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Women's > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Preterm Birth Risk Factors

A
  • History of spontaneous preterm delivery or preterm labor
  • Multifetal pregnancy
  • Mid-trimester bleeding
  • Infection
  • Some uterine, cervical, or placental abnormalities
  • < 17 or > 35
  • Low maternal educational attainment
  • Low SES
  • Unmarried
  • African American
  • Unplanned or unintended pregnancy
  • Short interpregnancy interval
  • Untreated vaginal or UTIs
  • STD’s
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2
Q

Preterm Birth Symptoms

A

Subtle and insidious
Often normalized by HCPs
Assumed common discomforts of pregnancy

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3
Q

Nifedipine

Action

A
  • Suppression of uterine activity

- MOA: relaxes SM by blocking Ca entry

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4
Q

Nifedipine

ADR

A

ADR: tachycardia, hypotension, HA, peripheral edema

Affects on uteroplacental perfusion from maternal hypotension (fetal/neonatal)

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5
Q

Nifedipine

Nursing

A
  • Assessment of maternal and fetal status per protocol

- Do not use with magnesium due to severe hypotension

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6
Q

Indomethacin

MOA

A
  • Prostaglandin synthetase inhibitor

- Action: relaxes SM by inhibiting prostaglandins

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7
Q

Indomethacin

ADR

A
  • N/V, dyspepsia, reduced platelet aggregation (increased risk of hemorrhage), oligohydramnios
  • Constriction of ductus arteriosus, decrease in fetal renal function
  • RDS, intraventricular hemorrhage, NEC, hyperbilirubinemia, pulmonary hypertension (neonatal)
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8
Q

Indomethacin

Nursing

A
  • Assessment of maternal and fetal status
  • Admin with food to decrease GI distress
  • Don’t use for women with bleeding potential
  • Use only when other methods fail
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9
Q

Antenatal corticosteroids

Action

A
  • Promotion of fetal lung maturity
  • IM injection given to mother (bethamethasone and dexamethasone)
  • Stimulates fetal lung maturity that induces surfactant release
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10
Q

Antenatal corticosteroids
Indications
ADR

A
  • Indications: reduction of severity of RDS in preterm infant (between 24-34 weeks)
  • ADR: maternal infection or pulmonary edema
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11
Q

Antenatal corticosteroids

Nursing

A
  • Give IM in gluteus

- Alternate injection sites

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12
Q

Management of inevitable preterm birth

A

Transfer to a tertiary care center

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13
Q

Teaching contraction recognition

A
  • This awareness is vital for timely care
  • Many women have difficulty discerning contractions
  • Nurses should teach women how to detect uterine activity
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14
Q

Actions to take if experiencing PTL

A
  • Call provider/hospital
  • Lie down on left side for one hr
  • Drink 2-3 glasses of water or juice
  • Palpate for contractions
  • If sx continue, call provider again/go to hospital
  • If sx stop, resume light activity, but don’t continue what you were doing when contractions started
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15
Q

Premature rupture of membranes

A

rupture before 37 weeks gestation

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16
Q

Premature rupture

Complications

A
  • Infection (chorioamnionitis): fetal complications include pneumonia, sepsis, and meningitis
  • Cord prolapse
  • Oligohydramnios leading to cord compression
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17
Q

Premature rupture

Signs and Sym

A
  • Uterine contractions
  • Cervical change
  • Back pain
  • Pelvic pain
  • Change in vaginal discharge
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18
Q

Premature rupture

Nursing

A
  • Maintain strict sterile technique
  • Educate pt to watch for s&s of infection, proper hygiene, fetal kick counts, don’t insert anything into vagina, be aware of s&s of PTL
  • Possible prophylactic antibiotic therapy
  • Support
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19
Q

Prolapsed Cord

Fetal

A
  • Fetal bradycardia with variable decels
  • Presenting cord
  • Position changes
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20
Q

Prolapsed Cord

Nursing

A
  • Call for help
  • Hold presenting part off of umbilical cord
  • Assist mom in position change if necessary
  • Ride the bed with mom to OR
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21
Q

Shoulder Dystocia

Signs and Sym

A

Turtle sign

Suprapubic pressure

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22
Q

Shoulder Dystocia
Maternal risk
Fetal risk

A

Maternal: excessive blood loss, lacerations, extension of episiotomy
Fetal: asphyxia, brachial plexus damage, fracture

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23
Q

Shoulder Dystocia

Nursing

A

McRoberts maneuver

Gaskins Maneuver

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24
Q

Long, difficult, or abnormal labor

A
  • Dysfunctional labor-ineffective uterine contraction or bearing down
  • Alterations in pelvic structure
  • Fetal causes (abnormal presentation/position, excessive size)
  • Maternal position (effects on gravity)
  • Psychological responses of the mother, related to past experiences, culture, support system
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25
Q

