maternal 2nd midterm Flashcards
(167 cards)
1
Q
What may be associated with fetal heart rate changes?
A
Fetal sleep state, prematurity, reaction to drugs, congenital anomalies, hypoxia, acidosis
These conditions can indicate fetal distress or other complications.
2
Q
What does a persistent fetal heart rate change for more than 30 minutes indicate?
A
Fetal distress
This is a critical indicator for monitoring fetal health during labor.
3
Q
What is considered fetal tachycardia?
A
> 160 bpm
Associated with prematurity, maternal fever, fetal activity, or fetal hypoxia/infection.
4
Q
What are the three types of decelerations in fetal heart rate monitoring?
A
Early, Late, Variable
Each type has different implications for fetal health.
5
Q
What does a late deceleration indicate?
A
Fetal hypoxia due to deficient placental perfusion
Monitoring is crucial to prevent complications.
6
Q
What is the normal fetal heart rate range?
A
120-160 bpm
This range indicates a healthy fetal status.
7
Q
What does absent variability in fetal heart rate indicate?
A
0-2 bpm or decreased 3-5 bpm
This may suggest fetal distress or other complications.
8
Q
Fill in the blank: _______ is a significant indicator of fetal well-being.
A
Beat-to-beat variability
Measured by internal Electronic Fetal Monitoring (EFM).
9
Q
What are some nursing care measures during the first stage of labor?
A
- Respect contraction time
- Change positions
- Voiding and bladder care
- Pain management
These measures help support the mother and monitor fetal condition.
10
Q
What is the purpose of the APGAR score?
A
To evaluate the condition of the neonate at birth
APGAR scores are assessed at 1 and 5 minutes after birth.
11
Q
What are the goals of pain relief during labor according to the 2020 National Health Goals?
A
- Reduce maternal mortality rate
- Reduce fetal/newborn death rate
Goals aim to improve outcomes for mothers and infants.
12
Q
What is the definition of analgesia?
A
Alleviation of the sensation of pain or elevation of one’s threshold for perception of pain
This is crucial for managing discomfort during labor.
13
Q
What is epidural anesthesia?
A
Injection of local anesthesia to block specific nerve pathways
Commonly used for pain relief during labor.
14
Q
What is the classification of perineal lacerations?
A
- First degree: Vaginal mucous membrane and skin
- Second degree: Vagina, perineal skin, fascia
- Third degree: Entire perineum, external sphincter
- Fourth degree: Entire perineum, rectal sphincter
Understanding these classifications is important for postpartum care.
15
Q
What is the indication for forceps delivery?
A
If the mother cannot push fetus out or compromised maternal/fetal status
Forceps may be used in specific circumstances to assist delivery.
16
Q
What are the indications for a cesarean section?
A
- Cephalopelvic disproportion
- Fetal malpresentation
- Non reassuring EFM strip
These conditions can necessitate surgical intervention for safe delivery.
17
Q
What is a classical uterine incision?
A
Incision made in the contractile portion of the uterus
This type carries a higher risk of uterine rupture.
18
Q
What is the significance of monitoring maternal blood pressure and pulse in the fourth stage of labor?
A
To assess uterine contractility, amount and color of lochia, and condition of episiotomy
This monitoring is crucial for maternal safety and recovery.
19
Q
What is fetal malpresentation?
A
The abnormal position of the fetus in the uterus
20
Q
What does a non reassuring EFM strip indicate?
A
Lower chance of uterine rupture, may have trial of labor
21
Q
What is required for a fetus to be in a safe position for labor?
A
The fetus must be in longitudinal lie
22
Q
What are the complications associated with cesarean birth?
A
- Hemorrhage
- Infection
- Visceral injury
- Thrombosis
23
Q
What is included in immediate preoperative care for a cesarean?
A
- Informed consent
- Hygiene
- GI tract preparation
- Baseline intake and output
- Hydration
- Preoperative medication
- Checklist
- Transport
- Role of support person
24
Q
What are selected indications for cesarean birth?
