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1
Q

What is our most common concern for LGA babies after delivery? (what lab do we need to monitor?)

A

Monitor for glucose and sx of respiratory distress

Common concern: birth trauma, polycythemia: abnormal increase in hemoglobin BLOOD CANCER, hypocalcemia. High risk of developing type 2 later in life

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2
Q

How do you identify a transfusion reaction and what actions do you take?

A

Hives, itching, SOB

Stop transfusion

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3
Q

What are TORCH infections?

A

Toxoplasmosis
Other (Hep B, Varicella-Zoster, Parvovirus, B19, Group B Strept
Rubella
Cytomegalovirus
Herpes Simplex Virus - localized, disseminated, CNS

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4
Q

What are common ways TORCH infections are passed?

A

Toxoplasmosis = parasite, undercooked meats or cat feces

Other =
HIV: A virus spread through sexual contact or direct contact with HIV-infected blood (like from sharing needles).
Fifth disease: A mild rash caused by parvovirus B19. It spreads through saliva and mucus when an infected person coughs or sneezes.
Chickenpox: A highly contagious disease caused by the varicella-zoster virus (VZV).
Zika virus: A virus spread by an infected mosquito in areas where the virus is common. It can also be passed through sex with an infected person.

Rubella = if you didn’t get a vaccine. if someone is sick, can cause blindness. Need to give the live attenuated vaccine after birth

Cytomegalogivrus = generalized infection via droplets (saliva and other bodily fluids), daycare, healthcare delivery centers

Herpes = sexual or direct contact. transplacental (RARE), commonly transmitted via birth canal during active infection

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5
Q

What are late preterm babies at risk for? (THIRJ)

A

Temperature instability
Hypoglycemia
Intravenous Infusions
Respiratory distress
Jaundice

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6
Q

What is the difference b/w birth injury and congenital anomaly?

A

Birth Injury: structural destruction or functional deterioration of the neonate’s body due to a traumatic event at birth

Congenital Anomaly: structural or functional anomalies that occur during intrauterine life and can be identified prenatally, at birth, or sometimes detected later in infancy

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7
Q

What are common birth injuries?

A

Skull/Clavicle Fractures: clavicle most fractured bone

Head bleeds
Subgaleal hemorrhage: risky = above periosteum and between EA large space. Swelling past eyebrows
Extradural hemorrhage

PNS
Erb-duchenne: brachial plexus injury resulting in paralysis*
Facial paralysis
Cranial nerve - only one side of the face
Phrenic nerve injury
Diaphragmatic paralysis on affected side - respiratory distress

Bruising: occur more with traumatic/breech deliveries
Increased risk of hyperbilirubinemia
Ecchymosis and bruising greater than in preterm than term infants

Birth trauma: asphyxiated infant - prolonged lack of adequate perfusion and oxygenation to the baby’s organs leading to brain damage, damage to other organs, or death
Born hypoxic and acidotic
Prepare for resuscitation

Neurologic: ischemic injuries, periventricular/intraventricular hemorrhage.
Most common in low birth weight and very low birth weight
Don’t milk the chord.
Therapeutic head or body cooling reduces severity of neurological damage if used early after birth
May result in major (CP, seizures) or minor (ADHD, poor coordination)

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8
Q

What are the s/sx of a diaphragmatic hernia in a newborn?

A

incomplete closure of diaphragm resulting in ABD contents entering thoracic cavity

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9
Q

What are signs and symptoms and risk factors of newborn sepsis?

A

SX: Hypothermia/hyperthermia
Respiratory distress
Tachycardia/bradycardia
Lethargy/irritability
Poor feeding
Apnea
Poor perfusion/hypotension
Vomiting
Jaundice
Hepatomegaly
Cyanosis
Seizures
Abd distention
diarrhea

Risk factors: premature rupture of membrane (PROM), meconium stained amniotic fluid (MSAF), foul smelling liquor, low birth weight, prematurity and low Apgar score at birth.

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10
Q

How does bili lights contribute to jaundice treatment? How do you care for a child under bili lights?

A

Bili lights = makes bilirubin more water soluble so it can be more easily excreted
Eyes must be covered to prevent retinal damage
Adequate hydration
Exchange transfusion
Appropriate follow up

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11
Q

Why do we give betamethasone?

A

If the person will give birth preterm to increase lung maturation

Administered b/w 23-24 wks if mother has possibility of delivering within the next 7 days

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12
Q

What are symptoms and treatment of hypoglycemia in infants?

A

SX: jittery, hypothermic, grunting, flaring, retracting, poor feeding, lethargy

Prompt treatment with IV dextrose

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13
Q

How do we know when a baby needs to be resuscitated? What are the first steps in newborn resuscitation?

A

Is the baby breathing or crying? Good tone?
Warm, clear airway if necessary, dry, stimulate

HR below 100, gasping, or apnea?
PPV, SpO2, monitoring

HR below 100
Take ventilation corrective steps

HR below 60
Consider intubation, chest compressions, coordinate with PPV

HR below 60
IV epinephrine

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14
Q

What are signs and symptoms of neonatal abstinence syndrome and nursing care/medications for infants?

A

NAS: Neonatal withdrawal after intrauterine exposure to certain drugs. Occurs with abrupt cessation of drug exposure at birth, most commonly with opioids or sedatives, polysubstances, barbiturates, alcohol

SX: Hypertonia, tremors, hyperreflexia, seizures, irritability/restlessness, high pitched cry, excessive crying, sleep problems,

TX: Promote infant and maternal regulation and to minimize the signs of NAS expression
Quiet, calm, dark environment
Feed well
Give medication = morphine or similar opioid to help withdraw comfortably
Don’t give: narcan

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15
Q

What is the difference between physiological vs pathologic jaundice?

A

Physiological
Seen in > 50% of all neonates
SX occur AFTER first 24 hrs of life
Cause: inability to metabolize bilirubin r/t to immature liver

Pathological
Less common but more serious
Jaundiced AT birth or WITHIN first 24 hrs of life
Cause: hemolysis in utero r/t to Rh factor or ABO incompatibility

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16
Q

What are common complications of infants who are preterm (below 1500g)?

A

Poor placental function- infant not receiving enough glucose, nutrients, etc. to support adequate fetal growth- Maternal infections, congenital malformations, chromosomal anomalies, genetic factors preeclampsia, severe diabetes smoking, drinking ETOH abuse, severe maternal malnutrition.

Hypoglycemia is common because of inadequate glycogen stores in the liver poor thermal regulation due to white fat and brown fat have been used up in utero to maintain the infant

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17
Q

What is the importance of fetal movement to assessing the wellbeing of the fetus?

A

Fetal movement - reassuring sign of fetal health
Decreased fetal movement = warning sign of impaired fetal oxygenation status and needs to be reported and evaluated
During 3rd semester, fetus makes 30 gross motor movements an hour, birthing parent feels 70-80%
Sleep cycles = 40 mins

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18
Q

What are the common causes of hemorrhages in immediate postpartum period?

A

80% of cases - uterine atony
Over distended uterus
Retained placenta fragments
Anesthesia and analgesia
Previous hx of atony
High parity
Prolonged labor, use of oxytocin
Trauma during labor and birth - forceps, vacuum, c section

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19
Q

What is the cause of early postpartum hemorrhage vs late postpartum hemorrhage?

A

Early postpartum hemorrhage = within the 24 hrs of birth, uterine atony

Late postpartum hemorrhage = after 24 hours but less than 6 weeks, retained placental fragments

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20
Q

What are signs and symptoms of thrombophlebitis, risk factors, and diagnostic methods?

A

SX: Swelling of veins. Blood clot in the vein can cause swelling.
Redness, pain

Risk factors:
Obesity
Length of labor/c section
Advanced maternal age

Diagnostic methods:
ask about discomfort and look for affected veins near the skin’s surface.
Can use ultrasound

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21
Q

What are signs, symptoms, and causes of various types of postpartum hemorrhages?
Cervical lacerations
Perineal Hematoma
Late PPH

A

Lacerations:
- Signs: continued bleeding despite firm fundus
- Causes: first baby, large baby, malpositioned head, use of VE or forceps

Hematoma:
- signs: blood collects in connective tissue of reproductive tract. bulging mass

Uterine inversion: fundal location

Late PPH: after 24 hrs PP up to 6 wks. Usually 7-14 days PP.
Uterine subinvolutino r/t retained placental fragments/infection

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22
Q

What are the most common medications used to manage PPH, what are the major contraindications to each of these medications?

