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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
Category I-III?
I: normal II: indeterminate III: abnormal
26
normal FHR:
110-160
27
Causes of fetal TACHYcardia?
chorioamnionitis (infection of membranes) hypoxia prematurity maternal fever
28
treatment of fetal TACHY?
stop the Pit | look for infection
29
causes of fetal BRADY?
heart px beta-blockers maternal brady second stage of labor
30
Nitrazine swab interpretation?
test pH to see if the fluid is amniotic or vaginal | blue stick = amniotic
31
Describe Leopold's maneuvers:
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)
32
What is the most important aspect of FHR?
variability
33
Describe variability:
absent: undetectable - VERY BAD minimal: fluctuation <5 bpm moderate (normal): fluctuation b/w 6-25bpm marked: fluctuation >25 bpm
34
causes of decreased variability:
hypoxia acidosis drugs fetal sleep
35
Criteria of accelerations?
baseline increase of at least 15bpm | lasts 15sec-2min
36
Cause of EARLY decels? Interventions?
head compression | NO intervention
37
Cause of VARIABLE decels? Intervenions?
cord compression reposition IV fluids give OP2
38
Cause of LATE decels? Interventions?
``` UPI STOP the Pitocin get ready for the OR IV fluids reposition give O2 ```
39
4 criteria to use an internal FHR monitor?
1. membranes have ruptured 2. 2 cm dilated 3. presenting fetal part low enough 4. skilled practitioner available
40
how long is a small box on an FHR monitor strip?
10 seconds (6 boxes = 1 minute)
41
Where do we put the FHR monitor?
over the baby's back
42
How to increase O2 supply to the baby during labor?
give O2 to mom | reposition mom
43
Elevated Alph-Fetoprotein levels indicate:
neural tube defects, hydrocephaly, turner syndrome
44
Low Alph-Fetoprotein levels indicate:
down syndrome
45
What do triple and quadruple marker screenings assess for?
neural tube defects and down syndrome
46
VEAL CHOP
``` Variable = Cord compression Early = Head compression Acceleration = OK Late = Placental Insufficiency ```
47
L/S ratio tests for _______. How do you assess the results?
fetal lung maturity L/S of 2 or higher = lung maturity L/S of 1.5 or less = respiratory distress syndrome (ARDS)
48
2 risks of the stress test
bradycardia | hyperstimulation of the uterus
49
Which two tests are diagnostic?
Amniocentesis and CVS "Chronic Villus Sampling"
50
Amniocentesis is done when?
2nd trimester to check for chromosomal abnormalities, hereditary metabolic defects, and neural tube defects.
51
What needs to be done before an amniocentesis?
full bladder during 1st-trimester empty bladder during 2nd and 3rd trimester Rh monitoring to make sure blood can mix
52
When is CVS done?
10-13 weeks to test for chromosomal abnormalities (NOT neural tube defects)
53
When can I do the Harmony test?
10 weeks analyzes DNA to test for the Trisomy's can also tell GENDER
54
What does a biophysical profile test for?
UPI
55
What is a normal biophysical profile score?
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
Biophysical profile score interpretation:
8-10 normal 4-8 suspicious 0-4 abnormal
57
What does a non-stress test look for?
accelerations in response to glucose | NOT contractions
58
What does a stress test look for?
contractions in response to oxytocin | we want to see 3 contractions in 10 minutes with NO decelerations
59
Define gestational HTN vs. HTN:
gestational: the onset of HTN with NO proteinuria after 20th-week chronic: present before pregnancy, or dx before 20th-week gestation
60
What is eclampsia?
seizure activity or coma after preeclampsia
61
What is the priority intervention for eclampsia?
mag sulfate
62
what is preeclampsia?
the onset of HTN WITH proteinuria after 20th week - indicative of placental px
63
What is a hallmark sign of preeclampsia?
3rd-trimester headache, increased pain, high BP
64
Pathology behind preeclampsia?
poor perfusion resulting in VASOSPASM
65
What are the 4 complications of preeclampsia?
DIC HELLP Proteinuria IUGR
66
What is the most common side effect of an epidural?
itching
67
What is HELLP?
Hemolysis (decreased RBC) Elevated Liver enzymes Low Platelets
68
When is mag sulfate indicated?
severe preeclampsia eclampsia HELLP used to decrease risk of seizures
69
Therapeutic magnesium sulfate level
4-7 mEq/L
70
Mag sulfate antidote?
calcium gluconate
71
S&S of mag sulfate toxicity?
SLOW SLOW SLOW | decreased RR, HYPOtension etc.
72
S&S of abruptio placenta vs. placenta previa:
Abrupto: PAIN, dark vaginal bleeding Previa: NO PAIN, light vaginal bleeding
73
Abruptio placenta management:
prevent DIC | left lateral
74
Placenta previa management:
monitor bleeding | DO NOT DO A VAGINAL EXAM
75
What are the 3 drugs to give during premature labor?
corticosteroids to increase fetal lung maturity betamethasone (best 2-7 days after 1st dose) Fibronectin (we want NEGATIVE result)
76
When am I assessing nuchal translucency?
11-14 weeks
77
When are tocolytics indicated?
to delay contractions
78
What is the MOST COMMON tocolytic?
mag sulfate
79
What are the 4 tocolytics?
``` INMT "it's not my time" Indomethacin Nephedapine Mag Sulfate Terbutaline ```

ABSN (18 decks)

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