Learn system Maternal NB 1 & 2 Flashcards
Post-op care of cerclage. P understands teaching?
a. I realize this will be my last pregnancy
b. I must avoid intercourse for the duration of my preg
c. I have to go to the hosp at the 1st sign of labor
d. I may notice some vaginal blding the 1st week after procedure
c. Cerclage is the suturing of the cervix in order to prevent painless dilation of the cervix during the 2nd trimester (which is a primary cause of recurrent spont. abortions). Sutures need to be removed near term, or at 1st sign of labor, in prep for vaginal deliveries, unless the p is having a C-section. Women can have further pregnancies, sex is not CI’d, and vaginal blding is abnml after a cerclage
P. reports constipation and that she has been taking mineral oil 30 mL q morning the past 3 weeks. RN response?
a. the med is more effective if taken at bedtime
b. let’s discuss your dietary and activity routine
c. tell me how effective the med has been
d. let’s discuss alternatives to treat your constipation
b. Asking the p. about activities and diet will allow the RN to provide suggestions to reduce constipation. Mineral oil, although more effective if taken at HS, should not be used in pregnant women as it interferes with absorption of fat-soluble vitamins and other nutrients. The RN should suggest alternatives
WOTF HCP orders should the RN question for a p. who is dx’d w/ placenta previa and admitted w/blding?
a. perform a vag exam
b. perform continuous FHR monitoring
c. take VS q15 minutes
d. assess hourly for onset of UCs
a. Vaginal examinations are CI’d for placenta previa and placenta abruptio as manipulation during the exam can cause tearing and increased blding. Placenta previa is a condition in which the placenta implants in the lower part of the uterus and obstructs the cervical os (opening to the vagina). The other options are all correct
Wotf fetal system anomalies is r/t Oligohydramnios?
a. cardiac
b. renal
c. GI
d. neurologic
b. Oligohydramnios is an abnmlly low level of amniotic fluid (less than 300 mL during the 3rd trimester) that is r/t poor placental bld flow, preterm membrane rupture, failure of fetal kidneys to develop, or blocked fetal urinary excretion. Cardiac anomalies do not affect amn. fld. GI and neurologic anomalies usually result in polyhydramnios
P. receiving oxytocin for labor induction. After one hour, UCs are 90-100 seconds and occurring q1-2min. RN action?
a. slow the maintenance IV fluid infusion rate
b. increase the flow rate of the maintenance IVF
c. d/c the oxytocin infusion
d. continue to mon. the UCs and FHR
c. d/c the oxytocin infusion. An effective labor pattern is UCs occurring every 2-3 minutes and lasting 40-90 seconds. Hypertonic UCs are those occurring q1-2 minutes and lasting >90 seconds. Oxytocin should be d/c’d if hypertonic UCs occur, if the uterus has minimal or no resting tone, or if there is an ominous or nonreassuring FHR pattern.
P. receiving IV mag sulfate for GHTN. Axmt findings: BP 160/110, resp 32, HR 90, DTR 4+. What other finding needs to be reported?
a. DTR 2+
b. bp change from 160/110 to 130/60
c. UOP 25mL/hr
d. Resp 16
c. UOP 25 mL/hr. Mag sulfate is excreted through the kidneys so adequate urine output is necessary to prevent mag toxicity. Any UOP less than 30ml/hr is a cause for concern
P. dx’d w/ a uterine fibroid asks the RN what will happen. Rn knows that fibroids
a. rarely cause probs and will shrink during preg.
b. can cause the uterus to not contract properly at term
c. should be removed soon to prevent probs w/fetal grwth
d. will prob be removed following a c-section
b. uterine fibroids interfere w/ the ability of the uterus to contract and the p. often needs a C-section. Uterine fibroids can also cause spontaneous abortion or preterm labor r/t uterine irritability. The tumors shrink after menopause, do not affect fetal growth, and shouldn’t be removed at time of birth bc of the increased circulation to the uterus at this time
Active phase of labor, FHR declines from 156 to 100 after the acme of a UC. The FHR returns to baseline after the UC is over. Document this as?
a. Late decel
b. early decel
c. fetal bradycardia
d. variable decel
a. late decel- Late decels begin late in the UC w/ the onset at or after the peak of the UC and the recovery occurring after the return of the UC to baseline. This is a nonreassuring pattern and is r/t placental insufficiency c/b maternal hypotension or by GHTN/GDM.
P. at 34 wks w/vaginal bleeding. RN knows the classic distinction b/w abruptio placentae and placenta previa is?
a. decreased hgb
b. fetal distress
c. maternal hypotension
d. abd pain
d. abn pain- sharp pain is r/t abruptio placentae as the placenta is torn from the uterine wall. Placenta previa presents w/ painless vaginal blding. Both conditions can cause decreased Hgb (from blding), fetal distress (r/t hypoxia and blding), and maternal hypotension
37 wks, having a NST. The FHR is 130 to 150 but no fetal movement is detected after 15 min. Rn should?
a. offer the p OJ and crackers
b. report this to the HCP
c. encourage the p. to ambulate for 10 min, then resume monitoring
d. turn the p to her left side and auscultate FHR w/ a doppler
a. most fetuses are more active after meals due to higher blood glucose levels in the mother.
