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Maternity part 3 Flashcards

1
Q

the initiation of uterine contractions by artificial means before spontaneous labor

A

induction of labor

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2
Q

name some indications for induction of labor

A

abruptio placentae, choriamnioitis, fetal demise, hx of precipitous delivery, HTn disorder, PROM, post term pregnancy, Fetal compromise (IUGR, oligohydramnios)

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3
Q

5 component tool for predicting inducibility

A

Bishop score (the higher the # the more inducible), objective measurements

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4
Q

what are the 5 components of the Bishop score

A

position of cervix, consitency, effacement, dilation, baby’s station

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5
Q

the higher the score the ______ inducible the women

A

more

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6
Q

what happens during the pathophysiology of induction (maternal and fetal factors)

A
  • Uterine muscles- strecth, prostoglandin released
  • cervical pressure- oxytocin is released
  • inhibition of Ca binding- oxytocin & prostoglandin which causes contractions
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7
Q

what methods are used for induction

A

stimulate prostaglandin release, admin of prostaglandin, or admin of oxytocin

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8
Q

what alternative methods are used for induction

A

herbals (red rasberry tea, accupuncture, castor oil, nipple stimulation, intercourse

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9
Q

more then 5 contractions in 10 minutes when averaged over a 30 minute window

A

tachysystole (major risk factor when induce labor)

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10
Q

what is used to ripen/open the cervix and/or stimulate labor

A

dilators, prepidil, amniotomy, cervidil, misoprostol

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11
Q

amniotomy is also known as

A

rupture of membranes

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12
Q

ROM release what

A

prostoglandins

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13
Q

ROM that release prostoglandins which speed up contractions, done anytime before or during labor, but when done before labor it is considered an induction procedure

A

amniotomy

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14
Q

what are the risks with amniotomy

A

infection, prolapsed cord, compression of cord

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15
Q

when is amniotomy contraindicated

A

HIV (risk of trasmisison to NB), disengaged fetal head

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16
Q

what needs to be documented with amniotomy

A

FHR, temperature, fluid (amt., color, odor), time

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17
Q

examiner digitally frees membranes of amniotic sac from the lower segment of uterus around cervical os

A

membrane stripping

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18
Q

when is membrane stripping done

A

at term, prenatal appt

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19
Q

what does membrane stripping cause

A

prostaglandin release from sac/cervix, and labor within 48 hours

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20
Q

what are the risks of membrane stripping

A

accidental ROM, vaginal placenta

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21
Q

mechanical dilation with weighted balloon pressing on internal os

A

foley bulb dilator

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22
Q

what does the foley bulb dilator lead to the release of

A

prostaglandin release, cervical ripening, and uterine contractions

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23
Q

what are the advantages of the foley bulb dilator

A

low cost, small risk of tachysystole, decrease duration of labor, decrease risk of C/S

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24
Q

what are the risks of using foley bulb dilator

A

vaginal bleeding, ROM, infection

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25
Q

absorbs fluid from surrounding tissue causing a dilator effect on the cervical os,

A

hygroscopic dilators

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26
Q

what is laminaria made of

A

stem of seaweed, remove after 12-24 hours, repeat prn, risks are infection

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27
Q

PGE2 preparation in a vaginal insert placed in posterior vagina which releases prostaglandins at a slow rate (0.3mg/hr)

A

cervidil (slow release)

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28
Q

cervidil

A

remove prior to ROM, increases success of delivery within 24 hours, doesn’t decrease risk of C/S, looks like shoe string (allows for easy removal)

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29
Q

risks with cervidil

A

tachysystole with FHR changes, PPH, uterine rupture, need to continue fetal/maternal monitoring for @ least 2 hours after removal

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30
Q

administration guidelines with cervidil

A

store in fridge, need to remain in bed 30 minutes after placement, if have too many ctx it must be removed, monitor uterine activity and FHR for minimum of 2 hours, if tachysystole occurs remove immediately, remove at onset of active labor or 12 hours after insertion, MUST remove before start of pitocin

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31
Q

who don’t you want to give cervidil to

A

pts with asthma, can result in broncho restriction

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32
Q

placement of cervidil

A

posterior fornix of vagina

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33
Q

intracervical PGE2 gel, releases prostaglandins at a faster rate than intravaginal insert, can repeat dose in 6-12 hours, coats cervix (doesn’t go in os)

A

prepidil

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34
Q

what does prepidil cause

A

cervical ripening and uterine ctx, increases vaginal delivery, doesn’t decrease risk for C/S

