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Test 3 Flashcards

1
Q

Postpartum Depression: S/Sx, How is it assessed?

A

S/Sx:

withdrawn
appetite changes
anxiety
crying/sadness
fatigued
difficulty concentrating
less responsive
suicidal ideation

Measured with Edinburg scale

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2
Q

Postpartum Psychosis

A

Break w/ reality
Confused
Delirium
Hallucination
Delusion
Panic

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3
Q

Preterm Birth: What is it? Risk Factors, Testing

A

What is it?

  • Any birth between 20 weeks at 36 weeks (6 days)

Risk Factors:

  • ART
  • Previous history of preterm birth
  • Smoking
  • Cocaine
  • Multifetal Gestation
  • Uterine Anomaly

Testing:

  • Cervical length >30mm in 2nd/3rd trimester less likely to deliver premature
  • Fetal Fibronectin (fFN) - predicts who will NOT go into labor
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4
Q

Tocolytic Medications

A

Given to delay birth until transferred to facility where corticosteroids can be given to enhance fetal lung maturity

Magnsium Sulfate
Terbutaline
Nifedipine
Indomethacin

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5
Q

MgSO4

A

CNS depressant - “cerebral neuroprotection”
Relaxes smooth muscle
Reduces chance of cerebral palsy before 32 weeks

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6
Q

Terbutaline

A

Do not give if HR >110-130bpm or BP < 90/60

Assess for chest pain, MI, pulmonary edema

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7
Q

Nifedipine

A

CCB

Relaxes smooth muscle by blocking calcium reentry

Do not give alongside MgSo4 or terbutaline

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8
Q

Indomethacin

A

Relaxes smooth muscle by inhibiting prostaglandins

Gestational age must be <32 weeks

C/I for renal or liver disease

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9
Q

Warning Signs of Preterm labor

A
  • Contractions q10 minutes
  • > 5 contractions in 1-hour
  • Menstrual-like cramps
  • Low, dull backache
  • Pelvic pressure
  • Increase/change in vaginal discharge
  • ROM
  • Periodic hardening of stomach w/ or w/o pain
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10
Q

PROM

A

Spontaneous rupture of amniotic sac and leakage of fluid prior to onset of labor at any gestational age

Oxytocin may be given

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11
Q

PPROM

A

Membranes rupture BEFORE 37 weeks

Preceeded by infection - chorioamionitis

Tocolytic to stop labor, steroid to enhance fetal lung maturity and antibiotic will be given

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12
Q

Chorioamnionitis: What is it? S/Sx? Treatment?

A

Bacterial Infection

S/Sx:
- Maternal fever
- Maternal/fetal tachycardia
- Foul odor in amniotic fluid

Treatment: amp/gent

Fetal Risks:

  • meningitis
    -PNA
    -Bacteremia
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13
Q

Postmaturity Syndrome

A

Decreased SC fat
Infant lacks lanugo/vernix
Dry, cracked and peeling skin
Meconium stained skin
Baby will have wasted appearance

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14
Q

Bishop Score: What is it?

A

Assesses cervix induciability
Scores range 0-13

Score > 8 indicates induction likely to be successful, and cervix is soft and anterior, 50% or more effaced, dilated 2cm or more, presenting part engaged

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15
Q

Stage 1 Labor

A
  • Regular contractions/ROM to 10cm dilated
  • 100% effacement

Early 0-5cm
Active 6-10cm

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16
Q

Stage 2 Labor

A

10cm dilated to delivery

Cervix must be 10cm dilated before pushing begins

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17
Q

Stage 3 Labr

A

Delivery of placenta
5-15 minutes
The longer this stage, increased risk of hemorrhage

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18
Q

Stage 4 Labor

A

Lasts for 2 hours post delivery of placenta

Frequent assessment for fundal firmness, height, massage uterus if boggy, ask mom to empty bladder if fundus displaced to right

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19
Q

Latent Phase of Labor

A

Beginning of “True Labor” until 3-4cm dilated

Contractions are mild (10-20minutes apart, 15-20 second duration)

Mom can still talk

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20
Q

Active Phase of Labor

A

4-7cm dilated

Mom is uncomfortable

Contractions are 2-3 minutes, 30-60 second duration

Anesthesia offered midway

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21
Q

Transitional Phase of Labor

A

8-10cm dilated

Mom may have nausea, hiccups, irritable

Contractions SEVERE - 1 1/2 minutes apart, 60-90 second duration

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22
Q

False Labor

A

NO lower back pain
Abdominal discomfort
Contractions decrease in intensity and frequency with mobility

