Exam 4

Question 1

Non Stress Testing

Answer 1

EFM is completed in office for at risk pregnancies.
Heart rate acceleration should match mom’s indication of fetal movement.
Reactive test is when an acceleration of at least 15 bpm for at least 15 seconds occurs within a 20 minute period.
If negative you can do vibroacoustic stimulation to make the fetus mad after 20 minutes.
Non reactive is no acceleration after 40 minutes, at which point you do more testing

Question 2

Amniocentesis

Answer 2

Needle, guided by ultrasound withdraws placental fluid.
Done after week 14 when there is concern for genetic disorders.
Can also test for pulmonary maturity and hemolytic disease.
If being done for genetic testing be sure to ask mom if the results would change her decision to carry a child to term. If not, the risks of amniocentesis should be avoided.

Question 3

Fetal Kick Counts

Answer 3

Mom sits quietly and counts kicks for an hour.
You want at least ten, many provider have mom stop counting after ten because the fetus will move an average of 30 times an hour.

Question 4

Gestation hypertension

Answer 4

Hypertension, without proteinuria after week 20 of pregnancy in a woman with previously normal blood pressure.
Goals: Ensure maternal safety and deliver as close to term as possible.

Question 5

Chronic hypertension

Answer 5

Hypertension before pregnancy
Ensure you are taking an accurate measurement: use the right cuff size, don’t use an electronic blood pressure reader, and focus on blood pressure readings over time instead of just during office visits.

Question 6

preeclampsia without severe features

Answer 6

BP between 140/90 and 160/110
Proteinuria greater than 300mg but less than 5000 (no longer used for diagnostic)
No pulmonary edema
No cerebral or visual disturbances
Both Severe and non-severe forms share: thrombocytopenia, impaired liver function, renal insufficiency

Question 7

Preeclampsia with severe features

Answer 7

Massive proteinuria (greater than 5000mg per dL)
epigastric or RUQ pain
pulmonary edema
new onset cerebral or visual disturbances

Question 8

HELLP Syndrome

Answer 8

Variant of preeclampsia
Hemolysis
Elevated Liver Enzymes
Low Platelet levels
Can develop in women hypertension or preeclampsia
Patients are at severe risk for hemorrhage and DIC

Question 9

Magnesium Sulfate

Answer 9

Used in preeclampsia to increase the seizure threshold, also helps with blood pressure
Be sure to monitor reflexes, keep the room quiet, and dark.
Monitor mag levels in urine since renal insufficiency is a part of most disorders that mag would be used to treat. If the kidneys are not clearing it fast enough levels can become toxic really quickly.
Side effects: warmth, flushing, burning at IV site.

Question 10

Hydatiform Mole

Answer 10

Abnormal fertilization leads to overgrowth of trophoblasts into white, grapelike sacs.
Complete: no embryonic or fetal parts present.
Partial: embryonic or fetal parts present.
Because no placenta is present to receive blood risk for bleeding is increased.
Diagnosed by ultrasound or HCG levels (levels are much higher than with normal pregnancy)
Mom is at a much higher risk for cancer for the next year and should not get pregnant again during this time.

Question 11

Ectopic pregnancy

Answer 11

pregnancy occurring outside of the uterus
Treated via methotrexate

Question 12

Placenta previa

Answer 12

Placenta obstructs the cervical os
Complete: covers all of the cervical os
marginal: only partially covers
low lying: less than 20mm away from cervix
S/S: painless bright red bleeding.
Risk factors: previous cesarean, older maternal age, high altitude living, cigarette smoking
Care: typically an initial hospital stay for testing / obs, then discharge home for bedrest is stable and prior to 36 weeks. Planned cesarean as close to term as possible so long as mom and baby are stable.

Question 13

Placental abruption

Answer 13

placenta partially or completely detaches too early
Hard to detect via ultrasound, clinically diagnosed.
S/S: vaginal bleeding, abdominal pain, uterine tenderness, contractions, abdominal stiffening.
Risks: maternal hypertension (chronic or gestational), cocaine use, cigarette smoking, trauma, or hx of abruption.

Question 14

Hemorrhage definition

Answer 14

10% decrease in HCT from admission
1000mL blood loss after delivery
Significant blood loss such that RBC transfusion necessary
Significant blood loss with S/S of hypovolemia

Question 15

4 T’s of hemorrhage

Answer 15

Tone - boggy uterine tone. Firm uterine tone applies pressure to the vessels/arteries associated with placenta and promotes hemostasis.
Trauma - pregnant people get in car accidents too
Tissue - retained placental fragments, acreta, increta, or percreta
Thrombin - clotting disorders like hemophilia, HELLP, or von willebrands

Question 16

Threatened miscarriage

Answer 16

Placenta, amniotic sac, and fetus are still within uterus
Slight spotting, mild uterine cramping
Testing done to determine whether or not fetus is still alive, no evidence based treatment is available to prevent progression from threatened to actual.

