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NCLEX > Maternity > Flashcards

Maternity Flashcards

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1
Q

What weeks are first trimester

A

Week 1-13

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2
Q

What are the 3 signs of pregnancy

A
  1. Presumptive
  2. Probable Signs
  3. Positive Signs of pregnancy
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3
Q

What are the S/S of Presumptive signs of pregnancy

A

Amenorrhea
N/V
Frequency- very 1st signs
Breast tenderness r/t excess hormones

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4
Q

What is the name of the hormone that causes amenorrhea

A

Progesterone

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5
Q

Trying to get pregnant when should you have sex

A

Keep a temperature chart and anticipate when temperature is going up
Every other day

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6
Q

What are other conditions that can increase hcG

A

hydatidiform mole, drugs

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7
Q

What sign of pregnancy does a hcg presence indicate

A

probable signs

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8
Q

What sign of pregnancy does a goodell’s sign indicate

A

Probable sign and gooodell is the softening of cervix

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9
Q

What sign of pregnancy does a Chadwick’s sign indicate

A

Probable sign and it is when there is bluish color of vaginal mucosa and cervix; 4 weeks

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10
Q

What sign of pregnancy does a Hegar’s sign occur

A

Probable sign, it is when there is softening of the lower uterine segment; 2nd 3rd month

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11
Q

What sign of pregnancy does a uterine contraction occur

A

Probable sign

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12
Q

When does Braxton contractions occur

A

Through out pregnancy-good helps move blood through the placenta

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13
Q

What sign of pregnancy does pigmentation/changes of skin occur

A

Probable sign of pregnancy

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14
Q

What are common pigmentation/changes of skin

A

Linea Nigra
Abdominal striae-stretch marks
Facial chloasma (mask of pregnancy)
Darkening of areloar (around nipple)

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15
Q 
the positive signs of pregnancy
-Fetal heart beat
Fetoscope
Fetal movement
Ultrasound
A

the positive signs of pregnancy

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16
Q

What week do you hear the doppler heartbeat

A

3-12 weeks

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17
Q

What week do you use a fetoscope

A

17-20 weeks

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18
Q

The # of times someone has been pregnant is called what?

A

Gravidity

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19
Q

The # of pregnancies someone has had and fetus has reached 20 weeks is called what?

A

Parity

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20
Q

What is viability

A

It’s when the baby has reached 24 and beyond weeks and the infant has the ability to live outside the uterus

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21
Q

Is a 20 week baby considered to be viable

A

No

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22
Q

Parity TPAL

A

T=Term
P=Preterm
A=Abortion
L=Living children

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23
Q

Naegele’s rule

A

1st day of the lmp, add 7 days, minus 3 months and one year

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24
Q

What are some client teachings regarding nutrition when pregnant

A
  1. talk about the 4 food groups
  2. Tell them to increase calories by 300 per day after first trimester
  3. Adolescents should increase calories to 500 per day after first trimester
  4. Increase protein to 60 grams per day
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25
Q

What about weight gain in the first trimester, what do you tell your patient to expect with pregnancy

A

You will expect to gain 4 pounds in the first trimester

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26
Q

What do you explain to your patient regarding prenatal vitamins

A

take iron even though it causes constipation
take iron with vit c
folic acid prevents neural tube defects- spinabifida
Prenatal vitamins take 400mcg/day

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27
Q

What do you explain to your patients regarding exercise

A

No high impact, only swimming and walking
No heavy or unaccustomed exercise program
No overheating
Don’t let your heart rate go above 140

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28
Q

With heart rate over 140 what are you worried about

A

Cardiac output and uterine perfusion

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29
Q 
Should you worry about:
Sudden gush of vaginal fluid
Bleeding
Persistent vomitting
Severe headache
Abdominal pain
increased temp
edema
no fetal movement
A

Yes worry, its danger sign

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30
Q 
Should you worry about:
varicose veins
ankle edema
hemorrhoids
constipation
backache 
Leg cramps
A

No, it’s common

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31
Q 
Should you worry about
N/V
breast tenderness
frequency
tender gums
fatigue
heartburn
increased vaginal secretions
nasal stuffiness
A

No, it’s common

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32
Q

What are you telling your patient about medications while pregnant

A

Talk to your doctor first

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33
Q

In the first 28 weeks how often should a client visit a physician

A

Once a month

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34
Q

In 28-36 weeks how often should a client visit a physician

A

Every 2 weeks

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35
Q

In 36 weeks how often should a client visit a physician

A

Weekly until delivery

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36
Q

Before an ultrasound what should you tell them to do, why

A

Drink water to distend bladder, it pushes uterus to abdominal surface

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37
Q

For a transvergenal u/s or prior to procedure what do you tell them to do

A

Void

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38
Q

Second trimester- what weeks

A

14-26

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39
Q

Weight gain expected, how much

A

Yes, 4 pounds/ month

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40
Q

Should your client be expecting

N/V, frequency and breast tenderness in 2 trimester

A

No to N/V and frequency but yes to breast tenderness

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41
Q

What is quickening

A

Fetal Movement

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42
Q

What is the normal fetal heart rate at 2nd trimester

A

120-160

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43
Q

Worry about fetal heart rate if?

A

110-120 worried and watching

Less than 110-panic

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44
Q

What do you teach about kegel exercise

A

it strengthens pubococcygeal muscles, stop urine flow and help prevent uterine prolapse

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45
Q

When is pregnancy considered term

A

37-40 weeks

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46
Q

What weeks are the 3 trimester in

A

27-40 weeks

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47
Q

What do you expect to assess in the 3rd trimester

A
  • weight gain-no more than a pound a week
  • monitor and report increased in BP- PIH
  • Fetal heart rate-120-160
  • Fetal Presentation/position
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48
Q

What do you use to determine fetal position/presentation and ask client to do what before doing this

A

Leopold Manuevers, void

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49
Q

If the client is having contractions when should you do leopold manuevers at?

A

Between Contractions

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50
Q

What are some signs of labor

A

Lightening
Engangement
Fetal stations

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51
Q

What is lightening

A

Usually occurs 2 weeks before term, when presenting part descends to pelivs- frequency is seen

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52
Q

What is engagement

A

When the largest part of the fetus is in the pelvic inlet– hopefully head

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53
Q

When membranes rupture we have to think what

A

Prolapse cord, if head is not engaged

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54
Q

What is fetal station

A

It is a measurement; measured in cm, and it measures the relationship of the presenting part of the fetus to the ischial spine of mom

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55
Q

What are some other signs of labor

A 
Braxton hicks contraction
Softening of cervix
bloody show (Not heavy bleeding)
Sudden burst of energy called nesting
diarrhea
rupture of membranes and sudden burst of energy
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56
Q

When should the client go to the hospital

A

When contractions are 5 minutes apart or when the membranes rupture

57
Q

What are we worried about when membranes rupture

A

Prolapse cord

58
Q

What are some of the diagnostic tests involved in pregnancy

A

Non-Stress Test
Biophysical Profile Test
Contraction Stress test

59
Q

What are some important things to remember with Non-stress test

A
  • want to see 2 or more accelerations of 15 b/min with fetal movement
  • Each increase should last 15 seconds and recorded over 20 minus
  • This test should be reactive
60
Q

What are some important things to remember with a BPP

A
  • Done in the last trimester or 32-34 weeks if high risk (maybe weekly or bi-weekly)
  • Measurements are done by ultrasound
  • Each one counts for 2 points
61
Q

What are the BPP measurements

A

1) Heart rate (NST) Reactive?
2) Muscle Tone: 1 Flexion/extension
3) Movement 3 times in 30 minutes
4) Breathing at least once
5) Amniotic Fluid- enough around the baby

In 30 minues,

62
Q

CST: what are some of the important things to remember

A

-DO this when NST was negative and with high risk pregancy: Preeclampsia, maternal diabetes,, and any condition where placental insufficiency is suspected

63
Q

Why do we do a CST?

A

To determine if the baby can handle stress with uterine contractions

64
Q

What is decelaration

A

It’s when the baby’s heart rate decreases due to decrease blood flow to the baby causing hypoxia

65
Q

What is uteroplacental insufficiency

A

Late decelarations- placenta is wearing off

66
Q

DO you want a positive or negative test with CST

A

Negative test, no late decelerations

67
Q

This test is done when

A

28 weeks, because it can induce contraction, and this can put them in labor

68
Q

With true labor we see what to contractions

A

Regular and increase

69
Q

With true labor we see

A

Discomfort to back and radiates to abdomen, and pain it increases with activity

70
Q

In a false labor what do you see

A

Irregular contractions
Discomfort to abdomen only
pain decreases with activity

71
Q

How do you position a patient when receiving an epidural

A

Lie on Left side, legs flexed

72
Q

When should an epidural be given

A

In stage 1 at 3-4 cm dilation

73
Q

Should the client experience headache or hypotension

A

usually no headache but hypotention is a complication

74
Q

What should we be monitoring with an epidural

A

BP

75
Q

What do you give prior to epidural

A

Bolus with 1000ml of NS or LR to fight hypotention

76
Q

Nursing considerations for Pitocin

A
  1. one to one care
  2. Be alert for complications
  3. Want a contraction rate of 1 every 2-3 minutes lasting 60 seconds
  4. it is piggy backed with main IV fluid
77
Q

