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nclex > maternity and its meds > Flashcards

maternity and its meds Flashcards

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1
Q

explain labor dystocia and meds for it

A

labor dystocia means prolong labor or difficult birth. fetal macrostomia (big baby) is a reason, maternal fatigue or uterine abnormality, epidural, etc..

oxytocin is a med that can help labor dystocia b/c it promotes uterine contraction. but we can also get mom to move position (depend on the epidural)

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2
Q

shoulder dystocia

what Is it, appropriate interventions?

contraindications?

A

baby’s shoulder is stuck, this is an emergency.
rn can push down on symphibis (mcroberts maneuver, suprapubic**). don’t push down anywhere else (fundal pressure can worsen things.

ask for help immediately**
can administer oxytocin as ordered

knees, trendelunburg

contraindications: fundal pressure, forceps associated births

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3
Q

prolapsed umbilical cord

A

cord is protruding in the cervix. can lead to cord compression. cord is how baby is getting oxygen

interventions: call for help (stay in room), requires emergency most of the time. get finger in to try to lift presenting part off of the cord

safest and quickest route is c-section, most of the times its c-section

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4
Q

c-section anesthetics

A

spinal anesthesia:
epidural anesthesia:

general anesthesia: can be given in emergency situations, no time to do a spinal or epidural

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5
Q

complication for c-section

A

top 2: hemorrhage and infections
provide antibiotics, IV fluid

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6
Q

which medication is given to delay labor (when the baby try to comes out too soon, ex: 27 weeks), to prevent/supressant preterm labor

A

terbutaline
you gotta wait in LINE for the baby.
given to calm and steady the uterus

as well as nifedipine, indomethacin

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7
Q

when should you administer Rho(D) globulin

A

at 28 weeks of pregnancy and within 72hrs after delivery
only if the mom is negative, if mom is positive, no need to give rhogam

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8
Q

bethametasone and dexamethasone

A

steroids that helps lungs mature

a steroid administered to mothers during preterm labor

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9
Q

exercise during pregnancy

A

swimming, walking,

too strong: aerel yoga

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10
Q

dizziness, blurred vision, persistent headache, edema are signs of

A

pre-eclampsia.
persistent headache means BP is high and is a sign of preeclampsia, as well as blurred vision.
scotoma as well (spots before eyes)

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11
Q

gush of fluid

A

signs that the person is in labor, water break
but if it happens 1st or 2nd trimester of pregnancy, go to hospital immediately

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12
Q

amt of folic acid

A

400 mcg/day to prevent neural tube defect

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13
Q

38 weeks pt has dark red vaginal bleeding, what to do first and what to avoid

A

could be placental previa so avoid vaginal examinations. and could be placenta abruptio or previa, so strict bed rest.

do fetal monitoring, maternal vital signs first then depend on c-section or abdominal surgery, but most common is c-section, but mom still has a say since it can still be possible

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14
Q

1 - 4.4 lbs during first trimester
1lbs a week during last 2 semesters

A
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15
Q

foods to minimize/avoid during pregnancy

A

fishes (tilefish, mackerel, tuna, shark, swordfish), raw fish
, undercooked meats, soft and unpasteurized cheese, risk of listeria, salmonella, so on

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16
Q

nuchal transluency or cell free dna

A

can detect trisomy 21

cell free dna can be done early as 10 weeks

cvs (samples of placenta) done after 10 weeks,
amniocentesis after 15-17 weeks

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17
Q

nonstress test should be

A

reactive

if it nonreactive, further testing will be done

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18
Q

transverse lie or shoulder presentation

A

a type of breech position (there are 4). when the baby is sideways (horizontal) instead of vertical.

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19
Q

good cervix to deliver baby?
gynecoid
android
anthropoid
platypelloid

A

AP is favorable b/c college credits
AnthroPoid
android (male shaped, not favorable, platepelloid not favorable.
apple is better than android.
GA (Georgia is nice b/c housing are afordable)
gynecoid (favorable), anthropoid

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20
Q

What determines the fetal position, engagement and presententation of the fetus in the uterus during the 3rd trimester

A

leopold’s maneuver

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21
Q

presentive part moves from

A

negative to positive.
positive means i’m out

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22
Q

primary force means contraction, what is 2ndary force?

