Exam 2 Summary Set Flashcards
1
Q
at what stage of labor are epidurals and opioids no longer safe?
A
stage 2
2
Q
____ is the only stage where sedatives are appropriate for pain management.
A
stage 1 - early labor
3
Q
____ does not stay in the system after inhalation
A
nitrous oxide
4
Q
what are sedatives used for in labor?
A
relaxation and possibly sleep
5
Q
____ is the sedative used in labor
A
vistaril
6
Q
what is the dose for vistaril?
A
25-100 mg
7
Q
what are the two opioids used in labor?
A
morphine, fentanyl
8
Q
____ (opioid) is most commonly used in early labor
A
morphine
9
Q
which opioid is more rapid-acting?
A
fentanyl
10
Q
what happens if we give opioids too late into labor?
A
no relief and can lead to neonatal respiratory depression
11
Q
what pain management method is used during a c-section?
A
spinal anesthesia
12
Q
____ block is used during vaginal birth
A
epidural
13
Q
____ is typically reserved for emergency situations, such as STAT c/s
A
general anesthesia
14
Q
what are the most common postpartum pain management options for NSVB?
A
analgesics (acetaminophen) and NSAIDs PO
15
Q
what is the pain management regimen for c-section postpartum?
A
(1) opioid analgesic PCA x24 hr, then ->
(2) opioid analgesic PO
(3) NSAID IV x24 hour, then ->
(4) NSAID PO
16
Q
IV and PO ____ canNOT be used at the same time!
A
NSAIDs
17
Q
risk factors for labor dystocia / dysfunction
A
(1) nullip
(2) obesity
(3) AMA
(4) short stature
(5) Induction of labor
(6) complications during pregnancy
18
Q
what is the nursing priority for hypertonic labor dysfunction?
A
maternal therapeutic rest and support for coping
19
Q
what are the nursing priorities for hypotonic labor dysfunction?
A
augmentation and position changes
20
Q
what are the nursing priorities for ineffective pushing dysfunction?
A
(1) position changes
(2) call to change epidural infusion rate
(3) assisted delivery
(4) prep for c/s
21
Q
what are the risk associated with prolonged labor? (4)
A
(1) infection
(2) maternal exhaustion
(3) higher levels of fear/anxiety
(4) maternal hemorrhage
22
Q
the biggest complication of precipitate labor is ___
A
tears / lacerations
23
Q
safe, high-quality care that recognizes and adapts to physical and psychosocial needs of the family
A
family-centered care
24
Q
basic principles of family-centered care
A
(1) childbirth is a normal, healthy event
(2) childbirth affects the entire family
(3) families can make decisions about their care if given adequate info
25
settings for childbirth are
(1) hospital
(2) free-standing birth centers
(3) home births
26
US birth rate is ___
declining
27
____ are more likely to delivery low-birth weight or preterm infants, compared to older women
teenagers
28
The death of a woman while pregnant or within 42 days of termination of pregnancy
maternal death
29
______ population has 3x higher maternal mortality rates, compared to non-Hispanic white population
non-Hispanic Black
30
infant mortality rate is highest for which ethnic population?
Non-Hispanic Black
31
An approach that recognizes the impact of trauma on individuals and creates a safe, supportive environment for healing
trauma-informed care
32
two things that can happen prior to the onset of birth are
lightening and engagement
33
widest part of the baby's head passes through the pelvic inlet and into the pelvis
engagement
34
subjective feeling of the baby settling into the lower uterine segment
lightening
35
T/F you can be in active labor and not have rupture of membranes occur yet
T
36
name the general stages of labor
stage 1 - cervical dilation
stage 2 - pushing
stage 3 - delivery of placenta
stage 4 - maternal stabilization
37
what are the 3 sub-stages of stage 1 of labor?
(1) latent
(2) active
(3) transition
38
during the latent stage, the cervix dilates ____
0 to ~3-5 cm
39
steady contractions that are very spaced out can be seen in __ stage
latent stage 1
40
in active stage 1, the _____ is complete
effacement
41
during the active stage 1, the cervix dilates ____
from 5 to 8 cm
42
at which stage does the fetal head engage?
active stage 1
43
when does coping during labor really initiate? (can have N/V, shaking, etc.)
active stage 1
44
in transition stage 1, the cervix dilates ____
from 8 to 10 cm
45
____ is common during the transition stage 1
emesis
46
contraction intensity is ____ during the transition stage 1
strong!
