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Labor and Delivery > exam 3 > Flashcards

exam 3 Flashcards

1
Q
  1. Which hormone is the earliest biological marker for pregnancy?
  2. What does this hormone do? When is it detected? Is it more accurate to detect in serum or urine?
  3. What kind of drugs could cause a false-negative pregnancy test?
  4. What kinds of drugs can cause a false positive pregnancy test?
A
  1. human chorionic gonadotropin
  2. It ensures supply of estrogen and progesterone. Detected 7-8 days before expected period. Serum
  3. diuretics and promethazine (lower than normal Hcg)
  4. anticonvulsants and tranquilizers (higher than normal Hcg)
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2
Q
  1. What is the Leading cause of maternal morbidity and mortality
  2. what amounts of blood loss qualify hemorrhage?
  3. What are the 4 T’s of hemorrhage?
  4. Although it’s not complicated can only a dr do controlled cord traction?
A
  1. hemorrhage
  2. > 500ml for vaginal delivery and 1000ml for c-section.
  3. Tone, Trauma, Tissue, Thrombin
  4. yes
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3
Q
  1. Which of the 4 T’s is the leading cause of postpartum hemorrhage?
  2. What are the warning signs of hemorrhage?
  3. what do we do?
A
  1. Tone - atony
  2. when bleeding increases, blood clots larger than a quarter, tachycardia, hypotension, oliguria, pale and cool skin, clammy, pad saturation <15min.
  3. funal massage, get help, stay w/patient, bimanual massage and compression (provider)
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4
Q
  1. What drugs can be given for hemorrhage?
  2. What is a hemotoma and why is it dangerous?
  3. where do hematomas occur?
  4. What is the biggest symptom of a hematoma?
A
  1. Oxytocin (routinely given), methylergonovine, cytotec, carboprost (hemabate)
  2. 250 to 500 mL of clotted blood within tissues that may appear as a bulging bluish mass. Dangerous because it is a hidden hemorrhage.
  3. the pelvic region or higher up in the vagina
  4. pain
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5
Q
  1. How can we know (aside from seeing it) that there is a laceration?
  2. What does the provider do to fix a hematoma?
  3. T or F, leftover placental fragments are more common in preterm deliveries?
A
  1. there is bleeding despite the uterus being firm.
  2. tie it off or evacuate the trapped blood (if >4cm)
  3. T (btw 20-24 weeks)
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6
Q
  1. What assessments would indicate that there is tissue left inside the uterus?
  2. What meds are used to expel tissue, and why?
  3. What are the primary nursing responsibilities (4) when
    caring for a client who is experiencing a postpartum hemorrhage associated with uterine atony?
A
  1. uterine atony, subinvolution, inversion, big clots, return to lochia rubra, malodorous lochia, elevated temp
  2. Oxytocin (to expel retained fragments). Terbutaline (relaxes uterus for D&C if oxytocin unsuccessful).
  3. Establish venous access,
    Perform fundal massage
    Prepare woman for surgery, foley cath
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7
Q
  1. What is Idiopathic thrombocytopenic purpura (ITP)?
  2. What is DIC?
  3. When are coagulopathies suspected?
  4. T or F, DIC is a secondary complication, meaning it is always stemming from something else rather that being a stand-alone problem?
A
  1. is a coagulopathy that is an autoimmune disorder in which the life span of platelets is decreased by antiplatelet antibodies.
  2. is a coagulopathy in which clotting and anticlotting mechanisms occur at the same time.
  3. when the usual measures to stimulate uterine contractions fail to stop vaginal bleeding.
  4. T
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8
Q
  1. How do we manage dic (4)?
  2. What is the dangher of DVT (deep vein thrombosis)?
  3. What are the risk factors to DVT?
  4. what are the interventions for DVT?
A
  1. Treat obstetric abnormality, massive blood transfusion, admin heparin, correct fibrinogen levels.
  2. may lead to pulmonary embolism?
  3. pregnancy, immobility, obesity, smoking, c-section, multiparity, >35y.o mother, history of, and diabetes
  4. don’t massage. bed rest w/legs elevated, warm/moist compress, measure leg circumference, thigh-high antiembolism stockings, admin of analgesics and anticoagulants
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9
Q
  1. What is the antidote to heparin?

2. What is the antidote to Warfarin (coumadin)?

A
  1. protamine sulfate

2. phytonadione (vitamin K)

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10
Q
  1. What are the signs and symptoms of a pumonary embolism?

