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z Here you go, Alexis! > maternity > Flashcards

maternity Flashcards

1
Q

first trimester

A

week 1 - 13

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2
Q

second trimester

A

week 14 - 26

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3
Q

third trimester

A

week 27 - 40

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4
Q

presumptive signs of pregnancy x4

A

amenorrhea
n/v
frequency
breast tenderness

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5
Q

what hormone causes amenorrhea

A

progesterone - secreted by corpus luteum

makes temperature increase after ovulation

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6
Q

probable signs of pregnancy

A 
positive pregnancy test (hCG levels)
Goodell's Sign
Chadwick's Sign
Hegar's Sign
uterine enlargement
Braxton Hicks contractions
pigmentation/skin changes (linea negra, abdominal striae, facial chloasma, areola darkening)
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7
Q

positive signs of pregnancy

A 
fetal heart beat (doppler, fetoscope)
fetal movement (clinician feels)
ultrasound
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8
Q

Goodell’s Sign

A

softening of cervix, month 2

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9
Q

Chadwick’s Sign

A

bluish color of vaginal mucosa and cervix, week 4

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10
Q

Hegar’s Sign

A

softening of lower uterine segment, month 2/3

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11
Q

fetal heartbeat can be heard via doppler when?

A

week 10 - 12

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12
Q

fetal heartbeat can be heard via fetoscope when?

A

week 17 - 20

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13
Q

gravidity

A

times someone has been pregnant

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14
Q

parity

A

of pregnancies in which fetus reaches 20 weeks

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15
Q

when is a fetus/baby considered viable?

A

week 24 (has the ability to live outside uterus)

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16
Q

GTPAL stands for

A 
gravidity
term
preterm
abortion (spontaneous and elective)
living
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17
Q

Naegele’s Rule

A

first day LMP
add 7 days
subtract 3 months
add 1 year

accurate +/- 2 weeks

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18
Q

increase calories by how much after first trimester?

A

300

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19
Q

pregnant women should increase protein to how much?

A

60g per day

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20
Q

expect to gain how many pounds in first trimester?

A

4

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21
Q

take iron with what to enhance absorption, if pregnant?

A

vitamin C

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22
Q

how much folic acid should pregnant women take daily

A

400 mcg/day

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23
Q

exercising pregnant women: do not let HR get above ? and why?

A

140 - CO drops and uterine perfusion drops

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24
Q

danger signs for pregnant women (mostly 3rd trimester)

A 
sudden gush of vaginal fluid
bleeding
persistent vom
severe headache
abdominal pain
increased temps
edema
no fetal movement
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25
Q

how often should pregnant women visit provider (first 28 weeks)

A

once a month

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26
Q

how often should pregnant women visit provider (28 - 36 weeks)

A

twice a month

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27
Q

how often should pregnant women visit provider (36+ weeks)

A

weekly until delivery

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28
Q

ultrasounds for pregnant clients: do what first and why?

A

drink water, distend bladder - pushes uterus to abdominal surface

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29
Q

expected weight gain in second trimester

A

1 pound per week

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30
Q

second trimester - does the client experience
n/v
frequency
breast tenderness

A

no
no (uterus rises)
yes

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31
Q

quickening

A

fetal movement 16 - 20 weeks

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32
Q

fetal heart rate during second trimester

A

120 - 160

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33
Q

fetal heart rate: normal, worry, panic

A

120 - 160
110 - 120
less than 110

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34
Q

kegels strengthen what

A

pubococcygeal muscles

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35
Q

pregnancy is considered term if it advances to?

A

37 - 40 weeks

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36
Q

best place to hear fetal heart tones

A

baby’s back

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37
Q

lightening

A

presenting part of fetus (typically head) descends into pelvis, occurs around 2 weeks before term

client feels less congested but frequency is problem again

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38
Q

engagement

A

largest presenting part is in pelvic inlet

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39
Q

signs of labor

A 
braxton hicks - more frequent, longer
softening of cervix
bloody show
nesting
diarrhea
rupture of membranes
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40
Q

besting

A

sudden burst of energy that is a sign of labor

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41
Q

when should pregnant woman head to hospital for labor?

A

contractions 5 minutes apart

OR

membranes rupture

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42
Q

non-stress test (maternity)

A

see 2+ accelerations of 15+ beats/minute with fetal movement

diagnostic test of pregnancy

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43
Q

acceleration (fetal heart rate)

A

abrupt increase from baseline, 15+ beats/minute lasting at least 15 seconds

back to baseline within 2 minutes

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44
Q

biophysical profile test (maternity)

A

last trimester or 32-34 for high risk (in 3rd trimester, 1 or 2 times a week)

1: HR (non-stress test reactive)
2: muscle tone (at least 1 flexion/extension)
3: movement (at least 3 times)
4: breathing (movements at least once)
5: amniotic fluid (enough fluid around baby)

observe for 30 minutes
8-10 good
6 worry
4 or less - ominous

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45
Q

deceleration (fetal heart rate)

A

blood flow decreases enough to cause hypoxia in the fetus resulting in decreased HR compared to baseline

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46
Q

contraction stress test/oxytocin challenge test (maternity)

A

done when NST non-reactive, high risk pregnancies (pre–eclampsia, maternal diabetes, suspected placental insufficiency)

determines if baby can handle stress of uterine contraction

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47
Q

variable decelerations

A

cord compression

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48
Q

early decelerations

A

head compression

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49
Q

accelerations

A

okay

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50
Q

late decelerations

A

(utero)placental insufficiency

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51
Q

false labor

A

irregular contractions, abdominal discomfort only, pain decreases/goes away with activity

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52
Q

major complication of epidural anaesthesia

A

hypotension

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53
Q

positioning for epidural anaesthesia

A

semi-fowlers on left side
legs flexed
not as arched with lumbar puncture
alternate sides hourly

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54
Q

when do you give epidural anaesthesia to pregnant woman in labor?

A

stage 1, 3-4cm dilation

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55
Q

what do you give to pregnant woman receiving epidural anaesthesia to fight hypotension?

A

1000mL NS or LR bolus

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56
Q

why is lithiotomy position bad?

A

vena cava compression impedes venous return, reduces CO and BP, therefore decreasing placental perfusion

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57
Q

unreassuring fetal heart tones do what?

A

reposition client to left side to enhance uterine perfusion

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58
Q

laboring patient receiving oxytocin requires what?

A

one-on-one care!

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59
Q

possible complications of oxytocin use during labor x3

A

hypertonic labor
fetal distress
uterine rupture

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60
Q

complete uterine rupture

A

through the uterine wall into peritoneal cavity

important s/s: hypovolemic shock due to hemorrhage, fetal heart tones absent

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61
Q

incomplete uterine rupture

A

through uterine wall but stops in peritoneum - not in the peritoneal cavity

important s/s: fetal heart tones may be lost

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62
Q

VBAC mothers at high risk for

A

uterine rupture, highest risk with oxytocin

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63
Q

oxytocin + labor = expected contraction rate

A

1 every 2-3 minutes lasting 60 seconds

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64
Q

discontinue oxytocin during labor if x4

A
  • contractions too often
  • too long
  • fetal distress
  • late decels
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65
Q

when should laboring mother push?

A

during contractions ONLY

66
Q

1 worry with retained placenta

A

hemorrhage

67
Q

when does placenta deliver?

A

w/in 30 minutes

68
Q

if you have to cut the baby’s cord yourself during an emergency delivery, how?

A

tie @ 4 and 8 inches from baby’s navel

cut with heated razorblade

69
Q

what should the uterus be like after delivery?

A

FIRM! if boggy, MASSAGE THE FUNDUS

70
Q

diastasis recti

A

abdominal muscles separate postpartum

vigorous exercise fixes this shit

71
Q

uterine position: immediately after birth

A

midline 2-3 fingerbreadths below umbilicus

72
Q

uterine position: a few hours after birth

A

rises to level of umbilicus or 1 fingerbreadth above

73
Q

if uterus is above expected level or not midline postpartum, suspect what?

A

bladder distention - increases risk of hemorrhage because it will not allow uterus to contract normally

74
Q

uterine fundal height will descend how?

