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Nursing School > NUR 238 - Heather's Study Guide > Flashcards

NUR 238 - Heather's Study Guide Flashcards

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1
Q

What is Gestational Diabetes?

A

Impaired tolerance to glucose for the first time during pregnancy.

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2
Q

What do you need to diagnose Gestational Diabetes Mellitus?

A

2 or more elevated glucose readings.

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3
Q

What is the ideal blood glucose level for a fasting pregnant patient?

A

60-99mg/dL

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4
Q

What is the ideal blood glucose level 2 hours after meals for a pregnant patient?

A

Less than 120mg/dL

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5
Q

What is the common complication with GDM?

A

Macrosomia.

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6
Q

What is Macrosomia?

A

Where the baby weighs more than 4,000g (8.8lbs) which can lead to dystocia.

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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
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8
Q

What are the conditions for Preelampsia?

A
  • GH

- Proteinuria greater or equal to 1 or more

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9
Q

What are the signs and symptoms of Preeclampsia?

A
  • Headaches
  • Irritability
  • Edema
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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
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11
Q

What are the conditions for Eclampsia?

A
  • Severe preeclampsia

- Onset of seizures or coma

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12
Q

What are the signs and symptoms of Eclampsia?

A
  • Headaches
  • Severe epigastric pain
  • Hyperreflexia and hemoconcentrations (warning signs of probable convulsions)
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13
Q

What do you assess when a patient has Eclampsia?

A
  • BP
  • Deep tendon reflexes
  • Respirations
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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)
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15
Q

What is HELLP?

A

Variant of GH in which hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction.

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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
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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.

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18
Q

What does Placenta Previa result in?

A

Bleeding in 3rd trimester as cervix begins to dilate and efface.

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19
Q

How do you diagnose Placenta Previa?

A

Ultrasound

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20
Q

What does Placenta Previa indicate?

A

C-Section.

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21
Q

What is Complete or Total Placenta Previa?

A

Os completely covered by placental attachment.

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22
Q

What is Incomplete or Partial Placenta Previa?

A

Os partially covered by placental attachment.

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23
Q

What is Marginal Placenta Previa?

A

Placenta is attached in the lower uterine segment but does not reach the os.

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24
Q

What is Low-Lying Placenta Previa?

A

Relationship of placenta to os not yet determined.

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25
Q

What are the signs and symptoms of Placenta Previa?

A
  • Painless
  • Bright red blood
  • Soft uterus
  • Normal VS
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26
Q

What is Abruptio Placentae?

A

Premature separation of placenta from uterus (partial or complete).

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27
Q

When can Abruptio Placentae occur?

A

After 20 weeks/3rd Trimester

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28
Q

What Placental Disorder is the leading cause of maternal death that also can result in fetal mortality and morbidity?

A

Abruptio Placentae.

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29
Q

What can occur from Abruptio Placentae?

A
  • Disseminated Intravascular Coagulopathy (DIC)

- Hypovolemic Shock

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30
Q

What are the signs and symptoms of Abruptio Placentae?

A
  • Pain
  • Dark red blood
  • Fetal distress
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31
Q

What is considered Perinatal Loss?

A
  • Stillbirth

- Intrauterine Fetal Demise

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32
Q

What are typical physiological causes for Perinatal Loss?

A
  • Diabetes
  • Preeclampsia
  • Congenital Anomalies
  • Infection
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33
Q

Prolonged Retention with Perinatal Loss?

A
  • Sepsis
  • Endometritis
  • DIC
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34
Q

What is the management process for Perinatal Loss?

A
  • Induction of labor
  • C/S if had a prior
  • Prostaglandin vaginal suppositories (PGE2) q4-6h until labor begins
  • Laminaria Tents
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35
Q

How do you determine the cause of death in Perinatal Loss?

A
  • Autopsy
  • MRI
  • Fetal Blood Tests
  • X-rays
  • Placental Studies
  • Chromosomal Studies
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36
Q

What is Spontaneous Abortion?

A

Pregnancy ends as a result of natural causes before 20 weeks gestation if a fetus weighs < 500g.

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37
Q

What is an Ectopic Pregnancy?

A

Implantation of a fertilized ovum outside the uterine cavity.

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38
Q

What is the risk with an Ectopic Pregnancy?

A

Hemorrhage.

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39
Q

What are the signs and symptoms of an Ectopic Pregnancy?

A
  • Stabbing unilateral lower abdominal tenderness

- Pain to diaphragm and phrenic nerve

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40
Q

What is Gestational Trophoblastic Disease?

A

Proliferation and degeneration of trophoblastic villi in placenta that becomes swollen and fluid-filled.

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41
Q

What happens in Gestational Trophoblastic Disease?

A

Embryo fails to develop beyond a primitive state and these structures are associated with choriocarcinoma.

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42
Q

What are the signs and symptoms for Gestational Trophoblastic Disease?

A
  • Prune-colored discharge
  • Hyperemesis gravidarum
  • Partial or Complete mole growth
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43
Q

What is an Acceleration in FHR?

A
  • Increase in FHR above baseline

- Indicate non-reactive stress test

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44
Q

What is an Early Deceleration in FHR?

A
  • Slowing of FHR at start of contraction
  • Return of FHR to baseline at end of contraction
  • No intervention
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45
Q

What is a Late Deceleration in FHR?

A
  • Slowing of FHR after a contraction has started

- Return of FHR to baseline well after contraction has ended

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46
Q

If the FHR depicts Late Deceleration, what nursing interventions do you take?

A
  • Place mom on side
  • IV Fluids
  • Discontinue Oxytocin
  • Administer 8-10L O2 via non-rebreather
  • Elevate Legs
  • Call Provider
  • Prepare for Delivery
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47
Q

What is Variable Deceleration in FHR?

A
  • 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
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48
Q

What is considered Fetal Tachycardia?

A
  • > 160bpm for 10+ mins
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49
Q

What is the intervention for Fetal Tachycardia?

A
  • Administer antipyretics if fever is present
  • Administer 10L O2 via non-rebreather
  • IV Fluid Bolus
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50
Q

What is considered Fetal Bradycardia?

A
  • <110bpm for 10+ mins
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51
Q

What is the intervention for Fetal Bradycardia?

A
  • Discontinue oxytocin
  • Lie mom on side
  • Administer 10L O2 via non-rebreather
  • IV Fluids
  • Tocolytic Meds
  • Notify Provider
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52
Q

What is VEAL?

A
  • Variable Deceleration
  • Early Deceleration
  • Accelerations
  • Late Decelerations
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53
Q

What is CHOP?

A
  • Cord Compression
  • Head Compression
  • Okay
  • Placental Insufficiency
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54
Q

What is a Prolapsed Umbilical Cord?

A
  • Cord displaced

- Preceding presenting part of fetus or protruding through cervix

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55
Q

What is the general line of events with a Prolapsed Umbilical Cord?

A
  • Prolapsed Cord
  • Cord Compression
  • Compromised Fetal Circulation
  • Fetal asphyxia or hypoxia
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56
Q

What is a life-threatening situation where the mom will report a “ripping” or a “tearing” abdominal pain?

A

Uterine Rupture.

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57
Q

What are the 2 types of Ruptures?

A
  • Complete

- Incomplete

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58
Q

What is a Complete Uterine Rupture?

A
  • Rupture of uterine wall
  • Rupture of peritoneal cavity/broad ligaments
  • Internal bleeding present
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59
Q

What is an Incomplete Uterine Rupture?

A

Dehiscence at the site of a prior scar (c-section, surgery, etc.).

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60
Q

When would an Anaphylactoid Syndrome of Pregnancy (Amniotic Fluid Embolism) occur?

A
  • During labor
  • At birth
  • Up to 30 minutes after amniotic fluid into maternal circulation
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61
Q

What happens in an Anaphylactoid Syndrome of Pregnancy (Amniotic Fluid Embolism)?

A
  • Amniotic fluid travels and obstructs pulmonary vessels
  • Causes respiratory distress
  • Causes circulatory collapse
62
Q

What other complications can result from Anaphylactoid Syndrome of Pregnancy (Amniotic Fluid Embolism)?

A

Disseminated Intravascular Coagulopathy (DIC).

63
Q

What are the signs and symptoms of Anaphylactoid Syndrome of Pregnancy (Amniotic Fluid Embolism)?

A
  • Respiratory Distress
  • Coagulation Failure
  • Circulatory Collapse
64
Q

What types of Analgesics would you provide to manage discomfort?

A
  • Sedatives (Barbiturates)
  • Opioid Analgesics
  • Metoclopramide
  • Epidural/Spinal Regional Analgesia
65
Q

What types of Pharmacological Anesthesias would you provide to mange discomfort?

A
  • Pudendal block
  • Epidural block
  • Spinal anesthesia
  • General anesthesia
66
Q

What stage of labor is it too late to give pain medication?

A

2nd stage and crowning.

67
Q

If pain is unmanageable during 2nd stage and crowning, what is the intervention?

A
  • Encourage breathing which will perfuse placenta

- Hyperventilation - Paper bag; no O2 because you want patient to be resistant

68
Q

What would you provide or perform when you want to induce labor?

A
  • Cytotec (Misoprostol)
  • Oxytocin (Pitocin)
  • Prostaglandin
  • Artificial Rupture of Membranes (AROM) with Amnio Hook
69
Q

What is Dystocia?

A

Dysfunctional Labor r/t

  • Passenger
  • Passageway
  • Powers
  • Position
  • Psychologic Response
70
Q

What prevents normal labor progression?

A

Atypical Contractions

71
Q

What is a Hypotonic Atypical Contraction?

A
  • Weak

- Absent

72
Q

What is a Hypertonic Atypical Contraction?

A
  • Frequent
  • Strong
  • Inadequate uterine relaxation
73
Q

What is Shoulder Dystocia?

A

Birth injury that occurs when one or both of baby’s shoulders get stuck inside mother’s pelvis during labor/birth.

74
Q

What is a risk factor for Dystocia?

A

Macrosomia Infant (>4500 grams).

75
Q

What is Cephalic Fetal Presentation?

A

Head first.

76
Q

What is Breech Fetal Presentation?

A

Pelvis first.

77
Q

What is Shoulder Fetal Presentation?

A
  • Transverse lie

- Scapula first

78
Q

What is Turtle’s Sign?

A

Neonate’s head slowly extends and emerges over the perineum, but then retracts back into the vagina.

79
Q

What is Bishop Score?

A

Score used to determine cervical ripening.

80
Q

What are the factors that go into account when determining Bishop Score?

A
  • Dilation
  • Effacement
  • Position
  • Consistency
  • Station
81
Q

What does cervical ripening indicate?

A

Determining decreasing or eliminating need for oxytocin.

82
Q

Developmental Tasks - Taking in/Dependent

A
  • 24-48 hrs
  • Rely on others for assistance
  • Talkative, excited
  • Urge to share birth story with others
83
Q

Developmental Tasks - Taking hold/Dependent-Independent

A
  • 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
Q

Developmental Tasks - Letting go/Interdependent

A
  • Focuses on family as a whole

- Resumption of other roles (partner, individual)

85
Q

Fetal Descent - Zero

A

Presenting part is at the level of the maternal ischial spines.

86
Q

Fetal Descent - Minus Stations

A

Presenting part is above the ischial spines.

87
Q

Fetal Descent - Plus Stations

A

Presenting part is below the ischial spine.

88
Q

What is Engagement?

A

When the greatest transverse diameter of head passes through pelvic inlet (usually 0 station).

89
Q

What is Descent?

A
  • Downward movement of fetal head until it is within the pelvic inlet
  • Occurs intermittently with cx
90
Q

What is Flexion?

A
  • 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
Q

What is Internal Rotation?

A

Baby’s head rotates about 45 degrees anteriorly to the midline under the symphysis.

92
Q

What is Extension?

A

Baby’s head emerges under symphysis pubis along with shoulders.

93
Q

What is External Rotation?

A

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
Q

What is Expulsion?

A

A force that occurs smoothly after birth of head and anterior and posterior shoulders.

95
Q

What is a Precipitous Labor?

A

Labor lasting <3 hours from onset of contractions to time of delivery.

96
Q

What is the cause for Precipitous Labor?

A
  • Hypertonic Uterine Dysfunction
  • Oxytocin Stimulation
  • Multiparous pt
97
Q

What is the risk that typically follows Precipitous Labor?

A

Laceration.

98
Q

What does a firm, but bleeding fundus indicate?

A
  • Laceration

- Ruptured Hematoma (Risk for hemorrhage)

99
Q

How much should the fundus decrease in a postpartum client?

A

1-2cm below the umbilicus each day.

100
Q

Postpartum - When is the fundus no longer palpable?

A

2 weeks.

101
Q

What is part of the postpartum physical assessment and what are the elements?

A
  • Breasts
  • Uterus
  • Bowel & GI Function
  • Bladder Function
  • Lochia
  • Episiotomy
  • Extremeties
  • Epidural
102
Q

What are the 3 types of Lochia?

A
  • Rubra, dark red; 1-3 days
  • Serosa, pinkish-brown; 4-10 days
  • Alba - yellowish-white; 10 days-8 weeks
103
Q

What is an episiotomy?

A

Incision made in perineum to enlarge vaginal outlet and theoretically shorten 2nd stage of labor.

104
Q

What is the plan of care for Laceration/Episiotomy patients?

A
  • 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
Q

What stage of labor do lacerations occur?

A

2nd stage.

106
Q

What is a 1st Degree Laceration?

A

Involves only skin and superficial structures above muscle.

107
Q

What is a 2nd Degree Laceration?

A

Extends through perineal muscles.

108
Q

What is a 3rd Degree Laceration?

A

Extends through anal sphincter muscle.

109
Q

What is a 4th Degree Laceration?

A

Continues through anterior rectal wall.

110
Q

Why do you pay special attention to 3rd/4th Degree Lacerations?

A

To prevent fecal incontinence.

111
Q

What increases risk for 3rd/4th Degree Lacerations?

A
  • Nulliparity
  • Asian/Pacific Islander Descent
  • Increased birth weight of newborn
  • Operative vaginal birth
  • Episiotomy
  • Longer 2nd stage of labor
112
Q

What is REEDA?

A

Evaluation of episiotomy healing.

113
Q

What are the elements of REEDA?

A
  • Redness
  • Edema
  • Ecchymosis
  • Discharge/Drainage
  • Approximation
114
Q

When do pregnancy hormones decrease?

A

Immediately after placenta is delivered.

115
Q

What lab tests do you run for DIC?

A
  • Platelets
  • Fibrinogen
  • PT
  • PTT
116
Q

What is the management for DIC?

A
  • Correct cause
  • Fluid volume replacement (PRBC’s)
  • Increase O2 & perfusion
  • Accurate I&O
117
Q

What is Atony?

A

Inability of uterus to contract adequately after birth.

118
Q

What are the series of events with Atony?

A
  • Inability of uterus to contract adequately after birth
  • Increased risk of vaginal bleeding
  • Manual exploration of uterus
  • Hysterectomy
119
Q

Hemorrhage facts.

A
  • Blood loss of 500mL after a VD

- Blood loss of 1000mL after c-section

120
Q

Postpartum Blues Facts.

A
  • 1-10 days
  • Mood swings, tearfulness, insomnia, lack of appetite
  • Resolves without intervention
121
Q

Postpartum Depression facts.

A
  • Within 12 months of delivery
  • Persistent sadness
  • Intense mood swings
  • Does not resolve without intervention
122
Q

Postpartum Psychosis facts.

A
  • First 2-3 weeks
  • Confusion, disorientation, etc.
  • May try to self harm or harm infant
  • Monitor infant for failure to thrive, secondary*
123
Q

Which patients are at higher risk for Postpartum Psychosis?

A

Patients with a hx of bipolar disorder.

124
Q

Teaching for Breastfeeding Mother’s Milk Production.

A
  • 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
Q

What are the nutritional recommendation for breastfeeding mothers?

A
  • Additional 450-500 calories a day

- Calcium-enriched foods

126
Q

Education for Non-Breastfeeding Mother’s Milk Production.

A
  • 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
Q

Nutritional recommendations for non-breastfeeding mothers.

A

Consume 1,800-2,200 kcal/day

128
Q

Which protein is an indicator and can be used for early ID of preterm labor?

A

Fibronectin.

129
Q

Fibronectin facts.

A
  • Protein
  • Can be detected between 24-34 weeks gestation
  • Indicates inflammation
  • Labor likely within 2 weeks
130
Q

Cervical Shortening facts.

A

> 30mm = low risk for preterm labor

131
Q

Which medications delay preterm labor?

A
  • Magnesium sulfate
  • Indomethacin
  • Nifedipine
  • Terbutaline
132
Q

What is Betamethasone’s side effect?

A

Pulmonary Edema

133
Q

What is Betamethasone’s effect?

A

Enhance lung maturity and surfactant production.

134
Q

What are the non-pharmacological ways to delay preterm labor?

A
  • Hydration
  • Activity restriction
  • Abstinence
135
Q

What are the non-pharmacological ways to delay preterm labor?

A
  • Hydration
  • Activity restriction
  • Abstinence
135
Q

What are the non-pharmacological ways to delay preterm labor?

A
  • Hydration
  • Activity restriction
  • Abstinence
135
Q

What are the non-pharmacological ways to delay preterm labor?

A
  • Hydration
  • Activity restriction
  • Abstinence
135
Q

What are the non-pharmacological ways to delay preterm labor?

A
  • Hydration
  • Activity restriction
  • Abstinence
136
Q

Normal Lab Values for Laboring Patients (Hgb, Hct, Platelets, WBC Count, Coagulation factors & Fibrinogen)

A 
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
Q

Which medications are given in preeclampsia?

A
  • Aspirin
  • Methyldopa
  • Nifedipine
  • Hydralazine
  • Labetalol
138
Q

What is Magnesium Sulfate’s purpose?

A
  • Prophylaxis

- Seizures r/t severe preeclampsia and eclampsia

139
Q

Uterotonics function.

A
  • Induce labor

- Assess uterine tone and vaginal bleeding

140
Q

What are the Uterotonics?

A
  • Hemabate (carboprost)
  • Methergine (methylergometrine)
  • Cytotec (misoprostol)
  • Oxytocin (pitocin)
141
Q

Tocolytics function.

A
  • Delay labor

- Keep fetus in utero until lungs mature enough

142
Q

Main side effect of terbutaline?

A

Tachycardia.

143
Q

List the Tocolytics.

A
  • Magnesium Sulfate
  • Indomethacin
  • Nifedipine
  • Terbutaline
144
Q

If a patient has magnesium sulfate toxicity, what is given?

A

Calcium Gluconate.

145
Q

Signs and symptoms of Magnesium Sulfate toxicity?

A
  • Absence of patellar deep tendon reflexes
  • <30mL/hr output of urine
  • <12/min RR
  • Decreased LOC
  • Cardiac dysrhythmias; chest pain
  • PE
  • Hypotension
146
Q

What is the treatment for Magnesium Sulfate toxicity?

A
  • D/C magsulfate
  • Administer calcium gluconate (or calcium chloride)
  • Prepare for prevention of cardiac/respiratory arrest
147
Q

Frequency of Betamethasone injections.

A

2 injections, 24hrs apart.

148
Q

Labetalol & Hydralazine

A

Normodyne & Apresoline

Nursing School (25 decks)

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