Mod 1 Flashcards
Define Accelerations
A visually apparent, abrupt increase in FHR above the baseline rate. The peak is at least 15 beats/min above the baseline and the acceleration lasts 15 seconds or more.
Causes of Accelerations
spontaneous fetal movement vaginal examination electrode application fetal scalp stimulation fetal retraction to external sound breach position occiput posterior position uterine contractions fundal pressure abdominal palpation
Intervention for Acceleration
none required
Early Deceleration occurs when in relation to the contraction?
generally the onset, nadir, and recovery of the deceleration correspond to the beginning, peak and end of the contraction. (mirror image)
Define Deceleration
a visually apparent, gradual decrease in and return to baseline fetal heart rate Associated with contractions
what is the cause of Early deceleration?
fetal head compression resulting from the following:
Uterine contractions
vaginal examination
fundal pressure
placement of the internal mode of monitoring
Intervention for Early Deceleration?
none required
Late Deceleration occurs when in relation to the contraction?
The deceleration begins after the contraction has started and the nadir of the deceleration occurs after the peak of the contraction. The deceleration usually does not return to baseline until after the contraction ends.
Define Late Deceleration
visually apparent, gradual decrease in and return to baseline fetal heart rate associated with contractions.
Cause of late Deceleration?
caused by disruption of oxygen transfer from the environment to the fetus caused by the following: uterine tachysystole maternal supine hypotension Epidural or spinal anesthesia placenta abruption placental previa hypertensive disorders post maturity intrauterine growth restrictions diabetes mellitus intraamniotic infection
Intervention of late Deceleration?
Change maternal position (lateral)
Correct maternal hypotension by elevating the legs
increase rate of maintenance Intravenous solution
palpate uterus to assess tor tachysystole
discontinue oxytocin if infusing
administer oxygen at 8 to 10 L/M nonrebreather
notify the doctor or midwife
consider internal monitoring
assist with birth if it cannot be corrected
Variable Deceleration occurs when in relation to the contraction?
occur anytime the UC phase.
Define Variable Deceleration
A visually apparent abrupt decrease in fetal heart rate below the baseline. The decrease is at least 15 beats/ min or more below the baseline, lasts at least 15 seconds, and returns to baseline in less than 2 minutes from the time of onset.
Cause of variable deceleration?
caused by compression of the umbilical cord caused by the following:
maternal position with the cord between fetus and maternal pelvis
cord around the fetal neck, arm, leg or other body part
short cord
knot in cord
prolapsed cord (emergency)
Intervention of variable deceleration
Change maternal position (side to side, knee to chest)
discontinue oxytocin if infusing
administer oxygen at 8 to 10 L/M nonrebreather
notify the doctor or midwife
assist with vaginal or speculum examination to assess for cord prolapse
assist with birth if it cannot be corrected
What does VEAL CHOP stand for?
variable cord compression
early head compression
acceleration ok
late placenta insignificancy
what is the normal baseline for fetal heart rate?
110 to 160 BPM
What is variability in the Fetal heart rate?
Irregular waves or fluctuations in the baseline FHR of two cycles per minute or greater. There are four possible categories of variability: absent, minimal, moderate, and marked.
What is bradycardia?
A baseline FHR less than 110 beats/min for 10 minutes or longer.
what is the most common cause of bradycardia?
structural defects viral infection maternal hypoglycemia maternal hypothermia fetal heart failure medications
what are nursing interventions for bradycardia?
depends on the cause
What is Tachycardia?
A baseline FHR greater than 160 beats/min for 10 minutes or longer.
what are nursing interventions for tachycardia?
dependent on the cause; reduce maternal fever with antipyretics as ordered and cooling measures; oxygen at 10 L/min by nonrebreather face mask may be of some value; carry out health care providers orders based on alleviating the cause
What nursing intervention is usually the first choice when dealing with late and variable decelerations?
change maternal position
what is the legal responsibilities of the perinatal nurse in regards to fetal monitoring?
Nurses who care for women during child birth are legally responsible for correctly interpreting FHR patterns, initiating appropriate nursing interventions based on those patterns, and documenting the outcomes of those interventions. Perinatal nurses are responsible for timely notification of the physician or mid-wife in the event of abnormal FHR patterns They are also responsible for initiating the institutional chain of command should difference in opinion arise among health care provider concerning the interpretation of FHR pattern and the intervention required
what is the effects of cocaine on pregnancy and the fetus?
increased incidence of miscarriages, preterm labor, small for gestational age, abruption of the placenta, and still birth
what is the effects of alcohol on pregnancy and the fetus?
plecenta perfusion and low birth weights in infants
what is the effects of cigarettes on pregnancy and the fetus?
Fetal alcohol syndrome, increase risk of miscarriage, still birth, preterm birth, and SID
what are the hallmark maternal symptoms of Candidiasis?
pruritis, vaginal dryness, dysuria
what is the treatment of Candidiasis?
antifungal preparation
comfort measures include:
sitz bath
no underwear
Define Amnioinfusion
Infusion of room-temperature normal saline or lactated Ringer’s solution through an intrauterine pressure catheter into the uterine cavity in an attempt to increase the fluid around the umbilical cord and prevent compression during uterine contractions.
Define Acculturation
The process of adopting the cultural traits or social patterns of a different population group.
Define Ethnocentrism
The opinion that the beliefs and customs of one’s own ethnic group are superior to those of others.
Define Assimilation
The process in which a person or a group of people of a different ethnic background become absorbed into a new culture.
what is a concept that health and normality emerge within a social context and that the content and form of mental health will vary greatly from one culture to another. Differences may result from variations in stressors, symbolic interpretation, acceptance of expression and repression, and cohesion and tolerance of deviation of social groups.
cultural relativism
what is bluish discoloration of the hands and feet caused by reduced peripheral circulation?