Hypertonic uterine dysfunction

A
  • Painful and frequent contractions that are ineffective in causing cervical dilation
  • Management: therapeutic rest (warm bath, analgesic)
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26
Q

Hypotonic uterine dysfunction

A
  • Normal progress into active phase, but then contractions become weak and inefficient or stop all together
  • Management: augmentation with oxytocin, hydrotherapy, pt education and advocacy, IUPC to evaluate uterine activity
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27
Q

Abnormal labor patterns

A

Prolonged

Precipitous

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28
Q

Dysfunctional labor

Risks

A

Overweight, short stature, advanced maternal age, infertility difficulties, cephalopelvic disproportion, maternal fatigue, dehydration, admin of analgesic too early in labor

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29
Q

Induction

Indications

A
  • Chemical or mechanical initiation of uterine contractions before spontaneous onset
  • Elective vs. medically indicated
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30
Q

Induction

Assessing readiness

A

Bishop score

Dilation, Length, Consistency, Position, Head

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31
Q

Methods of induction

A 
oChemical 
-Cervical ripening: prostaglandin E1 (misoprostol) and E2 (cervidil) soften and ripen the cervix
-Pitocin stimulates uterine contractions
oMechanical 
-Foley
oAmniotomy
-Artificial rupture of membranes 
-Used to induce or augment labor when conditions are favorable
32
Q

Induction

Interventions

A

oAugmentation
-Stimulations of uterine contractions after labor has started spontaneously but has not progressed
oForceps and Vacuum-assisted Birth
-One of the instruments used to assist the birth of the head
oCesarean Birth
-Birth of baby through incision in the uterus
-Elected or forced

33
Q

Transition to parenthood

A
  • Becoming a parent is a period of change and instability
  • Process of role transition
  • Nurse assists family members adapt
  • Parenting process requires cognitive and affective skills, knowledge, and motor skills
34
Q

Postpartum

social support

A

-Strongly related to positive adaptation by new parents
-Multidimensional
Number of people in social network
Type of support
Perceived general support
Satisfaction with support

35
Q

Postpartum

attachment

A

-Parents and child comes to love and accept each other
-Forming an emotional relationship with infant
-Attachment and bonding often used interchangeably
-Developed and maintained by proximity
-Facilitated by positive feedback
-Include mutuality
Infants behaviors lead to corresponding set of parental behaviors
Infant: crying, smiling, cooing, rooting, grasping
-Occurs more readily with the infant whore temperament, social capabilities, appearance fit parent’s expectation
-Important part: acquaintance
Use eye contact, touching, talking, and exploring to become acquainted with infant

36
Q

Postpartum

nursing - assessing attachment

A
  • Do parents reach out for infant
  • Do parents speak about infant in terms of id
  • Affection displayed
37
Q

Postpartum

nursing interventions

A
  • Heighten parental awareness of infant’s responses and ability to communicate
  • Bolster parent’s self esteem
  • Id actual and potential problems and collaborate as appropriate
38
Q

Postpartum complications

Uterine Atony

A
  • Marked hypotonia of uterus
  • Leading cause of PPH
  • Associated with: high parity, hydramnios, macrosomic fetus, multifetal gestation, traumatic birth, meds (magnesium sulfate, oxytocin)
39
Q

Thromboembolic Complications

Clinical manifestations

A
  • Superficial (pain, tenderness, warmth, redness, enlarged hardened vein over thrombosis site)
  • DVT (unilateral leg pain, calf tenderness, swelling, + Homans)
  • PE (apprehension, cough, tachycardia, hemoptsis, elevated temp, chest pain)
40
Q

Thromboembolic Complications

Management

A
  • Superficial (NSAIDs, elevation and rest, elastic stockings)
  • Deep (anticoagulant, IV heparin…>warfarin; bed rest, elevated leg, analgesia
  • PE (IV heparin….>subcutaneous injections or oral anticoagulant)
41
Q

Benefits of Breastfeeding

A
  • Enhanced uterine involution
  • Less postpartum blood loss
  • Decreased risk of osteoporosis, ovarian cancer, premenopausal breast cancer
  • Weight reduction
  • Enhanced mother-infant attachment, role attainment, and self esteem
  • Delayed ovulation-child spacing
  • Convenient
42
Q

Uterine Atony

Nursing

A 
Fundal massage 
Elimination of bladder distention
Continuous IV infusion
Meds 
-Oxytocin (20-40 u Pitocin added to IV fluids)
-Methylergonovine (methergine)
-Prostaglandin F2a (hemabate)
-Misoprostol
43
Q

