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Maternal OB > week 3 & 4 > Flashcards

week 3 & 4 Flashcards

1
Q

a nurse is caring for a client who is at 32 weeks gestation and has placenta a previa. the nurse notes that the client is actively bleeding. which of the following medications should the nurse expect the provider to prescribe?

  1. Betamethasone
  2. Indomethacin
  3. Nifeidipine
  4. Methylergonovine
A
  1. Betamethasone
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2
Q

a nurse is caring for a cliet who is suspected of having hyperemesis gravidarum and is reviewing the client’s lab reports. which of the following findings is a manifestation?
1. hgb 12.2
2. urine ketones present
3. alanine aminotransferase 20
4. blood glucose 114

A
  1. urine ketones present
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3
Q

antidotes for magnesium sulfate

A

calcium gluconate
calcium chloride

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4
Q

pyridoxine

A

vitamin B6 supplement prescribed to clients with hyperemesis gravidarum

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5
Q

spontaneous abortion

A

pregnancy ends as a result of natural causes BEFORE 20 WEEKS of gestation

4 types = threatened, inevitable, incomplete, and missed

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6
Q

threatened spontaneous abortion symptoms

A

mild cramps
slight spotting
no tissue passed
closed cervix

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7
Q

inevitable spontaneous abortion symptoms

A

mild/moderate cramps
moderate bleeding
no tissue passed
DILATED CERVIX

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8
Q

Incomplete spontaneous abortion symptoms

A

SEVERE cramps
HEAVY bleeding
YES - tissue passed
DILATED w tissue present

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9
Q

complete spontaneous abortion symptoms

A

mild cramps
minimal bleeding
tissue passed
CLOSED CERVIX

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10
Q

dilation & currettage (D&C)
vs
dilation & evacuation (D&E)

A

D&C = dilate & scrape uterine walls

D&E = dilate & excavate AFTER 16 WEEKS

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11
Q

prostaglandins & oxytocin

A

induce uterine contractions & expulse products

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12
Q

interventions with bleeding during pregnancy

A

count pads
NO VAGINAL EXAMS
bed rest

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13
Q

education about spontaneous abortions

A

small amount of discharge is normal for 1-2 weeks

no bath tubs, or sex for 2 weeks

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14
Q

ectopic pregancies usually occur in

A

fallopian tubes

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15
Q

s/s of ectopic pregnancy

A

referred shoulder pain

unilateral quadrant pain in lower abdomen

dark red/brown spotting after normal menses

hemorrhage /shock

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16
Q

methotrexate

A

chemo drug that inhibits cell division and embryo enlargement

**ectopic pregnancies
avoid folic acid vitamins

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17
Q

lab test w ectopic pregnancies

A

indicate lower than normal HcG levels

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18
Q

salpingostomy
vs
laproscopic salpingectomy

A

salp = salvages fallopian tube

lap = removal of fallopian tube

*ectopic pregnancies

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19
Q

gestational trophoblastic disease

A
  • Hydatidiform Mole*
    fluid filled grapelike clusters formed from the placenta associated w cancer (choriocarcinoma)

2 types = complete mole & partial mole

patient MUST follow up

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20
Q

complete hydatidiform mole

A

all genetic material is derived from father

ovum w/o genetics, fetus, placenta, fluid
higher risk for cancer

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21
Q

partial hydatidiform mole

A

genetic material from both parents

ovum fertilized w abnormal embro/fetal parts

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22
Q

s/s of hydatidiform mole

A

hyperemesis gravidarum
PRUNE JUICE blood
uterus LARGER than gestational age
preeclampsia
anemia

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23
Q

labs of a hydatidiform mole will indicate

A

abnormally high HcG

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24
Q

placenta previa

A

implantation of placenta in lower uterus or cervix instead of fundus
*bleeding risk
**diagnosed by ultrasound

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25
Q

s/s of placenta previa

A

PAINLESS vaginal bleeding (2/3 tri)
fundal height > gestational age
fetus not in position
uterus is soft and nontender
decreased urine output

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26
Q

nursing interventions for placenta previa

A

no vaginal exams
bed rest
WEIGH PERI PADS
treated with betamethasone (helps w fetal lung maturity)

27
Q

abruptio placentae

A

separations of placenta before fetus is born AFTER 20 WEEKS
**emergency – prepare for delivery
**increased bleeding, DIC, mortality

28
Q

s/s of abruptio placentae

A

INTENSE uterine pain
DARK red vaginal bleeding
fetal distress
contractions w hypertonicity

29
Q

risk factors for abruptio placentae

A

maternal HTN
cocaine & smoking
trauma to abdomen
multi-fetal pregnancies

30
Q

cervical insufficiency & s/s

A

**premature dilation of cervix BEFORE 36-37 wks

pelvic urge to push
pink vaginal discharge
rupture of membranes
contractions

31
Q

interventions for cervical insufficiency

A

increase hydration
avoid intercourse
prophylactic cerclage =surgical closure of cervix @ 12-14wks removed at 37/38wks

32
Q

hyperemesis gravidarum

A

excessive nausea / vomiting PAST 16 WEEKS

33
Q

urinalysis for hyperemesis gravidarum will show

A

ketones/ acetones (ahh-kalosis)

increased urine specific gravity (dehydration)

34
Q

meds for hyperemesis gravidarum

A

metoclopromide (anti-emetic)
IV LR
corticosteroid
pyridoxine (vit b6)

35
Q

a Hgb less than 11mg is an indication of

A

anemia in 1st & 3rd pregnancy trimester

36
Q

a hgb les than 10.5mg is an indication of

A

anemia in 2nd trimester

37
Q

s/s of hypoglycemia

A

blurred vision
weakness
irritability
headache
hunger

38
Q

s/s of hyperglycemia

A

poly’s
nausea
fruity breath
abdominal pain

39
Q

glucose tolerance tests occur when

A

24 to 28 weeks
starts w 1 hour test
**abnormal if greater than 140
follows w 3 hr test

40
Q

gestational hypertension

A

occurs AFTER 20 WEEKS gestation w bp of 140/90 on 2 occasions 4 hours apart

NO PROTEINS PRESENT
*normalized after 12 wks post-partum IF NOT = normal chronic HTN

41
Q

preeclampsia

A

HTN of 140/90 WITH proteinuria greater than or equal to 1– AFTER 20 WKS GESTATION

42
Q

s/s of preeclampsia

A

blurred vision
transient headaches
possible edema

43
Q

severe preeclampsia

A

bp greater than 160/110 w/ proteinuria greater than or equal to 3+

44
Q

s/s of severe preeclampsia

A

RUQ pain
hyperreflexia
epigastric pain
visual disturbances
blood creatinine > 1.1

45
Q

preeclampsia is treated w

A

beta methasone
magnesim sulfate (anti-convulsant)

46
Q

eclampsia

A

preeclampsia with ONSET OF SEIZURE / COMA

  • emergency
47
Q

HELLP Syndrome

A

HTN w severe preeclampsia & hepatic dysfunction
H = hemolysis = anemia & jaundice
EL = elevated liver enzymes
LP = low platelets < 100k

48
Q

magnesium sulfate toxicity

A

absence of patellar deep tendon reflex
decreased urine, resp, & LOC
cardiac dysrhythmias

49
Q

magnesium sulfate in pregnancy is used to

A

prevent seizures
slow contractions

50
Q

IV site w magnesium bolus is normal to experience

A

flushing
heat & burning
sedation
diaphoresis

51
Q

HTN meds for pregnancy

A

methyldopa
hydralazine
nifedipine
labetalol

*NO ACE or ARB’s

52
Q

Internal fetal monitoring methods & downsides

A

fetal scalp electrodes - fetal heart

intrauterine pressure catheter -acurate

*BOTH = require ruptured membranes and dilated cervix

53
Q

periodic vs episodic

A

periodic = assoc w uterine contractions

episodic = not associ w uterine contractions

54
Q

nitrazine paper is used for

A

asessing amniotic fluid

blue = amnio fluid is alkaline
yellow = acidic urine

55
Q

cervical changes that define labor

A

effacement & dilation

56
Q

5 P’s in childbirth

A

P = passenger (fetus & placenta)
P = passageway
P = power (contractions)
p = position (mom)
P = psychological response

57
Q

toco measures

A

uterine activity and contraction patterns

58
Q

passenger P consists of

A
  1. Fetal Presentation – what part is entering pelvis (head, breech, shoulder)
  2. Fetal Lie - relationship of spine to mom = transverse (sideways) or parallel*
  3. Fetal Attitude - relationship of fetus parts – flexion* or extension
  4. fetal position
59
Q

Fetal Position is descirbed by

A
  1. naming the side the baby is facing–right (R) or left (L)
  2. presenting part of fetus =
    - occiput /head (O)
    - sacrum (S)
    - mentum (M)
    - scapula (Sc)
59
Q

FIRST stage of labor

A

onset of labor to full dilation w/
- latent phase = 0 to 3cm
- active phase = 4 to 7cm
- transitional phase = 8 to 10 cm – expressing need for bowel movement

60
Q

second stage of labor

A

fully dilated cervix to birth of baby
**assess for lacerations – 4 degrees each indicative of # of areas injured

61
Q

third stage of labor

A

from the birth of fetus to the birth of the placenta

62
Q

fourth stage of labor

A

delivery of placenta to the first 2 hours after birth

63
Q
A

Maternal OB (8 decks)

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