EXAM 2 Flashcards
hypothyroidism
underproduction of the thyroid hormone
exophthalmos
protruding eyeballs
diabetes mellitus
endocrine disorder where pancreas can’t produce adequate insulin to regulate body’s glucose levels
(type 2)
what percentage of women develop GD while pregnant?
2-3%
define gestational diabetes mellitus
developing insulin resistance during pregnancy. Usually noticed at midpoint of pregnancy
tested during wks 24-28
sexual maltreatment
any sexual contact between a child and an adult
define “Megan’s Law”
a federal law requiring law enforcement authorities to report to neighbors when a sexual abuser moves into a neighboorhood.
rape trauma syndrome
often broken down into 2 stages:
-disorganization (humiliation, shame, guilt)
-reorganization (nightmares, difficulty trying to move on and heal)
Intimate partner violence
maltreatment by family member against another adult living in household
define abortion
interruption of a pregnancy before a fetus is born
define miscarriage
premature or immature birth
Describe early miscarriage
occurs before week 16
describe late miscarriage
occurs between weeks 16-20
symptoms of threatened miscarriage
-vaginal bleeding
-cramping
-no cervical dilatation present
key intervention for ectopic pregnancy:
avoiding strenuous activity for 24-48 hrs
imminent (inevitable) miscarriage
uterine contractions and cervical dilation occur together
D&C
dilatation and curettage
D&E
dilatation and evacuation
complete miscarriage
entire products of conception(fetus, membranes, and placenta) are expelled spontaneously without any assistance
incomplete miscarriage
part of conceptus (usually the fetus) is expelled, but membranes or placenta is retained in uterus.
missed miscarriage
fetus dies in utero but it is not expelled
ectopic pregnancy
implantation occurred outside uterine cavity
(commonly in fallopian tube)
gestational trophoblastic disease (hydatidiform mole)
abnormal proliferation and then degeneration of the trophoblastic villi
what procedure is used for gestational trophoblastic disease?
suction curettage
what is used to treat malignancy?
methotrexate
Cervical insufficiency (premature cervical dilation)
a cervix that dilates prematurely and therefore cannot retain a fetus until term
cervical cerclage
surgical operation performed preventing next pregnancy from experiencing premature cervical dilatation. (Tying string around cervix)
shirodkar technique
sterile tape threaded in a purse-string manner under submucous layer of cervix and sutured in place to achieve a closed cervix.
shirodkar sutures are removed at ______ weeks so fetus can be born vaginally
36-37 weeks
placenta previa
placenta is implanted abnormally in lower part of uterus. Most common cause of painless bleeding in 3rd trimester of pregnancy
premature separation of the placenta
placenta appears to have been implanted correctly. But suddenly, it begins separating and bleeding starts
couvelaire uterus
forming hard, board-like uterus
disseminated intravascular coagulation (DIC)
acquired blood clotting where fibrinogen level falls ot below effective limits
tocolytic agent
agent to halt labor
preterm rupture of membranes
rupture of fetal membranes with loss of amniotic fluid before 37 weeks of pregnancy
gestational hypertension
vasospasm occurs in small and large arteries during pregnancy causing increased BP
preeclampsia
pregnanacy-related disease process evidenced by increased BP and proteinuria
main 2 signs of preeclampsia
hypertension and proteinuria
what 3 catagories is preeclampsia broken into?
- preeclampsia without severe features
- preeclampsia with severe features
- eclampsia
describe a pregnancy with partial separation and concealed hemorrhage
placenta is partially separated from uterus causing a hemorrhage, however it is a concealed hemorrhage bc you can’t see hemorrhage during cervical exam
describe a pregnancy with partial separation and apparent hemorrhage
placenta is partially separated from uterus causing a hemorrhage. It is apparent bc you CAN see hemorrhage during cervical exam
describe a pregnancy with complete separation and concealed hemorrhage
placenta is COMPLETELY separated from uterus, however it is a concealed hemorrhage bc you can’t see it during cervical exam
define encephalopathy
brain damage or disfunction
pt with severe hyperemesis may develop this
list risk factors for GD
obesity
age: 25+
history of large babies
family history of diabetes
what is glycosylated hemoglobin? (HbA1c)
the measure of the amount of glucose attached to hemoglobin. Used to detect the degree of hyperglycemia present
when is insulin therapy needed for GD patients?
when diet and oral therapy do not help control diabetes
describe blood glucose monitoring for pt with GD
completed 4 times / day. Track with chart
S&S of hypoglycemia
feeling weak and nauseated. check blood sugar
what foods help patients with GD?
