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L & D > Exam 3 CH 11-16 > Flashcards

Exam 3 CH 11-16 Flashcards

1
Q

Chadwick Signs

A

bluish-purple coloration of the vaginal mucosa and cervix

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2
Q

Goodell Sign

A

Softening of the cervix

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3
Q

Hegar Sign

A

softening of the lower uterine segment
or isthmus

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4
Q

Presumptive Signs (subjective)

A
  • fatigue
  • breast tenderness/ enlargement
  • nausea/vomiting
  • amenorrhea
  • urinary frequency
  • uterine enlargement
  • quickening
  • hyperpigmentation of skin
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5
Q

Probable Signs (objective)

A
  • Braxton hicks
  • positive pregnancy test
  • abdominal enlargement
  • ballottement ( press the cervix and you can feel the baby go up and down)
  • Goodell, Chadwick, Hegar signs
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6
Q

Types of pregnancy test

A
  • stick (yes or no)
  • blood (quantitative/ numbered)
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7
Q

3 positive signs of pregnancy

A
  • ultrasound (seeing embryo)
  • Auscultation of fetal heart via doppler ( hearing)
  • Fetal movement by clinician ( feeling)
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8
Q

T/F
A positive pregnancy test is a positive sign of
pregnancy.

A

False

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9
Q

Reproductive Adaptations

A

UTERUS: estrogen causes the uterus to grow, increasing oxytocin receptors and contractions. Hegar sign. 20 weeks fundal height at the umbilicus can determin gestational age until 36 weeks
CERVIX: Goodell sign, mucus plug, Chadwick sign, ripening 4wks before birth
VAGINA: lengthen vagina, secrete leukorrhea, increase vascularity
OVARIES: enlargement until 12-14wk gestation, stop ovulation
BREAST: increase size, nipple size (erect and darker), colostrum production

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10
Q

Lightning (mothers belly drop)

A

Primate: 1st baby ( 2 weeks before due)
Multip: more than 1 baby. (4 weeks before due)

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11
Q

Orthostatic Hypotension
(mother shouldn’t lay on her back)

A

The pressure of the uterus on the inferior vena cava.
- light headiness
- dizziness
- getting up too fast
- blurry vision
- fainting

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12
Q

Gastrointestinal System adaptions

A
  • Gums: swollen, friable, hyperemic
  • ptyalism: excessive spitting
  • dental problems: gingivitis
  • constipation, hemorrhoids
  • heartburn
  • nausea/vomiting (diclegis drug for 1st trimester)
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13
Q

Cardiovascular Adaptations

A
  • increase blood supply ( 50%more prepreg level)
  • increased output, venous return, HR
  • Increase in number of RBCs; plasma volume > RBC
    leading to HEMODILUTION (physiologic anemia) MORE PLASMA THAN RBC (PEPSI & ICE)
  • Increased clotting factors (hypercoagulable state) due to iron, fibrin, and plasma levels.
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14
Q

When assessing a pregnant woman, which of
the following would the nurse expect to find?

A

complaints of nausea

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15
Q

Respiratory Adaptations

A
  • Diaphragmatic breathing
  • increase oxygen
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16
Q

Renal/ Urinary adaptations

A

Increase in glomerular filtration rate; increased
urine flow and volume

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17
Q

Musculoskeletal system Adaptations

A
  • Shifting balance
  • waddle gait
  • lordosis
  • relaxing joints and pubis symphysis
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18
Q

Integumentary Adaptions

A
  • hyperpigmentation
  • linea nigra ( line on the belly)
  • Striae Gravidarum ( stretch marks)
  • varicose veins/ spider veins
  • increase nail growth , decline in hair growth
  • palmar erythema (red hands)
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19
Q

Endocrine system adaptations

A
  • Thyroid gland: slight enlargement; increased activity;
    increase in BMR. Pregnancy induced hyperthyroidism
    -Pituitary gland: enlargement; decrease in TSH, GH;
    inhibition of FSH and LH; increase in prolactin, MSH;
    gradual increase in oxytocin with fetal maturation
  • Pancreas: insulin resistance due to hPL and other
    hormones in second half of pregnancy (see Box 11.2)
  • Adrenal glands: increase in cortisol and aldosterone
    secretion
  • Prostaglandin secretion
  • Placental secretion: hCG, hPL, relaxin, progesterone,
    estrogen (see Table 11.3)
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20
Q

T/F
Oxytocin is a hormone secreted by the anterior
pituitary gland.

A

False

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21
Q

Nutrition while pregnant

A
  • not eating for two (only need 300 more calories) breast feeding moms need 500 calories more)
  • vitamins/ folic acid
  • dietary considerations, like vegetarian, vegan, gluten-free, pica, lactose intolerance.
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22
Q

weight gain

A

Healthy weight BMI: 25 to 35 lb
o First trimester: 3.5 to 5 lb
o Second and third trimesters: 1 lb/wk
- BMI <19.8: 28 to 40 lb
o First trimester: 5 lb
o Second and third trimesters: +1 lb/wk
- BMI >25: 15 to 25 lb
o First trimester: 2 lb
o Second and third trimesters: 2/3 lb/wk

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23
Q

Maternal Emotional Respinses

A
  • Ambivalence: mixed feelings
  • Introversion: focusing only her own body and baby
  • Acceptance
  • Mood swings
  • Changes in body image: embrace or dislike
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24
Q

T/F
Ambivalence is a normal response during the
first trimester of pregnancy.

A

True

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25
Q

Couvade Syndrome

A

Dad has pregnancy symptoms

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26
Q

Risk factors for Pregnancy Box 12.2

A
  • Isotretinoins (like Accutane for acne)
  • Alcohol misuse
  • Antiepileptic drugs (valproic acid): prevent seizures
  • Diabetes (preconception)
  • Folic acid deficiency
  • HIV/AIDS
  • Hypothyroidism
  • Maternal phenylketonuria
  • Rubella seronegative
  • Obesity
  • Oral anticoagulant
  • STI
  • Smoking
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27
Q

Healthy mom =

A

Healthy baby

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28
Q

Obstetric History Terms
GTPAL or TPAL

A

G, gravida; T, term births; P, preterm births; A, abortions; L, living children
Parity — after 20 weeks
G—the current pregnancy to be included in count
P- Preterm
T—the number of term gestations delivering between 38 and 42 weeks
Para—the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks
A—the number of pregnancies ending before 20 weeks or viability
L—the number of children currently living

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29
Q

First Prenatal Visit

A

Establishment of trusting relationship
Focus on education for overall wellness
Detection and prevention of potential
problems
Comprehensive health history, physical
examination, and laboratory tests

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30
Q

Comprehensive Health History

A

Reason for seeking care
o Suspicion of pregnancy
o Date of last menstrual period
o Signs and symptoms of pregnancy
o Urine or blood test for hCG
Past medical, surgical, and personal history
Woman’s reproductive history: menstrual, obstetric,
and gynecologic history

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31
Q

Nagele ‘s rule for calculating due date

A
  1. Use the first day of the last normal menstrual period. 10/14/20
  2. Subtract 3 from the number of months. 7/14/20
  3. Add 7 to the number of days. 7/21/20
  4. Adjust the year by adding 1 year. 7/21/21
  5. Estimated due date (+ or − 2 weeks) = July 21, 2020.
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32
Q

A multipara refers to a woman who is pregnant for
the first time.

A

False

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33
Q

Gravid

A

State of being pregnant

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34
Q

Gravida/ Gravidity

A

The total number of times a woman has been pregnant, regardless of whether the pregnancy resulted in a termination or if multiple infants were born from a pregnancy

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35
Q

Nulligravida

A

A woman who has never experienced pregnancy

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36
Q

Primigravida

A

A woman pregnant for the first time

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37
Q

Secundigravida

A

A woman pregnant for the second time

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38
Q

Multigravida

A

A woman pregnant for at least the third time

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39
Q

Para

A

The number of times a woman has given birth to a fetus of at least 20 gestational weeks (viable or not), counting multiple births as one birth event

