NUR 113 Test 1 FC's Flashcards

1
Q

antipartum

A

the time between conception and the onset of labor or birth. Is used interchangable with prenatal.

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2
Q

gestation

A

the number of weeks since the first day of the LMP

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3
Q

abortion

A

delivery that occurs prior to 20 weeks gestation. Miscariage is a spontanous abortion

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4
Q

term

A

normal duration of pregnancy, beginning of 38th week to the end of 41st week

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5
Q

preterm

A

delivery that occurs after 20 weeks but before 38th week. Before is an abortion, after is a full term baby

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6
Q

postterm

A

delivery that occurs after the 41st week of gestation

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7
Q

intrapartum

A

time from the onset of labor until the delivery of the products of conception (infant and placenta)

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8
Q

postpartum

A

time from birth until the wonan’s body returns to an essentially prepregnancy state, the first 6 weeks following delivery

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9
Q

gravida

A

any pregnancy, regardless of duration, including present preg

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10
Q

nulligravida

A

a woman who has never been preg

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11
Q

multigravida

A

woman who has been preg more than once (multiv)

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12
Q

primigravida

A

a woman who is preg for first time (primiv) most dangerous type

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13
Q

stillborn

A

a fetus born dead after 20 weeks

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14
Q

perinatal

A

the period of time from the point of viability through the neonatal period

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15
Q

viability

A

22-24 wks, the capacity to live outside the uterus, fetal weight greater than 500gm

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16
Q

neonate

A

the first 28 days of life

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17
Q

5-Digit System

A

GTPAL (Great to play and laugh) Gravida, Term, Preterm, Abortions, Living children

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18
Q

first change that usually occurs in preg

A

enlargement of breasts

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19
Q

what is the biological marker for preg

A

Hcg

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20
Q

ways to tell if your preg (types)

A

subjective (presumptive), objective (probable signs), diagnostic (positive)

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21
Q

size of uterus

A

prepreg-golf ball, 10wks-orange, 12wks-grapefruit, rises up out of pelvis at 12 weeks

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22
Q

what happens to uterus during preg

A

grows in size d/t inc estrogen and progesterone, inc in vascularity and dilation of blood vessels, hyperplasia-prod of new fibers, hypertrophy-enlargement of existing fibers, thinning caused by growing fetus, development of decidua (endometrium)

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23
Q

subjective signs/presumptive signs woman is preg

A

amenorrhea, N/V, urinary freq, breast tenderness, quickening

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24
Q

objective/probable signs woman is preg

A

Hegar’s sign, Chadwick’s Sign, Goodell’s sign (6-8 weeks), uterine enlargement, Braxton Hicks contractions, enlargement of abdomen (HCG UBE)

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25
Q

Diagnostic/positive changes that confirm pregnancy

A

fetal heartbeat, visualization of fetus by ultrasound, fetal movement palpated by examiner

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26
Q

heights of fundus

A

at half way point (20wks) it will be at belly button

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27
Q

Hegar’s sign

A

practitioner puts 2 fingers into vag past cervix and feels for softening of lower uterine segment. This allows it to fall forward to carry baby in front, if not preg it will be very hard. Will cause woman to pee a lot since uterus sits on bladder. “Hey girl what are you doing”

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28
Q

dextorated uterus

A

uterus tilts to the right since on L side is the colon, so they will tilt to the right

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29
Q

lightening

A

when uterus drops back down into pelvis, this signals baby is coming out soon (within 2 weeks), allows them to breath easy again, but they will start peeing a lot again

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30
Q

round ligament pain

A

lower back pain d/t uterus pushing on things

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31
Q

how do you relieve round ligament pain***

A

pelvic rocking, getting onto all fours and rocking pelvis

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32
Q

Braxton Hicks

A

aka false labor-practice shocks for uterus, they do not change cervix, they do not get stronger, they usually stop with walking, occur after 28wks, they facilitate blood flow and oxygen delivery to fetus

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33
Q

what predicts health of baby?

A

the placenta, healthy placenta=healthy baby

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34
Q

what restricts blood flow to placenta

A

smoking, HTN, type 1 DM, drugs, sickle cell, hemorrhage, BP too high or low, contractions of the uterus, supine position, multiple gestations

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35
Q

what causes inc in uterine blood flow

A

estrogen

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36
Q

what dilates vessels in uterus

A

progesterone. When it drops it starts your period (when not preg)

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37
Q

Niphedipine (procardia)

A

Ca Channel blocker-dec BP, dec contractions to uterus since it is smooth musc.

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38
Q

positioning in preg women*****

A

don’t lay supine-dec perf to placenta b/c they are laying on the aorta/vena cava. They should lay on their left side. NEVER lay on their back in 2&3 trimester

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39
Q

Ballottement

A

occurs after 16-18th wks, when practitioner takes finger and tap on tip of cervix and fetus will move up and them come back down and tap their finger. This tests for content of fluid in uterus

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40
Q

Quickening

A

feeling of life, occurs in 16-20wks, can base gestational age on this. Multivs are more accurate and can feel them sooner. It bonds mom to child. It inc in intensity as preg goes on

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41
Q

Goodell’s Sign

A

practitioner puts finger into vag and feels the cervix. If positive they will have a softening of cervix. If not preg it will be firm like a nose. Press the doorbell, goodday

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42
Q

changes to cervix during preg

A

inc vascularity, hypertrophy, hyperplasia, softening (Goodell’s sign), bluish color, friability (bleeds easy, esp after sex), ballottement, quickening

