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Health and Illness 324 > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

What is placental previa? Types?

A

placenta abnormally implants in lower uterine segment near or over cervical oss

Complete/total
incomplete/partial
marginal/low laying

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2
Q

What is the danger with marginal placental previa?

A

if the cervix opens even slightly bright red bleeding may occur

impaired circulation of the part over the cervix once it opens due to the villi no longer being able to circulate

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3
Q

What is the treatment for placenta previa?

A

often just needs monitoring at the beginning
as the fetus develops and everything is in close proximity the placenta may look low lying but as the uterus continues to grow the placenta should be attaching to the fundus

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4
Q

What are the risk factors of placenta previa?

A

previous placenta previa

uterine scarring from previous C-sections, curettage, endometriosis

maternal age >35

multiple gestation and multiparity

closely spaced pregnancies

smoking or cocaine use

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5
Q

What are the clinical manifestations of placenta previa?

A

painless
bright red vaginal bleeding during 2nd or 3rd trimester
soft, relaxed, nontender uterus
fundal height>for gestational age
fetus in breech, oblique, or transverse position
VS will be normal while the cervix is not dilated

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6
Q

What is the Kleihauer-betke test? What is it used for?

A

detects fetal blood in maternal circulation for any potential active bleeding

placenta previa and placenta abruptio

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7
Q

What are nursing interventions for placenta previa?

A

cannot have vaginal birth d/t placenta being in front of uterus

assess for bleeding, contractions, and fetal wellbeing

refrain from inserting anything enter the vagina (including vaginal exams) to decrease risk of cervix dilation

recommend bed rest

administer betametasone if pregnancy <37 wks (preterm)

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8
Q

What is betametasone?

A

a drug that will help fetal lung development by helping surfactant development

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9
Q

What is placenta abruptio?

A

premature separation of placenta from uterus when >20wks which can be complete or incomplete

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10
Q

What can placenta abruptio cause?

A

maternal death (leading cause)

fetal: low birth weight, preterm delivery, asphyxia, stillbirth, perinatal death

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11
Q

What are the risk factors for placenta abruptio?

A

maternal HTN, preeclampsia
blunt external trauma to abdomen
cocaine and cigarette (vasoconstriction)
previous abruptio placenta
PROM
multiple gestation, multifetal
IUGR

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12
Q

What are the clinical manifestations of placenta abruptio?

A

sudden onset of intense localized uterine pain
dark red bleeding (if it’s present it will cause the pain)
firm, tender abdomen
uterus boardlike
contractions with hypertonicitiy
fetal distress (decreased fetal mvt)
hypovolemic shock

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13
Q

What are nursing interventions for placenta abruptio?

A

immediate birth
continuous fetal monitoring

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14
Q

What is ectopic pregnancy?

A

abnormal implantation outside the uterine cavity
locations can include: ovary, intestine, cervix, abdomen, fallopian tube (can cause fatal hemorrhage if ruptures)

second most frequent cause of bleeding
leading cause of infertility

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15
Q

What are the clinical manifestations of ectopic pregnancy?

A

lower-abdominal quadrant unilateral stabbing pain and tenderness (usually starts as dull pain and progresses into colicky, then sharp and stabbing, then diffuse)

delayed, lighter than usual, or irregular menses

scant, dark red or brown vaginal spotting, 6-8wks after LMP or red, vaginal bleeding if ruptured

referred shoulder pain d/t rupture and increase of blood in peritoneal cavity irritating diaphragm or phrenic nerve

s/s of shock and hemorrhage (hypotension, pallor, tachy)

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16
Q

What are the risk factors of ectopic pregnancy?

A

STI (gonorrhea/chlamydia)
assisted reproductive technologies
tubal surgery
have or using an IUD

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17
Q

What do the labs show during ectopic pregnancy?

A

decrease of progesterone and hCG

hCG is drawn every 48 hrs to determine viable pregnancy

progesterone >25 nanograms of millimeters almost always rule out ectopic or abnormal pregnancy

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18
Q

How is ectopic pregnancy managed if a rupture has not occurred?

