antipardum exam Flashcards

Question

ABO incompatibility - which blood type for mom?

Answer 1

Blood type incompatibility; when a mother with type O blood has become pregnant with a fetus with a different blood type (Type A, B, or AB). Mothers serum contains naturally occurring anti-A and Anti-B which can cross the placenta and hemolysis fetal RBCs

Answer 2

Nutritional needs Mothers likely to have poor maternal weight gain, iron-deficiency anemia, poor eating habits and inadequate nutrition

Answer 3

Contributes to loss of self-esteem, societal discrimination, a destruction of life projects, and the prolonging of poverty Faced with ethical dilemmas and decisions They lack information, skills, and services necessary to make informed choices related to their sexual and reproductive health Pregnancy can exacerbate their feeling of loss of control and helplessness 7/10 will drop out of school; more than 75% will receive public assistance within 5 years of having their 1st child Babies are at greater risk of preterm birth, low birth weight, child abuse, neglect, poverty, and death The younger the mother, the more likely she is to have another child in her teens; client is at risk for obstetric complications, STIs, poor maternal weight gain, preeclampsia, iron-deficiency anemia, poor eating habits and nutrition, and postpartum depression

Answer 4

Pregnant adolescents experience a higher rate of domestic violence and substance abuse (which contributes to low birth weight, fetal growth restrictions, preterm birth, newborn addiction, and sepsis) More likely to abuse substances, receive inadequate prenatal care, and have lower pregnancy weight Many clients are from minority backgrounds and live below the poverty line

Answer 5

80% do not want to be pregnant, fragile body image, immaturity, conflict btw their own needs and the babies, limited knowledge of child development

Answer 6

Cephalopelvic disproportion, increased nutrition needs for mom and baby, increased risk of preeclampsia, increased risk of anemia, increased risk of STIs, <15 has 60% greater mortality rate

Answer 7

Increased incarceration rates and health care costs; less likely to receive prenatal care or is late care; more likely to suffer domestic violence; higher infant mortality related to immaturity, may have less support

Answer 8

Female infertility, pregnancy loss, fetal abnormalities, stillbirth, and obstetric complications (gestational diabetes and hypertension, preeclampsia, small-for-gestational-age infants, spontaneous late preterm births, postpartum hemorrhage, genetic disorders and chromosomal abnormalities, placenta previa, fetal growth restrictions, low Apgar score, and cesarean section

Answer 9

Multifetal gestations, previous pregnancy w/ preeclampsia, renal disease, autoimmune disease, diabetes, first pregnancy, periodontal disease, chronic hypertension, and obesity

Answer 10

Hemolysis elevated liver enzymes low platelets Variant of the pre/-eclampsia syndrome; development of an abnormal trophoblastic (abnormal cells) invasion due to inadequate maternal immune tolerance

Answer 11

Prevention and treatment of eclamptic seizures

Answer 12

Monitor for signs of toxicity including hypotension, areflexia (loss of deep tendon reflexes DTR), respiratory depression and arrest, oliguria, SOB, chest pain, slurred speech, hypothermia, confusion, circulatory collapse

Answer 13

Allergic rxn (skin rash, itching, hives; swelling of face, lips, tongue or throat; confusion, drowsiness, facial flushing, redness, sweating, muscle weakness, fast or irregular heartbeat, trouble breathing, low BP

Answer 14

Newborn monitored for respiratory depression, muscle weakness, neurologic depression, loss of reflex, hypocalcemia, and hypotonia (decreased muscle tone); decreased fetal heart rate variability may occur

Answer 15

Nursing interventions: Administer loading dose of 4-6 g by IV in 100 mL of fluid, over 15-30 minutes followed by a maintenance dose of 1-2 g as continuous IV infusion;

Answer 16

Spontaneous Abortions: loss of fetus before 20 weeks. signs could be lower backpain

Answer 17

bedrest, fluids (threatened); D & D or suction curettage; D & E (2nd trimester); antibiotics (missed, septic); misoprostol; pain medications; PhoGAM (RH-)

Answer 18

vaginal bleeding. Abd pain, cramping, pelvic pressure, low back pain

Answer 19

S/S: early vaginal bleeding (often slight); no cervical dilation or change in cervical consistency; mild abd cramping; closed cervical os (?); no passage of fetal tissue. usually can't keep the baby.

Answer 20

S/S: vaginal bleeding (greater than w/ threatened); rupture of membranes; cervical dilation; strong abd cramping; possible passage of products of conception

Answer 21

S/S: intense abd cramping; heavy vaginal bleeding; cervical dilation; passage of some of the products of conception, but some still remains in uterus. pain and bleeding main reason women come to hospital

Answer 22

S/S: Hx of vaginal bleeding and abd pain; passage of tissue w/ subsequent decrease in pain and significant decrease in vaginal bleeding

Answer 23

(nonviable embryo retained in utero for at least 6 weeks) S/S: absent uterine contractions; irregular spotting; possible progression to inevitable abortion

Answer 24

(habitual): will start treating early, could be a hormone issue. 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period. infection could be an issue.

Answer 25

Complications of sex during pregnancy include preterm labor, pelvic inflammatory disease, antepartum hemorrhage in placenta previa, and venous air embolism. Generally sexual relations are concidered safe, abstinence is recommended for high-risk patients (risk for preterm labor or for antepartum hemorrhage due to placenta previa)

Answer 26

Hyperemesis Gravidarum is a severe form of N/V during pregnancy that begins 9 weeks gestation,which could lead to hospitalization; could be linked to higher and extended levels of hCG

Answer 27

are the relatively mild symptoms of pregnancy During 1st trimester, cause is unknown but may be hormonal; treatment involves eating dry carbs in the AM, avoid empty stomach and fatty/fried foods, do frequent small meals, eat ginger; PNV (?), Vit B6, doxylamine

Answer 28

Hyperemesis Gravidarum: severe, persistent, and uncontrolled N/V, dehydration, weight loss (> 5% of pre pregnancy body weight), electrolyte imbalance and nutritional imbalances and ketosis

Answer 29

Morning Sickness: mild N/V, only in 1st trimester

Answer 30

Diagnosis of exclusion, associated with symptoms. Looks for fluid and electrolyte imbalances, weight loss, uncontrolled N/V that extends passed the 1st trimester; multiple theories so look for Vitamin B6 deficiency (metabolic theory), genetic predisposition (genetic factors), and high levels of hCG and estrogen (endocrine theory) From lecture slides: look to exclude → is V from other causes?

Answer 31

Health history *R/O other causes ex. Gastroenteritis, pyelonephritis, pancreatitis, cholecystitis, hepatitis, thyroid Onset, duration and course of N/V

Answer 32

Weight loss Inspect mucus membranes for dryness, check skin turgor, BP changes (hypotension that may suggest fluid volume deficit) Complaints of weakness, fatigue, activity intolerance, dizziness, mood changes, and decreased ability to concentrate From lecture slides: assess for dehydration [hypotension, I/O, U/A (specific gravity); skin turgor, mucous membranes, electrolyte imbalances (labs, S/s of hypokalemia), Bit B1, B6 and B12 deficiencies (Wernicke-Korsakoff syndrome)]; IV fluids and electrolyte replacement, NPO

Answer 33

Liver enzymes: rule out hepatitis, pancreatitis, and cholestasis; elevation of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) usually present CBC: elevated RBC and hematocrit, indicates dehydration Urine ketones: + when body breaks down fat to provide energy in the absence of adequate intake TSH and T4: rule out thyroid disease BUN: increased in the presence of salt and water depletion Urine specific gravity: > 1.025, could indicate concentrated urine; ketonuria Serum electrolytes: decreased levels of potassium, sodium, and chloride resulting from excessive vomiting and loss of hydrochloric acid in stomach ultrasound

Answer 34

Promote comfort and nutrition; initially withhold oral flood and fluids, maintain NPO status to allow GI tract to rest Antiemetics IV fluids and electrolyte replacement therapy Monitor I/O Provide support and education, reduce stress

Answer 35

Any pregnancy in which the fertilized ovum implants outside the uterine cavity (includes the fallopian tubes, cervix, intestine, and abd cavity). The embryo grows and draws its blood supply from the site of abnormal implantation. As it gets bigger it creates the potential for organ rupture because only the uterus is designed to expand to accommodate a growing fetus. Can lead to massive hemorrhage, infertility and death

Answer 36

Triad of symptoms are abdominal pain, amenorrhea, and vaginal bleeding. Only half of women present with all three symptoms

Answer 37

Urine pregnancy test to confirm pregnancy, beta-hCG concentration to exclude a false-negative urine test, and a transvaginal ultrasound to visualize the misplaced pregnancy

Answer 38

Physical exam Assess for S/S of ectopic pregnancy, usually begin ~7th week of gestation

Answer 39

Previous ectopic pregnancy, history of STIs, fallopian tube scarring from PID, in utero exposure to DES, endometriosis, previous tubal or pelvic surgery, infertility and treatments, uterine abnormalities such as fibroids, presence of intrauterine contraception, use of progestin-only mini pill, postpartum or post abortion infection, altered estrogen and progesterone levels (interferes w/ tubal motility), age > 35 years, cigarette smoking From slides: Hx of STIs or PID, previous ectopic pregnancies, endometriosis, IUDs, assisted reproduction (in vitro)

Answer 40

Transvaginal ultrasound to visualize misplaced pregnancy

Answer 41

Nursing management - Analgesics for pain Teach about S/S of rupture is outpatient care (sever, sharp, stabbing, unilateral abd pain; vertigo/fainting; hypotension; and increased pulse). Advice to seek medical care immediately Emotional support Use of contraceptives for at least 3 menstrual cycles to allow for healing and repair

Answer 42

The standard treatment is oral antiretroviral drugs given daily until giving birth, IV administration during labor, and oral zidovudine (AZT) for the newborn within 6 to 12 hours of birth. Some reports suggest that cesarean birth may reduce the risk of HIV infection (King et al., 2019). Efforts to reduce instrumentation, such as avoiding the use of an episiotomy, fetal scalp electrodes, and fetal scalp sampling, will reduce the newborn’s exposure to body fluids

Answer 43

getting adequate sleep each night (7 to 9 hours) avoiding infections (e.g., staying out of crowds, practicing good hand hygiene) decreasing stress consuming adequate protein and vitamins increasing her fluid intake to 2 L daily to stay hydrated planning rest periods throughout the day to prevent fatigue

Answer 44

from mother to fetus during pregnancy or breast-feeding and amniotic fluid during childbirth.

Answer 45

Urinary frequency or incontinence: woman decrease her fluid intake 2 to 3 hours before bedtime and limit her intake of caffeinated beverages. Increased voiding is normal, but encourage the client to report any pain or burning during urination. Kegel exercises.

Answer 46

arrange work, child care, and other demands in her life to permit additional rest periods. Using pillows for support in the left-side–lying position relieves pressure on major blood vessels that supply oxygen and nutrients to the fetus when resting. Relaxation techinques.

Answer 47

eat small, frequent meals that are bland and low in fat. Eat dry crackers, Cheerios, or cheese or drinking lemonade before getting out of bed in the morning and increasing her intake of foods high in vitamin B6, such as meat, poultry, bananas, fish, green leafy vegetables, peanuts, raisins, walnuts, and whole grains, or making sure she is receiving enough vitamin B6.

Answer 48

wear a larger bra with good support can help alleviate this discomfort. Advise her to wear a supportive bra, even while s1leeping.

Answer 49

● Eat fresh or dried fruit daily. ● Eat more raw fruits and vegetables, including their skins. ● Eat whole-grain cereals and breads such as raisin bran or bran flakes. ● Participate in physical activity every day. ● Engage in pelvic floor exercises, stretching exercises, and yoga daily. ● Eat meals at regular intervals. ● Establish a time of day to defecate, and elevate feet on a stool to avoid straining. ● Drink six to eight glasses of water daily. ● Decrease intake of refined carbohydrates. ● Drink warm fluids upon arising to stimulate bowel motility. ● Decrease consumption of sugary sodas. ● Avoid eating large amounts of cheese.

Answer 50

keep the perineal area clean and dry, washing the area with mild soap and water during her daily shower. Cotton underwear. Wear nightgown. Avoid tampons and douching.

Answer 51

heat and ice, acetaminophen, massage, proper posturing, good support shoes, and a good exercise program for strength and conditioning. Pillow between legs when sleeping. Maintain correct posture with head up and shoulders back.

Answer 52

gently stretch the muscle by dorsiflexing the foot up toward the body. Wrapping a warm, moist towel around the leg muscle can also help the muscle relax. Advise the client to avoid stretching her legs, pointing her toes, and walking excessively. Stress the importance of wearing low-heeled shoes and support hose and arising slowly from a sitting position. Elevate legs.

Answer 53

supportive hose, elevate her legs above her heart while lying on her back for 10 minutes before she gets out of bed in the morning, elevate both legs above the level of the heart for 5 to 10 minutes at least twice a day.

Answer 54

increasing fiber intake and drinking at least 2 L of fluid per day. warm sitz baths, witch hazel compresses, or cold compresses. Elevate feet on stool when deficating.

Answer 55

avoid gas-forming foods, such as beans, cabbage, and onions, as well as foods that have a high content of white sugar. Adding more fiber to the diet, increasing fluid intake, and increasing physical exercise. Don’t chew gum

Answer 56

adjust her body position to allow for maximum expansion of the chest and to avoid large meals. emphasize that lying on the left side will displace the uterus off the vena cava and improve breathing. avoid exercise that precipitates dyspnea, to rest after exercise, and to avoid overheating in warm climate.

Answer 57

imit or avoid gas-producing or fatty foods and large meals. maintain proper posture and remain in the sitting position for 1 to 3 hours after eating to prevent reflux. maintain proper posture and remain in the sitting position for 1 to 3 hours after eating to prevent reflux. avoid foods that act as triggers such as caffeinated drinks; greasy, gas-forming foods; citrus; spiced foods; chocolate; coffee; alcohol; and spearmint or peppermint. avoid late-night or large meals and gum chewing and avoid lying down within 3 hours after eating. Elevate HOB to 10 - 30 degrees while sleeping.

Answer 58

● Elevate your feet and legs above the level of the heart periodically throughout the day. ● Wear compression stockings when standing or sitting for long periods. ● Change position frequently throughout the day. ● Walk at a sensible pace to help contract leg muscles to promote venous return. ● Avoid foods high in sodium, such as lunch meats, potato chips, and bacon. ● Avoid wearing knee-high stockings. ● Drink six to eight glasses of water daily to replace fluids lost through perspiration. ● Avoid high intake of sugar and fats because they cause water retention

Answer 59

typically in the 3rd trimester. keep herself well hydrated and to rest in a left-side–lying position to help relieve the discomfort. Breathing techniques. (brax is false)

Answer 60

(strep) Although GBS is rarely serious in adults, it can be life-threatening to newborns. GBS is the most common cause of sepsis and meningitis in newborns and is a frequent cause of newborn pneumonia.

Answer 61

GBS colonization in the mother is thought to cause chorioamnionitis, endometritis, and postpartum wound infection

Answer 62

uses a real-time ultrasound and NST to allow assessment of various parameters of fetal well-being that are sensitive to hypoxia. measures health of fetus. HR, muscle tone, breathing action, and how much amniotic fluid. also a non-stress test.

Answer 63

h) Body movements: three or more discrete limb or trunk movements i) Fetal tone: one or more instances of full extension and flexion of a limb or trunk j) Fetal breathing: one or more fetal breathing movements of more than 30 seconds k) Amniotic fluid volume: one or more pockets of fluid measuring 2 cm l) NST: normal NST = 2 points; abnormal NST = 0 points

Answer 64

AFI - (amniotic fluid index) measures the vertical depths of the largest pocket of amniotic fluid in all four quadranultts surrounding the maternal umbilicus and totaled. 5 - 25 cm is normal fluid amount.

Answer 65

ultrasound technician or doctor will introduce a probe into the vagina. It may be mildly uncomfortable, but will not hurt. The probe is covered with a condom and a gel. The probe transmits sound waves and records the reflections of those waves off body structures. Abdominal - also soundwaves.

Answer 66

provider will move the device over your abdomen until the baby's heartbeat is found. The baby's heart rate will be recorded on a monitor, while your contractions are recorded on paper. You may be asked to press a button on the device each time you feel your baby move.

Answer 67

To trigger contractions, your doctor may give you a dose of the drug oxytocin through an IV in your arm. Or your doctor may suggest that you rub your nipples through your clothing, which can start contractions. Then you wait while the monitors record contractions and your baby's heartbeat. The test takes about 2 hour.

Answer 68

lay back on the exam table. Then, your healthcare provider will extend a paper or plastic tape measure from the top of your symphysis pubis (pubic bone) to your uterus (fundus). The distance between these two spots is your fundal height.

Answer 69

daily movement counts - should be performed same time every day. lay on left side, hand on stomach, and lay for an hour and count. should be around 10 kicks an hour. best time is after meals.

Answer 70

AFI: either polyhdraminos or oligohyraminos -

Answer 71

used for many things - wellbeing - usually looks at movement, heartbeat, and RR, can see baby move, can see diaphragm. Abdominal or transvaginal. usually abdominal. if looking for anomalies, will do transvaginal.

Answer 72

Demonstrates findings of fetal jeopardy manifested by late decelerations or bradycardia.?

Answer 73

can fetus tolerate contractions?

Answer 74

determines SGA?

Answer 75

Evaluate fetal HR during movement; can be reactive (2 acceleration in 20 minutes) or nonreactive Accelerations: >50 over a baseline lasting 15 seconds or more (over 32 weeks gestation) Less than 32 weeks gestation >10 over 10 seconds

Answer 76

(lasts 20 minutes) is the most common method of prenatal testing used. Provides an indirect measurement of uteroplacental function.

Answer 77

Normal BMI: 25-35 lb

Answer 78

15-25 lb for overweight, and 11-20 lb for obese

Answer 79

raisins, Red meat, chicken, fish, green leafy vegetable, soy products, nuts and dried fruit, dried beans, eggs, fortified grains

Answer 80

Dairy products (milk, cheese, and yogurt), cereals; broccoli, spinach, and kale; salmon

Answer 81

- macrosomia (large fetus) resulting from hyperinsulinemia stimulated by fetal hyperglycemia - Hypoglycemia - Childhood obesity - Hyperbilirubinemia - birth trauma due to shoulder dystocia (mechanical problems during delivery) - Congenital anomaly due to hyperglycemia in the 1st trimester (cardiac problems, neural tube defects, skeletal deformities, and genitourinary problems) - Premature birth secondary to polyhydramnios (too much amniotic fluid) and an aging placenta; places the fetus in jeopardy - Fetal asphyxia secondary to fetal hyperglycemia and hyperinsulinemia - Intrauterine growth restrictions secondary to maternal vascular impairment and decreased placental perfusion, which restricts growth - Perinatal death due to poor placental perfusion and hypoxia - Respiratory distress syndrome resulting from poor surfactant production - Polycythemia (a blood disorder) due to excessive RBC production in response to hypoxia

Answer 82

preeclampsia and cesarean birth; greater risk of developing cardiovascular disease - Gestational hypertension of unknown etiology - Ketoacidosis due to uncontrolled hyperglycemia - Preterm labor secondary to premature membrane rupture - stillbirth in pregnancies - Hydramnios - Hypoglycemia as glucose is diverted to the fetus (in 1st trimester) - UTIs resulting from excess glucose in the urine - Chronic monilial vaginitis due to glucosuria (promotes yeast growth) - Difficult labor

Answer 83

1st trimester: Hypoglycemia as glucose is diverted to the fetus Late pregnancy: hyperglycemia; insulin peaks in last trimester to provide more nutrients to the fetus, causing an increase demand on the mother pancreas, and glucose levels rise

Answer 84

● Previous infant with congenital anomaly (skeletal, renal, central nervous system, cardiac) ● History of gestational diabetes or polyhydramnios in a previous pregnancy ● Family history of diabetes ● Medications like corticosteroids or antipsychotics ● Age 35 years or older ● Polycystic ovary syndrome ● Multiple pregnancy (twins, triplets) ● Previous infant weighing more than 9 lb (4,000 g) ● Previous unexplained fetal demise or neonatal death ● Maternal obesity (body mass index [BMI] over 30) ● Hypertension before pregnancy or in early pregnancy ● Hispanic, Native American, Pacific Islander, or African American ethnicity ● Recurrent monilia infections that do not respond to treatment ● Signs and symptoms of glucose intolerance (polyuria, polyphagia, polydipsia, fatigue) ● Presence of glycosuria or proteinuria (Farahvar et al., 2019).

