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maternal exam 2 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What are five parameters of BPP (biophysical profile)?

A

Fetal breathing, Fetal tone, Fetal gross body movements, Reactive NST, amniotic fluid volume

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2
Q

Amniocentesis measures…

A

lung maturity. ratio of L/S should be 2:1

 Done: 15-20 weeks for genetic testing; 30-39 weeks to determine lung maturity

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3
Q

What are the 5 P’s of Labor?

A 
Passage
Passenger
Power
Psyche
position
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4
Q

presentation of a baby indicates..

A

what position the babys presenting part is in (cephalic, breech)

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5
Q

LOA (left occiput anterior)

A

babys occiput is facing the mothers left, face down

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6
Q

Face down baby is better than face up baby..true or false

A

true

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7
Q

Should you see a mom who has had multiple kids or who is primipara first

A

multi babies (mulipara)

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8
Q

1st Stage of Labor:

A

Latent- 0-3cm dilated, 5-30 min between contractions, mom is talkative and anxious

Active- 4-7cm dilated, 2-5 minutes between contractions, mom is focused on self

Trasition- 8-10cm dilated, 2-3 minutes between contraction

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9
Q

2nd stage of labor

A

mother is in labor, feels urge to push, baby crowns

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10
Q

3rd stage of labor

A

placenta is delivered, rise of uterus, sudden gush of blood. Placenta is usually delivered within 5-30 minutes

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11
Q

4th stage of labor

A

recovery–> involves increased risk for hemorrhage. Make sure to check vitals every 15 X4, every 30 X2, every hour X2

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12
Q

Cardinal signs of Labor: SAY IN ORDER!

A 
Engagement
Flexion
Internal Rotation
Restitution
Extension
External rotation
Expulsion
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13
Q

What is a contraindication of AROM

A

if the baby is breech, transverse, floating (ballotment)

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14
Q

Oxytocin/pitocin is used to..

A

augmentation of labor. Increases contractions. It is given in the first stage of labor.

Monitor contractions closely– If >90sec. In duration or >frequent than q2min, D/C Pit.

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15
Q

Nursing interventions for oxytocin/pitocin:

A

monitor contractions (if >90 seconds in duration or more frequent than 2 minutes discontinue) , monitor FHR, check dilation, vital signs, DECELS, no obstructions, water intoxication so monitor I&O, monitor pain

Assess & record FHT q15min, variability, accels
Assess & record Uterine activity q15
Assess & record Maternal BP q 15-30min
Assess & record Maternal I & O continuously

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16
Q

Contraindications for giving oxytoxin

A

if baby is in distress, hypertonic uterus (VBAC), positive stress test, placenta previa, genital herpes

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17
Q

Prostaglandin helps to..

A

induce labor. Have the mom stay over night and monitor the fetus and vital signs. Semen contains prostaglandin

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18
Q

Cervidil

A

same as prostaglandin, it causes hyperstimulation therefore it should be discontinued. It causes ripening of cervix. Lay down for 2 hours after insertion.

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19
Q

cervical dilation causes what type of pain..

A

visceral (1st stage)

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20
Q

perineal pressure causes what type of pain..

A

somatic (2nd stage)

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21
Q

Psychoprophylaxis treatments.

A

Bradley- when husband helps coaching with quiet, slowed breathing

Grantley Dicks- exercise, relaxation, breathing techniques

TENS-electronic nerve therapy

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22
Q

What two analgesic medications can be given in the first stage of labor..

A 
Meperidine HCL (Demerol) may be give IV or IM in 1st stage of labor
Fentanyl (Sublimaze)may be given IV or IM in 1st stage of labor
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23
Q

Name two narcotic antagonist

A

stadol and nubain

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24
Q

Phenothiazides are considered a..

A

Analgesic Potentiators (ataractics).

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25
Q

Analgesic potentiators do what..

A

They do not decrease pain but decrease anxiety and apprehension and potentiate the action of narcotics

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26
Q

Butyrophenones

A

inapsine- hadol- used to produce profound amnesia and post op sedation

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27
Q

Barbituates

A

used to promote relaxation and sleep in early or false labor

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28
Q

benzodiazapines

A

valium- decrease anxiety, sedative/hypnotic

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29
Q

Epidural can cause what side effect

A

maternal hypotension. Give LR to increase fluids which can prevent hypotension

Epidurals do not cross what? the dura mater

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30
Q

Side effect of spinal anesthetic?

A

Headaches due to a leakage of cerebral spinal fluid. Need to take patients blood and block this leakage. Place patient lying down supine to decrease headaches. Caffeine may also help

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31
Q

How often should you assess BP after giving epidural

A

every 5 minutes for 20 minutes–> longer if the BP is decreased

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32
Q

Fentanyl is used for..

