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OB > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Antepartal hemorrhagic disorders effect

A

Blood loss = decreased oxygen carrying capacity = increased risk for complications

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2
Q

What risks are increased with antepartal hemorrhagic disorders

A

Hypovolemia
Anemia
Infection
Preterm labor
Impaired oxygen delivery to the fetus

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3
Q

What risks are increased with maternal hemorrhage for fetus

A

Blood loss, anemia
Hypoxemia
Hypoxia
Anoxia
Preterm birth

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4
Q

What gestational age is considered abortion

A

Less than 20 weeks

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5
Q

What percent of pregnancies end in miscarriage

A

25%

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6
Q

50% of miscarriages are due to what

A

Chromosomal anomalies

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7
Q

Types of miscarriages

A

Threatened
Inevitable
Incomplete
Complete
Missed
Recurrent/habitual

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8
Q

What gestational age is considered miscarriage

A

Before 20 weeks

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9
Q

Habitual/recurrent miscarriage

A

3 or more before 20 weeks
Or less than 500g

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10
Q

Threatened miscarriage

A

Vaginal bleeding/cramping - not profuse
Cervix remains closed

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11
Q

Interventions for threatened miscarriage

A

Ultrasound to check fetus
Beta HCG levels (increase throughout pregnancy)
Bedrest
No sex until bleeding stops

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12
Q

Inevitable miscarriage

A

Cervical dilation that cannot be prevented

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13
Q

Procedure performed after incomplete miscarriage

A

Dilation and curettage

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14
Q

Incomplete miscarriage

A

More bleeding than normal
Tx: Pitocin, D&C

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15
Q

Complete miscarriage

A

No retained tissue

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16
Q

Missed miscarriage

A

Fetal demise without leaving uterus

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17
Q

Tx for missed miscarriage

A

Depends on gestation
4-6 wks: D&C
12+ weeks: Cytotec

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18
Q

Effacement

A

Thinning of cervix

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19
Q

How to monitor bleeding

A

Weigh pads

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20
Q

Cervical cerclage

A

Passive and painless dilation of cervix during 2nd/3rd trimester

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21
Q

Premature dilation of cervix tx

A

Cervical cerclage: Surgical procedure that involves placing stitches to tighten the cervix to prevent preterm birth
Done if had previous preterm birth

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22
Q

When else is cervical cerclage used

A

16-23 weeks and dilated to 1cm or greater, cerclage can salvage pregnancy and prevent preterm labor

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23
Q

What finding indicates need for cervical cerclage

A

Cervical length of 25 mm or less

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24
Q

Ectopic pregnancy

A

Fertilized ovum is implanted outside the uterine cavity; also called “tubal pregnancies”
- Early pregnancy bleeding

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25
Q

Complication of ectopic pregnancy

A

Rupture of fallopian tubes

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26
Q

Ectopic pregnancy s/sx

A

Abd pain - refers to shoulder
Delayed menses
Abnormal vaginal bleeding

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27
Q

Ectopic pregnancy dx

A

Beta HCG levels

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28
Q

What finding indicates ectopic pregancy

A

1500 milliunits or greater means products of conception should be seen in uterus on ultrasound

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29
Q

Ectopic pregnancy tx

A

Methotrexate - destroys rapidly dividing cells and body absorbs it
Surgery - salpingectomy (tube removal)
- salpingostomy: hole in tube to remove blastocyst (embryo); no suture used

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30
Q

What does scar tissue from salpingostomy cause risk of

A

(Another) ectopic pregnancy

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31
Q

Molar Pregnancy (Hydatidiform Mole)

A

Type of gestational trophoblastic neoplasia (GTN)
Non-cancerous growth in the uterus that looks like grape-like clusters
Can interfere with pregnancy

