Maternity Part 2 Flashcards
1
Q
excessive or pernicious vomiting during pregnancy leading to dehydration and starvation
A
hyperemesis gravidarum
2
Q
what would you give through an IV for a pt with hyperemesis gravidarum
A
LR bc has electrolytes
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
4
Q
S/Sx of hyperemesis gravidarum
A
N & V , intractable
5
Q
Tx for hyperemesis gravidarum
A
hydration (3000mL within 24 hours
Rx (Zofran, phenegran)
nutritional supplements (ensure)
monitor for keytones
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
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
8
Q
Dx of incompetent cervix
A
Hx, examination (vag exam), U/S
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
10
Q
spontaneous ROM prior to onset of labor
A
premature rupture of membranes
*gestational age doesn’t matter
11
Q
spontaneous ROM: latent period
A
time from ROM to onset of labor (usually within 24 hours)
12
Q
spontaneous ROM: interval period
A
time from ROM to birth
13
Q
Etiology of PROM
A
unknown, contributing factors: infection, Esp. UTI, polyhydramnious, trauma, mult gestation
14
Q
what maternal risks can happen because of PROM
A
INFECTION
chorioamnionitis: inflammation of membranes
endometritis: postpartum infection of endometrial lining
15
Q
what neonatal risks can happen because of PROM
A
RDS, sepsis
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
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
18
Q
what Rx can you give to stop labot
A
Tocolytics
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
20
Q
funneling
A
greater than 50% funneling before 25 weeks has a 80% risk of preterm delivery
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
22
Q
if there is fetal fibronectin present between 20 and 34 weeks this is what
A
abnormal = risk for premature labor
23
Q
preterm labor Sx
A
abd tightness, menstrual cramping, back discomfort (comes and goes), pelvic pressure, intestinal cramping
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
25
what are the contraindications of suppressing labor
confirmed fetal death, fetal distress, gestational age less than 20 weeks
26
Ritodrine
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
27
Supress labor
cervix less 4 cm dilated, gestation less 37 weeks, viable infant, documentation of contractions, membranes intact, no medical or obstricial disorders
28
Terbutaline
B-adrenergic, relaxes smooth muscle, SQ or inhalation, Terbutanline pump
SE: tacycardia
29
Magnesium sulfate
CNS suppressant, secondary action-relaxes smooth muscle, monitor reflexes and BP
30
antidote for Magnesium sulfate
calcium gluconate
31
Nifedipine
Procardia, decrease smooth muscle contraction, SE increase HR, flushing, HA, decrease BP
32
Progesterone
relaxes uterine contratility
33
Bethamethasone
Celestone, accelerates fetal lung maturation (helps with surfactant), contraindicated with Ritodrine
34
developed from single fertilized ovum that divides, identical twins
monozygotic
35
the # of amnions and chorions depends on what
the timing of division after fertilization, the earlier the splitting the more independent the twins will develop
36
2 separate ova fertilized by 2 seperate sperm, fraternal twins (not identical)
Dizygotic
| (2 placentas, 2 chorions, 2 amnions, born singly
37
How do you Dx multifetal gestation
U/S see 2 gestational savs, have severe N & V due to increase HCG
38
Maternal complications with multifetal gestation
PROM, pre eclampsia, preterm labor, prolapsed cord, post partum hemorrhage (overdestended uterus), high risk UTI
39
Fetal complications with multifetal gestation
IUGR, fetal anomalies, premature, cerebral palsey, TTTS
40
twin to twin transfusion syndrome (TTTS)
single plaental, one baby sucks up all nutirents and other gets leftovers, abnormal blood vessels in placenta
41
donor twin
small twin
42
recipient twin
larter twin
43
what would be dont for Tx of TTTS babies
seperate circulation, selective cord coagulation (stop BF to one baby, results in death of twin)
44
create a hole between babies sacs, evens out fluid
| found in TTTS babies
septoplasty
45
what is the goal with multifetal gestations
keep pregnancyuntil 38 weeks for twins, 35 for triplets
46
what influences the delivery decision
position and presentation
47
what are the 4 factors of labor
passage, passenger, powers, psyche
48
false pelvis
above pelvic brim, supports weight of uterus
49
true pelvis
below pelvic brim
50
normal female pelvis, inlet is rounded, favorable for delivery, usually OA
gynocoid pelvis
51
normal male pelvis, inlet is heart shaped, prominent ischial spines, arrest of labor is frequent
