Exam 2 Flashcards by Katherine Rodriguez

What are some non pharmacological interventions for preTerm labor

Bedrest
Monitor FHR
Ensure hydration

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What are some Pharmacological Interventions for PreTerm Labor?

Administer Fluids
Administer medications
Terbutaline, magnesium sulfate , nifedipine

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What medications are administered for Preterm Labor?
*hint TMN**

Terbutaline
Magnesium Sulfate
Nifedipine

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What are some maternal side effects to monitor with Terbutaline?

HTN Crisis
Tachycardia
Chest pain
Hypokalemia, Hypoglycemia
Pulmonary edema
Cardiac arrhythmias
Intolerable BP (>90/60)

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What are some Fetal side effects to monitor with Terbutaline?

TACHYCARDIA
Potassium levels
Notify hcp of adverse effects

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What is Naegele’s Rule ?

Take a women’s LMP
Subtract 3 months
Add 7 days to days
Add 1 year

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What are some S&S to a Placental Abruption?

Sudden onse painful vaginal bleeding **
Uterine tenderness
Late decelerations with FHR
Hypovelmic shock (increase
BP, pale , decreased LOC, Urinary retention)
Contractions with hypertonicity

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What are some interventions for placental Abruption?

Notify MD
Place patient on side
Place on 02 and foley
Prepare for c section

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When and how is it appropriate to treat Group b strep?

After birth with antibiotics

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What is the nursing priority during epidural analgesic?

Monitor for HYPOTENSION

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What is the initial treatment for Gestational diabetes?

Management of diet first!!
Exercise

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What are other options to treat gestational diabetes?

Insulin if needed
Glyburide

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Contractions occurring regularly becoming stronger, longer and closer together.. True or false labor signs ?

True Labor Signs

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Contractions occurring more intense with walking are considered true or false labor ?

True Labor signs

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A patient comes into her doctor office and is 30 weeks of gestation she’s complaining of lower back pain radiating to her abdomen the nurse should consider these signs as true or false labor signs?

True

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A patient reports having bloody show during her doctors visit she is 28 weeks of gestation is this considered true or false labor signs ?

True

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Cervix softening with effacement ,urinary frequency are signs of false or true labor signs ?

True

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A patients comes in for an office visit complaining of contractions occuring irregularly and stoping when she walks or changes position, the nurse should consider these are signs of what kind of labor?

False

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A 28 week gestation client comes for her office visit complains of pain in her abdomen right above her umbilicus and can feel it in her back this is considered what kind of labor sign

False

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A soft cervix with no effacement and no bloody show can relate to what sign of labor ?

False

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Magnesium Sulfate is infused at what rate ?

125 ML/hr

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What are some pre-conceptual education for women?

Take folic acid before pregnancy
Take prenatal vitamins before pregnancy
Exercise
Avoid smoking , alcohol, drugs OTC medications if not stated otherwise by HCP

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What is the most reliable indicator of fetal growth?

Measurement Fundal Height
Uterine size

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At 12-16 weeks the fundus should be located ?

Top of the pubic bone

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At 21-36 weeks the fundus should be located?

At the top of the uterus

At 20 weeks the fundus should be located where

At the naval

Can the fundus at 21-22 weeks still be located at the naval?

Yes (normal)

How many stages of labor are there

What is stage 1 of labor

Where dilation occur Cervix will dilate from (1-10)

The latent stage of labor is where the cervix is dilated?

1-3 sm

The active stage of labor is where the cervix is dilated …

4-7sm

The transition phase of labor is where the cervix is dilated …

8-10 sm

Stage 2 of labor is considered what?

Pushing and ends when baby is delivered

What is the 3 stage of labor?

Placenta is delivered

Stage 4 of labor is ?

Recovery

What should the nurse do if the fundus is boggy and not at midline

Massage for 2-3 mins

What some nursing interventions during the 4th stage of labor ?

Monitor vitals Monitor for signs of infections ,RD, N/v, Low BP Monitor Lochia discharge Measure soaked peri pads

What should the nurse assess during the stage of recovery if patient is experiencing more than normal blood loss?

