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00NCLEX > Maternal > Flashcards

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)
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2
Q

Displaced fundus

A
  • fundus firm at umbilicus
  • veers to right
  • indicates bladder distention
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3
Q

Subinvolution

A
  • boggy uterus
  • increased bleeding
  • persistant lochial discharge
  • pelvic pain/heaviness
  • lower back pain
  • fatigue and malaise
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4
Q

Epidural analgesia

A
  • monitor for infection
  • give LR for hypotension
  • monitor for urinary retention
  • can cause bladder distention
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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
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6
Q

infant’s first signs of decreased cardiac output

A
  • hard to breathe when feeding
  • sweaty and pale during feedings
  • Irritability, restlessness, lethargy
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7
Q

Pre-eclampsia

A
  • no abdominal pain
  • proteinuria
  • hypertension
    • 140/90+
  • edema
  • oliguria
  • high creatine

treatment is magnesium sulfate

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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
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9
Q

Eclampsia

A
  • SEIZURE!
  • photophobia
  • blurred vision
  • abdominal pain
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10
Q

Only preeclampsia

A
  • BP 140-160/90+
  • no abdominal pain
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11
Q

Severe preeclampsia + eclampsia

A
  • 160+ / 110+
  • photophobia
  • blurred vision
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12
Q

All eclampsia

A
  • facial edema
  • headache
  • proteinuria
  • up to 6-10 weeks post-partum
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13
Q

Gestational hypertension

A
  • 140/90+
  • no abdominal pain
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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
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15
Q

Braxton-hick contractions

A
  • false labor
  • irregular, painful contractions that are decreased with repositioning
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16
Q

Fetal movements concern

A
  • less than 10 in 2 hours
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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
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18
Q

Simian line/crease

A
  • indicates chromosomal defect
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19
Q

Milia

A
  • tiny white bumps on newborns’ foreheads
  • These dermal cysts of keratin disappear during the first month of life
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20
Q

Vernix caseosa

A
  • newborn’s skin covered with a grayish-white, cheese-like substance
  • may provide antibacterial promotion and wound healing
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21
Q

Acrocyanosis

A
  • cyanosis around the mouth and the extremities
  • often seen in healthy newborns
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22
Q

Post-maturity

A

any baby born at or beyond 42 weeks gestation

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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)
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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
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25
Q

Average birth length

A
  • 20 inches
  • 18 - 22 inches is normal
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26
Q

Macrosomia

A

birth weight greater than 4000 to 4500 grams ( 4 to 4.5 kg)

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27
Q

Leopold maneuvers

A
  • non-invasive
  • feel through the abdominal wall to determine the presentation and location of the fetus
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28
Q

Nitrazine test

A
  • determines whether the amniotic sac has ruptured
  • paper measures pH of fluid
  • dark blue indicated rupture
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29
Q

Fetal heart rate good signs

A
  • 110-160
  • early accelerations
  • increase in variability
  • mild decelerations
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30
Q

Variable declarations

A
  • variable (very bad)
  • caused by
    • cord compression/prolapse
  • give aminoinfusion

.

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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
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32
Q

Effacement

A
  • thinning of cervix
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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
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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

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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
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36
Q

Late decelerations EKG

A
  • visually symmetric in shape
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37
Q

Contractions

A
  • lasts 60 to 75 seconds
  • every 2 to 3 minutes
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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
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39
Q

Hypoglycemia in the neonate

A
  • cool/clamy
  • muscle twitching
  • respiratory distress
  • lethargy
  • irritable
  • week/high pitch cry
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40
Q

Drug dependent neonate

Neonate abstinence syndrome (NAS)

A
  • jitteriness
  • hyperactivity
  • hyperactive reflexs
  • shrill cry
  • tacypnea
  • sweating
  • stuffy nose
  • diarrhea/vomiting
  • blotchy skin
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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

00NCLEX (30 decks)

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