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43
Q

Vaginal changes during preg

A

mucosa thickens (strengthens musc for delivery), conn tess loosens (allows for joints to stretch), SM hypertrophy, Vag vault lengthens, formation of the operculum (mucus plug), secretions are more acidic d/t inc lactic acid prod, inc risk for yeast inf (itiching), leukorrhea-whiteish discharge clensing of vag and washing of epithelial cells, inc sensitivity of genitalia, inc sexual interest, enlargement of genitalia

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44
Q

Chadwick’s Sign

A

bluish coloring of labia manora and inside vag. Chad choked and turned blue. Well estrogenized women have bluish tint to vag normally

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45
Q

Breast changes during preg

A

fullness, sensitivity, tingling, heaviness, inc pigmentation of nipples and areola-so baby can see it, more erect nipples, hypertrophy of sebaceous glands, venous congestion-more veins present on breasts, proliferation of lactiferous ducts and lobule alveolar tiss, colostrum appears in acini cells of the breast (3rd month of preg)

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46
Q

cardiac changes during preg

A

hypertrophy, inc CO, inc blood volume, displacement up and to the left, pulse inc by 10-15beats, possible cardiac rhythm changes-fluttering

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47
Q

BP changes during preg

A

affected by anxiety, positioning, size of cuff. During first tri BP same, 2nd dec, 3rd inc back to pre preg level. Watch for ORTHOSTATIC HYPOTENSION

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48
Q

what causes BP to dec

A

vasodilation d/t progesterone

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49
Q

trimesters

A

1-weeks 1-13 2-weeks 14-26 3-weeks 27-40

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50
Q

what trimester are tertogenic agents most harmful

A

first

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51
Q

Leukorrhea

A

is norm as long as it doesn’t have a fowl odor or itch

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52
Q

changes in blood vol during preg

A

increases 40-45% or 1500ml, starts at wks 10-12, peaks at 32-34wks (important for moms on cardiac meds) max workload of heart is after 32-34wks. Perif vasodilation occurs d/t progesterone.

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53
Q

blood contents change during preg

A

inc RBC, dec Iron, inc WBC, inc Chol, hemodilution-hgb 11, hct 35.

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54
Q

true anemia

A

hgb 10 or less, Hct 33 or less. Norm is 12-16 and 37-47

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55
Q

most at risk for anemia

A

teens, b/c their diet sucks

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56
Q

why do WBCs inc in preg

A

to inc defenses during birth 18-20 is ok. Norm is 5-10

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57
Q

clotting changes during preg

A

inc clotting, inc in factors 7-10, dec in fibrinolytic activity (breaking up of clots), inc risk for dvt. This is so mom doesn’t beed out during birth. After birth they will shed clots fot a while

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58
Q

coagualtion changes during preg

A

inc clotting, inc in factors 7-10

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59
Q

respiratory changes during preg

A

nasal congestion-d/t inc blood vol, may get epistaxis (nose bleeds), inc in BMR d/t inc need for oxygen, resp alk, relaxation of ribcage d/t estrogen, expansion of thoracic chage, thoracic breathing occurs, inc in tidal vol, inc in RR, inc in inspiratory capacity, asthma will be worsened

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60
Q

renal/urinary system during preg

A

inc press on kidneys, ureters dilate and lengthen, urine flow rate slows, inc vascularity-will have blood in pee from small accidents, nocturia, freq and urgency, dec in bladder tone-holds more, inc GFR, inc risk for UTI

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61
Q

why is inf bad for preg woman

A

b/c it causes inflam response, which may start preterm labor or try and attack fetus.

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62
Q

if having renal problems what should woman do?

A

bedrest, lie lateral recumbent-best for renal function

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63
Q

Fluid and Electrolyte changes during preg

A

Na and water reabsorption. Estrogen conserves Na, progesterone excretes Na. Do NOT give lasix to them, glucosuria-small amounts are ok, if BG is 160+ spilling will occur, proteinuria-trace or +1 are ok as long as mom doesn’t have HTN

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64
Q

Integumentary changes during preg

A

hyperpigmentation is stimulated by the anterior pituitary releasing melanotropin (can get a better tan), inc in hair and nail growth, sebaceous gland growth-sweat more, inc circulation causes rosy cheeks, striae gravidarum-stretch marks d/t inc in adrenocorticoisteriods stretching conn tiss, chlosoma-mask of pregnancy (across nose and cheeks), darkening of nipples and underarms, palmar erythema, linea nigra

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65
Q

what type of swelling should preg women not have?

A

periorbital edema

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66
Q

what things in preg do not go away afterwards

A

striae gravidarum, and expansion of rib cage

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67
Q

Musculoskeletal system changes during preg

A

lordosis, waddling gait, inc mobility of joints (can cause falls), seperation of rectus abdominis musc.

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68
Q

neurological system changes during preg

A

compression of pelvic nerves, lordosis, carpal tunnel syn, traction of brachial plexus (due to weight of belly pulling down on shoulder nerves), lightheadedness d/t vasomotor hypotension, hypoCa

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69
Q

gastrointestinal system changes during preg

A

appetite-dec in 1st tri d/t N/V, inc in 2nd tri, PICA, ptyalism, gingivitis, herniation of stom, pyrosis, constipation, gallstones, Ab discomfort, pelvic heaviness, flatulence and distention

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70
Q

what makes preg woman naseous

A

high levels of Hcg

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71
Q

PICA

A

cravings for non food items like starch, dirt or ice. More common in teen moms b/c their diet sucks

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72
Q

ptyalism

A

excess saliva during preg, may inc N/V, can accelerate gingivitis

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73
Q

what causes constipation in preg women

A

inc progesterone results in inc water resorption from colon (dries out poop), and being on Iron pills

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74
Q

endocrine changes in preg women

A

inc estrogen, progesterone, hCG,hCS serum prolactin, oxytocin, suppression of FSH and LH, thyroid gland gets bigger d/t to estrogen, parathyroid can’t keep up, pancreas-fetus steals glucose and AAs

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75
Q

why can’t you get preg on top of a preg

A

suppression of FSH by progesterone stops the release of eggs

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76
Q

what does oxytocin do?

