red spots on eyelid, nose, lower occipital bone and neck

168
Q

what are mongolian spots?

A

macular, bluish/black pigmentation on dorsal area or buttock

169
Q

what is a nevus flammeus birthmark?

A

port wine stain
capillary angioma below epidermis
doesnt grow, fade or blanch

170
Q

what can nevus flammeus birthmark indicate?

A

sturge weber syndrome

171
Q

what is a nevus vasculous birthmark?

A

strawberry mark
capillary hemangioma, dermal and subdermal
shirinks and resolves around 6 mon

172
Q

what is a diamond shaped anterior fontaneals location, time, and what can it do?

A

located at juncture of frontal and parietal bone
closes within 18 mon
may swell with crying, pooping and pulses with heartbeat

173
Q

what is a posteriors fontanelle shape, location and time?

A

small and triangular
formed by parietal and occipital bone closes within 8-12 weeks

174
Q

what is a cephalohematoma?

A

collection of blood from ruptured vessells between surface and cranial bone
does not cross the suture line
disappears 2 weeks-3mon

175
Q

what can a cephalohematoma cause and what should you check?

A

increases risk of jaundice
check billi levels

176
Q

what is a caput succedaneum?

A

localized soft area on scalp from long labor or vaccum extraction
fluid in caput is reestablished in 12 hr to a few days
crosses suture line

177
Q

when is eye color established?

A

3 mon but can change for up to a year

178
Q

why are newborn cries tearless?

A

lacrimal structures are immature

179
Q

what are the airway clearance guidlines for a newborn?

A

suction mouth first then nose
compress bulb before inserting
insert on one side of mouth not the middle

180
Q

what is the optimal tempreture range for a newborn?

A

97.5-99

181
Q

what can hypothermia lead to in a newborn and what is it used to prevent it?

A

Metabolic acidosis, hypoxia, and shock
-use radiant warmer during procedures

182
Q

what are signs of newborn distress?

A

increased RR
sternal retractions
nasal flaring
grunting
excess mucous
facial grimace
cyanosis
abdominal distention
vomiting bile
abscense of meconium and urine within 24 hours
jitteriness
glucose less than 40

183
Q

what is the process of cord care of a newborn?

A

AWHONN clean with sterile water and let air dry

184
Q

why is alcohol not used in cord care of a newborn?

A

can cause prolonged cord drying and seperation

185
Q

how often should circumcision care be assessed in a newborn?

A

hourly for the 1st 4-6 hours
-no bleeding and baby is voiding regulary

186
Q

if yellow exudate is formed around circumcision what do you do?

A

do not remove it bc it is part of the healing process

187
Q

what can be given to a newborn after a circumcision?

A

acetaminophen every 4 hour for 24 hours
-petrolleum jelly, A&D, Destin

188
Q

what happens to babies glucose after birth?

A

will decrease and stabalize at 50-60 during 1st several hours

189
Q

if a baby is born very large or from a diabetic mom what will need to be assessed?

A

glucose checks more frequently
warm heel first

190
Q

what needs to be made before discharge?

A

pediatrician follow up appt

191
Q

what is the milk production anatomy?

A

milk is synthesized in alveoli
during pregancy estrogen and progesterone increase which stimulates breast duct proliferation and develop alveoli and increase prolactin
once placenta is expelled, progesterone levels decrease which trigger milk production
if stimulation is not occuring by 3-4 days prolactin will drop

192
Q

what can trigger or increase milk production?

A

prolactin
-stretching nipple and compression of areola trigger the release of oxytocin

193
Q

what are the stages of human milk and what do they do?

A
  1. colostrum: helps excrete billi
  2. transition milk: day 3-5
  3. mature milk: 2 week postpartum (white and blue tinged)
194
Q

breastfed infants have a less likely chance of developing what longterm disorders?

A

Diabetes
lymphoma
leukemia
Hodgkins
Obeisty
Hypercholesterolemia
asthma

195
Q

breastfed infants have a less likely chance of developing what shorterm disorders?

A

URI
UTI
otitis media
bacterial meningitis
allergies

196
Q

what does IgA have?

