NUR 238 - Heather's Study Guide Flashcards
1
Q
What is Gestational Diabetes?
A
Impaired tolerance to glucose for the first time during pregnancy.
2
Q
What do you need to diagnose Gestational Diabetes Mellitus?
A
2 or more elevated glucose readings.
3
Q
What is the ideal blood glucose level for a fasting pregnant patient?
A
60-99mg/dL
4
Q
What is the ideal blood glucose level 2 hours after meals for a pregnant patient?
A
Less than 120mg/dL
5
Q
What is the common complication with GDM?
A
Macrosomia.
6
Q
What is Macrosomia?
A
Where the baby weighs more than 4,000g (8.8lbs) which can lead to dystocia.
7
Q
What are the conditions to determine that a patient has Gestational Hypertension?
A
- 140/90 or greater on 2 different occasions at least 4 hours apart (after 20th week gestation)
- No proteinuria
8
Q
What are the conditions for Preelampsia?
A
- GH
- Proteinuria greater or equal to 1 or more
9
Q
What are the signs and symptoms of Preeclampsia?
A
- Headaches
- Irritability
- Edema
10
Q
What are the conditions for Severe Preeclampsia?
A
- 160/110 or greater
- Proteinuria
- Oliguria
- Elevated creatinine (>1.1mg/dL)
- Visual disturbances
- Hyperreflexia (with possible ankle clonus)
- Pulmonary/Cardiac Involvement
- RUQ Pain
- Thrombocytopenia
- Peripheral edema
- Hepatic dysfunction
11
Q
What are the conditions for Eclampsia?
A
- Severe preeclampsia
- Onset of seizures or coma
12
Q
What are the signs and symptoms of Eclampsia?
A
- Headaches
- Severe epigastric pain
- Hyperreflexia and hemoconcentrations (warning signs of probable convulsions)
13
Q
What do you assess when a patient has Eclampsia?
A
- BP
- Deep tendon reflexes
- Respirations
14
Q
What are all the elements of HELLP?
A
- Hemolysis resulting in anemia or jaundice
- Elevated liver enzymes resulting in elevated ALT/AST, epigastric pain, N/V
- Low platelets (<100,000mm) resulting in thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, disseminated intravascular coagulopathy (DIC)
15
Q
What is HELLP?
A
Variant of GH in which hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction.
16
Q
What is the nursing care for a patient with HELLP?
A
- Accurate and consistent BP readings
- Observation of edema (+1 - +4)
- Deep tendon reflexes (0-5, patellar reflex)
- Urine/Protein output (24 hrs)
- Other complaints
17
Q
What is Placenta Previa?
A
Placenta implants in the lower uterine segment near or over internal cervical os instead of attaching to fundus.
18
Q
What does Placenta Previa result in?
A
Bleeding in 3rd trimester as cervix begins to dilate and efface.
19
Q
How do you diagnose Placenta Previa?
A
Ultrasound
20
Q
What does Placenta Previa indicate?
A
C-Section.
21
Q
What is Complete or Total Placenta Previa?
A
Os completely covered by placental attachment.
22
Q
What is Incomplete or Partial Placenta Previa?
A
Os partially covered by placental attachment.
23
Q
What is Marginal Placenta Previa?
A
Placenta is attached in the lower uterine segment but does not reach the os.
24
Q
What is Low-Lying Placenta Previa?
A
Relationship of placenta to os not yet determined.
25
What are the signs and symptoms of Placenta Previa?
- Painless
- Bright red blood
- Soft uterus
- Normal VS
26
What is Abruptio Placentae?
Premature separation of placenta from uterus (partial or complete).
27
When can Abruptio Placentae occur?
After 20 weeks/3rd Trimester
28
What Placental Disorder is the leading cause of maternal death that also can result in fetal mortality and morbidity?
Abruptio Placentae.
29
What can occur from Abruptio Placentae?
- Disseminated Intravascular Coagulopathy (DIC)
| - Hypovolemic Shock
30
What are the signs and symptoms of Abruptio Placentae?
- Pain
- Dark red blood
- Fetal distress
31
What is considered Perinatal Loss?