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32
Q

Partial molar pregnancy

A

Two sperm fertilize an egg, resulting in an extra set of paternal chromosomes

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33
Q

Molar pregnancy (Hydratidiform mole) s/sx

A

Anemia
N/V

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34
Q

Molar pregnancy (Hydratidiform mole) dx

A
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35
Q

Placenta previa s/sx

A

Bright red, painless blood during 2nd or 3rd trimester

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36
Q

Placenta abruption patho and s/sx

A

Placenta covers cervix
Placenta is separating from uterine wall
Painful bleeding

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37
Q

Placenta previa

A

Placenta implanted in lower uterine segment near or over internal cervical os

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38
Q

Placenta previa s/sx

A

Bright red, painless blood, 2nd or 3rd trimester

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39
Q

Placenta previa risk factors

A

Previous C section (scar tissue), AMA, multip, D&C, smoking, maternal cocaine use

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40
Q

Complications of placenta previa

A

Hemorrhage, preterm birth, IUGR, placenta accreta

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41
Q

Placenta accreta

A

Placenta grows into uterus and into other organs

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42
Q

How to dx placenta previa

A

Ultrasound (transabdominal initially then transvaginal)

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43
Q

Management of placenta previa

A

Bedrest, pelvic rest, no cervical checks

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44
Q

When to discharge pt after placenta previa

A

After 24 hours of no bleeding

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45
Q

Risk factors for placental abruption

A

HTN - chronic, gestational
Cocaine use, amphetamine use - increases BP
Cigarette smoking
Previous abruption

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46
Q

S/sx of placenta abruption

A

Vaginal bleeding - can but not always
Sudden, intense localized abd pain, tender uterus
Board-like uterus (blood)
Contractions

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47
Q

Vasa previa

A

Rare condition in which fetal vessels lie over the cervical os, and the vessels are implanted into the fetal membranes rather than into the placenta

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48
Q

Types of vasa previa

A

Velamentous insertion
Succenturiate placenta
Battledore (marginal) insertion

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49
Q

Velamentous insertion

A

Cord vessels branch at membranes and then onto placenta

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50
Q

Succenturiate placenta

A

Placenta has divided into two or more lobes

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51
Q

Battledore (marginal) insertion (consideration)

A

Increases risk of fetal hemorrhage

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52
Q

Complications r/t clotting

A

Disseminated intravascular coagulation (DIC)

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53
Q

Disseminated intravascular coagulation (DIC)

A

AKA consumptive coagulopathy or defibrination syndrome
Acquired syndrome characterized by intravascular activation of coagulation which is widespread, rather than localized, and results in excessive clot formation and hemorrhage

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54
Q

DIC cause

A

Triggered by release of large amount of tissue factor as a result of placental abruption

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55
Q

HTN complication during pregnancy

A

Major cause of maternal and perinatal morbidity and mortality

56
Q

Gestational hypertension

A

HTN after wk 20 (previously normal BP)
140+/90+
Resolves after birth (6-12 months)

57
Q

What can gestational HTN develop into

A

50% end up with preeclampsia

58
Q

Preeclampsia

A

HTN after 20 wks + protein in urine
- OR Thrombocytopenia , impaired liver function, pulmonary edema, renal insufficiency
Can develop in postpartum

59
Q

Eclampsia

A

Seizures develop from preeclampsia
Antepartum, during labor, or postpartum

60
Q

Chronic HTN

A

Dx before 20 wks gestation

61
Q

Chronic HTN with superimposed preeclampsia

A

Started pregnancy with HTN
AND either BP increases after being well controlled OR new onset of proteinuria

62
Q

Risk factors for preeclampsia

A

Mutifetal gestation (twins, triplets)
Hx of preeclampsia
Chronic HTN
Preexisting DM
Nulliparity - first pregnancy
Same father for subsequent pregnancies, risk decreases (diff. women = risk increases)

63
Q

Cause of preeclampsia

A

Unknown

64
Q

HELLP syndrome

A

H - hemolysis
EL - elevated liver enzymes
LP - low platelets

65
Q

Complication of HELLP

A

Bleeding risk

66
Q

How to dx or prevent preeclampsia

A

No reliable test or tool

67
Q

What to assess in preeclampsia

A

BP - positioned on left side
LE edema - face/hands edema is concerning
DTR’s - increased = preeclampsia
24 hour urine

