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Labor/Delivery > Test 3 > Flashcards

Test 3 Flashcards

1
Q

Leading cause of maternal morbidity/mortality

A

Postpartum Hemorrhage (PPH)

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2
Q

Blood loss during hemorrhage is usually….

A

Underestimated

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3
Q

Risk factors for postpartum hemorrhage include…

A
  1. Induction
  2. C/S
  3. Multiple births
  4. Over-distension of the uterus
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4
Q

Postpartum hemorrhage in a client who just delivered vaginally is considered blood loss greater than…

A

500 mL

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5
Q

Postpartum hemorrhage in a client who just delivered by C/S is considered blood loss greater than…

A

1000 mL

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6
Q

Patients who lose 1 L of blood or more are at risk for developing…

A

Shock

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7
Q

The three major causes of early PPH are

A
  1. Uterine atony
  2. Lacerations/trauma
  3. Hematoma
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8
Q

Uterine atony risk factors… (4)

A
  1. Overdistention of the uterus
  2. Dysfunctional or prolonged labor
  3. Induction/augmentation
  4. Analgesics/anesthesia
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9
Q

First thing you do with a postpartum hemorrhage…

A

Fundal massage!

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10
Q

Pitocin, Methergine, and Prostaglandins (carboprost/hemabate) are medications used to treat…

A

Postpartum Hemorrhage

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11
Q

Why should the nurse avoid giving hemobate to patients with asthma?

A

Can cause bronchospasms

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12
Q

Biggest difference between laceration bleeding and hemorrhage is…

A

Fundal firmness! (Fundus will be firm and contracted if laceration bleeding)

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13
Q

A patient complaining of persistent perineal/rectal pain after delivering may be experiencing…

A

Hematoma (s/s are subtle, be aware of any small complaint)

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14
Q

Nursing interventions for a postpartum hematoma…

A

Cold compress (decreases swelling and discomfort)

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15
Q

Major cause of late PPH

A

Retained placental fragments

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16
Q

Normally, it should take no longer than…. to deliver the placenta

A

30 minutes

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17
Q

An abnormal placental adherence that does NOT involve the muscle is known as…

A

Accreta

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18
Q

An abnormal placental adherence that DOES involve the muscle (usually bladder wall) is known as…

A

Percreta

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19
Q

A patient presents postpartum with a fever of 101 that started 24 hours after her delivery and has lasted for 2 days. She is exhibiting signs of…

A

Puerperal Infection

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20
Q

Signs/symptoms of a localized (wound) puerperal infection include…

A
  1. Redness of skin edges
  2. Edema
  3. Firmness of wound
  4. Tenderness
  5. May have purulent drainage
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21
Q

Signs/symptoms of a generalized puerperal infection may include…

A
  1. Fever, Chills
  2. Malaise, Lethargy
  3. Foul or purluent lochia
  4. Uterine tenderness
  5. Cramping, abdominal pain
  6. Subinvolution
  7. Increased WBC count
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22
Q

An extended infection that includes the connective tissue of the broad ligament is known as…

A

Parametritis (Pelvic cellulitis) - If left untreated can turn into peritonitis

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23
Q

An inflammatory infection of the breast

A

Mastitis

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24
Q

A major risk factor for mastitis is…

A

Sore, cracked nipples (portal of entry for bacteria)

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25
Q

Signs/symptoms of mastitis include…

A
  1. Sudden onset of flulike symtpoms (fever, chills, body ache, HA, malaise)
  2. Localized pain/tenderness
  3. Hot, reddened area
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26
Q

A women experiencing mastitis should continue breast feeding. True or False?

A

True (want to promote frequent emptying)

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27
Q

Treatment for mastitis includes…

A
  1. Antibiotics and analgesics
  2. Warm compresses before feeding
  3. Frequent nursing and good breast support
  4. Rest
  5. Fluids and nutrition**
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28
Q

Major defining characteristic that distinguishes baby blues for postpartum depression

A

Baby blues resolves by day 10

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29
Q

Signs/symptoms of postpartum depression get… overtime

A

Worse (onset and progression may be gradual)

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30
Q

The onset of postpartum psychosis is usually within…

A

3 months (1st 3-6 weeks)

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31
Q

Major predisposing factors to postpartum depression are…

A
  1. Prenatal depression and/or anxiety

2. A history of depression

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32
Q

Important education to women and their partners after delivery…

A

Difference between baby blues and postpartum depression (and when to seek professional help)

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33
Q

Any loss or neonatal death up to 1 month of age

A

Perinatal loss

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34
Q

A preterm infant is defined as…

A

Any infant born prior to 38 weeks that is physically and neurologically appropriate for the assessed gestational age

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35
Q

Physical signs/symptoms of a preterm infant include…

A
  1. Decreased muscle tone
  2. Thin skin and low fat
  3. Absent plantar creases (before 32 weeks)
  4. Flat nipples
  5. Vernix and lanugo
  6. Flat and pliable pinna of ear
  7. Easily exhausted with a weak cry
  8. Increased respiratory efforts (due to decreased levels of surfactant)
  9. Increased risk for hypothermia
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36
Q

Most accurate way of determining gestational age

A

Physical assessment

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37
Q

Signs/symptoms of pain in a newborn

A
  1. Changes in HR
  2. Increased respiration
  3. Decreased O2 saturation
  4. Grimace and rigidity
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38
Q

Failure of the newborn to establish continuous respiratory effort

A

Perinatal asphxia

Nursing management: Resuscitation

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39
Q

Mild degree of respiratory distress

A

Transient tachypnea of the newborn (TTN)

Nursing management: Supportive

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40
Q

Inhalation of meconium stool from amniotic fluid that occurs inutero and may be a possible cause of intrauterine distress

A

Meconium Aspiration Syndrome

Nursing managment: Intensive care situation

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41
Q

Insufficient production of surfactant that can be caused by a stressful intrauterine environment

A

Respiratory Distress Syndrome (RDS)

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42
Q

At risk infants for the development of RDS are..

A
  1. Pre-term
  2. Asphyxia
  3. Diabetic babies (insulin disrupts pulmonary maturation)
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43
Q

The signs/symptoms of RDS…

A

Present within 1 hour, worsen over 48-72 hours, and can result in the reopening of the ductus (return to fetal circulation)

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44
Q

Management of RDS includes…

A
  1. Use of exogenous surfactant
  2. Oxygen and ventilation
  3. Correcting the metabolic and respiratory acidosis
  4. Suctioning
  5. Thermoregulation
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45
Q

Difference between respiratory distress syndrome and respiratory distress

A

Syndrome lasts longer

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46
Q

Visual impairment of preterm infants that results from hemorrhage to fragile vessels leading to scarring/retinal detachment

A

Retinopathy of Prematurity (ROP)

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47
Q

ROP can be caused by…

A
  1. HIGH*/low O2
  2. Acidosis
  3. Prolonged ventilation
  4. Sepsis and shock
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48
Q

Serious intestinal infection in preterm infants that can be caused by sepsis, polycythemia, maternal cocaine use, hypoxia, or shock

A

Necrotizing Entercolitis (NEC)

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49
Q

Signs/Symptoms of NEC include…

A
  1. Lethargy
  2. Poor feeding, decreased BS
  3. Abdominal distention
  4. Bloody stools
  5. Apnea, bradycardia
  6. X-ray verification of free air in the abdomen
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50
Q

Management of an infant with NEC includes…

A
  1. Bowel rest (TPN)
  2. Antibiotics
  3. Respiratory monitoring
  4. Gastric decompression
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51
Q

Number 1 nursing intervention for parents of a preterm infant…

A

Encourage parental attachment

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52
Q

An infant that is small for gestational age (SGA) will weigh less than…

A

2500g (5lb8oz)

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53
Q

Complications for a SGA infant include…

A
  1. Asphyxia
  2. Hypoglycemia
  3. Inadequate thermoregulation
  4. Polycythemia
  5. Altered nutrition
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54
Q

An infant that is large for gestational age (LGA) will weigh more than…

A

4000g (8lb13oz)

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55
Q

Complication for a LGA infant include…

A
  1. Hypoglycemia
  2. Birth trauma/injuries (shoulder dystocia, fractures of clavicle or skull, brachial plexus, facial nerve injury)
  3. Seizures
  4. Bruising
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56
Q

Why do postterm infants have an increased rate of mortality?

A

Decreased placental functioning

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57
Q

Development of polycythemia in a newborn is due to..

A

Poor intrauterine oxygenation (fetus produces more erythrocytes to compensate)

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58
Q

Distinguishing feature between pathological and physiological jaundice is…

A

Time of onset (pathological jaundice appears in the 1st 24 hours)

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59
Q

Bilirubin levels in a newborn are monitored related to…

A

Age

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60
Q

Bilirubin encephalopathy

A

Kernicterus

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61
Q

Testing of maternal blood during pregnancy for antibodies against fetal blood

A

Indirect Coombs

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62
Q

Cord blood testing

A

Direct Coombs

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63
Q

Rh negative mothers are given RhoGAM within 72 hours of delivering a Rh positive baby because…

A

it will halt antibody formation for future pregnancies

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64
Q

Neonatal infection (Sepsis Neonatorum) is more commonly caused by…

A

GBS and E.Coli

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65
Q

Horizontal transmission

A

Moves from placenta to fetus

66
Q

Vertical transmission

A

Moves up the vagina

67
Q

Signs/Symptoms of Neonatal Infection

A
  • Early signs may be subtle
    1. Temperature instability (SUB NORMAL readings)
    2. Tachypnea, apnea
    3. Pallor/cyanosis
    4. Tachycardia, bradycardia
    5. Decreased BP
    6. Vomiting, hypoglycemia
    7. Lethargy, irritability
    8. Bulging fontanelle
68
Q

Syndrome seen in prenatal opiate or cocaine exposure

A

Neonatal Abstinence Syndrome

69
Q

How do you test an infant for Neonatal Abstinence Syndrome?

A

Urine sample (PUC)

70
Q

An infant who is irritable with a high pitched cry, normal blood glucose, has vomiting and diarrhea, and poor feeding whose mother tested positive for opiate dependency is exhibiting signs of…

A

Neonatal Abstinence Syndrome

71
Q

Nursing care for an infant exposed to drugs

A
  1. Focus on feedings (small, frequent), rest, and parental attachment
  2. Decrease environmental stimuli
  3. Swaddle and rock vertically
  4. Utilize PUC to diagnose and screen infant
72
Q

Teratogenic effects of alcohol on a fetus include…

A
  1. Prenatal and postnatal growth restriction
  2. Decreased attention and memory; mental retardation
  3. Facial anomalies (flat midface, low set ears, cranial anomalies)
73
Q

When the uterus displaces into the vaginal canal

A

Uterine prolapse

74
Q

Major sign/symptom of uterine prolapse

A

Backache

75
Q

Biggest potential issue with uterine prolapse

A

Infection

76
Q

A weakness between the vagina and bladder

A

Cystocele

77
Q

A weakness between the vagina and rectum

A

Rectocele

78
Q

Prolapse of the upper portion of the vaginal wall

A

Enterocele

79
Q

An abnormal opening caused by gyn procedures, childbirth, or carcinoma

A

Fistula

80
Q

With a vesico-vaginal fistula…. leaks into the vagina

A

Urine

81
Q

With a recto-vaginal fistula… leaks into the vagina

A

Stool

82
Q

Most common BENIGN tumor

A

Leiomyoma (Fibroid)

83
Q

Presence of normal endometrial tissue in sites outside the endometrial cavity

A

Endometriosis

84
Q

Signs/Symptoms of Endometriosis

A

Cyclic pain
INFERTILITY
Dyspareunia

85
Q

Danocrine is a synthetic androgen that inhibits the anterior pituitary used to treat…

A

Endometriosis (promotes ovarian suppression and pseudomenopause)

86
Q

Side effects of Danocrine include…

A
  1. Hirsutism
  2. Weight gain
  3. Acne
87
Q

Nursing management for endometriosis

A
  1. Educate about side effects of medications
  2. Comfort measures
  3. Psychological support (pain, infertility, sexual difficulties)
88
Q

Infection of the pelvic cavity caused by untreated GC, Chlamydia or by having multiple partners

A

Pelvic Inflammatory Disease (PID)

89
Q

A patient complaining of abdominal pain, dyspareunia, post-coital bleeding, ADNEXAL TENDERNESS, fever, and discharge is exhibiting symptoms of…

A

Pelvic Inflammatory Disease

90
Q

Long term complications of PID

A

Infertility and ectopic pregnancy due to the formation of scar tissue

91
Q

Benign endocrine disorder characterized by insulin resistance, androgen excess, and unbalanced hormone levels

A

Polycystic Ovarian Syndrome (PCOS)

92
Q

Clinical manifestations of PCOS

A
  1. Amenorrrhea
  2. Acne
  3. Hirsutism
  4. Obesity
  5. Alopecia
  6. Acanthosis nigricans
93
Q

Cause of benign cyst formation in PCOS

A

Increased LH and decreased FSH causes anovulation

94
Q

Treatment for PCOS includes…

A
  1. Exercise/weight loss
  2. Diet to help improve glucose tolerance; metformin
  3. Birth control pills
95
Q

Cause of cervical cancer

A

Human Papiloma Virus (HPV)

96
Q

Risk factors for the development of cervical cancer

A
  1. Low socioeconomic status
  2. Early sexual activity*
  3. Multiple partners*
  4. Smoking
  5. Exposure to DES in utero
97
Q

Signs/Symptoms of cervical cancer include…

A
  1. Intermenstrual bleeding
  2. Thin, watery discharge
  3. Post-coital bleeding
98
Q

A patient experiencing papular warty lesions, pain, post-coital bleeding and pruritis is exhibiting signs of…

A

HPV

99
Q

Low-risk strains of HPV responsible for genital warts

A

Strains 6 and 11

100
Q

High-risk strains of HPV responsible for cervical cancer

A

Strains 16 and 18

101
Q

Vaccine for HPV

A

Gardisil

102
Q

Most common GYN cancer

A

Endometrial cancer

103
Q

Biggest sign of endometrial cancer

A

Unexplained peri/post menopausal bleeding

104
Q

Risk factors for endometrial cancer include…

A
  1. Unopposed estrogen replacement (if taking estrogen, need progesterone to balance!)
  2. Obesity (fat makes estrogen)
  3. Nulliparity, low parity
  4. Diabetes, HTN
  5. Menopause
  6. Chronic anovulation
  7. PCOS
105
Q

Patient education in the prevention of endometrial cancer

A
  1. Be sure to take progestin in hormone replacement therapy
  2. Weight management
  3. Early evaluation of abnormal bleeding
106
Q

Risk factors for Ovarian Cancer

A
  1. Age
  2. Genetics
  3. High fat diet**
  4. History of other cancers
  5. Nulliparity**
  6. Infertility
107
Q

Why is ovarian cancer so difficult to diagnose?

A

Often asymptomatic in early stages and there is no screening test

108
Q

Common complaints with undiagnosed ovarian cancer

A

Indigestion and GI symptoms

109
Q

Patient education for all forms of reproductive cancer

A
  1. Prevent, screen, detect
  2. Symptomology
  3. Treatments
  4. Wound management
  5. Bowel and bladder elimination
  6. Self-care management
  7. Signs of infection
  8. Sexual dysfunction
110
Q

Leading cause of PID

A

Gonorrhea

111
Q

Penicillin is more commonly used to treat what STD?

A

Syphilis

112
Q

Most common STD

A

Chlamydia

113
Q

Most important part of treatment for chlamydia

A

Treat partner as well, and abstain from intercourse during treatment

114
Q

Metronidazole (Flagyl) is used to treat which STD?

A

Trichomoniasis

115
Q

Important education point when treating a patient with Flagyl

A

Avoid alcohol

116
Q

A patient complaining of malodorous (fishy) smelling discharge may be exhibing symptoms of…

A

Bacterial vaginosis (BV)

117
Q

Complication in pregnancy caused by BV

A

Preterm labor or premature rupture of membranes

118
Q

Patients with a positive history of herpes simplex virus are treated with what starting at 36 weeks gestation

A

Valtrex

119
Q

Leading cause of death in women

A

Cardiovascular disease

120
Q

Why is height an important components of a patient’s physical assessment?

A

It helps to determine bone density

121
Q

Precursor to osteoporosis

A

Osteopenia

122
Q

BMI to be considered overweight

A

25-29.9

123
Q

BMI to be considered obese

A

30-39.9

124
Q

These types of exercises will help to increase bone density

A

Resistance and weight training

125
Q

RDA of calcium for women aged 24-50 and for women 50-64 who ARE taking HRT

A

1000 mg/day

126
Q

RDA of calcium for women aged 50+ who are NOT taking HRT

A

1500 mg/day

127
Q

RDA of fiber

A

25-35 grams/day

128
Q

Nurses role in women’s health

A
  1. Assessment/history
  2. Identification of risk factors
  3. Counseling/emotional support
  4. Client education
  5. Advocacy
  6. Health promotion
129
Q

Highest incidence of benign breast disorder in women of childbearing age

A

Fibrocystic Change

130
Q

Signs/Symptoms of Fibrocystic Change

A
  1. Pain/tenderness
  2. Lumpiness in BOTH breast
  3. S/S usually appear 1 week before menses and subside 1 week after menses end
131
Q

Conservative management approach to fibrocystic change

A
  1. Diet modification (decreased Na, decreased caffeine)
  2. Supportive bra
  3. Vitamin E
132
Q

Medications used to treat fibrocystic change are ones that…

A

counteract the hormonal influence (decrease effects of estrogen)

133
Q

Nursing implications with any benign breast disorder

A
  1. Risk factors
  2. Lifestyle characteristics
  3. Events surrounding the mass
  4. How much time has elapsed between discovery and care seeking
  5. Pain relief strategies
  6. Encourage discussion of feelings
134
Q

Risk factors associated with the development of malignant breast disease

A
  1. High fat diet
  2. Obesity with menopause
  3. Race
  4. Sedentary lifestyle
  5. “menstrual markers” (early menarche, late menopause)
  6. Daily alcohol use
  7. Nulliparty/first pregnancy after 30
  8. Estrogen or HRT
  9. BRCA gene mutations
135
Q

Most common form of breast cancer

A

Invasive ductal carcinoma

136
Q

Late finding of invasive ductal carcinoma

A

Peau d’orange (orange peel skin)

137
Q

Most common symptom of breast cancer

A

Nontender, nonmobile palpable lesion

138
Q

Over half of breast cancer lesions are found…

A

In the upper, outer quadrant

139
Q

Why should the arm of the side where lymph nodes were removed in breast cancer treatment never be placed in a dependent position?

A

Increased risk of lymphedema development

140
Q

Anastrozole (arimidex) is used to treat…

A

Postmenopausal ER+ tumors (breast cancer)

141
Q

The ideal contraceptive is…

A
  1. Safe
  2. Easily available
  3. Economical
  4. Acceptable
  5. Easy-to-use
  6. Promptly reversible
142
Q

The “right” contraceptive product is defined as…

A

The lowest dose of hormone needed to prevent ovulation, has the least side effects, and is the least harmful

143
Q

How does hormone based contraception work?

A

It INCREASES estrogen and progesterone which DECREASES GnRH, FSH, and LH, and results in no ovulation.

144
Q

Physical responses to hormone based contraception

A
  1. Decreased tubal transport of ovum
  2. Thickening of the cervical mucosa (more difficult for sperm to penetrate)
  3. Decreases endometrial build-up (prevents implantation of pregnancy)
145
Q

Potential side effects of increased estrogen levels

A
  1. N/V
  2. Dizziness, visual changes
  3. Edema, swelling of breasts
  4. Leg cramps
  5. Chloasma (pigment changes)
  6. Increased BP, vascular headache
146
Q

Potential side effects of decreased estrogen levels

A
  1. Early spotting
  2. Hypomenorrhea
  3. Nervousness
  4. Atrophic vaginitis (leads to dyspaerunia)
147
Q

Potential side effects of increased progestin

A
  1. Increased appetite
  2. Tiredness, depression
  3. Breast tenderness
  4. Vaginitis
  5. Hirsutism
  6. Postpill amenorrhea
148
Q

Potential side effects of decreased progestin

A
  1. Late spotting/breakthrough bleeding
  2. Heavy flow with clots
  3. Decreased breast size
149
Q

Contraindications to hormone based contraception can be grouped into the ACHES acronym which stands for…

A 
A - Abdominal Pain
C - Chest Pain
H - Headaches/Neuro S/S
E - Eye Problems
S - Severe Calf Pain
150
Q

Which oral contraceptive is closes to the natural cycle?

A

Multiphasic

151
Q

What is the cause of toxic shock syndrome (TSS)?

A

Things being left too long in the vagina (i.e. diaphragm).

Need to educate patients regarding signs/symtpoms

152
Q

The PAINS acronym is used to describe the early IUD warning signs. It stands for…

A 
P - Period late; abnormal spotting
A - Abdominal pain
I - Infection
N - Not feeling well
S - String missing
153
Q

Important education points for a client utilizing an IUD are…

A
  1. Checking placement

2. Signs/symptoms of an ectopic pregnancy

154
Q

A patient utilizing the fertility awareness method of birth control should be taught that thermal shift occurs…

A

After ovulation due to an increase in progesterone

Fertile period is the day of increased temperature, continuing for 3 consecutive days of increase

155
Q

A patient utilizing the Billings method of birth control is checking…

A

Character of cervical mucosa (fertile phase = egg whites)

156
Q

Primary infertility is defined as…

A

Couple has never previously conceived

157
Q

Secondary infertility is defined as..

A

Couple may have conceived before, but are unable to conceive after a previous pregnancy

158
Q

Fertility drug that can be given to either men or women

A

Clomid

159
Q

Why is Clomid given to men?

A

To increase sperm count

160
Q

The minimum number of sperm needed to achieve a pregnancy

A

20 million/mL with normal mobility

161
Q

A women’s fertility is dependent on….

A
  1. Regular production of normal ova
  2. Open path from cervix to fallopian tube
  3. Uterine endometrium that supports implantation
162
Q

Most important portion of a female infertility assessment

A

History and physical! (Need to know previous menstrual pattern)

Labor/Delivery (2 decks)

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