Test 2 Flashcards
What are the 4 main hypertensive disorders of pregnancy?
Chronic hypertension
Gestational hypertension
Preeclamsia
Eclampia
What is considered chronic hypertension in pregnancy?
high blood pressure that was diagnosed before pregnancy or before 20 weeks gestation.
What is gestational hypertension?
This type of hypertension is blood pressure elevation (140/90 mm Hg or greater) with an onset after 20 weeks gestation.
There is no proteinuria or multiple organ system involvement with gestational hypertension.
When will gestational hypertension go away?
Gestational hypertension returns to normal within 6 weeks postpartum.
What is preeclampsia?
Preeclampsia is new onset hypertension (140/90 mm Hg on two or more occasions at least 4 hours apart) typically diagnosed after 20 weeks gestation that usually, but not always, includes the presence of proteinuria.
Multiple organ systems are involved in the pathophysiology.
What is eclampsia?
reeclampsia becomes eclampsia at the onset of a seizure secondary to preeclampsia
What is HELLP syndrome?
HELLP syndrome is a severe manifestation of a patient with preeclampsia in which multiple organs become severely affected by the disease process.
HELLP syndrome is usually associated with severe preeclampsia and is the laboratory diagnosis of Hemolysis, Elevated Liver enzymes (AST/ALT), and Low Platelets
All patients that have HELLP syndrome have ____________, but not all those that have _______________ have HELLP syndrome.
All patients that have HELLP syndrome have preeclampsia, but not all those that have preeclampsia have HELLP syndrome.
What is atypical HELLP syndrome?
HELLP syndrome where blood pressure is not severely elevated
What are the risk factors for preclampsia?
Maternal age >35 year
Chronic hypertension
Nulliparity
Assisted reproductive technology
Kidney disease
Preeclampsia in a previous pregnancy
Diabetes
Pre-pregnancy body mass index (BMI) >30
A protein to creatine ratio of __________ diagnoses preclampsia.
0.3 or greater
What does VEAL CHOP stand for?
V: Variability
E: Earlies
A: Accelerations
L: Lates
C: Chord Compression
H: Head entering birth canal
O: Ok!
P: Problem (or perfusion)
Fetal Assessment:
What is a category one?
1 is good, no ominous decels
Baseline rate is 110-160
Fetal Assessment:
What is category two?
2 had variability, recurrent lates (basically what doesn’t fit into 1 or 3)
Fetal Assessment:
What is category 3?
Baby needs to be delivered
Absent baseline variability with recurrent lates, variable decels or bradycardia
Sinusoidal pattern
Internal monitors are contraindicated in?
Both HIV and Hep B + moms
What are the cons to internal fetal monitors?
Membrane must be ruptured
Cervix must be 2 cm dilated
What are some of the appropriate nursing interventions for interpreting a fetal monitoring strip?
Have mom change positions
Perfusion
IV fluids
Oxytocin
Oxygen (placebo effect)
Amnioinfusion
In the first stage of labor, what is the difference between latent and active labor?
Latent means mom is 0-5cm dilated, contractions are mild (5-15 min), may experience ‘bloody show’, contractions can go away with comfort measures
Active means cervical change to 6-10 cm dilated, contractions every 2-3 min and very strong, pressure in rectum and urge to push present, membrane rupture
What is the second stage of labor?
Full dilation to the birth of the baby
What is the third stage of labor?
Birth of baby until birth of placenta
What is the fourth stage of labor?
Delivery of placeta to maternal stabilization of bleeding/uterine involution
How often should you check a laboring mom’s temp?
Q2
If fetal tachycardia is present, what is the first assessment that should be performed?
Maternal temperature check
If membrane rupture occurs, whether artificial or natural and a huge amount of fluid is lost, what is the concern?
If the baby is large AND a huge loss of fluid occurs, cord compression can be an issue
What is uterine involution?
How long it takes a uterus to return to pre-pregnancy.
Normally takes around 6 weeks.
A full bladder post labor can cause?
The uterus to become boggy
How often is a fundal assessment performed post delivery?
Every 15 minutes
During a post delivery fundal assessment, if the fundus goes to the right it could indicate what? What about to the left?
To the right: a clot
To the left: Full bladder
How often should a baby be breastfed?
Every 2-3 hours
When should a post partum mom expect her period to return?
Breastfeeding: 6 months
Bottle fed: 6/8 weeks
When do pregnant women receive the RhoGram injection?
at 28 weeks, and again after birth if Rh+ baby and bleeding occur
What are the measurements of the baby taken directly after birth?
Weight
Head circumference
Body Length
What are the newborn reflexes that are tested for at birth?
Sucking
Rooting
Palmer Grasp
Plantar grasp
Moro reflex
Tonic Neck reflex
Babinski reflex
Stepping
What percentiles qualify for appropriate for gestational age?
between the 10 & 90th percentiles
What are the expected reference ranges for measurements at birth?
Weight:
Length:
Head Circumference:
Chest Circumference:
Weight: 5.5-8.8lb, 2,500-4,000 g
Length: 18 to 22 inches, 45-55cm
Head Circumference: 12.6-14.5”, 32 to 36.6 cm
Chest Circumference: 12 to 13 inch, 30 to 33 cm
In postpartum discharge, what should we educate moms as far as bleeding goes?
If clots bigger than an egg or a plum are present or more than a pad an hour, contact their provider
Fever, redness in breast, and discomfort in breast are all indicators of?
Mastitis
What are the baby specific post-partum discharge instructions?
Well-newborn checkups
Immunization schedules
When to call doctor
Positioning and holding
___________________________ _______ is not produced in the gastrointestinal tract of the newborn until around day 7.
Vitamin K
How is Vitamin K produced?
In the colon by bacteria that form once breast milk or formula is introduced to the gut
What are the instructions on administration of the vitamin K shot?
Administer 0.5-1mg imtramuscularly into the vastus lateralis within one hour of birth
How long does the cord clamp stay in place, and who removes it?
24-48 hours and the nurse removes it
What education should we as nurses be providing parents on umbilical cord care?
Monitor for signs of infection such as moist and red chord, foul odor, or drainage (provider should be notified immediately)
Most chords fall off around 10-12 days
Keep chord dry
What is caput?
Swelling in the top of the head from the cervix
How long should infants remain in a carseat?
Until they are 2 or 35 pounds
When should the newborn baby be bathed?
A complete sponge bath should be given within the first one to two hours after birth under a radiant heat source (PowerPoint)
Should wait 24 hours (According to Hyatt)
What does APGAR stand for?
A: Appearance
P: Pulse
A: Activity
R: Respiration
What does a 0-3 APGAR score mean?
The baby is in severe distress
What does a 4-6 APGAR score mean?
the baby is having moderate difficulty
What does a 7-10 APGAR score mean?
The baby is having minimal to no difficulty adjusting to extrauterine life
What can occur if a newborn gets cold?
The newborn burns through brown fat stores, oxygen demands increase, and acidosis can occur
What 3 components make up the cold stress triangle?
Hypothermia
Hypoglycemia
Respiratory Distress
How should breast milk be stored?
Can be stored at room temp for 8 hr
Can be refridgerated in sterile bottles for 8 days
Can be frozen for 6 months
Can be deep frozen for 12 months
What is the best way of thawing breast milk for preservation of immunoglobinulins?
Thawing milk in fridge for 24 hours
How soon after birth should a new mother be encouraged to breast feed?
15-20 minutes
What are the contraindications for breastfeeding?
Maternal Cancer therapy
Active TB
HIV
Maternal Herpes (lesion on breast)
Galactosemia in infant
Varicella
Maternal substance abuse
Maternal T-cell leukemia virus
Certain medications
What are the main breastfeeding positions?
Football hold
Cross-cradle hold
Side lying
Cradle hold
Breastfeeding:
What constitutes a ‘good latch’?
Mouth is open wide, tongue goes under breast, sucking a few times then swallowing
What is the nursing education for breaking a latch?
Show mom how to insert finger in the side of the newborns mouth to break the suction from the nipple prior to removing the newborn from breast to prevent nipple trauma
When is formula feeding normally started?
around 2-4 hours of age
How often is newborn formula fed?
every 3-4 hours
How long is prepared formula good in the fridge?
48 hours
Why is it so important to follow preparation directions for formula?
It can cause electrolyte imbalances in the newborn if it is not prepared correctly
AFP can be measured in the amniotic fluid between?
15-20 weeks
When can fetal amniotic lung tests be performed?
in the 3rd trimester if less than 37 weeks
What is the fetal lung test Lecithin.Sphinomyeline ratio for fetal lung maturity?
2:1
In a fetal lung test, phosphatidyglycerol is absent, what does this indicate?
It’s absence is associated with respiratory distress
What is a biophysical profile?
Uses Ultrasound to visualize physical and physiological characteristics of the fetus to observe for fetal biophysical responses to stimuli
What are the indications for a biophysical profile?
Nonreactive Stress Test
Suspected oligohydramniosis
Suspected Fetal Hypoxia
On a biophysical profile, a score of 8-10 means?
Normal, with low risk of chronic fetal asphyxia
On a biophysical profile, a score of 4-6 means?
Abnormal suspect chronic fetal asphyxia
On a biophysical profile, a score of >4 means?
Very abnormal, strongly suspect chronic fetal asphyxia
What is a nonstress test?
A noninvasive, zero contraindications test that measures fetal movement by electronic fetal monitors and mom presses a buttom when she feels fetal movement
What defines a reactive nonstress test?
2 or more accelerations in a 20 minute period that are at least 15 beats above baseline and last at lease 20 seconds
How long are you supposed to wait between nonstress tests?
6 hours
If a non-stress test is deemed unreactive, what are the next steps?
Additional testing such as a contraction stress test or biophysical profile is needed
What constitutes a successful contraction stress test?
3 contractions in 10 minutes
Negative CST= good, no decels
What constitutes a positive stress test?
A positive CST has 2 decels in 10 minutes
What is gestational hypertension?
Onset of elevated blood pressure without proteinuria or other systemic findings diagnostic for preclampsia after week 20 of pregnancy
What blood pressure levels constitute gestational hypertension?
Systolic BP greater than 140, diastolic BP greater than 90
What is preclampsia?
Pregnancy developed condition in which elevated blood pressure is noted and protenuria develops after 20 weeks of gestation
What is eclampsia?
Onset of seizure activity or coma in a woman with preclamsia
What are the risk factors for eclampsia?
Multifetal gestation
History of preclampsia
Chronic hypertension
What is suspected to be the cause of preclampsia/eclampsia?
Placenta is deemed to be the root cause, and spiral arteries in the uterus normally become larger and thicker to handle increased blood volume
What are the indicators of possible seizure activity?
Edema
High BP
Reflex Checks
Clonus
What is HELLPS?
A result of arteriolar vasospasm, endothelial cell dysfunction with fibrin deposits, and adherence of platlets in blood vessels that causes:
Hemolysis of RBCs
Elevated Liver enzymes
Low Platelets
What is one symptom that is very promienent in preclampsia/eclampsia that is not a symptom of HELLPS?
Edema
IUGR associated with hypertension results in?
growth rates that did not meet expected norms
When do they screen for gestational diabetes?
28 weeks
