OB Flashcards
Ectopic pregnancy patho
Occurs when a fertilized egg implants and grows outside the uterus
S+S of ectopic pregnancy
Unilateral lower abdominal pain
Abnormal vaginal bleeding or spotting
Delayed menstrual period
Positive pregnancy test
Complications of ectopic pregnancy
Rupture/hemoperitoneum -> hemorrhage: hypotension, bleeding, hypovolemia
Nursing interventions of ectopic pregnancy
Methotrexate
Urine is toxic up to 72 hrs after administration
Avoid analgesics stronger than acetaminophen
Surgery may be required
Rupture is medical emergency
Preeclampsia patho
Hypertensive disorder of pregnancy
Systemic vasospasm
Onset > 20 wks gestation
Risk factors of preeclampsia
Chronic HTN
Prior hx of preeclampsia
DM
Dx of preeclampsia (w/o and w/ severe features)
Preeclampsia w/o severe features:
> 140/90
Proteinuria
W/ severe features:
> 160/110
Thrombocytopenia
Increased creatinine
Increased LFTs
Complications of preeclampsia (maternal and fetal)
Maternal:
AKI
Pulmonary edema
Ischemic stroke
Hepatic failure/rupture
DIC
Progression to eclampsia
Fetal:
Placental abruption
Restricted growth
Preterm birth
Fetal demise
Nursing interventions of preeclampsia
Facilitate and prepare for birth
Hourly I+O
Assess DTRs
Antihypertensives: stroke ppx
Seizure ppx: seizure precautions Magnesium sulfate (monitor for magnesium toxicity)
Preterm labor patho
Regular, painful uterine contractions causing progressive cervical dilation and effacement before 37 wks gestation
Preterm labor interventions
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
False labor vs. true labor
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
S+S of umbilical cord prolapse
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)
Nursing interventions of umbilical cord prolapse
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
A trimester is __ wks
13
GTPAL
Gravidity: number of pregnancies
Term births: >37 wks
Preterm births: 20-36 wks
Abortions/miscarriages: before 20 wks
Living children
Softened cervix = _________ sign
Goodell’s
Blue color of vulva, vagina, or cervix = _______ sign
Chadwick’s
Uterine softening
Hegar’s
Naegele’s rule
Estimate expected birth
Last menstrual period - 3 months + 7 days
TORCH
Toxoplasmosis
Virus B-19 (parvovirus)
Rubella
Cytomegalovirus
Herpes simplex virus
Total weight gain = ____ +/- _
1st tri: ____________
2nd and 3rd: __________
Total weight gain: 28 +/-3
1st tri: 1 lb/month
2nd and 3rd: 1 lb/wk
Ideal weight gain =
Week - 9
Fundus is not palpable until wk __
12
Fundus is at umbilicus at ______ of gestation
20-22
If fundus is at/below belly button = ____ tri
Who is priority?
2nd
She
If fundus is above umbilicus = ____ tri
Who is priority?
3rd
Baby
Quickening =
When baby kicks
16-20 wks
Morning sickness is w/in what tri? Tx?
1st tri
Tx: dry carbs before getting out of bed
Urinary incontinence is w/in what tri? Tx?
1st and 3rd tri
Tx: void every 2 hrs
Difficulty breathing is w/in what tri? Tx?
2nd and 3rd tri
Tx: tripod position
Back pain is w/in what tri? Tx?
2nd and 3rd tri
Tx: pelvic tilt exercises
Negative station
Head/presenting part is above tight squeeze
Positive station
Presenting part below ischial spines; made through tight squeeze
Stages of labor
Stage 1: cervix dilation
Latent
Active
Transition
Stage 2: baby delivered
Stage 3: placenta delivered
Stage 4: recovery
Active phase of labor
Dilation
Contraction frequency
Contraction intensity
Dilation: 5-7
Contraction frequency: every 3-5 mins
Contraction intensity: moderate
Contractions should not be longer than _____ secs
90
Frequency of contraction
Beginning of one to beginning of next
Duration of contraction
Beginning of end of one contraction
Intensity of contraction
Palpate over fundus w/ fingertips
Interventions for all other complications in labor and birth
LION
Left side
Increase IV
Oxygen
Notify HCP
Remember peak levels of route
SL
IV
IM
SL: 5-10 mins
IV: 15-30 mins after infusion
IM: 30-60 mins
Fetal HR
110-160
If low FHR…
LION and stop pitocin
If low baseline variability…
LION
Decelerations
In comparison to contractions (early, late, variable)
If late decelerations…
LION
If variable decelerations…
BAD
Prolapsed cord -> push, position
VEAL CHOP
Variable Cord compression
Early dec Head compression
Acceleration OK
Late dec Placental insuffiency
If boggy fundus…
Massage
If displaced fundus…
Catherize
APGAR
Activity
Pulse
Grimace
Appearance
Respiration
Baby RR
30-60
Caput succadeaneum
Edema
Crosses suture lines
Like a cap
Cephalohematoma
Birth trauma
Doesn’t cross suture lines
Molding
Abnormal head shape that results from pressure
Normal
Pathological jaundice vs. physiological jaundice
Patho: yellow baby comes out
Physio: appears after 24 hrs
Postpartum assessment
Breasts
Uterine fundus (firm, midline, height related to bellybutton)
Bladder
Bowel
Lochia (rubra, serosa, alba)
Episiotomy
Hemoglobin and hematocrit
Extremity check
Affect
Discomforts
Lochia types
Rubra: red
Serosa: pink
Alba: white
Postpartum hemorrhage def
Vaginal birth > 500 ml of blood
C-section > 1000 ml of blood
S+S of postpartum hemorrhage
Hypotonia of uterus
Atony/boggy uterus
Deviated to right
Uncontrolled bleeding
Hypovolemia: tachycardia, hypotension, dizziness
1 cause of uterine atony is…
full bladder
Drugs of postpartum hemorrhage
Oxytoxin
Methergine
Hemabate
Misoprostol
(Uterotonics)
Terbutaline
Causes maternal tachycardia
Tocolytic = stops labor
Magnesium sulfate
Tocolytic = stops labor
Watch for toxicity
Watch for hypermagnesemia
Pitocin
Can cause uterine hyperstimulation
Oxytocics = stimulate and strengthen labor
Methergine
Causes HTN
Oxytocics = stimulate and strengthen labor
Bethamethasone
Mom gets it
Given IM
Given before baby is born
Surfacant
Baby gets it
Transtracheal
Given after baby born
Magnesium toxicity S+S
Absent or diminished DTRs
Decreased RR or oxygen saturation
Somnolence
Placenta previa (what to expect and tx)
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
Toxoplasmosis
Exposure to infected cat feces or ingestion of undercooked meat or soiled-contaminated fruits/vegetables
Hyperemesis gravidarum def and S+S
Severe, persistent N+V
S+S: ketonuria (by-product of metabolism of fat for energy), weight loss > 5%, hypokalemia, dehydration, tachycardia
intermittent pain w/ contractions, small amt of blood-tinged mucus
Normal labor def
sudden-onset vaginal bleeding, abdominal pain, hypertonic/tender uterus, tachysystole
Placental abruption
Placental abruption tx
Emergency c-section
Continuous external fetal monitoring
Blood specimen for type and crossmatch
Concerns: maternal blood loss resulting in hypotension, shock, and fetal compromise
painless vaginal bleeding, ultrasound finding of placenta covering cervical os
Placenta previa
sudden-onset vaginal bleeding, constant abdominal pain, cessation of uterine contractions, loss of fetal station, fetal deterioration
Uterine rupture
HELLP syndrome labs and tx
Labs: hemolytic anemia, elevated liver enzymes, low platelet count
Tx: delivery, magnesium sulfate, antihypertensive drugs
Oligohydramnios vs. polyhydramnios tx
Oligo: amnioinfusion to help alleviate cord compression
Poly: oxytocic meds to prevent postpartum hemorrhage
Second stage of labor interventions
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
Preterm labor interventions
IM antenatal glucocorticoids (betamethasone)
Abx to prevent group B Streptococcus infx
Magnesium sulfate
Tocolytic meds (nifedipine, indomethacin) to suppress uterine activity
Teratogenic drugs
Thalidomide (immunomodulator)
Epileptic meds
Retinoid
Ace inhibitors, ARBs
Third element (lithium)
Oral contraceptives
Warfarin
Alcohol
Sulfonamides/sulfones
(TERATOWAS)
28 wks visit
Glucose tolerance test for diabetes
Anti-D injection if Rh negative
Pertussis vaxx
34-36 wks visit
Group B strep vaginal swab
Cleft lip and palate risk for
aspiration due to uncoordinated suck and swallow
Cleft lip and palate S+S
Feeding difficulties: poor suction and uncoordinated suck and swallow
Nursing interventions of cleft lip and palate
Encourage bonding
Feed upright position
Burp after each ounce of formula consumed
Position nipple toward back or side of moth
Use special nipples/bottles
Postop care for cleft lip repair
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
Hirschsprung dz patho
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
Hirschsprung dz S+S
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
Nursing interventions for Hirschsprung dz
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
Infant botulism S+S
Symmetric, descending paralysis
Hypotonia and decreased head control
Ptosis
Absent gag reflex
Poor feeding
Nursing interventions of botulism
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
Neonatal abstinence syndrome S+S
CNS:
Irritability, inconsolability, high-pitched cry
Hypertonia, tremors
Short sleep cycles
Sneezing, yawning
Uncoordinated swallowing
Respiratory: tachypnea
GI: vomiting and diarrhea
Neonatal abstinence syndrome nursing interventions
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)
Newborn hypoglycemia
BG < 40-45
Can cause seizures and neuro injury if untreated
S+S of newborn hypoglycemia
Can be asymptomatic
Hypothermia
Poor feeding
Irritability
Exaggerated Moro reflex
Tachypnea
Tremors
Lethargy
Nursing interventions of newborn hypoglycemia
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
S+S of myelomeningocele
Sac-like protrusion containing:
Spinal cord
Spinal nerves
Spinal fluid
Associated complications w/ spina bifida
Abnormal hip development
Tethered spinal cord
Hydrocephalus
Neurogenic bladder
Nursing interventions of spina bifida
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
Lactational mastitis S+S
Flu-like symptoms:
Fever
Chills
Myalgias
Malaise
Local changes:
Unilateral breast pain
Focal erythema
Induration
Nursing interventions of lactational mastitis
Abx
Analgesics
Warm compresses to breast
Adequate rest, nutrition, hydration
Education of lactational mastitis
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
Causes of postpartum hemorrhage
Tone
Trauma
Tissue
Thrombin
Uterine atony
Inadequate contraction of uterus -> relaxed uterus distended w/ blood
Placental site blood vessels are not clamped off -> excessive bleeding
Risk factors of postpartum hemorrhage
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
What vaccinations can pregnant people not get?
Live vaxx (MMR, rotavirus, varicella/varicella zoster)
Placental abruption patho
Premature separation of placenta from uterus causes hemorrhage from placental blood vessels
Uterine rupture patho
Spontaneous tearing of uterus that may result in fetus being expelled into peritoneal cavity
Dark-red vaginal bleeding
Abdominal rigidity
Severe abdominal pain
Possible fetal distress (late decelerations)
Placental abruption
Sudden onset of extreme abdominal pain
Abnormal bump in abdomen
No uterine contractions or positive contractions
Uterine rupture
Placental abruption tx
C-section
Uterine rupture tx
Immediate laparotomy with delivery of the fetus with repair of the uterus
Regular, painful uterine contractions cause progression cervical dilation and effacement before term gestation
S+S: painful frequent contractions, lower back pain
Preterm labor
For preterm labor <32 wks tx
Corticosteroids
PCN
Tocolysis: indomethacin
Magnesium sulfate
For preterm labor 32-24 wks tx
Corticosteroids
PCN
Tocolysis: nifedipine
Preeclampsia labs
Proteinuria and creatinine
Amniotomy interventions
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
Polyhydramnios at risk for
Umbilical prolapse
Postpartum hemorrhage
Neonatal abstinence syndrome tx
Opioids
No naloxone
Spina bifida S+S on newborn
Tuft of hair
Hemangioma
Nevus
Dimple
Along base of spine
Proper breastfeeding technique
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
Breast engorgement for those not breastfeeding
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
Priorities of placental abruption
Assess maternal VS
Palpate abdomen/uterus
Continuous FHR monitoring
Indication of fetal distress and/or maternal hemodynamic compromise -> c-section
Vaginal exam is not indicated during what scenarios?
Active bleeding until possibility of placenta previa is ruled out
Pregnant women can work w/
MRSA
Before placing a fetal scalp electrode, nurse must know
Bloodborne infx (hepatitis B, HIV)
Cervical dilation (>2-3 cm)
Membrane status
Priority action for HELLP syndrome and preeclampsia
Magnesium sulfate to prevent seizures
Follow-up on pregnant pt if they report
Copious amts of watery, clear vaginal discharge (rupture of membranes)
Dysuria and flank pain (UTI)
Headache and blurred vision (preeclampsia)