A

short term pain relief which is good for rapid laboring patients

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33
Q

Morphine is good for..

A

long term pain relief. It has risks to both the mom and the fetus. it can cause itching so you nay need to give benadryl or nubain. Assess respiratory status every hour

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34
Q

Bicitra

A

used for vomiting or aspiration and should be given 30 minutes before C-section

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35
Q

Blood volume would increase by what in pregnany?

A

increase 1500ml or 40-50% above nonpregnancy levels

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36
Q

Heart rate increases by what ?

A

10-15bpm during the 20th week of gestation

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37
Q

cardiac output increases by what..

A

30-50%

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38
Q

physiological anemia occurs during pregnancy because..

A

blood volume increases more rapidly than RBC production

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39
Q

RBC mass during pregnancy increases by

A

30-33% if iron supplement is taken

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40
Q

What is then normal level of WBC granulocytes..

A

60-85%

normal nonpregnancy levels–> 55-75%

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41
Q

blood pressure can drop by how much when the mother has inferior vena cava syndrome

A

30mmHg

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42
Q

Renal changes in a pregnant mother pertaining to GFR

A

GFR increases due to increase blood flow to kidneys

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43
Q

What position is best for kidney perfusion

A

lateral recumbant

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44
Q

dependent edema is normal in a pregnant mother as long as it is not pitting. TRUE or FALSE

A

TRUE

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45
Q

BUN levels in a pregnant mom:

A

decrease.. normal values are 8-20

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46
Q

creatinine levels in a pregnant mother:

A

decrease.

normal levels are (0.6-2)

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47
Q

Uric acid in a pregnant mom:

A

decrease in the first and second trimester, return to normal in the third trimester

Normal levels( 4.5-5.8)

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48
Q

Are traces of protein in the urine acceptable..

A

yes

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49
Q

Morning sickness in a mom:

A

occurs by 4-6 weeks, decreases by week 14
Encourage mom to eat 5-6 small meals
eat a snack before getting up in the morning
Hcg has been linked to nausesa
vitamin B6 can decrease sickness

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50
Q

ptyalism

A

excessive salivation is common- avoid spicy foods

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51
Q

pyrosis

A

heartburn increases due to progesterone production which causes the tone and mobility of smooth muscles to become decreased (leads to regurgitation and decrease gastric emptying)

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52
Q

What is the main source of hormones needed to sustain pregnancy?

A

Placenta

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53
Q

The placental becomes a primary source of estrogen and progesterone by what month of pregnany

A

2nd

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54
Q

What is produced in the anterior lobe?

A

prolactin

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55
Q

Gonadotropin activity in the anterior lobe is turned off what what

A

hormonal activity of the placenta. FSH and LH are turned off which is what causes ovulation

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56
Q

ocytocin is produced in what lobe

A

posterior lobe

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57
Q

Thyroid in pregnant women..

A

t3 increases, t4 decreases, metabolic rate increases

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58
Q

what predisposes moms to URI (upper respiratory infections)

A

steroids and proteins produced by the placenta

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59
Q

IgG

A

provides passive immunity to the fetus

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60
Q

IgA

A

increases GI immunity in breastfed babies

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61
Q

Preparation for mothers who planning to breastfeeding

A

teach moms to wear supportive bra, practice rolling the nipple between their fingers to promote eversion, encourage the use of shells for mothers who have inversion, promote breastfeeding classes

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62
Q

During postpartum there is a rapid drop in what hormones and an increase in what

A

rapid drop- progesterone, estrogen

increase in- prolactin and oxytocin

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63
Q

let down reflex

A

flow of milk results from oxytocin which increases contractility

milk comes down causing cramping- mother may feel tingling sensation, prickling sensation. It is stimulated by baby crying, orgasm, thoughts of the infant, suckling, infants presence

64
Q

Once lactation is established what is decreased

A

prolactin

65
Q

colostrum is present until how many days

A

2 days pp.

66
Q

colostrum contains..