A

methotrexate to dissolve the embryo

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19
Q

What are the nursing considerations for methotrexate?

A

the metabolite that is broken down from methotrexate is considered toxic for 72 hrs (need to double flush, can be present in stool for up to 7 days)

avoid alcohol and vitamins containing folic acid which can cause a toxic reaction to medication

avoid sun exposure

avoid gas forming foods

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20
Q

What is spontaneous abortion? Types?

A

pregnancy terminated before 20 wks or fetal weight<500g

types are classified by manifestations and if products of conception are partially or completely retained or expelled
threatened, inevitable, incomplete, complete

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21
Q

What is threatened spontaneous abortion? Clinical manifestations? Management?

A

cervix is not dilated, placenta still attached to uterine wall

cramping/backache, vaginal bleeding

bedrest

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22
Q

What is inevitable spontaneous abortion? Clinical manifestation? Management?

A

cervix dilated, placental separation from uterine wall

craping and moderate bleeding, membranes may rupture

if infection also present then a medical abortion will be performed

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23
Q

What is incomplete spontaneous abortion? Clinical manifestation? Management?

A

embryo or fetus are passed but the placenta remains in uterus

profuse bleeding and extensive cramping, cervix obviously dilated, hemorrhage

curettage of the remaining placenta to avoid any further complications

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24
Q

What diagnostics are done for spontaneous abortion?

