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
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
3
Q
What are the 5 P’s of Labor?
A
Passage Passenger Power Psyche position
4
Q
presentation of a baby indicates..
A
what position the babys presenting part is in (cephalic, breech)
5
Q
LOA (left occiput anterior)
A
babys occiput is facing the mothers left, face down
6
Q
Face down baby is better than face up baby..true or false
A
true
7
Q
Should you see a mom who has had multiple kids or who is primipara first
A
multi babies (mulipara)
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
9
Q
2nd stage of labor
A
mother is in labor, feels urge to push, baby crowns
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
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
12
Q
Cardinal signs of Labor: SAY IN ORDER!
A
Engagement Flexion Internal Rotation Restitution Extension External rotation Expulsion
13
Q
What is a contraindication of AROM
A
if the baby is breech, transverse, floating (ballotment)
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.
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
16
Q
Contraindications for giving oxytoxin
A
if baby is in distress, hypertonic uterus (VBAC), positive stress test, placenta previa, genital herpes
17
Q
Prostaglandin helps to..
A
induce labor. Have the mom stay over night and monitor the fetus and vital signs. Semen contains prostaglandin
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.
19
Q
cervical dilation causes what type of pain..
A
visceral (1st stage)
20
Q
perineal pressure causes what type of pain..
A
somatic (2nd stage)
21
Q
Psychoprophylaxis treatments.
A
Bradley- when husband helps coaching with quiet, slowed breathing
Grantley Dicks- exercise, relaxation, breathing techniques
TENS-electronic nerve therapy
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
23
Q
Name two narcotic antagonist
A
stadol and nubain
24
Q
Phenothiazides are considered a..
A
Analgesic Potentiators (ataractics).
25
Analgesic potentiators do what..
They do not decrease pain but decrease anxiety and apprehension and potentiate the action of narcotics
26
Butyrophenones
inapsine- hadol- used to produce profound amnesia and post op sedation
27
Barbituates
used to promote relaxation and sleep in early or false labor
28
benzodiazapines
valium- decrease anxiety, sedative/hypnotic
29
Epidural can cause what side effect
maternal hypotension. Give LR to increase fluids which can prevent hypotension
Epidurals do not cross what? the dura mater
30
Side effect of spinal anesthetic?
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
31
How often should you assess BP after giving epidural
every 5 minutes for 20 minutes--> longer if the BP is decreased
32
Fentanyl is used for..
short term pain relief which is good for rapid laboring patients
33
Morphine is good for..
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
34
Bicitra
used for vomiting or aspiration and should be given 30 minutes before C-section
35
Blood volume would increase by what in pregnany?
increase 1500ml or 40-50% above nonpregnancy levels
36
Heart rate increases by what ?
10-15bpm during the 20th week of gestation
37
cardiac output increases by what..
30-50%
38
physiological anemia occurs during pregnancy because..
blood volume increases more rapidly than RBC production
39
RBC mass during pregnancy increases by
30-33% if iron supplement is taken
40
What is then normal level of WBC granulocytes..
60-85%
normal nonpregnancy levels--> 55-75%
41
blood pressure can drop by how much when the mother has inferior vena cava syndrome
30mmHg
42
Renal changes in a pregnant mother pertaining to GFR
GFR increases due to increase blood flow to kidneys
43
What position is best for kidney perfusion
lateral recumbant
44
dependent edema is normal in a pregnant mother as long as it is not pitting. TRUE or FALSE
TRUE
45
BUN levels in a pregnant mom:
decrease.. normal values are 8-20
46
creatinine levels in a pregnant mother:
decrease.
normal levels are (0.6-2)
47
Uric acid in a pregnant mom:
decrease in the first and second trimester, return to normal in the third trimester
Normal levels( 4.5-5.8)
48
Are traces of protein in the urine acceptable..
yes
49
Morning sickness in a mom:
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
50
ptyalism
excessive salivation is common- avoid spicy foods
51
pyrosis
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)
52
What is the main source of hormones needed to sustain pregnancy?
