Maternity Flashcards

Question

Third Trimester ( Week 27 to 40) Assessment

Answer 1

Weight Gain: No more than a pound a week Monitor BP and report any changes from baseline (Worried about pregnancy induced HTN) Check for Protein Fetal heart Rate Use Leopolds Maneouver to discern fetal position/ presentation. Make sure Client voids first, and in between contractions.

Answer 2

Lightening : When the presenting part of the fetus descends into the pelvis Client will be able to breath easier but urinary frequency will be a problem again Engagement : The largest presenting part is in the pelvic inlet - Hopefully its the head Fetal station: measured in cm; measures the relationship of the presenting part of the fetus to the ischial spines of the mother ``` Braxton Hicks Softening of cervix Bloody show Sudden burst of energy called nesting Diarrhea Rupture of membranes Come to hospital, could prolapse cord when ROM and when contractions are 5 minutes apart ```

Answer 3

Want to see two or more accelerations of 15 beats/minute with fetal movement

Answer 4

is when the fetal heart rate has an abrupt increase from the baseline. This is visualized on the fetal heart monitor. The increase is above the baseline and at least 15 seconds, but the heart rate should come back to the baseline within 2 minutes. Record for 20 minutes.

Answer 5

30 minute test. 6 we are worried, 4 is an emergency. Heart rate - Based on NST ( reactive or non-reactive) Muscle tone - Does the baby have at least one flexion/extension movement in 30 mins? Movement-Does the baby move at least 3 times in 30 minutes? Breathing - does the baby have breathing movements at least once in 30 minutes? Amniotic Fluid- Is there enough Fluid around the baby?

Answer 6

Done when NST is non-reactive. Performed on higher risk pregnancies: preeclampsia, maternal diabetes and any condition in which placental deficiency is suspected. Determines if bb can handle the stress of contraction. Uterine contractions decrease blood flow to the uterus and the placenta. If there is hypoxia, there will be a deceleration. If it is late this is indicating uterine/placental insufficiency Performed after 28 weeks

Answer 7

Early: benign - caused by physiological hypoxia form fetal head compression Late: caused by uterine/placental insufficiency Variable: Caused by umbilical cord compression

Answer 8

Contraction regular and increase Discomfort in back and abdomen Increase pain with activity

Answer 9

Irregular Abd discomfort Change in activity decreases pain

Answer 10

Position: Lie on left side, Legs flexed Given at 3 -4 cm dilation Usually no headache/don't want to get to spinal fluid Major complication is hypotension so monitor BP Infuse bolus fluids to fight hypotension Put in semi-fowlers on left side to prevent vena cava compression. If compressed will decrease venous return, reduce cardiac output and BP and decrease placentral perfusion Alternate position side to side hourly

Answer 11

One to one care Complications: Hypertonic labour, fetal distress and Uterine rupture (complete or incomplete) Want contraction rate of 1 every 2 to 3 minutes, with each lasting 60 seconds Discontinue if: Contractions are too often Last too long Fetal distress Oxy must be piggy-backed into a main IV fluid Client receiving should be in any position except flat on back Any unreassuring fetal heart tones (like fetal bradycardia) put client on left side to enhance perfusion. If late decels occur STOP

Answer 12

Through the uterine wall into the peritoneal cavity Sudden sharp shooting pain. If in labor, contractions may stop and pain will be relieved; signs of hypovolemic shock due to hemorrhage; if the placenta separates, the fetal tones will be absent

Answer 13

Through the uterine wall but stops in the peritoneum. The peritoneal cavity is still intact. Internal Bleeding; pain may not be present, fetus may or may not have late decls; client may vomit, faint or have hypotonic uterine contractions and lack of progress - fetal heart tones maybe lost

Answer 14

Clients are at high risk for uterine rupture The scar from the c-section is prone to open when under stress Those at highest risk are those that are receiving oxytocin

Answer 15

The fetal heart pattern is that of repetitive deep variable decelerations. This pattern is likely due to a prolapsed umbilical cord after AROM. The priority intervention is to relieve the pressure on the cord from being trapped between the presenting part and the pelvis. This can be accomplished by manual pressure on the presenting part, placing the client in Trendelenburg position, or placing her in the knee-chest position.

