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NSG 211 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What is gestational onset?

A

Problems that appear during pregnancy that weren’t a problem before pregnancy

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2
Q

What are hemorrhagic disorders during pregnancy?

A

MEDICAL EMERGENCY (blood loss leads to decrease O2)

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3
Q

What do hemorrhagic disorders increase the risk for?

A

Hypovolemia, anemia, infection, preterm birth/labor, hypoxemia, hypoxia, anoxia

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4
Q

Why may spotting follow sex or exercise while pregnant?

A

Vagina is vascular so trauma can make it bleed

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5
Q

What are some nursing skills if a patient has vaginal bleeding while pregnant?

A

02, fetal monitor, maternal VS, count/weigh pad, large bore IV for blood transfusions, prepare supplies for exam, notify HCP

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6
Q

What can you not do if a patient is bleeding while pregnant?

A

NO CERVICAL EXAM

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7
Q

What is a threatened abortion?

A

Fetus is jeopardized
Cervix is closed
Bleeding and cramping
May or may not expel products of conception

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8
Q

What is an imminent abortion?

A

Increased bleeding/cramping
Cervix dialates
Membranes may rupture

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9
Q

What is a complete abortion?

A

All products of conception are expelled

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10
Q

What is an incomplete abortion?

A

Some products of conception are expelled (placenta)

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11
Q

What is a missed abortion?

A

Fetus died in uteri but not expelled
Cervix closed
DIC risk after 6 weeks

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12
Q

What is a septic abortion?

A

Infection from prolonged ROM, IUD, or unqualified termination

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13
Q

What are the signs of an abortion?

A

Pelvic cramping, bleeding, backache

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14
Q

What are the diagnostics for an abortion?

A

Ultrasound, HcG levels, HgB and HcT

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15
Q

What are the treatments for an abortion?

A

Bed rest
No sex
IV therapy
Blood transfusion
D&C/suction evacuation
Emotional support
RhOGAM within 72 hours

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16
Q

What do you do for a missed abortion in the 2nd trimester?

A

Labor is induced and a D&C is performed

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17
Q

What can cause an ectopic pregnancy?

A

Tubal damage from PID
Tubal surgery
Endometriosis
Previous ectopic pregnancy
IUD

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18
Q

What are the initial signs of an ectopic pregnancy?

A

Amenorrhea
Tender breast
Nausea
HcG in blood/urine

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19
Q

If a rupture occurs during an ectopic pregnancy what happens?

A

Bleeding into abdomen
Sharp one sided pain
Syncope
Right shoulder pain

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20
Q

What will happen during a pelvic exam and lab studies if a patient has an ectopic pregnancy?

A

Adnexal (severe) tenderness
Abdominal rigid and tender
Increase leukocytes
Decrease HgB and HcT

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21
Q

When can Methotrexate be used for desired future pregnancy r/t ectopic pregnancies?

A

Unruptured tubes <4cm
Stable condition
Not fetal heart rate motion
Cannot have blood, liver or kidney disease

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22
Q

When can an additional dose of methotrexate be given r/t ectopic pregnancy?

A

If HcG levels do not decrease by 15% FROM DAY 4-7, It will be given on day 7

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23
Q

What is the gestational trophoblastic disease?

A

Proliferation of trophoblastic cells
Hydatidi form mole
Invasive mole
Choriocarcinoma

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24
Q

What is a Hydatidi form mole (molar pregnancy) and what can it cause?

A

Abnormality of placenta caused by a problem when the egg and sperm join at fertilization, resulting in hydropic (fluid) grape like clusters. Can cause loss of pregnancy and increase risk for choriocarcinoma

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25
Q

What is a complete and partial Hydatidi form mole?

A

Complete is when there is no baby, placenta will still grow, increased HcG
Partial is when 2 sperm fertilize egg

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26
Q

What is an invasive mole?

A

Similar to a complete mole but also has uterine myometrium involvement

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27
Q

What are the symptoms of a Hydatidi form mole?

A

Brownish/red vaginal bleeding
Uterus larger than gestational age
Grapelike clusters are passed through vagina
Increase HcG causing hyperemesis gravidarum
Anemia
Absent FHR

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28
Q

What are the treatments for a Hydatidi form mole?

A

Suction evacuation and curettage to remove placenta
RHOGAM
Hysterectomy with choriocarcinoma
Pitocin to keep uterus contracted and prevent hemorrhage

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29
Q

What is done d/t the increased risk of choriocarcinoma with a Hydatidi form mole?

A

Extensive follow up
Initial baseline chest X-ray
Pelvic exam
HcG monitored weekly for a year

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30
Q

What is hyperemisis gravidarum and the lab levels?

A

Persistent excess N/V, decrease urine output, increased HcT and BUN

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31
Q

What can hyperemisis gravidarum lead to?

A

Dehydration
Ketonuria
Weight loss
Starvation
Hypovolemia
Hypotension

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32
Q

What is hypertension caused from in pregnancy?

A

Decreased placental perfusion BAD

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33
Q

What is gestational HTN?

A

Pregnancy induced HTN (PID), no proteinuria after 20 weeks

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34
Q

What is preeclampsia?

A

After 20 wk gestation
Reduced organ profusion with proteinuria
Progressive disorder that can lead to eclampsia (seizure)

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35
Q

What is the only cure for GH, preeclampsia, and eclampsia?

A

Delivery of baby

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36
Q

What causes preclampsia?

A

Poor perfusion from vasospams, impeded blood flow increased BP

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37
Q

If a patient has preclampsia and epigastric pain, what do you need to watch for?

A

Seizures

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38
Q

What can indicate oliguria with preclampsia?

A

Proteinuria of 3-4 + on 2 occasions 4hr apart

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39
Q

What is the HELLP syndrome?

A

Hemolysis
Elevated Liver enzymes
Low Platlets

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40
Q

When does the HELLP syndrome develop and what does it cause?

A

Develops with preclampsia in the 3rd trimester
Multi organ failure
Decreased HgB, epighastric pain, N/V, DIC

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41
Q

What do you do for HELLP syndrome?

A

Determine fetal lung development and deliver ASAP

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42
Q

What are the goals of medical management or prevention for preclampsia?

A

Prevent:
Cerebral hemorrhage
Convulsions
Hematologic complications
Renal/liver disease
Birth of uncompromising newborn

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43
Q

How is mild preclampsia managed at home and what needs to be assessed daily?

A

Activity restrictions, bed rest
Daily urine dipstick
Daily weight and BP

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44
Q

How is severe preclampsia and HELLP syndrome managed?

A

Tertiary care hospital
Bed rest
Anticonvulsants (Mag sulfate)
F/E replacements
Corticosteroids
Antihypertensives (Labetalol, Hydralazine)

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45
Q

What can you not give Labetalol with?

A

Heart failure or asthma

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46
Q

When should a patient with preclampsia report to HCP r/t weight?

A

If weight gain of 3lb in 24 hours or
4lbs in 3 days

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47
Q

What does magnesium sulfate prevent and what does it do?

A

Prevents seizures with eclampsia
Relaxes smooth muscles
Tocolytic: stops contractions
Depresses CNS
Suppress labor process in preterm labor

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48
Q

When should you notify a HCP when giving mag sulfate?

A

RR<12
Urinary output <30ml/hr
Absent DTR
Edema
Proteinuria

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49
Q

What is the first sign of toxicity with magnesium sulfate?

A

Decreased DTR (patellar)
Muscle spams (clonus: dorsiflex foot with knee down, let go of foot and count taps)
Decreased BP and LOC
Magnesium >9.6

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50
Q

What do you give for magnesium sulfate toxicity?

A

Calcium gluconate

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51
Q

What does corticosteroids do for the treatment of preclampsia while pregnant and what can it cause ?

A

Speeds up fetal lung maturity but can increase the risk for amniotic fluid infection

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52
Q

When can corticosteroids be given for preclampsia?

A

24-34 wk gestation, takes 24 hr to become effective

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53
Q

What is given after delivery with preclampsia?

A

Hydralazine for BP for 12-24 hr
If mom breastfeeds Methyldopa will be given instead

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54
Q

What is disseminated intravascular coagulation (DIC)?

A

Clotting factors are over activated
Thrombocytopenia and decreased fibrinogen

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55
Q

What infections can cross placenta and decreased well being of the fetus?