Answer 85

* Hydramnios due to fetal diuresis caused by hyperglycemia * Gestational hypertension of unknown etiology * Ketoacidosis due to uncontrolled hyperglycemia * Preterm labor secondary to premature membrane rupture * Stillbirth in pregnancies complicated by ketoacidosis and poor glucose control * Hypoglycemia as glucose is diverted to the fetus (occurring in first trimester) * Urinary tract infections resulting from excess glucose in the urine (glucosuria), which promotes bacterial growth * Chronic monilial vaginitis due to glucosuria, which promotes growth of yeast * Difficult labor, cesarean birth, postpartum hemorrhage secondary to an overdistended uterus to accommodate a macrosomic infant

Answer 86

Cord prolapse secondary to polyhydramnios and abnormal fetal presentation * Congenital anomaly due to hyperglycemia in the first trimester (cardiac problems, neural tube defects, skeletal deformities, and genitourinary problems) * Macrosomia resulting from hyperinsulinemia stimulated by fetal hyperglycemia * Birth trauma due to increased size of fetus, which complicates the birthing process (shoulder dystocia) * Preterm birth secondary to polyhydramnios and an aging placenta, which places the fetus in jeopardy if the pregnancy continues * Fetal asphyxia secondary to fetal hyperglycemia and hyperinsulinemia * Intrauterine growth restriction secondary to maternal vascular impairment and decreased placental perfusion, which restricts growth * Perinatal death due to poor placental perfusion and hypoxia * Respiratory distress syndrome resulting from poor surfactant production secondary to hyperinsulinemia inhibiting the production of phospholipids, which make up surfactant * Polycythemia due to excessive red blood cell (RBC) production in response to hypoxia * Hyperbilirubinemia due to excessive RBC breakdown from hypoxia and an immature liver unable to break down bilirubin * Neonatal hypoglycemia resulting from ongoing hyperinsulinemia after the placenta is removed * Subsequent childhood obesity and carbohydrate intolerance

Answer 87

caused by a parasite; cats primary host; spread by contaminated soil, raw meats, and unwashed fruits and veg. Fetus is high risk for preterm labor and stillbirth; low birth weight, enlarged liver and spleen, visual problems, cerebral palsy, hearing loss, seizures, chorioretinitis, jaundice, IUGR, hydrocephalus, microcephaly, neurologic damage and anemia

Answer 88

depends on the type but effects include: eye infections, pneumonia; low birth weight, stilllbirth, preterm birth; intrauterine growth restrictions; intellectual disabilities, blindness, seizures, premature birth, death; skin ulcers, weakness or hoarse cry, deafness, swollen liver and spleen, amnesia, various deformations; HIV positive status; warts in throat; premature rupture of membranes

Answer 89

Mom can be rH + or -; if baby is positive, and mom is -, mom will make antibodies against baby which can be dangerous if they cross over to the fetus and start destroying the RBCs - If mom gets pregnancy again, they will get rogan

Answer 90

Preeclampsia is a two-stage event; the underlying mechanisms involved are vasospasm and hypoperfusion. In the first stage, the key feature is widespread vasospasm. In addition, endothelial injury occurs, leading to platelet adherence, fibrin deposition, and the presence of schistocytes (fragments of erythrocytes).

Answer 91

a. generalized vasospasm results in elevation of blood pressure and reduced blood flow to the brain, liver, kidneys, placenta, and lungs. b. decreased brain perfusion leads to small cerebral hemorrhages and symptoms of arterial vasospasm such as headaches, visual disturbances, blurred vision, and hyperactive deep tendon reflexes c. hypertension d.decreased kidney perfusion reduces the glomerular filtration rate, resulting in decreased urine output and increased serum levels of sodium, blood urea nitrogen (BUN), uric acid, and creatinine e. reduction of plasma colloid osmotic pressure and moves more fluid into extracellular spaces; this leads to pulmonary edema and generalized edema f. Poor placental perfusion resulting from prolonged vasoconstriction contributes to intrauterine growth restriction, placental abruption, persistent fetal hypoxia, and acidosis

Answer 92

Multifetal gestations, previous pregnancy w/ preeclampsia, renal disease, autoimmune disease, diabetes, first pregnancy, periodontal disease, chronic hypertension, and obesity

Answer 93

Increases risk of placental abruption, preterm birth, intrauterine growth restriction, and fetal distress during childbirth

Answer 94

Oxytocin and magnesium sulfate can be given simultaneously via infusion pumps to ensure both are administered at the prescribed rate. Magnesium sulfate is given IV via an infusion pump.

Answer 95

The woman with preeclampsia with severe features usually requires hospitalization. Keep the client on complete bed rest in the left lateral lying position. Ensure that the room is dark and quiet to reduce stimulation. Give sedatives as ordered to encourage quiet bed rest. The client is at risk for seizures if the condition progresses. Therefore, institute and maintain seizure precautions, such as padding the side rails and having oxygen, suction equipment, and a call light readily available to protect the client from injury

Answer 96

Report varying degrees of vaginal bleeding, low back pain, abdominal cramping, and passage of products of conception tissue ask the woman about the color of the vaginal bleeding (bright red is significant) and the amount—for example, question her about the frequency with which she is changing her peripads (saturation of one peripad hourly is significant) and the passage of any clots or tissue. save any tissue or clots passed and bring them with her to the health care facility. d. obtain a description of any other signs and symptoms the woman may be experiencing, along with a description of their severity and duration. e. assess her vital signs and observe the amount, color, and characteristics of the bleeding. f. Rate pain level Ask her to rate her current pain level, using an appropriate pain assessment tool. g. Rate amount and intensity of the woman’s abdominal cramping or contractions, and assess the woman’s level of understanding about what is happening to her

Answer 97

d. provide continued monitoring and psychological support because the family is experiencing acute loss and grief. Reassure pt. e. Monitor the amount of vaginal bleeding through pad counts and observe for passage of products of conception tissue. f. Rate pain h. Assist in preparing the woman for procedures and treatments such as surgery to evacuate the uterus or medications such as misoprostol or prostaglandin E2 (PGE2). If the woman is Rh-negative and not sensitized, expect to administer RhoGAM within 72 hours after the abortion is complete.

Answer 98

physical and emotional support. e. Encourage friends and family to be supportive but give the family space and time to work through their loss. f. Referral to a community support group for parents who have experienced a loss can be helpful during this grief process.

Answer 99

EAB (elective abortion) - Purposeful interruption of a pre-viable pregnancy.

Answer 100

TAB (theraputic abortion) – Abortion for maternal/fetal disorder.

Answer 101

When a fetus is exposed to alcohol during development, it can result in a variety of adverse developmental effects including physical, neurological, and behavioral defects - Defects include - facial features: flattened philtrum, groove in upper lip up to nose; thin upper lip, short palpebral) - growth deficit: weight, height and BMI - structural/function CNS dysfunction: microcephaly, intellectual disability, psychiatric conditions, language, motor and memory disorders

Answer 102

Heart rate increases by 10-15 bpm CO increases by 30-50% Vasodilation of the blood vessels

Answer 103

BP decreases initially (due to progesterone which relaxes smooth muscle and placenta, decreasing resistance) until 32 weeks when it returns to normal Hyper coagulation to prevent hemorrhage, also contributes to edema 6x increased risk for CV disease Dependent edema

Answer 104

Cardiac hypertrophy: displaced by the enlarged uterus which pushes up on the diaphragm; 95% of women develop systolic murmurs, palpitations and arrhythmias *monitor women w/ preexisting conditions

Answer 105

Anemia due to hemodilution, the increase in blood volume which is greater than the increase in RBCs circulating; most dramatic in 2nd trimester

Answer 106

Values < 11 g/dl in 1st or 3rd trimester, or < 10.5 g/dl in 2nd, considered anemic; Hct 32% or less considered anemic

Answer 107

Supine hypotension, inferior vena cava syndrome; have pt lie on L sidea

Answer 108

Ptyalism- increase in saliva production Morning sickness Decreased GI peristalsis

Answer 109

Heartburn due to pressure of uterus on gut and progesterone (stomach doesn't empty properly so acid builds up)

Answer 110

Gall bladder does not empty normally, can produce gallstones (hypercholesterolemia)

Answer 111

Morning sickness (N/V at 4-6 weeks), decreased GI peristalsis, hemorrhoids, ptyalism (increased saliva production), bleeding gums, heartburn

Answer 112

The ureters elongate, become tortuous, and form single or double curves

Answer 113

Increase in blood flow and GFR to kidneys Increase in urination: production and due to pressure from the uterus Risk for urinary stasis and pyelonephritis (due to curves in ureters)

Answer 114

Diaphragm pushed up to make room for uterus Chest expands more- rib cage relaxes (estrogen), decreased resistance (progesterone)

Answer 115

Increase of CO2 blown off Increase of the secretion of bicarbonate (remove acidity) from the kidneys Capillary engorgement from express blood volume Renal pelvis and ureters dilate-

Answer 116

Baby pushes down on ureters- ureters from kidney to bladder have curves which hold urine and can cause UTIs Baby pushes down on ureters- ureters from kidney to bladder have curves which hold urine and can cause UTIs

Answer 117

Increased O2 consumption (20-40%), increased RR,

Answer 118

increased bicarbonate secretion from the kidneys;

Answer 119

capillary engorgement (bloody nose and nasal stuffiness) Increased tidal volume (30-40%), vital capacity unchanged, inspiratory volume increased, expiratory volume decreased, total lung capacity unchanged

Answer 120

Hegar’s sign: softening of the lower uterine segment known as Hegar’s sign – probable sign of pregnancy @ 6 weeks Increase in uterine blood flow

Answer 121

Braxton Hicks contractions: painless and intermittent and do not cause any cervical changes

Answer 122

Quickening: “fluttering feeling” when the woman first feels the fetus move; usually not until the eighteenth week or later; multiparous women may feel it as early as 14 weeks

Answer 123

Growth of the uterus is dramatic - increasing vascularity, production of new muscle fibers and fibroelastic fibers and enlargement of pre-existing muscles account for the rapid growth of the uterus in the first trimester. After the first trimester the growth of the uterus is primarily due to the growth of the fetus After 20 weeks, gestational age of fetus should correspond w/ height of the fundus, when measured from the symphysis pubis

Answer 124

chadwick sign (chad is blue) 6-8 weeks); formation of mucus plug (operculum); acid vaginal secretions (susceptible to yeast infections)

Answer 125

Breasts: larger, mammary glands grow in 2nd and 3rd trimester, increased pigmentation, montgomery tubercles (sebaceous and sweat glands which lubricate and prevent infection during breastfeeding) more pronounced, estrogen increases vascularity, colostrum at 16 weeks

Answer 126

Medications or treatments currently going on Diet history Ptyalism (excessive salivation), anorexia, indigestion, and abd pain or distention; any blood or mucus in stool

Answer 127

Review risk factors: young age, N/V with previous pregnancies, history of intolerance of oral contraceptives, nulliparity, trophoblastic disease, multiple gestation, emotional or psychological stress, gastroesophageal reflux disease, primigravida status, obesity, hyperthyroidism, and H. pylori seropositivity Dehydration and electrolyte levels **from lecture Make NPO (give the GI a rest, and give IV fluids for fluid and electrolyte replacement

Answer 128

The second stage of preeclampsia is the woman’s response to abnormal placentation, when symptoms appear (i.e., hypertension, proteinuria, headache, nausea and vomiting, retinal vascular changes causing blurred vision, and hyperreflexia due to hypoperfusion)

Answer 129

Diagnosis: elevated liver enzymes, low platelet counts, and hemolysis Bleeding precaution

Answer 130

monitor serum magnesium levels; assess DTRs and check for ankle clonus; have antidote available; monitor for S/S of toxicity

Answer 131

Antidote is Calcium gluconate (10mL of a 10% solution IV over 3 minutes)

Answer 132

S/S: vaginal bleeding, abd pain, cramping, pelvic pressure, low back pain

Answer 133

Risk factors: congenital malformations (1st trimester, 50% occur from chromosomal abnormalities; majority before 12 weeks), maternal infection, maternal endocrine problems, AMA, previous loss

Answer 134

Risk factors: hyperthyroid disorders, molar pregnancy, multiple gestation, DM, GI disorders, previous pregnancy

Answer 135

avoid noxious stimuli, avoid tight clothing; eat small, frequent meals; separate fluids from solids; avoid lying down at least 2 hrs after eating; use high protein supplement drinks, avoid foods high in fat; get fresh air; herbal teas with peppermint or ginger; avoid fatigue and manage stress Make NPO (give the GI a rest, and give IV fluids for fluid and electrolyte replacement Small frequent meals eventually Antiemetics

Answer 136

tender abdomen, painful vaginal exam, cervical motion tenderness, and possible adnexal mass (growth around uterus). From lecture slides: missed period, tenderness, pain, shoulder pain (internal bleeding), vaginal bleeding, and shock

Answer 137

Missed period, adnexal fullness, and tenderness may indicate an unruptured tubal pregnancy HALLMARK symptoms: abd pain w/ spotting within 6-8 weeks after a missed period Symptoms after rupture or hemorrhage: severe, sharp and sudden pain in lower abd; faintness, referred pain to shoulder (indicates bleeding in abd caused by phrenic nerve irritation), hypotension, marked abd tenderness w/ distention, hypovolemic shock

Answer 138

beta-hCG test (low serum levels suggest ectopic pregnancy) *w/ “normal” pregnancy levels typically double every 2-4 days until peak value is reached 60-90 days after conception

Answer 139

Lecture slides: methotrexate (stops cells from growing causes abortion), emergency surgery (salpingectomy), attempt to preserve tube, serial hCG levels (3-6 weeks)

Answer 140

● When taking a long car ride, stop to walk around every 2 hours. ● When standing, rock from the ball of the foot to the toes to stimulate circulation. ● Lie on your left side to keep the gravid uterus off the vena cava to return blood to the heart.

Answer 141

Newborns with early-onset (within a week after birth) GBS infections may have pneumonia or sepsis, while late-onset (after the first week) infections often manifest in meningitis

Answer 142

Maximum score of 10. For the test to be judged abnormal and a score of zero awarded for the absence of fetal movement, fetal tone, or fetal breathing movements, a period of not less than 30 minutes must have elapsed. a score of 8 to 10 is considered normal if the amniotic fluid volume is adequate. A score of 6 or below is suspicious, possibly indicating a compromised fetus.