- Stillbirth
| - Intrauterine Fetal Demise
32
What are typical physiological causes for Perinatal Loss?
- Diabetes
- Preeclampsia
- Congenital Anomalies
- Infection
33
Prolonged Retention with Perinatal Loss?
- Sepsis
- Endometritis
- DIC
34
What is the management process for Perinatal Loss?
- Induction of labor
- C/S if had a prior
- Prostaglandin vaginal suppositories (PGE2) q4-6h until labor begins
- Laminaria Tents
35
How do you determine the cause of death in Perinatal Loss?
- Autopsy
- MRI
- Fetal Blood Tests
- X-rays
- Placental Studies
- Chromosomal Studies
36
What is Spontaneous Abortion?
Pregnancy ends as a result of natural causes before 20 weeks gestation if a fetus weighs < 500g.
37
What is an Ectopic Pregnancy?
Implantation of a fertilized ovum outside the uterine cavity.
38
What is the risk with an Ectopic Pregnancy?
Hemorrhage.
39
What are the signs and symptoms of an Ectopic Pregnancy?
- Stabbing unilateral lower abdominal tenderness
| - Pain to diaphragm and phrenic nerve
40
What is Gestational Trophoblastic Disease?
Proliferation and degeneration of trophoblastic villi in placenta that becomes swollen and fluid-filled.
41
What happens in Gestational Trophoblastic Disease?
Embryo fails to develop beyond a primitive state and these structures are associated with choriocarcinoma.
42
What are the signs and symptoms for Gestational Trophoblastic Disease?
- Prune-colored discharge
- Hyperemesis gravidarum
- Partial or Complete mole growth
43
What is an Acceleration in FHR?
- Increase in FHR above baseline
| - Indicate non-reactive stress test
44
What is an Early Deceleration in FHR?
- Slowing of FHR at start of contraction
- Return of FHR to baseline at end of contraction
- No intervention
45
What is a Late Deceleration in FHR?
- Slowing of FHR after a contraction has started
| - Return of FHR to baseline well after contraction has ended
46
If the FHR depicts Late Deceleration, what nursing interventions do you take?
- Place mom on side
- IV Fluids
- Discontinue Oxytocin
- Administer 8-10L O2 via non-rebreather
- Elevate Legs
- Call Provider
- Prepare for Delivery
47
What is Variable Deceleration in FHR?
- Abrupt slowing of FHR (15/min or more below baseline for at least 15 seconds)
- Variable in duration, intensity, and timing in relation to uterine cx
- Vaginal exam
- Amniocentesis if ordered
48
What is considered Fetal Tachycardia?
- >160bpm for 10+ mins
49
What is the intervention for Fetal Tachycardia?
- Administer antipyretics if fever is present
- Administer 10L O2 via non-rebreather
- IV Fluid Bolus
50
What is considered Fetal Bradycardia?
- <110bpm for 10+ mins
51
What is the intervention for Fetal Bradycardia?
- Discontinue oxytocin
- Lie mom on side
- Administer 10L O2 via non-rebreather
- IV Fluids
- Tocolytic Meds
- Notify Provider
52
What is VEAL?
- Variable Deceleration
- Early Deceleration
- Accelerations
- Late Decelerations
53
What is CHOP?
- Cord Compression
- Head Compression
- Okay
- Placental Insufficiency
54
What is a Prolapsed Umbilical Cord?
- Cord displaced
| - Preceding presenting part of fetus or protruding through cervix
55
What is the general line of events with a Prolapsed Umbilical Cord?
- Prolapsed Cord
- Cord Compression
- Compromised Fetal Circulation
- Fetal asphyxia or hypoxia
56
What is a life-threatening situation where the mom will report a "ripping" or a "tearing" abdominal pain?
Uterine Rupture.
57
What are the 2 types of Ruptures?
- Complete
| - Incomplete
58
What is a Complete Uterine Rupture?
- Rupture of uterine wall
- Rupture of peritoneal cavity/broad ligaments
- Internal bleeding present
59
What is an Incomplete Uterine Rupture?
Dehiscence at the site of a prior scar (c-section, surgery, etc.).