A

antiviral and antibacterial properties

197
Q

what are the complications of breastfeeding?

A

smoking will decrease milk production
do not breastfeed if baby has galactosemia

198
Q

what are the hunger cues for breastfeeding moms?

A

Early: licking lips, excess moving, putting hands in mouth
Late: crying

199
Q

what is powdered formula?

A

Least expensive
not sterile
requires careful handeling to avoid contamination

200
Q

what is formula concentrate?

A

Expensive
must be diluted with equal part water that has been boiled

201
Q

what is ready to feed formula?

A

Most expensive
no mixing, and is sterile
given to immunocompromised babies

202
Q

how long should a baby be in a rear facing carseat?

A

2 years

203
Q

what kind of clothing should a baby wear in a carseat?

A

no heavy clothing

204
Q

when are newborn screenings given?

A

24-48 hours old
when they are feeding enough to metabolise

205
Q

what is peurperium?

A

interval between birth and return of reproductive organs to normal state

206
Q

what is involution?

A

return of uterus to a non-pregnant state

207
Q

what are the times of involution of uterus?

A

Immediatly: fundus is at midline 2cm above umbillicus
12hr: level umbillicus
24hr: 1 cm below umbillicus and it decreases 1-2cm every 24 hours
6 days: halfway btwn symphysis pubis and umbillicus
2 weeks: uterus is a pelvic organ again
6 weeks: returns to non preganant state

208
Q

what can slow uterine involution?

A

prolonged labor: muscles relax
Anesthsia: muscle relaxation results in boggy uterus
Difficult birth: uterus is manipulated causing muscle fatigue
Multipara: repeated distention leads to uterus stretching and decreased tone
Full bladder: uterus is pushed up, pressure interferes with effective contractions
Incomplete expulsion of placenta: tissue interferes with ability of uterus to remain contracted
Infection: inflammation decreases muscle ability to contract
Overdistention of uterus:

209
Q

what is lochia?

A

post birth uterine discharge

210
Q

what is lochia rubra?

A

blood and uterine debris (1-3 days)
red and dark red

211
Q

what is lochia serosa?

A

Old blood, serum, leukocytes and tissue debries (4-10days)
pink and brown

212
Q

what is lochia alba?

A

Leukocytes, mucus, serum, bacteria, and tissue debris (11day-4 weeks)
yellow and white

213
Q

what is a nursing action for lochia flow estimation?

A

how long the peripad has been in place

214
Q

what are the classifications of lochia?

A

Scant: less than 1 in
Light: less than 4 in
Moderate: less than 6 in
Heavy: saturation witin 1 hr of pad application

215
Q

how long does it take for menstruation to return postpartum?

A

7-12 weeks in nonlactating mom
3mon-3 year in lactating mom

216
Q

what do you assess with episiotomies and when do they heal?

A

REEDA and in 2-3 weeks

217
Q

when do hemmroids heal postpartum?

A

within 6 weeks

218
Q

what does colostrum do r/t changes postpartum?

A

helps binding of billi and has laxative effect to help pass meconium

219
Q

when does engorgment occur and what can it cause?

A

day 3-4
breast may be swollen, firm, tender and warm to touch
- use warm compress or ICE, dont over pump or stimulate and wear a sports bra

220
Q

what happens to prolocatin levels when not nursing?

A

drop rapidly

221
Q

what happens within 12 hours post birth r/t bladder of mom?

A

profuse diaphoresis due to decrease estrogen

222
Q

what hormones rapidly decrease after expulsion of placenta?

A

estrogen, preogesterone, prolactin, cortisol, and insulin

223
Q

what is the postpartum chill and when should it be a concern?

A

intense tremors/shivering after birth
-if not followed with a fever it is not a concern

224
Q

what happens to the cardiovascular system after birth and what should you assess?

A

increasing clotting factors anf risk for thromboembolism
assess Holmans sign and encourage ambulation
increased blood volume is eliminated with 1st 2 weeks

225
Q

what happens due to increased blood volume loss?

A

hypervolemia allows mom to tolerate blood loss
vaginal: 500ml
c-section: 1000ml

226
Q

when is baby blues and what can worsen them?

A

1st week and disappear by day 10
-symptoms worsen by sleep deprivation

227
Q

if baby blues extends past 10 days what could it be?

A

postpartum depression

228
Q

what immunizations are given to mom before discharge?

A

Rubello
RHOgam within 72 hours after birth
TDAPP to decrease pertiussis

229
Q

when can sexual intercourse return after birth?

A

2-4 weeks
-when bleeding has stopped and perineum has healed

230
Q

what is a BUBBLE-HE examination?

A

Breast
uterus
bladdar
bowel
laceration
episotomies
Hemmroids
emotions

231
Q

What is increment?

A

building up of contractions

232
Q

what is acme?

A

peak of contraction

233
Q

what is decrement?

A

letting up of contraction

234
Q

what is polycystic ovarian syndrome (PCOS)?

A

complex endocrine disorder of ovarian dysfunction

235
Q

what are common signs of PCOS?

A

Menstrual dysfunction
hyperandrogenism
obeisity
hyperinsulinemia
Infertility

236
Q

what is the most common cause of infertility?

A

PCOS

237
Q

what are the signs of high androgens?

A

deepened voice
increase hair growth
oily skin
ammenorhea and decreased breast size

238
Q

what do you need to do to diagnose PCOS?

A

rule out other endocrine disorders
4fold: hx, physical, labs, and imaging

239
Q

what does PCOS increase the risk for?

A

type 2 diabetes
HTN
cardiovascular disease
endometrial, breast, and ovarian cancer

240
Q

what is the treatment of PCOS?

A

oral contraceptions
antiandrogens
treat symptoms

241
Q

what is toxic shock syndrome (TSS)?

A

a disease of women that occur at or near menses or during postpartum period

242
Q

what are the signs of TSS?

A

high fever, hypotension, rash on truck, palms and soles, and multisystem involvement

243
Q

what can increase the risk for TSS?

A

keeping a tampon in for a long time, diaphragm and cervical caps

244
Q

what do lab levels look like with TSS?

A

Increased BUN and creatnine
increased liver enzymes
decreased platelets

245
Q

what is the causative organism of TSS?

A

Staph *it is preventable

246
Q

what is syphilis?

A

bacterial STI

247
Q

what is syphilis spread by?

A

vagina, anal, and oral
vaginal canal during birth and can cross placenta to infect baby in utero

248
Q

what are the early signs of syphilis?

A

Painless chancre sore, low grade fever, wt loss and malaise

249
Q

what are the late signs of syphilis?

A

6week-6mon
skin eruptions, rash on hands and feet, enlarged liver and spleen and chronic sore throat/hoarsness

250
Q

what is the treament of syphilis?

A

single injection of penecillin

251
Q

what can syphilis cause if left untreated?

A

blindness, insanity, paralysis, and death
preterm labor and still births

252
Q

what is Gonorrhea?

A

Bacterial STI

253
Q

what is Gonorrhea spread by?

A

Vaginal, anal and oral
In utero and vaginal canal during birth

254
Q

what are the signs of Gonnorhea?

A

yellow/grey/green discharge heavy menstruation, abdominal cramps and burning urination in women
swollen and painful testicals in men

255
Q

what is the treatment of Gonorrhea?

A

Cefixime or Ceftriaxone (Cephalosporin)
prophylactic eye tx in newborns

256
Q

why do you need to be aware of Cureal for the treatment of Gonorrhea?

A

it has ATB resistant strains of gonorrhea

257
Q

what is chlamydia?

A

bacterial STI and most common in US

258
Q

what is chlamydia spread by?

A

Vaginal, anal and oral
vaginal canal during birth

259
Q

what are the symptoms of chlamydia?

A

Many people have no symptoms
watery white discharge, burning on urination, abdominal pain, and swollen testicles

260
Q

what is the treatment of chlamydia?

A

single dose of azithromycin or 1 week of doxycline (BID)

261
Q

what is human pailloma virus (HPV)?

A

Viral STI

262
Q

what is HPV spread by?