Answer 16

Tell client to pant/blow to decrease urge to push. don't push between contractions. As head crowns tear sac if not ruptured. Once head is out, feel for the cord around the neck Keep head down DRY THE BABY CAUSE THEY CANT THERMOREGULATE Deliver placenta/inspect for intactness Tie cord off with piece of cloth or shoestring Check firmness of uterus

Answer 17

Temp: May increase to 38 during first 4 hours BP stable HR 50 to 70 is common for 6 -10 days TACHYCARDIA = Hemorrhage Breast : Soft for 2 to 3 days then engorgment Abd: Soft/loose; diastasis recti - abdominal muscles seperate GI: Hunger is common

Answer 18

Immediately after birth, should be midline 2 - 3 fingers below umbilicus Rises to umbilicus a few hours after birth - 1 -2 above FIRM FuNDuS Massage and then check for bladder distention ( increases chances of hemorrhage) Fundal height will decrease one finger a day

Answer 19

Rubra 3-4 days, a dark red Serosa 4 - 10 days, pinkish brown Alba 10 - 28 days ( can be as long as 6 weeks) whitish yellow Clots are ok as long as they are no larger than a nickel

Answer 20

Diuresis should begin 24 hours after delivery Dehydration is possible Legs should be inspected closely for DVT

Answer 21

Ice packs intermittently for 6 to 12 hours to decrease edema Warm water rinses Sitz baths 2 -4 times a day Anesthetic sprays ( both are indicated if they have epi, lac or hemorrhoids) Change Pads frequently

Answer 22

We don't want more than one an hour Report foul smell Report lochia changes

Answer 23

Stabilizes HR Improves O2 Saat Regulates temp Conserves calories Breasts can change in temp to warm or cool KANGAROO CARE/ 1 hour for at least 4 times a week

Answer 24

Cleanse with plain water after each feeding and let them air dry Support bra Ointment for soreness or express colostrum and let it air dry Breast pads to absorb moisture Mom can pump Increase caloric intake by 500 calories Fluid intake - 8 to 10 glasses of fluid a day

Answer 25

Ice packs, breast binders, chilled cabbage leaves (decrease inflammation and decrease engorgment) No stimulation of breast

Answer 26

Within 10 days after birth Teach proper hygiene and hand washing Usually get cultures and antibiotics

Answer 27

Early: More than 500 cc of blood ost in first 24 hours and a 10% drop from admission hct. You must have both to be true! Late: After 24 hours; up to 6 weeks postpartum Caused by uterine atony, lacerations, retained placenta fragments and forceps delivery Meds: Oxytocin/Methylergonovine Maleate Carboprost Misoprostol

Answer 28

Usually occurs at 2 -4 weeks ``` Treatment: Bed Rest Support bra Binding will cause stagnation Chilled cabbage leaves Breastfeed or pump to unblock duct Penicillin Pain Medication Heat Feed baby often ( offer affected breast first) ```

Answer 29

``` Suction Clamp and Cut cord Maintain body temperature Apgar - done at 1 and 5 minutes - looks at HR, muscle tone, reflex irritability, color. Want 9 -10 Erythromycin Phytonadione ( VIT K) ```

Answer 30

Dries and falls off in 10 to 14 days Cleanse with each diaper change using alcohol or NS Fold diaper below cord NO immersion until cord falls off - watch for infection

Answer 31

Experience because no longer getting sugar from mom LGA babies, SBA babes, preterm and babies of diabetic moms

Answer 32

Occurs in 24 hours, usually means RH/RBO compatibility (positive baby, negative mom)

Answer 33

After 24 hours.

Answer 34

``` Increase of immature RBC in fetal cirucation. It will result in: Anemia Hypoxia HF Neurologic damage Hydrops fetalis ```

Answer 35

Indirect Coombs - done on mom, measure # of antibodies in the blood Direct Coombs - done on baby, tell you if there are any antibodies on the RBC's For a RH+ and sensitized mother: Frequent ultrasounds, Early Birth

Answer 36

Within 72 hours after birth (protects next babies), at 28 Weeks (to protect the fetus) and whenever there is a chance that mom and babes blood has mixed

Answer 37

Spotting and cramping in combination is more indicative of a miscarriage Measure HcG levels- we worry when levels drop Bedrest and Pelvic rest (abstinence form sex If miscarriage is imminent - IV, Blood, D&C

Answer 38

Benign neoplasm - can turn malignant Grape like clusters of vesicles Uterus enlarges too fast Abscence of FHT's Bleeding (some will have vesicles) Diagnosis: Confirmed with Ultrasound Treatment: Small mole - D&C Do not get pregnant during follow up time Can become malignant, it is called chorocarcinoma CXR for metastasis Will measure hCG weekly until normal, 2 to 4 weeks then 1-2 months for 6 months to a year

Answer 39

Gestation outside of the uterus, usually the fallopian tube. Confirmed with ultrasound. First sign is pain and then will exhibit the usual signs and symptoms of Pregnancy. If the fallopian tube ruptures, vaginal bleeding may be present. Once she has one, she is at risk for another. Treatment: Methotrexate stops growth of embryo. If unsuccessful, laproscopic incision and removal of embryo. May have to remove the tube. If not dealt with, tube will rupture and they will hemorrhage

Answer 40

Most Common

Answer 41

Most Common cause of bleeding in the later months (7th) The placenta has implanted wrong - US to confirm Fetus doesn't get enough O2 because the placenta prematurely seperates. In a normal uterus, placenta is high but in this case, it may be on the side, partially or completely covering the uterus. Painless bleeding in second half of preg

Answer 42

Placenta is implanted normally, can be partial or complete. Bleeding can be external or concealed (bleeding into uterus) Seen in last half of pregnancy U/S confirms ``` Causes MVC, Domestic violence Previous C section, Rupture of Membranes Associated with Cocaine, PIH and smoking ``` Rigid board like abdomen, with or without vaginal bleeding Abdominal pain and increased uterine tone Difficult to palpate fetus due to abd full of blood

Answer 43

Usually requires hospitalizations from 32 weeks until birth to prevent blood loss and fetal hypoxia if client goes into labour ``` Rule out other sources of bleeding Monitor blood count and monitor baby closely Monitor for contractions C-SECTION NO VAGINAL EXAMS ``` ``` Complications Preterm delivery Intrauterine growth retardation Fetal distress Anemia ``` Hemorrhage Potential DIC risk

Answer 44

C SECTION NO VAGINAL EXAMS Manage fetal status and maternal shock

Answer 45

Cervix dilates prematurely. Occurs in the 4th month of pregnancy. Client has history of repeated painless 2nd trimester miscarriages The weight of the baby causes pressure on cervix causing the dilation. Treatment: Purse string suture at 14 - 18 weeks reinforces the cervix May have C section, or suture clipped to deliver vaginally 80 -90% of carrying baby to term after suture

Answer 46

Reg morning sickness, excessive vomiting, dehydration, starvation and then death Related to high levels of estrogen and HCG BP down HGB/HCT up UO down potassium low Weight Down Ketones in urine

Answer 47

Reg morning sickness, excessive vomiting, dehydration, starvation and then death Related to high levels of estrogen and HCG BP down HGB/HCT up UO down potassium low Weight Down Ketones in urine- because of dehydration, breaking down body fat ``` Treatment NPO for 48 hours 3000 ml/ 1st 24 hours Antiemetic Vitamins Quiet environment Oral hygeine Don't talk about food 6 - 8 small, dry feedings followed by cold water Foods/liquids should be hot or cold Well ventilated room ```

Answer 48

Increased BP, Proteinuria, Edema after 20 weeks. 130/90 is considered to be mild preeclampsia. Sudden Weight gain, Swollen face and hands. Headache, Blurred vision, seeing spots, Hyper-reflexia (increased DTR's), Clonus then Seizure. When you see a client that gains 2 or more pounds in a week, watch closesly and worry about PIH

