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NSG412 OB/Peds > Exam 2 - OB > Flashcards

Exam 2 - OB Flashcards

1
Q

this test is assessing fetal movement + fetal HR accelerations (no contractions)

A

NST

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2
Q

what is normal fetal HR

A

110-160

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3
Q

fetal movement + fetal HR accelerations means what (with NST)?

A

adequate oxygenation to fetus
+
autonomic nervous system is fxning correctly

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4
Q

how long do we monitor for with NST?

A

20-40 mins

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5
Q

normal NST =

A

reactive

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6
Q

reactive NST =

A

normal

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7
Q

what are components of reactive NST? (for >32 weeks, and <32 weeks)

A

> 32 weeks: accelerations 15 (bpm) x 15 (secs) 2x in 20 mins

<32 weeks: accelerations 10(bpm) x 10 (secs)

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8
Q

No accelerations in 40 min window = what result?

if you get this result, what happens next?

A

nonreactive on NST (abnormal)

further assessment (CST)

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9
Q

If fetus doesn’t show variability during a NST, what can we do?

A

give snack or auditory vibration/stimulation to get some movement + to wake dat baby up

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10
Q

2 ways we can stimulate contractions during Contraction stress test (CST)

A
  1. nipple stimulation

2. oxytocin stimulation

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11
Q

negative CST =

A

normal

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12
Q

positive CST =

A

abnormal

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13
Q

what are the components of a negative CST?

A

No late decels in 10 min period w/3 contractions

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14
Q

what are the components of a positive CST?

A

late decels in 50% of contractions

tell us baby might not be able to handle labor

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15
Q

what could late decels be indicative of?

A

placental insufficiency

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16
Q

what is major risk of CST? what should we have handy in preparation for this?

A

preterm labor risk → give tocolytics if they have >5 contractions in 10 mins

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17
Q

L/S ratio is tested via what?

A

amniocentesis

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18
Q

what is L/S ratio testing? what is ratio that indicates this?

bonus: what is ratio for preggo pt with diabetes?

A

fetal lung maturity (2:1)

diabetes L/S: 2.5:1 or 3:1

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19
Q

what is variability?

A

variations in fetal HR - moderate is normal, expected ◡̈

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20
Q

accelerations are what? what do they tell us?

A

increase in HR - indicates good oxygenation

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21
Q

early decels indicate what?

A

head compression

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22
Q

type of HR variation:

gradual decrease in FHR; mirrors contraction

A

early decels

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23
Q

type of HR variation:

abrupt decrease in FHR; resembles a V on monitor; no relation to contractions

A

variable decels

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24
Q

variable decels indicate what?

A

cord compression

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25
Q

what is intervention for variable decels?

A

repositioning 1st (side or knee to chest)

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26
Q

if cord prolapse occurs, what should you do? (5)

A
  1. gloved hand into vagina to relieve pressure off cord to perfuse baby
  2. emergency bell for assistance
  3. Trendelenburg positioning
  4. warm saline
  5. O2

C section if birth is not immediate

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27
Q

type of HR variation:

gradual decrease of FHR; onset after beginning of contraction

A

late decels :(

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28
Q

late decels are indicative of what?

A

placental insufficiency :(

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29
Q

what is intervention for late decels?

A

repositioning 1st

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30
Q

components of VEAL - CHOP

A

Variable - Cord Compression
Early - Head compression
Accelerations - Ok ◡̈
Late - Placental insufficiency

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31
Q

interventions for decels: (5)

A

1st: reposition (side, knee to chest)

Then… discontinue oxytocin, IV bolus of LR, O2 via face mask 8-10L/min, notify provider

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32
Q

true labor vs false labor

A

false labor: braxton hicks, irregular contractions, no cervical changes

true labor: cervical changes (dilation + effacement), regular contractions that increase in frequency and intensity

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33
Q

in simple terms, what happens in each stage of labor?

A

1: start of TRUE labor w/cervical changes - dilation up to 10cm
2: baby delivered
3: placenta delivered
4: recovery

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34
Q

what are the 3 phases of stage 1 of labor?

A

latent, active, transition

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35
Q

how long does latent phase last?

A

4-6 hrs

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36
Q

what is dilation range for latent phase?

A

0-3cm

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37
Q

what are contractions like in latent phase? (characteristic, frequency, duration)

A

mild, 5-30 mins apart, last 30-45 seconds

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38
Q

how long does active phase last?

A

2-3 hrs

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39
Q

what is dilation range for active phase?

A

4-7cm

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40
Q

what are contractions like in active phase? (characteristic, frequency, duration)

A

moderate to strong, 3-5 mins apart, last 40-70 seconds

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41
Q

what is important patient care in active phase of labor to keep progressing with fetal descent?

A

keep bladder empty

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42
Q

in active phase of labor, if pt experiences urge to push before fully dilated, what should we do?

A

encourage panting/shallow breathing to prevent urge to push until it’s go time

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43
Q

how long does transition phase last?

A

20-40 mins

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44
Q

what is dilation range for transition phase?

A

8-10cm

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45
Q

what are contractions like in transtion phase? (characteristic, frequency, duration)

A

strong!, 2-3 mins apart, lasting 45-90 seconds

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46
Q

what stage of labor is pushing happening in? (intense contractions 1-2 mins apart)

A

stage 2

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47
Q

when should you expect placenta delivery?

A

5-30 mins after baby

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48
Q

how long does stage 4 of labor last?

A

up to 4 hrs (recovery + stabilizing)

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49
Q

in stage 4, how often should position and firmness of uterus be assessed?

A

q 15 mins

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50
Q

intervention for boggy uterus

A

fundal massaaaagggeeee

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51
Q

If fundus is firm, but birth person is bleeding, what might be happening?

A

there might be a laceration - needing sutures

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52
Q

opening of cervical os (+ range)

A

dilation (0-10cm)

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53
Q

thinning + shortening of cervix (+ range)

A

effacement (0-100%)

54
Q

position of presenting part of fetus in pelvic cavity

A

station

55
Q

re: station of fetus, what is 0? what do negative numbers mean? what about positive numbers?

A

0 = ischial spine (narrowest opening baby must pass through)

  • numbers = above ischial spine

+ numbers = further down into pelvis (“positively moving towards delivery”)

56
Q

what station number would you see with crowning of head?

A

+3 (or +4)

57
Q

how many seconds is too long for a contraction?

A

> 90 seconds

58
Q

what is the number for too frequent of contractions?

A

> 5 in 10 min period

59
Q

if contractions are too long or too frequent, what interventions should you implement?

A

turn off pit, monitor contractions + fetal VS

if these don’t work, terbutaline to relax contractions

60
Q

term for: relationship of pregnant person’s spine to fetal spine

A

fetal lie

61
Q

term for: fetus posture

A

fetal attitude

62
Q

term for: part of fetus that will come through birth canal 1st

A

fetal presentation

63
Q

what is ideal fetal attitude (posture)

A

flexion (chin to chest)

64
Q

what is frank breech?

A

legs extended to shoulders

65
Q

what is complete breech?

A

bum presents + legs crossed

66
Q

what is footling breech?

A

one or both feet present 1st

67
Q

re: fetal position, what do these letters mean?

O
S
A
M

A

O: occiput (head)
S: sacrum (bum)
A: acromion process (shoulder)
M: mentum (chin/face)

68
Q

what is amniotomy?

A

artificial rupture of membranes by provider

69
Q

after amniotomy, what assessments should happen? (3)

A
  1. amniotic fluid - color, odor, volume
  2. temp q 2hr
  3. FHR
70
Q

how quickly after ROM does labor usually begin?

A

24 hours

71
Q

> 24 hrs after ROM (prolonged) = risk for what?

A

infection!

72
Q

If amniotic fluid is meconium stained, this means potential for what? what intervention do we need?

A

risk for respiratory distress in newborn - need NICU present @ birth

73
Q

what should be limited after ROM?

A

vaginal exams (to reduce infection risk)

74
Q

reason to use tocolytics

A

relaxes smooth muscles → reduce strength + frequency of contractions

for preterm labor

75
Q

reason to give betamethasone

A

preterm fetus - to stimulate surfactant to mature lungs

76
Q

reason to give cervidil + cytotec

A

stimulates powerful contractions

for PPH

77
Q

this med can be given to both initiate labor + to stop bleeding with PPH

A

oxytocin (Pitocin)

78
Q

will an epidural relieve pain + pressure?

A

only pain, NOT pressure

79
Q

2 things to do before epidural admin

A
  1. monitor FHR for 20-30 mins

2. fluid bolus to manage BP

80
Q

when should APGAR happen?

A

1 and 5 mins after birth

81
Q

components of APGAR

A 
Appearance
Pulse
Grimace (reflex)
Activity (tone)
Respiratory
82
Q

meanings of these APGAR scores:
0-3:
4-6:
7-10:

A

0-3: need full resuscitation
4-6: mild resuscitation (stimulation, suction, O2)
7-10: all good, normal monitoring

83
Q

what 3 things make up a fundal assessment?

A
  1. location
  2. consistency
  3. height
84
Q

when palpating the uterus, what should you ALWAYS do?

A

support lower segment

85
Q

where would you expect fundus to be on day of birth?

A

umbilicus

86
Q

where would you expect fundus to be immediately after birth?

A

-3 (3 fingers/cm below umbilicus)

87
Q

if fundus is displaced to right or left, what is your intervention?

A

empty bladder

88
Q

scant lochia:

A

<1 inch blood on pad

89
Q

light lochia:

A

<4 inch blood on pad

90
Q

moderate lochia:

A

blood covering most of pad

91
Q

heavy lochia:

A

saturating pad in 1 hr

92
Q

lochia rubra is what color for how many days?

A

bright red 1-3 days

93
Q

lochia serosa is what color for how many days?

A

pink or brown, serosangineous for 4-10 days

94
Q

lochia alba is what color for how many days?

A

yellow, white-ish for 11-21 days (longer if lactating)

95
Q

clots larger than _________ require further assessment

A

a nickel

96
Q

when assessing peri pads and lochia, what should we always do for most accurate assessment?

A

turn patient on side to check for pooling/dependent bleeding under patient

97
Q

for comfort after birth, what can we use in first 24 hours? then what after that?

A

1st 24: ice packs/cool

after that: warm to stimulate circulation + tissue repari

98
Q

breast engorgement is what? what is the intervention?

A

overfilled breasts

intervention: frequent feedings (q 2-3hrs) and pump after if needed

99
Q

what postpartum complication could this be?

unilateral redness, hard, painful, fever, chills, HA, feeling shitty

A

mastitis

100
Q

what postpartum complication could this be?

Severe pelvic pain + uterine tenderness, increased temp, dark lochia that has odor

A

endometritis

101
Q

what should you NEVER do when person has DVT?

A

massage the site !

102
Q

what postpartum complication could this be?

bulging swollen blue-ish area

A

hematoma

103
Q

what is uterine atony?

A

uterus cannot contract normally → boggy

104
Q

PPH is classified as how much blood loss (w/vaginal delivery + w/CS)?

A

> 500mL EBL with vaginal delivery

> 1000mL EBL with CS

105
Q

risk factors for uterine atony (7)

A 
macrosomia (big bebe)
multiples
prolonged labor
polyhydraminos
trauma
assistance during birth (forceps, vacuum)
retained placental fragments
106
Q

what med should we NOT use with pre-e patients b/c can cause HTN?

A

Methylergonovine (Methergine)

107
Q

what med should we NOT use with asthmatic patients b/c of bronchoconstriction?

A

Carboprost (Hemabate)

108
Q

name the meds we can use for PPH (5)

A
  1. Oxytocin (Pitocin)
  2. Methylergonovine (Methergine)
  3. Carboprost (Hemabate)
  4. Misoprostol (Cytotec)
  5. Dinoprostone (Prostin)

= stimulate uterine contraction to compress vessels to control bleeding

109
Q

Up + down with mood (teary, insomnia, feelings of inadequacies)
Resolves in ~10 days

A

postpartum blues (85% of ppl)

110
Q

interventions for PP blues

A

get adequate rest, eat good food, rely on support system

111
Q

PERSISTENT feelings of sadness + intense mood swings within 6 months of delivery

A

postpartum depression

112
Q

hallucinations, delusions, paranoia, disorientation within 1st couple weeks of delivery

A

postpartum psychosis

113
Q

intervention for postpartum psychosis

A

psychiatric care

114
Q

what is priority nursing care for newborn immediately after delivery? then what happens?

A

AIRWAYY - suction + clear respiratory tract before anything

then…. dry thoroughly + stimulate, cover with warm blanket, skin to skin + put hat on

115
Q

normal newborn RR

A

30-60 w/periods of apnea (<15 seconds)

116
Q

normal newborn temp

A

97.7-99.5 (axillary)

117
Q

if birthing person has hepatitis, infant should get __________________ with ________ of birth

A

Hep B immune globulin; 12 hrs

118
Q 
what are these reflexes?
Rooting
Palmar + plantar grasp
Moro 
Tonic neck
Babinski
Stepping
A

rooting: stroke cheek and will turn that direction
palmar + plantar grasp: wrapping fingers or toes around finger (“holding your hand”)
moro: startle
tonic neck: bow + arrow position
babinkski: stroke outside of foot from heel towards toes; positive = fan out
stepping: hold vertically + will look like they’re walking

119
Q

crosses suture line

A

caput (goes away in a few days)

120
Q

doesn’t cross suture line; bulging on head

A

Cephalohematoma (goes away in 3-6 weeks)

121
Q

circ care with Gomco + Mogen (clamps)

A

use vaseline

122
Q

circ care with plastibell

A

plastic ring will fall off within a week; no vaseline

123
Q

cold stress for newborns manifests as what?

A

respiratory distress

124
Q

risk factors for hypoglycemia in newborns

A
  1. mom with diabetes

2. small for gestational age (low glycogen stores)

125
Q

what are S+S of hypoglycemia in newborn

A

usual S+S with respiratory distress, flaccid muscle tone, weak cry, cyanosis

126
Q

interventions for hypoglycemia

A

breastfeeding ASAP

heel sticks to test blood glucose

127
Q

what is normal blood glucose for newborn

A

40-60

128
Q

physiologic vs pathologic jaundice

A

physiologic: occurs AFTER 24 hrs post birth (benign, but need tx)
pathologic: occurs within 24 hours post birth (underlying issue)

129
Q

expected bilirubin at 24 hrs

A

2-6

130
Q

expected bilirubin at 48 hrs

A

6-7

131
Q

expected bilirubin at 3-5 days

A

4-6

NSG412 OB/Peds (5 decks)

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