OB test 2

Question 1

Spontaneous abortion: threatened

Answer 1

bleeding is present with no cervical dilation, before 20 wks gestation

s/s: vaginal bleeding, abdominal cramping and back pain

Question 2

Spontaneous abortion: inevitable

Answer 2

cervix dilates or the membranes rupture w/o delivery of the fetus or placenta

complications: vaginal bleeding and imminent spontaneous abortion

s/s: vag bleeding, abd cramping and back pain

Question 3

Spontaneous abortion: missed

Answer 3

no expulsion of the products of conception and a closed cervix

s/s may be minimal or absent- usually discovered at an ultrasound apt. with absent fetal heart rate or growth- may still experience s/s of pregnancy

risks: infection and prolonged bleeding
-may require surgical intervention to clear it out

Question 4

Spontaneous abortion: recurrent

Answer 4

two or more consecutive spontaneous abortions that occur before 20 wks

suspected causes: genetic abnormalities, uterine defects, endometrial problems, infection , AI diseases, hormone imbalances and unhealthy lifestyle habits.

s/s: vag bleeding, cramping , passing of tissue, emotional distress

Dx/tx: testing to evaluate underlying etiology via physical assessment

Question 5

ectopic pregnancy

Answer 5

fertilized egg implants outside the uterus

RF: hx of ectopic pregnancy, pelvic infection, infertility tx, tubal surgery

s/s: vag bleeding, abd or pelvic pain, syncope, or shock- may be asymptomatic until rupture occurs

dx: transvaginal US and serial hog levels are used to rule out an intrauterine pregnancy

tx: indicated if abd or pelvic pain worsens, hug levels increase, or evidence of tubal rupture
- methotrexate
-surgery- laparoscopically

Question 6

gestation trophoblastic disease

Answer 6

RF: pt < 20 yr or >40 yrs old
-abnormal growth in the uterus (molar pregnancy) that would have become the placenta, grows as trophoblastic tissue.
-no viable fetus

s/s: vag bleeding, enlarged uterus, elevated hCG levels, and hyperemesis

Dx: US
TX: D&C (dilation and curettage) followed by series of serum hCG levels to ensure no more tumors develop
-DONT CONCEIVE FOR UP TO 1 YR AFTER
-if left untreated the trophoblasts can develop into tumors (benign or malignant)

Question 7

hyperemesis gravidarum

Answer 7

severe n/v during the first trimester- leads to electrolyte imbalances, weight loss, malnutrition and dehydration

factors: hormone changes r/t to hCG levels, decreased gastric motility, genetic predisposition, and psych factors (stress and anxiety)

complications: low fetal brith weight and preterm birth

tx: antiemetics, thiamine (vit B1) to prevent wernickes and refeeding syndrome

nursing interventions: assess severity, emotional support, education on diet and lifestyle modifications (small frequent meals, avoid spicy foods, drink fluids and rest). Meds: vitamin B6, doxylamine, benadryl, raglan, phenergan, or zofran. Inpatient: fluid/e- replacement

Question 8

monozygotic multiples

Answer 8

identical twins: one fertilized egg splits during development

Question 9

dizygotic multiples

Answer 9

two separate fertilized eggs

Question 10

RF and complications for multiple gestation

Answer 10

family hx, AMA, high parity, african american, assistive reproduction technology

complications: hyperemesis gravidarum, anemia, gestational diabetes, HTN disorders, placental insufficiency, increased size of uterus, preterm labor and delivery, and twin to twin transfusion

mgmt: US for abnormalities in fluid volume, cervcal length nd getal growth

Question 11

twin-to-twin transfusion syndrome

Answer 11

when a placenta is shared during a monochorionic pregnancy- causing an imbalance in fetal blood flow

DX: US
TX: nutritional counseling, bedrest, meds (prevention of preE, gestational diabetes, preterm labor, UTI)