A

one fingerbreadth per day

75
Q

involution

A

fundus descends and uterus returns to pre-pregnancy size

76
Q

afterpains

A

common for the first 2-3 days and will continue to be common if mom chooses to breast feed (surge of oxytocin)

77
Q

postpartum vital signs of interest x2

A

T up to 104 during 1st 4 hours

HR 50 - 70 common for 6-10 days

78
Q

lochia rubra

A

day 3-4, dark red

79
Q

lochia serosa

A

day 4-10, pinkish brown

80
Q

lochia alba

A

day 10-28, whitish yellow

81
Q

clots okay in lochia when?

A

nickel or smaller

82
Q

perineal care postpartum x4

A

intermittent ice packs first 6-12 hours (decrease edema)

especially for episiotomy, laceration, hemorrhoids:
warm water rinses
sitz baths 2-4 times a day
anesthetic sprays

83
Q

peripad saturation rule

A

patient should not saturate more than one per hour - if so, assume hemorrhage

84
Q

mom should increase caloric intake by how much for breastfeeding?

A

500 calories

85
Q

what can lead to mastitis?

A

insufficient fluid = plugged ducts

poor baby feeding

86
Q

post-partum infection: when & culprits

A

within 10 days

E Coli, beta hemolytic strep

87
Q

early postpartum hemorrhage

A

more than 500cc lost in first 24 hours
AND
10% drop from admission hematocrit

MUST BE BOTH

88
Q

late postpartum hemorrhage

A

after 24 hours, up to 6 weeks postpartum

89
Q

causes of postpartum hemorrhage

A

uterine atony
lacerations
retained fragments
forceps delivery

90
Q

typical causative agent of mastitis

A

staph

91
Q

mastitis: what & when

A

milk is okay, breast is messed up

usually around 2-4 weeks

92
Q

mastitis and breastfeeding: abx and method

A

penicillin is okay to take; feed baby then take abx

feed baby frequently and offer affected breast first (baby feeds more aggressively at first)

93
Q

what should non-breastfeeding mothers do for their boobs

A

ice packs, breast binder, chilled cabbage leaves (decrease inflammation and engorgement)

94
Q

apgar: when, what, ideal score

A

done at 1 and 5 minutes
HR, RR, muscle tone, reflex irritability, color
ideal: 8-10

95
Q

eye drops for baby: what and what organism

A

erythromycin - neisseria gonococcus

also kills chlamydia

96
Q

umbilical cord: care

A

dries and falls off 10-14 days
cleanse with each diaper change (alcohol, NS); diaper below cord
no immersion until cord falls off

97
Q

babies at greatest risk for hypoglycemia

A

small and large for gestational age
preterm
babies born to diabetic moms

98
Q

pathologic jaundice

A

first 24 hours

usually Rh/ABO incompatibility

99
Q

physiological jaundace

A

aka hyperbilirubinemia
after 24 hours
due to normal hemolysis of excess RBCs releasing bilirubin or liver immaturity

100
Q

indirect coombs test

A

Rh and ABO check, prenatal

done on mom, measures # antibodies in blood

101
Q

direct coombs test

A

Rh and ABO check

done on baby cord blood, tells if any antibodies stuck to RBCs

102
Q

when is Rho(D) immunoglobulin/RhoGAM given?

A

28 weeks gestation (protect fetus in case blood mixes)

within 72 hours after birth

with any bleeding episodes

for Rh- moms with Rh+ babes

103
Q

spotting and cramping during pregnancy

A

spotting common during pregnancy

but spotting + cramping more indicative of miscarriage

104
Q

hydatidiform mole

A

molar pregnancy - benign neoplasm (can become malignant)

grapelike clusters of cells - release hCG; uterus enlarges too fast
confirm with ultrasound, remove with D&C

105
Q

hydatidiform mole: important to remember about pregnancy

A

hCG produced; do not get pregnant during follow up period after removal of mole - hCG rise can’t be differentiated between pregnancy vs malignancy

106
Q

choriocarcinoma

A

hydatidiform mole becomes malignant - chest x-rays to check for mets

107
Q

how often to check hCG with molar pregnancy

A

weekly until normal
recheck every 2-4 weeks
then every 1-2 months for 6 months - ayear

108
Q

ectopic pregnancy: what, where, how to confirm, s/s, risk, treatment

A

gestation outside uterus, typically in fallopian tube
confirm with ultrasound

first sign: pain; then spotting, bleeding into peritoneum, vaginal bleeding

one ectopic pregnancy = risk for another

treat with methotrexate

109
Q

methotrexate

A

given to mom experiencing ectopic pregnancy to stop growth of embryo to save fallopian tube

110
Q

if methotrexate doesn’t work for ectopic pregnancy

A

laparoscopic incision into tube and embryo removed, entire tube may have to be removed

111
Q

placenta previa: what, types, nota bene x2

A

placenta has implanted wrong - begins to prematurely separate when cervix begins to dilate/efface and baby doesn’t get oxygen

low lying, partial, complete

placenta comes out first, bad

most common cause of bleeding in later months of pregnancy (typically 7th); confirm with ultrasound

some resolve during pregnancy due to uterine growth

112
Q

low lying placenta previa

A

placenta on side of uterus

113
Q

partial placenta previa

A

placenta halfway covering cervix

114
Q

complete placenta previa

A

placenta completely covering cervix

115
Q

placenta previa treatment

A

complete: hospitalization from as early as 32 weeks until birth to prevent blood loss and fetal hypoxia if labor begins

not much bleeding: bedrest, monitor

DO NOT PERFORM VAGINAL EXAM

116
Q

increases risk for placenta previa

A

previous C-section d/t scarred uterus

117
Q

abruptio placenta: what, blood, when, confirmation

A

placenta implanted normally, but separates prematurely from uterus - partial or complete (1-3 worst)

can bleed externally or concealed (into uterus)

seen in last half of pregnancy

ultrasound confirms

118
Q

abruptio placenta causes

A

MVC, DV, previous c-section, rapid uterus decompression/membranes rupture, associated with cocaine use, PIH, smoking

119
Q

abruptio placenta s/s

A

rigid board-like abdomen with or without vaginal bleeding (see this, worry patient is bleeding internally!)

abdominal pain, increased uterine tone, difficult to palpate fetus

120
Q

rigid board-like abdomen with or without vaginal bleeding

A

think abruptio placenta

121
Q

incompetent cervix: what, when, miscarriage note

A

cervix dilates prematurely because weight of baby causes pressure on cervix, occurs ~4th month of pregnancy

this client will have hx of repeated, painless, 2nd trimester miscarriages (most miscarriages 1st trimester!)

122
Q

cerclage (purse-string suture) what and when

A

for incompetent cervix, at 14-18 weeks

80-90% chance of carrying baby to term after cerclage

123
Q

causes of hyperemesis gravidarum

A

high levels of estrogen and hCG

124
Q

s/s hyperemesis gravidarum

A 
BP down
H/H up
uop down
K+ down
weight down
ketones in urine (breaking down body fat)
125
Q

preeclampsia

A

increased BP + proteinuria + edema
after 20th week

if pre-pregnancy BP is not known, 130/90 = mild preeclampsia

126
Q

BP indicative of mild pre-eclampsia for moms with unknown baseline

A

130/90

127
Q

preeclampsia: s/s

A

sudden weight gain
face and hands swollen (losing albumin so fluid leaks into tissue)

vasospasms cause –
headache, blurred vision, seeing spots, increased DTR, clonus to seizure

128
Q

see pregnancy client gains 2+ pounds in a WEEK, worry about

A

PIH

129
Q

mild-preeclampsia BP + treatment

A

30/15 off baseline documented 6 hours apart

bedrest, increase protein in diet

130
Q

severe preeclampsia BP + treatment

A

BP elevated 160/110 documented 6 hour apart

sedation to delay seizures, mag sulfate drug of choice!

131
Q

cure for preeclampsia

A

delivery

132
Q

how long is preeclamptic mother at risk for seizures after delivery

A

for 48 hours up to 4-6 weeks

133
Q

magnesium sulfate x3

A

anticonvulsant, sedative, vasodilator drug of choice given for preeclampsia

increases renal perfusion, helps avoid renal failure, increases placental perfusion

labor will stop (relaxes uterus) unless augmented with oxytocin/Pitocin

134
Q

never lay pregnant woman on back why?