A

TORCH
Toxoplasmosis: cat litter
Other infections: STI
Rubella: blind, deaf, cardiac disease
Cytomegalovirus
Herpes Simplex
MOM MAY HAVE FLU LIKE SYMPTOMS

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56
Q

What is group B streptococcus’s (GBS)?

A

Bacteria colonizes in vagina or rectum

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57
Q

What are the early and late signs of GBS?

A

Early: neonatal infections (pneumonia, apnea, shock
Late: meningitis

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58
Q

What is done for the treatment of GBS?

A

Screened at 35-37 wk
Prophylactic ATB if preterm or unknown

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59
Q

What is Rh incompatibility?

A

If Rh- blood is exposed to Rh+ blood then anti Rh agglinutin is formed and sensitized
Causes hemolysis of RBC in fetus

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60
Q

When does a RhOGAM vaccine need to be given?

A

If both baby and mom are Rh-

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61
Q

What are the fetal risk of Rh incompatibility?

A

Anemia
Edema (hydros fetalis) can lead to CHF
Jaundice (Iterus Gravis) can lead to neuro damage (kernicterus) (erythroblastosis fetalis)

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62
Q

What is ABO incompatibility and what can it cause?

A

Mom is type O and fetus is A, B, or AB
Hyperbill to anemia

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63
Q

How is gestational diabetes diagnosed and what are the levels ?

A

Screen at 24-28 weeks using 75gr 2 hr OGTT
Fasting: 92
1hour: 180
2 hour:153

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64
Q

What can a PROM cause for maternal risks?

A

Chorioamnionitis: intraamniotic infection
Endometritits
Abruptio placenta

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65
Q

What can a PROM cause in a fetus?

A

Respiratory distress
Fetal sepsis
Malpresentation
Prolapse cord
Compression of umbilical cord
Oligohydranios
Premature birth
Increase risk for mordibidy

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66
Q

What is the nursing management for PPROM?

A

Hospital on bed rest
Fetal well being, gestational age, amniotic fluid level assessments
NST and BPP
Maternal VS
Maternal corticosteroids

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67
Q

What is avoided with PPROM?

A

Vaginal exams

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68
Q

What are the signs of preterm labor?

A

Contractions less than 10 min for 1 hr
Low abdominal cramping with diarrhea
Dull intermittent low back pain/colicky
Painful menstruation like cramps
Suprapubic pressure
Urinary frequency
ROM

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69
Q

If symptoms of preterm labor occur, what should she do?

A

Stop, lay on left side for 1 hour, drink 2-3 glasses of water, if symptoms continue, call HCP

70
Q

What may be ordered for preterm labor signs?

A

Bed rest
Mag sulfate
Glucocorticoid
No sex, carrying heavy load, or climbing stairs
No nipple stimulation

71
Q

When does preterm labor progress to inevitable preterm birth?

A

Cervical dialation of 4

72
Q

If L/S ratio id low what do you give?

A

Glucocorticoid

73
Q

What is placenta previa?

A

When the placenta implants within the lower uterine segment over internal cervical opening

74
Q

What are the signs of placenta previa and what would you anticipate?

A

Painless vaginal bleeding
Trans abdominal ultrasound
C-section
Fetal transverse lie

75
Q

What cannot be done until placenta previa has been ruled out?

A

No vaginal exams

76
Q

What is placenta abruption?

A

Premature separation of placenta from uterine wall before delivery

77
Q

What are the signs of placenta abruption?

A

Painful vaginal bleeding
Abdominal pain
Uterine tenderness/contractions

78
Q

What can increase the risk for placenta abruption?

A

Maternal HTN
Cocaine
Abdominal trauma
Cig smoking
Multifetal pregnancies

79
Q

What is the 1st grade of placental abruption?

A

Mild separation, slight bleeding, FHR and maternal BP is unaffected

80
Q

What is the 2nd grade of placental abruption?

A

Partial abruption, moderate bleeding, uterine irritability, maternal pulse increases but BP is stable, non reassuring FHR

81
Q

What is the 3rd grade of placental abruption?

A

Complete separation, severe bleeding, maternal shock, painful contractions, fetal death

82
Q

What are the maternal implications of placenta abruption?

A

DIC, hemorrhagic shock, renal failure

83
Q

What is uterine dystocia?

A

Prolonged labor, cervical progression and abnormal contractions
Two types: tachystolic and hypotonic

84
Q

What are the risk factors for uterine dystocia?

A

Augmented labor, fatigue, anxiety, dehydration, non reassuring fetal status, prolonged pressure on fetal head

85
Q

What is tachysystolic uterine dystocia?

A

5 or more contractions in 10 min over 30 min window

86
Q

What is hypotonic uterine dystocia and what do you give ?

A

After the active phase of labor, contractions become weak causing cervical progression fewer than 2-3 contractions in 10 min
Give pitocin

87
Q

What is the clinical management for tachysystolic uterine dystocia?

A

Bed rest
Sedation
Pitocin
Amniotomy
Maternal position
Comfort

88
Q

What is cephalopelvic disproportion and what does it increase the risk for?

A

Babies head is poorly positioned or to large for pelvis
Increases risk for hypotonic uterine dystocia

89
Q

What is persistent occiput posterior position?

A

Most common fetal malpostion “sunny side up”

90
Q

What are the nursing actions for a prolapsed cord?

A

Relieve pressure off of cord, if you feel cord do not remove hand

91
Q

What is an amniotic fluid embolism?

A

Amniotic fluid contains debris, vernix, hair, skin, cells, meconium enters maternal circulatory system
LIFE THREATNING

92
Q

What are the nursing interventions for an amniotic fluid embolism?

A

Assess cardiac/respiratory failure
Transfer to ICU
Rapid response/code blue
Emergency c section: if mom dies, baby has to be out in 5 min

93
Q

What is shoulder dystocia?

A

Babies head is born but anterior shoulder is unable to pass under pubic arch

94
Q

What do you do for shoulder dystocia?

A

RN will apply suprapubic pressure while mom is in mcroberts position

95
Q

What is a uterine rupture?

A

Rupture of uterus and fetus is in abdominal cavity

96
Q

What can cause a uterine rupture?

A

Separation of scar tissue from previous c section
Uterine trauma
Strong uterine contraction
Pitocin
Overdistended uterus
Malpresentaion
Forcep evacuation
Multigravidas

97
Q

What is an external cephalon version (ECV)?

A

HCP attempts to turn fetus from breech or shoulder presentation to vertex
Gentle constant pressure on abdominal, US is sued to determine fetal position

98
Q

What is the nonpharmacological methods to induce labor?

A

Herbs
Castor oil, hot bath, enema
Sex, nipple stimulation
Accupuncture/ nerve simulation
Mechanical modalities

99
Q

What are the pharmacological methods to induce labor?

A

Prostoglandins (Cytotec, cervidil)
Pitocin
Dinoprostan
Misoprostol

100
Q

What are the surgical methods to induce labor?

A

Stripping of cervical membrane
Amniotomy if baby is engaged and 2 cm dialated

101
Q

What is used to measure the inducibility of labor?

A

Bishop score

102
Q

What is the nursing management for the induction of labor?

A

IV fluids
Empty bladder/ foley
Oxytocin/ pitocin
Monitor FHR

103
Q

What is a vacuum assisted birth?

A

Uses negative pressure to assist the birth of the head

104
Q

What is required in order to use birth assistive instruments?

A

Vertex presentation
Presenting part is engaged
ROM
Fully dialated
Bladder empty

105
Q

What does a vertical skin incision and vertical uterine incision increase the risk for?

A

Rupture

106
Q

What incision is given for emergency c sections?

A

Vertical lower uterus incision

107
Q

What is postpartum hemorrhage?

A

Loss of 500ml of blood after vaginal birth
Loss of 1000ml of blood after c section

108
Q

What is early PPH?

A

First 24 hours caused by uterine atony or placenta accreta

109
Q

What is uterine atony?

A

Hypotonic uterus, doesn’t contract

110
Q

What is placenta accreta?

A

Abnormal placental adherence to uterine wall in 3rd stage of labor

111
Q

What is late PPH?

A

24hr-6weeks PP
Caused by retained placenta fragments and uterine infections

112
Q

What do you do for PPH?

A

Assess fundal height, boggy fundus and return of lochia rubra

113
Q

What are the nursing interventions for PPH?

