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NCLEX > Maternity and Neonatology > Flashcards

Maternity and Neonatology Flashcards

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1
Q

What are presumptive signs of pregnancy?

A

These are subjective signs and symptoms reported by the patient.
K.I.S.S.: PRESUME

Period absent
Really tired
Enlarged breasts
Sore breasts
Urination frequency increases
Movement felt
Emesis and nausea

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2
Q

What are probable signs of pregnancy?

A

These are objective signs of pregnancy and include all the “signs”
K.I.S.S.: PROBABLE

Positive pregnancy test
Return of fetus when uterus is touched with finger (Ballotment)
Outline of fetus palpated
Braxton Hicks contractions
A softening of cervix (Goddell’s sign)
Blue tint to cervix (Chadwick’s sign)
Lower uterine segment soft (Hegar’s sign)
Enlarged uterus

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3
Q

What are positive signs of pregnancy?

A

These are signs related to the presence of a fetus and seen by the HCP.
K.I.S.S: FETUS

Fetal movement felt by HCP
Electronic device detects fetus
The delivery of a fetus
Ultrasound detects fetus
See visible movement by HCP

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4
Q

What is the vasculature of the umbilical cord?

A

K.I.S.S.: AVA
Two arteries carry deoxygenated blood to the placenta
One vein carries oxygenated blood and nutrients to the fetus

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5
Q

What is the normal amount of amniotic fluid by the end of pregnancy? What is it’s purpose?

A

800-1200 mL
Temperature regulation, protection, and promotes musculoskeletal development of the fetus.
Allows for fetal movement
Surrounds, cushions, and protects the fetus
Maintains the body temperature of the fetus
Can be used to measure fetal kidney function

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6
Q

What is Naegele’s Rule, how is it used?

A

Naegele’s rule is used to estimate a pregnant woman’s date of delivery.
1. Take the first day of the LMP (last menstrual period) and add seven days
2. Subtract three months
3. Add one year (if necessary)

Ex) Donna’s LMP was July 30, 1993
Add seven days (August 06)
Add one year 1994
Her estimated day of delivery is May 06, 1994

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7
Q

What is the purpose of an NST?

A

A non-stress test is a non-invasive procedure used to assess fetal well-being in the third trimester. This test specifically looks at the fetal heartrate in response to contractions or fetal movement.

The fetus is not challenged or stressed by uterine contractions to obtain the necessary data

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8
Q

How can you interpret the results of an NST?

A

Reactive: This is a GOOD result. You see two accelerations within twenty minutes
Non-reactive: This is a BAD result. There is no reaction.

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9
Q

What is McDonald’s rule?

A

Between 18-32 weeks gestation, the fundal height measured should approximate gestational age.

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10
Q

What is a contraction stress test (CST)?

A

This is a non-invasive antepartum assessment used to evaluate signs of fetal distress during contractions.

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11
Q

How do you evaluate a contraction stress test CST?

A

Negative: This is a NORMAL result. Here you see at least three uterine contractions in ten minutes with no late decelerations.
Positive: This is an ABNORMAL result. Here you see late decelerations with more than half of the contractions.

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12
Q

What is a biophysical profile (BPP)?

A

This is an antepartum assessment used to test to evaluate the fetus’s well-being.

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13
Q

How do you evaluate a biophysical profile (BPP)?

A

Scores are rated 0-10 based on five categories.
Normal: 8-10
Borderline: 6
Abnormal: 0-4
A normal finding will be awarded a two and an abnormal finding is given a 0.

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14
Q

What is an amniocentesis?

A

This is an invasive antepartum assessment done in early pregnancy to test for neural tube defects and other genetic work up.
This could also be performed later in pregnancy to test fetal lung maturity and well-being.

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15
Q

What is the range for a normal fetal heartrate?

A

110-160 bpm

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16
Q

What does GTPAL stand for? What do each of it’s components mean?

A

Gravidity: How many times has this person been pregnant?
Pregnancies with multiples are only counted once
Term: How many babies did this person have born after 37 weeks?
Preterm: How many babies did this person have born between 20-37 weeks?
Abortion: How many pregnancies were lost prior to twenty weeks?
Living: How many children does this person have that are alive right now?

Ex) A 30 year old female is 25 weeks pregnant with twins. She has 5 living children. Four of the 5 children were born at 39 weeks gestation and one child was born at 27 weeks gestation. Two years ago she had a miscarriage at 10 weeks gestation. What is her GTPAL?
G=6, T=2, P=2, A=1, L=5

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17
Q

What does TORCH stand for? What is the significance of this during pregnancy?

A

These are teratogenic infections that can be transmitted from mom to baby via placenta or bodily fluids (blood, breast milk)
Toxoplasmosis (don’t change cat litter, garden)
Other (syphilis, varicella, parvovirus)
Rubella (are you vaccinated? Avoid those with the infection, get the vaccination AFTER delivery)
Cytomegalovirus (part of the herpes family)
Herpes infections (can be transmitting during childbirth if the patient has active lesions.)

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18
Q

What is the expected prenatal visit schedule during pregnancy?

A

Once a month for weeks 1-32
Every two weeks from week 32-36
Every week from week 36 to delivery

Ex) If a person is 12 weeks pregnant, their next appointment will be at 16 weeks.

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19
Q

What are the severe features of pre-eclampsia?

A

KISS: TRIPPLES
Thrombocytopenia
Renal insufficiency
Intracranial disturbance (headache, blurry vision, seeing spots)
Pulmonary edema
Proteinuria
Elevated liver enzymes
Severe hypertension

Clonus
Crazy reflexes

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20
Q

What are the features of HELLP Syndrome?

A

Hemolysis
Elevated Liver enzymes AST, ALT tests
Low Platelet count (<100K, less platelets circulating in the blood)

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21
Q

How do you distinguish between pre-eclampsia and eclampsia?

A

Eclampsia will have all of the symptoms of pre-eclampsia in addition to seizure activity.

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22
Q

Where might a patient with HELLP syndrome complain of pain?

A

Epigastric or RUQ pain because of the liver involvement.

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23
Q

What is the goal of treatment for people with HELLP syndrome, pre-eclampsia, and eclampsia?

A

Get their blood pressure under control!
Labetalol and hydralazine are two great options.
Magnesium to calm down the body.

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24
Q

What is a priority assessment for a patient taking magnesium? What are the signs of magnesium toxicity?

A

Respiratory

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25
Q

What are the signs of magnesium toxicity?

A

Loss of reflexes, decreased respiratory rate, and decreased urine output.

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26
Q

What is the antidote for magnesium sulfate in the event of toxicity?

A

Calcium gluconate.

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27
Q

What is the line of treatment for severe eclampsia?

A

Induction of labor

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28
Q

What is placenta previa?

A

A condition typically seen in the third trimester of pregnancy. In this condition, the placenta is covering the cervix.
PAINLESS bright red bleeding
Replace blood loss
Evident in lower segment
Vitals indicate shock
Inspect FHR
Avoid vaginal exams

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29
Q

What is abruptio placentae?

A

A condition typically seen in the third trimester of pregnancy. In this condition, the placenta has separated from the uterine wall prematurely.
Dark red bleeding
Extended fundal height
Tender uterus
Abdominal pain contractions
Concealed bleeding (can lead to shock)
Hard abdomen, rigid
Experience DIC
DIC bleeding see in gums, IV Site, etc.
Distress Unstable fetal HR

30
Q

What are probable signs of pregnancy?

A

Positive pregnancy test
Return of fetus when pressed with finger
O
Braxton hicks contractions
A
Blue tint to lady bits (Chadwick’s sign)
Lover uterine segment soft (hegars sign)
E

31
Q

What is the ideal amount of weight a person would gain during pregnancy?

A

KISS: 25-35 pounds is expected to be gained during a healthy pregnancy.

1st Trimester: 1 lb/month (three pounds in the first three months)
2nd and 3rd Trimester:1 lb/week (28 pounds in 24 weeks)

32
Q

What does PROM, PPROM, and AROM stand for?

A

Premature rupture of membranes
Pre-term premature rupture of membranes
Artificial rupture of membranes

33
Q

What is PROM?

A

Premature rupture of membranes
This condition occurs when someone’s water breaks anytime after 28 weeks, but before the onset of labor.

34
Q

What is PPROM?

A

The amniotic fluid protects the baby from infection from the outside world. When the amniotic fluid breaks prematurely the baby is at risk for infection, so the mother will need to take antibiotics prophylactically.

35
Q

What is an ectopic pregnancy?

A

A fertilized ovum implants somewhere it is not supposed to be (usually the fallopian tube).

36
Q

What are some of the manifestations of an ectopic pregnancy?

A

Delayed or missed period
Unilateral stabbing pain and lower abdomen tenderness
Bleeding
Shock

37
Q

What is oligohydraminos?

A

You have a less than normal amount of amniotic fluid. This may contribute to IUGR, premature birth, and HIE (hypoxic ischemic encephalopathy).

38
Q

How many stages of labor are there?

A

Four

39
Q

How many phases of labor are there?

A

Three

40
Q

What is the first STAGE of labor?

A

This is when the cervix dilates from 0-10 cm

41
Q

What is the second STAGE of labor?

A

This is the pushing stage. From complete dilation to the delivery of baby.

42
Q

What is the third STAGE of labor?

A

This is after the delivery of baby until the delivery of the placenta. Contractions are mild; client is usually focused on their baby.

43
Q

What is the fourth STAGE of labor?

A

This is 1-2 hours after the delivery of the placenta.

44
Q

What is the first phase of labor? What happens during this time?

A

Latent phase
Dilation of the cervix from 0-4cm.
Mild contractions every 5 to 30 minutes lasting less than a minute.
Client is talkative and excited

45
Q

What is the second phase of labor? What happens during this time?

A

Active phase
Dilation of the cervix from 4-7cm
Moderately painful contractions every 3-5 minutes lasting 1.5 minutes
Client is anxious and in pain

46
Q

What is the third phase of labor? What happens during this time?

A

Transitional phase
Dilation of the cervix from 8-10cm
Very strong contractions every 2-3 minutes lasting up to two minutes.
Client may become irritable and have N/V

47
Q

How do we categorize FHR?

A

The three tier classification system

48
Q

What is a tier I classification of FHR?

A

Normal finding

49
Q

What is a tier III classification of FHR

A

Abnormal finding

50
Q

What is the mnemonic for FHR changes?

A

VEAL CHOP MINE
Variable
Early decelerations
Accelerations
Late accelerations

Cord compression
Head compression
Okay
Placental insufficiency

Move mom
Identify labor progress
Nothing
Execute actions immediately

51
Q

What is a tocolytic?

A

This is a medication used to slow or stop contractions (which could lead to premature labor).

52
Q

What is oxytocin used for in labor?

A

Used to stimulate contractions
May be used in all stages of labor

53
Q

What is methlergonovine used for in labor?

A

Stimulate uterine contractions AFTER delivery or to treat postpartum hemorrhage

54
Q

What is calcium gluconate used for in labor?

A

Antidote for magnesium sulfate toxicity

55
Q

What is tertbutaline used for in labor?

A

Tocolytic used for preterm labor

56
Q

What is indomethacin used for in labor?

A

Tocolytic used for preterm labor

57
Q

What is magnesium sulfate used for in labor?

A

Tocolytic used for preterm labor
CNS depressant to prevent seizure in preeclampsia

58
Q

What is naloxone HCL used for in labor?

A

Antidote for opiod-induced respiratory depression
Reverse pruritis from epidural opiod

59
Q

What is naloxone used for in labor?

A

Antidote for opiod-induced respiratory depression
Reverse pruritus from epidural opiod

60
Q

What is betamethasone used for in preterm labor?

A

Prevent or reduce neonatal respiratory distress syndrome in preterm infants
Stimulate the production of surfactant in preterm fetus

61
Q

What is the normal lung maturity ratio

A

2:1

62
Q

What is misoprostol used for in labor?

A

Preinduction cervical ripening (Bishop score of 4 or less)

63
Q

What is the Bishop scoring system?

A

This is an assessment used to determine if induction of labor will be necessary.
A score of 8 or more: Favorable
A score of 7 or less: Unfavorable

64
Q

What are the elements of true labor?

A

Timing of contractions
Radiating contraction
Unable to relieve pain with activity
Exam changes present

65
Q

What are the elements of false labor?

A

Fails to cause changes
Activity diminishes pain
Keep feeling contractions above belly button
Erratic timing of contractions

66
Q

What is AROM?

A

Aritifical rupture of membranes

67
Q

What is AROM?

A

Artificial rupture of membranes
Used to initiate or improve contractions

68
Q

What is a vacuum assisted delivery?

A

Attachment of a vacuum cup to the fetal head to assist in birth of the head.
May be used with maternal exhaustion or fetal distress in the second stage of labor

69
Q

What is efflurage?

A

Light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus

70
Q

What does RUQ pain in the third semester of pregnancy typically indicate?

A

HELLP Syndrome (a form of pre-eclampsia)

71
Q

What is the McRoberts maneuver?

A

knees to chest and apply downward pressure on pubic symphysis

NCLEX (9 decks)

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