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NCLEX YOU GOT THIS! > marky mark maternity and neonatology > Flashcards

marky mark maternity and neonatology Flashcards

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1
Q

ideal weight gained during pregnancy

A

28 lbs plus or minus 3

technically pt is WNL is +/- 1 to 2lbs of ideal gestational week

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2
Q

if weight gained is +/- 3 lbs what is NI

A

assess pt

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3
Q

if weight gained is +/- 4 lbs or more what is NI

A

biophysical profile on fetus

THERE IS TROUBLE!

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4
Q

when can fundal height be palpated

when is fundus at umbilicus

A

12 weeks
** fundus is midway btw umbilicus and pubic symphysis

fundus can be palpated at umbilicus btw 20 and 22 weeks

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5
Q

why is fundal height/being able to palpate it important

A

examiner should be able to determine what trimester pregnancy is in

    • pt is unconscious
    • diagnostic significance, much bigger than normal fundus may indicate molar pregnancy
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6
Q

molar pregnancy

A

rare complication by abnormal growth of triphoblasts, cells that normally develop in placenta

NO FORMATION OF FETAL TISSUE IN COMPLETE
PARTIAL –> may be some formation but unable to survive usually miscarried early in preg

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7
Q

when is fetal HR first heard

A

8-12 weeks gestation

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8
Q

when is quickening first felt

A

16-20 weeks gestation

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9
Q

MAYBE positive signs of pregnancy

A

positive urine/blood HCG test
Chadwicks sign (cervical color change to cyanosis bluish discoloration of the vulva, vag and cervix
Goodell sign - good and soft softening of the cervix
Hegar sign - uterine softening softening of lower uterine segment

UWORLD:
Uterine & cervical changes
Goodell sign
Chadwick sign
Hegar sign
Uterine enlargement
Braxton Hicks contractions
Ballottement
Fetal outline palpation
Uterine & funic souffle
Skin pigmentation changes
Chloasma
Linea nigra
Areola darkening
Striae gravidarum
Positive pregnancy tests
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10
Q

recommendation of prenatal visits

A

once a month until week 28
every other week until 28 and 36
once a week after week 36 until delivery or week 42 (whichever comes first)

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11
Q

hemoglobin level during 1,2,3 trimesters

A

normal female level: 12-16

1: 11
2: 10.5
3. 10

IF UNDER 9, ANEMIA EVAL

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12
Q

how to treat morning sickness

A

dry carbs, not before breakfast but before pt out of bed

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13
Q

how to deal w urinary incontinence

A

** seen in 1st and 3rd trimester

pt needs to void every 2 hours from the day she gets pregnant until 6 weeks postpartum

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14
Q

pt is having diff breathing… what do you advise her to do

A
    • problem of the 2nd and 3rd trimester **

1. advise pt to assume tripod position

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15
Q

pregnancy color and discharge during pregnancy

  1. normal
  2. thin, watery yellow
  3. thick, yellow
  4. foul smelling yellow
A
  1. clear, thin or milky white with slight odor
  2. could indicate an infection such as STI or leaking amniotic fluid
  3. typically yeast infection w burning or vag itching
  4. STI or yeast infection
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16
Q

back pain interventions

A

** seen in 2nd and 3rd trimester
ADVISE PELVIC TILT EXERCISES
**like hip thrust form, hold for 5 seconds relax and repeat

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17
Q

TRUEST AND MOST VALID SIGN OF LABOR

A

ONSET OF REG/PROGRESSIVE CONTRACTIONS

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18
Q

subjective (presumptive) signs pregnancy

A 
amenorrhea
N/V
urinary frequency 
breast tenderness
quickening
excessive fatigue
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19
Q

infant botulism clinical presentation + tx

A

Age <12 months
Constipation, poor feeding, hypotonia
Oculobulbar palsies (eg, absent gag reflex, ptosis)
Symmetric, descending paralysis
Autonomic dysfunction (eg, decreased salivation, fluctuating HR/BP)