47
what is cervical effacement?
going from long and thick cervix (0%) to paper thin (100%)
48
the vagina will ___ to allow for distention during labor
stretch
49
when the cervix is 10 cm dilated, it is as big as a
grapefruit
50
how do we assess cervical effacement and dilation?
vaginal exam
51
during stage ____, mother will have the spontaneous urge to push
2
52
swelling that appears as a cone-shaped head
caput
53
baby's head should ideally have ____ to be the smallest diameter during birth
the chin tucked
54
labor is longer for ___ than ___
nullips; multips
55
when should you take vitals during labor and why?
resting phase / between contractions b/c BP will increase during contractions
56
CO, HR, BP, and RR will __ during labor
increase
57
WBC count will ___ during labor
increase
58
it is normal for ____ to be slightly elevated during labor
temperature
59
what two physiological changes reflect a decrease during labor/
(1) gastric motility
(2) blood glucose
60
name the 5 Ps of labor
(1) passenger (fetus and placenta)
(2) passageway (pelvis)
(3) position (mom and fetus)
(4) power (contractions)
(5) psyche
61
part of the fetus that is entering into the pelvic inlet first
presentation
62
when the shoulder or scapula enters first, this is ____ presentation
transverse
63
when the fetus is head-down, this is ___ presentation
cephalic
64
when the fetus is sideways, this is ___ presentation
transverse lie
65
relationship of the maternal spine to the fetal spine is called ___
lie
66
the two types of lie are ____
longitudinal; transverse
67
relationship of the fetal body parts to one another
attitude
68
the two types of attitude are ____
flexion and extension
69
the ideal birthing position for the fetus is
left occiput anterior (LOA)
70
the 2nd best birthing position is
right occiput anterior (ROA)
71
the most optimal pelvic shape for delivery is ____
gynecoid
72
____ pelvic shape is not conducive for vaginal birth
platypelloid
73
the ___ pelvic shape can have birth occur but it may not progress
android
74
which pelvic shape often results in occiput posterior (OP) birth?
anthropoid
75
the 3 parts of the fetal are ____
face, base of the skull, and vault of the cranium
76
the _____ of the fetal head is not well-fused and meant to shift and mold
vault of the cranium
77
the relationship of the presenting part to an imaginary line b/w the ischial spines of the maternal pelvis is the ___
fetal station
78
when the fetus is at station 0, this means
the fetal head is engaged
79
what does +3 / +4 fetal station mean?
the fetus is close to crowning
80
we don't recommend pushing until the fetal head is at station ____
0 or lower
81
the beginning to the completion of one contraction is the
duration
82
the time between the beginning of one contraction and the beginning of another is
frequency
83
palpating a mild intensity contraction will feel like
tip of the nose
84
palpating a moderate-intensity contraction will feel like
the chin
85
palpating a strong-intensity contraction will feel like
a forehead
86
feelings of helplessness or loss of control may indicate ___
suffering
87
name at least 3 comfort measures for physical pain
(1) create a relaxing atmosphere
(2) give partner suggestions
(3) provide pressure / massage
(4) encouraging words of praise
(5) calming music
88
what is the main nursing priority in the 3rd stage of labor?
inspect the placenta when it is delivered to make sure it is intact
89
if the placenta is not delivered within 30 minutes, it is a ____
retained placenta
90
name at least 3 physical assessments that nurses perform during labor
(1) vital signs
(2) Leopold's maneuvers
(3) heart
(4) lung
(5) cervical dilation and effacement
(6) membranes status (ROM?)
(7) pain
(8) contractions
91
the 3 components of labor status are ___
contractions, cervix, and membranes
92
the amniotic fluid / membrane should be ___ in color
clear
93
during stage 1 of labor, what are the nursing assessments that must be completed?
(1) prenatal Hx and labs
(2) culture, language, religion
(3) labor status
(4) fetal status
(5) maternal status
94
during ___ stage, you should:
-help with position changes
-have delivery meds ready
-continue monitoring labor/parent/fetus
second (pushing)
95
during stage 3, _____ continue to deliver the placenta
uterine contractions
96
weighing pads for bleeding assessment, frequent fundal checks, and setup for laceration repair occurs in which stage of labor?
stage 3
97
helping parent bond with baby is important in which stage(s) of labor?
stage 3 and 4
98
the two major things we monitor for the fetus are ___
FHR and contractions / uterine activity
99
the external methods of FHR monitoring are ___
(1) intermittent auscultation
(2) continuous with transducer
100
the internal method of FHR monitoring is ____
internal fetal scalp electrode
101
the external method to measure uterine activity is
toco / transducer
102
the internal method to measure uterine activity is
intrauterine pressure catheter (IUPC)
103
the toco should be at the ____ location
top of the fundus
104
the transducer should be at the ____ location for best reading
fetal back
105
what are 3 reasons we would use an internal fetal scalp electrode?
