Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB EXAMS > OB EXAM 3 > Flashcards

OB EXAM 3 Flashcards

1
Q

GBS: Group B Streptococcus

A
  • GBS is a bacterial infection that can b passed to a fetus during labor and delivery
  • GBS- Group B streptococcus- NOT an STD- present in 25% of healthy pregnant women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

GBS preparing for delivery

A

Bacterial infection that can be passed to the fetus during labor and delivery

  • All women are screen between 35-37 weeks by doing a vaginal and rectal swab
  • Mother needs intrapartum antibiotics prophylaxis
  • Penicillin is initially given bolus via IV followed by Penicillin every 4 hours bolus until delivery (obviously check for cillin allergies)
  • Mother can still have vaginal birth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Epidural interventions

A
  • Administer a bolus of IV fluids to help offset maternal hypotension (hypotension is the biggest concern following an epidural)
  • Patient should sit in a side lying or modified Sims position with her back curved
  • Encourage woman to stay side lying after epidural
  • Coach the patient in pushing efforts
  • Monitor patient’s vital signs
  • Assess FHR continuously (can cause bradycardia)
  • Have oxygen and suction available
  • Raise side bed rails and do not allow client to ambulate unassisted
  • Assess the bladder for distention at frequent intervals and catheterize as necessary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

High Risk Perinatal Care: Pre-existing Conditions

Gestation Diabetes: Anticipated Pharmacological Interventions

A
  • Should be managed initially with diet and exercise but if not successful, insulin can be given (Pharmacological interventions started if fasting glucose is persistently higher than 95- 1 hour post meal)
  • Glyburide and Metformin are the only ORAL medications not contraindicated during pregnancy
  • Diagnosed when blood sugar is over 130-140 following 1-hour glucose test
  • Be sure to take insulin even if unable to eat or appetite is less than normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Placenta Previa- Postpartum Focus:

A
  • Placenta Previa- when placenta covers some of all of cervix instead of attaching to the fundus completely
  • The major complication after birth is hemorrhage because the large vascular channels in the lower uterus may continue to bleed because of diminished muscle content.
  • Hysterectomy may be necessary if bleeding doesn’t stop
  • C section is common with placenta previa so emotional support is important
  • Mother may need blood transfusion following complication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Abruptio placenta complication assessment

A
  • Ultrasound is done to check fetal wellbeing and biophysical profile
  • Palpate the uterus for tenderness and tone
  • Perform monitor of fundal height
  • Assess FHR pattern
  • IMMEDIATE BIRTH IS THE MANAGEMENT!!!!
  • Administer IV fluids, blood products and medications
  • Administer oxygen 8-10 L via face mask
  • Monitor maternal vital signs, observing for declining hemodynamic status
  • Continuous fetal monitoring
  • Assess urinary output and monitor fluid balance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Spontaneous abortion: anticipated intervention/nursing support

A

o notify the provider of heavy, bright red vaginal bleeding, elevated temperature or foul smelling discharge

o a small amount of discharge is normal for 1 to 2 weeks

o take prescribed antibiotics

o refrain from tub baths, sexual intercourse or placing anything in the vagina for 2 weeks

o avoid becoming pregnant for 2 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Ectopic pregnancy: anticipated intervention

A

**o transvaginal ultrasound shows an empty uterus

o levels of progesterone and elevated hCG rule out ectopic pregnancy**

o replace fluids, and maintain electrolyte balance

o provide client education and psychological support

o prepare patient for surgery and postoperative nursing care

o provide referral for client and partner for pregnancy loss support group

o octain serum hCG and progesterone levels, CBC, type and rH.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

HELLP syndrome identification

A
  • H: hemolysis; resulting in anemia and jaundice
  • EL; elevated liver enzymes- elevated ALT or AST, epigastric pain and n/v
  • LP; low platelet- less than 100,000 mm. Resulting in thrombocytopenia, abnormal bleeding and clotting time. Bleeding gums, petechiae, and possibly disseminated intravascular coagulation

** important to remember than many women with HELLP syndrome may not have signs or symptoms of preeclampsia with severe features. Most women will have hypertension but proteinuria may be absent, as a result women are misdiagnosed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Non-reassuring electronic fetal monitor signs

A
  • *Tachycardia- sign of maternal infection**
  • Late decels- BAD. Placenta problems.
  1. Discontinue oxytocin
  2. Side lying position
  3. Administer oxygen at 10 L
  4. Increase IV solution
  5. Palpate uterus
  6. Call the doctor
    * Variable decelerations- No good! Caused by cord issues. Cord around neck, cord has a knot, etc.
  7. Same interventions except…
  8. An amnioinfusion could be ordered
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Non-reassuring electronic fetal monitor signs

A
  • *Tachycardia- sign of maternal infection**
  • Late decels- BAD. Placenta problems.
  1. Discontinue oxytocin
  2. Side lying position
  3. Administer oxygen at 10 L
  4. Increase IV solution
  5. Palpate uterus
  6. Call the doctor
    * Variable decelerations- No good! Caused by cord issues. Cord around neck, cord has a knot, etc.
  7. Same interventions except…
  8. An amnioinfusion could be ordered
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Non-reassuring electronic fetal monitor signs

A
  • Early Decels- head compression and are okay. No interventions necessary
  • Accelerations- those are fine and reassuring! Baby moves, heart rate goes up. Makes sense!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Recognizing FHR decelerations (Matching)

A

o Early decels- heart rate drops when the contract starts and goes back up when contraction is over. No big deal. Head compression causes it.

o Late decels- The deceleration of the heart rate begins after the contraction has already started and it drops the lowest after the peak of the contraction. FHR doesn’t return to normal until after contraction is over. (so everything happens late, hence LATE decel)

o Variable decels- visually ABRUPT FHR that lasts at least 15 seconds and is 15 or more below the baseline. Should return to normal within 2 minutes. Can occur with or without contractions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Recognition of signs of OB emergencies: amniotic fluid embolism

A
  • Occurs when there is a rupture in the amniotic sac or maternal uterine veins accompanied by high intrauterine pressure which causes infiltration of the amniotic fluid into the maternal circulation. DIC can occur.
  • Mother will complain of SUDDEN chest pain and/or shortness of breath.*
  • Indications of respiratory distress:
    1. Restlessness, cyanosis, dyspnea, pulmonary edema

o Indications of coagulation failure

  1. Bleeding from incisions and venipuncture sites
  2. Petechia and ecchymosis
  3. Uterine atony
    - Indications of circulatory collapse:
  4. Tachycardia, hypotension
  5. Shock, cardiac arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Preterm labor management:

A

Focus is obviously stopping the contractions.

  • Activity restriction- modified bed rest, strict bed rest is bad and can have adverse effects
  • Avoid sexayyy time
  • Encourage client to rest in left lateral position
  • Ensure hydration
  • Make sure client knows any signs of infection
  • Monitor FHR and contraction pattern
  • Medications: TOCOLYTICS :
  • IT’S NOT MY TIME: INMT*

Don’t forget those lungs! Betamethasone- increases surfactant production in fetuses. Fetuses need 2 doses- 24 hours apart.

  • If giving mag sulfate- make sure you have calcium gluconate on hand!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Shoulder dystocia intervention

A
  • Assist with applicaition of fetal scalp electrode and/ or intrauterine pressure catherrer.
  • assist with amnioyomy (artfical rupture of membranes)
  • encourage client to engage in regular voiding to empty bladder
  • encourage position change to aid fetal decent or to open up pelvic. assist the client to a position on her hands and knees to help fetus rotate from posterior to anterior.
  • encourage ambulation to enhance the progression of labor
  • encourae hydo therapy other relaxion techniq
  • apply counter pressure using fist or heel/ hand to sacral area to alleviate discomfort
  • prepare for possible foreceps-assised, vacuum-assisted or c-section birth.
  • continue to monitor FHR in response to labor
17
Q

Preparing for external version

A
  • Ultrasound guided hands on procedure to externally manipulate the fetus to be head down
  • High risk of placental abruption, umbilical cord compression and emergency c section
  • Continuously monitor FHR during and for 1 hour after
  • Watch for hypotension in mother r/t vena cava compression
  • Tocolytics (Terbutaline) sometimes given before to prevent contractions
  • Monitor for ROM, bleeding, decrease in fetal activity and contractions
18
Q

Afterbirth cramping rationale

A

Uterus cramps after birth because it is attempting to return to its regular size. Breastfeeding can help breastfeeding return to its normal size. More babies you have, the more painful it generally is.

19
Q

Post-Partum Hemorrhage/ risk factor

A

Post-Partum Hemorrhage- client loses more than 500 ml for vaginal delivery and 1000 ml for c section

Risk factors:

  1. Uterine atony, overdistended uterus
  2. Previous history of uterine atony
  3. Placenta previa or abruptio
  4. Administration of magnesium sulfate
  5. Retained placenta fragments
20
Q

Post-Partum Hemorrhage findings

A

Expected findings:

  1. Boggy uterus
  2. Blood clots larger than a quarter
  3. Perineal pad saturation in 15 minutes or less
  4. Constant oozing or trickling of bright red blood from the vagina
  5. Tachy and hypotension
21
Q

Post-Partum Hemorrhage Nursing care/ meds

A

Nursing Care

  1. Massage that uterus
  2. Monitor vitals
  3. Assess bladder for distension- if distended go POTTY
  4. Initiate IV fluids
  5. Provide oxygen

Medications

  1. Oxytocin
  2. Methylergonovine
  3. Misoprostol (Cytotec)
22
Q

Mastitis risk factor

A

Risk factors:

  1. Most common in mothers who are breastfeeding for the first time
  2. Usually unilateral and can progress to an abscess if not treated
  3. Usually occurs after 6 weeks of delivery
  4. Milk stasis from a blocked duct
  5. Nipple trauma or cracked nipples
  6. Poor breastfeeding technique
  7. Decrease in feedings r/t using formula
  8. Poor hand hygiene
23
Q

Mastitis findings

A

Expected findings:

  1. Enlarged tender lymph noted on affected side
  2. Area of inflammation that can be red, swollen, warm or tender
24
Q

Mastitis Nursing care

A

Nursing Care

  1. Provide education regarding hand hygiene (thoroughly wash hands prior)
  2. Frequent change of breast pads
  3. Allow nipples to air dry
  4. Teach proper positioning and latch techniques
  5. Make sure client is completely emptying breasts with each feeding
  6. Use ice packs or warmth on affected breast to help discomfort
  7. NEED TO CONTINUE TO BREASTFEED
  8. Increase fluids- wear a well fitted bra

Medications:

  1. Antibiotics! (it’s an infection caused by bacteria so of course!!)
25
Q

DVT risk factors

A

Risk factors:

  1. Pregnancy or c section
  2. Smoking
  3. Older than 35
  4. Multiple babies
  5. Hx of clots
26
Q

DVT findings

A

Expected findings: D (deep pain in leg), V (violet or red color to leg), T (tense swollen leg)

  1. Leg pain and tenderness
  2. Unilateral area of swelling, warmth and redness
  3. Calf tenderness
27
Q

DVT Nursing care/ meds

A

Nursing Care

  1. To prevent one- compression devices until patient can ambulate, active and passive ROM if on bed rest, avoid prolonged periods of standing, sitting, immobility, avoid crossing legs, maintain fluid intake of 2-3 L, stop smoking
  2. To treat one- Encourage rest, elevation of leg above heart (avoid pillows under knees), DO NOT massage that leg… do you want a PE?! NO.
    * Medications:
  3. Heparin
  4. Warfarin
  5. ATI says NSAIDs but Mosby said no NSAIDs sooo not sure there
28
Q

infection risk factors

A

Infection- infection of what?? We talked about mastitis so let’s talk about a good old uterus infection (Endometritis)

Risk factors:

  1. Cervical dilation that provides the uterus with exposure to the external environment
  2. Wounds from lacerations, incisions or hematomas
  3. C section
  4. Prolonged rupture of membranes
  5. Multiple vag exams
  6. Epidural or episiotomy
29
Q

infection findings

A

Expected findings:

  1. Pelvic pain, chills, fatigue, loss of appetite
30
Q

infection Nursing care/ meds

A

Nursing Care

  1. Collect vaginal and blood cultures
  2. Administer IV antibiotics
  3. Administer analgesics
  4. Encourage client to maintain interaction with infant to facilitate bonding
  5. Teach client good ole hand hygiene

Medications

  1. Clindamycin (Antibiotic)
31
Q

Pulmonary embolism risk factors

A

Risk factors:

  1. Pregnancy or c section
  2. Smoking
  3. Older than 35
  4. Multiple babies
  5. Hx of clots
32
Q

Pulmonary embolism findings

A

Expected findings:

  1. Pleuritic chest pain
  2. Dyspnea
  3. Tachypnea
  4. Hemoptysis
  5. Distended neck veins
  6. Elevated temperature
  7. Apprehension
33
Q

Pulmonary embolism Nursing care

A

Nursing Care

  1. Place the client in a semi fowler’s position with the head of the bed elevated to facilitate breathing
  2. Administer oxygen by mask

Medications

  1. Heparin
  2. Warfarin
  3. Ateplase or streptokinase
34
Q

Anticoagulant teaching-

A
  • DVT- usually treated with continuous IV heparin for 3-5 days
  • Oral anticoagulant therapy (warfarin/coumadin)- is started after heparin and usually continues for 3 months if DVT and 6 months if PE
  • If mother is on long term anticoagulant therapy, the infant’s PTT should be monitored at least monthly
35
Q

Uterotonic drugs to treat atony-

A
  • Same as for hemorrhage:
  • Oxytocin- promotes uterine contractions
  • Methylergonovine- uterine stimulant
  • Cytotec (Misoprostol)- uterine stimulant
  • Carbopost Tromethamine- uterine stimulant
36
Q

Recognizing mood disorders-

A
  • Baby blues- should go away in a few days or 1 week
    1. s/s- anxious, sad, crying spells, loss of appetite, difficulty sleeping
  • Postpartum depression-
    1. Same signs as baby blues but they last longer and are more severe
    2. Thoughts of harming oneself or baby
    3. Not having any interest in baby
  • Postpartum psychosis-
    1. Seeing or hearing things that are not there
    2. Feelings of confusion
    3. Rapid mood swings
    4. Trying to hurt yourself or baby
  • Call doctor if:
    1. Baby blues continue for more than 2 weeks
    2. Symptoms of depression get worse
    3. Difficult performing tasks
    4. Inability to care for yourself or baby
    5. Thoughts of harming yourself or baby

OB EXAMS (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions