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Exam 2 Flashcards

1
Q

Why are C3-C5 injuries the most severe?

A

damage to phrenic nerve which is associated with the diaphragm

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2
Q

What injuries are most common?

A

cervical and lumbar

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3
Q

What area of the body is affected during a C4 injury?

A

below neck

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4
Q

What area of the body is affected during a C6 injury?

A

below shoulders

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5
Q

What area of the body is affected during a T6 injury?

A

below chest

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6
Q

What area of the body is affected during a L1 injury?

A

below waist

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7
Q

What are the primary mechanism of injury? (6)

A

Hyperflexion
Hyperextension
Flexion & extension
Axial loading/vertical compression
Excessive rotation
Penetrating trauma

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8
Q

Hyperflexion direction?

A

forward

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9
Q

Hyperextension direction?

A

backward

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10
Q

Flexion & Extension injury?

A

whiplash

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11
Q

What are secondary mechanisms of injury?

A

worsens the primary injury; may be reversible within the 1st 4-6hrs w/ early intervention

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12
Q

What are the causes of secondary injury? (5)

A

Hemorrhage
Ischemia
Hypovolemia
Impaired tissue perfusion
Local edema

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13
Q

What is the emergency management of someone who has a suspected c-spine injury?

A

immobilize head and neck in neutral position w/ C-collar and hard backboard

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14
Q

What are our priorities when caring for a trauma pt?

A
  1. Stop uncontrolled bleeding
  2. Immobilize C-spine
  3. ABCs
  4. resp function/perfusion/cardiac assessments
  5. GCS score
  6. sensory/mobility/neuro assessments
  7. pain assessment
  8. GI/GU assessment
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15
Q

What GCS score means intubation is indicated?

A

<8

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16
Q

ABCDEFGHI?

A

Airway
Breathing
Circulation and Control bleeding
Disability
Expose & Environmental control
Full set VS, Facilitate adjuncts, Family
Get monitoring devices, Give comfort
History and Head-to-Toe assessment
Inspect posterior surface

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17
Q

What diagnostic studies can you anticipate for a client with a suspected SCI?

A

CT scan: complete or incomplete injury
Cervical XR: hard to see C7 & T1
MRI: soft tissue
Comprehensive neurologic exam: q1hr
CT angiogram: vertebral artery damage

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18
Q

What is spinal shock?

A

Complete but temporary loss of motor, sensory, reflex, and autonomic function

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19
Q

What manifestations are associated with spinal shock?

A

Bradycardia
Hypotension
Low CO
No sweating below level of injury
Flaccid paralysis
Loss of sensation
Bowl and bladder dysfunction
Warm, dry extremities

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20
Q

How long does spinal shock last?

A

48hrs but can last for weeks

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21
Q

What is the onset of spinal shock?

A

occurs w/in 30-60min of injury

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22
Q

How do we treat spinal shock?

A

Keep MAP >85 using vasoconstrictors (levophed, sudophed)
Steriods: antiinflammatory
Keep normothermia

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23
Q

What is autonomic dysreflexia?

A

Exaggerated autonomic response to stimuli

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24
Q

What manifestations are associated with AD?

A

HTN (can cause stroke)
Bradycardia
Severe headache
Profuse sweating above level of injury
Flushing of skin/goosebumps
Blurred vision/spots in visual field
Apprehension

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25
Q

How is AD caused?

A

Distended bladder (most common)
Distended bowel
Skin stimulation

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26
Q

How do we treat and prioritize interventions for a client with AD?

A
  1. raise HOB
  2. find cause
  3. treat cause
  4. notify provider
  5. monitor and treat BP (vasodilators)
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27
Q

What is neurogenic shock?

A

hemodynamic changes resulting from sudden loss of autonomic tone

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28
Q

How is neurogenic different from spinal shock?

A

neurogenic is circulatory in nature

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29
Q

When does neurogenic shock occur?

A

24hrs following injury

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30
Q

What are manifestations of neurogenic shock?

A

Hypotension
Bradycardia
Low CO
Wide pulse pressure
Warm, flushed skin
Labored breathing
Dizziness

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31
Q

What kind of injury is Anterior Cord Syndrome?

A

flexion and compression injury

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32
Q

What damage is done during Anterior Cord Syndrome?

A

damage to anterior spinal artery

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33
Q

Manifestations of Anterior Cord Syndrome?

A

motor paralysis and loss of pain and temp sensation below level of injury

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34
Q

What kind of injury is Brown-Sequard Syndrome?

A

penetrating injury

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35
Q

What damage is done in Brown-Sequard Syndrome?

A

damage to 1/2 of cord

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36
Q

Manifestations of Brown-Sequard Syndrome?

A

Ipsilateral loss of motor function
Contralateral loss of pain and temp sensation

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37
Q

What kind of injury is Central Cord Syndrome?

A

Hyperextension

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38
Q

Manifestations of Central Cord Syndrome?

A

burning pain in upper extremities

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39
Q

How do TED hose and abdominal binders help orthostatic hypotension?

A

maintain blood volume

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40
Q

What meds prevent stress ulcers?

A

H2 receptor blockers (Famotidine, Cimetidine)
PPIs (Omeprazole, Pantoprazole)

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41
Q

What happens to the vagina during pregnancy?

A

becomes more acidic, therefore, more prone to yeast infections

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42
Q

What blood components increase during pregnancy?

A

WBC and fibrinogens

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43
Q

What happens to the respiratory status during pregnancy?

A

hyperventilation
respiratory alkalosis

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44
Q

What happens to insulin levels during pregnancy?

A

increases

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45
Q

What meds can pregnant ladies take to help with common discomforts?

A

tylenol & tums

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46
Q

What is the intervention for supine hypotension?

A

lay pregnant lady on left lateral side

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47
Q

Recommended wt gain during pregnancy for normal BMI?

A

28-35lbs

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48
Q

Recommended wt gain during pregnancy for underweight?

A

28-40lbs

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49
Q

Recommended wt gain during pregnancy for overweight?

A

15-25lbs

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50
Q

Recommended wt gain during pregnancy for obese?

A

11-20lbs

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51
Q

1st trimester length

A

1-13 weeks

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52
Q

How often are prenatal visits during the 1st trimester?

A

monthly

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53
Q

How much wt are you supposed to gain during 1st trimester?

A

1-4.5lb

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54
Q

What happens in the first prenatal visit?

A
  1. EDB (estimate due date)
  2. Health assessment
  3. pelvic exam/pap smear
  4. med reconciliation
  5. safety topics
  6. labs
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55
Q

What kind of labs do they order during the initial prenatal visit?

A

Blood typing
Rubella viral antigen screen
Hepatitis panel
STDs

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56
Q

What ed is provided during 1st trimester?

A

basics of what to expect during pregnancy
required nutrition
possible complications
fetal growth/development

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57
Q

2nd trimester length

A

14-26 weeks

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58
Q

In what trimester do you measure fundal height?

A

2nd trimester

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59
Q

How do you evaluate fundal height measurements?

A

weeks gestation should = measurement of fundal height

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60
Q

What measured difference in fundal height identifies a problem?

A

> 2cm< difference

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61
Q

What is leopold’s maneuvers?

A

palpating position of baby

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62
Q

What are the 1st signs of supine hypotension syndrome?

A

sweaty, dizzy

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63
Q

Which labs are assessed during the 2nd trimester?

A

Gestational DM screening
Rh(D) factor screening

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64
Q

When is gestational DM screening performed?

A

24-28weeks

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65
Q

1hr glucose tolerance test details?

A

don’t need to fast
50g oral glucose load
130-140 could indicate DM

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66
Q

3hr glucose tolerance test details?

A

need to fast
100g oral glucose load
1,2,3hr checks
2 of 4 elevated BS samples = diagnosis

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67
Q

What fasting glucose level indicates gestational diabetes?

A

> 95

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68
Q

After 1hr what BS level indicates gestational diabetes?

A

> 180

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69
Q

After 2hr what BS level indicates gestational diabetes?

A

> 155

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70
Q

After 3hr what BS level indicates gestational diabetes?

A

> 140

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71
Q

When is Rh(D) factor screening performed?

A

28 weeks

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72
Q

What Rh(D) factor screening result indicates a need for Rhogam prophylactically?

A

negative blood type

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73
Q

Why is Rhogam important to administer?

A

worried about viability of 2nd pregnancy

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74
Q

What ed is included during the 2nd trimester?

A

benefits of breastfeeding
seat belt safety
travel
fetal movement
complications
childbirth classes
develop birth plan

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75
Q

How many cal should pregnant lady consume during 2nd trimester?

A

350 calories?

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76
Q

How much wt should pregnant lady gain during 2nd & 3rd trimester?

A

1-2lbs per week

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77
Q

3rd trimester length?

A

27-40 weeks

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78
Q

How often are prenatal visits after 28 weeks?

A

every 2 weeks

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79
Q

How often are prenatal visits after 36 weeks?

A

weekly

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80
Q

How many fetal movements (kicks) should mom feel in an hour?

A

3 kicks

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81
Q

What labs are performed during 3rd trimester?

A

Hct & Hgb (H&H)
Group B strep screening

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82
Q

When is Group B strep screening performed?

A

35-37 weeks

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83
Q

If a pregnant lady is + for Group B strep what are the interventions?

A

antibiotics during labor 2-3 does

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84
Q

What ed is included during the 3rd trimester?

A

childbirth classes
coping methods
pain management
signs of labor
infant care
postpartum care
kick counts

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85
Q

How many calories is pregnant lady supposed to consume during 3rd trimester?

A

450 calories

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86
Q

When is the NST performed?

A

3rd trimester

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87
Q

Nursing considerations for NST?

A

Instruct pt to press the button on the event marker each time they feel a fetal movement

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88
Q

What NST finding is good?

A

reactive

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89
Q

Normal FHR?

A

accelerates at least 15bpmx15sec

occurs 2 or more times during 20min period

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90
Q

What assess fetal well-being measuring 5 variables with score of 0 or 2 (in 30min)?

A

BPP

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91
Q

What BPP result is normal?

92
Q

What BPP result is critical?

A

less than 4

93
Q

What are the 5 variables involved in a BPP?

A

FHR
Muscle tone
Body movements
Breathing movements
Amniotic fluid volume

94
Q

What values can an amniocentesis provide?

A

fetal lung maturity
Alpha-fetoprotein (AFP)

95
Q

What does high AFP indicate?

A

neural tube defects

96
Q

What does low AFP indicate?

A

chromosomal disorders

97
Q

Nursing considerations for amniocentesis?

A
  1. wedge under R hip to displace uterus off vena cava
  2. administer Rhogam if indicated
98
Q

HELLP Syndrome?

A

Hemolysis
Elevated Liver Enzymes
Low Platelets

99
Q

When does gestational HTN present itself?

A

20 weeks gestation

100
Q

What are the 2 ways to diagnose preeclampsia?

A

> 140/90 (on 2 occasions at least 4hr apart) & Proteinuria
OR
140/90 (on 2 occasions at least 4hr apart) & S/S of organ damage

101
Q

What is the patho of preeclampsia?

A

abnormal placentation = poor perfusion

102
Q

What is the term for severe preeclampsia?

A

eclampsia (tonic-clonic seizure)

103
Q

Sign of renal damage?

A

creatine >1.1

104
Q

Sign of liver damage?

A

R upper quadrant pain
elevated liver enzymes (AST/ALT)

105
Q

Sign of pulmonary damage?

A

edema occurs fast 1-2 days

106
Q

Sign of CNS damage?

A

seeing stars
hyperreflexia

107
Q

Low platelet value?

108
Q

What meds are administered to combat preeclampsia?

A

magnesium sulfate
labetalol
hydralazine
nifedipine

109
Q

How long is magnesium sulfate administered?

A

throughout labor and postpartum 24hrs

110
Q

What are the early signs of magnesium sulfate toxicity?

A

warmth, flushing

111
Q

What is the antidote for magnesium sulfate toxicity?

A

calcium gluconate

112
Q

What are S/S of magnesium sulfate toxicity?

A

decreased BP
decreased urine output
respirations <12
patella reflex absent

112
Q

Indication for magnesium sulfate?

A

used to prevent seizures & provide neurological protection

113
Q

Interventions for A1 GDM?

A

diet controlled & no meds

114
Q

Interventions for A2 GDM?

A

meds (metformin/insulin)

115
Q

Complications of gestational diabetes?

A

large babies
hypoglycemia after delivery

116
Q

After birth, when do pts follow-up with their provider when they had gestational diabetes?

A

6-12 weeks

117
Q

Description of placenta previa?

A

placenta is covering cervical os in different severities

118
Q

Which pregnancy complication indicates that vaginal delivery is not possible?

A

placenta previa

119
Q

S/S of placenta previa?

A

may or may not have vaginal bleeding
painless

120
Q

What is the treatment for placenta previa?

A

no vaginal exams or intercourse

121
Q

What are risk factors for placental abruption?

A

cigarette smoking
HTN disorders
cocaine use

122
Q

What are S/S of placental abruption?