A

vagina, anal and oral

263
Q

what are the signs of HPV?

A

Genital warts

264
Q

what is the treatment for HPV?

A

No cure but a healthy immune system can fight it off naturally

265
Q

what helps to protect against HPV?

A

Gardasil

266
Q

what can HPV cause in men?

A

throat cancer

267
Q

what can HPV cause in women?

A

cervical cancer

268
Q

what is Herpes simplex virus (HSV)?

A

Viral STI

269
Q

what is HSV spread by?

A

vaginal anal oral
vaginal canal during birth

270
Q

what is HSV1?

A

oral, cold sores

271
Q

what is HSV2?

A

genital

272
Q

what is HSV3?

A

chicken pox and shingles

273
Q

what birth is given to prevent spread of HSV to baby?

A

c section, bc neonatal herpes (congenital) increases risk of death

274
Q

what is the treatment for HSV?

A

No cure but antivirals can shorten or prevent outbreaks
Valtrex and Acvclovir

275
Q

what is human immunodeficency virus (HIV)?

A

viral STD found in blood semen vaginal fluid and breastmilk

276
Q

what is HIV spread by?

A

Vaginal. anal, and oral
blood
baby in utero d/t crossing placenta

277
Q

what can HIV cause?

A

Acquired Immune defienceny (AIDS)
*no visible signs of infection

278
Q

what is the treatment of HIV?

A

No cure but antivirals are given (Zidovudine)
Csection delivery
formula feed

279
Q

what is Hepatitis B (HBV)?

A

Viral STI
inflammation of liver and most common hepatitis

280
Q

what is hepatitis A?

A

oral fecal route

281
Q

what is hepatitis C?

A

blood route

282
Q

what is the treatment of HBV?

A

No cure but can prevent it by taking the Hep B vaccine

283
Q

what is the Hep B vaccine?

A

3 injections and requires consent

284
Q

what is trichomoniasis?

A

Parasitic STI
most common curable STI

285
Q

what is the threat of trich?

A

it increases womens vulnerability for HIV bc it thins the lining of vagina so other diseases are easier to get in

286
Q

what are the symptoms of trich?

A

Vaginal itching, forthy green/yellow discharge with a fishy odor

287
Q

what is the treatment of trich?

A

Metronidazole (flagyl)

288
Q

what do you need to avoid when taking flaglyl and what can it cause?

A

alchol can cause tremors and abd pain

289
Q

what can trich cause in pregncancy?

A

Premature birth and low birth weight babies

290
Q

what is trich linked to?

A

pelvic inflammatory disease

291
Q

what is bacterial vaginosis caused from?

A

imbalence in good and bad bacteria in vagina

292
Q

what are the signs of bacterial vaginosis?

A

fishy smell with thin/white/milkly discharge

293
Q

what can BV increase the risk for in pregnant women?

A

prematurity or LBW

294
Q

what is BV also known as and what is used to treat it?

A

vulvo vaginal candidas and Flaglyl

295
Q

what is subfertility?

A

when both parents have decreased fertitliy

296
Q

what is needed for a fertile female reproductive system?

A

cervical musous
patent fallopian tubes
functional hypothalamic pituitary
ovaries are able to release ova in a regular cycle
endometrium must be able to prepare for implantation
adequate reproductive hormones

297
Q

what can an ectopic pregnancy cause?

A

scarring in fallopian tubes which can cause infertiltiy

298
Q

what is the diagnostic test for tubal patency and uterine structer due to an ectopic pregnancy?

A

Hysterosalpingography

299
Q

what can increase the risk of infertitlity in men?

A

Pesticide exposure and smoking can decrease sperm

300
Q

what does the serum lab show for infertility?

A

Progesterone greater than 3 means ovulation is happening
Progesterone less than 3 means no ovulation which could be a problem with infertiltiy

301
Q

what test needs to be done if there is a lack of ovarian function?

A

basal body tempreture, hormone assessment, endometrial biopsy, and transvaginal ultrasound

302
Q

what test needs to be done if cervical problems are suspected?

A

the capacity of cervical mucous

303
Q

what test needs to be done if tubal or uterine problems are suspected?