Placenta
53
The placental becomes a primary source of estrogen and progesterone by what month of pregnany
2nd
54
What is produced in the anterior lobe?
prolactin
55
Gonadotropin activity in the anterior lobe is turned off what what
hormonal activity of the placenta. FSH and LH are turned off which is what causes ovulation
56
ocytocin is produced in what lobe
posterior lobe
57
Thyroid in pregnant women..
t3 increases, t4 decreases, metabolic rate increases
58
what predisposes moms to URI (upper respiratory infections)
steroids and proteins produced by the placenta
59
IgG
provides passive immunity to the fetus
60
IgA
increases GI immunity in breastfed babies
61
Preparation for mothers who planning to breastfeeding
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
62
During postpartum there is a rapid drop in what hormones and an increase in what
rapid drop- progesterone, estrogen
| increase in- prolactin and oxytocin
63
let down reflex
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
Once lactation is established what is decreased
prolactin
65
colostrum is present until how many days
2 days pp.
66
colostrum contains..
increase in protein and decrease in fats and lactose
67
mature milk contains
protein, lactose, fats, calories, H20
68
transitional milk
occurs after colostrum,
produced approx 2 weeks pp
where engorgement of breast occurs
consists of more fats, lactose, H2O and vitamins
69
When holding the baby for breastfeeding after a C-section what position is best
football hold
70
when breastfeeding initiation occurs, the baby should nurse on which side
they should nurse on whichever one they nursed on last, unless they only nursed on one breast then change positions
71
The baby is not latched onto the breast correctly if:
cheeks go inward, sucking noises are prsent
72
if baby is latched correctly you will see:
temporal movement
73
offer ice to what nursing moms
non nursing
74
warm showers and warm packs are used for what nursing moms
nursing moms
75
Contraindications to breastfeeding:
```
if the mom has:
breast cancer
HIV.ADIS
TB
CMV
Tegretol/dilantin or other antibiotics
mastectomy
```
76
increased urine protein can be a sign of
preeclampsia
| if past +1
77
tachycarddia in the baby can be due to..
drugs, maternal infection, SVT, amnionitis, fetal hypoxia
78
bradycardia in the baby is due to..
head or cord compression, fetal hypoxia, drugs, fetal heart blocks
79
minimal variability
1-5 bpm
80
moderate variability
6-25 bpm
81
marked variability
>25bpm
82
if beat to beat variability is poor what does this indicate
fetal distress, deliver baby soon!
83
fetal acceleration are caused by
movement, stimulation of ANS, vaginal exams, abdominal palpations, uterine contractions
84
causes of early decelerations
head compression, vaginal exams, uterine contractions, fundal pressure. NO intervention is needed
85
intervention for late decelerations
stop pitocin/oxytoxin, change position to left lateral, oxygen mask , elevate legs, increase IV bolus
86
CST monitors for..
placental insufficiency and contractions of the mother
87
CST cannot be performed when..
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
CST positive result
not good! shows persistent late deceleration with more than 50% of contractions. Sign of uteroplacental insufficiency
89
CST negative result
GOOD! shows 3 contractions of good quality lasting 40 seconds or more in 10 minutes. ABSENT DECELS!
90
increase in MSAFP means..
neural tube defect
91
decrease in MSAFP means..
trisomy 21/downs syndrome
92
if an abnormal result of MSAFP occurs..what test will be performed next
amniocentesis
93
amniocentesis can be done early between weeks
15-20wks
94
amniocentesis can be done late between weeks
30-39
95
amniocentesis should be performed in women over what age
35
96
MSAFP can be done between
16-22 WEEKS
97
CVS (choronic villi sampling)
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
PUBS nursing intervention
shallow breathing techniques
99
BPP score that is normal
8-10
100
if a BPP score is abnormal it signifies..
fetal asphyxia
101
absence of PG (phosphatidyglycerol)
respiratory distress association
102
transabdominal ultrasound
full bladder, noninvasive, get lube on belly
103
ultrasounds can provide..
immediate results, noninvasive and painless procedures and estimate gestational age
104
During an amniocentesis, the physician will do an ultrasound to assess what prior to procedure?
placental and fetal positioning
105
It would be appropriate to use what test when assessing a patient with intrauterine growth retardation?
CST
106
Risks for CVS
Intrauterine infection. Rupture of membranes. Spontaneous abortion.
107
What two pelvic types are favorable for labor delivery?
Gynecoid and antrhopoid
108
Android and platylepelloid are
pelvis that are not favorable and can result in transverse positioning
109
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:
impending labor
110
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:
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
Separation of placenta result in..
gush of blood and increase in fundal height
112
fourth stage of labor expected findings..
decrease in BP and an increase in HR
113
At 32 weeks of gestation and beyond, an acceleration has an acme of how many BPM and a duration of what?
Acme of 15 bpm above baseline with a duration of 15 seconds or more but less than 2 minutes
114
At less than 32 weeks of gestation, an acceleration has an acme of how many BPM and a duration of what
Acme of 10 bpm and a duration of 10 seconds or more but less than 2 minutes
115
Late decelerations are typically seen with
hyperstimulation of uterus with oxytocin, toxemia,postmaturity, maternal diabetes, cardiac disease, placenta previa
116
average variability
6-25 bpm
117
fetal circulation:
blood leaves the placenta through the umbillical vein, after circulating through the fetus it goes back through the arteries
118
The ductus venosus, foramen ovale, and ductus arteriosus
allow blood to bypass the fetal liver and lungs
119
progesterone main
maintains pregnancy
120
fertilization takes place in
the ampula
121
Hcg
secreted by chronic aveoli to provide life of corpus luteum
corpus-chronic
122
how much protein should the mom take in
60g
123
how much iron should the mom take in
27
124
gate control theory
nonpharmacological measures
| tactile stimulation and modified by activities controlled by CNS (efflaurage, massage, backrub, distractions)
125
epidural doesn't have effect on
fetus but can make labor longer
126
grantley dicks
3 techniques: exercise, breathing, relaxation
| BER DICKS
127
make sure the bladders stays empty. If patient received epidural make sure you straight cath every..
2 hours or foley
128
How often do you check the temperature in the first stage of labor
every 4 hours
129
Latent phase vitals, bloody show, fetal assessments, uterus activity, behavior
30-60 minutes
130
Active phase vitals and assessment how often
every 15-30 minutes
131
Transitional vitals and assessment how often
5-15 minutes
132
Nursing interventions during second stage of labor assessments:
Every 15 minutes,
Fetal descent: 5 minutes
vaginal show: 5-15 minutes
Low risk moms: 15 minutes
High risk moms: 5 minutes
133
uric acid
4.5-5.8. decreased in first and second trimester while returning to normal within the third
134
HpL
influences cellular growth in the fetus and helps prepare breasts for lactation.
135
Pelvic inlet is measured by assessing the ...
diagonal conjugate by doing a vaginal exam
136
Size of the outlet is determine by the..
intertuberous diameter
137
diagonal conjugate
distance from sacral promontory to symphisis pubis
138
distance between the intertuberous diameter
ischial tuberosity- approx width of fist
139
molding
overlapping of cranial bones during labor to fit through for delivery
140
lightning can occur when in primipara patietns
10-14 days before labor
141
lightning is..
when there is decent of fetal head into the pelvis
142
premonitory signs of labor..
* 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
blood loss in stage 4..
250-500cc
144
restitution
neck is twisted and turns the head to one side
145
external rotation:
shoulders in anteroposterior position
146
metabolix acidosis and respiratory alkalosis occur because of
pushing
147
Nubain can be given until what cm
4cm
148
analgesic potentiators
do not rid of pain but cause relaxation and alleviate anxiety
149
assess maternal respiratory status how often after she received long acting pain relief by morphine
every 1 hour for 24 hours
150
-caine drugs cross the
placenta
151
NST reactive
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
if MSAFP comes back negative
amnicentesis is done
153
After AROM or SROM the mother has risk for
prolapsed cord
154
low scoring for bishops score
C section
155
pitocin calc
1mU/min+= 6cc/hr
156
oxytocin output should be how many per hour
30-35 per hou or 120cc/4hr
