OBSTETRIC NURSING Flashcards
1
Q
What chromosomes do males and females contribute during sex?
A
• The male sperm contributes an X or a Y chromosome; the female ovum contributes an X chromosome.
2
Q
How many chromosomes does fertilisation produce in total?
A
A total of 46 chromosomes, including an XY combination (male) or an XX combination (female).
3
Q
What happens during first trimester of pregnancy?
A
• Organogenesis occurs during the first trimester of pregnancy, specifically, days 14 to 56 of gestation.
4
Q
What occurs after ovum fertilisation?
A
Implantation in the uterus occurs 6-10 days after…
5
Q
What is the chorion and its purpose?
A
The outermost extraembryonic membrane that gives rise to the placenta.
6
Q
Function of the corpus luteum
A
Secretes large quantities of progesterone.
7
Q
At what time are developing cells referred to as fetus?
A
From the 8th week of gestation through delivery
8
Q
Define a zygote
A
Union of male and female gamete which divides into fertilised ovum
9
Q
Time duration for spermatozoa to remain in vagina after sexual intercourse.
A
72 hours
10
Q
What happens when ovum is fertilised by spermatozoon carrying a Y chromosome?
A
It forms a male zygote
11
Q
Define implantation
A
When the cellular walls of the blastocyte implants itself in the endometrium, usually 7 to 9 days after fertilization.
12
Q
The time period for the beginning of heart development in the embryo.
A
It begins at 2 to 4 weeks and is complete by the end of the embryonic stage.
13
Q
What should patients do when they miss their period in the course of taking oral contraceptives as prescribed?
A
She should continue taking the contraceptive.
14
Q
What is the first menstrual flow?
A
Menarche and may be anovulatory (infertile).
15
Q
What happens when both breasts are used for breastfeeding?
A
The infant usually doesn’t empty the second breast. Therefore, the second breast should be used first at the nextfeeding.
16
Q
Factors that reduce a mother’s milk supply.
A
Stress,dehydration, andfatigue
17
Q
How do you break suction of a breast feeding infant?
A
Insert a finger at the corner of the infant’smouth.
18
Q
Why shouldn’t cow’s milk be given infants less than 1 years?
A
Because it has a low linoleic acid content and its protein is difficult for infants to digest.
19
Q
Care for the breasts after feeding.
A
Rub emollient cream, or few drops of breast milk(colostrum) on nipples and let them air dry to prevent cracking.
20
Q
Fluid intake for breastfeeding mothers
A
Should increase their fluid intake to 2½ to 3 qt (2,500 to 3,000 ml) daily.
21
Q
What should be done after breastfeeding an infant with cleft lip/ palate?
A
Rinse the mouth with sterile water.
22
Q
How is HIV transferred to an infant?
A
Since the virus has been cultured in breast milk, it can be transmitted during breastfeeding by HIV positive mother.
23
Q
Define Colostrum
A
This is the precursor of breast milk and it is the first milk to be secreted after delivery.
24
Q
How long should an infant breastfeeding session last?
A
Until infant is satisfied, and it ranges from 5 to 20 minutes
25
What happens to drugs taken by a breastfeeding mother?
They appear in breast milk.
26
Function of prolactin?
Stimulates and sustains milk production.
27
How to breastfeed a premature neonate(32 weeks of gestation).
The mother expresses the milk and feed the neonate by gavage.
28
What disqualifies a mother from breastfeeding?
One with a positive HIV test result.
29
Function of hot compress.
To relieve breast tenderness after breastfeeding.
30
Advantage of breast milk as compared to formula.
Contains maternal antibodies
31
What is the initial weight loss for a healthy infant ?
5% to 10% of birth weight.
32
Normal hemoglobin value for neonates.
17 - 20 g/dl
33
The circumference of a neonate's head in relation to that of the chest.
2-3cm greater than that of the chest
34
First nursing action after delivery
Establish the neonate's airway
35
Specific gravity of a neonate's urine.
1.003 to 1.030.
A lower specific gravity suggests overhydration; a higher one suggests dehydration.
36
During the first hour after birth...
The neonate is alert and awake.
37
The neonatal period...
Extends from birth to day 28.
AKA the first four (4) weeks or first month of life.
38
Low birth weight neonate
2,500 g (5 lb 8 oz) or less at birth.
39
Very low birth weight neonate
1,500 g (3 lb 5 oz) or less at birth.
40
Consequence of administering high oxygen amounts to neonates.
Causes blindness as a result of retrolental fibroplasia.
41
Apgar scores and interpretation.
7 to 10 - no immediate distress,
4 to 6 - moderate distress,
0 to 3 - severe distress.
42
How to elicit Moro's reflex.
The nurse holds the neonate in both hands and suddenly, but gently, drops the neonate’s head backward. Normally, the neonate abducts and extends all extremities bilaterally and symmetrically, forms a C shape with the thumb and forefinger, and first adducts and then flexes the extremities.
43
Assessment for jaundice in a neonate.
Examine the infant under natural window light. If natural light is unavailable, examine the infant under a white light.
44
Why is vitamin K administered to neonates
To prevent hemorrhagic disorders in neonates as their intestines cannot synthesise vitamin K
45
Define variability
Any change in the fetal heart rate (FHR) from its normal rate of 120 to 160 beats/minute.
Acceleration is increased FHR; deceleration is decreased FHR.
46
When does fetal alcohol syndrome present?
First 24 hours after birth and produces lethargy, seizures, poor sucking reflex, abdominal distention, and respiratory difficulty.
47
When does symptoms of heroin and methadone withdrawal begin in neonates?
Heroin - Several hours to 4 days after birth
Methadone - 7 days to several weeks after birth.
48
What are the cardinal signs of narcotic withdrawal in neonates?
coarse, flapping tremors;
sleepiness; restlessness;
prolonged, persistent, high-pitched cry; and
irritability.