(1) patient is moving
(2) patient's body type
(3) fetal position
106
a flexible thin tube that sits alongside the baby describes the ___
intrauterine pressure catheter
107
which device can measure the strength of a contraction?
intrauterine pressure catheter
108
the top of a FHR tracing shows the ___
FHR
109
the bottom section of a FHR tracing shows the ____
contractions
110
baseline normal FHR should be
110-160 bpm
111
<110 bpm is
bradycardia
112
fetal bradycardia could be due to ____
fetal hypoxia
113
maternal fever or fetal distress can cause
tachycardia
114
minimal variability is ____ change in amplitude
0-5 bpm
115
moderate variability is ____ change in amplitude
6-25 bpm
116
marked variability is ____ change in amplitude
>25 bpm
117
moderate variability indicates what?
reassuring sign of a well-oxygenated fetus with functioning autonomic nervous system
118
minimal or absent variability can suggest
hypoxia or acidemia
119
marked variability may suggest
acute hypoxia or cord compression
120
which type of variability is often seen during stage 2 of labor?
marked
121
temporary increases in the FHR from baseline of at least 15 bpm for at least 15 seconds
accelerations
122
___ are generally a reassuring sign of a well-oxygenated fetus responding to stimulus
accelerations
123
a gradual decrease and return to baseline where the nadir of decel and peak of contraction happen at the same time
early deceleration
124
VEAL CHOP stands for...
V - variable decels
E - early decel
A - acceleration
L - late decel
C - cord compression
H - head compression
O - Ok
P - placental insufficiency
125
onset to nadir is ____ seconds for an early and late decel
>30
126
gradual decrease and return to baseline where the nadir occurs after the peak of contraction
late deceleration
127
____ may indicate placental insufficiency
late deceleration
128
an abrupt decrease that is >= 15 bpm and lasts less than 2 min from onset
variable decel
129
variable decels are due to ____
umbilical cord compression
130
a decrease in FHR that is 15 bpm or more and lasts 2 to 10 minutes
prolonged decel
131
name 4 causes of a prolonged decel
(1) labor progressing quickly
(2) patient getting an epidural
(3) sudden position changes
(4) baby sudden position change
132
a ____ decel can lead to an emergency c-section
prolonged
133
tachysystole is defined as
>5 contractions in 10 minutes over a 30-minute window
134
name the 3 nursing interventions for tachysystole
(1) IV fluid bolus
(2) maternal repositioning
(3) stop pitocin and other meds that stimulate contractions
135
category I FHR patterns
(1) normal baseline
(2) moderate variability
(3) no late or variable decels
(4) early decels - present or absent OK
136
category III FHR patterns
absent variability AND
(1) recurrent late decels
(2) recurrent variable decels
(3) bradycardia
(4) sinusoidal pattern
137
the primary source of pain in stage 1 of labor is ____
dilation of the cervix
138
hypoxia of the uterine muscles causes pain in which stages of labor?
stage 1 and 2
139
pressure on lower back, buttocks, and thighs causes pain in which stages of labor?
stage 1 and 2
140
pain in stage 3 is caused by...
(1) cervical dilation as placenta is expelled
(2) uterine contractions
(3) perineal pain
141
what are the main sources of pain in stage 4 of labor?
(1) uterine contractions
(2) after pains
(3) perineal pain
(4) incisional pain
142
when asking about labor, what nurse should say:
"how are you coping with your labor?"
143
name the pain management options from least to most invasive
(1) nothing
(2) non-pharm methods
(3) NO
(4) sedatives
(5) opioids
(6) pudendal nerve block
(7) epidural analgesia
(8) spinal anesthesia
144
name at least 4 non-pharmacological methods for pain management
(1) heat / cold
(2) massage
(3) hydrotherapy
(4) breathing techniques
(5) counterpressure
(6) birth ball
(7) movement
145
____ can induce sleep at higher doses
vistaril
146
why do we give fentanyl more frequently?
