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NCLEX-PN > OB > Flashcards

OB Flashcards

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1
Q

Gynecoid Pelvis

A
  • Normal female pelvis
  • Round shape
  • Blunt, somewhat widely separated ischial spines
  • Diagonal conjugate measures 12.5 to 13 cm
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2
Q

Fertilization

A

Occurs in the ampulla (outer third) of the uterine (fallopian) tube

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3
Q

Implantation

A
  • 6 to 8 days after ovulation
  • Blastocyst secretes HCG to ensure that the corpus luteum remains viable and secretes estrogen and progesterone for the first 2-3 months of gestation.
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4
Q

Amniotic Fluid

A
  • 800-1200 mL by end of pregnancy
  • Fx: Surrounds, cushions, and protects fetus; allows fetal movement; maintains the body temp of fetus; contains fetal urine and is a measure of fetal kidney function
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5
Q

Placenta

A
  • Formed from the chorion (made by the blastocyst); begins to form at implantation; complete by week 12
  • Highly vascularized
  • Fx: exchange site for nutrients and waste products between the fetus and mother; produces hormones to maintain pregnancy (assumes full production of hormones by 12th week); transfers maternal immunoglobulin
  • By week 10 and 12: genetic testing can be done via chorionic villus sampling (CVS).
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6
Q

Fetal Circulation

A

-2 Arteries, 1 Vein
-Arts: deox blood, Vein: exy blood
-FHR: 160 to 170 bpm 1st tri; 110 to 160 bpm near or at term (about 2x maternal HR)
-Bypass: Ductus Arteriosus- pulmonary artery to aorta
Ductus Venosus- umbilical vein to to inferior vena cava
Foramen Ovale- opening between rt and lf atria

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7
Q

Pregnancy Signs

A

Presumptive: Amenorrhea; N/V; Inc size/fullness of breasts; pronounced nipples; Polyuria; Fatigue; Discoloration of vaginal mucosa; Quickening (usually 16th-20th week)

Probable: Positive HGC; Uterine enlargement; Goodell’s sign ( softening of cervix at beginning of 2nd mo of preg); Chadwick’s sign (Violet coloration of cervix/vagina/vulva approx. week 6); Hegar’s sign (Compressibility and softening of the lower uterine seg that occurs approx week 6); Ballottement (rebounding of the fetus against palpation); Braxton Hick’s contractions

Positive: Outline of fetus via radiography or ultrasound; FHR by doppler at 10-12 weeks or fetoscope at 20 weeks; Active fetal movements palpated

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8
Q

Fundal Height

A

16 weeks: approx. halfway between pubis symphysis and umbilicus
20 to 22 weeks: approx. at umbilicus
18-30 weeks: ht in cm = fetal age +/- 2 cm
36 weeks: at xiphoid process

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9
Q

Supine Hypertension

A
  • 2nd and 3rd trimester

- result of pressure of the uterus on the inferior vena cava

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10
Q

Maternal Risk Factors Ages

A

Age: <20 and >35

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11
Q

Antepartum Diagnostic Testing

A

1st 28 to 32 weeks: Every 4 weeks
32 to 36 weeks: Every 2 weeks
36 to 40 weeks: Every week

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12
Q

Rh negative mother

A

Rhogam shot at 28 weeks and after birth

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13
Q

Amniocentisis

A

-15 to 20 weeks ideal
-Ultrasound guided
-Full bladder <20 weeks; Empty >20 weeks
-Supine during; Left side after
Risks: Maternal hemorrhage; infection; Rh isoimmunization; Abruptio placentae; Amniotic fluid emboli; Premature rupture of membranes

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14
Q

Weight Gain

A

25 to 35 lbs
An inc of 300 kcal/day for pregnancy
An inc of 500 kcal/day for lactation

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15
Q

Abortion Intervention

A
  • Count perineal pads to evaluate blood loss.

- Save any expelled tissue and clots.

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16
Q

Anemia

A
  • Predisposes the patient to postpartum infection
  • Monitor H&H every 2 weeks
  • Take iron between meals and with Vit C. Avoid tea and milk products.
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17
Q

Blood Volume

A
  • Increases by 50%
  • Heart enlarges to accommodate
  • Blood vol peaks weeks 32 to 34. Dec slightly to week 40.
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18
Q

Chorioamnionitis

A
  • Bacterial infection of the amniotic cavity
  • Causes: premature rupture of membranes; vaginitis; ammniocentsis; intrauterine procedures
  • Result: Postpartum endometritis; neonatal sepsis
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19
Q

DM

A
  • 1st tri: insulin needs dec
  • 2nd and 3rd tri: placental hormones cause insulin resistance leading to a need for inc insulin
  • Watch for PP hypoglycemia
  • May not need insulin for 1st 24 hrs
  • Gest DM: occurs during 2nd or 3rd tri; Tx usually diet, sometimes insulin; oral hypoglycemic meds are unsafe
20
Q

Ectopic Pregnancy

A
  • Missed period
  • Abdominal pain
  • Vaginal spotting and bleeding that is dark red or brown
  • Rupture: Ince pain, referred shoulder pain, signs of shock
21
Q

Fetal Death

A
  • older than 20 weeks gestation
  • S/S: Absence of fetal movement/heart tones/growth; dec in fundal height; maternal weight loss; no evidence of cardiac activity
22
Q

TORCH

A 
Toxoplasmosis
Other (HIV, Syphilis, HBV, WEst Nile, etc)
Rubella
Cytomegalovirus
Herpes Simplex Virus
23
Q

Group B Strep

A

Dx: Vaginal and Rectal cultures between 35 and 37 weeks gestation

24
Q

TB

A

Trans: Transplacental is rare; Can occur during birth through aspiration of infected amniotic fluid; in newborn: contact with infected indiv

Maternal Risk: Active disease during preg has been associated with an inc in hypertensive disorders of pregnancy

25
Q

4 P’s of Labor

A

Powers: Uterine Contractions

Passageway: Bony pelvis, Cervix, Pelvic Floor, Vagina, introitus (external opening of vagina)

Passenger: Fetus, Membranes, Placenta

Psyche: Woman’s emotional structure that can determine her entire response to labor and influence physiological and psychological copping with the labor process; the mother may experience anxiety or fear

26
Q

Fetal Positioning

A

Attitude: Relationship of fetal body parts to one another; Normal: Flexion (fetal position)

Lie: Relationship of the spine of the fetus to the spine of the mother

Presentation: Portion of the fetus that enters the pelvis first; Cephalic/Breech/Shoulder

Presenting Part: the specific fetal structure lying nearest to the cervix

Station: Measurement of the progress of descent in cm above or below the midplane from the presenting part to the ischial spine;
Minus Station: above the ischial spine;
Station 0: at the ischial spine
Plus Station: below the ischial spine

Engagement: When the widest part has passed the inler; usually corresponds to a 0 station

27
Q

Fetal Monitoring

A

External fetal monitoring: non-invasive

Internal fetal monitoring: Invasive; requires rupturing the membranes and attaching an electrode to the presenting part; must be dialated 2-3cm

Bradycardia: <110 bpm for 10 mins or longer

Tachycardia: >160 bpm for 10 mins or longer

Accelerations: inc of at least 15 bpm over baseline for at least 15 secs; reassuring

Early Decelerations: Usually remains above 100 bpm; occur during contractions; Not associated with fetal compromise and require no intervention

Late Decelerations: Nonreassuring patterns that reflect impaired placental exchange or uteroplacental insufficiency; defree of the fall in the heart rate from baseline is not related to the amount of uteroplacental insufficiency

Variable Decelerations: Caused by conditions that restrict flow throught the umbilical cord;
Interventions: position change for mom; admin O2; discontinue oxytocin; mom VS; amnioinfusion as perscribed

28
Q

Stages of Labor

A 
Stage 1: Effacement and Dilation of the Cervix
3 Phases
Phase 1: Latent (1-4 cm dilation)
Phase 2: Active (4-7 cm dilation)
Phase 3: Transition (8-10 cm dilation)

Stage 2: Expulsion of the fetus

Stage 3: Separation and Expulsion of Placenta
- 5 to 30 mins after birth of baby

Stage 4: Physical Recovery
- 1 to 4 hours

29
Q

Oxytocin

A

Discontinue if:

  • Contraction frequency <2 mins
  • Contraction duration >90 secs
  • Fetal distress noted

Goal: frequency 2-3 mins; duration 60 secs

30
Q

Amniotomy

A
  • Artificial Rupture of Membranes (AROM)
  • Performed at 0 or plus station
  • Inc risk of cord prolapse or infection
  • Inc of variable decels after AROM
31
Q

External Version

A
  • External manipulation of the fetus from an unfavorable presentation into a favorable one for birth
  • Indicated for an abnormal presentation that exists after 34 weeks gestation
  • After: nonstress test to evaluate fetal well-being
32
Q

Placenta accreta

A
  • Abnormally adherent placenta
  • placenta penetrates the uterine muscle itself
  • Monitor for hemorrhage and shock
33
Q

Placenta Previa

A
  • Placenta imporoperly implanted in the lower uterine segment near or over the internal cervical os
  • total, partial, marginal
  • No digital vaginal examination
  • sudden onset of painless, bright red bleeding
  • uterus is soft, relaxed, and nontender
34
Q

Abruptio Placentae

A
  • Premaure separation of the placenta from the uterine wall after 20 weeks’ gestation and before the birth of the baby
  • Dark red vaginal bleeding
  • Uterine pain/tenderness
  • uterine rigidity
  • severe abdominal pain
  • signs of fetal distress
  • signs of maternal shock if bleeding is excessive
35
Q

Preterm Labor

A

After 20 weeks and before 37 weeks

36
Q

Premature Rupture of Membranes

A

Spontaneous rupture of the amniotic membrane befor the onset of labor

37
Q

Precipitous Labor and Delivery

A

Labor that lasts less than 3 hours

  • Have precipitous delivery tray available
  • Stay with the mother at all times
  • Deliver if PCHP is not available
38
Q

Amniotic Fluid Embolism

A
  • Escape of amniotic fluid into the maternal circulation
  • Usually fatal to mother
  • Abrupt onset of resp distress and chest pain
  • Cyanosis
  • Fetal bradycardia and distress if delivery has not occurred at the time of the embolism
  • Admin 8 to 10 L/min O2
  • Prepare for intubation and ventilation
  • Position on side
  • IV fluids, blood products, and meds for coag failure
  • Prepare for emer delivery after woman is stabilized
39
Q

Fetal Distress Signs and Interventions

A
  • FHR <110 or >160 bpm
  • Meconium-stained amniotic fluid
  • Fetal hypoactivity or hyperactivity
  • Pregressive dec in baseline variability
  • Severe variable decels
  • Late decels
  • Place mother in a lateral position
  • Admin O2 at 8 to 10 L/min
  • Discontinue oxytocin infusion
  • Monitor maternal and fetal status
40
Q

Postpartum Period

A

-Starts immediately after birth and is usually complete by week 6

41
Q

Involution of Uterus

A
  • Uterus dec from 2 lb to 2 oz
  • Endometrium regenerates
  • Fundus height dec about 1 cm per day (day 0: just above belly button)
  • 10 days PP: uterus cannot be palpated abdominally
  • Flaccid fundus indicates uterine atony (massage it)
  • Tender fundus indicates infection
42
Q

Lochia

A

-Uterine discharge fro blood vessels from the placental site and debis from the decidua

  • Rubra: Bright red; delivery to PP day 3
  • Serosa: Brownish-pink; PP day 4 to 10
  • Alba: White discharge; PP day 11 to 14
  • Odor: normal menstrual flow
  • Dec in amount daily
  • Inc with ambulation

Amount of Lochia (as measured by amount present on menstrual pad in an hour)

  • Scant: < 2.5 cm/ 1 in
  • Light: < 10 cm/ 4 in
  • Moderate: < 15 cm/ 6 in
  • Heavy: Fully sturated
  • Excessive: Pad saturaeated in 15 mins
43
Q

Breast Milk

A

Colostrum for 48 to 72 hours

Engorgement occurs approx. day 4

44
Q

Post Partum Interventions

A
  • VS (temp may inc in 1st 24 hrs; PR may be down to 50; RR and BP should be normal)
  • Pain Level
  • Fundus (with an empty bladder): ht, consistency, location
  • Lochia: color, amount, odor
  • Check breasts for engorgement
  • Perineum for swelling or discoloration
  • Perineal lacerations or episiotomy for healing
  • Incisions or dressings after C-section
  • I/O
  • Encourage frequent voiding
  • Monitor bowel status
  • Encourage ambulation
  • Extremities for thrombophlebitis
  • Rhogam admin within 72 hrs PP
  • Rubella immunization admin
  • Parent-Newborn bonding
  • Mother’s emotional status
45
Q

Hemorrhage and Shock

A
  • Bleeding of >500 mL after delivrey
  • Early (1st 24 hrs) or Late (>24 hrs)

Causes:

  • Uterine Atony
  • Laceration of the cervix or vagina
  • Hematoma development in the cervix, perineum, or labia
  • Retained placental fragments

Predisposing Factors:

  • Hx of PP Hem
  • Placenta Previa
  • Abruptio placentae
  • Overdistention of the uterus
  • Infection
  • Multiparity
  • Dystocia or prolonged labor
  • Operative Delivery (C-section, forceps, intrauterine manipulation.)
S/S:
Significant bleeding (perineal pad is soaked within 15 mins); Restlessness; inc HR; dec BP; cool/clammy skin; ashen/grayish color

Interventions:
Notify RN; Massage uterus; O2 (8 to 10 L/min); VS; Lay on side; meds; LR or NS; Blood/Blood products; Cathetre; Prep for surgery

46
Q

Infection

A

Any infection of the reproductive organs that occurs within 28 days of delivery or abortion

NCLEX-PN (11 decks)

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