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LPN To RN > Exam #2 > Flashcards

Exam #2 Flashcards

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1
Q

3 categories of signs and symptoms of pregnancy:

A

Probable
Presumptive
Positive

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2
Q

The umbilical cord connects the developing baby to the

A

Placenta

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3
Q

The placenta is made up of

A

2 arteries and 1 vein

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4
Q

Wharton’s Jelly

A

is the connective tissue that prevents compression of the blood vessels to ensure nutrients reach the developing baby.

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5
Q

Meconium

A

dark green/black tarry stool, a baby’s first stool accumulated in the fetal intestines.

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6
Q

Non-stress test

A

is based on the fact that the HR of a healthy fetus with an intact CNS, will usually accelerate in response to it’s own movements.

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7
Q

Full term

A

term designated for a pregnancy from weeks 38-42

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8
Q

Braxton Hick’s Contractions

A

uterine contractions that can be felt through the abdominal wall soon after the fourth month of pregnancy that do NOT change the cervix

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9
Q

Presentation

A

the part of the fetus that enters the pelvic inlet first

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10
Q

3 main types of presentation

A

cephalic (head)
breech (buttocks first)
transverse (shoulder)

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11
Q

Effacement

A

occurs with the shortening and thinning of the cervix during the first stage of labor; expressed as a percentage

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12
Q

Dilation

A

is enlargement or widening of the cervical opening and cervical canal; which occurs once labor has begun
Degree of process is expressed in cm from less than 1-10

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13
Q

The first stage of labor is considered to last from the start of _____________ to dilation/enfacement of the cervix.

A

Regular Uterine contractions

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14
Q

The 3 stages of labor are:

A

Latent
Active
Transition

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15
Q

The electronic fetal monitor continuously assessing ____.

A

Fetal Heart Tone (FHT)

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16
Q

2 methods of electronic fetal monitoring:

A

External and Internal

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17
Q

Palpation of the fetus through the abdomen is known as:

A

Leopold’s maneuvers

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18
Q

what puts pregnancy at risk:

A

pre-existing/predisposed conditions, health of the mother, nutritional status, education, age, and culture

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19
Q

Nagel’s Rule:

A

1st day of last period + 7 days - 3 months

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20
Q

Factors that categorize a pregnancy as as HIGH risk:

A

Psychological: drug history, DV, mental illness
Social: lack of support, poor housing, low economic status
Physical factors: secondary major illnesses, Hx of poor pregnancy outcome, Obesity/underweight

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21
Q

Progesterone:

A

relaxes everything

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22
Q

During Pregnancy blood volume increases by

A

50%

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23
Q

Vascular resistance

A

Decreases, due to increased blood flow

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24
Q

Cardiac output

A

Increases up to 50%, by 20 weeks gestation

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25
Q

Baby’s total blood volume at birth:

A

300mL

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26
Q

Normal blood loss for a mother during vaginal delivery:

During C-Section:

A

500mL

1000mL c-section

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27
Q

4 categories of at risk pregnancy:

A

Class 1: Uncompromised
Class 2: Slightly Compromised
Class 3: Markedly Compromised (affecting baby and mom)
Class 4: Severely Compromised

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28
Q

Assessment for cardiac problems:

A 
Chest pain
Edema 
SOB
weight
Neck vein distention
Tachycardia 
Syncope
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29
Q

Cardiac problems, a c-section is preferred because:

A

the mom’s blood pressure controls the blood flow to the placenta

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30
Q

Medications for cardiac problems:

A 
Digoxin- arrhythmia
Heparin- thrombophlebitis 
Diuretics
Beta Blockers
vasodilators
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31
Q

S/Sx of Hematologic disorders

A 
Decreased O2 carrying capacity 
Decreased Hgb (11)
Decreased Hct (32)
Fatigue 
Increased HR
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32
Q

Tx for hematologic disorders:

A

Iron supplements
Folic acid
Transfusions

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33
Q

Normal calorie increase during pregnancy:

A

300 calories

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34
Q

Increased calories during breastfeeding:

A

500 calories

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35
Q

S/Sx of Normal food intolerance during pregnancy:

A

Right side colic pain, under the ribs

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36
Q

Gastrointestinal changes during pregnancy:

A 
Decreased muscle tone
Increased thickening of bile
Increased emptying time
Intolerances for food
Colicky pain
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37
Q

Tx for GI changes during pregnancy:

A

Low fat diet
Increase Fluids
stool softeners
** if surgery is needed, 2nd trimester is best

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38
Q

S/Sx of GU disorders:

A

painful urination
frequency
fever

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39
Q

Tx for GU disorders:

A

Antibiotics

Increase fluid intake

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40
Q

Risks of Tx for Neurological disorders:

A

Teratogenic medications- can cause birth defects
Make sure the benefit outweighs the risk for both mom and baby
Pregnancy Hormones decrease seizure risk during pregnancy

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41
Q

S/Sx of Hyperthyroidism:

A 
fatigue
heat intolerance
tachycardia
decreased weight 
*** if untreated, baby can be born with symptoms of hyperthyroidism
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42
Q

S/Sx of Hypothyroidism:

A 
fatigue 
increased weight 
cold intolerance
constipation
muscle weakness
*** if untreated, baby can be born with hypothyroidism symptoms
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43
Q

LGA/SGA

A

Large for Gestational Age

Small for Gestational Age

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44
Q

Types of Diabetes:

A

Type 1
Type 2
Gestational Diabetes

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45
Q

Metabolic changes in early pregnancy

A

hormones can cause INCREASED insulin secretion and DECREASED glucose production - lead to hypoglycemia

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46
Q

Metabolic changes in Late pregnancy:

A

hormones have a blocking effect on insulin, causing INSULIN RESISTANCE
As the placenta grows, the more hormones = increased insulin production
Pancreas can’t produce enough insulin to overcome the resistance, leads to glucose buildup in cells

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47
Q

Risks of gestational diabetes

A 
Heart anomalies 
Hyperglycemia/hypoglycemia 
Stillbirth
Infection
Pre-eclampsia 
C-section
IUGR- intrauterine growth restriction
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48
Q

Rapid acting insulin

A

Onset 15 mins
Peak 2/3 hr
Duration 3/5 hr

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49
Q

Short acting insulin

A

Onset 30 mins
Peak 3/4 hr
Duration 6/8 hr

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50
Q

Intermediate insulin

A

Onset 2/4 hr
Peak 4/12 hr
Duration 12/24 hr

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51
Q

Long insulin

A

Onset 3/4 hr
Peak 12/24 hr
Duration 24/36 hr

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52
Q

S/Sx of autoimmune disorders

A 
Fatigue 
Fever
Skin rashes 
Weight loss
Joint pain
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53
Q

Transmission of HIV/AIDS

A

Maternal circulation
Labor/delivery
Breastmilk
Tx: meds to both mom and baby

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54
Q

TORCH infections

A 
Toxoplasmosis 
Other: syphilis, varicella, parvo B19
Rubella 
Cytomegalovirus (kids carry the most, bad cold & rash) (cmv) 
Herpes (acyclovir & c-section)
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55
Q

Substance Abuse

A 
Cocaine 
Amphetamines 
Marijuana 
PCP
Narcotics 
Inhalants 
Alcohol
***herbal remedies are not tested on pregnancy
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56
Q

Pica or eating excess amounts of ice chips

A

a lack of iron

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57
Q

Second leading cause of maternal morbidity/mortality in U.S.

A

HTN

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58
Q

Complications of HTN

A

Abruptio placenta
Preterm birth
Low birth weight
Eclampsia

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59
Q

Gestational HTN

A

High BP

No protein in urine

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60
Q

Chronic HTN

A

HTN before 20 weeks

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61
Q

Superimposed pre-eclampsia

A

Chronic HTN with protein in urine

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62
Q

Pre-Eclampsia

A

HTN and protein in urine after 20 weeks

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63
Q

Eclampsia

A

All s/s of preeclampsia plus seizures or coma
Increased ICP- give mannitol
Deliver ASAP

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64
Q

S/Sx of preeclampsia

A 
Increased BP x2 
Protein in urine (24hr collection) 
Increased Uric acid 
Decreased LOC 
Visual disturbances 
Increased liver enzymes 
Edema 
Hypoxia-poor perfusion
HA
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65
Q

Tx for preeclampsia

A

Magnesium sulfate loading dose followed by drip
Lab values q 6 hr
Pt will feel on fire, provide cool cloth, fan, ice, etc.
diet changes- increase protein/water, decrease salt
Bed rest and foley!
Delivery 32-36 weeks if needed

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66
Q

Magnesium sulfate antidote

A

Calcium glauconate

Toxicity= hyper reflexes and renal failure

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67
Q

HELLP syndrome

A 
Hemolysis 
Elevated 
Liver enzymes and 
Low 
Platelet count (
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68
Q

Assessment for HELLP syndrome

A 
Labs: liver enzymes, platelets, electrolytes, Cbc 
Monitor BP 
Edema 
Deep tendon reflexes 
Weight 
LOC 
O2 sat
Output
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69
Q

Tx for HELLP syndrome

A

FFP
Platelet and glucose infusions
Monitor hemorrhage
ULTIMATE Tx: Delivery

70
Q

Preterm Labor

A

Before 38 weeks gestation

71
Q

Causes of Preterm labor:

A 
Dehydration
UTI
Periodontal disease 
Chorioamnionitis (infection of amniotic fluids and chorion)
Inadequate prenatal care
72
Q

Tx for Preterm labor:

A 
Bed rest 
IV hydration
Tx infections
corticosteriods for fetal lung maturity (needs 2 doses) 
Tocolytic agent to stop labor
73
Q

Tocolytic agents used to stop labor:

A

Magnesium (IV)
Procardia (PO) q6h
Tributaline (subQ) (stops contracting muscles, acts on beta receptor)

74
Q

Hyperemesis Gravidarum

A

Vomiting, caused by an increase in HcG during pregnancy

75
Q

Hyperemesis Tx

A 
fluid replacement 
vitamins
Reglan- (increase emptying time) 
Phenergan/compazine/zofran
Maintenance after 3-5 days
76
Q

Hydatiform Mole

A

abnormal proliferation and degeneration of trophoblastic villi
Grape-like structures
Uterus increases in size, no embryo formation
*** HcG levels critically high (x3 normal)

77
Q

Tx for Hydatiform mole:

A

D&C
Continuous monitoring of HcG levels for 6-12 months
No pregnancy for 1 year

78
Q

Assessment for hemorrhagic disorders:

A 
Anemia
O2 carrying capacity 
hypovolemia 
miscarriage 
spontaneous abortion (8-20 weeks)
97% miscarry and dont know during the 1st 4 weeks
79
Q

DIC

A

over-activation of clotting factors

decreased platelets

80
Q

Tx for DIC

A

PRBC, FFP, fibrinogen, and platelets

81
Q

Threatened Miscarriage:

A

slight spotting and cramping; bedrest

82
Q

Inevitable miscarriage:

A

moderate bleeding and cramping; D&C

83
Q

Incomplete miscarriage:

A

Heavy bleeding and severe cramping; D&C

84
Q

Missed Miscarriage:

A

fetus has died without expulsion; D&C

give methyltrexate

85
Q

Incompetent Cervix:

A

dilation of the cervical os prior to active labor; passive and painless

86
Q

Tx for incompetent cervix:

A 
Cerclage (sew shut)
c-section
hysterectomy 
restricted activities 
no contractions or perineal pressure
87
Q

Ectopic Pregnancy:

A

fertilized ovum implanted outside of the uterine cavity, usually in the fallopian tube
Painful
KEY: early detection & removal
give: methyltrexate

88
Q

Increased risk factors for ectopic pregnancy:

A

IUD, STDs, scar tissue, trouble with fallopian tubes, smoking, adhesions

89
Q

Placental abruption:

A

PAINFUL bright red bleeding

90
Q

Placenta Previa:

A

Placenta implants in lower uterine near or over cervical os

91
Q

Tx for Placenta Previa:

A

Monitor bleeding and abdomen for rigidness
Monitor for severe pain
NO pelvic exam until physician assesses
Painless bright red bleeding

92
Q

Types of placenta previa:

A

complete- covers cervical os, must have c-section
partial- covers a portion of cervical os, must have c-section
low lying- near cervical os, not covering; monitor closely, may be able to have vaginal delivery

93
Q

Precipitous Labor

A

less than 3 hours

unexpected, sudden, & maybe unattended

94
Q

Maternal risks to Precipitous labor:

A

Cervical, vaginal, & rectal lacerations

Hemorrhage

95
Q

Fetal Risks of Precipitous labor:

A

Hypoxia
Injury during birth
Intracranial hemorrhage

96
Q

Nursing interventions for Precipitous labor:

A

Encourage to pant or blow to decrease urge to push
Use sterile gloved hand to apply pressure to fetal head to slow delivery
Suction nose/mouth and check neck for umbilical cord
clamp and cut cord

97
Q

Preterm labor:

A

occurs between 20-38 weeks gestation

Medical intervention required

98
Q

S/Sx of preterm labor:

A 
consistent firmness of the fundus
leakage of blood/fluids 
\+ ph strip from amniotic fluids 
Abnormal pain or low back pain 
cervical dilation
99
Q

Medications to STOP contractions:

A

Magnesium Sulfate (IV) - requires labs q6h
Procardia (PO)
Tributaline (subq)

100
Q

Medications to SPEED UP contractions:

A

Pitocin (IV)
Cytotec- (topical)
Cervadil- (prostaglandin)

101
Q

Prolonged Pregnancy:

A

pregnancy that goes beyond 42 weeks gestation; caused by anencephaly or paternal gene
Ca+ deposits on the placenta, causing inadequate placental function and late decels

102
Q

Estimated Due Dates:

A

+/- 2 weeks of anticipated due date

103
Q

C-sections are scheduled:

A

at 39 weeks gestation

104
Q

Risk factors to fetus/infant from prolonged pregnancy:

A 
Meconium aspiration 
Growth restriction 
Macrosomia
Shoulder dystocia
Brachial Plexus Injury
Still birth
105
Q

Risk factors for mom with prolonged pregnancy:

A 
Increased risk for c-section
increased rate of infection
Hemorrhage 
Emotional trauma 
injury to pelvic floor
106
Q

Dysfunctional Labor:

A

sluggishness of contractions or the force of labor has occurred
emotional time; can be very stressful!

107
Q

Causes of Dysfunctional labor:

A

Large fetus

hypotonic, hypertonic, or uncoordinated contractions occur

108
Q

Risks for dysfunctional labor:

A

Maternal postpartum infections
Hemorrhage
Infant mortality (baby gets too tired)

109
Q

first stage of Dysfunctional Labor:

A

Prolonged latent
Protracted active
Prolonged deceleration
Secondary arrest of dilation

110
Q

Second Stage of Dysfunctional Labor:

A

Prolonged Decent

Arrest of Descent - caused by LGA, shoulder stuck, tight nucal cord, inadequate pelvis

111
Q

Turtling:

A

baby’s head popping in and out of uterus but unable to deliver
Caused by nucal cord

112
Q

PIH:

A

Pregnancy Induced Hypertension

113
Q

Reasons for induced labor:

A 
Placenta Previa
PIH & Pre-eclampsia 
Daibetic
Premature rupture of membranes
Cardiovascular disease 
Post-term
114
Q

Methods of inducing labor:

A

Cervical Ripening with prostaglandins/laminaria
Amniotomy-artifical rupture of membranes (amnihook)
Cytotec- UC and cervical dilation
Pitocin/Oxytocin- increase intensity & duration of UC (painful)
Pineapple, walking, sex

115
Q

Malposition/Malpresentation: OP

A 
occiput posterior (sunny side up/ face up)
requires prolonged pushing 
25% of all term deliveries
116
Q

Malposition/Malpresentation: OT

A

Occiput transverse

requires C-section

117
Q

Malposition/Malpresentation: Breech presentation

A

can be footling breech- 1 foot
double footling- 2 feet
complete- legs/arms crossed (indian style)
Requires c-section

118
Q

Malposition/Malpresentation: Shoulder presentation

A 
Transverse position (shoulder position) 
requires uterine external version to reposition baby, if unsuccessful need c-section
119
Q

Management of Malpresentation:

A

Forcep delivery- causes fetal injury
Vacuum extraction- suction cup (3 pop offs & 9 pulls per pop off)
C-section
External version

120
Q

Fetal Distress:

A

insufficient oxygen to the fetus
caused by umbilical cord (variable deceleration) (V/W shape)
or uteroplacental insufficiency (late deceleration) (decreased O2)

