Maternity Exam IV Flashcards
1
Q
What is dystocia?
A
abnormal/difficult labor
2
Q
What are risk factors for dystocia?
A
epidural multiple gestation poor pushing/contractions occipital posterior position big fat bb
3
Q
What are the causes of dystocia?
A
4 P’s
powers, passageway, passenger, psyche
4
Q
What position makes a shoulder dystocia more likely?
A
occiput posterior position (OP)
5
Q
What is the nursing role for a shoulder dystocia?
A
give a back massage? (suprapubic pressure may worsen the dystocia
6
Q
What is hypotonic uterine dysfunction?
A
contractions slowing or stopping
“powers” of the 4 p’s
7
Q
What is induction vs augmentation?
A
induction - stimulating contractions BEFORE the onset of natural labor
augmentation - enhancing ineffectual active contractions AFTER natural labor has begun
8
Q
What drugs INDUCE labor?
A
prostaglandins: dinoprostone, dinoprostol, misoprostol
oxytocin (Pit)
9
Q
What drugs AUGMENT labor?
A
oxytocin (Pit)
10
Q
What are the side effects of Pitocin ?
A
N/V
H/A
HYPOtension
11
Q
What is the concentration/dilution of Pitocin that is administered ?
A
10 U in 1000mL LR
12
Q
What is the indication for using Cytotec (misoprostol)?
A
labor INDUCTION
13
Q
What is a side effect of Cytotec (misoprostol)?
A
hyperstimulation of the uterus
14
Q
How is uterine hyperstimulation defined?
A
more than 5 contractions in 10 minutes
leads to bradycardia, late decelerations and hypoxia
15
Q
How you you manage uterine hyperstmiulation?
A
STOP the pit side lying increase fluids give O2 notify HCP
Give terbutaline 0.25mg SQ
16
Q
What defines the neonatal period?
A
the first 28 days of life
17
Q
What are the normal vital signs for a newborn?
A
HR - 110-160
BP - 60/40
RR - 30-60
T - 97.9-99.7
18
Q
What is the weird part of newborn respiration that is still normal?
A
30-60 bpm with short periods of apnea <15s
19
Q
Adaptation to extrauterine life; cardiac -
A
ductus arteriosus closes
foramen ovale closes
HgB declines (physiologic anemia)
20
Q
Adaptation to extrauterine life; respiratory -
A
surfactant reduces surface tension of the lungs and prevents alveolar collapse after first breath
21
Q
Adaptation to extrauterine life; hepatic -
A
physiologic jaundice
22
Q
Adaptation to extrauterine life; GI -
A
bacteria colonize the gut
immature cardiac sphincter results in regurgitation
23
Q
Adaptation to extrauterine life; immune -
A
IgG crosses the placenta
24
Q
When does surfactant begin to be produced? When is it complete?
A
24-28 weeks
complete by 35 weeks
25
How does a newborn regulate their temperature?
by burning "brown fat"
26
Expected number of diaper changes:
6-8/day
27
normal weight loss for newborns
5-10% of their birth weight
28
S&S of cold stress:
hypotension
lethargy
weakness
29
What are Mongolian spots?
normal discoloration of a newborn that looks like bruising
30
What is lanugo?
downy, soft hair
31
What is vernix caseosa?
cottage cheesy stuff on a newborn
32
When do you take an APGAR
1 and 5 minutes after birth
33
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
34
What is the average head circumference?
32-38 cm
35
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
36
What condition increases the risk for jaundice?
cephalohematoma b/c the blood breaks down and releases bilirubin
37
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
38
When is a circumcision usually done? How long does it take to heal?
2-3 days after birth
7-10 days to heal
39
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
40
What are the characteristics of thrush?
white plaques in the mouth that can NOT be wiped away
41
Why do we give infants vitamin K?
it helps the liver produce prothrombin, which helps the baby clot - preventing vitamin K deficiency bleeding (rare)
42
How do we care for the umbilical cord stump?
keep it clean and dry
| it will change color from yellow to brown to black
43
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
```
44
Bathing recommendations for a newborn:
3X/week is enough
| don't get the stump wet ~10days
45
What is the main complication of providing oxygen therapy to the newborn?
ROP - retinopathy of prematurity
| major cause of blindness
46
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
47
Definition for a SGA infant
< 2500 g or 5lbs 8oz
or
below 10th percentile
48
Definition for a LGA infant
> 4000 g or 8lbs 13oz
or
above 90th percentile
49
Typical characteristics of a SGA infant:
large head
loose skin
scaphoid abdomen
thin umbilical cord
50
Typical characteristics for a LGA infant:
```
large body
fat face
proportional body size
poor motor skills
behavioral px
```
51
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
```
52
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
53
Why do we use Gavage feeding?
for prelim babies, so they don't use up their O2 demands eating
54
What does the Silverman Anderson Index score interpret?
Respiratory distress syndrome
| the higher the score, the worse the respiratory distress
55
What is RDS?
respiratory distress syndrome
- lungs are immature and are lacking surfactant
- RR > 60
- Silverman Anderson Score > 7
56
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
57
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
```
58
How do we define hyperbilirubinemia?
bilirubin > 5 mg/dL
59
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
60
Physiologic vs pathologic hyperbilirubinemia; how high the bilirubin goes:
physiologic: 10 mg/dL then declines rapidly
pathologic: 17 mg/dL
61
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
62
What is kernicterus?
chronic bilirubin encephalopathy
leads to severe neurotoxicity
preventable
63
Define preterm and postterm newborn:
preterm - before 37 weeks
| postterm - after 42 weeks
64
What are common characteristics of a PREterm newborn?
```
scrawny
undescended testes
lots of lanugo
lots of vernix caseosa
fused eyelids
```
65
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
```
66
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
```
67
Major complications of newborns exposed to tobacco, alcohol and drugs:
- IUGR
- cognitive restriction
- microcephaly
68
What is HYPOglycemia defined as in a newborn?
BG < 40
69
What is the best maintenance for newborn HYPOglycemia?
frequent early feedings
| temperature maintenance
70
Why would a mother use antiretroviral treatment during pregnancy?
to prevent mother to baby HIV transmission
71
How can HIV be acquired from mother to baby?
vertical transmission
| breastfeeding and through the placenta
72
When should pregnant HIV (+) women begin medication?
14 weeks gestation
73
What are the insulin needs for gestational diabetes by trimester?
1 - decreased need
| 2&3 - increased need
74
What are the hPL levels for gestational diabetes by trimester?
1 - low hPL
| 2&3 - high hPL
75
What are the glucose levels for gestational diabetes by trimester?
increased glucose use and storage during the 2nd and 3rd trimester
76
What are the postpartum needs for insulin for gestational diabetes?
abrupt decrease in need for insulin
77
When are labs drawn for pregnancy screening?
on the first visit and again at 24-28 weeks
78
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
79
What drugs are not recommended during pregnancy?
oral HYPOglycemics - teratogenic
80
Can mothers have insulin during pregnancy?
Yes - it doesn't cross the placenta
81
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
82
What is the main cause of postpartum hemorrhage?
uterine atony
83
What is the main cause of LATE/EXCESSIVE postpartum hemorrhage?
uterine sub involution
84
What are the 5 T's of postpartum hemorrhage?
```
tone
tissue
trauma
thrombin
traction
```
85
What are the 3 abnormal placental insertions?
accreta - partially in the myometrium
increta - most in the myometrium
percreta - in the perimetrium or past it
86
What nursing actions would you take for a patient with uterine atony?
```
fundal massage
Pitocin to contract the uterus
maintain IV fluids
Methergine
Hemabate
```
87
Expected findings for postpartum hemorrhage r/t hematoma and lacerations
firm uterus
bright red bleeding
bruising
88
side effect of Pitocin
hyperstimulation of the uterus
89
contraindications for Pitocin
do NOT give undiluted as a bolus injection
90
Methergine side effects
HTN
| seizures
91
Methergine contraindications
HTN
| hx of seizure
92
Hemabate side effects
bronchospasm
93
Hemabate contraindications
asthma
94
What characterizes postpartum psychosis
depression
delusions
thoughts of harming infant or self
95
S&S of postpartum infection
fever over 38 or 100.4 after 24 hours
96
What is the most common cause of postpartum infection?
endometritis
97
What can women do to prevent uterine prolapse?
kegals
passaries
surgery
98
What are the hallmark S&S of gestational trophoblastic disease?
high fundal height
| expulsion of grape like cysts
99
Which is likely malignant; molar or non-molar GTD?
non-molar (molar is usually benign)
100
What happens to HCG levels during gestational trophoblastic disease?
they're high
101
What do we do to manage gestational trophoblastic disease?
chemo for invasive moles and surgical evacuation
102
What does the followup care for gestational trophoblastic disease include?
hCG level tase at 6 months
103
pregnancy recommendations for gestational trophoblastic disease?
wait 6 months after evacuation AND have a normal hCG level, then pregnancy is ok
104
What is the medical definition of abortion?
expulsion of an embryo or fetus before viability (before 20 weeks)
105
What is the difference between primary and secondary infertility?
primary - can't conceive after 1 year
| secondary - can't conceive after previous pregnancy
106
What are the % of infertility causes by sex?
female - 40%
male - 40%
both - 20%
107
Average blood loss for menstruation?
35mL
108
Average menstrual period length
4-7 days
109
90% of blood loss is complete during the menstrual cycle by day ______.
3
110
How much chronic blood loss during menstrual periods leads to anemia?
>80mL/cycle
111
Meno-
menstrual related
112
Metro-
time
113
Oligo-
few
114
A-
without
115
Rhagia-
excess/abnormal
116
Dys-
not or pain
117
-rhea
flow
118
What is AUB? How is it different from DUB?
AUB: abnormal uterine bleeding
DUB: dysfunctional uterine bleeding - no organic pathology, r/t hormone px
119
What is dysmenorrhea?
weird periods
120
What is the difference between primary and secondary dysmenorrhea?
primary - increased prostaglandin production
| secondary - pelvic/uterine pathology (#1 cause is endometriosis)
121
What is TSS? Management?
bacterial infection that can lead to death
tx - hospitalization, antibiotics, potential dialysis
122
Effects on newborn: Chlamydia
eye infections
pneumonia
low birth weight/prematurity
123
Effects on newborn: Gonnorhea
inflammation
124
Effects on newborn: Herpes
intellectual disability
blindness
seizure
125
Effects on newborn: Syphilis
skin px
jaundice
anemia
126
Effects on newborn: Trichomoniasis
Premature rupture of membranes
127
Effects on newborn: Genital Warts
throat warts
128
What is HPV? Tx?
most common viral infection in the US ("genital warts")
tx - Gardasil, Cervarix
129
What is PID? S&S?
bacterial infection of the upper reproductive tract
S&S - fever, elevated WBC, abnormal vaginal discharge
130
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