A
- Active genital herpes
- AIDS or HIV-positive status
- Cephalopelvic disproportion
- Cervical cerclage
- Placenta previa
- Abruptio placenta
- Disabling conditions preventing vaginal birth
- Fetal distress
25
What is VBAC?
Vaginal birth after cesarean
26
What are the fetal factors that can lead to complications during labor?
* Compound conditions such as macrosomic fetus in a breech lie
* Extreme low birth weight
* Fetal distress
27
What are the three P's that can cause complications during labor or birth?
* Power
* Passenger
* Passage
28
What defines preterm labor?
Onset of regular contractions causing cervical changes between 20 and 37 weeks of gestation
29
What are predisposing factors to preterm labor?
* Problems with fetal position
* History of preterm birth
* PROM (premature rupture of membranes)
* Multiple gestation
* Bacterial vaginosis
30
What are tocolytic agents?
Medications that inhibit contractions
31
What is the purpose of corticosteroids in labor?
To accelerate fetal lung maturation
32
What characterizes premature rupture of membranes?
Spontaneous rupture of membranes before the onset of labor
33
What is dystocia?
Long, difficult, or abnormal labor caused by any of the four major variables affecting labor
34
What are the possible maternal complications of precipitate labor?
* Loss of coping ability
* Risk of uterine rupture
* Laceration of cervix, vagina, and perineum
* Postpartum hemorrhage
35
What is the definition of induction of labor?
Stimulation of uterine contractions before they begin spontaneously
36
What are the methods of induction of labor?
* Oxytocin
* Amniotomy
37
What is the management for cord prolapse?
* Relief of pressure on the umbilical cord
* Manual elevation of fetal head off the cord
* Prevention of cord drying
* Fetal blood sampling
* Surgical intervention
38
What are common postpartum deviations from the normal?
* Puerperal infection
* Postpartum hemorrhage
* Mastitis
* Thrombophlebitis
39
What are the '4 T's' of postpartum hemorrhage?
* Tone
* Trauma
* Tissue
* Thrombin
40
What is a common cause of postpartum hemorrhage?
Uterine atony
41
What is the assessment for puerperal infection?
* Temperature above 100.4°F
* Unusual odor and color of lochia
* Fundal pain on palpation
* Visual inspection of perineal suture lines
42
What are the signs of thrombophlebitis?
* Mottling
* Localized redness and warmth
* Leg swelling
43
What characterizes placenta succenturiata?
Placenta has one or more accessory lobes connected to the main placenta by blood vessels
44
What are the signs of pulmonary embolus?
* Sharp, sudden chest pain
* Tachypnea
* Tachycardia
* Cyanosis
45
What is the timeframe for early postpartum hemorrhage?
Occurs within the first 24 hours after delivery
46
What is the timeframe for late postpartum hemorrhage?
Occurs between 24 hours and 6 weeks after delivery
47
What is the assessment for emotional and psychological issues postpartum?
* Overwhelming sadness
* Anxiety
* Difficulty bonding with infant
* Presence of delusions or hallucinations
48
What is assessed in the urinary system postpartum?
• Primary bladder overdistention
• Urine retention with overflow
• Urinary tract infection
## Footnote
Check for time to first voiding (>8 hours), fundus tone and position, and frequency and amount of voiding.
49
What is placenta circumvallata?
A condition where the chorion membrane begins at the edge of the placenta, leaving no chorion covering the fetal side of the placenta
## Footnote
This type of placenta may have implications for fetal health.
50
What is the normal position of the fundus postpartum?
Midline, firm, and even to 1 cm/finger breadth above the umbilicus for the first 12 hours, then descends by one finger breadth each succeeding day
## Footnote
Pelvic organ usually returns to normal by day 8-10.
51
What are the stages of lochia postpartum?
• Lochia rubra: day 1-3 (bloody with fleshy odor; may be clots)
• Lochia serosa: day 4-9 (pink/brown with fleshy odor)
• Lochia alba: day 10+ (yellow-white)
## Footnote
At no time should there be a foul odor, indicating infection.
