OB Flashcards
1
Q
Ectopic pregnancy patho
A
Occurs when a fertilized egg implants and grows outside the uterus
2
Q
S+S of ectopic pregnancy
A
Unilateral lower abdominal pain
Abnormal vaginal bleeding or spotting
Delayed menstrual period
Positive pregnancy test
3
Q
Complications of ectopic pregnancy
A
Rupture/hemoperitoneum -> hemorrhage: hypotension, bleeding, hypovolemia
4
Q
Nursing interventions of ectopic pregnancy
A
Methotrexate
Urine is toxic up to 72 hrs after administration
Avoid analgesics stronger than acetaminophen
Surgery may be required
Rupture is medical emergency
5
Q
Preeclampsia patho
A
Hypertensive disorder of pregnancy
Systemic vasospasm
Onset > 20 wks gestation
6
Q
Risk factors of preeclampsia
A
Chronic HTN
Prior hx of preeclampsia
DM
7
Q
Dx of preeclampsia (w/o and w/ severe features)
A
Preeclampsia w/o severe features:
> 140/90
Proteinuria
W/ severe features:
> 160/110
Thrombocytopenia
Increased creatinine
Increased LFTs
8
Q
Complications of preeclampsia (maternal and fetal)
A
Maternal:
AKI
Pulmonary edema
Ischemic stroke
Hepatic failure/rupture
DIC
Progression to eclampsia
Fetal:
Placental abruption
Restricted growth
Preterm birth
Fetal demise
9
Q
Nursing interventions of preeclampsia
A
Facilitate and prepare for birth
Hourly I+O
Assess DTRs
Antihypertensives: stroke ppx
Seizure ppx: seizure precautions Magnesium sulfate (monitor for magnesium toxicity)
10
Q
Preterm labor patho
A
Regular, painful uterine contractions causing progressive cervical dilation and effacement before 37 wks gestation
11
Q
Preterm labor interventions
A
Magnesium sulfate administration at <32 wks gestation (fetal neuroprotection)
Tocolysis
Corticosteroids: accelerates fetal lung maturity
Abx (PCN): ppx for Group B Strep
Notify neonatal resuscitation team
Continuous fetal monitoring
Provide emotional support to pt and partner
12
Q
False labor vs. true labor
A
False:
Braxton-Hicks contractions
Contractions are irregular w/o progression
No cervical dilation, effacement, or fetal descent
Activities often relieve contractions
True:
Contractions are regular, become stronger, last longer, and are frequent
Cervical dilation and effacement are progressive
Fetus is engaged in pelvis and descends
13
Q
S+S of umbilical cord prolapse
A
Visualized cord protruding from vagina
Palpation of cord during vaginal exam
Sudden FHR changes in previously normal tracing:
Fetal bradycardia
Moderate to severe variable decelerations (cord compression)
14
Q
Nursing interventions of umbilical cord prolapse
A
Call for help and notify HCP
Prepare for expedited birth
Request neonatal resuscitation team at birth
Wrap protruding umbilical cord w/ sterile towel and warm saline
Don’t manipulate or replace cord
Administer IV fluid bolus and oxygen
Perform sterile vaginal exam and lift presenting fetal part off of umbilical cord until birth
15
Q
A trimester is __ wks
A
13
16
Q
GTPAL
A
Gravidity: number of pregnancies
Term births: >37 wks
Preterm births: 20-36 wks
Abortions/miscarriages: before 20 wks
Living children
17
Q
Softened cervix = _________ sign
A
Goodell’s
18
Q
Blue color of vulva, vagina, or cervix = _______ sign
A
Chadwick’s
19
Q
Uterine softening
A
Hegar’s
20
Q
Naegele’s rule
A
Estimate expected birth
Last menstrual period - 3 months + 7 days
21
Q
TORCH
A
Toxoplasmosis
Virus B-19 (parvovirus)
Rubella
Cytomegalovirus
Herpes simplex virus
22
Q
Total weight gain = ____ +/- _
1st tri: ____________
2nd and 3rd: __________
A
Total weight gain: 28 +/-3
1st tri: 1 lb/month
2nd and 3rd: 1 lb/wk
23
Q
Ideal weight gain =
A
Week - 9
24
Q
Fundus is not palpable until wk __
A
12
25
Fundus is at umbilicus at ______ of gestation
20-22
26
If fundus is at/below belly button = ____ tri
Who is priority?
2nd
She
27
If fundus is above umbilicus = ____ tri
Who is priority?
3rd
Baby
28
Quickening =
When baby kicks
16-20 wks
29
Morning sickness is w/in what tri? Tx?
1st tri
Tx: dry carbs before getting out of bed
30
Urinary incontinence is w/in what tri? Tx?
1st and 3rd tri
Tx: void every 2 hrs
31
Difficulty breathing is w/in what tri? Tx?
2nd and 3rd tri
Tx: tripod position
32
Back pain is w/in what tri? Tx?
2nd and 3rd tri
Tx: pelvic tilt exercises
33
Negative station
Head/presenting part is above tight squeeze
34
Positive station
Presenting part below ischial spines; made through tight squeeze
35
Stages of labor
Stage 1: cervix dilation
Latent
Active
Transition
Stage 2: baby delivered
Stage 3: placenta delivered
Stage 4: recovery
36
Active phase of labor
Dilation
Contraction frequency
Contraction intensity
Dilation: 5-7
Contraction frequency: every 3-5 mins
Contraction intensity: moderate
37
Contractions should not be longer than _____ secs
90
38
Frequency of contraction
Beginning of one to beginning of next
39
Duration of contraction
Beginning of end of one contraction
40
Intensity of contraction
Palpate over fundus w/ fingertips
41
Interventions for all other complications in labor and birth
LION
Left side
Increase IV
Oxygen
Notify HCP
42
Remember peak levels of route
SL
IV
IM
SL: 5-10 mins
IV: 15-30 mins after infusion
IM: 30-60 mins
43
Fetal HR
110-160
44
If low FHR...
LION and stop pitocin
45
If low baseline variability...
LION
46
Decelerations
In comparison to contractions (early, late, variable)
47
If late decelerations...
LION
48
If variable decelerations...
BAD
Prolapsed cord -> push, position
49
VEAL CHOP
Variable Cord compression
Early dec Head compression
Acceleration OK
Late dec Placental insuffiency
50
If boggy fundus...
Massage
51
If displaced fundus...
Catherize
52
APGAR
Activity
Pulse
Grimace
Appearance
Respiration
53
Baby RR
30-60
54
Caput succadeaneum
Edema
Crosses suture lines
Like a cap
55
Cephalohematoma
Birth trauma
Doesn't cross suture lines
56
Molding
Abnormal head shape that results from pressure
Normal
57
Pathological jaundice vs. physiological jaundice
Patho: yellow baby comes out
Physio: appears after 24 hrs
58
Postpartum assessment
Breasts
Uterine fundus (firm, midline, height related to bellybutton)
Bladder
Bowel
Lochia (rubra, serosa, alba)
Episiotomy
Hemoglobin and hematocrit
Extremity check
Affect
Discomforts
59
Lochia types
Rubra: red
Serosa: pink
Alba: white
60
Postpartum hemorrhage def
Vaginal birth > 500 ml of blood
C-section > 1000 ml of blood
61
S+S of postpartum hemorrhage
Hypotonia of uterus
Atony/boggy uterus
Deviated to right
Uncontrolled bleeding
Hypovolemia: tachycardia, hypotension, dizziness
62
#1 cause of uterine atony is...
full bladder
63
Drugs of postpartum hemorrhage
Oxytoxin
Methergine
Hemabate
Misoprostol
(Uterotonics)
64
Terbutaline
Causes maternal tachycardia
Tocolytic = stops labor
65
Magnesium sulfate
Tocolytic = stops labor
Watch for toxicity
Watch for hypermagnesemia
66
Pitocin
Can cause uterine hyperstimulation
Oxytocics = stimulate and strengthen labor
67
Methergine
Causes HTN
Oxytocics = stimulate and strengthen labor
68
Bethamethasone
Mom gets it
Given IM
Given before baby is born
69
Surfacant
Baby gets it
Transtracheal
Given after baby born
70
Magnesium toxicity S+S
Absent or diminished DTRs
Decreased RR or oxygen saturation
Somnolence
71
Placenta previa (what to expect and tx)
Placenta partly or completely covers the cervix, which is the opening of the uterus
At risk for hemorrhage
Vaginal exams are CI
Pelvic rest is recommended
C-section is planned
72
Toxoplasmosis
Exposure to infected cat feces or ingestion of undercooked meat or soiled-contaminated fruits/vegetables
73
Hyperemesis gravidarum def and S+S
Severe, persistent N+V
S+S: ketonuria (by-product of metabolism of fat for energy), weight loss > 5%, hypokalemia, dehydration, tachycardia
74
intermittent pain w/ contractions, small amt of blood-tinged mucus
Normal labor def
75
sudden-onset vaginal bleeding, abdominal pain, hypertonic/tender uterus, tachysystole
Placental abruption
76
Placental abruption tx
Emergency c-section
Continuous external fetal monitoring
Blood specimen for type and crossmatch
Concerns: maternal blood loss resulting in hypotension, shock, and fetal compromise
77
painless vaginal bleeding, ultrasound finding of placenta covering cervical os
Placenta previa
78
sudden-onset vaginal bleeding, constant abdominal pain, cessation of uterine contractions, loss of fetal station, fetal deterioration
Uterine rupture
79
HELLP syndrome labs and tx
Labs: hemolytic anemia, elevated liver enzymes, low platelet count
Tx: delivery, magnesium sulfate, antihypertensive drugs
80
Oligohydramnios vs. polyhydramnios tx
Oligo: amnioinfusion to help alleviate cord compression
Poly: oxytocic meds to prevent postpartum hemorrhage
81
Second stage of labor interventions
Assist pt to push while lying in supported lateral position
Open glottis pushing technique
Push w/ every other contraction
Push effort for 6-8 seconds
82
Preterm labor interventions
IM antenatal glucocorticoids (betamethasone)
Abx to prevent group B Streptococcus infx
Magnesium sulfate
Tocolytic meds (nifedipine, indomethacin) to suppress uterine activity
83
Teratogenic drugs
Thalidomide (immunomodulator)
Epileptic meds
Retinoid
Ace inhibitors, ARBs
Third element (lithium)
Oral contraceptives
Warfarin
Alcohol
Sulfonamides/sulfones
(TERATOWAS)
84
28 wks visit
Glucose tolerance test for diabetes
Anti-D injection if Rh negative
Pertussis vaxx
85
34-36 wks visit
Group B strep vaginal swab
86
Cleft lip and palate risk for
aspiration due to uncoordinated suck and swallow
87
Cleft lip and palate S+S
Feeding difficulties: poor suction and uncoordinated suck and swallow
88
Nursing interventions of cleft lip and palate
Encourage bonding
Feed upright position
Burp after each ounce of formula consumed
Position nipple toward back or side of moth
Use special nipples/bottles
89
Postop care for cleft lip repair
6-12 months after birth
Elbow restraints
Observe for excessive swallowing
Don't offer straws or pacifiers
Avoid rigid eating utensils
Diet: modified liquids or soft/blended foods
90
Hirschsprung dz patho
Congenital aganglionic megacolon
Absence of specialized nerve cells in distal large intestine
Impaired peristalsis
Inability of interior anal sphincter to relax
Prevention of stool passage
Increased risk for life-threatening bowel perforation or enterocolitis
91
Hirschsprung dz S+S
Abdominal distention
Feeding intolerance
Bilious vomiting
Ribbon-like stools
Poor weight gain or growth failure
Delayed meconium passage in newborns (>48 hrs)
Dx: barium enema or rectal biopsy
92
Nursing interventions for Hirschsprung dz
Preop:
Check serial abdominal circumference measurements
Prepare for surgery (removal of aganglionic portion of bowel)
Maintain NPO
Administer IV fluids
Older children may require enema prior to procedure
Postop:
Assess for S+S of infx at incision
If colostomy was performed, provide teaching
Assess stoma if colostomy was performed
93
Infant botulism S+S
Symmetric, descending paralysis
Hypotonia and decreased head control
Ptosis
Absent gag reflex
Poor feeding
94
Nursing interventions of botulism
Recognize symptoms early to avoid respiratory failure
IV botulism immune globulin
Supportive care:
Mechanical ventilation
Enteral tube feedings
Prevention: avoid honey before age 12 months
95
Neonatal abstinence syndrome S+S
CNS:
Irritability, inconsolability, high-pitched cry
Hypertonia, tremors
Short sleep cycles
Sneezing, yawning
Uncoordinated swallowing
Respiratory: tachypnea
GI: vomiting and diarrhea
96
Neonatal abstinence syndrome nursing interventions
Obtain newborn drug screen
Monitor daily weight
Feed in small, frequent amts
Minimize environmental stimuli
Swaddle tightly in flexed position
Provide pacifier
Administer prescribed meds and evaluate response: opioid agonists (morphine, methadone)
97
Newborn hypoglycemia
BG < 40-45
Can cause seizures and neuro injury if untreated
98
S+S of newborn hypoglycemia
Can be asymptomatic
Hypothermia
Poor feeding
Irritability
Exaggerated Moro reflex
Tachypnea
Tremors
Lethargy
99
Nursing interventions of newborn hypoglycemia
Screen newborn w/ risk factors or symptoms
Check BG frequently via heel stick
Early, frequent feedings and skin-to-skin contact
Monitor temp and RR
Administer: buccal dextrose and IV dextrose
100
S+S of myelomeningocele
Sac-like protrusion containing:
Spinal cord
Spinal nerves
Spinal fluid
101
Associated complications w/ spina bifida
Abnormal hip development
Tethered spinal cord
Hydrocephalus
Neurogenic bladder
102
Nursing interventions of spina bifida
Initial:
Use latex-free gloves
Cover site w/ sterile saline-soaked non-adherent dressing
Large defects: cover w/ plastic wrap to prevent heat loss
Only neurosurgeon removes dressing
No diaper
Maintain prone/lateral position
Ppx IV abx
Long-term:
Teach parents how to measure head circumference (risk for hydrocephalus)
Maintain bladder fx: clean intermittent catheterization
Maintain bowel fx: prevent constipation
Support musculoskeletal integrity:
Assistive devices to help walk
Routine ROM exercises
Prevent recurrence
103
Lactational mastitis S+S
Flu-like symptoms:
Fever
Chills
Myalgias
Malaise
Local changes:
Unilateral breast pain
Focal erythema
Induration
104
Nursing interventions of lactational mastitis
Abx
Analgesics
Warm compresses to breast
Adequate rest, nutrition, hydration
105
Education of lactational mastitis
Increase daily fluid intake
Continue to breastfeed
Start feeds w/ sore breast first
Feed at least 15-20 min per breast
Attempt to breastfeed every 2-3 hrs (8-12 times/day)
Wear soft, supportive bras
Use warm compress and massage
Insert clean finger beside newborn's gums to break suction before unlatching
106
Causes of postpartum hemorrhage
Tone
Trauma
Tissue
Thrombin
107
Uterine atony
Inadequate contraction of uterus -> relaxed uterus distended w/ blood
Placental site blood vessels are not clamped off -> excessive bleeding
108
Risk factors of postpartum hemorrhage
Inadequate contraction of uterus -> relaxed uterus distended w/ blood
Placental site blood vessels are not clamped off -> excessive bleedingUterine fatigue: prolonged labor
Chorioamnionitis
Uterine overdistension:
Multifetal pregnancy
Fetal macrosomia
Polyhydramnios
Grand multiparity (> 5 births)
Hx of postpartum hemorrhage
109
What vaccinations can pregnant people not get?
Live vaxx (MMR, rotavirus, varicella/varicella zoster)
110
Placental abruption patho
Premature separation of placenta from uterus causes hemorrhage from placental blood vessels
111
Uterine rupture patho
Spontaneous tearing of uterus that may result in fetus being expelled into peritoneal cavity
112
Dark-red vaginal bleeding
Abdominal rigidity
Severe abdominal pain
Possible fetal distress (late decelerations)
Placental abruption
113
Sudden onset of extreme abdominal pain
Abnormal bump in abdomen
No uterine contractions or positive contractions
Uterine rupture
114
Placental abruption tx
C-section
115
Uterine rupture tx
Immediate laparotomy with delivery of the fetus with repair of the uterus
116
Regular, painful uterine contractions cause progression cervical dilation and effacement before term gestation
S+S: painful frequent contractions, lower back pain
Preterm labor
117
For preterm labor <32 wks tx
Corticosteroids
PCN
Tocolysis: indomethacin
Magnesium sulfate
118
For preterm labor 32-24 wks tx
Corticosteroids
PCN
Tocolysis: nifedipine
119
Preeclampsia labs
Proteinuria and creatinine
120
Amniotomy interventions
Monitor temp at least every 2 hrs
Assess FHR before and after the procedure
Note amniotic fluid color, amount, and odor
Place in side-lying or upright position
Explain that the procedure is painless
121
Polyhydramnios at risk for
Umbilical prolapse
Postpartum hemorrhage
122
Neonatal abstinence syndrome tx
Opioids
No naloxone
123
Spina bifida S+S on newborn
Tuft of hair
Hemangioma
Nevus
Dimple
Along base of spine
124
Proper breastfeeding technique
Breastfeed every 2-3 hrs on average
Breastfeed “on demand” whenever the newborn exhibits hunger cues (sucking, rooting reflex)
Position newborn “tummy to tummy” w/ mouth in front of nipple and head in alignment w/ body
Ensure proper latch (grasps both nipple and part of areola)
Feed for 15-20 mins per breast
Insert clean finger beside gums to break suction before unlatching
Alternate which breast is offered first at each feeding
125
Breast engorgement for those not breastfeeding
Ice packs to both breasts for 15-20 mins every 3-4 hrs
Chilled, fresh cabbage leaves to both breasts
Take NSAIDs
Maintain firm breast support
126
Priorities of placental abruption
Assess maternal VS
Palpate abdomen/uterus
Continuous FHR monitoring
Indication of fetal distress and/or maternal hemodynamic compromise -> c-section
127
Vaginal exam is not indicated during what scenarios?
Active bleeding until possibility of placenta previa is ruled out
128
Pregnant women can work w/
MRSA
129
Before placing a fetal scalp electrode, nurse must know
Bloodborne infx (hepatitis B, HIV)
Cervical dilation (>2-3 cm)
Membrane status
130
Priority action for HELLP syndrome and preeclampsia
Magnesium sulfate to prevent seizures
131
Follow-up on pregnant pt if they report
Copious amts of watery, clear vaginal discharge (rupture of membranes)
Dysuria and flank pain (UTI)
Headache and blurred vision (preeclampsia)