49
How long do you count a neonate's respiration?
1 minute
50
Treatment for narcotic addiction in neonates
Chlorpromazine (Thorazine) is used
51
What environment should be provided for a neonate who's experiencing Narcotic withdrawal ?
Dark quiet environment.
52
Drugs used to treat withdrawal symptoms in neonates.
Phenobarbital (Luminal), Camphorated opium tincture (paregoric), and
Diazepam (Valium).
53
Signs of respiratory distress in premature neonates.
Nostril flaring,
substernal retractions, and inspiratory grunting.
54
What causes Respiratory distress syndrome (hyaline membrane disease) in premature infants?
It develops because their pulmonary alveoli lacks surfactant.
55
What position should an infant be placed in to sleep?
The parent or caregiver should position the infant on the back
56
What is the percentage of water in a neonate’s body?
78% - 80%
57
What position is used to perform a nasotracheal suctioning in an infant?
Neck slightly hyper-extended in a sniffing position with chin up and head tilted back slightly
58
How is the neonate's umbilical cord tied after birth?
It is tied 1"(2.54cm) from the abdominal wall with a cotton cord, plastic clamp or rubber band.
59
What parent teaching would you give for umbilical cord care?
Clean the umbilical area with a cotton ball saturated with alcohol after every diaper change to prevent infection and promote drying.
60
What is ortolani's sign and what does it indicate?
This is an audible click or palpable jerk that occurs with thigh abduction and it confirms congenital hip dislocation in a neonate.
61
What is Cutis marmorata and what does it indicate?
Mottling or purple discoloration of the skin.
Transient vasomotor response that occurs primarily in the arms and legs of infants exposed to cold.
62
What is the first immunization for a neonate and when is it administered?
Hepatitis B vaccine
Administered in the nursery shortly after birth.
63
What are the symptoms that infants with Down syndrome present?
Marked hypotonia,
Floppiness,
Slanted eyes,
Excess skin on the back of the neck, Flattened bridge of the nose,
Flat facial features,
Spade-like hands,
Short and broad feet,
Small male genitalia,
Absence of Moro’s reflex, and
A simian crease on the hands.
64
Why would the nurse instill erythromycin in a neonate's eyes?
To prevent blindness caused by gonorrhea or chlamydia.
65
What does fever in the first 24 hours postpartum mean in a neonate?
Most likely dehydration rather than an infection.
66
What intervention is done for preterm neonates who can't maintain a skin temperature of at least 97.6° F (36.4° C) ?
Receive care in an incubator (Isolette) or a radiant warmer.
In a radiant warmer, a heat-sensitive probe taped to the neonate’s skin activates the heater unit automatically to maintain the desired temperature.
67
What disease does a cesarean birth neonate have a higher incidence for?
Respiratory distress syndrome
68
What should the nurse do when providing phototherapy to a neonate ?
Cover the eyes and the genital area
69
Why is the narcotic antagonist naloxone (narcan) given to neonates?
To correct respiratory depression caused by narcotic administration to the mother during labour.
70
What are the symptoms of respiratory distress syndrome in a neonate?
Expiratory grunting or whining, Sandpaper breath sounds, and Seesaw retractions.
71
Symptoms of cerebral palsy in neonates present as:
Asymmetrical movement,
Irritability, and
Excessive, feeble crying in a long, thin infant.
72
What should the nurse assess for in a breech birth neonate?
Hydrocephalus, hematomas, fractures, and other anomalies caused by birth trauma.
73
What indicates post maturity in neonates?
Long brittle fingernails
74
What is common in postmature neonates?
Desquamation (skin peeling)
75
How does the average birth weight of neonates born to smoking mothers compare to those born to non smoking ones?
6 oz (170 g) less than that of neonates born to nonsmoking mothers.
76
What is the name given to neonatal jaundice in the first 24 hours?
Pathological jaundice and it is a sign of erythroblastosis fetalis.
77
How long does lanugo cover the fetus' body?
Till 20 weeks of gestation. Then it begins to disappear from the face, trunk, arms, and legs, in that order.
78
What are the Signs of hypoglycaemia in a neonate?
Temperature instability, hypotonia, jitteriness, and seizures.
Premature, postmature, small-for-gestational-age, and large-for-gestational-age neonates are susceptible to this disorder.
79
What is the required daily amount of calories for neonates?
50 - 55 cal per pound of body weight daily.
80
What does variable decelerations mean in fetal heart rate monitoring?
It indicates compression or prolapse of the umbilical cord.
81
What assessment should be done for a neonate whose mother has diabetes?
Should be assessed for hyperinsulinism.
82
What is the best technique for assessing jaundice in neonates?
Blanch the tip of the nose or the area just above the umbilicus.
83
How does Milia occur in a neonate?
Occurs as pinpoint spots over a neonate’s nose.
84
What is a normal finding in a neonate?
Strabismus
85
What are milia?
Milia are tiny white or yellowish bumps that can appear on a newborn's nose, cheeks, forehead, and chin.
They are caused by blocked pores and are common in infants, appearing in up to half of all newborns.
86
What is strabismus?
Strabismus is a vision disorder that occurs when the eyes do not align properly with each other.
87
What is the implication of rubella infection in a pregnant woman?
• Rubella infection in a pregnant patient, especially during the first trimester, can lead to spontaneous abortion or stillbirth as well as fetal cardiac and other birth defects.
88
What is the Apgar score?
This is used to assess the neonate’s vital functions.
It’s obtained at 1 minute and 5 minutes after delivery.
The score is based on respiratory effort, heart rate, muscle tone, reflex irritability, and color.
89
Why is erythromycin given at birth?
To prevent ophthalmia neonatorum (infection that occurs in the eyes of newborn babies.
It is usually caused by exposure to bacteria or viruses during childbirth, typically from the mother's genital tract.)
90
What is the normal blood glucose level in neonates ?
45 to 90 mg per DL
91
When is hepatitis B vaccine and hepatitis B immune globulin given?
Hep B vaccine - Within 48 hours of birth
Hep B immune globulin - within 12 hours of birth.
92
Why shouldn't boys with hypospadias be circumcised after birth?
Because the first may be needed for constructive surgery
93
What does cold stress do to a neonates?
It affects the circulatory, regulatory, and respiratory systems.
94
What is fetal embodiment?
Maternal developmental task that occurs in the second trimester. During this stage, the mother may complain that she never gets to sleep because the fetus always gives her a thump when she tries.
95
What are Mongolian spots?
They are bluish gray birth marks that appear at birth or shortly after and can range from brown to blue. Their color depends on how close melanocytes are to the surface of the skin. They most commonly appear as patches across the sacrum, buttocks, and legs.
96
Mongolian spots are commonly found among which kind of infants?
White infants and they usually disappear at age 2 - 3 years.
97
What is Vernix caseosa?
A cheeselike substance that covers and protects the fetus’s skin in utero. It may be rubbed into the neonate’s skin or washed away in one or two baths.
98
Define Caput succedaneum.
This is edema that develops in and under the fetal scalp during labor and delivery. It resolves spontaneously and presents no danger to the neonate. The edema doesn’t cross the suture line.
99
Define Nevus flammeus, AKA port-wine stain ?
A diffuse pink to dark bluish red lesion on a neonate’s face or neck.
100
What is The Guthrie test ?
A screening test for phenylketonuria most reliable if it’s done between the second and sixth days after birth and is performed after the neonate has ingested protein.
101
What should the nurse do to assess the condition of sucking and swallowing?
Observe the neonate’s first breastfeeding or sterile water bottle-feeding.
102
What should the mother do to establish milk supply pattern?
Breast-feed her infant at least every 4 hours.
During the first month, she should breast-feed 8 to 12 times daily (demand feeding).
103
What should the nurse do to avoid contact with blood and other bodily fluids ?
Wear gloves when handling the neonate until after the first bath is given.
104
What indicates that a mother has adequate milk supply?
If a breast-fed infant is content, has good skin turgor, an adequate number of wet diapers, and normal weight gain.
105
What happens when a pregnant woman is placed in the supine position?
A pregnant patient’s enlarged uterus impairs venous return from the lower half of the body to the heart, resulting in supine hypotensive syndrome, or inferior vena cava syndrome.
106
What are the tocolytic agents used to treat preterm Labour?
Terbutaline (Brethine),
Ritodrine (Yutopar), and
Magnesium sulfate.
107
What does a pregnant woman with hyperemesis gravidarum require?
Hospitalization to treat dehydration and starvation.
108
Why is Diaphragmatic hernia an urgent neonatal surgical emergency?
By compressing and displacing the lungs and heart, this disorder can cause respiratory distress shortly after birth.
109
Common complications of early pregnancy (up to 20 weeks gestation) include:
Fetal loss and serious threats to maternal health.
110
What should be done when the neonate is stable?
The mother should be allowed to breast-feed within the neonate’s first hour of life.
111
The normal measurements for a neonate
At birth, a neonate normally weighs 5 to 9 lb (2 to 4 kg),
measures 18″ to 22″ (45.5 to 56 cm) in length,
has a head circumference of 13½” to 14″ (34 to 35.5 cm), and has a
chest circumference that’s 1″ (2.5 cm) less than the head circumference.
112
Normal neonatal measurement at birth(CON'T)
temperature normally ranges from 98° to 99° F (36.7° to 37.2° C),
apical pulse rate averages 120 to 160 beats/minute, and
respirations are 40 to 60 breaths/minute.
113
When does the various fontanels close?
• The diamond-shaped anterior fontanel usually closes between ages 12 and 18 months.
The triangular posterior fontanel usually closes by age 2 months.
114
What are Supernumerary nipples ?
also known as accessory or extra nipples, are small bumps on the skin that resemble nipples and can occur anywhere on the body, They usually appear along a line that runs from each axilla, through the normal nipple area, and to the groin.
115
What is meconium?
A material that collects in the fetus’s intestines and forms the neonate’s first feces, which are black and tarry.
116
What does the presence of meconium in amniotic fluid indicate?
This Indicates possible fetal distress and the need to evaluate the neonate for meconium aspiration.
117
How do you assess the neonate's rooting reflex?
Touch a finger to the cheek or the corner of the mouth. Normally, the neonate turns his head toward the stimulus, opens his mouth, and searches for the stimulus.
118
What indicates Harlequin sign ?
This is present when a neonate who is lying on his side appears red on the dependent side and pale on the upper side.
119
Why does insulin requirements increase during third trimester?
This is due to the anti- insulin effects of placental hormones.
120
How is gestational age calculated?
Ultrasound measurement of maternal abdominal circumference, fetal femur length, and fetal head size. These measurements are most accurate between 12 and 18 weeks gestation.
121
What are the most common disorders of infants born to diabetic women?
Skeletal system abnormalities and ventricular septal defects. The incidence of congenital malformation is three times higher in these infants than in those born to nondiabetic women.
122
What sign will you see on a patient with preeclampsia?
Puffiness around the eyes and edema of the hands
123
What are Kegel exercises?
They're exercises that require contraction and relaxation of the perineal muscles. These exercises help strengthen pelvic muscles and improve urine control in postpartum patients.
124
Symptoms of postpartum depression range from:
Mild postpartum blues to intense, suicidal, depressive psychosis.
125
Why would a preterm neonate require gavage feedings?
Because of a weak sucking reflex, uncoordinated sucking, or respiratory distress.
126
Why is Acrocyanosis (blueness and coolness of the arm and legs) normal in neonates?
Because of their immature peripheral circulatory system.
127
To prevent ophthalmia neonatorum (a severe eye infection caused by maternal gonorrhea), the nurse may administer:
Either tetracycline, silver nitrate, or erythromycin.
128
What position should the nurse place a neonate to facilitate mucus drainage?
30-degree Trendelenburg position
129
What is used to suction a neonate's nose and mouth?
Bulb syringe or suction trap.
130
How do you prevent heat loss in a neonate during suctioning and initial delivery room care ?
Place neonate under a radiant warmer then wrap the neonate in a warmed blanket for transport to the nursery.
131
What is the composition of blood vessels in the umbilical cord?
Normally has two arteries and one vein.
132
What should the nurse do when providing care to an infant?
The nurse should expose only one part of an infant’s body at a time.
133
What is lightening?
Settling of the fetal head into the brim of the pelvis.
134
What are the physical characteristics of preterm and full term neonates?
Full-term neonate - skin creases appear over two-thirds of the neonate’s feet.
Preterm neonates - heel creases that cover less than two-thirds of the feet.
135
What happens to the fundus at 12 weeks, 20 weeks and 36 weeks gestation respectively?
12 weeks gestation - the fundus should be at the top of the symphysis pubis.
20 weeks gestation - fundus is at the level of the umbilicus.
36 weeks gestation - fundus is at the lower border of the rib cage.
136
Who is a premature neonate?
One born before the end of the 37th week of gestation.
137
Define Gravida
This is the number of pregnancies a woman has had regardless of the outcome.
138
Define para
The number of pregnancies that reached viability, regardless of whether the fetus was delivered alive or stillborn. A fetus is considered viable at 20 weeks gestation.
139
Who is a multipara woman?
A multipara is a woman who has had two or more pregnancies that progressed to viability, regardless of whether the offspring were alive at birth.
140
List some positive signs of pregnancy.
Ultrasound evidence, fetal heart tones, and fetal movement felt by the examiner (not usually present until 4 months gestation
141
When does quickening occur?
A presumptive sign of pregnancy, that occurs between 16 and 19 weeks gestation.
142
What is Goodell's sign?
Softening of the cervix
143
During pregnancy...
Ovulation ceases
144
How is immunity to rubella measured?
Hemagglutination inhibition test (rubella titer).
This test identifies exposure to rubella infection and determines susceptibility in pregnant women. In a woman, a titer greater than 1:8 indicates immunity.
145
How do you estimate date of delivery using Nagele's rule?
Count backward three (3) months from the first day of the last menstrual period then add seven (7) days to this date.
146
What is the average weight gain during pregnancy?
25 to 30 lb (11 to 13.5 kg).
147
What is the effect of rubella on the fetus?
It has a teratogenic effect on the fetus during the first trimester. It produces abnormalities in up to 40% of cases without interrupting the pregnancy.
148
What is chloasma?
The mask of pregnancy, is pigmentation of a circumscribed area of skin (usually over the bridge of the nose and cheeks) that occurs in some pregnant women.
149
What is the most ideal pelvis for delivery?
Gynecoid pelvis.
Other types include platypelloid (flat), anthropoid (ape-like), and android (malelike).
150
What advice should be given to pregnant women on alcohol intake?
There is no safe level of alcohol intake.
151
Define Linea Nigra
Dark line that extends from the umbilicus to the mons pubis, commonly appears during pregnancy and disappears after pregnancy.
152
Define Culdoscopy.
Visualization of the pelvic organs through the posterior vaginal fornix.
153
What are some nutrition advice for a pregnant vegetarian and pregnant women in general?
Pregnant vegan-obtain protein from alternative sources, such as nuts, soybeans, and legumes.
Pregnant patient - take only prescribed prenatal vitamins because over-the-counter high-potency vitamins may harm the fetus.
High-sodium foods can cause fluid retention, especially in pregnant patients.
154
Nutrition advice for pregnant women CON'T
Add fiber to diet to avoid constipation and hemorrhoids.
Should drink at least eight 8-oz glasses (about 2,000 ml) of water daily.
155
What is the leading cause of congenital viral infection?
Cytomegalovirus
156
Indications and contraindications of tocolytic therapy.
Indicated in premature labor, but contraindicated in fetal death, fetal distress, or severe hemorrhage.
157
What is measured by ultrasonography?
The biophysical profile assesses fetal well-being by measuring fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate (nonstress test), and qualitative amniotic fluid volume.
158
Define Pica.
A craving to eat nonfood items, such as dirt, crayons, chalk, glue, starch, or hair. It may occur during pregnancy and can endanger the fetus.
159
Why should a pregnant patient take folic acid and iron ?
Folic acid - for rapid cell division.
Iron supplement - help prevent anemia.
Administration of folic acid during the early stages of gestation may prevent neural tube defects.
160
What should be told to a woman taking clomiphene (Clomid) to induce ovulation?
Should be informed of the possibility of multiple births with this drug.
161
What should a pregnant woman avoid during first trimester?
All drugs unless doing so would adversely affect her health.
162
FDA classifications of drugs based on their birth defect causing potential.
A, no evidence of risk;
B, no risk found in animals, but no studies have been done in women; C, animal studies have shown an adverse effect, but the drug may be beneficial to women despite the potential risk;
D, evidence of risk, but its benefits may outweigh its risks; and
X, fetal anomalies noted, and the risks clearly outweigh the potential benefits.
163
What are some probable signs of pregnancy?
McDonald’s sign - characterized by an ease in flexing the body of the uterus against the cervix.
• Amenorrhea
• The presence of human chorionic gonadotropin in the blood or urine.
164
Why should a pregnant woman’s partner avoid introducing air into the vagina during oral sex?
Because of the possibility of air embolism.