A

produced in post pituitary. Infant sucking releases oxytocin which causes contractions that shrink the uterus. It also causes labor to begin.

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77
Q

what does parathyroid do?

A

regulates Ca and Mg, this is why people may lose a tooth while preg from not enough Ca.

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78
Q

does glucose cross placenta?

A

yes

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79
Q

does insulin cross placenta?

A

no, placenta creates it also

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80
Q

where is insulin created in mom

A

beta cells of pancreas

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81
Q

how does glucose work with fetus

A

baby steals glucose and dec mothers ability to produce glucose by stealing amino acids (AA) from mom also, this dec mom’s BG. When too much insulin is produced and cells can’t reuptake it all you get gestational DM?

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82
Q

RBC

A

inc

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83
Q

Blood vol

A

inc

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84
Q

muscle tone

A

dec

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85
Q

WBC

A

inc

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86
Q

BP in 1st tri

A

same

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87
Q

BP in 2nd tri

A

dec (d/t vasodilation from progesterone)

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88
Q

BP in 3rd tri

A

inc bac to first tri level

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89
Q

HR

A

inc

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90
Q

CO

A

inc

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91
Q

fibrolytic activity (ability to break up clots)

A

dec

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92
Q

why do we have inc blood vol during preg

A

to inc perfusion to placenta

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93
Q

where does uterus shift to during preg

A

up and to the right

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94
Q

what is the expected reaction from a woman when she finds out she is preg

A

ambivilance- b/c that is the point of no return. Is a norm reaction for first few weeks

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95
Q

Rubin’s Psychological changes of preg

A

Safe Passage- 1st tri-mom seeks out medical care. 2nd tri-concerned for baby. 3rd tri-worried about labor and delivery

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96
Q

most important tri for fetal well being

A

first

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97
Q

father’s role during preg

A

support

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98
Q

Nagele’s rule or EDC (estimated date of confinement)

A

take first day of LMP and subtract 3 months and add 7 days

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99
Q

first MD appointment

A

pelvic exam, intense health Hx, Chadwicks, Goodell’s, Hegars, drug use, menstrual Hx, preg Hx, violence, STIs, get prepreg weight

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100
Q

MD appointments

A

first at 8-10 weeks, then monthly till 26weeks, bimonthly till 36weeks, then every week till delivery

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101
Q

best indicator of how preg is going

A

weight gain

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102
Q

can you drug test preg woman?

A

only if they give permission, you can however test baby when it is born (through their diaper)

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103
Q

what drug causes preterm labor

A

cocaine, it vasoconstricts vessels and can cause detachmenet from uterine wall, preterm

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104
Q

what drug can we give addicts to help them during preg

A

methadone, to maintain their levels so they don’t go through withdrawls

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105
Q

fetal alcohol syn

A

causes low birth weight, microcephaly, MR, unusual facial features, cardiac defects

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106
Q

greatest preventalbe cause of MR

A

alcohol

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107
Q

cigarettes

A

dec perf to baby, preterm, small babies

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108
Q

caffeine

A

limit to 3 cups per day, inc risk for miscariage

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109
Q

babies with withdrawls are

A

irritable, diarrhea, need quiet envt, skin is very sensitive, are given morphine for withdrawls b/c once cord is cut they stop getting drugs

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110
Q

when do we screen mom for DM

A

24-28 wks

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111
Q

SGA

A

small for gestitaional age

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112
Q

IUGR

A

intrauterine growth restriction, 10th percentile baby, very small, little musc, very wrinkly, leathery skin, due to dec perfusion

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113
Q

*** 1 hour glucose test (O’Sullivan’s or 1ogt)

A

no fasting, maybe carb load prior. Have mom drink 50gm of glucola wait an hr and then draw blood, if 140+ she fails. Then we need to follow up and do 3hr test

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114
Q

***3Hr Oral Glucose Challenge Test **

A

NPO after midnight prior to test (or carb load), draw fasting BG, then drink 100gm glucola, then draw blood at 1,2,3hrs. 4 blood draws total. 2 or more abnormal results = gestational diabetic

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115
Q

GBS screening

A

group B strep, normal flora in many people, can cause death in newborns they become septic, and can cause preterm labor, penicilin G is given either to cure mom or to prep baby so it can fight it, try to get 3 doses into mom prior to birth. If unsure of mom’s GBS we keep baby 48hrs

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116
Q

Diabetes I vs II

A

type one can cause birth defects, gest DM doesn’t affect baby till late-it affects size of baby and possible hypoglycemia when born

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117
Q

relationship of gest DM vs type II

A

women what have gest DM are 70% more likely to get Type II DM in the future, usually several years later

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118
Q

S/S of infection in neonate

A

dec in temp, don’t eat

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119
Q

toxoplasmosis

A

bacterial inf found in litter boxes, can cause birth defects

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120
Q

blood type and match

A

group- A,B,AB,O, types -,+

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121
Q

why is Rh factor important in preg

A

if baby is + and mom is -, mom will try and attack baby, or will build antibodies and attack next baby. You will be given Rhogam-is a type of blood product. IM inj given profalactically. When baby is born we check blood if baby is born - then mom will not need more Rhogam, if + she will get another shot within 72hrs, also given for abortions or anytime fetal and maternal blood mixes. MUST GIVE before they go HOME.

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122
Q

Rhubella titer

A

drawn on mom, if immune they don’t need anything, if not give her vaccine right after birth. Do NOT give during preg, not supposed to get preg within 1 month of getting rhubella vaccine. If baby gets it causes-Hearing, cardiac, MR

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123
Q

fundal height measurements

A

should be within +- 2cm of gestation age charts

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124
Q

each visit

A

always assess for violence, calculate EDC, learning needs, assess knowledge level

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125
Q

weight gain in preg

A

for average women 25-35lbs, if malnurished may be more, if obese may be less. Wt gain indicates health of baby, adequate weight gain reduces risk of small baby, inadeq wt gain may inc risk for IUGR. Too much wt gain (macrosomia) or too little

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126
Q

weekly weight gain

A

first Tri (1-13) 2-4lbs total, then 1lb per week for second and third. First and 2nd Tri increases are in mother-blood vol, breast tiss,etc. 3rd Tri-baby grows. This is why preterm babys are little-they don’t grow much till 3rd tri. Ex 16 week fetus should be 2-4 +3 lbs = 5-7lbs. ex. 26week fetus = 2-4 +13 = 15-17lb. ex 40week fetus = 2-4+27 = 29-31lbs. +- 2 lbs either way is ok

127
Q

macrosomia

A

large baby

128
Q

where does all the weight go?

A

amniotic fluid 2, breast tiss 1-2, blood4-5, fat storage 4-6, extra tiss3-5, fetus 6-9, placenta 2, total 25-35

129
Q

preterm labor

A

cervical changes and uterine contractions occuring between 20-38wks. CERVICAL CHANGES, mostly in 2nd Tri. Preterm labor also causes milk dev, fetal lung surfactant prod

130
Q

preterm birth

A

birth that occurs before 38th week

131
Q

low birth weight

A

a newborn that falls within the 10th percentile, usually d/t preterm birth, have more health problems

132
Q

what helps iron to be absorbed

A

vit C, orange juice. Also may give stool softener to prevent constipation

133
Q

number one cost associated with preg

A

preterm labor

134
Q

risk factors for preterm labor

A

35, noncaucasian, poor, unmarried, low education, long car rides (d/t sitting up and not peeing), women who took DES or short cervix, multigravita, PREVIOUS PRETERM LABOR-history repeats itself

135
Q

goal with preterm labor

A

to stop it and extend preg to a term preg

136
Q

what is point of no return

A

once dilated 4cm, we can’t stop it, but if we catch it before we can stop it

137
Q

diabetes in lung dev

A

diabetic babies don’t get the fetal lung maturity till late, so delivering early is risky

138
Q

S/S of preterm labor

A

uterine activity or contractions (may be painless), discomfort, vaginal discharge-has it changed? If cervix is opening discharge will change, cramps that don’t go away, pelvic pressure like baby is pushing down, dull backaches, may have diarrhea

139
Q

what happens to baby during contraction

A

it balls up b/c it is getting squeezed

140
Q

PROM

A

premature rupture of membranes-woman’s water breaking prior to 38wks, once this happens and they are preterm they must go to hosp b/c its no longer a closed envt for fetus. This does not mean we will take baby out right away-may leave it in longer to become full term as long as they don’t have S/S of inf

141
Q

if woman suspects preterm labor what should they do? Short term

A

dring lots of water, lie on L side for an hr. If it does not stop or if fluid begins to leak from vag, then come to hosp. May be from dehyd or over exertion

142
Q

if woman suspects preterm labor what should they do? Long term

A

no sexual activity (sperm has prostiglandins that will stimulate cervix, also orgasms stimulate contractions-it releases oxytocin, breast stim-releases oxytocin), avoid long trips, no heavy lifting, no hard physical work. May be put on bedrest

143
Q

bedrest

A

necessary if woman has incompetent cervix-where they require surgery to fix cervix. Negative affects of bedrest-dec in Ca in bones, musc wasting, wt gain.

144
Q

home uterine activity monitoring

A

ext monitor placed on uterus to monitor FHR, put toco on top of uterus to monitor contractions

145
Q

Betamethasone (dexamethasone)

A

steroid that inc prod of surfactant in fetal lungs for preterm babies, given IM in buttocks, then exactly 24hrs later get second shot.

146
Q

Terbutaline (brethine)

A

asthma med, beta 2 adrenergic agonist-can be used for imeadiate pause of contractions (till we get them to OR) or longer term prevention of contractions (at home with a drip). relaxes SM, dilates uterus, bronchodil, vasodilation of vessels, can cause jitters, tremors, inc HR. Can be given IV,oral,orSC

147
Q

Magnesium Sulfate

A

CNS depressant- depresses uterine activity prevents contractions, relaxes SM. Used for preterm labor and preeclamsia. S/E resp dep, hypotension, cardiac arrest. Monitor Resp, LOC, HR, BP. Calcium Gluconate is antidote

148
Q

Prostaglandin Synthetase Inhibitors

A

Naproxen, Motrin-are used only short term under MD direction. Prostaglandins cause the uterus to contract so these work against that to stop contractions. S/E N/V, HA, GIB, and lots of others use with caution

149
Q

Nifedipine (procardia)

A

relaxes SM and dec uterine contractions, dec in BP, watch for orthostatic hypotension, flushing, monitor HR, BP

150
Q

tocolytics

A

meds that break up contractions. Betamethasone, terbutaline, Mg Sulfate

151
Q

where do contractions start

A

top of uterus and work their way down, to push baby out

152
Q

most important thing to know about pregnant woman before giving turp?

