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NCLEX > Maternity > Flashcards

Maternity Flashcards

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1
Q

Presumptive Signs of Pregnancy

A

Period absent (amenorrhea; 3+ months)
Really tired
Enlarged breasts
Sore breasts
Urination frequency increased
Movement perceived (quickening)
Emesis and nausea

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2
Q

Probable Signs of Pregnancy

A

Positive pregnancy test
Return of fetus when tapped (ballottement)
Outline of fetus palpable
Braxton hicks contractions
A softening of cervix (Goodell’s sign)
Bluish color to cervix (Chadwick’s sign)
Lower uterine segment softens (Hegar’s sign)
Enlarged uterus

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3
Q

Positive signs of pregnancy

A

Fetal movement felt by HCP
Electronic device detects fetal heart sounds
The delivery of the fetus
Ultrasound detects the fetus
See movement of the fetus (by HCP)

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4
Q

Naegele’s Rule

A

1st day of last menstrual period + 7 days - 3 months + 1 year = estimated due date (EDD)

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5
Q

Fetus development Weeks 1-4

A

fertilized egg grows, water tight sac forms around it creating the amniotic sac, placenta develops, primitive face is formed and heart tube develops

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6
Q

Fetus development Weeks 5-8

A

facial features continue to develop, neural tube is well formed, 6 weeks heartbeat can be detected by U/S

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7
Q

Fetus development Weeks 9-12

A

hands, arms, fingers, feet and toes are fully developed, will begin to open and close hands, by end of third month fetus is fully formed; all organs and limbs are present and will continue to become functional, circulatory and urinary symptoms are functional

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8
Q

All or nothing effect

A

If exposed to harm before the end of month 1 the placenta will either not develop and attach and miscarriage will occur OR there is no effect and placenta will develop and attach and pregnancy continues

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9
Q

the embryo is referred to as a fetus beginning at week ___

A

8

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10
Q

The risk of miscarriage goes down after the first trimester because _______________ and the most symptoms are experience in this time because

A

most of the development has already taken place; symptoms occur because of all the development going on

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11
Q

Fetus development Weeks 13-16

A

fetal HR now audible with doppler consistently, facial features develop and nervous system is starting to function

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12
Q

Fetus development Weeks 17-20

A

fetus is developing muscles and is exercising, hear and lanugo begin to develop, skin becomes coated with vernix caseaosa

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13
Q

Fetus development Weeks 21-24

A

eyelids begin to open, fetus responds to movement or increased maternal HR

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14
Q

If born prematurely baby may survive if born after ____ weeks

A

23 weeks but will require a very long NICU stay

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15
Q

Fetus development Weeks 25-28

A

fetus begins to develop body fat and hearing is fully developed, changes position frequently and will respond to stimuli (sound, pain, light). Fetus likely to survive if born after the 7th month

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16
Q

Fetus development Weeks 29-32

A

Kicking increases and there is rapid brain development, fetus can see and hear

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17
Q

Fetus development Weeks 33-36

A

lungs complete development, there are coordinated reflexes and fetus becomes more responsive to stimuli

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18
Q

Fetus development Weeks 37-40

A

Labor can happen any time, movement decreases as space becomes tighter in the womb, if not in right position provider will discuss changing fetal position prior to delivery

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19
Q

term = ___ weeks
full term = ___ weeks

A

term = 37
full term = 40

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20
Q

Nutrition in pregnancy

A

lean protein options are ideal, healthy fats for development of fetal organs and placenta, about 300 additional calories to support their growing fetus

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21
Q

Folate or folic acid helps to

A

prevent birth defect of the spine and brain (neural tube defects)

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22
Q

Iron

A

helps mother create more blood and oxygen carrying capacity to support fetal oxygenation

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23
Q

DHA

A

omega 3 fatty acid important for eye and brain development in fetus

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24
Q

Iodine

A

vital for fetal brain and nerve growth

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25
Q

calcium and vitamin D

A

fetal bone and teeth development, and overall maternal health in pregnancy

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26
Q

foods to avoid in pregnancy

A

fish high in mercury, cold deli meats, raw meats and eggs, unpasteurized dairy products, liver, unwashed produce, alcohol, caffeine (no more than 200mg/day)

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27
Q

Drugs to avoid in pregnancy

A

NSAIDs, ACE inhibitors, ARBS, Retin A, sulfonamide an fluoroquinolone abx, codeine, warfarin, benzos, castor oil, mineral oil, bismuth subsalicylate, isotretinoin

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28
Q

prenatal / antepartum testing

A

blood type, Rh factor, STI testing, glucose test, UA, U/S, NST, GBS, kick counts

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29
Q

infant is put at risk for erythroblastosis fetalis when

A

mother is Rh negative and baby is Rh positive

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30
Q

Rhogam is given at ____ weeks and ____ weeks if mother is Rh ____

A

28 and 40 weeks; Rh negative

31
Q

Rhogam

A

contains small amount of Rh proteins that stops blood from making Rh antibodies

32
Q

Oral glucose tolerance test

A

done at 28 weeks, 50g glucose, BG checked 1 hr later, if greater than 140 (7.8mmol/L), the 3 hr glucose test is done

33
Q

3 hr glucose tolerance test

A

done only if 1 hr is failed, fasting 8 hrs, 100g glucose drink, BG checked at 1hr, 2hr, 3hr; pass = no gestational diabetes, fail = + gestational diabetes

34
Q

NST assesses

A

fetal well being and oxygenation of placenta, evaluates changes in fetal heart rate with movement

35
Q

increase in fetal heart rate with movement (contraction) = _________ which is a _____ sign

A

acceleration = good sign

36
Q

decrease in fetal heart rate with movement (contraction) = ________ which is a _____ sign

A

deceleration = bad sign

37
Q

Reactive NST

A

at least two accelerations of 15bpm for 15 seconds in a 20 minute period

38
Q

Non-reactive NST

A

not at least two acceleration of 15 bpm for 15 seconds in 20 min

39
Q

fetal HR deceleration with movement is a sign that the fetus will not tolerate ______

A

labor

40
Q

NST 3 N’s

A

Nonstress test, non-reactive, not good!

41
Q

Contraction Stress test

A

done when NST is non-reactive, always done in hospital as oxytocin is given to induce contractions, checks to see if baby will tolerate labor and shows signs of stress

42
Q

Negative contraction stress test

A

Normal; baby did NOT have any decels in response to contractions

43
Q

Positive contraction stress test

A

Bad; baby had decels with contractions indicating distress in response to movement

44
Q

variability

A

fluctuation in fetal HR; absent, marked, or moderate

45
Q

absent variability

A

very little to no fluctuation in FHR, bad sign

46
Q

Marked variability

A

can be good or bad

47
Q

moderate variability

A

ranges between 6 and 25 bpm; good sign

48
Q

early decelerations

A

mirror the contraction; when contraction rises or falls decel also falls or rises as uterus compresses head/neck (stimulates vagus nerve causing HR to drop), not an issue as long as HR returns back to baseline when contraction ends

49
Q

variable decelerations

A

do not match with contraction; decel is not dependent on contraction, likely cord compression or pressure on umbilical vein causing drop in HR, this is ALARMING! as fetal blood is suddenly being restricted, emergency C-section

50
Q

Late decelerations

A

decels are late compared to contraction (decel begins after contraction began instead of at same time), indicates placental insufficiency, can be caused by epidural turned up to fast, sudden maternal hypotension, severe dehydration or anemia, can indicate sudden hemorrhage, emergency C-section

51
Q

VEAL CHOP

A

Variable Deceleration -> Cord Compression
Early Deceleration -> Head Compression
Accelerations -> Okay!
Late Deceleration -> Placental Insufficiency

52
Q

Reassuring NST signs

A

baseline HR normal: 110-160 bpm
moderate variability
accelerations

53
Q

Non reassuring NST signs

A

fetal tachycardia >160bpm
fetal bradycardia <110bpm
decrease variability
variable decelerations
late decelerations

54
Q

Non-reassuring fetal HR nursing interventions

A

lay mother on left side
increase IV fluids
oxygen
notify HCP
discontinue pitocin

55
Q

GTPAL

A

Gravidity - # of pregnancies including current, twins only count once (one pregnancy)
Term - # of pregnancies to term, 37+ week gestation, twins only count once
Preterm - # of preterm births, between 20 and 36+6 weeks gestation, twins only count once
Abortions - # of pregnancies ending prior to 19+6 weeks, spontaneous or termination, twins count only once
Living children - # of children currently alive, twins count twice

56
Q

Hyperemesis Gravidarum

A

extreme morning sickness, intense n/v during pregnancy

57
Q

Morning Sickness vs. Hyperemesis Gravidarum

A

nausea that may cause vomiting vs. nausea with excessive, persistent vomiting

nausea subsides around 20 weeks vs. n/v does not subside

vomiting does not cause dehydration vs. can cause dehydration, weight loss, electrolyte imbalances

can keep some food down vs. cannot keep any food down

58
Q

Hyperemesis Gravidarum management

A

sit up after meals, small portions, drink in between meals not with, nothing too spicy, hot, or cold (limit irritation), promethazine, IVF, TPN

59
Q

Preeclampsia

A

htn occurring >20 weeks, BP >140/90 2 times, 4 hrs apart, protein in urine, can lead to eclampsia

60
Q

preeclampsia S&S

A

increased BP
sudden, big weight gain
proteinuria
facial puffiness
pedal edema

61
Q

preeclampsia management

A

delivery, prepare for preterm baby, magnesium sulfate (prevent maternal seizures), betamethasone (help develop baby’s lungs), antihypertensives

62
Q

antihypertensives that can be given during pregnancy and what can’t

A

Yes: labetalol, nifedipine, hydralazine

No: ACE Inhibitors, ARBs

63
Q

HELLP Syndrome

A

hemolysis, elevated liver enzymes, low platelet count

no known cause but preeclampsia or eclampsia have much higher risk

needs very quick treatment and is life threatening

64
Q

HELLP S&S

A

epigastric substernal pain (d/t liver enzymes being high), n/v and indigestion (d/t liver enzymes), severe headaches/blurry visions (due to high bp), severe swelling, SOB

65
Q

HELLP syndrome management

A

corticosteroids, antihypertensives, administration of blood products/components, delivery

66
Q

Gestational Diabetes

A

pancreas is unable to deal with increased insulin requirements of pregnancy

67
Q

glucose tolerance test is done at ______ weeks

A

24-28 weeks

68
Q

Gestational diabetes complications

A

macrosomia (large baby), preeclampsia, hypoglycemia in new born

69
Q

cholestasis

A

maternal liver condition that typically occurs in later pregnancy causing bile acids to enter the bloodstream, as bile acids rise, fetal safety is significantly compromised. Bile acids in the bloodstream causes intense itching that is mostly on the soles of the feet and palms of the hands

70
Q

cholestasis complications

A

mother: severe itching and scratching can lead to scarring, results in lower vitamin K-dependent factors, can impact the ability to clot

baby: preterm birth, lung problems d/t aspiration of meconium, death

71
Q

cholestasis tx

A

no known prevention focus is on recognition and intervention, give Ursodiol early in third semester (before 36 weeks) it helps to lower bile acids in the blood and can relieve some of the symptoms of itching, if before 36 weeks the fetus is closely monitored with NSTs at least twice weekly, if after 36/37 weeks plan to deliver no matter what

72
Q

ectopic pregnancy

A

an egg is fertilized but implants outside the uterine cavity (fallopian tube, cervix, abdomen)

73
Q

ectopic pregnancy symptoms

A

dizziness or fainting, n/v, abdominal or pelvic pain, loss of appetite, when rupturing/ruptured can quickly become hemodynamically unstable

74
Q

ectopic pregnancy therapeutic management

A

prevent rupture (detect with U/S), methotrexate (stops embryo from being able to grow), Rh immune globulin (prevents erythroblastosis fetalis if mom is Rh negative)

NCLEX (23 decks)

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