Exam 6- 1st Maternity Exam Flashcards
Maternity History 2-4 Birthing Choices/Expanded Roles/Trends 5-7 Vital Statistics 3-6 Standards of Care 2-3 A&P of Pregnancy 17-23 Sexuality in Pregnancy 2-4 Diagnosis of Pregnancy 5-8 Discomforts of Pregnancy 3-4 Psychosocial Adjustments 3-4 Heart Disease in Pregnancy 2-4 Nutrition during Pregnancy 4-7 Antepartal Nursing Management 10-14 Antepartal Nursing Care and Assessment “Jeopardy Game” 9-14 Pregestational Disea
1
Q
1ST Drugs used to alleviate child birth pain
A
19th Century
2
Q
WIC Established
A
1975
3
Q
1981
A
Medicad reimburses for midwife deliveries
4
Q
Shift to family centered nursing
A
1960’s
5
Q
Presumptive Signs of Pregnancy
A
symptoms or changes felt by woman
Amenorrhea
N/V (Morning sickness)
Excessive Fatigue (1st/ 3rd Trimester)
Urinary Frequency (1st/ 3rd)
Breast Changes/ pain
Quickening
6
Q
Earliest Presumptive Sign of Pregnancy
A
Amenorrhea
7
Q
Probable Signs
A
Observed by healthcare provider;
Not definitive diagnosis
Ex: Positive Pregnancy Test
8
Q
Goodell’s Sign
A
-Softening of the cervical tip
-Increased vascularity, hypertrophy, hyperplasia, edema, elasticity
9
Q
Palpate fetal movements
A
20 weeks
10
Q
Fetoscope FHR
A
FHR @ 17-20 wks
11
Q
Doppler FHT
A
FHT @ 10-12 wks
12
Q
Softening of isthmus (lower portion of uterus)
On exam it feels thin
A
Hegar’s Sign
13
Q
Chadwick’s Sign
A
Change in color of the cervix, vagina, and vulva
14
Q
Ballottement
A
palpate a floating fetus →gentle returning tap
strongest of probable sign; seen after 24 wks
15
Q
strongest of probable sign
A
Ballottement
Seen after 24 wks
16
Q
Morning Sickness Subsides
A
15-16 wks
17
Q
1/2 - 3/4 pregnant women experience
A
Nausea/ Vomiting (“Morning Sickness”)
18
Q
Ptyalism
A
increased saliva
May have bitter taste
often asc. with nausea
Tx: good oral hygiene, lozenges, candy, gum, Increased fluid intake
19
Q
Class I - Heart Disease in Pregnancy:
A
Asymptomatic
No limits to physical activity
normal pregnancy with few complications
20
Q
Common Problems of LGA
A
Birth Trauma
Hypoglycemia
Polycythemia
Hyperbilirubinemia
21
Q
Postmature Characteristics
A
dry cracked skin (parchment paper)
long hard nails
decreased subcutaneous fat
“old person” appearance
No Vernix
meconium staining
wide eyed alert look
22
Q
Amt of Fetal lung fluid in lungs @ birth
A
80-100ml
23
Q
Vaginal Squeeze removes how much fetal lung fluid
A
1/3
Remainder=hypotonic–> removed via lymphatic system.
24
Q
Primary Stimuli for respirations in NB
A
Chemical & Thermal
Mechanical (considered by some)
25
Secondary Stimuli for respirations in NB
Mechanica (recoil after vag. squeeze)
Physical
26
type II alveolar cells funx
synthesis and storage of surfactant
27
surfactant begins to equalize the pressure in the alveoli of various sizes and prevents flow of air from one alveolus to another
28- 32 weeks
28
Age of viability
24 wks
-->Severe problems
29
L/S Ratio @ 30-32 weeks
1.2 – 1
30
L/S Ratio @ >35 weeks
2-1
Maturity attained
Unless diabetic mother (gestational diabetes) d/t delayed production of surfactant
31
Lecithin
amt ⬆️ w/ ea. wk of gestation
Surfactant
→ alveolar stability;
secretions starts at 26wks
prevents alveolar collapse at end of expiration
32
Sphingomyelin
secreted @ 26 wks;
amt constant
phospholipid→ decreases surface tension→ prevents alveolar collapse at end of expiration;
33
PG
last matured surfactant
presence indicates good surfactant level
34
Severity of symptoms parallels the amount of meconium aspirated
MAS
35
ECMO
Extra corporeal membrane oxygenation
36
Most common anomaly of the nose
Choanal Atresia
37
Diaphragmatic hernia
defect in the formation of the diaphragm
mortality rate 50-80%
38
Diaphragmatic hernia mortality rate
50-80%
39
Very preterm
Neonates born <32wks
40
Premature
Neonates born 32-34wka
41
Late Premature
Neonates born 34-37WKS
42
Lanugo Premature Assessment
present btwn 20-28 wks gestation
@28wks begin to disappear from face and front of trunk
43
Creases on the front of foot start to form
28-30wks gestation
creases ⬆️ & spread towards heel w/ gestation
44
Eyelids open btwn
26-28wks gestation
45
Administer to women in preterm labor or when preterm labor is anticipated to reduce likelihood of RDS, NEC, IVH, need for respiratory support, systemic infections, and neonatal death
Corticosteroids, betamethasone, or dexamethasone
46
NEC s/s
Abdominal Distention, Discoloration
Bowel loops
Feeding intolerance (emesis/residuals)
Bloody Stools
Abnormal V/S
47
No sex during antepartum if
Uterine bleeding
History of abortion/ preterm birth
ROM
48
Must always avoid during the Antepartum Sex
Forceful penetration
Blowing into vagina (risk of air emboli)
Sex w/ someone w/ an STD
49
bimanual exam NOT done
at each prenatal visit or if patient presents with vaginal bleeding
50
Nagele’s Rule
determine due date
(LMP-3MO)+7DAYS
Most accurate -regular cycle
51
uterus just rises out of pelvic cavity
palpate fundus at level of synthesis pubis
12 weeks
20 weeks: umbilicus
52
Quad Screen
Screens
Screens for fetal aneuploidy
• AFP (Alpha Feto Protein)
• hCG- human chorion gonadotropin
• UE-unconjugated estriol
• Inhibin-A
53
Screening for preeclampsia
Urine Dipstick (protein) @ ea. Prenatal visit
54
GBS
cultures between 35-37 weeks (rectal/vaginal)
+ →prophylactic PCN
55
Fetal Movement Counts
non invasive, inexpensive reflection fetal oxygenation
56
Fetal Sleep Cycles
May last up to 20 mins
57
Non-stress Test Reactive
2 + 15x15 accels in a 20 min period
<32 wks 10x10 accels are considered reactive
58
Biophysical Profile 5 critical measurements
FHR Pattern
Fetal movements, tone, breathing
AFI or Volume
59
BPP/BPA score 8/10
reassuring
60
First to be lost with hypoxia
FHR reactivity-->breathing--> movement-->then tone
61
Adolescent Mom more likely to have
Fe Deficiency Anemia
Cephalopelvic disproportion
Preeclampsia and eclampsia
STD’s
Depression
62
Separation of the placenta from site of implantation before delivery
Abruptio placenta
63
Time period beginning with conception and ending with the onset of labor
Antepartum/ Antepartal
64
Augmentation
Stimulation of ineffective uterine contractions after the onset of spontaneous labor to manage labor dystocia
65
Bluish-purple coloration of the vagina and cervix evident in the first trimester of pregnancy
Chadwick's sign
66
Occurrence of symptoms r/t to pregnancy, such as n/v & abd pain, in the mate of a pregnant woman
Couvade syndrome
67
Twins that result from the fertilization of two eggs;
may be different gender;
dichorionic
Dizygotic twins
68
Vomiting during pregnancy that is so severe it leads to dehydration, electrolyte and acid base imbalance, and starvation ketosis
Hyperemesis gravidarum
69
Decreased amniotic fluid (less than 500 mL at term or 50% reduction of normal amounts) during pregnancy
Oligohydramnios
70
Psychological work done by the mom to development of a + adaptation & establish maternal identity
Maternal tasks of pregnancy
71
(LMP- 3 mo + 7 days)= ~DOB
Naegele's rule
72
Objective signs of pregnancy (noted by the examiner) that can only be attributed to the fetus
Positive signs
73
collagen substance that surrounds the vessels of the umbilical cord; protects the vessels from compression
Wharton's Jelly
74
Chronic lung condition OF neonates asc w/ Mechanical ventilation and oxygen
Bronchopulmonary dysplasia (BPD)
75
Prevents alveolar collapse at end of expiration
Lecithin & Sphingomyelin
76
Hyperemesis Gravidarum
Excessive/ pernicious vomiting during pregnancy--> dehydration & starvation
77
Tx Hyperemesis Gravidarum (HG)
Hydration (3000mL/24h)
LR
NPO
Meds( Zofran)
Progress to Brat diet
Parental Nutrition PRN
Monitor urine for Ketones
78
Protein of fetal membranes
Fetal Fibronectin
79
Tocolytic Medications
Arrest Labor
80
Ritodrine Contraindications
Concurrent use w/ glucocorticoid steroids
Risk of Pulmonary Edema
81
CNS Depressant used for secondary action (relaxes smooth muscle)
Magnesium Sulfate
82
Antidote for Magnesium Sulfate
Calcium Gluconate
83
Administration Route Magnesium Sulfate
IV-loading dose, then drip
84
Monozygotic Twins
1 fertilized ovum divides-->2
Identical Twins
85
➡️production of colostrum as early as 16wks
Prolactin (produced by anterior pituitary)
86
Admin. of Corticosteroids pre-term or expected pre-term labor is anticipated reduce the occurrence of
RDS
NEC
IVH
87
4 defects of Tetralogy of Fallot
1. VSD
2. Severe Pulmonary Stenosis
3. Mal-positioned Aorta
4. RV Hypertrophy
88
classic sign of hypoxia
Irritability
89
Cyanotic
Clubbing (notes)
Inhibited growth
Cardiac Personality
Polycythemia
"Squatters"(Knee Chest Position)
TET spells
S/S Tetralogy of Fallot
90
Cyanotic Defects
Tetralogy of Fallot
Tricuspid artesia
Transposition of Great Vessels
Trunkus Arteriosis
91
TET spells
Hypercyanotic Spells
Increased RR & Cyanosis --> Decreased CO -->Seizure
92
Relieve TET spells
Remain Calm
Stop activity
Admin O2
Squat/ knee chest
Do NOT treat respiratory acidosis
93
Blalock-Tulsig Shunt
- Gortex graft btwn subclavian & pulmonary artery
- Increase blood to lungs
- Tx Severe Tetralogy of Fallot
94
Tetralogy of Fallot Prognosis w/ Tx
1-5% Mortality
w/o Tx:
- 30% by 2 yo
- 50% by 6 yo
- 95% by 20 yo
95
Failure of the Tricuspid valve to develop forces Foramen Ovale to remain open;
Blood completely bypasses lungs
Tricuspid Atresia
96
Tricuspid Atresia s/s
Cyanosis/ Chronic Hypoxia developing w/in 15h
97
Jatene
Arterial Switch Sx
10-14d
Takes 20h
Tx: Transposition of Great Vessels
98
Aorta and Pulmonary artery do NOT divide
often accompanied by VSD
Trunkus Arteriosis
99
d/t Underdeveloped LV, mitral valve, & aorta;
PDA maintains systemic circulation
Hypoplastic Left Heart
100
Norwood Procedure
Bypasses LV--> Deoxygenated blood directly to lungs, RV pumps blood for systemic circulation
3 Sx @ 1wk, 6mo, 12 mo
Tx Hypoplastic Left Heart
101
Tx Hypoplastic Left Heart
**Norwood Procedure**
Transplant
102
Lanoxin > 1mL
CHECK YOUR MATH
103
Normal Dose Lanoxin
10-20 mcg/kg/24h
RN Double Check
104
Lanoxin -->
increase contractility & CO
decrease HR
ALWAYS ask MD for parameters!!
105
Hold Lanoxin
4hrs on a missed dose
106
Includes Mestural, Obstetric, Gynecological, Contraceptive, and Sexual History
Reproductive Assessment
107
Folic acid supplementation (Prenatal)
decrease risk of neural tube defects
greatest impact 1 mo prior and through first trimester
0.4mg/d for childbearing-aged women
108
Chloasma
aka mask of pregnancy/ Melasma
brownish pigmentation over the forehead, temples, cheek, and/ or upper lip
109
Dark line that runs from the umbilicus to the pubis
Linea Nigra
110
Softening of lower uterine segment
Palpated at 6wks
Probable Sign
Hegar's sign
111
First trimester
1st day LMP-14 completed wks
112
2nd Trimester
15wks-28 completed wks
113
Oxytocin
Uterine Contractions
Milk let-down
114
Leukorrhea
vaginal discharge
increases during pregnancy d/t influence of estrogen
115
Acidic pH of Vag during Preg->
inhibits bacteria
May-->overgrowth of Candida albicans-- Risk for yeast infections
116
Braxton-Hicks Contractions
Intermittent, painless
Begin in 2nd tri, most won't feel until 3rd
117
Wt of Uterus at Term
1100-1200 g
118
Prolactin
Produced by ant. pituitary
Production of colostrum (16wks)
119
Maternal CO
increases (30-50%) peaks 25-30wks
120
Maternal HR
increases 15-20bpm
121
Maternal Plasma Volume
increases 40-50%
peaks 32-34 wks
122
Maternal Plasma Volume
increases 40-50%
peaks 32-34 wks
123
Iron-deficiency anemia
hgb <33%
124
Hypervolemia of preg
Blood volume increases to 1500mL (40-45%)
Peaks during 2nd tri
125
Hypotensive condition d/t compression of IVC when lying on back (mid to late preg)
s/s-->dizzy & faint
Supine Hypotensive Syndrome
126
Hypotensive condition d/t compression of IVC when lying on back (mid to late preg)
s/s-->dizzy & faint
Supine Hypotensive Sydrome
127
Avoid excess (>10,000 IU), increases the risk of birth defects
Vit A
128
secretes estrogen & progesterone until around 12-14 wks; then the placenta takes over that role
Corpus luteum
129
After implantation produce hCG which maintains the corpus luteum
the fertilized ovum and the chorionic villi
130
Cotyledons
segments of the placenta
131
By the 7th week the placenta is
producing the majority of estrogen
132
By the 10th-12th wk the placenta is
producing the majority of progesterone
133
By the 11th wk the placenta is
producing enough estrogen & progesterone to maintain the pregnancy;
hCG levels will drop
corpus luteum begins to shrink
134
During preg. growth increases in capacity (500-1000 x bigger than normal)
Uterus (smooth muscle organ)
135
80% of uterine blood flow is to the
placenta
136
decrease in CO=
decrease in uterine blood flow
137
As uterine contraction duration & intensity increases
blood flow to the placenta decreases
138
thick, rich, gold in color, contains a lot of antibodies, forms in last trimester
Colostrum’s
139
Supine Hypotensive Syndrome
(Vena Cava Syndrome): pts should not lie flat!
140
Hemoglobin <11
requires iron supplementation
141
posterior pituitary
secretes oxytocin→stimulates uterine contraction and the let-down reflex (milk is released from the milk ducts after birth)
142
anterior pituitary
produces prolactin--> stimulates breast development and the production of milk
