Families Exam 1 Flashcards
What are some presumptive signs of pregnancy?
- amenorrhea
- fatigue
- N/V
- quickening
- uterine enlargement
What is Hegar’s sign?
softening/compressibility of the lower uterus
What is Chadwick’s sign?
blue/purple color of the cervix and vaginal mucosa
What is Goodell’s sign?
softening of the cervical tip
What sign of pregnancy is ballottement?
Probable
Is a positive pregnancy test a probable or positive sign of pregnancy?
Probable
What cardiovascular components INCREASE with pregnancy?
- CO (30-50%)
- BV (30-45% @ term)
- HR (10-15/min)
What is striae gravidarum?
stretch marks
What is linea nigra?
a dark line from the belly to the pubic area
What is chloasma?
increased pigmentation on face
What does Naegle’s rule determine? How?
- delivery date
- take the first day of your last period, subtract 3 months and add 7 days
What is the G in GTPAL?
Gravidity: # of pregnancies, including current pregnancy and abortion/miscarriage
What is the T in GTPAL?
Term births: 38+ weeks
What is the P in GTPAL?
Preterm births: up to 38 weeks
What is the A in GTPAL?
Abortion/miscarriage: lost before 20 weeks
What is the L in GTPAL?
Living children
What are signs of infection during pregnancy?
- burning on urination
- diarrhea
- fever/chills
What are signs of miscarriage or ectopic pregnancy?
- abdominal cramping
- vaginal bleeding
How can backache be relieved during pregnancy?
- pelvic tilt exercises
- side-lying position
What side should you lay on if experiencing supine hypotension?
left
How can SOB be relieved during pregnancy?
extra pillows
How can gingivitis be relieved during pregnancy?
brushing teeth gently
How can nasal stuffiness be relieved during pregnancy?
use of a humidifier
How can epistaxis be relieved during pregnancy?
NS drops/spray
How can varicose veins and edema be relived during pregnancy?
- elevate legs
- NO restrictive clothing
- DONT sit/stand too long
- DONT cross knees
What could a gush of fluid from the vagina mean?
ROM
What could decreased fetal movement mean?
fetal distress
When is a GBS done?
35-37 weeks
What med do you give if the patient is GBS positive?
Penicillin G
What could protein in the urine indicate?
gestational HTN
What could glucose/ketones in the urine indicate?
gestational diabetes
What could WBC’s in the urine indicate?
infection/UTI
What does TORCH stand for?
- toxoplasmosis
- other infections
- rubella
- cytomegalovirus
- herpes
When is a maternal serum alpha-fetoprotein test done? What does it test for?
- between 15-22 weeks
- down syndrome (low level)
- neural tube defects (high level)
What should the patient do before an amniocentesis?
empty their bladder
What position should the patient be in for an amniocentesis?
supine with a wedge under the right hip
What complications can arise from an amniocentesis?
- AF emboli
- hemorrhage
- infection
- PROM
What med promotes fetal lung maturity?
betamethasone
When is a glucose tolerance test done?
between 24-28 weeks
Why would you do a 3 hour glucose tolerance test?
if the 1 hour result was >140
What glucose test do you have to fast for?
3 hour
How is gestational diabetes diagnosed?
by 2 elevated blood glucose readings from the 3 hour glucose tolerance test
How much weight gain should occur during the first trimester?
up to 4.4 pounds
How much weight gain should occur in the second and third trimesters?
1 pound/week
How much weight should a normal person gain during pregnancy?
25-35 pounds
How much weight should an underweight person gain during pregnancy?
28-40 pounds
How much weight should an overweight person gain during pregnancy?
15-25 pounds
How much weight should an obese person gain during pregnancy?
11-20 pounds
In what trimester should your calories increase by 340?
second
In what trimester should your calories increase by 452?
third
What should you eat in the morning before getting up if experiencing nausea?
crackers or dry toast
How much folic acid should you take a day when pregnant?
600 mcg
How much calcium should be taken when pregnant?
1000 mg
How should iron supplements be taken?
in between meals with vitamin C
What does the BPP assess?
- FHR
- fetal breathing movements
- gross body movements
- fetal tone
- qualitative amniotic fluid volume
What is an ideal BPP score?
8-10
What does an NST assess?
FHR response to fetal movement
What position should the patient be in for an NST?
reclining chair, semi-fowlers, or left lateral
What should the patient do during an NST?
press the button when she feels the baby move (FHR should increase)
What result do you want from an NST?
- reactive
- moderate variability
- accelerations (15/min for 15 seconds, 2 times in 20 mins)
What should you do if you receive a nonreactive NST result?
CST or BPP
How can you test how the fetus will tolerate labor?
a contraction stress test
What is a negative CST result?
- normal finding
- 3 contractions with NO late decels in a 10 min period
Which type of ultrasound requires a full bladder?
transabdominal
What is the biggest risk to the fetus with gestational diabetes?
HYPOGLYCEMIA
How is gestational diabetes treated?
diet and exercise
Is there treatment for cytomegalovirus?
NO
What med should be administered to babies born to a mom with Gonorrhea?
erythromycin eye drops
What causes the compromise of fetal circulation?
placental abruption
What term explains gestational HTN with proteinuria?
preeclampsia
What BP and level of proteinuria show MILD preeclampsia?
- BP 140/90
- 1+ proteinuria
What BP and level of proteinuria show SEVERE preeclampsia?
- BP 160/110
- 3+ proteinuria
What symptom might you see with SEVERE preeclampsia?
RUQ abdominal pain
What symptoms might you see with preeclampsia?
- severe HA
- blurry vision
- face/hand edema
- weight gain
How can you assess for proteinuria?
clean catch specimen
What med should you give if the systolic BP is >160?
labetalol
What med can you give for preterm labor?
mag sulfate
What should you monitor is preterm labor is suspected?
FHR and contraction pattern
How long should you avoid pregnancy after a spontaneous abortion?
2 months
Hyperemesis gravidarium can cause metabolic acidosis and metabolic alkalosis. How?
- starvation can cause met. acidosis
- vomiting can cause met. acidosis
What happens the electrolytes with hyperemesis gravidarium?
they are low (Na, K, Cl)
What happens to HR and BP with hyperemesis gravidarium?
HR increases and BP decreases
What does HELLP stand for?
- Hemolysis
- Elevated Liver enzymes
- Low Platelets
What can low platelets result in?
- thrombocytopenia
- abnormal bleeding/clotting time
- bleeding gums
- petechiae
- DIC
What are the symptoms of HELLP syndrome?
- severe continuous HA
- N/V
- blurred vision, flashes of lights/dots
- periorbital/facial/hand/abdominal edema
- proteinuria
- jaundice
- epigastric/RUQ pain
- seizures
What med prevents seizures, suppresses contractions/stops labor, and is used for HTN?
mag sulfate
What do decreased DTR’s, LOC, UO, and RR show signs of?
mag sulfate toxicity
What is the antidote for mag sulfate?
calcium gluconate/chloride
What is the therapeutic range for mag sulfate?
5-8
When is rhogam given?
- between 24-28 weeks
- 72 hours after birth
- after amniocentesis
What is terbutaline’s function?
- relaxes smooth muscles
- inhibits uterine activity
What is the fetal lie?
- the baby’s spine in relation to the mom’s spine
What are the 3 types of fetal lie?
- longitudinal/parallel: up & down
- oblique: diagonal
- transverse: straight across
What is fetal attitude?
The relationship of fetal parts to one another
What do you want the fetal attitude to be?
flexed chin
What is a negative fetal station?
- above the ischial spine
- no baby yet
What is a positive fetal station?
- below the ischial spine
- yes baby
What is station 0?
- presenting part: baby’s head
- widest part of the head is level with mom’s ischial spine
What are the most favorable and least favorable passageways?
- most: gynaecoid
- least: platypelloid
What causes enlargement/widening of the cervical opening and canal?
dilation
What causes the shortening/thinning of the cervix?
effacement
How soon after ROM does labor usually occur?
within 24 hours
What is the pH of amniotic fluid?
7-7.5
What should be assessed immediately after ROM?
FHR
What are the cardinal movements?
- engagement
- descent
- flexion
- internal rotation
- extension
- external rotation
- birth by expulsion
What do Leopold’s maneuvers determine?
- baby’s position
- position, lie, attitude
What is the fetal part that is ideal at the fundus?
the butt (should feel soft and squishy)
How can you tell if the baby is engaged?
it cannot be pushed back up from the lower part of the uterus
What is lightening?
when the fetal head descends onto the pelvis
When does lightening happen, and what does it help with?