What are the complications related to Pitocin

A

Hypertonic labor
Fetal Distress
Uterine Rupture

78
Q

What are the 2 types of uterine ruputre

A

Complete and incomplete

79
Q

What are the s/s of complete rupture

A

The rupture goes through uterine wall into peritoneal cavity;

  • Sudden sharp shooting pain(something gave way)
  • s/s of hypovolemic shock due to hemorrhate
  • if placenta separates, fetal heart tone will be absent
80
Q

What are the s/s of incomplete rupture

A

tear through peritoneal wall, but not through the cavity

  • internal bleeding
  • pain may or may not be present
  • fetus may or may not have late decels
  • client may vomit
  • faint
  • have hypotonic uterine contractions and lack progress
  • fetal heart tones may be lost
81
Q

Which clients are at high risk for uterine rupture

A

VBAC- vaginal births after c-section

82
Q

How long do you want a contraction to last when on oxytocin

A

1 every 2-3 minutes lasting 60 seconds

83
Q

If a client is having:

  • contractions too often
  • they last too long
  • and fetal is in distress what do you do with oxytocin
  • decelerations
A

Discontinue it

84
Q

What position should the client be in when receiving oxytocin

A

Any position except flat on back, but best on the side; LEFT

85
Q

Do you want to pause between contractions

A

YES, baby is getting oxygen

86
Q

With an emergency delivery what should you make sure when the baby first comes out

A 
Keep head of baby down
Dry baby
Keep baby at level of uterus
place on mothers abdomen
cover baby
87
Q

Where do you want tie the cord

A

one knot about 4 inches from baby’s navel and one 8 inches from baby’s navel

88
Q

What should you check for in the uterus

A

Firmness, not boggy

89
Q

In the post partal period what do you expect with vital signs

A

T may increase to 100.4 during 1st 4 hours
BP stable
HR- 50-70 for 6-10 days

90
Q

If a person has tachycardia in postpartum what should you be thinking

A

Hemorrhage

91
Q

What happens to the breast post-partum

A

They would be soft for the first 2-3 days and then engorgement occurs

92
Q

What happens to the abdomen post-partum

A

It is soft/loose; the abdomen muscles separate- diastasis recti(Line down the abdomen) Vigourous exercise to make it go away

93
Q

Is hunger common postpartum

A

Yes

94
Q

What does the uterus do right after delivery

A

immediately after birth the fundus is midlne 2-3 finger breaths below umbilicus

95
Q

What happens to the uterus hours after birth

A

It should rise to the level of the umbilicus or one FB above

96
Q

What do we want the fundus to feel like post-partal

A

Firm

97
Q

What happens if the fundas is boggy

A

massage until firm and check for bladder distention

98
Q

How much should the fundus height descent to

A

one figerbreath/day

99
Q

What is the proper term used when fundus descends to uterus and returns to pre-pregnancy sixe

A

Involution

100
Q

When are afterpains seen

A

for 2-3 days and if mom breastfeeds

101
Q

If uterus is not involuting what are we worried about

A

Hemorrhage

102
Q

When do you see dark red color what are you thinking

A

RUBRA the days should be 3-4 day’s and it’s red

103
Q

When do you see pinkish brown color what are you thinking

A

Serousa 4-10 days

104
Q

When do you see whitish yellow color what are you thinking

A

Alba 10-28 days can be as long as 6 weeks

105
Q

What size are clots ok to be

A

Nickel size

106
Q

What should urine output be

A

diuresing, monitor for dvt’s and dehydration

107
Q

What can you do for perineal care

A
  • ice packs to decrease edema
  • warm water rinzes
  • sitz baths 2-4 times a day
  • anesthetic sprays
  • change pads frequently
  • teach to report foul smell
  • report lochia changes
108
Q

What is the Peripad rule

A

NOT TO HAVE MORE THAN 1 PERIPAD/HOUR

109
Q

Why is bonding important between baby, and parents

A

it develops trust. not only an emotional need but a physiological need:
stabalizes hr
improves o2 sats
regulates infant temp
conserves calories
breast changes from warm to cool to comfort infant

