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ABSN > Maternity Exam II > Flashcards

Maternity Exam II Flashcards

1
Q

Where are contractions felt during Braxton Hick’s contractions?

A

Not in the front

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2
Q

When should mom come in when she has contractions?

A

5 minutes apart
45-60 seconds
strong enough to not be able to converse

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3
Q

Dilation for early, active and transition phases:

A

E: 0-3
A: 4-7
T: 8-10

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4
Q

Effacement for early, active and transition phases:

A

E: 0-40
A: 40-80
T: 80-100

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5
Q

Duration for early, active and transition phases:

A

E: 5-6hrs
A: 4-6hrs
T: 30min-1hr

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6
Q

Contractions for early, active and transition phases:

A

E: 1-2 for 30-45seconds
A: 2-5 for 45-60seconds
T: 5-10 for 60-90seconds

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7
Q

What are the 3 phases of the contraction?

A

increment
acme
decrement

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8
Q

when do the fontanel’s close?

A

anterior: 18-24 months
posterior: 6-12 weeks

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9
Q

Signs of placental separation:

A

cord lengthens
uterus becomes globular
vagina is filled with blood

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10
Q

When is the Rubella vaccine recommended?

A

w/i 48 hours after birth before discharge

Do NOT take for 28 days before becoming pregnant

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11
Q

Can BF moms get the Rubella vaccine?

A

YES - does not pass through breast milk

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12
Q

What is the main side effect of an epidural?

A

HYPOtension

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13
Q

What must be done before an epidural?

A

administer during the ACTIVE phase

administer IV bolus to avoid the HYPOtension

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14
Q

What must be monitored after an epidural?

A

HYPOtension (don’t be supine)
urinary retention (pee w/i 12 hours)
fetal BRADYcardia
maybe give pit to contract a boggy uterus

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15
Q

Intervention for spinal headache after an epidural?

A

maternal blood patch

lateral recumbent

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16
Q

When is a pudendal block indicated? Side effects?

A

after mom tears, or has an episiotomy

SE: bruising, numbness, allergic rxn

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17
Q

Describe lochia postpartum

A

rubra - deep red for 3-4 days
serosa - pink/brown for 3-10 days
alba - white/light brown for 10-14 days (up to 6 weeks)

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18
Q

Describe vitals/WBC postpartum

A

temp is elevated for 24 hours
HR is BRADY for 2 weeks at 40-60 r/t HYPOvolemia
WBC elevated for 4-6 days

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19
Q

cardiac output postpartum

A

increased for 3 months

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20
Q

what is a common complication of pregnancy r/t hematology?

A

DVT - Pregnancy is a hypercoagulable state and mom will stay that way for 2 weeks

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21
Q

Involution of the uterus:

A

immediately after - midline b/w umbilicus and pubic symphysis
12 hours after - 20 cm (umbilicus)
each day after it drops 1cm until day 10 when it drops into the true pelvis and we can’t feel it

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22
Q

What is the danger of bladder distention?

A

it can cause uterine atony

straight cath mom if she hasn’t voided in 12 hours

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23
Q

Nursing actions for postpartum hemorrhage:

A

fundal massage (for boggy uterus) and void (to avoid bladder distention)

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24
Q

When should we administer Rhogam?

A

within 72 hours of birth

if we know, then give a dose b/w 26-28 weeks

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25
Q

Category I-III?

A

I: normal
II: indeterminate
III: abnormal

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26
Q

normal FHR:

A

110-160

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27
Q

Causes of fetal TACHYcardia?

A

chorioamnionitis (infection of membranes)
hypoxia
prematurity
maternal fever

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28
Q

treatment of fetal TACHY?

A

stop the Pit

look for infection

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29
Q

causes of fetal BRADY?

A

heart px
beta-blockers
maternal brady
second stage of labor

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30
Q

Nitrazine swab interpretation?

A

test pH to see if the fluid is amniotic or vaginal

blue stick = amniotic

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31
Q

Describe Leopold’s maneuvers:

A

1: presentation (feel fundus for butt or head)
2: position (where is baby’s back)
3: confirmation of presentation
4: fetal attitude (is head flexed/engaged in the pelvis)

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32
Q

What is the most important aspect of FHR?

A

variability

33
Q

Describe variability:

A

absent: undetectable - VERY BAD
minimal: fluctuation <5 bpm
moderate (normal): fluctuation b/w 6-25bpm
marked: fluctuation >25 bpm

34
Q

causes of decreased variability:

A

hypoxia
acidosis
drugs
fetal sleep

35
Q

Criteria of accelerations?

A

baseline increase of at least 15bpm

lasts 15sec-2min

36
Q

Cause of EARLY decels? Interventions?

A

head compression

NO intervention

37
Q

Cause of VARIABLE decels? Intervenions?

A

cord compression
reposition
IV fluids
give OP2

38
Q

Cause of LATE decels? Interventions?

A 
UPI 
STOP the Pitocin 
get ready for the OR 
IV fluids
reposition 
give O2
39
Q

4 criteria to use an internal FHR monitor?

A
  1. membranes have ruptured
  2. 2 cm dilated
  3. presenting fetal part low enough
  4. skilled practitioner available
40
Q

how long is a small box on an FHR monitor strip?

A

10 seconds (6 boxes = 1 minute)

41
Q

Where do we put the FHR monitor?

A

over the baby’s back

42
Q

How to increase O2 supply to the baby during labor?

A

give O2 to mom

reposition mom

43
Q

Elevated Alph-Fetoprotein levels indicate:

A

neural tube defects, hydrocephaly, turner syndrome

44
Q

Low Alph-Fetoprotein levels indicate:

A

down syndrome

45
Q

What do triple and quadruple marker screenings assess for?

A

neural tube defects and down syndrome

46
Q

VEAL CHOP

A 
Variable = Cord compression 
Early = Head compression 
Acceleration = OK
Late = Placental Insufficiency
47
Q

L/S ratio tests for _______. How do you assess the results?

A

fetal lung maturity
L/S of 2 or higher = lung maturity
L/S of 1.5 or less = respiratory distress syndrome (ARDS)

48
Q

2 risks of the stress test

A

bradycardia

hyperstimulation of the uterus

49
Q

Which two tests are diagnostic?

A

Amniocentesis and CVS “Chronic Villus Sampling”

50
Q

Amniocentesis is done when?

A

2nd trimester to check for chromosomal abnormalities, hereditary metabolic defects, and neural tube defects.

51
Q

What needs to be done before an amniocentesis?

A

full bladder during 1st-trimester
empty bladder during 2nd and 3rd trimester
Rh monitoring to make sure blood can mix

52
Q

When is CVS done?

A

10-13 weeks to test for chromosomal abnormalities (NOT neural tube defects)

53
Q

When can I do the Harmony test?

A

10 weeks
analyzes DNA to test for the Trisomy’s
can also tell GENDER

54
Q

What does a biophysical profile test for?

A

UPI

55
Q

What is a normal biophysical profile score?

A

3 or more body movements
3 discrete fetal movements
2 FHR accelerations (reactive non-stress)
1 breathing movement
1 pocket of amniotic fluid volume 2cm or more

56
Q

Biophysical profile score interpretation:

A

8-10 normal
4-8 suspicious
0-4 abnormal

57
Q

What does a non-stress test look for?

A

accelerations in response to glucose

NOT contractions

58
Q

What does a stress test look for?

A

contractions in response to oxytocin

we want to see 3 contractions in 10 minutes with NO decelerations

59
Q

Define gestational HTN vs. HTN:

A

gestational: the onset of HTN with NO proteinuria after 20th-week
chronic: present before pregnancy, or dx before 20th-week gestation

60
Q

What is eclampsia?

A

seizure activity or coma after preeclampsia

61
Q

What is the priority intervention for eclampsia?

A

mag sulfate

62
Q

what is preeclampsia?

A

the onset of HTN WITH proteinuria after 20th week - indicative of placental px

63
Q

What is a hallmark sign of preeclampsia?

A

3rd-trimester headache, increased pain, high BP

64
Q

Pathology behind preeclampsia?

A

poor perfusion resulting in VASOSPASM

65
Q

What are the 4 complications of preeclampsia?

A

DIC
HELLP
Proteinuria
IUGR

66
Q

What is the most common side effect of an epidural?

A

itching

67
Q

What is HELLP?

A

Hemolysis (decreased RBC)
Elevated Liver enzymes
Low Platelets

68
Q

When is mag sulfate indicated?

A

severe preeclampsia
eclampsia
HELLP

used to decrease risk of seizures

69
Q

Therapeutic magnesium sulfate level

A

4-7 mEq/L

70
Q

Mag sulfate antidote?

A

calcium gluconate

71
Q

S&S of mag sulfate toxicity?

A

SLOW SLOW SLOW

decreased RR, HYPOtension etc.

72
Q

S&S of abruptio placenta vs. placenta previa:

A

Abrupto: PAIN, dark vaginal bleeding
Previa: NO PAIN, light vaginal bleeding

73
Q

Abruptio placenta management:

A

prevent DIC

left lateral

74
Q

Placenta previa management:

A

monitor bleeding

DO NOT DO A VAGINAL EXAM

75
Q

What are the 3 drugs to give during premature labor?

A

corticosteroids to increase fetal lung maturity
betamethasone (best 2-7 days after 1st dose)
Fibronectin (we want NEGATIVE result)

76
Q

When am I assessing nuchal translucency?

A

11-14 weeks

77
Q

When are tocolytics indicated?

A

to delay contractions

78
Q

What is the MOST COMMON tocolytic?

A

mag sulfate

79
Q

What are the 4 tocolytics?

A 
INMT "it's not my time"
Indomethacin
Nephedapine
Mag Sulfate
Terbutaline

ABSN (18 decks)

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