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OB > Exam 2 > Flashcards

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
Q

What is valvular stenosis caused by?

A

Infection or blockage of the heart (can sometimes be surgically repaired)

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26
Q

When is a pregnant pt most at risk for an MI?

A

Third trimester

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27
Q

What is cardiomyopathy?

A

Rare and often fatal disorder of heart muscle structure

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28
Q

What are examples of a left-to-right shunt?

A

Atrial septal defect (hole between atria)
Ventricular septal defect (hole between ventricles)
Patent ductus arteriosus (opening between two blood vessels leaving the heart)

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29
Q

What are examples of right-to-left shunts?

A

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)

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30
Q

S/S of heart disease

A

Dyspnea with exertion
Syncope with exertion
Hemoptysis
Paroxysmal nocturnal dyspnea
Chest pain with exertion

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31
Q

Which classes of heart disease are safe to get pregnant, and which aren’t?

A

Class I or II, high risk, but ok to get pregnant
Class III or IV, should not get pregnant (risk for MI if cardiomyopathy)

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32
Q

Drug therapy for pts with cardiac disease

A

Anticoagulants
Antirrhythmics
Ant-infectives
Drugs for heart failure

33
Q

Recommendations for delivery for a pt with cardiac disease

A

Vaginal delivery (less blood)
Minimize pushing and use of Valsalva maneuver
Limit prolonged labor

34
Q

Postpartum management for pts with cardiac disease

A
  • 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
Q

Recommended weight gain for obese women (BMI 30 or >)

A

11 to 20 lbs

36
Q

Recommended weight gain for overweight women (BMI 25-29.9)

A

15 - 25 lbs

37
Q

What is a normal/safe contraction pattern?

A

< or equal to 5 contractions in 10 mins

38
Q

What should you do if tachysystole or nonreassuring FHR during induction/augmentation of labor?

A

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
Q

Nursing actions for pt undergoing induction/augmentation of labor

A

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
Q

What causes contractions?

A

Stimulated by oxytocin
Coordinated process between uterus and fluctuations of estrogen and progesterone

41
Q

Frequency of contractions

A

How often
Measured from the beginning of one contraction to the beginning of the next (in minutes)

42
Q

Duration of contractions

A

How long the contraction lasts
Measured from the beginning of one contraction to the end of it (in seconds)

43
Q

Intensity of contractions

A

Measured by pain scale, palpation

44
Q

Three phases of each contraction

A

Increment (period of increasing strength)
Peak (most intense period)
Decrement (period of decreasing intensity)

Interval (period of time between contractions)

45
Q

What are you checking during a cervical exam?

A

Effacement (thinning of cervix)
Dilation (cervix opening)
Station
Presenting part of baby
(And if membranes are still intact)

46
Q

What happens to maternal blood flow during labor?

A
  • 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
Q

What happens to respirations during labor?

A

Increased depth and rate
Hyperventilation (rapid and deep breathing), respiratory alkalosis (too much CO2), tingling

48
Q

What happens to hematopoietic system during labor?

A
  • Normal blood loss: 500mL vaginal, 1000mL c/s
  • Clotting factors elevated (fibrinogen) during pregnancy, labor, and after delivery
49
Q

What are the four Ps of childbirth?

A

Powers - contractions and maternal pushing
Passage - parts of the pelvis
Passenger - fetus, membranes, placenta
Psyche - anxiety, culture, expectations, experience, support

50
Q

Fetal anatomical and positional variables that influence the course of labor

A
  • 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
Q

Cardinal movements of the head in normal labor

A

Engagement
Descent
Flexion
Internal rotation
Crowing
Extension
Restitution
External rotation

52
Q

First stage of labor

A

From start of labor until full dilation
3 phases

53
Q

3 phases of the first stage of labor

A

Latent phase (0-3 cm)
Active phase (4-6 cm)
Transition (7-10 cm)

54
Q

Second stage of labor

A

Complete dilation to delivery of baby

55
Q

Third stage of labor

A

Delivery of baby to after placenta is delivered

56
Q

Fourth stage of labor

A

1-4 hours after delivery

57
Q

What should be done if a pt has an epidural and maternal hypotension occurs?

A

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
Q

What can happen if the epidural catheter moves?

A

Intravascular injection: an intense block or one that is too high, absence of anesthesia, or a unilateral block

59
Q

If a pt has an epidural and it is found that she has a fever, what should be done?

A

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
Q

Adverse effects of epidural opioids

A

N/v
Pruritus
Shivering
Delayed respiratory depression (for 12 hrs after admin of epidural opioid)

61
Q

Monitoring vitals after epidural placement

A

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
Q

Other types of spinal meds given besides epidural

A

Intrathecal opioids
CSE (combined Intrathecal opioids with epidural)
Spinal block

63
Q

Types of parenteral analgesia

A

Neperidine (Demerol) - controversial
Fentanyl (Sublimaze)
Butorphanol (Stadol)
Nalbuphine (Nubian)

64
Q

Which parenteral analgesics should a mother with opioid dependence issues not be given? and why?

A

Butorphanol and nalbuphine
Because they are mixed agonist-antagonist drugs and may cause withdrawal effects in herself and newborn

65
Q

5 factors for adequate fetal oxygenation

A

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
Q

Instruments used for intermittent auscultation

A

Fetoscope
Picard stethoscope
Handheld Doppler ultrasound

67
Q

What causes early decelerations?

A

Fetal head compression
Benign and not associated with interruption of fetal hypoxia, acidosis, or low APGAR scores

68
Q

What causes late decelerations?

A

Decreased fetal blood flow, resulting in fetal hypoxia
(Will typically dissipate with repositioning, etc. Concerning when they are recurring)

69
Q

What causes variable decelerations?

A

Interruption of oxygenation at the level of the umbilical cord, where cord vessels may be compressed

70
Q

Corrective measures that may be done when nonreassuring FHR patterns are noted

A

Maternal repositioning
IV fluid blouses
Administer oxygen
Reduce UA
Correct maternal hypotension
Perform amnioinfusion
Modify second-stage pushing efforts

71
Q

What does repositioning mother to lateral or hands and knees help with?

A

Variable or prolonged decelerations r/t cord compression
Lateral repositioning may also increase uterine blood flow

72
Q

How does in IV bolus of fluid help with placental perfusion and fetal oxygenation?

A

Increases circulating blood volume and improves cardiac output

73
Q

Nursing actions for a maternal hypotension

A

Lateral repositioning
IV hydration

If those actions are not sufficient, may need medication to increase BP (epi or phenylephrine)

74
Q

What does veal shop stand for?

A

Variable - Cord compression
Early - Head compression (OK)
Accelerations - OK
Late - Placental insufficiency

75
Q

What is a prolonged FHR pattern?

A

Can be periodic or episodic
Acceleration or deceleration that lasts >2 min - 10 min
After 10 min = Brady or tachycardia

76
Q

4 categories needed to assess UA

A

Frequency
Duration
Intensity
Resting tone

77
Q

Categories of fetal heart rate patterns

A

Category 1 = normal
Category 2 = indeterminate
Category 3 = abnormal and need to deliver baby

78
Q

What do variable, late, or prolonged decelerations indicate? What should be done?

A

Interruption of oxygen transfer
Need to:
move pt to left side
IV fluids
Oxygen
Notify provider (last)
Slow contractions

79
Q

What is the ABCD approach to FHR management?

A

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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