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Nursing 250- OB/Peds > OB test 2 > Flashcards

OB test 2 Flashcards

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1
Q

Spontaneous abortion

A

pregnancy that ends before 20 weeks.

ends by natural causes.

most occur with in the first 12 weeks.

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2
Q

Possible causes of spontaneous abort

A
  • chromos abnormalities
  • endocrine disorder- hypothyrodism
  • infections- syhphillis. G/C
  • implantation disorders
  • structural factors (incompetent uterus)
  • immunologic factors
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3
Q

s/s of abortion

A

Bleeding, uterine cramping/pain/ctx

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4
Q

complications of an abortion

A
  • risk for infection
  • risk for hemorrhage
  • tissue/organ damage with instrumental procedures
  • potential RH sensitization
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5
Q

Threatened abortion

A

typically just bleeding

days or weeks

may have cramping, back and pelvic pressure which indicates increased risk for inevtiable abortion

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6
Q

management for threatend abortion

A

speculum rxam w/ gentle SVE

ultrasound

type and screen, beta hCG and progesterone (maintains preg, develops lining)

pelvic rest

pad count

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7
Q

inevitable abortion s/s

A

SROM

dilation

ctx’s

active bleeding

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8
Q

incomplete abortion s/s

A

partial expulsion of parts of conception (the parts will leave uterus but remain in vagina due to being so small)

severe abd cramping

uterine bleeding

dilation

tissue passed

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9
Q

managment of incomplete

A

stablize mom= Vs O2 and IV

Labs: t&s, antibody screen

once stable: sedation, vaccum curettage or D&C, oxytocin or methergine after, PhoGAM PRN

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10
Q

complete abortion

A

All POC passed, incomplete becomes complete onces all parts pass

cramping and bleeding subside

cervix closes

loss of preg symptoms

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11
Q

management of complete

A

Beta hCG tracked (will go down), pad count, monitor for infection, No intercouse until check, RhoGAM PRN

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12
Q

Missed abortion

A

Dead fetus is retained in uterus

s/s- loss of preg symptoms @

size < date

possible brownish-red vag bleeding

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13
Q

managemen of misses

A

U/S - will be no FHR

beta hCG - decreased

evacuation procedure or labor initiation

RhoGAM PRN

A D&C will be done in 1st trimester

Cytotec or methylitrexate - used to expell fetus

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14
Q

reccurrent abortion

A

2 or morse losses in 1st trimester

causes:

genetic or chromosomal

reproductive tract anomalies

systemic conditions

STDS

DM, Lupus

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15
Q

incompetent cervix

A

reproductive tract abdnormality that cause painless dilation of cervix in 2nd trimester

cannot hold preg to term

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16
Q

possible causes of incompetent cx

A

scarring

lacerations/trauma hx

over-stretching

excessive cx dilation in previous D&C

shorten cx

infections

LEEp or cone procedure - takes part of uterus

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17
Q

Cerclage

A

A small stitch put on the cervix to help it stay closed

done between 13-14 wks, rarely done after 25 wks, took out at 37 wks, and some will go right into labor, some dont .

Risks- Rupture of members, chorioaminoitist (infection), Pre term labor from stimulating the uterus.

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18
Q

nursing care post cerclage

A

montior for contractions, SROM, signs of infection

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19
Q

medical termination of pregnancy < 7 wks

A

RU-486 & cytotec

methotrexate

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20
Q

medical termination of pregnancy >7 wks

A

thru 12th week - vacuum aspiration

after 12th wk- dilation and evacuation.

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21
Q

s/s of ectopic preg

A

missed period, vag bleeding, abd pain, + preg test, shock s/s possible if full on rupture

unrupture - dull/ intermittent to colicky pain

rupture- acute pain

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22
Q

management of ectopic preg

A

check labs- hcG will be down and progeterone will be done, get CBC, type & cross match, RH

Transvaginal U/S done

salpingostomy - open and scrap out tube

methotrexate - folic acid antagonist - stops pregnancy

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23
Q

complete mole

hydatidiform mole

A

results from fertilized egg with no nucleus

looks like a bunch of white grapes on u/s
-no fetus, placenta, membranes or fluid

20% progess to choriocarnioma later on

vag bleeding/hemorrage are common

hcG goes up

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24
Q

incomplete mole

hydatidiform mole

A

often contrains embryonic or fetal parts and amniotic sac

congential anomolies common

rarely develop cancer later

symptoms may mimic an imcomplete or missed AB

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25
Q

s/s of molar pregnancy

A

absense of F<3R

vag bleeding

n/v- casued by increase hcG levels

preg induced hypertension before 20 wks

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26
Q

management of molar preg

A

dx by u/s and b-hcG

tc for HEG or preeclampsia

follow-up care

  • serial b-hcG for 1 year
  • delay another preg
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27
Q

risk for placenta previa

A

previous c/s

increase risk with multiple gestations- more babies more chance a placenta will implant near OS

cocaine use

smoking

mulitpara

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28
Q

Assessment of previa pt.. s/s

A

sudden onset of Paibless birght red bleeding after 20 wks, scant to profuse amount, may cease, may recur

VS-normal,FHT- reassuring

abd- soft, relaxed, non-tender, with normal tone, fetus often unengaged due to placental location

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29
Q

management of previa pt

A

get hx- bleeding hx?, amt of bleeding

general status and VS - usually no chagne till late

external fetal monitoring - fetal status, ctx’s

labs: CBC, T&S, coags

US

spec exam, NO SVE

if 36 wks and lung maturity documented or is in labor is active significant bleedin - immediate labor !

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30
Q

Assessment of abruptio pt

A

may have vag bleeding (dark red) or it may be concealed

abd or low back pain =dull or ache

uterine tenderness- localized - slight to ridgid/board-like

uterine activity = irritability with hypertoncity common or hyerstimulation

elevated uterine resting tone

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31
Q

risk factors for abruptio placentae (premature seperation of placenta prior to delivery

A

maternal HTN

advanced maternal age

trauma

cocaine use

PROM

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32
Q

managment of abruptio

A

determine by amount of blood loss, fetal maturity, and maternal/fetal status

evaluate bleeding

monitor labs - H&H decreases, decrease in clotting factors
Kleihauer-betke (fetal blood cells in mothers system) - to see if theres been a bleed- exchange of fetal and maternal blood.

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33
Q

S/S of uterine atony (most common cause of Early PPH)

A

uterine fundus difficult to locate

boggy uterus

fundus firms w/ massage then becomes soft again

elevated fundal height

excessive bleeding often more bright red

excessive clots

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34
Q

meds for atony

A

oxytocin, methergine, carboprost, hemabate or prostin, cytotec.

35
Q

subinvolution

A

-most common cause of late hemorrhage

uterus will be larger than normal and its often soft or boggy

causes- retained placental frags, pelvic infection

TX
retained placental frags - D&C
infections - ABX
methergine

36
Q

nursing care for PPH

A

montior closey

assist with care to stablize hemodynamic status

emotional support

Teaching - fatigue/exhaustion potential, high iron foods, vit C, protein, nutrition, activity guidelines, support systems.

37
Q

mngt hemorrhagic shock

A

promote tissue oxygenation
-lateral postition w/ HOB flat
-limit activity
reduce anxiety & fear
-02 tx

Restore circulation/address blood volume

  • large bore IV access
  • fluids
  • PRBCs, fresh frozen plasma
  • monitor output

hemodynamic monitoring

monitor for signs of coagulopathy
-labs: T&S, CBC, coags

38
Q

DIC (disorcer of clotting)

A

consumes large amounts of clotting factors

causes: abruptio, amniotic fluid emboli, dead fetus syndrome, PIH, infection, cardiopulmonary arrest, and hemorrhage

managment-correct underlying cause, volume replacement, blood component therapy, increase oxygenation, and montior labs and pt status

nursing care: ongoing assess of bleeding, admin fluids and blood products, strict I&O montoring.

