Exam 2 Study Guide & Tutor Notes Flashcards

(100 cards)

1
Q

Intrauterine Growth Restriction

KNOW THIS - Per Study Guide!!!!!

A

Limited nutrients from the placenta to the baby

  • can lead to low birthweight – < 2500 grams (5.5 lbs)
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2
Q

Signs & Symptoms of Preterm Labor

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A
  • Vaginal discharge (change / increase)
  • Pelvic pressure
  • Mild abdominal cramps
  • Constant dull back pain
  • Regular contractions / ruptured membrane
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3
Q

What is Chorioamnionitis?

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A

Bacterail infection of the amniotic cavity

Tx: IV broad spectrum antibiotics & deliver baby

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4
Q

Signs & Symptoms of Chorioamnionitis

A
  • Fever
  • Tachycardia
  • Uterine tenderness
  • Foul odor amniotic fluid
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5
Q

What is Group Beta Strep (GBS)?

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A

Leading cause of perinatal infections including bacteremia, endometritis, chorioamnionitis & UTIs
* Vaginal-rectal culture is usually done between 35-37 weeks

  • TX: IAP antibiotics (intrapartum antibiotic prophylaxis) to decrease risk of chorioamniotitis
  • Effect on Newborn: can cause focal or systemic disease – severe respiratory distress, pneumonia, shock,& meningitis (less often to develop meningitis); osteomyelitis & septic arthritis
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6
Q

How can Group Beta Strep (GBS) effect a newborn?

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A

Can lead to severe respiratory distress, pneumonia, shock, & in rare cases meningitis

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7
Q

What can Group Beta Strep cause? What is the treatment? What impact does it have on the newborn?

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A

Can cause infections including chorioamnionitis & UTIs

  • Tx = IAP (intrapartum antibiotic prophylaxis)
  • Newborn Impact: severe respiratory distress, pneumonia, shock, & in rare cases meningitis
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8
Q

What is considered Preterm birth?

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A

Birth between 20 - 36 6/7 weeks

  • Very Preterm < 32 weeks
  • Moderately Preterm 32-34 weeks
  • Late Preterm 34 - 36 6/7 weeks

CAUSES:
* infection (UTIs)
* congenital structural abnormalities of the uterus
* placental causes
* maternal & fetal stress
* uterine overdistention
* allergic reaction
* decreased progesterone
* periodontal disease

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9
Q

What is considered Posterm Labor?

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A

birth at > 42 weeks (< 0.5% of mothers)

  • increased maternal morbidity
  • dysfunctional labor
  • abnormal growth
  • shoulder dystocia
  • meconium stained fluid
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10
Q

What is external cephalic version (ECV)?

A

Attempt to turn the fetus from breech or shoulder presentation for birth

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11
Q

Amniotomy

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A

Artificial Rupture of Membranes (AROM)

  • when the amniotic sac is ruptured with a hook

do NOT rupture membranes until baby is ≥ -3 station (-3, -2, -1, 0)

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12
Q

Indications for Forceps-Assisted or Vacuum-Assisted Birth

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A

Forceps or Vacuum may be used in…
*

  • 2nd stage of labor (10 cm dilation & 100% effaced)
  • HTN or cardiovascular disease
  • Mom is exhausted

Must Be / Have:
* full dilation
* empty bladder
* baby’s head must be down
* ≥ 34 weeks
* ruptured membranes

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13
Q

What is Uterine Atony?

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A

failure of the uterus to contract firmly (down to its pre-pregnancy size) (hypotonia = low muscle tone of the uterus)

  • most common cause of postpartum hemorrhage
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14
Q

Postpartum Hemorrhage
* Early PPH
* Late PPH
* Medications

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A

Cumulative blood loss ≥ 1000 mL or s/s of hypovolemia with in 24 hours after birth

  • Early (within 24 hours of birth) – atony, bladder distention, trauma
  • Late (> 24 hours or < 6 weeks) – infection, subinvolution, retained placenta, or coagulation defects
  • Medications = Methergine or Hemabate (also IV oxytocin)
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15
Q

Define Postpartum Hemorrhage

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A

Cumulative blood loss ≥ 1000 mL or s/s of hypovolemia within 24 hours after birth

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16
Q

Early Postpartum Hemorrhage

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A

Within 24 hours of birth
* uterine atony
* bladder distention
* trauma (vaginal, cervical, uterine)

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17
Q

Late Postpartum Hemorrhage

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A

> 24 hours but < 6 weeks after birth
* infection
* subinvolution
* retained placenta
* coagulopathy

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18
Q

When can Braxton Hicks contractions begin?