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40
Q

Parity

A

Refers to the number of pregnancies, not the number of fetuses, carried to the point of viability, regardless of the outcome

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41
Q

Nullipara (para 0)

A

A woman who has not produced a viable offspring

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42
Q

Primipara

A

A woman who has given birth once after a pregnancy of at least 20 weeks, commonly referred to as a “primip” in clinical practice

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43
Q

Multipara

A

A woman who has had two or more pregnancies of at least 20 weeks’ gestation resulting in viable offspring, commonly referred to as a “multip

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44
Q

T/F
A multipara refers to a woman who is pregnant for
the first time.

A

False

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45
Q

Physical Exam

A
  • head to toe/ vitals
  • chest, abdomen, extremities
  • Pelvic examination
    o Examination of external and internal genitalia
    o Bimanual examination
    o Pelvic shape: gynecoid, android, anthropoid,
    platypelloid
    o Pelvic measurements: diagonal conjugate, true
    (obstetric) conjugate, and ischial tuberosity
46
Q

Pelvic Shapes Figure 13.2 Page 423

A

o Gynecoid: favorable for vaginal delivery
o Android: male shaped, not favorable
o Anthropoid: usually adequate
o Platypelloid: not favorable

46
Q

Gynecoid Pelvis

A

Best pelvis for a vaginal delivery

47
Q

Lab tests

A
  • Urinalysis
  • Complete blood count
  • Blood typing
  • Rh factor
  • Rubella titer
  • Hepatitis B surface antigen
  • HIV, VDRL, and RPR testing
  • Cervical smears
  • Ultrasound
48
Q

Follow up visits

A
  • Every 4 weeks up to 28 weeks
  • Every 2 weeks from 29 to 36 weeks
  • Every week from 37 weeks to birth
    Assessments
    o Weight and BP compared to baseline values
    o Urine testing for protein, glucose, ketones, and
    nitrites
    o Fundal height (see Figure 12.5)
    o Quickening/fetal movement (see Box 12.4)
    o Fetal heart rate (see Nursing Procedure 12.1)
49
Q

T/F
A woman who is 24 weeks’ pregnant would arrange
for a follow-up visit every 2 weeks.

A

False

50
Q

Doppler flow ultrasound

A

Colored picture to see the blood flow between the baby and the heart.
- 2nd and 3rd trimester, and done abdominally

51
Q

normal amount of amniotic fluid full term

A

1 L/ 1000 ML

52
Q

Polyhydramnios

A

Too much amniotic fluid

53
Q

Oligohydramnios

A

Too little amniotic fluid

54
Q

L/S Ration

A

over 2: adequate fetal lung maturity
less than 2:

55
Q

Coombs test

A

given to every pregnant person to see if they have antibodies against Rh-positive blood

56
Q

Lab and diagnostic tests

A

Table 10.1

57
Q

While assessing a woman at 18 weeks’ gestation,
which of the following would the nurse report as
unusual?

A

urinary frequency

58
Q

Saunas and Hottubs

A

increases body temperature. can be dangerous for the baby.

59
Q

Rubella and Varicella vaccine

A

Cannot get while pregnant

60
Q

Cervical soffening

A

Effacement

61
Q

Lightening

A

when baby drops

62
Q

Molding

A

the elongated shape of the fetus skull at birth

63
Q

Fetal attitude

A

the posturing (flexion or extension) of the joints and the relationship of fetal parts to one another
- transverse lie (shoulder presentation)
- longitudinal lie

64
Q

SROM (RUPTURE OF MEMBRANES)
AROM
PROM
PPROM

A

S: spontaneous
A: Artificial
P: premature: 37+ no contractions
PPROM: preterm premature: 20-36.6

65
Q

Fetal Lie

A

relationship of the long axis (spine) of the fetus to the long axis (spine ) of the mother

66
Q

Fetal Presentation

A

body part of the fetus that enters the pelvic inlet first. (the presenting part)

67
Q

Fetal station

A

relationship of presenting part to the level of the mothers pelvic ischial spine

68
Q

Fetal engagement

A

entrance of the largest diameter of the fetal presenting part (usually the head) to the smallest diameter of the mothers pelvis

69
Q

Uterine Contraction terms

A
  • Frequency: how often
  • Duration: how long it lasts
  • Intensity: strength of contraction
70
Q

Doula

A

emotional support

71
Q

Difference between true and false labor

A

Table 13.1 page 421

72
Q

5 Ps that effect labor and birth

A
  • Passageway (birth canal: pelvis and soft tissues)
  • Passenger (fetus and placenta)
  • Powers (contractions)
  • Position (maternal)
  • Psychological response
73
Q

T/F
The true pelvis lies below the linea
terminalis

A

TRUE

74
Q

Cephalic (head first) presentation
figure 13.7

A

o Military
o Brow
o Fac

75
Q

Breech positions

A

o Frank(feet up)
o Full or complete: c ball butt down
o Footling or incomplete: single or double footing

76
Q

Cephalic presentation refers to a fetus whose head enters the pelvic inlet first.

A

True

77
Q

stations -4 to +4

A

relationship of the head to bony projections in the pelvis (ischial spines).
0 station is engaged
Above: negative: higher baby is to the abdomin
Below: positive: closer baby is to exit

78
Q

T/F
The second stage of labor is the longest stage.

A

False

79
Q

Anterior Fontanel

A

baby soft spot

80
Q

Fetal Landmarks

A

Left or Right (L/R) Anterior or posterior (A/P)

o Occipital bone (O): vertex presentation back of the baby’s head
o Chin (mentum [M]): face presentation
o Buttocks (sacrum [S]): breech presentation
o Scapula (acromion process [A]): shoulder presentation

81
Q

3 stages of labor table 13.2

A

1st stage: Longest stag. 0-10cm dilation
- Latent : 0-3 cm
- Active: 4-7 cm
- Transition: 8-10cm
2nd Stage: deliver the baby
3rd stage: deliver the placenta

82
Q

Leopold Maeuvers

A

determines presentation, position, and lie of fetus.
- First maneuver: fundal grip. While facing the woman, palpate the woman’s upper abdomen with both hands. …
- Second maneuver: lateral grip. …
- Third maneuver: second pelvic grip or Pawlik’s grip. …
- Fourth maneuver: Leopold’s first pelvic grip.

83
Q

Fetal Assessment during Labor

A
  • Amniotic Fluid
    -FHR
84
Q

Categories of fetal HR pattern

A
  • Category 1: NORMAL
  • Category 2: Indeterminate
  • Category 3: Abnormal
85
Q

Comfort and Pain Management. Nonpharmacological methods

A
  • Continuous labor support
  • Hydrotherapy
  • Ambulation and position changes
  • Acupuncture and Acupressure
  • Heat and cold packs
  • focus imagery
  • breathing techniques
  • effleurage and massage
86
Q

Comfort and pain management
Pharmacological Methods

A
  • opioids: morphine, meperidine,
    butorphanol, nalbuphine, fentanyl
  • Antiemetics: Hydroxyzine, promethazine, prochlorperazine
  • Benzodiazepines: Diazepam, Midazolam
  • Epidural analgesia, combined spinal epidural or patient controlled epidural
  • Local infiltration (lidocaine)
  • Pudendal Nerve block or spinal (intrathecal) anesthesia
  • General Anesthesia: c section
87
Q

Assessment during first stage of labor
LATENT PHASE

A
  • vitals: 30-60 mins
  • Temp: Q4H, more if membranes ruptures
  • Contractions: 30-60 mins palpate or EFM
  • FHR: every hours by doppler ot EFM
  • Vaginal Exam: initial admission, as needed on mothers cues
  • Behavior: with every client encounter. talkative, excited, anxious
88
Q

Assessment during first stage of labor
ACTIVE PHASE

A
  • vitals: 15-30 mins
  • Temp: Q4H, more if membranes ruptures
  • Contractions: 15-30 mins palpate or EFM
  • FHR: 15-30 by doppler ot EFM
  • Vaginal Exam: as needed on mothers cues
  • Behavior: with every client encounter. self absorbed, intense, and quiet
89
Q

Episiotomy

A

incision made in the perineum to enlarge the vaginal outlet.