39
Q

Classifications of Gest HTN

A

>140 systolic or >90 diastolic afer 20 eks, in previously normotensive women, neg or trace protenruia, BP to normal within 6 weeks PP

40
Q

Classifications or preeclampsia

A

>140 S or >90 D and > 1+ proteinuria

seen after 20 wks

41
Q

Classifcations of chronic HTN

A

>140 S or >90 D

dx prior to preg or before 20

neg or trace protenuria

puts pt at greater risk of becoming preeclamptic

42
Q

Risk factors or developing preeclampsia

A

primipara (first baby), age >35, anemia, family hx of it, obesity, multifetal pregnancy, DM, renal disease, HTN, antiphospholipid syndrome, angiotensin gene T 235

43
Q

Patho of preeclampsia

A

vasospasm and hypoperfusion
-Arteriolar vasospasm injures endothelial cells so platelets aggregate, fibrin deposits are laid down, and blood vessels decrease in diameter which lyses RBCs and decrease blood flow to all organs and increases BP

sensitive to angiotensin II (vasoconstrictor)

44
Q

s/s of mild preeclampsia of mom

A

>140/90 BP, 1+ 2+ proteinuria, dependent edema-eyes, face, fingeres, no pulmonary

45
Q

s/s of severe preeclampsia in mom

A

>160/110 BP

> or = 3+ proteinuria

generalized edema with possible pulmonary

<30 ml/hr urine output

headache usually

visual problems

46
Q

Fetal symptoms of mild preeclampsia

A

placental perfusion reduced

47
Q

fetal symptoms of severe preeclampsia

A

Placental perfusion = IUGR, abruptio placenta, FHT late decels

premature placental aging = small size, signs of aging (white and red infants)

48
Q

preeclampsia managment

A

early detection is key

mild- home mangement - assessed every 2-3 wks - NST, BPP, freq U/S

49
Q

Lacerations

A

1st degree- no repair needed

2nd degree- muscle, repair needed

3rd degree - muscle and anal sphincter, repair

4th degree- muscle, anal sphincter, and anus, repair

50
Q

Hematomas (early PPH)

A

location: vulvar, vag, retroperitoneal
appearance: discolored, bulging mass

common with SVD or assister deliveries

51
Q

hematomas s/s

A

cause deep unrelived pain and pressure; sensative to touch

firm fundus, may not be visible, systemic signs of concealed blood loss

52
Q

care for hematomas

A

O2, IV fluid, stabilize if s/s of shock, anesthesia, OR - incisie and drain, incise and cauterize vessel

53
Q

HELLP syndrome

A

H- hemodylasis (burr cells, increase bilirubin)

EL-elevated liver enzymes (AST, ALT)

LP= low plateletes (<100,000 mm3 )

prominent symptom = epigastric pain
-n/v, generalized edema

sign that preeclampsia is getting worse

54
Q

Care for HELLP

A

cont close monitoring
cont mgSo4
-24 hrs after delievery minimally

monitor lochia - increase PPH risl, oxytocin or prostaglandins for increase bldg ,not ERGOT preps they increase BP

if dia BP remains above 105 then put on antihypertensive

55
Q

Iron deficiency anemia

A

hgb 10.5 -11

maternal - causes decrease O2 carrying capacity of blodd, pallor, fatigue, pica (non-food craving), increase risk of infection

fetal - iron supp-325 mg - 1-3/day, take with vit C (OJ)

56
Q

hyperemesis s/s

A

severe n/v, dehydration, decrease BP, increase P, poor skin tugor
weight loss <5% of pre-preg weight
acidosis from starvation
ketosis (elevated blood and urine ketones)

liver dysfunction
alkalosis from loss of hydrocholoride acid in gastric fluids
hypokalemia

57
Q

hyperemesis managment

A

NPO - 24-36 hts

IV fluids

Monitor: wt, I&O, VS’s, fetal status, U/S, labs-liver, electrolytes, H&H

dark, quiet enviornment

meds- zofran, phenergan, benadryl

diet-progress slowly

58
Q

Insulin needs with DM in preg

A

first half- decrease in maternal glucose levels

second half - increase in insulin resistance

by term - insulin needs double or triple

after deliver- need goes down, baby stops taking sugar

59
Q

DM mom complications

A

ketoacidosis (can lead to death)
increase preeclampsia incidence - type 1 greater risk then GDM
polyhydramnios- baby has increase sugar, pees a lot more
infections- uti, vaginitis
PTL
birth trauma - big babies
C/S delivery
PPH

60
Q

intrapartum pre-existing DM care

A

IV therapy - two lines - reg insulin and glucose solution

BS q 1-2 hr goal is 80-110

61
Q

antepartum pre-existing DM care

A

goal = euglycemia

hosp prn for glucose sontrol

delievery time - >39wks

62
Q

Preterm Labor (PTL)