Assess fundus , massage Measure soaked peripad Assess if Pitocin was received during labor

What is the expected weight gain for a healthy BMI patient ?

25-30lbs

What is the Expected weight gain in the first trimester ?

1-2kg

What is the expected weight gain in the last two trimester ?

0.5 kg per week

If a patients BMI is less than 18.5 what is expected of them ?

Gain 28-40 lbs

What is a risk for pregnancy if BMI is less than 18.5 ?

Preterm Labor

If a patients BMI is over 25 what is expected of them?

Weight loss of 15-25 lbs

What are some risk associated with pregnancy if patient BMI is over 25?

Risk for C-section Complicated Prolonged Recovery

What are some nursing interventions for Hypermesis Gravidarum?

Prevent dehydration and N/V Assess vitals, weight and calorie count Monitor FHR Encourage small meals with fluid intake inbetween Encourage sitting up right after meals

During the summer pregnant women are more prone to experience what and why?

Braxton Hicks Due to lack of hydration

Back pain is a sign of what in pregnant women?

Active Labor

What are some warning signs for women at 28 week gestation ?

Premature labor Placenta previa or abruption Decrease fetal movement ROM Back pain signaling active labor

A 28year old women arrives for her 28 weeks gestation visit exhibiting Shob with exertion ? What can this indicate

Active labor Not NORMAL

What are some interventions to do if a patient experiences signs of ROM?

Monitor FHR Assess the membranes Limit cervix checks Notify md

Why should the nurse limit cervix checks for ROM?

Risk of infection

Early decelerations are caused by ?

Head compression

What are the nursing interventions for early decelerations?

Continue to monitor No intervention needed

What would early decelerations look like on the monitor ?

Mirror image of moms contractions

What is the highest priority for a prolapsed cord ?

Push the presenting part back up with 2 fingers and prepare for c section

How will a prolapsed cord look on a monitor ? Think VEAL—> CHOP

Variable decelerations

What is a precipitous birth ?

Fast birth within 3 hours or less

What is the main intervention for a precipitous birth ?

Skin to skin for mother and baby

What is chronic villus sampling?

Assessment of developing placenta

When does Chronic villus sampling occur ?

10-13 weeks of gestation

How is Chronic villus sampling conducted ?

Aspirated through abdominal wall or intravaginally with syringe

What is phenegran used for in pregnant mothers?

Nausea/ Vomiting Sedative in labor

How would a nurse administer Phenegran?

Slow Push

How often should fetal kicks be assessed by mother?

Daily

What is a normal fetal kick count?

10 kicks within 2 hours

When can an expecting mother feel her baby move ?

16-20 weeks of gestation

A patient reports feeling 4 movements in a 1 hr session is this considered normal?

Yes

During what gestation should fetal kicks be surveillanced ?

28 weeks

When should the mother notify her HCP regarding fetal kicks ?

Fewer than 3 movements in 2 hrs After rest and eating if fetal count continues to remain fewer than expected

What is priority nursing action for fetal heart tones?

If heart tone is heard at the top of abdomen after 32 weeks (Breech Baby)

A mother comes in at 6 weeks gestation and the nurse is unable to hear the baby heart tones is this considered normal?

Yes normal reassure mom

What actions should the nurse take if unable to hear fetal heart tones?

Reposition mother Assess mothers radial pulse while reading for babys tone

Where should the nurse expect to hear a fetal tone?

Moms right or left lower abdomen

What is the cause of variable decelerations ?

Cord compression

What are the nurse interventions for variable decelerations ?

D/c oxytocin Position change Oxygen (non rebreather) Push presenting part back up with two fingers Prepare for C-section Amino infusion Breathing technique

On the monitor what will variable decelerations look like

“V”

What is the priority nursing intervention for Pitocin ?

STOP INFUSION if signs of complications Monitor FHR changes (stop if changes occur)

What can be expected at a 18 week gestation ultrasound visit?

Ensuring appropriate development of fetus and adequate amniotic fluid.

During a prenatal health history what should be obtained first ?

Obstetrical history (Complications of prior pregnancies)

What other information will be obtained during a prenatal health history visit?