A

number of weeks gestation

153
Q

what determines fetal lung maturity

A

L/S ratio, greater than 2=mature lungs

154
Q

FHR

A

can be heard at 10wks by doppler, detects live fetus and promotes maternal/fetal bonding

155
Q

Kick test or daily fetal movement count (DFMC)

A

24-28wks, mom reports how many movements in 1hr, 3 or more is +. A healthy baby moves

156
Q

Non Stress test (NST)

A

after 27th week, mom is placed on ext monitor, when baby moves we want to see their FHR inc. Toco is placed at fundus, transducer is placed on baby’s back, use leopold’s manuvers to feel baby. When mom feels baby move she pushes button so we can look at monitor FHR for inc, should accelerate 15beats, this is called REACTIVE. non-reactive is BAD, if non-reactive do CST or skip to BPP

157
Q

Contraction Stress Test (CST)

A

done if NST is non-reactive, done same day, this puts the baby under stress by giving Ptosin (nipple stim can also be used) to cause small contractions so it can test its reaction. When mom has contraction FHR should inc, if it dec or has a late decelleration then placental perf is compromised. you want this test to be negative for decelerations

158
Q

Biophysical profile (BPP)

A

done after 24wks if NST is non-reactive, assess to see if fetus is compromised. It measures 5 things with a 2 or a 0. Fetal Breathing movement, Gross body movement, Fetal tone, Reactive FHR (NST), Qualitative amniotic fluid vol. 10 is highest score, 0 is lowest-below 6 indicates asphyxia or oligohydramnios (low amniotic fluid) of fetus and may have to deliver.

159
Q

Ultrasound

A

can be done at any point in preg, usually at first visit, determines fetal age/due date, measures size of fetus, fluid, and placenta, checks for abnormalities, used in biophysical profile eval also. Is NOT done just to check sex

160
Q

Maternal serum Alpha fetoprotein (AFP or MSAFP)

A

done between 15-22wks, blood test that screens for neural tube defects, not done often, has false positives and doesn’t work in multiple gestations

161
Q

Amniocentesis

A

possible after 14wks, dx of genetic disorder or abnormalities, assessment of pulm maturity and fetal hemolytic disease. Is done before C section to make sure baby can breath

162
Q

nursing care post amniocentesis

A

instruct pt to call md if leaking, fever, cramping. May indicate PTL. Or if inc or dec in fetal movement afterwards.

163
Q

L/S ratio (lecithin/sphingomyelin) or PG ratio

A

35week and beyond, determines fetal lung maturity and if baby is safe to be delivered. Greater than 2 indicates fetal lung maturity. Betamethasone will inc this.

164
Q

Chorionic Villi sampling (CVS)

A

removal of small piece of tiss is removed from placenta, detects fetal chromosomal abnormalities

165
Q

danger signs of pregnancy

A

Call a CCAABBBSS Chills and fever, Cerebral disturbances, Ab pain, Alteration of fetal movement, Blurred vision, Blood press, Bleeding-early on, Swelling, Sudden escape of fluid

166
Q

nursing care for N/V

A

small meals, eat dry meals with fluid in between, avoid greasy/potent foods

167
Q

nursing care of pyrosis

A

small meals, avoid overeating, don’t lie down after meals,

168
Q

nursing care for ptyalism

A

mouthwashes, chew gum, hard candy

169
Q

nursing care for varicose veins

A

elevate, wear supportive hose, avoid crossing legs at knee

170
Q

nursing care for hemorrhoids

A

avoid constipation, ice packs, topical ointments, anesthetics, warm soaks, sitz baths, reinsert into rectum

171
Q

nursing care for backache

A

practice dorsiflexion of feet, heat, arise slowly

172
Q

what defines labor?

A

a change in cervix. Without that they are just contractions

173
Q

where is FHR best heard

A

in their back

174
Q

What has to happen for internal fetal monitoring?

A

the water has to break, either naturally or MD can do it. Then monitor is placed next to baby’s head

175
Q

FHR

A

should accelerate and decelerate according to the baby’s movement. A steady HR is worrysome unless baby is sleeping.

176
Q

how does cord compression affect FHR

A

it decreases it

177
Q

stomach sizes of babies

A

day 1 - size of a marble (7ml) Day 3- ping pong ball (22ml) Day 10- egg size (80ml)

178
Q

what are cabbage leafs used for?

A

they are put on breasts to reduce swelling, sometimes with ice too

179
Q

If mom is NOT breast feeding what should she do with her breasts?

A

wear tight fitting bra, and avoid heat on breasts, don’t want to stimulate breast milk

180
Q

Stool colors in newborns

A

starts out black (meconium), then will become greenish if breast feeding, if formula it will become brown. May get constipated if using formula

181
Q

urinary output in newborns

A

may only pee 1 time in first 24hrs, then 2 times day 2, then up to 6-8 times per day within first week

182
Q

why is vit K given to newborns

A

because they cannot clot, especially before circumcision

183
Q

why is erythromycin given to babies

A

to protect them from getting STI that mother may have had and exposed them to during birth. Ghonorrhea and chlamidia.

184
Q

how is erythromycin given

A

it is a cream that is placed across their conjunctival sac

185
Q

when is Hep B given to babies?

A

when baby is stable-up to 1 month, can be done in hosp or at MD office. If mother is + then baby is also given IGG

186
Q

Sweet-ease

A

pain med given to infants (sugar water) for distraction

187
Q

hypospadias

A

an abnormal opening of the urethra on the penis, usually below the head

188
Q

epispadias

A

an opening of the urethra on top of the penis

189
Q

Nursing care for circumcised child

A

should check for bleeding q15min for a while, if bleeding apply pressure till it stops. Most types vasoline is applied so it doesn’t stick to the diaper. Yellow crust around head is normal, don’t try to peel it off

190
Q

Nursing care for umbilicial stump

A

should be clamped for first 24hrs, keep it dry, clean 4 times a day with alcohol, wipe whole stump with alcohol, this helps disinfect and dry it out, check for 2 arteries (carry waste and deoxygenated blood away from baby) and 1 vein (carries nutrients to baby). Should fall off within 2 weeks

191
Q

IM injection in newborns

A

done in Vastus lateralis, mid third between hip and knee, use 25g 5/8th inch.

192
Q

PIH

A

pregnancy induced HTN

193
Q

PNV

A

prenatal vitamins

194
Q

4 P’s of intrapartum

A

passenger-fetus and placenta, passageway-birth canal, Powers-primary contractions (involuntary) and secondary contractions (voluntary), Psyche-mental state

195
Q

pelvis anatomy

A

false pelvis-outer rim or iliac crest, true pelvis-inner canal or birth canal, ischial spines-protruding knobs on inner part of pelvis, pubic symphasis-cartalige that holds pelvis together-can expand

196
Q

factors determining how baby moves through canal

A

size of head, presentation, lie, attitude, and fetal position

197
Q

fetal skull anatomy

A

bones-2 parietal 2 temporal, 1 frontal, 1 occipital. Sutures-sagittal seperates parietal, lambdoidal seperates occipital and parietal, coronal seperates frotnal and parietal. 2 fontanels-ant (diamond), post (triangle)

198
Q

purpose of fontanels

A

allow for head to mold and move in pelvis. Also used to help determine fetal presentation, position, and attitude after ROM

199
Q

biparietal diameter

A

measurement across the top of head. Largest transverse measurement 9.25cm

200
Q

suboccipitobregmatic

A

smallest diameter of fetal head, is in complete flexion (chin to chest) 9.5cm

201
Q

if chin is to chest what fontanel will you feel upon exam?

A

posterior or occipital

202
Q

the more the chin is off the chest the more___

A

space the head will need

203
Q

Lie

A

the relationship of the spine of the fetus to the spine of the mother. If both lined up it is longitudinal/vertical (can be head down or breach), if perpindicular we call this transverse/horizontal/oblique (can’t have baby like this)

204
Q

attitude

A

relationship of fetal body parts to each other in utero. Normal or General Flexion- is rounded back, chin to chest, arms crossed and cord lies b/w arms and legs

205
Q

Wharton’s Jelly

A

slime that covers cord, is very slippery and makes cord float up, so it doesn’t choke baby

206
Q

presentation

A

the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor at term. Cephalic (O), Breech or sacrum (S), Shoulder/Scapula (SC). The part first felt during exam

207
Q

** Position **

A

the relationship of the presenting part to the 4 quadrants of mom’s pelvis. L/R, O/S/SC, A/P/T. Where presenting part faces. Ex baby facing to the left front with head to chin = ROP because occiputant is facing

208
Q

station

A

how far down the birth canal the baby is, whatever part is going down first. 0 is even with with ischial spines, +1 is below (coming out is good). -1 is above ischial spines. Is used when labor begins to measure progress. Determined by vaginal exam

209
Q

VSE

A

speculum or sterile vaginal exam, using hands to measure and check fetus

210
Q

engagement

A

indicates that the largest transverse diameter has passed through the pelvic brim into the true pelvis to station 0. This is the point of no return (once you get engaged you can’t back out) Is good b/c it_s a tight fit so cord can’t prolapse

211
Q

LOP description

A

baby is chin to chest facing forward and slightly to the right (according to David)

212
Q

what part of pelvis do we sit on

A

ischial tuberosity

213
Q

CPD

A

cephalopelvic disproportionation-babys head is too big for pelvis. d/t procreating with big headed man

214
Q

types of pelvis

A

Gynecoid-cicrular, most women Android-heart shaped, men Anthropoid-oval Platypelloid-really flat oval

215
Q

efacement

A

the thinning and shortening out of uterus, happens naturally, but can also be done artificially. If it doesn’t completely thin it may have a lip

216
Q

when should women push

A

when dilated 10cm, fully efaced, and at acme of contraction

217
Q

amniotomy

A

artificial ROM. RN should monitor FHR before and after to rule out cord prolapse

218
Q

ferguson reflex

A

when baby’s head touches pelvic floor, it causes urge to push, wait for this for most effective pushing. It stimulates the inc in prod of oxytocin, which inc intensity of cont

219
Q

which position of baby causes lots of back pain?

A

occipitoposterior, b/c baby’s head is pushing against spine.

220
Q

duration of contractions

A

time between the onset and end of contraction, should be 90 sec or less

221
Q

frequency (timing)

A

start of the cont to the start of next cont, want it to be 2min or more. When about 5 min apart come into hosp

222
Q

resting tone

A

time between the end of one cont and the beginning of the next, important for perf. Towards end this is dec due to inc contractions

223
Q

intensity of cont

A

the strength of cont at its peak, mild, mod, and frim. Can be felt on mom as well. If rock hard it is a strong cont.

224
Q

terms for monitor strip of contractions

A

increment-beginning of cont, have mom breath, Acme-peak, mom should push, Decrement-downside of cont, have mom exhale. Resting tone-in between cont, mom relax

225
Q

what happens if resting tone is too low

A

can cause titanic contractions

226
Q

what should RN do if cont are too freq or too long

A

stop Pit first. Then give 02 and turn to side

227
Q

Signs of preceding labor

A

lightneing, bachache, stronger Braxton Hicks, bloody show (cervical mucus from plug), cervical ripening, inc urinary freq, dec in SOB, spontaneous ROM, wt loss (small amount d/t water shift), burst of energy

228
Q

what can you do if cervix doesn’t ripen?