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35
Q

risks of prepidil

A

tachysystole with FHR changes, PPH, uterine rupture

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36
Q

administration guidelines for prepidil

A

given by MD or midwife, stored in fridge (room temp before application), stop if have too many ctx if need to stop administer tocolytic, 30 minute rest after given, monitor fetal and ctx for 4 hours after administration, delay oxytocin administration 6-12 hours

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37
Q

tablet prostaglandin, more effective but not FDA approved, synthetic PGE1 agent, safe use 1–mcg tablet (use 1/4 of tablet) vaginal or oral, low cost

A

Misiprostol (Cytotec)

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38
Q

risks of Misiprostol (Cytotec)

A

increased incidence of significant tachysystole with or without FHR changes

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39
Q

administration guidelines of Misiprostol (Cytotec)

A

continuous monitoring of uterine activity and FHR, can be repeated Q 3-6 hours, delay oxytocin for 4 hours after last dose

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40
Q

when is Misiprostol (Cytotec) contraindicated

A

previous C/S, or uterine surgery bc of possible uterine rupture

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41
Q

common for induction/augmentation, oxytocic, stimulates uterine contractons bc the myometrial cells more excitable and increase strength of ctx

A

oxytocin (Pitocin)

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42
Q

what is oxytocin used for

A

control PPH, induction

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43
Q

oxytocin is naturally released from maternal pituitary gland in response to what

A

cervical pressure, dilation, effacement

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44
Q

what is the goal of oxytocin

A

to stimulate ctx that produce cervical changes and fetal descent while avoiding tachysystole and fetal distress (Q2-3 minutes, last 60-90 seconds)

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45
Q

standard Pitocin dose

A

20 units/1000ml LR
ALWAYS administer with pump!!!
then titrated to the ctx pattern we want

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46
Q

what has to be assessed prior to increasing pitocin

A

fetal status (FHR), ctx pattern (duration, intensity, frequency), uterine tone (soften, frequency, intensity, duration)

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47
Q

Pitocin calculation

*what changes

A

20 units x 1 hr. x. min x. 1000 mu
*the mu of Pitocin ordered/minute

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48
Q

risks with Pitocin

A

uterine tachysystole, fetal distress, HTN, hypotension, uterine rupture, water intoxication (exess fluid in kidneys, dilution, hyponatremia, which all increase risk for seizures)

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49
Q

Administration guidelines for Pitocin

A

monitor VS, FHR, I&O, uterine exam, ALWAYS piggyback Pitocin NEVER main line (always placed on lowest port), resting tone (soft btwn ctx to allow fetal perfusion), baseline resting tone 0-10mmHg

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50
Q

if you have a pt who is in tachysystole what would you do

A

STOP Pitocin, give Tocolytic

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51
Q

stimulating of a spontaneous occurring labor, but not progressing the way we want

A

augmentation, continually monitor, MD must be on unit @ all times

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52
Q

during an emergency delievery, what position do you want to keep mother prior to delivery and why

A

left side to decrease hypotension syndrome

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53
Q

when the babies head is out what do you have mom do

A

stop pushing, check umbilical cord, suction or wipe the mouth and nose, place hands on each side of babies head, apply gentle pressure to head and guide downward, after delivery of placenta massage uterus until firm

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54
Q

dystocia

A

difficulty delivering shoulders

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55
Q

McRoberts

A

hyperflex moms legs backwards, which opens pelvis to aid in delivery, apply suprapubic pressure to push shoulder down

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56
Q

once the baby is out, prior to cutting umbilical cord where do you place baby

A

keep baby at uterine level to aid blood flow to baby

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57
Q

umbilical cord has ? arteries and veins

A

2 arteries 1 vein

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58
Q

if you have a baby with a heart rate less than 100 with no respiratory effort what do you do w

A

CPR

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59
Q

placental separation

A

lengthening of cord, increase gush of blood, check for placenta for missing fragments, assess vagina

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60
Q

what can be done to decrease risk of hemorrhage

A

breast feeding, massage of uterus

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61
Q

the most common type of cesarean incision is

A

low transverse

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62
Q

which type of anesthesia is most commonly used for cesarean

A

regional

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63
Q

which of the following is contraindicated with an external cephalic version

A

polyhydramnios

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64
Q

an episiotomy is routinely performed because of its ability to speed delivery and heal faster than a laceration ? T OR F

A

false

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65
Q

forceps and vacuum extractors are not used in a cesarean birth? T OR F

A

false

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66
Q

what is not an automatic reason for a C/S

A

fetal distress (POPI)

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67
Q

brestfeeding after a cesarean, can it be done

A

yes, with help and support

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68
Q

a vaginal birth after c/s

A

contraindicated after a classical incision

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69
Q

what factors affect labor pain

A

fear, culture, support, previous experience, physical causes (stretching of perineum, pressure ctx of uterine muscles)

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70
Q

what is a good question to ask a pt about their pain

A

what is your plan for pain management

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71
Q

will sedatives have the same effect on mom as fetus

A

yes, they are used in early phase of labor and false labor

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72
Q

what sedatives are used for relaxation

A

seconal, ambien, Phenergan, vistaril, benadryl

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73
Q

systemic (IV/IM Rx)

A

all cross the placenta, fetus is greatly affected, if given too early cause prolonged labor, if given too late can cause fetal problems after delivery

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74
Q

common systemic Rx

A

nubain, stadol, Demerol, fentanyl*

doesn’t cross the placenta as well so has limited affects on NB

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75
Q

Side effects of systemic Rx

A

mom & fetus: resp depression, urinary retention, N/V, drosey, dizziness, itching
fetus: decrease variability, decrease baseline, wont see accelerations

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76
Q

nursing care when giving pt systemic rx for pain

A

viod prior to giving, admin at peak of ctx (decrease the blood flow to fetus), precipitate withdrawal, assess VS (can decrease sucking in NB)

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77
Q

what can reverse pain rx effects

A

Narcan

watch for withdraw on baby and possibility of seizure

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78
Q

local anesthetic into tissue which blocks pain transmission, remain awake

A

regional anesthesia

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79
Q

placed in pudendal nerve, relief of perineal stretching, has no SE

A

pudendal

forceps, vacuum, episiotomy repair

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80
Q

medication placed into the epidural space via lumbar spine, doesn’t reach fetus circulation

A

epidural anestesia

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81
Q

toxic reaction to epidural

A

LOC convulsions, cardiovascular collapse

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82
Q

major maternal side effect of epidural

A

maternal hypotension

fetus: late decels (decrease of O2 to fetus)

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83
Q

nursing care after placement of epidural

A

lateral tilt 10-15 minutes after, void prior, monitor hypotension, monitor pain

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84
Q

what do you do if you have hypotension after placement of epidural

A

administer O2, IV bolus, trendelenburg, elevate legs, notifiy anesthesia, administer ephedrine if needed

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85
Q

what is a common side effect of epidural

A

itching

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86
Q

injected into spinal fluid in the subarachnoid space, prevents windows

A

spinal anesthesia

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87
Q

risks and complications of spinal

A

high spinal (RR issues), intubation, hypotension, spinal HA

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88
Q

Tx for spinal HA

A

fluids, caffeine, encourage lay flat, blood patch will remove maternal blood and relieve HA instantly

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89
Q

emergency C/S or difficult spinal/epidural, mother is not awake

A

general anesthesia

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90
Q

complications with general

A

fetal depression: Rx will reach the fetus in 2 minutes, anticipate resuscitation

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91
Q

alteration in the progress of labor

A

dystocia

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92
Q

delivery of malpresented fetus (complete, frank, incomplete)

A

breech extraction

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93
Q

risks with breech extraction

A

head trauma, entrapment, meconium aspiration, fetal asphyxia

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94
Q

procedure to change fetal presentation

A

version

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95
Q

external maternal abdominal manipulation to change fetus from breech, oblique or transverse lie to vertex presentation

A

external cephalic version

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96
Q

criteria for external cephalic version

A

single fetus, 36 weeks gestation, not engaged, adequate fluid, NST reactive, US, if have previous uterine surgery or malformed uterus cant do version

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97
Q

what has to be done intra op for external cephalic version

A

NPO, IV, NST, tocolytic (soften uterus to aid with movement)

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98
Q

when do you have to stop the external cephalic version

A

repeat failures, too much pain, abnormal FH pattern

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99
Q

nursing care after external cephalic version

A

VS, fetal status, RhoGam (fetal/maternal bleeding)

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100
Q

what would be a sign of revision of the external cephalic version

A

excess movement

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101
Q

multiple gestation to deliver 2nd twin after vaginal delivery of 1st, (not common procedure)

A

internal/podalic version

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102
Q

unplanned tear in perineum, uterus, vaginal wall or supporting tissues during delivery, more common with nulliparas, rapid head expulsion, LGA

A

laceration

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103
Q

1st degree laceration

A

skin & mucous membranes

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104
Q

2nd degree laceration

A

skin & mucous membranes & muscle

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105
Q

3rd degree laceration

A

skin & mucous membranes & muscle & anal sphincter

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106
Q

4th degree laceration

A

skin & mucous membranes & muscle & through anal sphincter & rectal mucosa

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107
Q

incision to enlarge the vaginal outlet

A

episiotomy

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108
Q

what are disadvantages of an episiotomy

A

increases PP pain, infection, blood loss, painful intercourse, flatal incontinence