A

labs: hCG, CBC, US (to determine what is still in uterus and if viable)
FHB

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25
What nursing education will be given for spontaneous abortion?
Heavy, bright red vaginal bleeding; elevated temperature; or foul-smelling vaginal discharge Expect a small amount of vaginal discharge for 1-2 weeks Take RX antibiotics, pain meds, or other meds for nausea Medications to aid expulsion of products of conception (Misoprostol: stimulate uterine contraction and Mifestopristone: stimulate uterine contraction and promotes endometrium to slough) Avoid tub baths, sexual intercourse, no tampons for 2 weeks
26
What is the ideal BG level during pregnancy? Ideal A1C?
70-110 <6
27
What changes to BG control occurs during pregnancy?
unable to respond to demands of pregnancy, especially in the third trimester insulin resistance increases to provide more nutrients to fetus become hyperglycemic and damage to vascularization
28
What risk are there to the fetus with maternal diabetes?
spontaneous abortion high risk of birth defects polyhydraminos ketoacidosis
29
What changes to the fetus can happen with hyperglycemia?
macrosomia difficult birth (shoulder dystocia) fetal demise birth defects
30
What is hyperemesis gravidarum? Possible causes?
prolonged excessive nausea and vomiting occuring >20 wks elevated hCG during early 3rd trimester
31
What labs are done for hyperemesis gravidarum?
urinalysis (ketones and acetone, elevated urine specific gravity) chemistry (metabolic acidosis (starvation) metabolic alkalosis (excessive vomiting), elevated liver enzymes, biliruben) thyroid (hyperthyroidism) CBC (hct elevation)
32
What is gestational trophoblastic disease? Types of growth? How are the types determined?
proliferation and degeneration of trophoblastic villi in placenta, the embryo will fail to develop (non-viable) complete mole, partial mole chromosomal analysis
33
What is complete mole GTD? Clinical manifestations?
no genetic material develops from an "empty egg" fertilized by normal sperm 46 chromosomes hmeorrhage into uterine cavity resulting in dark brown or bright red vaginal bleeding anemia preeclampsia hyperemesis gravidum uterus larger than expected for wk 20% progress to choriocarcinoma
34
What is partial mole GTD? Clinical manifestations?
two sperm fertilize ovum - 69 chromosomes contains abnormal embryonic or fetal parts, an amniotic sac, and fetal blood small or normal size uterus for dates vaginal bleeding hypermesis gravidarum 6% progress to choriocarcinoma
35
What is preterm PROM? Management?
premature rupture of membranes occurring <37 weeks with a great concern for infection and preterm birth induce labor at 34 wks if benefit over risk
36
What tests are done to rule in ROM?
amnisure: swabbing looking for fetal fibronectin nitrazine: nitrazine paper should turn blue to indicate rupture (done in addition to other tests) fern: swab amniotic fluid and smear on glass slide, when it dries it'll look like a boston fern sterile speculum exam: speculum inserted and fluid will flow out US: views amniotic fluid index
37
What is preterm labor?
contractions that causes cervical change before 37th wk
38
What is cervical insufficiency? Treatment?
premature cervical dilation that can cause preterm labor prevent cervix from dilating and loss of pregnancy with prophylactic cervical cerclage
39
What is prophylactic cervical cerclage? Nursing education? Postoperative monitoring?
surgical reinforcement of cervix to prevent premature cervical dilation done 12-14wks and removed at 37wks or spontaneous labor no heavy lifting and no not insert anything into vagina uterine contractions, ROM, signs of infection
40
What are the types of HTN?
chronic, gestational, preeclampsia, eclampsia, chronic HTN with superimposed preeclampsia
41
What is chronic HTN? Nursing management?
existing HTN prior to pregnancy or before 20th wk or persistence >12 wk postpartum frequent antepartial visits, monitor for abruptio placenta, preeclampsia, daily rest periods, home BP monitoring, close monitoring during labor, birth, and postpartum
42
What is gestational HTN?
BP >140/90mmHg occurring after 20 wks w/o proteinura, BP will return to normal by 12 wk postpartum may develop into preeclamsia and eclampsia
43
What screening is done for gestational HTN at every prenatal visit?
weight bp edema - orbital edema proteinuria headaches (progressive that does not resolve with interventions) blurred vision urine retention epigastric pain
44
What is preeclampsia?
HTN with proteinuria (at least 300mg in 24hrs) that effects multiple systems and can be mild or severe depending on amount of organ involvement
45
What are maternal risk factors for preeclampsia?
high BMI previous preeclampsia multiple gestations DM, chronic HTN, renal disease family hx pregnancies resulting from insemination younger than 19yr and older than 40
46
What are the effects of preeclampsia to CV system?
vasoconstriction and vasospasm: reduced renal perfusion and GFR (edema), reduced placental perfusion, IUGR
47
What are clinical manifestations of preelampsia?