A

Assess VS, fundus, lochia and pain
Firm fundal massage
O2 coagulation studies
T&C for transfusion
Increase pitocin
Decrease bladder distinction (up and deviated to the right)
IV fluids

114
Q

What is puerperal sepsis and what does it lead to?

A

Childbed fever
Infection of genital canal within 28 days
Leads to blood poisoning, organ failure and death

115
Q

What does puerperal sepsis exclude?

A

The first 24hr PP because its normal for mom to have a fever

116
Q

What are signs of puerperal sepsis?

A

Fever on 2 days between day 2-10 PP
N/V, HA, increased HR and RR
Odor discharge
Abdominal and leg pain

117
Q

What is mastitis and the symptoms?

A

Breast infection by bacteria through nipple
Sore/cracked nipple
Ineffective latching
Chills/fever
Fatigue
Breast swelling red and warm

118
Q

How can lactation be maintained with mastitis?

A

Pump and sump every 3-4 hours
Baby can breastfeed from other breast

119
Q

What is given in the treatment of PP depression?

A

Lithium
Topamax
Klonapin
NO BREASTFEEDING

120
Q

What is a late preterm?

A

34-36 weeks

121
Q

What is used to identify a high risk newborn?

A

Birth weight and length
Head circumference
Gestational age

122
Q

SGA babies are commonly seen with mothers who do what?

A

Smoke and have a high BP

123
Q

What does SGA babies increase the risk for?

A

Hypoglycemia and polycythemia

124
Q

What are the complications of SGA/IUGR babies?

A

Hypoxia
Aspiration syndrome
Hypothermia
Hypoglycemia
Polycythemia
Cognitive impairments

125
Q

What are the complications with LGA babies?

A

Birth trauma
Hypoglycemia
Polycythemia
Hyperviscosity

126
Q

If an LGA has hyperviscosity what are the signs and what should you do?

A

Increased risk for seizures and respiratory distress
Twitching
High pitch cry
Breastfeed immedialty

127
Q

What is a very low birth weight and what are they at increased risk for?

A

<1500gm or <3.3 lb
Asphyxia
Brain damage
Hypoglycemia
Temp instability

128
Q

What are the complications of an infant of a diabetic mother?

A

Hypoglycemia <40
Hypocalcemia
Hyperbillirubinemia
Birth trauma
Polycythemia
Respiratory distress
Congenital birth defects

129
Q

What are the post term baby complications?

A

Thin emaciated placenta
Intrauterine hypoxia
Skin dry, peeling, vernix absent
Meconium aspiration syndrome

130
Q

What can be done for meconium staining in amniotic fluid?

A

Amnioinfusion : puts solution into cervix to dilute fluid

131
Q

What are the respiratory and cardiac complications in a preterm newborn?

A

Inadequate surfactant
Ineffective gas exchange
Hypoxia
Ductus arterosus may not close: pulmonary congestion and cO2 retention
Heat loss

132
Q

What are the GI complications of a preterm newborn?

A

Decreased gag reflex
Incompetent esophageal spincter
Poor sucking/swallowing
Difficulty with digestion of fats, lactulose and protein

133
Q

What are the renal complications in a preterm newborn?

A

Decreased GFR
Fluid overload
Metabolic acidosis
Drug toxicity

134
Q

What is patent ductus arterosus and what does it cause?

A

Ductus arterosus doesn’t close causing
Systolic murmur
Tachycardia
Tachypnea
Crackles
Hepatomegaly
Metabolic acidosis

135
Q

What do you give for patent ductus arterosus?

A

Indomethacin

136
Q

What is choanal atresia and what can it cause?

A

Abnormal structure of nose
Bony septum develops between nose and pharynx
Can cause nasal obstruction: cyanosis, retractions, unable to feed well
SURGERY

137
Q

What is an omphalocele and what do you do?

A

Protrusion do abdominal contents into umbilical cord
Cover with sterile bag
NG tube
Low suction to decrease distinction
ATB

138
Q

What is an imperforated anus and what do you do?

A

Absence of anal opening
Surgery, colostomy, NG

139
Q

What is a gastroschisis and what do you do?

A

Viscera outside of body to the right of umbilical cord (intestines exposed)
Maintain hydration and temperature
Sterile bag to armpits
NG low suction
ATB

140
Q

What is ambiguous genitalia?

A

Abnormal genitals
Enlarged clit or micro penis

141
Q

What is polydactyly?

A

Hands and feet have extra digits
Hereditary

142
Q

What is talipes varus?

A

Inversion/ bending inward

143
Q

What is talipes valgus?

A

Eversion/bending outward

144
Q

What is talipes equinus?

A

Plantar flexion/toes below heel

145
Q

What is talipes calcaneus?

A

Dorsiflexion/ toes are above heel

146
Q

What is anencephaly?

A

Baby born without cerebral hemisphere of brain
Hospice and palliative care
Baby wont live long

147
Q

What is microcephaly and what can cause it?

A

Small growth restrictive head
Decreased psychomotor function
Heroin or chromosomal abnormality

148
Q

What is spina bifida?

A

Neural tube doesn’t close which causes a sac to hang out of spinal cord

149
Q

What is a meningocele?

A

Sac contains meninges and CSF

150
Q

What is a myelomeningocele?

A

Sac contains meninges, nerves, and CSF (sensory and motor deficits)

151
Q

How can you prevent spina bifida?

A

Take folic acid

152
Q

What do you do for a baby with spina bifida?

A

C section
Sterile, non adhesive covering to prevent rupture of sac
Position baby off of back

153
Q

What can alcohol cause to a baby?

A

Fetal alcohol syndrome

154
Q

What can tobacco cause to a baby?

A

LBW
Pneumonia
Bronchitis
NWS
Irritable

155
Q

What can marijuana cause to a baby?

A

LBW and tremors

156
Q

What can cocaine cause to a baby?

A

LBW
Preterm
Poor feeding
Diarrhea
Microcephaly
Abruptio placenta

157
Q

What can phencyclidine cause to a baby?

A

Jittery and irritable

158
Q

What can heroine and math cause to a baby?

A

LBW, agitation and vomiting

159
Q

What can increase the risk for fetal alcohol syndrome?

A

Caffeine and nicotine with alcohol

160
Q

What are signs of fetal alcohol syndrome?

A

Railroad track ears
Upturn nose
Smooth filtrum, thin upper lip

161
Q

What are signs of newborn withdraw?

A

High pitch cry
Sleeps less than 1-3hr after feeding
Hyperactive Moro reflex
Tremors
Increase muscle tone/ convulsions
Sweating/fever
Yawning
Nasal stuffiness/sneezing
Nasal flaring
RR>60
Poor feeding/ excess sucking
Vomiting/diarrhea

162
Q

What are preterm babies at increased risk for?

A

Respiratory distress and necrotizing enterocolitis

163
Q

What is given for respiratory distress syndrome?

A

Exogenous surfactant (Curosurf)
Ventilator/O2
Monitor ABG
Maintain thermal environments, fluid/nutrition
Minimal crying to decrease energy waste, dim lights
No loud noise

164
Q

What are the peripheral NS injuries?

A

Brachial palsy: hand paralysis
Facial nerve paralysis: feeding issues common with forcep assisted deliveries
Phrenic nerve paralysis: diaphragmatic paralysis, cyanosis, respiratory distress, NICU and ventilator

165
Q

What is a CNS injury?

A

Intracranial, subarachnoid hemorrhage, subdural hematoma, spinal cord injury

166
Q

What are the signs of a CNS injury?

A

CNS depression, irritable, poor feeding, seizure, unequal pupils, bulging Fontnels

167
Q

What is the diagnostics and treatment for a CNS injury?

A

C7 lumbar puncture
NICU, iV, TPN, shunt, decrease stimuli, neuro assessment every 30 min

168
Q

What are the most common nosocomial infections of a newborn?

A

MRSA and candida

169
Q

What is Grp B strep and what do you give?

A

Deadly to baby, ampicillin or Gentamicin

170
Q

What is toxoplasmosis and what can it cause?

A

Acquired infection, moms contact to cat feces, preterm and jaundice

171
Q

What is cytomegalovirus and what will it cause ?

A

Acquired infection Mom has mononucleosis illness (muscle aches, fever, fatigue)
Baby will have rash, neuro deficit, hearing loss, seizure, jaundice

NSG 211 (3 decks)

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