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S3 1538 > S3 M3 Reproduction week 2 (placenta stuff) > Flashcards

S3 M3 Reproduction week 2 (placenta stuff) Flashcards

1
Q

Placenta previa

afterbirth first

A

placenta shifts to lower uterus and covers the cervical opening

occurs last 2 trimesters

High risk of hemorrhage

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2
Q

Placenta previa risk increases with

Can lead to

A

C sections

Hemorrhage
Abruption (separation) of placenta
Emergency cesarean birth

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3
Q

Placenta previa pathophysiology

A

Assumed to be due to embryo implantation in lower uterus and scarring of the upper uterus

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4
Q

Is the placenta edge is less than 2cm from internal os but DOES not cover it, this is called

A

Low lying placenta

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5
Q

Therapeutic management of placenta previa

A

Prevention of primary cesarean section

Prenatal care and timely diagnosis

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6
Q

Placenta previa symptoms

A

Painless bright red vaginal bleeding during 2nd and 3rd trimester, recurring

1st bleeding occurs at 27-32 weeks

Uterine contractions may occur with bleeding

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7
Q

Diagnosing Placenta Previa

A

Transvaginal ultrasound

MRI

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8
Q

Placenta accreta, increta, parcreta

A

Accreta - adheres to myometrium
Increta - penetrates myometrium
Parcreta - goes past myometrium and into peritoneal lining

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9
Q

Myometrium

A

Central/widest layer of the uterus structure

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10
Q

Nursing management of placenta previa

A

S/S of vag bleeding
Fetal distress

educate pt about condition and options

Majority of women will need C section

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11
Q

Monitoring vag bleeding

A

Perpiad count for changes and frequency

estimate/document amount

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12
Q

Monitoring fetal distress

A

Fetal heart rate via doppler
Electronic monitoring

Have O2 ready
Encourage lying on side to increase placenta perfusion

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13
Q

Placental abruption

A

Early separation of placenta after the 20th week

bleeding occurs between decidua(thick mucus lining uterus during birth) ad placenta

leads to hemorrhage

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14
Q

Maternal consequences of having placental abruption

A 
Hemorrhage
Hysterectomy
Disseminated intravascular coagulopathy DIC
Postpartum gland necrosis
Renal failure
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15
Q

Prenatal consequences of having placental abruption

A

Low weight, preterm birth, asphyxia, death

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16
Q

Placental abruption patho

A

Maternal vessels tear away from placenta, bleeding occurs between lining and placenta

As bleeding increases placenta separates and loses function

result is fetal hypoxia/death

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17
Q

Placental abruption classifications

0 1 2 3

A

0 - unrecognized, diagnosis made after birth

1 - bleeding less than 500ml, 10%-20% separation

2 - bleeding at 1000-1500ml, 20% to 50% separation

3 - bleeding over 1500ml, 50% separation

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18
Q

S/S of mild (1st stage) placental abruption

A

tender uterus

no coagulopathy
no shock
no fetal distress

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19
Q

S/S of moderate (2nd stage) placental abruption

A 
Continuous abdomen pain 
Mild shock
Normal maternal BP
Maternal tachycardia
Fetal distress
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20
Q

S/S of severe (3rd stage) placental abruption

A 
Profound shock
Dark vaginal bleeding
Severe stomach pain
v in maternal BP
^ in maternal HR
DIC
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21
Q

Placental abruption onset is

A

FAST
unexpected
sudden
intense

Immediate treatment

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22
Q

Emergency measures for Placental abruption

A

2 large bore IV line
NS and LR

blood specimen for values and typing

Evidence of fetal distress = caesarian

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23
Q

Nursing assessment for placental abruption

A

Hemodynamic status and fetal wellbeing

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24
Q

Placenta previa onset is

placenta abruption onset is

A

Insidious

Sudden

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25
Q

Bleeding with previa vs abruption

A

Always visible, increasing episodes over time
Bright red

Can be concealed and severe
Dark red

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26
Q

Pain with previa vs abruption

uterine tone previa vs abruption

A

none
constant

soft
frim

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27
Q

Fetus during previa vs abruption

HR and presentation

A

HR normal
HR distress/absence

May breech of transverse lie
No relationship

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28
Q

Labs/diagnostics for Placental abruption for mom

A

CBC
Fibrinogen(clotting factor) level
PT aPTT time (coagulation status)
Blood typing