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20
Q

preeclampsia

A

new onset of hypertension (SBP >/ 140 mmHg &/or DBP >/ 90 mmHg) @ 20 weeks gestation
PLUS
proteinuria and or end-organ damage

severe features

  • thrombocytopenia
  • increase creatinine
  • increase transaminases
  • pul edema
  • visual or cerebral symptoms
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21
Q

management of preeclampsia

A

w/o severe features: delivery >/ 37 weeks

w severe features: delivery at 34 weeks

magnesium sulfate (seizure prophylaxis)

antihypertensives

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22
Q

gestational diabetes

A

new-onset elevated BP at >/ 20 weeks gestation

no proteinuria or signs of end-organ damage

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23
Q

eclampsia s/s

A

preeclampsia and new onset of tonic clonic seizures

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24
Q

dilation

A

opening cervix from 0 to 10 cm

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25
Q

effacement

A

thinning of cervix

goes from thick to 100% efface (thin like paper)

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26
Q

station

A

relation btw fetal presentaiton part and mother’s ischial spines narrowest part of the pelvis

positive numbers = baby made it through tight squeeze

if baby stays at -3, -2, -1 it can’t get through vaginally… needs c-section for delivery

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27
Q

engagement

A

station zero, means presenting part is at ischial spines

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28
Q

lie

A

relationship between the spine of the mother and the baby

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29
Q

vertical vs transverse lie

A

vertical: compatible with vaginal birth - we got a baby!

perendicular (transverse lie) = trouble… c-section

30
Q

most common presentation

A

ROA or LOA

right before left

31
Q

before giving digitalis what should you do

A

TAKE APICAL HR

32
Q

purpose of 4th stage

A

stop bleeding!

33
Q

when does postpartum begin?

A

2 hours after delivery of placenta

34
Q

priority in 2nd phase

A

pain management

35
Q

priority in 2nd stage

A

baby’s airway… CLEAR IT

36
Q

priority in 3rd phase

A

checking cervical dilation

helping mom w breathing and pain management

37
Q

priority in 3rd stage

A

assess the placenta for smoothness and intactness… 3 vessels, umbilical cord present

38
Q

uterine contractions should be…

A

no longer than 90 seconds and no closer than 2 minutes

39
Q

sign uterine tetany and hyperstimulation + parameters to stop pitocin

A

contractions 2 minutes or less and 90 seconds or more

40
Q

intensity of labor

A

teach her how to palpate with one hand over the fundus with the pads of the fingers

41
Q

intervention for painful back pain “OP”

A

** ANYTHING R/L OCCIPUT POSTERIOR

position-push
KNEE-CHEST position
PUSH with fist into sacrum to use counter pressure

42
Q

intervention for prolapsed cord

A

push head in off cord and position knee-chest or trendelenburg

prep for C-SECTION

THINK PUSH/POSITION

43
Q

interventions for all other pregnancy complications ** tetany, maternal htn, vena cava syn, toxemia, uterine rupture

A 
LION!!!!
left side 
IV
o2 
notify HCP
STOP PITOCIN (pit) if it was running IS THE FIRST THING TO DO 
1. stop pit
2. LION
44
Q

when to admin systemic pain med

A

do not admin tp woman in labor if baby is likely to be born when med is at its peak

45
Q

low fetal HR interventions

A

HR <110

LION! + STOP PIT first if running

46
Q

high fetal HR interventions

A

HR >160
document acceleration of fetal HR
take mother’s temp
not a priority… baby is WNL

47
Q

low baseline variability interventions

A

BAD, fetal HR stays the same… it doesn’t change

LION + first stop PIT if running

48
Q

high baseline variability interventions

A

fetal HR is always changing, this is good

document finding

49
Q

early decel interventions

A

this is normal, document findings

50
Q

variable decels interventions

A

VERY BAD
possibly prolapsed cord
NI: PUSH AND POSITION

51
Q

late decel interventions

A

BAD!

stop pit then LION

52
Q

when in doubt with the answer

A

CHECK FETAL HR

53
Q

second stage of l&d

A

Delivery of the fetus … This is about order.

