Maternity Exam IV Flashcards
What is dystocia?
abnormal/difficult labor
What are risk factors for dystocia?
epidural multiple gestation poor pushing/contractions occipital posterior position big fat bb
What are the causes of dystocia?
4 P’s
powers, passageway, passenger, psyche
What position makes a shoulder dystocia more likely?
occiput posterior position (OP)
What is the nursing role for a shoulder dystocia?
give a back massage? (suprapubic pressure may worsen the dystocia
What is hypotonic uterine dysfunction?
contractions slowing or stopping
“powers” of the 4 p’s
What is induction vs augmentation?
induction - stimulating contractions BEFORE the onset of natural labor
augmentation - enhancing ineffectual active contractions AFTER natural labor has begun
What drugs INDUCE labor?
prostaglandins: dinoprostone, dinoprostol, misoprostol
oxytocin (Pit)
What drugs AUGMENT labor?
oxytocin (Pit)
What are the side effects of Pitocin ?
N/V
H/A
HYPOtension
What is the concentration/dilution of Pitocin that is administered ?
10 U in 1000mL LR
What is the indication for using Cytotec (misoprostol)?
labor INDUCTION
What is a side effect of Cytotec (misoprostol)?
hyperstimulation of the uterus
How is uterine hyperstimulation defined?
more than 5 contractions in 10 minutes
leads to bradycardia, late decelerations and hypoxia
How you you manage uterine hyperstmiulation?
STOP the pit side lying increase fluids give O2 notify HCP
Give terbutaline 0.25mg SQ
What defines the neonatal period?
the first 28 days of life
What are the normal vital signs for a newborn?
HR - 110-160
BP - 60/40
RR - 30-60
T - 97.9-99.7
What is the weird part of newborn respiration that is still normal?
30-60 bpm with short periods of apnea <15s
Adaptation to extrauterine life; cardiac -
ductus arteriosus closes
foramen ovale closes
HgB declines (physiologic anemia)
Adaptation to extrauterine life; respiratory -
surfactant reduces surface tension of the lungs and prevents alveolar collapse after first breath
Adaptation to extrauterine life; hepatic -
physiologic jaundice
Adaptation to extrauterine life; GI -
bacteria colonize the gut
immature cardiac sphincter results in regurgitation
Adaptation to extrauterine life; immune -
IgG crosses the placenta
When does surfactant begin to be produced? When is it complete?
24-28 weeks
complete by 35 weeks
How does a newborn regulate their temperature?
by burning “brown fat”
Expected number of diaper changes:
6-8/day
normal weight loss for newborns
5-10% of their birth weight
S&S of cold stress:
hypotension
lethargy
weakness
What are Mongolian spots?
normal discoloration of a newborn that looks like bruising
What is lanugo?
downy, soft hair
What is vernix caseosa?
cottage cheesy stuff on a newborn
When do you take an APGAR
1 and 5 minutes after birth
What does the APGAR acronym stand for?
activity
0 - absent
1 - arms and legs flexed
2 - active movement
pulse
0 - absent
1 - < 100
2- > 100
grimace
0 - flaccid
1 - some flexion of extremities
2 - active motion
Appearance (skin color)
0 - blue/pale
1 - pink body, blue extremities
2 - pink
Respiration
0 - absent
1 - slow and irregular
2 - vigorous crying
Scoring:
0-3 severely depressed
4-6 moderately depressed
7-10 excellent condition
What is the average head circumference?
32-38 cm
Caput succedaneum vs cephalohematoma:
Caput Succedaneum - serous fluid that crosses the suture line below the skin
Cephalohematoma - blood b/w the periosteum and skull (swelling of the skin, not below it)
Both are normal
What condition increases the risk for jaundice?
cephalohematoma b/c the blood breaks down and releases bilirubin
what are some considerations for the PKU heel stick?
- infant should be supine
- do NOT use posterior pole of heal or calcaneus
- DO use outer edge to minimize pain
When is a circumcision usually done? How long does it take to heal?
2-3 days after birth
7-10 days to heal
Circumcision care
wash with warm soapy water and try to keep it away from stool
over the tip of the penis with petroleum jelly coated gauze to prevent it from sticking to the diaper
What are the characteristics of thrush?
white plaques in the mouth that can NOT be wiped away
Why do we give infants vitamin K?
it helps the liver produce prothrombin, which helps the baby clot - preventing vitamin K deficiency bleeding (rare)
How do we care for the umbilical cord stump?
keep it clean and dry
it will change color from yellow to brown to black
Describe the (5) infant reflexes:
Tonic Neck (fencer) - until 3/4 mo Palmar Grasp - until 3/4 mo Moro (oh no) - until 3/6 mo Rooting (piggy) - until 4/6 mo Babinski (toes should FAN OUT) - until 12 mo
Bathing recommendations for a newborn:
3X/week is enough
don’t get the stump wet ~10days
What is the main complication of providing oxygen therapy to the newborn?