A

Hysterosalpingography, hysteroscopy, and a laparscopy

304
Q

what test needs to be done if male infertility is suspected?

A

Semen analysis and screen for antisemen antibodies

305
Q

when is pharacologic intervention take place for infertiltity?

A

if there is an abnormal ovarian or endometrial function

306
Q

what is assessed when looking at cervical mucous?

A

if mucous is watery it means that ovulation is occuring bc it allows the cervix to become elastic so that sperm can pass through

307
Q

if semen and ovary analysis are normal, what med is given for fertility?

A

Clomid

308
Q

what does CLomid do?

A

induces ovulation, which can increase the risk of multiple babies

309
Q

what are the side effects of Clomid?

A

visual disturbances and hormonal flucuations

310
Q

what are the indications for vitro fertilization (IVF)?

A

infertility from tubal factors
mucous abnormalities
male infertility
female immunologic infertility
cervial factors

311
Q

can women with diabetes mellitus breastfeed and why?

A

Yes, insulin requirements decrease with breasftfeeding , so eat a prenursing snack

312
Q

if a women is breastfeeding with diabetes mellitus, what calorie change does she need?

A

increase during lactation by 500-800kcal above pre pregnancy requirments

313
Q

what happens to insulin postpartum?

A

decreased insulin requirements and decreased blood glucose levels

314
Q

what are the recommendations of testing for HIV in pregnant women?

A

emphasize as routine but ensure that its voluntary and informed

315
Q

what is used in intital testing of HIV in pregnant women?

A

4th generation HIV 1/2 antigen immunoassay
-if positive confirmatory testing is done using HIVq/ HIV2 differentiation

316
Q

how can a women who has HIV reduce the risk of transmitting to baby?

A

Prophylatic antiretroviral throughout pregnancy, labor and birth and give ART meds to baby for 4-6 weeks
no breastfeeding
no prechewing food

317
Q

How is HIV transmitted to fetus?

A

Placenta. amniotic membranes, breast milk, and contaminated blood

318
Q

what is the test for diagnosis of HIV in newborns?

A

PCR and HIV RNA assay

319
Q

what is the treatment for HIV in pregnant women?

A

ART therapy

320
Q

what 5 conditions could potentially cause harm to the fetus?

A

Diabetes mellitus, anemia, substance abuse, HIV, and heart disease

321
Q

what is glucose to the fetus and how is it transported?

A

the primary fuel for the fetus
transmitted across placenta by diffusion (fetus glucose is proportional to moms levels)

322
Q

how does pregnancy affect diabetis mellitus in the 1st trimester?

A

hypoglycemia

323
Q

how does pregnancy affect diabetis mellitus in the 2nd and 3rd trimester?

A

decrease tolerance to glucose, hyperglycemia

324
Q

how does pregnancy affect diabetis mellitus during birth?

A

Pre pregnancy glucose levels

325
Q

what are the maternal risk of diabetes mellitus?

A

increased difficulties with glucose tolerance control
HTN
hydramnios/polyhydramios ( increased amniotic fluid >2000ml)
infections
Ketoacidosis/hypoglycemia
preterm labor
PROM

326
Q

what are the fetal risk of diabetes mellitus?

A

stillbirth
congenital anomalies
macrosomia (>4000gm)
respiratory distress

327
Q

what are the most common congenital anomalies?

A

cardiac and CNS deficits

328
Q

how many prenatal visits if mom has diabetes mellitus?

A

1 and 2 trimester every 1-2 weeks
3 trimester is 2 times a week

329
Q

when is a glucose test given if mom has diabetes mellitus?

A

prior to 12 weeks and between 24-28 weeks

330
Q

what happens during labor of a mom who has diabetes mellitus?

A

maternal insulin requirments drop rapidly during labor

331
Q

what is the postpartum care of a mom who has diabetes mellitus?

A

removal of placenta will decrease insulin requirements
encourage breastfeeding
use a contraception

332
Q

which anemia is most common in pregnant women and what should they take?

A

iron deficency, takle prenatal vitamins and iron supplements
HGB<11

333
Q

what does anemia cause maternally?