  1. Deliver head … The mother needs to stop pushing
  2. Suction the mouth then the nose … ABC order
  3. Check for nuchal (around the neck) cord
  4. Deliver the shoulders, next, the body
  5. Make sure baby has ID band on before it leaves the delivery area
54
Q

4th stage of L&D

A

4 THINGS YOU DO 4X AN HOUR
1. Vital signs: Assessing for shock … Blood pressure goes down, HR goes up … Pt looks
pale, cold, and clammy
2. Fundus: If it is boggy, massage it … If displaced, catheterize it
3.Check perineal pads … If there is excessive bleeding, the pad will saturate in 15
minutes or less
4.Roll pt over and check for bleeding underneath her

55
Q

POST PARTUM assessment

A
  • Assess every 4 to 8 hours
  • Assess for “BUBBLE HEAD”
  • Make sure you focus on the 3 designated steps stated as important from BUBBLE HEAD
56
Q

what is the height of fundus at delivery

A

at the umbilicus or navel

  • *involutes about 2cm every day PP
  • *location should be midline, if not then bladder is distended
57
Q

BUBBLE HEAD

A 
Breasts 
uterine fundus *firm*
BLADDER 
BOWEL
LOCHIA 
EPISIOTOMY 
HEMOGLOBIN/HCT
EXTREMITIES 
AFFECT
DISCOMFORTS
58
Q

lochia colors + amount

A

rubra - red
serosa - pink (rosy)
alba (albino) - white

moderate amount: 4 to 6 inches on pad in an hour
excessive: saturate a pad in 15 minutes

59
Q

what are we assessing when looking at extremities in bubble assessment

A

thrombophlebitis
BEST WAY: measure BILATERAL calf circumference

** homan’s sign not the best answer …. calf pain at dorsiflexion of foot

60
Q

milia

A

white, pinhead size, distended sebaceous glands on nose, cheek, chin, occasionally on the trunk… disappear a few weeks after bathing

61
Q

epstein pearls

A

palatal cysts of the NB, are small white or yellow cystic vesicles

62
Q

mongolian spot

A

bluish discoloration in the sacral region of NB usually seen in AAs… carefully document its presence to avoid abuse charges

63
Q

erythema toxicum neoratorum

A

described as flee-bitten lesion… pink rash with ferm, yellow-white papules or pustule on the face, chest, abdomen, back and buttocks of some newborns

usually appears 24-48 hours after birth and disappeared in a few days

64
Q

hemangioma

A

an abnormal accumulation of blood vessels in the skin of the NB. it is one of the most common birthmarks associated with childhoood and affect 10% of all children

65
Q

caephalohematoma

A

collection of blood btw the periosteum of a skull bone and the bone itself

  • occurs in one or both sides of the head
  • occasionally forms over the occipital bone
  • develops within first 24-48 hours after birth
66
Q

caput succedaneum

A

edema of the scalp of the neonate during birth from mechanical trauma of the initial portion of scalp pushing through narrowed cervix

  • edema crosses the suture lines
  • may involve wide areas of the head or may just be a size of a large egg
  • caput succedaneum (CS) - Crosses Suture line, and Caput Symmetrical
67
Q

vernix caseosa

A

fatty, whitish secretion of the fetal sebaceous gland to protect the skin from amniotic fluid exposure

68
Q

acrocyanosis

A

blue discoloration of the hands and feet in the newborns during the first few days after birth

normal finding and not indicative of poor o2, resp distress or cold stress

69
Q

nevi (telangiectatic nevi)

A

stork bites
pink and easily blanched skin lesion that appear on upper eyelid, nose, upper lip, lower occipital area and nape of the neck

  • no clinical significance
  • disappears by 2
70
Q

port wine stain (nevus flammeus)

A

seen at birth and is composed of a plexus of newly formed capillaries in the papillary layer of the corium

  • commonly found on face/neck
  • red to purple, varies in size, shape, location
  • does not blanch on pressure
71
Q

OB meds

A 
terbutaline (brethine)
mag sulfate
pitocin
methergine
bexamethasone
surfactant

NCLEX YOU GOT THIS! (14 decks)

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