ROP - retinopathy of prematurity
major cause of blindness
What are the resuscitation guidelines for newborns?
A - airway - suction mouth, nose then trachea if HR <100
B - breathing - use PPV for apnea or HR <100 and ventilate at 40-60 bpm
C - circulation - start compressions if HR <60 after 30 seconds of PPV (3 compressions to 1 breathe Q2sec)
D - drugs - give epic if HR is <60 after 30 seconds CPR
Definition for a SGA infant
< 2500 g or 5lbs 8oz
or
below 10th percentile
Definition for a LGA infant
> 4000 g or 8lbs 13oz
or
above 90th percentile
Typical characteristics of a SGA infant:
large head
loose skin
scaphoid abdomen
thin umbilical cord
Typical characteristics for a LGA infant:
large body fat face proportional body size poor motor skills behavioral px
Common problems for a SGA infant vs a LGA infant
SGA: HYPOglycemia and polycythemia asphyxia thermoregulation px meconium aspiration
LGA: HYPOglycemia and polycythemia both trauma ARDS HYPERbilirubinemia
Symmetric vs Asymmetric IUGR characteristics
Symmetric:
< 28 weeks
infant never catches up in size
head, bones, and abdomen are all proportionally decreased in size
Asymmetric:
> 28 weeks
able to catch up in size
normal head and bones size but decreased abdomen size
Why do we use Gavage feeding?
for prelim babies, so they don’t use up their O2 demands eating
What does the Silverman Anderson Index score interpret?
Respiratory distress syndrome
the higher the score, the worse the respiratory distress
What is RDS?
respiratory distress syndrome
- lungs are immature and are lacking surfactant
- RR > 60
- Silverman Anderson Score > 7
Where and how would we assess a baby for jaundice?
press a finger over a bony part of the baby
- nose, forehead and STERNUM are best
How do we grade infant jaundice?
0 - none 1 - face and neck only 2 - chest and back 3 - abdomen below the umbilicus to the knees 4 - arms and legs below knees 5 - hands and feet
How do we define hyperbilirubinemia?
bilirubin > 5 mg/dL
Physiologic vs pathologic hyperbilirubinemia; when it appears:
physiologic: 3rd-4th day of life
(can be late onset on day 14 - still not pathologic)
pathologic: 1st day of life
Physiologic vs pathologic hyperbilirubinemia; how high the bilirubin goes:
physiologic: 10 mg/dL then declines rapidly
pathologic: 17 mg/dL
What is the indication for phototherapy in newborns? Considerations?
indicated for hyperbilirubinemia
cover the newborn’s genitals and eyes to protect them from the light
What is kernicterus?
chronic bilirubin encephalopathy
leads to severe neurotoxicity
preventable
Define preterm and postterm newborn:
preterm - before 37 weeks
postterm - after 42 weeks
What are common characteristics of a PREterm newborn?
scrawny undescended testes lots of lanugo lots of vernix caseosa fused eyelids
What are common characteristics of a POSTterm newborn?
dry, cracked skin long nails creases over entire soles of feet wide eyed and alert thin umbilical cord NOT MUCH vernix and lanugo
What are the main characteristics for neonatal abstinence syndrome?
WITHDRAWAL
Wakefulness Irritability Temp variation, Tremors, Tachycardia Hyperactivity, Hyperreflexia, Hypertonia Disturbed sleep, Diarrhea, Disorganized suck Respiratory distress, Rhinorrhea Apneic attacks Weight loss Alkalosis (respiratory) Lacrimation
Major complications of newborns exposed to tobacco, alcohol and drugs:
- IUGR
- cognitive restriction
- microcephaly
What is HYPOglycemia defined as in a newborn?
BG < 40
What is the best maintenance for newborn HYPOglycemia?
frequent early feedings
temperature maintenance
Why would a mother use antiretroviral treatment during pregnancy?
to prevent mother to baby HIV transmission
How can HIV be acquired from mother to baby?
vertical transmission
breastfeeding and through the placenta
When should pregnant HIV (+) women begin medication?
14 weeks gestation
What are the insulin needs for gestational diabetes by trimester?
1 - decreased need
2&3 - increased need
What are the hPL levels for gestational diabetes by trimester?
1 - low hPL
2&3 - high hPL
What are the glucose levels for gestational diabetes by trimester?
increased glucose use and storage during the 2nd and 3rd trimester
What are the postpartum needs for insulin for gestational diabetes?
abrupt decrease in need for insulin
When are labs drawn for pregnancy screening?
on the first visit and again at 24-28 weeks
What are insulin needs for breastfeeding vs nonbreastfeeding mothers?
Breastfeeding DECREASES the need for insulin b/c it helps stabilize glucose levels for mother and baby
What drugs are not recommended during pregnancy?
oral HYPOglycemics - teratogenic
Can mothers have insulin during pregnancy?
Yes - it doesn’t cross the placenta
What hormone regulates insulin? How does it work?
hPL and GH
they both increase as the placenta grows and resists insulin
insulin rises to counteract the rise in hPL and GH levels
this is not a px for non diabetic women, but women with diabetes can not cope with the rising insulin and get HYPERglycemia
What is the main cause of postpartum hemorrhage?
uterine atony
What is the main cause of LATE/EXCESSIVE postpartum hemorrhage?
uterine sub involution
What are the 5 T’s of postpartum hemorrhage?
tone tissue trauma thrombin traction
What are the 3 abnormal placental insertions?
accreta - partially in the myometrium
increta - most in the myometrium
percreta - in the perimetrium or past it
What nursing actions would you take for a patient with uterine atony?
fundal massage Pitocin to contract the uterus maintain IV fluids Methergine Hemabate
Expected findings for postpartum hemorrhage r/t hematoma and lacerations
firm uterus
bright red bleeding
bruising
side effect of Pitocin
hyperstimulation of the uterus
contraindications for Pitocin
do NOT give undiluted as a bolus injection
Methergine side effects
HTN
seizures
Methergine contraindications
HTN
hx of seizure
Hemabate side effects
bronchospasm
Hemabate contraindications
asthma
What characterizes postpartum psychosis
depression
delusions
thoughts of harming infant or self
S&S of postpartum infection
fever over 38 or 100.4 after 24 hours
What is the most common cause of postpartum infection?
endometritis
What can women do to prevent uterine prolapse?
kegals
passaries
surgery
What are the hallmark S&S of gestational trophoblastic disease?
high fundal height
expulsion of grape like cysts
Which is likely malignant; molar or non-molar GTD?
non-molar (molar is usually benign)
What happens to HCG levels during gestational trophoblastic disease?
they’re high
What do we do to manage gestational trophoblastic disease?
chemo for invasive moles and surgical evacuation
What does the followup care for gestational trophoblastic disease include?
hCG level tase at 6 months
pregnancy recommendations for gestational trophoblastic disease?
wait 6 months after evacuation AND have a normal hCG level, then pregnancy is ok
What is the medical definition of abortion?
expulsion of an embryo or fetus before viability (before 20 weeks)
What is the difference between primary and secondary infertility?
primary - can’t conceive after 1 year
secondary - can’t conceive after previous pregnancy
What are the % of infertility causes by sex?
female - 40%
male - 40%
both - 20%
Average blood loss for menstruation?
35mL
Average menstrual period length
4-7 days
90% of blood loss is complete during the menstrual cycle by day ______.
3
How much chronic blood loss during menstrual periods leads to anemia?
> 80mL/cycle
Meno-
menstrual related
Metro-
time
Oligo-
few
A-
without
Rhagia-
excess/abnormal
Dys-
not or pain
-rhea
flow
What is AUB? How is it different from DUB?
AUB: abnormal uterine bleeding
DUB: dysfunctional uterine bleeding - no organic pathology, r/t hormone px
What is dysmenorrhea?
weird periods
What is the difference between primary and secondary dysmenorrhea?
primary - increased prostaglandin production
secondary - pelvic/uterine pathology (#1 cause is endometriosis)
What is TSS? Management?
bacterial infection that can lead to death
tx - hospitalization, antibiotics, potential dialysis
Effects on newborn: Chlamydia
eye infections
pneumonia
low birth weight/prematurity
Effects on newborn: Gonnorhea
inflammation
Effects on newborn: Herpes
intellectual disability
blindness
seizure
Effects on newborn: Syphilis
skin px
jaundice
anemia
Effects on newborn: Trichomoniasis
Premature rupture of membranes
Effects on newborn: Genital Warts
throat warts
What is HPV? Tx?
most common viral infection in the US (“genital warts”)
tx - Gardasil, Cervarix
What is PID? S&S?
bacterial infection of the upper reproductive tract
S&S - fever, elevated WBC, abnormal vaginal discharge
What is an ectopic pregnancy? S&S? Tx?
ovum implantation outside the uterus
S&S - abdominal pain with spotting 6-8 weeks after a missed period
Tx - education of the S&S of rupture, pain management
