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Maternity Part 2 Flashcards

1
Q

excessive or pernicious vomiting during pregnancy leading to dehydration and starvation

A

hyperemesis gravidarum

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2
Q

what would you give through an IV for a pt with hyperemesis gravidarum

A

LR bc has electrolytes

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3
Q

what is a possible etiology of hyperemesis gravidarum

A

possible bc of increase level of HcG, thyroid dysfunction, disruption of GI motility, increase estrogen level

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4
Q

S/Sx of hyperemesis gravidarum

A

N & V , intractable

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5
Q

Tx for hyperemesis gravidarum

A

hydration (3000mL within 24 hours
Rx (Zofran, phenegran)
nutritional supplements (ensure)
monitor for keytones

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6
Q

cervix is unable to support the increasing weight of the pregnancy, results in painless dilation of cervical os without labor or contractions, associated with repeated 2nd trimester abortion )16-28 weeks)

A

incompetent cervix

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7
Q

predisposing factors for incompetent cervix

A

prior traumatic delivery, Hx of D&C, conization, cauterization, mother of pregnant women who took DES, anomaly of uterus or cervix

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8
Q

Dx of incompetent cervix

A

Hx, examination (vag exam), U/S

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9
Q

Tx for incompetent cervix

A

cerclage or purse string suture, inserted in cervix to prevent preterm cervical dilation and pregnancy loss, tightened and secured anteriorly

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10
Q

spontaneous ROM prior to onset of labor

A

premature rupture of membranes

*gestational age doesn’t matter

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11
Q

spontaneous ROM: latent period

A

time from ROM to onset of labor (usually within 24 hours)

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12
Q

spontaneous ROM: interval period

A

time from ROM to birth

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13
Q

Etiology of PROM

A

unknown, contributing factors: infection, Esp. UTI, polyhydramnious, trauma, mult gestation

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14
Q

what maternal risks can happen because of PROM

A

INFECTION

chorioamnionitis: inflammation of membranes
endometritis: postpartum infection of endometrial lining

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15
Q

what neonatal risks can happen because of PROM

A

RDS, sepsis

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16
Q

Management of PROM

A

Abx, bedrest, CBC, fetal monitoring, Temp Q4 hours, daily WBC, corticosteroids and amniocentesis prn, L/S ratio to check lung maturity

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17
Q

occurrence of regular uterine contractions at less than 10 minute intervals after 20 weeks but prior to 37 completed weeks gestation, it is the greatest single problem in OB

A

premature labor

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18
Q

what Rx can you give to stop labot

A

Tocolytics

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19
Q

what do you need to do to identify those pts at risk for premature labor

A

gather Hx, cervical length and funneling, ffn (fetal bibronectin), Sx of preterm labor

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20
Q

funneling

A

greater than 50% funneling before 25 weeks has a 80% risk of preterm delivery

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21
Q

extracellular matrix protein of fetal membranes binds placenta and membranes to decidua, found before 20 weeks and after 34 weeks

A

fetal fibronectin

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22
Q

if there is fetal fibronectin present between 20 and 34 weeks this is what

A

abnormal = risk for premature labor

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23
Q

preterm labor Sx

A

abd tightness, menstrual cramping, back discomfort (comes and goes), pelvic pressure, intestinal cramping

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24
Q

what can the pt do to decrease the risk for preterm labor

A

regular PN care, refrain from sexual intercourse, empty bladder Q2 hours, curtail work activities, allow for rest, left lateral position, maintain adequate nutrition and hydration

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25
Q

what are the contraindications of suppressing labor

A

confirmed fetal death, fetal distress, gestational age less than 20 weeks

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26
Q

Ritodrine

A

1st and only Rx approved, works on beta receptors in smooth muscle

risks: pulmonary edema
assess: BP, HR, RR, I&O, lung sounds
contraindications: concurrent Tx with glucocorticosteriods

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27
Q

Supress labor

A

cervix less 4 cm dilated, gestation less 37 weeks, viable infant, documentation of contractions, membranes intact, no medical or obstricial disorders

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28
Q

Terbutaline

A

B-adrenergic, relaxes smooth muscle, SQ or inhalation, Terbutanline pump
SE: tacycardia

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29
Q

Magnesium sulfate

A

CNS suppressant, secondary action-relaxes smooth muscle, monitor reflexes and BP

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30
Q

antidote for Magnesium sulfate

A

calcium gluconate

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31
Q

Nifedipine

A

Procardia, decrease smooth muscle contraction, SE increase HR, flushing, HA, decrease BP

