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NURS 714 Maternal/Newborn > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What are the causes of bleeding in the first trimester?

A

Spontaneous Abortion
Ectopic Pregnancy

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2
Q

What are the causes of bleeding in the second trimester?

A

Gestational trophoblastic disease

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3
Q

What are the causes of bleeding in the third trimester?

A

Placenta Previa
Abruptio Placenta
Vasa Previa

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4
Q

A sponaneous Aborption is?

A

A pregnancy that ends as result of natural causes before 20 weeks

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5
Q

What is a hydatidiform mole?

A

Gestational trophoblastic disease (GTD) is the proliferation and degeneration of trophoblastic villi in the placenta that becomes swollen, fluid-filled, and takes on the appearance of grape-like clusters. The embryo fails to develop beyond a primitive state and these structures are associated with choriocarcinoma, which is a rapidly metastasizing malignancy. Two types of molar growths are identified by chromosomal analysis.

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6
Q

Gestational Trophoblastic Disease is also referred to as?

A

Hydatidiform Mole
Molar Pregnancy

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7
Q

What are the qualifications for a complete mole?

A

All genetic materal is paternally derived

Ovum has no genetic material (or inactive)

No fetus, placenta, amniotic membrane or fluid

No placenta (hence hemorrage)

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8
Q

What are the qualifications for a partial mole?

A

Both maternal and paternal genetic material

Normal ovum is fertilized by 1/2 sperm but meiodid or chromosome reduction does not occur

Often contains abnormal embryonic/fetal parts, amniotic sac and fetal blood

6% of partial mole progresses to a choriocarcinoma

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9
Q

Some qualities of a hydatidiform mole are?

A

The clusters grow really fast
Fundal height is large
Belly grows both fast and big
Bleeding is often dark brown (resembling prune juice)
HcG us at a high level for 10-12 weeks gestation

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10
Q

What is an incompetent cervix?

A

Passive dilation of the cervix during the second trimester

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11
Q

What is the treatment for an incompetent cervix?

A

Cerclage at 12-14 weeks gestation for the best results that is removed at 37 weeks

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12
Q

What are the symptoms of an incompetent cervix?

A

Increased pelvix pressure or urge to push
Pink stained vagina discharge
Possible gush of fluids (ROM)
Contractions with expulsion fetus
US showing short cervix (<25mm/funneling or effacing)

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13
Q

What occurs in a placental abruption?

A

Premature separation of placenta from the uterus which can be partial or complete that normally occurs after 20 weeks in the 3rd trimester

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14
Q

What are the symptoms of a placental abruption?

A

Placenta detaches
Dark red blood
Painful uterus
Abdominal is board like
If fetal heart tones are detected->Emergency C section

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15
Q

If bright red bleeding in 3rd trimester accompanied by a soft uterus with no pain occurs, what is the likely diagnosis?

A

Placenta Previa

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16
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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17
Q

What is the inervention for an ectopic pregnancy?

A

Salpingostomy (removal of the effected area of the tube)
Before rupture

Salpingectomy (removal of the tube)
If ruptured or no desire for future pregnancy

All surgeries may be followed by a dose of Methotrexate to destroy any remaining tissue.

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18
Q

What are the fetal complications of gestational diabetes?

A

Respiratory Distress
Hypoglcemia

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19
Q

What is Oliogohyramnios?

A

Lack of aminiotic fluid that could indicate a renal issue

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20
Q

What is polyhydramnios?

A

Too much amniotic fluid that could indicate a renal issue

Associated with diabetes

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21
Q

What are the lab values that could indicate hyperemesis gravidarum?

A

Ketones in urine

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22
Q

What are indications of positive rupture of membranes?

A

leakage of fluid
vaginal discharge/bleeding
pelvic pressure
no contractions
Fern test
nitrazine paper

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23
Q

What is a fern test?

A

The Fern Test is one of several tests used to detect rupture of the membranes. Vaginal secretions are inspected under a microscope for crystallization or a ferning pattern. The crystallization is due to an increased concentration of protein and electrolytes within the fluid.

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24
Q

When is a nitrazine paper test performed?

A

This test is done to ascertain the nature of fluid in the vagina during pregnancy especially when premature rupture of membranes (PROM) is suspect. This test involves putting a drop of fluid obtained from the vagina onto paper strips containing nitrazine dye. The strips change color depending on the pH of the fluid.

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25
Q

What is PPROM?

A

Premature spontaneous rupture of membrane before 37 weeks

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26
Q

What are the complications of PPROM?

A

Infection (like chorioamnionitis, sepsis, endometritis)
Prolapsed cord
Abruption placentae
Preterm labor

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27
Q

What is Chorioamnionitis?

A

Uterine tenderness
Foul smelling amniotic fluid
Fever
Fetal Tachycardia

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28
Q

What are you looking for during a Nitrazine test?

A

Since the amniotic fluid is alkaline, the solution should turn blue (you need to know when the membrane was ruptured)

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29
Q

What is the test for preterm labor?

A

A fetal fibronectin test that tests for the glycoprotiec glue found in plasma that predicts who will NOT go into preterm labor

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30
Q

A negative fetal fibronectin test indicates?

A

That there is less than a 1% chance of giving birth within two weeks

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31
Q

-tocolytic medications do what?

A

Supress uterine activity and are given if at risk of preterm labor

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32
Q

What medication is given to mothers in premature labor that helps with fetal lung maturity?

A

Celestone/Betamethason 12mgIM

then 12mg IM 24 hours after first injection

33
Q

What is precipitous labor?