A

Pitocin
Lactated ringers, titrated to uterine firmness
Contracts uterus

Methergine (methylergonovine)
Same family as LSD
Causes smooth muscle contractions
Contraindicated in people w severe hypertension (preeclampsia)

Hemabate (carboprost)
Causes massive uncontrolled diarrhea due to due to smooth muscle contractions
Causes uterine contraction and bronchoconstriction
Contraindicated in asthmatics

Cytotec (misoprostol)
Early abortion, induce labor in small amounts
Given after labor to cause contractions
rectally

Tranexamic acid
Antifibrinolytic drug
Helps clotting cascade
Reduces bleeding in surgical and trauma pts

Dinoprostone
Not given as much

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23
Q

What is the differences between and treatment of postpartum blues, postpartum depression and postpartum psychosis?

A

Postpartum blues: subsyndromal depressive sx
Mild transient mood disturbance - emotionally labile. Restless, fatigue, easily cries, sad
Peaks at 5 days, subsides by 10

Postpartum depression: major mood disorder
SX: far more persistent than pp blues, irritability, tearful, despondent, feelings of inadequacy, guilt, unable to cope, fatigue, difficulty concentrating, sleeping, lack of interest in activities and appearance, guilt about depressive feelings. Severe anxiety &panic attacks.
Red flags: inability to sleep and thoughts of self harm or harm to infant
Treatment:
Medication: ssri & tricylics
Psychotherapy
Peer support groups
Individualized care
Family education

Postpartum psychosis
SX
Sleep disturbance, agitation, irritability
Delusions
Hallucinations
Potential for suicide and/or infanticide
Tx:
Psychiatric emergency
Hospitalization
Recover w aggressive tx

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24
Q

What are s/sx of a puerperal (postpartum) infection? Endometritis, wound infections, UTI, mastitis

A

Endometritis: most common
Infection of lining of uterus beginning at placental site.
Fever, uterine tenderness, tachycardia that parallels the rise of temp, midline lower abd pain

Wound infections

UTI

Mastitis
Initial lesion: Nipple fissure, then ductile system
Fever, chills, localized tenderness, palpable, hard reddened mass

Predisposition to puerperal infection

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25
How do you calculate QBL?
Weigh chux and pads and anything else with blood, subtract dry weight and any amount of solutions like saline that we used 1 G = 1 ML of blood
26
First actions in a postpartum hemorrhage- what is the first thing that a nurse should do when an increase in bleeding is noted?
Massage fundus with only the force needed to obtain contractions and express clots Provide uterotonic drugs to manage PPH.
27
What is the purpose, side effects of magnesium and how do you identify magnesium toxicity?
Mag Sulfate = CNS depressant used to prevent seizure activity Side effects: nausea, cramping, diarrhea Magnesium Toxicity: hypotension, nausea, vomiting, facial flushing, retention of urine, ileus, depression, and lethargy before progressing to muscle weakness, difficulty breathing, extreme hypotension, irregular heartbeat
28
What is a hydatifidorm mole pregnancy? What should be involved in patient teaching after a hydatifidorm mole pregnancy?
Definition: noncancerous tumor that develops in uterus = nonviable pregnancy Teaching: Follow up serum hCG levels for at least 1 year to detect trophoblastic neoplasia, if normal for a year, may consider pregnancy Avoid pregnancy for a year and come in to be assessed for trophoblastic neoplasia.
29
Why do we put in cerclages and what are the goals?
Placed due to cervical insufficiency - inability of uterine cervix to retain a pregnancy in the 2nd trimester in absence of clinical contractions, labor, or both Placed at 11-15 wks, removed when 37 wks or spontaneous labor
30
What do biophysical profiles tell us? How are they scored?
BPP = noninvasive, easily learned and performed antepartum test for eval fetal well being. Ultrasound used to assess Fetal movement Fetal tone Fetal breathing Amniotic fluid vol Non Stress Test Separate nonstress tests of the fetal HR can also be performed as a component of BPP.
31
Placenta previa- what is it? What is contraindicated when a person is diagnosed with one?
Late pregnancy bleeding that covers opening of cervix Placenta implanted in lower uterine segment near or over internal cervical os Contraindications: delivering vaginally with complete previa. Never do a vaginal exam on a patient – plan for a c section
32
What is the difference in fetal issues between patients dx with gestational diabetes and type 1,2 diabetes?
Pregestational diabetes Type 1: absolute insulin deficiency Type 2: relative insulin deficiency Risk of fetal anomalies increases due to diabetes Gestational diabetes (develops after 20 wks of pregnancy) When pancreas is unable to meet increased demand for insulin production during pregnancy A1: 2 or + abnormal values on the oral glucose tolerance test but fasting and postprandial glucose values are diet controlled A2: was not know to have diabetes prior to pregnancy but now requires medication for glucose control Risk of fetal anomalies doesn’t increase due to diabetes
33
With GDM, what is our first mode of treatment?
Insulin therapy = readjusted as pregnancy progresses Monitor blood glucose levels
34
What is the first line tx of patients hospitalized with hyper-emesis?
Excessive vomiting. Accompanied by dehydration, elyte imbalance, ketosis, acetonuria = acetone in urine Loss of 5% of pregnancy weight Tx: IV fluid and electrolyte replacement. TPN in severe cases Monitor fetus Small meals, clear liquids
35
What are the s/sx and tx of preeclampsia?
SX: - CNS dysfunction New onset cerebral or visual disturbance Photopsia, scotomata, cortical blindness, retinal vasospasm Severe headache Altered mental status - Hepatic abnormality Severe persistent RUQ/serum transaminase concentration - Severe BP elevation 160/110 thrombocytopenia - Renal abnormality Progressive renal insufficiency - Pulmonary edema TX: Mild Preeclampsia: home care Activity restriction BP Weight Urinalysis Diet Consider steroids if fetus is preterm Severe features: hospital care Magnesium sulfate Control BP w nifedipine, hydralazine, labetalol, methyldopa Delivery of baby when risks to mom outweigh benefits of continued pregnancy
36
What are s/sx of HELLP syndrome?
Severe preeclampsia with hepatic dysfunction. Dx assoc. W increased risk for adverse perinatal outcomes Hemolysis (H) Elevated Liver Enzymes (EL) Low Platelets (LP)
37
What is the purpose of antiretrovirals when treating HIV in pregnancy?
Reduces chance that HIV infection will be transmitted from HIV pregnant person to child Untreated = birthing parent child transmission rate is 18-26%
38
What is the diff b/w monochorionic and dizygotic? What are the common complications with monochorionic twins?
Monochorionic - when the fetus shares a placenta Identical, always same gender Dizygotic - fertilization of 2 eggs Same or different genders Twin to twin transfusion syndrome; One twin (donor) becomes dehydrated and other twin (recipient) develops high BP and produces too much urine and overfills sac
39
Ectopic pregnancy- what is it? S/sx? How do we treat it?
Pregnancy where gestational sac is implanted outside uterine cavity ABD pain/tenderness progresses as pregnancy progresses, accompanied by dark red or brown vaginal bleeding TX: Methotrexate if < 6 wks to stop growth of pregnancy Advanced: requires surgery
40
Difference between a placenta previa and an abruption- what are signs of each?
