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Women's > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Recommended weight gain for a singleton

A

Underweight: 28-40
Normal: 25-35
Overweight: 15-25
Obese: 11-20

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2
Q

Emotional impact of a singleton

A

Accepting pregnancy: ambivalence and mood swings and normal
Preparing for birth and mother role
Establishing attachment to fetus

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3
Q

Prenatal chromosomal abnormality tests

A 
XX female
XY male 
Normal largo type: 46 chromosomes
Extra or missing chromosomes can occur
Advanced maternal age increases risk of abnormalities
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4
Q

Psychological effects of high risk pregnancy

A

Disruption of family roles
Financial strain
Frustration with activity restriction

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5
Q

Thromboembolic disorders

A 
DVT
Other risk factors of DVT: 
    Advanced maternal age
    Multigravida
    Use of OCPs before 
    Smoking
    Employment with prolonged standing 
S and S:
    Unilateral leg pain
    Swelling and tenderness 
Decrease risk:
    Use SCDs or compressive stockings
    Leg and ankle exercises
    Avoid positioning with sharply flexed knees
    Hydration
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6
Q

Signs and symptoms of pulmonary embolism

A

Sob
Tachypnea
Tachycardia

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7
Q

Gestational HTN

A

Onset after 20 weeks

No proteinuria

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8
Q

Preeclampsia

A

High bp which causes damage to another organ system (usually kidneys)

Causes decreased placental perfusion

Increased risk later in life for cv disease and kidney disease

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9
Q

Scotoma and HTN

A

Visual disturbances and HTN in pregnancy

Major red flag

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10
Q

Eclampsia

A

Onset of seizures or coma

During seizure: place woman on side if possible
Time the seizure
After: first priority is abc, then fetal assessment

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11
Q

Magnesium sulfate

A

Drug of choice to prevent seizure activity
Therapeutic serum level: 4-7 mEq/L
Calcium Gluconate is antidote
Signs of toxicity:
Respiratory depression (rr less than 12)
Slurred speech
Oliguria

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12
Q

Diabetes and pregnancy

A

Insulin resistance occurs during 2nd and 3rd trimesters to meet nutritional demands of fetus

If body is unable to produce enough insulin to counteract: gestational diabetes mellitus can occur

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13
Q

Diabetes screening
Risk factors
Infant

A 
Screening: 24-28 weeks 
    Fasting glucose should be under 95 
Risk factors 
    Previous macrosomic infant 
    Multifetal pregnancy 
    Ethnicity 
Can cause macrosomia in the infant
Mom should be periodically screened for type 2 DM after pregnancy
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14
Q

Pregnant women with preexisting diabetes

A

Poor glycemic control before and during early pregnancy can cause congenital anomalies

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15
Q

Hemorrhagic disorders of pregnancy

A

Vaginal bleeding is a warning sign that should be further evaluated
Especially if in first trimester

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16
Q

Placenta previa

A

Bright red bleeding with no pain
Placenta implanted in lower uterine segment, partially over cervical os

Vaginal exams are contraindicated

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17
Q

Placental abruption warning signs

A

Abdominal pain

Dark red bleeding

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18
Q

Hyperemesis gravidum

A

Excessive vomiting and loss of 5% of prepregnancy weight

Intractable nausea and vomiting during first trimester
Causes disturbance in nutrition and fluid and electrolyte balance

Meds for nausea
Monitor
Encourage intake of small portions
Monitor urine for ketones

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19
Q

False vs true labor

A

True: regular contractions, get closer and stronger over time, don’t change with position or walking

False: irregular contractions, may stop with walking or position change, cervix not effaced or dilated

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20
Q

Signs preceding true labor

A

Bloody show
Surge of energy
Lightening
Passing of mucus plug

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21
Q

Contractions
Purpose
Relaxation phase
Palpation

A

Purpose
First stage: cervical dilation and
effacement
Second: birth
Third: expulsion of placenta, minimize bleeding

Relaxation phase: important bc contractions can affect fetal oxygenation
Duration longer than 90 sec or interval more frequent than 60 sec can cause fetal compromise

Mom’s BP: will increase at peak of contraction
Mom’s CO: increase during labor

Palpation: evaluate intensity of contractions by pressing fingertips into fundus

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22
Q

First stage

A

Encourage slow and easy breathing
Assess amniotic fluid: should be pale, straw color with small white particles
Kneeling, sitting, or walking will stimulate fetal descent

23
Q

Second stage

A

Set up birthing table and radiant warmer close to delivery
Partners should still be present and active
Squatting position will increase pelvic outlet if needed

24
Q

Third stage

A

Lengthening of cord is a sign of placental separation

25
Q

Nonpharmacologic measures for pain management

A

Counter pressure against sacrum for back pain
Baby probably in occipital posterior
Endorphin levels will be higher in a spontaneous natural childbirth

26
Q

Pharmacologic pain management

A

Opioids:
Can decrease RR and BP
Cross the placenta and can affect fetus
Assess maternal VS and fetal HR before admin

Epidural:
Assess for urinary retention and hypotension post procedure

27
Q

Fetal monitoring

A

Leopold maneuvers

Determine fetal position and best placement of FHR

28
Q

Cervical exam

A

Dilation/effacement/station
Station is location in relation to ischial spine

2/50/-2 example
Cervix 2cm dilated
Cervix 50% effaced
Presenting part 2cm above ischial spine

29
Q

Stage one phases

A

Latent: 0-3 cm, 6-8 hours
Contraction 5-30 min apart, 30-45 sec long

Active: 4-7 cm, 3-6 hours
Contractions 3-5 min apart, 40-70 sec long

Transition: 8-10 cm, 20-40 min
Contractions 2-3 min apart, 45-90 sec long

30
Q

Position of baby

A

Determined by body part that will lead through birth canal

Presenting part: O, S, M, Sc
Maternal pelvis: R or L
A, P, or T

31
Q

Abbreviations for fetus position

A

First letter: R or L
Second: presenting part (O, S, M, Sc)
Third: maternal pelvis (A, P, T)

32
Q

CV changes and assessment

A

Bp increase
Supine hypotension
Decreased CO when holding breath - leads to decreased bp
Wbcs increase

Assess bp in between contractions
Encourage side lying
Encourage open glottis pushing
Assess fetal response

33
Q

Respiratory changes and assessment

A

RR increases
Tingling and numbness in fingers

Encourage relaxing and breathing techniques

34
Q

Renal changes and assessment

A

Spontaneous voiding may be difficult and/or may occur during contractions

Palpate above symphysis to detect full bladder
Encourage voiding every 2 hrs
Use nitro one to determine urine/amniotic fluid
Catheterize if needed

35
Q

MS changes and assessment

A

Diaphoresis and fatigue

Encourage rest between contractions
Positioning and comfort measures

36
Q

Neuro changes and assessment

A

Endorphins are relaxed - analgesic effect
Ischemia of perineal tissues
Behavior changes during labor phases

Provide support and encouragement
Provide safety

37
Q

GI changes and assessment

A

Decreased GI motility - nausea and vomiting
Mouth breathing - dry lips and mouth

Intake per orders
Assess dehydration

38
Q

Passageway

A

Birth canal
Bony pelvis
Soft tissues

39
Q

Physical exam during first stage of labor

A

General systems
VS
Leopold maneuvers
Assessment of FHR and pattern

40
Q

Operculum

A

Mucus plug

Blood tinged mucoid vaginal discharge indicates passing during first stage

41
Q

Inadequate weight gain in pregnancy

Excessive weight gain

A

Less than 2 lbs per month

Over 6 lbs per month

42
Q

Pattern of weight gain

A

First trimester 1-5 lbs

Second and third 1-1.5 lbs per week

43
Q

Nutrition in pregnancy

A

8-10 glasses of water per day
Folic acid intake 0.4 mg in fortified foods
Singleton needs around 300 calories more per day

44
Q

Pica

A

Eating non foods or non nutritive foods

Usually due to low iron - iron deficient anemia

45
Q

Nitrazine test

A

Vaginal secretions have ph of 4.5-5.5

Amniotic fluid has ph of 7-7.5 and turns swab blue

46
Q

Newborn of a diabetic mother has risk of

A 
Hypoglycemia 
Hyperbilirubinemia 
RDS
Hypocalcemia
Congenital abnormalities
47
Q

Gestational diabetes and delivery

A

Need for c section is more likely

48
Q

Posterior position of child leads to what?

A

Back pain/back labor

49
Q

Severe back pain - nurse expects baby to be in what position

A

LOP

50
Q

Doing Leopolds maneuvers. Baby in LOP position, what do you put the Doppler for FHR monitoring?

A

LLQ

51
Q

What is first intervention by nurse after the mom suspects her water breaks?

A

Check fetal heart rate

52
Q

What is the characteristics of the powers of the first stage of labor?

A

Controlled by involuntary nervous system
Responsible for cervical dilation and effacement
Responsive to nursing interventions

53
Q

Most common and potentially harmful maternal complication of epidural is what?

A

Hypotension

Women's (4 decks)

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