Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nursing Semester 2 > Toni - Week 6 - Exam 4 > Flashcards

Toni - Week 6 - Exam 4 Flashcards

You may prefer our related Brainscape-certified flashcards:
Nursing Pharmacology flashcards NCLEX-RN® flashcards Nursing Mental Health flashcards Nursing Fundamentals flashcards Nursing Safety & Infection flashcards Nursing Adult Health flashcards NCLEX-PN® flashcards Nursing Management of Care flashcards Nursing Pediatrics flashcards Nursing Maternity flashcards
1
Q

what is the definition of preterm labor?

A

contractions/cervical change 20 - 37 weeks (36 6/7 week)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the risk factors for preterm labor?

A

short cervix, overstretched uterus (multigravida, twins, large baby), or infection (chorioamnionitis, UTI, STI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the s/sx of preterm labor?

A

UCs, pelvic pressure, backache.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What can pregnant women do at home to determine if they are having PTL?

A
  • Empty bladder, PO fluids, side-lying

- If UCs >/= 6 UCs/hr, call MD/CNM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In the hospital, what are interventions that we can do for a woman in PTL?

A
  • vaginal exam
  • bedrest
  • hydration PO
  • external fetal monitor
  • rule out contraindication to continuing pregnancy ( evidence of chorioamonitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PTL Management: what two characteristics predict that delivery is unlikely within the next 2 weeks?

A
  • negative fetal fibronectin test ( protein found in mother’s mucous, made by infant; doesn’t show up until two weeks before birth)
  • cervical length > 3 cm (via transvaginal ultrasound)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PTL management: what can delay delivery???

A

tocolytics - relax smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PTL management: what are 3 different types of tocolytics?

A
  • IV magnesium sulfate
  • SubQ terbutaline (airway med; ability to quiet contractions right away) - SHORT TERM
  • PO nifedipine (Ca2+ channel blocker)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PTL management: how can we accelerate fetal lung maturity?

A

with betamethasone (corticosteroid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PTL management: when is betamethadone indicated?

A

Indicated for PTL between 24 - 34 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PTL management: what is the betamethadone dose and how long is the effect?

A

2 doses IM 24hrs apart

  • ideally give 2nd dose 24hr before delivery
  • **effect on fetal lungs lasts for 7 days `
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is dystocia?

A

abnormal labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the different types of dystocia?

A
  • precipitate (rapid) labor
  • FTP: failure to progress - despite everything
  • CPD: cephalopelvic disproportion - too big to fit through pelvic
  • Macrosomic fetus too large to pass through pelvis
  • Malpresentations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are 2 charcteristics of FTP?

A
  • cervix fails to dilate

- fetus fails to descend (needs to get passed 0 station)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the 3 malpresentations?

A

breech, face/brow, occiput posterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are 5 non-medication ways to induce labor?

A
  • nipple stimulation
  • castor oil
  • soap suds enema
  • stripping of membranes (MD)
  • amniotomy (AROM) - crochet hook
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is proper nipple stimulation?

A

one breast at a time; one nipple for 5 minutes, wait 15 minutes → cease if UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the stripping of the membranes?

A

a vigorous vaginal exam; irritate attachment of cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the 2 different pharmaceutical inducement methods?

A
  • prostaglandin inserted close to cervix to soften + efface

- oxytocin (pictocin) IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the names of the 2 different prostaglandin drugs used to induce labor?

A 
dinoprostone insert (cervidil)
misoprostol tablet (cytotec)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how is oxytocin IV administered and why?

A

solution is administered with a second pump with primary tubing that is piggy backed into the most proximal port of primary tubing infusing her primary IV - small amount of med is in tubing if have to stop med quickly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the usual order as far as titrating oxytocin IV?

A

Titrated until UC q 2 - 3 min and 60 - 90 sec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

when should the oxytocin infusion be decreased? D/C?

A
  • Decrease infusion if
  • UCs become closer than q 2 min
  • UC duration > 90 sec
  • **D/C infusion if fetal distress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

T/F oxytocin IV crosses the placental barrier?

A

FALSE; it doesn’t cross

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

T/F we can not administer oxytocin to preeclampic patients

A

FALSE; we CAN admin to preeclampic patients; can be given at the same time as Mag Sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are the adverse effects of oxytocin IV”?

A 
uterine hypertonicity (tetanic contraction)
water intoxication (lower blood concentration; nausea, muscle cramp, confusion, hyponatremia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is shoulder dystocia?

A

Shoulders stuck above symphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is a sign of shoulder dystocia?

A

Turtle sign: head appears to retract after emerging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are three common ways that shoulder dystocia is managed?

A

–Flex mom’s thighs on abdomen
–Suprapubic pressure to dislodge anterior shoulder
–Mom on all fours to deliver posterior shoulder first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are 2 rare maneuvers to treat shoulder dystocia?

