Exam 3 Flashcards
What is gestational onset?
Problems that appear during pregnancy that weren’t a problem before pregnancy
What are hemorrhagic disorders during pregnancy?
MEDICAL EMERGENCY (blood loss leads to decrease O2)
What do hemorrhagic disorders increase the risk for?
Hypovolemia, anemia, infection, preterm birth/labor, hypoxemia, hypoxia, anoxia
Why may spotting follow sex or exercise while pregnant?
Vagina is vascular so trauma can make it bleed
What are some nursing skills if a patient has vaginal bleeding while pregnant?
02, fetal monitor, maternal VS, count/weigh pad, large bore IV for blood transfusions, prepare supplies for exam, notify HCP
What can you not do if a patient is bleeding while pregnant?
NO CERVICAL EXAM
What is a threatened abortion?
Fetus is jeopardized
Cervix is closed
Bleeding and cramping
May or may not expel products of conception
What is an imminent abortion?
Increased bleeding/cramping
Cervix dialates
Membranes may rupture
What is a complete abortion?
All products of conception are expelled
What is an incomplete abortion?
Some products of conception are expelled (placenta)
What is a missed abortion?
Fetus died in uteri but not expelled
Cervix closed
DIC risk after 6 weeks
What is a septic abortion?
Infection from prolonged ROM, IUD, or unqualified termination
What are the signs of an abortion?
Pelvic cramping, bleeding, backache
What are the diagnostics for an abortion?
Ultrasound, HcG levels, HgB and HcT
What are the treatments for an abortion?
Bed rest
No sex
IV therapy
Blood transfusion
D&C/suction evacuation
Emotional support
RhOGAM within 72 hours
What do you do for a missed abortion in the 2nd trimester?
Labor is induced and a D&C is performed
What can cause an ectopic pregnancy?
Tubal damage from PID
Tubal surgery
Endometriosis
Previous ectopic pregnancy
IUD
What are the initial signs of an ectopic pregnancy?
Amenorrhea
Tender breast
Nausea
HcG in blood/urine
If a rupture occurs during an ectopic pregnancy what happens?
Bleeding into abdomen
Sharp one sided pain
Syncope
Right shoulder pain
What will happen during a pelvic exam and lab studies if a patient has an ectopic pregnancy?
Adnexal (severe) tenderness
Abdominal rigid and tender
Increase leukocytes
Decrease HgB and HcT
When can Methotrexate be used for desired future pregnancy r/t ectopic pregnancies?
Unruptured tubes <4cm
Stable condition
Not fetal heart rate motion
Cannot have blood, liver or kidney disease
When can an additional dose of methotrexate be given r/t ectopic pregnancy?
If HcG levels do not decrease by 15% FROM DAY 4-7, It will be given on day 7
What is the gestational trophoblastic disease?
Proliferation of trophoblastic cells
Hydatidi form mole
Invasive mole
Choriocarcinoma
What is a Hydatidi form mole (molar pregnancy) and what can it cause?
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
What is a complete and partial Hydatidi form mole?
Complete is when there is no baby, placenta will still grow, increased HcG
Partial is when 2 sperm fertilize egg
What is an invasive mole?
Similar to a complete mole but also has uterine myometrium involvement
What are the symptoms of a Hydatidi form mole?
Brownish/red vaginal bleeding
Uterus larger than gestational age
Grapelike clusters are passed through vagina
Increase HcG causing hyperemesis gravidarum
Anemia
Absent FHR
What are the treatments for a Hydatidi form mole?
Suction evacuation and curettage to remove placenta
RHOGAM
Hysterectomy with choriocarcinoma
Pitocin to keep uterus contracted and prevent hemorrhage
What is done d/t the increased risk of choriocarcinoma with a Hydatidi form mole?
Extensive follow up
Initial baseline chest X-ray
Pelvic exam
HcG monitored weekly for a year
What is hyperemisis gravidarum and the lab levels?
Persistent excess N/V, decrease urine output, increased HcT and BUN
What can hyperemisis gravidarum lead to?
Dehydration
Ketonuria
Weight loss
Starvation
Hypovolemia
Hypotension
What is hypertension caused from in pregnancy?
Decreased placental perfusion BAD
What is gestational HTN?
Pregnancy induced HTN (PID), no proteinuria after 20 weeks
What is preeclampsia?
After 20 wk gestation
Reduced organ profusion with proteinuria
Progressive disorder that can lead to eclampsia (seizure)
What is the only cure for GH, preeclampsia, and eclampsia?
Delivery of baby
What causes preclampsia?
Poor perfusion from vasospams, impeded blood flow increased BP
If a patient has preclampsia and epigastric pain, what do you need to watch for?
Seizures
What can indicate oliguria with preclampsia?
Proteinuria of 3-4 + on 2 occasions 4hr apart
What is the HELLP syndrome?
Hemolysis
Elevated Liver enzymes
Low Platlets
When does the HELLP syndrome develop and what does it cause?
Develops with preclampsia in the 3rd trimester
Multi organ failure
Decreased HgB, epighastric pain, N/V, DIC
What do you do for HELLP syndrome?
Determine fetal lung development and deliver ASAP
What are the goals of medical management or prevention for preclampsia?
Prevent:
Cerebral hemorrhage
Convulsions
Hematologic complications
Renal/liver disease
Birth of uncompromising newborn
How is mild preclampsia managed at home and what needs to be assessed daily?
Activity restrictions, bed rest
Daily urine dipstick
Daily weight and BP
How is severe preclampsia and HELLP syndrome managed?
Tertiary care hospital
Bed rest
Anticonvulsants (Mag sulfate)
F/E replacements
Corticosteroids
Antihypertensives (Labetalol, Hydralazine)
What can you not give Labetalol with?
Heart failure or asthma
When should a patient with preclampsia report to HCP r/t weight?
If weight gain of 3lb in 24 hours or
4lbs in 3 days
What does magnesium sulfate prevent and what does it do?
Prevents seizures with eclampsia
Relaxes smooth muscles
Tocolytic: stops contractions
Depresses CNS
Suppress labor process in preterm labor
When should you notify a HCP when giving mag sulfate?
RR<12
Urinary output <30ml/hr
Absent DTR
Edema
Proteinuria
What is the first sign of toxicity with magnesium sulfate?
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
What do you give for magnesium sulfate toxicity?
Calcium gluconate
What does corticosteroids do for the treatment of preclampsia while pregnant and what can it cause ?
Speeds up fetal lung maturity but can increase the risk for amniotic fluid infection
When can corticosteroids be given for preclampsia?
24-34 wk gestation, takes 24 hr to become effective
What is given after delivery with preclampsia?
Hydralazine for BP for 12-24 hr
If mom breastfeeds Methyldopa will be given instead
What is disseminated intravascular coagulation (DIC)?
Clotting factors are over activated
Thrombocytopenia and decreased fibrinogen
What infections can cross placenta and decreased well being of the fetus?
TORCH
Toxoplasmosis: cat litter
Other infections: STI
Rubella: blind, deaf, cardiac disease
Cytomegalovirus
Herpes Simplex
MOM MAY HAVE FLU LIKE SYMPTOMS
What is group B streptococcus’s (GBS)?
Bacteria colonizes in vagina or rectum
What are the early and late signs of GBS?
Early: neonatal infections (pneumonia, apnea, shock
Late: meningitis
What is done for the treatment of GBS?
Screened at 35-37 wk
Prophylactic ATB if preterm or unknown
What is Rh incompatibility?
If Rh- blood is exposed to Rh+ blood then anti Rh agglinutin is formed and sensitized
Causes hemolysis of RBC in fetus
When does a RhOGAM vaccine need to be given?
If both baby and mom are Rh-
What are the fetal risk of Rh incompatibility?
Anemia
Edema (hydros fetalis) can lead to CHF
Jaundice (Iterus Gravis) can lead to neuro damage (kernicterus) (erythroblastosis fetalis)
What is ABO incompatibility and what can it cause?
Mom is type O and fetus is A, B, or AB
Hyperbill to anemia
How is gestational diabetes diagnosed and what are the levels ?
Screen at 24-28 weeks using 75gr 2 hr OGTT
Fasting: 92
1hour: 180
2 hour:153
What can a PROM cause for maternal risks?
