Exam Number 1 Study Guide Flashcards
1
Q
Nagele’s Rule
A
LMP - 3 months + 7 days
2
Q
Presumptive signs of pregnancy
A
amenorrhea nausea/vomiting fatigue urinary frequency breast changes quickening
3
Q
Probable signs of pregnancy
A
Changes in pelvic organs/vascular congestion Abdominal enlargement Braxton hicks contractions Skin pigmentation changes Uterine soufflé Fetal outline Pregnancy test Ballottement (sharp push against uterine wall)
4
Q
Positive/diagnostic signs of pregnancy
A
FHT
Fetal movement
Visualization in ultrasound
5
Q
purpose of hCG in pregnancy
A
maintains corpus luteum, maintains pregnancy until placenta is developed
6
Q
hPL in pregnancy
A
antagonist to insulin, breaks down fats to feed baby
7
Q
estrogen in pregancny
A
stimulates uterine development, develops ductal system in breast
8
Q
progesterone in pregnancy
A
secreted until placental production is sufficient, maintains pregnancy, develops acini and lobes of breast
9
Q
relaxin
A
inhibits uterine activity, relaxes pelvic ligaments
10
Q
vaccines in pregnancy
A
no attenuted live viruses due to possible teratogenic effects.
pertussis vacc in third trimester
11
Q
first trimester screenings
A
ultrasound for nuchal translucency
12
Q
second trimester screenings (6)
A
gestational diabetes HGB and HCT Amnio if advanced maternal age US Rhogam Vaccinate for pertussis (third)
13
Q
Third trimester
A
strep b
14
Q
Chadwick’s sign
A
bluish coloring of cervix
15
Q
Goodell’s sign
A
softening of cervix
16
Q
respiratory changes in pregnancy
A
thoracic breathing
nasal stuffiness
17
Q
CV changes in pregnancy
A
blood volume increases, pulse increases 10-15 BPM, BP decreases slightly
18
Q
skin and hair changes in pregnancy
A
Linea nigra, hyperactive sweat and sebaceous glands, significant hair shedding
19
Q
Metabolic changes in pregnancy
A
Gain of 25-35 points, water retention, need for carbs increases in 2nd and 3rd trimester
20
Q
Additional calorie intake in pregnancy
A
300 kcal/day
21
Q
Protein intake in pregnancy
A
add 60g/day
22
Q
Micronutrient needs in pregnancy
A
increase calcium, iron, zinc, B12, D
23
Q
Recommended weight gain in pregnancy for normal, overweight, obese, and underweight mothers
A
Normal: 25-35lbs
overweight: 15-25 lbs
Obese: 11-20 lbs
Underweight: 28-40lbs
24
Q
Folic acid supplements in pregnancy
A
.4mg/day, >.4mg/day if previous child had neural tube defects
25
Frequency of contractions
determined from beginning of one contraction to the beginning of the next
26
FHR assessment frequency during second stage
q5-15 minutes
27
What types of fetal lie are there? Which is most favorable?
Longitudinal- most favorable and common
| Transverse- oblique and horizontal
28
Fetal presentation types
Cephalic: head. Occiput (best), brow
Breech: buttocks first
Shoulder
29
engagement
largest part of the presenting part reaches/passes through the pelvic inlet
30
station
where the presenting part is in relation to the ischial spines. From -3 to +3, with 0 being at the ischial spine.
31
Fetal position designation
R/L
O/M/S/A
A/P/T
32
effacement
thinning of the cervix
33
secondary force of labor
the use of the abdominal muscles
34
acme
peak of contraction
35
decrement
relaxation of a contraction
36
contractions are stimulated by
oxytocin
37
Cause of cervical dilation
fetal head pushing against cervix
38
lightening
indicates engagement, fetus settling into pelvic inlet. decreased SOB and increased urinary frequency
39
False labor pains
relieved by ambulation, bath, rest, mainly in lower abdomen and groin
40
4 Stages of labor
1. onset of labor -> full dilation
2. complete dilation -> birth
3. birth of newborn -> birth of placenta
4. delivery of placent -> 1-4 hrs PP, uterus contractions for bleeding control
41
First stage of labor latent phase
Beginning of regular contractions -> 4cm dilation
~8 hours nulliparous
~5 hours multiparous
42
First stage of labor active phase
4-> 7cm dilation, fetal descent. Cervical dilation 1.2-1.5cm/hour
43
First stage of labor transition phase: how long?
Cervical dilation from 8cm-> complete. 1 hour for multip, 3 hours for nullip.
