Exam #2 Flashcards
1
Q
3 categories of signs and symptoms of pregnancy:
A
Probable
Presumptive
Positive
2
Q
The umbilical cord connects the developing baby to the
A
Placenta
3
Q
The placenta is made up of
A
2 arteries and 1 vein
4
Q
Wharton’s Jelly
A
is the connective tissue that prevents compression of the blood vessels to ensure nutrients reach the developing baby.
5
Q
Meconium
A
dark green/black tarry stool, a baby’s first stool accumulated in the fetal intestines.
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.
7
Q
Full term
A
term designated for a pregnancy from weeks 38-42
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
9
Q
Presentation
A
the part of the fetus that enters the pelvic inlet first
10
Q
3 main types of presentation
A
cephalic (head)
breech (buttocks first)
transverse (shoulder)
11
Q
Effacement
A
occurs with the shortening and thinning of the cervix during the first stage of labor; expressed as a percentage
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
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
14
Q
The 3 stages of labor are:
A
Latent
Active
Transition
15
Q
The electronic fetal monitor continuously assessing ____.
A
Fetal Heart Tone (FHT)
16
Q
2 methods of electronic fetal monitoring:
A
External and Internal
17
Q
Palpation of the fetus through the abdomen is known as:
A
Leopold’s maneuvers
18
Q
what puts pregnancy at risk:
A
pre-existing/predisposed conditions, health of the mother, nutritional status, education, age, and culture
19
Q
Nagel’s Rule:
A
1st day of last period + 7 days - 3 months
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
21
Q
Progesterone:
A
relaxes everything
22
Q
During Pregnancy blood volume increases by
A
50%
23
Q
Vascular resistance
A
Decreases, due to increased blood flow
24
Q
Cardiac output
A
Increases up to 50%, by 20 weeks gestation
25
Baby's total blood volume at birth:
300mL
26
Normal blood loss for a mother during vaginal delivery:
| During C-Section:
500mL
| 1000mL c-section
27
4 categories of at risk pregnancy:
Class 1: Uncompromised
Class 2: Slightly Compromised
Class 3: Markedly Compromised (affecting baby and mom)
Class 4: Severely Compromised
28
Assessment for cardiac problems:
```
Chest pain
Edema
SOB
weight
Neck vein distention
Tachycardia
Syncope
```
29
Cardiac problems, a c-section is preferred because:
the mom's blood pressure controls the blood flow to the placenta
30
Medications for cardiac problems:
```
Digoxin- arrhythmia
Heparin- thrombophlebitis
Diuretics
Beta Blockers
vasodilators
```
31
S/Sx of Hematologic disorders
```
Decreased O2 carrying capacity
Decreased Hgb (11)
Decreased Hct (32)
Fatigue
Increased HR
```
32
Tx for hematologic disorders:
Iron supplements
Folic acid
Transfusions
33
Normal calorie increase during pregnancy:
300 calories
34
Increased calories during breastfeeding:
500 calories
35
S/Sx of Normal food intolerance during pregnancy:
Right side colic pain, under the ribs
36
Gastrointestinal changes during pregnancy:
```
Decreased muscle tone
Increased thickening of bile
Increased emptying time
Intolerances for food
Colicky pain
```
37
Tx for GI changes during pregnancy:
Low fat diet
Increase Fluids
stool softeners
** if surgery is needed, 2nd trimester is best
38
S/Sx of GU disorders:
painful urination
frequency
fever
39
Tx for GU disorders:
Antibiotics
| Increase fluid intake
40
Risks of Tx for Neurological disorders:
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
