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OBGYN > Test 5 > Flashcards

Test 5 Flashcards

1
Q

life or well-being of the mother or infant is jeopardized by a biophysical or psychosocial disorder coincidental w/ or unique to pregnancy

A

high risk pregnancy

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2
Q

the goal is to determine whether the intrauterine environment continues to support the fetus

A

Electronic fetal monitoring

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3
Q

Types of electronic fetal monitoring (3)

A

Nonstress test
Vibroacoustic stimulation (VAS)
Contraction Stress Test (CST)

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4
Q

prenatal test used to check on a baby’s health; baby’s heart rate is monitored to see how it responds to the baby’s movement

A

Non-Stress Test

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5
Q

How Nonstress test is performed (3)

A

-Woman is seated in a recliner in semi-fowlers
-FHR is recorded w/ a Doppler transducer
-Tocodynamometer is applied to detect uterine contractions or fetal movements

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6
Q

what is considered a “reactive” NST (2)

A

Gestation > 32 weeks: 2 accelerations lasting 15 sec each within a 20 min window
Gestation <32 weeks: 2 accelerations lasting 10 sec each within a 20 min window

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7
Q

NST results and meaning

A

reactive: normal/good
nonreactive: requires further evaluation

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8
Q

Nonreactive NST:

A

if there’s no activity for 40 min or more, get provider

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9
Q

common for NST to take up to ______ to determine results

A

20 minutes

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10
Q

Reasons to do NST based on term: (2)

A

1st-2nd tri: after diagnosis of fetal anomalies
3rd: determine whether the intrauterine environment continues to support the fetus

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11
Q

Patients that are recommended for NST: (6)

A

Chromosomal abnormalities
Intrauterine growth restriction
Poorly controlled maternal DM
Hemorrhage/Risk of hemorrhage
Fetal congenital abnormalities
Maternal Heart disorders

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12
Q

Buzzer placed on stomach –> see if baby reacts on monitor to buzzer

A

Vibroacoustic stimulation (VAS)

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13
Q

Procedure done one of two ways:
-Nipple-stimulated ___________
-Oxytocin-Stimulated ___________

A

contraction stress test (CST)

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14
Q

Contraction Stress Test interpretations: (2)

A

Negative: desired
Positive: Late FHR decelerations are present

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15
Q

Obtains amniotic fluid to test for potential complications

A

amniocentesis

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16
Q

who would be offered an amniocentesis (4)

A

Older mom
Genetic concerns
Fetal maturity
Fetal hemolytic disease

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17
Q

Why are amniocentesis done? (3)

A
  • Prenatal diagnosis of genetic disorders/ congenital anomalies (neural tube defects)
  • Assessment of pulmonary maturity
  • Diagnosis of fetal hemolytic disease (rare)
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18
Q

used to monitor fetus in pregnancies complicated by conditions that may affect oxygenation

A

Daily fetal movement count (DFMC)
AKA: Fetal Kick Counts

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19
Q

Why do parents do DFMC (FKC)

A

Used to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation

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20
Q

How do parents do DFMC (FKC)

A

-Count of fewer than 3 kicks in 1 hour warrants further evaluation by a nonstress test
-Tell patient 3 kicks/1hr is an AVERAGE
(Baby can kick more during certain times of day so important to use average)

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21
Q

considered to be the most valuable diagnostic tool used in obstetrics

A

ultrasounography

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22
Q

two routes of ultrasounds

A

abdominal
transvaginal

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23
Q

three levels of ultrasound

A

Standard (basic)
Limited
Specialized (targeted

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24
Q

why are ultrasounds done

A

Fetal heart activity
Gestational age
Fetal growth
Fetal anatomy

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25
Q

primary use of ultrasound:

A

establish gestational age & predict due date of birth

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26
Q

secondary use of ultrasound: (3)

A

monitor structural development,
monitor heart rate
detect deformities

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27
Q

high risk indications of ultrasound (3)

A

-Fetal genetic disorders and physical anomalies such as Down’s (Nuchal translucency (NT) screening)
-Placental position and function
-Adjunct to other invasive tests (Amniocentesis risks are reduced w/ use of ultrasound)

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28
Q

what is measured in a biophysical profile

A

-Fetal breathing movements
-Gross body movements
-Fetal tone
-Reactive fetal heart rate
-Qualitative amniotic fluid volume

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29
Q

Biophysical profile: Normal score (2)
-Fetal breathing movements
-Gross body movements
-Fetal tone
-Reactive fetal heart rate
-Qualitative amniotic fluid volume

A

-Fetal breathing movements: 1 or more episodes in 30 min each lasting 30 sec or more
-Gross body movements: three or more discrete body/limb movements in 30 min
-Fetal tone: 1 or more episodes of active extension w/ return to flexion of limbs or trunk (including hands)
-Reactive fetal heart rate: 2 or more episodes of acceleration in 20 min each lasting 15 sec or more and associated w/ fetal movement (15 bpm or more)
-Qualitative amniotic fluid volume: 1 or more pockets of fluid measuring > 1cm in 2 perpendicular planes

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30
Q

Biophysical profile: abnormal score (0)
-Fetal breathing movements
-Gross body movements
-Fetal tone
-Reactive fetal heart rate
-Qualitative amniotic fluid volume

A

-Fetal breathing movements: absent or no episodes 30 sec or more in 30 mins
-Gross body movements: less than 3 episodes of body/limb movement in 30 sec
-Fetal tone: slow extension w/ return to flexion, movement of limb in full extension, or fetal movement absent
-Reactive fetal heart rate: < 2 episodes of accelerations or acceleration of <15bpm in 20 mins
-Qualitative amniotic fluid volume: pockets absent or pocket < 1 cm in 2 perpendicular planes

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31
Q

Biophysical profile score:
-Normal
-Equivocal
-Abnormal

A

-Normal: 8-10
-Equivocal: 6
-Abnormal: <4

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32
Q

Biophysical profile score 8-10 means:

A

CNS is functional & fetus is not hypoxemia

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33
Q

Biophysical profile score <4 means:

A

along w/ oligohydramnio –> labor induction

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34
Q

disorder of amniotic fluid resulting in decreased amniotic fluid volume for gestational age

A

Oligohydramnio

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35
Q

Biophysical profile done for ________ pregnancies, including: (4)

A

High risk pregnancies
-Asthma
-Post dates
-Previous stillbirth
-Decreased fetal movement

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36
Q

Modified BPP

Includes a combination of: (2)
How often are they done?
Predictive of:

A

Nonstress test (NST): twice a week
Amniotic fluid index (AFI): once a week
Predictive of fetal well being for 72 hours

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37
Q

Gestational Hypertension

A

onset of hypertension w/o proteinuria or other systemic findings diagnostic for preeclampsia after 20 weeks of pregnancy; BP at or greater than 140/90
resolves after giving birth

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38
Q

Chronic Hypertension

A

hypertension present before pregnancy or diagnosed before 20 weeks gestation

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39
Q

Chronic hypertension w/ superimposed preeclampsia

A

women w/ chronic hypertension may acquire preeclampsia or eclampsia
Difficult to diagnose

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40
Q

Chronic hypertension w/ superimposed preeclampsia
Treatment (ideally & high risk)

A

Ideally, management of chronic hypertension begins before conception
□ Lifestyle modifications:
□ Smoking/alcohol cessation
□ Exercise
□ Weight loss
High risk management:
□ Antihypertensive medications
□ Frequent assessments of maternal and fetal well-being

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41
Q

How to take an accurate BP for hypertensive women

A

Manual BP ALWAYS

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42
Q

Pre-Eclampsia w/o severe features:

A

-hypertension w/o proteinuria w/ systemic findings
-develops after 20 weeks of gestation in a previously normotensive women
-can also develop for the first time during the postpartum period

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43
Q

Pre-Eclampsia w/o severe features: Systemic findings (5)

A

Thrombocytopenia
Impaired liver function
New-onset renal insufficiency
Pulmonary edema
New-onset cerebral or visual disturbances

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44
Q

Pre-Eclampsia w/o severe features: Goals (2)

A

Ensure maternal safety
Deliver a healthy newborn as close to term as possible

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45
Q

Pre-Eclampsia w/o severe features: Treatment (5)

A

-Waiting game- reduce risks to keep baby in as long as medically safe
-Outpatient management usually possible
-Laboratory evaluation
-Fetal evaluation
-Activity restriction (No evidence that bedrest improves outcomes)

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46
Q

Pre-eclampsia w/ severe features (3)

A

-hypertension w/ proteinuria & systemic findings
-develops after 20 weeks of gestation in a previously normotensive women
-can also develop for the first time during the postpartum period

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47
Q

Pre-eclampsia w/ severe features: Goals (2)

A

-Ensure maternal safety
-Formulate a plan for delivery

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48
Q

Pre-eclampsia w/ severe features: Treatment (5)

A

-Magnesium Sulfate (med of choice)
-Continuous FHR and uterine contraction monitoring
-Bed rest w/ side rails ups
-Calm environment: dark room, quiet
-Assess for s/s of placental abruption

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49
Q

Pre-eclampsia w/ severe features: Risk factors (6)

A

Multifetal gestation
History of preeclampsia
Chronic hypertension
Preexisting diabetes and/or thrombophilia
Women w/ limited sperm exposure w/ the same partner
Paternal factors

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50
Q

Pre-eclampsia w/ severe features: Cause (6)

A

Unknown
Current thought:
-Inadequate vascular remodeling ->
-Decreased placental perfusion and hypoxia->
-Endothelial cell dysfunction->
-Vasospasm, increased peripheral resistance, increased endothelial cell permeability ->
-Decreased tissue perfusion

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51
Q

Pre-eclampsia w/ severe features: Nursing interventions (3+)

A

Control BP: antihypertensive medications for BP exceeding 160/110

Postpartum care:
-vitals, DTRs, LOC
-Magnesium sulfate infusion is continued after birth for seizure prophylaxis as ordered (usually 24 hours)

Future health care: increased risk of developing preeclampsia in future as well as chronic hypertension and cardiovascular disease

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52
Q

Pre-eclampsia w/ severe features: Neonatal concerns (2)

A

Fetal growth restrictions
Fetal demise

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53
Q

Pre-eclampsia w/ severe features: Care management (3)

A

Identify and prevent
-No reliable test/screening have been developed
-Low-dose aspirin (81mg/day) may help certain high-risk women
-NO NSAIDS

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54
Q

Pre-eclampsia w/ severe features: assessment (5)

A

-Accurately measure BP (manual)
-Assess edema
-Deep tendon reflexes
-Assess for hyperactive reflexes (clonus)
-Proteinuria

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55
Q

Proteinuria is ideally determined by evaluation of:

A

24 hour urine collection

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56
Q

s/s of severe preeclampsia (4)

A

Headaches
Epigastric pain
RUQ abdominal pain
Visual disturbances

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57
Q

medication of choice for preventing and treating seizure activity and preventing labor

A

magnesium sulfate

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58
Q

Mag Sulfate: administration (2)

A

-Administer intravenously as a secondary infusion (piggyback) by a volumetric infusion pump
-Initial loading dose –> continuous maintenance dose

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59
Q

Mag sulfate: nursing interventions: (3)

A

-Monitor output- mag excreted through urine
-Monitor for magnesium toxicity (renal function decline)
Blood draws
-Monitor EKG & respiratory status

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60
Q

Mag Sulfate: toxicity cure

A

Calcium gluconate

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61
Q

Mag Sulfate: Common side effects (4)

A

-Feeling of warmth
-Flushing
-Diaphoresis
-Burning at IV site

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62
Q

Mag Sulfate: Toxicity s/s (3)

A

-Absent deep tendon reflexes
-Decreased respiratory rate
-Decreased LOC

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63
Q

Pre-eclampsia: Paternal factor (2)

A

-men who have fathered a preeclamptic pregnancy are ~2x likely to father another preeclamptic pregnancy w/ a different women
-Regardless of whether the new partner has a history of a preeclamptic pregnancy

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64
Q

Eclampsia

A

-onset of seizure activity or coma in women w/ preeclampsia
-No history of preexisting (seizure-related) pathology

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65
Q

Women can develop eclampsia in the ___________ period

A

immediate postpartum

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66
Q

Eclampsia interventions (3+)

A

-Premonitory s/s
□ Persistent headache and blurred vision
□ Epigastric or RUQ pain
□ Altered mental status
-Convulsions can also appear w/o warning
-Immediate care
□ Ensure patent airway and client safety
□ Note the time of onset and duration of the seizure
□ Call for help but remain at the bedside

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67
Q

HELLP syndrome stand for:

A

(H)emolysis
[E]levated (L)iver enzymes
(L)ow (P)latelets

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68
Q

HELLP: dx (3)

A

-Laboratory diagnosis for a variant of preeclampsia that involves hepatic dysfunction
-Can develop in women who do not have hypertension or proteinuria
□ Often misdiagnosed
-Result of arteriolar vasospasm, endothelial cell dysfunction w/ fibrin deposits, and adherence of platelets in blood vessels

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69
Q

HELLP: s/s (4)

A

History of malaise
Influenza-like symptoms
Epigastric or RUQ abdominal pain
S/s worse at night and improve during the daytime

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70
Q

HELLP: treatment & cure

A

T: beta blockers
C: delivery

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71
Q

HELLP: risks (2)

A

-Perinatal mortality rate ranges from 7.4-34% w/ a maternal mortality rate of ~1%
-Severe risks for bleeding/going into DIC

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72
Q

type of gestational trophoblastic disease; benign proliferative growth of the placental trophoblast in which the chorionic villi develop into edematous, cystic, avascular transparent vesicles that hang in a grapelike cluster

A

Hydatidiform mole (molar pregnancy)

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73
Q

types of Hydatidiform mole (molar pregnancies) (2)

A

Complete: no embryonic or fetal parts
Partial: often have embryonic or fetal parts and an amniotic sac

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74
Q

Hydatidiform mole (molar pregnancy) dx (2)

A

-Transvaginal ultrasound
-HIIIIGH serum hCG levels

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75
Q

Hydatidiform mole (molar pregnancy): Nursing care management (3)

A

-Most moles abort spontaneously
-Suction curettage can safely be used
-Follow up care: monitor beta-hCG levels

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76
Q

Hydatidiform mole (molar pregnancy) Patient teaching

A

-Should not get pregnancy for at least one year
(HIGH risk for uterine cancer)

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77
Q

fertilized ovum is implanted outside uterine cavity

A

Ectopic pregnancy (tubal pregnancy)

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78
Q

Ectopic pregnancy (tubal pregnancy): s/s (3)

A

-Abdominal pain
-Delayed menses
-Abnormal vaginal bleeding

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79
Q

Ectopic pregnancy (tubal pregnancy) Dx (2)

A

-Quantitative HcG levels
-Transvaginal ultrasound

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80
Q

Ectopic pregnancy (tubal pregnancy): tx (3)

A

-Meds used: Methotrexate
-Surgical depends on location
-Follow up care

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81
Q

placenta implanted in lower uterine segment near or over internal cervical OS

A

Placenta previa

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82
Q

Degree to which the internal cervical OS is covered by placenta used to classify three types

A

-Complete
-Marginal
-Low-lying

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83
Q

Placenta previa: risk factors (5)

A

-Previous c-section birth
-Advanced maternal age (>35 -40)
-Multiparity
-History of prior suction curettage
-Living at a higher altitude smoking

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84
Q

Placenta previa: classic s/s (3)

A

-Painless, bright red vaginal bleeding during second or third trimester
-Most cases are diagnosed by ultrasound before significant vaginal bleeding occurs
-Abdominal examination usually reveals a soft, relaxed, nontender uterus with normal tone

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85
Q

Placenta previa: maternal and fetal outcomes (5)

A

-Major complication is hemorrhage
-Morbidly adherent placenta, an abnormally firm placental attachment
-Surgery-related trauma (most deliver by c-section)
-Preterm birth
-Intrauterine growth restriction (IUGR)

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86
Q

Placenta Previa: management (6)

A

-Monitor- contraction and FHR
-Less than 34 weeks: antenatal corticosteroids
-Vaginal bleeding preceded by or associated w/ uterine contractions: tocolytic medications (mag sulfate)
-Modified bed rest
-No vaginal/rectal exams
-No intercourse

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87
Q

placenta partly or completely separates from the inner wall of the uterus before delivery
○ Decrease or block the baby’s supply of oxygen and nutrients
○ Cause heavy bleeding in the mother

A

Placental abruption

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88
Q

Placental abruption R/F (5)

A

High blood pressure
Trauma
Cigarette smoking
Previous abruption
Cocaine use

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89
Q

Placental abruption S/S (5)

A

Severe abdominal pain
Vaginal bleeding (may be little to none)
Back pain
Uterine tenderness or rigidity
Uterine contractions- Often coming one right after another

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90
Q

Placental abruption: management (conservative & severe)

A

Conservative
□ Serial ultrasounds
□ Planned induction or c-section by 40 weeks
Severe requires immediate delivery
□ Correction of any coagulopathies
□ Increased risk for PPH

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91
Q

Hemorrhage

A

an escape of blood from a ruptured blood vessel, especially when profuse

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92
Q

Hemorrhage: most common causes

A

-Tone
-Trauma
-Tissue
-Thrombin (clotting)
-Coagulopathies of pregnancy

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93
Q

Hemorrhage: tone (9)

A

uterus contracts after delivery and may have problems related to
Prolonged labor
Inductions (Pitocin use or overuse)
Multiples w/ overdistension
Infections to uterus
Numerous Gs/Ps
Anesthetics (inhaled)
Magnesium sulfate or terbutaline
Hydramnios
Obesity

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94
Q

Hemorrhage: tone main cause

A

overuse/stretching out muscles

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95
Q

Hemorrhage: tone causes
-anesthetics & magnesium
-polyhydramnios

A

Anesthetics & magnesium: cause uterus to relax
Polyhydramnios: lots of amniotic fluid = overdistention of the uterus

96
Q

Hemorrhage: trauma (6)

A

Lacerations
Hematomas of the vagina or cervix
Inverted/ruptured uterus
Compound presentation such as a hand
Precipitous delivery (<3 hours)
Instrument assisted delivery

97
Q

Hemorrhage: trauma
hematomas of the vagina or cervix s/s (4)

A

Unresolved severe pain
No obvious sings of bleeding
Pelvic pressure
Episiotomies

98
Q

Hemorrhage: trauma
common cause of ruptured uterus

A

trying to have a vaginal delivery after having a c-section

99
Q

Hemorrhage: tissue (4)

A

Retained placental fragments
Should come out within 15-30 minutes max
Nurse should look for intactness of placenta
Acreta or percreta can occur

100
Q

Hemorrhage: tissue
placenta is attached to the myometrium (slight)

A

caret

101
Q

Hemorrhage: tissue
placenta is in the myometrium (deep)

A

increta

102
Q

Hemorrhage: tissue
placenta penetrates the myometrium and goes to or past the serosa

A

percreta

103
Q

Hemorrhage: tissue
Percreta: Surgical intervention required (2)

A

D&C
Hysterectomy

104
Q

Hemorrhage: thrombin
Coagulation disorders that may lead to PPH (3)

A

-Hemophilia
-Von Willebrand’s disease
-Idiopathic thrombocytopenia purport (ITP)

105
Q

Hemorrhage: Coagulopathies of pregnancy
Risk Factors

A

Prior DVTs
Embolism

106
Q

Hemorrhage Management
Safety bundle for obstetric hemorrhage recommended: (4)

A

Readiness
Recognition and Prevention
Response
Reporting and Systems Learning

107
Q

Hemorrhage management
Medical (5)

A

Firm massage of the uterine fundus
Elimination of bladder distention
Continuous IV infusion of 10-40 units of oxytocin added
Volume replacement
Uterotonic medications

108
Q

Hemorrhage management
Uterotonic medications & when to use (5)

A

Pitocin- 1st line
Other medications are given on a case-by-case basis
-Tranexamic acid
-Methergine
-Hemabate
-Cytotec

109
Q

Hemorrhage management:
Severe management (4)

A

Vaginal sweep
Pack w/ gauze
Uterine tamponade w/ balloon (Bakri, EBB, Jada)
D&C

110
Q

Hemorrhage:
Surgical management (2)

A

Visualization for repair of any tears
Hysterectomy last resort

111
Q

Hemorrhage:
Nursing role (4)

A

Identify excessive blood loss
Potential hypovolemia
Assist w/ correction of these underlying causes
Use of protocol

112
Q

Hemorrhage:
Nursing intervention: anticipatory management (5)

A

16-18 gauge IV
Manual massage of uterus
Foley to manage bladder distention and look for urine output
Frequent assessment of vital signs
-Looking for hypovolemia
Pitocin IV or IM- active management of 3rd stage of labor (EBP)

113
Q

Hemorrhage:
S/S of compensated hypovolemia (3)

A

increased pulse
decreased BP
increased respiratory rate

114
Q

Hemorrhage: anticipatory management
ORDER

A

Oxygen
Restore circulating volume
Drug therapy
Evaluation
Remedy underling cause

115
Q

Hemorrhage: anticipatory management
REACT

A

Resuscitate
Evaluation
Arrest hemorrhage
Consult
Treat complications

116
Q

Hemorrhage: Lab & diagnostic tests (3)

A

CBC (H&H/ platelets)
PT
PTT (both determine body’s clotting abilities)

117
Q

Hemorrhage: s/s (7)

A

Compensated shock
Pallor
Anemia
Lightheadedness or faint
Boggy uterus (atony)
Uterus above umbilicus
Large clots w/ uterine massage (weight the clots)

118
Q

pregnancy that ends as a result of natural causes before feal viability

A

Miscarriages

119
Q

Threatened miscarriage
-Amount of bleeding
-Uterine cramping
-Passage of tissue
-Cervical dilation
-Management

A

-Amount of bleeding: slight, spotting
-Uterine cramping: mild
-Passage of tissue: no
-Cervical dilation: no
-Management: bedrest & monitor

120
Q

Inevitable miscarriage
-Amount of bleeding
-Uterine cramping
-Passage of tissue
-Cervical dilation
-Management

A

-Amount of bleeding: moderate
-Uterine cramping: mild to severe
-Passage of tissue: no
-Cervical dilation: yes
-Management
-no pain, bleeding or infection: expectant management
-pain, bleeding, or infection: prompt termination (dilation & suction curettage)

121
Q

Incomplete miscarriage
-Amount of bleeding
-Uterine cramping
-Passage of tissue
-Cervical dilation
-Management

A

-Amount of bleeding: heavy-profuse
-Uterine cramping: severe
-Passage of tissue: yes
-Cervical dilation: yes, tissue in cervix
-Management:
*may require additional dilation
*med: misoprostol (cytotec)

122
Q

Missed miscarriage
-Amount of bleeding
-Uterine cramping
-Passage of tissue
-Cervical dilation
-Management

A

-Amount of bleeding: none-spotting
-Uterine cramping: no
-Passage of tissue: no
-Cervical dilation: no
-Management:
* med: misoprostol (Cytotec)
*dilation & suction curettage

123
Q

acquired syndrome characterized by intravascular activation of coagulation which is widespread and results in excessive clot formation and hemorrhage

A

Disseminated intravascular coagulopathy (DIC)

124
Q

Why does DIC occur w/ postpartum hemorrhage (2)

A

-Glycoprotein: found in body organs containing many blood vessels (placenta and amniotic fluid) activates circulating clotting factors when it is released from damaged tissue
-Release of large amounts of tissue factor as a result of placental abruption

125
Q

measuring out all blood loss physically (difference between dry pad and bloody pad)

A

quantitative blood loss

126
Q

measuring blood loss by multiplying the perioperative difference of hemoglobin (or hematocrit) by the patient’s estimated blood volume

A

estimated blood loss

127
Q

Value of doing QBL

A

more accurate

128
Q

DM present before pregnancy
10% of pregnancies have preexisting DM

A

pre gestational diabetes

129
Q

Pre-gestational diabetes: Maternal risk and complications (5)

A

-Macrosomia w/ increased risk of birth complications
-Hydramnios (polyhydramnios)
-Infections
-Ketoacidosis -> DKA
-Hypoglycemia/hyperglycemia

130
Q

Pre-gestational diabetes fetal/neonatal risk (4)

A

Perinatal mortality rates 3x higher
IUFD (stillbirth)
Congenital malformations
Hypoglycemia at birth

131
Q

Pre-gestational diabetes: assessment (2)

A

-Complete physical examination & thorough evaluation of her health status
-Routine prenatal laboratory tests & glycosylated hemoglobin A1C level

132
Q

Pre-gestational diabetes: antepartum care (9)

A

More frequent monitoring
Diet
Exercise
Insulin therapy
Self-monitoring of blood glucose
Urine testing
Complications requiring hospitalization
Fetal surveillance
Determination of birth date and mode

133
Q

Pre-gestational diabetes: primary goal

A

achieving and maintaining constant euglycemia

134
Q

Pre-gestational diabetes: intrapartum care (5)

A

-Monitoring for dehydration, hypoglycemia, and hyperglycemia
-Blood glucose levels carefully monitored
-Continuous EFM
-Intravenous infusion
Possible cesarean birth for macrosomia

135
Q

Pre-gestational diabetes: postpartum care (4)

A

-First 24 hours, insulin requirement drops substantially
-Risk for hemorrhage due to uterine distention
-Women w/ diabetes are encouraged to breastfeed
-Contraceptive methods education

136
Q

Gestational Diabetes s/s (4)

A

-Decreased tolerance to glucose
-Increased insulin resistance
-Decreased hepatic glycogen stores
-Increased hepatic production of glucose

137
Q

Gestational diabetes
Diagnosis made during ______ of pregnancy

A

2nd half

138
Q

Glucose tolerance test: two steps and result evaluation

A

1-hour, 50g oral glucose
◊ Positive: BS > 130-140
◊ Negative: BS < 130
3-hour, 100g oral glucose
◊ Positive: BS > 130-140
◊ Negative: BS < 130

139
Q

Risk factors for GDM (6)

A

-Family history of diabetes
-Previous pregnancy that resulted in an unexplained stillbirth or the birth of a malformed or macrosomic fetus
-Obesity
-Hypertension
-Glycosuria
-Maternal age >25

140
Q

GDB: maternal risk (3)

A

Preeclampsia
Cesarean delivery
Development of type 2 diabetes later in life

141
Q

GDB: neonate risk (2)

A

-Macrosomia and associated risks for birth trauma
-Electrolyte imbalances including neonatal hypoglycemia and hyperinsulinemia

142
Q

GDB: antepartume care (7)

A

-Goal is strict blood glucose control
-Dietary modification
-Exercise
-Self-monitoring of blood glucose
-Pharmacologic therapy
-Fetal surveillance
-Women who require insulin or oral hypoglycemic agents for BG control may have twice-weekly NSTs beginning at 32 weeks gestation

143
Q

GDB: intrapartum care (2)

A

-Blood glucose levels monitored hourly in labor
□ Maintain levels at 80-110 mg/dl (strict window)
-nfusion of insulin, if needed

144
Q

GDB: Postpartum care (4)

A

-Will return to normal glucose levels after birth
-High risk for recurrent GDM in future pregnancies
-ACOG recommends assessing all women who had GDM for carbohydrate intolerance with a 75-g, 2-hr OGTT or a fasting plasma glucose level at 6-12 weeks postpartum
-Lifelong repeat screening at least every 3 years

145
Q

excessive, prolonged vomiting accompanied by:
Weight loss Electrolyte imbalance Nutritional deficiencies Ketonuria

A

Hyperemesis gravidarum

146
Q

Normal n/v complicates 50-80% of all pregnancies, typically beginning _____________ gestation
Usually resolved by ___________ gestation
Cause:

A

4-10 weeks
20 weeks
unknown

147
Q

Hyperemesis gravidarum risk factors (11)

A

Younger maternal age
Nulliparity
BMI < 18.5 OR BMI> 25
Low socioeconomic status
Asthma
Migraines
Pre-existing DM
Psychiatric illness
Hyperthyroid disorder
Gastrointestinal disorder
Previous pregnancy complicated by Hyperemesis gravidarum

148
Q

Hyperemesis gravidarum (5)

A

Significant weight loss and dehydration
Dry mucous membranes
Decreased BP
Increased pulse rate
Poor skin turgor

149
Q

Hyperemesis gravidarum: assessment (3)

A

-Severity, frequency, and duration of episodes
-Determination of ketonuria
-Psychosocial assessment: role of anxiety

150
Q

Hyperemesis gravidarum: interventions (5)

A

-IV therapy for correction of fluid and electrolyte imbalances
-Medications
-Enteral or parenteral nutrition as a last resort
-Prevent recurrence of N/V
-Follow up care

151
Q

hyperemesis gravidarum: priorities (2)

A

-Dehydration related to excessive vomiting
-Inadequate weight gain related to nausea and persistent vomiting

152
Q

a set of disorders that can occur anytime during pregnancy as well as in the first year postpartum

A

Perinatal mood disorders (PMD)

153
Q

Perinatal mood disorders (PMD) (3)

A

Post partum depression
Bipolar Disorder
Postpartum Psychosis

154
Q

PPD Discharge instructions (3)

A

-Medications risks - increased risk of suicide first couple of weeks
-Attachment behaviors w/ infant
-Resources for support - meals on wheels, getting family in to help with newborn & help with sleep deprivation

155
Q

PPD: Care at home

A

Combination of antidepressants and cognitive-behavioral therapy (CBT) or interpersonal psychotherapy (IPT)

156
Q

PPD: Antidepressant medications (4)

A

Selective serotonin reuptake inhibitor (SSRI)
Serotonin/norepinephrine reuptake inhibitor (SNRI)
Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitor (MAOI)

157
Q

PPD: nursing interventions (3)

A

-Educate about depression as an illness and the plan of care, including medications
-Discuss alternative treatments and respect her choice if she refuses medications
-Maintain a caring, hopeful relationship

158
Q

PPD w/o psychotic features

A

Irritability; feeling of detachment toward the newborn

159
Q

PPD w/ psychotic features

A

Feelings of wanting to harm self, baby, or others

160
Q

PPD screening (4)

A

-Rule out thyroid abnormalities and anemia first
-S/s of major depression
-Edinburgh Postnatal Depression Scale (EPDS)
(most accurate)
-Postpartum Depression Screening Scale (PDSS)

161
Q

Substance abuse interventions (5)

A

-Education
-Individualized treatment
-Smoking cessation: USPSTF recommendations
-Detoxification
-Medical withdrawal from opioids during pregnancy is currently not recommended

162
Q

head born but anterior shoulder cannot pass under pubic arch

A

shoulder dystocia

163
Q

Shoulder Dystocia: “turtle sign”

A

head comes out then reseeds due to shoulder being stuck

164
Q

shoulder dystocia: risks to newborn (3)

A

Asphyxia
Brachial plexus damage
Fractured clavicle

165
Q

Shoulder dystocia: risks to mother (3)

A

Uterine atony/ rupture
Lacerations
Hemorrhage

166
Q

Shoulder dystocia: nursing interventions

A

McRoberts Maneuver: lay flat and pull legs back and apply suprapubic pressure

167
Q

Shoulder dystocia: Zavanelli maneuver (2)

A

push baby back in and do a crash c-section
LAST RESPORT

168
Q

Can a baby w/ shoulder dystocia be removed w/ forceps?

A

NO

169
Q

indicates fetus has passed stool prior to birth and has possible inhaled it

A

Meconium-stained amniotic fluid

170
Q

Meconium-stained amniotic fluid: possible causes (4)

A

-Normal physiologic function of maturity (post dates)
-Breech presentation
-Hypoxia-induced peristalsis
-Umbilical cord compression

171
Q

Meconium-stained amniotic fluid: inter-professional care management (3)

A

-Presence of an interprofessional team skilled in neonatal resuscitation is required
-Assess if baby is “vigorous” at birth
□ If so -> go skin to skin
□ If not -> intubate and try to clear meconium
-Observation

172
Q

occurs when cord lies below the presenting part of the fetus

A

cord prolapse

173
Q

cord prolapse: contributing factors (5)

A

-Cord length (>100cm)
-Malpresentation (breech)
-Transverse lie
-Unengaged presenting part
-Artificial rupture of membranes when presenting part is not engaged

174
Q

Cord prolapse: priority interventions (5)

A

Prompt recognition
Pressure off cord
Position change to keep pressure off the cord
Stat C-section
□ Nurse cannot remove venial hand until provider has baby out

175
Q

symptomatic disruption and separation of the layers of the uterus or previous scar

A

uterine rupture

176
Q

most frequent cause of uterine rupture (2)

A

-Separation of scar of a previous classic cesarean birth
-Uterine trauma (accident, surgery)

177
Q

incomplete uterine rupture; separation of a prior scar

A

uterine dehiscence

178
Q

rare but devastating complication of pregnancy characterized by sudden, acute onset of hypotension, hypoxia, and hemorrhage caused by coagulopathy

A

Amniotic Fluid Embolus (AFE)

179
Q

results from formation of blood clot(s) inside a blood vessel caused by inflammation or partial obstruction of vessel

A

Venous thromboembolism (VTE)

180
Q

VTE type: involvement of the superficial saphenous venous system
Most common
Pain and tenderness in the lower extremity

A

Superficial

181
Q

VTE type: occurs most often in the lower extremities; involvement varies but can extend from the foot to the iliofemoral region
Positive Homan’s sign

A

deep vein thrombosis (DVT)

182
Q

complication of DVT occurring when part of a blood clot dislodges and is carried to the pulmonary artery, where it occludes the vessel and obstructs blood flow to the lungs

A

pulmonary embolism (PE)

183
Q

Cesarean birth __________________ the risk for VTE

A

doubles

184
Q

VTE care management: (3)

A

Ongoing assessment
Education
Anticoagulation use

185
Q

any clinical infection of the genital tract that occurs w/in 28 days after miscarriage, abortion, or birth

A

Puerperal infection (postpartum infection)

186
Q

Three types of postpartum infections

A

endometritis
wound infection
urinary tract infection

187
Q

infection of the lining of the uterus

A

endometritis

188
Q

Most common postpartum infection

A

endometritis

189
Q

indication of postpartum infection

A

Presence of a fever of 38* C (100.4) or more on 2 successive days of the first 10 postpartum days

190
Q

management of postpartum infections

A

IV broad-spectrum antibiotic therapy

191
Q

birth of a fetus through a transabdominal incision of the uterus to preserve the well-being of the mother and her fetus

A

cesarean section

192
Q

Primary cesarean birth w/o medical or obstetric indications

A

elective

193
Q

most common reason for scheduled c-section

A

breech presentation

194
Q

forced cesarean (2)

A

Maternal-fetal conflict
Ethical implications

195
Q

considerations w/ unplanned cesarean

A

Can cause a lot of mental distress in parents
□ Not the birth they intended
□ Fell like they “missed out” on a vaginal delivery

196
Q

attempt to turn fetus from breech or shoulder presentation to vertex presentation for birth

A

External Cephalic Version (ECV)

197
Q

External Cephalic Version (ECV): RF

A

Cord strangulation
Decreased HR

198
Q

regular contractions along w/ a change in cervical effacement or dilation or both or presentation w/ regular uterine contractions or cervical dilation of at least 2 cm

A

preterm labor

199
Q

any birth that occurs between 20 weeks and 36 weeks and 6 days of gestation

A

preterm birth

200
Q

level of preterm
Very preterm:
Moderately preterm:
Late preterm:

A

Very preterm: < 32 weeks
Moderately preterm: 32-34 weeks
Late preterm: 30-36 weeks & 6 days

201
Q

Preterm vs Low birth weight

A

Preterm is more dangerous than birth weight alone because less time in the uterus correlated w/ immaturity of body systems

202
Q

what qualifies as low birth weight

A

< 2500 grams at birth

203
Q

Cause of spontaneous preterm labor/birth (6)

A

Congenital structural abnormalities of the uterus
Placental causes
Maternal/fetal stress
Uterine overdistention (multiples)
Allergic reaction
Decrease in progesterone

204
Q

Only definitive factor of preterm labor/birth

A

infection

205
Q

used to predict who will not go into preterm labor

A

Fetal Fibronectin (fFN) test

206
Q

glycoprotein “glue” found in plasma and produced during fetal life

A

fFN

207
Q

Fetal Fibronectin (fFN) test result interpretation

A

Negative result = <1% chance of giving birth within two weeks

208
Q

preterm nursing interventions (6)

A

Prevention
Early recognition and diagnosis
Lifestyle modifications
Activity restriction
Restriction of sexual activity
Home care

209
Q

Preterm meds given and why

A

Steroids: promotion of fetal lung maturity Tocolytic medications: suppression of uterine activity (stops contractions)

210
Q

Preterm meds: tocolytics

A

mag sulfate
terbutaline

211
Q

Preterm meds: steroids

A

Antenatal glucocorticoid: significantly reduce the incidence of:
□ respiratory distress syndrome -Intraventricular hemorrhage
-Necrotizing enterocolitis
-Death in neonates

Betamethasone: given to help mature lungs

212
Q

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

A

Premature Rupture of Membranes (PROM)

213
Q

membranes rupture before 37 weeks gestation

A

Premature Prolabor Rupture of Membranes (PPROM)

214
Q

Premature Prolabor Rupture of Membranes (PPROM): interventions (6)

A

-Less than 32 weeks: manage expectantly and conservatively
-Vigilance for s/s of infection
-Fetal assessment
NSTs at least twice daily
-Antenatal glucocorticoids for all women w/ preterm PROM between 24-34 weeks gestation
-7-day course of broad-spectrum antibiotics
-Administering mag sulfate for fetal neuroprotection

215
Q

bacterial infection of the amniotic cavity

A

Chorioamnionitis

216
Q

Chorioamnionitis: clinical findings (4)

A

Maternal fever
Maternal and fetal tachycardia
Uterine tenderness
Foul odor of amniotic fluid

217
Q

Chorioamnionitis: neonatal risk (4)

A

Pneumonia
Bacteremia
Meningitis
Death more likely if preterm

218
Q

Chorioamnionitis: neonatal at increased risk for (3)

A

Respiratory distress syndrome
Periventricular leukomalacia
Cerebral palsy

219
Q

Chorioamnionitis: treatment (2)

A

Broad spectrum antibiotics
Birth of baby

220
Q

pregnancy greater than or equal to 42 weeks of gestation

A

post term/ postdates

221
Q

post term: maternal and fetal risk (7)

A

-Increased maternal morbidity
-Dysfunctional labor and birth canal trauma
-Labor and birth interventions more likely
-Abnormal fetal growth (macrosomia)
-Prolonged labor
-Should dystocia or operative birth risks increase
-Post maturity syndrome

222
Q

prompting the uterus to contract during pregnancy before labor begins on its own for a vaginal birth

A

induction

223
Q

Why are inductions performed? (2)

A

elective
medically indicated

224
Q

medical indications of induction (5)

A

-Post-dates
-Gestational diabetes
-HTN or preeclampsia
-Fetal abnormalities
-Maternal co-morbidity

225
Q

risks of induction (3)

A

-Increased rates of cesarean birth
-Increased neonatal morbidity
-Increased cost

226
Q

induction should not be initiated until client is at least

A

39 weeks

227
Q

should be completed to assess “readiness for labor” or cervical ripeness

A

bishop score

228
Q

best indicator for successful induction

A

cervical ripeness

229
Q

mechanical methods to ripen cervix (2)

A

Balloon catheter- transcervical foley balloon
§ Similar to foley balloon but can hold up to 60 cc fluid
§ When it “falls out” client is usually 3-4 cm dilated
Amniotomies: artificial rupture of membranes
§ Used to induce or augment labor

230
Q

Chemical methods to ripen cervix (2)

A

prostaglandins:
Misoprostil
Cervidil

231
Q

use of pharmacological or surgical interventions to help the progression of a previously dysfunctional labor

A

augmentation

232
Q

augmentation drug of choice

A

Pitocin

233
Q

Mechanical augmentation (2)

A

vacuum extractor
forceps-assisted-birth

234
Q

augmentation indications (2)
Both methods should never: (2)

A

Maternal exhaustion
Fetal distress
should never
-both be used together
-have attempt restrictions

235
Q

VEAL CHOP

A

Variable————>Cord Compression
Early decels——->Head Compression
Acceleration——->OK
Late decels——–>Placental inefficiency

OBGYN (6 decks)

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