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NUR 209 - Maternaty > Test 2 - Powerpoints > Flashcards

Test 2 - Powerpoints Flashcards

1
Q

Baseline FHR

A

110-1160

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2
Q

Causes of bradycardia

A

maternal depressant drugs, prolonged fetal hypoxia, hypercapnia, acidemia (low pH)

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3
Q

Causes of tachycardia

A

maternal fever; maternal stimulants; prolonged fetal hypoxia

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4
Q

Variability

A

Absent, minimal, moderate

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5
Q

Absent variability

A

no discernible variation around baseline

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6
Q

Minimal Variability

A

<5 bpm variation around baseline

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7
Q

Moderate Variability

A

6-25 bpm variation around baseline (good)

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8
Q

Marked Variability

A

>25 bpm

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9
Q

Acronym for Acels and Decels to causes

A

V - C
E - H
A - O
L - P

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10
Q

VEAL

A

V - Variable (can happen, not good if Ix doesn’t change)
E - Early Decel (kinda good)
A - Acel (good)
L - Late Decel (always bad,3 tolerated but if Ix don’t work must c-section)

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11
Q

CHOP

A

C - Cord compression (kinked garden hose)
H - Head compression (women feels pressure in pressure)
O - Oxygenated baby (kicking, moving, “good”)
P - Placental insufficiency (Hemorrhage, HT, smoking, etc)

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12
Q

Acceleration description

A

At least 15 bpm high and 15 sec long (1.5x1.5 boxes)

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13
Q

Variable Deceleration Actions

A

TOONDA -
Turn pt
Open mainline IV (bolus)
Oxygen (8-10 L masks)
Notify HCP
Document
Amnioinfusion (if ordered)

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14
Q

Late Deceleration actions

A

pTOONDA -
Pitocin off
Turn pt
Open mainline IV (bolus)
Oxygen (8-10 L masks)
Notify HCP
Document
Assess

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15
Q

Rapid repeating Variable deceleration cause and Ix

A

most likely because of a cord prolapse (passes through the vagina and can wrap around the head while the station is high and bag gushing causing the cord to go first)
Requires an emergent c-section

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16
Q

Cord prolapse Ix

A

Stick hand into vagina, and hold the cord from the head squishing it

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17
Q

Is variable = variability

A

No

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18
Q

Cause of Absent variability

A

infection or drugs in system

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19
Q

causes of minimal variability

A

decreased O2 - infection - drugs - baby sleeping (tolerated for 20 min then IxTOONDA) - negative response to something

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20
Q

How soon should late decels resolve?

A

with in minutes but report if not with in normal in 20 min; if not c-section would be needed

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21
Q

What variability accompanies late decels

A

minimal or absent

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22
Q

What does mom feel on early decels

A

pressure

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23
Q

Infertility

A

lack of conception despite 12 months of unprotected intercourse

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24
Q

Subfertility

A

prolonged times to conceive, or can conceive but just takes longer

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25
Q

sterility

A

inability to conceive

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26
Q

Infertility affects

A

10-15% (6.1 mil) of reproductive age population, increases with age esp women >35 yrs

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27
Q

RF related to female infertility

A

Age - smoking - EtOH - caffeine - stress - poor diet - athletic training - over/underwt - STIs - hormonal disorders

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28
Q

RF related to male infertility

A

EtOH - drugs - smoking - age - environmental factors - medicines - radiation - medical conditions - Kidneys or hormonal problems - obesity - excessive exposure to heat

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29
Q

Male Structural Infertility

A

Undecended testes (child assessed at birth, more likely to occur preterm, referral) - Hypospadias (opening of the penis is on the underside rather than the tip)- Varicocele (varicose veins of the scrotum)

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30
Q

Male Hormonal Infertility

A

Low testosterone - Azoospermia - oligospermia

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31
Q

Azoospermia

A

no sperm produced

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32
Q

Oligospermia

A

low sperm count

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33
Q

Assessment of male

A

semen analysis - ultrasonography

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34
Q

Assessment of couple

A

Postcoital test (PCT)

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35
Q

Intrauterine Insemination (IUI) Therapeutic Insemination

A

artificial insemination directly into uterus - bypasses vagaina - cheapest artificial method ($300-500) - useful if hostile muscs in vagina

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36
Q

In Vitro Fertilization (IVF)

A

fertilization of eggs in tube/petri dish and implantation - emotionally/financially burdensom bc can take ~3 sesson/cycles each being 12k

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37
Q

Other options of childbearing

A

Surrogacy (keep prts nearby or next room during delivery) or adoption (therapeutic communication and respect decisions of mother for giving up baby)

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38
Q

Augmentation vs induction

A

Augmentation: jump starting something that has already started (suas giving pitocin/cervidil/breaking water when labor has slowed down)

Induction: artificial staring of labor (reasons: Diabetic mom at 39 or sooner weeks because they tend to have bigger babies, high BP: preeclampsia, fetal demise, if baby stops growing inside)

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39
Q

Amniotomy

A

Augmentation - deliberate rupturing of the amniotic sac - first priority is to assess FHR then fluid TACO

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40
Q

Pitocin

A

synthetic oxytocin - stims uterine contractions - titrated slowly in milliunits (usually 2mU/15 or 30 min)

Always observe how zi responds to pitocin, stop if poor reponse

41
Q

tachysystole

A

contractions at <2 min - risks cutting fetus from O2

Ideal is 2-3 min

42
Q

Dysfunctional labor = dystocia

A

difficult labor and/or delivery (painful or non-progressive labor, start-stop ctx Ix[stop pitocin, turn pt])
precipitous delivery
hypertonic labor dysfunction

43
Q

antepartum

A

before delivery - such as if woman is in preterm labor woman would go into antepartum unit and monitor

44
Q

intrapartum

A

during labor

45
Q

postpartum

A

after delivery

46
Q

Q to ask couple about infertility

A

How long have they been trying - how often (diluted sperm counts) - how often she ovulates - pt Hx (DM, HT, hypothyroidism) - financial status (for IUI or IVF)

47
Q

Secondary Infertility

A

inability to conceive after one or more successful pregnancies or cannot sustain a pregnancy

48
Q

precipitous delivery

A

Delivery that takes total of <3H - face of infant is bruised because it was forced through too quickly (this can cause jaundice) - for mom delivery can cause tears/lacerations from uncontrolled delivery

49
Q

Structural causes of female infertility

A

hostile mucus, cervical obstruction, fibroids, fallopian tube blockage caused by scar tissue or escaped eggs, inadequate egg production (women over 35 make less eggs)

50
Q

Female structural abnormalities

A
  1. from birth or surgery, makes pregnancy harder
  2. mks it hard for eggs to grow bc of septum

3/4. can have 2 babies at the same time that are not twins

51
Q

Sperm abnormalites

A

abn in head/tail number, size, length, bend, point

52
Q

Level of fertility testing (least invasive to most)

A

Detection of ovulation - hormone analysis - Ultrasonography - timed endometrial biopsy - hystero-salpingo-graphy - laparoscopy

53
Q

detection of ovulation

A

OTC test on woman

54
Q

hormone analysis

A

blood test on man and woman

55
Q

ultrasonography

A

for structural abn on man and woman

56
Q

timed endometrial biopsy

A

biopsy to determine if more tests needed on woman

57
Q

hysterosalpingography

A

looking into structure of fallopian tubes and uterus

58
Q

laparoscopy

A

in depth look at internal anatomy

59
Q

fertility testing done in its order because

A

more invasive procedures can cause scar tissues

60
Q

semen analysis

A

sample to check sperm quality and quantity

61
Q

postcoital test (PCT)

A

planned and timed intercourse: have sex and come into office within 8 hours to test mucus/semen levels and see how its working together for any stressors

62
Q

IVF ethical complications

A

usually 3-4 eggs injected since RF them dying off and due to expense- Parental ethics of how many eggs if they all take whether they can afford the children or selective abortion; there is increased RF disabilities if multips;

63
Q

Tachysystole Ix

A

STOP PITOCIN if running

if not pitocin use terbutaline to slow contrations (MgSO4 supposedly works too but terbutaline is the one mentioned)

64
Q

Assisted delivery

A

forceps or vaccum - baby must almost/already crowning and mother unable to puch enough

65
Q

Assisted delivery process

A

(MD)? very gently pull while woman is pushing

3 times, 3 attemps is the maximum then C-section other risks permanent damage

66
Q

Forceps risks

A

damage to brachial plexus nerve (temp or perm) but usually none

67
Q

Vaccum delivery risks

A

scalp lacerations, bruising, swelling - all begnin but very rare to have permenant damage

68
Q

Natural tear vs episiotomy

A

Natural >> episiotomy

natural tears only what is necessary, episiotomy is only useful when it is necessay to birth baby faster

69
Q

Tear care

A

massage perinium before birth?

ice tear for first 24 hr, (witch hazel, dermaplast spray, anesthetics)

70
Q

Version

A

manual turning of the baby from breach or transverse in urtero when mother wants to deliver vaginally instead of by c-section - done at 39? wks however the baby is already large and there is very small room