52
What is the definition of placenta increta?
Invasion of the placenta into the myometrium
## Footnote
This condition can lead to complications during delivery.
53
What is the management for postpartum urinary complications?
• Monitor episiotomy/laceration
• Teach techniques to prevent infection
• Encourage voiding every 24 hours
## Footnote
Early ambulation and peri care are important.
54
What are the symptoms of urinary tract infections (UTIs) in pregnancy?
• Urinary frequency and urgency
• Dysuria
• Sometimes hematuria
## Footnote
Upper tract infections may present with fever, malaise, and abdominal/back pain.
55
What is the TORCH test series?
A group of maternal systemic infections that can be transmitted across the placenta or by ascending infection to the fetus
## Footnote
Infections early in pregnancy may cause significant fetal deformities.
56
What is the treatment for syphilis in pregnancy?
• <1 year: Benzathine Penicillin G, 1 dose
• >1 year: 3 doses of Benzathine Penicillin G
## Footnote
This treatment can prevent congenital syphilis.
57
What are the risks associated with varicella infection during pregnancy?
• Infection during the 1st trimester can cause spontaneous abortion
• Infection after the 20th week can lead to premature birth
## Footnote
Survivors may have permanent visual damage.
58
What is the characteristic discharge of simple vaginitis?
Yellow discharge, itching, burning, and edema
## Footnote
Best treated with dilute vinegar douche and antibiotics.
59
What are the signs and symptoms of pelvic inflammatory disease (PID)?
• Lower abdominal pain and tenderness
• Malaise
• Fever
• Purulent vaginal discharge
## Footnote
Usually associated with gonorrhea and/or chlamydia.
60
What is the management for fibroadenoma?
• Surgery of enlarged lesion if necessary
## Footnote
Fibroadenoma is the 2nd most common benign disorder of the breast.
61
What are the symptoms of gonorrhea in females?
• Profuse and purulent vaginal discharge
• Itching of the vulva
• Painful urination
## Footnote
Can cause complications like spontaneous abortion and preterm delivery.
62
What is the treatment for Candida albicans infection?
Clotrimazole type antifungal agent for 7 days
## Footnote
This infection can cause thrush in newborns.
63
What are the symptoms of atrophic vaginitis?
Pale, thin, dry mucosa, itching, dyspareunia
## Footnote
This condition occurs after menopause.
64
What are the potential complications of herpes type 2 during pregnancy?
Risk of newborn infection upon passage in the vaginal canal if active lesions are present
## Footnote
Cesarean delivery may be necessary.
65
What is the assessment for cytomegalovirus (CMV) infection?
Anemia, hyperbilirubinemia, thrombocytopenia, hepatosplenomegaly
## Footnote
May lead to severe neurological impairment in newborns.
66
What is hypoplasia or hyperplasia of the breast?
Conditions associated with severe eye infection that may affect a woman’s self-concept and may require surgery for breast size adjustment.
## Footnote
Cosmetic blindness may occur.
67
What is mastitis?
Infection of the breast, most often during lactation, characterized by fever, fatigue, and inflamed, tender breast.
## Footnote
Caused by inadequate cleanliness, plugged ducts, or infections.
68
What are the management strategies for mastitis?
Includes systemic antibiotics, warm packs, and wearing a supportive brassiere.
## Footnote
Key symptoms include exudates from the nipple and axillary adenopathy.
69
What is fibrocystic disease?
Characterized by multiple soft, tender cysts in the breast that enlarge during menstruation and subside during pregnancy or lactation.
## Footnote
Most common benign condition of the breast.
70
What are the types of mastectomies?
1. Partial (lumpectomy)
2. Subcutaneous (adenomastectomy)
3. Simple mastectomy
4. Radical mastectomy
5. Modified radical mastectomy
6. Superradical mastectomy
## Footnote
Each type varies in the amount of tissue removed.
71
What is a fibroid (leiomyoma)?