Placental abruption: when placenta prematurely separates from wall of uterus Vaginal bleeding, dark red, but might not be any ABD pain Back pain Uterine tenderness, rigidity Uterine contractions Placenta previa: placenta implanted in lower uterine segment near or over internal cervical OS Vaginal bleeding, usually bright red and painless
41
NSTs- what is a reactive, non-reactive NST? How do you identify?
Nonstress test: assessment of fetal well being that analyzes response of fetal heart to fetal movement, performed after 23-24 wks of gestation Reactive NST: 2 accelerations over 20 min period, normal baseline, moderate variability, and no decelerations False pos - fetal sleep cycles, medications, fetal maturity
42
What are the fetal effects of tobacco use in pregnancy?
Spontaneous pregnancy loss, placental abruption, preterm PROM, placenta previa, preterm labor and delivery, low birth weight, and ectopic pregnancy Long term consequences: SIDS, respiratory infections, asthma, atopy, otitis media, infantile colic, bronchiolitis, short stature, lower reading/spelling scores, shorter attention span, hyperactivity, childhood obesity, decreased school performance Secondhand smoke: still birth and LBW
43
Oxytocin: uses, effectiveness, when do we discontinue it? (think uterine tachysystole and/or fetal issues)
Labor stimulation Induction of labor D/c: -If contractions last longer than 60 seconds -consistently occur more often than every 2 mins - uterine tetany (continuous contraction)
44
Risk factors and nursing care of a prolapsed cord
Risk factors Long cord Malpresentation (breech) Transverse lie Unengaged presenting part Nursing care: 1. position woman head down with hips elevated (in knee chest, modified sims or trendelenburg) 2. keep gloved hand in vagine and exert upward pressure on fetal presenting part to stop compression of cord
45
What are nursing actions when a patient has an amniotic fluid embolism?
Amniotic fluid embolism: when amniotic fluid enters maternal circulation and obstructs pulmonary vessels, causing sudden onset of respiratory distress and circulatory collapse. Actions: 1. give immediate and vigorous tx 2. give oxygen by facemask 3. maintain normal blood volume thru admin of plasma and IV fluids
46
What does a nurse do during a shoulder dystocia and why?
Head is born but the anterior shoulder can’t pass under pubic arch. Nurse needs to perform McRoberts maneuver and apply suprapubic pressure while woman flexes her thighs against her ABD which straightens pelvic curve
47
What are the contraindications to a vaginal delivery?
Trauma to the infant head, nerve damage Cervical lacerations, hematomas, trauma to perineum
48
TOLACs and VBACs- what do you need to know before one can be offered?
TOLAC - trial of labor after cesarean Failed TOLAC without VBAC = repeat cesarean delivery Risk of rupture of uterus = emergency C section Previous transverse uterine incisions has lowest risk of rupture. T shaped uterine incisions - higher risk of uterine rupture VBAC - vaginal birth after cesarean (successful)
49
How do we know if someone is in preterm labor?
Menstrual like cramping Mild irregular contractions Low back ache Pressure sensation in the vagina or pelvis Vaginal discharge of mucus = may be clear, pink, slightly bloody (mucus plug, bloody show) Spotting, light bleeding
50
What are s/sx of uterine rupture?
Serious obstetric injury *Warning signs: non reassuring FHR, loss of fetal station, constant abdominal pain with tearing sensation, cessations of UC’s, signs of shock *Prepare for emergency cesarean & neonatal resuscitation
51
What are s/sx of shoulder dystocia?
Shoulder dystocia is when, after vaginal delivery of the head, the baby's anterior shoulder gets caught above the mother's pubic bone. Signs include retraction of the baby's head back into the vagina, known as "turtle sign". Complications for the baby may include brachial plexus injury, or clavicle fracture.
52
What are s/sx of prolapsed cord?
palpated during a vaginal exam. decelerations, and/or variable decelerations with EFM. Abnormal FHR pattern following ROM may be the first indication of cord prolapse. the umbilical cord is seen in front of presenting part during an ultrasound.
53
What are s/sx of amniotic fluid embolism?
when amniotic fluid enters maternal circulation and obstructs pulmonary vessels, causing sudden onset of respiratory distress and circulatory collapse.
54
What medications are given during pregnancy?
Hemabate (Carboprost) Synthetic prostaglandin which causes uterine contractions. Usually used as a second line medication Pitocin (Oxytocin) Naturally produced in the hypothalamus and released by the posterior pituitary. Given IM/IV as first line Methergine (Methylergonovine) This medication is in the same family as LSD but is at 10x below causing hallucinogenic effects Cytotec (Misoprostol) A synthetic prostaglandin medication used to prevent and treat stomach and duodenal ulcers, induce labor, cause an abortion Tranexamic Acid An antifibrinolytic drug that reduces bleeding, it can decrease the risk of death due to bleeding by one third
55
Endometritis = most common cause of PP infection. It is an infection of the lining of the uterus. It usually begins at placental sited is treated with abx and supportive care. What are the signs and symptoms of endometritis? (SATA)
Tachycardia - parallels the rise in temperature Uterine tenderness! Fever
56
The nurse is assessing neonatal heads. On the first infant the nurse feels edema on the head the crosses the suture lines. The nurse knows that this is benign and likely a result of the birthing process. The nurse charts this as
