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NUR 209 - Maternaty > Test 2 - Book > Flashcards

Test 2 - Book Flashcards

1
Q

Uterine Rupture variations

A

complete rupture - incomplete rupture - dehiscence

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2
Q

Uterine Rupture complete rupture

A

direct communication btwn uterine and peritoneal cavities

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3
Q

Uterine Rupture incomplete rupture

A

rupture into the peritoneum covering the uterus or into the broad ligament but not into the peritoneal cavity

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4
Q

Uterine Rupture dehiscence

A

partial separation of an old uterine scar, little to no bleeding, rupture, “window”, may be found by accident by a future abd surgery

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5
Q

Uterine Rupture etiology

A

rare - commoner in women with previous uterine surgeries (c-s, fibroid removal) (higher in women who had vertical c-s), use of pitocin

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6
Q

Uterine Rupture Manifestations

A

abd pain even with analgesics - chest pain on inspiration - hypovolemic shock (TC, TP, pallor, cool clammy skin, anxiety, HoT(late sign)) - stop of ctx - palp of fetus outside of uterus - late decels

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7
Q

Uterine rupture Ix

A

stabilize and perform c-s

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8
Q

Uterine rupture RN considerations

A

Carefully admin pitocin - be aware of hypertonic ctx (w/ or w/o pitocin)

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9
Q

Cord prolapse what

A

when the cord slips down after the membrane rupture subjecting it to compression between fetus and pelvis

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10
Q

Cord prolapse etiology

A

when there is poor fit between the presenting part of the fetus and the pelvis when the membrane ruptures, more likely to occur when: fetus at high station - small fetus - fetus is breech or transverse - hydramnios (large amount of fluid in the amniotic sac)

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11
Q

Cord prolapse SS

A

can be complete with it visible at the vaginal opening, palpable but inside, or an occult prolapse (can’t be seen or palp but is detectable via FHR changes)

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12
Q

Cord prolapse Ix

A

Priority is to relieve pressure – 1. position hips higher than head (knee-chest, trendelenburg) – 2. if no change sterile gloved hand into vagina to push fetus back – Avoid/min manual palp or handling of cord (vasospasm/vessel trauma) – US to confirm FHR before c-s – give O2 8-10L or terbutalin, saline towel to prevent cord drying
– woman prognosis good, baby’s depends

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13
Q

Meconium aspiration syndrome

A

10-15% of births - obstruction, air trapping and chemical pneumonia caused by meconium in lungs

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14
Q

Meconium aspiration pathology

A

hypoxia causes more peristalsis in SI/LI and anal sphincter relaxation releasing meconium. Causes deep respiratory passage obstruction, atalectasis, asphyxiation

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15
Q

Meconium aspiration SS

A

respiratory distress present at birth with cyanosis, retractions, nasal flaring, grunting, rales, meconium stains on body, barrel-chest from hyperinflation
–radiography (atelectasis, consolidation, hyperexpansion)

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16
Q

Meconium aspiration Ix

A

if infant vigorous (good respirations, muscle tone, HR>100) no action is needed; if not endotracheal tube is used to remove meconium

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17
Q

Meconium aspiration RN considerations

A

notify MD as soon as meconium is seen so that NICU RN and neonatologist are available with O2and suction –attn to thermoregulation and decreased stimulation

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18
Q

Dysfunctional labor - the 4 P et al

A

Problem with the powers, passenger, passage, psyche, duration

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19
Q

Power - Ineffective contractions

A

caused by fatigue, analgesia, F/E imbalance, hypotonic/hypertonic dysfunction

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20
Q

Power - Hypotonic dysfunction / secondary arrest

A

coordinated contractions that are too weak,

21
Q

Power - hypertonic dysfunction

A

painful but ineffective, long and nonproductive - high resting tone - seen in abruptio placentae (premature separation of placenta) - dont give O - tocolytic drugs needed (reduce tone)

22
Q

Power - ineffective maternal pushing

A

caused by technique, fear of injury, no urge to push, tired, analgesia,

23
Q

Problem with passenger

A

macrosomia (>8 lb 13 oz, or 4kg), shoulder dystocia, rotation abnormalities, breach, deflexion abn (face presentation), multips, fetal abn

24
Q

Passage problems

A

Pelvis small or shape (good: gynecoid, anthropoid; poor: android, platypellpod), full bladder

25
Q

Problems with psyche

A

stress from pain, fear, nonsupport, circumstance causes energy depletion, more pain perception

26
Q

Abn labor duration

A

dilation at 1.4cm/hr - caused by infection, tired, anxiety - precipitous birth

27
Q

PPD SS

A
  • feelings of sadness
  • loss of pleasure in usual activities
  • anxiety, agitation, irritability
  • feelings of guilt
  • fatigue, sleep disturbances
  • diff concentrating, making decisions
  • depression
  • suicidal thoughts
28
Q

PPD when

A
  • 50% starts antepartum

- >2 wks of depressed mood

29
Q

PPD Dx criteria

A

> 4 SS

  • change in appetite or wt
  • decreased energy
  • feelings of worthlessness or guilt
  • concentration/decision-making impairment
  • suicidal
30
Q

PPD etiology

A

Hx of mental illness, stress, chronic illness, child’s illness

31
Q

PPD impact

A

family avoids mom making things worse, worsens relationship with partner
- mother thinks self as incompetent, fails to meet babies needs

32
Q

PPD Tx

A

therapy, Rx, early ID (identifying early subjective signs: apathy, sadness, sleeplessness)

33
Q

Uterine Atony what

A

relaxing of uterine muscles allowing rapid bleeding

34
Q

Uterine atony etiology

A

uterine distension, macrosomia, hydramnios (too much amniotic fluid), obesity, long or strong labor, assisted delivery

35
Q

Uterine atony SS

A
  • boggy uterus
  • hard to find uterus
  • uterus losses tone after massage
  • higher than normal uterus
  • excessive bright red lochia
  • excessive clots
36
Q

Uterine atony Ix

A
  • admin IV O fast or IM
  • massage uterus and express (don’t push on uterus that is not contracted bc could invert and cause massive hemorrhage and rapid shock)
  • Foley
  • IV LR until >30 ml/hr
37
Q

PP discharge criteria

A
  • Mom no complications and assessments normal
  • labs and injections taken and administered
  • mother given all instructions on self-care, deviations from normal and responses for danger signs
  • mom given instructions on PP activity restrictions
38
Q

Puerperal Infection types

A

could be endometritis, mastitis, endomyomitritis, endoparametritis, Metritis

39
Q

Puerperal Infection RF

A

Hx of past infections, c-s, trauma, foley, hemorrhage, poor health

40
Q

Endometritis bacteria

A

caused by strep, E coli, K. pneumonia, Proteus, Bacteriods, gardnerella

41
Q

Endometritis SS

A

looks sick, fever, chills, malaise, anorexia, abd pain, uterine pain, foul lochia,

42
Q

Endometritis Ix

A

IV ATB (cephalosporins, clindamycins, gentamycin, ampicillin) `

43
Q

Endometritis complications

A

sterility, sepsis, peritonitis

44
Q

Endometritis RN considerations

A

place in fowlers, VS q2hr

45
Q

pregnancy wastage

A

can conceive but repeatedly lose pregnancy before it is old enough to survive

46
Q

factors that impair sperm

A

hormones, disease, environment, drugs

47
Q

factors that cause male infertility

A

abn sperm, erections (ED), ejaculation (retrograde ejaculation - into bladder, hypospadias), seminal fluid

48
Q

factors that cause female infertility

A

ovulation disorders, fallopian tube abn, cervical disorders

NUR 209 - Maternaty (7 decks)

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