A

increase in protein and decrease in fats and lactose

67
Q

mature milk contains

A

protein, lactose, fats, calories, H20

68
Q

transitional milk

A

occurs after colostrum,
produced approx 2 weeks pp
where engorgement of breast occurs
consists of more fats, lactose, H2O and vitamins

69
Q

When holding the baby for breastfeeding after a C-section what position is best

A

football hold

70
Q

when breastfeeding initiation occurs, the baby should nurse on which side

A

they should nurse on whichever one they nursed on last, unless they only nursed on one breast then change positions

71
Q

The baby is not latched onto the breast correctly if:

A

cheeks go inward, sucking noises are prsent

72
Q

if baby is latched correctly you will see:

A

temporal movement

73
Q

offer ice to what nursing moms

A

non nursing

74
Q

warm showers and warm packs are used for what nursing moms

A

nursing moms

75
Q

Contraindications to breastfeeding:

A 
if the mom has:
breast cancer
HIV.ADIS
TB
CMV
Tegretol/dilantin or other antibiotics
mastectomy
76
Q

increased urine protein can be a sign of

A

preeclampsia

if past +1

77
Q

tachycarddia in the baby can be due to..

A

drugs, maternal infection, SVT, amnionitis, fetal hypoxia

78
Q

bradycardia in the baby is due to..

A

head or cord compression, fetal hypoxia, drugs, fetal heart blocks

79
Q

minimal variability

A

1-5 bpm

80
Q

moderate variability

A

6-25 bpm

81
Q

marked variability

A

> 25bpm

82
Q

if beat to beat variability is poor what does this indicate

A

fetal distress, deliver baby soon!

83
Q

fetal acceleration are caused by

A

movement, stimulation of ANS, vaginal exams, abdominal palpations, uterine contractions

84
Q

causes of early decelerations

A

head compression, vaginal exams, uterine contractions, fundal pressure. NO intervention is needed

85
Q

intervention for late decelerations

A

stop pitocin/oxytoxin, change position to left lateral, oxygen mask , elevate legs, increase IV bolus

86
Q

CST monitors for..

A

placental insufficiency and contractions of the mother

87
Q

CST cannot be performed when..

A

there is bleeding in the third trimester, previous C sections have occured, incompetent cervix, more than one fetus in the womb.

MUST HAVE 3 CONTRACTIONS IN 40 SECONDS IN ORDER TO HAVE THIS TEST

88
Q

CST positive result

A

not good! shows persistent late deceleration with more than 50% of contractions. Sign of uteroplacental insufficiency

89
Q

CST negative result

A

GOOD! shows 3 contractions of good quality lasting 40 seconds or more in 10 minutes. ABSENT DECELS!

90
Q

increase in MSAFP means..

A

neural tube defect

91
Q

decrease in MSAFP means..

A

trisomy 21/downs syndrome

92
Q

if an abnormal result of MSAFP occurs..what test will be performed next

A

amniocentesis

93
Q

amniocentesis can be done early between weeks

A

15-20wks

94
Q

amniocentesis can be done late between weeks

A

30-39

95
Q

amniocentesis should be performed in women over what age

A

35

96
Q

MSAFP can be done between

A

16-22 WEEKS

97
Q

CVS (choronic villi sampling)

A

can be done early after 9 weeks. (10-12)

this is the earliest test that can be performed to determine PKU, downs, muscular dystrophy

98
Q

PUBS nursing intervention

A

shallow breathing techniques

99
Q

BPP score that is normal

A

8-10

100
Q

if a BPP score is abnormal it signifies..

A

fetal asphyxia

101
Q

absence of PG (phosphatidyglycerol)

A

respiratory distress association

102
Q

transabdominal ultrasound

A

full bladder, noninvasive, get lube on belly

103
Q

ultrasounds can provide..

A

immediate results, noninvasive and painless procedures and estimate gestational age

104
Q

During an amniocentesis, the physician will do an ultrasound to assess what prior to procedure?

A

placental and fetal positioning

105
Q

It would be appropriate to use what test when assessing a patient with intrauterine growth retardation?

A

CST

106
Q

Risks for CVS

A

Intrauterine infection. Rupture of membranes. Spontaneous abortion.

107
Q

What two pelvic types are favorable for labor delivery?

A

Gynecoid and antrhopoid

108
Q

Android and platylepelloid are

A

pelvis that are not favorable and can result in transverse positioning

109
Q

client at 39 weeks’ gestation calls the clinic nurse with complaints of pelvic pressure, urinary frequency, and vaginal secretions. The nurse would correctly interpret these as signs and symptoms of:

A

impending labor

110
Q

A nurse is caring for a client admitted to the birthing unit with rupture of membranes that occurred two hours ago. A pelvic exam reveals a dilatation of 4 cm, and the presenting part is not engaged. The patient asks if she can walk in the hallway. The nurse’s response that bed rest is required is based on the risk of:

A

prolapsed cord–When a pelvic exam reveals a dilatation of 4 cm and the presenting part is not engaged, the nurse should anticipate a prolapsed cord.

111
Q

Separation of placenta result in..

