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Exam 2 Flashcards

1
Q

What is gestational trophoblastic disease?

A

Hydatidiform mole, where trophoblasts develop abnormally. Placenta does not develop normally and if fetus is present, there will be fatal chromosomal defect

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2
Q

Medical management for hydatidiform mole

A
  • Evacuation of trophoblastic tissue of the mole (usually by vacuum aspiration followed by curettage, then oxytocin)
  • Continuous follow up to detect malignancies (choriocarcinoma may occur)
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3
Q

Difference between marginal placenta previa and partial placenta previa

A

Marginal: placenta’s border >3 cm from cervical os
Partial: placenta’s border <3 cm from cervical os, not completely covering it

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4
Q

What is abruptio placentae?

A

Separation of normally implanted placenta before fetus is born

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5
Q

S/S of placenta previa

A

Sudden onset of painless uterine bleeding in last half of pregnancy

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6
Q

S/S of abruptio placentae

A

Bleeding (may be concealed behind placenta)
Uterine tenderness
Frequent, low-intensity contractions
Abdomen/low back pain
High uterine resting tone, board like abdomen
Port wine colored amniotic fluid
Nonreassuring FHR patterns or fetal death
Signs of hypovolemic shock

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7
Q

Risk factors for placenta previa

A

Older women
Multiparty
Previous c/s
Prior uterine surgery
Asian ethnicity
Cocaine/cigarette use
Male fetus

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8
Q

Risk factors for abruptio placentae

A

Abdominal trauma
Cocaine/cigarette use
HTN
Multigravida status
Short umbilical cord
Premature rupture of membranes
Previous abruptio placentae

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9
Q

Symptoms of pre-eclampsia

A

HTN (>140/90) after 20 weeks. May be accompanied by Proteinuria

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10
Q

Risk factors for pre-eclampsia

A

Obesity
Pre-pregnancy diabetes

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11
Q

Treatment for preeclampsia

A
  • Bedrest, monitor BP at home, daily weight, urinalysis, increased fetal assessments, high protein/high calorie diet
  • Antihypertensive meds if BP >160/110
  • 37 weeks or more: delivery
  • 34-37 weeks: steroids and delay birth for 48 hrs
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12
Q

Meds given for severe preeclampsia

A

Lebatalol, Hydralazine, or Nifedipine
Magnesium sulfate

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13
Q

How does magnesium sulfate work?

A

CNS depressant, decreases amount of acetylcholine

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14
Q

Antidote for magnesium sulfate

A

Calcium gluconate

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15
Q

Therapeutic serum level of magnesium sulfate and toxic level

A

5-8 mg/dL
Toxic = >8 mg/dL

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16
Q

Significant adverse reactions of magnesium sulfate

A

CNS depression, respiratory depression, loss of DTR

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17
Q

Risks for mother with eclampsia

A

Ruptured membranes from seizure
Pulmonary edema
Heart failure
Reduced renal blood flow = Oliguria

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18
Q

What does HELLP stand for?

A

Hemolysis
Elevated liver enzymes
Low platelets

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19
Q

Risk factors for HELLP

A

Eclampsia
Chronic HTN

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20
Q

Diagnosis of gestational diabetes

A

During 1 hr GCT, if glucose > 140 mg/dL, need 3 hr
If 3 hr GTT glucose is >140 mg/dL = diabetes

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21
Q

Risks for fetus is mom has gestational diabetes

A

Congenital malformation
Small or large for gestational age
Hypoglycemia
Hypocalcemia
Hyperbilirubinemia
Respiratory distress syndrome

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22
Q

Classification of cardiac disease

A

Acquired heart disease:
- Rheumatic
- Valvular stenosis
- MI
- Cardiomyopathy

Congenital heart disease:
- Left-to-right shunt
- Right-to-left shunt
- other congenital lesions

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23
Q

Cause of rheumatic heart disease

A

Sometimes following streptococcal pharyngitis that causes scarring of heart valves (mitral valve most common)

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24
Q

What can rheumatic heart disease lead to?

A

Pulmonary HTN
Pulmonary edema
Congestive heart failure

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25
What is valvular stenosis caused by?
Infection or blockage of the heart (can sometimes be surgically repaired)
26
When is a pregnant pt most at risk for an MI?
Third trimester
27
What is cardiomyopathy?
Rare and often fatal disorder of heart muscle structure
28
What are examples of a left-to-right shunt?
Atrial septal defect (hole between atria) Ventricular septal defect (hole between ventricles) Patent ductus arteriosus (opening between two blood vessels leaving the heart)
29
What are examples of right-to-left shunts?
Tetralogy of Fallot (combo of 4 heart defect, causes oxygen poor blood to flow from heart into body) Eisenmenger syndrome (irregular blood flow in heart and lungs, causes blood vessels in lungs to become stiff and narrow)
30
S/S of heart disease
Dyspnea with exertion Syncope with exertion Hemoptysis Paroxysmal nocturnal dyspnea Chest pain with exertion
31
Which classes of heart disease are safe to get pregnant, and which aren’t?
Class I or II, high risk, but ok to get pregnant Class III or IV, should not get pregnant (risk for MI if cardiomyopathy)
32
Drug therapy for pts with cardiac disease
Anticoagulants Antirrhythmics Ant-infectives Drugs for heart failure
33
Recommendations for delivery for a pt with cardiac disease
Vaginal delivery (less blood) Minimize pushing and use of Valsalva maneuver Limit prolonged labor
34
Postpartum management for pts with cardiac disease
- Possible cardiac decomposition during postpartum period - Observe for signs of infection, hemorrhage, thromboembolism (conditions can act together to cause heart failure in cardiac pts) - Watch for S/S of congestive heart failure
35
Recommended weight gain for obese women (BMI 30 or >)
11 to 20 lbs
36
Recommended weight gain for overweight women (BMI 25-29.9)
15 - 25 lbs
37
What is a normal/safe contraction pattern?
< or equal to 5 contractions in 10 mins
38
What should you do if tachysystole or nonreassuring FHR during induction/augmentation of labor?
1 - reduce or stop infusion 2 - side lying position 3 - oxygen by face mask at 10L/min 4 - notify provider (anticipate order for terbutaline) 5 - oxytocin may be administered again if tachysystole resolves and FHR returns to normal
39
Nursing actions for pt undergoing induction/augmentation of labor
Assess for excessive uterine activity Assess BP and pulse every 30 min & with each oxytocin increase Record intake and output Observe for signs of water intoxication Assess for uterine antony in pp period (soft uterus, excess lochia)
40
What causes contractions?
Stimulated by oxytocin Coordinated process between uterus and fluctuations of estrogen and progesterone
41
Frequency of contractions
How often Measured from the beginning of one contraction to the beginning of the next (in minutes)
42
Duration of contractions
How long the contraction lasts Measured from the beginning of one contraction to the end of it (in seconds)
43
Intensity of contractions
Measured by pain scale, palpation
44
Three phases of each contraction
Increment (period of increasing strength) Peak (most intense period) Decrement (period of decreasing intensity) Interval (period of time between contractions)
45
What are you checking during a cervical exam?
Effacement (thinning of cervix) Dilation (cervix opening) Station Presenting part of baby (And if membranes are still intact)
46
What happens to maternal blood flow during labor?
- Decreased blood flow to uterus during contraction = decreased placental blood flow - increase in blood volume - increased BP and slowed pulse - supine hypotension more likely (encourage other positions)
47
What happens to respirations during labor?
Increased depth and rate Hyperventilation (rapid and deep breathing), respiratory alkalosis (too much CO2), tingling
48
What happens to hematopoietic system during labor?
- Normal blood loss: 500mL vaginal, 1000mL c/s - Clotting factors elevated (fibrinogen) during pregnancy, labor, and after delivery
49
What are the four Ps of childbirth?
Powers - contractions and maternal pushing Passage - parts of the pelvis Passenger - fetus, membranes, placenta Psyche - anxiety, culture, expectations, experience, support
50
Fetal anatomical and positional variables that influence the course of labor
- Fetal head (want cephalic presentation) - Fetal lie (orientation of the long axis of the fetus to the long axis of the woman. Want it to be longitudinal and parallel to the long axis of the woman) - Attitude (Relation of fetal body parts to one another. Want flexion) - Presentation (fetal part that first enters the pelvis. Want cephalic vertex) - Position (location of presenting part in relation to four quads of pelvis)