Medical history Social history Family history Environmental history Abuse or at risk of abuse hx

Gravidity stand for?

#’s of pregnancies

GTPAL is

Gravidity Term births Preterm births Abortions or miscarriages Living children

Twins are counted as one in GTPAL expect for in?

Living children

What is the nursing assessment during ROM?

Nitrazine test Assess membranes Monitor vital Fetal monitoring

What are some teachings for adolescent prenatal care ?

Nutrition Support system Encourage continued prenatal care and appropriate assistance Encourage adolescent to apply for wic if nutrition is a concern

What are some risk for ectopic pregnancy

STI IUDs Assisted reproductions Tubal surgery

What are expected findings in ectopic pregnancies?

Unilateral stabbing pain and tenderness in lower abdomen quadrant Delayed menses (1-2 weeks) Scant dark red/vaginal spotting lasting 6-8 weeks after menses Red vaginal bleeding indicating rupture Hemorrhage shock

What is the nursing care for ectopic pregnancy ?

Replace fluids , maintain electrolytes Provide client with education and physiological support Administer meds as prescribed Prepare for sx Provide referral to event and partner to pregnancy loss support group Obtain HCG and progesterone levels, liver and renal function studies.

What is an increased risk of complication with previous cesarean sections?

Higher risk for placenta previa

What are some nursing actions for patients in active stage 1 labor?

Promote comfort Warm shower, massage, walk, epidural Provide quiet environment Encourage voiding 1-2 hrs Encourage effective breathing pattern and rest between contractions Encourage participation in care and keep informed

What are some nursing actions for patients in stage 2 labor?

Provide ice chips and ointment for dry lips Provide praise and encouragement to the mother Monitor for signs of birth ( perineal bulging or vizualation of fetal head)

During active labor there is no change with the station of baby, mother is fully effaced and dilated what are the nurses action?

Prepare for sx

During active labor the mother is fully effaced and 7 sm dilated what is the nurses actions?

Instruct not to push, can cause swelling and prolonged labor Encourage effective breathing techniques

What is the progression for nulliparous ?

First time moms should progress 1 sm per hr

What is variability on fetal monitor ?

Variable decelerations Accelerations Early decelerations Late decelerations

Variable decelerations is caused by

Cord compression

Early deceleration is caused by?

Head compression

Accelerations is caused by ?

Normal fetal compression

Late decelerations is caused by?

Placental insufficiency

What are some nursing interventions for Late decelerations ?

D/c oxytocin Position change Oxygen Hydration Elevate legs to correct hypotension

How are late decelerations viewed on monitor?

Come after moms contractions

What are some nursing actions for patients in transition phase of labor ?

Encourage rest in between contractions Provide privacy Wake mother during contraction so she can begin breathing techniques Obtain FHR Offer fluids, ice chips and ointment for lips Encourage voiding q1-2 hrs

What are some pharmacological measures for patients in active labor?

DO NOT GIVE PAIN meds if past a 5 or 90%effaced Opioid analgesics Bulophranol/ nalbuphine Epidural/ spinal analgesic Regional block

What is the main risk associated with type 1 diabetes during pregnancy ?

Fetal Demise

What are S&S of magnesium toxicity ?

Decreased respirations Absent tendon reflexes Decrease during output (>30ml/hr) Decreased level of consciousness Cardiac arrythmias

What is the main Intervention for Magnesium toxicity ?

STOP infusion Administer antidote (calcium gluconate/ Calcium Chloride) Prepare for actions to prevent respiratory or cardiac arrest

A mother is RH negative and Gave birth to a RH positive baby what are the nurse actions ?

RHOGAM Can be administered at 28 weeks

How is oxygen carried to the fetus

Carried through the umbilical arteries

What is the first organ system to begin forming in the embryo?

Fetal circulation

What allows the oxygenated blood to bypass the fetal lungs?

Foreman oval

When will the Ductus arteroirus normally close ?

After newborn period

A patient who is 13 weeks of gestation came in to receive a chronic virull sample, she is Rh negative what would the patient receive ? Why?

Rhogam Due to increase risk of RH sensitization