A
  • Deliberate clavicle fracture

* Push head back into birth canal; then C/S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is the definition of assisted delivery?

A

Device used to shorten 2nd stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what are the indications for assisted delivery?

A

maternal exhaustion, fetal distress, tight fit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what 2 tools are used in assisted delivery?

A

Vacuum extractor

Forceps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How is the vacuum extractor used?

A
  • Vacuum cup applied to head with negative pressure

* Gentle traction applied with UC (3 pop-offs allowed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

how are the forceps used?

A
  • Curved blades grasp fetal head

* Traction applied during contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the definition of cesarean section?

A

delivery via abdominal incision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what is the preferred incision for C/S?

A

Low transverse incision preferred

38
Q

what are the indications for C/S?

A

macrosomia/CPD, fetal distress, breech, previous C/S, FTP

39
Q

T/F elective C/S is now an option for primipara

A

TRUE

40
Q

what are maternal risks for C/S?

A

Maternal risks include hemorrhage,infection, DVT, organ damage

41
Q

what are fetal risks for C/S?

A

Fetal risks include prematurity, birth injury, moist lungs

42
Q

what occurs during C/S preop prep?

A

shave, oral antacid, Foley,draw “clot to hold” - Type and cross if needed

43
Q

what is a spinal block for C/Section?

A

Anesthetic injected into intrathecal space

• Intrathecal narcotics may also be added *

44
Q

what are the advantages of a C/S spinal block?

A

excellent pain

relief & awake for birth

45
Q

what are the disadvantages of a C/S spinal block?

A

– Risk of hypotension, urinary retention, spinal HA

– * Narcotic may cause maternal respiratory depression & pruritus

46
Q

what are the nursing responsibilities for C/S spinal block?

A
  • Give large IV preload
  • Intrathecal narcotics - special considerations
  • Request blood patch if spinal headache occurs
47
Q

what are the special nursing responsibilities for intrathecal narcotics (C/S)??

A

– Monitor respiratory rate q hour x 18 hrs
– Treat pruritis: • IV Benadryl • Narcan (0.4 mg/liter)
in primary IV

48
Q

what is a vaginal delivery after cesarean? (VBAC) when is this recommended?

A

• Trial of labor initiated for woman with previous C/S
• Recommended only in hospitals with 24 hr in-house
anesthesia

49
Q

what is the success rate of VBAC?

A

80%

50
Q

when is VBAC contraindicated?

A

if > 2 previous C/S or vertical uterine
incision; and malpresentation, contracted pelvis, or
macrosomia

51
Q

what are the risks of VBAC?

A

possible uterine rupture (< 1% low transverse)

52
Q

what are the advantages of VBAC?

A

experience labor & delivery, less costly, less

complications, & faster recovery

53
Q

when can an umbilical cord prolapse occur?

A

Can occur when membranes rupture in presence of: high station, breech, transverse lie, small fetus, polyhydramnios

54
Q

the compressed cord may be ___, ____, or ______

A

seen, felt, suspected

55
Q

what are the nursing interventions to correct prolapsed cord?

A
  • Restore fetal O2/blood flow

* Emergency requiring stat C/S

56
Q

what are ways to restore fetal O2 and blood flow when a cord is prolapsed?

A

– Pushing presenting part off cord
Place mom in Trendelenberg or knee-chest
– If cord prolapsed through vagina, keep moist

57
Q

what is the definition of postpartum hemorrhage?

A

Excessive blood loss first 24 hours:
– > 500 ml after vaginal
– > 1000 after C/S

58
Q

what are the causes of postpartum hemorrhage?

A
  • Hypotonic uterus r/t: • Over-distention, multiparity, prolonged labor, drugs (mag sulfate, oxytocin), full bladder
    – Retained placental fragments
    – Laceration of genital tract: continuous bleeding with firm fundus
    – Vulvar hematoma: blood loss can be severe: may not see blood → “sitting on egg”
59
Q

what are 6 nursing interventions for postpartum hemorrhage?

A
  • Catheterize if unable to void
  • Assess fundus; massage if boggy
  • Weigh pads & chux (1 ml = 1 gm)
  • Elevate legs; replace fluids
  • Give uterotonic meds
  • Balloon tamponade: inflated in uterus to control bleeding
60
Q

what are the uterotonic medication?

A

– Oxytocin IV/IM
– Methergine IM/PO -contraindicated if hypertensive
– Prostaglandins
• Misoprostol (Cytotec) rectally (SE: shivering, fever)
• Carboprost (Hemabate) IM (SE: severe cramping,
diarrhea, nausea , vomiting, chills, fever)

61
Q

what is Deep Vein Thrombosis (DVT)

A

obstructing clot in deep veins of leg

62
Q

what are the s/sx of DVT?

A

pain, unilateral swelling, erythema, heat, edema

positive Homan’s sign may be present

63
Q

How can DVT be diagnosed?

A
  • doppler ultrasound

- D-dimer blood test (small protein present in blood after clot deteriorated by natural clot buster

64
Q

what are 8 ways to manage DVT?

A

• Anticoagulant therapy (heparin → warfarin)
• Bedrest/elevation of leg
• Analgesia
• Measure leg circumference (q shift/q4hr)
• Analgesia
• Monitor for s/sx of PE (SOB, tachypnea, cough, CP)
• Antiembolic stockings only after s/sx decreased
- Not in acute phase
***don’t massage or walk → could dislodge it

65
Q

what is endometritis? (metritis)

A

infection of uterine lining

66
Q

when does endometritis occur?

A

may occur secondary to C/S, vaginal delivery, SAB, or TAB

67
Q

what are s/sx of endometritis?

A

– Temp > 100.4º (38º), tachycardia & chills
– Abnormal amount & odor of lochia (should have fleshy smell)
– Pelvic or abdominal pain
– Malaise, nausea, fatigue
– Labs: ↑ WBC & erythrocyte sed rate, positive blood cultures

68
Q

what is treatment for endometritis?

A

– Culture & sensitivity; IV antibiotics

– Analgesics, antipyretics, hydration, rest

69
Q

where are wound infections possible?

A

C/S incision (most common), also episiotomy/laceration

70
Q

what are the s/sx of wound infection?

A

– T > 100.4, tachycardia & chills
– Malaise, nausea, fatigue
– Pain at incision
– REEDA

71
Q

what is the treatment for an infected wound?

A 
– Culture wound drainage (sometimes RN/MD)
– Antibiotics 
– Analgesics, antipyretics 
– Wound care (wet to dry)
– Sitz baths if perineal infection
72
Q

what is mastitis?

A

Inflammation of breast connective tissue - “cold in the breast”

73
Q

what are the risk factors for mastitis?

A

milk stasis, bacteria promotion, nipple trauma,

blocked ducts, fatigue, stress,

74
Q

what are the s/sx of mastitis?

A

– Usually involves 1 breast
– Warm, reddened, swollen, painful
– Chills, fever
– May have enlarged, tender axillary lymph nodes

75
Q

what are 6 ways to PREVENT mastitis?

A 
• Wash hands before feed
• Frequent breastfeeding (empty breast)
• Avoid pressure on breast
• Correct positioning/latch
• Maintain nipple integrity
• Ensure emptying
– Change nursing positions
– Gentle massage
– Moist heat to breasts
76
Q

how can you treat mastitis? (2ways)

A
  • Prevent further milk stasis

* Treat infection

77
Q

mastitis: how can we prevent milk stasis?

A

– Offer affected breast first
– Breastfeed frequently
– Heat to affected area

78
Q

mastitis: how can we treat the infection?

A

– Rest
– Acetaminophen
– Antibiotics if not improved
in 24 hours

79
Q

what is postpartum blues?

A

Transient depression occurring after birth - occurs to 80% of women - can last 1 - 10 days

80
Q

what are the s/sx of postpartum blues?

A

mood swings, anger, tearfulness, & insomnia

81
Q

what is the suspected cause of PP blues?

A

Cause unknown; r/t changes in hormone levels, fatigue, stress

82
Q

how long does it take to resolve PP blues?

A
  • 1 - 2 weeks
83
Q

what is good to educate about PP blues?

A

Teach if symptoms severe or persist, seek evaluation for

postpartum depression

84
Q

what is the definition of PP depression?

A

S/sx more intense & persist beyond 2 weeks postpartum

85
Q

what are the s/sx of PP depression?

A

– Decreased interest in surroundings, loss of emotional
responses
– Feels guilty, unworthy, inept
– Fatigue, difficulty concentrating, weight changes, sleep
disturbances, panic attacks, suicidal thoughts, obsessive
thoughts

86
Q

what are the possible causes of PP depression?

A

hormones, fatigue, marital issues, financial worries

87
Q

what is the treatment for PP depression?

A

counseling & drug

88
Q

define PP psychosis

A

• May present 3 weeks after birth as bipolar illness, schizophrenia, depression

89
Q

what are s/sx of PP psychosis?

A 
--  Irritability, hyperactivity, euphoria,
little need for sleep, poor judgment
&amp; confusion
– Tearful, guilt, sleep/appetite
disturbances
– Hallucinations/delusions, ­ risk
suicide infanticide
90
Q

what are two things important for treatment?

A
  • Need immediate medical attention

* Antipsychotics & hospitalization likely

Nursing Semester 2 (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions