maternity Flashcards Preview

z Here you go, Alexis! > maternity > Flashcards

Flashcards in maternity Deck (161):
1

first trimester

week 1 - 13

2

second trimester

week 14 - 26

3

third trimester

week 27 - 40

4

presumptive signs of pregnancy x4

amenorrhea
n/v
frequency
breast tenderness

5

what hormone causes amenorrhea

progesterone - secreted by corpus luteum
makes temperature increase after ovulation

6

probable signs of pregnancy

positive pregnancy test (hCG levels)
Goodell's Sign
Chadwick's Sign
Hegar's Sign
uterine enlargement
Braxton Hicks contractions
pigmentation/skin changes (linea negra, abdominal striae, facial chloasma, areola darkening)

7

positive signs of pregnancy

fetal heart beat (doppler, fetoscope)
fetal movement (clinician feels)
ultrasound

8

Goodell's Sign

softening of cervix, month 2

9

Chadwick's Sign

bluish color of vaginal mucosa and cervix, week 4

10

Hegar's Sign

softening of lower uterine segment, month 2/3

11

fetal heartbeat can be heard via doppler when?

week 10 - 12

12

fetal heartbeat can be heard via fetoscope when?

week 17 - 20

13

gravidity

# times someone has been pregnant

14

parity

# of pregnancies in which fetus reaches 20 weeks

15

when is a fetus/baby considered viable?

week 24 (has the ability to live outside uterus)

16

GTPAL stands for

gravidity
term
preterm
abortion (spontaneous and elective)
living

17

Naegele's Rule

first day LMP
add 7 days
subtract 3 months
add 1 year

accurate +/- 2 weeks

18

increase calories by how much after first trimester?

300

19

pregnant women should increase protein to how much?

60g per day

20

expect to gain how many pounds in first trimester?

4

21

take iron with what to enhance absorption, if pregnant?

vitamin C

22

how much folic acid should pregnant women take daily

400 mcg/day

23

exercising pregnant women: do not let HR get above ? and why?

140 - CO drops and uterine perfusion drops

24

danger signs for pregnant women (mostly 3rd trimester)

sudden gush of vaginal fluid
bleeding
persistent vom
severe headache
abdominal pain
increased temps
edema
no fetal movement

25

how often should pregnant women visit provider (first 28 weeks)

once a month

26

how often should pregnant women visit provider (28 - 36 weeks)

twice a month

27

how often should pregnant women visit provider (36+ weeks)

weekly until delivery

28

ultrasounds for pregnant clients: do what first and why?

drink water, distend bladder - pushes uterus to abdominal surface

29

expected weight gain in second trimester

1 pound per week

30

second trimester - does the client experience
n/v
frequency
breast tenderness

no
no (uterus rises)
yes

31

quickening

fetal movement 16 - 20 weeks

32

fetal heart rate during second trimester

120 - 160

33

fetal heart rate: normal, worry, panic

120 - 160
110 - 120
less than 110

34

kegels strengthen what

pubococcygeal muscles

35

pregnancy is considered term if it advances to?

37 - 40 weeks

36

best place to hear fetal heart tones

baby's back

37

lightening

presenting part of fetus (typically head) descends into pelvis, occurs around 2 weeks before term

client feels less congested but frequency is problem again

38

engagement

largest presenting part is in pelvic inlet

39

signs of labor

braxton hicks - more frequent, longer
softening of cervix
bloody show
nesting
diarrhea
rupture of membranes

40

besting

sudden burst of energy that is a sign of labor

41

when should pregnant woman head to hospital for labor?

contractions 5 minutes apart

OR

membranes rupture

42

non-stress test (maternity)

see 2+ accelerations of 15+ beats/minute with fetal movement

diagnostic test of pregnancy

43

acceleration (fetal heart rate)

abrupt increase from baseline, 15+ beats/minute lasting at least 15 seconds

back to baseline within 2 minutes

44

biophysical profile test (maternity)

last trimester or 32-34 for high risk (in 3rd trimester, 1 or 2 times a week)

1: HR (non-stress test reactive)
2: muscle tone (at least 1 flexion/extension)
3: movement (at least 3 times)
4: breathing (movements at least once)
5: amniotic fluid (enough fluid around baby)

observe for 30 minutes
8-10 good
6 worry
4 or less - ominous

45

deceleration (fetal heart rate)

blood flow decreases enough to cause hypoxia in the fetus resulting in decreased HR compared to baseline

46

contraction stress test/oxytocin challenge test (maternity)

done when NST non-reactive, high risk pregnancies (pre--eclampsia, maternal diabetes, suspected placental insufficiency)

determines if baby can handle stress of uterine contraction

47

variable decelerations

cord compression

48

early decelerations

head compression

49

accelerations

okay

50

late decelerations

(utero)placental insufficiency

51

false labor

irregular contractions, abdominal discomfort only, pain decreases/goes away with activity

52

major complication of epidural anaesthesia

hypotension

53

positioning for epidural anaesthesia

semi-fowlers on left side
legs flexed
not as arched with lumbar puncture
alternate sides hourly

54

when do you give epidural anaesthesia to pregnant woman in labor?

stage 1, 3-4cm dilation

55

what do you give to pregnant woman receiving epidural anaesthesia to fight hypotension?