41
S/Sx of Hyperthyroidism:
```
fatigue
heat intolerance
tachycardia
decreased weight
*** if untreated, baby can be born with symptoms of hyperthyroidism
```
42
S/Sx of Hypothyroidism:
```
fatigue
increased weight
cold intolerance
constipation
muscle weakness
*** if untreated, baby can be born with hypothyroidism symptoms
```
43
LGA/SGA
Large for Gestational Age
| Small for Gestational Age
44
Types of Diabetes:
Type 1
Type 2
Gestational Diabetes
45
Metabolic changes in early pregnancy
hormones can cause INCREASED insulin secretion and DECREASED glucose production - lead to hypoglycemia
46
Metabolic changes in Late pregnancy:
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
47
Risks of gestational diabetes
```
Heart anomalies
Hyperglycemia/hypoglycemia
Stillbirth
Infection
Pre-eclampsia
C-section
IUGR- intrauterine growth restriction
```
48
Rapid acting insulin
Onset 15 mins
Peak 2/3 hr
Duration 3/5 hr
49
Short acting insulin
Onset 30 mins
Peak 3/4 hr
Duration 6/8 hr
50
Intermediate insulin
Onset 2/4 hr
Peak 4/12 hr
Duration 12/24 hr
51
Long insulin
Onset 3/4 hr
Peak 12/24 hr
Duration 24/36 hr
52
S/Sx of autoimmune disorders
```
Fatigue
Fever
Skin rashes
Weight loss
Joint pain
```
53
Transmission of HIV/AIDS
Maternal circulation
Labor/delivery
Breastmilk
Tx: meds to both mom and baby
54
TORCH infections
```
Toxoplasmosis
Other: syphilis, varicella, parvo B19
Rubella
Cytomegalovirus (kids carry the most, bad cold & rash) (cmv)
Herpes (acyclovir & c-section)
```
55
Substance Abuse
```
Cocaine
Amphetamines
Marijuana
PCP
Narcotics
Inhalants
Alcohol
***herbal remedies are not tested on pregnancy
```
56
Pica or eating excess amounts of ice chips
a lack of iron
57
Second leading cause of maternal morbidity/mortality in U.S.
HTN
58
Complications of HTN
Abruptio placenta
Preterm birth
Low birth weight
Eclampsia
59
Gestational HTN
High BP
| No protein in urine
60
Chronic HTN
HTN before 20 weeks
61
Superimposed pre-eclampsia
Chronic HTN with protein in urine
62
Pre-Eclampsia
HTN and protein in urine after 20 weeks
63
Eclampsia
All s/s of preeclampsia plus seizures or coma
Increased ICP- give mannitol
Deliver ASAP
64
S/Sx of preeclampsia
```
Increased BP x2
Protein in urine (24hr collection)
Increased Uric acid
Decreased LOC
Visual disturbances
Increased liver enzymes
Edema
Hypoxia-poor perfusion
HA
```
65
Tx for preeclampsia
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
66
Magnesium sulfate antidote
Calcium glauconate
| Toxicity= hyper reflexes and renal failure
67
HELLP syndrome
```
Hemolysis
Elevated
Liver enzymes and
Low
Platelet count (
```
68
Assessment for HELLP syndrome
```
Labs: liver enzymes, platelets, electrolytes, Cbc
Monitor BP
Edema
Deep tendon reflexes
Weight
LOC
O2 sat
Output
```
69
Tx for HELLP syndrome
FFP
Platelet and glucose infusions
Monitor hemorrhage
ULTIMATE Tx: Delivery
70
Preterm Labor
Before 38 weeks gestation
71
Causes of Preterm labor:
```
Dehydration
UTI
Periodontal disease
Chorioamnionitis (infection of amniotic fluids and chorion)
Inadequate prenatal care
```
72
Tx for Preterm labor:
```
Bed rest
IV hydration
Tx infections
corticosteriods for fetal lung maturity (needs 2 doses)
Tocolytic agent to stop labor
```
73
Tocolytic agents used to stop labor:
Magnesium (IV)
Procardia (PO) q6h
Tributaline (subQ) (stops contracting muscles, acts on beta receptor)
74
Hyperemesis Gravidarum
Vomiting, caused by an increase in HcG during pregnancy
75
Hyperemesis Tx
```
fluid replacement
vitamins
Reglan- (increase emptying time)
Phenergan/compazine/zofran
Maintenance after 3-5 days
```
76
Hydatiform Mole
abnormal proliferation and degeneration of trophoblastic villi
Grape-like structures
Uterus increases in size, no embryo formation
*** HcG levels critically high (x3 normal)
77
Tx for Hydatiform mole:
D&C
Continuous monitoring of HcG levels for 6-12 months
No pregnancy for 1 year
78
Assessment for hemorrhagic disorders:
```
Anemia
O2 carrying capacity
hypovolemia
miscarriage
spontaneous abortion (8-20 weeks)
97% miscarry and dont know during the 1st 4 weeks
```
79
DIC
over-activation of clotting factors
| decreased platelets
80
Tx for DIC
PRBC, FFP, fibrinogen, and platelets
81
Threatened Miscarriage:
slight spotting and cramping; bedrest
82
Inevitable miscarriage:
moderate bleeding and cramping; D&C
83
Incomplete miscarriage:
Heavy bleeding and severe cramping; D&C
84
Missed Miscarriage:
fetus has died without expulsion; D&C
| give methyltrexate
85
Incompetent Cervix:
dilation of the cervical os prior to active labor; passive and painless
86
Tx for incompetent cervix:
```
Cerclage (sew shut)
c-section
hysterectomy
restricted activities
no contractions or perineal pressure
```
87
Ectopic Pregnancy:
fertilized ovum implanted outside of the uterine cavity, usually in the fallopian tube
Painful
KEY: early detection & removal
give: methyltrexate
88
Increased risk factors for ectopic pregnancy:
IUD, STDs, scar tissue, trouble with fallopian tubes, smoking, adhesions
89
Placental abruption:
PAINFUL bright red bleeding
90
Placenta Previa:
Placenta implants in lower uterine near or over cervical os
91
Tx for Placenta Previa:
Monitor bleeding and abdomen for rigidness
Monitor for severe pain
NO pelvic exam until physician assesses
Painless bright red bleeding
92
Types of placenta previa:
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
Precipitous Labor
less than 3 hours
| unexpected, sudden, & maybe unattended
94
Maternal risks to Precipitous labor:
Cervical, vaginal, & rectal lacerations
| Hemorrhage
95
Fetal Risks of Precipitous labor:
Hypoxia
Injury during birth
Intracranial hemorrhage
96
Nursing interventions for Precipitous labor:
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
Preterm labor:
occurs between 20-38 weeks gestation
| Medical intervention required
98
S/Sx of preterm labor:
```
consistent firmness of the fundus
leakage of blood/fluids
+ ph strip from amniotic fluids
Abnormal pain or low back pain
cervical dilation
```
99
Medications to STOP contractions:
Magnesium Sulfate (IV) - requires labs q6h
Procardia (PO)
Tributaline (subq)
100
Medications to SPEED UP contractions:
Pitocin (IV)
Cytotec- (topical)
Cervadil- (prostaglandin)
101
Prolonged Pregnancy:
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
Estimated Due Dates:
+/- 2 weeks of anticipated due date
103
C-sections are scheduled:
at 39 weeks gestation
104
Risk factors to fetus/infant from prolonged pregnancy:
```
Meconium aspiration
Growth restriction
Macrosomia
Shoulder dystocia
Brachial Plexus Injury
Still birth
```
105
Risk factors for mom with prolonged pregnancy:
```
Increased risk for c-section
increased rate of infection
Hemorrhage
Emotional trauma
injury to pelvic floor
```
106
Dysfunctional Labor:
sluggishness of contractions or the force of labor has occurred
emotional time; can be very stressful!
107
Causes of Dysfunctional labor:
Large fetus
| hypotonic, hypertonic, or uncoordinated contractions occur
108
Risks for dysfunctional labor:
Maternal postpartum infections
Hemorrhage
Infant mortality (baby gets too tired)
109
first stage of Dysfunctional Labor:
Prolonged latent
Protracted active
Prolonged deceleration
Secondary arrest of dilation
110
Second Stage of Dysfunctional Labor:
Prolonged Decent
| Arrest of Descent - caused by LGA, shoulder stuck, tight nucal cord, inadequate pelvis
111
Turtling:
baby's head popping in and out of uterus but unable to deliver
Caused by nucal cord
112
PIH:
Pregnancy Induced Hypertension
113
Reasons for induced labor:
```
Placenta Previa
PIH & Pre-eclampsia
Daibetic
Premature rupture of membranes
Cardiovascular disease
Post-term
```
114
Methods of inducing labor:
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
Malposition/Malpresentation: OP
```
occiput posterior (sunny side up/ face up)
requires prolonged pushing
25% of all term deliveries
```
116
Malposition/Malpresentation: OT
Occiput transverse
| requires C-section
117
Malposition/Malpresentation: Breech presentation
can be footling breech- 1 foot
double footling- 2 feet
complete- legs/arms crossed (indian style)
Requires c-section
118
Malposition/Malpresentation: Shoulder presentation
```
Transverse position (shoulder position)
requires uterine external version to reposition baby, if unsuccessful need c-section
```
119
Management of Malpresentation:
Forcep delivery- causes fetal injury
Vacuum extraction- suction cup (3 pop offs & 9 pulls per pop off)
C-section
External version
120
Fetal Distress:
insufficient oxygen to the fetus
caused by umbilical cord (variable deceleration) (V/W shape)
or uteroplacental insufficiency (late deceleration) (decreased O2)
121
Signs and Symptoms of Fetal Distress:
meconium stained amniotic fluid
changes in FHT rate or FHT pattern (variability)
normal: 6-25 bpm
25 neurologic malfunction
122
Intrauterine Rescitation:
place mom on LEFT SIDE
increase oxygen to 10 LITERS/MIN
IVF wide open (999)
123
Amnioinfusion
Warm sterile saline infused to replace amniotic fluids
124
Stop Uterine Contractions to allow uteroplacental circulation to improve using:
terbulaline
125
Cephalopelvic Disproportion (CPD)
fetal head is too large to pass through the bony pelvis
| Platypollid and Anthropoid are 2 common shapes that lead to CPD
126
Shoulder Dystocia
Difficulty or inability to deliver the shoulders of the fetus
127
Fetal Stress test:
20 minutes long; looking for good variability and acellerations (up 15 beats by 15 sec)= a reassuring strip
Normal FHR is 120-160
128
Premature Rupture of Membranes (PROM)
rupture of fetal membranes with loss of amniotic fluids before 38 weeks gestation
often associated with infection
129
Intervention for Premature rupture of membranes (PROM):
Biophysical profile- to measure amniotic fluid, fine/gross motor skills, Heart rate, and Resp.