60
When would an Anaphylactoid Syndrome of Pregnancy (Amniotic Fluid Embolism) occur?
- During labor
- At birth
- Up to 30 minutes after amniotic fluid into maternal circulation
61
What happens in an Anaphylactoid Syndrome of Pregnancy (Amniotic Fluid Embolism)?
- Amniotic fluid travels and obstructs pulmonary vessels
- Causes respiratory distress
- Causes circulatory collapse
62
What other complications can result from Anaphylactoid Syndrome of Pregnancy (Amniotic Fluid Embolism)?
Disseminated Intravascular Coagulopathy (DIC).
63
What are the signs and symptoms of Anaphylactoid Syndrome of Pregnancy (Amniotic Fluid Embolism)?
- Respiratory Distress
- Coagulation Failure
- Circulatory Collapse
64
What types of Analgesics would you provide to manage discomfort?
- Sedatives (Barbiturates)
- Opioid Analgesics
- Metoclopramide
- Epidural/Spinal Regional Analgesia
65
What types of Pharmacological Anesthesias would you provide to mange discomfort?
- Pudendal block
- Epidural block
- Spinal anesthesia
- General anesthesia
66
What stage of labor is it too late to give pain medication?
2nd stage and crowning.
67
If pain is unmanageable during 2nd stage and crowning, what is the intervention?
- Encourage breathing which will perfuse placenta
| - Hyperventilation - Paper bag; no O2 because you want patient to be resistant
68
What would you provide or perform when you want to induce labor?
- Cytotec (Misoprostol)
- Oxytocin (Pitocin)
- Prostaglandin
- Artificial Rupture of Membranes (AROM) with Amnio Hook
69
What is Dystocia?
Dysfunctional Labor r/t
- Passenger
- Passageway
- Powers
- Position
- Psychologic Response
70
What prevents normal labor progression?
Atypical Contractions
71
What is a Hypotonic Atypical Contraction?
- Weak
| - Absent
72
What is a Hypertonic Atypical Contraction?
- Frequent
- Strong
- Inadequate uterine relaxation
73
What is Shoulder Dystocia?
Birth injury that occurs when one or both of baby's shoulders get stuck inside mother's pelvis during labor/birth.
74
What is a risk factor for Dystocia?
Macrosomia Infant (>4500 grams).
75
What is Cephalic Fetal Presentation?
Head first.
76
What is Breech Fetal Presentation?
Pelvis first.
77
What is Shoulder Fetal Presentation?
- Transverse lie
| - Scapula first
78
What is Turtle's Sign?
Neonate's head slowly extends and emerges over the perineum, but then retracts back into the vagina.
79
What is Bishop Score?
Score used to determine cervical ripening.
80
What are the factors that go into account when determining Bishop Score?
- Dilation
- Effacement
- Position
- Consistency
- Station
81
What does cervical ripening indicate?
Determining decreasing or eliminating need for oxytocin.
82
Developmental Tasks - Taking in/Dependent
- 24-48 hrs
- Rely on others for assistance
- Talkative, excited
- Urge to share birth story with others
83
Developmental Tasks - Taking hold/Dependent-Independent
- Day 2 or 3 - 10 or several weeks
- Focuses on baby care
- Wants to be independent, but still looks for acceptance from others
- May experience "baby blues"
84
Developmental Tasks - Letting go/Interdependent
- Focuses on family as a whole
| - Resumption of other roles (partner, individual)
85
Fetal Descent - Zero
Presenting part is at the level of the maternal ischial spines.
86
Fetal Descent - Minus Stations
Presenting part is above the ischial spines.
87
Fetal Descent - Plus Stations
Presenting part is below the ischial spine.
88
What is Engagement?
When the greatest transverse diameter of head passes through pelvic inlet (usually 0 station).
89
What is Descent?
- Downward movement of fetal head until it is within the pelvic inlet
- Occurs intermittently with cx
90
What is Flexion?
- Baby's chin is brought into contact with fetal thorax and the presenting diameter is changed from occipitofrontal to suboccipitobregmatic (9.5cm)
- Smallest fetal skull diameter presenting to the maternal pelvic dimensions
91
What is Internal Rotation?
Baby's head rotates about 45 degrees anteriorly to the midline under the symphysis.
92
What is Extension?
Baby's head emerges under symphysis pubis along with shoulders.
93
What is External Rotation?
After the head is born and free of resistance, it untwists, causing occiput to move about 45 degrees back to its original left or right position (restitution).
94
What is Expulsion?
A force that occurs smoothly after birth of head and anterior and posterior shoulders.
95
What is a Precipitous Labor?
Labor lasting <3 hours from onset of contractions to time of delivery.
96
What is the cause for Precipitous Labor?
- Hypertonic Uterine Dysfunction
- Oxytocin Stimulation
- Multiparous pt
97
What is the risk that typically follows Precipitous Labor?
Laceration.
98
What does a firm, but bleeding fundus indicate?
- Laceration
| - Ruptured Hematoma (Risk for hemorrhage)
99
How much should the fundus decrease in a postpartum client?
1-2cm below the umbilicus each day.
100
Postpartum - When is the fundus no longer palpable?
2 weeks.
101
What is part of the postpartum physical assessment and what are the elements?
- Breasts
- Uterus
- Bowel & GI Function
- Bladder Function
- Lochia
- Episiotomy
- Extremeties
- Epidural
102
What are the 3 types of Lochia?
- Rubra, dark red; 1-3 days
- Serosa, pinkish-brown; 4-10 days
- Alba - yellowish-white; 10 days-8 weeks
103
What is an episiotomy?
Incision made in perineum to enlarge vaginal outlet and theoretically shorten 2nd stage of labor.
104
What is the plan of care for Laceration/Episiotomy patients?
- Ice packs first 24h
- Heat therapy, sitz treatment after each BM for hemorrhoid relief
- Analgesics
- Frequently change perineal pads
- Clean from front to back
- Avoid tampons
- Mild soap
- Avoid tub baths for 4-6 weeks
- Hand hygiene
105
What stage of labor do lacerations occur?
2nd stage.
106
What is a 1st Degree Laceration?
Involves only skin and superficial structures above muscle.
107
What is a 2nd Degree Laceration?
Extends through perineal muscles.
108
What is a 3rd Degree Laceration?
Extends through anal sphincter muscle.
109
What is a 4th Degree Laceration?
Continues through anterior rectal wall.
110
Why do you pay special attention to 3rd/4th Degree Lacerations?
To prevent fecal incontinence.
111
What increases risk for 3rd/4th Degree Lacerations?
- Nulliparity
- Asian/Pacific Islander Descent
- Increased birth weight of newborn
- Operative vaginal birth
- Episiotomy
- Longer 2nd stage of labor
112
What is REEDA?
Evaluation of episiotomy healing.
113
What are the elements of REEDA?
- Redness
- Edema
- Ecchymosis
- Discharge/Drainage
- Approximation
114
When do pregnancy hormones decrease?
Immediately after placenta is delivered.
115
What lab tests do you run for DIC?
- Platelets
- Fibrinogen
- PT
- PTT
116
What is the management for DIC?
- Correct cause
- Fluid volume replacement (PRBC's)
- Increase O2 & perfusion
- Accurate I&O
117
What is Atony?
Inability of uterus to contract adequately after birth.
118
What are the series of events with Atony?
- Inability of uterus to contract adequately after birth
- Increased risk of vaginal bleeding
- Manual exploration of uterus
- Hysterectomy
119
Hemorrhage facts.
- Blood loss of 500mL after a VD
| - Blood loss of 1000mL after c-section
120
Postpartum Blues Facts.
- 1-10 days
- Mood swings, tearfulness, insomnia, lack of appetite
- Resolves without intervention
121
Postpartum Depression facts.
- Within 12 months of delivery
- Persistent sadness
- Intense mood swings
- Does not resolve without intervention
122
Postpartum Psychosis facts.
- First 2-3 weeks
- Confusion, disorientation, etc.
- May try to self harm or harm infant
- Monitor infant for failure to thrive, secondary*
123
Which patients are at higher risk for Postpartum Psychosis?