A

before end of the 37th

leading cause of infant death w/in 1 mo

common- RDS, infections, congential heart defects, IVH, acidosis

63
Q

PTL risk factors

A

UTI, drug use, mulitples, smoking, anemia, violence, STDs, hydramnios, infections, short cervix

64
Q

PTL drugs

A

tocolytics therapy - goal to delay delivery - gen gain 2-7 days, allows fro steriod admin fro fetal lung maturity

mag sulfate - decreases uterine contractility

beta-adrengergic agonists (ritrodrine and terbutaline) - not used often - serious M//F s.e - tachycardia

Calcium channel blocker - Nifedipine - inhibits calcium from enter smooth muscle and decrease ctx given PO

Indomethacin (NSAID) blocks prostaglandins - short term use only (not after 32 wks) has potential to close ductus arteriosus

65
Q

hypotonic uterine dysfunction

A

ctx weaken, shorten and less frquent

1st assess fetal size and pelvis, if ok then,,

ambulate, IV hydrate, position change, AROM, nip atim, pain manage, decrease anxiety, OXYTOCIN

if abnormal - c/s

66
Q

hypertonic uterine dysfunction

A

frequent, painful ctxs that do not dialte the cx, encourage decent or effacement

ctx is uncoordinated,may not completely relax between ctx, usually in latent and nulliparous

TX= rest-warm bath/shower and analgesics - morphine

goal- sedation, usually after 4-6 hrs of rest they wake up in active labor

67
Q

shoulder dystocia TX

A

mcroberts maneuver ( mom flat, knees to chest)

suprapubic pressure- abd pressure over pubic area

episiostomy gives more room

68
Q

prolapse cord variations

A

occult - hidden so it isnt seen and cannot be felt by SVE

complete - visible protruding from vag

69
Q

prolapse cord risk facotrs

A

fetus remains in high station, SGA, breech, transverse, hydramnios, AROM/ROM

70
Q

TX for prolapse cord

A

carefully assess during and after ROM

PRIORITY- relieve pressure on cord

mom in knee chest, trendelenburg or modified sims

SVE till delivery - to lift presenting part off cord - do not touch cord
-nurse doing SVE stays in bed with mom, to hold baby in until c/s

71
Q

vaginal birth after having had c/s (VBAC)

A

Trial of Labor

attemp lab when:

mothers pelvis right size
fetus right position

if had classic incision for a previous c/s cant have trial of labor

72
Q

Induction

A

labor started artificially

needs to be present before induction:

  • benefit of delivery outweighs continuing preg
  • fetus is longitudinal lie
  • cervix is ripe
  • no CPD
  • fetus is mature

dont do if:

previa, prolapse, abnormla presentation, scarred upper uterus

73
Q

augmentation

A

assisting labor that started spontaneiously that has slowed or stopped

nip stim, cervix softening

74
Q

bishop score

A

Predicts inducibility of cervix

Score includes - dilation, effacement, fetal station, cervix consistency, cervix position

a score over 8 means a successful induction is likely

5-6 prostaglandin gel used

8-10 pitocin can be used

75
Q

Infertility

A

inability to conceive after ONE YER of unprotected, regular intercourse.

primary - never had a baby

secondary- had a child, now cant have another

76
Q

fetal implications of adolescent pregnancy

A

higher risk for:

prematurity
low birth weight
IUGR

77
Q

delayed pregnancy

A

women >35 yrs

these are good moms to teach - suport

78
Q

fetal px with tobacco use

A

decrease O2, LBW

79
Q

fetal px with alcohol use

A

IUGR, CNS dysfunction

80
Q

fetal px with marijuana use

A

increased moro reflex and tremors

81
Q

px with cocaine use

A

abruption, LBW

82
Q

px with amphetamines use

A

vasoconstriction

83
Q

cycle of violence

A

1st phase: Tension building - anger, blaming, arguing occur

2nd phase: Acute battering= battering incident occurs

3rd phase: honeymoon stage - batterer asks for forgiveness, promises never will happen again.

then repeats itself

Nursing 250- OB/Peds (3 decks)

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