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Maternal/Child - Nrsg 206 > Exam 2 - Test Map (Units C&D) > Flashcards

Exam 2 - Test Map (Units C&D) Flashcards

1
Q

Does placenta previa or abruptio placentae involve painful bleeding?

A

Abruptio placentae

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2
Q

What are the 3 classifications of abruptio placentae?

A

Marginal abruption (grade 1=10-20% detached); Partial abruption (grade 2=20-50% detached); Complete abruption (grade 3=>50% detached)

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3
Q

What is abruptio placentae the leading cause of?

A

Maternal deaths

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4
Q

What is abruptio placentae?

A

The detachment of part or all of the placenta from the implantation site

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5
Q

When does abruptio placentae usually occur during pregnancy?

A

After 20wks of gestation and before birth of baby

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6
Q

What are the risk factors for abruptio placentae?

A

Maternal HTN, MVA, maternal battering, cocaine abuse resulting in vasoconstriction, previous abruptio placentae, cig. smoking, PROM, & multifetal preg

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7
Q

What labs are done for abruptio placentae?

A

Hgb & Hct decrease; Coagulation factors decrease; Clotting (fibrinogen) defects (DIC); Type & cross match (for possible blood transfusion)

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8
Q

How could a woman with abruptio placentae end up with DIC?

A

Her body uses all her fibrinogen to form clots to stop the bleeding

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9
Q

What are the s/s of abruptio placentae?

A

Sharp/stabbing pain localized in the uterus/fundus, occult (bright red or dark) vaginal bleeding, board-like abd that’s tender, uterine hypertonicity (firm, rigid uterus with contractions), fetal distress, & s/s of hypovolemic shock

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10
Q

Why is a vaginal, abd, pelvic, or rectal exam never done on a woman with abruptio placentae?

A

It can dislodge the placenta

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11
Q

What is normal urine output per hr?

A

1-2 mL/kg/hr

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12
Q

What is a quick test to see if a pt with abruptio placentae now has DIC?

A

Put 5mL of blood in a dry test tube for 5 min, if there’s no clot then its suspected DIC

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13
Q

What is the tx for abruptio placentae?

A

IV Heparin (to stop clotting cascade), O2 8-10L via face mask, VS q5-15min, lateral maternal position, prepare for stat birth, monitor urine output, FFP or platelets, Betamethasone (Celestone) given

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14
Q

Why is Betamethasone (Celestone) given to a woman with abruptio placentae?

A

A corticosteroid given for fetal lung maturation

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15
Q

What are Indomethacin (Indocin) & Terbutaline (Brethine) given for?

A

Used to tx preterm labor

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16
Q

What is Methylergonovine (Methergine) used to tx?

A

Postpartum hemorrhage

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17
Q

What is gestational trophoblastic disease (Hydatidiform mole, choriocarcinoma, & molar pregnancy)?

A

An abnormal proliferation and degeneration of the trophoblastic villi in the placenta. As cells degenerate they fill with clear fluid and appear as grape-like vessels. The embryo fails to develop beyond the primitive start

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18
Q

What is choriocarcinoma and what is it associated with?

A

Rapidly metastasizing malignancy associated with molar preg. (hydatidiform mole)

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19
Q

Is the genetic material in a complete molar pregnancy derived maternally, paternally, or both?

A

Paternally; Nucleus of sperm (23X) duplicates itself = diploid # (46XX)

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20
Q

Is the genetic material in a partial molar pregnancy derived maternally, paternally, or both?

A

Both maternally and paternally

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21
Q

Describe the ovum in a complete molar pregnancy.

A

Has no genetic material or the material is inactive

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22
Q

Describe the ovum in a partial molar pregnancy.

A

Is fertilized by 2 sperm or one sperm in which meiosis or chromosome reduction and division didn’t occur

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23
Q

Since there is no placenta to receive maternal blood in a complete molar preg., what happens?

A

Hemorrhage into the uterine cavity occurs and vaginal bleeding results

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24
Q

What does a complete molar preg. contain?

A

No fetus, placenta, amniotic membranes, or fluid

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25
Q

What does a partial molar preg. contain?

A

Often contains abnormal embryonic or fetal parts, an amniotic sac, and fetal blood, but congenital anomalies are present

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26
Q

What are the risk factors for a hydatidiform mole?

A

Low protein intake, 35yrs of age, Asian population & women with blood type A with a man with type O

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27
Q

What are the s/s of a hydatidiform mole?

A

Vaginal bleeding (bright red or dark brown), hyperemesis gravidarum (d/t increases hCG levels), rapid uterine growth, higher fundus, s/s of PIH prior to 20 wks (HTN, edema, & proteinuria)

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28
Q

How often does a woman with a hydatidiform mole need their hCG levels checked?

