Chapter 7

Question 1

Late preterm infant

Answer 1

34-47 weeks

Question 2

Very preterm infant

Answer 2

Less than 32 weeks

Question 3

Complex factors overlapping influence preterm labor

Answer 3

Genetics, medical conditions, environmental, psychosocial, infertility treatments, biological factors

Question 4

Select factors of preterm labor

Answer 4

Drugs, tobacco, stress, low income, infection, domestic violence, age <17>35, IVF pregnancy, PROM

Question 5

Warning signs of preterm labor

Answer 5

Contraction every 10 min or more
Vaginal bleeding, ROM
Pelvic pressure. Backache
Cramps that feel like menstrual period

Question 6

Dignities of preterm labor

Answer 6

> 20 or <37 weeks gestation
6 or more contractions in one hour AND
ROM or cervical dilation change >1 cm or 80% effaced

Question 7

fFN

Answer 7

Fetal fibronectin-
Glue like protein helps the amniotic sac attach to the lining of uterus.
Cannot use if ROM

Question 8

Contraindications for treating preterm labor

Answer 8

Fetal compromise 
Fetal death
Severe maternal disease 
Active hemorrhage 
Chorioamnionitis
Previable gestation

Question 9

Prevention of preterm birth

Answer 9

Adequate diet
Reduce risk of infection
Eliminate substance abuse
Report to triage if cramps persist

Question 10

Nursing action immediate care of preterm birth

Answer 10

Hydration 
Fetal monitoring 
UC pattern
Medications 
Obtain fFN, vaginal cultures 
Monitor cervical dilation

Question 11

Call your doctor or midwife if

Answer 11

Bag of waters breaks
Baby stops moving
Have more than ---- contractions in an hour
Low backache or cramps
Increase discharge 
Fever 100.4
Feel something is not right

Question 12

Tocolytic drugs

Answer 12

May prolong pregnancy for 2-7 days allowing steroids to improve fetal lung maturity or maternal transport to another facility

Question 13

Magnesium sulfate

Answer 13

Relaxes smooth muscle

Loading dose 4-6g in 20 minutes, then 2g/hr

Question 14

Magnesium sulfate therapeutic level

Answer 14

5-8mg/dl

Question 15

Magnesium sulfate maternal side effects

Answer 15

PULMONARY EDEMA, headache, flushing, dry mouth, cardiac arrest, diplopia, weakness

Question 16

Magnesium sulfate fetal side effects

Answer 16

Respiratory depression

Hypotonia

Question 17

Magnesium sulfate antidote

Answer 17

Calcium gluconate

Question 18

Nursing implications for magnesium sulfate

Answer 18

Monitor FHT, UC, serum levels, respirations. Output <30 mL per hour

Question 19

Indomethacin naproxen

Answer 19

Depressed synthesis of prostaglandins. Delays delivery for 48+ hours. Used before 32 weeks

Question 20

Indomethacin naproxen doses

Answer 20

Loading dose 50 mg oral then 25-50 mg po q6hrs

Question 21

Contraindications of indomethacin naproxen

Answer 21

Significant renal and hepatic impairment

Question 22

Side effects of indomethacin naproxen MATERNAL

Answer 22

Nausea, heartburn

Question 23

Side effects of indomethacin Naproxen FETAL

Answer 23

Ateriousus constriction, pulmonary hypertension, hemorrhages

Question 24

Nifedipine

Answer 24

Calcium channel blocker

Question 25

Nifedipine dose

Answer 25

10-20 mg PO q4-6 hours

Question 26

Side effects of nifedipine

Answer 26

Hypotension, tachycardia, flushing, HA, nausea

Question 27

Contraindications of nifedipine

Answer 27

Do NOT use with terbutaline or cardiac disease

Question 28

Nursing with nifedipine

Answer 28

May hold dose if BP <90/50 | Or HR >120

Question 29

Terbutaline

Answer 29

``` Beta adrenergic agonist Suppress uterine activity Meant for asthma Can delay delivery for 3 days Bronchodilator**** ```

Question 30

Terbutaline FDA warning

Answer 30

Injectable not used in pregnant women for prolong or preventable treatment for preterm delivery. Serious maternal heart problems, death

Question 31

Terbutaline dose

Answer 31

0.25mg sq q3-4 hrs | IV max dose 0.08mg/min

Question 32

Terbutaline side effects maternal

Answer 32

Cardiac, pulmonary edema, MI, hypotension, increase glucose,

Question 33

Terbutaline side effects-fetal

Answer 33

Tachycardia Hyperglycemia Septal hypertrophy

Question 34

Nursing terbutaline

Answer 34

Hold dose if hr >120 | Glucose, FHR, UC, I&O, lungs

Question 35

Ritodrine

Answer 35

Beta adrenergic agonist

Question 36

Ritodrine dose

Answer 36

IV max dose 0.350 mg/min

Question 37

Progesterone

Answer 37

Prevent preterm birth for women with a history of spontaneous preterm birth. Not used if multiple gestation

Question 38

Progesterone dose

Answer 38

250mg/week starting at 16 weeks to 36 weeks. Not used in multiple gestation

Question 39

Corticosteroid therapy

Answer 39

Betamethasone | Stimulates production of more mature surfactant in fetal lungs

Question 40

Betamethasone dose

Answer 40

12 mg IM q24 hrs

Question 41

Risk factors for PPROM

Answer 41

Sepsis PTB Hypoxia Deformities

Question 42

PPROM diagnosis

Answer 42

<37 weeks +nitrazine + ferning Pooling of amniotic fluid

Question 43

PPROM management

Answer 43

Prolong gestation No infection Assess lung maturity Meds

Question 44

Latency

Answer 44

Time from membrane rupture to delivery