121
Q

Signs and Symptoms of Fetal Distress:

A

meconium stained amniotic fluid
changes in FHT rate or FHT pattern (variability)
normal: 6-25 bpm
25 neurologic malfunction

122
Q

Intrauterine Rescitation:

A

place mom on LEFT SIDE
increase oxygen to 10 LITERS/MIN
IVF wide open (999)

123
Q

Amnioinfusion

A

Warm sterile saline infused to replace amniotic fluids

124
Q

Stop Uterine Contractions to allow uteroplacental circulation to improve using:

A

terbulaline

125
Q

Cephalopelvic Disproportion (CPD)

A

fetal head is too large to pass through the bony pelvis

Platypollid and Anthropoid are 2 common shapes that lead to CPD

126
Q

Shoulder Dystocia

A

Difficulty or inability to deliver the shoulders of the fetus

127
Q

Fetal Stress test:

A

20 minutes long; looking for good variability and acellerations (up 15 beats by 15 sec)= a reassuring strip
Normal FHR is 120-160

128
Q

Premature Rupture of Membranes (PROM)

A

rupture of fetal membranes with loss of amniotic fluids before 38 weeks gestation
often associated with infection

129
Q

Intervention for Premature rupture of membranes (PROM):

A

Biophysical profile- to measure amniotic fluid, fine/gross motor skills, Heart rate, and Resp.
normal value: 20

130
Q

Symptoms of PROM:

A

Sudden GUSH of fluid or continuous leakage of fluid feeling wet, sensation of inability to stop urinating

131
Q

Assessment of PROM:

A 
Check for pooling of amniotic fluid
Check nitrazine paper for pH (purple) 
Check for cervical leakage with cough or fundal pressure
Perform a pelvic exam for dilation
Ultrasound
132
Q

Prolapsed Umbilical Cord:

A

fetus not engaged in Pelvic inlet, considered an emergency situation
prolapsed cord decreases blood flow and oxygen to the fetus

133
Q

Causes of Prolapsed Cord:

A

Rupture of membranes,
Small fetus,
Breech presentation,
Shoulder presentation

134
Q

Intervention for Prolapsed cord:

A

Hips higher than head (knee to chest or transdelenburg)
Continuous fetal monitoring
C-section or rapid vaginal delivery necessary
Saline soaked gauze to protruding cord

135
Q

Uterine Rupture:

A

Tearing or separation of the uterus wall

considered a medical emergency

136
Q

Causes of uterine rupture:

A 
previous c-section
uterine trauma 
intense contractions
overstimulation of uterus with Pitocin 
external version
137
Q

Symptoms of uterine rupture:

A

SUDDEN, SHARP low abdominal pain
tearing sensation
STOP uterine contractions

138
Q

Normal rate of contractions:

A

3-4 contractions in 10 minutes

139
Q

Tx for Uterine Rupture:

A

Manage shock and blood loss
HYSTERECTOMY
Incomplete rupture- repair and blood transfusion

140
Q

Types of incisions for C-Section:

A

Classic (complete anterior placenta previa)
Low transverse* Incision of choice
Low vertical (multiple, scar tissue, avoid placenta)

141
Q

Pre-Op Care:

A

Education & consents
NPO
abdominal prep (shave if needed)
IV fluids & anesthesia

142
Q

Post-Op Care:

A 
Pain Control
Monitor VS & I/O
Fundal Message 
TCDB & ambulation 
Bonding
143
Q

2020 National Health Goals:

A

Reduce maternal mortality to 11.4 per 100,000 live births
Increase breastfeeding to 81.9%
Increase breastfeeding at 6 months to 60.6%

144
Q

PostPartum Assessment: BUBBLE:

A 
Breast
Uterus
Bladder
Bowel
Lochia
Episiotomy
145
Q

Types of Lochia:

A

Rubra- heavy, clotting, odor (red)
Serosa- moderate (pink)
Alba- light (white)
Normal: bleed 22-27 days

146
Q

Postpartum: Abdomen

A

regains muscle control, tone, and color within 6 weeks

147
Q

Postpartum: Bladder

A

Returns within 1 month

Diuresis starts 12 hours postpartum, can last 2-3 days

148
Q

Postpartum: Bowel

A

returns 2-3 days postpartum
Consider: dehydration, muscle tone, episiotomy
Need stool softeners

