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NCLEX > maternity > Flashcards

maternity Flashcards

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1
Q

hormone that induces amenorrhea

A

progesterone

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2
Q

presumptive signs of pregnancy

A

amenorrhea
n/v
urine frequency
breast tenderness

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3
Q

probable s/s of pregnancy

A

positive test (based on hCG levels)
Goodell’s sign (softening of cervix)
chadwick’s sign (bluish color of vaginal mucosa and cervix)
Hegar’s sign (softening of lower uterine segment)
uterine enlargement
braxton hicks contractions throughout pregnancy

pigmentation changes:
linea nigra (dark line down the center of the abdomen)
facial chloasma (mask of pregnancy)
abdomen striae (stretch marks)
darkening of the areola
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4
Q

positive signs of pregnancy

A

fetal heartbeat:
doppler (10-12wk)
fetoscope (17-20wk)

fetal movement
ultrasound

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5
Q

gravidity

A

number of times someone has been pregnant

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6
Q

parity

A

number of pregnancies in which fetus reaches 20wks

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7
Q

viabililty

A

24 wks gestation

infant can live outside uterus

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8
Q

TPAL

A

T: term
P: preterm
A: abortion (includes spontaneous and elective)
L: living children

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9
Q

spontaneous abortion

A

AKA miscarriage:
bleeding, cramping, backache– think miscarriage
hCG levels will drop

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10
Q

Naegele’s rule for EDD

A

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

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11
Q

first trimester nutrition & supplements

A

increase protein to 60g/day
weight gain of 1-4pounds

biggest complaint of iron (constipation and GI upset)
always take iron with vitamin C (enhances absorption)
folic acid prevents neural tube defects

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12
Q

first trimester exercise

A

no high impact
walking
swimming
no heavy exercise program
dont let HR get above 140 (can decrease CO/perfusion to baby)
don’t overheat (no hot tubs or heating blankets–increase body temp and cause birth defects)

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13
Q

danger signs and potential complications of maternity

A 
sudden gush of vaginal fluid
bleeding
***persistent vomiting
severe headache
abdominal pain
increased temp
edema
*** no fetal movement
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14
Q

common discomforts

A 
constipation
ankle edema
n/v
breast tenderness
urinary frequency 
tender gums
fatigue
heartburn
increased vaginal secretions
nasal congestion
varicose veins
hemorrhoids
backache
leg cramps
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15
Q

1st trimester meds, smoking, HCP visits, ultrasounds

A

no meds unless approved by HCP

stop smoking
can have small gestational age, low birth weight babies, cleft lip or palate, placental abruption

first 28wks = once a month
28-36wks = every 2 wks/twice a month
after 36wks = weekly

drink water before ultrasound to distend the bladder and push uterus up closer to abdominal surface so it’s easier to get a picture
ultrasound before procedure (amniocentesis): void

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16
Q

2nd trimester nutrition

A

wk 14-26

increase 300cals
adolescent can increase 500cal

1 pound weight gain/wk

should not experience n/v and urinary frequency
can still have breast tenderness

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17
Q

quickening

A

fetal movement (16-20wks)

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18
Q

fetal HR

A

110-160

less than 110=panic!!!

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19
Q

kegel exercise

A

strengthen pubococcygeal muscles
help stop urine flow
keep uterus from falling out

20
Q

3rd trimester assessment

A

wk 27-40

term if advances to 40 weeks

no more than 1lb weight per week

monitor BP:
pre-eclampsia develops after 20wks: 
they will have high BP
proteinuria
edema
BP 160/110 or greater documented 6 hours apart
***two or more pounds of weight gain in a week, watch close and worry about possible pre-eclampsia:
can have a seizure
magnesium sulfate is drug of choice:
given IV
close supervision
anticonvulsant
sedates
vasodilator
***it is called eclampsia when they have a seizure

FHR: 110-160

fetal position determined by leopold maneuvers:
have them void
if having contractions, do it between contractions

21
Q

signs of labor

A 
lightening:
2wk before term
presenting part (head) descends into the pelvis
abe to breath easier
urinary frequency

engagement:
largest presenting part in pelvic inlet (head)

fetal station:
measured in cm

braxtion hicks (more frequent and stronger than before)
softening of cervix
bloody show
sudden burst of energy called nesting
diarrhea
ruptured membranes

when should they go to the hospital:
contractions are 5minutes apart
membranes rupture
worried about prolapsed cord when membranes rupture

22
Q

non stress test

A

two or more accelerations of 15beats/min or move with or without fetal movement

acceleration:
FHR has an abrupt increase 
increase is greater than 15beat/min 
lasts for 15 seconds
should come back to baseline within 2minutes

each increase should last for 15 seconds and recorded for 20minutes

***want it to be reactive

23
Q

biophysical profile test

A

commonly done in last trimester
measured by ultrasounds and each of the parameters count 2 points
10/10 = perfect score

parameters:
HR
muscle tone
movement
breathing
amount of amniotic fluid
BPP test:
observation time is 30minutes by sonogram
8-10 = good
6 = worrisome
less than 4 = ominous (deliver)
24
Q

contraction stress test

A

oxytocin challenge test
for high risk pregnancies
determines if baby can handle the stress of contractions

deceleration:
blood flow decreases & causes hypoxia then FHR will decrease

*** do not want to see late decelerations (uteroplaental insufficiency = placenta is wearing out)

** want a negative test

25
Q

types of decelerations

A

early:
not bad
benign
caused by physiological hypoxia from fetal head compression

late:
bad
caused by uteroplacental insuffiency

variable:
bad
caused by umbilical cord compression

26
Q

true vs false labor

A 
true:
regular contractions
increase in frequency and duration
discomfort in back and radiates to abdomen
pain increases with activity

false:
irregular contractions
discomfort in abdomen (front)
pain decreases/goes away with activity

27
Q

premature/preterm labor

A

contractions occur with dilation between 20-37 weeks
stop the labor
treat any existing vaginal/UTI
hydrate the mom will often stop preterm labor
bedrest

Meds:
magnesium sulfate (IV relaxes uterus)
betamethasone (IM, steroid helps fetal lungs mature)
terbutaline (SQ)
indomethacin (PO)
nifedipine (PO)
28
Q

epidural anesthesia

A

lie on L side
legs flexed
prop up over the bedside table
given at 3-4cm dilation
usually no headache
major complication (hypotension)
IVFs (bolus with 1000ml of NS/LR to fight hypotension)
monitor BP close
semi-fowlers
tilt on side to prevent vena cava compression
vena cava compression will decrease venous return (reduces CO and BP)
if BP decreases perfusion to baby goes down
alternate position from side to side hourly
check urine output and assess bladder

29
Q

client receiving oxytocin

A

considerations:
one-on-one care

complications:
hypertonic labor
fetal distress
uterine rupture
contraction rate of 1 every 2-3 minutes with each lasting 60seconds

discontinue oxytocin when:
contractions are too often
contractions last too long
fetal distress

oxytocin is piggly backed into a main IV fluid so when you turn off turn off IV fluids too

any position except flat
put on L side with any fetal distress

turn it off with any late decelerations

30
Q

emergency delivery/precipitous delivery

A 
pant/blow to decrease the urge to push only during contractions
wash hands
elevate HOB
place something under butt
decrease touching vaginal area
tear amniotic sac as head crowns
place hand on fetal head and apply gentle pressure
when head is out, feel for the cord around he neck (nuchal cord)
ease each shoulder out
keep baby's head down
****dry baby (cannot regulate temp)
place on mom's abdomen
cover baby (skin to skin)
wait for placenta to separate/deliver 
can push to deliver placenta 
****want placenta out wihtin 30minutes
check firmness of uterus
31
Q

normal post partal period assessment

A

VS:
temp may increase
BP stable
HR 50-70 common for 6-10days after

**tachy + partum = hemorrhage

breast soft for 2-3 days then the engorgement occurs
soft/loose abdomen
hunger is common
fundus is midline 2-3 finger breaths below umbilicus
fundus rises a few hours after birth
want fundus to be firm

if uterus is boggy:
massage the fundus
check for bladder distention (increases hemorrhage)

fundus height will descend one finger breath/day

lochia:
rubra 3-4 days (dark red)
serosa 4-10days (pink/brown)
alba 10-18 days (white, yellow)
can have alba up to 6wks
clots are okay as long as no bigger than a nickel

urine output:
diurese the excess fluid around 24 hours after deliver
dehydration is possible
inspect close for DVT