Whole grains have a low glycemic index and are rich in fiber, which helps regulate blood glucose levels. They should be included in the diet for better glucose control
The nurse is teaching a pregnant woman with gestational diabetes about self-monitoring of blood glucose. Which statement by the patient demonstrates an understanding of proper technique?
“I will check my blood sugar before meals and two hours after eating.”
Glucose challenge test:
test type: fasting
pregnant glucose level: ____
pregnant glucose level: 95
Glucose challenge test:
test type: 1 hour
pregnant glucose level: ____
pregnant glucose level: 180
Glucose challenge test:
test type: 2 hours
pregnant glucose level: ____
pregnant glucose level: 155
Glucose challenge test:
test type: 3 hours
pregnant glucose level: ____
pregnant glucose level: 140
A nurse is caring for a postpartum woman who had gestational diabetes and is breastfeeding. Which of the following statements is most important for the nurse to include in her discharge teaching?
“Your blood glucose levels will likely return to normal after delivery, but you should be screened for diabetes in 6 weeks.”
describe placenta previa
abnormally implanted placenta that is too close to the cervix
signs of eclampsia
proteinuria, blurring of vision, hyperflexia
define gestational hypertension
elevated BP of 140/90 after 20 weeks gestation with no proteinuria or edema
What does HELLP stand for?
Hemolysis Elevated
Liver enzymes
Low Platelets
(pt may complain of epigastric pain or RUQ from painful liver)
Describe gestational hypertension
BP is 140/90, no proteinuria, BP returns to normal range after birth
Describe mild preeclampsia
BP is 140/90, proteinuria 1+ or 2+, weight gain 2lb per week, mild edema in face
*triad of hypertension, proteinuria, & edema = signs of preeclampsia
Describe severe preeclampsia
BP is 160/110, proteinuria 3+ or 4+, oliguria, headache, blurred vision, extensive peripheral edema, epigastric pain, thrombocytopenia
Describe Eclampsia
Seizure or coma along with signs of severe preeclampsia
What med class is NOT safe while pregnant?
ACE Inhibitors and ARBs
What is the antidote for magnesium sulfate toxicity?
calcium gluconate
what does PRE stand for?
proteinuria, Rising BP, Edema
We know there is a Central Nervous System issue if what is affected?
visual changes
+ clonus
4+ DTR )deep vein reflexes
signs of magnesium sulfate toxicity
hyporeflexia
RR depression
CNS depression
when assessing for clonus, the nurses assesses dorsiflexion. What would a positive reading look like?
jerky rapid contraction of ankle and foot
Define efflerage
counter pressure on lower back
Describe 5 pain managements
- non pharmacological (Ex: peanut ball/ massage)
- pharmacological (Ex: analgesics)
- systemic (Ex: opioids)
- regional (Ex: epidural)
- general (Ex: general anesthesia)
Tailor Sitting
looks like “criss cross applesauce”, but without ankles stacked on top of each other
Describe the Dick-Read Method
fear leads to tension which leads to pain. Prevent fear with good education about childbirth
Describe the psychosexual method
“flow with” instead of “struggle against” pain and discomfort. This method involves deep breathing and relaxation of the mind
Describe hypnobirthing
Daily commitment to meditation during pregnancy in preparation for labor and birth
Describe the Lamaze Philosophy
gate control theory of pain relief. Focuses on using mind to prevent pain
Describe the Leboyer method of alternative birthing methods
Birthing room is darkened so there is no sudden contrast in light. Everything is warm, gentle, and quiet. Delayed cutting of cord is desired.
Describe placenta previa
placenta abnormally implants too low near opening of cervix
Describe abruptio placentae
The premature separation of the placenta from the uterus
Describe Vasa previa
fetal umbilical vessels implant into fetal membranes rather then placenta
Describe cervical insufficiency
premature cervical dilation
List a few non-pharm pain management options during labor
-Relaxation
-Focusing and imagery
-Breathing techniques
-Aromatherapy
-Hot/cold applications
define pressure anesthesia
pressure to an area of the body that interferes with pain receptors
describe analgesia vs anesthesia
analgesia reduces/decreases awareness of pain, where anesthesia causes partial or complete loss of the pain sensation
can narcotics be given during labor?
yes, but all narcotics cause respiratory depression so use caution
what is regional anesthesia?
local. It blocks specific nerve pathways
define a pudendal nerve block
injection of local anesthetic. Allows pain-free birth and suturing if needed. Monitor BP for hypotension
Is general anesthesia used commonly for laboring patients?
