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OB Exam 2 > Exam 2 Study Guide & Tutor Notes > Flashcards

Exam 2 Study Guide & Tutor Notes Flashcards

1
Q

Intrauterine Growth Restriction

KNOW THIS - Per Study Guide!!!!!

A

Limited nutrients from the placenta to the baby

  • can lead to low birthweight – < 2500 grams (5.5 lbs)
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2
Q

Signs & Symptoms of Preterm Labor

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A
  • Vaginal discharge (change / increase)
  • Pelvic pressure
  • Mild abdominal cramps
  • Constant dull back pain
  • Regular contractions / ruptured membrane
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3
Q

What is Chorioamnionitis?

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A

Bacterail infection of the amniotic cavity

Tx: IV broad spectrum antibiotics & deliver baby

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4
Q

Signs & Symptoms of Chorioamnionitis

A
  • Fever
  • Tachycardia
  • Uterine tenderness
  • Foul odor amniotic fluid
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5
Q

What is Group Beta Strep (GBS)?

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A

Leading cause of perinatal infections including bacteremia, endometritis, chorioamnionitis & UTIs
* Vaginal-rectal culture is usually done between 35-37 weeks

  • TX: IAP antibiotics (intrapartum antibiotic prophylaxis) to decrease risk of chorioamniotitis
  • Effect on Newborn: can cause focal or systemic disease – severe respiratory distress, pneumonia, shock,& meningitis (less often to develop meningitis); osteomyelitis & septic arthritis
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6
Q

How can Group Beta Strep (GBS) effect a newborn?

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A

Can lead to severe respiratory distress, pneumonia, shock, & in rare cases meningitis

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7
Q

What can Group Beta Strep cause? What is the treatment? What impact does it have on the newborn?

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A

Can cause infections including chorioamnionitis & UTIs

  • Tx = IAP (intrapartum antibiotic prophylaxis)
  • Newborn Impact: severe respiratory distress, pneumonia, shock, & in rare cases meningitis
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8
Q

What is considered Preterm birth?

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A

Birth between 20 - 36 6/7 weeks

  • Very Preterm – < 32 weeks
  • Moderately Preterm – 32-34 weeks
  • Late Preterm – 34 - 36 6/7 weeks

CAUSES:
* infection (UTIs)
* congenital structural abnormalities of the uterus
* placental causes
* maternal & fetal stress
* uterine overdistention
* allergic reaction
* decreased progesterone
* periodontal disease

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9
Q

What is considered Posterm Labor?

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A

birth at > 42 weeks (< 0.5% of mothers)

  • increased maternal morbidity
  • dysfunctional labor
  • abnormal growth
  • shoulder dystocia
  • meconium stained fluid
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10
Q

What is external cephalic version (ECV)?

A

Attempt to turn the fetus from breech or shoulder presentation for birth

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11
Q

Amniotomy

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A

Artificial Rupture of Membranes (AROM)

  • when the amniotic sac is ruptured with a hook

do NOT rupture membranes until baby is ≥ -3 station (-3, -2, -1, 0)

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12
Q

Indications for Forceps-Assisted or Vacuum-Assisted Birth

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A

Forceps or Vacuum may be used in…
*

  • 2nd stage of labor (10 cm dilation & 100% effaced)
  • HTN or cardiovascular disease
  • Mom is exhausted

Must Be / Have:
* full dilation
* empty bladder
* baby’s head must be down
* ≥ 34 weeks
* ruptured membranes

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13
Q

What is Uterine Atony?

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A

failure of the uterus to contract firmly (down to its pre-pregnancy size) (hypotonia = low muscle tone of the uterus)

  • most common cause of postpartum hemorrhage
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14
Q

Postpartum Hemorrhage
* Early PPH
* Late PPH
* Medications

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A

Cumulative blood loss ≥ 1000 mL or s/s of hypovolemia with in 24 hours after birth

  • Early (within 24 hours of birth) – atony, bladder distention, trauma
  • Late (> 24 hours or < 6 weeks) – infection, subinvolution, retained placenta, or coagulation defects
  • Medications = Methergine or Hemabate (also IV oxytocin)
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15
Q

Define Postpartum Hemorrhage

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A

Cumulative blood loss ≥ 1000 mL or s/s of hypovolemia within 24 hours after birth

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16
Q

Early Postpartum Hemorrhage

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A

Within 24 hours of birth
* uterine atony
* bladder distention
* trauma (vaginal, cervical, uterine)

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17
Q

Late Postpartum Hemorrhage

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A

> 24 hours but < 6 weeks after birth
* infection
* subinvolution
* retained placenta
* coagulopathy

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18
Q

When can Braxton Hicks contractions begin?