A

places pressure on vena cava which will
impair kidney perfusion and impair CO
and impair placenta perfusion

preferable: left side (CO greater)

135
Q

magnesium sulfate for preeclampsia: nursing considerations

A

check for toxicity every 1-2 hours (BP, respirations, DTR, LOC)

uop hourly, serum mag periodically

136
Q

first sign of mag toxicity

A

DTR decrease

137
Q

if dbp greater than 100 in preeclamptic woman receiving mag

A

give apresoline/Hydralazine too

side effect: tachycardia (compensatory for BP drop)

138
Q

betamethasone: what + when + how

A

given for premature babes with immature lungs - stimulates surfactant production in alveoli causing less tension when infant breathes

given between 24 & 34 weeks gestation to reduce infant mortality

IM to mom - inj 24 hours apart

139
Q

why do babies born to preeclamptic mothers require steroid therapy

A

aka betamethasone

vasoconstriction in mom = lack of blood flow to placenta = less oxygen and nutrients to baby = preterm delivery = immature lungs at birth

140
Q

eclampsia + tx

A

preeclampsia becomes this when a seizure happens (super high BP)

monitor FHT, watch for labor and heart failure; also stroke, MI, renal failure, DIC, HELLP syndrome, neuro damage, multisystem organ failure

141
Q

PIH

A

pregnancy induced hypertension - occurs after 20 weeks

proteinuria

142
Q

gestational hypertension

A

occurs after 20 weeks

NO proteinuria

143
Q

PIH vs gestational hypertension

A

PIH has proteinuria

gestational does not

144
Q

chronic hypertension with superimposed PIH

A

client hypertensive prior to pregnancy and it got worse with proteinuria after 20 weeks

145
Q

premature labor + tx

A

occurs between 20-37 weeks

stop labor with: tocolytic (terbutaline), mag sulfate(relaxes uterus)

give betamethasone (for baby lungs)

146
Q

terbutaline/Brethine + side effects

A

bronchodilator and also tocolytic

increased pulse and hyperactivity

147
Q

less common ways to stop preterm labor

A

hydration, treat vaginal/UTI

148
Q

prolapsed cord

A

umbilical cord falls through cervix, most likely to happen when presenting part not engaged and membranes rupture

149
Q

nursing action when membranes rupture (spontaneous or artificial)

A

check FHT

cord compression: variable decels

150
Q

prolapsed cord treatment

A

lift head off cord until physician arrives
trendelenburg or knee-chest position
administer oxygen (hyperox to max O2 to baby)
monitor FHT
NEVER PUSH BACK IN

151
Q

shoulder dystocia

A

fetal head delivered but impacted fetal shoulder within maternal pelvis halts delivery

anterior shoulder impacted by symphysis pubis

hard to predict

152
Q

shoulder dystocia risk to fetus

A 
hypoxia = cerebral palsy, asphyxia 
brachial plexus injury = erb's palsy
broken clavicle
bell's palsy
many resolve but can lead to permanent damage
153
Q

erb’s palsy

A

drooping/paralysis of an arm caused by excessive traction and stretching of brachial nerve

happens to shoulder dystocia babies

154
Q

increase risk for shoulder dystocia x4

A

LGA or macrosomic greater than 4000g
gestational diabetes
previous history
post date delivery with a large fetus

155
Q

McRoberts Maneuver

A

for shoulder dystocia

mom’s legs are hyperextended

156
Q

Mazzanti techniques

A

for shoulder dystocia
suprapubic pressure easing shoulder past symphysis pubis
provider does this

do not apply fundal pressure!!

157
Q

Gaskin maneuver

A

for shoulder dystocia

mom on all fours with arched back

158
Q

group b strep + tx

A

leading cause of neonatal morbidity; risk for fetus is only after rupture of membranes

transmitted to infant from birth canal of infected mother during delivery

give prophylactic abx therapy, penicillin (clindamycin if allergy)

NOT AN STD

159
Q

leading cause of neonatal morbidity

A

group b strep

160
Q

when do you culture for group b strep

A

~35-37 weeks

on admission to L&D

161
Q

premature rupture of membranes greater than 18 hours worry about

A

neonatal group b strep

z Here you go, Alexis! (23 decks)

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