51
Cardinal movements of the head in normal labor
Engagement Descent Flexion Internal rotation Crowing Extension Restitution External rotation
52
First stage of labor
From start of labor until full dilation 3 phases
53
3 phases of the first stage of labor
Latent phase (0-3 cm) Active phase (4-6 cm) Transition (7-10 cm)
54
Second stage of labor
Complete dilation to delivery of baby
55
Third stage of labor
Delivery of baby to after placenta is delivered
56
Fourth stage of labor
1-4 hours after delivery
57
What should be done if a pt has an epidural and maternal hypotension occurs?
Rapid no dextrose IV fluid bolus Maternal repositioning O2 administration If those are ineffective, IV phenylephrine or ephedrine administered to promote vasoconstriction to raise BP
58
What can happen if the epidural catheter moves?
Intravascular injection: an intense block or one that is too high, absence of anesthesia, or a unilateral block
59
If a pt has an epidural and it is found that she has a fever, what should be done?
Should look for other symptoms of infection like: Fetal tachycardia or amniotic fluid with strong odor Could not be infection and be resulting from epidural block instead
60
Adverse effects of epidural opioids
N/v Pruritus Shivering Delayed respiratory depression (for 12 hrs after admin of epidural opioid)
61
Monitoring vitals after epidural placement
Should assess maternal BP and FHR every 5 min for first 15 min or after every increase of med Repeat assessment of BP and FHR at 30 min and 1 hr after the procedure
62
Other types of spinal meds given besides epidural
Intrathecal opioids CSE (combined Intrathecal opioids with epidural) Spinal block
63
Types of parenteral analgesia
Neperidine (Demerol) - controversial Fentanyl (Sublimaze) Butorphanol (Stadol) Nalbuphine (Nubian)
64
Which parenteral analgesics should a mother with opioid dependence issues not be given? and why?
Butorphanol and nalbuphine Because they are mixed agonist-antagonist drugs and may cause withdrawal effects in herself and newborn
65
5 factors for adequate fetal oxygenation
1- Sufficient maternal blood flow and volume to placenta 2- Normal maternal oxygen saturation 3- Adequate exchange of oxygen and carbon dioxide 4- Open circulatory path from placenta to fetus through umbilical cord vessels 5- Normal fetal circulatory and oxygen-carrying functions
66
Instruments used for intermittent auscultation
Fetoscope Picard stethoscope Handheld Doppler ultrasound
67
What causes early decelerations?
Fetal head compression Benign and not associated with interruption of fetal hypoxia, acidosis, or low APGAR scores
68
What causes late decelerations?
Decreased fetal blood flow, resulting in fetal hypoxia (Will typically dissipate with repositioning, etc. Concerning when they are recurring)
69
What causes variable decelerations?
Interruption of oxygenation at the level of the umbilical cord, where cord vessels may be compressed
70
Corrective measures that may be done when nonreassuring FHR patterns are noted
Maternal repositioning IV fluid blouses Administer oxygen Reduce UA Correct maternal hypotension Perform amnioinfusion Modify second-stage pushing efforts
71
What does repositioning mother to lateral or hands and knees help with?
Variable or prolonged decelerations r/t cord compression Lateral repositioning may also increase uterine blood flow
72
How does in IV bolus of fluid help with placental perfusion and fetal oxygenation?
Increases circulating blood volume and improves cardiac output
73
Nursing actions for a maternal hypotension
Lateral repositioning IV hydration If those actions are not sufficient, may need medication to increase BP (epi or phenylephrine)
74
What does veal shop stand for?
Variable - Cord compression Early - Head compression (OK) Accelerations - OK Late - Placental insufficiency
75
What is a prolonged FHR pattern?
Can be periodic or episodic Acceleration or deceleration that lasts >2 min - 10 min After 10 min = Brady or tachycardia
76
4 categories needed to assess UA
Frequency Duration Intensity Resting tone
77
Categories of fetal heart rate patterns
Category 1 = normal Category 2 = indeterminate Category 3 = abnormal and need to deliver baby
78
What do variable, late, or prolonged decelerations indicate? What should be done?
Interruption of oxygen transfer Need to: move pt to left side IV fluids Oxygen Notify provider (last) Slow contractions
79
What is the ABCD approach to FHR management?
Assess O2 pathway and identify etiology of FHR changes (both maternal and fetal) Begin conservative measures Clear obstacles to delivery Determine delivery plan

OB (11 decks)

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