Sim Lab CTR Cards Flashcards
Vaginal bleeding with or without discomfort
Spontaneous abortion
Placenta previa
Placental abruption
Lesions of the cervix or vagina
Bloody show
Swelling of fingers or puffiness of face or around eyes
Excessive edema
Preeclampsia
Continuous pounding headache
Chronic HTN
Preeclampsia
Visual disturbances (blurred vision, dimness, flashing lights, spots before the eyes)
Worsening preeclampsia
Persistent or severe abdominal or epigastric pain
Ectopic pregnancy
Worsening preeclampsia
Placental abruption
Chills or fever
Infection
Persistent vomiting
Hyperemesis gravidarum
Change in frequency or strength of fetal movements
Fetal compromise or death
Signs or symptoms of preterm labor
Uterine contractions
Cramps
Constant or irregular low backache
Pelvic pressure
Watery vaginal discharge
How short is too short for intervals between contractions?
Should not be shorter than 45-60 seconds
What would happen due to maternal hypotension?
May divert blood flow away from the placenta to ensure adequate perfusion to maternal brain and heart
What would happen due to maternal hypertension?
May be associated with vasospastic in spiral arteries, which supply the intervillous spaces of the placenta
PPH risk factors
Grand multi parity (5 or more)
Over distention of the uterus (large baby, twins, hydramnios)
Precipitous labor (less than 3 hours)
Prolonged labor
Retained placenta
Placenta previa or accrete or placental abruption
Drugs (tocolytics, magnesium sulfate, general anesthesia, prolonged use of oxytocin)
Operative procedures (c/s, vacuum extraction, forceps)
Risks for infection
Operative procedures
Multiple cervical examinations
Prolonged labor
Prolonged rupture of membranes
Manual extraction of placenta or retained fragments
Diabetes
Catheterization
Bacterial colonization in lower genital tract
Symptoms of a distended bladder
Location of fundus above baseline level
Fundus displaced to side from midline
Excessive lochia
Bladder discomfort
Bulge of bladder above symphasis
Frequent voiding of less than 150 mL (may indicate urinary retention with overflow)
Hazards of cold stress in newborn
Increased oxygen need
Decreased surfactant production
Respiratory distress
Hypoglycemia
Metabolic acidosis
Jaundice
Signs of inadequate thermoregulation in newborn
Axillary temp <36.3C or > 36.9C (<97.3F or >97.7F)
Poor feeding or feeding intolerance
Irritability followed by lethargy
Weak cry or suck
Decreased muscle toe
Cool skin temperature
Mottled, pale, or acrocyanotic skin
Signs of hypoglycemia
Signs of respiratory difficulty (apnea, retractions, etc)
Poor weight gain, if chronic
Symptoms of concealed hemorrhage in placental abruption
Increase in fundal height
Hard, board-like abdomen
High uterine baseline tone on electronic monitoring strip
Persistent abdominal pain
Systemic signs of early hemorrhage (tachycardia, tachypnea, falling BP, falling UOP, restlessness)
Slight or absent vaginal bleeding
Symptoms of excessive uterine activity
Contraction duration > 120 seconds
<60 seconds between contractions in first labor stage, <45-50 seconds between in later labor stage
Uterine resting tone firm by palpation
More than 5 contractions in a 10 minute window, averaged over 30 minutes
Nursing actions for excessive uterine activity
Position pt on side
Administer IV fluid bolus of at least 500 mL
If tachysystole does not resolve in 10-15 mins, oxytocin infusion should be decreased by half
If still persists after another 10-15 mins, oxytocin infusion should be stopped until uterine activity is normal
If a pt is on oxytocin and has abnormal fetal heart rate patterns:
Stop the oxytocin infusion and administer bolus of at least 500 mL
Keep woman side lying to prevent artocaval compression and increase placental blood flow
Consider oxygen administration at 10L/min via nonrebreather face mask until FHR pattern improves
Notify provider and anticipate order for terbutaline if no improvement occurs with other interventions
Symptoms of triple I
Maternal fever
Fetal tachycardia
Maternal WBC > 15,000
Purulent fluid emanating from cervix os
Cloudy, yellowish, thick discharge coming from cervical canal
Factors that increase risk for prolapsed umbilical cord
Ruptured membranes and:
Fetal presenting part at high station
Fetus that poorly fits the pelvic inlet because of small size or abnormal presentation
Excessive volume of amniotic fluid
Symptoms of PPH
Uterus that does not contract or does not remain contracted
Large gush or slow, steady trick of blood from vagina
Saturation of one peripad per 15 min
Severe, unrelieved perineal or rectal pain
Tachycardia