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A

after the 4th month

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19
Q

Lightening

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A

38-40 weeks, “baby drops”

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20
Q

Hegar Sign

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A

Softening of the lower uterine segment

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21
Q

Ballottement

A

between 16-18 weeks

  • passive movement of the unengaged fetus
  • movability of a floating object such as a fetus
  • diagnostic technique using palpation: floating object, when tapped or pushed, moves awy & then returns to touch the examiner’s hand
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22
Q

Quickening

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A

First recognition of fetal movements

  • 16-20 weeks gestation (felt earlier by multiparous woman)
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23
Q

Goodell Sign

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A

Softening of cervix

  • probable sign of pregnancy

  • begins around 6 weeks gestation
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24
Q

Friability

A

Tissue is easily damaged

  • increased in pregnancy * can result in slight bleeding after vaginal exam
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25
**Operculum** | **KNOW THIS -- Per Tutor!!!!!**
**Mucous plug** * *acts as a barrier against bacterial invasion* ## Footnote * plug of mucous that fills the endocervical canal during pregnancy
26
**Chadwick Sign** | **KNOW THIS -- Per Tutor!!!!!**
**violet/blue color of vaginal mucosa & cervis** ## Footnote * visible at approximately 6-8 weeks of pregnancy * caused by increased vascularity
27
**Striae Gravidarum** | **KNOW THIS -- Per Tutor!!!!!**
**remains after pregnancy** ## Footnote * stretch marks
28
**Presumptive Signs of Pregnancy** | **KNOW THIS -- Per Tutor!!!!!**
**subjective changes experienced by the woman** * amenorrhea, fatigue, breast changes
29
**List presumptive signs of pregnancy** | **KNOW THIS -- Per Tutor!!!!!**
* amenorrhea * fatigue * breast changes
30
**Probable Signs of Pregnancy** | **KNOW THIS -- Per Tutor!!!!!**
**objective changes observe / perceived by the EXAMINER & strongly suggest pregnancy** * hegar sign, ballottement, pregnancy tests
31
**List probable signs of pregnancy** | **KNOW THIS -- Per Tutor!!!!!**
* Hegar sign * Ballottement * Pregnancy test
32
**Who reports presumptive signs of pregnancy?** | **KNOW THIS -- Per Tutor!!!!!**
**The woman**
33
**Who reports probable signs of pregnancy?** | **KNOW THIS -- Per Tutor!!!!!**
**The examiner / provider**
34
**Positive Signs of Pregnancy** | **KNOW THIS -- Per Tutor!!!!!**
**objective changes observed / perceived by the examiner that indicate PROOF OF PREGNANCY** * fetal heart tones, ultrasound
35
**What is the difference in probable & positive signs of pregnancy?**
**Positive signs of pregnancy show proof of pregnancy,** while probable signs *strongly suggest* pregnancy
36
**List positive signs of pregnancy** | **KNOW THIS -- Per Tutor!!!!!**
* fetal heart tones * ultrasound
37
**Naegel's Rule** | **KNOW THIS -- Per Tutor!!!!!**
**1.) Calculate first day of LMP** **2.) Subtract 3 calendar months** **3.) Add 7 days** * *Calculate estimated date of birth* ## Footnote * assumes woman has a 28 day cycle & that fertilization occurs on the 14th day
38
**A woman presents to the clinic because she missed her last menstrual period (LMP) & thinks she may be pregnant. She reports fatigue, breast tenderness, urinary frequency, and nausea & vomiting in the morning. THe healthcare provider will interpret these findings as which of the following changes of pregnancy?** **a.)** Positive **b.)** Probable **c.)** Presumptive **d.)** Possible
**c.) Presumptive** * subjective
39
