FInal Flashcards
(118 cards)
1
Q
Most common cause of postpartum hemorrhage
A
uterine atony
massage the fundus!
2
Q
Medical mgmt of uterine atony
A
- massage uterus
- eliminate bladder distention
- continuous IV infusion of pitocin
3
Q
most common symptom of uterine rupture
A
abdominal pain or hemorrhage; possible shock
4
Q
S/sx of hemorrhage and hypovolemic shock
A
respirations-rapid, shallow
pulses-rapid, weak
skin color, temp, turgor- pale, cool, clammy
LOC-lethargic, coma
capillary refill- prolonged
monitor pulse ox and urinary output
look for presence of anxiety, restlessness, disorientation
5
Q
where should the fundus be after birth?
A
at or near the umbilicus
6
Q
when may a pt start showing signs of shock?
A
when 30-40% of blood volume lost
7
Q
HELLP syndrome
A
Hemolysis, Elevated Liver enzymes, and Low Platelets
hemolysis=destruction of RBCs
8
Q
von Willibrand disease
A
type of hemophilia, factor VIII deficiency. Woman may be at risk up to 4 weeks after delivery
9
Q
Early signs of respiratory distress in the newborn
A
nasal flaring
grunting
tachypnea
increasing respiratory effort (retractions)
10
Q
Priority nursing dx for preterm neonate
A
Impaired Gas Exchange
Impaired Thermoregulation
Risk for Infection
Altered Nutrition r/t poor suck/swallow reflexes
11
Q
complications that can occur in the LGA infant
A
high incidence of birth injuries, asphyxia (deprived of oxygen), congenital anomalies, heart defects, hypoglycemia, risk for morbidity (more than SGA)
12
Q
NSG interventions for LGA infant
A
careful monitoring in labor and need to be prepared for C/S
13
Q
Tx for preterm labor
A
bed rest
Risks with bed rest:
decreased muscle tone, weight loss, calcium loss, glucose intolerance, constipation, fatigue, isolation, anxiety & depression
14
Q
Pharmacologic mgmt of preterm labor
A
Tocolytics: medications used to suppress uterine activity
15
Q
What are the best reasons to use tocolytic therapy?
A
to allow for the use of antenatal glucocorticoids to accelerate fetal lung maturity and to allow time for maternal transport to facility with NICU
16
Q
Brethine and S/Es
A
tocolytic agent S/Es: Tachycardia hypotension SOB hyperglycemia tremors- you want them to feel shaky, this means it is working!
17
Q
Nsg interventions for Brethine
A
hold dose and notify MD if pulse over 120 bpm
assess lungs for signs of pulm edema
monitor electrolytes and glucose levels
18
Q
Magnesium Sulfate, S/Es, and NSG
A
tocolytic agent
S/Es: decreased DTRs and decreased BP
NSG: monitor BP, respirations, and DTRs
have Calcium gluconate readily available for mag toxicity (levels over 7)
19
Q
Indomethacin and NSG
A
tocolytic agent
NSG: may cause premature closure of DA in fetus, do not use with women with any potential for bleeding, monitor for postpartum hemorrhage
20
Q
List the tocolytic agents
A
Brethine, Magnesium Sulfate, Indomethacin, Procardia
21
Q
NSG care for preterm labor
A
fluid restriction of 1500-2500mL, bed rest, monitor I&Os
22
Q
Dystocia
A
long, difficult, abnormal labor
23
Q
causes of dystocia
A
dysfunctional labor (ineffective uterine contractions) pelvic size fetal position & size maternal position in labor psychologic responses of mom to labor
24
Q
Risk factors for labor dystocia
A
Body build of mom: 30 or more lbs overweight, short stature uterine abnormalities malpresentation CPD over stimulation with pitocin maternal fatigue
25
Nurse Practice Act
individual states are responsible for legally determining the scope of practice for nurses
26
Scope of Practice
limits nursing practice set forth in state statutes
27
Standards of nursing care
establishes minimum criteria for competent, proficient delivery of nursing care
28
Recommendations for mammograms
every 1-2 years after age 40
| every year after age 50
29
S/sx of PMS
anxiety, cravings, depression, mood swings, difficulty sleeping, weight gain, bloating, breast tenderness, headache, hot flashes, acne
30
s/sx of endometriosis
dysmenorrhea, pain during intercourse, heavy menstrual bleeding
31
s/sx of endometrial hyperplasia
heavy menstrual bleeding, period longer than 21 days, bleeding after menopause
32
**Clinical manifestations of breast cancer**
| I'm pretty sure this was a select all that apply on a test!
- lump or thickening, swelling, asymmetry
- unilateral nipple discharge
- skin changes: dimpling, change in skin color or texutre (peau d'orange), retraction
33
Nurses role in assisting mother relinquishing infant
be the pt's advocate, acknowledge her grief, help her say goodbye, make her acknowledge the baby (get memory items for birth mother)
34
nurses role in assisting adopting parents
introducing the infant, promote bonding, safety, provide privacy, encourage new parents to hold infant close, educate
35
What are the 5 factors that affect L&D?
```
passenger (fetus and placenta)
passageway (birth canal)
powers (contractions)
position of the mother
psychologic response
```
36
Fetal lie
relationship of the longitudinal axis of the fetus to the longitudinal axis of the mother
37
fetal presentation
determined by the body part of the fetus that is the lowest in the mother's pelvis
38
fetal attitude
the relation of the fetal body parts to each other
| ex: flexed arms and legs, curved spine
39
fetal position
the relation of the presenting part to the four quadrants of the mother's pelvis (ROA, ROP, LOA, LOP, etc.)
40
fetal station
relation of the presenting part to the ischial spines of the maternal pelvis (0cm is even with ischial spines, +1, +2, etc are below the ischial spine)
41
Primary powers
involuntary uterine contractions that signal the beginning of labor
42
Ferguson reflex
maternal urge to bear down, causes release of endogenous oxytocin
43
secondary powers
voluntary bearing down efforts by mother
44
Signs of preceding labor
- Lightening- fetus has "dropped"
- Braxton Hicks contractions
- Bloody show- vaginal mucus becomes more profuse and may be brownish or blood tinged
- Cervix ripens (becomes soft)
- Some women state a burst of energy
45
First Stage of Labor
0cm-10cm dilation and 100% effacement
46
Transition phase of first stage of labor
8-10 cm dilation
47
Second Stage of Labor
10cm dilation and 100% effacement to delivery of baby
48
Third Stage of Labor
Placental separation
| -delivery of baby to delivery of placenta
49
Fourth Stage of Labor
Recovery
| -approx 1-4 hrs after delivery of the placenta
50
Latent phase
0-3cm dilation
51
Active phase
4-7cm dilation
52
Bearing-down efforts are best achieved by..?
open-glottis, grunting, don't hold breath longer than 5-7 seconds
53
When to notify the HCP for an antenatal patient:
- Contractions less than or equal to 10 minutes apart in one hour
- Persistent cramping or pelvic pressure for one hour
- spotting or leaking of fluid from the vagina
54
Recommended weight gain for antenatal pt
25-35lbs
1lb/month in 1st trimester
1lb/week in 2nd and 3rd trimesters
55
How many extra calories/day does the antenatal pt need?
300
56
How can fetal growth be assessed?
uterine evaluation, fetal heart tones, quickening (feeling fetus move), fundal height, US
57
how is fundal height measured?
from the top of the symphysis to the top of the uterus in centimeters and it should match your baby's gest. age within one to three cm
58
What is preeclampsia?
HTN and proteinuria after the 20th week of pregnancy
59
S/sx of mild preeclampsia
BP 140/90, proteinuria, absent/transient HA, irritability, placental perfusion reduced
60
S/sx of severe preeclampsia
BP 160/110 or more on 2 separate occasions, proteinuria, hyperreflexia (3+), ankle clonus, output 20mL/hr, severe HA, blurred vision, photophobia, blind spots, severe mood change, epigastric pain, serum creatinine increased, thrombocytopenia, decreased placental perfusion
61
eclampsia
seizure activity or coma in woman diagnosed with preeclampsia
62
what are two problems associated with preeclampsia?
main problem is poor perfusion. Others are restriction of fetal growth and placental abruption
63
Therapeutic ranges for mag sulfate
4-7.5mEq/L or 5-7mg/dL
64
s/sx of mag toxicity
```
*decreased DTRs
nausea
feeling of warmth
flushed
slurred speech
decreased LOC
resp depression
oliguria
muscle weakening
```
65
antidote to mag sulfate
calcium gluconate
66
3 things to monitor closely while pt on magnesium sulfate
BP, pulse, respirations
67
DOC for controlling BP for preeclamptic pt
IV hydralazine
68
what s/sx is eclampsia usually preceeded by?
headache, severe epigastric pain, and hyperreflexia
69
Immediate care of eclampsia
SAFETY
ensure patent airway
monitor fetus
watch for ROM during seizure
70
DOC for treating chronic HTN pt
Aldomet
71
What is placenta previa?
placenta implants in lower uterine segment near or over the internal cervical os
72
Clnical manifestations of placenta previa
* *PAINLESS uterine bleeding
- vaginal bleeding associated with uterine activity
- suspect if pt is bleeding after 20wks gestation
- vital signs may be normal- can lose up to 40% of blood volume before s/sx of shock
- no change in FHR unless significant blood loss
* Uterus relaxed, non tender and soft
73
Active mgmt of placenta previa
US to confirm dx
continuous fetal monitoring
If term- immediate C/S
observe for PP hemorrhage even if fundus firm
74
Expectant mgmt of placenta previa
- rest and close observation
* no vaginal exam until >34wks
* assess bleeding- pad count and weight
- may be hospitalized, anticipate need for immediate C/S
75
What is placental abruption?
detachment of all or part of the placenta from the implantation site
76
Clinical manifestations of placental abruption
* *abdominal PAIN
* vaginal bleeding
* port wine stained amniotic fluid
- abdomen hypertonic, rigid, board-like
- uterine tenderness
* abnormal FHR patterns or fetal death
- clotting defects (DIC)
77
When should the nurse suspect placental abruption?
with sudden onset of intense, usually localized uterine pain with or without vaginal bleeding
also look for increased fundal height- could indicate concealed bleeding
78
Tx for placental abruption
*maintain urine output >30mL/hr and Hct over or equal to 30%
Tx if mild-expectant care
if stable-vaginal delivery attempt, otherwise C/S
-Will require blood and fluid vol replacement
79
Presumptive signs of pregnancy
```
Amenorrhea
N/V
Urinary Frequency
Fatigue
Quickening
Breast Tenderness
```
80
Probable signs of pregnancy
```
Uterine enlargement
Pigmentation changes
Goodell's, Hegar's, and Chadwick's signs
Ballottement
Braxton Hicks
Positive Serum hCG test
```
81
Positive signs of pregnancy
Hearing FHT's
Palpating active fetal movements
Visualizing the fetus via ultrasound
See it, hear it, feel it!
82
Cardiovascular system changes that occur during pregnancy
- Pulse increases 10-15bpm (increased HR)
- Increased CO
- murmurs & arrhythmias
- BP should never increase!
- 2nd trimester BP decreases
- 3rd trimester edema and varicosities due to decreased blood flow to the legs r/t pressure of expanding uterus on vessels
- Blood volume increases 1500mL
- physiologic anema (plasma increases faster than number of RBCs)
- increased clotting factors so increased risk for clot
83
what newborn complications can occur in a woman diagnosed with gonorrhea?
