Introduction Part 1 maternity & mental health Flashcards
1
Q
electronic fetal monitoring identifies what
A
non reassuring fetal heart rate tracings
2
Q
what is the amplitude of external contraction monitoring effected by?
A
belt tightness, amount of adipose tissue, amount of amniotic fluid, position of mom and fetus and contraction strength
3
Q
internal monitoring can be used only if…
A
after the rupture of membrane and cervical dilation
4
Q
internal contraction monitoring accurately measures what
A
frequency, duration, intensity, resting tone, fetus’s favorite color
5
Q
what is the normal fetal heart rate baseline
A
110-160 bpm
6
Q
the frequency of a contraction is measured on the strip from what to what
A
beginning of one contraction to the beginning of the next contraction
7
Q
the resting phase of a contraction pattern is wen the fetus gets what
A
re-oxygenated
8
Q
when can you start listening to the fetal heart rate
A
8-12 weeks
9
Q
abnormal findings in heart rate mean what
A
a compromised fetal state
10
Q
what are reasons that a fetal heart rate can not be auscultated
A
too early in pregnancy fetal death maternal obesity polyhydramnios fetal position peak of contraction
11
Q
polyhydramnios
A
too much amniotic fluid
12
Q
why was fetal monitoring first done
A
so cerebral palsy can be detected
13
Q
doppler
A
ultrasound device, detects heart rate, used for low risk labor
14
Q
electronic fetal monitoring
A
ongoing assessment of fetal oxygenation, looking for changes, device is placed over the fetal back and transmits to the monitor
15
Q
the electronic fetal monitoring measures what
A
rate and pattern of fetal heart tones
16
Q
uterine monitoring
A
placed on maternal fundus (top portion of uterus, gets tightest during contractions), measures in mmHg
17
Q
uterine monitoring measures what
A
frequency, duration, intensity and resting tone
18
Q
where is the fetal internal monitoring placed
A
electrode is clipped to baby’s skin (scalp)
19
Q
does external monitoring show intensity of a contraction?
A
no, intensity is done by palpation
20
Q
why is internal monitoring used
A
more accurately detects fetal heart rate and changes in FHR, and is not impeded by obesity, position or fluid
21
Q
internal uterine monitoring is done because
A
shows pressure changes in uterus, more exact (objective) measurement of uterine activity (frequency, duration, resting tone and intensity)
22
Q
what are the components of the internal/external monitoring paper
A
upper portion = fetal heart rate
lower portion = uterine activity
small block 10 seconds
large block 1 minute
23
Q
average fetal HR observed during a 10 minute window, increases and decreases will not be counted
A
baseline
24
Q
interplay between the sympathetic and parasympathetic nervous systems
A
baseline variability
25
absent baseline variability
amplitude is undetectable
26
minimal baseline variability
1-5 bpm (peak to trough)
27
moderate baseline variability
6-25 bpm (peak to trough)
28
marked baseline variability
more than 25 bpm (peak to trough)
29
where do we want the baseline variability to be?