A

Labor that lasts less than 3 hrs from the onset of contractions to the time of birth

34
Q

What is considered operative delivery?

A

Forcepts or vacuum guided birth

35
Q

Forcepts or vacuum guided birth can have what complication?

A

It can cause a hematoma on the babies head

36
Q

What is TOLAC?

A

trial of labor after cesaran

37
Q

What are considered obstetric emergencies?

A

meconium stained amniotic fluid (dark green, pea green that can be caused from hypoxia in utero or breech presentation)

Shoulder dystocia

38
Q

What are puerperal infections?

A

Infections of the uterus and surrounding tissue after birth

39
Q

What symptoms indicate a puerperal infection?

A

Fever after 24 hours of 100.4

(Fever of 100.4 in first 24 hours is ok)

40
Q

What is endometritis?

A

Inflammation of uterine lining

41
Q

What are the symptoms of endometritis?

A

Late PPH sign
Pelvic pain
Chills
Fatigue
Loss of Appetite
Tender uterus
Prolonged cramping
Bleeding
Foul smelling lochia

42
Q

When does endometritis normally present?

A

Usually begins of the 2nd-5th day of PP

43
Q

What is the treatment of endometritis?

A

Antibiotics

44
Q

What is uterine subinvolution?

A

Uterus remains enlarged with continued lochia discharge

45
Q

What are the risks of uterine subinvolution?

A

retained placenta (could be cause)
Infection

46
Q

If a mother is experiencing mastitis, how does this affect breastfeeding?

A

It doesn’t-mom can still breastfeed on both sides for 15-30 minutes because it does not hurt the baby to feed on infected side

47
Q

What is the most common cause of PPH?

A

Uterine Atony

48
Q

What are the indications for PPH?

A

Blood loss of:
500mL vaginal birth
1000mL c-section

(if they soak a pad in less than 10 minutes-it is too much PP)

49
Q

Late PPH (after 24hrs to 12 weeks) is most likely caused by

A

Retained placental fragments

50
Q

What is the 1st intervention for PPH?

A

fundal massage

51
Q

What are the two classifications of PPH?

A

Early PPH
Late PPH

52
Q

What are the most common causes of early PPH?

A

Uterine Atony
Trauma
Lacerations
Hematomas

53
Q

What is oxytocin?

A

A uterine stimulant that promotes contractions

54
Q

What are the adverse reactions for oxytocin?

A

Water intoxication->
lightheadedness
Nausea
Vomiting
Headache
Malaise

This can lead to seizures, coma and death

55
Q

What is Methylergonovine?

A

A uterine stimulant that controls PPH

56
Q

In what patient demographic should you never administer Methylergonovine?

A

Patients with hypertension

57
Q

What adverse reactions should you monitor for Methylergonovine?

A

Hypertension
Nausea
Vomiting
Headache

58
Q

What is Mistoprostol?

A

A uterine stimulant that controls PPH

59
Q

What is carboporost tromethamine?

A

A uterine stimulant (hemabate)

60
Q

What are the contraindicated patients for carboprost?

A

Asthma

61
Q

What are the adverse reactions of carboprost?

A

Fever
Chills
Headache
Nausea
Vomiting
Diarrhea

62
Q

What are the symptoms of RDS (respiratory distress syndrome) in newborn?

A

Blue lips
Nasal flaring
Grunting
Retractions
Seesaw breathing

63
Q

What causes RDS in newborns?

A

Hyperglycemia (it prevents surfactant production in infant’s lungs-> the surfactant normally keeps lungs from closing)

64
Q

Beractant, calfactant, and lucinactant are all?

A

Lung surfactant that can be given down ET tube

65
Q

What is necrotizing enterocolitis?

A

A highly transerable inflammatory disease of the GI mucosa due to ischemia

66
Q

What are the symptoms of necrotizing enterocolitis?

A

A distended abdomen
Bloody Stools
Impaired thermoregulation

67
Q

What is short gut syndrome?

A

A condition that is secondary to removal of most or part of the necrotic small intestine from necrotizing enterocolitis

68
Q

What is are the causes of small for gestational age?

A

IUGR
Hypoglycemia after delivery
Placental insufficency

69
Q

What is retinopathy that is associated with prematurity?

A

Retinas of babies eyes are damaged due to complications of respiratory distress syndrome

70
Q

A Postdate Newborn is?

A

A newborn that had a gestational age over 42 weeks

71
Q

What are the risks of postdate newborns?

A

Meconium aspiration because of placental insufficency

72
Q

What symptoms indicate neonatal abstinence?

A

High pitched cry
Resists being swaddled or held
Not consolable
Hands at face

73
Q

What is macrosomia?

A

Uncontrolled hyperglycemia during pregnancy that increases risks of injuries during birth including shoulder dystocia from large shoulders

74
Q

What are the interventions for hyperbilirubinemia? What are the precautions for the therapy?

A

Phototherapy

-Eye protection, turn baby every 2 hrs, assess for dehydration, and don’t interrupt feeding schedule

75
Q

What is a sign of fetal alcohol syndrome?

A

A thin upper lip

76
Q

When does PPD enter into the realm of post partum psychosis?

A

When they start to develop hallucinations

77
Q

When does PP psychosis develop?

A

2-3 weeks after delivery
Biopolar depression puts mothers at higher risk

78
Q

What can help initiate the process of grief?

A

Offer to hold/see the baby
Say I’m sorry your baby has died

NURS 714 Maternal/Newborn (3 decks)

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