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Women's Health > Test 3 > Flashcards

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withdrawn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
Q

Vertex

A

head down
cephalic

26
Q

Shoulder

A

acromonian

27
Q

Breech

A

buttocks

28
Q

Brow

A

sinciput

29
Q

Chin

A

mentum

30
Q

COAT

A

Refers to ROM assessment

Color
Odor
Amount
Time - do not want to exceed 24hrs, abx at 18hrs

31
Q

Hyperventilation: What does it result in? S/Sx? Intervention?

A

Results in respiratory alkalosis

S/Sx

dizziness
tingling of fingers
stiff mouth

Ask mom to breathe into cupped hands or paper bag

32
Q

Placental Separation: S/Sx, Intervention

A

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
Q

Maternal Blood Loss: Vaginal

A

<500cc

34
Q

Maternal Blood Loss: Cesarean

A

<1000cc

35
Q

First Degree laceration

A

involves epidermis

36
Q

Second Degree Laceration

A

Involves epidermis, dermis, muscle and fascia

37
Q

Third Degree Laceration

A

Extends into anal sphincter

38
Q

Fourth Degree Laceration

A

Extends up rectal mucosa

39
Q

Gate Control Theory: What is it, types

A

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
Q

Pudendal Block

A

Blocks vaginal pain, perineum pain

useful for vacuum, forceps, vaginal delivery w/ epiotomy

41
Q

Epidural Anesthesia

A

Blocks uterine pain

42
Q

Fentanyl

A

Never give 1hr before delivery due to risk of neonatal respiratory depression, safety, and fetal monitoring

43
Q

Stadol and Nubain

A

NEVER give 1hr prior to delivery due to risk of neonatal respiratory depression

44
Q

Shoulder Dystocia: Clinical Sign, Intervention, Maternal Risks, Fetal Risks

A

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
Q

Prolapsed Umbilical Cord: patho, ews, intervention

A

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
Q

Amniotic Fluid Embolism: patho, assessment, interventions

A

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
Q

Hypotonic Uterine Dysfunction:

A

Occurs during active phase

Woman makes normal progress into active phase, then contractions are weak and inefficient or stop altogether

48
Q

Hypertonic Uterine Dysfunction

A

Occurs during latent phase of stage 1

Frequent contractions that are ineffective in causing cervical dilation or effacement

Mom needs rest

49
Q

External Cephalic Version: What is it? Medication given

A

Attempt to turn fetus from breech or shoulder to vertex for birth

Terbutaline will be given to relax uterus

50
Q

Elective Induction

A

Labor initiated w/o medical indication
Not initiated until mom is 39 weeks

51
Q

Precipitous Delivery

A

Labor is less than 3 hours from start of contractions

Associated with increased hemorrhage risk

52
Q

Placental Abruption: Patho, assessment, intervention

A

Placenta tears away from decidua causing mom to hemorrhage

Asssessment:
- New onset pain, despite epidural
- Bleeding
- Hard, firm abdomen

Intervention: stat c-section

53
Q

Placenta Previa: patho, assessment, intervention

A

Placenta implanted lower

Assessment:
- Vaginal bleeding, bright red
- No pain
- Soft uterus

Intervention: prep for c-section

54
Q

Postpartum Hemorrhage

A

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
Q

Treatment for Uterine Tone/Atony Hemorrhage

A

70% of PPH

Fundal massage
Oxytocin, cytotec, methergine, hemobate

56
Q

Treatment for Uterine Tissue Retained

A

10% of PPH

Inspect placenta for breaks
US
D&C or vaginal removal

57
Q

Treatment for Uterine Trauma

A

20% of PPH

S/Sx
- Inspect for lacerations, rupture, inversion, hematoma

Treatment: repair tissue, evacuate hematoma

58
Q

Oxytocin: what is it, action, contraindications

A

PPH medication

Contraction of uterus

No contraindications

59
Q

Misoprostol: what is it, action, contraindications

A

PPH medication

Action: Contraction of uterus

Contraindications: None

60
Q

Methylergonovine: what is it, action, contraindications

A

What is it? PPH med

Action - contraction of uterus

Contraindications:
- HTN
- Preeclampsia
- Cardiac Disease

61
Q

15-methylprostaglandin: what is it, action, contraindications

A

What is it? PPH medication

Action - contraction of uterus

Contraindications:
- Asthma
-HTN

62
Q

Dinoprostone: what is it, action, contraindications

A

PPH medication

Contraindications:
- Asthma
- HTN
- Hypotension

Women's Health (6 decks)

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