A

q1-2wks until levels are normal, q2-4wks for 6mo, & q2mo for 1yr

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29
Q

What do hCG levels that plateau or increases with a hydatidiform mole suggest?

A

Malignant transformation (choriocarcinoma)

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30
Q

What is placenta previa?

A

Occurs when the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus

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31
Q

What are the risk factors for placenta previa?

A

Previous placenta previa, uterine scarring (previous c-section, curettage, endometritis), maternal age >35yrs, multifetal gestation, & multiple gestation or closely spaced pregnancies

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32
Q

What are the 3 types of placenta previa dependent upon?

A

Dependent on the degree to which the cervical os is covered by the placenta

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33
Q

What are the 3 types of placenta previa?

A

Marginal (low-lying), Incomplete (partial) & Complete (total)

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34
Q

Describe marginal placenta previa

A

When the placenta is attached in the lower uterine segment but doesn’t reach the cervical os

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35
Q

Describe incomplete placenta previa

A

Cervical os is only partially covered by the placental attachment

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36
Q

Describe complete placenta previa

A

Cervical s is completely covered by the placental attachment

37
Q

Why must you never do a vaginal or rectal exam on a pt with placenta previa?

A

It can dislodge the placenta

38
Q

When does placenta previa usually occur during a pregnancy?

A

30wks gestation

39
Q

How is placenta previa managed?

A

Bedrest until viability, NST or BPP wkly, c-section

40
Q

What are the s/s of placenta previa?

A

Painless, bright red vaginal bleeding that increases as the cervix dilates; soft, relaxed, nontender uterus with normal tone; Fundal ht that is greater than usually expected for gestational age; Fetus in breech, oblique, or transverse position; Palpable placenta; VS are WNL; Decreased urinary output

41
Q

At what % of placenta previa does a woman have a SVD? C-section?

A

SVD = 30% previa

42
Q

What is a Lecithin/sphingomyelin (L/S) ratio, how is it obtained, and what is the normal ratio?

A

A L/S ratio is obtained from amniotic fluid to determine fetal lung maturity. Normal = 2:1 & for DM = 3:1

43
Q

What is hyperemesis gravidarum?

A

Excessive N/V (r/t increased hCG levels) that is prolonged past 12wks of gestation

44
Q

What does hyperemesis gravidarum result in?

A

A 5% wt loss from prepregnancy wt, electrolyte imbalance, acetonuria, & ketosis

45
Q

What are the risk factors for hyperemesis gravidarum?

A

Maternal age <20yrs, obesity, 1st preg, multifetal gestation, gestational trophoblastic disease, hx of psyc disorders, transient hyperthyroidism, Vit B deficiencies, high stress levels

46
Q

What are the s/s of hyperemesis gravidarum?

A

Excessive vomiting for prolonged periods, dehydration, wt loss, increased pulse rate, decreased BP, and poor skin turgor

47
Q

What will lab results show in hyperemesis gravidarum?

A

Urinalysis for ketones and acetones (breakdown of protein & fat) is most important initial lab; Increased specific gravity; Decreased sodium, potassium, & chloride (from low intake); Acidosis (from excessive vomiting); Increased liver enzymes; Thyroid tests (Hyperthyroidism); Increased Hct (inability to retain fluid results in hemoconcentration)

48
Q

What is the tx for hyperemesis gravidarum?

A

IV therapy, NPO status until vomiting free X’s 48hrs, Antiemetics (Inapsine, Reglan, or Phenergan), strict I&O, & a restful environment

49
Q

What med is given to tx refractory hyperemesis gravidarum?

A

Corticosteroids

50
Q

What can cause fetal bradycardia (FHR <110/min for 10 min or more) or late decels in FHR?

A

Uteroplacental insufficiency

51
Q

How is uteroplacental insufficiency tx?

A

Pt in side-lying position, IV therapy, discontinue oxytocin, admin 8-10L O2 via mask, notify PCP, possibly admin tocolytic meds, and prepare for SVD or c-section

52
Q

What are Leopold maneuvers?

A

Abdominal palpation of the # of fetuses, the fetal presenting part, lie, attitude, descent, and the best location for fetal heart tones

53
Q

What is a prolapsed cord?

A

When the umbilical cord is displaced, preceding the presenting part of the fetus, or protruding thru the cervix

54
Q

What does a prolapsed cord result in?

A

Cord compression and compromised fetal circulation

55
Q

What are the risk factors for a prolapsed cord?

A

ROM, abnormal fetal presentation, transverse lie, SGA, cord length >100cm, multiparity, cephalopelvic disproportion, placenta previa, intrauterine tumor, & polyhydraminos

56
Q

What is polyhydraminos?

A

Excessive amniotic fluid >2,000mL

57
Q

What are the s/s of a prolapsed umbilical cord?

A

Fetal bradycardia with variable or prolonged decels, cord is seen/felt/protruding from the vagina, extreme increase in fetal activity & then ceases (suggestive of severe fetal hypoxia)

58
Q

What happens if blood flow is occluded to and from the fetus for more than 5 min?

A

Usually results in CNS damage or fetal death

59
Q

What are the interventions for a prolapsed umbilical cord?

A

Extreme Trendelenburg, Modified Sim’s, or knee-chest position, O2 via mask @ 8-10L/min until birth, Increase IV fluids, continuous FHR monitoring, immediate vag delivery if fully dilated or c/s if not

60
Q

What interventions are done if the prolapsed cord is seen/felt?

A

Insert 2 fingers & exert upward pressure against the presenting part or wrap the cord loosely in sterile towel soaked with warm saline

61
Q

What is Nagele’s rule for EDD?

A

1st day of LMP, subtract 3 mo, add 7 days & 1yr OR count forward 9 mo & add 7 days

62
Q

When does engagement occur during labor?

A

When the presenting part passes the pelvic inlet at the level of the ischial spines. Referred to as station 0 (zero).

63
Q

What is the fetal “lie”?

A

The relationship of the fetal spine to maternal spine. Primary lies: Longitudinal (vertical) & transverse (horizontal or oblique); Vertical lie: either cephalic or breech. Vag birth isn’t possible with transverse lie

64
Q

What are the 5 P’s affecting labor?

A

Passenger, passageway, powers, position, & psychologic response

65
Q

When does an AFE occur?

A

When amniotic fluid containing debris (vernix, hair, meconium, etc.) enters maternal circulation & obstructs pulmonary vessels = respiratory distress & circulatory collapse

66
Q

What are the risk factors for AFE?

A

Multiparity, tumultuous labor, abruptio plancentae, oxytocin admin, fetal macrosomia, hydramnios, fetal demise, & meconium-stained amniotic fluid

67
Q

What are the s/s of respiratory distress with an AFE?

A

Restlessness, dyspnea, cyanosis, pulmonary edema, and respiratory arrest

68
Q

What are the s/s of circulatory collapse with an AFE?

A

Hypotension, tachycardia, shock, cardiac arrest

69
Q

What are the hemorrhage s/s with an AFE?

A

Coagulation failure (bleeding and uterine atony)

70
Q

What are the AFE interventions?

A

O2 (8-10L/min via mask or rebreather @ 100%, intubation & mechanical ventilation, CPR, & tilt woman 30 deg to side); Maintain cardiac output & replace fluid losses & VS (PRBCs, FFP, hourly I&O)

71
Q

When are nursing interventions most important during labor?

A

During the 3rd & 4th stages

72
Q

What type of medication is used to control BP during an AFE?

A

Vasopressor

73
Q

What must be monitored for an AFE until a pulmonary catheter is placed?

A

Pulse oximetry

74
Q

What labs are done for an AFE?

A

CBC, platelet count, type & cross match, PT, PTT, fibrinogen, chem panel, and renal fxn

75
Q

What are some signs that precede labor?

A

Lightening, Braxton Hicks contractions become stronger, Increased vaginal mucus (white/gray discharge with no odor), bloody show 24-48hrs before, nesting, & wt loss (btwn 1-3 lbs)

76
Q

What is lightening?

A

Presenting part descends into the true pelvis

77
Q

What factors are included in the onset of true labor?

A

Changes in uterus, cervix, and pituitary gland

78
Q

Define prodromal/false labor

A

No change in cervix within 1-2hrs

79
Q

Define true labor

A

Cervical changes/dilation

80
Q

What are some childbirth complications?

A

Preterm labor, prolapsed umbilical cord, AFE, & shoulder dystocia

81
Q

Describe FHR baseline variability?

A

Fluctuations in the FHR baseline that are irregular in frequency & amplitude

82
Q

What are the classifications of variability?

A

Absent or undetectable (0-2bpm, nonreassuring), Minimal (3-5bpm), Moderate (6-25bpm), & Marked (>25bpm)

83
Q

What is the average variability in a FHR?

A

6-10bpm

84
Q

What FHR variability is exhibited in a normal, healthy fetus?

A

Moderate variability

85
Q

What type of FHR variability is seen with fetal sleep, maternal meds or fetal anomalies?

A

Decrease in variability

86
Q

What is persistent minimal or absent variability a sign of?

A

Inadequate fetal oxygenation

87
Q

What are some causes of decreased variability in a FHR?

A

Fetal hypoxia, acidosis, congenital heart defects and fetal tachycardia

88
Q

What are the nonreassuring FHR patterns?

A

Fetal bradycardis and tachycardia, absence of FHR variability, late decels & variable decels

89
Q

What is the FHR in fetal bradycardia?

A

FHR <110bpm for 10min or more

Maternal/Child - Nrsg 206 (1 decks)

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