Patients with a hx of bipolar disorder.
124
Teaching for Breastfeeding Mother's Milk Production.
- Well-fitting bra without an underwire
- Nurse 8-12 times in a 24hr period
- Engorgement (warm shower to promote letdown and milk flow) before breastfeeding
- Empty each breast completely after feedings
- Ice breasts after feeding
125
What are the nutritional recommendation for breastfeeding mothers?
- Additional 450-500 calories a day
| - Calcium-enriched foods
126
Education for Non-Breastfeeding Mother's Milk Production.
- Well-fitted supportive bra continuously for the first 72hrs
- Avoid breast stimulation and warm showers until no longer lactating
- Engorgement (3rd or 5th PP day) -> Intermittent cold compress to suppress lactation
127
Nutritional recommendations for non-breastfeeding mothers.
Consume 1,800-2,200 kcal/day
128
Which protein is an indicator and can be used for early ID of preterm labor?
Fibronectin.
129
Fibronectin facts.
- Protein
- Can be detected between 24-34 weeks gestation
- Indicates inflammation
- Labor likely within 2 weeks
130
Cervical Shortening facts.
>30mm = low risk for preterm labor
131
Which medications delay preterm labor?
- Magnesium sulfate
- Indomethacin
- Nifedipine
- Terbutaline
132
What is Betamethasone's side effect?
Pulmonary Edema
133
What is Betamethasone's effect?
Enhance lung maturity and surfactant production.
134
What are the non-pharmacological ways to delay preterm labor?
- Hydration
- Activity restriction
- Abstinence
135
What are the non-pharmacological ways to delay preterm labor?
- Hydration
- Activity restriction
- Abstinence
135
What are the non-pharmacological ways to delay preterm labor?
- Hydration
- Activity restriction
- Abstinence
135
What are the non-pharmacological ways to delay preterm labor?
- Hydration
- Activity restriction
- Abstinence
135
What are the non-pharmacological ways to delay preterm labor?
- Hydration
- Activity restriction
- Abstinence
136
Normal Lab Values for Laboring Patients (Hgb, Hct, Platelets, WBC Count, Coagulation factors & Fibrinogen)
```
Hgb
- 12-16g
- 1g decrease per 250mL blood loss
Hct
- 35-47
- 4 point decrease for 3-4 days, then begin to increase
Platelets
- 200,000-400,000
- Slight decrease, <100,000 = HELLP
WBC
- 5,000-10,000
- Increase for 4-7 days after delivery (as high as 30,000 after delivery
Coagulation factors & fibrinogen
- Increase during pregnancy
```
137
Which medications are given in preeclampsia?
- Aspirin
- Methyldopa
- Nifedipine
- Hydralazine
- Labetalol
138
What is Magnesium Sulfate's purpose?
- Prophylaxis
| - Seizures r/t severe preeclampsia and eclampsia
139
Uterotonics function.
- Induce labor
| - Assess uterine tone and vaginal bleeding
140
What are the Uterotonics?
- Hemabate (carboprost)
- Methergine (methylergometrine)
- Cytotec (misoprostol)
- Oxytocin (pitocin)
141
Tocolytics function.
- Delay labor
| - Keep fetus in utero until lungs mature enough
142
Main side effect of terbutaline?
Tachycardia.
143
List the Tocolytics.
- Magnesium Sulfate
- Indomethacin
- Nifedipine
- Terbutaline
144
If a patient has magnesium sulfate toxicity, what is given?
Calcium Gluconate.
145
Signs and symptoms of Magnesium Sulfate toxicity?
- Absence of patellar deep tendon reflexes
- <30mL/hr output of urine
- <12/min RR
- Decreased LOC
- Cardiac dysrhythmias; chest pain
- PE
- Hypotension
146
What is the treatment for Magnesium Sulfate toxicity?
- D/C magsulfate
- Administer calcium gluconate (or calcium chloride)
- Prepare for prevention of cardiac/respiratory arrest
147
Frequency of Betamethasone injections.
2 injections, 24hrs apart.
148
Labetalol & Hydralazine
Normodyne & Apresoline