110
Q

What do we do for breast care with breast feeding mum

A
  • Cleanse with warm water after each feed-let air dry
  • support bra
  • Ointment for soreness or express some colostrum and let it dry
  • Breast pads-absorb moisture after milk come in
  • mother need to initiate breast feeding asap after birth
  • mum can pump
  • increase calories intake by 500 calories
  • 8-10 8 ouncesglasses of fluid a day
111
Q

What do we care for non-breast feeding mom’s breasts

A
  • Ice packs, breast bonders, chilled cabbage leaves
  • chilled leaves decrease inflammation and decrease engorgement
  • no stimulation of breast
112
Q

What are some complications related to post-partal period

A
  • Postpartum infection
  • postpartum hemorrhage
  • mastitis
113
Q

With early hemorrhage what 2 things must be true

A

more than 500cc of blood lost in the first 24 hours and 10percent drop from admission hematocrit

114
Q

What is considred late postpartum hemorrhage

A

after 24 hours up to 6 weeks postpartum

115
Q

What does uterine atony, laceration, retained fragments and forcep delivery cause

A

postpartum hemorrhage

116
Q

What does oxytocin, methylergonovine laeate and carboprost Tromethamine used for

A

halt excessive postpartum hemorrhage

117
Q

What bacteria causes mastitis and when does it occur

A

Staphylococcus and occurs 2-4 weeks

118
Q

Is Penicillin okay to use when breastfeeding

A

Yes

119
Q

Which breast should the mom offer to baby first if mastitis

A

Affected breast first

120
Q

What do you need to do right away for newborn care

A 
Suction
Clamp and cut the cor
maintain body temp
Apgar score 1-5 mins from delivery (Hr, R,  muscle tone, reflex irritability, color)
Erythromycin
Phytonadione
121
Q

What is erythromycin used for

A

Prophylaxis for Neisseria gonococcus, will also kill growing STD chlamydia

122
Q

What does Phytonadione aquamephyton used for and given where

A

Promotes formation of clotting factors, vastus lateralis

123
Q

Cord care

A

Dries and falls off 10-14 days
cleanse with each diaper change and use alcohol or normal saline
Fold diaper below cord
no immersions until cord falls off, watch for infection

124
Q

What are some complications related to newborns

A

1) Hypoglycemia
2) Pathologic Jaundice
3) Physiological Jaundice
4) Rh Sensitization

125
Q

Which babies are at risk for hypoglycemia

A

-Larger for gestatiional age
-smaller for gestational age
-preterm
-diabetic mum babies
Not getting glucose from mom

126
Q

When does pathological jaundice occur and what does it mean

A

in the first 24 hours, usually means Rh/ABO incompatibility

127
Q

When does physiological jaundice occur and what does this mean

A

After 24 hours, and it is due to normal hemolysis of RBC releasing bilirubin, or liver immaturity

128
Q

What must occur to have an RH sensitization

A
  • Rh- mum and Rh+ fetus
  • mums blood comes in contact with baby’s blood when placenta separates
  • occurs at miscarriage, amniocentesis or when trauma to mom’s abodmen
  • mom produces antibodies agains baby’s RH
129
Q

Is the first offspring affected by Rh factor

A

No

130
Q

What happends in the second pregnancy

A

The antibodies enters baby through placenta- and hemolysis occurs
Baby tries to compensate

131
Q

What is it called when baby is trying to compensate for hemolysis

A

Erythroblastosis fetalis (immature RBC production in fetal circulation)

132
Q

What can erythroblastosis fetalis result in

A
  • hyperbilirubinemia
  • anemia
  • hypoxia
  • hf
  • neuro damage
  • hydrops fetalis
133
Q

What can you do diagnose Rh factor

A

Indirect combs

Direct combs

134
Q

What is Indirect coombs

A

it is measuring number of antibodies in blood of mum

135
Q

What is direct coombs

A

It is measuring antibodies stuck on RBC done on baby

136
Q

What do you do if you have an Rhpositive fetus and a sensitized mum

A

frequent u/s and monitor growth

early birth when growing stops

137
Q

When do you give Rhogam

A

some give it at 28 weeks incase of any mixing of blood and again Within 72 hours after birth
and with any bleeding episodes

138
Q

How does Rhogam work

A

It destroys fetal cells that go into mum’s blood and it does this before any antibiodies can be formed

NCLEX (21 decks)

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