68
Q

Gestational HTN and preeclampsia severe features

A

RUQ pain - liver
Severe headache
Vision changes
Photosensitive

69
Q

Postpartum care for gestational HTN and preeclampsia

A

Going home with BP medications

70
Q

Nursing managements for gestational HTN and preeclampsia

A

Dark, quiet environment
Monitor fetal HR
Assess for s/sx of placenta abruption
Limit activity, bed rest
Administer antihypertensives

71
Q

Magnesium sulfate

A

Med of choice for preventing and treating seizures (eclampsia)

72
Q

Magnesium sulfate route

A

IVPB

73
Q

Magnesium sulfate administration timing

A

Initial loading dose
Then continuous maintenance dose

74
Q

Magnesium sulfate SE

A

Dizziness
N/V
Sweating
Blurred vision
Headache

75
Q

Magnesium sulfate nursing management

A

Strict I/O’s with catheter - limit intake to 125mL/hour
Continuous EFM (Electronic Fetal Monitoring) and toco
DTR’s

76
Q

Antidote for magnesium sulfate

A

Calcium gluconate

77
Q

Early eclampsia s/sx

A

Altered mental status
Severe headache
N/V
Blurred vision, seeing double
Abd pain RUQ pain
Decreased UOP
Proteinurea

78
Q

Nursing consideration if seizure occurs

A

Safety
Patent airway - position on side
No restraint
Call for help, do not leave pt bedside
Call light available

79
Q

What population is at higher risk for chronic HTN

A

African Americans

80
Q

Factors that affect the process of labor and birth - the 5 P’s

A

Passenger: Fetus and Placenta
Passageway: Birth canal
Powers: Contractions
Position (of mother)
Psychologic Response

81
Q

Frank breach

A

Legs folded ankles to head

82
Q

Single footling breach

A

One foot sticking out

83
Q

Complete breach

A

Legs crossed, butt first

84
Q

Shoulder presentation

A

Type of breach
Shoulder coming out first

85
Q

Fetal lie

A

How spine of fetus and mother line up

86
Q

Longitudinal fetal lie

A

Most common
Fetus aligned with mother

87
Q

Transverse fetal lie

A

Fetus positioned across mother’s pelvis
Most common early in pregnancy

88
Q

Oblique fetal lie

A

Baby turned sideways
Spine facing laterally

89
Q

Vertex presentation

A

Chin tucked
Type of fetal attitude

90
Q

Sinciput presentation

A

Chin neutral position
Type of fetal attitude

91
Q

Brow presentation

A

Chin up
Type of fetal attitude

92
Q

Types of fetal positions

A

ROA
ROT
ROP
LOP
LOT
LOA
Right/Left
Occipito
Anterior/Posterior/Transverse

93
Q

Best fetal positions

A

ROA and LOA
Facedown

94
Q

Fetal station

A

Measures the decent of the baby
In relation to ischial spine

95
Q

x/x/x

A

dilation/effacement/station
ex. 8/100/0

96
Q

Types of bony pelvis’

A

Gynecoid
Android
Anthropoid
Platypelloid

97
Q

Gynecoid

A

Optimal pelvis type
Round, wide bone structure

98
Q

Android

A

Wedge- or cone-like shape, with a wider top and narrower bottom

99
Q

Anthropoid

A

Narrow, oval-shaped pelvis that’s deeper than it is wide

100
Q

Platypelloid

A

Flat, wide, and shallow pelvis that’s the least common type. It’s more bean-shaped than heart-shaped

101
Q

Lower uterine segment

A

Where contraction occur
Pushes baby down, putting pressure on cervix
Type of soft tissue