caput
57
The nurse feels the skull of the next infant, the nurse feels swelling that does not cross suture lines and is limited to one of the skull bones. The nurse understands that this is a small bleed that occurred between the periosteum and the skull bone. It is limited in size and unlikely to cause issues. The nurse charts this as
cephalohematoma
58
On the third infant, the nurse feels the head and it feels like a water balloon, a fluctuant mass with ill defined borders. The nurse understands that is a bleed between epicranial aponeurosis of the scalp and the periosteum. The nurse knows this is a rare type of bleed but a medical emergency. The nurse charts this as a
subgaleal hemorrhage
59
A term infant is born and placed skin-to-skin with the birth parent. At 10 seconds of life the infant is not displaying respiratory effort. The first nursing action should be to:
open airway, continue to dry and stimulate, keep warm
60
A type 1 diabetic patient has elevated serum gluclose levels throughout her pregnancy in particular in the first trimester. Which of the following potential complication may occur in the fetus?
Congenital anomalies
61
A woman who has had no prenatal care was assessed and found to have polyhydramnios on admission to the labor unit and has since delivered a baby weighing 4500 grams. Which of the following complications of pregnancy likely contributed to these findings?
Gestational diabetes
62
Approximately 8 hours ago, your patient, a 32-year-old G1 P0, gave birth after 2 hours of pushing. She required an episiotomy and a forceps birth for birth of a 4190 gram newborn. When performing an assessment of her perineal area a walnut sized bulge is visualized with the presence of ecchymoses to the right of the episiotomy. You patient describes her perinuim as “extremely painful.” The most likely cause of these signs and symptoms is:
Hematoma formation
63
During the postpartum assessment, the perinatal nurse notes that a patient who has just experienced a forceps-assisted birth now has a large quantity of bright red bleeding. Her uterine fundus is firm. The nurse's most appropriate action is to notify the physician/certified nurse midwife and describes a:
Need for vaginal/cervical assessment and repair
64
The labor and delivery nurse is doing advice calls. A 35 week pregnant person calls the advice line and states, "I last felt my baby move 12 hours ago. They are usually pretty active around now, I am concerned, what do you recommend I do?" The best response would be:
"I would like you to come to the hospital now so that we can monitor you and your baby."
65
The nurse is performing a non-stress test on a pregnant person at 34 weeks. The NSTs have been ordered 2x a week as the patient is a type 1 diabetic and her blood glucose has been difficult to control. The nurse interprets this strip as:
reactive NST indicating current fetal well-being
66
The nurse is working in triage. A pregnant person walks in, stating that they are 30 weeks pregnant and just "doesn't feel well." The nurse places the person on the monitor and sees that there are no contractions, the fetal heart rate is 140, moderate variability with accelerations. Vital signs are: 98.3-85-16-142/92. 97% on RA. Urine dips at 3+ protein. What should the nurse include in the assessment? (Select all that apply) Ask the patient about any vision changes Check for edema, especially edema in the hand and face Ask the patient about any headaches Check for clonus Check reflexes Ask the patient about any epigastric pain Ask the provider to order a CBC with diff, AST/ALT, uric acid, a 24-hour urine, and a protein-creatinine ratio
Ask the patient about any vision changes Check for edema, especially edema in the hand and face Ask the patient about any headaches Check for clonus Check reflexes Ask the patient about any epigastric pain Ask the provider to order a CBC with diff, AST/ALT, uric acid, a 24-hour urine, and a protein-creatinine ratio
67
The nurse is doing advice calls. A person calls and states that they had a positive pregnancy test 3-weeks ago, but they haven't seen their OB yet. The patient states that they are experiencing some brown discharge which looks like old blood to them, and generalized abdominal pain which is increasing and radiating to the shoulder. They are also feeling lightheaded. The nurse suspects that the patient is experiencing:
ECTOPIC PREGNANCY SYMPTOMS Symptoms of ectopic pregnancy, when they occur, appear early in pregnancy, sometimes before the woman realizes she is pregnant. The most common symptoms include: Abdominal pain A missed menstrual period Vaginal bleeding, which may be minimal Symptoms of pregnancy (such as breast tenderness, frequent urination, or nausea)
68
A placental abruption is when part or all of the placenta prematurely separates from the wall of the uterus. The amount of separation dictates the severity of the problem. The birthing parent will be bleeding into the abruption site and the fetus will have its 02 supply and other placental functions disrupted. A placenta previa is when the placenta grows over the os (the opening- the cervix) of the uterus. When the cervix starts to dilate massive bleeding will happen, and, if not treated, may kill the birth parent and fetus. Which of the following is true for a patient experiencing a complete placenta previa?
The birthing parent will have a c-section to deliver the baby
