OB Exam 3 Pt 1 Flashcards
What is a high-risk pregnancy?
One in which the life or health of the mother or fetus is jeopardized by a disorder coincidental with or unique to pregnancy.
What is the free noninvasive low tech way of assessing a fetus after 20 weeks?
Kick counts, or DFMC (daily fetal movement counts.)
When is vaginal U/S the preferred method of sonogram?
In the first trimester.
For which kind of sonogram does the mother need a full bladder?
Abdominal U/S, to displace the uterus upward.
Which five variables are studied in a biophysical profile?
Fetal breathing movements, gross body movements, fetal tone, reactive FHR, qualitative amniotic fluid volume. Pg. 643.
What are indications for an amniocentesis?
To diagnose genetic disorders or congenital anomalies, fetal pulmonary maturity, and fetal hemolytic disease..
When is the earliest possible time (in weeks of pregnancy) when an amniocentesis can be done?
14 weeks.
When can CVS be performed in terms of weeks of pregnancy?
First or second trimester, ideally between 10 – 13 weeks. Pg. 647
Though 16 – 18 weeks for the MSAFP screen is ideal, between how weeks of pregnancy is it reliable?
15 – 20 weeks. Pg. 648
We usually use the triple or quad screen or multiple test marker now, rather than just the MSAFP because the multiple markers tests for two disorders. Which two disorders?
Chromosomal abnormalities like Down’s syndrome and other types of trisomy, and neural tube defects. Pg. 649
At how many weeks gestation should the triple marker be done?
16 – 18 weeks
For which disorder does the Coombs’ test screen?
Antibodies that indicate Rh incompatibility, and some other antibodies.
According to page 649, what is the goal of 3rd trimester testing?
To determine whether the intrauterine environment continues to be the best place for the fetus.
When doing an NST the Doppler transducer and tocometer are attached to the belly, as we do when we will monitor a laboring woman. We also give the woman a button to press. When should she press it?
When she feels fetal movement.
What are the criteria for a reactive NST tracing?
(1)Two or more accelerations of 15 beats per minute lasting 15 seconds in a 20 minute period. Box 26-7
The contraction stress test (CST) is done using oxytocin to cause contractions. What are the two sources of oxytocin that may be used in this?
IV oxytocin and nipple stimulation
With CST, as with other tests, a “negative” test means that there are no “bad” or unwanted results. A “positive” test means there was an untoward or unwanted result. What is a positive result for a CST?
Late decelerations with 50% or more contractions. Box 26-8.
Is pregnancy-related hypertension on the rise, or is it declining?
Rising. Pg. 654
List the complications that hypertensive women are at risk for, beginning with abruptio placenta.
Abruptio placenta, ARDS, stroke, cerebral hemorrhage, hepatic or renal failure thrombocytopenia, DIC, pulmonary edema.
Maternal death from preeclampsia is usually a result of complications from:
Hepatic rupture, abruptio placenta, eclampsia.
Gestational HTN begins after ____ weeks of pregnancy and– is—or is not? –associated with proteinuria.
20 weeks and is not associated with proteinuria Pg. 655
Preeclampsia develops after 20 weeks of pregnancy with two initial manifestations: _____ and ______.
Hypertension and proteinuria
What is the B/P measurement that defines HTN that is given in your book?
140/90 pg. 655
Which parameters define severe preeclampsia? (pg 786)
B/P >160/110 and >5 gm/24 hours protein in the urine, which would equal >3 + on the dipstick. Table 27-2.
Which signs and symptoms of severe preeclampsia might women manifest?
Oliguria, headache, visual disturbances (like scotomata) or blurred vision, irritability or changes in affect. Hepatic involvement including epigastic pain, RUQ pain, impaired liver function, thrombocytopenia with platelets < 100,000 mm3; pulmonary edema, Table 27-2.
When does preeclampsia become eclampsia?
When seizures or coma occur.
How can we know if a woman has chronic hypertension or if it is pregnancy –related?
If it is discovered before the pregnancy, or even before 20 weeks of gestation. Then it is chronic HTN..
Though B/P is the easiest problem to measure when a woman has preeclampsia, it is not the main pathogenic factor. What is? (This is important.)
Poor perfusion as a result of vasospasm and decreased plasma volume. Pg. 657.
Which liver complication is life-threatening and a surgical emergency?
Rupture of a subcapsular hematoma, Pg. 658.
What neurological signs and symptoms might preeclampsia demonstrate that the nurse can see and monitor?
Complaints of headache, reflexes > +2, positive ankle clonus, seizures. Pg.658.
How does impaired placental perfusion affect the fetus?
Fetal growth restriction, incidence of placental abruption, premature birth, and early degenerative aging of the placenta.
To which laboratory findings and diagnosis does the acronym HELLP correlate?
Hemolysis, elevated liver enzymes, low platelets.
What is the typical ethnicity of women who develop HELLP syndrome?
Caucasian women.
List possible adverse outcomes of HELLP syndrome.
Pulmonary edema, ARF, DIC, placental abruption, liver hemorrhage or failure ARDS, sepsis and stroke and preterm birth.
How could a nurse assess for clonus? What is the normal finding when assessing for this?
Dorsiflex the foot, hold it then release’ normal findings are that no jerk of the foot is noted after release. Pg. 661.
A woman is mildly preeclamptic. How could the status of her fetus be evaluated?
A BPP, nonstress testing, and serial ultrasonography. Pg. 662.
A woman with mild preeclampsia is being managed at home. Which three things might she be asked to do by way of self- monitoring, to determine her status?
Urine dipstick protein, B/P checking, and kick counts. (Teaching for self-management box).
When a woman has severe gestational hypertension,HELLP Syndrome or severe preeclampsia, at how many weeks of pregnancy at the earliest, could an induction be performed?
34 weeks. Pg. 663.
Which is the drug of choice to prevent seizures in preeclampsia and HELLP syndrome?
Magnesium sulfate.
What is the IV loading dose of magnesium sulfate and what is a typical hourly dose?
4 – 6 grams IV; 2 grams/hour.
What are the target therapeutic serum levels of magnesium?
4 – 7 mEq /L.
Know and list the signs of mild and increasing magnesium toxicity.
Mild toxicity: lethargy, muscle weakness, decreased or absent DTRs, double vision and slurred speech. Increasing toxicity: maternal hypotension, bradycardia, bradypnea and cardiac arrest.
A patient is experiencing magnesium sulfate toxicity. The nurse stops the magnesium drip and gives the antidote. What is the antidote for magnesium sulfate?
Calcium gluconate, IV push. 665
