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Flashcards in Maternity Part 2 Deck (217):
1

excessive or pernicious vomiting during pregnancy leading to dehydration and starvation

hyperemesis gravidarum

2

what would you give through an IV for a pt with hyperemesis gravidarum

LR bc has electrolytes

3

what is a possible etiology of hyperemesis gravidarum

possible bc of increase level of HcG, thyroid dysfunction, disruption of GI motility, increase estrogen level

4

S/Sx of hyperemesis gravidarum

N & V , intractable

5

Tx for hyperemesis gravidarum

hydration (3000mL within 24 hours
Rx (Zofran, phenegran)
nutritional supplements (ensure)
monitor for keytones

6

cervix is unable to support the increasing weight of the pregnancy, results in painless dilation of cervical os without labor or contractions, associated with repeated 2nd trimester abortion )16-28 weeks)

incompetent cervix

7

predisposing factors for incompetent cervix

prior traumatic delivery, Hx of D&C, conization, cauterization, mother of pregnant women who took DES, anomaly of uterus or cervix

8

Dx of incompetent cervix

Hx, examination (vag exam), U/S

9

Tx for incompetent cervix

cerclage or purse string suture, inserted in cervix to prevent preterm cervical dilation and pregnancy loss, tightened and secured anteriorly

10

spontaneous ROM prior to onset of labor

premature rupture of membranes
*gestational age doesn't matter

11

spontaneous ROM: latent period

time from ROM to onset of labor (usually within 24 hours)

12

spontaneous ROM: interval period

time from ROM to birth

13

Etiology of PROM

unknown, contributing factors: infection, Esp. UTI, polyhydramnious, trauma, mult gestation

14

what maternal risks can happen because of PROM

INFECTION
chorioamnionitis: inflammation of membranes
endometritis: postpartum infection of endometrial lining

15

what neonatal risks can happen because of PROM

RDS, sepsis

16

Management of PROM

Abx, bedrest, CBC, fetal monitoring, Temp Q4 hours, daily WBC, corticosteroids and amniocentesis prn, L/S ratio to check lung maturity

17

occurrence of regular uterine contractions at less than 10 minute intervals after 20 weeks but prior to 37 completed weeks gestation, it is the greatest single problem in OB

premature labor

18

what Rx can you give to stop labot

Tocolytics

19

what do you need to do to identify those pts at risk for premature labor

gather Hx, cervical length and funneling, ffn (fetal bibronectin), Sx of preterm labor

20

funneling

greater than 50% funneling before 25 weeks has a 80% risk of preterm delivery

21

extracellular matrix protein of fetal membranes binds placenta and membranes to decidua, found before 20 weeks and after 34 weeks

fetal fibronectin

22

if there is fetal fibronectin present between 20 and 34 weeks this is what

abnormal = risk for premature labor

23

preterm labor Sx

abd tightness, menstrual cramping, back discomfort (comes and goes), pelvic pressure, intestinal cramping

24

what can the pt do to decrease the risk for preterm labor

regular PN care, refrain from sexual intercourse, empty bladder Q2 hours, curtail work activities, allow for rest, left lateral position, maintain adequate nutrition and hydration

25

what are the contraindications of suppressing labor

confirmed fetal death, fetal distress, gestational age less than 20 weeks

26

Ritodrine

1st and only Rx approved, works on beta receptors in smooth muscle
risks: pulmonary edema
assess: BP, HR, RR, I&O, lung sounds
contraindications: concurrent Tx with glucocorticosteriods

27

Supress labor

cervix less 4 cm dilated, gestation less 37 weeks, viable infant, documentation of contractions, membranes intact, no medical or obstricial disorders

28

Terbutaline

B-adrenergic, relaxes smooth muscle, SQ or inhalation, Terbutanline pump
SE: tacycardia

29

Magnesium sulfate

CNS suppressant, secondary action-relaxes smooth muscle, monitor reflexes and BP

30

antidote for Magnesium sulfate

calcium gluconate

31

Nifedipine

Procardia, decrease smooth muscle contraction, SE increase HR, flushing, HA, decrease BP