90
Q

Reading FHR

A
  • Normal HR 110-160
  • Variability: Absent, Minimal (5 or less), Moderate (6-25), Marked (26 and higher)
  • acceleration: 15 in 15 mins
  • deceleration
  • Contractions: Normal or tachysystole.
91
Q

Lochia

A

Vaginal discharge after birth. can last up to 4-8 weeks after birth.
- Lochia Rubra: deep red
- Lochia serosa: pink brown
- Lochia alba: white light brown

92
Q

Degree of lacerations

A

1 degree: Vagina and vulva
2 degree: perineal muscles
3 degree: anal sphincter
4degree: anal sphincter and rectal mucosa.

93
Q

Lactation

A

secretion of milk by the breast.
-breast stimulation causes the pituitary gland to secrete.
- oxytocin to help with contracting the uterus and let-downs
- prolactin helps with the synthesis and release of breast milk.
ENGORGEMENT: swollen, hard, tender to touch breast

94
Q

Phases of Maternal Adaption

A
  1. taking in phase: immediately after birth
  2. taking hold phase: 2nd to 3rd day postpartum. Her and the baby.
  3. Letting go phase: reestablish relationships with other people.
95
Q

Engrossment

A

Partner spending time with their newborn. ex. father and their newborn.

96
Q

Partners 3 stage role development process

A

stage 1: expectations
stage 2: reality
stage 3: transition to mastery

97
Q

Puerperium Period

A

begins after delivery of the placenta and lasts up to 6 weeks

98
Q

3 processes of Involution

A
  • Contraction of muscle fibers to reduce stretched ones
  • Catabolism reduce enlarged individual cells
  • Regeneration of uterine epithelium
99
Q

sitz bath

A

warm, shallow bath you sit in to relieve pain, burning or itching in your perineum.

100
Q

peri bottle

A

plastic squeeze bottle filled with warm tap water to spray over the perineal area after voiding and before applying a new pad.

101
Q

Postpartum Assessment
BUBBLE-EE

A
  • Breast
  • Uterus
  • Bowel
  • Bladder
  • Lochia
  • episiotomy/ perineum/ epidural site/ extremeties/ emotions
102
Q

AAP breastfeeding recommendations

A

breastfeed for the first 6 months and continued with foods until 12 months of life or longer.

103
Q

Lochia amounts

A
  • scant: 1-2 in stain 10ml or less
  • light or small: about 4 in stain 10-25 ml loss
  • Moderate: 4-6in stain 25-50ml loss
  • Large or heavy: pad saturated within an hour
104
Q

en face position of attachment

A

face to face

105
Q

factors for postpartum infection

A
  • operative procedures
  • diabetes
  • prolonged labor
  • indwelling catheter
  • anemia
  • multiple vaginal exams during labor
  • prolonged rupture of membranes
  • manual extraction of the placenta
  • HIV
106
Q

factors of postpartum hemorrhage

A
  • precipitous labor
  • uterine atony
  • placenta previa or abruptio placenta
  • labor induction or augmentation
  • operative procedure
  • retained placental fragments
  • prolonged third stage of labor
  • multiparity spaced closely
  • uterine overdistension.
107
Q

DANGER SIGNS postpartum

A
  • fever 100.4 or greater
  • foul-smelling lochia or unexpected change in amount
  • large blood clots, or saturated peripad in an hour
  • severe headaches
  • vision changes
  • calf pain with dorsiflexion of the foot
  • swelling redness or discharge at episiotomy site
  • dysuria, burning or incomplete emptying of the bladder
  • shortness of breath, difficulty breathing
  • mood swings or depression
108
Q

bottle feeding newborn teaching

A

infants need 2-4oz of milk and about 6 feeding a day. milk will increase and feeding will decrease as the child gets older.

109
Q

baby blues

A

postpartum depression

L & D (5 decks)

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