2. What are the interventions for a patient with pulmonary embolism?

A
  1. sudden shortness of breath, chest pain, anxiety, dizziness, palpitations, hemoptysis, sweating, low BP, DVT
  2. patient in semi fowlers (head of bed elevated), O2 by mask, admin of meds and thrombolytic therapy
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11
Q
  1. What are the interventions for an inverted uterus?
  2. How long after delivery are women susceptible to infection?
  3. what is the big danger that can come from infection?
  4. What are the 4 types of possible infections? Which one is the most common?
A
  1. stop oxytocin, administer terbutaline (can’t invert a cintracted uterus), admin of O2, IV fluids, anticipate surgery, and admin of antibiotics
  2. 28 days after
  3. septicemia
  4. uterine infection (aka endometritis), UTI, wound infection, and mastitis. Endometritis is the most common
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12
Q
  1. how many cal per day does a newborn need thru his first 3 mo’s of life?
  2. How much fat do they need?
  3. How many carbs per day?
  4. How much protein?
  5. How much vitamin D?
  6. At what age do we begin supplementing with iron?
A
  1. 110 cal per kg
  2. 15% of daily calories should be from fat
  3. 60g
  4. 9.1g/day
  5. 400IU of vitamin D daily
  6. 6mo
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13
Q
  1. When can babys have cow’s milk?
  2. When is breastfeeding contraindicated?
  3. How many lobes does the typical breast have?
  4. …………. production is stimulated by infant suckling and emptying the breasts
  5. ………… production is stimulated by suckling via hypothalamus and pituitary gland (“let-down” reflex)
A
  1. Not until 1 year
  2. HIV, chronic disease, cetain meds like opioids, cleft lip/palate, inadequate sucking force, metabolism problems like PKU and galactosemia
  3. 15 - 20
  4. Prolactin
  5. Oxytocin
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14
Q
  1. Breast milk can be kept out how long?
  2. in the fridge how long?
  3. In the normal freezer how long?
  4. In the deep freezer how long?
A
  1. 4 hours
  2. up to 48 hours
  3. up to 3 months
  4. up to 6 months
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15
Q
  1. What things can make Hcg higher?

2. What things can make lower than normal Hcg?

A
  1. multi gestations (twins), molar pregnancy, down syndrome

2. impending miscarriage, ectopic pregnancy

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16
Q
  1. What are presumptive signs of pregnancy and when do they occur?
  2. What are probably signs of pregnancy and when do they occur?
  3. What are positive signs of pregnancy and when do they occur?
A
  1. Presumptive: 3-20wks, things the woman feels: amenorrhea, fatigue, change in breast tissue, nausea, vomiting, urinary frequency, and quickening.
  2. 5-28 wks. Things the physician observes: Hegar’s sign,
    ballottement, Goodell, Chadwick, positive pregnancy test, Braxton-Hicks contractions
  3. 5wks to late gestation. Provider notes these signs attributed to
    the presence of fetus, such as hearing fetal tones, visualizing
    fetus and palpating fetal movements
17
Q
  1. What is quickening?
  2. What is ballottement?
  3. What is lightening or dropping?
A
  1. the mothers first feeling of fetal movement. Usually 14-16 weeks for multiparous and 20 weeks for first pregnancy.
  2. provider puts finger to cervix and gently
    taps causing fetus to bounce a little bit up and down.
  3. happens between 38-40 weeks. The fundal height
    decreases and fetus begins to descend into true pelvis in preparation
    for delivery.
18
Q
  1. What is leukorrhea?