A

tires easily
suseptible to infections
increased risk for preclampsia and postpartum hemmorage

334
Q

what does anemia cause in a fetus?

A

low birth weight
increased risk of preterm birth
fetal hypoxia

335
Q

what can alcohol cause in a fetus?

A

mental retardation
microcephaly
cardiac anomalies
IUGR
fetal alcohol syndrome

336
Q

what can cocaine cause maternally?

A

Seizure
hallucinations
respiratory failure
heart problems
increased risk of spontaneous abortion
IUGR
still birth
abruptio placenta

337
Q

what can cocaine cause fetally?

A

IUGR
microcephaly
altered brain development
congenital anomalities

338
Q

what can cocaine cause in newborns?

A

neurobehavioral disturbances
irritability
increase risks of SIDS
feeding difficulties

339
Q

what can cocaine cause in toddlers?

A

hyperactivity

340
Q

what can smoking cause in a fetus and what are the health risks?

A

decreased O2 and food to fetus from placenta
- bleeding.
-spontaneous abortion
-stillbirth
-prematurity
-placenta preuia
-placenta aabruption
-LBW
-SIDS

341
Q

If a women declines HIV screening what is it called?

A

opt out strategy

342
Q

what are the cardiac diseases that can affect pregnancy?

A

Rheumatic fever, congenital disease, and mitral valve disease

343
Q

what can hyperthyroidism cause in pregnancy?

A

increased risk for preclampsia and PPH

344
Q

is breastfeeding contradicted in women with hyperthyroidism?

A

only if on antithyroid meds

345
Q

what can hypothyroidism cause in pregnancy?

A

maternal issues are rare because they often have fertility issues

346
Q

what can hypothyroidism cause r/t the fetus?

A

if mother is untreated, there is an increased risk of death and newborns are at high risk for neuro and congenital goiter

347
Q

what are the maternal effects of tobacco?

A

decreased placental perfusion/vasoconstriction
increase risk for PROM, miscarriage, preterm birth, placental abruption, and placenta previa

348
Q

what are the fetal affects of tobacco?

A

LBW from decreased placental perfusion
Nicotene withdraw symptoms
irritability

349
Q

what are the maternal effects of alcohol?

A

HTN
miscarriage, preterm, and stillbirth
anemia
nutritional defictis
alcohol hepatitis
cirrhosis

350
Q

what are the fetal effects of alcohol?

A

fetal alcohol syndrome
mental retardation
behavorial problems
learning difficulties

351
Q

what are the maternal effects of marijuana?

A

it crosses the placenta and increases co2 in blood which decreases 02 in fetus

352
Q

what are the fetal effects of marijuana?

A

LBW and tremors

353
Q

what are the maternal effects of cocaine?

A

Tachycardia, HTN, and MI
corornary artery spasm
uterine and blood vessel spasms
liver damage
hemorrhagic bronchitis
seperation of placenta
preterm labor

354
Q

what are the fetal effects of cocaine?

A

Preterm labor or bleeding r/t placental abruption
LBW
poor feeding
diarrhea
microcephaly

355
Q

what are the maternal effects of meth?

A

tachycardia, HTN
weight loss
insomnia
paranoia
violent bahaviors
seixures
cardiac shock

356
Q

what are the fetal effects of meth?

A

IUGR
preterm birth
microcephaly
agitation
vomiting

357
Q

what are 2 methods to obtain FHR?

A

US transducer and a handheld doppler

358
Q

what does the spiral electrode do?

A

FHR

359
Q

what are early decelerations?

A

they mirror contraction and caused by fetal head compression

360
Q

what are late decelerations?

A

non reassuring andd baby has a low APGAR

361
Q

what is variability r/t FHR caused by?

A

caused by interaction of sympathetic and parasympathetic nervous system

362
Q

what is occiput?

A

vertex/ back of head presentation

363
Q

what is mentum?

A

face presentation

364
Q

what is scarum?

A

breech/ butt and feet presentation

365
Q

what is acromion?

A

shoulder and scapula presentation

NSG 211 (3 decks)

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