OB Flashcards

Question

Signs of False labor

Answer 1

No significant cervical change Irregular contractions Often stop with ambulation Usually just back or upper abdominal pain Often stop with comfort measures

Answer 2

*Latent Phase: Onset to 4cm, 5-10 hrs UC’s every 10-15 min, increasing to every 5 minutes, duration 30-40 seconds, mild to moderate intensity, she is excited, but still sociable *Active Phase-4-8 cm, 3-14 hours UC’s every 3-5 min., 60-90 sec., mod to strong, focused, increasing discomfort *Transition Phase-8-10 cm, 1-2 hours UC’s every 1 ½ to 3 min., 90 sec., strong with urge to push, irritable, restless, angry Pushing during transition can cause swelling and cervical lacerations. Mom needs to be fully dilated and effaced before pushing.

Answer 3

MATERNAL One of the safest major surgical procedures. But it is a major surgical event so carries all the risks of surgery along with uterine hemorrhage. INFANT Diagnostic studies are often done to ensure that fetal lungs are mature when C/S birth is planned. Clearance of fetal lung tissue is slowed related to lack of push of contractions.

Answer 4

Preterm Contractions/ Labor/ Delivery Contractions prior to 37 weeks but after 20 weeks Cervical change denotes labor Use of Morphine sulfate and Cortisones Consequences of prematurity: Lung maturation not complete

Answer 5

Emergency condition Late, deep fetal heart decelerations with little or no recovery Decreased to no variability Put mother in Trendelenburg or knee-chest position to take pressure off cord Nurse puts hand in cervix to push up on the baby’s head to keep cord from being compromised Emergency delivery possibly by cesarean section

Answer 6

*Assess VS (similar to post op VS) Every 15 min x 1hour Every 30 min x 2 Every 4 hrs x 24 hrs After 24 hrs, every 8 hrs *BP should be baseline May have orthostatic hypotension *Temp May have low grade temp (100.4 F) 1st 24 hours possibly from dehydration *Pulse May be bradycardic ( 50-60) for first 48 hours *Tachycardia would be symptom of blood loss and needs to be reported immediately

Answer 7

*Assess: Healing of episiotomy Tears/ lacerations Hematomas Hemorrhoids *Episiotomy: 1–2-inch surgical incision made in muscular area between vagina & anus (perineum) to enlarge vaginal opening before birth. *Normal findings: intact with tissue edges closely approximated, mild edema, minor ecchymosis, mild to mod pain. *Use the REEDA Scale for episiotomy Redness Edema Ecchymosis Discharge Approximation

Answer 8

Ensure proper latch-improper placement of baby’s mouth on breast is major cause of nipple soreness Apply small amount of breast milk or pure lanolin cream to sore nipples Wear breast shields in bra Avoid trauma to nipples Avoid tight bra Ensure good latch-roll flat nipples between fingers just before breastfeeding to help them become more erect. Notify provider if still sore and cracked after 4 weeks

Answer 9

Frequent BF or pumping to empty ducts. Encourage mother to continue to BF while on oral antibiotics (Complete entire course of antibiotics). Bed rest during acute phase- plenty of fluids (>3000ml/day) Supportive bra Ice or heat application on affected breast Analgesics. Note: Usually resolves 24-48 hours, mom can BF on both sides, infant may refuse affected side because of changes in composition (still need to pump).

Answer 10

Oxygen exchange between placenta and fetus switches to pulmonary gas exchange Ductus venosus-constricts at birth. More blood to the liver Ductus arteriosus-closes and more blood goes to lungs Foramen ovale-closes and more blood goes to lungs

Answer 11

Put the baby to the breast immediately after delivery Mother and baby should room in together. Artificial nipples (bottles or pacifier) should not be given to the baby No restriction on length of feedings or frequency. No supplements of water, sugar water or formula. Proper positioning and latching on are crucial

Answer 12

Contributing factors: age (2-4 months) , winter, low birth weight (LBW) Manage: supine for sleeping (back to sleep)

Answer 13

Risk for hypoglycemia May be preterm but large for gestational age Manage: frequent heel sticks for blood glucose levels, IV glucose

Answer 14

Fetal alcohol syndrome and neonatal substance withdrawal Manage: supportive: gentle rocking, decrease sensory stimuli, small, frequent feedings. Monitor I and O; benzodiazepines for seizures

