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ABSN > Ob exam 2 - intra comps > Flashcards

Ob exam 2 - intra comps Flashcards

1
Q

when is PROM considered prolonged

A

when membranes have been ruptured for greater than 18 hours

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2
Q

fetal & newborn risk of (P)PROM

A

-respiratory distress syndrome (esp pporm)
-sepsis
-malpresentation
-prolapse of the umbilical cord
-non reassuring FHR pattern
-compression of the umbilical cord
-premature birth

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3
Q

nursing care of clients with PPROM

A

-determine duration of rom
-assess GA
-observe for signs & symptoms of infection
-assess hydration status
-assess fetal status
-assess childbirth preparation & coping
-encourage resting on left side
-comfort measures
-education

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4
Q

what meds might you deliver to a pt w/ (P)PROM

A

maternal corticosteroid administration to enhance fetal lung maturity
betamethasone 12 mg IM x 2 doses; 12-24 hrs apart

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5
Q

when does preterm labor (PTL) or premature onset of labor (POL) occur

A

between 20-36 6/7 weeks

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6
Q

uterine contractions that correspond to PTL

A

4 within 20 mins or 8 in 1 hour

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7
Q

PTL S/s

A

-cervical change or dilation
-mild menstrual like cramps felt low in the abdomen
-pelvic pressure
-ROM
-low, dull backache
-increased vaginal discharge

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8
Q

strongest predictors of preterm birth

A

-positive fetal fibronectin results
-abnormal cervical length measurement (shortening, <25mm before term
-hx of PTL
-presence of infection

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9
Q

what to monitor w/ procardia (nifedipine)

A

BP bc we are not giving it for high BP but instead to relax the uterine muscles
do not give if SBP is <90

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10
Q

what are the tocolytic medications to stop contractions

A

-procardia (nifedipine)
-mag sulfate
-terbutaline (brethine)
-progesterone therapy

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11
Q

what to monitor w/ mag sulf

A

alertness, respirations, BP, reflexes & I/Os

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12
Q

what to monitor w/ terbutaline

A

length of administration -> acute use so only 2-3 days
do not give if HR is greater than 120 bc can cause tachy
side effects include flushes face, heart is racing and trembling

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13
Q

does mag sulf need to be in the primary or secondary line

A

primary only do enough for 2hr worth at a time for safety

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14
Q

what is a secondary benefit of mag sulf when being used for preterm labor

A

neuroprotective decreases the risk of intracranial hemorrhage & necrotizing enterocolitis in the babies

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15
Q

what is the steroid window

A

48 hours past 1st dose

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16
Q

what is the effect of steroids that promotes lung maturity

A

causes a release of surfactant

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17
Q

cervical insufficiency “incompetent cervix”

A

painless dilation of the cervix without contractions cervical defect, will see shortened cervical length <25 mm
dx could be made if pt has had pervious miscarriages w/o contractions

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18
Q

cervical insufficiency medical care

A

-serial cervical ultrasounds beginning between 16-24 wks GA
-bed rest
-progesterone supplementation
-abx (not entire pregnancy)
-education about signs of impending birth (lower back pain, pelvic pressure, changes in discharge & bleeding after cerclage) *call HCP**

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19
Q

cervical insufficiency surgical intervention

A

cerclage surgical closure of cervix using suture (stitching)

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20
Q

when would a cerclage be used

A

-cervical insufficiency
-prophylactic pregnancy w/ multiples

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21
Q

if a cerclage is placed, what should be monitored

A

bleeding
activity level -> pt does not need to be on strict bed rest at home, goal is for cervix to stabilize and light activity be performed

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22
Q

if a cerclage is placed, when is it removed

A

for delivery -> cut either before a vaginal birth or if C section then can be left in place and removed later

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23
Q

placenta previa

A

placental implantation in the lower uterine segment which causes placenta villi to be torn from the uterine wall leading to bright red painless bleeding

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24
Q

placenta previa causes

A

-high gravidity
-increasing age / advanced maternal age
-prior C section
-recent spontaneous or induced abortion
-cigarette smoking
-male fetus (more common)

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25
Q

placenta previa: complete

A

the placenta completely covers the cervix

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26
Q

placenta previa: partial

A

the placenta partially covers the cervix

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27
Q

placenta previa: marginal

A

placenta is near the cervix low lying

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28
Q

placenta previa: low lying

A

low lying
fairly close to cervix but not touching it

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29
Q

placenta previa nursing care

A

-no vaginal exams
-assess for bleeding (active = transfusion)
-VS & fetal monitoring & contractions
-anticipate unengaged fetal presenting part (transverse lie is common)
-obtain consent for C section ICE
-administer tocolytics as ordered

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30
Q

abruptio placentae

A

premature separation of a normally implanted placenta from the uterine wall

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31
Q

abruptio placentae: marginal

A

placenta separates at its edges

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32
Q

abruptio placentae: central

A

placenta separates centrally -> concealed bleeding hard abdomen where blood is pooling

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33
Q

abruptio placentae: complete

A

total separation -> massive vaginal bleeding

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34
Q

abruptio placentae: grade 1

A

48%
mild separation, slight vaginal bleedingV

35
Q

abruptio placentae: grade 2

A

27%
partial abruption with moderate bleeding

36
Q

abruptio placentae: grade 3

A

24%
complete separation with moderate to severe bleeding

37
Q

abruptio placentae S/s

A

-sudden & stormy onset
-bleeding is external or concealed
-blood is dark
-severe & steady pain, uterus is tender
-uterine tone is firm

38
Q

placenta previa S/s

A

-quiet & sneaky onset
-external bleeding
-blood is bright red
-pain only present at labor, uterus is not tender
-uterine tone is soft & relaxed

39
Q

abruptio placentae care

A

-external monitoring of contractions
-external monitoring fetus
-monitor for c/o abdominal pain
-monitor for development of DIC (coag test)
-immediate priorities are maintaining maternal cardiovas status
-C section is usually safest delivery

40
Q

maternal and fetal risks of multiple gestations

A

PLT
uterine dysfunction
abnormal fetal presentations
instrumental or C section
PP hemorrhage
higher mortality rate than for single fetus
decreased intrauterine growth rate
increased incidence of fetal anomalies
increase in cord accidents
increase in cerebral palsy

41
Q

multiple gestations: discomforts

A

-SOB / dyspnea on exertion
-bachache
-round ligament pain
-heartburn
-pelvic or suprapubic pressure
-pedal edema

42
Q

multiple gestation: comfort measures

A

-side lying position w/ lower body elevated
-pelvic rocking
-good posture
-good body mechanics

43
Q

multiple gestation: care

A

-more frequent visits & educate on signs of fetal activity and preterm labor
-serial ultrasounds
-anesthesia & cross match blood ready @ delivery
-dual monitoring
-likely choose c section

44
Q

multiple gestation: nutrition

A

-prenatals
-daily folic acid intake of 1mg
-wt gain of 40-45 lbs (24 lbs gain by wk 24)

45
Q

amniotic fluid embolism

A

amniotic fluid leaks into the maternal circulation through a small tear in the amnion or chorion of the uterus during placental separation or through cervical tears under pressure -> embolism blocks vessels of the lungs rare but 80-90% mortality rate

46
Q

amniotic fluid embolism S/s

A

chest pain, dyspnea, cyanosis, frothy sputum, tachycardia, hypotension, massive hemorrhage

47
Q

amniotic fluid embolism: care

A

-stabilize cardiovascular & res system
-displace uterus to allow better blood flow
-infusion of whole blood
-placement of central venous pressure line to monitor fluid overload
-immediate birth may be needed

48
Q

dysfunctional labor patterns: hypertonic contractions

A

tachysystole -> more than 5 contractions in a 10 min time period

49
Q

dysfunctional labor patterns: hypotonic contractions

A

fewer than 2-3 contractions in 10 minutes (low intensity contractions)

50
Q

tachysystole care

A

-assess contractions, vitals & FHR
-comfort measures
-change positions & back rubs
-turn off oxytocin
-tocolytic
-sedation / pain meds

51
Q

care for hypotonic contractions

A

-assess contractions, vitals & FHR
-consider cephalopelvic disproportion
-rule out malpresentation
-maintain adequate hydration
-monitor for signs of infection
-stimulation of contractions (oxytocin)

52
Q

post dates

A

pregnancy has gone beyond estimated date of birth

53
Q

post term

A

pregnancy has gone beyond 42 completed weeks

54
Q

care for post term pregnancies

A

-assess fetal well being
-daily fetal movement counts
-NST
-biophysical profile
-induction of labor

55
Q

maternal risks for post term pregnancy

A

-perineal damage
-hemorrhage
-increased risk of C section
-anxiety
-emotional fatigue
-persistence of normal discomforts