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29
Q

Labs/diagnostics for Placental abruption for fetus

A

Nonstress test - fetal jeopardy

Bio profile - fetal jeopardy

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30
Q

Nursing management of placental abruption

A

Strict bed rest
LEFT Lateral position, prevents pressure on vena cava.

Vitals Q15min for blood loss
Start Foley
Start Large bore IV port

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31
Q

In placental abruption, fundal height change/increase indicates

A

bleeding

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32
Q

In placental abruption monitor for DIC symptoms which are

A

Gum bleeding
Tachycardia
Oozing at IV site
Petechia (red spots caused by bleeding into skin)

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33
Q

PROM

Prelabor ruptur of membrane

A

Spontaneous rupture of amniotic sac(bag of water) before true labor

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34
Q

Risk factors for developing PROM

A 
Low socioeconomic status
Multiple gestations
Low BMI
Tobacco
History of preterm labor, placenta previa, placental abruption, UTI, Vag bleeding
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35
Q 
Prolonged PROM (greater than _h)
increases risk for _
A

24h

infection

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36
Q

time period between amniotic rupture(PROM) and contractions is called

A

Latent period

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37
Q

S/S of PROM

A

Leakage of fluid
Vag discharge and bleeding
Pelvic pressure WITHOUT contractions

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38
Q

Diagnosing PROM

A

speculum exam or cervix and vag

nitrazine paper(pH indicator) testing fluid

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39
Q

PROM vs PPROM

A

PROM is beyond 37 weeks

PPROM is less than 37 weeks

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40
Q

PROM Treatment

A

UNDER NO CIRCUMSTANCE is a unsterile digital examination performed until the woman enters ACTIVE labor

If fetal lungs are mature, labor is induced

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41
Q

What not to do with PROM

A

UNDER NO CIRCUMSTANCE is a unsterile digital examination performed until the woman enters ACTIVE labor

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42
Q

PROM treatment if fetal lungs are immature

A

^ Hydrate
v physical activity
pelvic rest
observation for infection (labs/vitals)

GIVE antibiotics

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43
Q

If pt presents with PROM make sure they don’t already have

A

UTI

Pelvic or vaginal infection

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44
Q

S/S of labor

A

Cramping
Pelvic pressure
Back pain

look for this after PROM

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45
Q

Meconium presence in amniotic fluid indicates

A

Fetal distress due to hypoxia

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46
Q

Meconium stains the fluid

A

yellow to green brown

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47
Q

With PROM start monitoring fetal

A

HR

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48
Q

Diagnosing PROM

A

Nitrazine (pH)
Fern test (fluid dries like fern)
Ultrasound

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49
Q

PROM nursing management

A

Prevent infection

ID contractions

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50
Q

Fetal tachycardia may indicate

A

Infection

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51
Q

Variable deceleration may indicate

A

Cord compression

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52
Q

Basics of assessing fetal wellbeing that a mother can do

A

kick counting

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53
Q

Preterm labor

A

regular contractions
cervical effacement and dilation

before 37 weeks gestation

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54
Q

Leading cause of death within the first month of life

A

Premature birth

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55
Q

Therapeutic management for PTL

A 
Tocolytic drugs (promote uterine relaxation
Steroids to improve fetal lung maturity
Single dose of corticosteroids at 24 go 34 weeks
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56
Q

Tocolytic drugs

A

Promote uterine relaxation to prolong pregnancy for 2 to 7 days

Is usually ordered for PTL that is BEFORE 34 weeks

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57
Q

Tocolytic drug names

A

Magnesium sulfate
Indomethacin
Nifedipine

Being tocolytic is an off label use for all of the above

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58
Q

Corticosteroid given at 24 to 34 weeks for PTL

A

reduce frequency and severity of respiratory distress syndrome in premature infants

