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N201 > Exam 6- 1st Maternity Exam > Flashcards

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

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2
Q

WIC Established

A

1975

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3
Q

1981

A

Medicad reimburses for midwife deliveries

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4
Q

Shift to family centered nursing

A

1960’s

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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

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6
Q

Earliest Presumptive Sign of Pregnancy

A

Amenorrhea

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7
Q

Probable Signs

A

Observed by healthcare provider;
Not definitive diagnosis
Ex: Positive Pregnancy Test

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8
Q

Goodell’s Sign

A

-Softening of the cervical tip
-Increased vascularity, hypertrophy, hyperplasia, edema, elasticity

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9
Q

Palpate fetal movements

A

20 weeks

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10
Q

Fetoscope FHR

A

FHR @ 17-20 wks

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11
Q

Doppler FHT

A

FHT @ 10-12 wks

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12
Q

Softening of isthmus (lower portion of uterus)
On exam it feels thin

A

Hegar’s Sign

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13
Q

Chadwick’s Sign

A

Change in color of the cervix, vagina, and vulva

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14
Q

Ballottement

A

palpate a floating fetus →gentle returning tap
strongest of probable sign; seen after 24 wks

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15
Q

strongest of probable sign

A

Ballottement
Seen after 24 wks

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16
Q

Morning Sickness Subsides

A

15-16 wks

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17
Q

1/2 - 3/4 pregnant women experience

A

Nausea/ Vomiting (“Morning Sickness”)

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18
Q

Ptyalism

A

increased saliva
May have bitter taste
often asc. with nausea
Tx: good oral hygiene, lozenges, candy, gum, Increased fluid intake

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19
Q

Class I - Heart Disease in Pregnancy:

A

Asymptomatic
No limits to physical activity
normal pregnancy with few complications

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20
Q

Common Problems of LGA

A

Birth Trauma
Hypoglycemia
Polycythemia
Hyperbilirubinemia

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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

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22
Q

Amt of Fetal lung fluid in lungs @ birth

A

80-100ml

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23
Q

Vaginal Squeeze removes how much fetal lung fluid

A

1/3
Remainder=hypotonic–> removed via lymphatic system.

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24
Q

Primary Stimuli for respirations in NB

A

Chemical & Thermal
Mechanical (considered by some)

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25
Q

Secondary Stimuli for respirations in NB

A

Mechanica (recoil after vag. squeeze)
Physical

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26
Q

type II alveolar cells funx

A

synthesis and storage of surfactant

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27
Q

surfactant begins to equalize the pressure in the alveoli of various sizes and prevents flow of air from one alveolus to another

A

28- 32 weeks

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28
Q

Age of viability

A

24 wks
–>Severe problems

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29
Q

L/S Ratio @ 30-32 weeks

A

1.2 – 1

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30
Q

L/S Ratio @ >35 weeks

A

2-1
Maturity attained
Unless diabetic mother (gestational diabetes) d/t delayed production of surfactant

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31
Q

Lecithin

A

amt ⬆️ w/ ea. wk of gestation
Surfactant
→ alveolar stability;
secretions starts at 26wks
prevents alveolar collapse at end of expiration

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32
Q

Sphingomyelin

A

secreted @ 26 wks;
amt constant
phospholipid→ decreases surface tension→ prevents alveolar collapse at end of expiration;

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33
Q

PG

A

last matured surfactant
presence indicates good surfactant level

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34
Q

Severity of symptoms parallels the amount of meconium aspirated

A

MAS

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35
Q

ECMO

A

Extra corporeal membrane oxygenation

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36
Q

Most common anomaly of the nose

A

Choanal Atresia

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37
Q

Diaphragmatic hernia

A

defect in the formation of the diaphragm
mortality rate 50-80%

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38
Q

Diaphragmatic hernia mortality rate

A

50-80%

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39
Q

Very preterm

A

Neonates born <32wks

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40
Q

Premature

A

Neonates born 32-34wka

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41
Q

Late Premature

A

Neonates born 34-37WKS

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42
Q

Lanugo Premature Assessment

A

present btwn 20-28 wks gestation
@28wks begin to disappear from face and front of trunk

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43
Q

Creases on the front of foot start to form

A

28-30wks gestation
creases ⬆️ & spread towards heel w/ gestation

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44
Q

Eyelids open btwn

A

26-28wks gestation

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45
Q

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

A

Corticosteroids, betamethasone, or dexamethasone

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46
Q

NEC s/s

A

Abdominal Distention, Discoloration
Bowel loops
Feeding intolerance (emesis/residuals)
Bloody Stools
Abnormal V/S

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47
Q

No sex during antepartum if

A

Uterine bleeding
History of abortion/ preterm birth
ROM

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48
Q

Must always avoid during the Antepartum Sex

A

Forceful penetration
Blowing into vagina (risk of air emboli)
Sex w/ someone w/ an STD

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49
Q

bimanual exam NOT done

A

at each prenatal visit or if patient presents with vaginal bleeding

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50
Q

Nagele’s Rule

A

determine due date
(LMP-3MO)+7DAYS
Most accurate -regular cycle

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51
Q

uterus just rises out of pelvic cavity
palpate fundus at level of synthesis pubis

A

12 weeks
20 weeks: umbilicus

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52
Q

Quad Screen
Screens

A

Screens for fetal aneuploidy
• AFP (Alpha Feto Protein)
• hCG- human chorion gonadotropin
• UE-unconjugated estriol
• Inhibin-A

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53
Q

Screening for preeclampsia

A

Urine Dipstick (protein) @ ea. Prenatal visit

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54
Q

GBS

A

cultures between 35-37 weeks (rectal/vaginal)
+ →prophylactic PCN

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55
Q

Fetal Movement Counts

A

non invasive, inexpensive reflection fetal oxygenation

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56
Q

Fetal Sleep Cycles

A

May last up to 20 mins

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57
Q

Non-stress Test Reactive

A

2 + 15x15 accels in a 20 min period
<32 wks 10x10 accels are considered reactive

58
Q

Biophysical Profile 5 critical measurements

A

FHR Pattern
Fetal movements, tone, breathing
AFI or Volume

59
Q

BPP/BPA score 8/10

A

reassuring

60
Q

First to be lost with hypoxia

A

FHR reactivity–>breathing–> movement–>then tone

61
Q

Adolescent Mom more likely to have

A

Fe Deficiency Anemia
Cephalopelvic disproportion
Preeclampsia and eclampsia
STD’s
Depression

62
Q

Separation of the placenta from site of implantation before delivery

A

Abruptio placenta

63
Q

Time period beginning with conception and ending with the onset of labor

A

Antepartum/ Antepartal

64
Q

Augmentation

A

Stimulation of ineffective uterine contractions after the onset of spontaneous labor to manage labor dystocia

65
Q

Bluish-purple coloration of the vagina and cervix evident in the first trimester of pregnancy

A

Chadwick’s sign

66
Q

Occurrence of symptoms r/t to pregnancy, such as n/v & abd pain, in the mate of a pregnant woman

A

Couvade syndrome

67
Q

Twins that result from the fertilization of two eggs;
may be different gender;
dichorionic

A

Dizygotic twins

68
Q

Vomiting during pregnancy that is so severe it leads to dehydration, electrolyte and acid base imbalance, and starvation ketosis

A

Hyperemesis gravidarum

69
Q

Decreased amniotic fluid (less than 500 mL at term or 50% reduction of normal amounts) during pregnancy

A

Oligohydramnios

70
Q

Psychological work done by the mom to development of a + adaptation & establish maternal identity

A

Maternal tasks of pregnancy

71
Q

(LMP- 3 mo + 7 days)= ~DOB

A

Naegele’s rule

72
Q

Objective signs of pregnancy (noted by the examiner) that can only be attributed to the fetus

A

Positive signs

73
Q

collagen substance that surrounds the vessels of the umbilical cord; protects the vessels from compression

A

Wharton’s Jelly

74
Q

Chronic lung condition OF neonates asc w/ Mechanical ventilation and oxygen

A

Bronchopulmonary dysplasia (BPD)

75
Q

Prevents alveolar collapse at end of expiration

A

Lecithin & Sphingomyelin

76
Q

Hyperemesis Gravidarum

A

Excessive/ pernicious vomiting during pregnancy–> dehydration & starvation

77
Q

Tx Hyperemesis Gravidarum (HG)

A

Hydration (3000mL/24h)
LR
NPO
Meds( Zofran)
Progress to Brat diet
Parental Nutrition PRN
Monitor urine for Ketones

78
Q

Protein of fetal membranes

A

Fetal Fibronectin

79
Q

Tocolytic Medications

A

Arrest Labor

80
Q

Ritodrine Contraindications

A

Concurrent use w/ glucocorticoid steroids
Risk of Pulmonary Edema

81
Q

CNS Depressant used for secondary action (relaxes smooth muscle)

A

Magnesium Sulfate

82
Q

Antidote for Magnesium Sulfate

A

Calcium Gluconate

83
Q

Administration Route Magnesium Sulfate

A

IV-loading dose, then drip

84
Q

Monozygotic Twins

A

1 fertilized ovum divides–>2
Identical Twins

85
Q

➡️production of colostrum as early as 16wks

A

Prolactin (produced by anterior pituitary)

86
Q

Admin. of Corticosteroids pre-term or expected pre-term labor is anticipated reduce the occurrence of

A

RDS
NEC
IVH

87
Q

4 defects of Tetralogy of Fallot

A
  1. VSD
  2. Severe Pulmonary Stenosis
  3. Mal-positioned Aorta
  4. RV Hypertrophy
88
Q

classic sign of hypoxia

A

Irritability

89
Q

Cyanotic
Clubbing (notes)
Inhibited growth
Cardiac Personality
Polycythemia
“Squatters”(Knee Chest Position)
TET spells

A

S/S Tetralogy of Fallot

90
Q

Cyanotic Defects

A

Tetralogy of Fallot
Tricuspid artesia
Transposition of Great Vessels
Trunkus Arteriosis

91
Q

TET spells

A

Hypercyanotic Spells
Increased RR & Cyanosis –> Decreased CO –>Seizure

92
Q

Relieve TET spells

A

Remain Calm
Stop activity
Admin O2
Squat/ knee chest
Do NOT treat respiratory acidosis

93
Q

Blalock-Tulsig Shunt

A
  • Gortex graft btwn subclavian & pulmonary artery
  • Increase blood to lungs
  • Tx Severe Tetralogy of Fallot
94
Q

Tetralogy of Fallot Prognosis w/ Tx

A

1-5% Mortality
w/o Tx:
- 30% by 2 yo
- 50% by 6 yo
- 95% by 20 yo

95
Q

Failure of the Tricuspid valve to develop forces Foramen Ovale to remain open;
Blood completely bypasses lungs

A

Tricuspid Atresia

96
Q

Tricuspid Atresia s/s

A

Cyanosis/ Chronic Hypoxia developing w/in 15h

97
Q

Jatene

A

Arterial Switch Sx
10-14d
Takes 20h
Tx: Transposition of Great Vessels

98
Q

Aorta and Pulmonary artery do NOT divide
often accompanied by VSD

A

Trunkus Arteriosis

99
Q

d/t Underdeveloped LV, mitral valve, & aorta;
PDA maintains systemic circulation

A

Hypoplastic Left Heart

100
Q

Norwood Procedure

A

Bypasses LV–> Deoxygenated blood directly to lungs, RV pumps blood for systemic circulation
3 Sx @ 1wk, 6mo, 12 mo
Tx Hypoplastic Left Heart

101
Q

Tx Hypoplastic Left Heart

A

Norwood Procedure
Transplant

102
Q

Lanoxin > 1mL

A

CHECK YOUR MATH

103
Q

Normal Dose Lanoxin

A

10-20 mcg/kg/24h
RN Double Check

104
Q

Lanoxin –>

A

increase contractility & CO
decrease HR
ALWAYS ask MD for parameters!!

105
Q

Hold Lanoxin

A

4hrs on a missed dose

106
Q

Includes Mestural, Obstetric, Gynecological, Contraceptive, and Sexual History

A

Reproductive Assessment

107
Q

Folic acid supplementation (Prenatal)

A

decrease risk of neural tube defects
greatest impact 1 mo prior and through first trimester
0.4mg/d for childbearing-aged women

108
Q

Chloasma

A

aka mask of pregnancy/ Melasma
brownish pigmentation over the forehead, temples, cheek, and/ or upper lip

109
Q

Dark line that runs from the umbilicus to the pubis

A

Linea Nigra

110
Q

Softening of lower uterine segment
Palpated at 6wks
Probable Sign

A

Hegar’s sign

111
Q

First trimester

A

1st day LMP-14 completed wks

112
Q

2nd Trimester

A

15wks-28 completed wks

113
Q

Oxytocin

A

Uterine Contractions
Milk let-down

114
Q

Leukorrhea

A

vaginal discharge
increases during pregnancy d/t influence of estrogen

115
Q

Acidic pH of Vag during Preg->

A

inhibits bacteria
May–>overgrowth of Candida albicans– Risk for yeast infections

116
Q

Braxton-Hicks Contractions

A

Intermittent, painless
Begin in 2nd tri, most won’t feel until 3rd

117
Q

Wt of Uterus at Term

A

1100-1200 g

118
Q

Prolactin

A

Produced by ant. pituitary
Production of colostrum (16wks)

119
Q

Maternal CO

A

increases (30-50%) peaks 25-30wks

120
Q

Maternal HR

A

increases 15-20bpm

121
Q

Maternal Plasma Volume

A

increases 40-50%
peaks 32-34 wks

122
Q

Maternal Plasma Volume

A

increases 40-50%
peaks 32-34 wks

123
Q

Iron-deficiency anemia

A

hgb <33%

124
Q

Hypervolemia of preg

A

Blood volume increases to 1500mL (40-45%)
Peaks during 2nd tri

125
Q

Hypotensive condition d/t compression of IVC when lying on back (mid to late preg)
s/s–>dizzy & faint

A

Supine Hypotensive Syndrome

126
Q

Hypotensive condition d/t compression of IVC when lying on back (mid to late preg)
s/s–>dizzy & faint

A

Supine Hypotensive Sydrome

127
Q

Avoid excess (>10,000 IU), increases the risk of birth defects

A

Vit A

128
Q

secretes estrogen & progesterone until around 12-14 wks; then the placenta takes over that role

A

Corpus luteum

129
Q

After implantation produce hCG which maintains the corpus luteum

A

the fertilized ovum and the chorionic villi

130
Q

Cotyledons

A

segments of the placenta

131
Q

By the 7th week the placenta is

A

producing the majority of estrogen

132
Q

By the 10th-12th wk the placenta is

A

producing the majority of progesterone

133
Q

By the 11th wk the placenta is

A

producing enough estrogen & progesterone to maintain the pregnancy;
hCG levels will drop
corpus luteum begins to shrink

134
Q

During preg. growth increases in capacity (500-1000 x bigger than normal)

A

Uterus (smooth muscle organ)

135
Q

80% of uterine blood flow is to the

A

placenta

136
Q

decrease in CO=

A

decrease in uterine blood flow

137
Q

As uterine contraction duration & intensity increases

A

blood flow to the placenta decreases

138
Q

thick, rich, gold in color, contains a lot of antibodies, forms in last trimester

A

Colostrum’s

139
Q

Supine Hypotensive Syndrome

A

(Vena Cava Syndrome): pts should not lie flat!

140
Q

Hemoglobin <11

A

requires iron supplementation

141
Q

posterior pituitary

A

secretes oxytocin→stimulates uterine contraction and the let-down reflex (milk is released from the milk ducts after birth)

142
Q

anterior pituitary

A

produces prolactin–> stimulates breast development and the production of milk

N201 (21 decks)

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