A

can put cervadil on it to soften it

229
Q

fetal fibronectin

A

test for detecting premature labor. Is a vaginal swab

230
Q

ROM

A

rupture of membranes-water breaking, can be spontaneous or artificial (done by MD called amniotomy)

231
Q

Stages of labor

A

4 stages, each with phases.

232
Q

Stage 1: Phase1

A

Latent or Early- 0-3cm, cont 30min-5min mild to moderate 30-45sec, lasts 6-8hrs, longest phase, station 0 to -2, brownish discharge, mucus plug or pale pink scant, mom is excited, follows directions, good time for teaching.

233
Q

Stage 1: Phase2

A

Active- 4-7cm, 3-6hrs, moderate to strong 40-70sec, 3-5min apart, station +1 to +2, pink to bloody mucus scant to moderate, mom becomes more serious, pain control, desires companionship and encouragement

234
Q

Stage 1: Phase 3

A

Transition- 8-10cm, 20-60min, strong to very strong 45-90sec, 2-3min apart, station +2 to +3, copious bloody mucus, mom irritable, lots of pain, sweaty, shaking, feels the need to defecate, man should be quiet and no touching

235
Q

Stage 2: Phase 1

A

Latent phase- period of peace and rest, 10-30min, station 0 to +2, no urges to bear down yet, mom quiet, Feels like the worst is over, waiting for ferguson’s reflex

236
Q

Stage 2: Phase 2

A

Decent phase- time varies, cont 2-2.5min apart, last 90sec, dark red blood, inc urge to bear down, grunting, very vocal, altered breathing pattern

237
Q

Stage 2: Phase 3

A

Transition- 5-15min, overwhelmingly strong cont, 1-2min apart, last 90sec, station +4 to birth, fetus present, inc reflex to push, may scream or swear, extreme pain, RING of FIRE, train can’t be stopped

238
Q

Stage 3

A

birth of fetus until placenta

239
Q

Stage 4

A

1hr after delivery of placenta

240
Q

engagement

A

when the biparietal diameter of the fetal head passes the pelvic inlet

241
Q

descent

A

progress of fetal head through the pelvis. Is measured by the station

242
Q

flexion

A

how stretched out the baby is.

243
Q

extension

A

emerging of the fetal head under the symphysis pubis

244
Q

restitution

A

after head pops out it realigns itself with the shoulders

245
Q

expulsion

A

delivery of the rdmainder of the fetus by lifting up toward the symphysis pubis

246
Q

Early deceleration

A

is a good sign, it occurs during active phasewhen head is compressed during cont. FHR goes down when mom has cont then goes back to norm

247
Q

Late deceleration

A

indicates a perf problem, baby can’s sustain during labor, can happen d/t positioning, DM, HTN, preeclamsia, placental abruption. FHR dec after cont and takes a while to recover. Have mom lay on L side, give LR & 02, if it continues call MD

248
Q

variable deceleration

A

occurs d/t cord compression, can happen after AROM, FHR isn’t affected by contractions its affected by compression of cord. If deep drop it can be cord prolapse, low fluid may affect this

249
Q

amnio infusion

A

inserting cath into uterus to run NS into uterus. May be done if mom is having variable decelerations d/t oligohydramious

250
Q

meconium

A

first baby poop-is very sticky so must be careful if it happens during birth so it doesn’t go in baby’s lungs, take to neonatal if this happens.

251
Q

if RN suspects cord compression what should they do?

A

feel inside mom for the cord, if it can be felt, lift the presenting part off the cord to restore perf. Leave hand in there until they get to OR to get baby out. Can give 02 after.

252
Q

APGAR

A

newborn assessment tool-done at 1 and 5min after birth. 5 categories 0,1,2 for each best score is 10, 8-10=healthy baby, 6-7needs 02, 4 or less may need CPR. Activity (flexion/musc tone) Pulse (100-160 can get from umb stump), Grimace (reflex response does baby cry when we pull away), Apperance (color), Respiratory effort

253
Q

S/S of hypoventilation

A

dizziness, sweating, tingling of lips and fingers, inc HR, lightheaded, give nonrebreather, or breath into hands

254
Q

what causes baby to take first breath

A

inc in arterial CO2 pressure and dec in arterial pH

255
Q

nitrazine test

A

test to see if ROM has occurred-swab in cervix and put on pH paper if it turns blue or alkaline then ROM has occurred since vagina will be acidic

256
Q

ferns test

A

if you swab amniotic fluid onto a slide it will dry in the shape of a fern

257
Q

how can you test for clonus beats?

A

if doing ankle fexion if ankle pulses and kind of twitches it can signal you may have a seizure (too much stimulation)

258
Q

placenta previa

A

placenta that is covering the bottom of the cervix, can be completely covering it, partial, or just low lying. Low lying ones can move up during preg. Can have SUDDEN PAINLESS bleeding

259
Q

what test do we NOT do with a previa

A

vag exam-can cause bleeding or abruption. Also must have C-section

260
Q

what can cause previa

A

previous previa or C/S, cocaine, cigarettes, many pregnancies

261
Q

Abruptio placenta

A

where the placenta pulls away from uterus, can be marginal, partial, or complete. Complete is very bad and usually results in death of fetus