- about 14 days before labor
- makes it easier to breathe
How much weight is lost preceding labor?
1-3.5 pounds
What position does the cervix move to in true labor?
anterior
How dilated is the patient during the latent phase?
0-3 cm
What is the duration and frequency of ctx during the latent phase?
30-45 seconds for 5-30 mins
How dilated is the patient during the active phase?
4-7 cm
What is the duration and frequency of ctx during the active phase?
40-70 seconds for 3-5 mins
How dilated is the patient during the transition phase?
8-10 cm
What is the duration and frequency of ctx during the transition phase?
45-90 seconds for 2-3 mins
What is the pushing stage of labor?
second
How frequent are contractions during the second stage of labor, and how long does the stage last?
every 1-2 minutes for 30 mins-2 hours
What part of the placenta should be delivered first?
the surface that was facing the baby and touching amniotic fluid (shiny shultze)
How long does the third stage of labor last?
5-30 mins
How long does the fourth stage of labor last?
1-4 hours
What is considered a prolonged contraction?
> 90 seconds
What is considered too frequent of contractions?
> 5 in 10 mins
What can a bad resting tone lead to?
hypoxia and decreased FHR
What is effleurage?
light, gentle, circular stroking of the patient’s abdomen with the fingertips
What is sacral counterpressure?
applying pressure to the patient’s sacral area using the heel of the hand or fist to counteract lower back pain
When during labor are opioids given?
the early part of active labor (labor must be well established - 4 cm dilated, station 0)
What is the antidote for opioid toxicity?
naloxone
How long can opioids be given?
NOT after 7 cm dilated
When can epidural anesthesia be used during labor?
From at least 4 cm dilated until 9.5 cm dilated
What eliminates sensation from the belly button to the thighs?
epidural anesthesia
How should the patient be positioned for epidural anesthesia?
with back curved
How can you prevent hypotension with an epidural?
- 2 L IV fluid bolus before
- IV vasopressor
What is local anesthesia for the perineum, vulva, and rectal areas?
pudendal block
When is a pudendal block given?
10-20 mins before delivery
What is a normal FHR?
110-160 bpm
Do you want variability in the FHR?
yes, moderate (6-25/min)
What variability of the FHR is non-reassuring?
none, minimal (<5/min) or too much (>25/min)
What decelerations of the FHR are non-reassuring?
late and variable
Are FHR accelerations normal?
YES
What should you do for a patient having late decels?
- side lying position
- increase IVF
- O2
- prepare for c-section
What can cause variable decels?
cord compression
What can cause early decels?
head compression
What can cause late decels?
placental indufficiency
What medication should you give for hypotonic ctx?
oxytocin
What medication should you give for hypertonic contractions?
mag sulfate
What does the bishop score have to be for induction of labor?
> 8 for multiparous, >10 for nulliparous
What is rated for the bishop score?
- dilation
- effacement
- consistency
- position
- station
What should you watch for with pitocin/oxytocin?
uterine hyperstimulation
How is oxytocin given?
on a pump using the most central IV port
If the patient reports feeling something coming through her vagina, what could this be?
the umbilical cord
How can severe fetal hypoxia possibly be identified?
excessive fetal activity and then no fetal activity
What position should the patient be in if prolapsed cord is suspected?
knees to chest
How should you keep the visible umbilical cord from drying out?
a warm, sterile, saline-soaked towel
What is McRoberts maneuver?
bringing the mom’s thighs close to the chest to help with shoulder dystocia
Why should panting be encouraged during precipitous labor?
it controls the urge to push
What characterizes fetal bradycardia?
FHR <110/min for 10 mins or more
What should you do to oxytocin in the event of fetal bradycardia?
DISCONTINUE
What characterizes fetal tachycardia?
FHR is >160/min for 10 mins or more
Most commonly, what color is meconium-stained amniotic fluid?
green
What L/S ratio indicates fetal lung maturity?
2:1
What does the absence of PG indicate?
respiratory distress
What ctx frequency is associated with uterine hyper stimulation?
> q 2 mins
What ctx duration is associated with uterine hyperstimulation?
> 90 seconds
What ctx intensity pressure is associated with uterine hyperstimulation?
> 90 mmHg
What uterine resting tone is associated with uterine hyperstimulation?
> 20 mmHg between ctx