A

maternal pushing during 2nd stage of labor

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23
Q

apgar score

which requires medical attention
when do we do them and what does it indicate?

A

when counting, its best to start with 10 and subtracting, rather than adding.
A: appearance
P: pulse
G: grimace
A: activity
R: respiratory effort
do apgar at 1mn then 5mn after birth, if its 7 or above, baby is considered in good health. if its lower than 7(requires medical attention) you can redo a 3rd one at 10mn if its lower than 7

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24
Q

best position for baby during giving birth

A

occipito anterior position

worst is breech

25
Q

which is 1st stage latent phase of labor vs 1st active phase of labor
6 - 10cm

0 - 6cm

what is full dilation and effacement

A

0 - 6cm is the latent (early) phase
contractions last 30 - 45sec and every 15-20mn

while 6 - 10cm is the 1st stage in active stage
contraction 45 - 60sec and every 5mn, - 10mn more frequent
0.5cm - 1cm dilation per hr so 1st stage may last up to 19hrs

26
Q

separation and delivery of placenta

A

3rd sstage

27
Q

talk about 2nd stage of labor

A

2nd stage begins w/ full dilation 10cm and effacement (baby is at +4 - +5 station), pushing or expulsion and it ends with the birth of the baby
contraction every 2-5mn and last 60 - 90 sec.
last mn to 2+hrs

28
Q

3rd stage

A

placental separation
uterus rises.
it changes shape to globular
cord lengthens

29
Q

fourth stage of labor

A

1-4hrs after birth
shaking, hungry, thirsty
uterus remains contracted midline and midway b/w symphysis and umbilucus
give oxytocin to prevent bleeding or hemorrhage

30
Q

how often to do maternal fetal assessment in 2nd stage of labor

A

every 5-15mn for 2nd stage

31
Q

fetal hr

A

110 - 160

32
Q

variability normal value

A

beat to beat fluctuations,
normal variability, 6 - 25bpm
indicates fetal oxygen

33
Q
A

feed 3-4hrs for the first 24hrs
administer antibiotic to eyes 1-2hrs after birth
administer vitamin K shortly after birth

34
Q

discharge

A

lochia rubra, serosa, alba
rubra 3-4 days of blood
serosa: mostly leukocytes, old blood, serum and debris. last up to 2 weeks
alba: leukocytes, epithelial cells, bacteria, last 2-6 weeks postpartum

35
Q

infants who have blood type A or B and who are born to type O mothers have an inc. risk of?

A

jaundice

do cooms test to determine inc. risk of jaundice
might require treatments w/ phototherapy if severe

36
Q

rh positive mom does not have to worry whether baby is positive or negative, but why does rh negative mom worry?

A

if rh negative mom has a rh positive baby, they need to receive rhogam within 72hrs after delivery to prevent antibodies dvpt

37
Q

chloasma disapear after pregnancy, but stretch marks and linea nigra might not disappear fully

A

increase production of urine (diuresis) also occur after childbirth, within 12hrs. for first 3 days

38
Q

uterine atony

A

hemorrhage, uterus don’t contract.
low BP, high hr
give oxytocin

39
Q

4 diseases of placenta: previa, abruptio, vasa previa, accreta.
explain placenta previa and nursing interventions
is previa painful, what’s the blood color?

A

placenta previa
placenta grow out of womb. low lying can clear on its own. overlying, usually later in pregnancy (c-section will be recommended)

may cause painless, bright red bleeding.
bed rest, IV fluids, bethamethasone
No vaginal examinations

risk: age, smoking, prior c-section
placental abruption
placental accretia
vasa previa

40
Q

placenta abruptio nursing interventions

A

bed rest
give oxygen
vital signs, support, cbc
risk for materal mortality is inc. w/ placental abruptio b/c it causes hemorrhage, also post op. patient might be in ICU receiving blood tranfusion

41
Q

placenta doesn’t stop growing, continues grow in the uterus, grabs on to the uterus (attaches to the uterus), bladder, once the placenta is remove, it can cause lots of bleeding, associated w/ lots of bleeding (hemorrhage). and inc. risk of maternal mortality and morbidity

A

placenta accreta
c-section may be recommended

risk factors: placenta previa
ultrasound to diagnose.
blood transfusion during or after c-section/delivery. needing to be admitted to the ICU after delivery

42
Q

unprotected blood umbilical cord travels to the cervical os: vasal previa, what are nursing interventions

A

may have scant dark red bleeding
planned c-section

43
Q

gestational diabetes is tested

A

24-28 weeks

44
Q

preeclampsia management

A

activity restriction, quiet
mag sulfate iv
IV and electrolyte fluid
steroids
anti-htn as needed

45
Q

magnesium sulfate interventions for iv and toxicity signs

A

check deep tendons reflexes ever 2hr
listen to lung sounds
give a bedpan or urinary output min 30ml/hr, assess for skeletal muscle weakness and hypotonia

toxicity signs: Dec. urine ouput and Dec. deep tendons reflexes
may result in resp depression

46
Q

contraindications to breastfeeding

A

cancer therapy, HIV, herpes, cytomegalovirus, galactosemia

47
Q

colostrum

A

starts during 3rd trimester. last 3-5 days after delivery. colostrum is more concentrated, has more nutrition
then develops into mature human milk, which starts 3-5 days after delivery

48
Q

umbilical cord care

A

natural healing, soap & water, alcohol or providone-iodine. remove clamp once the stump is dry, before discharge from hospital. the cord falls off by itself, approx after 10 days.

49
Q

abortion, how to and meds

A

misoprostol + mifepristone (until 12 weeks)

surgical ways: vacuum aspiration, for the 1st trimester
dilation and evacuation, >16 weeks

50
Q

contraceptive risks

A

stroke, breast cancer, vte
contraindications: >35yrs & >15 cigs a day, CVD risk

birth control pills prevents ovulation

51
Q

primary vs 2ndary amenorrhea

A

primary: no period by age 15-16
2ndary: absence of period for 3 cycles

52
Q

candidadis

A

yeast infection: thick white discharge, itching, no bad odor
bv: bad odor
vaginitis: bv, trichomnioasis: sti caused by parasite, painful, odor, often no symptom
candida vulvovaginitis (yeast infection)

53
Q

how to calculate due date?

if I get pregnant June 7 2024, when will I give birth?

how about april 29 2024

A

LMP- 3 months + 7 days and adjust the year

June 7th
June - 3 months = March 7+7 = March 14th, 2025
April 29 - 3 months = Jan 29+7 = Jan 5th, 2025

for games
lmp = May 29th 2024
may - 3 = Feb 29+7 = March 7th, 2025, Feb was 29 days this week, but this was a tough one.

missed abortion: nonviable pregnancy but no other symptoms
complete: everything comes out
incomplete abortion
inevitable pregnancy: will not be saved b/c cervix is open

54
Q

ectopic pregnancy med

A

methotrexate
this meth is epic

55
Q

lots of vomiting, possible dehydration, weight loss, nausea

A

hyperemesis gravidum

56
Q

2+ edema normal in late pregnancy?

A

no, 1+ edema is common.

57
Q

A fetal scalp electrode (FSE) is a common, internally applied, electronic monitoring device used to closely evaluate fetal heart rate (FHR). Indications for FSE placement may include high-risk maternal conditions such as (eg, obesity, diabetes, hypertension) and/or nonreassuring FHR patterns (eg, late decelerations, minimal variability).

what are the contraindications?

A

HIV infection, blood borne infection such as hepatitis. since the risk of infection increase with site puncture

58
Q

whenever there is a problem with the fetal heart monitor (ex: late decels, variable decels, high or low fetal hr), YOU ALWAYS TURN OFF THE OXYTOCIN IF IT’S RUNNING (FIRST RESPONSE)

low fetal hr: under 110

A

LATE DECEL
turn off oxytocin
turn pt on left side
apply o2
notify obstetrician

low hr variability, late DECEL, low fetal hr, all these L’S are really bad

nclex (17 decks)

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