32

Progesterone

relaxes uterine contratility

33

Bethamethasone

Celestone, accelerates fetal lung maturation (helps with surfactant), contraindicated with Ritodrine

34

developed from single fertilized ovum that divides, identical twins

monozygotic

35

the # of amnions and chorions depends on what

the timing of division after fertilization, the earlier the splitting the more independent the twins will develop

36

2 separate ova fertilized by 2 seperate sperm, fraternal twins (not identical)

Dizygotic
(2 placentas, 2 chorions, 2 amnions, born singly

37

How do you Dx multifetal gestation

U/S see 2 gestational savs, have severe N & V due to increase HCG

38

Maternal complications with multifetal gestation

PROM, pre eclampsia, preterm labor, prolapsed cord, post partum hemorrhage (overdestended uterus), high risk UTI

39

Fetal complications with multifetal gestation

IUGR, fetal anomalies, premature, cerebral palsey, TTTS

40

twin to twin transfusion syndrome (TTTS)

single plaental, one baby sucks up all nutirents and other gets leftovers, abnormal blood vessels in placenta

41

donor twin

small twin

42

recipient twin

larter twin

43

what would be dont for Tx of TTTS babies

seperate circulation, selective cord coagulation (stop BF to one baby, results in death of twin)

44

create a hole between babies sacs, evens out fluid
found in TTTS babies

septoplasty

45

what is the goal with multifetal gestations

keep pregnancyuntil 38 weeks for twins, 35 for triplets

46

what influences the delivery decision

position and presentation

47

what are the 4 factors of labor

passage, passenger, powers, psyche

48

false pelvis

above pelvic brim, supports weight of uterus

49

true pelvis

below pelvic brim

50

normal female pelvis, inlet is rounded, favorable for delivery, usually OA

gynocoid pelvis

51

normal male pelvis, inlet is heart shaped, prominent ischial spines, arrest of labor is frequent

android pelvis

52

ape like pelvis, inlet is oval, facorable influence on labor

anthropoid pelvis

53

flat pelvis, transverse oval inlet, if passes through inlet delivery is rapid

platypelloid pelvis

54

accomodation, overlapping of cranial bones under pressure of the powers of labor

passenger

55

swelling of soft tissues of scalp

caput

56

what is the suture on the back of the head, seperating the parietal and occipital bones

lambdodial suture

57

what is the suture on the front of the head seperating the frontal and parietal

coronal sutures

58

what is the suture that seperates the right and left parietal bones

sagital suture

59

the anterior fontenelle is AKA

Bregma

60

what is the fontenlle on the lateral side of the face in the cheek area

sphenoid fontenelle

61

the frontal bones are also known as

sinciput

62

mentum

fetal chin

63

sinciput

fetal brow

64

bregma

anterior fontenelle

65

vertex

area between anterior and posterior fontenelles

66

occiput

area beneath posterior fontenelle

67

relationship of the fetal spine to the maternal spine

Lie
*longitudinal/vertical
horizontal/transverse

68

relationship of fetal parts to one another, 4 types

attitude

69

what are the 4 types of attitudes

vertix; head flexed
military: partialy flexed
brow: partly extended
face: well extended, largest diameter of head to come through)

70

which fetal body part enters the pelvis first or lying over inlet, 4 types

presentation

71

what are the 4 presentation types

cephalic: fetal head 1st
breech: fetal butt, knees, feet first
shoulder: transverse line
compound: more than one presenting part

72

fetal hips and knees are flexed, thighs on abdomen, butt and feet present

complete breech

73

fetal hips flexed, knees extended, butt present

frank
"frank-feet-face"