Breastfeeding position

A
  • Tummy to tummy at breast level
  • Cheek, nose, chin touching the breast
  • Body aligned in straight line: ear, shoulder, hip
44
Q

Breastfeeding latch

A
  • Important step: wide open
  • Wait for the gape
  • Stroke baby’s lips with nipple
  • Look for flared lips
  • Baby’s tongue extended over gum ridge
  • Break suction by inserting finger in corner of baby’s mouth
45
Q

Breastfeeding

Suck

A
  • Starts quickly, then slows
  • Feel tugging
  • Ears and temple wiggle
46
Q

Breastfeeding

Milk transfer

A
  • Full breast softer after feeding
  • Audible swallow
  • Milk visible on nipple or infant mouth
  • Mother feels uterine contraction
  • Increased lochia flow
  • Drowsiness
  • Thirst
  • Milk leaking from other breast
47
Q

Mastitis

Signs

A

Unilateral, develops after flow of milk established, Hemolytic S. aureus, infected nipple fissure -> ducts can lead to abscess, most first time moms

48
Q

Mastitis

Symptoms

A

2-4th week, chills, fever, malaise, breast tenderness, redness, axillary adenopathy

49
Q

Mastitis

Treatment

A

Antibiotics

Maintain lactation

50
Q

Postpartum changes

Reproductive system

A

-Uterus: rapid reduction in size (involution)- returns to pre-pregnant size ~ 5 weeks; descent of uterine fundus ~1-2cm/day
-Lochia: vaginal discharge after delivery; lochia rubra, lochia serosa, lochia alba
-Cervix: soft right after birth – closes gradually
Perineum: Edematous, tender, bruised

51
Q

Postpartum changes
Reproductive system
Nursing

A

-Determine relationship of fundus to the umbilicus
-Assess bleeding
-Complications: infection, bleeding
Increased risk of infection, IUD could fall out

52
Q

Postpartum changes

Breasts

A

Little change in first 24 hours then full but soft

53
Q

Postpartum changes
Breasts
Nursing

A

Colostrum initially; Assess consistency, size, shape, symmetry, inspect nipples.
Complications

54
Q

Postpartum changes

GI

A

Resumes normal activity (progesterone decreases)

55
Q

Postpartum changes
GI
Nursing

A

Constipation may occur

56
Q

Postpartum changes

Urinary

A

Kidney function returns to normal within a month.

Decrease in tone ureters ..>bladder fills quickly but empty incompletely

57
Q

Postpartum changes
Urinary
Nursing

A

UTI, distended bladder

58
Q

The Four T’s
Blood loss
> 500 ml is PPH

A

Tone (soft uterus)
Trauma (Tear/inversion of uterus)
Tissue (placenta retained)
Thrombin (blood not clotting)

59
Q

Shoulder dystocia

A

Anterior shoulder (facing up) can’t get past pubic arch, head is starting to come out then goes back

give suprapubic pressure to push shoulder down to get baby through

60
Q

Obesity
C section
Epidural

A

Very difficult and chance of infection is high

Harder to place epidurals in obese mothers

61
Q

Bishops score

A

Scores that exceed 8 are most successful

Scores less than 6 require cervical ripening

62
Q

PPT

A

number one cause of death

Use cord contraction, uterine massage, and monitor BP

63
Q

Thromboembolic disease

most at risk

A

C-section delivery

Obese

64
Q

Flu like symptoms when breastfeeding

A

could have mastitis

65
Q

Postpartum depression

A

10-15 % women get

66
Q

Primary responsibility of nursing with newborn delivery

A

Maintain a patent airway
make sure baby keeps open airway
bulb syringe

67
Q

APGAR scoring

three questions?

A

Done at 1 and 5 min after birth
Meconium?
term baby?
breathing/good tone?

68
Q

Newborn

blood glucose

A

<40 is abnormal

feed early to prevent hypoglycemia

69
Q

Vitamin K

A

prevents internal bleeding

70
Q

Caput Succedaneum vs Cephalohematoma

A

Caput: swelling across suture lines - fluid and pressure, heals
Cephalo: doesn’t cross suture line - could be pressure from prolonged birth
-need to make sure no trauma

71
Q

Breast feeding benefits to baby

A

malocclusion: using different muscles

72
Q

Frequency of feeding

A

2-3 hours or on que

73
Q

Formula vs Breast

Stool

A

formula fed have more stool
formula: brown
Breast: no odor, yellow and seedy

74
Q

Engorgement

A

Milk in breast that needs to be release

Cabbage: put in fridge then put on breasts

75
Q

Colostrum

A

contains antibodies to protect

helps baby pass meconium (bilirubin - good)

76
Q

Yeast infections

A

need antifungal cream and baby needs to be treated for thrush
If untreated, will just keep reinfecting each other

Women's (4 decks)

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