2. What is operculum?

A
  1. a white or grey discharge that smells musty. Due to estrogen and progesterone.
  2. the mucus plug
19
Q
  1. What is Chadwicks sign?
  2. What is Hegars sign?
  3. What is the Goodell sign?
A
  1. a probable sign seen by provider at 6-8 weeeks. It is caused by increased vascularity to the cervix causing a bluish tint to it.
  2. a softening of the lower segment of the uterus (uterine isthmus) causing antiflexion in first 3 mos of pregnancy. This causes urinary frequency from uterus pressing on bladder.
  3. softening of the cervical tip
20
Q
  1. How much does cardiac output increase in pregnancy? Why?
  2. How much does blood volume increase by?
  3. Does BP increase or decrease? Why?
  4. Does HR increase? How much?
  5. What hematologic changes occur?
A
  1. 30-50%, needed to meet mom’s metabolic demands to provide for fetal
    development.
  2. 1500ml
  3. slight decrease from prepregnancy because of progesterone
  4. increases by 10-15bpm
  5. physiological anemia, decreased hemoglobin. Huge increase in wbcs up to 25,000. Coagulation factors increase.
21
Q
  1. What does estrogen do to the ligaments of the rib cage?
  2. Why are pregnant women susceptible to thrombi?
  3. Why does mom’s O2 consumption increase?
  4. Why does mom feel short of breath?
A
  1. relaxes them causing chest expansion.
  2. elevated coagulation factors, stasis of blood in lower extremities,and progesterone relaxes the walls of blood
    vessels
  3. due to acceleration of metabolism
  4. the upward displacement of the diaphragm
22
Q
  1. the upper respiratory tract becomes
    more vascular in response to ……… This can make a woman feel ………..
    in her nose, throat, sinuses, and ears.
  2. What happens to GFR in pregnancy? What does this do to the reabsorption of glucose?
  3. what does urinary stasis put the woman at risk for?
A
  1. estrogen, congested
  2. increase up to 50%. This impairs glucose reabsorption so glucosuria is common
  3. UTI
23
Q
  1. Name a few skin conditions that hormones cause during pregnancy:
  2. What causes back pain in pregnancy?
  3. what causes leg cramps?
  4. T or F, carpal tunnel syndrome is common in pregnancy? Why?
  5. T or F, paresthesia is common in pregnancy?
A
  1. pruritis, hyperpigmentation, linea nigra, angiomas, palmar erythema, and striae gravidarum
  2. the realignment of the spinal curvatures in pregnancy. Basically the center of gravity shifts forward
  3. hypocalcemia and the weight of the pregnant uterus on the neurons
  4. T b/c of pressure of edema on peripheral nerves
  5. T (tingling and burning in the hands and feet).
24
Q
  1. T or F, tension headaches, lightheadedness, syncope, emotional changes, and postural hypotension are all common effects of pregnancy?
  2. What is hyperemic gums and epulis?
  3. When progesterone decreases gastric smooth muscle tone, what is the result?
  4. What is PICA?
  5. what is ptyalism?
A
  1. T
  2. little nodules on the gums that bleed easily.
  3. constipation and heartburn
  4. a craving
    for non-food substances and they are due to lack of elements.
  5. hypersalivation
25
Q
  1. What is the difference between a lunar month and a calendar month?
  2. From when do we calculate the length of gestation?
  3. What is conceptual age?
A
  1. lunar month has 28 day and calendar month has 30. Pregnancy lasts 10 lunar months, or 9 calendar months
  2. first day of the last menstrual period (40 weeks)
  3. two weeks less than gestational age - 38 weeks (obviously you get pregnant 2 weeks after period)
26
Q
  1. where does egg get fertilized, and how long does it stay there? What is it called?
  2. What is the name once the zygote had divided into 8 cells?
  3. When does the morula become a blastocyst?
  4. on which day does the blastocyst implant into the uterine wall? Where does it typically attach?
A
  1. Fallopian tube, 24 hours, zygote
  2. morula around day 2 or 3
  3. when uterine water enters morula. Becomes blastocyst
  4. day 10. upper posterior wall of uterus.
27
Q
  1. When does the placenta become fully functional?
  2. what is the yolk sac?
  3. what are shiny schultz and dirty duncan?
  4. How many arteries and veins are in the cord? What do they each carry?
A
  1. 12 weeks
  2. It’s primitive digestive system of the embryo.
  3. shiny schultz is the fetal side of the placenta. Dirty duncan is the maternal side
  4. 2 arteries and 1 vein. Arteries carry deoxygenated fetal blood bak towards mother and vein carries oxygenated maternal blood to fetus.
28
Q
  1. Why should the physician look at the placenta after delivery?
  2. What are the 4 functions of the placenta?
  3. Does the placenta produce hormones? If so, which ones?
A
  1. first to see if it is entirely intact, secondly, it reveals info such as anemia, abruptio, infection etc.
  2. respiratory, nutrition, excretion, and storage.
  3. Hcg, Hcs, progesterone, and estrogen
29
Q
  1. Explain the role of each of the following hormones: Hcg, Hcs, progesterone, and estrogen
A
  1. Hcg- pregnancy hormone. Ensures estrogen and progesterone to maintain pregnancy.

hCS promotes normal
growth and development of fetus. Basically it makes glucose available
for developing baby and promotes insulin resistance.

progesterone is the main
pregnancy hormone. supports and maintains implantation
and developing embryo. It maintains endometrium and decreases
contractility of the uterus, also stimulates maternal metabolism.

Estrogen stimulates development and enlargement of
uterus, supports uteroplacental blood flow and prepares breast
for breastfeeding. It facilitates proliferation of the breast tissue.
Also it causes pelvic ligament relaxation and participates in fetal
development

30
Q
  1. What are the names of the 2 fetal membranes?
  2. what are the funstions of the amniotic fluid?
  3. what is oligohydramnios?
  4. polyhydramnios
A
  1. amnion and chorion. Amnion is the inner membrane ,chorion is the outer
  2. thermoregulation, cushion, oral fluid and repository for waste, infection barrier
  3. less than 300 cc of amniotic fluid
  4. more than 1.5 L of amnitotic fluid
31
Q
  1. What are the 3 stages of intrauterine development?
  2. what are the 3 primary germ layers?
  3. which stage of development is most critical to organ development and most susceptible to teratogens and malformations?
A
  1. preembrionic (conception to 14 days), embryo (week 3 - 8), fetus (week 9 until delivery)
  2. endoderm, mesoderm, and ectoderm
  3. weeks 3-8 embryo
32
Q 
1. Give the timeframe in gestation for when defects occur in the following systems: Cardiovascular
GI system
Renal
Endocrine
Musculoskeletal
A
  1. Cardiovascular: 3rd-5th week

GI: embryonic stage, but anorecto malformations in week 5-10

Renal: weeks 5-10

Endocrine: embryonic stage

Musculoskeletal: embryonic stage (spina-bifida)

Labor and Delivery (3 decks)

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