Question 17

Inevitable miscarriage

Answer 17

Moderate bleeding, mild to severe uterine cramping, cervical dilation present.
No passage of tissue yet, but miscarriage is inevitable.

Question 18

Incomplete miscarriage

Answer 18

Heavy, profuse bleeding, severe cramping, tissue passage is incomplete, cervical dilation with tissue stuck in cervix.
May require further cervical dilation before D/C.

Question 19

Complete miscarriage

Answer 19

Slight bleeding, mild cramping, complete passing of fetus, placenta, and amniotic sac. Cervix closes after the passage of tissue.
No further intervention may be needed if uterine contractions are sufficient to stop bleeding.

Question 20

Missed miscarriage

Answer 20

No bleeding, cramping, tissue passage, or cervical dilation.
Fetal heartbeat is absent in utero.
Expectant management can allow for passage on its own.
D/C or misoprostol can medically terminate pregnancy.

Question 21

Disseminated Intravascular Coagulopathy (DIC)

Answer 21

Large numbers of clots form in blood vessels all over the body exhausting the body’s clotting factors.
The rest of the blood supply, absent clotting factors, is especially prone to hemorrhage.

Question 22

Quantitative vs Estimated Blood Loss

Answer 22

Quantitative involves collecting blood and recording in mL.
Estimated blood loss can be off by up to 50%.
Weighing pads and other absorbent materials and recording blood absorbed in ccs.
Remember grams weighed = mL lost = cc lost

Question 23

Gestational diabetes

Answer 23

Diabetes that develops in a mother who previously did not have diabetes.
Glucose tolerance test done between weeks 24 and 28
Increases risk for IUGR or LGA babies.
Increase risk of hydramnios (too much amniotic fluid).
Fetal monitoring with non stress tests unless the woman/fetus is extremely low risk.

Question 24

Hyperemesis gravidarum

Answer 24

When N/V is excessive enough to cause weight loss, electrolyte imbalance, nutritional deficiencies, and ketonuria
First priority treatment: If patient is unable to retain clear fluids by mouth they must have IV therapy to correct imbalances.
Vitamin B6 and unisom are first line medications.
Diclegis, and dopamine antagonists (like phenergan) can be used.

Question 25

Postpartum Depression without psychotic features

Answer 25

Symptoms of irritability, crying spells, detachment from the newborn.
Can be managed via medication
Reassure mom that PPD happens for many mothers, do not encourage isolation.
Assess for risk to mother or infant.

Question 26

Postpartum depression with psychotic features

Answer 26

Book includes symptoms of mania, hallucinations, etc.
Dorene specified thoughts of hurting the baby specifically.
I can’t find anything about discharge instructions for PPD.
Most common test for PPD is the Edinburgh

Question 27

Preterm labor

Answer 27

Definition: between 20 0/7 and 36 6/7 weeks.
Magnesium sulfate: inhibits contractions in preterm labor
Terbutaline: used to stop or delay preterm labor (also a bronchodilator)
Betamethasone: steroid used for development of fetal lungs
Nursing interventions: health promotion to prevent preterm labor, education for mom to know the signs of preterm labor.

Question 28

Prelabor rupture of membranes

Answer 28

Rupture of the amniotic sac at any time prior to labor.
increases risk for infection (chorioamnionitis)
treatment: most of the time you don’t try to delay, because at best you’ll get a few days and a higher risk for infection. Just prepare for birth. <- That’s from the book, but I tbh don’t know what Dorene wants.

Question 29

shoulder dystocia

Answer 29

Head born, but anterior shoulder cannot pass (turtle sign)
Asphyxia, brachial plexus damage, or fractured clavicle are risks
McRoberts maneuver to fix it: lay flat and pull legs back

Question 30

External Cephalic Version

Answer 30

Attempt to turn fetus from breech or shoulder presentation to a vertex presentation for birth
Biggest risk is fetal distress especially bradycardia

Question 31

cesarean births

Answer 31

Breech presentation is the number one reason for a primary cesarion
can cause mental distress because it is not the birth they intended, may feel like they missed out

Question 32

Forceps or vacuum delivery

Answer 32

assistance method is down to provider preference
Vacuum can only pop off so many times
may cause cephalohematoma
Forceps - protocols for how many attempts if unsuccessful move to c-section
Indications: maternal exhaustion, fetal distress, baby should be crowning +3 or more station to attempt either

Question 33

Bishop’s score

Answer 33

Indicates process of cervix readying for labor
Score of 8 or more is a good indicator of readiness and predicts a favorable outcome for vaginal birth

Question 34

Induction vs augmentation

Answer 34

Induction occurs when labor is initiated without having started spontaneously, aka before any uterine contractions have occurred.
Augmentation: contractions have started, but it is unsatisfactory or dysfuncitonal
Pitocin used for both
Risk: increased c-section rate, increased neonatal morbidity, increased cost

Question 35

VEAL CHOP

Answer 35

Variable Cord compression
Early Head compression
Acceleration Okay (oxygen good)
Late Placental insufficiency