262
Q

causes of abrution

A

ELEVATED BP, cocaine, uterine trauma

263
Q

S/S of abruption

A

intense pain in AB, like pulling off a scab, AB will be rock hard d/t hematoma

264
Q

pushing

A

stage 2

265
Q

0-3cm dilated

A

stage 1, latent phase

266
Q

birth of fetus

A

stage 3

267
Q

moderate to strong contractions

A

stage 1, active phase

268
Q

ring of fire

A

stage 2, transition phase

269
Q

removal of placenta

A

stage 3

270
Q

cont 40-70sec

A

stage 1, active phase

271
Q

cont 1-2min apart

A

stage 2, transition phase

272
Q

1st hr after delivery

A

stage 4

273
Q

cont 30-45 sec

A

stage 1, latent phase

274
Q

when does mom start to get irritable

A

stage 1, transition phase

275
Q

best time for teaching

A

stage 1, latent stage

276
Q

mom thinks worst is over

A

stage 2, latent phase

277
Q

ferguson reflex begins

A

stage 2, decent phase

278
Q

10cm dilated

A

end of stage 1, transition phase

279
Q

grunting begins

A

stage 2, decent phase

280
Q

4-7cm dilated

A

stage 1, active phase

281
Q

swearing and screaming

A

stage 2, transition phase

282
Q

bloody show

A

stage 2, decent phase

283
Q

mom wants companionship and encouragement

A

stage 1, active phase

284
Q

N,V, perspiration, tremor, need to defecate

A

stage 1, transition phase

285
Q

why are we concerned if placenta doesn’t come out by itself?

A

can cause bleeding/hemorrage

286
Q

what is the body’s natural pain killers

A

endorphins (not as good as morphine though)

287
Q

what is the major cause of pain in labor?

A

fear and tension

288
Q

non pharm ways to relieve pain

A

effleurage, counter press, water therapy, wet washcloth, TENS, acupressure, ice/heat, hypnosis, biofeedback, aromatherapy

289
Q

highest priority during labor

A

fetal response to labor, it determines what actions are taken

290
Q

do meds from epidural get to baby?

A

NO, it is not systemic so it does NOT cross placenta

291
Q

best time to give epidural

A

4-6cm dilated, too early may slow labor, too late will not relive pain

292
Q

systemic analgesics

A

demerol, Stadol, Nubain. These do affect baby and may require narcan after birth. If mom received this 1-4hrs before birth baby will have them it their system

293
Q

Demerol

A

narcotic CNS depressant, crosses placenta, causes N/V, hypotension, bradycardia, resp dep, can be given IM, SC,or IV. Dec FHR and variability

294
Q

Stadol

A

analgesic at CNS level, crosses placenta, causes sedation, floating feeling, lightheaded, confusion, nausea, hypotension, resp dep. Dec FHR and variability, and musc tone

295
Q

Nubain

A

Same as Stadol: analgesic at CNS level, crosses placenta, causes sedation, floating feeling, lightheaded, confusion, nausea, hypotension, resp dep. Dec FHR and variability, and musc tone

296
Q

Narcan

A

narcotic reversal agent, combats resp dep associated narcotics, IV/SC/IM, give ever 2-3min. Can give into umbilical vein or endotrachael for baby, may have to repeat in few hrs too

297
Q

what does nurse do before calling MD for epidural

A

bolus mom with 500-1000 of LR, it_s a volume expander and will prevent mom’s BP from dropping too low. Also, take vitals of mom and baby first

298
Q

why can epidural slow down labor?

A

b/c bolus hydrates and relaxes uterus, and epidural can cause numbness and dec mom’s pushing sensation

299
Q

what is blood patch and why would it be used?

A

if MD sticks epidural too far and goes into spinal cord, it will leak. This leaking will cause severe spinal headache. Blood is drawn and injected into spinal cord location of leak and it will clot and close the leak

300
Q

why does epidural dec mom’s BP

A

it causes pooling of blood in extremities

301
Q

positions for mom to be in for epidural insertion

A

laying on side with knees to chest, or sitting upright hunched over. MD needs to see and count vertabrae

302
Q

if hypotension occurs d/t epidural what should RN do?

A

have pt lay Left Lateral, inc IV fluids that do NOT have pit, give 02 (6-10L) by face mask, vasopressors if ordered, keep supine for a few min to let meds circulate body

303
Q

when should RN discontinue Pit

A

fetal distress, bradycardia, late or variable decel, meconium staining, too frequent cont or sustained cont. Then turn client to L side and give 02.

304
Q

BTL

A

bilateral tubal ligation

305
Q

pudenal block

A

is injections of local anesthesia injected right near ischeal spines, huge needle, usually used for episiotomy and real bad tears. Not used often

306
Q

vaginal tears

A

can be 1-4th degree. 4th is the worst. 3-4 prob need stitches

307
Q

Bishop scoring

A

a scale that ranks indicates if induction will be successful. 8 or higher means that you can induce. If cervix is hard-pit will not work.

308
Q

reasons for inducing labor

A

HTN, complications, inf, low fluid, way past due date, epidural slowed labor too much

309
Q

Pitocin

A

causes uterine contractions, or enhances existing cont, is started low and increased. RN must monitor pt 1:1. Always run in secondary bag, too much can rupture uterus, has very short half life

310
Q

baby extraction devices

A

forceps and vacuum. Neither can be used if baby is CPD (cephlopelvic disproportianate or big head). Both are used when baby is becoming distressed

311
Q

forceps

A

big tongs that are inserted into vag and pull on baby’s head. S/E tearing of perineal area, facial palsy (usually temp)

312
Q

vacuum

A

sucks on baby’s head to help pull it out. Can leave red circle on head, hematoma, or scalpal lacerations

313
Q

Depo-Provera

A

contraception injection given every 3 months

314
Q

Cesarean births

A

Classical- cut from bellybutton down-easy, quick, if you ever had this one you will always have C/S next time. Lower uterine segment incisions (LUS)-cutting across bikini line, takes more time and skill, risky can hit bladder, less scarring, can have vaginal birth after this type (VBAC) with trial of labor (TOL) where they see if it works