56
Q

fetal risks for post term pregnancy

A

-decreased perfusion
-oligohydramnios
-SGA
-macrosomia
-increase risk for meconium stain ed fluid

57
Q

malposition (OP) techniques to move baby

A

-mother rotates side to side
-knee to chest position
-hands and knees position
-physician / CNM may manually rotate fetal head during labor

58
Q

malpresentation

A

-shoulder presentation
-brow presentation
-face presentation
-breech

59
Q

version

A

turning of the fetus in utero

60
Q

version: external cephalic version

A

external manipulation of maternal abdomen to change fetus from breech to cephalic position

61
Q

version: podalic version

A

internal
used in delivery of 2nd twin

62
Q

if a version is about to happen, what must be done

A

-pt signs consent to procedure & c sections +
-IV is in place
-ultrasounds
-terbutaline if contracting
-fasting for 8hrs
-fetal monitoring (w/ reactive NST)
-rhogam if pt is Rh negative

63
Q

reasons for a non reassuring fetal status

A

-variation in HR
-decreased fetal movement
-meconium stained amniotic fluid
-persistent late decels
-persistent severe variable decels

64
Q

umbilical cord prolapse

A

umbilical cord precedes presenting fetal part and is compressed against maternal pelvis

65
Q

how to prevent umbilical cord prolapse

A

bed rest if fetal presenting part high in pelvis & amniotic fluid is ruptured

66
Q

if umbilical cord is felt during vaginal exam, what do you do

A

keep gloved fingers in vagina to relieve pressure & position for gravity to help relieve compression (knees to chest or trendelenburg) -> apply O2 mask & prepare for C section

67
Q

is baby has true cephalopelvic disproportion (CPD), how should baby be delivered

A

can use vacuum or forceps assessed vaginal birth but best practice is C section

68
Q

fetal risk for CPD

A

-increased risk of cord prolapse
-excessive molding of fetal head
-bruising
-nerve trauma

69
Q

macrosomia

A

large fetus weighing more than 4000 grams

70
Q

macrosomia risks

A

-dysfunctional labor
-uterine rupture
-perineal lacerations
-postpartum hemorrhage
-should dystocia

71
Q

when do you want to ID macrosomia

A

before labor begins

72
Q

if cleared for vaginal delivery with a macrosomia baby, what should the nurse be prepared for

A

-lack fetal descent should raise suspicion that infant is too large for vaginal birth
-unexpected shoulder dystocia, may be asked to assist w/ McRoberts maneuver or apply suprapubic pressure to aid shoulder delivery never perform fundal pressure

73
Q

shoulder dystocia

A

shoulders entrapped behind suprapubic bone

74
Q

dangers of shoulder dystocia

A

-brain damage from hypoxia
-brachia plexus damage
-umbilical cord occlusion

75
Q

interventions of a shoulder dystocia

A

-lower head of bed
-McRoberts maneuver (rotate legs up and out to open pelvis)
-suprapubic pressure (downward w/ hand)
-document interventions & length of time of dystocia

76
Q

retained placenta

A

retention of placenta beyond 30 mins after birth, bleeding can be excessive & may require manual removal of placenta -> possible transfusion after depending on blood loss
increased risk for infection

77
Q

lacerations

A

-spontaneous tearing of the perineal area
-suspected when bright red vaginal bleeding persists despite well contracted uterus
- 1 to 4 degrees
- assist w. 4th stage labor repair and observe for bleeding and approximation during PP

78
Q

placenta: accreate, increta / percreta

A

-abnormal adherence of the placenta to the uterine wall
-associated w/ maternal hemorrhage & failed placental separation after birth
high incidence of abdominal hysterectomy

79
Q

placenta accreta

A

chorionic villi attach directly to the uterine myometrium

80
Q

placenta increta

A

myometrium is invaded

81
Q

placenta percreta

A

myometrium is penetrated
-sometimes attaches to nearby organs like the bowel or bladder

82
Q

where does the placenta usually connect to

A

the endometrium

83
Q

placenta accreate, increta / percreta care

A

-monitor for bleeding
-deliver before 38 wks
-type & cross for blood transfusion
-2/3 women have hysterectomy to prevent maternal hemorrhage
-repair organ damage

84
Q

if a baby is lost in utero, what organization always has to be consulted

A

KODA for organ donation

ABSN (90 decks)

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