149
Q

Postpartum: Breasts

A

little change in 24 hrs
colostrum expressed
Milk comes in 72-96 hrs postpartum

150
Q

Postpartum: Endocrine

A

Diabetes: BS normal in 7-10 days
Ovulation occurs between 27 days and 10 weeks
70% have normal periods w/in 12 weeks
If breastfeeding periods will return to normal in 6 months

151
Q

Postpartum: Cardiovascular

A

500-1000mL blood loss during delivery
volume need is decreased
fluids replace necessary volume

152
Q

Postpartum : blood Work

A

H&H decreases then increases w/in 7 days
WBC increase slightly
Coagulation factors return within a few days

153
Q

Mothers and Newborns Act:

A

allows the mother and newborn to stay in the hospital for a minimum of 48 hours following vaginal delivery and 96 hours following a C-Section
** most complications happen w/in 24 hr

154
Q

Signs & Symptoms of Postpartum complications:

A 
increased temp, pulse, B/P
Fatigue
Boggy uterus
Lochia Heavy or odorous 
Edematous perineum 
\+ homans signs 
No appetite, voiding, or sleep
155
Q

Nursing considerations for Postpartum:

A 
change pads frequently 
sitz bath/peri-care
monitor lochia: amount, clots
assess uterus placement: size and position 
Comfort: heat/ice, topical treatment, NSAIDs, narcotics
REST
Activity: amb, TED, ROM, Kegels
Adequate nutrition
Rh-Rhogam 
Follow up: 2 weeks 
No sex for 6 weeks
156
Q

Uterine Atony

A

lack of uterine muscle tone, no contractions postpartum

157
Q

Retained Placenta

A

placenta not delivered or fragments remain in uterus

caused by fundal message before placental separation occurs

158
Q

Subinvolution

A

uterus does not return to normal size, lochia flow may not progress as expected
Rubra may last > 2 weeks

159
Q

Nursing interventions for HEMORRHAGE

A

fundal message q 15 mins x2 hrs, check fundal height
assess bleeding q 10-15 min x1 hr & q 30 min x1hr
Asess signs of shock, bladder distention, & pain
Admin uterine stimulants : Cytotec, oxytocin, methergen

160
Q

Lacerations

A

cervical, vaginal, or perineal

KEY: firm uterus with continuous trick of bright red blood

161
Q

Types of lacerations:

A

1st degree- tear around vaginal opening
2nd degree- Vag. tissue & perineal muscle (stitches needed)
3rd degree-vag. tissue, perineal muscle, & anal sphincter (stitches & pain)
4th degree- most severe- vag. tissue, perineal muscles, anal sphincter, & rectum (stitches, foley, long recovery)

162
Q

Hematoma

A

collecting or pooling of blood, injury to blood vessels

163
Q

Uterine Dispplacement

A

Rectocele- rectum prolapsed
Cystocele- bladder prolapsed
feel vaginal pressure like something there, need to push

164
Q

Tx for urinary incontinence or retention:

A

monitor output, straight cath if needed or place indwelling

usually resolves after 48 hours

165
Q

Infection of vaginal tract:

A

Strep or Staph

not used sterile technique or equipment

166
Q

Symptoms of Endometritis or Metritis

A

bloody, foul smelling discharge
uterine tenderness
spike in temp
tachycardia

167
Q

Symptoms of Pelvic cellulitis aka Parametritis

A 
inflammation of perineal cavity 
high temp
fatique
abd pain
increase HR
168
Q

Symptoms of episiotomy or laceration

A 
redness
warmth
edema
purulent drainage
wound opens 
severe pain
169
Q

Mastitis

A

infection of breast tissue in lactating women

Tx: warm compresses, ABX, continue breastfeeding

170
Q

Symptoms of mastitis

A 
fever
pain
PIE-SHAPED redness
flu-like symptoms 
warm
171
Q

Symptom of Thrombophlebitis

A 
Redness
edema
\+ homans sign
warmth
peripheral pulses decreased
172
Q

Attachment or bonding disorder considerations

A 
age
social status
culture
personal aspirations 
hearing/visual impairment

LPN To RN (4 decks)

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