165
Why isn't radiography normally used in pregnant women?
It may harm the developing fetus. If radiography is essential, it should be performed only after 36 weeks gestation.
166
What should a pregnant woman who has had ruptured membranes or experiencing vaginal bleeding not do?
Shouldn't engage in sexual intercourse
167
Why shouldn't a pregnant staff be assigned to work with a patient who has cytomegalovirus infection?
Because the virus can be transmitted to the fetus.
168
What causes nausea and vomiting during first trimester of pregnancy?
Rising levels of the hormone human chorionic gonadotropin.
169
What should the nurse do before performing a keeps Leopold maneuver?
Ask the patient to empty her bladder.
170
What is the benefit of pelvic tilt exercises?
Help to prevent or relieve backache during pregnancy.
171
What should the nurse do before the mother and neonate leave the delivery room?
Place identification bands on them
172
What is Dinoprostone (Cervidil) used for?
To ripen the cervix.
173
What should be done for pregnant women with diabetes?
Since they have a higher incidence of birth anomalies than those without, an alpha-fetoprotein level may be ordered at 15 to 17 weeks gestation
174
Painless vaginal bleeding during last trimester of pregnancy may indicate...
Placenta previa.
175
What is the indication of the presence of human chorionic gonadotropin?
a marker for pregnancy.
176
What is a common genetic problem in advanced maternal age?
Down syndrome
177
What is the function of Methergine?
Stimulates uterine contractions.
178
Clinical manifestation of a prolapsed umbilical cord is...
variable decelerations.
179
How should the sac of meningomyelocele be kept moist?
With normal saline solution
180
Abnormalities of fundal height and their causes
Less than 2cm - growth retardation, missed abortion, transverse lie, or false pregnancy.
More than 2cm - multiple gestation, polyhydramnios, uterine myomata, or a large baby.
181
What is a major developmental task for a pregnant woman during the first trimester?
accepting the pregnancy.
182
What form of assessment is contraindicated in a pregnant woman with vaginal bleeding?
Pelvic examination
183
What causes the finding of glucose in urine in the early stages of pregnancy?
increased shunting of glucose to the developing placenta, without a corresponding increase in the reabsorption capability of the kidneys.
184
A patient who has premature membrane rupture is at significant risk for....
infection if labor doesn’t begin within 24 hours.
185
What are infants of diabetic mothers susceptible to?
macrosomia as a result of increased insulin production in the fetus.
186
How is heat loss prevented in a neonate during bathing?
Bathe one part of his body at a time and keep the rest of the body covered.
187
Patients who have had a Cesarean delivery are at a greater risk for....
Infection than the patient who gives birth vaginally.
188
What causes thrush in the neonate?
Caused by contact with the organism during delivery through the birth canal.
189
When is Maternal serum alpha-fetoprotein detectable?
7 weeks of gestation and peaks in the third trimester.
High levels detected between the 16th and 18th weeks are associated with neural tube defects.
Low levels are associated with Down syndrome.
190
When does an arrest of descent occur?
Occurs when the fetus doesn’t descend through the pelvic cavity during labor.
Commonly associated with cephalopelvic disproportion, and cesarean delivery may be required.
191
Late sign of preeclampsia
epigastric pain as a result of severe liver edema
192
When does blood pressure return to normal in a patient with preeclampsia?
During the puerperal period.
193
What is estriol level and how is it assessed?
Estriol level is used to assess fetal well-being and maternal renal functioning as well as to monitor a pregnancy that’s complicated by diabetes.
To obtain an estriol level, urine is collected for 24 hours.
194
What term is given to the period between contractions?
Interval, or resting phase. During this phase, the uterus and placenta fill with blood and allow for the exchange of oxygen, carbon dioxide, and nutrients.
195
What happens in a patient who has hypertonic contractions?
The uterus doesn’t have an opportunity to relax and there is no interval between contractions. As a result, the fetus may experience hypoxia or rapid delivery may occur.
196
List two qualities of the myometrium.
Elasticity, which allows it to stretch yet maintain its tone,
Contractility, which allows it to shorten and lengthen in a synchronized pattern.
197
What happens during crowning?
The presenting part of the fetus remains visible during the interval between contractions.
198
What is uterine atony and what is its major cause?
Failure of the uterus to remain firmly contracted.
Major cause of uterine atony is a full bladder.
199
What should be done if the mother wished to breastfeed?
The neonate should be nursed as soon as possible after delivery
200
Improper placement of the infant’s mouth over the nipple is indicated by:
A smacking sound, milk dripping from the side of the mouth, and sucking noises.
201
What should be done before feeding is initiated?
An infant should be burped to expel air from the stomach
202
In mastitis, breastfeeding should be done...
On both the affected and the unaffected breast
203
Neonates are near sighted this is indicated by:
Their focus on items that are held 10″ to 12″ (25 to 30.5 cm) away.
204
Low set ears in a neonate are associated with...
Chromosomal abnormalities like down syndrome
205
When is meconium usually passed?
First 24 hours; however, passage may take up to 72 hours.
206
How is obstetric data obtained?
Using the F/TPAL system:
F/T: Full-term delivery at 38 weeks or longer
P: Preterm delivery between 20 and 37 weeks
A: Abortion or loss of fetus before 20 weeks
L: Number of children living (if a child has died, further explanation is needed to clarify the discrepancy in numbers).
207
Define parity
It doesn’t refer to the number of infants delivered, only the number of deliveries.
208
Women carrying more than one fetus should be encouraged...
To gain 35 to 45 lb (15.5 to 20.5 kg) during pregnancy.
209
The recommended amount of iron supplement for the pregnant patient is...
30 - 60mg daily
210
What activity can cause fetal alcohol syndrome?
Drinking six alcoholic beverages a day or a single episode of binge drinking in the first trimester
211
When is Chorionic villus sampling performed?
8 to 12 weeks of pregnancy for early identification of genetic defects.
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What is percutaneous umbilical blood sampling?
This is where a blood sample is obtained from the umbilical cord to detect anemia, genetic defects, and blood incompatibility as well as to assess the need for blood transfusions.
213
Define Hemodilution of pregnancy.
An increase in blood volume that occurs during pregnancy. The increased volume consists of plasma and causes an imbalance between the ratio of red blood cells to plasma and a resultant decrease in hematocrit.
214
Define visualisation?
• Visualization in pregnancy is a process in which the mother imagines what the child she’s carrying is like and becomes acquainted with it.
215
What is considered as hypertension in pregnancy?
Mean arterial pressure of greater than 100 mm Hg after 20 weeks of pregnancy
216
Define Laden's sign.
An early indication of pregnancy, causes softening of a spot on the anterior portion of the uterus, just above the uterocervical juncture.
217
What happens to the abdominal line during pregnancy?
The abdominal line from the symphysis pubis to the umbilicus changes from linea alba to linea nigra.
218
What is the treatment for supine hypotension syndrome?
Have the patient lie on her left side.
219
Indicate a contributing factor in dependent edema.
Increase of femoral venous pressure from 10 mm Hg (normal) to 18 mm Hg (high).
220
When does Hyperpigmentation fade from a pregnant patient's face?
• Hyperpigmentation of the pregnant patient’s face, formerly called chloasma and now referred to as melasma, fades after delivery.
221
What is the function of the hormone relaxin?
• The hormone relaxin, which is secreted first by the corpus luteum and later by the placenta, relaxes the connective tissue and cartilage of the symphysis pubis and the sacroiliac joint to facilitate passage of the fetus during delivery.
222
What is the function of progesterone?
Maintains the integrity of the pregnancy by inhibiting uterine motility.
223
How do you relieve supine hypotension during labor?
It is manifested as nausea and vomiting and paleness.
To deal with this, turn the patient on her left side.
224
What happens during the transition phase of the first stage of labor?
Cervical dilation - 8-10cm
Contractions occur 2 - 3 minutes apart.
Lasts for 60 seconds.
225
Give brief descriptions of the various labour stages.
1st stage - begins with onset ends with full cervical dilation of 10 cm
2nd stage - begins with full cervical dilation ends with the neonate’s birth.
3rd stage - begins after the neonate’s birth and ends with expulsion of the placenta.
4th stage - lasts up to 4 hours after the placenta is delivered. This time is needed to stabilize the mother’s physical and emotional state after the stress of childbirth.
226
Distinguish between false and true labour.
• Unlike false labor, true labor produces
regular rhythmic contractions, abdominal discomfort,
progressive descent of the fetus, bloody show, and
progressive effacement and dilation of the cervix.
227
Define floating and engagement in relation to degree of fetal descent.
Floating- presenting part is not engaged in the pelvic inlet, but is freely movable (ballotable) above the pelvic inlet.
Engagement - largest diameter of the presenting part has passed through the pelvic inlet.
228
What are fetal stations?
They indicate the location of the presenting part in relation to the ischial spine.
It’s described as –1, –2, –3, –4, or –5 to indicate the number of centimeters above the level of the ischial spine; station –5 is at the pelvic inlet.
229
Give another description for fetal stations.
They are also described as +1, +2, +3, +4, or +5 to indicate the number of centimeters it is below the level of the ischial spine; station 0 is at the level of the ischial spine.
230
What does vaginal bleeding in pregnancy usually represent?
It should be considered a complication until proven otherwise.
231
What should be done during delivery, if the umbilical cord can’t be loosened and slipped from around the neonate’s neck?
clamped with two clamps and cut between the clamps.
232
Which position provides the greatest degree of comfort during the first stage of labor?
the side-lying position usually provides the greatest degree of comfort, although the patient may assume any comfortable position.
233
Define amniotomy
artificial rupture of the amniotic membranes.
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What are the three phases of uterine contraction?
Increment,
Acme, and
Decrement.
235
How is the intensity of labor contractions assessed and graded?
By the indentability of the uterine wall at the contraction’s peak. Intensity is graded as:
mild (uterine muscle is somewhat tense),
moderate (uterine muscle is moderately tense), or
strong (uterine muscle is boardlike).
236
Frequency of uterine contractions
Measured in minutes, is the time from the beginning of one contraction to the beginning of the next.
237
What should be done before internal fetal monitoring ?
A pregnant patient’s cervix must be dilated at least 2 cm, the amniotic membranes must be ruptured, and the presenting part of the fetus (scalp or buttocks) must be at station –1 or lower, so that a small electrode can be attached.
238
Why are teenage mothers more likely to have low-birth-weight neonates ?
because they seek prenatal care late in pregnancy (as a result of denial) and are more likely than older mothers to have nutritional deficiencies.
239
What is the narrowest diameter of the pelvic inlet ?
anteroposterior (diagonal conjugate).
240
What is the resting phase between contractions during labor?
at least 30 seconds.
241
What happens to the length of the uterus during pregnancy?
It increases from 2½” (6.3 cm) before pregnancy to 12½” (32 cm) at term.
242
How is the true conjugate of pelvis estimated?
True conjugate (the smallest inlet measurement of the pelvis)
Deduct 1.5 cm from the diagonal conjugate (usually 12 cm).
A true conjugate of 10.5 cm enables the fetal head (usually 10 cm) to pass.
243
What is the intertuberous diameter?
Smallest outlet measurement of the pelvis which is the transverse diameter between the ischial tuberosities.
244
What is electronic fetal monitoring used for?
To assess fetal well-being during labor.
If compromised fetal status is suspected, fetal blood pH may be evaluated by obtaining a scalp sample.
245
What should be done in an emergency delivery?
Enough pressure should be applied to the emerging fetus’s head to guide the descent and prevent a rapid change in pressure within the molded fetal skull.
246
What is the purpose of massaging the uterus?
Helps to stimulate contractions after the placenta is delivered.
247
What should be done when a patient is admitted to the unit in active labour?
Listen for fetal heart tones.
248
What is Nitrazine paper used for?
To test the pH of vaginal discharge to determine the presence of amniotic fluid.
249
Weight changes in pregnant women?
Gains 2 to 5 lb (1 to 2.5 kg) during the first trimester and slightly less than 1 lb (0.5 kg) per week during the last two trimesters.
250
Precipitate labor lasts for...
Approximately 3 hours and ends with delivery of the neonate.
251
What drug is used for emergency treatment of uterine bleeding?
0.2 mg of methylergonovine (Methergine) is injected I.V. over 1 minute while the patient’s blood pressure and uterine contractions are monitored.
252
Where are Braxton Hicks contractions and true labour contractions felt?
Braxton Hicks - usually felt in the abdomen and don’t cause cervical change.
True labor contractions - felt in the front of the abdomen and back
leads to progressive cervical dilation and effacement.
253
What should be done when a fetus has late decelerations (sign of fetal hypoxia)?
Instruct the mother to lie on her left side and then administer 8 to 10 L of oxygen per minute by mask or cannula.
Notify the physician.
The side-lying position removes pressure on the inferior vena cava.
254
What is the function of oxytocin (Pitocin)?
Promotes lactation and uterine contractions.
255
What should be done when administering oxytocin?
Must be administered under close observation to help prevent maternal and fetal distress since it induces powerful uterine contractions.
256
What is molding?
Process by which the fetal head changes shape to facilitate movement through the birth canal.
257
What should be done when a woman suddenly becomes hypotensive during labor?
Increase the infusion rate of I.V. fluids as prescribed.
258
What can be done after placenta delivery?
The nurse may add oxytocin (Pitocin) to the patient’s I.V. solution, as prescribed, to promote postpartum involution of the uterus and stimulate lactation.
259
When is cervical suturing done and removed?
Done between 14 and 18 weeks gestation to reinforce an incompetent cervix and maintain
Typically removed by 35 weeks gestation.
260
What are the mechanics of delivery?
Engagement,
descent and flexion,
internal rotation,
extension,
external rotation,
restitution, and expulsion.
261
When is the duration of contraction timed?
From the moment that the uterine muscle begins to tense to the moment that it reaches full relaxation.
It’s measured in seconds.
262
What is fetal demise?
death of the fetus after viability.
263
The most common method of inducing labor after artificial rupture of the membranes is:
Oxytocin infusion
264
What should be done after the amniotic membranes rupture ?
Initially, assess the fetal heart rate.
265
The most common reasons for caesarean birth...
Malpresentation, fetal distress, cephalopelvic disproportion, pregnancy-induced hypertension, previous cesarean birth, and inadequate progress in labor.
266
Negative effects of amniocentesis
Increases the risk of spontaneous abortion, trauma to the fetus or placenta, premature labor, infection, and Rh sensitization of the fetus.
267
Complications of amniocentesis
Abdominal cramping or spontaneous vaginal bleeding
268
What should be done to prevent an Rh-negative primigravida patient from developing Rh antibodies?
Should receive Rho(D) immune globulin (RhoGAM) after delivering an Rh-positive neonate.
269
What should be done when a patient's amniotic membranes has broken?
Check fetal heart tones and then maternal vital signs.
270
What is crowning?
Appearance of the fetus’s head when its largest diameter is encircled by the vulvovaginal ring.
271
Subinvolution may occur if...
the bladder is distended after delivery.
272
What interventions should be done in the case of an extramural delivery (one that takes place outside of a normal delivery center)?
Priorities for care of the neonate include maintaining a patent airway, supporting efforts to breathe, monitoring vital signs, and maintaining adequate body temperature.
273
When is oxytocin administration stopped?
When contractions are 90 seconds or longer.
274
If a pregnant patient’s rubella titer is less than 1:8...
she should be immunized after delivery.
275
What does maternal hypotension indicate?
complication of spinal block.
276
What should be done before performing amniocentesis?
Determine The mother’s Rh factor.
277
What occurs with early maternal age?
cephalopelvic disproportion
278
Spontaneous rupture of the membranes
increases the risk of a prolapsed umbilical cord.
279
What is lochia?
Lochia is the vaginal discharge that starts post-delivery. It is composed of blood, mucus, and other uterine tissues.
280
Explain the types of lochia
• Lochia rubra - vaginal discharge of almost pure blood that occurs during the first few days after childbirth.
• Lochia serosa - serous vaginal discharge that occurs 4 to 7 days after childbirth.
• Lochia alba - vaginal discharge of decreased blood and increased leukocytes that’s the final stage of lochia. It occurs 7 to 10 days after childbirth.
281
Why is a multiparous woman more susceptible to bleeding than a primiparous woman?
Because her uterine muscles may be overstretched and may not contract efficiently.
282
The nurse should suggest ambulation to...
A postpartum patient who has gas pain and flatulence.
283
After stillbirth...
the mother should be allowed to hold the neonate to help her come to terms with the death.
284
What should be done when a woman receives a spinal block during delivery?
monitor the patient’s blood pressure closely.
285
A postpartum patient may resume sexual intercourse...
after the perineal or uterine wounds heal (usually within 4 weeks after delivery).
286
If a pregnant patient’s test results are negative for glucose but positive for acetone...
Assess the patient’s diet for inadequate caloric intake.
287
Direct antiglobulin (direct Coombs’) test is used
to detect maternal antibodies attached to red blood cells in the neonate.
288
What instructions would be given to patients who have had an abortion?
Instruct her to report bright red clots, bleeding that lasts longer than 7 days, or signs of infection, such as a temperature of greater than 100° F (37.8° C), foul-smelling vaginal discharge, severe uterine cramping, nausea, or vomiting.
289
The fundus of a postpartum patient is massaged...
to stimulate contraction of the uterus and prevent hemorrhage.
290
Laceration of the vagina, cervix, or perineum produces...
bright red bleeding that often comes in spurts.
The bleeding is continuous, even when the fundus is firm.
291
What should be done to avoid puncturing the placenta?
Vaginal examination should not be performed on a pregnant patient who is bleeding.
292
The patient should empty her bladder after delivery...
if the fundus is boggy and deviated to the right side.
293
In the early postpartum period...
The fundus should be midline at the umbilicus.
294
An ectopic pregnancy...
one that implants abnormally, outside the uterus.
295
A habitual aborter is...
a woman who has had three or more consecutive spontaneous abortions.
296
When does threatened, complete and incomplete abortion occur?
• Threatened abortion occurs when bleeding is present without cervical dilation.
Complete abortion occurs when all products of conception are expelled
Incomplete abortion occurs when the fetus is expelled, but parts of the placenta and membrane remain in the uterus.
297
Define Hydramnios (polyhydramnios).
excessive amniotic fluid of more than 2,000 ml in the third trimester.
298
When a pregnant patient has undiagnosed vaginal bleeding...
vaginal examination should be avoided until ultrasonography rules out placenta previa.
299
Clinical manifestations of ruptured ectopic pregnancy
sharp pain in the lower abdomen, with spotting and cramping.
may have abdominal rigidity; rapid, shallow respirations; tachycardia; and shock
300
A 16-year-old girl who is pregnant is at risk for...
having a low-birth-weight neonate.
301
Should a rubella vaccine be administered to pregnant women?
Rubella vaccine shouldn’t be given to a pregnant woman. The vaccine can be administered after delivery, but the patient should be instructed to avoid becoming pregnant for 3 months.
302
Nonstress test Indications.
A nonstress test is usually performed to assess fetal well-being in a pregnant patient with a prolonged pregnancy (42 weeks or more), diabetes, a history of poor pregnancy outcomes, or pregnancy-induced hypertension.
303
Define Nonstress test
A diagnostic procedure in which fetal heart rate and uterine contractions are monitored to evaluate a pregnancy.
Typically performed during the third trimester of pregnancy, to assess the baby's well-being.
304
The parameters for positive (nonreactive) and negative (reactive) nonstress tests.
Non reactive (positive) if fewer than two fetal heart rate accelerations of at least 15 beats/minute occur in 20 minutes.
Reactive (negative) if two or more fetal heart rate accelerations of 15 beats/minute above baseline occur in 20 minutes.
305
Define placenta previa and its types
It is the abnormally low implantation of the placenta so that it encroaches on or covers the cervical os.
• In complete (total) placenta previa, the placenta completely covers the cervical os.
• In partial (incomplete or marginal) placenta previa, the placenta covers only a portion of the cervical os.
306
Define Abruptio placentae.
The premature separation of a normally implanted placenta.
It may be partial or complete, and usually causes abdominal pain, vaginal bleeding, and a boardlike abdomen.
Usually treated by immediate cesarean delivery.
307
Sign of placenta previa
Bleeding is painless and seldom fatal on the first occasion, but it becomes heavier with each subsequent episode.
308
Nursing interventions for placenta previa include:
Positioning the patient on her left side for maximum fetal perfusion, monitoring fetal heart tones, and administering I.V. fluids and oxygen, as ordered.
309
The major difference between abruptio placentae and placenta previa is...
the degree of pain. Abruptio placentae causes pain, whereas placenta previa causes painless bleeding.
310
What happens when there's is blood flow interruption to or from the placenta?
There's increase in fetal partial pressure of arterial carbon dioxide and decreases fetal pH.
This is because the placenta functions majorly as a fetal lung.
311
Define pre eclampsia (AKA Pregnancy-induced hypertension ).
An increase in blood pressure of 30/15 mm Hg over baseline or blood pressure of 140/95 mmHg on two occasions at least 6 hours apart accompanied by edema and albuminuria after 20 weeks gestation.
312
What are the classic triad symptoms of preeclampsia?
Hypertension, edema, and proteinuria.
Additional symptoms of severe preeclampsia include hyperreflexia, cerebral and vision disturbances, and epigastric pain.
313
What should be done after administering magnesium sulfate to a pregnant patient for hypertension or preterm labor?
the nurse should monitor the respiratory rate and deep tendon reflexes.
314
Define eclampsia.
Occurrence of seizures that aren’t caused by a cerebral disorder in a patient who has pregnancy-induced hypertension.
315
In a patient with preeclampsia, epigastric pain...
is a late symptom and requires immediate medical intervention.
316
What can preeclampsia lead to in a pregnant patient?
May progress to eclampsia, which is characterized by seizures and may lead to coma.
317
List the unusual variation of preeclampsia using the HELLP acronym.
Hemolysis,
Elevated liver enzymes, and
Low platelets
318
The failure rate of a contraceptive is determined by...
the experience of 100 women for 1 year. It’s expressed as pregnancies per 100 women in a year.
319
What should be done before providing a specimen for a sperm count...
The patient should avoid ejaculation for 48 to 72 hours.
320
If a patient misses two consecutive menstrual periods while taking an oral contraceptive...
she should discontinue the contraceptive and take a pregnancy test.
321
If a patient who is taking an oral contraceptive misses a dose...
she should take the pill as soon as she remembers or take two at the next scheduled interval and continue with the normal schedule.
322
If a patient who is taking an oral contraceptive misses two consecutive doses...
she should double the dose for 2 days and then resume her normal schedule. She also should use an additional birth control method for 1 week.