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109
Q

what are the 2 locations of an episitomy

A

*midline
less blood loss but can extend to 4th degree laceration
*mediolateral
perineum cut at 45 degree angle, advantage is no 4th degree laceration

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110
Q

after repiar of laceration/episiotomy you want to assess

A

site, bleeding, drainage, edema, odor, tenderness, hardened areas, approximated

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111
Q

what patient teaching can you do for an laceration/episiotomy repair

A

clean front to back, peri bottle, apply ice, ibuprofen, Colace, dermaplast, sitz bath, change pads frequently

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112
Q

instrument (2 curved blades) that are used during delivery for holding, repositioning or extracting the fetal head

A

forceps

*used during the second stage of labor (pushing)

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113
Q

3 types of forceps

A

outlet (head is visible on perineum)
low (fetal skull is at station +2 not yet on pelvic floor)
midforceps ( fetal skull above station 2

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114
Q

when using forceps what do you document

A

procedure, placed, type used, # of applications, amt of time used

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115
Q

maternal risks of using forceps

A

infection, hemorrhage, trauma, laceration

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116
Q

fetal risks of using forceps

A

facial trauma, cephalahematoma, capet (increase risk of jaundice later)

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117
Q

vacuum applied to fetal head to assist with birth (negative pressure), d/c after a maximum of 3 pop offs, cant be applied longer than 30 minutes

A

vacuum assisted birth

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118
Q

contraindications for vacuum assisted birth

A

true CPD, non vertex presentation, extreme premature, macrosomia, fetal scalp trauma

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119
Q

chignon

A

artificial capet, it will go away on its own (hours to 3 days)

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120
Q

delivery through an abdominal and uterine incision

A

c/s

121
Q

postoperative complications of C/S

A

infection, dehiscence, hemorrhage, DVT, longer recovery, bladder laceration, urethral injury, reaction to anesthesia, increase length of stay

122
Q

pfannenstiel

A

incision made just below the pubic hairline

aka low transverse

123
Q

infraumbilical

A

between naval and symphysis pubis

124
Q

classical incision

A

rarely used, except in emergencies
increase risk of uterine rupture
*cant have vaginal delivery after this

125
Q

POST OP from C/S

A

bowel sounds, output, early ambulation, pain, VS, want to have foot ball hold when breastfeeding

126
Q

normal resting tone

A

1015 mmHg

127
Q

if mom has fibroids that puts her at a higher risk of

A

dysfunctional labor, PPH, fetal mal position

128
Q

ineffective uterine contractions

A

uterine dysfunction

129
Q

hypertonic uterine dysfunction

A

too much, uncoordinated = ineffective, discomfort
no dilation
increase risk nullipara, exhaustion, UPI (uterine placental insufficiency)

130
Q

Tx for hypertonic uterine dysfunction

A

hydration, rest, pain rx, sleep pill

131
Q

hypotonic uterine dysfunction

A

weak ctx,

increase risk of multipara, UPI, exhaustion, over use of analgesia

132
Q

tx for hypotonic uterine dysfunction

A

Pitocin, ambulation (increase strength of ctx)

133
Q

precipitous labor

A

fast labor within 3 hours, risk of birth trauma, uterine rupture

134
Q

tx for precipitous labor

A

tocolytic

135
Q

prolonged labor

A

lasts longer than 24 hours, extended 1st stage of labor, caused by unfavorable cervix

136
Q

tx for prolonged labor

A

Pitocin, hydration

137
Q

dystocia

A

difficult labor

138
Q

CPD

A

cephalopelvic disproportion

139
Q

anterior shoulder wedged behind pubic symphysis

A

shoulder dystocia

140
Q

Tx for dystocia

A

suprapubic pressure, downward traction

141
Q

what would cause a soft tissue obstruction

A

full bladder, fibroids, bicornate uterus

142
Q

fetal head doesn’t turn, may need forceps or C/S, causes prolonged labor, exhaustion, back labor, very uncomfortable

A

persistent OP (occiput-posterior)