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32
Q

Progesterone

A

relaxes uterine contratility

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33
Q

Bethamethasone

A

Celestone, accelerates fetal lung maturation (helps with surfactant), contraindicated with Ritodrine

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34
Q

developed from single fertilized ovum that divides, identical twins

A

monozygotic

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35
Q

the # of amnions and chorions depends on what

A

the timing of division after fertilization, the earlier the splitting the more independent the twins will develop

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36
Q

2 separate ova fertilized by 2 seperate sperm, fraternal twins (not identical)

A

Dizygotic

(2 placentas, 2 chorions, 2 amnions, born singly

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37
Q

How do you Dx multifetal gestation

A

U/S see 2 gestational savs, have severe N & V due to increase HCG

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38
Q

Maternal complications with multifetal gestation

A

PROM, pre eclampsia, preterm labor, prolapsed cord, post partum hemorrhage (overdestended uterus), high risk UTI

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39
Q

Fetal complications with multifetal gestation

A

IUGR, fetal anomalies, premature, cerebral palsey, TTTS

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40
Q

twin to twin transfusion syndrome (TTTS)

A

single plaental, one baby sucks up all nutirents and other gets leftovers, abnormal blood vessels in placenta

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41
Q

donor twin

A

small twin

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42
Q

recipient twin

A

larter twin

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43
Q

what would be dont for Tx of TTTS babies

A

seperate circulation, selective cord coagulation (stop BF to one baby, results in death of twin)

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44
Q

create a hole between babies sacs, evens out fluid

found in TTTS babies

A

septoplasty

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45
Q

what is the goal with multifetal gestations

A

keep pregnancyuntil 38 weeks for twins, 35 for triplets

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46
Q

what influences the delivery decision

A

position and presentation

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47
Q

what are the 4 factors of labor

A

passage, passenger, powers, psyche

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48
Q

false pelvis

A

above pelvic brim, supports weight of uterus

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49
Q

true pelvis

A

below pelvic brim

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50
Q

normal female pelvis, inlet is rounded, favorable for delivery, usually OA

A

gynocoid pelvis

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51
Q

normal male pelvis, inlet is heart shaped, prominent ischial spines, arrest of labor is frequent

A

android pelvis

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52
Q

ape like pelvis, inlet is oval, facorable influence on labor

A

anthropoid pelvis

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53
Q

flat pelvis, transverse oval inlet, if passes through inlet delivery is rapid

A

platypelloid pelvis

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54
Q

accomodation, overlapping of cranial bones under pressure of the powers of labor

A

passenger

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55
Q

swelling of soft tissues of scalp

A

caput

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56
Q

what is the suture on the back of the head, seperating the parietal and occipital bones

A

lambdodial suture

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57
Q

what is the suture on the front of the head seperating the frontal and parietal

A

coronal sutures

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58
Q

what is the suture that seperates the right and left parietal bones

A

sagital suture

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59
Q

the anterior fontenelle is AKA

A

Bregma

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60
Q

what is the fontenlle on the lateral side of the face in the cheek area

A

sphenoid fontenelle

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61
Q

the frontal bones are also known as

A

sinciput

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62
Q

mentum

A

fetal chin

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63
Q

sinciput

A

fetal brow

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64
Q

bregma

A

anterior fontenelle

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65
Q

vertex

A

area between anterior and posterior fontenelles

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66
Q

occiput

A

area beneath posterior fontenelle

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67
Q

relationship of the fetal spine to the maternal spine

A

Lie
*longitudinal/vertical
horizontal/transverse

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68
Q

relationship of fetal parts to one another, 4 types

A

attitude

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69
Q

what are the 4 types of attitudes

A

vertix; head flexed

military: partialy flexed
brow: partly extended
face: well extended, largest diameter of head to come through)

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70
Q

which fetal body part enters the pelvis first or lying over inlet, 4 types

A

presentation

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71
Q

what are the 4 presentation types

A

cephalic: fetal head 1st
breech: fetal butt, knees, feet first
shoulder: transverse line
compound: more than one presenting part

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72
Q

fetal hips and knees are flexed, thighs on abdomen, butt and feet present

A

complete breech

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73
Q

fetal hips flexed, knees extended, butt present

A

frank

“frank-feet-face”

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74
Q

fetal hips and legs extended, feet present, may be single or double footling

A

footling

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75
Q

fetal body part present in or on cervical os

A

presenting part

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76
Q

when largest diameter of present part reaches or passes through pelvic inlet

A

engagement

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77
Q

relative position of fetal presenting part above or below an imaginary line drawn between the maternal ischial spines

A

station

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78
Q

relationship of an orbitrarily choosen fetal reference point on presenting fetal part to its location front, back or side of maternal pelvis

A

position

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79
Q

forces of labor

A

powers

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80
Q

primary powers

A

uterine muscle contractions

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81
Q

secondary powers

A

use of abdominal muscles, “pushing”

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82
Q

what is the increment in a uterine contraction

A

building up (longest phase)

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83
Q

what is the peak of the uterine contraction

A

acme

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84
Q

what is the letting up phase in a uterine contraction

A

decrement

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85
Q

pressure in uterus between contractions

A

resting tone

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86
Q

period of time from start of one to start of another contraction (ex. 2-3 minutes)

A

frequency

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87
Q

period of time from start of one contraction to end of same contraction (ex 45-60 seconds)

A

duration

88
Q

contraction strength at its acme

A

intensity

mild-nose, moderate-chin, strong-forehead

89
Q

coping with labor ocntractions, influenced on fears, social support culture, etc

A

psyche

90
Q

predisposing factors for HTN/HELLP

A

primigravida, Hx of vascular disease, increased age, genetic hx, , multifetal gestation

91
Q

elevated BP WITHOUT proteinuria, developes after 20 weeks gestation & BP levels return to normal postpartum (HTN 140/90)

A

gestational HTN

92
Q

HTN & proteinuria after 20 weeks gestation BP 140/90 or higher & proteinuria (0.3g or higher or +1) in a 24 hour collection

A

pre eclampsia

93
Q

Tx for pre eclampsia

A

Left side lying

diet: no added salt, high protein

94
Q

presence of one or more of following BP 160/110, 3+ proteinuria, oliguria, pulmonary edema, RUQ, impaired liver function, IUGR

A

severe pre eclampsia

95
Q

new onset of grand mal seizures

A

eclampsia

96
Q

new onset of proteinuria in women with HTN prior to 20 weeks gestation, sudden increase in HTn or HELLP syndrome

A

superimposed preeclampsia

97
Q

HTN prior to conception or before 20 weeks gestation

A

chronic HTN

*Tx seperatly from preeclampsia

98
Q

what Rx is given for chronic HTN women who are pregnant

A

aldomet, goal is to decrease vasospasm, prevent seizure

99
Q

acronym used for lab markers in pts with severe pre eclampsia

A

HELLP syndrome
H-hemolysis
EL-elevated liver enzymes
LP- low platelets

100
Q

what is the Tx for HELLP syndrome

A

delivery, regardless of gestational age

101
Q

danger signs in pre eclampsia

A

severe HA, vision changes, RUQ pain

102
Q

magnesium sulfate

A

monitor I&O, RR, BP, deep tendon reflexes, serum magnesium level

103
Q

when magnesium sulfate is given, what do you need to watch for in a NB

A

lethargy, poor feedings

104
Q

antidote for magnesium sulfate

A

calcium gluconate

105
Q

what Rx is used for a HTN crisis

A

Hydralazine (labelolol) 160/110

106
Q

intermittent ctx, irregular & painless, felt more in front than back, walking doesn’t effect

A

Braxton hicks CTX

107
Q

cervix becomes shorter, thinner

A

effacement, 0-100%

108
Q

cervix is soft, thinner, dilatable

A

ripening

109
Q

expulsion of mucous plug (pink in color)

A

bloody show

sign that labor is imminent (within 24-48 hours)

110
Q

leak in amniotic sac, labor usually begins within 24 hours, if not labor is induced

A

ROM

111
Q

what is the danger of ROM if labor is not induced

A

danger of infection, or prolapsed cord if not delivered

112
Q

SROM

A

spontaneous ROM, rupture anytime before or during labor

113
Q

AROM

A

artificially ROM

114
Q

amniotic fluid

A

clear, musty, smell, may have white flecks (vernix), alkaline

115
Q

green amniotic fluid

A

meconium, fetal distress

116
Q

strange odor with amniotic fluid

A

amnionitis present

117
Q

how do you DX ROM

A

visualization, nitrazine paper (yellow=intact, blue=membrane rupture), arborization test (ferning, its the most reliable method for DX, passage of meconium from vagina

118
Q

dilation

A

opening of cervical os (1-10 cm)

119
Q

effacement

A

thinning of cervix (1-100%)

120
Q

descent

A

progress of fetus through maternal pelvis (+ or -, in relation to location of presenting part of fetus to ischial spine)

121
Q

Phases of labor

A

4 stages (labor, baby, placenta, recovery)

122
Q

1st stage of labor

A

onset of labor to complete cervical dilation

  • latent phase
  • active phase
  • transition phase
123
Q

latent phase

A

occurs in 1st stage of labor, labor onset to 3 cm dilation

124
Q

active phase

A

occurs in the 1st stage of labor, 4-7 cm dilation

125
Q

transition phase

A

occurs in the 1st stage of labor, 8-10 cm dilated

126
Q

2nd stage of labor

A

complete dilation (10 cm) to birth of baby, have urge to push, increase of bloody show, if ROM hasn’t happened you will have AROM

127
Q

3rd stage of labor

A

birth to placental expulsion

128
Q

4th stage of labor

A

1-4 hours after placental expulsion, uterus contracts to control bleeding at placental site

129
Q

occurs when widest part of babies head is completely encircled by vagina (ring)

A

crowning

130
Q

characteristics of transition

A

increase bloody show, increase anxiety, hyperventilation, increase sensitivity to touch, leg cramps, low back ache, inward focus, increase rectal pressure

131
Q

movement of presenting part through pelvis, measured by stations

A

descent

132
Q

why does flexion of the head happen during delivery

A

decrease the diameter of babies head

133
Q

babies head rotates into position

A

internal rotation

134
Q

turns back to initial position

A

restitution

135
Q

after presenting part goes through symphis pubis head comes out, face towards rectum

A

extension

136
Q

delivery of shoulders

A

external rotation

137
Q

cardinal movements in order

A

descent, flexion, internal rotation, extension, restitution, external rotation, expulsion

138
Q

how much time should it take between birth of baby to birth of placenta

A

no longer than 30 minutes

139
Q

signs of placental separation

A

uterine fundus rises in abdomen, sudden trickle or gush of blood, umbilical cord lengthens

140
Q

if you have a single gush of blood or trickle after delivery of placenta is that normal

A

yes

141
Q

during the 4th stage of labor what are the S/sx of placental separation

A

decrease BP, increase HR, tachycardia, uterine fundus is firm, midline bit below umbilicus, shaking chills, thirst

142
Q

Shiny shultz

A

fetal side of placenta delivers 1st, less blood loss

143
Q

dirty duncan

A

maternal side delivers 1st, increase blood loss, have retained fragments, increase risk for infection

144
Q

pscyh of latent phase

A

anxious but able to cope, excitement level high, station doesn’t change

145
Q

pscych of active phase

A

increase anxiety, inward focus, rapid dilation, change in station

146
Q

pscych of transition phase

A

totally out of control, quick stage, dilation slows

147
Q

pattern of labor becomes regular, gets close together, increase intensity, pain in back and radiates forward, walking increases intensity, will have cervical changes, will have presenting part

A

true labor

148
Q

irregular contractions, no change in intervals, no changes in intervals, easily sedated, no change with cervix, walking has no effect in intensity

A

false labor

149
Q

what is the only way to Dx labor

A

cervical exam

150
Q

during the first stage of labor how does the BP change

A

have increase of systolic BP with uterine contractions

151
Q

during the 2nd stage of labor how does the BP change

A

increase of systolic and diastolic during contractions

152
Q

what other VS changes can happen during labor

A

increase RR, increase WBC, decrease GI motility, decrease of BL

153
Q

how do you assess intensity of contractions

A

palpate

154
Q

in order to have a internal monitoring or IUPC what has to happen

A

need dilation and ROM

155
Q

pressure in uterus between contractions

A

resting tone

156
Q

what can cause a false reading on a nitrazine test

A

lubricant used, vaginal exam, blood

157
Q

what nursing care would you give after ROM

A

assess FHR, monitor amniotic fluid (color, odor, amt, time), temperature Q1-2 hours

158
Q

labor curve

A

labor progressing as it should

159
Q

will a vaginal exam be done if bleeding

A

NO

160
Q

guidelines for uterine contractions

A

Q15-30 minutes, must validate intensity with palpation, note frequency, duration, intensity, tone

161
Q

guidelines for FHR

A

document Q15-30 minutes in 1st stage

Q5-15 minutes in second stage

162
Q

guidelines for temperature

A

Q2-4 hours, after ROM Q1-2 hours

163
Q

guidelines for VS

A

Q hour, dictated by status, Rx, induction

164
Q

Pitocin VS

A

Q15 minutes for one hour and so on

165
Q

Epidoral VS

A

Q3 minutes

166
Q

end of one contraction to beginning of next

A

interval period

167
Q

what labs are done prior to labor

A

H&H, type and cross, WBC

168
Q

bladder care

A

encourage frequent voiding, if needed we can cath

169
Q

effleurage

A

soft gentle stroking where pain is (back)

170
Q

counter pressure

A

palm of hand where pain is, push on that area

171
Q

leg cramps

A

occur while pushing, extend legs, flex foot

172
Q

psychoprophylaxis

A

breathing and relaxation techniques

173
Q

deep breath at beginning and end of contraction, slow in through nose and out through mouth

A

slow paced

174
Q

deep breath at beginning and end of CTX, with light mouth breathing, rhythmic

A

mod paced

used for transition period

175
Q

deep breath at beginning and end of CTX, mouth breathing with “hee hee hoo”

A

combined

176
Q

how do you tell a mom to slow down breathing and inhibit from pushing

A

panting

177
Q

nuchal cord

A

cord wrapped around neck

178
Q

Ritgens maneuver

A

places gloved finger with towel into anus, places pressure on chin to aid in delivery

179
Q

cord that gets longer, gush of blood, uterus rises high in abdomen,

A

placenta separation

180
Q

what Rx is given post delivery

A

oxytocic Rx

stimulates contractions and decreases hemorrhage

181
Q

post partum assessments

A

Fundus (firm & midline=normal), bleeding, hemorrhoids, perineum (edema, sutures intact)

182
Q

synchronous with fetal heart, sound is coming from blood flow in umbilical arteries

A

funic soufflé

183
Q

synchronous with maternal heart rate, blood passing though large vessels of uterus

A

uterine soufflé

184
Q

what is used during prenatal appts, baseline, rhythm, cant ID decels

A

doppler

185
Q

measures rate and pattern of fetal heart rate, detect fetal myocardial movements

A

external fetal monitor

*does not tell intensity

186
Q

what does internal monitoring assess for

A

baseline, variability, accels, decels, and dysrhythmias

187
Q

baseline of FHR

A

10 minute period (accels and decels not counted

188
Q

is variability good

A

yes it shows that the CNS is working

189
Q

absent variability

A

0 or undetectable

190
Q

minimal variability

A

1-5

191
Q

moderate variability

A

6-25

192
Q

marked variability

A

26 or more

193
Q

normal baseline FHR

A

110-160 (round to nearest 5)

194
Q

regular smooth, undulating wave pattern, no accels or decels

A

sinusoidal pattern

195
Q

sinusoidal pattern is a sign of

A

severe fetal anemia

196
Q

when do you have concern for fetal demise with HR

A

over 200

197
Q

what can be a cause of tachycardia

A

mom-fever, dehydration, anxiety, some Rx

baby-hypoxia, asphyxia, anemia, infection, premature

198
Q

bradycardia

A

less than 110

199
Q

causes of bradycardia

A

mom-Rx, hypotension

baby-hypoxemia, stimulation of vagus nerve, late fetal ashyxia

200
Q

abrupt temporary increase of at least 15 bpm above baseline

A

accelerations

201
Q

early declarations

A

mirrors contraction, head compression

BENIGN, no nursing interventions

202
Q

variable declerations

A

abrupt decrease in FHR, onset of decal to lowest point (nader) is less than 30 seconds with a quick return to baseline and has variability

203
Q

VEAL

A

CHOP

204
Q

non-reassuring variable deceleration

A

variable with decrease in variability, concern for fetal hypoxia
*shoulder, overshoot, slow to recover

205
Q

management for variable decelerations

A

POPI

206
Q

POPI

A

position
oxygen
Pitocin
IV bolus

207
Q

prolonged deceleration

A

decrease in FHR more between 2-10 minutes

208
Q

tactile scalp stimulation

A

via vaginal exam, look for accelerations (normal and good)

209
Q

fetal blood flow

A 
maternal artery
intervillius space
fetal villi
umbilical vein
fetus
umbilical arteries
maternal vein
210
Q

rapid slow or irregular FHT

A

fetal hypoxia

211
Q

port wine colored amniotic fluid/bleeding

A

placenta previa, separation of placenta, DIC

212
Q

rising BP

A

pre eclampsia

213
Q

low BP

A

shock, postural hypotension, reaction to Rx

214
Q

fever

A

amnioitis, extra uterine infection

215
Q

maternal tachycardia

A

impending shock

216
Q

abnormal abdominal pain or tenderness

A

separation of placenta, rupture of uterus,

217
Q

uterine tetany

A

premature separation of placenta, possible uterine rupture

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