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A

after the 4th month

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19
Q

Lightening

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A

38-40 weeks, “baby drops”

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20
Q

Hegar Sign

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A

Softening of the lower uterine segment

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21
Q

Ballottement

A

between 16-18 weeks

  • passive movement of the unengaged fetus
  • movability of a floating object such as a fetus
  • diagnostic technique using palpation: floating object, when tapped or pushed, moves awy & then returns to touch the examiner’s hand
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22
Q

Quickening

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A

First recognition of fetal movements

  • 16-20 weeks gestation (felt earlier by multiparous woman)
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23
Q

Goodell Sign

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A

Softening of cervix

  • probable sign of pregnancy

  • begins around 6 weeks gestation
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24
Q

Friability

A

Tissue is easily damaged

  • increased in pregnancy * can result in slight bleeding after vaginal exam
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25
Q

Operculum

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A

Mucous plug

  • acts as a barrier against bacterial invasion

  • plug of mucous that fills the endocervical canal during pregnancy
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26
Q

Chadwick Sign

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A

violet/blue color of vaginal mucosa & cervis

  • visible at approximately 6-8 weeks of pregnancy
  • caused by increased vascularity
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27
Q

Striae Gravidarum

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A

remains after pregnancy

  • stretch marks
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28
Q

Presumptive Signs of Pregnancy

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A

subjective changes experienced by the woman

  • amenorrhea, fatigue, breast changes
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29
Q

List presumptive signs of pregnancy

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A
  • amenorrhea
  • fatigue
  • breast changes
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30
Q

Probable Signs of Pregnancy

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A

objective changes observe / perceived by the EXAMINER & strongly suggest pregnancy

  • hegar sign, ballottement, pregnancy tests
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31
Q

List probable signs of pregnancy

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A
  • Hegar sign
  • Ballottement
  • Pregnancy test
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32
Q

Who reports presumptive signs of pregnancy?

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A

The woman

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33
Q

Who reports probable signs of pregnancy?

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A

The examiner / provider

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34
Q

Positive Signs of Pregnancy

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A

objective changes observed / perceived by the examiner that indicate PROOF OF PREGNANCY

  • fetal heart tones, ultrasound
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35
Q

What is the difference in probable & positive signs of pregnancy?

A

Positive signs of pregnancy show proof of pregnancy, while probable signs strongly suggest pregnancy

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36
Q

List positive signs of pregnancy

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A
  • fetal heart tones
  • ultrasound
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37
Q

Naegel’s Rule

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A

1.) Calculate first day of LMP
2.) Subtract 3 calendar months
3.) Add 7 days

  • Calculate estimated date of birth

  • assumes woman has a 28 day cycle & that fertilization occurs on the 14th day
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38
Q

A woman presents to the clinic because she missed her last menstrual period (LMP) & thinks she may be pregnant. She reports fatigue, breast tenderness, urinary frequency, and nausea & vomiting in the morning. THe healthcare provider will interpret these findings as which of the following changes of pregnancy?

a.) Positive
b.) Probable
c.) Presumptive
d.) Possible

A

c.) Presumptive

  • subjective
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39
Q

Chorioamnionitis

KNOW THIS – Per Tutor!!!!!

A

bacterial infection of the amniotic sac

S/S: fever, foul / purulent amniotic odor, tachycardia (mom & fetus), uterine tenderness

Risk to Mom: sepsis

  • Risk to BABY: respiratory distress syndrome, meningitis, cerebral palsy, pneumonia, sepsis
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40
Q

What is chorioamnionitis?

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A

bacterial infection of the amniotic sac

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41
Q

What are signs & symptoms of chorioamnionitis?

KNOW THIS – Per Tutor!!!!!

A
  • maternal fever
  • foul / purulent amniotic odor
  • tachycardia (mom & fetus)
  • uterine tenderness
42
Q

Chorioamnionitis puts a mom at risk for what?

KNOW THIS – Per Tutor!!!!!

A

sepsis

43
Q

Chorioamnionitis puts the fetus at risk of what?

KNOW THIS – Per Tutor!!!!!

A
  • RDS (respiratory distress syndrome)
  • meningitis
  • Cerebral Palsy
  • Pneumonia
  • Sepsis
44
Q

Infants of Diabetic Mothers

KNOW THIS – Per Tutor!!!!!

A

At risk for HYPOglycemia after birth

  • glucose crosses the placenta, but insulin does not
  • Baby is used to making their own insulin & after birth they aren’t receiving the glucose from the placenta but are still making insulin
  • Feed within 1st hour during 1st period of reactivity before they get drowsy & monitor closely
  • Also at risk for respiratory distress syndrome due to increased surfactant production
45
Q

What are babies of diabetic mothers at risk of?

KNOW THIS – Per Tutor!!!!!

A

HYPOGLYCEMIA after birth

  • also at risk for respiratory distress syndrome because of decreased surfactant production
46
Q

Preeclampsia

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A

HTN / proteinuria that develops after 20 weeks in normotensive women

  • can also develop for first time in post-partum period
  • In absence of proteinuria, preeclampsia may be defined as HTN along with:
  • thrombocytopenia
  • impaired liver function
  • new onset renal insufficiency
  • pulmonary edema
  • new onset cerebral or visual disturbances

Tx: magnesium
Tx antidote: calcium gluconate

S/S of Magnesium Toxicity:
* loss of deep tendon reflexes
* respiratory depression (↓ RR)
* ↓ LOC

47
Q

**

What is Preeclampsia?

KNOW THIS – Per Tutor!!!!!

by definition

A

HTN + proteinuria that develops after 20 weeks in normotensive women

Can also be HTN + (one of the following):
* thrombocytopenia
* impaired liver function
* new onset renal insufficiency
* pulmonary edema
* new onset cerebral or visual disturbances

48
Q

What is the treatment for preeclampsia?

KNOW THIS – Per Tutor!!!!!

A

Magnesium sulfate

49
Q

What is the antidote for magnesium?

KNOW THIS – Per Tutor!!!!!

A

calcium gluconate

50
Q

What is the treatment for preeclampsia & what is the antidote?

KNOW THIS – Per Tutor!!!!!

A

Tx = magneisum

  • Antidote = calcium gluconate
51
Q

What are the signs & symptoms of magnesium toxicity?

KNOW THIS – Per Tutor!!!!!

A
  • loss of DTR (deep tendon reflexes)
  • respiratory depression (↓ RR)
  • ↓ LOC
52
Q

Biophysical Profile (BPP)

KNOW THIS – Per Tutor!!!!!

A
  • Amniotic fluid volume, fetal tone, & fetal HR
  • score 0-10
  • 8 is great (score wise) - nothing is wrong, baby is doing well
53
Q

Placenta Previa

KNOW THIS – Per Tutor!!!!!

A

ATTACHMENT ISSUE

  • the placenta is implanted in the lower uterine segment (should be implanted at the top)

Signs & Symptoms:
* painless bright red bvaginal bleeding during second or third trimesters

Exam Findings: soft, relaxed, non-tender uterus with normal tone

54
Q

What is placenta previa?

KNOW THIS – Per Tutor!!!!!

A

Placenta does not attach in the correct place

  • attaches in the lower uterine segment
55
Q

What are signs & symptoms / exam findings of placenta previa?

KNOW THIS – Per Tutor!!!!!

A
  • Painless bright red vaginal bleeding
  • Abdominal Exam: soft, relaxed, non-tender uterus w/ normal tone
56
Q

Placental Abruption

KNOW THIS – Per Tutor!!!!!

A

Premature separation / detachment of part or all of the placenta from the uterus

Signs & Symptoms:
* vaginal bleeding
* abdominal pain
* uterine tenderness
* contractions
* board-like abdomen

57
Q

What is placental abruption?

KNOW THIS – Per Tutor!!!!!

A

Premature separation or detachment of part or all of the placenta from the uterus

58
Q

Signs & Symptoms of Placental Abruption

KNOW THIS – Per Tutor!!!!!

A
  • vaginal bleeding
  • abdominal pain
  • uterine tenderness
  • contractions
  • board-like abdomen
59
Q

How can you differentiate between placental abruption & placenta previa?

KNOW THIS – Per Tutor!!!!!

A

bleeding type, uterine tone, & absence or presence of pain

Placenta Previa
* painless vaginal bleeding
* soft, relaxed, non-tender uterus w/ normal tone

Placental Abruption
* vaginal bleeding w/ pain (contractions / abdominal pain)
* uterine tenderness
* board-like abdomen

60
Q

What is a cerclage?

KNOW THIS – Per Tutor!!!!!

A

A suture is placed around the cervix to hold it closed when premature dilation occurs

  • A suture is placed around the cervix beneath the mucosa to constrict the internal os of cervix
61
Q

What is cervical insufficiency? What is the interprofessional care management & the follow up care for cervical insufficiency?

KNOW THIS – Per Tutor!!!!!

A

Passive, painless dilation of the cervix leading to recurrent preterm births during the second trimester in absence of other causes

Tx / Interprofessional Management:
* cerclage – suture the cervix closed when premature dilation occurs due to weakness

Follow Up Care
* validity of bed rest has not been scientifically proven
* Progesterone therapy may be recommended for some women
* Watch for & report signs of perterm labor, rupture of membranes, & infection

62
Q

What is Cervical Insufficiency?

KNOW THIS – Per Tutor!!!!!

A

passive, painless dilation of the cervix

  • leads to recurrent preterm births during second trimester in absence of other causes
63
Q

What is the treatment of choice for cervical insuffiency? What is the follow up care?

KNOW THIS – Per Tutor!!!!!

A

Cerclage (suture the cervix closed)

Follow Up Care: watch for & report signs of preterm labor, rupture of membranes, & infection

  • validity of bed rest has not been scientifically proven
  • progesterone therapy may be recommended for some women
64
Q

Gestational Diabetes

KNOW THIS – Per Tutor!!!!!

A

Risk Factors
* family hx of diabetes
* previous pregnancy that resulted in unexplained stillbirth or the birth of a malformed or macrosomic fetus
* obesity, HTN, glycosuria, maternal age > 25 years
* more than half of women with GDM have none of these risk factors

diagnosed during second half of pregnancy

65
Q

What are risk factors for developing gestational diabetes?

KNOW THIS – Per Tutor!!!!!

A
  • family hx of DM
  • previous pregnancy that resulted in an unexplained stillbirth or the birth of a malformed or macrosomic fetus
  • obesity, HTN, glycosuria, & maternal age > 25 years

more than half of women with GDM have none of these risk factors

66
Q

A patient is diagnosed with gestational hypertension & is receiving magnesium sulfate. Which findings would the nurse interpret as indicating a therapeutic level of medication?

a.) Urinary output of 20 mL per hour
b.) Respiratory rate of 10 breaths per minute
c.) Deep tendon reflexes 2+
d.) Difficulty in arousing

A

c.) deep tendon reflexes 2+

With magnesium sulfate, deep tendon reflexes of 2+ would be considered normal & therefore a therapeutic level of the drug.

  • urinary output of less than 30 mL, a respiratoyr rate of less than 12 breaths/minute, & a diminished level fo consciousness would indicate manesium toxicity
67
Q

When is gestational diabetes diagnosed?

KNOW THIS – Per Tutor!!!!!

A

Second half of pregnancy

68
Q

Fetal Fibronetic (fFN) test

KNOW THIS – Per Tutor!!!!!

A

Used to predict who will NOT go into preterm labor because its negative predictive value is high

  • fFN is a glycoprotein “glue” found in plasma & produced during fetal life
  • women with a negative test have a less than 1% chance of giving birth in 2 weeks
69
Q

Shoulder Dystocia

KNOW THIS – Per Tutor!!!!!

A
  • suprapubic pressure
  • position change
  • turtle sign
  • Risk for diabetic mothers due to macrosomia
70
Q

Cord Prolapse

KNOW THIS – Per Tutor!!!!!

A
  • Position change to take pressure off the cord
  • Prepare for c-section
71
Q

Early Postpartum Hemorrhage

KNOW THIS – Per Tutor!!!!!

A

within 24 hours of birth

Causes:
* uterine atony (uterus doesn’t contract / shrink back to pre-pregnancy size)
* distended bladder
* trauma

72
Q

Late Postpartum Hemorrhage

KNOW THIS – Per Tutor!!!!!

A

more than 24 hours but less than 6 weeks after birth

Causes:
* infection
* subinvolution (uterus does not go down to prepregnancy size
* retained placenta

73
Q

Induction of Labor

KNOW THIS – Per Tutor!!!!!

A

chemical or mechanical initiation of uterine contractions before spontaneous onset (for the purpose of bringing about birth)

74
Q

Augmentation of Labor

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A

Stimulation of uterine contractions AFTER labor has started spontaneously & progress is unsatisfactory

  • Common Methods:
  • oxytocin
  • amniotomy (breaking the water)
75
Q

The nurse is developing a plan of care for a woman who is pregnant with twins. The nurse includes interventions focusing on which of the following because of the woman’s increased risk?

a.) Oligohydramnios
b.) Preeclampsia
c.) Post-term labor
d.) Chorioamnionitis

A

b.) Preeclampsia

Oligohydramnios = too little amniotic fluid

76
Q

Maternal substance use

KNOW THIS – Per Tutor!!!!!

A
  • Tobacco = growth restriction
  • Cocaine / Amphetamines = placental abruption
  • Alcohol = cognitive impairment
77
Q

How does maternal use of tobacco impact the fetus?

KNOW THIS – Per Tutor!!!!!

A

Growth restriction

78
Q

How does maternal cocaine / amphetamine use impact the fetus?

KNOW THIS – Per Tutor!!!!!

A

placental abruption

79
Q

How does maternal alcohol use impact the fetus?

KNOW THIS – Per Tutor!!!!!

A

cognitive impairment

80
Q

Hypospadias

KNOW THIS – Per Tutor!!!!!

A

urethra is on VENTRAL aspect (underside / bottom) of the penis

81
Q

Epispadias

KNOW THIS – Per Tutor!!!!!

A

urethral opening is on the DORSAL aspect (on top) of the penis

82
Q

A 1-day-old neonate, 32 weeks gestation, is in an overhead warmer. The nurse assesses the morning axillary temperature as 96.9 F. Which of the following could explain this assessment finding?

a.) This is a normal axillary temperature for a preterm neonate.
b.) Axillary temperatures are not valid for preterm babies.
c.) The supply of brown adipose tissue is incomplete.
d.) Conduction heat loss is pronounced in the baby.

A

c.) The supply of brown adipose tissue is incomplete.

83
Q

Which vital sign deviates from the normal reading as a result of puerperal sepsis?

a.) Temperature
b.) Respirations
c.) Blood pressure
d.) Pulse

PowerPoint Question

A

a.) Temperature

  • Fever is > 100.4 F
84
Q

A number of changes in the integumentary system occur during pregnancy. Which change persists after birth?

a.) Epulis
b.) Chloasma
c.) Striae gravidarum
d.) Telangiectasia

PowerPoint Question

A

c.) Striae gravidarum

85
Q

With regard to follow-up visits & the physical examination for women receiving prenatal care, nurses should be aware that…

a.) The interview portions become more intensive as the visits become more frequent over the course of the pregnancy.

b.) Monthly visits are scheduled for 1st trimester, every 2 weeks for 2nd trimester, & weekly for 3rd trimester.

c.) During the abdominal examination, the nurse should be alert for supine hypotension.

d.) For pregnant women, a systolic BP of 130/80 is sufficient to be considered hypertensive.

PowerPoint Question

A

c.) During the abdominal examination, the nurse should be alert for supine hypotension.

Supine hypotension: occurs when a pregnant person’s uterus compresses the inferior vena cava & aorta while they are lying on their back

86
Q

Gestational Hypertension

A
  • onset of HTN w/out other findings after 20 weeks
  • BP > 140/90 (resolves after giving birth)
87
Q

Care of Macrosomic Infant

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A

Large babies (macrosomic) are at risk for:

  • Hypoglycemia
  • Polycythemia (RBCs)
  • Birth injuries (shoulder dystocia)
  • Metabolic Issues (obesity, diabetes, cardiovascular disease)
87
Q

Women with hyperemesis gravidarum…

a.) Are a majority, because 80% of all women suffer from it at some time.

b.) Have vomiting severe & persistent enough to cause weight loss, dehydration, & electrolyte imbalance.

c.) Need IV fluid & nutrition for most of their pregnancy.

d.) Often inspire similar, milder symptoms if their male partners & mothers

PowerPoint Question

A

b.) Have vomiting severe & persistent enough to cause weight loss, dehydration, & electrolyte imbalance.

88
Q

Ectopic Pregnancy

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A

Fertilized ovum is implanted OUTSIDE the uterine cavity

Signs & Symptoms:
* abdominal pain
* delayed menses
* abnormal vaginal bleeding (spotting)

89
Q

**Gestational Diabetes - Preconception Guidance **

KNOW THIS – Per Study Guide!!!!!

A
  • Frequent monitoring in pregnancy
  • Primary Goal: achieve & maintain constant euglycemia
  • diet, exercise, insulin therapy, self monitoring blood glucose, urine testing
90
Q

5 Stages of Grief

KNOW THIS – Per Study Guide!!!!!

A

1.) Denial
2.) Anger
3.) Bargaining
4.) Depression
5.) Acceptance

91
Q

Perinatal Loss

KNOW THIS – Per Study Guide!!!!!

A

Loss associated with childbearing

  • miscarriage
  • fetal diagnosis
  • pregnancy termination
92
Q

Survivors Guilt

KNOW THIS – Per Study Guide!!!!!

A

A feeling of guilt about going on with life after other people close to you have died

93
Q

Care of NAS babies
* neonatal abstinence syndrome

KNOW THIS – Per Study Guide!!!!!

A
  • keep lights dim
  • TV & radio off
  • Use soft, quiet voices
  • Sensitive to stimulation
94
Q

How to calculate newborn weight loss percentage

KNOW THIS – Per Study Guide!!!!!

A

(weight at birth - current weight) / birth weight x 100

Can also do:

100 - ( current weight / birth weight)

  • 100 - (3000/3500) = 0.857
  • 0.857 = 85.7
  • 100 - 85.7 = 14.3
95
Q

Meds for hypertension during pregnancy

KNOW THIS – Per Study Guide!!!!!

A

Labetalol
* beta blocker to decrease BP

Hydralazine
* IV only
* monitor FHT
* mom in L lateral position

Nifedipine / Procardia
* calcium channel blocker to decrease contractions

Magnesium sulfate for severe preeclampsia (not necessarily for BP)

96
Q

What are the 3 most common medications used to control hypertension during pregnancy? (NOT for preeclampsia)

KNOW THIS – Per Study Guide!!!!!

A
  • Labetalol
  • Hydralazine (IV only)
  • Nifedipine / procardia
97
Q

What are the 3 Tocolytic drugs & what are they used for?

A

Tocolytic = inhibit contractions

Not My Time
* nifedipine
* magnesium sulfate
* terbutaline

98
Q

What medications are used for postpartum hemorrhage?

KNOW THIS – Per Study Guide!!!!!

A
  • Cytotec (misoprostol)
  • Hemabate – do NOT use w/ asthma
  • Methergine – do NOT use w/ HTN
  • Oxytocin / pitocin
99
Q

What is methotrexate used for?

KNOW THIS – Per Study Guide!!!!!

A

used for the medical treatment of ectopic pregnancy

OB Exam 2 (4 decks)

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