moderate
30
what is the most sensitive indicator of fetal well being, and most important aspect of the strip
baseline variability
31
baseline of less than 110 bpm
bradycardia
32
what can unresolved bradycardia lead to
hypoxia
| *intervention is needed
33
baseline of greater than 160 bpm
tachycardia
34
baseline of greater than 180 bpm
severe tachycardia
35
visual abrupt, temporary increase in FHR above baseline
accelerations
| increase of 15 bpm, that 15 seconds of baseline from beginning to end
36
are accelerations normal? why or why not
yes, indicate fetal well being and an intact nervous system (seen with fetal movement)
37
decrease of FHR baseline, occurs with blood supply change to fetus
decelerations
38
Early Deceleration
gradual decrease of FHR below baseline, ALWAYS occurs with the contraction
*mirrors contraction
39
cause of early deceleration
fetal head compression
40
fetal head compression causes what
increase of ICP = decrease cerebral blood flow = vagal nerve stimulation = decrease of FHR
41
variable deceleration
abrupt decrease of FHR & abrupt recovery
| Shape of V, W, U
42
are variable decelerations common
yes
43
what is the cause of a variable deceleration
cord compression
44
late deceleration
gradual decrease in FHR, occurs after contraction and with every contraction
**NOT GOOD
45
when does an early deceleration happen
mirrors contractions
46
when does a variable deceleration happen
varies
47
when does a late deceleration happen
after every contraction and with every contraction
48
cause of late deceleration
utero-placental insufficiency
| *decrease in available O2 to fetus
49
fetal heart rate patterns that are abnormal may indicate what
fetal distress
50
what are S & Sx of fetal distress
bradycardia, tachycardia, decrease baseline variability (decrease of fetal movement), periodic changes
51
POPI
POSITION-relieve cord compression & fetal weight on moms vena cava (Left lateral position)
OXYGEN-non re-breather 10 lpm
Stop PITOCIN-stop Rx, which will stop contractions
IV Bolus- increase blood flow to fetus, increase intravascular volume
52
what can be done if there is fetal distress
POPI, internal monitor, call MD, administer tocolytic
53
Tocolytic
soften uterus (stop contractions)
54
who dictates the definition of "mental illness"
society
55
the inability of the general population to understand the motivation behind a behavior.
incomprehensibility
56
behavior is categorized as "normal or abnormal" according to ones cultural or societal norms
cultural relativity
57
the walking wounded
Severely mentally ill
this population is neglected, the people who need the most care are the ones who are not getting the help bc are poor or no insurance
58
worried well
majority of people in therapy, see therapist bc they have the money or insurance to pay for it
59
homelessness
70% are linked to drug/alcohol use
60
pre-enlightenment
Assistance- least restrictive approach, provided food and money to help keep family intact
Banishment-wandering bands of lunatics
Confinement-most restrictive, often chained, placed on display
61
period of enlightenment
1790 asylums, Dorothea Dix had first asylum in US
62
period of scientific study
1870 shift from sanctuary to Tx
sigmound freud
classification of mental disorders
63
period of psychotropic drugs
1950
Thorazine: antipsychotic
Lithium: antimanic
Tofranil: antidepressant
64
period of community health
1960
least constrictive movement
federal funds
commitment laws
65
decade of the brain
1990s
brain research
1st diagnostic manual
1st introduced into RN books
66
Axis I
the mental disorder
67
Axis II
disorders related to personality & mental retardation
68
Axis III
Current medical problems
69
Axis IV
Psychosocial/Environmental Problems
| -loss of job, homelessness, prison etc
70
Axis V
Global Assessment of Functioning (GAF)
| scale of 0-100
71
what 3 things are needed in the psychotherapeutic management
nurse patient relationship-use of self
psychopharmacology-use of Rx
milieu-use of environment
72
what is the major intervention is the nurse patient relationship
communication
73
rapport
development of trust, getting acquainted
74
empathy
hear what you are saying and ask how YOU are feeling
75
sympathy
feeling sorry for someone and relating how it has effected them
76
what are circumstances that blur boundaries
over helping, controlling, narcissism, transference, counter-transference
77
transference
pt relates caregiver as someone they know
78
counter-transference
caregiver relates pt as someone they know
79
narcissism
all about me not the pt
80
milieu
therapeutic community or environment
81
active listening allows for the RN to do what
watch pts non-verbals
82
using silence allows for the client to do what