normal value: 20
130
Symptoms of PROM:
Sudden GUSH of fluid or continuous leakage of fluid feeling wet, sensation of inability to stop urinating
131
Assessment of PROM:
```
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
Prolapsed Umbilical Cord:
fetus not engaged in Pelvic inlet, considered an emergency situation
prolapsed cord decreases blood flow and oxygen to the fetus
133
Causes of Prolapsed Cord:
Rupture of membranes,
Small fetus,
Breech presentation,
Shoulder presentation
134
Intervention for Prolapsed cord:
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
Uterine Rupture:
Tearing or separation of the uterus wall
| considered a medical emergency
136
Causes of uterine rupture:
```
previous c-section
uterine trauma
intense contractions
overstimulation of uterus with Pitocin
external version
```
137
Symptoms of uterine rupture:
SUDDEN, SHARP low abdominal pain
tearing sensation
STOP uterine contractions
138
Normal rate of contractions:
3-4 contractions in 10 minutes
139
Tx for Uterine Rupture:
Manage shock and blood loss
HYSTERECTOMY
Incomplete rupture- repair and blood transfusion
140
Types of incisions for C-Section:
Classic (complete anterior placenta previa)
Low transverse* Incision of choice
Low vertical (multiple, scar tissue, avoid placenta)
141
Pre-Op Care:
Education & consents
NPO
abdominal prep (shave if needed)
IV fluids & anesthesia
142
Post-Op Care:
```
Pain Control
Monitor VS & I/O
Fundal Message
TCDB & ambulation
Bonding
```
143
2020 National Health Goals:
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
PostPartum Assessment: BUBBLE:
```
Breast
Uterus
Bladder
Bowel
Lochia
Episiotomy
```
145
Types of Lochia:
Rubra- heavy, clotting, odor (red)
Serosa- moderate (pink)
Alba- light (white)
Normal: bleed 22-27 days
146
Postpartum: Abdomen
regains muscle control, tone, and color within 6 weeks
147
Postpartum: Bladder
Returns within 1 month
| Diuresis starts 12 hours postpartum, can last 2-3 days
148
Postpartum: Bowel
returns 2-3 days postpartum
Consider: dehydration, muscle tone, episiotomy
Need stool softeners
149
Postpartum: Breasts
little change in 24 hrs
colostrum expressed
Milk comes in 72-96 hrs postpartum
150
Postpartum: Endocrine
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
Postpartum: Cardiovascular
500-1000mL blood loss during delivery
volume need is decreased
fluids replace necessary volume
152
Postpartum : blood Work
H&H decreases then increases w/in 7 days
WBC increase slightly
Coagulation factors return within a few days
153
Mothers and Newborns Act:
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
Signs & Symptoms of Postpartum complications:
```
increased temp, pulse, B/P
Fatigue
Boggy uterus
Lochia Heavy or odorous
Edematous perineum
+ homans signs
No appetite, voiding, or sleep
```
155
Nursing considerations for Postpartum:
```
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
Uterine Atony
lack of uterine muscle tone, no contractions postpartum
157
Retained Placenta
placenta not delivered or fragments remain in uterus
| caused by fundal message before placental separation occurs
158
Subinvolution
uterus does not return to normal size, lochia flow may not progress as expected
Rubra may last > 2 weeks
159
Nursing interventions for HEMORRHAGE
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
Lacerations
cervical, vaginal, or perineal
| KEY: firm uterus with continuous trick of bright red blood
161
Types of lacerations:
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
Hematoma
collecting or pooling of blood, injury to blood vessels
163
Uterine Dispplacement
Rectocele- rectum prolapsed
Cystocele- bladder prolapsed
feel vaginal pressure like something there, need to push
164
Tx for urinary incontinence or retention:
monitor output, straight cath if needed or place indwelling
| usually resolves after 48 hours
165
Infection of vaginal tract:
Strep or Staph
| not used sterile technique or equipment
166
Symptoms of Endometritis or Metritis
bloody, foul smelling discharge
uterine tenderness
spike in temp
tachycardia
167
Symptoms of Pelvic cellulitis aka Parametritis
```
inflammation of perineal cavity
high temp
fatique
abd pain
increase HR
```
168
Symptoms of episiotomy or laceration
```
redness
warmth
edema
purulent drainage
wound opens
severe pain
```
169
Mastitis
infection of breast tissue in lactating women
| Tx: warm compresses, ABX, continue breastfeeding
170
Symptoms of mastitis
```
fever
pain
PIE-SHAPED redness
flu-like symptoms
warm
```
171
Symptom of Thrombophlebitis
```
Redness
edema
+ homans sign
warmth
peripheral pulses decreased
```
172
Attachment or bonding disorder considerations
```
age
social status
culture
personal aspirations
hearing/visual impairment
```