Acrocyanosis
what is thick, white substance that protects the skin of the fetus?
Vernix caseosa
define cold stress
Excessive loss of heat that results in increased respirations and nonshivering thermogenesis to maintain core body temperature.
what is convection?
the flow of heat from the body surface to cooler ambient air.
what is radiation?
the loss of heat from the body surface to a cooler solid surface not indirect contact but in relative proximity. (window)
what is evaporation?
the loss of heat that occurs when liquid is converted into vapor. in the newborn heat loss by evaporation occurs as a result of moisture from the skin.
what is conduction?
it is the loss of heat from the body surface to a cooler surface indirect contact.
what are the hallmark maternal symptoms of bacterial vaginosis (BV)?
fishy odor and increased thin vaginal discharge
what is the treatment of bacterial vaginosis?
oral metronidazole (flagyl) vaginal preparations (metronidazole gel, clindamycin cream)
what are the hallmark maternal symptoms of Trichomoniasis?
inflammation of the vulva, vagina, or both
irritation
pruritus
dysuria
dyspareunia
tiny petechiae (strawberry spots) on the cervix and vaginal walls
what is the treatment for Trichomoniasis?
metronidazole or tinidazole orally in a single dose
what are the hallmark maternal symptoms of Gonorrhea?
often asymptomatic but when symptoms are present they may have a greenish-yellow purulent endocervical discharge and menstruation irregularities.
may complain of chronic or acute severe pelvic or lower abdominal pain.
rectal: profuse purulent anal discharge blood in the stool pain itching fullness diarrhea
what is the treatment for Gonorrhea?
ceftriaxone once IM
what are the hallmark maternal symptoms of HIV?
HIV seroconversion may be totally asymptomatic but is usually accompanied with a viremic influenza like response: fever headache night seats malaise generalized lymphadenopathy myalgia nausea/diarrhea weight loss sore throat rash
what is the treatment for HIV?
no cure
triple drug antiviral therapy or highly active (zidovudine) antiretroviral therapy to decrease the risk of perinatal transmission
which contraceptives protect against STIs and HIV?
abstinence
male condom
female condom
Vaccination to prevent: hep B, some strains of HPV
what are the benefits Intrauterine devices?
lighter flow during menses and less cramping with thelevonorgestrel intrautrerine
do not have to remember pill or other manipulation between coital acts
what are the disadvantages Intrauterine devices?
increased risk of PID
risk of perforation
doesn’t protect against HIV or STDs
heavier flow during menses with the copper T380A
how does a intrauterine device work?
the copper is used as a spermicide and inflames the endometrium prevent fertilization
What are the long term treatment plans for adolescents with eating disorders?
reinstitution of normal nutrition or reversal of the severe state of malnutrition
resolution of disturbed patterns of family interaction
individual psychotherapy to correct deficits and
distortions in physiologic functioning
What are some of the factors that would indicate when someone was a victim of intimate partner violence (IPV)?
overuse of health services vague nonspecific complaints missed appointments unexplained injuries untreated serious injuries injuries not matching the description intimate partner never leaving the patients side intimate partner insisting on telling the story of the injury
What are the most common maternal medical risk factors when providing care for the pregnant woman?
the leading cause of maternal death all over the world:
hypertensive disorders, infection, and hemorrhage
in the us: hypertension, pulmonary embolism and hemorrhage
factors: younger than 20 older 35 lack of prenatal care low education unmarried status non-Caucasian race
which type of family is most socially vulnerable?
single parent families
What is the make-up of the multigenerational family?
grandparents, children and grandchildren
What is the make-up of the no-parent family ?
children live independently in foster care or in kinship care such as living with a grandparent
What is the make-up of the married blended family ?
those that form as a result of divorce and remarriage
What is the make-up of the cohabiting- parent families?
those which children live with two unmarried biological parents or two adoptive parents
What is the make-up of the single-parent family?
an unmarried biological or adoptive parent who may or may not live with another adult?
What is the make-up of the homosexual family?
lesbians or gays may live together with or without children
Which is the most common STI?
chlamydia trachomatis
Who is most at risk for chlamydia?
sexually active women younger then 20
Who is most at risk for gonorrhea?
young adults
active teenagers
African Americans
Anyone younger than 20 and engage in sexual activity with multiple partners
Who account for most cases of syphilis?
African American women account for one half of all the case reported
Who is most at risk for herpes?
women between the ages of 15 and 35
what is the process IVF-ET?
a women’s eggs are collected from her ovaries, fertilized in the laboratory with sperm and transferred to her uterus after normal embryo development has occurred
what is the process of GIFT?
Oocytes are retrieved from the ovary, placed in a catheter with washed motile sperm and immediately transferred into the fimbriated end of the uterine tube. fertilization occurs in the uterine tube
what hormones involved in milk production?
prolactin and oxytocin
what are the benefits Breastfeeding for the infant?
it reduces the risk of: nonspecific gastrointestinal infections celiac disease childhood inflammatory bowel disease necrotizing enterocolitis in preterm infants clinical asthma, atopic dermatitis and eczema lower respiratory tract infections otitis media SIDS obesity in adolescence and adulthood type 1 and 2 diabetes acute lymphocytic and myeloid leukemia
what are the benefits Breastfeeding for the mother?
decrease postpartum bleeding and more rapid uterine involution
reduces the risk of:
ovarian cancer and breast cancer
type II diabetes
hypertension, hypercholesterolemia, and cardiovascular disease
rheumatoid arthritis
