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Lab values > Mark k lecture 10\ > Flashcards

Mark k lecture 10\ Flashcards

1
Q

Determining the estimated date of delivery

A

Use the Naegele rule—take first day of last menstrual period (LMP), add 7 days and subtract
3 months from it
o For instance, if the last menstrual period of a pt was between June 10 and 15
o The estimated date of delivery = March 17

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2
Q

Weight gained during pregnancy
* 1st trimester (12 weeks)

A

o 1 lb per month = Total of 3 lbs

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3
Q

Weight gained during pregnancy 2nd and 3rd trimesters

A

o Add 1 lb every week

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4
Q

The ideal weight gained during pregnancy

A

o 28 lbs, plus or minus 3
o Between 25 to 31 lbs

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5
Q

If weight gained during pregnancy is within +/–1 to 2 lbs of the ideal weight for the
gestational week

A

Pt is WNL

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6
Q

If weight gained is within +/–3 lbs , +/–4 lbs

A
  • +/–3 lbs … Assess her
  • +/–4 lbs or more… There is trouble
    o perform a BPP on the fetus
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7
Q

A woman is in her 28th week gestation. She gained 22 lbs, what is your impression?

A
  • Using the long method
    o First trimester (12 weeks) … She gained 3 lbs
    o 28 weeks minus 12 weeks = 16 weeks
    o Therefore, she would add an extra 16 lbs on her weight
    o 3 + 16 = 19 lbs … She has 3 lbs extra than her ideal weight
    o Therefore, assess the pt
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8
Q

A pregnant woman at 31 weeks gestation gained 15 lbs. what is your impression?

A
  • Using the short method, this pt ideal weight should be
    o 31 – 9 = 22 lbs
    o However, 22 – 15 = 7 lbs less than the ideal
    o Therefore, the nurse needs to assess the biophysical profile (BPP) on the fetus
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9
Q

Fundal Height 1st trimester

A
  • Fundal height cannot be palpated until week 12
    o That when the fundus is midway between the umbilicus and the pubic symphysis
  • The fundus can be palpated at the umbilicus between 20 and 22 weeks
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10
Q

What is the significance of being able to palpable fundal height?

A
  • The examiner should be able to determine in what trimester the pregnancy is
    o In case pt is unconscious, for instance
    o It has diagnostic significance as well … A much bigger than normal fundus may indicate
    molar pregnancy
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11
Q

For instance, the fetal HR can be heard first between

A

8 to 12 weeks gestation

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12
Q

Quickening (baby Qicks) may be first felt between

A

16 to 20 weeks gestation

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13
Q

Maybe Signs of Pregnancy

A
  1. Positive urine/blood hCG tests
    * A positive pregnancy test may result from other conditions
    * For instance, cancer
  2. Chadwick sign—cervical color change to cyanosis (Cs)
    * Bluish discoloration of the vulva, vagina and cervix
    Goodell sign—good and soft
    * Softening of the cervix
    Hegar sign—uterine softening
  • Softening of lower uterine segment
    Chadwich ! Goodells ! Hegar
  • All 3 signs are in alphabetical order and
  • Move up from the vulva, vagina, cervix to the uterus
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14
Q

During pregnancy, pt is advised to go for prenatal visits as

A
  • Once a Month until week 28
  • Every other week between 28 and 36
  • Once a week after week 36 until delivery or week 42, whichever comes first
    o At week 42, delivery can be induced or by C-section
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15
Q

If a woman comes in for her 12th week prenatal checkup, when is her next prenatal visit?

A
  • Her next visit is at 16 weeks
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16
Q

Hemoglobin (Hb) during pregancy

A
  • Normally Hb in female = 12 – 16
  • A pregnant woman can tolerate lower levels of Hb
  • First Trimester: Hb can fall to 11 and be perfectly normal
  • Second Trimester: Hb can fall to 10.5 and be perfectly normal
  • Third Trimester: Hb can fall to 10 and be perfectly normal
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17
Q

How do you treat morning sickness?

A
  • Morning sickness is usually seen during the 1st trimester
  • Treatment: Dry carbohydrates—not before breakfast but—before pt gets out of bed
18
Q

How do you deal with urinary incontinence?

A
  • Urinary incontinence is seen in the 1st and 3rd trimesters
  • Pt needs to void every 2 hours from the day she gets pregnant until 6
    weeks postpartum
19
Q

A pregnant pt complains of difficulty breathing. What should you advise her to
do?

A
  • Difficulty breathing is a problem during the 2nd and 3rd trimesters
  • Advise pt to assume to tripod position
    o Tripod position is a physical stance often assumed by people
    experiencing respiratory distress
    o The pt will be leaning forward with hands on knees or the surface of a desk or table
20
Q

A pregnant pt complains of back pain. What
should you advise her to do?

