Exam 2 Flashcards
1
Q
How do you know when baby is done feeding
A
Breast is soft
Breast produces right amount for growth state infant is in
2
Q
How to tell if newborn has been sufficiently fed
A
Might nod off, calm, not irritable, will stop crying
3
Q
How big is newborn’s stomach on day 1
A
5-7 ml
4
Q
Newborn stomach size on day 3
A
23-27ml
5
Q
Positive signs of labor
A
Fetal movement by examiner
Fetal heart sounds
Visualization of Fetus by US
6
Q
Probable signs of labor
A
Fetal outline by examiner Breast changes Positive test Abdominal and uterine enlargement Chadwick’s sign - blueish cervix Goodell’s sign Ballotement Braxton Hicks Skin pigmentation Hagor’s sign
7
Q
Presumptive signs of labor (from mom’s perspective)
A
N/V (morning sickness) Fatigue Amenorrhea (absence of period) Urinary frequency Quickening (flutter feeling - could be gas) Breast changes
8
Q
Chadwick’s sign
A
Blue cervix
9
Q
Goodell’s sign
A
Softening of the cervix
10
Q
Hegor sign
A
Softening of the uterus
11
Q
Ballottement
A
Tap and fetus gets bumped to top of cervix and comes back down
12
Q
how much weight do newborn’s lose after birth?
A
5-10%
13
Q
when do newborns regain their weight ?
A
10-14 days after birth
14
Q
when can babies start having solids
A
6 mons to avoid food allergies
15
Q
T/F: length is a better measure of growth
A
True - grow 2.5 cm per month in the first 6 months
16
Q
what does skin to skin do for breastfeeding?
A
mom releases oxytocin faster
promotes milk production
promotes uterine involution
more demand, the more mom supplies
17
Q
when should breastfeeding start?
A
w/i 30 mins of birth to take advantage of alert stage
18
Q
LATCH Assessment
A
L - latch - too sleepy, repeated attempts, lips flared/rhythmic sucking
A- audible swallowing - non, a few, spontaneous/intermittent/frequent
T - type of nipple.- inverted, flat, everts after stimulation
C - comfort - engorged/severe pain, filling/red, soft/non tender
H- hold - full assist, minimal assist, no assist
19
Q
how often should moms feed
A
every 2-3 hours during the day and every 4 hours at night
15-20 mins on each breast
must empty breast to avoid plugged ducts
20
Q
stages of human milk
A
colostrum = days 1-2
transitional milk - day 3
mature milk by day 14
21
Q
engorgement
A
when breast is too full - want to make sure breast is emptying to avoid
22
Q
T/F: preemie milk is fattier
A
True
23
Q
immunologic advantages of breastmilk
A
IgA antibodies
non allergenic
colonizes infant gut with proper bacteria
24
Q
nutritional advantages of breastmilk
A
whey high concentration of cholesterol and balance of amino acids promote myelination and neuro dev minerals iron - more readily absobred self regulated eating less ear infections
25
psychosocial advantages of breastfeeding
provides more frequent direct skin contact b/w mother and infant
26
maternal benefits of breastfeeding
lowers risk of breast and ovarian cancer
less osteoporosis
faster involution of uterus and pre pregnancy weight
27
other newborn benefits of breastfeeding
increases o2 saturation
maintains temp regulation
decreases SIDs
reduction in cancer, asthma, dermatitis, type 1 and 2 diabetes
28
contraindications of breastfeeding
fetal galactosemia
mastectomy/breast enlargement
HIV
cytomegalovirus, active TB, varicella, human T cell lymphotropic virus type I and II
maternal medications (chemo, illegal drugs, radiation therapies, antiretrovirals)
29
common breast feeding positions
cradle hold
cross cradle
football hold
side lying hold
30
steps in breastfeeding
massage breast
tap lower lip of baby to open mouth
scoop mouth over nipple
31
problems in breastfeeding
```
nipple soreness - check latch/position
cracked nipples - check latch
flat or inverted nipples - address latch
engorgement - pain control, emptying
inadequate/excessive let down
plugged dugs - patience/feeding
mastitis - medical intervention
```
32
how to prevent breast milk from coming in
ice packs, cabbage leaves, avoid stimulation (tight fitting bra and no hot water)
33
how to know if newborn baby has had enough
weight loss should not exceed 10%
birthweight should return in a few weeks
fontanelles should be flat, skin should not be dry
stools shouldn't be hard
34
T/F: you should wake an infant up to feed
true
35
how to store fresh breastmilk
4-6 hours at room temp
8 days in the fridge
3-4 months in the freezer
if thawed, good for 24 hrs in the fridge
36
how to store formula
24-48 hours in the fridge
| do not freeze
37
T/F: if the milk is in contact with the baby during the feed, you can reuse
False! Finish feed within 1 hour and discard
38
recommended weight gain for BMI 18.5 - 24.9
25-35 pounds
2.2-4.4 in first trimester
1 pound per week in the last trimester
39
recommended weight gain for BMI less than 18.5
28-40 lbs
40
recommended weight gain for BMI 25-29.9
15-25 pounds
41
recommended weight gain for BMI 30 and above
11-20 lbs
42
calorie requirements during pregnancy
no change during first trimester
| 300 cals extra during 2nd and 3rd trimester
43
carb requirements for pregnancy
increase during 2nd and 3rd timester
44
protein requirements for pregnancy
71 g compared to 46 g for nonpregnant women
45
how many servings of Ca a day in pregnancy?
4 servings
46
what do you have increased need for when it comes to nutrition
Mg, Zn, Selenium
Vit A and C
Thimaine, riboflavin, niacin, folate, B6, B12
iron
47
risk factors associated with iron deficiency anemia
low birth weight, increases risk of preterm birth, inadequate fetal brain development, maternal and infant mortality
daily supplement of iron 30 mg
48
why is folate important during preg
associated with neural tube defects 3-4 weeks after conception
fresh green veggies, liver, peanuts and fortified foods
400 mcg should be taken daily
49
how much water should a pregnant woman drink per day
at least 8-12 glasses of fluid a day
| 4-6 should be water
50
what should a pregnant woman not consume
```
energy drinks
mercury
raw or undercooked eggs
soft cheeses
alcohol
```
51
complications of pregnancy
nausea
constipation (can come from iron)
PICA
PKU
52
what to avoid to avoid nausea
caffeine, fats, spices, triggers
| avoid fluid with meals
53
PICA
craving/consumption of non food substances
associated with iron deficiency, poor or excessive weight gain, fecal impaction, lead poisoning, decreased infant head circumference, low birth weight
impacts 11-16% of women
54
PKU
genetic disease
linked to developmental delays and behavioral problems
should resume PKU diet (low in protein) at least 3 months before pregnancy and continue through
55
PP nutrition recommendations
weight loss of 10-12 pounds
| high fluid intake
56
PP nutrition for breastfeeding moms
adequate caloric intake (330 for first 6 mos, 400 for second 6 months)
no caffeine or alcohol
increased protein
calcium
57
hormones of the repro cycle
```
GnRH
FSH
LH
estrogen
progesterone
```
58
when does ovulation occur
just after decline of estrogen
59
how long is the follicular phase
varies in women
| 1-14 days
60
how long is the luteal phase
always 14 days - fixed
days 15-28
ovulation to menses
61
where does fertilization occur
outer third of the fallopian tube = ampulla
62
what happens to the egg if it is fertilized (what does it secrete first)
secretes hCG - maintains progesterone levels until the placenta takes over
63
OTC pregnancy tests detect...
hCG
| 99% accurate
64
what can high levels of hCG indicate
multifetal pregnancy
ectopic pregnancy
hydatidiform mole
genetic abnormality (like Down's)
65
what can low levels of hCG indicate
miscarriage
66
stages of lacerations
first degree - small tear
second degree - involves underlying muscles
third degree - involves anal sphincter
fourth degree - extends to rectum
67
t/f: episiotomy is evidenced based
false
68
disadvantages of episitomy
blood loss, infection, pain, discomfort, major perineal trauma, sexual dysfunction
69
does the vagina go back to pre pregnancy state
not necessarily
70
do vaginal secretions increase or decrease during pregnancy
increase
71
what is covered in the first antepartum appt
```
current pregnancy - how?
past pregnancies
gyno history - abnormal paps, issues/ovaries
current and past medical history
pertinent histories - birth father's
maternal assessment
fetal assessment
education
job/occupation
```
72
nagele's rule
add 7 days to LMP and subtract 3 months
73
is fundal height measurement a good indication of how far along
no but b/w 18-32 weeks can be + or - 2 cm
74
abortion
before 20 weeks
75
stillbirth
demise/loss after 20 weeks
76
preterm
after 20 weeks, before 36.6
77
early term
37.0 to 38.6 weeks
78
full term
39.0 to 40.6 weeks
79
late term
41.0 weeks to 41.6
80
post term
more than 42.0 weeks
81
GTPAL
```
gravidity = all pregnancies including current
term = births beyond 37.0 weeks
preterm = births b/w 20.0 and 36.6 weeks
abortion = before 20.0 weeks
living = number of living children
```
82
gyno history questions
```
pap smear history
previous infections?
surgery?
infertility or dysmenorrhea?
contraceptives
```
83
current medical history questions
```
immunizations
all medications/drugs
infections/illnesses/chronic diseases
weight and nutrition
activity
eye and dental exams
```
84
past and family medical history
hospitalizations, accidents
blood transfusion history
presence of chronic illness or diseases in immediate family
history of multiple births, congenital diseases
mental illness
c-sections
85
pertinent history
```
genetic
religious/cultural
occupational
birth father
social history
```
86
prenatal visit frequency
monthly for 7 months
every 2 weeks during 8th month
every week during last month
87
education during pregnancy
```
avoid all OTC meds and supplements
avoid alcohol, tobacco, substance use, raw fish, soft cheeses
flu vaccine
genetic testing
exposure to hazardous materials
exercise
avoid hot tubs or saunas
2-3L of water every day
```
88
common discomforts of 1st trimester
```
N/V
breast tenderness
nose bleeds
urinary frequency
UTIs
fatigue
ptylaism - increased saliva
increased vaginal discharge
```
89
what labs should you have done during first trimester
rubella, CBC, hep B titer, blood type
90
common discomforts during 2nd trimester
```
UTIs
heartburn
constipation/hemorrhoids
backaches
varicosities, edema
braxton hicks
supine hypotension
```
91
education during 2nd trimester
```
breastfeeding
lifestyle - sex, rest, relaxation, can lose balance
complications
fetal growth and dev
birth methods/birth plan
```
92
3rd trimester education
childbirth prep
| use back pillows to prop to side
93
common discomforts of 3rd trimester
```
UTIs, urinary frequency
fatigue
heartburn
constipation/hemorrhoids
backaches
SOB
leg cramps, edema, varicosities
braxton hicks
supine hypotension
```
94
t/f: pregnant women and close friends/family should get the tdap vaccine
true
| will reduce cases by 33%, hospitalizations by 38%, deaths by 49%
95
Antepartum danger signs
Abdominal pain
High fever above 38.3 (101F)
Vaginal bleeding
Decreased or absent fetal movement
Epigastric pain (RUQ) —> associated with preeclampsia, associated with liver
Sudden gush of fluid
Persistent vomiting
Blurred vision/dizziness (any visual changes) - sign of HBP/preeclampsia
Painful urination - dysuria
Swelling of hands and face
Severe/persistent headache that doesn’t go away with tylenol
96
Prenatal Head Assessment
- headache, dizziness, visual changes
- rhinitis/nose bleeds (d/t increased estrogen)
- hypertrophy of gingival tissue (d/t increased estrogen)
- neck nodes (d/t increased estrogen)
- slight hyperplasia of thyroid by third month (d/t increased estrogen)
- nutrition
- increased fluids —> decreased dehydration can cause contractions
- N/V
97
Prenatal Psychosocial Assessment
```
Desire for pregnancy
Fear r/t anticipation of pain
Body image changes
Social support
Sleeping/rest
Mobility/balance - center of balance has changed
```
98
Prenatal skin assessment
```
Consistent with racial/ethnic background
Edema of lower extremities
Spider nevi = common
2nd trimester = striae gravidarum (can be based on heredity), hyperpigmentation (cholasma, Linea Nigra)
Acne
```
99
Prenatal chest/lungs assessment
- lungs clear bilaterally
- heart sounds are regular
- palpitations d/t to SNS
- short systolic murmurs
- breasts: darker pigmentation of nipple and areola, increased in first 20 weeks, nodular, heavy
100
Prenatal CV assessment
- pulse increases 10-50/min around 20.0 week
- cardiac hypertrophy
- respirations increase 1-2/min
- BP range w/ in pre-pregnancy range during 1st trimester
- BP decreases 5-10 mm Hg during 2nd trimester
- BP returns to pre-pregnancy after 20.0 week
- supine hypotensive syndrome
101
Pernatal abdomen assessment
- no upper right quadrant pain
- linea nigra; purple striae
- decreased gastric mobility
- N/V from hormonal changes; increased pressure
- diastasis of rectus muscles
- fundal measurement
- fetal HR
- fetal movement
102
Prenatal perineum assessment
- odorless discharge; non irritating
- Goodell’s sign
- hegar sign
- Chadwick sign
- posterior cervix
- pelvic exam
- urinary frequency and output stays the same
- increased filtration rate
- assess for ketones/proteinuria/UTI
103
Prenatal extremities assessment
- swelling of feet (and should assess for swelling of hands)
- pulses, temp, ROM, varicosities, palmar erythema
- reflexes
- carpal tunnel syndrome b/c of fluid retention
104
Muscular skeletal prenatal assessment
- backache: lumbar spinal curve accentuated
- pelvic joints relax
- weight increases causes body alteration
105
Prenatal endocrine assessment
Large amounts of hCG, progesterone, estrogen, lactogen, prostaglandins from placenta
106
Prenatal Lab Tests
```
Blood type, rh factor
CBC with diff
Hgb electrophoresis
Rubella titer
hep B screen
GBS (35-37 weeks)
Urinalysis
One hour glucose tolerance (24-28 weeks)
Pap test
Vaginal/cervical culture
PPD screen
VDRL (sphyllis)/HIV screen
TORCH screening
MSAFP
```
107
Clincial pelvimetry
Pelvic type is assessed externally or via sterile vaginal exam
108
Most common pelvic type?
Gynecoid (50%)
109
Prior to tests, what should you teach?
- assess whether the woman knows the reason for the test
- provide an opportunity for questions
- explain the test procedure
- validate the woman’s understanding of the prep
- answer any questions
110
Ultrasound scanning
Use of high frequency sound waves
| Takes 20 minutes
111
What does an ultrasound show?
allows the observation of fetal movements including breathing, cardiac action, and vessel pulsation
112
If GBS +, when do you give antibiotics
During active labor or ROM
113
When to give rubella vaccine if non-immune?
Vaccine prior to hospital discharge
| no pregnancy for 3 months after vaccine
114
If Rh -, when do you give Rhogam?
28 weeks, or after any trauma or exams that could cause mixing of blood
Within 72 hours of birth
115
If infant direct Coombs is positive why dont we give rhogam?
Mom is already alloimmunized so rhogam won’t prevent anything, she is alloimmunized for life
116
How can you tell if a newborn was born by c section?
No conehead/molding
117
Benefits of spontaneous labor
Provides natural pain relief
Helps calm woman
Facilitates normal detachment of placenta
Enhance breastfeeding
Warm the mother’s skin
Clear fetal lung fluid
Ensure transfer of maternal antibodies to the fetus
118
Vaginal seeding
Babies born through vaginal canal have stronger immune system to bacteria they encounter after
May be d/t traveling vaginal canal and exposure to flora in canal
Seeding = swab canal/flora and swab infant’s mouth if baby is born by C-section
119
Why 39 weeks for bishop scoring?
Estimated Date of birth - someone at 39 weeks is going to be b/w 38-40 weeks.
120
How can pitocin be delivered?
IV or IM
121
Interventions or medications for blood loss postpartum
- fundal massage, IV fluids, empty bladder, balkri balloon
| - methergine, hemabate, pitocin, cytotec
122
When is methergine contraindicated?
Hypertension
123
external abdominal ultrasound - when is it useful?
noninvasive
| more useful after first trimester
124
internal transvaginal US
first trimester
invasive
detects ectopic pregnancy
establishes gestational age
125
doppler ultrasound blood flow analysis
noninvasive
| IUGR evaluation
126
Level I US characteristics
assess number of fetuses, presentations, lie, viability, location of placental site, and amniotic fluid volume
127
Level II US characteristics
more comprehensive
| evaluates fetal anatomy along with level I parameters
128
when can a US show the gestational sac?
4-5 weeks
129
when can US show fetal heart mvmts?
7 weeks
130
when can US show fetal breathing mvmts?
11 weeks
131
when can US measure crown rump length?
before 12 weeks
132
what can a US do in the second trimester?
measure fetal biparietal diameter, femur length, abdominal and head circumferences to estimate gestational age and weight
133
Quadruple check
- MSAFP
- uE3 conjugated estriol
- hCG
- inhibin A
**screening not diagnostic
134
indications of Downs from MSAFP
MSAFP = low
uE3 = low
hCG = high
inhibin A = high
135
AFP
alpha fetoprotein - produced by fetus and can be detected in maternal serum by 7th week
most accurate b/w weeks 16-18
136
what can impact MSAFP levels that is not abnormalities?
diabetes, smoking and multiples
137
what does amniocentesis measure?
Chromosomal and biochemical determinations
-measures AFP for neural tube defects and L/S ratio for fetal lung maturity (later in pregnancy), blood typing
Can validate abnormalities detected by US
138
how and when is amniocentesis performed?
aspiration though a needle of amniotic fluid (through abdominal wall or intravaginally)
15-16 weeks gestation
139
what does a pregnant women have to do before amniocentesis?
empty bladder
| sign consent form
140
post amniocentesis and CVS responsibilities
monitor UCs at start and then 1-2 hours post procedure
141
how and when is chorionic villi sampling performed
aspiration through a thin catheter or syringe of chorionic villi (through abdominal wall or intravaginally)
9-12 weeks gestation
142
what does the mom need to do before CVS?
drink plenty of fluid to fill bladder so fetus can't move around as much
provide consent
143
risks of CVS
spontaneous abortion
infection of amniotic fluid
break amniotic fluid
144
PUBS (percutaneous umbilical blood sampling)
most common method to sample fetal blood during amniocentesis.. can use that blood for:
- Kleihauer Betke test (fetal blood)
- CBC count with diff
- indirect coombs
- visualization of chromosomes
- blood gases
145
risks of PUBS
- cord laceration
- cord infection
- hemorrhage
146
fetal movement assessment low tech intervention
kick count
| helps woman become aware of fetal activity
147
what is normal for a fetal movement assessment
3 or more mvmts in 1 hour
148
when should you call your HCP regarding fetal movement
no fetal movement in 8 hours
less than 10 fetal movements in 12 hours (really 2)
violent fetal movement followed by decreased activity
149
when should fetal movement assessments happen
when you can feel the fetus
same time every day that the fetus is active
count kicks and document once you reach 10
can drink water to wake baby up
150
When do you do the non stress test?
3rd trimester
151
How do you conduct a non stress test
Place on EFM for 20 minutes
152
What does a reactive stress test mean?
2 or more accelerations of at least 15bpm, each lasting at least 15 seconds, during the 20 mins
No decels
Moderate variability
153
What does a non reactive stress test mean?
Criteria wasn’t met
154
What do you do for non reactive stress test result?
Give baby more time
Snack for mom
More detailed test
155
How often do AMA get non stress test?
Weekly in third trimester
156
How often do diabetics and high BP patients get a non stress test?
1-2x per week during last trimester
157
How to perform contraction stress test?
Nipple stimulation (for 2 minutes, rest 5 minutes and repeat)
Pitocin stimulation
Terbutaline to stop contractions
158
What is a normal result for a contraction stress test
```
Negative = normal, no fetal heart rate decels
3 contractions (40 seconds) within 10 minute periods
```
159
What does a positive contraction stress test mean?
Abnormal
| Late decels
160
When would you recommend a biophysical profile
Negative non stress test = non reactive
| Positive contraction test
161
How do you score BPP
Score of 10 with 2 points for each:
- FHR reactivity
- fetal breathing movements
- fetal body movements
- fetal tone
- amniotic fluid volume
Fetal asphyxia = 0
7/10 or below = induce
162
Hyperemesis gravidarum
N/V post first trimester
Women at risk for weight loss, dehydration, electrolyte imbalances, ketonuria, acidosis
Can cause IUGR
163
Cause of hyperemesis gravidarum
High hCG/estradiol
H. Pylori infection
History of migraines or asthma
164
How to diagnoses hyperemesis gravidarum
Weight loss > 5% pre pregnancy weight
Dehydration
Ketonuria
History of intractable vomiting
165
How to treat hyperemesis gravidarum
```
Avoid odors
Frequent small meals
Vitamin b6
Phenergan / reglan / Zofran
Ginger
Acupressure/ acupuncture
IV fluids
```
166
If rh- mom is exposed to rh+ fetus…
Mom Will create IgG antibodies against RBC of fetus = alloimmunization
Will impact second rh + baby that mom has
167
If an indirect Coombs test is negative…
Mom is not alloimmunized
Give rhogam at 28 weeks, after any trauma or procedure, and within 72 hours after birth (after another negative indirect Coombs at birth)
168
If indirect Coombs is positive at birth…
Run Coombs on infant , run KB test
| If positive = no rhogam —> mom is already alloimmunized. Need to frequently monitor and observe
169
Oligohydramnios
Too little amniotic fluid, a 5cm or less pocket of amniotic fluid
Seen with post maturity, IUGR, renal malformations
170
How to treat oligohydraminos
Amnioinfusion
171
Polyhydramnios
Too much fluid
>20 cm pocket
Seen with congenital anomalies
172
How to treat polyhydramnios
Indocin (indomethacin)
173
PROM
Premature rupture of membranes anytime after 37 weeks before onset of labor
174
PPROM
Preterm premature rupture of membranes anytime before 37 weeks
175
Prolonged rupture
More than 24 hours before birth
176
How to manage PROM
Birth within 24-48 hours (unless PPROM - birth can be delayed with close mgmt)
Treat for infection (chorioamnionitis)
Risk for decels and cord prolapse
177
How to treat prolapse cord
priority: get pressure off of cord
Keep hand in vagina and push presenting part away from cord but don’t push cord in!
-Place mom in trendelenburg or chest prone down/kneeling position, buttocks up
-Type and cross match blood, large bore IV
-monitor FHR
-Prepare for emergency c section
-cover with gauze and saline
178
Placenta previa
Placenta abnormally implants in lower segment of uterus near or over cervical os (2% incidence)
Can result in bleeding in first trimester
179
Placenta previa grade 1 or 2
Low lying placenta
180
Grade 3 partial previa
Partial previa
| Usually cannot have vaginal birth
181
Grade 4 placenta previa
Total
Most complicated - c section
Can’t efface or dilate
182
Factors that may contribute to previa
```
Precious hx of placenta previa
Uterine scarring
Maternal age greater than 35-40 years
Multifetal gestation
Smoking and/or cocaine use
Large placenta
Placenta accreta
```
183
Previa assessment
- painless bright red vaginal bleeding in 2nd or 3rd trimester
- fetus position
- reassuring FHR
- normal VS
- h/h, CBC, blood type and rh, coag profile, kleihauer-betke
- transabdominal or transvaginal US
- refrain from SVE to avoid bleeding
- BRP (bed rest) if no bleeding
184
Placenta accreta
Abnormally deep attachment into uterine wall
| 1 in 2000 pregnancies
185
Accreta
Attach to myometrium (75% of cases)
186
Increta
Invades myometrium (17%)
187
Percreta
Penetrates myometrium (5-7%)
188
How do estrogen and progesterone impact insulin?
Stimulate insulin production
| Increase tissue response to insulin to make insulin more easily stored
189
T/f: Insulin needs during first trimester are decreased
True
190
Can insulin cross the placenta?
No
191
Can glucose cross the placenta?
Yes
192
Do insulin requirements increase or decrease at birth?
Decrease because placenta separation causes decrease in hormones which causes decrease in insulin requirements at the tissue level
193
What happens to insulin requirements post partum
Decrease
| Decrease further with breastfeeding
194
What causes hypoglycemia in neonates
Lack of glucose supply, but production of excessive insulin
Blood sugar drops when cord is clamped
Glucose comes from food/milk in 2-4 hours- babies also get sleepy
195
Gestational diabetes mellitus
Glucose intolerance
| Gestational is controlled with diet and education
196
Risks associated with diabetes
```
Hydraminos
Preeclampsia (treat w/ low dose aspirin)
Ketoadidosis
Fetal macrosomia and IUGR
UTI/vaginitis
Retinopathies
Congenital abnormalities
Sacral agenesis
Respiratory distress syndrome
```
197
What should you watch for during 1st prenatal visit r/t diabetes
HbAic >= 6.5%
Fasting glucose >= 126
2 hour glucose >= 200
198
How do you monitor glucose during l&d and postpartum
Glucose levels every 1-2 hours during active labor
Discontinue insulin at end of 3rd stage of labor
Monitor s/s postpartum
Reassess 4-12 weeks postpartum
199
What is the hemoglobin level considered anemic?
Less than 11 g/dl
200
Risk factors for anemia
```
Race
Altitude
Smoking
Nutrition
Medications
```
201
When is the greatest need for iron?
Second half of pregnancy
202
Nursing interventions for anemia
- education on iron supplementation
- monitor h/h every 2 weeks
- take vitamin c but avoid with caffeine or milk
- recognize signs and symptoms - fatigue, headache, pallor, tachycardia, hgb < 11
- advocate for pain month in cases of sickle cell anemia
203
Impact of marijuana during pregnancy
Lower birth weight
204
Impact of cocaine/crack during pregnancy
Placental vasoconstriction
SAB, abruption, IUGR, preterm birth, stillbirth
Microcephaly, anomalies, SIDS
No breastfeeding!
205
Impact of opioids during pregnancy
Abnormal placental implantation, abruption, PTL, PROM, meconium
IUGR, LBw, preterm birth, fetal distress
206
Impact of heroin
Anemia
Preeclampsia/eclampsia
STI
preterm birth, IUGR
207
Can psych drugs cross the placenta
Yes
No psychotropic drugs are approved by FDA
Need to balance risk associated with parental exposure
208
What congenital heart defects, if repaired, can proceed as normal?
Tetralogy of fallot, atrial septal defect, ventricular septal defect, patent ductus arteriosus
209
What congenital heart defects make pregnancy contraindicated
```
Eisenmenger syndrome
Pulmonary HTN
Uncorrected coarctation of the aorta
Aortic stenosis
Marfan syndrome
All cause persistent cyanosis
```
210
What congenital heart defect tolerates pregnancy well
Mitral valve prolapse
211
What is peripartum cardiomyopathy and what are the s/s (cow dep)
serious dysfunction of left ventricle that occurs toward end of pregnancy or in first 5 months postpartum
No previous history
Chest pain, Dyspnea, orthopnea, palpitations, weakness, edema
212
WHO risk classes for CVD: no contraindications
Class I and II
213
WHO risk classes for CVD: contraindicated pregnancy
Schedule IV
214
Heart disease in pregnancy assessments
```
Frequent prenatal appts
Assessment b/w 28-32 weeks
Oxygen and diuretics during labor
Pain mgmt to decrease pain
Assisted birth to decrease pushing
Critical period of 48 hours postpartum
```
215
T/f: bleeding during pregnancy is normal
False - abnormal. Always has to be investigated
216
Causes of bleeding in pregnancy: before 20 weeks
Abortion
Ectopic pregnancy
Gestational trophoblastic disease
Trauma
217
Causes of bleeding during pregnancy: second half of pregnancy
```
Trauma
Placenta previa
Abruptio placentae
Labor
Preterm labor
```
218
Nurses role in bleeding during pregnancy
- assess history
- monitor VS and bleeding ant
- assess gestational age and fetal heart tones
- insert IV, collect GTs, H&H
- prepare for US and/ or vaginal exam
- rh status
- psychological support
- assess signs of shock, phlebitis, ectopic pregnancy
219
Spontaneous abortion
Expulsion of products of conception before age of viability (20 weeks or 500g)
220
Causes of SAB
```
Chromosomal abnormalities
Teratogenic drugs
Structural abnormalities
Placental abnormalities
Maternal disease
Cervical insufficiency
Endocrine imbalances
```
221
SAB procedures
US
cervical exam
D&C
Dilation and evacuation - to evacuate uterine contents after 16 weeks
Prostaglandins into amniotic sac or as a vaginal suppository and oxytocin
222
Dilation and curettage
- empty bladder
- assist woman to relax
- watch for vasovagal reaction
- observe for signs of uterine perforation afterwards
- may be given prophylactic antibiotics
- monitor vital signs
- give rhogam if woman is Rh negative
223
SAB discharge instructions
contact provider if:
Heavy bright red bleeding
Elevated temp
Foul smelling discharge
```
Small amount of discharge normal for 1-2 weeks
Pelvic rest for 2 weeks
Avoid pregnancy for 2 months
Antibiotics
Support groups
```
224
Ectopic pregnancy
Implantation of a fertilized ovum in a site other than the endometrial lining of the uterus
225
Cause of ectopic pregnancy
```
PID, endometriosis, previous ectopic pregnancy
IUD
Pelvic or tubal surgery
AMA
Ovulation inducing drugs
```
226
S/s of ectopic pregnancy
One sided lower abdominal pain or diffuse lower abdominal pain
Fainting/dizziness
Referred right shoulder pain —> ask if appendix has been removed
227
Ectopic pregnancy interventions
```
IV access
Labs
Pelvic exam
US
Emotional support
```
228
treatment for ectopic pregnancy
methotrexate IM, saplingostomy/salpingectomy
229
Gestational trophoblastic disease (molar pregnancies)
- a group of rare tumors that develop during the early stages of pregnancy
- hydatidiform mole
230
hydatidiform mole
- growth of an abnormal fertilized egg or an overgrowth of tissue from the placenta and produce HcG
- will show a positive pregnancy test result
- complete (empty egg) and partial (69 chromosomes instead of 46)
- risk of choriocarcinoma (cancer)
231
symptoms of gestational trophoblastic disease
```
vaginal bleeding
anemia
N/V
elevated HCG
low levels of AFP
hyperemesis
HTN before 24th week (due to rapid growing, causing pressure vascularly)
absent fetal heart tones
uterus enlarges at a rapid rate
```
232
interventions of gestational trophoblastic disease
- baseline chest X ray
- serum HCG weekly until negative and then monthly
- avoid pregnancy for a year
233
trauma
- assessing for placental detachment, mixing of fetal and maternal blood
- EFM; vital signs, KB test, hemoglobin F
234
KB test
measures amount of fetal hemoglobin transferred to maternal bloodstream
diagnoses fetomaternal hemorrhage, quantification, risk for PTL
low sensitivity and tendency to over estimate volume of hemorrhage
235
hemoglobin F
quantification more reliable test for quantifying fetomaternal hemorrhage
236
placenta previa
placenta abnormally implants in lower segment of the uterus near or over the cervical os (2% incidence)
237
abruptio placentae (abruption)
premature separation of a normally implanted placenta (1% incidence)
238
factors that may contribute to abruption
- maternal HTN
- blunt external abdominal trauma
- cocacine use resulting in vasoconstriction
- hx of abruption
- smoking
- PROM
- multifetal pregnancy
239
assessment of abruption
- dark red bleeding, port wine amniotic fluid
- acute abdominal pain, sudden onset
- board like abdomen, increase in uterine size
- contractions with hypertonicity
- fetal distress
- woman is at risk DIC
- H/H, coag factors, KB test, clotting factors
- urine output less than 30 cc per hour
240
what values would you see in DIC
fibrinogen and platelet decreased
| PT and PTT prolonged
241
risk factors for preterm labor
- infections
- hx of PTB, abortions
- multifetal pregnancy
- hydraminos
- age below 17 or above 35
- low SES
- smoking, substance abuse
- domestic violence
- diabetes or HTN
- lack of prenatal care
- placenta previa/abruption
- short pregnancy interval (short time b/w last and current birth)
- uterine abnormalities
- recurrent premature cervical dilation
242
assessment of PTL (mother's perspective)
- persistent low backache
- pelvic pressure and cramping
- GI cramping, with or without diarrhea
- urinary urgency, frequency
- vaginal discharge
- cervical change, bleeding
- contractions, with or without pain
- PROM
243
what does a positive fetal fibronectin mean?
determines risk of preterm birth in the next 7 days
related to inflammation of placenta
swab of vaginal secretions b/w 24 and 34 weeks
244
what other assessments would you do for PTL?
- endocervical length measurement with US - if less than 30mm --> risk of PTL
- home uterine activity monitoring
- cervical culture
- BPP, NST
245
how to prevent PTL
hydration
cerclage
infection screening
246
how to treat PTL
focus is to stop uterine contractions
activity restriction
hydration
treat infections (tachycardia, elevated temp, fetal tachycardia)
247
medications for PTL
- progesterone (prophylactic)
- nifedipine (procardia, adalat)
- mag sulfate (prophylactic)
- indomethacin (indocin)
- betamethasone (celestone) - helps surfactant develop
- terbutaline (brethine)
248
when to use terbutaline?
48-72 hours use to gain time in order to administer 2 doses of betamethasone
long term use is questionable --> associated with maternal deaths
249
cervical insufficiency: assessment
- cervical length surveillance b/w 16 and 24 weeks
- assessment for funneling/thinning of cervix
- cerclage
- serial US of cervix throughout pregnancy to make sure its closed
- no sex until 34 weeks and then remove it before dilation
250
what are hypertensive disorders associated with
```
associated with abruption
kidney failure
hepatic rupture
PTB
fetal and maternal death
```
251
chronic hypertension
HTN before 20 weeks
140/90 prior to pregnancy
no proteinuria
252
gestational HTN
after 20th week of pregnancy
elevated BP (140/90) at least twice, 4-6 hours apart, within 1 week
no proteinuria
BP returns to baseline 6 weeks PP
253
what is the treatment for preeclampsia
birth
| exclusively a disease of pregnancy
254
cause of preeclampsia/eclampsia
- immune response against pregnancy
- presence of widespread arteriolar vasospasm
- injury of endothelial lining of blood vessels
- intravascular fluid moves to extravascular space
255
mild preeclampsia
gestational HTN with proteinuria of greater than 1+
24 hour protein test > 300mg
may or may not have transient headaches and/or edema
256
severe preeclampsia
```
blood pressure 160/100 or greater
proteinuria 2+ or more - greater than 500 mg in 24 hour test
elevated serum creatinine (>1.2 mg/dL)
oliguria
visual disturbances
hyperreflexia with possible clonus
edema hands and face
right upper quadrant epigastric pain
thrombocytopenia
```
257
eclampsia
severe preeclampsia with onset of seizure activity or coma
-preceded by headache, severe epigastric pain, hyperreflexia, and hemo-concentrations (warning signs of probably convulsions)
258
HELLP syndrome
variant of gestational HTN in which hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction
H: hemolysis
EL: elevated liver enzymes, epigastric pain, N/V
LP: low platelets, abnormal bleeding and clotting time and possible DIC
259
cause of HELLP
- platelets accumulate at lesion sites (thrombocytopenia) and a fibrin network forms (elevated liver enzymes)
- RBCs are forced through fibrin network under high BP, resulting in hemolysis with damaged erythrocytes (hyperbilirubinemia; jaundice)
- maternal liver damage from microemboli in hepatic vasculature, which causes ischemia/tissue damage within liver
- obstruction of hepatic blood flow and continual deposit of fibrin causes hepatic distension (can palpate liver)
260
risk factors for HTN disorders
- younger than 20, older than 40
- morbid obesity
- chronic renal disease
- chronic HTN
- hx of preeclampsia, gestational HTN
- diabetes
- molar pregnancy
261
nursing care: preeclampsia
- assess LOC
- pulse oximetry
- daily weights
- vital signs
- NST, BPP, AFI
- assess for proteinuria
- s/s
- frequent rest
262
medications for mild preeclampsia
```
low dose aspirin
methyldopa (aldomet)
nifedipine (adalat, procardia)
hydralazine (apresoline, neopresol)
labetalol PO
```
263
medications for severe preeclampsia
mag sulfate --> to prevent seizures and keep BP normal
| labetalol/hydralazine IV bolus
264
low dose aspirin
81mg daily after 12 weeks gestation
reduced premature birth by 14%
reduced IUGR by 20%
does not increase risk of excessive bleeding at birth
265
nursing care: severe preeclampsia
```
nursing care for preeclampsia
hourly VS, urine output (>30 cc), reflexes, lung sounds, visual assessment, clonus, edema and epigastric pain eval
continuous fetal monitoring
strict I/O (IV fluid max 125)
expect mag sulfate
dim, quiet room
```
266
MgSO4 dose
loading dose of 4-6g - 20-30 min via pump, with maintenance of 2-3 g/hr via pump
continue for 24 hours postpartum
267
MgSO4 toxicity signs
```
absence of reflexes
decreased urine output (less than 30/hr)
decreased respirations (<12 / min)
decreased LOC
cardiac dysrhytmias
```
268
MgSO4 antidote
calcium gluconate (1 g of 10% solution IV push over 3 mins)
269
MgSO4 fetal effects
hypotonia
observe infant for delayed effect after birth
NICU
270
PP management
BP may rise 3-6 days postpartum
antihypertensive meds for 4-6 wks PP (potentially)
late PP eclampsia (more than 48 hours but less than 4 weeks PP)
past 4 weeks = chronic HTN
271
labor dystocia
```
interference in 5Ps
psychosocial
passenger
power
passageway
position
```
272
hypertonic uterus (dystocia of power)
- frequent, intense, painful UCs
- tachysystole (terbuatline short term to space out contractions)
- rest with short term opioid/sedative
273
hypotonic uterus (dystocia of power)
contractions are infrequent or not strong enough to cause labor
either prolonged labor less than 1cm per hour or arrest of progress: no cervical change for 2 hours
274
how to treat hypotonic uterus
augment with pitocin
| amniotomy to rupture membranes
275
amniotomy
artificial rupture of membranes with amniohook
form of augmentation of labor
should only happen when fetus is engaged
nurse should note TACO
276
chorioamnionitis
infection that can occur with rupture of membranes
277
risks associated with ROM
risk for variable decels d/t lack of fluid d/t cord compression
risk for cord prolapse
278
amnioinfusion
0.9% sodium chloride or LR through IUPC to supplement amniotic fluid amt
279
oligohydramnios
too little amniotic fluid
280
RN's role in dystocia of power
```
manage pitocin
position changes
LOCK
assist with amniotomy
assist with IUPC
```
281
dystocia: position (4 things)
use or misuse of gravity
shoulder dystocia
inadequate maternal expulsion power from lying on back for too long
affected psychological response
282
what happens during a shoulder dystocia
inferior shoulder gets stuck by pelvic bone
| can lead to brachial nerve injury
283
RN role during shoulder dystocia
```
subrapubic pressure
stool
timer --> need to know when it starts and for how long
team - get team assembled - NICU
McRobert's position
```
284
how to anticipate shoulder dystocia
leopold's
turtling effect
read chart first - big baby, post date, diabetic mom, no previous birth or failed vaginal birth
285
how to avoid shoulder dystocia
w/ squatting
286
episiotomy
can be used in shoulder dystocia to create more space
| happens at pelvic bone level
287
treatment for episiotomy
ice then heat
stitches dissolve on their own
no baths
288
dystocia: passenger
- persistent occiput posterior position
- brow, face, shoulder, compound presentation
- transverse
- breech
289
moxibustion complementary therapy
burn incense - thought to help turn baby
290
external cephalic version
an attempt to turn the fetus so that he or she is head down (from breech)
291
when can you perform ECV
after 37 weeks
292
risks w/ ECV
ROM
prolapse
uterus rupture
decels
293
RN role during ECV
```
IV
assist with sonogram
rhogam/KB if indicated
tocolytics
OR team
NST
```
294
macrosomnia
> 4000 grams - can lead to fetus not being engaged and can lead to shoulder dystocia
295
what to expect with dystocia (passenger)
```
position changes
pelvic rocking
counterpressure on lower back for pain
instrumental delivery
C-section
```
296
cephalopelvic disproportion (CPD)
```
head doesn't fit
could be d/t
-contracture/narrowing of pelvis
-fetus is too large for size of pelvis (doesn't mean fetus is too large)
-android and platypelloid pelvis at risk
```
297
trial of labor
might try to see if vaginal birth can happen
298
why does sitting or squatting help with dystocia of passage
can increase outer diameters
299
when might you need cervical ripening
post dates
preeclampsia
water broke but no labor
gestational DM
300
what is the bishop scale used for
used to determine maternal readiness for labor by evaluating cervix
301
what is the bishop scale composed of
```
dilation
effacement
station
consistency
position
```
302
what score do you want for multiparous
>8
303
what score do you want for nulliparous
>10
304
what does cervical ripening do
-promotes cervical softening, dilating, effacement, and a more successful induction of labor
305
cervical ripening: mechanical and physical methods
```
foley bulb catheter (w/o urine bag) - pump up 50 cc --> puts pressure on cervix
membrane stripping
amniotomy
laminaria
lamicel
```
306
cervical ripening: chemical methods
misoprostol (cytotec tablets orally or vaginally)
| dinoprostone (cervidil, prepidil)
307
what are the benefits of dinoprostone vs. misoprostol
dinoprostone can be removed - wrapped around cervix and dissolves to help efface and dilate. can remove string and stop
can't take back misoprostol --> can cause labor
308
what do you do if there is fetal distress caused by cervical ripening, induction, augmentation?
stop medication
| LOCK - position, oxygen, fluids, notification, possibly terbutaline
309
what is induction of labor
- initiation of uterine contractions to stimulate labor before spontaneous onset
- mechanical or chemical cervical ripening
310
pharmacological methods of induction
IV oxytocin, endogenous oxytocin (nipple stimulation)
311
nonpharm methods of induction
```
membrane stripping
castor oil (GI irritation that can cause induction)
```
312
contraindications of induction of labor
vertical incision on uterus, placenta previa or suspected abruption, multiple gestation other than twins, abnormal fetal lie
313
when do you augment labor
stimulation of hypotonic contractions once labor has spontaneously begun but progress is inadequate
314
vacuum assisted birth
cuplike suction device attached to fetal head
| traction applied DURING contraction to apply the pressure before the next contraction
315
when could you have a vacuum assisted birth
vertex (head down) presentation
no CPD
ruptured membranes
316
risks of vacuum assisted birth
lacerations
subdural hematoma
cephalohematoma (must monitor bump where suction was placed)
317
caput succedaneum
normal occurrence with vacuum
| resolves within 24 hours
318
how many times can you try a vacuum assisted birth
can only pop off 3 times
| nurse should record how many tries
319
forceps assisted birth
two curved spoon like blades applied during contraction
| put on hard parts of cranium, turn head or help with traction
320
when can you use forceps
abnormal presentation
arrest of rotation
no CPD
ruptured
321
risks associated with forceps
lacerations
bladder or urethral injuries to mom
facial nerve palsy
bruising
322
when is C-section indicated
```
failed vaginal birth
CPD
failure to progress
shoulder dystocia
placenta previa
transverse
shouldn't be elective
```
323
factors influencing rate of c sections
```
changing philosophies regarding best method for delivering breech
interpretation of EFM tracings
changing practice related to VBACs
increased use of epidural anesthesia
convenience
```
324
RN role: c section preop
- bring support person in
- assessment data
- consents, identification, lab data, blood type, Rh
- anti embolism stockings and sequential compression device
- admin preop medications
- assist in epidural placement
- urine catheter placement
- positioning in PACU
- prepare surgical site
- bovie pad, straps
- warm blankets
- TIME OUT
- oversee sterility and OR conduct
- counts
325
what's included in a time out
right patient, time, procedure and provider
326
RN role: c section post op
REEDA
fundal tenderness
lochia
post surgical assessments
327
what could indicate endometritis
foul smelling lochia
328
things for RN to note post c section
baby bonding / breast feeding may be impacted
increased risk of constipation
C/S limits number of children (no more than 3-4)
risk of adhesions (chronic pain, infertility, GI problems) which increase with each subsequent c section
329
when would VBACs not be possible
- evidence of uterine ruptures
- vertical incision from previous c section
- uterus shape changes
- non-reassuring fetal HR
- trial of labor
- myocmectomies - surgery to remove uterine fibroids
- active Herpes outbreak
- 3 or more cesareans
330
when do VBACs have the best outcome
1 C/S w/ horizontal incision and previous successful vaginal birth
331
complete uterine rupture
uterus splits open
332
incomplete uterine rupture
layers separate along previous incisions or surgery
333
risks for uterine rupture
```
congenital uterine anomaly
uterine trauma
LGA
multiples
polyhydramnios
hyperstimulation
versions
multigravida
```
*would want to put in IUPC to know contraction pressure
334
signs of uterine rupture (assessment)
```
sensation of ripping or tearing
sharp abdominal pain
uterine tenderness
contractions "that don't go away"
nonreassuring FHR
change in uterine shape
cessation of contractions
```
335
recommendation for uterine rupture
alert provider while IV fluids
be ready for possible blood transfusion
stat C/S
336
precipitous labor
3 hours or less from onset of contractions to time of birth
337
risks with precipitous labor
```
tearing
fetal distress (not enough time to transition)
hemorrhage
mom panicking
placenta retention
```
338
RN role during precipitous labor
```
DO NOT leave unattended
call for help
globes
do not breakdown bed
stay calm
pant with an open mouth
light pressure on fetal head
eye contact
to buy time and stop pushing
encourage her to stay calm
```
339
PP hemorrhage
cumulative blood loss >= 1000ml within 24 hour after birth process regardless of route of birth
*might be over 500 for vaginal births and over 1000 for CS
340
early (primary) hemorrhage
within 24 hours
341
late (secondary) hemorrhage
up to 12 weeks PP
342
what can cause early PP hemorrhage
- uterine atony (relaxation of the uterus)
- lacerations of the gential tract
- retained placenta
- vulvar, vaginal, pelvic hematomas
- uterine inversion
- coag disorders (DIC)
343
risk factors for uterine atony
```
macrosomia
polydramnios
multiple gestation
prolonged or precipitous birth
oxytocin augmentation/induction
retained placenta
placenta previa/accrete
abruption
magnesium
```
344
4 Ts of uterine atony
tone
trauma
tissue
thombin time
345
what can cause late PP hemorrhage
result of subinvolution (failure to return to normal size of uterus) or retention of placental tissue
346
signs of late PP hemorrhage
scant brown lochia
irregular heavy bleeding - bright red, more than 1 pad/ hour
boggy fundus that doesn't respond to massage
abnormal clots
high temp
unusual pelvic discomfort or backache
persistent bleeding, firm fundus
rise in fundal height
increased pulse, decreased BP - sign of shock
hematoma formation
347
late PP hemorrhage: nursing assessment
monitor fundus, lochia, bladder
perineal pain
weighing of perineal pads (1 ml = 1g)
348
PP hemorrhage treatment (in order of less invasive to more)
- fundal or uterine massage
- elevate legs 20-30 degrees
- fluid replacement
- meds
- prepare for blood transfusion
- uterine tamponade - bakri balloon catheter
- uterine artery embolization
- laparoscopy: compression/ligation of arteries
- hysterectomy = last resort
349
meds for PP hemorrhage
pitocin
methergine
cytotec (800-1000 mg rectally)
hemabate
350
what can prevent a uterus from contracting
retained placenta
351
risk factors for retained placenta
excessive traction on cord
partial separation
abnormal adherence
preterm births (20-24 wks)
352
retained placenta assessment
```
monitor uterus (atony)
monitor lochia
monitor VS (increased temp)
maintain or initiate IV fluids
oxygen
```
353
retained placenta: recommendations
H & H
| alert provider for manual separation or D&C
354
uterine inversion
turning inside out of uterus
| emergency situation
355
risk factors for uterine inversion
```
retained placenta
uterine atony
excessive fundal pressure
multiparity
fundal implantation
extreme traction on cord
```
356
uterine inversion assessment
```
pain in lower abdomen
large red mass protrusion
dizziness
hypotension
pallor
assess introitus
stop oxytocin
```
357
introitus
any type of entrance or opening
| assess/visualize lochia
358
uterine inversion recommendations
alert provider stat
be ready with terbutaline, antibiotics
C-section for future births!
359
hematomas assessment
250-500 ml of clotted blood within tissues
pain rather than noticeable bleeding
monitor size and note time
icepacks for first 24 hours
360
hematomas recommendation
notify provider
| evacuation/ligation
361
venous thromboembolism
thrombopheblitis: thrombus associated with inflammation
pulmonary embolism
DVT
362
VTE assessment
```
leg pain and tenderness
unilateral area of swelling
warmth
calf tenderness
redness
```
363
how to prevent VTE
antiembolism stockings
early and frequent ambulation
avoid prolonged periods of immobility
fluid intake
364
VTE recommendation
- facilitate bedrest
- elevate extremity above heart avoiding pillow under knees
- intermittent or continuous warm moist compresses as prescribed
- do not massage affected area
- thigh high antiembolism stockings
- anticoags
- monitor aPTT, PT
- avoid pregnancy, aspirin, ibuprofen, alcohol
365
pulmonary embolism
fragments of entire clot dislodges and moves into circulation
complications of DVT
366
when fatalities occur within PE?
within 30-60 mins
367
PE assessments
```
apprehension
pleuritic chest pain
peripheral edema
dyspnea
tachypnea
hypotension
hypoxia
```
368
PE recommendations
scans and angiograms of lungs
embolectomy
meds - alteplase, streptokinase
369
amniotic fluid embolism
infiltration of amniotic fluid into maternal circulation
amniotic fluid can obstruct pulmonary vessels
can be d/t sac or veins rupturing d/t pressure
370
amniotic fluid embolism assessment
```
sudden chest pain
resp. distress
bleeding from incisions / IV sites
uterine atony
circulatory collapse
```
371
amniotic fluid embolism recommendation
```
alert provider
oxygen
IV fluids
be ready to assist with ventilation and intubation
position on side with tilted pelvis
foley
C/S
```
372
ITP (idiopathic thombocytopenic purpura)
autoimmune disorder
| platelet life span is decreased resulting in severe hemorrhage following a C/S or lacerations
373
disseminated intravascular coag (DIC)
clotting and anticlotting mechanism occur at same time
374
risk factors for DIC
abruption, fetal demise, severe preeclampsia or eclampsia, hemorrhage, molar pregnancy, amniotic fluid embolism
375
ITP & DIC assessment
```
epistaxis
petechiae
ecchymoses
excessive bleeding
hypotension
tachycardia
oliguria
```
376
ITP & DIC recommendation
CBC with diff
clotting factors (platelets, fibrinogen, PT increased)
platelet transfusion
possible splenectomy
377
puerperal infection
- infection of repro tract associated w/ childbirth that occurs at any time up to 6 weeks following childbirth or abortion
- temp of 100.4 or higher for 2 consecutive days during first 10 days after birth
378
s/s of puerperal infection
- body aches
- chills
- fever
- malaise
- tachycardia
- sites includes uterus, wounds, bladder or breast
379
endometritis
infection of uterine lining
| usually begins on 2-5th day PP
380
risk factors for endometritis
```
C/S
retained placenta
PROM/chrioamniotis
multiple vaginal exams
prolonged labor
infections (i.e. chlamydia)
```
381
endometritis assessments
```
uterine tenderness and enlargement
lower abdominal pain
tachycardia
chills
fatigue
loss of appetite
dark profuse lochia that is malodorous
```
382
endometritis recommendations
notify provider for labs and medications (i.e. antibiotics)
383
What can lead to wounds from the birthing process
Cesarean, episiotomies, lacerations, trauma to birth canal
384
how to assess wounds
```
REEDA
redness
edema
ecchymosis
discharge
approximation
```
385
UTI
can be secondary to bladder trauma during birth or a break in aseptic technique during foley placement
386
UTI assessments
```
urgency, frequency
dysuria
pelvic discomfort
fever
chills
malaise
```
387
what should you encourage for UTI
voiding
sitz bath, warm water, running water, in and out cath
avoid bladder distension!
388
UTI recommendations: nursing
urinalysis
blood work
antibiotics
389
Is mastitis always bacterial and is it 1 or 2 breasts?
inflammation of breast with or without bacteria infection
usually cause by staph
usually unilateral
390
when does mastitis usually occur
usually 2-4 weeks in breastfeeding women
391
risk factors for mastitis (4)
milk stasis from blocked duct
nipple trauma
poor breastfeeding technique, including decreased frequency
poor hygiene
392
what can cause burning nipple pain
candida
393
mastitis assessments
painful or tender localized hard mass
reddened area
chills
fatigue
394
mastitis recommendations
continue breastfeeding at least every 2-4 hours
| contact the provider for antibiotics to get rid of infection
395
What does high levels of AFP indicate
Open neural tube defects, spina bfida, anencephaly
OR could indicate incorrect gestational age, more than one fetus, gastroschisis (hole in abdominal wall) or fetal death
396
When can you perform quadruple check
Second trimester
| *more accurate when combined with ultrasound
397
What is a quadruple check used to screen
NTD, trisomy 21, and trisomy 18
398
indications for amniocentesis
AMA
couples who already had a cild with a birth defect or family history of chromosomal birth defects
pregnant women with other abnormal screening or genetic test results
399
what does chorionic villi sampling test for
genetic, metabolic and DNA abnormalities
| usually completed 10-12 weeks gestation
400
priority after amniocentesis
monitor fetus
401
bishop score: what is it used for?
a scale used by medical professionals to assess how ready your cervix is for labor
402
arrest of progress
no cervical change for 2 hours
403
prolonged labor
less than 1 cm per hour