gives client the opportunity to collect and organize thoughts
83
paraphrasing
restating in different words
84
restating
repeating the main idea and using the same key words
85
reflecting
questions and feeling are referred back to client
86
nursing process
assessment, verify data, nursing Dx, outcomes, planning, implementation, evaluation
87
S & Sx for postpartum infection of uterus
uterine tenderness, pain, foul smelling lochia, temp elevation, tachycardia, N/V, chills
88
S & Sx for postpartum infection of episiotomy
tenderness, firmness, edema, redness, loss of approximation, may or may not have temp
89
S & Sx for postpartum infection of UTI
LQ pain, dysuria, frequent voids, incomplete emptying of bladder, bladder distention, temp increase
90
S & Sx for postpartum infection of phlebitis
pain, warmth, tenderness, color changes, low grade temp, Homan's sign may or may not be present
91
BUBBLE-HE
```
breast
uterus
bladder
bowel function
lochia
episiotomy/perineum
Homans sign
emotional stress
```
92
what is the #1 Dx for pregnancy pt
risk for bleeding
93
why is risk for bleeding the #1 Nursing Dx for any OB pt
overstretched uterus, weak tired muscles, obstruction, trauma
94
lochia Rubra
red 3-4 days
95
lochia serosa
pink 4-10 days
96
lochia alba
white 10 days- 2 weeks
97
fundal
top of fundus (uterus)
98
fundal height and firmness day of delivery
at umbilicus
99
fundal height and firmness 1 day after deliver
1 finger breath below umbilicus
100
involution
decreasing of size of uterus after birth
101
amenorrhea
absence of menstruation
102
quickening
first movements of fetus felt by the mother (16-18 weeks)
103
funic souffle
hissing sound synchronous with fetal heart beat and produced by the umbilical cord
104
uterine souffle
heard when auscultating abdomen over the uterus
105
bloody show
discharge of blood tinged mucous from cervix as labor begins
106
effacement
thinning measurement of the cervix
107
protracted
slow rate of progress
108
prolonged
long span of time for progress to occur
109
arrested
progress stops
110
gestation
number of weeks since first day of last menstrual period
111
abortion
birth that occurs before end of 20 weeks gestation
112
fetal demise
fetal death
113
term
normal duration of pregnancy (37-42 weeks)
114
antepartum
time between conception and the onset of labor; prenatal
115
intrapartum
time from onset of true labor until birth of infant and placenta
116
postpartum
time from birth until woman's body returns to pregnant condition
117
premature labor
labor that occurs between 20 and 36 and 6/7 weeks
118
still birth
infant born dead after 20 weeks
119
gravida
any pregnancy, including present
120
nulligravida
never been pregnant
121
primigravida
pregnant for the 1st time
122
multigravida
multiple pregnancies
123
para-
birth after 20 weeks gestation
124
nullipara
no births after 20 weeks gestation
125
primipara
one birth after 20 weeks gestation
126
multipara
two or more births after 20 weeks
127
GTPAL
```
G- # times pregnant
T- # of term births
P- # of premature babies
A- # of pregnancies ending in abortion
L- # of living children
```
128
AGA
appropriate for gestational age
129
AMA
advanced maternal age
130
AROM
artificial rupture of membranes
131
C/S
c section
132
CNM
certified nurse midwife
133
CPD
cephalopelvic disproportion
134
Ctx
contractions
135
EDC
est date of confinement
136
EDB
est date of birth
137
EDD
est date of delivery
138
FHT
fetal heart tones
139
FHS
fetal heart sounds
140
FOB
father of baby
141
GBS
group b strep
142
IUFD
intrauterine fetal demise
143
LGA
large for gestational age
144
LMP
last menstrual period
145
MLE
midline episiotomy
146
NB
neborn
147
NST
non stress test
148
NSVD
normal spontaneous vaginal delivery
149
PN
prenatal
150
PROM
premature rupture of membranes
151
SGA
small for gestational age
152
SVD
spontaneous vaginal delivery
153
VBAC
vaginal birth after C section
154
VE
vaginal exam
155
Vtx
vertex
156
storage of breast milk
5 hours on counter
5 days in fridge
5 month in freezer
157
no pacifiers until when
4-6 weeks
158
are babies born hungry
no
159
sore nipples result from what
poor positioning, shallow latch
160
where is the baby placed after delivery
skin to skin
| promotes oxytocin release-decrease bleeding
161
how many feedings in 24 hours
6-8
162
1st 24 hours the baby should pee and poop
1 pee 1 poop, increases by one each day
163
maternal benefits for breast feeding
burns calories, contracts uterus, lower cost
164
benefits for newborn for breast feeding
forms barrier in intestines, decrease risk of respiratory , obesity and cancer, increase brain growth, prevents allergies
165
American academy of pediatrics recommend breast milk for how long
6 months