Answer 15

Up to 75 % are asymptomatic or vague Men--white or clear discharge, burning, itching, urinary frequency, dysuria Women—vague-yellow vaginal discharge, itching, dysuria, pelvic pain, low-grade fever, vaginal bleeding

Answer 16

Many are asymptomatic Urethritis Purulent discharge If anal: pain with defecation If pharyngeal, throat is sore

Answer 17

*Primary Stage: Firm and hard at first but within 3-7 days it becomes a painless, weeping lesion Found on genitalia, lips, mouth, on the anus, in the rectum, on the nipples and on the hands and fingers Chancre disappears without treatment in 6 weeks but the spirochete spreads systemically Chancres are highly infectious *Secondary Stage: Systemic symptoms- Malaise, lymphedema, fever , headaches and pains, sore throat, nausea and general flu- like symptoms Defining characteristic of secondary stage: Non-tender rash and skin lesions Can take several forms, often begins with papules and pustules Rash crosses the palmar and pedal surfaces, which is unique to syphilis. Condylomata lata - characteristic gray white genital lesions on the labia, perineum and anus Lesions are highly contagious Rash subsides spontaneously in 2 - 6 weeks but may reoccur *Latent Stage: No symptoms Disease is not transmitted by sexual contact during this phase Transmission can occur via blood and from mother to fetus Can last up to 20 years *Tertiary Stage: Terminal at this stage if not treated but systemic damage is not reversible even if treated Develops in 4-20 years Significant morbidity and mortality rates due to damage on internal organ systems “Gummatous lesions” develop Benign lesions of the skin and mucous membranes which are contagious. Can occur on any part of body Symptoms: Cardiovascular changes-aneurysms, aortitis, heart failure Neurological changes- Central nervous system problems- called neurosyphilis include mental illness, ataxic gate, paralysis, senility and loss of judgment Not infectious in this stage

Answer 18

Sexual: intimate sexual contact Parenteral: sharing needles with drug use Perinatal: Passes from mother to fetus during: Pregnancy and/or delivery Breast feeding Transfusion of blood products

Answer 19

*Medical Management: No vaccine or antibiotic but immunization now available Characterized by exacerbations and remissions Cytotoxic agents: topical cream agents that treat the virus treatment can take as long as eight weeks *Surgery: Carbon Dioxide Laser Surgery Crytotherapy with liquid nitrogen Electrocautery Surgical excision *Nursing Care: All partners should be treated concurrently to avoid reoccurrence Abstain from sexual intercourse while lesions are present Condoms should be used at all times because virus can shed even without lesions

Answer 20

Diabetes (35-50% of men with diabetes have ED) Hypertension Vascular disease-Insufficient blood flow to the penis Atherosclerosis (hardening of the arteries from plaque)-50-60% of ED cases in men 60 and older Damaged nerves to the penis Hormonal disorder Certain drugs Psychologic issues

Answer 21

Obesity and overweight High cholesterol Kidney disease Smoking Alcohol Use of recreational drugs Exercise Stress Depression

Answer 22

ED is an unavoidable consequence of aging. Tight underwear causes ED.

Answer 23

Should begin at adolescence Done monthly after a warm shower or bath, in front of a mirror Examine each testicle, one at a time, using both hands Scrotum palpated for nodules, masses or inflammation Normal for one testes to be larger than the other Epididymis is located on back of testicle Inspect and palpate penis along both spermatic cords for nodules, masses, inflammation, and discharge If uncircumcised, retract foreskin for visualization of glans penis

Answer 24

Men younger than 35: most likely due to STI such as chlamydia and gonorrhea. Men older than 35: most likely caused by infection with urinary tract pathogens E coli and pseudomonas Symptoms: unilateral pain and swelling, develops over 24-48 hours. Erythema and edema of the scrotum Treatment: Antibiotics, rest, scrotal support, analgesics

Answer 25

Void often and assist bladder emptying by leaning forward on the toilet "bearing down" (valsalva maneuver) or pressing down on the bladder while on the toilet. Drink frequent small volumes of oral fluids so the bladder doesnt become extremely full at one time Limit alcohol and caffine, which increases urgency to urinate. Limit cough, cold, allergy medications that contain decongestants which can interfere with urination. Note any s/s of acute urinary obstuction and urinary infection indecate the need for medical attention.