74

fetal hips and legs extended, feet present, may be single or double footling

footling

75

fetal body part present in or on cervical os

presenting part

76

when largest diameter of present part reaches or passes through pelvic inlet

engagement

77

relative position of fetal presenting part above or below an imaginary line drawn between the maternal ischial spines

station

78

relationship of an orbitrarily choosen fetal reference point on presenting fetal part to its location front, back or side of maternal pelvis

position

79

forces of labor

powers

80

primary powers

uterine muscle contractions

81

secondary powers

use of abdominal muscles, "pushing"

82

what is the increment in a uterine contraction

building up (longest phase)

83

what is the peak of the uterine contraction

acme

84

what is the letting up phase in a uterine contraction

decrement

85

pressure in uterus between contractions

resting tone

86

period of time from start of one to start of another contraction (ex. 2-3 minutes)

frequency

87

period of time from start of one contraction to end of same contraction (ex 45-60 seconds)

duration

88

contraction strength at its acme

intensity
(mild-nose, moderate-chin, strong-forehead)

89

coping with labor ocntractions, influenced on fears, social support culture, etc

psyche

90

predisposing factors for HTN/HELLP

primigravida, Hx of vascular disease, increased age, genetic hx, , multifetal gestation

91

elevated BP WITHOUT proteinuria, developes after 20 weeks gestation & BP levels return to normal postpartum (HTN 140/90)

gestational HTN

92

HTN & proteinuria after 20 weeks gestation BP 140/90 or higher & proteinuria (0.3g or higher or +1) in a 24 hour collection

pre eclampsia

93

Tx for pre eclampsia

Left side lying
diet: no added salt, high protein

94

presence of one or more of following BP 160/110, 3+ proteinuria, oliguria, pulmonary edema, RUQ, impaired liver function, IUGR

severe pre eclampsia

95

new onset of grand mal seizures

eclampsia

96

new onset of proteinuria in women with HTN prior to 20 weeks gestation, sudden increase in HTn or HELLP syndrome

superimposed preeclampsia

97

HTN prior to conception or before 20 weeks gestation

chronic HTN
*Tx seperatly from preeclampsia

98

what Rx is given for chronic HTN women who are pregnant

aldomet, goal is to decrease vasospasm, prevent seizure

99

acronym used for lab markers in pts with severe pre eclampsia

HELLP syndrome
H-hemolysis
EL-elevated liver enzymes
LP- low platelets

100

what is the Tx for HELLP syndrome

delivery, regardless of gestational age

101

danger signs in pre eclampsia

severe HA, vision changes, RUQ pain

102

magnesium sulfate

monitor I&O, RR, BP, deep tendon reflexes, serum magnesium level

103

when magnesium sulfate is given, what do you need to watch for in a NB

lethargy, poor feedings

104

antidote for magnesium sulfate

calcium gluconate

105

what Rx is used for a HTN crisis

Hydralazine (labelolol) 160/110

106

intermittent ctx, irregular & painless, felt more in front than back, walking doesn't effect

Braxton hicks CTX

107

cervix becomes shorter, thinner

effacement, 0-100%

108

cervix is soft, thinner, dilatable

ripening

109

expulsion of mucous plug (pink in color)

bloody show
sign that labor is imminent (within 24-48 hours)

110

leak in amniotic sac, labor usually begins within 24 hours, if not labor is induced

ROM

111

what is the danger of ROM if labor is not induced

danger of infection, or prolapsed cord if not delivered

112

SROM

spontaneous ROM, rupture anytime before or during labor

113

AROM

artificially ROM

114

amniotic fluid

clear, musty, smell, may have white flecks (vernix), alkaline

115

green amniotic fluid

meconium, fetal distress

116

strange odor with amniotic fluid

amnionitis present

117

how do you DX ROM

visualization, nitrazine paper (yellow=intact, blue=membrane rupture), arborization test (ferning, its the most reliable method for DX, passage of meconium from vagina

118

dilation

opening of cervical os (1-10 cm)

119

effacement

thinning of cervix (1-100%)

120

descent

progress of fetus through maternal pelvis (+ or -, in relation to location of presenting part of fetus to ischial spine)

121

Phases of labor

4 stages (labor, baby, placenta, recovery)

122

1st stage of labor

onset of labor to complete cervical dilation
*latent phase
*active phase
*transition phase

123

latent phase

occurs in 1st stage of labor, labor onset to 3 cm dilation

124

active phase

occurs in the 1st stage of labor, 4-7 cm dilation

125

transition phase

occurs in the 1st stage of labor, 8-10 cm dilated

126

2nd stage of labor

complete dilation (10 cm) to birth of baby, have urge to push, increase of bloody show, if ROM hasn't happened you will have AROM

127

3rd stage of labor

birth to placental expulsion

128

4th stage of labor

1-4 hours after placental expulsion, uterus contracts to control bleeding at placental site

129

occurs when widest part of babies head is completely encircled by vagina (ring)

crowning

130

characteristics of transition

increase bloody show, increase anxiety, hyperventilation, increase sensitivity to touch, leg cramps, low back ache, inward focus, increase rectal pressure

131

movement of presenting part through pelvis, measured by stations

descent

132

why does flexion of the head happen during delivery

decrease the diameter of babies head

133

babies head rotates into position

internal rotation

134

turns back to initial position

restitution

135

after presenting part goes through symphis pubis head comes out, face towards rectum

extension

136

delivery of shoulders

external rotation

137

cardinal movements in order

descent, flexion, internal rotation, extension, restitution, external rotation, expulsion

138

how much time should it take between birth of baby to birth of placenta

no longer than 30 minutes

139

signs of placental separation

uterine fundus rises in abdomen, sudden trickle or gush of blood, umbilical cord lengthens

140

if you have a single gush of blood or trickle after delivery of placenta is that normal

yes

141

during the 4th stage of labor what are the S/sx of placental separation

decrease BP, increase HR, tachycardia, uterine fundus is firm, midline bit below umbilicus, shaking chills, thirst

142

Shiny shultz

fetal side of placenta delivers 1st, less blood loss

143

dirty duncan

maternal side delivers 1st, increase blood loss, have retained fragments, increase risk for infection

144

pscyh of latent phase

anxious but able to cope, excitement level high, station doesn't change

145

pscych of active phase

increase anxiety, inward focus, rapid dilation, change in station

146

pscych of transition phase

totally out of control, quick stage, dilation slows

147

pattern of labor becomes regular, gets close together, increase intensity, pain in back and radiates forward, walking increases intensity, will have cervical changes, will have presenting part

true labor

148

irregular contractions, no change in intervals, no changes in intervals, easily sedated, no change with cervix, walking has no effect in intensity

false labor

149

what is the only way to Dx labor

cervical exam

150

during the first stage of labor how does the BP change

have increase of systolic BP with uterine contractions

151

during the 2nd stage of labor how does the BP change

increase of systolic and diastolic during contractions

152

what other VS changes can happen during labor

increase RR, increase WBC, decrease GI motility, decrease of BL

153

how do you assess intensity of contractions

palpate

154

in order to have a internal monitoring or IUPC what has to happen

need dilation and ROM

155

pressure in uterus between contractions

resting tone

156

what can cause a false reading on a nitrazine test

lubricant used, vaginal exam, blood

157

what nursing care would you give after ROM

assess FHR, monitor amniotic fluid (color, odor, amt, time), temperature Q1-2 hours

158

labor curve

labor progressing as it should

159

will a vaginal exam be done if bleeding

NO

160

guidelines for uterine contractions

Q15-30 minutes, must validate intensity with palpation, note frequency, duration, intensity, tone

161

guidelines for FHR

document Q15-30 minutes in 1st stage
Q5-15 minutes in second stage

162

guidelines for temperature

Q2-4 hours, after ROM Q1-2 hours

163

guidelines for VS

Q hour, dictated by status, Rx, induction

164

Pitocin VS

Q15 minutes for one hour and so on

165

Epidoral VS

Q3 minutes

166

end of one contraction to beginning of next

interval period

167

what labs are done prior to labor

H&H, type and cross, WBC

168

bladder care

encourage frequent voiding, if needed we can cath

169

effleurage

soft gentle stroking where pain is (back)