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59
Q

S/S that may indicate preterm labor will happen

A 
Change/increase in vag discharge
Pelvic pressure
Back pain
UTI symptoms
N/V/D
More than 6 contractions per 1h
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60
Q

Lab/diagnostics for PTL

A

CBC and urinalyses for infection
Amniotic fluid test for lung maturity

Fetal fibronectin
Cervical length Measurement

61
Q

Fetal fibronectin

A

Biologic glue attaching sac to uterine lining

Not supposed to be present between 24 and 34 weeks of pregnancy.

If present over 0.05mcg, may indicate PTL within 7 to 14 days

62
Q

Cervical length measurement

A

done via transvaginal ultrasound

measures cervical length/width, funnel length/width and percentage of funneling

Best for weeks 16 to 24

63
Q

Cervical length of 3cm or more indicates delivery within

A

14 days

64
Q

Nursing management of preterm labor

A 
Early detection
Monitor vitals
Intake/output measuring
Encouraging bed rest on left side
Monitor FHR
65
Q

Tocolysis

A

Use of contraction inhibiting drugs

goal is to delay birth for up to 48h

66
Q

Diagnosis of preterm labor requires both

A

contractions AND cervical change

67
Q

Prevention of PTL

A

Adequate nutrition and weight gain
Pregnancy interval of 18 months
Progesterone therapy

68
Q

Overdose indicators of Magnesium sulfate

A

Resp problems and deep tendon reflexes

69
Q

Side effects of magnesium sulfate

A 
N/V
headache
weakness
hypotension
Cardiopulmonary arrest
70
Q

With magnesium sulfate, fetus may experience

A

vHR
Drowsiness
Hypotonia

71
Q

Calcium channel blockers

Nifedipine side effects

A 
Hypotension
Tachycardia
Headache
Nausea
Facial flushing
72
Q

Indomethacin

Cyclooxygenase inhibitor

A

Reduces prostaglandin synthesis

73
Q

Indomethacin side effects on fetus

A

oligohydramnios

decrease in fetal renal blood flow

74
Q

Indomethacin maternal side effects

A

N/V
Gastritis

NOT for gestation of 32 weeks or longer

75
Q

With indomethacin monitor

A

urine output
mom temp
Amniotic fluid index

76
Q

Preeclampsia

A

Leading cause of maternal morbidity

New onset hypertension w/proteinuria and maternal organ dysfunction

77
Q

Preeclampsia/eclampsia affects what orgnas/systems

A

cardiovascular
hepatic
renal
CNS

78
Q

1st stage of preeclampsia

A

widespread vasospasms

platelet/fibrin adherence

79
Q

2nd stage of preeclampsia

s/s appear

A

Woman’s response to abnormal placentation

hypertension
proteinuria
N/V/H
blurred vision
hyperreflexia due to hypoperfusion
80
Q

In preeclampsia the vasospasms result in elevated BP and reduce blood flow to

A 
Brain
Liver
Kidneys
Placenta
Lungs
81
Q

BP in

preeclampsia moderate
preeclampsia severe
eclampsia

A

140/90 after 20 weeks

160/110 on 2 occasions at least 6h apart while on bed rest

160/110 is standard

82
Q

Seizures/come and hyperreflexia for

Moderate preeclampsia
Severe preeclampsia
Eclampsia

A

no and no
no and yes
yes and yes

83
Q

Eclampsia s/s

A

Severe headache
Generalized edema

right upper quadrant and epigastric pain

Visual disturbances

cerebral hemorrhage

renal failure

84
Q

Cure for pre/eclampsia

A

birth

85
Q

To reduce preeclampsia symptoms lie in the

this improves

A

lateral recumbent position

uteroplacental blood flow
reduces bp
promotes diuresis

86
Q

What labs are done for preeclampsia

A 
CBC
Serum electrolytes
BUN,
Creatinine
Hepatic enzymes
Platelet count
87
Q

With preeclampsia advise mother to

A

do daily kick counts
monitor bp
report decrease in fetal movement

88
Q

Does preeclampsia need sodium restricted diet

A

NO

89
Q

Fetal surveillance for preeclampsia

A

Fetal movement
Nonstress testing
Ultrasound
Amniotic fluid

90
Q

With preeclampsia monitor for

A

hypoxemia
seizures
^ intracranial pressure

91
Q

What med is given to women with severe preeclampsia prior to 34 weeks gestation

A

Betamethasone

92
Q

Prophylactic meds for preeclampsia

A

Prenatal asp and prenatal magnesium sulfate

93
Q

S/S of severe preeclampsia

A 
Cerebral/visual symptoms
Pulmonary edema
Epigastric pain 
Liver failure
Thrombocytopenia
Kidney failure
94
Q

In labor with preeclampsia
oxytocin is given to
antihypertensive are given to
Magnesium sulfate is given to

A

stimulate contractions

control bp

prevent seizures

95
Q

Antidote for magnesium sulfate overdose

A

Calcium gluconate

96
Q

S/S of magnesium toxicity

A

Resp depression
Hypocalcemia
Hypotonia

97
Q

Eclampsia

A

Hallmark of preeclampsia complications

Onset of SEIZURE ACTIVITY

98
Q

Eclampsia seizures start at _ and present as…

They than continue to _

A

Face
twitching ,eye bulging, mouth foaming

Body

99
Q

During eclampsia seizure patient cant _

After eclampsia seizure patient goes into _

A

Breath

Coma

100
Q

Managing eclampsia

A

Lay on left
Admin O2
Protection from injury due to seizure
Suction secretions

101
Q

Magnesium sulfate is given for _h after eclampsia seizure, to prevent recurrence

A

24

102
Q

Most significant sign of pre/eclampsia

A

Proteinuria

Hypertension

103
Q

Diet for preeclampsia should be high in

A

Protein

104
Q

Preeclampsia and reflexes

A

DTR
Hyperreflexia

indicates CNS involvement in condition

105
Q

In pre/eclampsia, HYPOreflexia indicates

A

Magnesium sulfate toxicity

106
Q

During eclampsia seizure breathing_

A

stops

107
Q

Nursing management of eclapmsia

A

Raise all side rails and provide padding
Dim lights
suction nasopharynx
admin O2

Fetal monitoring

108
Q

After birth, monitor for pre/eclampsia for at least

A

48h

109
Q

SCD

Sickle cell disease

A

hemolytic anemia due to inheritance of Sickle Hemoglobin HbS

110
Q

Since blood cells become sickle due to low O2 this can happen due to natural decrease or in what blood vessels

A

Veins

111
Q

Sickle cell trait vs anemia

A

trait means carrier

anemia is the actual sickness

112
Q

Clinical manifestation of sickle cell anemia

A

Low hemoglobin values 5-11dL (13-17dL normal)
Jaundice
Enlargement of bones

Tachycardia
murmurs
enlarge heart
HF

113
Q

Which organs usually suffer from SCD

A

Those with slow circulation

Spleen Lungs CNS

114
Q

Complications with SCD

A

Hypoxic tissue damage
Ischemic necrosis
Pneumonia
Osteomyelitis

115
Q

Three types of sickle cell crisis

A

Vaso Occlusive crisis - Sickle cells block blood supply

Aplastic crisis - Human Parvovirus infection, hemoglobin drops fast

Sequestration crisis - an organ fills with bad cells. Spleen most common for kids. Liver and lungs most common for adults.

116
Q

Acute chest syndrome

S/S

A

Infection, embolism, infarction related to SCD

Tachypnea, cough, wheezing, fever

117
Q

Managing Acute Chest Syndrome

A

Red cell transfusion
Antimicrobials
Bronchodilators
Mechanical ventilation

118
Q

SCD pulmonary hypertension

S/S

A

High blood pressure in lungs

Fatigue
dyspnea
Dizziness
chest pain
Syncope
119
Q

Pulmonary hypertension

pulse oximetry and breath sounds

A

typically normal and clear despite the sickness

120
Q

Screening for SCD pulm hypertension

A

Doppler echocardiography
BNP levels
CT Scan

121
Q

SCD Stroke

S/S

A

Ischemic (block in blood supply to brain) in kids and old adults
Hemorrhagic (bleeding into brain) in young adults

Declining neurocognitive function in beguiling symptom

122
Q

Treating SCD stroke

A

Red cell transfusion to reduce hemoglobin S

123
Q

Reproductive problems with SCD

A

Men - impotence, low libido, infertilities
Women - delayed menarche

Use contraption if on Hydroxyurea

124
Q

Teratogenic med for SCD

A

Hydroxyurea

125
Q

Patient with SCD will have what blood labs

A

Low hematocrit, sickled cells on the smear

High WBC due to chronic inflammatory state

126
Q

Hematopoietic stem cell transplans

A

May cure SCD but low availability due to lack of donors

127
Q

Hydroxyurea for SCD

A

Chemo agent
increases fetal hemoglobin thereby decreasing hemoglobin S

Will need folic acid replacement

Lowers Leukocyte formation so Infections will need to be treated promptly

128
Q

Transfusion therapy for SCD

A

RBC transfusion

Good for severe situations like anemia crisis (any one of the 3), acute chest syndrome, organ failure or stroke.

129
Q

Risks of Transfusion therapy

A

infection
delayed reactions

Iron overload, which primarily accumulates in liver, WILL need chelation therapy

130
Q

Chelation therapy

A

Rids blood of excess irons and metals

131
Q

Exchange transfusion

A

Replacing existing blood for blood without HbS to a target of 10g/dL

132
Q

Alloimmunization

A

development of antibodies toward different kinds of blood due to frequent transfusions

133
Q

Distinguishing between anemic crisis and delayed blood reaction

A

S/S will be the same except patient will be LESS anemic with delayed blood reactions

134
Q

With SCD swollen joints should be_

after swelling goes down…

A

Elevated

Aggressive physical therapy, whirlpool baths, TENS to preserve function

135
Q

Meds for SCD Pain

A 
NSAIDS
Aspirin
SNRIs
Antidepressants
Gabapentin
136
Q

Tocodynameter

A

Measures contraction frequency
NOT strength

Strength can only be measured through contact with belly

137
Q

Contractions

A 
Involuntary
Have systole (building up and peaking) and diastole (going down)
138
Q

What to document about contractions

A

Frequency
Duration
Intensity
Resting tone- are there relaxation periods

139
Q

What to reference for contraction strengt

A

Nose
Chin
Forehead

140
Q

Montevideo unites

A

Unit of measurement used with an internal uterine catheter to measure contraction pressure

141
Q

Normal contractions per 10 min

Tachysystole/hyperstimulation

A

5

more than 5
SHUT OFF PITOCIN

142
Q

TOCO vs IUPC

A

Toco-external
IUPC-internal (and pressure)

measure contraction frequency

143
Q

Fetal heart rate variability

A

change from baseline

low- below 6bpm
moderate- 6 to 25bpm
high- over 25bpm

144
Q

Acceleration

A

2 or more increases of 15bpm above baseline at least 15 sec apart in 20 min

145
Q

With nifedipine as a tocolytic monitor

A

BP

146
Q

With indomethacin as a tocolytic dont give to women with

A

Peptic ulcer disease
Will irritate GI

CONTRAINDICATED if fetus is greater than 32 weeks

147
Q

Nitrizine strips when in contact with amniotic fluid turn what color

A

Blue

148
Q

DIC

A

Disseminated Intravascular Coagulation

No more clotting factor, mom will most likely die.

S3 1538 (15 decks)

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