69
Twins are always high-risk pregnancies because of the stress that is put on the birthing body. Dizygotic twins, accounting for about 70% of all twins, are always fraternal twins, meaning that each twin is genetically unique.Monozygotic twins, accounting for 30% of all twins, are _____ identical twins, meaning they have the same genetic information. Monochorionic, diamniotic twins means that the twins share a ___ , but not ______
ALWAYS PLACENTA AMNIOTIC SAC
70
A patient who is in the third trimester of pregnancy is informed that she will need a cesarean hysterectomy and bladder reconstruction due to a placenta defect. Which medical condition does the nurse explain to the patient?
Placenta percreta
71
A primiparous woman has been admitted at 35 weeks' gestation and diagnosed with HELLP syndrome. Which of the following laboratory changes is consistent with this diagnosis
Hematocrit dropped to 28% Normal: 36-44%
72
A woman who is 36 weeks pregnant presents to the labor and delivery unit with a history of congestive heart disease. Which of the following findings should the nurse report to the primary health-care practitioner?
10-pound weight gain in two weeks
73
The patient is complaining of back pain. The nurse performs Leopold's maneuvers and finds the fetus to be in this position:
Occiput posterior (OP)
74
A patient at 34 weeks gestation is in labor with twins. The primary care provider decides the fetuses need to be delivered by cesarean. What medical and nursing interventions will be in place for this delivery?
1. Delivery is attended by two medical personnel. For multiple births, either two experienced obstetricians or one obstetrician and a board-certified midwife will attend the delivery. 2. The placement of a large-bore IV access is ensured. The nurse will make sure that a large-bore IV access is in place for fluid replacement in case of hemorrhage or need for emergency fluid replacement and anesthesia administration. 3. A hospital with a Level II or III nursery is selected. Due to the possibilities of fetal distress or need of special care related to immaturity, the cesarean needs to be performed in a hospital with either a Level II or III nursery.
75
A patient at 36 weeks gestation reports a constant dull backache, regular frequent contractions that are painless, and lower abdominal pressure. Physical examination reveals intact membranes and cervical dilation of 3 cm. Which order by the health care provider is unexpected by the nurse?
Obtain fetal fibronectin levels
76
A patient is being prepared for an unplanned cesarean section. Which pre-procedure information is most important for the nurse to report before the administration of regional anesthesia?
Laboratory value indicating a low platelet count
77
A patient who is pregnant expresses a desire to attempt a vaginal delivery after a cesarean birth 2 years before. The primary care provider initiates trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (CVAC) screening. The nurse is aware that which patient information will likely disqualify the patient for CVAC?
Cesarean due to pelvic abnormalities
78
During labor induction with oxytocin, the fetal heart rate baseline is in the 140s with moderate variability. Contraction frequency is assessed to be every 2- 2 1/2 minutes with duration of 60 seconds, of moderate strength to palpation. Based on this assessment, the nurse should take which action?
Maintain present oxytocin infusion rate and continue to assess
79
If the umbilical cord prolapses during labor, the nurse should immediately:
Apply manual pressure to the presenting part to relieve pressure on the cord
80
In preparation for a emergent cesarean birth, the nurse expects what medical-based preoperative interventions?
1. Administration of prophylactic antibiotics Administration of narrow-spectrum prophylactic antibiotics should occur within 60 minutes prior to the skin incision for any cesarean. If the cesarean is emergent, the antibiotics can be administered during or immediately after the procedure. Prescription of medications is a medical-based intervention. 2.Assessment for risk of venous thromboembolism (VTE) Performing an assessment for risk of venous thromboembolism (VTE) and classifying the woman based on VTE classification guidelines is a medical-based intervention. Preoperative anticoagulant therapy may be necessary for women classified as moderate or high risk or with a history of recurrent thrombosis. 3. Prescription for sequential compression devices prior to surgery Application of sequential compression devices prior to surgery is to promote lower extremity circulation and aid in the prevention of blood clots. The nurse performs the action based on a medical prescription.
81
Preeclampsia Pathophysiology
Implantation of blastocyst in the wall of the uterus Cytotrophoblasts are released from blastocyst with the job of telling spiral arteries to straighten and dilate to bring greater blood flow to uterus Cytotrophoblasts fail to invade deeply enough. Inadequate spiral artery remodeling Blood flow diminished to the uterus resulting in placenta hypoxia/ischemia Hypoxic placenta releases proinflammatory proteins/antiangiogenic factors Endothelial cell disruption and vasospasm Proteinuria, high blood pressure, headache, blurry vision, edema, epigastric pain, hyperreflexia, clonus End organ failure, stroke, HELLP, eclampsia

Maternity (2 decks)

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