OB Final Flashcards
What increases the effectiveness of a diaphragm? How should it be applied?
spermicidal cream
place 15 min before intercourse, remove 6 hours after (though only effective for 1 hour)
What is client education for diaphragm use? What is the timeframe of use? What are the contraindication for use?
Be properly fitted
Replace q2yrs and/or with 15-20% weight fluctuation
Empty bladder prior to insertion
Wash with mild soap and warm water
Can be inserted up to 6 hrs before intercourse
Stays in place 6-24 hrs after intercourse
Hx of TSS
cystocele (prolapsed bladder)
uterine prolapse
frequent UTIs
What is the nature of combined oral contraceptives? What is some client education? What are other therapeutic effects?
combines hormones estrogen and progestin to suppress ovulation and thicken cervical mucus
Routine pap smears and breast exams
Must be consistent to be effective
Take at bedtime if nausea occurs
decreased iron def. anemia
regulates cycles
reduces dysmenorrhea
improves acne
protects against some cancers
inhibits ovarian cyst growth
What are increased risks with use of COCs? What are the contraindications for the use of COCs? When can a COCs resume postpartum?
DVT
stroke
heart attack
HTN
gallbladder disease
liver tumor
exacerbates migraines, epilepsy, asthma, kidney and heart disease
Hx of DVTs, HAs, stroke, CAD, gallbladder disease, cirrhosis, migraines, HTN, DM, breast or estrogen-related cancers
Smoking
>35 yrs
Pregnancy, lactating
6+ weeks
When is ovulation? What are the physiological identifiers of ovulation? What is the spinnbarkeit sign? How is the fertile period then identified?
generally 14 days prior to menstration
Following ovulation mucus becomes thin and flexible (like egg whites) because of estrogen and progesterone
This allows for sperm to be more mobile in the canal
Mucus is stretchiest during ovulation
begins when mucus thins and lasts 4 days after the last day of thin mucus
What is the physiology of the placenta? When does circulation from the placenta begin? In what way does the exchange occur? What are the functions of the placenta?
Begins as a few trophoblastic cells and grows into a “pancake” organ
12th day of pregnancy, by 3rd week transporting O2 and nurtrients
osmosis
fascilitates the transpirt of O2 and nutrients
Filters waste
Acts a a barrier for some toxins and insulin
What are the hormones produced by the uterus and their functions?
hCG (human chorionic gonadotropin)
ensures corpus luteum continues to produce E and P to maintain the endometrium and to protect the placenta
progesterone
maintains pregnancy with the endometrial lining, reduce contractility of uterus to prevent preterm labor
estrogen
stimulates uterine growth, facilitates lactation in the mammary gland
hPL (human chorionic somatomammotropin)
promotes growth and lactation, regulates mom’s glucose, protein and fat supply to the fetus
oxytocin and prostaglandin
fascilitates labor
What is the purpose of a nonstress test? When the fetus moves what should be the effect on the FHR? What is the concern if there is no change in FHR with movement? How long does the test take? what constitutes a non reactive nonstress test? What can lessen the variability?
measure the response of the FHR to fetal movement
should increase approximately 15 beats for about 15 seconds
low perfusion
20 minutes/2 movements
no acceleration (or less than 6 beat acceleration) with movent or no movement
fetus sleeping
smoking
drug use
hypoglycemia
What is a biophysical profile? What is used to determine the assessment? What do the scores mean?
assesses
fetal reactivity
fetal breathing movements
fetal body movments
fetal tone
amniotic fluid volume
sonogram and nonstress test
8-10 doing well
6 suspicious
4 fetus is at risk
How is the variability of the FHR rated on the rhythm strip?
Absent: no peak or trough detected
Minimal: amplitude detected, rate is 5 beats/minute or less
Moderate/normal: range detected with rate of 6-25 beats/min
Marked: amplitude detected with rate 25< beats/min
What are reproductive changes with pregnancy? What are some examples of presumptive changes within these areas?
Those that involve the uterus, ovaries, vagina and breasts
breast tenderness
ammenorrhea
What are the presumptive/probable signs of Hegar’s, Chadwick’s and Goodell’s assessing?
Hegar’s sign – softening and compressibility of lower uterus
Chadwick’s sign – deepened violet-bluish color of cervix and vaginal mucosa.
Goodell’s sign – softening of cervical tip.
What changes occur to the cardiovascular system during pregnancy? Why are these changes important? What occurs with impaired blood return? How can the effects be manages? What is supine hypotension syndrome?
Cardiac output increases 25 to 50%
blood volume increases by 25 to 30%
increased heart rate
clotting factor increase
ensures adequate placental and fetal circulation for oxygenation and nutrition
Impaired blood return from the lower extremities can lead to edema.
increased periods of rest, elevation of legs to facilitate circulation and reduce edema, limiting dietary sodium, increase fluid intake to 12 cups of water a day
laying supine compresses the vena cava and causes decreased return to the heart
What is the purpose of prenatal care? What is the nursing assessment?
assess and educate on pregnancy and birth
establish baseline of health
determine influence on patient’s health
determine gestational age
monitor fetal development
monitor pregnancy well-being
identify complications
minimize risk
educate
What is the GTPAL staus and interpretation?
G (Gravida) = number of pregnancies, including current pregnancy
T (Term) = 37 + weeks gestation
P (Preterm) = 20 weeks gestation to 36 weeks and 6 days gestation
A (Abortions) = less than 20 weeks gestation
L (Living) = Living children
What is para, gravida, primigravida, primipara, multigravida, grand multipara, multipara, nulligravida?
Para: The number of pregnancies that have reached viability, regardless of whether the infants were born alive
Gravida: A person who is or has been pregnant
Primigravida: A person who is pregnant for the first time
Primipara: pregnant for the first time
Multigravida: A person who has given birth past the age of viability previously
Grand multipara: A person who has carried five or more pregnancies to viability
Multipara: A person who has carried two or more pregnancies to viability
Nulligravida: A person who has never been and is not currently pregnant
What are regular calorie needs for a normal weight woman? What are the needs when pregnant?
2200 cal/day
300 additional/2500 cal/day
What is the recommened weight gain for a normal BMI of 18.5-24.9? Overweight (BMI 25-29.9)? Obese (BMI 30+)?
25-35 lbs
15-25 lbs (10 lbs less)
11-20 lbs.
What foods should be avoided during pregnancy?
Raw fish/Predatory fish
Lunch meats/hot dogs
Soft cheeses
Caffeine/alcoholic beverages
Undercooked red meat
What are the 4 Ps of labor?
The passage (pelvis) is of adequate size and contour.
The passenger (the fetus) is of appropriate size and in an advantageous position and presentation.
The powers of labor (uterine factors) are adequate.
The psyche, or psychological state, which may either encourage or inhibit labor. This can be based on the pregnant person’s past life experiences as well as present psychological state.
How is fetal presentation (position of baby) determined? How can the baby present? What is the fetal attitude? What are the 4 general fetal attitudes?
by the quadrant of mom: right, left, anterior, posterior
cephalic/vertex
breech
face
shoulder
degree of flexion in fetus’s head (how much does he chin tuck to the chest)
vertex/full flexion
sinciput/moderate flexion/military
brow/partial extension
face/poor flexion/complete extension
How is the fetal presentation documented and what do the letters mean?
First letter indicates:
R = right plane
L = left plane
Second letter indicates the presenting part of the fetus.
O = occiput (head)
S = sacrum (breech)
SC = Scapula (shoulder)
M = mentum/face
Third letter indicates the position of the fetal backbone/back of head in relation to the maternal pelvis.
A = Anterior- towards the maternal abdomen
P = Posterior- towards the maternal backbone
T = Transverse- turned at a 90-degree angle to maternal backbone
What is the initial, most general description of fetal lie?
Transvese or longitudinal
What is the most favorable presentation? What kind of labor can be predicted with a posterior presentation?
anterior
longer labor and delivery (more rotations required for fetus)
back pain w/contractions
What are the cardinal movements of labor? why does the fetus naturally move this way?
descent
flexion
internal rotation
extension
external rotation
expulsion
to keep the parts that are the smallest diameter of the baby always presenting to the smallest diameter of the pelvis
What is stage one of labor? How is it broken down? What are nursing interventions?
Stage 1 – is cervical dilation from 0 to 10 cms. Separated into three phases.
Early or Latent phase. Usually the longest phase, especially for primipara clients.
Active phase – considered to begin once the cervix reaches 6 cm dilation
Transition phase – 8 to 10 cm dilation. Contractions more intense and more frequent.
monitor contraction time, change positions, support, and encourage client, pain management
What occurs in stage 2 of labor? Nursing interventions? Stage 3? What are the 2 phases of stage 3? Why is oxytocin often given right after the birth of the placenta?
Stage 2 – time span from full dilatation and cervical effacement to crowning of the head and birth of the baby.
Preparing for birth, positioning for birth, pushing, perineal cleaning, episiotomy, birth, cutting and clamping cord.
Stage 3 – begins immediately after delivery of the baby through delivery of placenta. Separated into 2 phases.
Placental separation phase includes lengthening of the cord, a sudden gush of blood, and placenta visible at vaginal opening.
Placental expulsion phase is accomplished by natural bearing down of the client or gentle pressure on the contracted uterus by the healthcare provider
facilitate uterine contractions and prevent hemorrhage.
What is stage 4 of labor? Why is this time important?
Recovery/first few hours after delivery
Mom is most at risk for hemorrhage and infection
Baby most at risk for cold stress, hypoglycemia and respiratory distress
What are the interpretations of the FHR patterns and periodic changes (VEAL)? What are the possible causes for the 4 changes in FHR pattern (CHOP)? What are nursing interventions with each reason for the pattern changes (MINE)?
V = variable decelerations
E = early decelerations
A = accelerations
L = late decelerations
C = cord compression can cause variable decels, think sharp descending V pattern
H = head compression with progression of labor
O = OK
P = placental insufficiency, indicate fetal distress and must be investigated
M = move mom, possible amnioinfusion to add fluid to prevent cord compression
I = It’s normal progression of labor
N = Non
E = Emergent: move mom to left, apply O2, stop oxytocin, VS/IV bolus, notify HCP, prepare for delivery
What is the common maneuver to determine fetal presentation and position? How is it administered?
Leopold maneuver
explain procedure
empty bladder
position supine with knees slightly flexed
place towel roll under their left side
observe abd. for longest diameter and fetal movement
palpate through the maneuvers to determine the presentation
What is the station/engagement of the fetus? How is it measured?
fetal descent, relationship of the presenting part (preferably head) to the level of the ischial spines
0 is presenting at the spines
negative numbers (-1 to -4) are before the head reaches the spines, meaning just entering engagement. -4 is the furthest away from the ischial spines
positive numbers are after ischial spines and in the birth canal, +4 being at the outlet
What are examples of effective nonpharmacological methods of pain mangt.?
Reflexology is the practice of stimulating nerve endings on the hand, feet, and ears.
Effleurage: Light, gentle circular stroking of abdomen in rhythm with breathing during contractions. Can be on thighs and arms and back.
Sacral counterpressure: Consistent pressure is applied with heel of the hand or fist against the client’s sacral area to counteract pain in the lower back.
What is the difference between analgesia and anesthesia? What is the chief concern with anesthesia medications?
analgesia decreases awareness of pain
anesthesia causes a partial or complete loss of pain sensation
causes hypotension which can decrease O2 to the fetus and can result in hypoxia