Answer 49

MILD BP 30/15 off the baseline, documented 6 hours apart Bed rest as much as possible Increase protein - GLOMERULAR DAMAGE Severe BP elevated 160/110, 6 hours apart Sedation to delay seizures MgSO4

Answer 50

Anticonvulsant, sedative, vasodilator Vasodilation will increase renal perfusion. Helps avoid renal failure, and increases placental perfusion Hypertonic solution so client is at high risk for pulmonary edema since it goes back into the vascular space Check for toxicity every 1 - 2 hours. These include BP, respirations, DTRs and LOC Urinary output is monitored hourly and serum mag is checked periodically. If used, labor will stop unless augmented with oxytocin. We use MgSO4 for preterm labour. If diastolic >100 apresoline in combo with MGSO4. side effects is tachycardia and cure is delivery. After delivery, client is at risk for seizures 48 hours after delivery, also for 4 - 6 weeks Nursing Care: Single Room Very quiet/Dark environment Steroid therapy for bb also needed

Answer 51

Turning point is when they have a seizure Monitor FHT Watch labor Watch Heart failure, stroke, heart attack, renal failure, DIC, HELLP syndrome, neurological damage and multi-system organ failure

Answer 52

Treatment: Drug therapy to stop labor Tocolytic terbutaline - bronchi dilator - side effects are pulse and hyperactivity MgSO4 relaxes the uterus Betamethasone - IM to mom Preterm labor can be stopped by hydrating mom and treating urinary/vaginal infections

Answer 53

When the umbilical cord falls through the cervix. Happens when presenting part is not engaged and membranes rupture Check FHT when they rupture artificially or naturally If cord is being compressed you will see variable decels in FHT so immediate c-section is indicated If cord ceases to pulsated fetal death has occured. We want the cord to pulsate because this tell us the baby is getting some oxygen Lift head off the cord until physician arrives. This is a manual lift to relieve pressure on the cord Trendelenburg or knee chest position Admin O2 MOnitor fetal heart tones Don't push baby back in

Answer 54

Fetal head us delivered and further delivery of the fetus is prevented by the impaction of the fetal shoulder with the maternal pelvis Anterior shoulder of fetus becomes impacted by the symphysis pubis Risk to Fetus: Hypoxia - Leads to cerebral palsy and asphyxia Brachial plexus injury - leadings to Erb's Palsy (drooping paralysis of an arm caused by excessive traction and stretching of the brachial nerve at delivery) Broken Clavicle Bell's palsy is paralysis of face with dropping of one side of the face Caused from forceps Many resolve but can lead to permanent damage ``` Maternal Risks: Traumatic delivery leading to permanent damage Bruised bladder Extension of episiotomy Rectal tear Torn Cervix and/or uterus ``` At RIsk: LGA, Gestatioal diabetes, Previous history of shoulder dystocia, post date delivery (aka BIG BABY)

Answer 55

Routinely assess for BGS risk factors during pregnancy (week 35 - 37 ) and on admission to L&D. Transmitted to infant from birth canal during delivery. Risk to fetus only after ROM Not a sexually transmitted disease Risks include - preterm less than 37 week birth, + prenatal cultures in pregnancy, premature rupture of membranes (longer than 18 hours), positive history for early onset neonatal GBS, intrapartum maternal fever higher than 38 and previous infant with GBS Prophylactic antibiotic therapy; penicillin is drug of choice

Answer 56

HELLP syndrome is a life-threatening pregnancy complication usually considered to be a variant of preeclampsia. Both conditions usually occur during the later stages of pregnancy, or sometimes after childbirth. HELLP syndrome was named by Dr. Louis Weinstein in 1982 after its characteristics: H (hemolysis, which is the breaking down of red blood cells) EL (elevated liver enzymes) LP (low platelet count) HELLP syndrome can be difficult to diagnose, especially when high blood pressure and protein in the urine aren't present. Its symptoms are sometimes mistaken for gastritis, flu, acute hepatitis, gall bladder disease, or other conditions. The physical symptoms of HELLP Syndrome may seem at first like preeclampsia. Pregnant women developing HELLP syndrome have reported experiencing one or more of these symptoms: Headache Nausea/vomiting/indigestion with pain after eating Abdominal or chest tenderness and upper right upper side pain (from liver distention) Shoulder pain or pain when breathing deeply Bleeding Changes in vision Swelling Signs to look for include: High blood pressure Protein in the urine The most common reasons for mothers to become critically ill or die are liver rupture or stroke (cerebral edema or cerebral hemorrhage). These can usually be prevented when caught in time. If you or someone you know has any of these symptoms, please see a healthcare provider immediately.

Answer 57

This "stress test" is usually not performed if there are any signs of premature birth, placenta praevia, vasa praevia, cervical incompetence, multiple gestation, previous classic caesarian section. Other contraindications include but are not limited to previous uterine incision with scarring, previous myomectomy entering the uterine cavity, and PROM. Any contraindication to labor is contraindication to CST.

Answer 58

Suprapubic/fundal pressure. Must be done by the physician.

Answer 59

Suppresses active antibody response and formation of Rho (D) antibodies Contraindications: Immune globulins IgA deficiency Hypersensitivity IM/IV Interactions: May interfere with the immune response to live MMR and varicella vaccines. MoA: Suppresses the active antibody response and formation of Rho (D) antibodies in Rho (D) negative women who have been exposed to Rho (D) positive blood as the result of pregnancy or other obstetric condition. Also used to suppress Rh isoimmunization in Rho (D) negative individuals following transfusion of Rho positive blood. Treatment of ITP in Rho (D) positive non-splenectomized patients ``` Side Effects: Fever Headache Nausea Dizziness Rash Malaise Mild hemolysis (increased bilirubin, decreased hemoglobin), Injection-site reaction ``` Adverse: IV hemolysis Interventions: Administer within 72 hours after termination of pregnancy, delivery or obstetric complication. Closely monitor patients with ITP in a healthcare setting for ≥8 hours after administration. Perform dipstick urinalysis as baseline and after administration at 2 hours, 4 hours, and just prior to the end of monitoring period.1 25 Monitor for signs and symptoms of intravascular hemolysis. Assess renal function (including BUN and creatinine) before initiating Rho(D) EDucation: Teach women the importance of informing clinicians if they are or plan to become pregnant or plan to breast-feed. Teach patients when using RhoGAM, the importance of retaining the patient identification card and of presenting this card to healthcare providers. Instruct patients receiving Rho(D) IG for the treatment of ITP to immediately report signs or symptoms of hemolysis (e.g., back pain, chills, fever, discolored urine, swelling, SOB).

Answer 60

The Bishop score is a system for the assessment and rating of cervical favorability and readiness for induction of labor. The cervix is scored (0-3) on consistency, position, dilation, effacement, and station of the fetal presenting part. A higher Bishop score indicates an increased likelihood of successful induction that results in vaginal birth. For nulliparous women, a score ≥8 usually indicates that induction will be successful

Answer 61

a leading cause of ectopic pregnancy and infertility, occurs when bacteria from the genital tract spread upward through the cervix and cause infection of the female reproductive organs (eg, uterus, fallopian tubes, ovaries) and pelvic cavity. Symptoms may include pelvic or lower abdominal pain, menstrual irregularities or increased menstrual cramps, painful intercourse, fever, and abnormal vaginal discharge. Untreated sexually transmitted infections (STIs) (eg, gonorrhea, chlamydia) are the most common cause of PID. The nurse should assess for other risk factors, including: History of PID Multiple sexual partners (Option 3) Previous STI (Option 4) Unprotected sexual intercourse (ie, without condom use) Placement of an intrauterine device within the past 3 weeks Recent abortion or pelvic surgery (Option 5)

Maternity Flashcards

(85 cards)