32
Q

perineal care post delivery

A

intermittent ice packs for the first 24hours to decrease edema
warm water
sitz bath 2-4x/day
anesthetic sprays
change pads frequently
*** we don’t want the client to saturate more than 1 pad/hour
report any foul smell and any lochia changes

33
Q

bonding post delivery

A 
develops trust
emotional and physiological need
physiological impact:
stabilizes HR
improves O2
regulates temp
conserves cals
breasts can change in temp 
skin to skin = kangaroo care
34
Q

breastfeeding mothers

A 
cleanse with warm water after each feeding
let air dry
support bra
ointment for soreness
express some colostrum and let it dry 
breast pads absorb moisture
mother needs to initiate breastfeeding asap after birth
mom can pump 
increase cals by 500/day 
fluid/milk intake" 8-10oz/day
35
Q

non-breastfeeding moms

A

ice packs
breast binders
chilled cabbage leaves (decrease inflammation and decrease engorgement)
no stimulation of breast

36
Q

postpartum infection

A 
within 10days
E. Coli/Beta hemolytic strep
proper hygiene (front to back)
hand wash
cultures
antibiotics
37
Q

postpartum hemorrhage

A

early:
more than 500ml blood lost in first 24hours accompanied by a 10% drop from admission hematocrit ***must have both to be true

Late:
after 24hs and up to 6wks postpartum

causes:
uterine atony
lacerations
retained fragments and forceps delivery

Meds used to halt excessive postpartum hemorrhage:
oxytocin
methylergonovine maleate
carboprost tromethamine
misoprostol
38
Q

mastitis

A

major bacteria is staphylococcus
2-4wks

s/s
fever
chills
swollen breast
hard/tender breast
malaise
treatment:
bedrest
support bra
binding/chilled cabbage leaves
penicillin
pain meds
heat
feed baby frequently (offer affected breast first)
39
Q

immediate newborn care

A

body temp

apgar: 
1 & 5 minutes
looks at HR
respiration
muscle tone
reflex irritability
color
want at least 8-10

erythromycine (eye ointment) can be used because it will kill Chlamydia
phytonadione promotes formation of clotting factors

40
Q

cord care

A

dries and falls off in 10-14 days
cleanse with each diaper change using alcohol/NS
fold diaper below the cord
no immersion until cord falls off (infection)

41
Q

hypoglycemia in newborn

A 
not getting enough glucose from mom
greatest risk:
large 
small
diabetic moms
42
Q

pathologic jaundice

A

occurs first 24 hours

usually means Rh/ABO incompatibility

43
Q

physiological jaundice

A

occurs after 24 hours

due to both normal hemolysis of excess RBCs releasing bilirubin and immaturity of the liver

44
Q

Rh sensitization or Rh factor

A

*** Rh- mom and Rh+ baby

1st pregnancy:
Rh+ blood from baby comes in contact with mom’s blood
when placenta separates at birth
mom’s body thinks of it as foreign
mom produces antibodies
first offspring is not affected by antibodies

2nd pregnancy:
increases because with every pregnancy there is a risk of mom and baby’s blood coming in contact
if Rh- sensitized mom gets pregnant:
antibodies enter baby’s bloodstream though the placenta, baby’s RBC breakdown (hemolysis), releases immature RBCs (erythroblastosis fetalis)

45
Q

diagnosis of Rh

A

indirect coombs:
done in mom
measures number of antibodies

direct coombs:
done on bbay
tells if there are any antibodies stuck to RBCs
done on cord

treatment: frequent ultrasounds

prevention:
Rhogam
to mom 72hours after birth
once at 28wk gestation
also with any bleeding episode
destroys positive fetal blood cells that get into the mothers negative blood

NCLEX (17 decks)

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