Test #7: OB Flashcards
What is the largest cause of spontaneous abortion?
Congenital problems of the baby
What is a “spontaneous abortion”?
The medical term for miscarriage
What is a “threatened abortion”?
Bleeding in the first half of pregnancy
Post-miscarriage, what will contents left in the uterus cause?
Bleeding and infection
What is a “missed abortion”?
Where the mother is unaware that the baby died
What is the only “absolute” sign of pregnancy?
Fetal Heart Rate
What should a patient, post-miscarriage be taught?
No tampon use or sex until being cleared by the doctor
After a missed-abortion, what will contents left in the uterus cause?
Bleeding (DIC) and infection
What is a risk factor for ectopic pregnancy?
Pelvic infection or pelvic inflammatory disease
What is the most sensitive test to determine fibrin levels (used in patients with DIC)?
D-dimer
How long should a woman who had a molar-pregnancy be monitored for choriocarcinoma?
For 1 year
How is a molar pregnancy treated?
Vacuum aspiration is used to extract the mole; then IV oxytocin is used to contract the uterus
What is it important not to stimulate uterine contractions before the uterus is evacuated? (in molar pregnancy)
Because contractions can cause trophoblastic tissue to be drawn into venous circulation, resulting in embolization of the vesicles
What is the “classic sign” of placenta previa?
Painless uterine bleeding in the second half of pregnancy
What assessment should not be done on a patient with placenta previa?
Digital examination of the cervical os (can cause serious bleeding)
What 4 things should a patient be taught to monitor for management of placenta previa at home?
- Assess discharge or bleeding
- Count fetal movement
- Assess uterine activity (contractions) daily
- No sex (to prevent displacement of the placenta)
Why is a pregnant woman positioned on her left side?
Because lying flat on her back can cause vena cava compression; side-lying promotes placenta perfusion
What is the main symptom of a concealed abruptio placenta?
Rigid, board-like abdomen
What is the primary risk factor for abruptio placenta?
Maternal cocain use
What test cannot be used to diagnose abruptio placenta?
Ultrasound; because placental seperation and bleeding look similar on ultrasounds
What is the major danger for a woman with abruptio placenta?
Hemorrhage, DIC and/or hypovolemic shock
What test cannot be used to diagnose abruptio placenta?
Ultrasound; because placental separation and bleeding look similar on ultrasounds
What is “gestational hypertension”?
Blood pressure of >140/90 that develops after 20 weeks without proteinuria
What is “pre-eclampsia”?
A BP of >140/90 after 20 weeks with significant proteinuria
What is eclampsia?
Progression of preclampsia to seizures
What does epigastric pain in a patient with pre-eclampsia indicate?
It is a warning sign of decreased liver perfusion and often indicates that a seizure is imminent
What classification in Magnesium Sulfate?
A CNS depressant (tocolytic)
What is a warning sign of magnesium toxicity?
Respirations less than 12/min
What is the drug to treat magnesium toxicity?
Calcium gluconate
What is generally the first sign of eclampsia and/or impending maternal seizure?
Facial twitching
What is the advantage of Hydralazine over other antihypertensives?
In addition to vasodilation, it increases cardiac output and placental bloodflow.
What is the classic symptom of the HELLP syndrome?
Pain in the right upper quadrant, epigastrium or lower chest.
When does an Rh incompatibility occur?
When the Mom is Rh negative and the baby is Rh positive
What test is used to predict Rh incompatibility?
Coombs test
What complication might a diabetic mother have with amniotic fluid?
They may have an excess of amniotic fluid
What intervention is indicated for a prolapsed umbilical cord?
Immediate C-section
How much bleeding/lochia is considered “too much” after birth?
More than 1 pad per hour
How long should lochia be red?
First 3 days
How often should vital signs be checking in the post-partum patient?
Every 15 minutes until stable and then every hour
What contraction-inducing medication should not be given to a woman with hypertension?
Methergine
What contraction-inducing medication would be given if Pitocin is ineffective?
Prostin E2
Any time excessive bright red uterine bleeding is present and the fundus is contracted firmly at expected location, what is suspected as the cause?
lacerations of birth canal
What is subinvolution of the uterus?
where the uterus does not return to its normal size
How fast does the uterus normally descend?
1 cm per day
How often should a newborn be nursed?
Every 2-3 hours
What is the technical definition of “preterm” or “premature” baby?
Less than 38 weeks
What is the normal respiratory rate of a neonate/newborn?
30-60
What respiratory rate is considered tachypnea in a neonate/newborn?
More than 60
What 3 things point to infection in the postpartum woman?
fever >100.4 F, pelvic tenderness, or vaginal discharge with a foul odor
What is the range of Proteinuria in mild preclampsia?
> 0.3 g but
What is the range of Proteinuria in severe preclampsia?
> 5 g on 24 hour urine; 3+ or higher on dipstick
What is the range of Proteinuria in severe preclampsia?
> 5 g on 24 hour urine; 3+ or higher on dipstick
What is the therapeutic range of Magnesium?
4-8
What is the antidote for Magnesium?
Calcium gluconate
What is the antidote for Magnesium?
Calcium gluconate
Why does the nurse have to be cautious when administering Magnesium and anti-hypertensives together to a woman in severe preclampsia?
Because signs of magnesium toxicity includes hypotension
Why does the nurse have to be cautious when administering Magnesium and anti-hypertensives together to a woman in severe preclampsia?
Because signs of magnesium toxicity includes hypotension
What does “HELLP” stand for?
Hemolysis
Elevated Liver enzymes
Low Platelet count
What is the first sign of HELLP syndrome?
Pain in right upper quadrant, lower chest, or epigastric area
What is the first sign of HELLP syndrome?
Pain in right upper quadrant, lower chest, or epigastric area
What should the nurse keep in mind with administering Methyldopa to a pregnant patient with hypertension?
It may cause a positive Coombs test
What should the nurse keep in mind with administering Methyldopa to a pregnant patient with hypertension?
It may cause a positive Coombs test
What is the purpose of a Coombs test?
To detect detect maternal antibodies to Rh positive blood
What is the purpose of a Coombs test?
To detect detect maternal antibodies to Rh positive blood
When should RhoGam be administered?
At 28 weeks and within 72 hours of delivery
When should RhoGam be administered?
At 28 weeks and within 72 hours of delivery
When should RhoGam be administered?
At 28 weeks and within 72 hours of delivery
What is Procardia (Nifedipine)?
A calcium channel blocker; used in pregnancy to relax smooth muscle (as a Tocolytic)
In the event of premature birth, what intervention will decrease the risk/severity of hyperbilireubinemia?
Clamping the cord immediately rather than letting it pulsate
What is the treatment for HELLP syndrome?
FFP, mag and hydralazine (and birth the baby)
What is the treatment for HELLP syndrome?
FFP, mag and hydralazine (and birth the baby)
What effects does gestational diabetes have on the baby?
Hypoglycemia, hypocalcemia and hyperbilireubinemia
What effects does gestational diabetes have on the baby?
Hypoglycemia, hypocalcemia and hyperbilireubinemia
How does an ectopic pregnancy often present?
Sudden, sharp, stabbing pain in the lower abdominal quadrant–referred pain the neck or shoulder
Why is it important for Mom to void every 1-2 hours during labor?
Soft tissue obstruction; can keep labor from progressing
Why is it important for Mom to void every 1-2 hours during labor?
Soft tissue obstruction; can keep labor from progressing
What fetal heart rate is indicative of infection?
greater than 160
What fetal heart rate is indicative of infection?
greater than 160
In the event of premature rupture of membranes, what will the nitrazine paper show?
pH greater than 6.5, alkaline and paper will turn blue
In the event of premature rupture of membranes, what will the nitrazine paper show?
pH greater than 6.5, alkaline and paper will turn blue
When are corticosteriods used to mature the baby’s lungs?
Most effective given between 24 and 34 weeks gestation
How long do corticosteroids need to take effect?
Birth must be halted for 24-48 hours for the drug to take effect
How long do corticosteroids need to take effect?
Birth must be halted for 24-48 hours for the drug to take effect
How long do corticosteroids need to take effect?
Birth must be halted for 24-48 hours for the drug to take effect
What complication may be seen in a mother that goes over her due date?
Cord compression due to oligohydramnios, decreased placental function and meconium aspiration
What complication may be seen in a mother that goes over her due at date?
Cord compression due to oligohydramnios, decreased placental function and meconium aspiration
What is done to pt in prolonged labor?
if cervix is ripened (soft, dilate, and slight effacement) ten labor is induced. if not prostaglandin gel applied to the cervix
What is a hypertonic contraction?
Longer than 90 seconds, less than 2 minutes between contractions or less than 30 seconds rest between contractions,
What is a hypertonic contraction?
Longer than 90 seconds, less than 2 minutes between contractions or less than 30 seconds rest between contractions,
manifestations of uterine atony after birth
fundus difficult to locate, uterus relaxes when massage stop, vaginal bleeding - pad every 15 is excessive
management for uterine atony
regular fundal message, pitocin, metergine and hysterectomy for extreme atonia
management for uterine atony
regular fundal message, pitocin, metergine and hysterectomy for extreme atonia
management for uterine atony
regular fundal message, pitocin, metergine and hysterectomy for extreme atonia
How long after birth until the uterus is not palpable anymore?
2 weeks
What assessment finding indicates PKU?
musty urine
what test detects PKU?
Guthrie blood test
what typically results if PKU goes untreated?
mental retardation, musty body odor or urine, and seizures (trt includes low protein diet)
What is Kernicterus?
it is the toxic accumulation of bilirubin in the brain and may cause severe brain damage.
what is the most common cause of hyperbilirubinemia and kernicterus?
Rh and ABO inccompatibility
what at some indications of a hopycalcemic newborn d/t diabetic mother
irritability, tremors, and high pitched cry
the test used to screen for gestational diabetes is the?
oral glucose tolerance test
a woman has shoulder dystocia when giving birth. the RN should expect which intervention
suprapublic pressure
a mother has excess lochia 2 hours after delivering an 8lb baby, what should be the RN’s priority
assess the firmness of her uterus
the best position for a women who has postpartum endometritis is?
Fowler’s
what intervention would be expected in the first 8-12 hours after a post-term birth
blood glucose determination