Answer 143

first trimester – conception to 12 weeks. second trimester – 13 to 27 weeks. third trimester – 28 to 40 weeks.

Answer 144

early, late and variable deceleration

Answer 145

top - fetal HR bottom - mom's contractions

Answer 146

***Mom's contractions will mirror baby's HR (happen at the same time) look at mom's contractions first - compare with baby. compare peak of mom's peak and look at baby's HR.

Answer 147

baby's HR responds after mom's contraction. upside down U. uteral placental insufficiency.

Answer 148

not uniform. baby's HR will respond at different times. means cord compression. causes little Vs.

Answer 149

early decelerations. always check the HR. anything below 120 is not normal.

Answer 150

Endogenous or Exogenous Oxytocin, Evaluate FHT with contractions,

Answer 151

Negative: No decelerations with 3 UC’s lasting 40-60 seconds in 10 minutes,

Answer 152

Positive: Decelerations with 50% or more of UC’s (we don’t want a positive) (we want negative)

Answer 153

Polyhydraminos: > 2,000ml 32-36 weeks 2% of pregnancies Associated with DM (on test) Fetal anomalies Risk for Preterm labor, PPROM, PROM

Answer 154

Oligohydraminos: <500ml 32-36 weeks 4% of pregnancies Fetus unable to make urine or something blocks the urination Poor pregnancy outcomes

Answer 155

Recommended twice weekly, after 28 weeks gestation (3rd trimester), for clients with diabetes and other high-risk conditions

Answer 156

Reactive = 2 accelerations in 20 minutes; accelerations are FHR equal or greater than 15 BPM over baseline lasting 15 seconds or more, occurs twice during \

Answer 157

NST (called acceleration) Non-reactive = abnormal, does not meet criteria; indicates the need for more testing

Answer 158

A loading dose of 4 to 6 g is given over 15 to 30 minutes, followed by an infusion of 1 to 2 g/hr as a continuous infusion. If overdosage occurs, calcium gluconate (10 mL of a 10% solution injected intravenously (10 mL of a 10% solution injected IV over 3 minutes) is an effective antidote.

Answer 159

Between 12 and 14 weeks’ gestation, the fundus can be palpated above the symphysis pubis. The fundus reaches the level of the umbilicus at approximately 20 weeks and measures 20 cm. Fundal measurement should approximately equal the number of weeks of gestation until week 36. For example, a fundal height of 24 cm suggests a fetus at 24 weeks’ gestation. After 36 weeks, the fundal height then drops due to lightening and may no longer correspond with the week of gestation

Answer 160

MMR, varicella

Answer 161

hypertension and preeclampsia

Answer 162

clotting issues (DIC)

Answer 163

greater than 2,000 and less than 500 mL

Answer 164

after 37 weeks, and before 37 weeks

Answer 165

Fasting blood glucose level: Less than 95 mg/dL At 1 hour: Less than 140 mg/dL At 2 hours: Less than 120 mg/dL At 3 hours: Less than 95 mg/dL

Answer 166

PCOS, advanced age, steroids, antipsychotics, large baby

Answer 167

greater than 32 weeks. Less than 32 weeks is 10 bpm over baseline and lasting 10 seconds.

Answer 168

we don't want a positive because that means the fetal HR is going down with contractions = baby not getting enough O2

Answer 169

placenta is over top of cervix. placenta won't attach where there is a scar, so c-section is at higher risk. multiple gestation because it gets too heavy.

Answer 170

you want this - 15 bpm above baseline for at least 15 seconds

Answer 171

around 5 bpm above baseline (can go up or down) . minimal could be baby is asleep or got sedatives.

Answer 172

this is good - between 6-25 bpm

Answer 173

above 25 bpm - can't see the baseline. baby is trying to get more 02, or cardiac issues.

Answer 174

2 accelerations in 15 min. we want this.

Answer 175

no increase in BPM. can give mom sugar to wake up baby.

Answer 176

loss before 20 weeks. also called miscarriage.

Answer 177

after 20 weeks (intrafetal uterine demise)

Answer 178

advanced age

Answer 179

2nd trimester

Answer 180

slow down contractions

Answer 181

STIs and PID

Answer 182

ectopic pregnancy

Answer 183

dark brown bleeding, large uterus, high Hcg levels, hyperemesis, pre-e

Answer 184

SOB - has moved to lungs

Answer 185

hyperthyroidism, diabetes

Answer 186

usually pre-e (the liver)

Answer 187

160/110 THIS IS AN EMERGENCY (gestational hypertension is 140/90). you need 2 readings in 4 hours - they both have to be high.

Answer 188

lobetalol or hydralazine

Answer 189

every 5 min

Answer 190

1.3 to 2.1 mEq/L

Answer 191

12-14 weeks

Answer 192

lower abd. pain, temp greater than 100.4, foul smelling lochia, and flu like symptoms

Answer 193

within 1 year of delivery

antipardum exam Flashcards

(225 cards)