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OB Exam 3 Pt 1 Flashcards

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1
Q

What is a high-risk pregnancy?

A

One in which the life or health of the mother or fetus is jeopardized by a disorder coincidental with or unique to pregnancy.

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2
Q

What is the free noninvasive low tech way of assessing a fetus after 20 weeks?

A

Kick counts, or DFMC (daily fetal movement counts.)

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3
Q

When is vaginal U/S the preferred method of sonogram?

A

In the first trimester.

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4
Q

For which kind of sonogram does the mother need a full bladder?

A

Abdominal U/S, to displace the uterus upward.

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5
Q

Which five variables are studied in a biophysical profile?

A

Fetal breathing movements, gross body movements, fetal tone, reactive FHR, qualitative amniotic fluid volume. Pg. 643.

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6
Q

What are indications for an amniocentesis?

A

To diagnose genetic disorders or congenital anomalies, fetal pulmonary maturity, and fetal hemolytic disease..

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7
Q

When is the earliest possible time (in weeks of pregnancy) when an amniocentesis can be done?

A

14 weeks.

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8
Q

When can CVS be performed in terms of weeks of pregnancy?

A

First or second trimester, ideally between 10 – 13 weeks. Pg. 647

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9
Q

Though 16 – 18 weeks for the MSAFP screen is ideal, between how weeks of pregnancy is it reliable?

A

15 – 20 weeks. Pg. 648

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10
Q

We usually use the triple or quad screen or multiple test marker now, rather than just the MSAFP because the multiple markers tests for two disorders. Which two disorders?

A

Chromosomal abnormalities like Down’s syndrome and other types of trisomy, and neural tube defects. Pg. 649

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11
Q

At how many weeks gestation should the triple marker be done?

A

16 – 18 weeks

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12
Q

For which disorder does the Coombs’ test screen?

A

Antibodies that indicate Rh incompatibility, and some other antibodies.

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13
Q

According to page 649, what is the goal of 3rd trimester testing?

A

To determine whether the intrauterine environment continues to be the best place for the fetus.

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14
Q

When doing an NST the Doppler transducer and tocometer are attached to the belly, as we do when we will monitor a laboring woman. We also give the woman a button to press. When should she press it?

A

When she feels fetal movement.

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15
Q

What are the criteria for a reactive NST tracing?

A

(1)Two or more accelerations of 15 beats per minute lasting 15 seconds in a 20 minute period. Box 26-7

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16
Q

The contraction stress test (CST) is done using oxytocin to cause contractions. What are the two sources of oxytocin that may be used in this?

A

IV oxytocin and nipple stimulation

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17
Q

With CST, as with other tests, a “negative” test means that there are no “bad” or unwanted results. A “positive” test means there was an untoward or unwanted result. What is a positive result for a CST?

A

Late decelerations with 50% or more contractions. Box 26-8.

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18
Q

Is pregnancy-related hypertension on the rise, or is it declining?

A

Rising. Pg. 654

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19
Q

List the complications that hypertensive women are at risk for, beginning with abruptio placenta.

A

Abruptio placenta, ARDS, stroke, cerebral hemorrhage, hepatic or renal failure thrombocytopenia, DIC, pulmonary edema.

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20
Q

Maternal death from preeclampsia is usually a result of complications from:

A

Hepatic rupture, abruptio placenta, eclampsia.

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21
Q

Gestational HTN begins after ____ weeks of pregnancy and– is—or is not? –associated with proteinuria.

A

20 weeks and is not associated with proteinuria Pg. 655

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22
Q

Preeclampsia develops after 20 weeks of pregnancy with two initial manifestations: _____ and ______.

A

Hypertension and proteinuria

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23
Q

What is the B/P measurement that defines HTN that is given in your book?

A

140/90 pg. 655

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24
Q

Which parameters define severe preeclampsia? (pg 786)

A

B/P >160/110 and >5 gm/24 hours protein in the urine, which would equal >3 + on the dipstick. Table 27-2.

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25
Which signs and symptoms of severe preeclampsia might women manifest?
Oliguria, headache, visual disturbances (like scotomata) or blurred vision, irritability or changes in affect. Hepatic involvement including epigastic pain, RUQ pain, impaired liver function, thrombocytopenia with platelets < 100,000 mm3; pulmonary edema, Table 27-2.
26
When does preeclampsia become eclampsia?
When seizures or coma occur.
27
How can we know if a woman has chronic hypertension or if it is pregnancy –related?
If it is discovered before the pregnancy, or even before 20 weeks of gestation. Then it is chronic HTN..
28
Though B/P is the easiest problem to measure when a woman has preeclampsia, it is not the main pathogenic factor. What is? (This is important.)
Poor perfusion as a result of vasospasm and decreased plasma volume. Pg. 657.
29
Which liver complication is life-threatening and a surgical emergency?
Rupture of a subcapsular hematoma, Pg. 658.
30
What neurological signs and symptoms might preeclampsia demonstrate that the nurse can see and monitor?
Complaints of headache, reflexes > +2, positive ankle clonus, seizures. Pg.658.
31
How does impaired placental perfusion affect the fetus?
Fetal growth restriction, incidence of placental abruption, premature birth, and early degenerative aging of the placenta.
32
To which laboratory findings and diagnosis does the acronym HELLP correlate?
Hemolysis, elevated liver enzymes, low platelets.
33
What is the typical ethnicity of women who develop HELLP syndrome?
Caucasian women.
34
List possible adverse outcomes of HELLP syndrome.
Pulmonary edema, ARF, DIC, placental abruption, liver hemorrhage or failure ARDS, sepsis and stroke and preterm birth.
35
How could a nurse assess for clonus? What is the normal finding when assessing for this?
Dorsiflex the foot, hold it then release’ normal findings are that no jerk of the foot is noted after release. Pg. 661.
36
A woman is mildly preeclamptic. How could the status of her fetus be evaluated?
A BPP, nonstress testing, and serial ultrasonography. Pg. 662.
37
A woman with mild preeclampsia is being managed at home. Which three things might she be asked to do by way of self- monitoring, to determine her status?
Urine dipstick protein, B/P checking, and kick counts. (Teaching for self-management box).
38
When a woman has severe gestational hypertension,HELLP Syndrome or severe preeclampsia, at how many weeks of pregnancy at the earliest, could an induction be performed?
34 weeks. Pg. 663.
39
Which is the drug of choice to prevent seizures in preeclampsia and HELLP syndrome?
Magnesium sulfate.
40
What is the IV loading dose of magnesium sulfate and what is a typical hourly dose?
4 – 6 grams IV; 2 grams/hour.
41
What are the target therapeutic serum levels of magnesium?
4 – 7 mEq /L.
42
Know and list the signs of mild and increasing magnesium toxicity.
Mild toxicity: lethargy, muscle weakness, decreased or absent DTRs, double vision and slurred speech. Increasing toxicity: maternal hypotension, bradycardia, bradypnea and cardiac arrest.
43
A patient is experiencing magnesium sulfate toxicity. The nurse stops the magnesium drip and gives the antidote. What is the antidote for magnesium sulfate?
Calcium gluconate, IV push. 665
44
Which 5 antihypertensives does your book list as used for the treatment of HTN in preeclampsia?
IV hydralazine, labetalol, nifedipine, and methyldopa. Box 27-5.
45
How quickly after birth do signs and symptoms of preeclampsia resolve, usually?
48 hours
46
In a postpartum woman with preeclampsia that is beginning to show signs and symptoms of PPH, which medications to increase uterine tone would be used? Which will we not use, and why?
Use: oxytocin or prostaglandins. Do not use: ergots like ergotrate and methylergonovine. Pg. 667
47
Define spontaneous abortion/miscarriage.
A pregnancy that ends as a result of natural causes before 20 weeks of gestation. Pg. 670
48
What percentage of confirmed pregnancies in the US end in miscarriage?
10 – 15 %
49
What is a D & C?
A surgical procedure in which the cervix is dilated and curette is inserted to scrape the uterine walls and remove uterine contents. Pg. 673.
50
What is an incompetent cervix?
Passive and painless dilation of the cervix during the second trimester.
51
How is incompetent cervix treated?
Bedrest, pessaries, antibiotics, anti-inflammatory drugs, and cerclage.
52
What is the cause of a complete hydatidaform mole?
Fertilization of an egg with a lost or inactivated nucleus.
53
What is the cause of a partial mole?
Two sperm fertilizing an apparently normal ovum Pg. 679
54
List signs and symptoms of molar pregnancy.
Vaginal bleeding, uterus larger than expected, anemia, excessive nausea and vomiting, cramping, preeclampsia.
55
Hydatidaform moles and GTN are easily treatable but can recur and cause malignancy. What blood test is used to test for this?
Serum HCG levels. A pathologic form of clotting that is diffuse and consumes large amounts of tissue thromboplastin.
56
Name six situations, listed in your book, which may trigger DIC in the setting of reproductive health.
Abruptio placenta, retained dead fetus, amniotic fluid emboli, severe preeclampsia, HELLP Syndrome and gram negative sepsis. Pg. 686.
57
What is the key to optimal pregnancy outcomes in patients with diabetes?
Strict maternal glucose control. Pg. 689.
58
What is gestational diabetes mellitus?
Any degree of glucose intolerance with the onset of first recognition occurring pregnancy.
59
How does the fetal glucose level relate to the maternal glucose levels?
It is directly proportional. Pg. 690.
60
Where does the fetus get its insulin?
It manufactures its own insulin, since insulin does not cross the maternal fetal barrier.
61
Is a woman more susceptible to hyper or hypoglycemia during the first trimester?
Hypoglycemia. Pg. 690.
62
When does insulin resistance usually begin in pregnancy?
As early as 14 – 16 weeks. Pg. 691.
63
Women with either pre-existing diabetes are at risk for a number of disorders. Which disorders can occur that end up making the uterine size larger?
Polyhydramnios (or hydramnios), and fetal macrosomia. Pg.691 and 693
64
Are diabetic patients more or less likely to be preeclamptic?
More likely. Pg. 691.
65
DKA carries significant risk for mother and fetus, and pregnancy changes the threshold for sequelae (bad stuff) to happen. While glucose levels are at least 300 – 500mg/dl before DKA occurs in the non-pregnant person, what can they be in pregnancy?
DKA may occur with blood glucose levels barely exceeding 200 mg/ dl. Pg. 692
66
DKA is more likely during times of stress in diabetic moms, just as they are in all diabetic patients. What effect can this have on the fetus?
Fetal death.
67
During labor in a diabetic woman, how often are glucose levels checked? (See the study guide for this since it is not in the book.)
Hourly. Pg. 837
68
If the 1-hour screening glucose tolerance test is ____ mg/dl or greater, a more extensive glucose test is done to determine if the woman is diabetic or not.
It used to be 140 mg/dl. Now we are getting stricter, which is reflected in the 10th ed.Lowdermilk, where it is expanded to 130 – 140 mg/dl. (Pg. 701)
69
At how many weeks of pregnancy is the 1 hour glucose tolerance typically done if not done early in pregnancy?
24 – 28 weeks. (If warranted, it can be done at any point).
70
In the 3-hour OGTT, how many values must be elevated to diagnose GDM?
2 or more.
71
Dietary modification is the main stay of treatment for GDM. What is the usual number of calories per day allowed in the diet?
1500 – 2000. This is for obese women, and since the per/kg amount is higher in normal women, the overall amount is similar, depending on size: 30 kcal/kg/day for normal, 25 for obese.
72
What percentage of patients with GDM will need to take insulin?
Up to 20%. Pg 702.
73
What medications are often prescribed for hyperemesis gravidarum?
Pyridoxine, doxylamine, Phenergan and metoclopramide. Pg. 843.
74
Babies can be born small because they are preterm. Conversely, they may be born at the correct time and still be too small. What is the term for this?
IUGR or low birth weight babies. Pg. 780
75
What are the three diagnostic criteria for preterm labor (pg 783)?
Gestational age between 20 – 37 weeks, uterine activity (contractions) and progressive cervical change.
76
Bedrest is usually implemented wit PTL. What are some of the deleterious effects of bedrest on the pregnant woman?
Decreased muscle tone, weight loss, calcium loss, glucose intolerance, bone demineralization, constipation, fatigue, isolation, loneliness, anxiety and depression. (List any of those listed in Box 33-4—these are just a few.)
77
At which point in the process of cervical dilation would tocolytics not be used?(See my notes as this is not listed in the book—it was in the 9th ed. and is still actually valid in practice.)
Note that the condition of 6 cm dilation is not listed in the 10th ed. Though tocolysis is not usually implemented at or after 6 cm of dilation (and in some situations not after 4 cm) we are likely to take it on a case-by-case basis.
78
List some of the adverse effects of beta-adrenergic agonists as tocolytics.
See page 934 9thed, or 788 10th ed. – there are many. Here are a few: SOB, coughing, nasal stuffiness, tachypnea, pulmonary edema. Tachycardia, palpitations, myocardial ischemia, hypotension, muscle cramps, hyperinsulinemia nausea and vomiting.
79
What is the purpose of giving antenatal corticosteroids to the mother in PTL?
To accelerate fetal lung maturity.
80
What is PROM?
PROM: ROM beginning before the onset of labor. Pg. 791.
81
What is PPROM?
PPROM: ROM before 37 weeks.
82
Define chorioamnionitis.
Bacterial infection of the amniotic cavity --it is potentially life-threatening.
83
Define precipitous labor.
Labor lasting < 3 hours from onset of contractions to birth. Pg. 794.
84
What is CPD?
Cephalopelvic disproportion: fetus cannot fit through the maternal pelvis. Either the baby is too big or the pelvis is too small, and the baby cannot be born though the birth canal—meaning it will have to be born via C/S.
85
What are the most common malpositions?
OP presentations, ROP or LOP.
86
What is the most common malpresentation?
Breech.
87
Your book notes that risk for long-term problems such as cerebral palsy is higher among what sort of births?
Multiple birth. Pg. 796.
88
What position that the mother may assume during labor promotes fetal descent and shorts the second stage of labor?
Upright positions like sitting and squatting .Pg. 797
89
To avoid a C/S for malpresentation, external version may be attempted. What precautions are taken preparatory to this?
Ultrasound, NST (nonstress test), possible tocolytic agents and informed consent pg 799..
90
What are contraindications to external version?
Uterine anomalies, previous C/S, CPD (cephalopelvic disproportion), placenta previa or any third trimester bleeding, multiple gestation, oligohydramnios, evidence of uteroplacental insufficiency, evidence of a nuchal cord (cord around the neck).
91
What are the most common methods of induction used in the US?
Amniotomy and Pitocin infusion, with prostaglandins increasingly being used. Pg. 800
92
Which “score” designation is used to determine inducibility of a pregnancy?
Bishop score.
93
List the cervical ripening methods listed in your textbook.
Prostaglandin E 1 & 2, laminaria tents and lamicel, amniotomy and membrane stripping
94
How often should temperature be checked after amniotomy?
Every 2 hours.
95
What are the common adverse reactions of oxytocin infusions?
Water intoxication (This has been on a recent HESI and I mention it in the study guide), uterine hyperstimulation leading to excessive contractions or rupture with fetal effects being decreased FHR and hypoxia.
96
List some non-invasive methods of augmenting the process of labor listed by your book.
Empty the bladder, ambulate, change position, relaxation techniques, nourishment and hydration, water/hydrotherapy. Pg. 805.
97
In active management of labor, how many hours after admission is delivery desired?
12 hours.
98
List the 2 mechanical (your book uses the term: operative) methods of assisting vaginal birth and expediting second stage (using specialized equipment)?
Forceps assisted and vacuum assisted.
99
Which labor management approach result in a lower risk for C/S?
Early continuous on-on-one support throughout labor. Pg. 808.
100
After which C/S incision is a VBAC permitted?
Low transverse.
101
What is postterm pregnancy?
A pregnancy extending past the 42nd week.
102
What are indications for amnioinfusion?
Oligohydramnios ( or meconium, sometimes).Pg. 816.
103
What is the “turtle sign”?
When the head emerges from the vagina, it retracts against the perineum.
104
What are 3 maneuvers for dealing with shoulder dystocia that the nurse may be asked to help with?
Suprapubic pressure, McRoberts and Gaskin maneuvers, and other position changes like squatting or lateral recumbent positions.
105
When dealing with a prolapsed cord, the nurse should call for assistance then put the woman in which sort of position?
Knee-chest position or any that uses gravity to help keep the head of the fetus off the pelvis to prevent cord compression..
106
What are causes of uterine rupture?
Past classic-type C/S, Intense contractions possibly from augmentation, over-distended uterus, malpresentation, version forceps.
107
What are S/S of uterine rupture?
Possibly decels or other non-reassuring FHR patterns, bleeding, sharp, shooting or tearing abdominal pain, cessation of contractions and possibly shock. Pg. 820
108
What are signs and symptoms (S/S) of amniotic fluid embolism?(See my notes since this is not in the book.)
Hysterectomy and blood replacement. | Acute dyspnea, restlessness, cyanosis, pulmonary edema

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