Chorioamnionitis: intraamniotic infection
Endometritits
Abruptio placenta
What can a PROM cause in a fetus?
Respiratory distress
Fetal sepsis
Malpresentation
Prolapse cord
Compression of umbilical cord
Oligohydranios
Premature birth
Increase risk for mordibidy
What is the nursing management for PPROM?
Hospital on bed rest
Fetal well being, gestational age, amniotic fluid level assessments
NST and BPP
Maternal VS
Maternal corticosteroids
What is avoided with PPROM?
Vaginal exams
What are the signs of preterm labor?
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
If symptoms of preterm labor occur, what should she do?
Stop, lay on left side for 1 hour, drink 2-3 glasses of water, if symptoms continue, call HCP
What may be ordered for preterm labor signs?
Bed rest
Mag sulfate
Glucocorticoid
No sex, carrying heavy load, or climbing stairs
No nipple stimulation
When does preterm labor progress to inevitable preterm birth?
Cervical dialation of 4
If L/S ratio id low what do you give?
Glucocorticoid
What is placenta previa?
When the placenta implants within the lower uterine segment over internal cervical opening
What are the signs of placenta previa and what would you anticipate?
Painless vaginal bleeding
Trans abdominal ultrasound
C-section
Fetal transverse lie
What cannot be done until placenta previa has been ruled out?
No vaginal exams
What is placenta abruption?
Premature separation of placenta from uterine wall before delivery
What are the signs of placenta abruption?
Painful vaginal bleeding
Abdominal pain
Uterine tenderness/contractions
What can increase the risk for placenta abruption?
Maternal HTN
Cocaine
Abdominal trauma
Cig smoking
Multifetal pregnancies
What is the 1st grade of placental abruption?
Mild separation, slight bleeding, FHR and maternal BP is unaffected
What is the 2nd grade of placental abruption?
Partial abruption, moderate bleeding, uterine irritability, maternal pulse increases but BP is stable, non reassuring FHR
What is the 3rd grade of placental abruption?
Complete separation, severe bleeding, maternal shock, painful contractions, fetal death
What are the maternal implications of placenta abruption?
DIC, hemorrhagic shock, renal failure
What is uterine dystocia?
Prolonged labor, cervical progression and abnormal contractions
Two types: tachystolic and hypotonic
What are the risk factors for uterine dystocia?
Augmented labor, fatigue, anxiety, dehydration, non reassuring fetal status, prolonged pressure on fetal head
What is tachysystolic uterine dystocia?
5 or more contractions in 10 min over 30 min window
What is hypotonic uterine dystocia and what do you give ?
After the active phase of labor, contractions become weak causing cervical progression fewer than 2-3 contractions in 10 min
Give pitocin
What is the clinical management for tachysystolic uterine dystocia?
Bed rest
Sedation
Pitocin
Amniotomy
Maternal position
Comfort
What is cephalopelvic disproportion and what does it increase the risk for?
Babies head is poorly positioned or to large for pelvis
Increases risk for hypotonic uterine dystocia
What is persistent occiput posterior position?
Most common fetal malpostion “sunny side up”
What are the nursing actions for a prolapsed cord?
Relieve pressure off of cord, if you feel cord do not remove hand
What is an amniotic fluid embolism?
Amniotic fluid contains debris, vernix, hair, skin, cells, meconium enters maternal circulatory system
LIFE THREATNING
What are the nursing interventions for an amniotic fluid embolism?
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
What is shoulder dystocia?
Babies head is born but anterior shoulder is unable to pass under pubic arch
What do you do for shoulder dystocia?
RN will apply suprapubic pressure while mom is in mcroberts position
What is a uterine rupture?
Rupture of uterus and fetus is in abdominal cavity
What can cause a uterine rupture?
Separation of scar tissue from previous c section
Uterine trauma
Strong uterine contraction
Pitocin
Overdistended uterus
Malpresentaion
Forcep evacuation
Multigravidas
What is an external cephalon version (ECV)?
HCP attempts to turn fetus from breech or shoulder presentation to vertex
Gentle constant pressure on abdominal, US is sued to determine fetal position
What is the nonpharmacological methods to induce labor?
Herbs
Castor oil, hot bath, enema
Sex, nipple stimulation
Accupuncture/ nerve simulation
Mechanical modalities
What are the pharmacological methods to induce labor?
Prostoglandins (Cytotec, cervidil)
Pitocin
Dinoprostan
Misoprostol
What are the surgical methods to induce labor?
Stripping of cervical membrane
Amniotomy if baby is engaged and 2 cm dialated
What is used to measure the inducibility of labor?
Bishop score
What is the nursing management for the induction of labor?
IV fluids
Empty bladder/ foley
Oxytocin/ pitocin
Monitor FHR
What is a vacuum assisted birth?
Uses negative pressure to assist the birth of the head
What is required in order to use birth assistive instruments?
Vertex presentation
Presenting part is engaged
ROM
Fully dialated
Bladder empty
What does a vertical skin incision and vertical uterine incision increase the risk for?
Rupture
What incision is given for emergency c sections?
Vertical lower uterus incision
What is postpartum hemorrhage?
Loss of 500ml of blood after vaginal birth
Loss of 1000ml of blood after c section
What is early PPH?
First 24 hours caused by uterine atony or placenta accreta
What is uterine atony?
Hypotonic uterus, doesn’t contract
What is placenta accreta?
Abnormal placental adherence to uterine wall in 3rd stage of labor
What is late PPH?
24hr-6weeks PP
Caused by retained placenta fragments and uterine infections
What do you do for PPH?
Assess fundal height, boggy fundus and return of lochia rubra
What are the nursing interventions for PPH?
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
What is puerperal sepsis and what does it lead to?
Childbed fever
Infection of genital canal within 28 days
Leads to blood poisoning, organ failure and death
What does puerperal sepsis exclude?
The first 24hr PP because its normal for mom to have a fever
What are signs of puerperal sepsis?
Fever on 2 days between day 2-10 PP
N/V, HA, increased HR and RR
Odor discharge
Abdominal and leg pain
What is mastitis and the symptoms?
Breast infection by bacteria through nipple
Sore/cracked nipple
Ineffective latching
Chills/fever
Fatigue
Breast swelling red and warm
How can lactation be maintained with mastitis?
Pump and sump every 3-4 hours
Baby can breastfeed from other breast
What is given in the treatment of PP depression?
Lithium
Topamax
Klonapin
NO BREASTFEEDING
What is a late preterm?
34-36 weeks
What is used to identify a high risk newborn?
Birth weight and length
Head circumference
Gestational age
SGA babies are commonly seen with mothers who do what?
Smoke and have a high BP
What does SGA babies increase the risk for?
Hypoglycemia and polycythemia
What are the complications of SGA/IUGR babies?
Hypoxia
Aspiration syndrome
Hypothermia
Hypoglycemia
Polycythemia
Cognitive impairments
What are the complications with LGA babies?
Birth trauma
Hypoglycemia
Polycythemia
Hyperviscosity
If an LGA has hyperviscosity what are the signs and what should you do?
Increased risk for seizures and respiratory distress
Twitching
High pitch cry
Breastfeed immedialty
What is a very low birth weight and what are they at increased risk for?
<1500gm or <3.3 lb
Asphyxia
Brain damage
Hypoglycemia
Temp instability
What are the complications of an infant of a diabetic mother?
Hypoglycemia <40
Hypocalcemia
Hyperbillirubinemia
Birth trauma
Polycythemia
Respiratory distress
Congenital birth defects
What are the post term baby complications?
Thin emaciated placenta
Intrauterine hypoxia
Skin dry, peeling, vernix absent
Meconium aspiration syndrome
What can be done for meconium staining in amniotic fluid?
Amnioinfusion : puts solution into cervix to dilute fluid
What are the respiratory and cardiac complications in a preterm newborn?
Inadequate surfactant
Ineffective gas exchange
Hypoxia
Ductus arterosus may not close: pulmonary congestion and cO2 retention
Heat loss
What are the GI complications of a preterm newborn?
Decreased gag reflex
Incompetent esophageal spincter
Poor sucking/swallowing
Difficulty with digestion of fats, lactulose and protein
What are the renal complications in a preterm newborn?