1000mL NS or LR bolus

56

why is lithiotomy position bad?

vena cava compression impedes venous return, reduces CO and BP, therefore decreasing placental perfusion

57

unreassuring fetal heart tones do what?

reposition client to left side to enhance uterine perfusion

58

laboring patient receiving oxytocin requires what?

one-on-one care!

59

possible complications of oxytocin use during labor x3

hypertonic labor
fetal distress
uterine rupture

60

complete uterine rupture

through the uterine wall into peritoneal cavity

important s/s: hypovolemic shock due to hemorrhage, fetal heart tones absent

61

incomplete uterine rupture

through uterine wall but stops in peritoneum - not in the peritoneal cavity

important s/s: fetal heart tones may be lost

62

VBAC mothers at high risk for

uterine rupture, highest risk with oxytocin

63

oxytocin + labor = expected contraction rate

1 every 2-3 minutes lasting 60 seconds

64

discontinue oxytocin during labor if x4

- contractions too often
- too long
- fetal distress
- late decels

65

when should laboring mother push?

during contractions ONLY

66

#1 worry with retained placenta

hemorrhage

67

when does placenta deliver?

w/in 30 minutes

68

if you have to cut the baby's cord yourself during an emergency delivery, how?

tie @ 4 and 8 inches from baby's navel
cut with heated razorblade

69

what should the uterus be like after delivery?

FIRM! if boggy, MASSAGE THE FUNDUS

70

diastasis recti

abdominal muscles separate postpartum
vigorous exercise fixes this shit

71

uterine position: immediately after birth

midline 2-3 fingerbreadths below umbilicus

72

uterine position: a few hours after birth

rises to level of umbilicus or 1 fingerbreadth above

73

if uterus is above expected level or not midline postpartum, suspect what?

bladder distention - increases risk of hemorrhage because it will not allow uterus to contract normally

74

uterine fundal height will descend how?

one fingerbreadth per day

75

involution

fundus descends and uterus returns to pre-pregnancy size

76

afterpains

common for the first 2-3 days and will continue to be common if mom chooses to breast feed (surge of oxytocin)

77

postpartum vital signs of interest x2

T up to 104 during 1st 4 hours
HR 50 - 70 common for 6-10 days

78

lochia rubra

day 3-4, dark red

79

lochia serosa

day 4-10, pinkish brown

80

lochia alba

day 10-28, whitish yellow

81

clots okay in lochia when?

nickel or smaller

82

perineal care postpartum x4

intermittent ice packs first 6-12 hours (decrease edema)

especially for episiotomy, laceration, hemorrhoids:
warm water rinses
sitz baths 2-4 times a day
anesthetic sprays

83

peripad saturation rule

patient should not saturate more than one per hour - if so, assume hemorrhage

84

mom should increase caloric intake by how much for breastfeeding?

500 calories

85

what can lead to mastitis?

insufficient fluid = plugged ducts
poor baby feeding

86

post-partum infection: when & culprits

within 10 days
E Coli, beta hemolytic strep

87

early postpartum hemorrhage

more than 500cc lost in first 24 hours
AND
10% drop from admission hematocrit

MUST BE BOTH

88

late postpartum hemorrhage

after 24 hours, up to 6 weeks postpartum

89

causes of postpartum hemorrhage

uterine atony
lacerations
retained fragments
forceps delivery

90

typical causative agent of mastitis

staph

91

mastitis: what & when

milk is okay, breast is messed up
usually around 2-4 weeks

92

mastitis and breastfeeding: abx and method

penicillin is okay to take; feed baby then take abx
feed baby frequently and offer affected breast first (baby feeds more aggressively at first)

93

what should non-breastfeeding mothers do for their boobs

ice packs, breast binder, chilled cabbage leaves (decrease inflammation and engorgement)

94

apgar: when, what, ideal score

done at 1 and 5 minutes
HR, RR, muscle tone, reflex irritability, color
ideal: 8-10

95

eye drops for baby: what and what organism

erythromycin - neisseria gonococcus
also kills chlamydia

96

umbilical cord: care

dries and falls off 10-14 days
cleanse with each diaper change (alcohol, NS); diaper below cord
no immersion until cord falls off

97

babies at greatest risk for hypoglycemia

small and large for gestational age
preterm
babies born to diabetic moms

98

pathologic jaundice

first 24 hours
usually Rh/ABO incompatibility

99

physiological jaundace

aka hyperbilirubinemia
after 24 hours
due to normal hemolysis of excess RBCs releasing bilirubin or liver immaturity

100

indirect coombs test

Rh and ABO check, prenatal
done on mom, measures # antibodies in blood

101

direct coombs test

Rh and ABO check
done on baby cord blood, tells if any antibodies stuck to RBCs

102

when is Rho(D) immunoglobulin/RhoGAM given?

28 weeks gestation (protect fetus in case blood mixes)

within 72 hours after birth

with any bleeding episodes

for Rh- moms with Rh+ babes

103

spotting and cramping during pregnancy

spotting common during pregnancy
but spotting + cramping more indicative of miscarriage

104

hydatidiform mole

molar pregnancy - benign neoplasm (can become malignant)

grapelike clusters of cells - release hCG; uterus enlarges too fast
confirm with ultrasound, remove with D&C

105

hydatidiform mole: important to remember about pregnancy

hCG produced; do not get pregnant during follow up period after removal of mole - hCG rise can't be differentiated between pregnancy vs malignancy

106

choriocarcinoma

hydatidiform mole becomes malignant - chest x-rays to check for mets

107

how often to check hCG with molar pregnancy

weekly until normal
recheck every 2-4 weeks
then every 1-2 months for 6 months - ayear

108

ectopic pregnancy: what, where, how to confirm, s/s, risk, treatment

gestation outside uterus, typically in fallopian tube
confirm with ultrasound

first sign: pain; then spotting, bleeding into peritoneum, vaginal bleeding

one ectopic pregnancy = risk for another

treat with methotrexate

109

methotrexate

given to mom experiencing ectopic pregnancy to stop growth of embryo to save fallopian tube

110

if methotrexate doesn't work for ectopic pregnancy

laparoscopic incision into tube and embryo removed, entire tube may have to be removed

111

placenta previa: what, types, nota bene x2

placenta has implanted wrong - begins to prematurely separate when cervix begins to dilate/efface and baby doesn't get oxygen

low lying, partial, complete

placenta comes out first, bad

most common cause of bleeding in later months of pregnancy (typically 7th); confirm with ultrasound

some resolve during pregnancy due to uterine growth

112

low lying placenta previa

placenta on side of uterus

113

partial placenta previa

placenta halfway covering cervix

114

complete placenta previa

placenta completely covering cervix

115

placenta previa treatment

complete: hospitalization from as early as 32 weeks until birth to prevent blood loss and fetal hypoxia if labor begins

not much bleeding: bedrest, monitor

DO NOT PERFORM VAGINAL EXAM

116

increases risk for placenta previa

previous C-section d/t scarred uterus

117

abruptio placenta: what, blood, when, confirmation

placenta implanted normally, but separates prematurely from uterus - partial or complete (1-3 worst)

can bleed externally or concealed (into uterus)

seen in last half of pregnancy

ultrasound confirms

118

abruptio placenta causes

MVC, DV, previous c-section, rapid uterus decompression/membranes rupture, associated with cocaine use, PIH, smoking

119

abruptio placenta s/s

rigid board-like abdomen with or without vaginal bleeding (see this, worry patient is bleeding internally!)

abdominal pain, increased uterine tone, difficult to palpate fetus

120

rigid board-like abdomen with or without vaginal bleeding

think abruptio placenta

121

incompetent cervix: what, when, miscarriage note

cervix dilates prematurely because weight of baby causes pressure on cervix, occurs ~4th month of pregnancy

this client will have hx of repeated, painless, 2nd trimester miscarriages (most miscarriages 1st trimester!)

122

cerclage (purse-string suture) what and when

for incompetent cervix, at 14-18 weeks

80-90% chance of carrying baby to term after cerclage

123

causes of hyperemesis gravidarum

high levels of estrogen and hCG

124

s/s hyperemesis gravidarum

BP down
H/H up
uop down
K+ down
weight down
ketones in urine (breaking down body fat)

125

preeclampsia

increased BP + proteinuria + edema
after 20th week

if pre-pregnancy BP is not known, 130/90 = mild preeclampsia

126

BP indicative of mild pre-eclampsia for moms with unknown baseline

130/90

127

preeclampsia: s/s

sudden weight gain
face and hands swollen (losing albumin so fluid leaks into tissue)

vasospasms cause --
headache, blurred vision, seeing spots, increased DTR, clonus to seizure

128

see pregnancy client gains 2+ pounds in a WEEK, worry about

PIH

129

mild-preeclampsia BP + treatment

30/15 off baseline documented 6 hours apart

bedrest, increase protein in diet

130

severe preeclampsia BP + treatment

BP elevated 160/110 documented 6 hour apart

sedation to delay seizures, mag sulfate drug of choice!

131

cure for preeclampsia

delivery

132

how long is preeclamptic mother at risk for seizures after delivery

for 48 hours up to 4-6 weeks

133

magnesium sulfate x3

anticonvulsant, sedative, vasodilator drug of choice given for preeclampsia

increases renal perfusion, helps avoid renal failure, increases placental perfusion

labor will stop (relaxes uterus) unless augmented with oxytocin/Pitocin

134

never lay pregnant woman on back why?

places pressure on vena cava which will
impair kidney perfusion and impair CO
and impair placenta perfusion

preferable: left side (CO greater)

135

magnesium sulfate for preeclampsia: nursing considerations

check for toxicity every 1-2 hours (BP, respirations, DTR, LOC)

uop hourly, serum mag periodically

136

first sign of mag toxicity

DTR decrease

137

if dbp greater than 100 in preeclamptic woman receiving mag

give apresoline/Hydralazine too

side effect: tachycardia (compensatory for BP drop)

138

betamethasone: what + when + how

given for premature babes with immature lungs - stimulates surfactant production in alveoli causing less tension when infant breathes

given between 24 & 34 weeks gestation to reduce infant mortality

IM to mom - inj 24 hours apart

139

why do babies born to preeclamptic mothers require steroid therapy

aka betamethasone

vasoconstriction in mom = lack of blood flow to placenta = less oxygen and nutrients to baby = preterm delivery = immature lungs at birth

140

eclampsia + tx

preeclampsia becomes this when a seizure happens (super high BP)

monitor FHT, watch for labor and heart failure; also stroke, MI, renal failure, DIC, HELLP syndrome, neuro damage, multisystem organ failure

141

PIH

pregnancy induced hypertension - occurs after 20 weeks

proteinuria

142

gestational hypertension

occurs after 20 weeks

NO proteinuria

143

PIH vs gestational hypertension

PIH has proteinuria
gestational does not

144

chronic hypertension with superimposed PIH

client hypertensive prior to pregnancy and it got worse with proteinuria after 20 weeks

145

premature labor + tx

occurs between 20-37 weeks

stop labor with: tocolytic (terbutaline), mag sulfate(relaxes uterus)

give betamethasone (for baby lungs)

146

terbutaline/Brethine + side effects

bronchodilator and also tocolytic

increased pulse and hyperactivity

147

less common ways to stop preterm labor

hydration, treat vaginal/UTI

148

prolapsed cord

umbilical cord falls through cervix, most likely to happen when presenting part not engaged and membranes rupture

149

nursing action when membranes rupture (spontaneous or artificial)

check FHT

cord compression: variable decels

150

prolapsed cord treatment

lift head off cord until physician arrives
trendelenburg or knee-chest position
administer oxygen (hyperox to max O2 to baby)
monitor FHT
NEVER PUSH BACK IN

151

shoulder dystocia

fetal head delivered but impacted fetal shoulder within maternal pelvis halts delivery

anterior shoulder impacted by symphysis pubis

hard to predict

152

shoulder dystocia risk to fetus

hypoxia = cerebral palsy, asphyxia
brachial plexus injury = erb's palsy
broken clavicle
bell's palsy
many resolve but can lead to permanent damage

153

erb's palsy

drooping/paralysis of an arm caused by excessive traction and stretching of brachial nerve

happens to shoulder dystocia babies

154

increase risk for shoulder dystocia x4

LGA or macrosomic greater than 4000g
gestational diabetes
previous history
post date delivery with a large fetus

155

McRoberts Maneuver

for shoulder dystocia
mom's legs are hyperextended

156

Mazzanti techniques

for shoulder dystocia
suprapubic pressure easing shoulder past symphysis pubis
provider does this

do not apply fundal pressure!!

157

Gaskin maneuver

for shoulder dystocia
mom on all fours with arched back

158

group b strep + tx

leading cause of neonatal morbidity; risk for fetus is only after rupture of membranes

transmitted to infant from birth canal of infected mother during delivery

give prophylactic abx therapy, penicillin (clindamycin if allergy)

NOT AN STD

159

leading cause of neonatal morbidity

group b strep

160

when do you culture for group b strep

~35-37 weeks
on admission to L&D

161

premature rupture of membranes greater than 18 hours worry about

neonatal group b strep