Question 12

cervical insufficiency

Answer 12

painless dilation of the cervix that often results in the inability to carry the fetus beyond the 2nd trimester
AKA: shortened or incompetent cervix

s/s: low back pain, pelvic pressure, vag bleeding or discharge

RF: hx of cervical surgery or pregnancy losses, unknown etiology

Question 13

cervical cerclage

Answer 13

surgically placed sutures around the cervix to prevent dilation- removed as preg approaches term

Question 14

placenta previa

Answer 14

placenta sits at the lower portion of the uterus near the internal cervical os

RF: hx of prevue, multiple gestation, multiparty, hs of uterine surgeries (c-sections included), uterine abnormalities, AMA, reproduction technology, and smoking

low lying: partially covering os, previa is used for complete coverage of os

Dx: 2nd trimester US
Complications: hemorrhage

nursing: monitor for signs of hemorrhage, advise pt to limit physical activity- bedrest, educate on what s/s to seek med attention for. No digital cervical exam, or vag intercourse due to risk for bleeding

MUST HAVE CSECTION- vag contraindicated

Question 15

vasa previa

Answer 15

fetal blood vessels overlie the internal cervical os or lay within 2 cm of the cervix

type 1: blood vessels between the umbilical cord and the placenta run along the fetal membranes overlying the cervix- risk for those with resolved placenta previa

Type 2: succenturiate placenta- which is made up of multiple lobes ( usually two)- blood vessels connecting them

type 3: vessels pass through the membranes at the margin of the placenta

Complications: membrane rupture risks vessel rupture = fetal hemorrhage, exsanguination and asphyxia

-usually resolves prior to 28 weeks
-csection if not resolves

Nursing: antepartum NST and BPP (30-34 weeks)

Question 16

abruptio placentae

Answer 16

part or all of placenta separates from the uterine lining
complications: significant maternal blood loss, fetal demise or maternal death

s/s: suddenly onset of severe abdominal pain, back pain, vag bleeding, painful, prolonged uterine contractions or a uterus that reminds contracted without a resting tone and changes in fetal heart rate

nursing: monitor for signs, fetal HR, hemodynamic monitoring, fluid replacement with blood if needed

Question 17

placenta accreta spectrum : accreta

Answer 17

attachment of placental villi to the myometrium instead of just to the decidua (majority of morbidly adherent placenta MAP)

RF: hs of C-section, placenta accrete or uterine surgery, AMA, hx of infertility and pelvic radiation

s/s: hemorrhage

complications: DIC, renal failure, hemorrhage, massive transfusion and death, uterine rupture, infection

Dx: US or MRI or may be undiagnosed

-Csection delivery to reduce risks, likely followed by hysterectomy

Question 18

placenta accreta spectrum : increta

Answer 18

penetration of placenta into the myometrium

Question 19

placenta accreta spectrum : percreta

Answer 19

chorionic villi penetrate the myometrium and may grow into uterine serosa and surrounding tissue

Question 20

Gestational hypertension

Answer 20

occurs after 20 wks gestation/preE

RF: obesity, null parity, hs of preE, preexisting diabetes, renal disease, and multiple gestation pre

-140/90
-nifedipine, mag sulfate, labetolol, hydralazine

Question 21

preeclampsia

Answer 21

occurs after 20 weeks gestation and ups to 6 wks PP- vascular changes in placenta and uterus- spiral arteries in uterus dont allow for increased blood flow to the placenta

RF: nulliparity, extremes in maternal age, obesity, multiple gestation, kidney disease, chronic HTN, diabetes and hx of prE

S/s: HTN, proteinuria, edema, HA, vision changes and epigastric pain, n/v

adverse outcomes: C-section, preterm birth, low apgar scores, placental abruption, SGA infants

risk reduction: daily low dose aspirin, magnesium sulfate (reduce risk of seizures), antihypertensive tx
true tx: delivery

nursing: monitor for signs of worsening condition -> eclampsia, vitals, neuro status (LOC, reflexes, signs of mag toxicity- loss of DTR, resp depression, decreased UO) fetal monitoring, mag levels and liver and renal function tests

Question 22

HELLP syndrome

Answer 22

Hemolysis, elevated liver enzymes, low platelet count- HTN disorder that occurs as a complication of preE

s/s:fatigue, abnormal bruising, abdominal pain (RUQ), edema, n/v, and petechiae or prolonged bleeding time
some s/s of preEclampsia: epigastric pain, HA, vision changes- they dont always develop HTN

Complications: DIC, placental abruption, ARF, pulmonary edema, hematoma of liver, retinal detachment

Tx: delivery if >34 weeks, supportive care and mgmt of possible hemorrhage

nursing: monitor vitals, symptoms worsening, meds, monitor fetal status

Question 23

gestational diabetes

Answer 23

secondary to hormonal changes during pregnancy that lead to increased insulin resistance w/o adjusted insulin secretion- high circulating volume of glucose in the blood= hyperglycemia

-results in macrosomia
-glucose passes through placenta but maternal insulin doesn’t- baby now has to produce large amounts of insulin to address this = LGA baby

Question 24

amniotic fluid imbalance: polyhydramnios

Answer 24

abnormally high volume of amniotic fluid

causes:maternal diabetes, anemia, or AI disorders, multiple gestation

complications: preterm birth, placental abruption, PROM, umbilical cord prolapse or fetal malpresentation

Tx: amnioreduction- amniocentesis to remove excess fluid

Question 25

amniotic fluid imbalance: oligohydramnios

Answer 25

abnormally low volume of amniotic fluid is present (fluid is primarily comprised of fetal urine, fetal lung and GI secretions and fluid from placenta and umbilical cord- congenital renal anomalies, placental dysfunction, fetal growth restriction, or ruptured membranes, could caused this. mgmt: monitor amniotic fluid volume, fetal status and maternal hydration

Question 26

preterm labor

Answer 26

onset of labor before 37 weeks DX: fetal fibronectin test (tests for fibronectin that exists between the uterine lining and amniotic sac)- negative test is a sign against preterm labor within 7-10 days -transvaginal US- detect ccervical length. <25 mm indicates preterm labor -Nitrazine pH test- 7.0-7.3 indicates amniotic fluid leaking- and darker green/blue on paper RF: hx of preterm birth, infection, cervical abnormalities, chronic medical conditions, multiple gestation, substance use, poor diet, stress Tx: tocolytic meds (indocin, nifedipine, mag- neuroprotection of fetus, and terbutaline) CC (betamthasone- for feta lung development)

Question 27

preterm premature rupture of membranes

Answer 27

ROM before 37 weeks- leakage of fluid RF: infection (genital tract), multiple gestation, hx of preterm labor, smoking, vaginal bleeding during pregnancy Tx: CC for lung maturity of fetus, ABx if caused by infection, tocolytics

Question 28

PUPPs

Answer 28

"pruritic Urticarial Papules and Plaques of Pregnancy" (polymorphic eruption of pregnancy)- occurs in last few weeks of pregnancy or early pp, often first time pregnancies - caused by inflammatory process caused by stretching of the skin -not harmful to fetus s/s: pruritic papules within striae tx: topical CC and antihistamine

Question 29

cholestasis

Answer 29

impaired bile flow from the liver- maternal bile acids pass the placenta- creates risk for preterm delivery, fetal demise, and NICU admission s/s: (late 2nd- 3rd trimester) uncomfortable pruritus (hands/feet), clay-colored stools, dark urine, fatigue, nausea, poor sleep, jaundice, RUQ pain Tx: ursodeoxycholic acid- reduce bile acid concentration, pruritic control meds, antepartum BPP test or NST twice weekly until delivery- usually deliver by 36-37 weeks -resolves with delivery

Question 30

trauma

Answer 30

blunt force or penetrating trauma, emotional, or intimate partner violence -falls, motor vehicle accidents most common type of blunt force nursing: US for fetal status after trauma, physical assessment of mother, watch for signs of IPV, emotional support for IPV victims, give resources

Question 31

electronic fetal monitoring documentation

Answer 31

parameters for documenting and performing: - continuous: evaluation of FHR and contraction pattern Q15-30 min, frequency of assessment and interpretation of FHR. Documenting fetal status before and after altering the dose

Question 32

FHR baseline

Answer 32

avg bpm in 10 min segment (excluding marked variability -100-160 tachy: >160 brady< 110

Question 33

FHR tachycardia

Answer 33

>160 bpm RF: maternal: infection, anxiety, dehydration, meds like atropine and terbutaline, hyperthyroidism, nicotine. fetal: compromise/hypoxia, anemia, infection, prematurity, arrhythmia

Question 34

FHR bradycardia

Answer 34

<110 bpm differentiate between benign episode or a prolonged deceleration intervention: reposition mom, IV fluids RF: maternal: anesthesia, hypotension, meds: mag sulfate, propranolol, hypoglycemia, hypothermia, uterine rupture, placental abruption, hypothyroidism. Fetal: head compression from head down position, congenital heart block ,hypoxia, prolonged umbilical cord compression

Question 35

continuous electronic fetal monitoring

Answer 35

- ultrasound transducer placed over fetal back closest to fetal head where FHR is heard loudest -Toco senses change in uterine muscle during a contraction parameters for documenting and performing:

Question 36

internal fetal monitoring

Answer 36

how: fetal scalp electrode (FSE) that fixes to the scalp, and the intrauterine pressure catheter (IUPC) that measures contraction "stats" when: amniotic sac must be ruptured, used for situations when in-depth fetal surveillance is required (non reassuring FHR), low amniotic fluid or difficulty tracing FHR externally risks/contraindications: placing in fontanelle, inserting through placenta- hemorrhage, risk for infection

Question 37

NICHD Normal

Answer 37

ALL REQUIRED: - Moderate variability - Baseline rate 110-160 - No late or variable decels - Early decels present or absent - Accels: present or absent -Strongly associated with normal acid/base baseline

Question 38

NICHD Abnormal

Answer 38

- Absent baseline variability and any of the following: - Recurrent late decels (50% or more of contractions) - Recurrent variable decels - Bradycardia - Sinusoidal pattern - Predictive of abnormal fetal acid base status

Question 39

variability

Answer 39

means: fluctuations in sympathetic vs parasympathetic nervous system classified: absent, minimal, moderate or marked management:

Question 40

moderate variability

Answer 40

fluctuation between 6-25 bpm- considered normal -normal umbilical cord pH

Question 41

minimal variability

Answer 41

fluctuation of 5 bpm or fewer -associated with fetal acidemia causes: fetal sleep cycles, feta anomalies of CNS, meds (mag sulfate), preterm gestation

Question 42

absent variability

Answer 42

lack of fluctuation of baseline= severely compromised fetus -result of poor oxygenation leading to metabolic acidosis example: sinusoidal pattern- wavelike- fetal anemia or med induced

Question 43

Marked variability

Answer 43

fluctuation great than 25 bpm- undeterminable baseline- suggest hypoxia

Question 44

Earlies (decel)

Answer 44

gradual FHR decline and then return to baseline -fetal head compression activates the vagal nerve -proportional to strength of uterine contraction -common during active labor at the head descend into the pelvis -NORMAL

Question 45

Late Decel

Answer 45

always indicate fetal hypoxia -uteroplacental insufficiency -begins late in uterine contraction due to decrease in oxygen to fetus -lowest dip occurs after contraction -common cause: tachysystole contractions (lasting longer than 2 mins or occurring too frequently) -more causes: HTN, placental abruption, anemia

Question 46

variable deceleration

Answer 46

decel of at least 15 bpm below baseline (vary in onset, depth and duration) -causes: fetus compressing cord against uterine wall, or mvmt of mom or baby -may or may not be in conjunction wit contractions -may lead to fetal hypoxia