android pelvis
52
ape like pelvis, inlet is oval, facorable influence on labor
anthropoid pelvis
53
flat pelvis, transverse oval inlet, if passes through inlet delivery is rapid
platypelloid pelvis
54
accomodation, overlapping of cranial bones under pressure of the powers of labor
passenger
55
swelling of soft tissues of scalp
caput
56
what is the suture on the back of the head, seperating the parietal and occipital bones
lambdodial suture
57
what is the suture on the front of the head seperating the frontal and parietal
coronal sutures
58
what is the suture that seperates the right and left parietal bones
sagital suture
59
the anterior fontenelle is AKA
Bregma
60
what is the fontenlle on the lateral side of the face in the cheek area
sphenoid fontenelle
61
the frontal bones are also known as
sinciput
62
mentum
fetal chin
63
sinciput
fetal brow
64
bregma
anterior fontenelle
65
vertex
area between anterior and posterior fontenelles
66
occiput
area beneath posterior fontenelle
67
relationship of the fetal spine to the maternal spine
Lie
*longitudinal/vertical
horizontal/transverse
68
relationship of fetal parts to one another, 4 types
attitude
69
what are the 4 types of attitudes
vertix; head flexed
military: partialy flexed
brow: partly extended
face: well extended, largest diameter of head to come through)
70
which fetal body part enters the pelvis first or lying over inlet, 4 types
presentation
71
what are the 4 presentation types
cephalic: fetal head 1st
breech: fetal butt, knees, feet first
shoulder: transverse line
compound: more than one presenting part
72
fetal hips and knees are flexed, thighs on abdomen, butt and feet present
complete breech
73
fetal hips flexed, knees extended, butt present
frank
| "frank-feet-face"
74
fetal hips and legs extended, feet present, may be single or double footling
footling
75
fetal body part present in or on cervical os
presenting part
76
when largest diameter of present part reaches or passes through pelvic inlet
engagement
77
relative position of fetal presenting part above or below an imaginary line drawn between the maternal ischial spines
station
78
relationship of an orbitrarily choosen fetal reference point on presenting fetal part to its location front, back or side of maternal pelvis
position
79
forces of labor
powers
80
primary powers
uterine muscle contractions
81
secondary powers
use of abdominal muscles, "pushing"
82
what is the increment in a uterine contraction
building up (longest phase)
83
what is the peak of the uterine contraction
acme
84
what is the letting up phase in a uterine contraction
decrement
85
pressure in uterus between contractions
resting tone
86
period of time from start of one to start of another contraction (ex. 2-3 minutes)
frequency
87
period of time from start of one contraction to end of same contraction (ex 45-60 seconds)
duration
88
contraction strength at its acme
intensity
| mild-nose, moderate-chin, strong-forehead
89
coping with labor ocntractions, influenced on fears, social support culture, etc
psyche
90
predisposing factors for HTN/HELLP
primigravida, Hx of vascular disease, increased age, genetic hx, , multifetal gestation
91
elevated BP WITHOUT proteinuria, developes after 20 weeks gestation & BP levels return to normal postpartum (HTN 140/90)
gestational HTN
92
HTN & proteinuria after 20 weeks gestation BP 140/90 or higher & proteinuria (0.3g or higher or +1) in a 24 hour collection
pre eclampsia
93
Tx for pre eclampsia
Left side lying
| diet: no added salt, high protein
94
presence of one or more of following BP 160/110, 3+ proteinuria, oliguria, pulmonary edema, RUQ, impaired liver function, IUGR
severe pre eclampsia
95
new onset of grand mal seizures
eclampsia
96
new onset of proteinuria in women with HTN prior to 20 weeks gestation, sudden increase in HTn or HELLP syndrome
superimposed preeclampsia
97
HTN prior to conception or before 20 weeks gestation
chronic HTN
| *Tx seperatly from preeclampsia
98
what Rx is given for chronic HTN women who are pregnant
aldomet, goal is to decrease vasospasm, prevent seizure
99
acronym used for lab markers in pts with severe pre eclampsia
HELLP syndrome
H-hemolysis
EL-elevated liver enzymes
LP- low platelets
100
what is the Tx for HELLP syndrome
delivery, regardless of gestational age
101
danger signs in pre eclampsia
severe HA, vision changes, RUQ pain
102
magnesium sulfate
monitor I&O, RR, BP, deep tendon reflexes, serum magnesium level
103
when magnesium sulfate is given, what do you need to watch for in a NB
lethargy, poor feedings
104