143
Q

risks due to breech presentation

A

difficult delivery

144
Q

risk with transverse lie presentation

A

uterine rupture

145
Q

macrosomia

A

weighs over 4000 grams

146
Q

hydrocyphalus

A

excess of fluid in brain

147
Q

if you have an absent umbilical artery what other issues might you have

A

kidney, ear

develop at the same time

148
Q

velamentous insertion

A

cord is distal to placenta

increase risk of cord compression, separation = hemorrhage

149
Q

what risk do you have with a short cord

A

more compression as baby descends in birth canal

150
Q

what risk do you have with a long cord

A

increase risk nucal cord or knots (stricture)

151
Q

prolapsed cord

A

cord is delivered first, happens when have breech, SROM before head is tightly at cervix

152
Q

Tx for prolapsed cord

A

emergency!
check FHR and give mom O2, place mom in knee chest position, and with sterile glove lift presenting part off the cord, STAT C/S

153
Q

succenturiate placenta

A

accessory lobe, attached to placenta by small vessels

risk for PPH

154
Q

circumvallate placenta

A

double infolding of chorion, decreases perfused area of placenta
risks for bleeding, shearing of membranes

155
Q

battledorf placenta

A

cord is inserted next to margin, can interfere with perfusion of placenta
risk for cord compression

156
Q

risks of placental infarcts/calcification

A

hypoxia to fetus, will see late decels

157
Q

placenta is implanted low in uterus

A

placenta previa

158
Q

3 types of placenta previa

A

low placental implantation-near margin of cervical os
partial previa-over top of cervical os
complete previa-completely covers cervical os

159
Q

S.sx of placenta previa

A

painless vaginal bleeding (bright red blood), uterus will have normal tone, non tender

160
Q

what is contraindicated in placental previa

A

vaginal exam

161
Q

management of placenta previa

A

if less 37 weeks- bed rest, IV fluids, observe, if still not doing well then C/S
if greater than 37 weeks- induction, C/S
if have signs of shock- tx shock & C/S

162
Q

complications of placenta previa

A

shock, anemia, coagulopathy, risk for PPH, infection

163
Q

implanted corrected placenta but has separated from wall of uterus

A

abruptio placenta

164
Q

cause of abruptio placenta

A

degradation of arterioles of endometrium leads to necrosis

HTN, cocaine use, smoking, trauma

165
Q

Types of abruptio placenta

A

marginal- margin of placenta has separated, may see bleeding
central- center of placenta has separated
massive- complete placenta has seperated

166
Q

S.Sx of abruptio placenta

A

may or may not have bleeding, pain, tender uterus, late decels, uterus is board like (hard)

167
Q

Tx for abruptio placenta

A

C/S STAT

168
Q

complications of abruptio placenta

A

DIC (disseminated intravascular coagulation)

overstimulation of the coagulation process

169
Q

DIC

A

have bleeding from every orifice, have clotting and bleeding at the same time

170
Q

Labs that you would see in DIC

A 
fibrinogen decreases (normal for pregnancy is 450)
platelets decreases 
fibrin increases (normal is 10-20)
PT/PTT prolonged
171
Q

Tx for DIC

A

remove trigger factor, replacement (clotting factors, blood products), give anticoagulants (heparin), supportive care (O2, ventilator, vasopressor

172
Q

couvelaise uterus

A

so much bleeding into wall of uterus that it doesn’t contract

173
Q

sudden respiratory distress, circulatory collapse, EMERGENCY

A

embolism (anaphylactoid syndrome)

174
Q

Excessive amniotic fluid around fetus, increase risk SOB, dependent edema

A

hydramnios

greater than 2000 ml fluid

175
Q

oligohydramnios

A

check fetus kidney function, compression of cord, club foot

176
Q

what can hinder coagulation

A

hypothermia

177
Q

what effects can progesterone have on PPH

A

slows gastric motility, constipation, heart burn

178
Q

normal labs in pregnancy

A

pH 7.4-7.5

creatinine 0.4-0.8

179
Q

what is the most common reason for PPH

A

failure of uterus to contract after delivery

180
Q

what is the #1 risk factor for PPH

A

hx of PPH

181
Q

retained placenta

A

prevents uterus from contracting after delivery, bleeding persists from placental site

182
Q

placenta accreta

A

placenta grows into uterine wall, rare, does not separate, high risk for hysterectomy

183
Q

methylergonovine

A

contracts smooth muscle, 0.2 mg IM, contraindicated in HTN pts, SE: hypotension

184
Q

carboprost (hemabate)

A

produces uterine contraction, 250mcg IM

cause N/V, diarrhea, use with caution in asthma pts

185
Q

misoprostol (cytotec)

A

induces uterine contractions, PO, buccal, sublingual, rectal

causes fever, N/V diarrhea, shivering

186
Q

minimum output

A

30ml/hour

187
Q

what is used as last resort tx

A

hysterectomy

188
Q

when will you start to have VS changes with EBL

A

1500-2000ml

189
Q

what labs would you monitor

A

CBC, DIC, electrolytes, BUN, creatinine

190
Q

what do you need to look for when you have increase of IV fluids going in

A

S.sx of fluid overload, watch electrolytes

191
Q

EBL for vag and C/s

A

500 Vag

1000 C/S

192
Q

Late PPH

A

24 hours after delivery, usually within 1st 1-2 weeks

193
Q

failure of uterus to involve normally

A

subinvolution

194
Q

what is the most common reason for subinvolution

A

infection, retained placental fragments

manual removal increases risk

195
Q

S/Sx of late PPH

A

uterus is enlarged, soft
lochia is excessive, rubra
back pain, ill feeling

196
Q

Tx for late PPH

A

methergine-po for 24-48 hours
D & C if fragments on US
Abx if infection
educate about change in lochia

197
Q

blood collects in soft tissue of vagina or perineum, caused by vessel injury, the tissue has little resistance so easily expanded

A

hematomas

198
Q

what can make you at higher risk for hematoma

A

operative delivery, precipitous delivery, macrosomia

199
Q

Tx for hematoma

A

ice and analgesia, sitz bath and heat, I &D, Abx

200
Q

wound infection S.sx

A

temperature, cultures, CODA

201
Q

infection of the reproductive tract until6 weeks PP, risk because of bacterial presence

A

puerperal infection

bc: ROM, uterus (warm, dark, moist, nutrient rich)

202
Q

when you have a PP with a temperature what should you expect first

A

endometritis

usually at placental site

203
Q

risk factors for endometritis

A

ROM, hands, laceration/episiotomy, operative delivery, foley, PROM, mult. vaginal exams, DM

204
Q

what is not a reliable lab for PP infection

A

WBC (bc already elevated due to pregnancy)

205
Q

PP what do you want to increase in your diet

A

protein (promote healing)

206
Q

vascular occlusive process with impeded blood flow

A

thromboembolic disease

207
Q

what PP factors contribute to thromboembolic disease risk

A

increase of platelets, thromboplastin (released from tissue after delivery), fibrinolysis inhibitors (increase amount)

208
Q

what anticoagulants are given

A

heparin through pregnancy

Coumadin in PP period

209
Q

S/Sx of thromboembolic disease

A

6 P’s, edema, low grade fever, chills, palpable cord

210
Q

prevention of thromboembolic disease

A

elevate legs, don’t cross, ambulate, knee position, support hose, hydrate

211
Q

clogged mild duct without infection

A

plugged duct

breast milk pools behind a duct and blocks milk from exiting

212
Q

S.sx of plugged duct

A

massage towards nipple, warm compress, nursing, pumping

213
Q

unilateral inflammation of breast tissue

A

mastitis, inflammation due to plugged duct

214
Q

S.sx of mastitis

A

sudden onset, pain, febrile, flulike sx

215
Q

Tx of mastitis

A

warm compress before, cold after BF, rest, NSAIDS, Abx, continue to BF

216
Q

Prevention of mastitis

A

hand washing, supportive bra, good technique, regular nursing, air dry milk on nipple

217
Q

infection of the bladder/urethra

A

cystitis
increased risk due to PP diuresis, decrease of bladder sensitivity
overdistension or incomplete emptying = stasis + bacterial growth

218
Q

S.Sx of cystitis

A

frequency, dribbling, urgency, hematuria, dysuria, suprapubic pain
systemic S.sx: increase fever, chills, flank pain, N/V

219
Q

Tx of cystitis

A

UA, Abx, antispasmodics (peridion), void schedule, monitor output, badder US, cranberry juice

220
Q

decrease of size of an organ due to a decrease in cell

A

involution

221
Q

delay or absence of uterine involution

A

subinvolution

222
Q

time following childbirth

A

puerperium (4th trimester)

223
Q

changes with uterus PP

A

seals off where placental insertion site was, organ decreases in size can take 5-6 weeks, @24 hours 1 FB below U, @10days-2 weeks wont be able to palpate the fundus

224
Q

are afterpains normal

A

yes, they are part of involution process, happens bc uterus has relaxation and contractions, breast feeding also increases after birth pains

225
Q

self destruction of excess hypertrophy tissue

A

autolysis

226
Q

heals from underneath superficial layer is necrotic and sloughs off and layer underneath is brought to surface, no scar tissue forms

A

exfoliation

227
Q

what can cause retard involution

A

retained placenta, full bladder, infection, LGA, multipara women, prolonged labor, anesthesia

228
Q

changes with cervix PP

A

slit like, soft thin fragile cervix, takes about 1-2 weeks to regain shape

229
Q

changes with vagina PP

A

edematous, bruised, few wrinkles, smooth @3 weeks PP Rugae will reappear

230
Q

if the hymine is torn what will happen

A

heal irregularly & leave small tags called caruncalae myrtioform

231
Q

changes with perineum PP

A

edema, tenderness

232
Q

changes with lochia PP

A

lasts 2-6 weeks, Lochia rubra (2-3 days), lochia serosa (3-10 days), lochia alba (2-3 weeks)

233
Q

when should you have an increase in lochia discharge

A

heaviest in morning, exertion, breast stimulation

234
Q

prolactin

A

promotes milk production by stimulating aveolar cells in breast

235
Q

oxytocin

A

posterior pituitary (secretes oxytocin), in response to infant sucking stimulates let down, causes release of milk

236
Q

when will menses start again PP

A

3-4 months after delivery or stop lactation

237
Q

changes in cardiovascular system

A

stroke volume/cardiac output will return to normal in 2 weeks, HR & BP will quickly return to normal

238
Q

changes in Respiratory system

A

RR increase, 6-8 weeks to return to normal

239
Q

changes in urinary system

A

have edema in bladder, urethra, decrease of tone and sensitivity
kidney function returns to normal about 1 month

240
Q

changes in gastrointestinal system

A

constipation bc decrease peristalsis

hemorrhoids common

241
Q

changes in musculoskeletal system

A

abdominal wall decrease muscle tone, Diastasis recti-abdominal separation resolves without intervention

242
Q

changes in integumentary system

A

striae gravideium- stretch marks, cloasmia- pregnancy mask, straie negri-dark line in abdomen

243
Q

VS changes PP

A

temperature slight increase, (slight increase when milk comes in), pulse decreases bc of increase blood volume, blood pressure slight increase, respirations slight increase

244
Q

changes in endocrine system

A

estrogen, progesterone, human placental lactogen all decrease after placental separation
lowest levels are @ 1 week PP
prolactin levels increase & remain increase while beast feeding

245
Q

Bromage scale

A

flex knees, lift legs off bed, raise butt

used for recovery from regional anesthesia

246
Q

breast care for bottle feeding moms

A

tight well fitted bra, ice analgesics, no hot showers, no partner play, apply cabbage leaves

247
Q

breast care for breast feeding moms

A

bra, no soap on nipples, no stimulation other than baby sucking, shields, assess S/Sx engorgement, Lanolin (nipple cream), milk on nipples

248
Q

when is Rhogam indicated

A

if mom is Rh negative and newborn is Rh+

249
Q

what test is done for NB for antibodies

A

Coombs test

250
Q

what PP exercise tips can you give a new mom

A

begin with low reps & gradually increase
avoid fatigue
stop if bleeding increases or changes
maintain hydration

251
Q

mom should not get Rubella vaccine if what

A

is getting Rhogam bc it suppresses the immune system

252
Q

caput succedaneum

A

localized scalp swelling, edema that crosses the suture line, caused by the presentingpart on undilated cervix

253
Q

Dx & Tx for caput succedaneum

A

Dx; visual

Tx: none

254
Q

cephalhematoma

A

subperiosteal hemorrhage, edema that doesn’t cross the suture line, no color change, caused by head hitting the pelvis

255
Q

Dx & Tx for cephalhematoma

A

Dx: visual
Tx: none, resolves in 2-6 weeks
*SE can have jaundice occur when healing begins

256
Q

diffuse scalp hemorrhage

A

edema of scalp & possible forehead, decrease in H&H, caused by traumatic delivery or vacuum use

257
Q

Dx & Tx for diffuse scalp hemorrhage

A

Dx: visual CT scan
Tx: neuro assessment, possible transfusion
can cause hypovolemic shock and death
RARE

258
Q

Subcutaneous fat necrosis

A

lesion, stays 2-6 weeks, overlying skin is intact, usually on face or cheeks, caused by pressure against bony pelvis, vigorous maneuvering of fetal body, RARE

259
Q

Dx & Tx of Subcutaneous fat necrosis

A

Dx: S/Sx
Tx: watch, will disappear in 4-6 weeks

260
Q

cause of petechaie/ecchymosis

A

nuchal cord, mechanical device, Dx visually, Tx observe, test if needed for coagulation deficit

261
Q

subconjunctival hemorrhage

A

red spot on sclera, caused by pressure during birth

262
Q

retinal hemorrhage

A

due to venous congestion from compression of head

263
Q

injury to liver

A

due to manilpulation of body during delivery (breech), also during CPR
S/Sx:poor feeding, increase HR, listlessness, palpate a mass in RUQ

264
Q

Dx & Tx for injury to liver

A

Dx: parasentesis
Tx: evacuate hematoma
if not tx= death

265
Q

erbs palsy

A

waiters tip

trauma to C5-C6, arm hangs limply @ side and is rotated internally, elbow is extended but fingers and wrist is flexed

266
Q

Dx & Tx of erbs palsy

A

Dx: check moro reflex, Xray
Tx: none specific, immobility arm to decrease inflammation

267
Q

Klumpke

A

trauma to C8-T1, involvement of hand and forearm, weak wrist

268
Q

Dx & Tx for Klumpke

A

Dx: check moro (no movement in hand)
Tx: splint hand, claw hand deformity

269
Q

phrenic nerve paralysis

A

diaphragm, have labored respirations, cyanosis, decrease breath sounds on effected side

270
Q

Dx & Tx for phrenic nerve paralysis

A

Dx: x-ray show elevating diaphragm
Tx: postion on effective side, assist with resp efforts, recovery within 6 weeks

271
Q

facial nerve injuries

A

have paralysis on effected side, caused by pressure over facial nerves, forceps or position in utero

272
Q

Dx & Tx for facial nerve injuries

A

Dx: visual
Tx: careful feedings, parent support, tape effected eye shut, use of artifical tears, function return in 2-3 weeks, gone in 2-3 months

273
Q

fractures

A

clavical most common, have decrease movement on effected side

274
Q

Dx & Tx of fractures

A

Dx: moro intact with pain, xray
Tx: immobolization not required, heal rapidly, minimize movement

275
Q

torticollis

A

“wry neck”, sternocleidomastoid muscle injury, painless swelling in neck

276
Q

Tx for torticollis

A

ROM, take 5-6 months to disappear

277
Q

spinal cord injury

A

usually from breech delivery, have paralysiss at level of defect. rare

278
Q

women who develop carbohydrate intolerance of variable severity during pregnancy

A

gestational DM

279
Q

birth anomalies are most common in women with hyperglycemia when

A

in the 1st trimester,

ketoacidosis is associated with interuterine death

280
Q

if a type 2 DM pregnant women is taking ACE inhibitors prior to pregnancy, what medication will she be put on during pregnancy

A

beta blocker

281
Q

what do most gestational DM women have

A

chronic beta cell dysfunction

282
Q

what are factors for gestational DM

A

family hx, obesity (BMI greater 30), increase age, Hx abnormal glucose metabolism, previous LGA, Hx of polycystic ovary disease

283
Q

when is screening done for gestational DM

A

week 24-28

a value of greater 140mg/dl requires further evaluation with a 3 hour OGTT

284
Q

3 hour OGTT

A

fasting less than 95
1 hour less than 180
2 hour less than 155
3 hour less than 140

285
Q

what are the normal metabolic changes during pregnancy

A

fetus depends on mother for fuel to meet growth needs, glucose crosses placenta, incrase insulin levels in late pregnancy

286
Q

normal changes in pregnancy

A

normal growth of placenta releases increase of glucose hormones, maternal need for insulin is increased each trimester

287
Q

in a previous DM what must they be taught about the 3rd trimester

A

moms pancreas must release 3-4 times the amt of insulin, so this will require significant changes in insluin need

288
Q

when does gestational DM go away

A

once baby and placenta are removed from moms body

289
Q

what risks do mothers have with hyperglycemia in pregnancy

A

retinal changes, hydyramnious (extra amniotic fluid), pre-eclampsia, HTN, fluid retention

290
Q

what risks to babies have when mom is hyperglycemic during pregnancy

A

macrosomic, preterm, difficult delivery, still birth, neonatal death

291
Q

goal for one hour post meal glucose

A

130 mg/dl or less

292
Q

glyburide

A

outcomes similar to insulin use

293
Q

metformin

A

crosses placenta

294
Q

short acting insulin

A

Regular, Humalog

295
Q

long acting insulin

A

humulin N

296
Q

at delivery what is the risk for the baby

A

low blood sugar, since the baby lived in a higher sugar enviornment in moms placenta, the babys pancreas may release extra insulin and cause the sugar to go too low after delivery

297
Q

what can be done if the babys blood sugar is too low

A

formula or breast milk, if unable to suck IV glucose is given

298
Q

the child carried during this pregnancy has a risk of

A

obesity, insulin resistance, dyslipidemia, type 2 DM

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