It is not as long-lasting
147
why is narcan contraindicated in mother / fetus with maternal narcotic drug use or methadone treatment?
it can precipitate drug withdrawal
148
_____ provides some pain relief and motor block
regional analgesia
149
____ provides complete pain relief and motor block
regional anesthesia
150
primary use of local perineal infiltration anesthesia is ____
repair of perineal lacerations
151
pudendal nerve block is appropriate during which stages of labor?
stages 2 and 3
152
the two advantages of spinal anesthesia during c/s are
(1) pt stays awake and can participate in birth
(2) pt retains airway reflex
153
name at least 3 limitations to spinal anesthesia
(1) maternal hypotension
(2) FHR changes
(3) delayed respiratory depression
(4) N/V
(5) pruritus
(6) spinal headache
(7) urinary retention
154
____ leads to reduced motor function from xiphoid process down to toes
spinal block
155
pts can typically have movement in their legs but can't walk with ____
epidural
156
____ is given continuous infusion via catheter of anesthetic and opiate
epidural
157
the most important thing to monitor during an epidural is ___
maternal hypotension
158
what should be given to offset maternal hypotension with an epidural?
IV fluid bolus
159
what two things should be available when someone gets an epidural?
O2 and suction
160
name 3 health consequences of preterm birth
(1) developmental delays
(2) chronic respiratory issues
(3) vision and hearing impairment
161
name at least 3 risk factors for preterm labor
(1) low pre-pregnancy weight
(2) smoking
(3) substance use
(4) history of preterm labor
(5) cervical length issues
(6) infection
(7) short interval b/w pregnancies
162
s/s of preterm labor include (name at least 4)
(1) cramping
(2) palpable contractions
(3) vaginal bleeding or spotting
(4) sense of "feeling badly"
(5) ROM
(6) pelvic / vaginal pressure
163
4 contractions in 20 minutes or 8 contractions in 60 minutes + cervical changes indicates ____
labor / preterm labor
164
labor before 37 weeks gestation is considered
preterm
165
___ and ___ are inefficient in preventing preterm birth
bedrest and hydration
166
the 4 meds for management of preterm labor are
(1) betamethasone
(2) terbutaline
(3) nifedipine
(4) Mg sulfate
167
the purpose of betamethasone/corticosteroids in preterm labor is ___
to enhance fetal lung maturity
168
betamethasone is given ___ route
IM
169
betamethasone 12mg dose is given ___ times
2
170
terbutaline route
subQ
171
side effects of terbutaline are
tachycardia (both mom and fetus) and palpitations
172
which medications are tocolytics for preterm labor?
terbutaline and nifedipine
173
what is the purpose of tocolytics in preterm labor?
reduce uterine contractions and slow down labor
174
Nifedipine route
PO
175
side effects of Nifedipine
hypotension, headache, dizziness, flushing, nausea
176
Mg sulfate is used in preterm labor for ____ at <32w GA
fetal neuroprotection
177
____ is key in preventing preterm birth
prenatal care
178
artificial rupture of membranes is
rupture by a clinician
179
when someone's water breaks, we call this
spontaneous rupture of membranes
180
when ROM occurs, nurses should assess:
when, amount, color, and odor
181
when ROM occurs, patients should be instructed to ____
come to the clinic or hospital for evaluation
182
most term PROM cases lead to labor within ___
24 hours
183
PPROM increases the risk of...
neonatal and maternal complication
184
when ROM occurs but there is no labor yet
PROM
185
when prelabor ROM occurs before term
PPROM
186
the most significant consequence of PROM is ___
intrauterine infection
187
PPROM can lead to ____
premature birth
188
PROM and PPROM can put newborns at risk for ____& ____
sepsis and respiratory distress
189
name at least 3 risk factors for PROM and PPROM
(1) amniotic infection
(2) h/o PROM or PPROM
(3) low BMI
(4) smoking
(5) illicit drug use
(6) T2/T3 bleeding
(7) short cervical length
(8) low SES
190
___ is a social factor and risk for preterm labor
race
191
management of PROM includes 3 main things:
(1) weigh risk vs. benefits of induction
(2) assess GBS status
(3) monitor for infection and fetus status
192
if fetus is <34 weeks gestation with PPROM, you need to ___
weigh risk vs. benefit of premature induction vs. infection
193
if fetus is >34 weeks gestation with PPROM, typically they will __
have induction of labor
194
bacterial infection of the amniotic cavity is ___
chorioamnionitis
195
what is the triple I of chorioamnionitis?
(1) intrauterine inflammation
(2) infection
(3) both
196
name at least 3 risk factors for chorioamnionitis
(1) prolonged ROM
(2) multiple vaginal exams
(3) prolonged labor
(4) low SES
(5) young age
(6) nullip
197
diagnosis of chorioamnionitis
maternal temp > 38 C / 100 F +
-WBC >15,000
-maternal HR > 100
-FHR > 160
-tender uterus
-foul smell amniotic fluid
198
pneumonia, bacteremia, meningitis, and RDS are all neonatal results of
chorioamnionitis
199
chorioamnionitis is treated with ____
antibiotics (ampicillin/gentamicin, penicillin)
200
postpartum with chorioamnionitis, monitor for ___, ___, and ___
endometritis, UTI, sepsis
201
when it prolapses out of the uterus in front of the presenting fetus after ROM
cord prolapse
202
why is cord prolapse a medical emergency?
interrupts blood flow and O2 -> potentially fatal to fetus
203
name at least 3 risk factors for cord prolapse
(1) PROM
(2) polyhydramnios
(3) long umbilical cord
(4) fetal malpresentation
(5) multip
(6) growth restricted fetus
204
what is the main nursing role during cord prolapse?
support the fetal head until delivery by emergency c-section
205
why do you support the fetal head during cord prolapse?
to relieve cord compression and avoid cutting off blood / O2 supply
206
descent of anterior shoulder obstructed by symphysis pubis
shoulder dystocia
207
the head going in and out from the vaginal canal is called
turtle sign
208
turtle sign is an indicator of
shoulder dystocia
209
name two obstetric emergencies
cord prolapse and shoulder dystocia
210
maternal complications r/t shoulder dystocia are
(1) PPH
(2) perineal lacerations
(3) maneuvers of fetal manipulation & anal sphincter injuries
211
neonatal complications r/t shoulder dystocia are
(1) encephalopathy
(2) brachial plexus injuries
(3) clavicle and humerus fractures
(4) death
212
name at least 3 risk factors for shoulder dystocia
(1) LGA
(2) maternal diabetes
(3) prolonged labor
(4) excessive weight gain during pregnancy
(5) h/o shoulder dystocia
213
what should you NEVER do during shoulder dystocia?
give fundal pressure
214
explain 3 things you SHOULD do during shoulder dystocia
(1) document time of head delivery, time of diagnosis, and maneuvers used
(2) request assistance from NICU, providers, etc.
(3) assist with maneuvers
(4) ask pregnant person NOT to push
215
which maneuver is when the knees are tucked up to help with shoulder dystocia?
McRoberts Maneuver
216
process that prepares the cervix for labor induction
cervical ripening
217
procedures that stimulate contractions of labor
inudction
218
stimulation of uterine contractions after labor has already started
augmentation
219
name at least 3 maternal indications for induction of labor (IOL)
(1) PROM
(2) HTN disorders
(3) maternal diabetes
(4) post-term pregnancy
(5) elective
220
name at least 3 fetal indications for induction of labor (IOL)
(1) fetal growth restriction
(2) oligohydramnios
(3) chorioamnionitis
(4) non-reassuring tracings
221
complete placenta previa, non-cephalic presentation, and active genital herpes are all _____
contraindications for IOL
222
if we can't IOL, we do ___
c-section
223
we do a ____ to start an induction
vaginal exam
224
the vaginal exam is used to get a ___ score
Bishop
225
a Bishop score of ____ indicates need for cervical ripening
6 or less
226
the two types of cervical ripening are ___ and ___
mechanical, pharmacologic
227
___ is the mechanical method of cervical ripening
intracervical balloon
228
the main benefit of the intracervical balloon is ___
it is safe for those with previous c-section
229
the cons of intracervical balloon are ____
(1) can cause SROM upon insertion
(2) displacement of the fetal head
230
____ are the pharmacologic method for cervical ripening
prostaglandins
231
the two types of prostaglandins used for cervical ripening are ___ and ___
misoprostol; dinoprostone
232
____ is contraindicated for prostaglandin cervical ripening
previous c-section or uterine surgery
233
the main risk of use of prostaglandins for cervical ripening is ___
tachysystole
234
____ is the brand name for vaginal insert of a prostaglandin
Cervadil
235
misoprostol route for cervical ripening
PO, vaginal
236
the most common form of induction method is
IV Pitocin
237
what are the potential dangers of pitocin? (3)
(1) tachysystole
(2) uterine rupture
(3) uterine atony and PPH
238
why do you hang the IV pitocin as close to the venipuncture site as possible?
it limits the amount of drug that is infused after stopping it
239
describe the administration of pitocin for induction of labor
start at a low dose and increase every 20-30 minutes until regular uterine contractions occur
240
___ is a high-risk med and requires two nurses to check
pitocin
241
monitor patient's BP and HR at what interval when on pitocin?
q30 minutes
242
what can be administered if pitocin use leads to fetal non-reassuring patterns?
terbutaline
243
AROM can be used for ____
labor induction and augmentation
244
the two risks of AROM are
(1) cord prolapse
(2) chorioamnionitis
245
amnihook is used to perforate the amniotic sac in ___
amniotomy
246
the nursing priorities for an amniotomy are _____ (4)
(1) monitor FHR baseline and during procedure
(2) provide supplies
(3) chart color, quantity, and odor of fluid
(4) assess for infection
247
the two types of operative vaginal delivery are
(1) vacuum
(2) forceps
248
the main indication for operative vaginal delivery is to ___
shorten stage 2 of labor for any reason
249
the major risks of operative vaginal delivery for mom are ___, ___, and ___
lacerations, hematoma, episiotomy
250
ecchymoses, facial and scalp lacerations, facial nerve injury, cephalohematoma, and intracranial hemorrhage are risks of what?
operative vaginal delivery for fetus
251
what are the main nursing priorities prior and after operative vaginal delivery?
(1) ensure pt's bladder is empty
(2) assess FHR
(3) observe for trauma to pt or baby
(4) check fundus for firmness
(5) reduce pain with cold pack
252
when assessing the newborn after an operative vaginal delivery, look for...
(1) skin breaks
(2) facial asymmetry
(3) neurologic abnormalities
(4) scalp edema
253
TOLAC
trial of labor after cesarean
254
VBAC
vaginal birth after cesarean
255
unsuccessful TOLAC ending in cesarean has _____, compared to elective repeat or VBAC
more complications
256
3 benefits of TOLAC include
(1) avoid surgery
(2) lower rates of hemorrhage, infection, TE
(3) shorter recovery
(4) decrease risks associated with multiple cesarean
257
___ and ___ account for ~50% of all C-sections
labor dystocia; abnormal FHR tracings
258
name at least 3 indications for C-section
(1) suspected macrosomia
(2) multiple gestation
(3) cord prolapse
(4) previous / elected
(5) placental abnormalities
259
name at least 3 risks of C-section
(1) hemorrhage
(2) infection
(3) cardiac arrest
(4) anesthetic complications
(5) injury to newborn
(6) uterine rupture
(7) shock
260
pt needs to be NPO for ____ prior to c-section
8 hrs
261
what lab work should be obtained before c/s?
(1) CBC
(2) blood type and screening
262
what two medications will be given prior to c/s?
(1) Antibiotic - Ancef IV push
(2) Bicitra/pepcid for gastric secretions
263
T/F - insert a catheter before c/s?
True
264
the three main buckets of perinatal mental health are
(1) baby blues
(2) postpartum major mood disorders
(3) postpartum pyschosis
265
transient period of "depression" that subsides in 10-12 days is
baby blues
266
major or minor episodes that occur during or in the first 12 months after birth is
perinatal depression
267
what is the biggest risk factor for postpartum depression?
depression during pregnancy
268
most common medication to treat postpartum depression is ___
sertraline / Zoloft
269
___ is a psychiatric emergency
postpartum psychosis
270
bipolar disorder and family h/o psychotic illness are risk factors for
postpartum psychosis
271
perinatal anxiety disorders can be...
GAD, OCD, PTSD
272
the 5 stages of grief are
(1) shock / denial
(2) anger / guilt
(3) bargaining
(4) depression / disorientation
(5) acceptance / resolution
273
____ may receive less support during perinatal loss than their partner
the birthing person's partner (AKA the other parent)
274
never say ____ to a grieving parent
"god's will"
"it was for the best"
275
the main nursing role during perinatal loss is ___
facilitate bonding and create an environment to initiate the grieving process
276
1st degree laceration
skin only
277
2nd degree laceration
tears of the perineal muscle and fascia
278
3rd degree laceration
anal sphincter is torn
279
4th degree laceration
rectal tears
280
which drugs are safe during TOLAC, and which are contraindicated?
Safe - Pitocin
Contraindicated - Prostaglandins
281
The two main indications for cesarean birth are
labor dystocia and abnormal / indeterminate FHR tracing
282
patient must be NPO ____ hrs before c-section
8
283
what medications are administered prior to C-section?
(1) antibiotic - Ancef IV Push
(2) Bicitra / Pepcid for gastric secretions
284
every day, the uterus will be about ____ lower
1 fingerbreadth lower
285
If blood collects and forms clots within uterus, what happens to the fundus?
it rises and becomes boggy
286
it's normal to not have first spontaneous BM for ____ after birth
2-3 days
287
normal elimination pattern will return by ____
8-14 days
288
Breastfeeding people may get their period as early as ____ or as late as _____
8 weeks; 18 months
289
what are signs of a distended bladder? (4)
(1) fundus is displaced from midline
(2) excessive lochia
(3) bladder discomfort
(4) bulge of bladder above symphysis
290
name the 10 physical assessments to do during labor
(1) VS
(2) Leopold's
(3) headache/dizziness/vision changes
(4) contractions
(5) cervical dilation and effacement
(6) membranes status
(7) heart
(8) lungs
(9) pain
(10) pulses
291
nursing interventions for epidural
(1) IV fluid bolus
(2) monitor maternal and fetal VS
(3) side-lying position
(4) coach pushing
(5) O2 and suction available
(6) SCD for prophylaxis
(7) insert catheter
(8) monitor for return of sensation and standing for first time
292
REEDA is an acronym that describes lacerations. What does it stand for?
R = redness
E = edema
E = ecchymoses
D = discharge
A = approximation
293
Methergine is contraindicated in ____
hypertension and cardiac disease
294
Methergine MOA is to ____
contract smooth muscle
295
Hemabate is contraindicated in ____
asthma; renal, cardio, and liver disease
296
you can use ____ instead of methergine if patient has HTN or cardiac disease
hemabate
297
____ is a side effect of hemabate
diarrhea
298
Tranexamic Acid (TXA) is given to ___
aid in clotting
299
Which patient is at greatest risk for an early PPH?
a. 41 weeks being induced with Pitocin
b. pt who is receiving Mg sulfate, severe preeclampsia, and urgent c/s
c. spontaneous labor at full term
B
300
the single biggest cause of postpartum hemorrhage is
uterine atony
301
the #1 thing to do during PPH is
massage the fundus
302
the 5 drug options during PPH are
(1) Pitocin
(2) Methergine
(3) Cytotec
(4) Hemabate
(5) TXA
303
risk factors that put someone at low risk for PPH are (4)
(1) singleton
(2) <4 previous deliveries
(3) no uterine scarring
(4) no past h/o PPH
304
name 3 risk factors that put someone at moderate risk for postpartum hemorrhage
(1) previous c/s or uterine surgery
(2) chorioamnionitis
(3) use of Mg sulfate
(4) prolonged use of oxytocin
305
name 3 risk factors that put someone at high risk for postpartum hemorrhage
(1) placental abnormalities
(2) bleeding admission
(3) h/o postpartum hemorrhage
(4) known coagulation defect
306
the main causes of hematomas are ___ and ___
lacerations, blood vessel injury
307
what are 3 risk factors for hematomas?
(1) nullips
(2) babies > 4000 g
(3) prolonged 2nd stage
(4) preeclampsia
(5) multifetal pregnancy
(6) vulvar variscosities
308
deep, severe unilateral pain and hypovolemia are s/s of ____
hematoma
309
the three treatment options for hematoma are ___, ___, and ___
conservative management, surgery, and arterial embolization
310
risk factors for retained placenta are G and 5Ps - what are they?
Grand multip
Prematurity
Previous c/s
Placenta previa
Placental manipulation in 3rd stage
Prolonged 3rd stage
311
how can you remove a retained placenta?
(1) manual removal
(2) dilation and curettage
312
the 4 most common postpartum infections are
endometritis, UTI, mastitis, and wound infection
313
fever, chills, tender uterus, and foul-smelling lochia may describe
endometritis
314
endometritis is treated with
IV antibiotics
315
2 common causes of UTI are
urinary stasis, catheterization
316
CVA tenderness, flank pain, and nausea and vomiting may indicate
pyelonephritis
317
which infection should get a UA/UC?
UTI
318
the main complication r/t mastitis is ___
an abscess
319
___ and ___ can lead to mastitis
milk stasis; breast engorgement
320
name 3 s/s of mastitis
fever, pain, redness, localized lump
321
3 things someone with mastitis should do to treat it are
(1) PO antibiotics
(2) ice packs / heat pads
(3) keep breastfeeding on affected side
322
management of wound infection can include:
(1) come into doctor's office
(2) drain wound
(3) culture exudate
(4) analgesics
(5) warm compresses and sitz baths
323
SSRIs may cause ___ in the newborn
RDS (respiratory distress syndrome)
324
cultural and/or public display of one's grief
mourning
325
the three types of thromboembolism that are common in postpartum are
(1) superficial venous thrombophlebitis
(2) DVT
(3) PE
326
hardened vein over the thrombosis and calf tenderness are s/s of
DVT
327
management of DVT includes
(1) elevate limb above the heart
(2) frequent position changes
(3) warm, moist compresses
(4) DO NOT Massage
(5) NSAIDs for pain
(6) anticoagulant (warfarin, heparin)
(7) measure calf size regularly
328
name s/s of PE
dyspnea
chest pain
tachycardia
tachypnea
hemoptysis
decreased O2
329
management of PE includes
(1) call for help
(2) VS, esp. RR and breath sounds
(3) raise HOB
(4) narcotic analgesics (morphine)
(5) O2 at 8-20 LPM face mask
(6) ensure IV access
330
involution / after pains can be most acute for...
multips; overdistention of uterus; breastfeeding
331
if the fundus is above the _____ in postpartum, this can be a cue that the bladder is full
belly button
332
on days 4-10 PP, lochia is
serosa - pink or brown
333
on days 11-14, lochia is
alba - yellow, cream, or white
334
on days 1-3, lochia is
rubra - dark red
335
at birth, lochia is
bright red
336
we expect ____ of blood loss before we become concerned
~500 mL
337
during labor, CO will ____ and will return to pre-labor values within ____
increase; 1 hour
338
Cardiac output will return to pre-pregnancy levels by
6-12 weeks
339
how does plasma volume return to normal pre-pregnancy levels?
diuresis and diaphoresis
340
WBC will return to normal levels within ___
6 days
341
coagulation risk is increased for _____ weeks postpartum
4-6
342
first spontaneous bowel movement may not be for ____ after birth
2-3 days
343
normal bowel pattern returns ____ days after birth
8-14
344
flatulence is common postpartum, especially for ___
c-section patients
345
if fundus is higher than expected on palpation and is not midline, we would suspect
bladder distention
346
diastasis recti usually resolves within
6 weeks
347
spinal headaches are usually relieved by which position?
supine
348
the first few menstrual cycles for lactating and non-lactating patients are often
anovulatory
349
immediate postpartum weight loss is ____ lbs d/t fetus, fluids, and blood
10-12 lbs
350
an additional 9 lbs is lost in the first 2 weeks d/t
fluid loss
351
adipose tissue gained during pregnancy can take how long to lose?
6-12 months
352
postpartum assessment schedul
q15 minutes for 1 hour
q30 minutes for 1 hour
q1h for 2 hours
q4h for 24 hours (c/s)
q8h for 24 hours (NSVD and c/s after 24 hours)
353
the 7Bs + E are
Brain
Breast
Belly
Bladder
Bowel
Bottom
Blood
Extremities
354
Brain assessment is looking at ___ status
emotional
355
when assessing Breast, a "lump" may indicate
various lobes beginning to produce milk
356
the two main things to assess for Belly are
incision and uterus
357
if the uterus is soft and "boggy" we ___
perform a fundal massage
358
we want to monitor ____ in Bladder assessment
(1) first 2-3 voids
(2) signs of distended bladder
359
typically 300-400 mL void indicates ___
bladder has been emptied
360
name 3 things we can do to care for Bottom during postpartum?
change pads, ice for comfort, topical agents
361
we want to assess the ___, ___, and ___ in postpartum blood
amount, type, odor
362
constipation in postpartum may cause
hemorrhoids
363
DTR should be ____ or ___ in postpartum
1+ or 2+
364
in Extremities assessment, we are looking for
(1) varicosities
(2) s/s of thrombophlebitis
(3) edema
(4) DTR
365
first 12 hours, sitz bath should have ___ water
cool
366
stitches will __ in the perineum
dissolve
367
the 6 warning signs to call a provider in postpartum are:
(1) severe mood changes
(2) concerns for infection
(3) heavy bleeding
(4) high blood pressure
(5) increase in swelling (edema)
(6) shortness of breath
368
nothing is recommended in the vagina for ___ following birth
6 weeks
369
which type of birth control are NOT recommended in postpartum?
CHCs
370
Which treatment for postpartum hemorrhage has the slowest onset of action?
a. methergine
b. oxytocin
c. cytotec
d. hemabate
C
371
primary concerns with uterine tachysystole
decreased fetal oxygenation, maternal exhaustion, uterine rupture
372
Trendelenburg position is associated with what condition?
cord prolapse
373
which maternal condition is most commonly associated with polyhydramnios?
a. gestational HTN
b. gestational diabetes
c. preeclampsia
d. fetal growth restriction
B
374
What is the typical timeline for the uterus to return to its pre-pregnancy size?
6 weeks
375
a patient experiencing hypotonic labor would have ____ type of contractions
frequent but weak
376
prolonged labor, precipitous labor, and fetal macrosomia are all risk factors for ____
postpartum hemorrhage
377
Which intervention is most effective in promoting fetal rotation from occiput posterior to occiput anterior?
hands-and-knees position
378
Which of the following interventions may help correct fetal malposition (e.g., occiput posterior)? (Select all that apply.)
a. hands-and-knees position
b. peanut ball between legs
c. encourage side-lying position
d. continuous supine position
A, B, C