44
Second stage of labor— description and length
Pushing phase- 10cm-> birth. 15 minutes multips, 2 hours for nullips. 3 Hours wth epidural.
45
Third stage of labor
30 minutes
Placenta separates.
Placenta examined after delivery for vessels and fetal (Schultze) and maternal (Duncan) sides to ensure no retained parts.
46
Fourth stage of labor
1-4 hrs after birth
250-500ml blood loss is normal, blood is redistributed
Fundus should be massaged and midway between SP and umbilicus.
BP lowered, tachy
47
Nursing interventions fourth stage of labor
Check lochia
Check UT firmness q15 x 4 hours
check for hemmorhoids
vital signs q5-15
48
Early decelerations FHR
normal, positive sign. Indicates head compression
49
Contraction pattern: latent phase
q10-30min -> q5-7
50
Contraction pattern: active phase
q2-5 -> q40-60s
51
Contraction pattern: transition phase
q1.5-2min, -> 60s-90s strong
52
FHR assessment intervals
first stage of labor: q30 min low risk, q15 minute high risk
2nd stage: q15 minutes low risk, q5 minutes high risk
Before or following AROM, ambulation, med administration, abnormal UC pattern, VE
53
FHR accelerations
Transient increase in FHR, sign of fetal well-being and oxygenation
54
Normal FHR
110-160 bpm
55
Baseline FHR
average rounded to increments of 5 BPM during a 10 minute period
56
absent FHR variability
no detectable amplitude
57
minimal FHR variability
detectable but less than 5 BPM
58
moderate FHR variability
6-25 BPM, normal
59
marked FHR variability
>25 bpm
60
best predictor for fetal compromise
reduced variability
61
late decelerations
uteroplacental insufficiency in bloodflow due to maternal hypo or hypertension, uterine tachysystole, diabetes, placental abruption- nonreassuring.
62
Interventions for late decelerations
continuous monitoring, immediate intervention
63
variable FHR decelerations
umbilical cord compression. Abrupt, V shaped decelerations.
64
Catergory I FHR
```
110-160 BPM
Moderate variability
No variable/late decels
Early decels may be present or absent
No action required
```
65
Category II FHR
```
Bradycardia or tachycardia
BSL changes in variability
No accels
Episodic decels or variable decels
Rx: evaluation, surveillance, reevaluation
```
66
Category III FHR
```
Absent variability
Recurrent late decels or variable decels
bradycardia
Sinusoidal FHR patterns— may be due to fetal anemia, infx, drug response, cardiac issues
Requires prompt eval, delivery ASAP
```
67
Fetal tachycardia
If accompanied by late decels, severe variable decels, decreased variability— ominous sign
If maternal fever, antipyretics/antibiotics.
68
interventions for late decels
```
L lateral position until FHR improves or stabilizes
increase fluids
O2 via mask 7-10LPM
Alert provider
Provide explanation and support
D/C oxytocin
Monitor BP and HR
Assess cervix
Prepare for possible C-section
doc interventions
```
69
Variable decels nursing intervention
Position changes to relieve pressure on cord
O2 7-10L/min
Notify provider
Possible amnioinfusion if oligohydramnios present or decels persist
possible c-section
explanation to woman & partner
70
interventions for prolonged decels
```
Vaginal examination for prolapsed cord
Change maternal position
D/C oxytocin
Notify provider
Support
Increase IV fluids
Administer tocolytic if tachysystole is occurring
Anticipate provider intervention
```
71
APGAR Scoring (5 variables)
HR >100
Respirations- good with crying
Tone- active extremity movement
reflex- cry, cough, sneeze, pulls away when touched
skin color- pink body and extremities (acrocyanosis=pink body with blue extremities)
≥7/10 indicates good condition
72
RR in newborn
30-60 RPM
73
Signs of imminent placental separation
Uterus rises upward in the abdomen
Umbilical cord lengthens
Sudden trickle or spurt of blood appears
Shape of uterus changes from disk to globe
74
What is administered after delivery of the placenta?
10-20units of IV pitocin, or 10 units IM
75
BP and pulse monitoring during 4th stage
monitored q5-10 minutes
76
Treating epidural hypotension
IV ephedrine, hydration (LR bolus prior to insertion and more for bradycardia). Maternal repositioning, 10L O2, leg elevation
77
Epidural nursing interventions
continuous fetal monitoring
IV infusion in place prior to epidural
Indwelling catheter if epidural in place for prolonged period
Assist mom in side lying or sitting for administration
78
Epidural documentation
"Black tip visualized"— ensure no part remains inside
79
Contraindications for an epidural
```
Coagulation deficiencies
Hx of back injuries, back surgery
Allergies
Skin issues at epidural site
Obesity- may complicate insertion
```
80
General anesthesia
rarely used, except for emergency c-section
Fetal depression and maternal intubation issues, blood loss, vomiting/aspiration, amnesia. Prophylactic antacid therapy for mom
81
conception occurs ___ after LMP
2 weeks
82
ovaries during pregnancy
cease ovum production
hCG matains corpus luteum
secrete progesterone until placental production is sufficient
83
maternal O2 requirements increase by _____% a minute
30-40%
84
breathing becomes ____ during pregnancy
thoracic
85
Blood volume increases by up to ____ % by ___ weeks
50% by 34 weeks
86
pulses increase ______ bpm
10-15
87
BP is lowest in the ____ trimester
2nd
88
What causes N/V in pregnancy?
elevated hCG and altered carbohydrate metabolism
89
What causes bloating and constipation in pregnancy?
delayed gastric emptying, decreased peristalsis due to progesterone
90
BMR increases by
20-25%
91
GPTPAL
gravida: # pregnancies
parity: # babies >20 weeks
T= term infants
P= infants from 20 weeks -> 36.6 weeks
A= number of pregnancies ending in spontaneous or induced abortions
L= number of current living children
92
Fundal height measurement: how is it done and when?
Tape measure measures from symphysis pubis to top of uterus. Used after 22 weeks to assess grown.
93
When does quickening occur?
between 16-22 weeks
94
When can fetal heart tones be detected?
between 8-12 weeks
95
When can US detect gestational sac?
4-5 weeks
96
Women with abnormal screening results are offered:
genetic counseling, CVS, and amniocentesis
97
Gestational diabetes screening is done when?
between 24 and 28 weeks
98
Second trimester nursing interventions
administer RhoGam
| Educate on pertussus, administer vaccine each pregnancy.
99
Vegan diets during pregnancy require a supplement of ____
4mg of B12, along with calcium and vitamin D if no soy milk is consumed.
100
Danger signs of pregnancy (12)
```
Gush of fluid from vagina
Vaginal bleeding
Abdominal pain
Fever about 38.3°C with chills
dizziness, blurred vision, seeing spots
persistent vomiting
Edema
Muscular irritability, convulsions
Epigastric pain
Oliguria
Dysuria
Absence of fetal movement
```
101
Frequency of PNC visits
Every 4 weeks for the first 28 weeks
Ever 2 weeks until 36 weeks
Weekly from 36-40 weeks
Biweekly with NST after 40 weeks
102
Frequency of fetal kicks
10x/hour is normal. Call provider if <10 movements within 3 hours
103
Amniotic fluid index. Normal amount?
Indicator of how much fluid is present. 5-20 cm is normal
104
quad screen
for AFP, hCG, UE and inhibin A (chromosomal disorders)— abnormal results lead to an amniocentesis. Occurs during second trimester
105
How often to check uterine firmness in the fourth stage of labor
q15 for the first 4 hours
106
Normal blood loss in 4th stage of childbirth
250-500mL
107
Mechanisms of birth
```
Descent
Engagement
Flexion
Internal rotation
Extension
Restitution
External rotation
Expuulsion
```
108
Vital sign checks during the latent stage
Q1 vitals
| Q4 temp
109
UC and FHR checks during latent stage
q30min
110
How often do you palpate UCs during the transition phase?
Q15 min
111
Labor support during childbirth reduces...
```
Use of pain meds
Operative delivery
Length of labor
Low Apgar scores
PP Depression
Breastfeeding failure
```
112
BP and pulse monitoring frequency in the 4th stage
q5-15
113
When can an epidural be started?
As soon as active labor is established
114
ova are fertile for ___ hours
12-24
115
sperm are fertile for ___ hours
72
116
nidation
implantation— occurs 7-10 days after fertilzation
117
maternal portion of the placenta
decidua
118
fetal portion of the placenta
chorionic villi
119
when can fetal heart tones be heard?
12 weeks
120
when does spontaneous movement occur?
12 weeks
121
when is fetal movement felt by mother?
20 weeks (earlier if you are multiparous)
122
when is considered full term?
38 weeks
123
when do alveoli begin to form?
24 weeks
124
when does the heart first begin to beat?
4 weeks
125
Most significant time in the development of organs and main external features
embryonic period 15 days-8 weeks