increased BP visual changes: blurred and/or scotma epigastric/RUQ pain (d/t liver involvement) jaundice N/V bleeding gums headaches edema decreased urinary output and proteinuria fetal impact
48
What is fetal impact?
poor placental perfusion and prolonged vasonctriction resulting in: IUGR, placenta abruptio, presistent fetal hypoxia and acidosis
49
What is management for mild preeclampsia?
bedrest daily BP monitoring fetal movement counts hospitalization and IV Mg sulfate during labor
50
What is management of severe preeclampsia?
goal: stabilize and prepare for birth treat aggressively control HTN prevent seizures bedrest - left lateral position prevent maternal and fetus death birth is the only "cure" while in labor: Mg sulfate and oxytocin antepartum: antiHTN medications, Mg sulfate
51
What are the differences between mild and severe preeclamspia?
mild: >140/90, proteinuria: 300mg/24hr severe: 160/110, proteinuria>500mg/24hr
52
What are clinical manifestations of severe preeclampsia?
hyperreflexia Oliguria Elevated serum creatinine greater than 1.1 mg/dL Cerebral or visual disturbances (H/A, blurred vision, blind spots) Pulmonary or cardiac involvement (pulmonary edema) Extensive peripheral edema Hepatic dysfunction (epigastric and RUQ pain) Thromocytopenia (platelet count <100,000 platelets/mm) HELLP syndrome
53
What is eclampsia?
preelampsia with seizures
54
What is an eclamptic seizure?
life threatening event convulsive activity begins with facial twitching, followed by generalized muscle rigidity apnea during seizure compromises fetal oxygenation
55
What is the management for eclampsia?
maintain open airway and remove secretions increase placental perfusion by lying on left side Mg sufate drip that continues until 48hr postpartum after stabilization continue monitoring or prepare for delivery either IOL or C section
56
What are clinical manifestations of eclampsia?
seizure activity preceded by headache severe epigastric pain hyperrelexia bp>160/110 proteinuria genearlized edema cerebral hemorrhage renail failure HELLP
57
What is assessed during labor?
cervical changes: ripening, effacement (100%=paper thin), dilation (0-10cm) station contractions
58
What is station?
level of the presenting part in relation to the ischial spines measured in cm above and below ischial spines ischial spines are 0 station = engagement above the spines are negative, below the spines are positive floating = when presenting part is entirely out of pelvis and freely moveable in inlet
59
How do contractions present during labor?
latent: onset of labor, irregular, palpate mild to moderate, 5 to 30 min apart lasting 30 to 45 sec active: become regular, palpate moderate to strong, 3 to 5 min apart lasting 40 to 70 sec (cervical changes will occur here) transition: very intense, palpate strong to very strong, 2 to 3 min apart lasting 45 to 90 sec
60
What is fetal attitude? What fetal attitude is optimal for birth?
degree of flexion or extension of fetal head in cephalic presentation vertex: most common and normal presentation, fetal dimension is smallest, chin tucked to chest, body curled into ball
61
What is baseline FHR?
average over 10 minutes, rounded to nearest 5 bpm
62
What is variability FHR?
beat to beat fluctuations in baseline FHR that are irregular in amplitude and frequency, should be 6-25bpm
63
What is acceleration FHR?
transient increase in FHR from baseline rise of >15bpm lasting >15sec (at >32 wks) strong predictor of adequate fetal oxygenation and acid-base status
64
What is early deceleration? Cause? Interpretation? Interventions?
category 1 uniform, gradual decrease and return to baseline onset, nadir, and recovery from deceleration show an inverse relationship with beginning, peak, and ending of uterine contraction cause: head compression causing vagal stimulation as it pushes through pelvis no intervention needed, continue monitoring, good indication of movement of fetus through labor
65
What is variable deceleration? Cause? Interpretation? Interventions?
category 2 abrupt decrease in FHR from baseline independent of contraction shape is usually V or W, varies cause = umbilical cord compression d/t loss of amniotic fluid indeterminant: not predictive of abnormal fetal acid-base status nursing intervention: reposition patient, evaluation and continue monitoring
66
What is late deceleration? Cause? Interpretation? Intervention?
category 3 uniform shape in FHR late in timing with nadir occurring after peak of uterine contraction, at the peak of contraction there is vasoconstriction cause: uteroplacental insufficiency (decreased blood/oxygen supply to fetus during uterine contraction d/t maternal hypotension, placental previa, placenta abruption, uterine hyperstimulation w/ oxytocin, preeclampsia, DM, post term) reflects decreased oxygenation to fetus causing it to become acidotic nursing intervention: change position to left lateral side lying, fluid bolus, d/c oxytocin, O2, prepare for vaginal birth or C-section
67
What is nadir?
lower point of FHR at the peak of uterine contraction
68
What is prolonged deceleration? Cause? Nursing intervention?
visually apparent FHR decrease below baseline, decrease of 15bpm or more lasting 2 minutes or more with less than 10 min from onset to return to baseline causes: uteroplacental insufficiency, umbilical cord prolapse, maternal hypotension, fetal congenital heart block, anesthetic medications nursing intervention: d/c oxytocin, side-lying positon, O2, tocolytic meds
69
What are the phases of labor?
first stage: 0cm to complete cervical dilation (10cm), true labor, longest of all stages, phases: latent (longest, cervix variable dilation) and active (steady cervical changes) second stage: cervix 10cm dilation to birth of fetus, phases: latent (individual may not perceive need to bear down, contraction pattern may be spread out) and active (individual will be bearing down, Ferguson's reflex (cervix and upper portion of vagina begin getting sensation of pressure, can cause spontaneous breath holding) third stage: birth to placental separation, passive process (pt will not need to bear down), placental separation and expulsion fourth stage: 1 to 4 hours antepartum
70
What are some non-pharmacologic interventions for labor pain relief?
sacral counterpressure (to aid in backpain d/t fetal back is pushing against maternal back) massage therapeutic touch heat and cold relaxation imagery effleurage: rubbing in purposeful motion acupuncture hypnosis biofeedback
71
What are systemic analgesics used for? Examples? Side effects?
relief of moderate to severe pain morphine, fentanyl, butorphanol n/v puritus, respiratory depression, maternal hypotension, if given too close to time of birth fetus will have to use its liver to breakdown the narcotic which could send it into respiratory distress
72
What is epidural block?
continuous infusion or intermittent injection usually started when dilation >5cm to not slow labor down
73
What is a pudendal block?
intrathecal analgesia usually for 2nd stage, episiotomy, or operative vaginal birth placed into pudendal nerve bilaterally to block pain to cervix and bladder
74
What are neuraxial analgesia technique? Side effects? Nursing interventions? Advantages?
use of analgesic continuously or intermittently into epidural or intrathecal space antiemetic (used in combo with opioids to decreasee n/v), respiratory depression, maternal hypotension nursing intervention: safety (fall risk), assess for n/v, monitor maternal vital signs and allergic response advantages: usually safe and effective pain relief, sometimes speeds labor
75
How is an epidural block monitored?
administer IV fluid bolus to prevent hypotension before give block (as long as no preeclampsia) monitor maternal hypotension and respiratory depression assist with position (left-lateral side lying) coach patient on pushing efforts assess for bladder distention monitor sensation and motor control
76
What is spinal blood patch?
treatment done to counter act complications of epidural block uses blood to stop the leaking of CSF through dural holes
77
What is spontaneous rupture of membranes? Nursing intervention?
can occur at any time but most likely during transition, spontaneous labor will occur in majority of women within 24 hours (if it takes too long there can be complications and infection) first priority is to listen to FHR for decelerations
78
How is spontaneous rupture of membranes assessed?
watery, clear, pale (put down white towel to see if there's any discolorations and if it's green could be meconium (an indication of fetal distress)) no foul odor volume:500-1200mL nitrazine to confirm it is alkaline (turns dark blue, if it turns yellow it could be acidic) amnisure and/or ferning test
79
What is bishop score? Indications? What scores would indicate ready for induction for multiparous and nulliparous?
evaluation of cervix to determine readiness for induction based on cervical exam any medical condition that threatens well-being multiparous (had multigestations) >8 nulliparous: 10
80
What is cervical ripening?
ripening gets cervix ready for labor by softening, dilation, and effacement
81
What are nonpharmacologic methods for cervical ripening?
herbal agents: primrose oil, black haw, black and blue cohosh, red raspberry leaves, caster oil sexual intercourse with breast stimulation: natural prostaglandins promote release of oxytocin
82
What is trial of labor? Indications? Contraindications?
ability to have a vaginal birth after previous cesarean section indication: low transverse uterine incision, no other uterine scars or hx of previous rupture, adequate pelvis contraindication: large for gestational age, malpresentation, cephalopelvic disporportion, previous classical vertical uterine incision, previous transfundal uterine surgery (myomectomy), cervical ripening agents are contraindicated due to increase chance of uterine rupture
83
What are indications for artificial rupture of amniotic membranes? Nursing interventions?
slow labor progression induction of labor vertex and engaged amnioinfusion needed for cord compression monitor FHR prior to an immediately following AROM assess color, odor, consistency of fluid temperature Q2H comfort measures for leaking of fluid
84
What are nursing interventions for cord prolapse?
an emergency call for help immediately and notify provicer lift presenting part away from cord to relieve pressure on cord change patient position to knee-chest cover cord with warm, sterile saline soaked gauze O2, IV fluid bolus prepare for immediate birth
85
What is shoulder dystocia? What are the signs? What can it cause?
an emergency where the fetal neck is compressed by maternal pelvis d/t shoulders being wider than head delayed fetal descent, turtling (when the pregnant person pushes the fetus moves but when the pregnant person relaxes the fetus moves back) fetal anoxia, asphyxia, increased ICP and brain damage (5min = hypoxemia and acidosis, 6min or more = permanent brain and organ damage),
86
What are the types of perineal lacerations?
first degree: skin of perineum second degree: skin and muscles into perineum third degree: skin, muscles, perineum, extrenal anal sphincter muscle fourth degree: skin, muscles, anal sphincter, anterior rectal wall
87
What are indications for assisted birth?
postterm fetus >42wks preelcampsia/eclampsia prolonged rupture of membranes >24hrs maternal medical conditions (Rh-isoimmunization, DM, pulmonary, cardiac, or renal disease, gestational HTN) fetal demise chorioamnnionitis hx of precipitous labor or how far the pt lives from hospital
88
What nursing cares are done during the first stage of labor?
ask about childbirth plan check lab results/special tests previously done complete physical assessment: fundal height, uterine activity, status of membranes, cervical dilation, contraction, effacement, FHR, position, station, pain orient to room orient to pain management what changes to expect vaginal examination encourage ambulation, position changes, and support from support person
89
What nursing cares are done during the second stage of labor
assessment: contraction (frequency, duration, intensity), maternal VS (coping), FHT, amniotic fluid status (color, volume), support of partner, watch for bulging perineum = fetal head ready to crown interventions: continuous support, set up birthing equipment, prepare for neonatal resuscitation, assist with birth, provide immediate care of newborn, as crowning occurs put warm compress for support with slight resistance to avoid sheering force on perineum and make the process smooth and gentle to avoid perineal trauma
90
What nursing cares are done during the third stage of labor?
assess: placental separation, fundal massage (after placenta is expelled to ensure bleeding is controlled), examine placenta to ensure it is all there, determine est. blood loss, exam of placenta and fetal membranes, perineal lacerations, explaining/performing assessments of mother and neonate interventions: placing neonate on mom's chest, establish breastfeeding within first hr of birth, provide warmth, give oxytocin, assist women into comfortable position, care for perineum (cleaning and ice), cord management (assess for vessels, obtain cord blood)
91
What are the ways of pushing?
directed pushing: interferes with o2 exchange between mother and fetus d/t forced bearing down and compression, can lead to damage to pelvic floor and maternal exhaustion, closed glottis (deep breath and hold for 10s, repeat 3-4x each contraction) spontaneous pushing: recommended, urge to bear down and use own breathing pattern (become in tune with ferguson's reflex), open glottis (instinctively hold breath as needed for about 6s while bearing down), more sense of control
92
What are three signs of placental separation
umbilical cord lengthens fundus rises in abdomen (uterus becomes more firm and globular) bleeding may increase
93
Why and when is pitocin given?
aids uterine contraction after placenta is expelled given right after fetal birth to allow for it start working after placenta is expelled
94
Why is newborn placed on chest right after birth?
increases secretion of oxytocin ensures warmth of fetus
95
What is nifedipine?
tocolytic (relax uterine muscle) for preterm labor, very commonly used worried about hypotension
96
What is magnesium sulfate? Side effects? Signs of toxicity?
tocolytic (relax uterine muscle) for preterm labor facial flushing, fatigue, hypotension need to monitor for toxicity: depressed respiratory rate, decreased urinary output, pulmonary edema
97
What is hypertonic uterus? When does it occur?
uterus never fully relaxes could compromise the fetus, contractions are excessively frequent, uncoordinated, strong intensity rarely occurs due to spontaneous labor artifical prostaglandins things done to induce labor
98
How do you count number contractions on a strip?
start at the beginning of contraction and end of the second
99
What are risk factors of using chemical ripening agents for cervix?
fetal distress, fetal tachy systole
100
What is induction versus augmentation?
induction: stimulating contractions via medical or surgical means, initiated d/t medical complications augmentation: enhancing ineffective contractions after labor has begun (ex/ AROM)

Health and Illness 324 (5 decks)

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