antidote for magnesium sulfate
calcium gluconate
105
what Rx is used for a HTN crisis
Hydralazine (labelolol) 160/110
106
intermittent ctx, irregular & painless, felt more in front than back, walking doesn't effect
Braxton hicks CTX
107
cervix becomes shorter, thinner
effacement, 0-100%
108
cervix is soft, thinner, dilatable
ripening
109
expulsion of mucous plug (pink in color)
bloody show
| sign that labor is imminent (within 24-48 hours)
110
leak in amniotic sac, labor usually begins within 24 hours, if not labor is induced
ROM
111
what is the danger of ROM if labor is not induced
danger of infection, or prolapsed cord if not delivered
112
SROM
spontaneous ROM, rupture anytime before or during labor
113
AROM
artificially ROM
114
amniotic fluid
clear, musty, smell, may have white flecks (vernix), alkaline
115
green amniotic fluid
meconium, fetal distress
116
strange odor with amniotic fluid
amnionitis present
117
how do you DX ROM
visualization, nitrazine paper (yellow=intact, blue=membrane rupture), arborization test (ferning, its the most reliable method for DX, passage of meconium from vagina
118
dilation
opening of cervical os (1-10 cm)
119
effacement
thinning of cervix (1-100%)
120
descent
progress of fetus through maternal pelvis (+ or -, in relation to location of presenting part of fetus to ischial spine)
121
Phases of labor
4 stages (labor, baby, placenta, recovery)
122
1st stage of labor
onset of labor to complete cervical dilation
* latent phase
* active phase
* transition phase
123
latent phase
occurs in 1st stage of labor, labor onset to 3 cm dilation
124
active phase
occurs in the 1st stage of labor, 4-7 cm dilation
125
transition phase
occurs in the 1st stage of labor, 8-10 cm dilated
126
2nd stage of labor
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
3rd stage of labor
birth to placental expulsion
128
4th stage of labor
1-4 hours after placental expulsion, uterus contracts to control bleeding at placental site
129
occurs when widest part of babies head is completely encircled by vagina (ring)
crowning
130
characteristics of transition
increase bloody show, increase anxiety, hyperventilation, increase sensitivity to touch, leg cramps, low back ache, inward focus, increase rectal pressure
131
movement of presenting part through pelvis, measured by stations
descent
132
why does flexion of the head happen during delivery
decrease the diameter of babies head
133
babies head rotates into position
internal rotation
134
turns back to initial position
restitution
135
after presenting part goes through symphis pubis head comes out, face towards rectum
extension
136
delivery of shoulders
external rotation
137
cardinal movements in order
descent, flexion, internal rotation, extension, restitution, external rotation, expulsion
138
how much time should it take between birth of baby to birth of placenta
no longer than 30 minutes
139
signs of placental separation
uterine fundus rises in abdomen, sudden trickle or gush of blood, umbilical cord lengthens
140
if you have a single gush of blood or trickle after delivery of placenta is that normal
yes
141
during the 4th stage of labor what are the S/sx of placental separation
decrease BP, increase HR, tachycardia, uterine fundus is firm, midline bit below umbilicus, shaking chills, thirst
142
Shiny shultz
fetal side of placenta delivers 1st, less blood loss
143
dirty duncan
maternal side delivers 1st, increase blood loss, have retained fragments, increase risk for infection
144
pscyh of latent phase
anxious but able to cope, excitement level high, station doesn't change
145
pscych of active phase
increase anxiety, inward focus, rapid dilation, change in station
146
pscych of transition phase
totally out of control, quick stage, dilation slows
147
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
true labor
148
irregular contractions, no change in intervals, no changes in intervals, easily sedated, no change with cervix, walking has no effect in intensity
false labor
149
what is the only way to Dx labor
cervical exam
150
during the first stage of labor how does the BP change
have increase of systolic BP with uterine contractions
151
during the 2nd stage of labor how does the BP change
increase of systolic and diastolic during contractions
152
what other VS changes can happen during labor
increase RR, increase WBC, decrease GI motility, decrease of BL
153
how do you assess intensity of contractions
palpate
154
in order to have a internal monitoring or IUPC what has to happen
need dilation and ROM
155
pressure in uterus between contractions
resting tone
156
what can cause a false reading on a nitrazine test
lubricant used, vaginal exam, blood
157
what nursing care would you give after ROM
assess FHR, monitor amniotic fluid (color, odor, amt, time), temperature Q1-2 hours
158
labor curve
labor progressing as it should
159
will a vaginal exam be done if bleeding
NO
160
guidelines for uterine contractions
Q15-30 minutes, must validate intensity with palpation, note frequency, duration, intensity, tone
161
guidelines for FHR
document Q15-30 minutes in 1st stage
| Q5-15 minutes in second stage
162
guidelines for temperature
Q2-4 hours, after ROM Q1-2 hours
163
guidelines for VS
Q hour, dictated by status, Rx, induction
164
Pitocin VS
Q15 minutes for one hour and so on
165
Epidoral VS
Q3 minutes
166
end of one contraction to beginning of next
interval period
167
what labs are done prior to labor
H&H, type and cross, WBC
168
bladder care
encourage frequent voiding, if needed we can cath
169
effleurage
soft gentle stroking where pain is (back)
170
counter pressure
palm of hand where pain is, push on that area
171
leg cramps
occur while pushing, extend legs, flex foot
172
psychoprophylaxis
breathing and relaxation techniques
173
deep breath at beginning and end of contraction, slow in through nose and out through mouth
slow paced
174
deep breath at beginning and end of CTX, with light mouth breathing, rhythmic
mod paced
| used for transition period
175
deep breath at beginning and end of CTX, mouth breathing with "hee hee hoo"
combined
176
how do you tell a mom to slow down breathing and inhibit from pushing
panting
177
nuchal cord
cord wrapped around neck
178
Ritgens maneuver
places gloved finger with towel into anus, places pressure on chin to aid in delivery
179
cord that gets longer, gush of blood, uterus rises high in abdomen,
placenta separation
180
what Rx is given post delivery
oxytocic Rx
| stimulates contractions and decreases hemorrhage
181
post partum assessments
Fundus (firm & midline=normal), bleeding, hemorrhoids, perineum (edema, sutures intact)
182
synchronous with fetal heart, sound is coming from blood flow in umbilical arteries
funic soufflé
183
synchronous with maternal heart rate, blood passing though large vessels of uterus
uterine soufflé
184
what is used during prenatal appts, baseline, rhythm, cant ID decels
doppler
185
measures rate and pattern of fetal heart rate, detect fetal myocardial movements
external fetal monitor
| *does not tell intensity
186
what does internal monitoring assess for
baseline, variability, accels, decels, and dysrhythmias
187
baseline of FHR
10 minute period (accels and decels not counted
188
is variability good
yes it shows that the CNS is working
189
absent variability
0 or undetectable
190
minimal variability
1-5
191
moderate variability
6-25
192
marked variability
26 or more
193
normal baseline FHR
110-160 (round to nearest 5)
194
regular smooth, undulating wave pattern, no accels or decels
sinusoidal pattern
195
sinusoidal pattern is a sign of
severe fetal anemia
196
when do you have concern for fetal demise with HR
over 200
197
what can be a cause of tachycardia
mom-fever, dehydration, anxiety, some Rx
| baby-hypoxia, asphyxia, anemia, infection, premature
198
bradycardia
less than 110
199
causes of bradycardia
mom-Rx, hypotension
| baby-hypoxemia, stimulation of vagus nerve, late fetal ashyxia
200
abrupt temporary increase of at least 15 bpm above baseline
accelerations
201
early declarations
mirrors contraction, head compression
| BENIGN, no nursing interventions
202
variable declerations
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
VEAL
CHOP
204
non-reassuring variable deceleration
variable with decrease in variability, concern for fetal hypoxia
*shoulder, overshoot, slow to recover
205
management for variable decelerations
POPI
206
POPI
position
oxygen
Pitocin
IV bolus
207
prolonged deceleration
decrease in FHR more between 2-10 minutes
208
tactile scalp stimulation
via vaginal exam, look for accelerations (normal and good)
209
fetal blood flow
```
maternal artery
intervillius space
fetal villi
umbilical vein
fetus
umbilical arteries
maternal vein
```
210
rapid slow or irregular FHT
fetal hypoxia
211
port wine colored amniotic fluid/bleeding
placenta previa, separation of placenta, DIC
212
rising BP
pre eclampsia
213
low BP
shock, postural hypotension, reaction to Rx
214
fever
amnioitis, extra uterine infection
215
maternal tachycardia
impending shock
216
abnormal abdominal pain or tenderness
separation of placenta, rupture of uterus,
217
uterine tetany
premature separation of placenta, possible uterine rupture
