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NCLEX > OB > Flashcards

OB Flashcards

1
Q

Ectopic pregnancy patho

A

Occurs when a fertilized egg implants and grows outside the uterus

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2
Q

S+S of ectopic pregnancy

A

Unilateral lower abdominal pain
Abnormal vaginal bleeding or spotting
Delayed menstrual period
Positive pregnancy test

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3
Q

Complications of ectopic pregnancy

A

Rupture/hemoperitoneum -> hemorrhage: hypotension, bleeding, hypovolemia

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4
Q

Nursing interventions of ectopic pregnancy

A

Methotrexate
Urine is toxic up to 72 hrs after administration
Avoid analgesics stronger than acetaminophen

Surgery may be required
Rupture is medical emergency

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5
Q

Preeclampsia patho

A

Hypertensive disorder of pregnancy
Systemic vasospasm
Onset > 20 wks gestation

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6
Q

Risk factors of preeclampsia

A

Chronic HTN
Prior hx of preeclampsia
DM

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7
Q

Dx of preeclampsia (w/o and w/ severe features)

A

Preeclampsia w/o severe features:
> 140/90
Proteinuria

W/ severe features:
> 160/110
Thrombocytopenia
Increased creatinine
Increased LFTs

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8
Q

Complications of preeclampsia (maternal and fetal)

A

Maternal:
AKI
Pulmonary edema
Ischemic stroke
Hepatic failure/rupture
DIC
Progression to eclampsia

Fetal:
Placental abruption
Restricted growth
Preterm birth
Fetal demise

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9
Q

Nursing interventions of preeclampsia

A

Facilitate and prepare for birth
Hourly I+O
Assess DTRs
Antihypertensives: stroke ppx
Seizure ppx: seizure precautions Magnesium sulfate (monitor for magnesium toxicity)

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10
Q

Preterm labor patho

A

Regular, painful uterine contractions causing progressive cervical dilation and effacement before 37 wks gestation

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11
Q

Preterm labor interventions

A

Magnesium sulfate administration at <32 wks gestation (fetal neuroprotection)
Tocolysis
Corticosteroids: accelerates fetal lung maturity
Abx (PCN): ppx for Group B Strep
Notify neonatal resuscitation team
Continuous fetal monitoring
Provide emotional support to pt and partner

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12
Q

False labor vs. true labor

A

False:
Braxton-Hicks contractions
Contractions are irregular w/o progression
No cervical dilation, effacement, or fetal descent
Activities often relieve contractions

True:
Contractions are regular, become stronger, last longer, and are frequent
Cervical dilation and effacement are progressive
Fetus is engaged in pelvis and descends

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13
Q

S+S of umbilical cord prolapse

A

Visualized cord protruding from vagina
Palpation of cord during vaginal exam

Sudden FHR changes in previously normal tracing:
Fetal bradycardia
Moderate to severe variable decelerations (cord compression)

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14
Q

Nursing interventions of umbilical cord prolapse

A

Call for help and notify HCP
Prepare for expedited birth
Request neonatal resuscitation team at birth
Wrap protruding umbilical cord w/ sterile towel and warm saline
Don’t manipulate or replace cord
Administer IV fluid bolus and oxygen
Perform sterile vaginal exam and lift presenting fetal part off of umbilical cord until birth

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15
Q

A trimester is __ wks

A

13

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16
Q

GTPAL

A

Gravidity: number of pregnancies
Term births: >37 wks
Preterm births: 20-36 wks
Abortions/miscarriages: before 20 wks
Living children

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17
Q

Softened cervix = _________ sign

A

Goodell’s

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18
Q

Blue color of vulva, vagina, or cervix = _______ sign

A

Chadwick’s

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19
Q

Uterine softening

A

Hegar’s

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20
Q

Naegele’s rule

A

Estimate expected birth
Last menstrual period - 3 months + 7 days

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21
Q

TORCH

A

Toxoplasmosis
Virus B-19 (parvovirus)
Rubella
Cytomegalovirus
Herpes simplex virus

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22
Q

Total weight gain = ____ +/- _
1st tri: ____________
2nd and 3rd: __________

A

Total weight gain: 28 +/-3
1st tri: 1 lb/month
2nd and 3rd: 1 lb/wk

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23
Q

Ideal weight gain =

A

Week - 9

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24
Q

Fundus is not palpable until wk __

A

12

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25
Q

Fundus is at umbilicus at ______ of gestation

A

20-22

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26
Q

If fundus is at/below belly button = ____ tri
Who is priority?

A

2nd
She

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27
Q

If fundus is above umbilicus = ____ tri
Who is priority?

A

3rd
Baby

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28
Q

Quickening =

A

When baby kicks
16-20 wks

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29
Q

Morning sickness is w/in what tri? Tx?

A

1st tri
Tx: dry carbs before getting out of bed

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30
Q

Urinary incontinence is w/in what tri? Tx?

A

1st and 3rd tri
Tx: void every 2 hrs

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31
Q

Difficulty breathing is w/in what tri? Tx?

A

2nd and 3rd tri
Tx: tripod position

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32
Q

Back pain is w/in what tri? Tx?

A

2nd and 3rd tri
Tx: pelvic tilt exercises

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33
Q

Negative station

A

Head/presenting part is above tight squeeze

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34
Q

Positive station

A

Presenting part below ischial spines; made through tight squeeze

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35
Q

Stages of labor

A

Stage 1: cervix dilation
Latent
Active
Transition
Stage 2: baby delivered
Stage 3: placenta delivered
Stage 4: recovery

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36
Q

Active phase of labor
Dilation
Contraction frequency
Contraction intensity

A

Dilation: 5-7
Contraction frequency: every 3-5 mins
Contraction intensity: moderate

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37
Q

Contractions should not be longer than _____ secs

A

90

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38
Q

Frequency of contraction

A

Beginning of one to beginning of next

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39
Q

Duration of contraction

A

Beginning of end of one contraction

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40
Q

Intensity of contraction

A

Palpate over fundus w/ fingertips

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41
Q

Interventions for all other complications in labor and birth

A

LION
Left side
Increase IV
Oxygen
Notify HCP

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42
Q

Remember peak levels of route
SL
IV
IM

A

SL: 5-10 mins
IV: 15-30 mins after infusion
IM: 30-60 mins

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43
Q

Fetal HR

A

110-160

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44
Q

If low FHR…

A

LION and stop pitocin

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45
Q

If low baseline variability…

A

LION

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46
Q

Decelerations

A

In comparison to contractions (early, late, variable)

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47
Q

If late decelerations…

A

LION

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48
Q

If variable decelerations…

A

BAD
Prolapsed cord -> push, position

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49
Q

VEAL CHOP

A

Variable Cord compression
Early dec Head compression
Acceleration OK
Late dec Placental insuffiency

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50
Q

If boggy fundus…

A

Massage

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51
Q

If displaced fundus…

A

Catherize

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52
Q

APGAR

A

Activity
Pulse
Grimace
Appearance
Respiration

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53
Q

Baby RR

A

30-60

54
Q

Caput succadeaneum

A

Edema
Crosses suture lines
Like a cap

55
Q

Cephalohematoma

A

Birth trauma
Doesn’t cross suture lines

56
Q

Molding

A

Abnormal head shape that results from pressure
Normal

57
Q

Pathological jaundice vs. physiological jaundice

A

Patho: yellow baby comes out
Physio: appears after 24 hrs

58
Q

Postpartum assessment

A

Breasts
Uterine fundus (firm, midline, height related to bellybutton)
Bladder
Bowel
Lochia (rubra, serosa, alba)
Episiotomy
Hemoglobin and hematocrit
Extremity check
Affect
Discomforts

59
Q

Lochia types

A

Rubra: red
Serosa: pink
Alba: white

60
Q

Postpartum hemorrhage def

A

Vaginal birth > 500 ml of blood
C-section > 1000 ml of blood

61
Q

S+S of postpartum hemorrhage

A

Hypotonia of uterus
Atony/boggy uterus
Deviated to right
Uncontrolled bleeding
Hypovolemia: tachycardia, hypotension, dizziness

62
Q

1 cause of uterine atony is…

A

full bladder

63
Q

Drugs of postpartum hemorrhage

A

Oxytoxin
Methergine
Hemabate
Misoprostol
(Uterotonics)

64
Q

Terbutaline

A

Causes maternal tachycardia
Tocolytic = stops labor

65
Q

Magnesium sulfate

A

Tocolytic = stops labor
Watch for toxicity
Watch for hypermagnesemia

66
Q

Pitocin

A

Can cause uterine hyperstimulation
Oxytocics = stimulate and strengthen labor

67
Q

Methergine

A

Causes HTN
Oxytocics = stimulate and strengthen labor

68
Q

Bethamethasone

A

Mom gets it
Given IM
Given before baby is born

69
Q

Surfacant

A

Baby gets it
Transtracheal
Given after baby born

70
Q

Magnesium toxicity S+S

A

Absent or diminished DTRs
Decreased RR or oxygen saturation
Somnolence

71
Q

Placenta previa (what to expect and tx)

A

Placenta partly or completely covers the cervix, which is the opening of the uterus
At risk for hemorrhage
Vaginal exams are CI
Pelvic rest is recommended
C-section is planned

72
Q

Toxoplasmosis

A

Exposure to infected cat feces or ingestion of undercooked meat or soiled-contaminated fruits/vegetables

73
Q

Hyperemesis gravidarum def and S+S

A

Severe, persistent N+V
S+S: ketonuria (by-product of metabolism of fat for energy), weight loss > 5%, hypokalemia, dehydration, tachycardia

74
Q

intermittent pain w/ contractions, small amt of blood-tinged mucus

A

Normal labor def

75
Q

sudden-onset vaginal bleeding, abdominal pain, hypertonic/tender uterus, tachysystole

A

Placental abruption

76
Q

Placental abruption tx

A

Emergency c-section
Continuous external fetal monitoring
Blood specimen for type and crossmatch
Concerns: maternal blood loss resulting in hypotension, shock, and fetal compromise

77
Q

painless vaginal bleeding, ultrasound finding of placenta covering cervical os

A

Placenta previa

78
Q

sudden-onset vaginal bleeding, constant abdominal pain, cessation of uterine contractions, loss of fetal station, fetal deterioration

A

Uterine rupture

79
Q

HELLP syndrome labs and tx

A

Labs: hemolytic anemia, elevated liver enzymes, low platelet count
Tx: delivery, magnesium sulfate, antihypertensive drugs

80
Q

Oligohydramnios vs. polyhydramnios tx

A

Oligo: amnioinfusion to help alleviate cord compression
Poly: oxytocic meds to prevent postpartum hemorrhage

81
Q

Second stage of labor interventions

A

Assist pt to push while lying in supported lateral position
Open glottis pushing technique
Push w/ every other contraction
Push effort for 6-8 seconds

82
Q

Preterm labor interventions

A

IM antenatal glucocorticoids (betamethasone)
Abx to prevent group B Streptococcus infx
Magnesium sulfate
Tocolytic meds (nifedipine, indomethacin) to suppress uterine activity

83
Q

Teratogenic drugs

A

Thalidomide (immunomodulator)
Epileptic meds
Retinoid
Ace inhibitors, ARBs
Third element (lithium)
Oral contraceptives
Warfarin
Alcohol
Sulfonamides/sulfones
(TERATOWAS)

84
Q

28 wks visit

A

Glucose tolerance test for diabetes
Anti-D injection if Rh negative
Pertussis vaxx

85
Q

34-36 wks visit

A

Group B strep vaginal swab

86
Q

Cleft lip and palate risk for

A

aspiration due to uncoordinated suck and swallow

87
Q

Cleft lip and palate S+S

A

Feeding difficulties: poor suction and uncoordinated suck and swallow

88
Q

Nursing interventions of cleft lip and palate

A

Encourage bonding
Feed upright position
Burp after each ounce of formula consumed
Position nipple toward back or side of moth
Use special nipples/bottles

89
Q

Postop care for cleft lip repair

A

6-12 months after birth
Elbow restraints
Observe for excessive swallowing
Don’t offer straws or pacifiers
Avoid rigid eating utensils
Diet: modified liquids or soft/blended foods

90
Q

Hirschsprung dz patho

A

Congenital aganglionic megacolon
Absence of specialized nerve cells in distal large intestine
Impaired peristalsis
Inability of interior anal sphincter to relax
Prevention of stool passage
Increased risk for life-threatening bowel perforation or enterocolitis

91
Q

Hirschsprung dz S+S

A

Abdominal distention
Feeding intolerance
Bilious vomiting
Ribbon-like stools
Poor weight gain or growth failure
Delayed meconium passage in newborns (>48 hrs)
Dx: barium enema or rectal biopsy

92
Q

Nursing interventions for Hirschsprung dz

A

Preop:
Check serial abdominal circumference measurements
Prepare for surgery (removal of aganglionic portion of bowel)
Maintain NPO
Administer IV fluids
Older children may require enema prior to procedure

Postop:
Assess for S+S of infx at incision
If colostomy was performed, provide teaching
Assess stoma if colostomy was performed

93
Q

Infant botulism S+S

A

Symmetric, descending paralysis
Hypotonia and decreased head control
Ptosis
Absent gag reflex
Poor feeding

94
Q

Nursing interventions of botulism

A

Recognize symptoms early to avoid respiratory failure
IV botulism immune globulin
Supportive care:
Mechanical ventilation
Enteral tube feedings
Prevention: avoid honey before age 12 months

95
Q

Neonatal abstinence syndrome S+S

A

CNS:
Irritability, inconsolability, high-pitched cry
Hypertonia, tremors
Short sleep cycles
Sneezing, yawning
Uncoordinated swallowing
Respiratory: tachypnea
GI: vomiting and diarrhea

96
Q

Neonatal abstinence syndrome nursing interventions

A

Obtain newborn drug screen
Monitor daily weight
Feed in small, frequent amts
Minimize environmental stimuli
Swaddle tightly in flexed position
Provide pacifier
Administer prescribed meds and evaluate response: opioid agonists (morphine, methadone)

97
Q

Newborn hypoglycemia

A

BG < 40-45
Can cause seizures and neuro injury if untreated

98
Q

S+S of newborn hypoglycemia

A

Can be asymptomatic
Hypothermia
Poor feeding
Irritability
Exaggerated Moro reflex
Tachypnea
Tremors
Lethargy

99
Q

Nursing interventions of newborn hypoglycemia

A

Screen newborn w/ risk factors or symptoms
Check BG frequently via heel stick
Early, frequent feedings and skin-to-skin contact
Monitor temp and RR
Administer: buccal dextrose and IV dextrose

100
Q

S+S of myelomeningocele

A

Sac-like protrusion containing:
Spinal cord
Spinal nerves
Spinal fluid

101
Q

Associated complications w/ spina bifida

A

Abnormal hip development
Tethered spinal cord
Hydrocephalus
Neurogenic bladder

102
Q

Nursing interventions of spina bifida

A

Initial:
Use latex-free gloves
Cover site w/ sterile saline-soaked non-adherent dressing
Large defects: cover w/ plastic wrap to prevent heat loss
Only neurosurgeon removes dressing
No diaper
Maintain prone/lateral position
Ppx IV abx

Long-term:
Teach parents how to measure head circumference (risk for hydrocephalus)
Maintain bladder fx: clean intermittent catheterization
Maintain bowel fx: prevent constipation
Support musculoskeletal integrity:
Assistive devices to help walk
Routine ROM exercises
Prevent recurrence

103
Q

Lactational mastitis S+S

A

Flu-like symptoms:
Fever
Chills
Myalgias
Malaise

Local changes:
Unilateral breast pain
Focal erythema
Induration

104
Q

Nursing interventions of lactational mastitis

A

Abx
Analgesics
Warm compresses to breast
Adequate rest, nutrition, hydration

105
Q

Education of lactational mastitis

A

Increase daily fluid intake
Continue to breastfeed
Start feeds w/ sore breast first
Feed at least 15-20 min per breast
Attempt to breastfeed every 2-3 hrs (8-12 times/day)
Wear soft, supportive bras
Use warm compress and massage
Insert clean finger beside newborn’s gums to break suction before unlatching

106
Q

Causes of postpartum hemorrhage

A

Tone
Trauma
Tissue
Thrombin

107
Q

Uterine atony

A

Inadequate contraction of uterus -> relaxed uterus distended w/ blood
Placental site blood vessels are not clamped off -> excessive bleeding

108
Q

Risk factors of postpartum hemorrhage

A

Inadequate contraction of uterus -> relaxed uterus distended w/ blood
Placental site blood vessels are not clamped off -> excessive bleedingUterine fatigue: prolonged labor
Chorioamnionitis
Uterine overdistension:
Multifetal pregnancy
Fetal macrosomia
Polyhydramnios
Grand multiparity (> 5 births)
Hx of postpartum hemorrhage

109
Q

What vaccinations can pregnant people not get?

A

Live vaxx (MMR, rotavirus, varicella/varicella zoster)

110
Q

Placental abruption patho

A

Premature separation of placenta from uterus causes hemorrhage from placental blood vessels

111
Q

Uterine rupture patho

A

Spontaneous tearing of uterus that may result in fetus being expelled into peritoneal cavity

112
Q

Dark-red vaginal bleeding
Abdominal rigidity
Severe abdominal pain
Possible fetal distress (late decelerations)

A

Placental abruption

113
Q

Sudden onset of extreme abdominal pain
Abnormal bump in abdomen
No uterine contractions or positive contractions

A

Uterine rupture

114
Q

Placental abruption tx

A

C-section

115
Q

Uterine rupture tx

A

Immediate laparotomy with delivery of the fetus with repair of the uterus

116
Q

Regular, painful uterine contractions cause progression cervical dilation and effacement before term gestation
S+S: painful frequent contractions, lower back pain

A

Preterm labor

117
Q

For preterm labor <32 wks tx

A

Corticosteroids
PCN
Tocolysis: indomethacin
Magnesium sulfate

118
Q

For preterm labor 32-24 wks tx

A

Corticosteroids
PCN
Tocolysis: nifedipine

119
Q

Preeclampsia labs

A

Proteinuria and creatinine

120
Q

Amniotomy interventions

A

Monitor temp at least every 2 hrs
Assess FHR before and after the procedure
Note amniotic fluid color, amount, and odor
Place in side-lying or upright position
Explain that the procedure is painless

121
Q

Polyhydramnios at risk for

A

Umbilical prolapse
Postpartum hemorrhage

122
Q

Neonatal abstinence syndrome tx

A

Opioids
No naloxone

123
Q

Spina bifida S+S on newborn

A

Tuft of hair
Hemangioma
Nevus
Dimple
Along base of spine

124
Q

Proper breastfeeding technique

A

Breastfeed every 2-3 hrs on average
Breastfeed “on demand” whenever the newborn exhibits hunger cues (sucking, rooting reflex)
Position newborn “tummy to tummy” w/ mouth in front of nipple and head in alignment w/ body
Ensure proper latch (grasps both nipple and part of areola)
Feed for 15-20 mins per breast
Insert clean finger beside gums to break suction before unlatching
Alternate which breast is offered first at each feeding

125
Q

Breast engorgement for those not breastfeeding

A

Ice packs to both breasts for 15-20 mins every 3-4 hrs
Chilled, fresh cabbage leaves to both breasts
Take NSAIDs
Maintain firm breast support

126
Q

Priorities of placental abruption

A

Assess maternal VS
Palpate abdomen/uterus
Continuous FHR monitoring
Indication of fetal distress and/or maternal hemodynamic compromise -> c-section

127
Q

Vaginal exam is not indicated during what scenarios?

A

Active bleeding until possibility of placenta previa is ruled out

128
Q

Pregnant women can work w/

A

MRSA

129
Q

Before placing a fetal scalp electrode, nurse must know

A

Bloodborne infx (hepatitis B, HIV)
Cervical dilation (>2-3 cm)
Membrane status

130
Q

Priority action for HELLP syndrome and preeclampsia

A

Magnesium sulfate to prevent seizures

131
Q

Follow-up on pregnant pt if they report

A

Copious amts of watery, clear vaginal discharge (rupture of membranes)
Dysuria and flank pain (UTI)
Headache and blurred vision (preeclampsia)

NCLEX (40 decks)

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