Maternal Flashcards
1
Q
Cholestasis
A
- liver condition during pregnancy
- jaundice is common
- dark urine
- pale stools
- colicky pain that radiates to back and shoulder
- pruritus (esp hands and feet)
- pain after eatig fatty/fried foods
- nausea/vomiting
- high WBC
- fever
- inflammation
- positive Murphy’s sign
- increase bilirubin
- elevated aminotransferase (live enzymes)
2
Q
Displaced fundus
A
- fundus firm at umbilicus
- veers to right
- indicates bladder distention
3
Q
Subinvolution
A
- boggy uterus
- increased bleeding
- persistant lochial discharge
- pelvic pain/heaviness
- lower back pain
- fatigue and malaise
4
Q
Epidural analgesia
A
- monitor for infection
- give LR for hypotension
- monitor for urinary retention
- can cause bladder distention
5
Q
Nulliparous vs nulligravida
A
- nullipara
- woman who has not given birth
- could have been pregnant but result in abortion/miscarriage before 20 weeks
- nulligravida
- never been pregnant before
6
Q
infant’s first signs of decreased cardiac output
A
- hard to breathe when feeding
- sweaty and pale during feedings
- Irritability, restlessness, lethargy
7
Q
Pre-eclampsia
A
- no abdominal pain
- proteinuria
- hypertension
- 140/90+
- edema
- oliguria
- high creatine
treatment is magnesium sulfate
8
Q
Severe preeclampsia
A
- 160/110
- abdominal pain
- right-upper quadrant pain suggestive of a liver injury
- headache
- photophobia
- blurred vision
- HELLP
- hemolysis
- elevated liver enzymes
- low platelets
9
Q
Eclampsia
A
- SEIZURE!
- photophobia
- blurred vision
- abdominal pain
10
Q
Only preeclampsia
A
- BP 140-160/90+
- no abdominal pain
11
Q
Severe preeclampsia + eclampsia
A
- 160+ / 110+
- photophobia
- blurred vision
12
Q
All eclampsia
A
- facial edema
- headache
- proteinuria
- up to 6-10 weeks post-partum
13
Q
Gestational hypertension
A
- 140/90+
- no abdominal pain
14
Q
Gestational diabetes mellitus (GDM)
A
- high sugar levels
- increases risk of macrosomnia
- predisposed to shoulder dystocia
- high risk
- older than 25
- BMI 25+
- history of
- METABOLIC SYNDROME
- polycystic ovary syndrome
- prediabetes
- close relative with diabetes
- glucose tolerance test
- 24-28weeks
15
Q
Braxton-hick contractions
A
- false labor
- irregular, painful contractions that are decreased with repositioning
16
Q
Fetal movements concern
A
- less than 10 in 2 hours
17
Q
Placenta previa
A
- placenta develops over cervix
- do not assess cervix manually
- use ultrasound instead
- vaginal bleeding after 20 weeks
- painless
- cocaine, endometriosis, multiple gestation, c-section INCREASE RISK
18
Q
Simian line/crease
A
- indicates chromosomal defect
19
Q
Milia
A
- tiny white bumps on newborns’ foreheads
- These dermal cysts of keratin disappear during the first month of life
20
Q
Vernix caseosa
A
- newborn’s skin covered with a grayish-white, cheese-like substance
- may provide antibacterial promotion and wound healing
21
Q
Acrocyanosis
A
- cyanosis around the mouth and the extremities
- often seen in healthy newborns
22
Q
Post-maturity
A
any baby born at or beyond 42 weeks gestation
23
Q
Fetus development
A
- 20 weeks
- 7.5 inches long
- 24 weeks
- lungs begin to move
- 28 weeks
- open eyes
- 38 weeks
- fingernails complete (starts at 10 weeks)
24
Q
Average birth weight
A
- 7.5 lb
- range between 5.5 lb. (2.5 kg) and 8.2 lb. (4.0 kg) is normal
25
Q
Average birth length
A
- 20 inches
- 18 - 22 inches is normal
26
Q
Macrosomia
A
birth weight greater than 4000 to 4500 grams ( 4 to 4.5 kg)
27
Q
Leopold maneuvers
A
- non-invasive
- feel through the abdominal wall to determine the presentation and location of the fetus
28
Q
Nitrazine test
A
- determines whether the amniotic sac has ruptured
- paper measures pH of fluid
- dark blue indicated rupture
29
Q
Fetal heart rate good signs
A
- 110-160
- early accelerations
- increase in variability
- mild decelerations
30
Q
Variable declarations
A
- variable (very bad)
- caused by
- cord compression/prolapse
- give aminoinfusion
.
31
Q
Aminoinfusion
A
- infusion of warmed isotonic solution
- corrects fetal heart rate changes (variable decelerations)
- cord compression/prolapse
- membrane rupture
- cushion the cord and relieve pressure
32
Q
Effacement
A
- thinning of cervix
33
Q
Station
A
- relation between fetal presenting part and the mother’s ischial spines
- narrowest part of pelvis
- positive numbers = positive sign
- baby has made it through this tight
- –3, –2, –1
- can’t get through vaginally
- needs C-section
- 0 = engagement
34
Q
Stage 1 of labor
A
- Latent = phase 1
- dilation 0 to 4 cm
- contractions 5 to 30 minutes apart
- lasting 15 to 30 seconds
- mild intensity
- Active = phase 2
- dilation 5 to 7 cm
- contractions 3 to 5 minutes apart
- lasting 30 to 60 seconds
- moderate intensity
- Transition = phase 3
- dilation 8 to 10 cm
- contractions 2 to 3 minutes apart
- lasting 60 to 90 seconds
- strong intensity
Onset of labor > dilation . effacement
35
Q
Stage 2,3,4 of labor
A
- Stage 2
- delivery of Baby
- Stage 3
- delivery of Placenta
- Stage 4
- recovery
- 2 hours until bleeding stop
36
Q
Late decelerations EKG
A
- visually symmetric in shape
37
Q
Contractions
A
- lasts 60 to 75 seconds
- every 2 to 3 minutes
38
Q
Infants born before 37 weeks risks
A
- hypoglycemia
- hypothermia
- decreased muscles and fat
- Respiratory distress syndrome
- Intraventricular hemorrhage
- bleeding in brain
- Patent ductus arteriosus
- oxygen poor and rich blood mix
- retinopathy
39
Q
Hypoglycemia in the neonate
A
- cool/clamy
- muscle twitching
- respiratory distress
- lethargy
- irritable
- week/high pitch cry
40
Q
Drug dependent neonate
Neonate abstinence syndrome (NAS)
A
- jitteriness
- hyperactivity
- hyperactive reflexs
- shrill cry
- tacypnea
- sweating
- stuffy nose
- diarrhea/vomiting
- blotchy skin
41
Q
Rh
A
- positive can receive Rh positive or negative blood
- negative can only receive negative Rh blood
- give RhoGAM
- at 28 weeks and 72 hours after birth
- to Rh-negative mothers
- stops mother from producing antibodies against Rh-positive fetus
42
Q
CVS test
A
- as early as 10 weeks
- determine the presence of chromosomal abnormalities
- small samples from the placenta for prenatal genetic diagnosis
43
Q
Indirect Coombs
A
- test for Rh negative women
- determines if the mother has developed antibodies due to previous exposure to Rh-positive blood
44
Q
Direct Coombs’ testing
A
- test for Rh negative women
- umbilical cord blood is used to determine blood type, Rh factor, and antibody titer of the newborn.
45
Q
GTPAL
A
- G = pregnancies
- T = term (37 weeks or greater)
- twin birth counts as 1
- P = preterm (20-36 weeks)
- A = abortions (prior to 20 weeks)
- ectopic pregnacy counts as abortion
- L = living children.
46
Q
Contraction stress test (CST)
A
- for high-risk clients who are in the third trimester
- as early as 34 weeks
- requires contractions through oxytocin or nipple stimulation
- determines how baby will handle labor
47
Q
Prolapsed umbilical cord
A
- may lead to fetal hypoxia
- variable decelerations
- bradycardia
- prolonged decelerations
- position the woman’s hips higher than her head
48
Q
Prolapsed cord/variable decelerations care
A
- apply pressure to presenting fetal part
- stay and call for help
- place in trendelenburg or knee-chest position
- adminster oxygen
- via simple face mask (8-10 L/min)
- prepare for C-section
49
Q
Nonstress test (NST)
A
- third trimester usually
- but can be done as early as 26 weeks
- reactive
- expected finding, indicates fetal well-being
- 2 or more FHR accelerations within 20-minutes
- FHR increased by at least 15 beats per minute, lasting for 15 seconds
50
Q
Calories during pregnancy
A
- second trimester
- 1 fetus = 350 extra calories
- twins = 600 extra calories
- triplets = 900 extra calories
- third trimester
- 450 extra calories
51
Q
HR newborn - 4 years old
A
- 0 to 1 month old: 70 to 190 beats per minute.
- 1 to 11 months old: 80 to 160 beats per minute.
- 1 to 2 years old: 80 to 130 beats per minute.
- 3 to 4 years old: 80 to 120 beats per minute.
52
Q
Meconium
A
- should be passed up to 48 hours after birth
- if not, assess for intestinal obstruction
- can be a sign of Hirschsprung’s disease
53
Q
RR for newborn
A
30 - 60
54
Q
Pregnancy increase risk of
A
- gingivitis
- cavities
- preform elective dental procedures in the 2nd trimester
55
Q
Third trimester findings
A
- increased fetal movement
- edema in the feet
- increased unrinary frequency
56
Q
Provoke fetal movements
A
- eat/drink sweetened beverage
57
Q
Coarction of the Aorta
A
- narrowing of aorta near the ductus arteriosus
- increased blood flow to upper extremities
- bounding upper pulses
- better perfusion = warm and pink hands
- decreased blood flow to lower extremities
- faint lower pulses
- feet cold and pale
58
Q
Tetralogy of Fallot
A
- overriding aorta
- pulmonary stenosis
- hypertrophy of right ventricle
- VSD
- murmur and cyanosis
- immediately calm the infant
59
Q
Hypoplastic left heart syndrome
A
- underdeveloped left side of heart
- cyanosis and murmur
60
Q
Transposition of the great arteries
A
- pulmonary artery + aorta leave the right ventricle
- severely cyanotic
- early surgery required
61
Q
Ductus arteriosus
A
- should close after birth
- machine-like murmur
62
Q
Fetal circulation
A
- alveoli are filled with fluid
- causes high pressures in the lungs
- causes decreased pulmonary circulation
- ductus venosus is a bypass
- shunts blood away from weak liver to the brain
- allows brain to get fresh oxygen first
- pressures on right side of the heart are higher than left
- foramen ovale and ductus arteriosus close after birth
- allows lungs to take over oxygenation
63
Q
Amniocentesis
A
- ultrasound guided
- detects fetal abnormalities
- determines gender
- no sedation or meds
- mild cramping is expected
64
Q
Types of neonate heat loss
A
- conduction = losing heat with direct contact with cold object
- convection = heat loss aided by air currents
- evaporation = heat loss through moisture
- radiation = heat loss to colder objects not in direct contact (windows)
65
Q
Erythroblastosis fetalis
A
- maternal-fetal blood incompatibility
- anemic due to destruction of RBC
- hydrops fetalis
- severe anemia resulting in HF and edema
- use Rho(D) and RhoGAM
66
Q
APGAR
A
- HR
- muscle tone
- response to stimuli
- color
- 0-2 each category
- 1 min after birth, then 5 min after birth
- 7-10 = good
- if below, assess again every 5 min
67
Q
Ectopic pregnancy
A
- presumptive pregnancy signs
- nausea
- breast tenderness
- vaginal bleeding
- increased hCG levels = postive pregnancy test
- unilateral abdominal pain
68
Q
Pregnant with rubella
A
- increased risk for miscarriage or still birth
- intrauterine growth restriction
- hydrocephaly
69
Q
Linea nigra
A
- linear hyperpigmentation of the midline of the abdomen
- occurs during the 2nd trimester
70
Q
Chloasma
A
- butterfly-shaped pigmentation on the face
- seen during the 1st trimester
71
Q
Breastfeeding
A
- do not alternate from breast to formula
- start with the breast with which the last feeding ended
- 15-20 min
- upportive bra with no underwire
- most of the areola on the underside is covered by the baby’s mouth
72
Q
Spinal change in pregnancy
A
- lordosis
73
Q
Leg cramps whe pregnant
A
- increase intake of vitamin D and magnesium
- avocados
- blackberries
- spinach
- collard greens
74
Q
Mastitis
A
- 2-4 weeks postpartum
- flu-like symtoms
- enlarged lymph nodes
- breast
- tender
- swollen
- erythema
- caused by bacteria
75
Q
Expulsion of the placenta
A
- does not trigger the production of oxytocin
- triggers a decrease in progesterone levels
- decrease in estrogen levels
- increase in prolactin levels
76
Q
Nägele’s rule
A
- subtract 3 months
- add 7 days
77
Q
Prenatal nutrition
A
- limit cafferine to less than 200 mg/day
- avoid undercooked foods
- increased blood volume - increase need for sodium
- moderate intake of fish (12 oz weekly)
- salmon
- pollack
- avoid high levels of mercury
- shark
- swordfish
- king mackerel
- tilefish
78
Q
Oligohydramnios
A
- low amniotic fluid
- causes low fetal growth/movement
- fetus easier to outline and palpate
79
Q
Risks for postpartum hemorrhage (PPH)
A
- P.A.R.T.U.M
- Polyhydramnios (excessive amniotic fluid)
- Prolonged labor
- Antepartum hypertension (eclampsia)
- recent bleeding history
- twins
- uterine fibriods
- multiparity
- uterine atony = MOST COMMON
- instrument assisted delivery
- due to potential trauma
- fetal macrosomia
80
Q
Uterine atony
A
- soft fundus
- inability for muscles to contract after birth
- leads to vaginal bleeding/post partum hemorrhage
- perform fundal massage to try to get uterus to contract
- BMI over 40 is risk
- stop magnesium sulfate
81
Q
Sex when pregnant
A
- pleasure is heightened during 2nd trimester
- can have sex in all trimesters
- unless risk for preterm labor or placenta previa
82
Q
Small for gestational age (SGA)
A
- weight below 10th percentile
83
Q
Low birth weight vs very low birth weight vs extremely low
A
- low
- born less than 2500 grams (5lbs 8oz)
- very low
- born less than 1500 grams
- extremely low
- born less than 1000 grams
84
Q
Lightening
A
- descent of the fetus toward the pelvic inlet before labor
- 2 to 3 weeks before labor
85
Q
Ballottement
A
- examination technique
- sudden tap on the cervix cause the fetus to rise in the amniotic fluid and then rebound to its original position
86
Q
Infant botulism
A
- ingestion of spores of Clostridium botulinum found in dust/soil/vegetables
- inhibits release of acetylcholine
- weakness, poor feeding
- constipation
- difficulity swallowing
- double vision
87
Q
Anemia in pregnancy
A
- relative/ physiological anemia
- results from increase in plasma volume
- plasma volume greater than blood volume
- low hemoglobin and hematocrit
- normal
88
Q
Postpartum fundus
A
- immediately post-birth
- located midline of abdomen
- halfway between the umbilicus and symphysis pubis
- next hours
- fungus rise to midline of stomach
- slightly above umbilicus
- height of fundus decreases by 1cm/1 finger breath daily
- by 10th fundus is not felt
89
Q
Presumptive signs of pregnancy
A
- amenorrhea
- ausea and vomiting
- fatigue
- urinary frequency
- quickening (slight fluttering movement, usually between 16-20 weeks gestation)
subjective signs that may indicate pregnancy, can other conditions.
90
Q
Probable signs of pregnancy
A
- Goodell’s sign
- Chadwick’s sign
- Hegar’s sign
- ballottement
- Braxton hicks contractions
- positive pregnancy test
- palpation of fetal outline
91
Q
Goodell’s sign
A
- softening of the cervix
- see in 1st trimester
92
Q
Chadwick’s sign
A
- bluish/purple appearance of the cervix
93
Q
Hegar’s sign
A
- softening of the isthmus of the cervix
94
Q
Tracheoesophageal fistula in neonate
A
- cyanosis is notable symtpom
95
Q
Infant cold stress
A
- vasocontriction
- tachycardia
- tachypnea
- cyanosis
- do not shiver until 6 months old
- hypoglycemia
96
Q
Alpha-fetoprotein (AFP) levels
A
- low or high, notify
- low
- can be a sign of Down’s Syndrome
- high
- can indicate neural tube defect
97
Q
Folic acid
A
- prevent neural tube defects
98
Q
Mineral oil
A
- NOT recommended in pregnancy
99
Q
Episiotomy
A
- incision into perineum (between anus and vulva)
- helps deliver big babbies
- infection is main risk
- cold application first 12 hours, then warm for next 12 hours
- increase fluid and fiber
100
Q
Retained placenta
A
- placenta not delivered after birth
- increases risk of hemorrhage and infection
- fever
- bleeding with clots
- persistant cramps/abdominal pain
- cord traction
- pulling placenta out by its cord
- give oxytocin
- uterine massage
101
Q
Circumcision care
A
- do not wipe yellow exudate
- will go away on own
- don’t use alcohol wipes
- still place in car seat
- fasten diaper loosely