170

counter pressure

palm of hand where pain is, push on that area

171

leg cramps

occur while pushing, extend legs, flex foot

172

psychoprophylaxis

breathing and relaxation techniques

173

deep breath at beginning and end of contraction, slow in through nose and out through mouth

slow paced

174

deep breath at beginning and end of CTX, with light mouth breathing, rhythmic

mod paced
used for transition period

175

deep breath at beginning and end of CTX, mouth breathing with "hee hee hoo"

combined

176

how do you tell a mom to slow down breathing and inhibit from pushing

panting

177

nuchal cord

cord wrapped around neck

178

Ritgens maneuver

places gloved finger with towel into anus, places pressure on chin to aid in delivery

179

cord that gets longer, gush of blood, uterus rises high in abdomen,

placenta separation

180

what Rx is given post delivery

oxytocic Rx
stimulates contractions and decreases hemorrhage

181

post partum assessments

Fundus (firm & midline=normal), bleeding, hemorrhoids, perineum (edema, sutures intact)

182

synchronous with fetal heart, sound is coming from blood flow in umbilical arteries

funic soufflé

183

synchronous with maternal heart rate, blood passing though large vessels of uterus

uterine soufflé

184

what is used during prenatal appts, baseline, rhythm, cant ID decels

doppler

185

measures rate and pattern of fetal heart rate, detect fetal myocardial movements

external fetal monitor
*does not tell intensity

186

what does internal monitoring assess for

baseline, variability, accels, decels, and dysrhythmias

187

baseline of FHR

10 minute period (accels and decels not counted

188

is variability good

yes it shows that the CNS is working

189

absent variability

0 or undetectable

190

minimal variability

1-5

191

moderate variability

6-25

192

marked variability

26 or more

193

normal baseline FHR

110-160 (round to nearest 5)

194

regular smooth, undulating wave pattern, no accels or decels

sinusoidal pattern

195

sinusoidal pattern is a sign of

severe fetal anemia

196

when do you have concern for fetal demise with HR

over 200

197

what can be a cause of tachycardia

mom-fever, dehydration, anxiety, some Rx
baby-hypoxia, asphyxia, anemia, infection, premature

198

bradycardia

less than 110

199

causes of bradycardia

mom-Rx, hypotension
baby-hypoxemia, stimulation of vagus nerve, late fetal ashyxia

200

abrupt temporary increase of at least 15 bpm above baseline

accelerations

201

early declarations

mirrors contraction, head compression
BENIGN, no nursing interventions

202

variable declerations

abrupt decrease in FHR, onset of decal to lowest point (nader) is less than 30 seconds with a quick return to baseline and has variability

203

VEAL

CHOP

204

non-reassuring variable deceleration

variable with decrease in variability, concern for fetal hypoxia
*shoulder, overshoot, slow to recover

205

management for variable decelerations

POPI

206

POPI

position
oxygen
Pitocin
IV bolus

207

prolonged deceleration

decrease in FHR more between 2-10 minutes

208

tactile scalp stimulation

via vaginal exam, look for accelerations (normal and good)

209

fetal blood flow

maternal artery
intervillius space
fetal villi
umbilical vein
fetus
umbilical arteries
maternal vein

210

rapid slow or irregular FHT

fetal hypoxia

211

port wine colored amniotic fluid/bleeding

placenta previa, separation of placenta, DIC

212

rising BP

pre eclampsia

213

low BP

shock, postural hypotension, reaction to Rx

214

fever

amnioitis, extra uterine infection

215

maternal tachycardia

impending shock

216

abnormal abdominal pain or tenderness

separation of placenta, rupture of uterus,

217

uterine tetany

premature separation of placenta, possible uterine rupture