71
Q

Version procedure

A
  1. Start IV access for fluids or in case of emergency
  2. Toco and US for FHR (always ensure reassuring FHR mod acel before starting)
  3. Give terbutaline (increases HR, CI if over 120 BPM) when ready bc it has 20 min life (given to relax uterus it’ll start to contract once started)
  4. US to confirm fetus positioning
  5. Reassure mother
72
Q

Shoulder dystocia

A

head out but shoulder stuck - child losing circultion bc of cord compression

73
Q

shoulder dystocia Ix

A

call rapid response because time is of the essance

  • apply supraspubic pressure by fist above pelvis bone pushing down shoulder of child so MD can pull on head while woman is pushing
  • Episiotomy likely, woman set into McRoberts position
  • RN on stepstool so that appropriate force can be applied
74
Q

umbilical cord prolapse

A

cord is compressed by the head or cervix

emergency c-section within 10 min

75
Q

cord prolapse Dx

A

many variable decels - checking if they go away upon Ix

vag exam to determine prolapse

76
Q

cord prolapse Ix

A

stick hand in to protect child head from crushing cord

woman is to assume a chest-knee position (knees and elbows on the floor with hips elevated and thigh-hips at right angles)

77
Q

Uterine rupture

A

Life threatening for mother and baby

78
Q

Uterine rupture SS in mom

A

Internal bleeding - Rigid and hard abd (differentiated by constant/persistant ctx) - uterus will not relax - increase in HR (before change in BP) - shock

79
Q

Uterine rupture SS in baby

A

late decels by placental insufficency with absent/minimal variablity

80
Q

Uterine rupture Ix

A

IV fluid bolus and emergency C-S

Check FHR response

81
Q

Cesarean Birth

A

Vertical and Low Transverse

82
Q

Vertical Cesarean Birth

A

Emergency procedure - faster, painful with longer recovery period (increased risk for dehiscence) - prevents future vaginal births bc insicion will not be able to handle stress of ctx or pitocin - more visible - better for obese women

83
Q

Pfannenstiel Cesarean Birth (Low Transverse /Bikini cut )

A

takes longer but more ideal - less visible when healed - less risk for dehiscence - will be able to give vaginal birth in future

84
Q

Cesarean Birth OR

A

Anesthesiologist gives spinal block , OB MD, assisting MD, neonatologist, RNs to deliver/receive baby

Surgical time out - allergies, why Hx

Know blood type, have set of heart tones, have foley in for the anesthesiologist to know if the bladder has been nicked via blood in the urine

85
Q

Postpartum complications

A

PP Hemorrhage

PP infection

Mastitis

86
Q

PP hemorrhage causes

A

Lacerations of the genital track (lacerations of the cervix, vagina or perineum) from Precipitous birth, Macrosomia (big baby), Use of forceps or vacuum, Uterine atony

87
Q

PP hemorrhage - uterine atony

A

=boggy uterus

causes: macrosomia (big baby), dyfunctional labor, induction of labor (can dev. tol to pitocin Ix is to intermittantly stop pitocin), grand multip (>4 births), preeclampsia, retained placenta, placenta previa (placenta grows over cervix), assisted deliveries

88
Q

EBL in PP hemorrhages

A

500 cc in vaginal birth

1000 cc in c-s

89
Q

meds used in PP hemorrhage

A

Ocytocin/Pitocin

Methergine

Hemabate

Cytotec

90
Q

Pitocin CI

A

long labor induction

91
Q

Methergine CI

A

high blood pressure, preeclampsia

92
Q

Hemobate CI

A

Asthmatics

93
Q

Hemobate SE

A

near immediate major diarrhea

94
Q

Cytotec facts and CI

A

used in 0.25 ug to induce

800 ug rectally to ctrl hemorrhage

CI: when has 4° tear

95
Q

PP hemorrhage Ix

A

MASSAGE - weigh pads to determine blood loss (1g=1ml) - express any clots - start another IV access - insert foley to empty bladder (so it doesn’t push uterus and increase loss) - VS q15 min - Assess LoC - Doc each Ix - comm with MD

96
Q

Puerperal Infection

A

Infection of the reproductive tract associated with childbirth - endometritis - most common infection of the uterine lining

97
Q

Puerperal infection / Endometritis SS

A

Fever >100.4 lasting over 24H after delivery

Abd pain - extreme tenderness to the touch

malaise

flu-like symptoms

foul smelling lochia

98
Q

Puerperal infection Ix

A

treat with ATB after the 24 hr mark of fever, not before because it can be a response to labor

Asses perinium for foul smelling lochia

NUR 209 - Maternaty (7 decks)

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