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23
Q

Cervical Positions: Anterior vs Posterior

A

Anterior - easily palpated
Posterior - difficult to palpate

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24
Q

Fetal Station

A

Location of presenting part in relation to midpelvis or ischial spine

Expressed in cm above/below spine

0 station - engaged
+/- 2 - 2 cm above/below spines

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25
Vertex
head down cephalic
26
Shoulder
acromonian
27
Breech
buttocks
28
Brow
sinciput
29
Chin
mentum
30
COAT
Refers to ROM assessment Color Odor Amount Time - do not want to exceed 24hrs, abx at 18hrs
31
Hyperventilation: What does it result in? S/Sx? Intervention?
Results in respiratory alkalosis S/Sx dizziness tingling of fingers stiff mouth Ask mom to breathe into cupped hands or paper bag
32
Placental Separation: S/Sx, Intervention
S/Sx: - Lengthening of umbilical cord outside vagina - Gush of Blood - Uterus changes from oval (discoid) to globular - Mom describes vagina as "full" Intervention - Mom BP - Oxytocic medication AFTER placenta is delivered
33
Maternal Blood Loss: Vaginal
<500cc
34
Maternal Blood Loss: Cesarean
<1000cc
35
First Degree laceration
involves epidermis
36
Second Degree Laceration
Involves epidermis, dermis, muscle and fascia
37
Third Degree Laceration
Extends into anal sphincter
38
Fourth Degree Laceration
Extends up rectal mucosa
39
Gate Control Theory: What is it, types
Pain sensations travel along sensory pathway, only limited sensations can pass through Distraction techniques help block capacity to deliver pain message Aromatherapy, music, massage, hypnosis, guided imagery
40
Pudendal Block
Blocks vaginal pain, perineum pain useful for vacuum, forceps, vaginal delivery w/ epiotomy
41
Epidural Anesthesia
Blocks uterine pain
42
Fentanyl
Never give 1hr before delivery due to risk of neonatal respiratory depression, safety, and fetal monitoring
43
Stadol and Nubain
NEVER give 1hr prior to delivery due to risk of neonatal respiratory depression
44
Shoulder Dystocia: Clinical Sign, Intervention, Maternal Risks, Fetal Risks
Turtle Sign - head is born, but anterior shoulder not able to pass under pubic arch Intervention - Stool - McRobert's posiiton - Suprapubic pressure Maternal Risks: - PP hemorrhage - Internal bleeding - 4th degree laceration Fetal Risks: - Facial bruising - broken clavicle - Brain damage - brachial plexus injury
45
Prolapsed Umbilical Cord: patho, ews, intervention
Fetus in negative or high station Fetus not vertex/cephalic Membranes ruptured and cord delivers or proplapses and is compressed (no O2 or CO2 exchange) EWS: - Fetal heart tone - Variable decel Intervention: - knee/chest - Trendelenburg - Stat c-section
46
Amniotic Fluid Embolism: patho, assessment, interventions
Patho: - Amniotic fluid crosses into placental circulation then maternal circulation, passes through heart causing major asphyxiation Assessment - VS - Lung sounds - Decreased LOC - Respiratory changes Interventions: - Code - Start CPR - Transfer to ICU - C-Section if not delivered yet
47
Hypotonic Uterine Dysfunction:
Occurs during active phase Woman makes normal progress into active phase, then contractions are weak and inefficient or stop altogether
48
Hypertonic Uterine Dysfunction
Occurs during latent phase of stage 1 Frequent contractions that are ineffective in causing cervical dilation or effacement Mom needs rest
49
External Cephalic Version: What is it? Medication given
Attempt to turn fetus from breech or shoulder to vertex for birth Terbutaline will be given to relax uterus
50
Elective Induction
Labor initiated w/o medical indication Not initiated until mom is 39 weeks
51
Precipitous Delivery
Labor is less than 3 hours from start of contractions Associated with increased hemorrhage risk
52
Placental Abruption: Patho, assessment, intervention
Placenta tears away from decidua causing mom to hemorrhage Asssessment: - New onset pain, despite epidural - Bleeding - Hard, firm abdomen Intervention: stat c-section
53
Placenta Previa: patho, assessment, intervention
Placenta implanted lower Assessment: - Vaginal bleeding, bright red - No pain - Soft uterus Intervention: prep for c-section
54
Postpartum Hemorrhage
Cumulative blood loss > 1000cc w/ in 24-hours of delivery OR Blood loss partnered with signs associated w/ hypovolemia 24hrs of delivery Clinical Signs - Soaked peripad in 15 minutes - VS changes - WIdening pulse pressure, increase HR, narrowed/decreasing bp, decrease O2 sats, pallor, then gray Causes: Tone Trauma Tissue Thrombin
55
Treatment for Uterine Tone/Atony Hemorrhage
70% of PPH Fundal massage Oxytocin, cytotec, methergine, hemobate
56
Treatment for Uterine Tissue Retained
10% of PPH Inspect placenta for breaks US D&C or vaginal removal
57
Treatment for Uterine Trauma
20% of PPH S/Sx - Inspect for lacerations, rupture, inversion, hematoma Treatment: repair tissue, evacuate hematoma
58
Oxytocin: what is it, action, contraindications
PPH medication Contraction of uterus No contraindications
59
Misoprostol: what is it, action, contraindications
PPH medication Action: Contraction of uterus Contraindications: None
60
Methylergonovine: what is it, action, contraindications
What is it? PPH med Action - contraction of uterus Contraindications: - HTN - Preeclampsia - Cardiac Disease
61
15-methylprostaglandin: what is it, action, contraindications
What is it? PPH medication Action - contraction of uterus Contraindications: - Asthma -HTN
62
Dinoprostone: what is it, action, contraindications
PPH medication Contraindications: - Asthma - HTN - Hypotension

Women's Health (6 decks)

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