Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Test 2- Intrapartum > L & D slides pt 2 > Flashcards

L & D slides pt 2 Flashcards

1
Q

What are some pre-labor complications?

A

-placental complications (previa, abruption)
-cervical insufficiency
-amniotic fluid complications
-premature ROM
-preterm labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is placenta previa?

A

Placenta implanted in the lower uterine segment near or covering the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What causes placenta previa?

A

*UNKNOWN
may be r/t prev. c/s smoking/medical abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the characteristics of a complete placenta previa?

A

internal cervical os completely covered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the characteristics of a partial (marginal) placenta previa?

A

internal cervical os partially covered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the characteristics of a low-lying placenta previa?

A

near cervix but not covering the cervix (<2 cm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the classic sign of previa?

A

**painless bright-red vaginal bleeding
usually slight at first then increases in subsequent unpredictable episode
the abdomen is usually soft, non-tender

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What can happen if a woman goes into labor with placenta previa?

A

Hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How should placenta previa be managed if there is NO active bleeding?

A

-monitor placenta location by US throughout pregnancy
-NO vaginal or rectal exams
-Delivery by c-section at full-term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What education should be done for a pt with placenta previa?

A

-Pelvic rest
-S/S of concern: decreased FM or bleeding
-Delivery and emergency plan of care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

True or False: you should NEVER do a vaginal check if mom is bleeding.

A

True
**Nothing in the vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If there is no frank bleeding during a pregnancy with placenta previa what should be done?

A

Nothing. Continue to monitor the pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a placental abruption?

A

Premature separation of the placenta from the uterine wall, leading to loss of oxygen and blood to the fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

True or False: A placental abruption IS life threatening to both mom and fetus.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Premature separation is the leading cause of _____ ________.

A

perinatal mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is placental abruption most commonly associated with?

A

-hypertension
-cocaine use
-abdominal trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Symptoms of placental abruption:
_____ vaginal bleeding
*bleeding can be concealed
_____ pain
uterine _____/______
elevated _____ tones
rapid s/s of maternal _____/_____ distress

A

painful
abdominal
rigidity/tenderness
resting
shock/fetal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the maternal implications for a placental abruption?

A

-hemorrhage
-DIC
-Shock
-Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are fetal/neonatal implications for a placental abruption?

A

-preterm labor/birth
-anemia
-hypoxia
-death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the nursing plan for a placental abruption?

A
  1. Monitor: maternal shock and fetal distress
  2. Could have rapid fetal distress
  3. Prepare for immediate delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Disseminated Intravascular Coagulation (DIC)?

A

Widespread activation clotting cascade– blood clots in vessels throughout body resulting in tissue damage
**process uses up clotting factors/platelets, massive hemorrhage may ensure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What S/S may be noted in a pt with DIC?

A

localized bleeding: vaginal, oozing IV sites, ecchymosis, hematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the treatment plan for a pt with DIC?

A

-Monitor PT/PTT and CBC
-protect from injury
-NO IM injections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

__-__% of pts with DIC will die.

A

20-50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the management for a pt with a placental abruption?

A

Maintain the cardiovascular status of the mother. Monitor for DIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

If MILD abruption and fetus is pre-term & in no distress, then what should be done?

A

BED REST and tocolytic meds
*may consider a vaginal delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

If the abruption if moderate-severe, the pt will need an _____.

A

immediate C/S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Cervical insufficiency is also known as ____ _____.

A

Incompetent cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is cervical insufficiency?

A

painless dilation of the cervix (without contractions) due to structural or functional defect of the cervix.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How should I manage cervical insufficiency?

A

-transvaginal US of cervical length b/w 18-20 weeks
-cervical cerclage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is a cervical cerclage?

A

stitches used to close the cervix during pregnancy to help prevent pregnancy loss or premature birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Is an emergent or elective cervical cerclage preferred?

A

elective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

When will an elective cervical cerclage be placed?

A

late in the first trimester or early in the second trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the success rate for an elective cervical cerclage?

A

80-90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When is an emergent cervical cerclage placed?

A

When dilation and effacement have already occured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the success rate for an emergent cervical cerclage?

A

40-60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

After __ completed weeks gestation, ____ may be cut and vaginal birth permitted, or the suture may be left in place and _____ birth performed.

A

37
suture
cesarean

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Amniotic fluid is in a constant state of _____.

A

Circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

In the second half of pregnancy the main sources of fluid production are from the baby:
____ (700mls per day) &
____ ____ (350 mls per day)

A

urine
lung secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is having TOO MUCH amniotic fluid called?

A

Polyhydraminos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is having TOO LITTLE amniotic fluid called?

A

Oligohydraminos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

In a pt diagnosed with polyhydraminos, more than ___ ml of amniotic fluid is present.

A

2000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the key indicator of polyhydraminos?

A

Fundal height increases out of proportion to the gestational age.
*should be within 3cm of gestational age in weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What maternal conditions are associated with polyhydraminos?

A

-DM
-Rh sensitization
-Multiple gestation (twins or triplets)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What might the mother experience if the amniotic fluid is >3000?

A

SOB and edema in lower extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are the fetal/neonatal implications of polyhydraminos?

A

-preterm birth d/t pre-term labor
-placental abruption due to sudden loss of large amt of fluid
-mal-presentation
**increased risk for c-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is Oligohydraminos?

A

There is less than normal (<500 ml) amount of amniotic fluid present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the key indicator of oligohydraminos?

A

Fundal height does not increase appropriate to gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

If there is a cord compression during delivery due to oligohydraminos, what is the treatment?

A

Amnioinfusion

50
Q

What are the maternal implications of oligohydraminos?

A

dysfunctional labor, slow progress

51
Q

What are the fetal/neonatal implications of oligohydraminos?

A

-fetal skin/skeletal abnormalities
-pulmonary hypoplasia
-cord compression
-amniotic band syndrome
-renal anomalies

52
Q

What is the typical cause for oligohydraminos?

A

reduced urine output (baby)

53
Q

When is oligohydraminos most often seen?

A

post maturity, maternal hypertension, IUGR secondary to placental insufficiency

54
Q

What is amniotic band syndrome?

A

Occurs when the unborn baby becomes entangled in fibrous string-like amniotic bands in the womb

55
Q

What does amniotic band syndrome do and what does it affect?

A

It restricts blood flow to the fetus affecting the baby’s development

56
Q

What is pulmonary hypoplasia?

A

Oligohydraminos reduce the intrathoracic cavity size, thus disrupting fetal lung growth and leading to pulmonary hypoplasia

57
Q

If a pt presents with PROM and/or preterm labor, what should you assess?

A
  1. time of suspected rupture
  2. last cervical exam
  3. last intercourse
  4. pathologic discharge (STI?)
58
Q

What is pooling?

A

Pooling is when a collection of amniotic fluid can be seen in the back of the vagina (vaginal fornix)

59
Q

Amniotic fluid is slightly ___ (pH of 7.1-7.3) compared to normal vaginal secretions which are ____ (pH 4.5-6)

A

basic
acidic

60
Q

What does a Amnisure ROM test for?

A

screens for a protein marker of the amniotic fluid in vaginal discharge

61
Q

What are the most common causes of PROM?

A

infections
incompetent cervix
fetal abnormalities
sexual intercourse

62
Q

PROM occurs in __% of U.S. deliveries?

A

3

63
Q

What is PROM?

A

Spontaneous rupture of membranes prior to onset of labor

64
Q

What is P-PROM?

A

ROM prior to 37 weeks gestation

65
Q

What is the biggest risk in a pt with P-PROM?

A

Ascending intrauterine infection

66
Q

What is the treatment and nursing care of a pt with P-PROM?

A

-pelvic rest
-fetal steroids
-CHECK TEMP FREQUENTLY
-bed rest
-prepare for delivery

67
Q

Risk of infection increases after ___ hours from rupture time.

A

24

68
Q

What is a pt with prolonged rupture of membranes at risk for?

A

Chorioamnionitis

69
Q

What is chorioamnionitis?

A

Intra-amniotic infection
*includes inflammation of the fetal membranes (amnion and chorion due to bacterial infection

70
Q

What causes chorioamnionitis?

A

bacteria ascending into the uterus from the vagina

71
Q

What are chorioamnionitis risk factors?

A

-prolonged labor
-prolonged ROM
-internal fetal monitoring
-multiple vaginal exams
-meconium
+GBS carrier
-STI

72
Q

What is the most important maternal sign of chorioamnionitis?

A

maternal fever
can also be: uterine tenderness & purulent discharge

73
Q

What is the most common fetal sign of chorioamnionitis?

A

fetal tachycardia (180-200)

74
Q

What is the treatment for chorioamnionitis?

A

Antibiotics: ampicillin Q6 hours and gentamicin Q8-24 hours
Supportive: antipyretics

75
Q

What is a prolapsed umbilical cord?

A

prolapse of the umbilical cord through the cervical canal BEFORE the presenting part

76
Q

What can a prolapse cord result in?

A

Loss of oxygen to the fetus
*fetal death!

77
Q

What is the goal of treatment with a prolapsed cord?

A

relieve the pressure on the cord

78
Q

True or False: it is okay to attempt to replace the cord if it is prolapsed.

A

False, you should never attempt

79
Q

Umbilical cord prolapse is an acute obstetric emergency that requires immediate ___ of the baby.

A

Delivery
*usually by c-section

80
Q

What might you see in a baby that has a prolapsed cord?

A

bradycardia (<120 bpm)

81
Q

What should the nurse do if your patient has a prolapsed cord?

A

**Immediately place in trendelenburg or knee-chest position
-elevate part with sterile gloved hand to relieve the compression
-10L O2 mask
-cover cord with sterile wet gauze
-plan to go to the OR

82
Q

What is premature labor?

A

Labor that occurs after 20 weeks but before 37 completed weeks

83
Q

What is the goal of treatment in a patient with premature labor?

A

STOP THE LABOR and suppress uterine activity using tocolytics

84
Q

What should the nurse assess in a pt with preterm labor?

A

-uterine activity
-ROM
-vaginal bleeding
-fetal presentation
-cervical dilation and effacement
-fetal station

85
Q

Management strategies in a pt with preterm labor:
____ therapy (if GBS+)
bedrest
Corticosteroid therapy (fetal ____ maturation)
IV _____ therapy

A

Antibiotic
lung
tocolytic- will slow labor but does NOT improve neonatal outcomes

86
Q

Bacterial infections presumed cause for many PTL ____ weeks

A

<32

87
Q

What med is usually given under 32 weeks, after premature closure of the ductus arterioles is no longer an issue.

A

Indomethacin

88
Q

What medications are uterine relaxants (tocylytics)?

A

Indomethacin, Nifedipine, Magnesium sulfate, Terbutaline

89
Q

If a pt is not fully dilated and wants to push, what should the nurse encourage?

A

Pursed lip breathing through ctx.

90
Q

What are some dysfunctional contraction patterns?

A

hypotonic and tachysystolic

91
Q

What is a hypotonic contraction patterns?

A

contractions decrease in frequency and intensity
*fewer than 2-3 contractions in 10 minutes

92
Q

What are some possible causes of a hypotonic contraction pattern?

A

-overstretched uterus
-uterine distention preventing descent
-excessive use of analgesia/pain medications

93
Q

How should the nurse manage a hypotonic contraction pattern?

A

walking, augmentation of labor, position changes, amniotomy, minimize vaginal exams

94
Q

A pt with a tachysystolic labor pattern may experience:

A

painful contractions (cramping)

95
Q

What is a tachysystolic labor pattern?

A

-ineffectual, erratic, uncoordinated
-occuring <2 min frequency, >90 seconds duration
**increase in frequency but intensity decreased
DOES NOT bring about dilation and effacement of the cervix

96
Q

What is the management for a pt that has a tachysystolic ctx pattern?

A

rest, hydration, sedation, facilitate rotation of fetal head, stop pit, AROM, side-lying position

97
Q

What are the implications of a tachysystolic ctx pattern?

A

-maternal exhaustion, dehydration, infection
-reduced utero-placental exchange resulting in a non-reassuring fetal status
-prolonged pressure on fetal head

98
Q

What does prolonged pressure on fetal head result in?

A
  1. excessive molding
  2. caput succedaneum
  3. cephalhematoma
  4. fetus is at risk for fetal hypoxia
99
Q

What are the different types of fetal malpresentation?

A

face, breech, shoulder

100
Q

What is a vertex presentation?

A

head flexed/chin tucked

101
Q

What is a sinciput (military) presentation?

A

head is neither flexed or extended

102
Q

What is a brow presentation?

A

head partially extended

103
Q

What is a face presentation?

A

head is hyper-extended

104
Q

True or False: you can use a scalp electrode in a fetus with face or chin presentation.

A

False

105
Q
A
106
Q

What are the maternal implications for a brow/face presentation?

A

-longer labor
-dysfunctional labor pattern
-c-section IF brow presentation persists or if the fetus is large

107
Q

What are the fetal implications for a brow/face presentation?

A

-facial cephalohematoma
-facial edema
-laryngeal and tracheal damage
-pronounced cranial molding
-subconjunctival hemorrhage

108
Q

What is the clinical treatment for a brow/face presentation?

A

-IF failure to convert to occipital from face presentation, c-section is usually indicated.
-If a vaginal birth is attempted, the woman is closely monitored
-You SHOULD NOT attempt to rotate the fetus or use vacuum/forceps

109
Q

What is a breech presentation?

A

occurs when a baby is born feet or butt first instead of head first

110
Q

A breech presentation occurs in __-__% of pregnant women.

A

3-5

111
Q

What is a complete breech presentation?

A

hips/knees are flexed and the feet are not below the level of the fetal buttocks

112
Q

What is a footling breech presentation?

A

one or both feet are presenting first

113
Q

What is a frank breech presentation?

A

hips are flexed and the legs are extended

114
Q

What is the goal of breech presentation management?

A

convert breech presentation to cephalic presentation before labor beings

115
Q

Antepartum management of a breech baby?

A

**ECV (external cephalic version)
-IV, tocolytics, ultrasound

116
Q

What is the criteria for ECV?

A

-36 weeks gestation
-reactive NST immediately before
-fetal presenting part not engaged

117
Q

What are some contraindications for ECV?

A

previous CS, multiple gestation, non-reassuring monitoring, ruptured membranes

118
Q

What is the current recommendations for breech presentations that can not be converted by ECV?

A

c-section

119
Q

What are some complications of ECV?

A

-fetal bradycardia
-placental abruption
-feto-maternal hemorrhage
-uterine rupture

120
Q

What is the most dangerous breech presentation to try and delivery vaginally?

A

Footling

121
Q

What are the risks associated with vaginally delivering a footling breech baby?

A

-umbilical cord prolapse
-delivery of the feet through an incompetent dilated cervix leading to arm or head entrapment
-neck entrapment

Test 2- Intrapartum (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions