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Repro Exam 2 > Repro 2, part 1 > Flashcards

Repro 2, part 1 Flashcards

1
Q

Hot or cold packs to suppress breast milk production?

A

Cold compresses to suppress; cold cabbage leaves too

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2
Q

Name 3 interventions that you can encourage a formula feeding mother to do in order to suppress lactation:

A
  1. wear a 24 hour support bra
  2. apply cabbage leaves to the breast tissue
  3. avoid all nipple stim for 7-10 days
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3
Q

What comfort measures can you encourage a breastfeeding mother to use?

A

warm compresses, making sure to fully drain a breast of milk, lanolin on dry/cracked nipples, ensure a proper latch is occurring

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4
Q

What is preterm labor?

A

labor between 20-36 completed weeks gestation

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5
Q

What is a lab test that can confirm preterm labor?

A

fFN (22-34 weeks) Fetal fibronectin leaks into the vagina and a + test result means that a mother will go into preterm labor, although it may not be for weeks

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6
Q

What other s/s must be present in addition to fFN to confirm that the mother is currently in preterm labor (PTL)?

A

A +fFN and cervical change (length and funneling)

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7
Q

Name some of the most common risks for PTL:

A

preg. with multiples, polyhydramnios, fetal anomaly, trauma, smoking, HTN, obesity, substance abuse, Hx of PTL, uterine anomaly, febrile illness

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8
Q

Risks to moms in PTL?

A 
medication side effects (pulmonary edema)
chorio amnionitis-if causes is PPROM
thromboembolism if on bedrest
financial loss
child care issues
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9
Q

Define PPROM

A

Preterm Premature rupture of membranes

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10
Q

What are the risks to the baby of a mom in PTL?

A

increased morbidity and mortality rate
respiratory distress and lung immaturity
intraventricular hemorrhage
necrotizing enterocolitis (NE)

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11
Q

What is the goal of medical intervention in PTL?

A

To slow/cease the process of labor and prolong the length of fetal gestation

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12
Q

In which cases would you not want to prolong the length of gestation for a mom in PTL?

A

in cases of fetal demise, fetal anomaly, severe preeclampsia/eclampsia, hemorrhage, severe IUGR, olighydramnios, reversed Doppler flow

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13
Q

Do you treat a mom in PTL with antibiotic prophylaxis?

A

It’s a debated point and is provider-dependent

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14
Q

What is the med to have on hand when using Magnesium sulfate?

A

Calcium Gluconate

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15
Q

What are some nursing priorities for a mom in PTL?

A 
monitor mom and baby's vitals
administer meds/antibiotics/fluids as prescribed
encourage rest and hydration
Treat any underlying infection
Prepare parents for a preterm infant
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16
Q

What talking points should be discussed with a mom in PTL when delivery is probable?

A

educate parents on the process-transport if necessary, NICU stay for baby, introduce social work and maternal and fetal medicine provider, offer support

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17
Q

What is the cervical stitch called?

A

A cerclage

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18
Q

when would magnesium sulfate be an appropriate med to administer to a gravid mom?

A

When mom has severe preeclampsia and/or when mom is in PTL WITH cervical change.

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19
Q

What is the rate you give calcium gluconate via IV should you need to reverse the effects of Mag Sulf.?

A

1g via IV over 3 minutes

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20
Q

What is the therapeutic level of Mag Sulf?

A

4-8mg/dL

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21
Q

What are some nursing assessments performed on a mom on Mag Sulf?

A

BP (make sure pt is no longer hypertensive, but monitor how well pt responds to catch any s/s of hypotension)
reflexes-test ankle in dorsiflexion (turn Mag down if reflexes severely diminished)
respirations
Urine output should be less than 30 cc/hour

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22
Q

What is polyhydramnios?

A

Excessive amniotic fluid

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23
Q

what is olighydramnios?

A

deficient amniotic fluid

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24
Q

What can increase the risk of oligohydramnios?

A 
diabetes
HTN/preeclampsia=IUGR of placental insufficiency 
substance abuse
maternal dehydration
fetal birth defect
postmaturity
leaking amniotic fluid
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25
Q

What would you suspect if fundal height is less than expected?

A

oligohydramnios

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26
Q

What is a major concern of a mother delivering with known oligohydramnios?

A

cord compression

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27
Q

What is a red flag in monitoring a baby with suspecting oligohydramnios?

A

a nonreassuring FHR

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28
Q

What are 2 common birth defects associated with polyhydramnios?

A

hydrocephalus and anencephaly

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29
Q

What increases the risk of polyhydramnios?

A

diabetes=macrosomnia
fetal anomaly
fetal anemia
past Hx of polyhydramnios

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30
Q

common complications of polyhydramnios:

A 
cord prolapse****
inadequate labor
malpresentations
postpartum hemorrhage
PTL
maternal discomfort
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31
Q

What’s the normal FHR?

A

110-160bpm

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32
Q

What could early decelerations indicate?

A

usually head compression

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33
Q

What would late decelerations indicate?

A

usually a placental issue

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34
Q

What would variable decelerations indicate?

A

usually a cord issue

35
Q

Is variability in FHR a good or bad sign?

A

Good-moderate variability w/o decels

BAD-Marked variability or variability with decels

36
Q

What are some interventions for a worrisome FHR?

A

lay mom on left side or reposition
apply O2
manage pain/anxiety w/ meds or distraction
assess for bleeding
monitor contractions-uterus could be hyperstimulated which may not give baby enough time to recover between contractions

37
Q

Accelerations of the FHR: good or bad?

A

Good

38
Q

What would absent variability indicate in a FHR?

A

no neuro involvement

39
Q

How often do you assess FHR in the latent stage of labor?

A

Q30mins

40
Q

How often do you assess the FHR in the active stage of labor?

A

Q30mins

41
Q

How often do you assess the FHR in the transitional stage of labor?

A

Q15-30 mins

42
Q

When would you notify a provider of the need for intervention based on FHR readings?

A 
Late decels
prolonged decels that do not return to baseline
variable decels (may need to relace amniotic fluid with amnioinfusion
43
Q

What is a diagnosis that accompanies severe pre eclampsia?

A

HELLP syndrome: Hemolysis Elevated Liver enzymes and Low Platelets

44
Q

What is the cure of pre-eclampsia?

A

birth (but continure to monitor for 48 hours as seizures may still occur)

45
Q

What is the classification of pre-eclampsia and severe pre-eclampsia?

A

pre-eclampsia= BP 140/90 with proteinuria of 300mg/24 hours

severe pre-eclampsia=BP 160/110 with proteinuria of 500mg/24hours and nausea, hyperreflexia and epigastric pain

46
Q

What is eclampsia?

A

BP of at least 140/90 with proteinuria and the presences of SEIZURES

47
Q

what’s the difference between preeclampsia and gestational HTN?

A

Preeclampsia involves the presence of proteinuria

48
Q

What is the most common medical complication of pregnancy?

A

hypertensive disorders of pregnancy

49
Q

pre-eclampsia can lead to what risk factors?

A

thrombocytopenia, fetal growth restriction, pulmonary edema, elevated liver enzymes, seizures and coma

50
Q

What are some rick factors to developing pre-eclampsia?

A 
Hx of pregnancies w/ preeclampsia
multiple gestation
poor nutrition
age= VERY YOUNG OR OVER40
obesity
chronic kidney disease
preexisting hypertension
pregnancy after donor insemination
51
Q

What is the treatment for mild preeclampsia?

A 
rest in left lateral position
frequent prenatal visits
fetal surveillance
maternal lab work: CBC, liver enzymes, clotting studies
24 hour urine screen for protein
52
Q

What is the treatment for severe preeclampsia?

A 
hospitalization
lab work
fetal surveillance
vigilant reflex assessments
seizure prevention
Mag Sulfate
betamethasone, IM for fetal lung maturity if pre-term
quiet environment
Vitals
53
Q

What are the meds used to treat preeclampsia?

A

labetalol and mag sulfate

54
Q

What are s/s that require immediate attention as a result of a preeclampsia diagnosis?

A

facial edema and clonus

55
Q

S/S of preeclampsia?

A 
elevated BP at least 140/90
edema
epitaxis
headaches
dizziness
proteinuria
56
Q

What med can you administer for a rapid contraction pattern?

A

Terbutaline

57
Q

What causes pain in labor?

A

cervical dilation
effacement
pressure of the descending fetus
anxiety

58
Q

What are some non-pharmacological labor pain management interventions?

A

breathing, visualization, massage, music, movement, tub

59
Q

Common side effect of Nubain?

A

sedation, sweating, N/V

60
Q

What’s the dosage of Nubain?

A

10-20mg Q3-6 hours via IV/SC/IM

61
Q

Nursing considerations upon administering Nubain?

A

Nubain is for moderate to severe pain and analgesic effect is equal to morphine; alert provider if RR is <12, assist patient with ambulation after administering

62
Q

What is the dosage for Stadol?

A

IM: 1-4mg Q3-4h
IV: .5-2mg Q6-8h

63
Q

What is the common side effect of Stadol?

A

sedation; life threatening respiratory depression

64
Q

What are contraindications for using Stadol for labor pain?

A

narcotic dependency, breastfeeding

65
Q

Dosage for Demerol for labor pain relief?

A

50-100mg IM or SC Q3-4h;

23-50mg IV Q3-4 hours

66
Q

What are some contraindications for using Demerol for labor pain relief?

A

narcotic dependency, epilepsy, hypersensitivity to the drug

67
Q

What is the dosage for Morphine for labor pain relief?

A

IV: 2.5-15mg Q4h

IM/SC: 5-20mgQ4h

68
Q

What are common side effects of Morphine?

A

itching, nausea, constipation

69
Q

What are contraindications for using morphine?

A

hypersensitivity to opiates, acute asthma, chronic pulmonary diseases, pulmonary edema, decreased respirations, Addison disease, hypothyroidism

70
Q

Name 2 antiemetics used for labor and delivery:

A

ondansetron and phenergan

71
Q

What are some pharmacologic interventions to assist with labor anxieties?

A

Vistaril, Benadryl, Nitrous, valium

72
Q

What meds are used in epidural pain relief?

A

Fentanyl and/or local anesthetic

73
Q

What’s the dosage for a bolus of Mag Sulfate?

A

4-6g IV in 100 ML of fluids of 20 mins

74
Q

What is nifedipine?

A

a calcium channel blocker used to stop PTL by reducing contractile activity.

75
Q

Who is contraindicated from receiving Nifedipine?

A

women with heart disease, cardiovascular compromise, multiple gestation, maternal HTN, and intrauterine infection

76
Q

What is the dosing of Nifedipine?

A

20mg orally stat
followed by 20mg orally Q 30 mins in contractions persisit followed by 20mg Q3-8 hours for the next 48-72 if contractions persist. MAX des 160 mg per day

77
Q

What prostaglandin is usually effective in stopping PTL?

A

Indomethacin (but no longer widely used d/t being associated with necrotizing colitis. Not used past 34 weeks gestation)

78
Q

What does terbutaline do?

A

relax the uterus

79
Q

What is the dosage of terbutaline?

A

.25mg IM, a second does of .25mg IM in 15-30 mins if uterus has not relaxed

80
Q

What is a tocolytic?

A

A medication used in an attempt to stop labor

81
Q

What are some of the side effects of tocolytics?

A

hypotension, cardiac arrhythmias, tachycardia, palpitations, myocardial ischemia, pulmonary edema, and maternal hyperglycemia

82
Q

What are contraindications for using tocolytics?

A

It’s case dependent upon maternal presentation: health history and risk factors

83
Q

What is recommended to be administered to a woman at risk of PTL?

A

A cortico steroid (either betamethasone or dexamethasone) for fetal lung maturity.

Repro Exam 2 (1 decks)

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