Exam 2 Flashcards
(108 cards)
1
Q
what causes lactation
A
- decreasing estrogen and progesterone
* increasing prolactin and oxytocin
2
Q
PP lochia abnormalities
A
- constant trickle
- excessive w/ ctx
- foul smelling
3
Q
REEDA
A
•episiotomy/incision assessment
- Redness
- Edema
- Ecchymosis
- Discharge
- Approximation
- infection if have pain too
4
Q
PP s/sx to report
A
- fever > 100.4
- unilateral breast edema w/ flu s/sx
- abd tenderness/pressure
- perineal pain
- UTI
- DVT
- lochia change
5
Q
early PP hemorrhage
A
- w/in 24 hr
- vag: > 500 cc EBL
- C/S: > 1500 cc EBL
6
Q
s/sx early PP hemorrhage
A
- excessive lochia
- soft/diff. to locate fundus
- fundus above expected level
7
Q
PP hemorrhage causes
A
- uterine atony
- placental complications/retention
- laceration/trauma/hematoma
- uterine inversion
- sub-involution of uterus
- coagulopathies (DIC)
8
Q
uterine atony causes
A
- overdistention
- muliparity
- tocolytics
- prolonged/precipitous labor
- C/S
- induction
9
Q
early PP hemorrhage tx
A
- fundal massage
- ABCs
- bolus Pit
- new large IV
- admin meds/blood
- elevate legs
10
Q
meds for early PP hemorrhage
A
- O2
- oxytocin (Pit)
- methergin
- cytotec
- Hespan
- Hemabate
11
Q
late PP hemorrhage
A
- b/t 24 hr and 2 wks PP
* caused by uterine sub-involution
12
Q
sub-involution causes
A
- retained placental fragments
* endometritis
13
Q
s/sx subinvolution
A
- prolonged, foul lochia
- hemorrhage
- pelvic pain/heaviness
- backache
- malaise/fatigue
- soft/large uterus
14
Q
subinvolution tx
A
- methergine
- abx
- D&C (last resort)
15
Q
endometritis tx
A
- IV abx
- analgesics (no ASA, ibuprofen)
- high fowlers (drain lochia)
16
Q
meaty clots indicate…
A
•uterine atony
17
Q
thin/shiny clots indicate
A
•trauma
18
Q
trauma causes
A
- macrosomia
- operative vag. delivery
- soft part abnormality
- rapid delivery
19
Q
trauma tx
A
•ice
•pressure
•treat shock
*call MD
20
Q
early signs hypovolumetric shock
A
•tachycardia •thready pulse •increased RR •BP normal *body trying to compensate
21
Q
late signs hypovolumetric shock
A
•falling BP •cool, moist, pale skin •bradycardia •change in mental status *body CANT compensate
22
Q
hypovolumetric shock tx
A
- trendelberg/elevate legs
- O2
- multiple IVs (blood, NS, etc)
- admin Hespan
- ABCs
23
Q
stages of fetal response to Rh incompatibility
A
- fetal hemolytic anemia
- fetal hyperbilirubinemia
- erythroblastosis fetalis
- hydrops fetalis
24
Q
when to admin RhoGAM
A
- 28 wk GA Rh- mom
- post-invasive procedure
- post-abortion
- w/in 72 hrs delivery if baby Rh+
25
amniocentesis
•measures amnt. bilirubin in amniotic fld. (urine) to determine severity of fetal hemolytic anemia
26
early abortion
```
•before 12 wks
•r/t abnormalities of:
-chromosomes
-endocrine
-immune
-systemic
```
27
late abortion
```
•b/t 12-20 wks
•r/t:
-AMA
-multiparous
-infection
-drug use
```
28
threatened abortion s/sx
* SPOTTING
* BACKACHE
* cramping
* pelvic pressure
29
threatened abortion tx
•pelvic rest
30
inevitable abortion
* ROM
* DILATION
* bleeding
* cramping
31
inevitable abortion tx
* allow nature to work
| * if incomplete, D&C
32
incomplete abortion s/sx
* PROFUSE BLEEDING
* DILATION
* severe cramping
* retained placental pressure
33
incomplete abortion tx
* < 14 wk, D&C
| * > 14 wk, induce
34
complete abortion s/sx
* CTX STOP
* CERVIX CLOSED
* PG signs/test neg.
35
complete abortion tx
•nothing unless excessive bleeding or complications
36
missed abortion s/sx
* RED/BROWN spotting
* WEIGHT LOSS
* PG s/sx disappear
37
miss abortion tx
•wait and then D&C
38
complications of missed abortion
* sepsis
| * DIC
39
DIC risk factors
* missed Ab
* sepsis
* abruption
* severe PIH
* AFE
40
s/sx DIC
•bleeding from orafices
•low platelets
•prolonged bleeding time
*DONT give epidural or spinal
41
risks r/t bicornuate uterus
* poor baby perfusion
| * labor issues b/c head doesn't push on cervix effectively
42
methotrexate
```
•antineoplastic ectopic PG tx
•N/V
•no etoh/sex until no hCG
•must be < 8 wks and < 4 cm
*preferred tx b/c less scarring risk
```
43
placental previa s/sx
* painless bright red bleeding
* uterus soft/nontender
* FHT distress
44
normal bloody show
* mucous mixed w/ blood
* pink
* small amnt.
45
pathological bloody show
* dark red
| * copious
46
DONT do vag. exam if bleeding until...
* know where placenta is
| * MUST assess for placental previa first
47
placental abruption
```
•premature separation of normally implanted placenta
•r/t
-HTN***
-trauma
-nicotine/cocaine
```
48
placental abruption s/sx
* abd. pain
* board-like abd
* pathological bloody show
* uterine irritability
* poor rlxn b/t ctx
* FHT distress/absence
49
grade I abruption
* 10-20% detached
| * mom and fetus NOT in distress
50
grade II abruption
* 20-50% detached
* mom in shock
* fetus in distress
51
grade III abruption
* > 50% detached
* mom in shock and has DIC
* fetus dead
52
gestational HTN
* dx after 20 wks
* BP > 140/90
* no proteinuria
53
mild preeclampsia
* BP > 140/90
* proteinuria 1+
* irritable, edema, abd pain
54
severe preeclampsia
* BP > 160/110
* proteinuria 3+
* HA, visual distrubances, hyperreflexia, oliguria
55
severe preeclampsia tx
* MgSO4
* hospitalized bed rest
* induce labor w/ pit
* fld. restriction
56
MgSO4 uses
* smooth muscle relaxant for SEIZURE PRECAUTIONS
* S/E is lower BP
* given to non HTN mom when baby on steroids to prevent baby cerebral hemorrhage
57
therapeutic MgSO4 range
•4-8 mg/dL
58
loss of patellar reflex MgSO4
•9-10 mg/dL
59
respiratory distress MgSO4
•12-17 mg/dL
60
cardiac arrest MgSO4
•30-35 mg/dL
61
signs of MgSO4 toxicity
* absent DTR
* fluid in lungs (dec. RR)
* decreased UOP
62
r/o uterus rupture
•macrosomia/hydrops
•hx of C/S or uterine surgery
•D&C
*hypervascularized so MAJOR bleeding risk
63
anemia in PG
* Hgb < 11 g/dl in 1st/3rd trimester
* Hgb < 10.5 g/dl in 2nd trimester
* Hct < 33%
64
main consequences of anemia
•PREECLAMPSIA and HF b/c less O2 capacity means CO increase
65
thalassemia
* genetic disorder causing production of short-life span RBC
| * DONT give Fe supp. b/c they store Fe in excess
66
pre-existing diabetes increases r/o...
* abortion
* congenital anomalies (heart)
* macrosomia
* shoulder distocia
* PIH
* C/S
* over distention of uterus
* IUGR
* UPI (perif. vasc. site)
67
influence of diabetes on newborn
* cardiac anomalies
* rebound hypoglycemia
* RDS b/c late surfactant development
* birth trauma r/t macrosomia
* hypocalcemia
* hyperbilirubinemia (r/t trauma)
68
why fetus of diabetic mom at risk for macrosomia
* hyperinsulinemia
| * lots of sugar from hyperglycemic mom
69
hyperemesis gravidarum effect on fetus
* IUGR
| * preterm birth
70
toxoplasmosis
```
•protozoan transmitted thru undercooked meat and cat feces
•can cause:
-LBW
-enlarged spleen/liver
-jaundice
-anemia
```
71
congenital varicella syndrome
* fetal infected by varicella before 20 wks GA
* lib hypoplasia
* cutaneous scars
* microcephaly
72
zidovudine
* PO med given to HIV+ mom @ 14 to prevent transmission
* IV during labor
* elixir for baby up to 6 wks
73
preventing HIV transmission to neonate
* zidovudine
* elective C/S @ 38 wks
* DONT allow ROM
* DONT BF
74
GBS neonate effects
•sepsis
•pneumonia
•meningitis
*crucial to vag. screen mom @ 36 wks
75
GBS abx tx if...
* hx of infant w/ GBS
* GBS during current PG
* preterm birth
* maternal fever during labor
* ROM longer than 18 hrs
76
what conditions can cause IUGR
•diabetes
•hyperemesis gravidarum
*baby thin, pale, loose, dry skin
77
molar PG basics
* partial- 2 sperm, 1 egg
* complete- 1 sperm, one egg w/o nucleus
* key s/sx hyperemesis gravidarum; grape-like clusters, fundus wrong for GA; scant dark discharge
78
L/S ratio
* determines fetal pulmonary maturity
* 2+: mature
* 1.5-: r/o RDS
79
neonate thermoregulations
* flexed position
* constriction of peripheral vessels (acrocyanosis)
* brown fat metabolism
* crying/restless
80
cold stress
•ineffective thermoregulation leading to hypoxia, acidosis, and hypoglycemia
81
cold stress s/sx
* drop in temp
* RR increase
* tachy then brady
* mottle skin; acrocyanosis
* if RD, decreased activity
* no RD, increased activity
82
newborn sucking coordination
* 32-34 wks
| * 1500 g
83
neonate hepatic system fxn
* carb metabolism
* Fe storage
* bilirubin conjugation
* coagulation
84
hyperbilirubinemia risks
* prematurity
* blood incompatibilities
* cephalhematoma/bruising
* cold stress
* poor intake/BF
* sepsis
85
physiologic jaundice
```
•hyperbilirubinemia that appears after 1st 24 hrs
•benign
•resolves by day 4
•bili < 12
*normal
```
86
pathologic jaundice
•hyperbilirubinemia w/in first 24 hrs
•r/t excessive RBC destruction
•bili remains high
*abnormal
87
kernicterus
* bilirubin encephalopathy
* severe jaundice
* neurological damage and death
* bili > 25
88
HR apgar scores
* 0: none
* 1: < 100
* 2: > 100
89
RR apgar scores
* 0: apnea
* 1: irregular/shallow
* 2: crying
90
muscle tone apgar scores
* 0: flaccid
* 1: some flexion
* 2: well flexed
91
reflex irritability apgar scores
* 0: none
* 1: grimace/withdraw
* 2: crying
92
color apgar score
* 0: central cyanosis
* 1: peripheral cyanosis
* 2: pink
93
classification of gestational age
* preterm: before 37 wks
* term: 38-42 wks
* possterm: after 42 wks
94
post-mature
* > 3 wks past EDD
* placenta failiing -> less O2/nutrients
* must induce
* LBW, dry, long hair/nails
* r/o meconium aspiration
95
expected newborn measurements
* length: 45-55 cm
* head: 32-37 cm
* chest: 30-33 cm
96
expected newborn VS
* 97.7-98.9
* HR: 110-160
* RR: 30-60
* BP: 60-80/40-50
97
RR indicating RDS
•apnea > 15-20 sec
98
infant caloric intake
•110 kcal/kg/day
| *milk 20 kcal/oz
99
how to know if neonate receiving enough to eat
* content b/t feeding
* 6-8 wet diapers/day
* gains weight
100
how should bottle-feeding mom relieve breast engorgement
* wear snug, supportive bra
| * DONT pump
101
healthy neonate blood glucose
•50-60
102
when are neonate lungs mature?
* 37 wks
| * amniocentesis to determine maturity if < 37 wks
103
avg. cord separation
•10-14 days
104
pre-eclampsia impact on organs
* decreased fxn of placenta, kidney, liver, brain
| * d/t vasospasms that diminish diameter of vessels, impeding flow
105
most prevalent symptom of abruptio placentae
•intense abdominal pain
* what differentiates it from placenta previa
- both have bleeding, uterine activity, and cramping
106
s/sx rupture of uterus
* hypotonic activity
* hypovolemia
* no pain
107
most important factor affecting pregnancy outcome of pre-GDM mom
* glucose control
| * no vessel dz
108
most important cause of perinatal loss in diabetic pregnancy
•congenital malformations, esp. heart