A

abdomen appears board-like
vaginal bleeding

123
Q

Treatment for placental abruption?

A

emergency C-section

124
Q

What is the Kleihauer-Betke test?

A

associates’ fetal blood in maternal circulation

125
Q

S/S of ectopic pregnancy?

A

sharp, stabbing pain in lower abdomen
scant, dark red, or brown vaginal discharge
referred shoulder pain

126
Q

Treatment for ectopic pregnancy?

A

methotrexate
surgery

127
Q

S/S of impending labor? (3)

A

contractions are regular
presence of bloody show or lose mucus plug
wt loss of 1-3lbs

128
Q

5P’s: crucial factors affecting L&D?

A

Powers (contractions)
Passageway
Passenger
Psyche
Postion

129
Q

primary contractions

A

involuntary

130
Q

Frequency definition?

A

beginning of one contraction to the beginning of another

131
Q

Duration definition?

A

beginning to end of one contraction

132
Q

How is intensity of contractions evaluated?

A

palpation of abdomen

133
Q

How much should mom be dilated before pushing?

134
Q

How much should mom be effaced before pushing?

135
Q

Effacement definition?

A

thinning & shortening of cervix

136
Q

Ballotable definition?

A

fetus is up high

137
Q

3 factors involved in fetal station assessment?

A

engagement
presentation
position

138
Q

Zero station?

A

fetal head is by ischial spine in pelvis

139
Q

Negative station?

A

baby is high (not engaged)

140
Q

Positive station?

A

baby is low (engaged)

141
Q

Presentation?

A

lie & attitude

142
Q

Appropriate lie for delivery?

A

longitudinal

143
Q

Attitude?

144
Q

Attitude:extension position?

A

face first

145
Q

What fetal body part should come out first?

146
Q

Ideal fetal position for delivery?

A

right occipitoanterior or left occipitoanterior

147
Q

Cervical Ripening Agents (3)?

A

dinoprostone (cervidil)
misoprostol (cytotec)
foley bulb

148
Q

What is a bishop score used for?

A

to determine need for induction

149
Q

What factors are involved with bishop scoring?

A

position
consistency
effacement
dilation
baby’s station

150
Q

The higher the bishop score?

A

better candidate for induction

151
Q

Bishop score indicating need for induction for primipara?

A

6 or greater

152
Q

Bishop score indicating need for induction for multipara?

A

8 or greater

153
Q

What does external fetal monitoring measure?

A

frequency and duration of contractions

154
Q

What does internal fetal monitoring measure?

A

frequency, duration, intensity of contractions

155
Q

How long do you count to obtain FHR?

156
Q

Normal FHR?
BPM

157
Q

What is the indication for tocolytics?

A

slow labor

158
Q

Examples of tocolytics?

A

nifidipine
magnesium sulfate
terbutaline
indomethacin

159
Q

When to use tocolytics?

A

btw 24-34 weeks gestation

160
Q

What corticosteroids are used to develop fetal lung maturity?

A

betamethasone
dexamethasone

161
Q

S/S of true labor?

A

cervical change (dilation, effacement)

162
Q

What is the 4-1-1 rule?

A

new contraction every 4min that lasts at least 1min and contractions occurring for 1hr

163
Q

When should a mom go to the hospital? (5)

A

decrease in fetal activity
break their water
vaginal bleeding
consistent abdominal pain
pt is concerned about anything

164
Q

What is involved in the 1st stage of labor?

A

regular contraction to complete dilation

165
Q

What is latent dilation?

166
Q

What is active dilation?

167
Q

What is transitional dilation?

168
Q

What is involved in the 2nd stage of labor?

A

cervical dilation to delivery of fetus

169
Q

What is involved in the 3rd stage of labor?

A

birth of fetus to when placenta is delivered

170
Q

How long does it take to deliver the placenta?

171
Q

What are S/S of placental separation? (3)

A

cord lengthens
uterus has globular shape (rises in abdomen)
sudden gush of blood

172
Q

What med is used to treat placental separation?

A

Pitocin (oxytocin)

173
Q

What is involved in the 4th stage of labor?

A

maternal hemostatic stabilization
continues for 1-4hrs after delivery of placenta

174
Q

What is the gate control theory of pain?

A

focused concentration or distraction blocks painful stimuli

175
Q

Positives of nitrous oxide?

A

helps reduce anxiety
quick onset
small duration

176
Q

S/E of nitrous oxide?

A

giddiness or dizziness

177
Q

Common IV opioids used during L&D?

A

Fentanyl
Stadol
Nubain

178
Q

S/E of IV opioids?

A

lower BP
itching
nausea

179
Q

S/E of epidural?

A

lower BP
slower labor
fever

180
Q

Nursing responsibilities during epidural administration?

A

IV fluid bolus before
consent
assess for bladder distension
lateral in fetal position
external fetal monitor

181
Q

Best time to get an epidural?

A

whenever they want
try to wait longer until the active phase

182
Q

Benefits of not administering epidural?

A

reduce risk of infection
reduce risk of spinal headache
have control of body
less tearing

183
Q

How is the pudendal block administered?

A

transvaginally

184
Q

Variability definition?

A

difference btw lowest point of FHRr and highest point (amplitude)

185
Q

How long is variability assessed?

186
Q

What is minimal variability?

187
Q

What is moderate variability?

188
Q

What is the normal variability?

189
Q

What is marked variability?

190
Q

What is the primary indicator of fetal well-being?

A

variability

191
Q

What is normal accelerations?

A

rise in FHR of at least 15bpm that lasts for 15sec

192
Q

Accelerations are a positive or negative indicator?

193
Q

VEAL CHOP MINE
(VCM)?

A

Variable deceleration
Cord compression
Maternal repositioning

194
Q

VEAL CHOP MINE
(EHI)?

A

Early deceleration
Head compression
Identify labor progress

195
Q

VEAL CHOP MINE
(AON)?

A

Acceleration
Okay
No interventions

196
Q

VEAL CHOP MINE
(LPE)?

A

Late deceleration
Placental insufficiency
Excute interventions

197
Q

What fetal heart tone pattern “mirrors” contractions?

A

early decelerations

198
Q

When do variable decelerations become concerning?

A

when they occur with contractions

199
Q

What fetal heart tone pattern is concerning when it occurs at the peak of a contraction?

A

late decelerations

200
Q

Interventions for late decelerations?

A

reposition mom to L lateral side
increase IV fluids
stop pitocin
apply O2
notify provider

201
Q

How often should vitals be taken during pitcoin administration?

202
Q

How often should pitcoin be titrated?

203
Q

What are nursing responsibilities with pitocin?

A

vitals
titration
continuous fetal monitoring
monitor for signs of labor
urine output

204
Q

How often should the nurse monitor for signs of labor when administering pitocin?

205
Q

How long are too long contractions?

A

greater than 90sec
>2min apart

206
Q

What do long contractions indicate?

A

hypertonic uterus
fetus hypoxia

207
Q

If membranes are rupture for more than 24hrs what is the nurse’s concern?

208
Q

What would the nurse need to notice when membranes rupture?

A

time, amount, color, odor

209
Q

What is the pH of amniotic fluid?

210
Q

With what complications do you not want to induce labor?

A

cord prolapse
placenta previa

211
Q

Risk factors for cord prolapse?

A

polyhydramnios
multiple fetuses
prematurity
ROM
negative station

212
Q

What is amniotomy?

A

artificially rupture membranes

213
Q

What are nursing interventions for cord prolapse?

A

keep hand inserted in vagina
position pt in knee-chest position
elevate fetal head off umbilical cord with gloved finger
emergency C/S

214
Q

What is shoulder dystocia?

A

fetal shoulder is stuck

215
Q

What is a sign of shoulder dystocia?

A

turtle sign

216
Q

What are nursing interventions for shoulder dystocia?

A

suprapubic pressure
mcrobert’s maneuver

217
Q

What is mcrobert’s maneuver?

218
Q

What is chorioamnionitis?

A

intraamniotic infection

219
Q

S/S of chorioamnionitis?

A

maternal hyperthermia, tachycardia
fetal tachycardia

220
Q

Nursing interventions for chorioamnionitis?

A

IV antibiotics for mom and infant

221
Q

What are risk factors for preterm birth?

A

lower education and income level
extreme ages
african american ethnicity

222
Q

Diagnostics for preterm birth?

A

fetal fibronectin (fFN)
ultrasound of cervical length

223
Q

What does a positive fFN level indicate?

A

> 50
active labor within 10 days

224
Q

What cervical length indicates possibility of preterm birth?

225
Q

What is the treatment for preterm birth?

A

bedrest
reduce stress
no intercourse
L lateral position
hydration

PCC IV (4 decks)

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