**Chorioamnionitis** | **KNOW THIS -- Per Tutor!!!!!**
**bacterial infection of the amniotic sac** **S/S:** fever, foul / purulent amniotic odor, tachycardia (mom & fetus), uterine tenderness **Risk to Mom:** sepsis * **Risk to BABY:** respiratory distress syndrome, meningitis, cerebral palsy, pneumonia, sepsis
40
**What is chorioamnionitis?** | **KNOW THIS -- Per Tutor!!!!!**
**bacterial infection of the amniotic sac**
41
**What are signs & symptoms of chorioamnionitis?** | **KNOW THIS -- Per Tutor!!!!!**
* maternal **fever** * foul / purulent **amniotic odor** * **tachycardia** (mom & fetus) * **uterine tenderness**
42
**Chorioamnionitis puts a mom at risk for what?** | **KNOW THIS -- Per Tutor!!!!!**
**sepsis**
43
**Chorioamnionitis puts the fetus at risk of what?** | **KNOW THIS -- Per Tutor!!!!!**
* **RDS** (respiratory distress syndrome) * **meningitis** * **Cerebral Palsy** * **Pneumonia** * **Sepsis**
44
**Infants of Diabetic Mothers** | **KNOW THIS -- Per Tutor!!!!!**
**At risk for HYPOglycemia after birth** * glucose crosses the placenta, but insulin does not * Baby is used to making their own insulin & after birth they aren't receiving the glucose from the placenta but are still making insulin * Feed within 1st hour during 1st period of reactivity before they get drowsy & monitor closely * Also **at risk for respiratory distress syndrome due to increased surfactant production**
45
**What are babies of diabetic mothers at risk of?** | **KNOW THIS -- Per Tutor!!!!!**
**HYPOGLYCEMIA after birth** * also at risk for *respiratory distress syndrome because of decreased surfactant production*
46
**Preeclampsia** | **KNOW THIS -- Per Tutor!!!!!**
**HTN / proteinuria that develops after 20 weeks in normotensive women** * can also develop for first time in post-partum period * *In absence of proteinuria, preeclampsia may be defined as HTN along with:* * thrombocytopenia * impaired liver function * new onset renal insufficiency * pulmonary edema * new onset cerebral or visual disturbances **Tx: magnesium** **Tx antidote:** calcium gluconate **S/S of Magnesium Toxicity:** * loss of deep tendon reflexes * respiratory depression (↓ RR) * ↓ LOC
47
# **** **What is Preeclampsia?** | **KNOW THIS -- Per Tutor!!!!!** ## Footnote by definition
**HTN + proteinuria that develops after 20 weeks in normotensive women** ## Footnote **Can also be HTN + (one of the following):** * thrombocytopenia * impaired liver function * new onset renal insufficiency * pulmonary edema * new onset cerebral or visual disturbances
48
**What is the treatment for preeclampsia?** | **KNOW THIS -- Per Tutor!!!!!**
**Magnesium sulfate**
49
**What is the antidote for magnesium?** | **KNOW THIS -- Per Tutor!!!!!**
**calcium gluconate**
50
**What is the treatment for preeclampsia & what is the antidote?** | **KNOW THIS -- Per Tutor!!!!!**
**Tx = magneisum** * *Antidote = calcium gluconate*
51
**What are the signs & symptoms of magnesium toxicity?** | **KNOW THIS -- Per Tutor!!!!!**
* **loss of DTR** (deep tendon reflexes) * **respiratory depression** (↓ RR) * **↓ LOC**
52
**Biophysical Profile (BPP)** | **KNOW THIS -- Per Tutor!!!!!**
* **Amniotic fluid volume, fetal tone, & fetal HR** * score 0-10 * **8 is great** (score wise) - nothing is wrong, baby is doing well
53
**Placenta Previa** | **KNOW THIS -- Per Tutor!!!!!**
**ATTACHMENT ISSUE** * the placenta is *implanted in the lower uterine segment* (should be implanted at the top) **Signs & Symptoms:** * **painless bright red bvaginal bleeding** during second or third trimesters **Exam Findings:** soft, relaxed, non-tender uterus with normal tone
54
**What is placenta previa?** | **KNOW THIS -- Per Tutor!!!!!**
**Placenta does not attach in the correct place** * attaches in the lower uterine segment
55
**What are signs & symptoms / exam findings of placenta previa?** | **KNOW THIS -- Per Tutor!!!!!**
* **Painless bright red vaginal bleeding** * **Abdominal Exam:** *soft, relaxed, non-tender uterus w/ normal tone*
56
**Placental Abruption** | **KNOW THIS -- Per Tutor!!!!!**
**Premature separation / detachment of part or all of the placenta from the uterus** **Signs & Symptoms:** * vaginal bleeding * abdominal pain * uterine tenderness * contractions * **board-like abdomen**
57
**What is placental abruption?** | **KNOW THIS -- Per Tutor!!!!!**
**Premature separation or detachment of part or all of the placenta from the uterus**
58
**Signs & Symptoms of Placental Abruption** | **KNOW THIS -- Per Tutor!!!!!**
* vaginal bleeding * abdominal pain * uterine tenderness * contractions * **board-like abdomen**
59
**How can you differentiate between placental abruption & placenta previa?** | **KNOW THIS -- Per Tutor!!!!!**
**bleeding type, uterine tone, & absence or presence of pain** *Placenta Previa* * *painless vaginal bleeding* * *soft, relaxed, non-tender uterus w/ normal tone* **Placental Abruption** * **vaginal bleeding w/ pain** (contractions / abdominal pain) * **uterine tenderness** * **board-like abdomen**
60
**What is a cerclage?** | **KNOW THIS -- Per Tutor!!!!!**
**A suture is placed around the cervix to hold it closed when premature dilation occurs** * A suture is placed around the cervix beneath the mucosa to constrict the internal os of cervix
61
**What is cervical insufficiency? What is the interprofessional care management & the follow up care for cervical insufficiency?** | **KNOW THIS -- Per Tutor!!!!!**
**Passive, painless dilation of the cervix** leading to recurrent preterm births during the second trimester in absence of other causes **Tx / Interprofessional Management:** * **cerclage --** suture the cervix closed when premature dilation occurs due to weakness **Follow Up Care** * validity of bed rest has not been scientifically proven * Progesterone therapy may be recommended for some women * Watch for & report signs of perterm labor, rupture of membranes, & infection
62
**What is Cervical Insufficiency?** | **KNOW THIS -- Per Tutor!!!!!**
**passive, painless dilation of the cervix** ## Footnote * leads to recurrent preterm births during second trimester in absence of other causes
63
**What is the treatment of choice for cervical insuffiency? What is the follow up care?** | **KNOW THIS -- Per Tutor!!!!!**
**Cerclage** (suture the cervix closed) *Follow Up Care: watch for & report signs of preterm labor, rupture of membranes, & infection* ## Footnote * validity of bed rest has not been scientifically proven * progesterone therapy may be recommended for some women
64
**Gestational Diabetes** | **KNOW THIS -- Per Tutor!!!!!**
**Risk Factors** * family hx of diabetes * previous pregnancy that resulted in unexplained stillbirth or the birth of a malformed or macrosomic fetus * obesity, HTN, glycosuria, maternal age > 25 years * more than half of women with GDM have none of these risk factors **diagnosed during second half of pregnancy**
65
**What are risk factors for developing gestational diabetes?** | **KNOW THIS -- Per Tutor!!!!!**
* **family hx of DM** * previous pregnancy that resulted in an unexplained stillbirth or the birth of a malformed or macrosomic fetus * **obesity, HTN, glycosuria, & maternal age > 25 years** ## Footnote **more than half of women with GDM have none of these risk factors**
66
**A patient is diagnosed with gestational hypertension & is receiving magnesium sulfate. Which findings would the nurse interpret as indicating a therapeutic level of medication?** **a.)** Urinary output of 20 mL per hour **b.)** Respiratory rate of 10 breaths per minute **c.)** Deep tendon reflexes 2+ **d.)** Difficulty in arousing
**c.) deep tendon reflexes 2+** ## Footnote **With magnesium sulfate, deep tendon reflexes of 2+ would be considered normal & therefore a therapeutic level of the drug.** * urinary output of less than 30 mL, a respiratoyr rate of less than 12 breaths/minute, & a diminished level fo consciousness would indicate manesium toxicity
67
**When is gestational diabetes diagnosed?** | **KNOW THIS -- Per Tutor!!!!!**
**Second half of pregnancy**
68
**Fetal Fibronetic (fFN) test** | **KNOW THIS -- Per Tutor!!!!!**
**Used to predict who will NOT go into preterm labor** because its negative predictive value is high ## Footnote * fFN is a glycoprotein "glue" found in plasma & produced during fetal life * women with a negative test have a less than 1% chance of giving birth in 2 weeks
69
**Shoulder Dystocia** | **KNOW THIS -- Per Tutor!!!!!**
* **suprapubic pressure** * **position change** * **turtle sign** * **Risk for diabetic mothers due to macrosomia**
70
**Cord Prolapse** | **KNOW THIS -- Per Tutor!!!!!**
* **Position change** to take pressure off the cord * **Prepare for c-section**
71
**Early Postpartum Hemorrhage** | **KNOW THIS -- Per Tutor!!!!!**
**within 24 hours of birth** * **Causes:** * **uterine atony** (uterus doesn't contract / shrink back to pre-pregnancy size) * **distended bladder** * **trauma**
72
**Late Postpartum Hemorrhage** | **KNOW THIS -- Per Tutor!!!!!**
**more than 24 hours but less than 6 weeks after birth** * **Causes:** * **infection** * **subinvolution** (uterus does not go down to prepregnancy size * **retained placenta**
73
**Induction of Labor** | **KNOW THIS -- Per Tutor!!!!!**
**chemical or mechanical initiation of uterine contractions before spontaneous onset** (for the purpose of bringing about birth)
74
**Augmentation of Labor** | **KNOW THIS -- Per Tutor!!!!!**
**Stimulation of uterine contractions AFTER labor has started spontaneously & progress is unsatisfactory** * * **Common Methods:** * **oxytocin** * **amniotomy** (breaking the water)
75
**The nurse is developing a plan of care for a woman who is pregnant with twins. The nurse includes interventions focusing on which of the following because of the woman's increased risk?** **a.)** Oligohydramnios **b.)** Preeclampsia **c.)** Post-term labor **d.)** Chorioamnionitis
**b.) Preeclampsia** ## Footnote **Oligohydramnios =** too little amniotic fluid
76
**Maternal substance use** | **KNOW THIS -- Per Tutor!!!!!**
* **Tobacco =** growth restriction * **Cocaine / Amphetamines =** placental abruption * **Alcohol =** cognitive impairment
77
**How does maternal use of tobacco impact the fetus?** | **KNOW THIS -- Per Tutor!!!!!**
**Growth restriction**
78
**How does maternal cocaine / amphetamine use impact the fetus?** | **KNOW THIS -- Per Tutor!!!!!**
**placental abruption**
79
**How does maternal alcohol use impact the fetus?** | **KNOW THIS -- Per Tutor!!!!!**
**cognitive impairment**
80
**Hypospadias** | **KNOW THIS -- Per Tutor!!!!!**
**urethra is on VENTRAL aspect** (underside / bottom) **of the penis**
81
**Epispadias** | **KNOW THIS -- Per Tutor!!!!!**
**urethral opening is on the DORSAL aspect** (on top) **of the penis**
82
**A 1-day-old neonate, 32 weeks gestation, is in an overhead warmer. The nurse assesses the morning axillary temperature as 96.9 F. Which of the following could explain this assessment finding?** **a.)** This is a normal axillary temperature for a preterm neonate. **b.)** Axillary temperatures are not valid for preterm babies. **c.)** The supply of brown adipose tissue is incomplete. **d.)** Conduction heat loss is pronounced in the baby.
**c.) The supply of brown adipose tissue is incomplete.**
83
**Which vital sign deviates from the normal reading as a result of puerperal sepsis?** **a.)** Temperature **b.)** Respirations **c.)** Blood pressure **d.)** Pulse | **PowerPoint Question**
**a.) Temperature** * * Fever is **> 100.4 F**
84
**A number of changes in the integumentary system occur during pregnancy. Which change persists after birth?** **a.)** Epulis **b.)** Chloasma **c.)** Striae gravidarum **d.)** Telangiectasia | **PowerPoint Question**
**c.) Striae gravidarum**
85
**With regard to follow-up visits & the physical examination for women receiving prenatal care, nurses should be aware that...** **a.)** The interview portions become more intensive as the visits become more frequent over the course of the pregnancy. **b.)** Monthly visits are scheduled for 1st trimester, every 2 weeks for 2nd trimester, & weekly for 3rd trimester. **c.)** During the abdominal examination, the nurse should be alert for supine hypotension. **d.)** For pregnant women, a systolic BP of 130/80 is sufficient to be considered hypertensive. | **PowerPoint Question**
**c.) During the abdominal examination, the nurse should be alert for supine hypotension.** ## Footnote **Supine hypotension:** occurs when a pregnant person's uterus compresses the inferior vena cava & aorta while they are lying on their back
86
**Gestational Hypertension**
* **onset of HTN w/out other findings after 20 weeks** * * **BP > 140/90** (resolves after giving birth)
87
**Care of Macrosomic Infant** | **KNOW THIS -- Per Study Guide!!!!!**
Large babies (**macrosomic**) are at risk for: * **Hypoglycemia** * Polycythemia (RBCs) * **Birth injuries** (shoulder dystocia) * **Metabolic Issues** (obesity, diabetes, cardiovascular disease)
87
**Women with hyperemesis gravidarum...** **a.)** Are a majority, because 80% of all women suffer from it at some time. **b.)** Have vomiting severe & persistent enough to cause weight loss, dehydration, & electrolyte imbalance. **c.)** Need IV fluid & nutrition for most of their pregnancy. **d.)** Often inspire similar, milder symptoms if their male partners & mothers | **PowerPoint Question**
**b.) Have vomiting severe & persistent enough to cause weight loss, dehydration, & electrolyte imbalance.**
88
**Ectopic Pregnancy** | **KNOW THIS -- Per Study Guide!!!!!**
**Fertilized ovum is implanted OUTSIDE the uterine cavity** * **Signs & Symptoms:** * abdominal pain * delayed menses * abnormal vaginal bleeding (spotting)
89
**Gestational Diabetes - Preconception Guidance** | **KNOW THIS -- Per Study Guide!!!!!**
* Frequent monitoring in pregnancy * *Primary Goal: achieve & maintain constant euglycemia* * **diet, exercise, insulin therapy, self monitoring blood glucose, urine testing**
90
**5 Stages of Grief** | **KNOW THIS -- Per Study Guide!!!!!**
**1.) D**enial **2.) A**nger **3.) B**argaining **4.) D**epression **5.) A**cceptance
91
**Perinatal Loss** | **KNOW THIS -- Per Study Guide!!!!!**
**Loss associated with childbearing** * miscarriage * fetal diagnosis * pregnancy termination
92
**Survivors Guilt** | **KNOW THIS -- Per Study Guide!!!!!**
**A feeling of guilt about going on with life after other people close to you have died**
93
**Care of NAS babies** * neonatal abstinence syndrome | **KNOW THIS -- Per Study Guide!!!!!**
* keep lights dim * TV & radio off * Use soft, quiet voices * Sensitive to stimulation
94
**How to calculate newborn weight loss percentage** | **KNOW THIS -- Per Study Guide!!!!!**
**(weight at birth - current weight) / birth weight x 100** ## Footnote Can also do: **100 - (** *current* weight **/** birth weight**)** * 100 - **(**3000/3500**) = 0.857** * *0.857 = 85.7* * 100 - 85.7 **= 14.3**
95
**Meds for hypertension during pregnancy** | **KNOW THIS -- Per Study Guide!!!!!**
**Labetalol** * beta blocker to decrease BP **Hydralazine** * IV only * monitor FHT * mom in L lateral position **Nifedipine / Procardia** * calcium channel blocker to decrease contractions **Magnesium sulfate for severe preeclampsia** (not necessarily for BP)
96
**What are the 3 most common medications used to control hypertension during pregnancy?** (NOT for preeclampsia) | **KNOW THIS -- Per Study Guide!!!!!**
* **Labetalol** * **Hydralazine** (IV only) * **Nifedipine / procardia**
97
**What are the 3 Tocolytic drugs & what are they used for?**
**Tocolytic = inhibit contractions** **N**ot **M**y **T**ime * **n**ifedipine * **m**agnesium sulfate * **t**erbutaline
98
**What medications are used for postpartum hemorrhage?** | **KNOW THIS -- Per Study Guide!!!!!**
* **Cytotec** (misoprostol) * **Hemabate --** do NOT use w/ asthma * **Methergine --** do NOT use w/ HTN * **Oxytocin / pitocin**
99
**What is methotrexate used for?** | **KNOW THIS -- Per Study Guide!!!!!**
used for the medical treatment of **ectopic pregnancy**