102
Q

Introitus

A

Vaginal opening

103
Q

Primary powers

A

Contractions

104
Q

Secondary powers

A

Bearing down

105
Q

What to measure during contractions

A

Frequency, duration, intensity

106
Q

Where to measure contraction on strip

A

From beginning of one to the beginning of the next

107
Q

How much time is between the dark lines of the fetal monitoring strip

A

1 minute
Each box is 10 seconds

108
Q

Phases of contractions

A

Increment: Increasing
Acne: Peak
Decrement: Decreasing

109
Q

Signs preceding labor

A

Lightening - fetal head drops into pelvis
Bloody show
Losing mucus plug
Persistent low back pain
Braxton Hick’s contractions - no cervical change
Wt loss - 1-3lbs, fluid/electrolyte shifting
Nesting - surge to prepare for baby

110
Q

Phases in first stage of labor

A

Latent: 0-3cm
Active: 4-7cm
Transition: 8-10cm

111
Q

First stage of labor

A

Events preceding full dilation

112
Q

Second stage of labor

A

Time from fully dilated to baby coming out

113
Q

Third stage of labor

A

Pushing stage

114
Q

Fourth stage of labor

A

Delivery of placenta until mom is stable

115
Q

Things that initiate the onset of labor

A

Sex
Nipple stimulation - releases oxytocin

116
Q

7 Cardinal movements of mechanisms of labor

A

Engagement
Descent
Flexion
Internal rotation
Extension
External rotation (also called Restitution)
Expulsion

117
Q

Normal fetal HR

A

Monitor during labor
110-160

118
Q

What factors affect fetal HR

A

Reduction of blood flow d/t HTN (gestational or chronic), hemorrhage, hypotension, anemia

119
Q

Factors that alter fetal circulation

A

Compressed of umblilical cord
Fetal head compression
Reduction in blood flow to intervillous space of placenta

120
Q

Ways to monitor fetal HR

A

Intermittent auscultation - Usually Q30mins, with doppler, fetoscope, fetal monitor ultrasound
- Does not detect patterns
Electronic fetal monitoring (EFM)
- External or internal

121
Q

What must happen before internal EFM is used

A

Water broken
Dilated 1-2cm
Monitors uterine contractions
IUPC - Intrauterine pressure catheter
FSE - Fetal scalp electrode

122
Q

Sinusoidal pattern

A

Sawtooth FHR pattern
Not good

123
Q

When can you determine FHR is brachy or tachy

A

After 10 minutes

124
Q

Periodic changes in FHR

A

Occur in reaction to uterine contractions

125
Q

Episodic changes in FHR

A

Not related to uterine contractions

126
Q

Normal acel for 32+ wk

A

15x15 acels
For at least 15 seconds
1 box up and over

127
Q

Cause of early decels

A

Good thing, indicates progression of labor
Head compression d/t contractions
Peak of contraction should mirror decel (Periodic)
More than 30 seconds

128
Q

Cause of late decels

A

Poor oxygenation
Uterine tachysystole, hypertonus
Hypotension
Postterm date
Maternal diabetes
IUGR - small baby
Occurs right after contraction (Periodic)
More than 30 seconds

129
Q

Nursing interventions for late decels

A

Turn patient
Oxygen - nonrebreather at 10L
Fluid bolus
Turn off Pitocin
Administer Terbutaline - slow contractions

130
Q

Cause of variables/variablity

A

Cord compression
Abrupt onset
For less than 30 seconds

131
Q

Nursing intervention for variability

A

Turn pt
Fluids
Turn of Pitocin
Amnioinfusion: Fluid into uterus, more cushioning
Notify HCP

132
Q

Prolonged decel

A

Gradual or abrupt
At least 15 beats below baseline, more than 2 mins but less than 10 (after 10 min is considered baseline change)

133
Q

FHR category 1

A

HR WNL
Moderate variability
Absent late or variables
Early decels present or absent
Acels present or absent

134
Q

FHR category 2

A

Anything between 1 and 3
No acels after stimulation

135
Q

FHR category 3

A

Absent baseline variability
Recurrent late decels
Recurrent variable decels
Bradycardia
Sinusoidal pattern

136
Q

How often to document assessment of pt with epidural vs not

A

Q15mins
Q30mins

OB (6 decks)

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