Decreased GFR
Fluid overload
Metabolic acidosis
Drug toxicity
What is patent ductus arterosus and what does it cause?
Ductus arterosus doesn’t close causing
Systolic murmur
Tachycardia
Tachypnea
Crackles
Hepatomegaly
Metabolic acidosis
What do you give for patent ductus arterosus?
Indomethacin
What is choanal atresia and what can it cause?
Abnormal structure of nose
Bony septum develops between nose and pharynx
Can cause nasal obstruction: cyanosis, retractions, unable to feed well
SURGERY
What is an omphalocele and what do you do?
Protrusion do abdominal contents into umbilical cord
Cover with sterile bag
NG tube
Low suction to decrease distinction
ATB
What is an imperforated anus and what do you do?
Absence of anal opening
Surgery, colostomy, NG
What is a gastroschisis and what do you do?
Viscera outside of body to the right of umbilical cord (intestines exposed)
Maintain hydration and temperature
Sterile bag to armpits
NG low suction
ATB
What is ambiguous genitalia?
Abnormal genitals
Enlarged clit or micro penis
What is polydactyly?
Hands and feet have extra digits
Hereditary
What is talipes varus?
Inversion/ bending inward
What is talipes valgus?
Eversion/bending outward
What is talipes equinus?
Plantar flexion/toes below heel
What is talipes calcaneus?
Dorsiflexion/ toes are above heel
What is anencephaly?
Baby born without cerebral hemisphere of brain
Hospice and palliative care
Baby wont live long
What is microcephaly and what can cause it?
Small growth restrictive head
Decreased psychomotor function
Heroin or chromosomal abnormality
What is spina bifida?
Neural tube doesn’t close which causes a sac to hang out of spinal cord
What is a meningocele?
Sac contains meninges and CSF
What is a myelomeningocele?
Sac contains meninges, nerves, and CSF (sensory and motor deficits)
How can you prevent spina bifida?
Take folic acid
What do you do for a baby with spina bifida?
C section
Sterile, non adhesive covering to prevent rupture of sac
Position baby off of back
What can alcohol cause to a baby?
Fetal alcohol syndrome
What can tobacco cause to a baby?
LBW
Pneumonia
Bronchitis
NWS
Irritable
What can marijuana cause to a baby?
LBW and tremors
What can cocaine cause to a baby?
LBW
Preterm
Poor feeding
Diarrhea
Microcephaly
Abruptio placenta
What can phencyclidine cause to a baby?
Jittery and irritable
What can heroine and math cause to a baby?
LBW, agitation and vomiting
What can increase the risk for fetal alcohol syndrome?
Caffeine and nicotine with alcohol
What are signs of fetal alcohol syndrome?
Railroad track ears
Upturn nose
Smooth filtrum, thin upper lip
What are signs of newborn withdraw?
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
What are preterm babies at increased risk for?
Respiratory distress and necrotizing enterocolitis
What is given for respiratory distress syndrome?
Exogenous surfactant (Curosurf)
Ventilator/O2
Monitor ABG
Maintain thermal environments, fluid/nutrition
Minimal crying to decrease energy waste, dim lights
No loud noise
What are the peripheral NS injuries?
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
What is a CNS injury?
Intracranial, subarachnoid hemorrhage, subdural hematoma, spinal cord injury
What are the signs of a CNS injury?
CNS depression, irritable, poor feeding, seizure, unequal pupils, bulging Fontnels
What is the diagnostics and treatment for a CNS injury?
C7 lumbar puncture
NICU, iV, TPN, shunt, decrease stimuli, neuro assessment every 30 min
What are the most common nosocomial infections of a newborn?
MRSA and candida
What is Grp B strep and what do you give?
Deadly to baby, ampicillin or Gentamicin
What is toxoplasmosis and what can it cause?
Acquired infection, moms contact to cat feces, preterm and jaundice
What is cytomegalovirus and what will it cause ?
Acquired infection Mom has mononucleosis illness (muscle aches, fever, fatigue)
Baby will have rash, neuro deficit, hearing loss, seizure, jaundice