A

gush of blood and increase in fundal height

112
Q

fourth stage of labor expected findings..

A

decrease in BP and an increase in HR

113
Q

At 32 weeks of gestation and beyond, an acceleration has an acme of how many BPM and a duration of what?

A

Acme of 15 bpm above baseline with a duration of 15 seconds or more but less than 2 minutes

114
Q

At less than 32 weeks of gestation, an acceleration has an acme of how many BPM and a duration of what

A

Acme of 10 bpm and a duration of 10 seconds or more but less than 2 minutes

115
Q

Late decelerations are typically seen with

A

hyperstimulation of uterus with oxytocin, toxemia,postmaturity, maternal diabetes, cardiac disease, placenta previa

116
Q

average variability

A

6-25 bpm

117
Q

fetal circulation:

A

blood leaves the placenta through the umbillical vein, after circulating through the fetus it goes back through the arteries

118
Q

 The ductus venosus, foramen ovale, and ductus arteriosus

A

allow blood to bypass the fetal liver and lungs

119
Q

progesterone main

A

maintains pregnancy

120
Q

fertilization takes place in

A

the ampula

121
Q

Hcg

A

secreted by chronic aveoli to provide life of corpus luteum

corpus-chronic

122
Q

how much protein should the mom take in

A

60g

123
Q

how much iron should the mom take in

A

27

124
Q

gate control theory

A

nonpharmacological measures

tactile stimulation and modified by activities controlled by CNS (efflaurage, massage, backrub, distractions)

125
Q

epidural doesn’t have effect on

A

fetus but can make labor longer

126
Q

grantley dicks

A

3 techniques: exercise, breathing, relaxation

BER DICKS

127
Q

make sure the bladders stays empty. If patient received epidural make sure you straight cath every..

A

2 hours or foley

128
Q

How often do you check the temperature in the first stage of labor

A

every 4 hours

129
Q

Latent phase vitals, bloody show, fetal assessments, uterus activity, behavior

A

30-60 minutes

130
Q

Active phase vitals and assessment how often

A

every 15-30 minutes

131
Q

Transitional vitals and assessment how often

A

5-15 minutes

132
Q

Nursing interventions during second stage of labor assessments:

A

Every 15 minutes,

Fetal descent: 5 minutes
vaginal show: 5-15 minutes

Low risk moms: 15 minutes
High risk moms: 5 minutes

133
Q

uric acid

A

4.5-5.8. decreased in first and second trimester while returning to normal within the third

134
Q

HpL

A

influences cellular growth in the fetus and helps prepare breasts for lactation.

135
Q

Pelvic inlet is measured by assessing the …

A

diagonal conjugate by doing a vaginal exam

136
Q

Size of the outlet is determine by the..

A

intertuberous diameter

137
Q

diagonal conjugate

A

distance from sacral promontory to symphisis pubis

138
Q

distance between the intertuberous diameter

A

ischial tuberosity- approx width of fist

139
Q

molding

A

overlapping of cranial bones during labor to fit through for delivery

140
Q

lightning can occur when in primipara patietns

A

10-14 days before labor

141
Q

lightning is..

A

when there is decent of fetal head into the pelvis

142
Q

premonitory signs of labor..

A
  • weight loss (2.2-6)
  • increased urination
  • braxton hicks contractions
  • bloody show
  • gush of fluid
  • increased energy or nesting syndrome (24-48 hrs before)
  • Diarrhea
143
Q

blood loss in stage 4..

A

250-500cc

144
Q

restitution

A

neck is twisted and turns the head to one side

145
Q

external rotation:

A

shoulders in anteroposterior position

146
Q

metabolix acidosis and respiratory alkalosis occur because of

A

pushing

147
Q

Nubain can be given until what cm

A

4cm

148
Q

analgesic potentiators

A

do not rid of pain but cause relaxation and alleviate anxiety

149
Q

assess maternal respiratory status how often after she received long acting pain relief by morphine

A

every 1 hour for 24 hours

150
Q

-caine drugs cross the

A

placenta

151
Q

NST reactive

A

2 or more contractions in 20 minutes with or without fetal movement

 Must be at least 15bpm above the baseline and last 15 seconds from baseline and baseline

152
Q

if MSAFP comes back negative

A

amnicentesis is done

153
Q

After AROM or SROM the mother has risk for

A

prolapsed cord

154
Q

low scoring for bishops score

A

C section

155
Q

pitocin calc

A

1mU/min+= 6cc/hr

156
Q

oxytocin output should be how many per hour

A

30-35 per hou or 120cc/4hr

maternal exam 2 (1 decks)

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