No bc it carries danger of hypoxia and possible choking on vomit during administration
why might a anesthesiologist prescribe ranitidine (Zantac) for a labor pt about to go on anesthesia?
reduces level of acid in stomach should aspiration occur
what does the “passage” and “passenger” refer to?
passage: pelvis
passenger: fetus
define fetal attitude and list 4 types
degree of flexion a fetus is during labor
(think how curled up they are vs how sprawled out)
1. vertex
2. sinciput
3. Brow
4. Face
Describe fetal lie
relationship between long axis of fetal body and long axis of mom’s body. (transverse, vertical)
Describe fetal presentation
describes part of fetus body that will first contact cervix. Goal: cephalic presentation
Describe fetal position
the relationship of the presenting part to a specific quadrant and side of the mom’s pelvis
define engagement
the settling of the presenting part of a fetus far enough into the pelvis that it rests at the midpoint of the pelvis
define station
the relationship of the presenting part of the fetus to the level of the ischial spines
+3 or +4 means baby is crowning
mechanisms (cardinal movements of labor)
various position changes of fetus keeping smallest diameter of fetal head presenting to smallest diameter of pelvis
decent
downward movement of the biparietal diameter of the fetal head within the pelvic inlet
flexion
As decent is completed, the head bends forward onto the chest
ripening
cervix softening
cooks catheter is for…
balloons on top and underneath cervix to put pressure and open cervix. Mimics fetus’s head
Effacement
thinning and shortening of cervix approaching labor
dilation
cervix widening
station
position of baby’s presenting part in relation to mom’s pelvis
baseline
average fetal HR over 10 minutes
variability
irregular fluctuations in fetal HR
accelerations
temporary increase in fetal HR
variable decelerations
sudden drop in fetal HR lasting at least 15 sec
early decelerations
normal HR pattern due to contractions
late declerations
gradual drop in HR after contraction
contraction consistency by palpation
using hand to feel contraction
tachysystole
uterus contracts too forcefully during labor. 5 or more in 10 min period
duration
length of uterine contractions
frequency
how often uterine contractions occur
augmentation of labor
body is laboring well, but healthcare workers intervene
induction
body is not laboring or ready for labor and healthcare workers interviene
SROM
spontaneous rupture of membrane
AROM
artifical rupture of membrane
Miconium
first stool of baby. It is black and sticky like tar
particulate
little flecks of miconium at various times
PROM
premature rupture of membranes
PPROM
pre-term premature rupture of membranes
IUCP
intrauterine pressure catheter
FSE
fetal scalp electrode
tocotranducer
monitors contractions, goes on top of uterus, has bump on back
describe powers of labor
force supplied by fundus of the uterus and implemented by uterine contractions
describe phases of contractions
A contraction consists of three phases: the increment, when the intensity of the contraction increases; the acme, when the contraction is at its strongest; and the decrement, when the intensity decreases
describe the Schultze presentation of a placenta
Placenta appears shiny and glistens from fetal membranes
how is a pt’s progress in labor recorded?
a Partogram (labor record)
describe ineffective uterine force
contractions have less strength then usual or are rapid but ineffective
hypotonic uterine contractions
of contractions is unusually infreqquent (not more than 2-3 occuring in a 10-min period
hypertonic contractions
increase in resting tone to more than 15 mmHg
Dysfunction at first stage of labor
prolonged latent phase, protracted phase, prolonged deceleration phase, and secondary arrest of dilatation
should you push a prolapsed cord back into the cervix?
no
occipitoposterior position
-baby’s head is down but facing front of pelvis
-also known as “sunny side up”
shoulder dystocia
The problem occurs at the second stage of labor, when the fetal head is born but the shoulders are too broad to enter and be born through the pelvic outlet
external cephalic version
turning of fetus from a breech to a cephalic position before birth
Amniotomy
the artificial rupturing of membranes during labor if they do not rupture spontaneously to allow the fetal head to contact the cervix more directly
episiotomy
surgical incision of the perineum made to release pressure on the fetal head with birth and possibly shorten the last portion of the second stage of labor
what is the most precise method for assessing FHR and uterine contractions?
Internal Electronic Monitoring
why do infants often develop respiratory issues from a C section?
during a vag birth, the pressure from squeezing out the vag cannal forces fluid out of baby’s lungs. During a C section, this does not happen
pre OP diagnostic procedures
vital signs
UA
CBC
Coagulation profile
blood type
difference between prolapsed cord and cord compressionl
cord compression can occur when cord is still inside womb. possibly from baby’s head pressing against it which can be helped by mom changing positions.
prolapsed cord IS CORD COMPRESSION occurring due to cord being outside cervix/vagina, and presenting part of fetus pressing against it.