A

Back Pain is seen during the 2nd and 3rd
trimester
* Advise pelvic tilt exercises to pt

21
Q

What is the truest most valid sign that she is in
labor?

A
  • The truest most valid sign of labor is the
    onset of regular/progressive contractions
22
Q

Dilation

A

is opening cervix from 0 to 10 cm

23
Q

Effacement

A

Effacement is thinning of the cervix. It goes from thick to 100% efface (thin like paper)

24
Q

Station

A

is the relation between fetal presenting part and the mother’s ischial spines (know
this)—the narrowest part of the pelvis
o Positive numbers mean the baby has made it through this tight squeeze—good to go
o Positive numbers = Positive news
o If a baby stays at a –3, –2, –1, it can’t get through vaginally. It needs C-section for delivery

25
Q

Engagement

A
  • Engagement is station zero—this means the presenting part is at the ischial spines
26
Q

Lie

A

relationship between the spine of the mother and spine of the baby
* You want a vertical lie—compatible with vaginal birth
o If the mother’s spine and the baby’s spine is parallel—we got a baby
* If lie is perpendicular—tranverse lie = Trouble … C-section
o If we got them perpendicular, we’ve got trouble—T

27
Q

Most common presentation is ROA or LOA—that’s the guess—don’t bother memorizing.

A
  • ROA (right occiput anterior)
  • LOA (left occiput anterior)
  • Pick ROA before LOA
28
Q

Delivery of the Fetus and the Placenta
* There are 4 stages of labor

A
  • Stage 1—Onset of Labor ! Cervical Dilation and Effacement
    o Phase 1—Latent
    o Phase 2—Active
    o Phase 3—Transition
  • Stage 2—Delivery of Baby
  • Stage 3—Delivery of Placenta
  • Stage 4—Recovery: 2 hours until bleeding stops
29
Q

3 phases of labour

A
  • Latent—cervical dilation from 0 to 4 cm
    o Phase 1
    o Contractions are 5 to 30 minutes apart, lasting 15 to 30 seconds
    o Mild intensity
  • Active—cervical dilation from 5 to 7 cm
    o Phase 2
    o Contractions are 3 to 5 minutes apart, lasting 30 to 60 seconds
    o Moderate intensity
  • Transition—cervical dilation from 8 to 10 cm
    o Phase 3
    o Contractions are 2 to 3 minutes apart, lasting 60 to 90 seconds
    o Strong intensity
30
Q

What is a sign of uterine tetany?

A
  • No longer than 90 seconds and no closer than 2 minutes
31
Q

What parameters regarding uterine contraction would make you stop Pitocin?

A
  • No longer than 90 seconds and no closer than 2 minutes
32
Q

What is uterine hyperstimulation?

A
  • No longer than 90 seconds and no closer than 2 minutes
33
Q

Assessment of frequency of
contraction

A
  • Frequency is from the
    beginning of one
    contraction and beginning
    of the next
34
Q

Assessment of duration of
contraction

A
  • Duration of contraction is
    from the beginning to end
    of one contraction
35
Q

Painful Back pain—“OP”

A
  • Position—Push
  • What position?
    o KNEE-CHEST position
    then
    o PUSH with fist into sacrum to use counter pressure
36
Q

Prolapsed Cord

A
  • Push head in off cord and position knee-chest or
    Trendelenburg
  • Prep for C-section
  • Think PUSH/POSTION
    o Push head off the cord of fetus and position mother to
    knee-chest
37
Q

Interventions for all other complications

A
  • Tetany
  • Maternal hypertension
  • Vena cava syndrome
  • Toxemia
  • Uterine rupture
  • All treated the same—with “LION”
    o Left side (place mother on the left side)
    o IV
    o Oxygen
    o Notify HCP
  • Stop Pitocin (pit) if it was running—the first thing to do
38
Q

Implement before “LION”

A

In an OB crisis, if pitocin is running, stop it first. Then, implement “LION”

39
Q

When to administer systemic pain medication

A

Do not administer a systemic pain medication to a woman in labor if the baby is likely to be
born when the med is at its peak

40
Q
  • You have a primagravida at 5-cm dilated who wants her IV push pain med. What is the
    nursing intervention?
A

o Hold the pain medication
o This is because the pt is primagravida and will deliver in about 15 to 30 minutes when the
medication peaks
* You have a multigravida at 8-cm wants her IM pain med. What is the nursing intervention?
o Do not administer the pain medication

Lab values (12 decks)

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