neonatal conjunctivitis (aka opthalmia neonatorum), co-existing chlamydia infection, infection in embryonic sac, PID, salpingitis, PROM, preterm birth, IUGR, chorioamnionitis, neonatal sepsis, maternal PP sepsis, resp distress syndrome
84
s/sx of HPV
painless, flesh-colored cauliflower-like warts on vagina or cervix
85
topical meds for HPV
liquid nitrogen, cautery/laser/surgical excision
86
complications of abortion in first trimester
infection, bleeding, retained products of conception
87
most common birth injury
clavicle fracture
88
#1 Nsg dx for diaphragmatic hernia
Impaired Gas Exchange
89
Newborn relexes
rooting, sucking, palmar grasp, plantar flexion, tonic neck "fencing", Moro reflex, stepping, Babinski reflex
90
normal newborn stool
meconium first 12-24hrs, 3rd day transitional stools, 4th day milk stools
91
non-pharmacological interventions for the newborn experiencing pain
nonnutritive sucking, containment, and swaddling
92
two hormones associated with milk production
oxytocin and prolactin
93
X-linked Dominant disorders
all of the daughters and non of the sons of an AFFECTED MALE have the condition;
while both male and female offspring of an AFFECTED WOMAN have a 50% chance of inheriting and presenting with the condition
Ex's= VIt D resistance, Rickets, and Fragile X syndrome
94
X-linked Recessive disorders
If a male inherits this then he will express the condition
Males affected more than females bc he has only one X chromosome and all of the X's are affected
Any man who is affected will have carrier daughters
If a woman is a carrier, there is a 50% chance that her sons will be affected and a 50% chance that her daughters will be carriers
Ex's= hemophilia, color blindness, and Duchenne MD
95
the umbilical cord has ____ vessels
1 large vein, 2 small arteries
96
What is Wharton's jelly?
surrounds the 3 vessels of the umbilical cord to prevent compression
97
What is the purpose of the ductus arteriosus?
connects the pulmonary artery and descending aorta
used to bypass the non-functioning, fluid-filled lungs of the fetus
closes hours to days after birth
98
Alpha-fetoprotein test
screens for neural tube defects in pregnancy and can also test chromosomal abnormalities such as Down syndrome
99
Common Elements of IPV (intimate partner violence) **Was a select- all that apply!!
```
Economic deprivation (Financial)
Sexual Abuse (Sexual)
Intimidation (Psychological)
Isolation (Psychological
Stalking (Psychological)
Terrorizing the victims and their children (Emotional)
```
*The one I missed was economic!
100
Behaviors demonstrated by the batterer
- Low self-esteem, feeling powerless and ineffective
- Believe a woman's place is in the home; views women as objects
- Blame others for own actions
- Jealous
- Use drugs/alcohol to relieve stress
- Sex as act of aggression
- Believe battering should not have consequences
- Always ask for a second chance
- May seem charming to non-family members
- May abuse their children
- Unpredictable behavior
- Were likely abused themselves as children or witnessed abuse of loved one
101
Predictive demographics for IPV
young age, single, lower socioeconomic status, unplanned pregnancy
102
Interview questions to assess woman for potential abuse:
*previous test Q
Are you with a spouse or partner who threatens or physically hurts you?
Within the past year or in this pregnancy has anyone hit, slapped, or kicked you?
Has anyone forced you to have sexual activities that made you uncomfortable?
103
Insulin requirements for diabetic pt during pregnancy
- insulin requirements decreased during 1st trimester
| - increase during 2nd and 3rd trimesters
104
Good HgA1C for diabetic pregnant pt
less than 7% but should be closer to 6% or less
105
what do late decelerations usually mean?
uteroplacental insufficiency
106
Spinal Electrode- when can it be used?
Can only be used when membranes are ruptured and the cervix is sufficiently dilated
107
sinusoidal FHR pattern
occurs with fetal hypoxia- need C/S asap!
108
tachycardia FHR pattern
considered an early sign of hypoxemia
109
Bradycardia FHR pattern
sign of fetal hypoxia and may be result of prolonged compression of the umbilical cord
110
Causes of Increased Variability
- early mild hypoxemia
- fetal stimulation (uterine palpation, uterine contractions, fetal activity, maternal activity, *STREET DRUGS cocaine and meth*)
111
Causes of Decreased Variability
Hypoxia/Acidosis
| Fetal sleep cycles (lasting about 20-30mins)
112
Early Decels
- Fetal head compression
- Normal and benign finding
- No intervention needed
113
Late Decels are associated with
fetal hypoxemia, acidemia, and low Apgar scores
114
Nursing interventions for Late Decels
- Change maternal position
- Elevate legs
- Increase IV rate
- D/C oxytocin if using
- Admin Oxygen
- Fetal scalp stimulation
115
Variable decels are usually caused by?
umbilical cord compression
116
Nsg interventions for variable decels
- Change maternal position
- D/C oxytocin if using
- Admin oxygen
117
How long does a decel have to last to be considered a prolonged decel?
more than 2 minutes
118
Nsg intervention for prolonged decel
Notify physician immediately!
