Exam 2 Tutor Flashcards
when to feel Braxtonhicks
4th month
are Braxton hicks true labor
no
lightening time frame
38-40 weeks
what is lightning
baby drops
lightening is sooner in
primip
hegar sign
softening of the lower uterine segment
ballotment time
16-18 weeks
quickening
first regongitoon of fetal movement
- first kick
gooodeell sign
softening of the cervix
friability
tissue is easily damage
operculum
mucus plug
Chadwick sign
violet blue color of vaginal mucosa and cervix
striae gradidaram
remain after preg
- stretch marks
presumptive
subjective, changes experienced by the woman
Presumptive: ex
amenorrhea, fatigue, breast changes
probable
objective, changes observed/perceived by examiner & strongly suggest pregnancy
probable ex
Hegar sign, ballottement, pregnancy tests
positive
objective, changes observed/perceived by examiner indicate proof of pregnancy
positive ex
fetal heart tones, ultrasound!!!!
Naegele’s rule to calculate EDB
Assumes woman has a 28 day cycle and that fertilization occurs on the 14th day
After determining the first day of the LMP, subtract 3 calendar months and add 7 days
Chorioamnionitis
s/s
Maternal fever, foul/purulent amniotic odor, tachycardia (mom and fetus), uterine tenderness,
Chorioamnionitis risk for mom
sepsis
Chorioamnionitis risk for baby
RDS, meningitis, CP, pneumonia, sepsis
Chorioamnionitis risk factor
ruptured logner than 18 hr
infant of DM at risk for
hypogly
RDS - decreased surfactant production
what crosses the placenta
glucose
when to feed baby
first hour before drowsy
preeclampsia
HTN/proteinuria develops after 20 weeks in normotensive woman
Can also develop for first time in PP
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
mag antidone
calcium gluc
s/s of mag tox
loss of DTR
resp depression
normal mag s/s
burning at IV
flushed
decrease DTR
preterm mag why given
neural and tocolytic
preeclampsia why give mag
anti seizure
when can preeclampsia be diagnosed
after 20
if a woman has preeclampsia and then seizes that is it
eclampsia
what is tested in BPP
Amniotic fluid volume
Fetal tone
Fetal HR
what is a good score for BPP
8 is great
t/f always report any bleeding in pregnancy as well as decreased fetal movement
true
placental preva s/s
painless
bright red bleeding
soft relaxed contender uterus with normal tone
can previa do vag birth or vag exams or internal monitoring
no
abruption s/s
bleeding
pain
uterine tenderness
contractions
board line abdomen
how to differentiate previa and abruption
type of bleeding
uterine tonicity
presence or absence of pain
tx for cervical insuff
cerclage
cervial insuff
cervical change before ready with no contraction
cerclage
suture is placed around the cervix beneath the mucosa to constrict the internal os of cervix (McDonald technique)
DM rx factor
Family history of diabetes
Previous pregnancy that resulted in an unexplained stillbirth or the birth of a malformed or macrosomic fetus
Obesity, hypertension, glycosuria, and maternal age >25 years
BUT…more than half of women with GDM have none of these risk factors
when is GDM diagnosed
2nd half of preg
fFN
who should not go into labor
- neg: good! No labor soon
- pos: not good, labor soon
FFN what type of predictive value
negative
what do we see with s dystocia
turtle sign
who has an increase risk for dystocia
DM due to macrosomia
what do we due to s dystocia
suprapubic pressure
mcroberts
what to do if cord prolapse
position change, take pressure off of cord, prepare for c-section
early PPH
atony
late PPH
sub involution
induction
before
augmentation
after labor started
5 stages of grief
Denial
Anger
Bargaining
Depression
Acceptance
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
preeclam
- Women with multiple gestations are at high risk for preeclampsia, preterm labor, hydramnios, hyperemesis gravidarum, anemia, and antepartal hemorrhage. There is no association between multiple gestations and the development of chorioamnionitis.
tobacco
growth restriction
cocaine/amp
placental abruption
alcohol
cognitive impairment
caffine
now BW
hypospadias
ventral
epispadias
dorsal
t/f vernix has benefits for preterm infant skin
yes
mag
Magnesium sulfate- given in severe preeclampsia but not necessarily for BP, instead for neuroprotection (preventing seizures). Can also prolong pregnancy short term
Normal effects- flushed, warm feeling, burning at IV site
Abnormal effects (possible mag toxicity, give calcium gluconate as antidote)- resp depression, hypotension, absence of DTRs.
Calcium gluconate- antidote for mag sulfate- adverse effects include bradycardia, arrhythmias and cardiac arrest
labetalol
beta blocker to decrease BP
hydralazine
IV only. vasodilator. Monitor FHT, mom in left lateral position
Procardia / nifedipine
calcium channel blocker to decrease contractions, also helps hypertension
tocolytic
drugs that inhibit contractions. May be used in preterm labor
tocolytic drugs
terbutaline/brethine
mag
Procardia
terbutaline/brethine
relaxes uterus, given subcutaneously, only used before 37 weeks but usually stopped by 34 weeks due to adverse effects
mag tocolytic
relaxes muscles including the uterus
Procardia toco
calcium channel blocker to decrease contractions, also treats hypertension
Betamethasone/Dexamethasone-
given for baby’s benefit, not moms. If a mom is in preterm labor and delivery is inevitable, the steroid is given to increase the production of surfactant which therefore helps their respiratory system develop before birth.
Betamethasone/Dexamethasone- dose
12 mg every 24 hours for 2 doses IM
Betamethasone/Dexamethasone use up till
only if mom is 23/24 weeks and risk for delivery within 7 days use up to 34 days
Cervidil/ Dinoprostone
prostaglandin, ripens the cervix for labor. Risk for uterine tachysystole (inserted)
Cytotec/ Misoprostol,
prostaglandin, ripens the cervix for labor. Risk for uterine tachysystole (oral)
Oxytocin/ Pitocin
induces or augments labor. Side effect is uterine tachysystole, aka over 5 contractions within 10 minutes, averaged over a 30 minute period. Also helps control bleeding postpartum
Hemabate/ carboprost
useful when hemorrhage is from uterine atony that isn’t resolving from fundal massage and oxytocin. Contraindicated with asthma.
Methergine
useful for uterine atony and subinvolution. Contraindicated with hypertension
meds for PPH
cytotec
hemabate
methergine
pit
newborn meds
Erythromycin- ointment for eyes to prevent ophthalmia neonatorum and prevent blindness. Should be administered within one hour of birth. 1cm of ointment instilled into each lower conjunctival sac, do not wipe away.
Vitamin K- IM in vastus lateralis, prevents hemorrhagic disease due to low vitamin K (sterile GI system). Should be administered within 2 hours.
Hep B- IM in vastus lateralis, delay if baby has a suspected infection (including GBS). Should be administered within 12 hours. If mom is HepB+, baby also gets HBIG
Sucrose- procedural pain, stimulates opioid receptors for pain relief
Narcan- can help with effects of opioids given pre birth, contraindicated if mom is opioid dependent
Rhogam
Rh neg mother with Rh pos baby, IM injection, includes blood products, protects future pregnancies. + Coombs test means that antibodies are present.