Benign tumors on the myometrium, often asymptomatic but can cause pain and menorrhagia.
## Footnote
Risk factors include early coitus, multiple sexual partners, and exposure to STDs.
72
What are the risk factors for uterine cancer?
1. Obesity
2. Multiparity
3. Diabetes Mellitus
4. Hormone Replacement Therapy
5. Early menarche
6. Late menopause
## Footnote
These factors can contribute to the development of endometrial cancer.
73
What is HELLP syndrome?
A variation of gestational hypertension characterized by hemolysis, elevated liver enzymes, and low platelet count.
## Footnote
It poses significant risks to both mother and infant.
74
What is the primary symptom of cervical cancer?
Painless vaginal bleeding, often followed by foul-smelling discharge and irregular menstrual bleeding.
## Footnote
Diagnosis is confirmed via Pap smear and cervical biopsy.
75
What is toxic shock syndrome?
A condition caused by Staphylococcus aureus, often related to tampon use, characterized by fever, rash, and hypotension.
## Footnote
Other symptoms include myalgia and inflamed mucous membranes.
76
What is a cystocele?
Protrusion of the bladder through the vaginal wall, often associated with childbirth and obesity.
## Footnote
Symptoms include urinary incontinence and vaginal fullness.
77
What is pseudocyesis?
False pregnancy characterized by symptoms such as nausea and abdominal enlargement in non-pregnant women.
## Footnote
Management includes counseling to prevent depression.
78
What is a rectocele?
Protrusion of the rectum through the vaginal wall, causing rectal pressure and heaviness.
## Footnote
Symptoms may include constipation and hemorrhoids.
79
What is endometriosis?
Endometrial tissue located outside the uterine cavity, often causing pain and scarring.
## Footnote
Commonly occurs in women aged 20-45.
80
What are the management strategies for uterine fibroids?
Management may include surgery, intravaginal radiation implants, or hysterectomy.
## Footnote
Diagnosis is often confirmed through imaging techniques like ultrasonography.
81
What are the nursing priorities for a high-risk newborn?
1. Initiation and maintenance of respirations
2. Establishment of extra-uterine circulation
3. Maintenance of fluid/electrolyte balance
4. Control of body temperature
5. Intake of adequate nourishment
## Footnote
Additional priorities include prevention of infection and establishment of infant-parent relationship.
82
What is the significance of a Pap smear?
A diagnostic tool used to detect cervical cancer and other abnormalities in cervical cells.
## Footnote
Regular Pap smears are crucial for early detection.
83
What is the laryngoscope size recommended for newborns?
Size 0 or 1
84
What is developmental care?
Care that balances physiologic needs and stimulation for the best development.
85
What is the appropriate ET size for infants less than 1,000 grams?
2.5mm
86
What is the appropriate ET size for infants over 3,000 grams?
4.0mm
87
What is a sign that lung expansion is good in infants?
The sound of a baby’s crying
88
What may infants experience if they have difficulty breathing?
Residual neurologic morbidities due to cerebral hypoxia.
89
When should respiration start after delivery?
Within 2 minutes
90
What is the purpose of resuscitation for newborns?
To assist those who fail to take a first breath or have difficulty maintaining adequate respirations.
91
What is the first step in the organized process of resuscitation?
Establish and maintain the airway.
92
What should be done if a newborn does not initiate spontaneous breathing?
Place the infant under a radiant heat warmer in a 'sniffling' position.
93
What is Naloxone (Narcan) used for in newborns?
Should not be routinely given as it has little effect and may cause seizures.
94
What indicates a newborn needs chest compressions?
If CR is below 60 beats/min.
95
What is the recommended position for an infant under a radiant heat warmer?
Head slightly tipped back
96
What is a common sign of respiratory compromise in newborns?
Grunting
97
What does increased respiratory rate in a newborn indicate?
Potential respiratory distress or obstruction.
98
What is the significance of maintaining fluid and electrolyte balance in newborns?
To prevent dehydration and maintain blood pressure.
99
What should be monitored to assess dehydration in infants?
Urine output and specific gravity.
100
What is the common cause of early onset sepsis in infants?
Group B streptococcus
101
What is the definition of SGA infants?
Small for gestational age; those who fall below the 10th percentile of weight for their age.
102
What are LGA infants?
Large for gestational age; those who fall above the 90th percentile of weight for their age.
103
What is the common problem associated with low birth weight (LBW) infants?
Hypoglycemia
104
What are signs of prematurity in infants?
Immature reflexes and extensive bruising or birth injury.
105
What is the management for meconium aspiration syndrome?
Amnioinfusion to dilute meconium, O2 administration, and assisted ventilation.
106
What is apnea in newborns?
Cessation in respirations lasting longer than 20 seconds.
107
What are signs of increased intracranial pressure (ICP) in newborns?
Vomiting, bulging fontanelles, high-pitched cry.
108
What is the purpose of caffeine in treating apnea of prematurity?
To stimulate breathing.
109
What is the recommended treatment for hypoglycemia in newborns?
10% dextrose in water.
110
What is a significant risk factor for LGA infants?
Maternal diabetes mellitus.
111
What is the role of parental bonding in neonatal care?
To ensure parents are informed and involved in their infant's care.
112
What is the effect of maternal smoking on newborns?
Increases risk of infections and complications.
113
What can dehydration in infants lead to?
Hypotension and increased risk of complications.
114
What is the importance of skin-to-skin contact for newborns?
Helps stabilize temperature and promotes bonding.
115
What is the significance of monitoring oxygen levels in newborns?
To determine and correct causes of respiratory distress.
116
What is the definition of actant?
An actant is a term used in narrative theory to describe any entity that participates in an action.
117
When should suctioning be performed on infants?
Suction gently and only when needed.
118
What are some causes of nasopharyngeal irritation in infants?
Minimize nasopharyngeal irritation.
119
What complications are associated with prematurity?
Apnea, sepsis, meconium aspiration syndrome.
120
Why should rectal temperatures be avoided in certain infants?
It can cause vagal stimulation leading to bradycardia.
121
What medication can be prescribed for apnea of prematurity?
Caffeine.
122
What is the pathologic feature of Sudden Infant Death Syndrome (SIDS)?
Hyaline-like membrane formed from an exudate lining the terminal bronchioles, alveolar ducts, and alveoli.
123
What is SIDS?
A sudden unexplained death in infancy.
124
What are some higher risk factors for SIDS?
* Infants of adolescent mothers
* Infants of closely spaced pregnancies
* Underweight and preterm infants.
125
What are some subtle signs of SIDS?
* Low body temperature
* Nasal flaring
* Sternal and subcostal retractions
* Tachypnea
* Cyanotic mucous membranes.
126
What is Periventricular Leukomalacia?
A result of ischemia of the white matter of the brain.
127
What is the cause of Periventricular Leukomalacia?
Anoxic episode interfering with circulation to a portion of the brain.
128
What type of blood is used for exchange transfusion?
Type O negative.
129
What is Hemolytic Disease of the Newborn?
Occurs due to Rh incompatibility when the mother is Rh negative and the fetal blood is Rh positive.
130
What is the treatment for a newborn with Rh incompatibility?
Rho immune globulin (RHIG or RhoGAM) given within 72 hours after birth.
131
What is Necrotizing Enterocolitis (NEC)?
The bowel develops necrotic patches, interfering with digestion.
132
What is Retinopathy of Prematurity (ROP)?
Acquired ocular disease that leads to partial or total blindness.
133
What is the most common causative agent of Ophthalmia Neonatorum?
Neisseria gonorrhoeae and Chlamydia trachomatis.
134
What is Neonatal Abstinence Syndrome?
Withdrawal symptoms in infants whose mothers took drugs close to birth.
135
What are some signs of Neonatal Abstinence Syndrome?
* Irritability
* Disturbed sleep pattern
* Constant movement.
* Tremors.
136
What are the distinctive facial features of an infant with fetal alcohol exposure?
Short palpebral fissure; thin upper lip.
137
What is the most serious long-term effect of Generalized Herpesvirus infection?
Cognitive challenge.
138
What is the Pierre Robin Sequence?
A rare triad of micrognathia, cleft palate, and glossoptosis.
139
What is Cleft Palate?
An opening of the palate due to failure of the palatal process to close.
140
What is Developmental Dysplasia of the Hip (DDH)?
A condition where the acetabulum is unusually shallow, preventing the head of the femur from remaining properly positioned.
141
What is the treatment for Cleft Palate?
Two-stage palate repair: soft palate repair at 3-6 months, hard palate repair at 6-18 months.
142
What is Ankylglossia (Tongue-tie)?
An abnormal restriction of the tongue caused by an abnormally tight frenulum.
143
What are Thyroglossal Cysts?
Congenital defects located in or around the midline of the neck.
144
What is Esophageal Atresia?
Incomplete formation of the esophageal lumen.
145
What are cysts in the context of congenital defects?
Congenital defects located in or around the midline of the neck.
## Footnote
As cyst fills with fluid, swelling and obstruction can lead to respiratory difficulty from pressure on the trachea.
146
What is esophageal atresia?
The incomplete formation of the esophageal lumen resulting in the proximal esophagus forming a 'blind pouch'.
147
What occurs during a tracheoesophageal fistula?
An opening develops between the closed distal esophagus and the trachea.
148
What is the most common orofacial cleft?
Cleft lip.
149
What is polyhydramnios?
Always present during pregnancy when the fetus cannot swallow.
150
What must be done whenever polyhydramnios is diagnosed?
An NGT must be passed at birth to exclude esophageal atresia before the first feed is given.
151
What is the best position for infants with esophageal atresia?
Upright, at a 60-degree angle to prevent acid reflux.
152
What is intestinal obstruction?
Atresia (complete closure) or stenosis (narrowing) of the intestines.
153
What is an umbilical hernia?
Protrusion of a portion of the intestine through the umbilical ring, muscle, and fascia surrounding the umbilical cord.
154
What is gastroschisis?
Similar to omphalocele except the abdominal wall disorder is a distance from the umbilicus and abdominal organs are not contained by a membrane.
155
What are the two types of hydrocephalus?
* Communicating or extraventricular hydrocephalus
* Obstructive or intraventricular hydrocephalus
156
What are the three main reasons why CSF accumulates?
* Overproduction of fluid by the choroid plexus
* Obstruction of the passage of fluid in the narrow aqueduct of Sylvius
* Interference with the absorption of CSF from the subarachnoid space
157
What is microcephaly?
The fetal brain grows so slowly that it falls more than three standard deviations below on a growth chart at birth.
158
What are some signs of increased intracranial pressure in infants?
* Bradycardia
* Bradypnea
* Increased temperature
* Increased BP
* Hyperactive reflexes
* Strabismus
* Optic atrophy
159
What is spina bifida occulta?
The mildest form of NTD; occurs when the posterior laminae of the vertebrae fail to fuse.
160
What is meningocele?
Meninges herniate through an unformed vertebrae, protruding as a circular mass at the center of the back.
161
What is anencephaly?
Absence of cerebral hemispheres.
162
What is encephalocele?
A cranial meningocele that occurs most often in the occipital area of the skull.
163
Fill in the blank: The infant must be examined for other congenital anomalies such as _____ syndrome.
VACTERL syndrome.
164
What is the management for esophageal atresia before surgery?
TPN to supply nutrients and keep the bowel from filling with air or stool.
165
What are some signs of intestinal obstruction in infants?
* No passage of meconium
* Abdominal distension and tenderness
* Sour smelling vomitus
166
What is the immediate post-operative care for cysts?
Observe for respiratory distress.
167
What is the characteristic of a skull with increased intracranial pressure?
A skull that is enlarging anteriorly with a shallow posterior fossa.