Question 47

prolonged deceleration

Answer 47

sporadic deceleration of at least 15 bpm that lasts 2-10 mins before returning to baseline causes: uterine hyperactivity, cord compression, hypotension, placental abruption, seizure, or impending birth -risk for fetal hypoxia depending on duration

Question 48

Accelerations

Answer 48

usually associated with fetal mvmt, and are NOT r/t contraction activity -sign of fetal well-being -onset to peak =30 sec, 15 bpm higher for 15 sec (15x15 rule) (or 10x10 if before 32 wks gestation)

Question 49

decelerations

Answer 49

classified as early, late, variable or prolonged -associated with fetal hypoxia- require intervention

Question 50

Decelerations: VEAL-CHOP-MINE

Answer 50

Variable - cord compression (brief, or baby playing with cord)- maternal reposition Early- head compression (common, often as labor is progressing, not a worry)- identify labor progress Acceleration- OKAY! - no intervention Late- perfusion problem = bad!, baby is getting tired and responding late, can't recover from contraction well- execute actions immediately

Question 51

True labor

Answer 51

regular contractions, bloody show, mucous plug, lightening (baby moves into pelvis), nesting, GI distress, wt loss (1-3 lb) **CERVICAL CHANGE**

Question 52

false labor

Question 53

5 P's that affect labor

Answer 53

1. Power-force of uterine contractions and pushing efforts 2. Passageway- anatomy of moms pelvis and soft tissues 3. Passenger- fetal factors (position, weight, size) 4. Psyche- mom state of mind 5. Position- (of mom) what supports and shortens labor

Question 54

Power

Answer 54

Primary: uterus contracts and applies pressure on fetus, cervix dilates and effaces in response to pressure. - effected by frequency, duration and intensity Secondary: mom pushing efforts after cervix is dilated and she has the urge to -effective pushing with contractions (3x/contraction)

Question 55

Passageway

Answer 55

shape of pelvis and ability of soft tissue to stretch -muscles of pelvic floor help orient fetus through mvmt of delivery OPTIMAL: gynecoid (symmetrical and round) -anthropoid (oval, narrow end) -android (almost triangular, guitar pick-esque) LEAST IDEAL: platypelloid (narrow and long)

Question 56

Passenger

Answer 56

-fetal head size -fetal presentation -fetal attitude -position of baby -fetal lie

Question 57

Passenger: fetal head size

Answer 57

- cephalopelvic disproportion (CPD)- head is bigger than space in pelvis to be able to move through it -skull bones aren't fused and can shift to adjust for birth canal

Question 58

Passenger: fetal presentation

Answer 58

cephalic/vertex- head down (ideal) or breech - complete: feet and butt - footling: 1 or both feet coming first - frank: legs point up, bottom emerges 1st -breeches go to csection

Question 59

Passenger: fetal attitude

Answer 59

how is baby's head tucked in canal - vertex presentation- complete flexion of chin to chest- crown of head emerges first (ideal) - military- moderate flexion, top of head first - brow presentation- neck extended, forehead 1st - face presentation- face first, bruising/trauma to face

Question 60

Passenger: position of baby

Answer 60

where is occiput? (back of head) - occiput posterior- face toward moms front -IDEAL: OCCIPUT ANTERIOR- fact toward mom's back, helps tuck under pubic bone

Question 61

Passenger: fetal lie

Answer 61

position r/t moms spine - longitudinal- breech or vertex - transverse- horizontal compared to moms spine -asynclitic birth- baby came down with ear to shoulder, bump on one side of head

Question 62

Psyche

Answer 62

impacts labor!! -factors that slow labor: anxiety, stress (birth plan out of order for example), fear (pain they are about to encounter), pain tolerance low -relaxation augments labor

Question 63

Position (mom)

Answer 63

-gravity = friend- contractions more effective with woman standing upward -most conducive for labor if hips are sharply flexed (like squatting -lithotomy position- ideal for provider

Question 64

stages of labor

Answer 64

1. dilation and effacement of cervix 2. cervix @10 cm- ends with birth of baby 3. begins with baby birth and ends with placenta delivery 4. delivery of placenta-4H later or when mom is clinically stable

Question 65

cardinal movements of labor

Answer 65

fetal head rotates fro optimal delivery as it descends -engagement- fetal head reaches ischial spines -descent- fetus moves past spines -flexion- chin touches chest, responding to pressure from contraction -internal rotation- head rotates to face downward -extension- chin comes off chest, neck arches as head is born -external rotation- head rotates as shoulders move into position for delivery -expulsion- body born

Question 66

support during pushing

Answer 66

open glottis pushing- allow for breaths and air flow -give specific instructions, try new positions? -use eye contact -speak calm and firm -focus on breathing

Question 67

maternal assessments postpartum

Question 68

neonate assessments postpartum

Question 69

non-pharm pain mgmt

Answer 69

movement- labor dance, birth ball touch: counter pressure on back, acupressure focus: guided imagery, hypnobirthing

Question 70

pharm pain mgmt

Answer 70

fentanyl- short acting, may cause respiratory depression in fetus -mixed opioid agonist/antagonist: lower risk for fetal respiratory depression. ex: nubain or stall (single doses, last for 3-4 hours) -Nitrous oxide- inhaled before contraction (s/e: n/v, lightheaded) -epidural (not in CSF)- requires more drug to diffuse across membrane

Question 71

epidural vs. spinal

Answer 71

spinal: needle removed after med administration, used before surgery, immediate action- single dose but less medication is likely needed epidural: catheter left in place, can titrate medication, continuous infusion, may need more medication for desired effect, can be used in post-op setting, some areas may not go completely numb

Question 72

RN documentation during labor and delivery

Question 73

how often should RN assess during labor and delivery

Answer 73

low risk: - intermittent: auscultate with doppler for 1 min before, during and after contraction -latent: hourly until they dilate more than 4 cm, then Q15-30, then active stages Q15- to Q5 as she progresses to second stage of active -continuous: same for 1st stage latent and active. 2nd stage, passive descent: Q30 2nd stage, active pushing Q15 HIGH RISK: continuous 1st stage latent (<4 cm)- Q15-30 depending on oxytocin use- Q15 for active stage. 2nd stage- Q5 min

Question 74

1st stage of labor

Answer 74

Latent: (0-6 cm) longest lasting phase, period of excitement, contraction start out feeling like period cramps- mild to palpation and then progress to regular and painful, moderate to palpation Active: (6-10 cm) may become more focused, anxious or restless. contractions are strong and close together. They may feel out of control, irritable or dependent. Moderate-strong to palpation -visceral pain: abdomen, lower back, thighs, with contractions

Question 75

1st stage labor nursing interventions

Answer 75

18G IV, draw blood- CBC, CMP, urine dip, blood lab sample (type and cross if needed), vitals, continuous/intermittent fetal monitoring, encourage void Q2H, assess progress, provide labor support, pt education PRN, pain meds

Question 76

2nd stage of labor

Answer 76

-infant delivery -somatic pain- vagina, rectum and perineum -may last mins to hours -cardinal movements!

Question 77

3rd stage of labor

Answer 77

placenta delivery- w/in 5-30 min. uterus contracts slightly and mom may need to give slight push. -uterus needs to pinch down to close off blood vessels in decider to prevent hemorrhage -uterine atony- primary cause of PPH, uterus doesnt contract down. intervention:asses size and shape of fungus right after delivery. Assess for bleeding. dr may increase oxytocin orders

Question 78

4th stage of labor

Answer 78

PP recovery -baby/family bonding- allow them to watch assessments and help with bath. -assessments: VS and fundal checks (firm)- Q15 x1 H and then Q30 x1H - comforts: ice packs, analgesics, warm blankets, food, fluid -bathroom: assess moms ability to stand, peri-care, peri-bottle, pads, wiping, witch hazel (*remove epidural before) -education: what to expect PP, self care- esp if they had laceration/episiotomy, safety- bassinet in hallways for walks, abduction prevention

Question 79

PP physiologic adaptations

Answer 79

Vitals: slight temp increase (no > 100.4/38), BP (no >140/90- pp PreE, gestational/chronic HTN, but no < 90/60- PPH), slight increase in RR PP fluid shift: pregnant edema shifts back into intravascular space- diaphoresis. Blood loss: 150-1000 mL CV instability: CO increases in immediate PP- fluid shifts, makes heart work harder. preexisting cardiac conditions may worsen Urinary: difficulty emptying fully, urethral swelling (genital tract trauma), lacerations or episiotomy-painful urination Breasts: striae, veins, darken areola from pregnancy fades over 1st 6 wks. Lactogenesis (secrete milk) uterus/lochia: involutes or shrinks (1cm/day)- takes about 6 wks to fully involute. -lochia- vag bleeding during PP period- if it saturates a pad in less than 1 hour is is considered excessive and requires assessment for hypovolemia. 1 g of blood = 1 mL of blood loss. Color changes from Rubra (days 1-3), to serosa (days 4-10), to alba (days 10-28) cervical: bruised and floppy after vag birth. permanently changes shape after 1st vag birth. Returns to prepregant state, less than 1 cm dilated, about 1 week PP Vagina: kegel education to strengthen pelvic floor muscles, 10x/day. in case of urinary incontinence, 30x/day MSK/skin: diastases recti abdominis (RF: multiple gestation, polyhydramnios, macrosomia, short intervals between press and multiparous, csection) should be healed by 6wks pp. relaxin decreases, pelvic bones return to prepregnant state by 5 months. skin striae, -csection incision should heal in 6 wks, roll to side while getting out of bed. GI system: n/v common, constipation (dehydration, poor diet, decreased motility, hormonal shifts or meds for pain), hemorrhoids- fear of defecation due to this pain Wt loss: 10-15 lb immediately after birth. weight will gradually decrease. Eat 330 extra calories per day for breastfeeding Neuro: elevated up to 20-30,000- returns to 4-10 by 1 week PP

Question 80

Breast changes and lactation

Answer 80

Lactogenesis (secrete milk)- after birth, progesterone levels drop and prolactin levels rise, which triggers the second stage of this process- secretion. -Colostrum- nutrient dense, antibody filled, thick milk (for 2-3 days)- increase in temp when milk comes in -supply/demand system- newborns feed every 2-3 hours -foremilk: high in water and protein, low in fat- released at beginning of breastfeeding session -hindmilk- high in fat and calories, released later in breastfeeding session (important to empty one breast before switching sides) - engorgement- achy, full breasts -letdown- reflex caused by release of oxytocin that contracts alveoli, ejecting milk from breast ( caused by: heat, hearing infants cry, thinking of infant, or while infant is feeding) can be stopped by cold therapy

Question 81

Maternal Role attainment theory

Answer 81

early skin-to-skin contact, breast feeding, and minimizing time apart promotes bonding, decreases maternal anxiety and allows for maternal role attainment 1st hour =golden hour

Question 82

PPH

Answer 82

cause: vag (500 mL) or csection (1000 ml)- uterine atony (r/t infection or retained placenta or fetal membranes- most common causes) RF: polyhydramnios, multiple pregs, macrosomia, mag sulfate or anesthesia use, gestational HTN, intrauterine fetal demise tx: firm massage and utertonic admin

Question 83

Venous thromboembolic conditions

Answer 83

DVT, PE (acute onset of cough, sweating, pleuritic chest pain, dyspnea), TX: PP: low molecular weight heparin/heparin, rivaroxaban for 10 days. Pregnant: heparin (warfarin and anti Xa crosses placenta. Nursing: compression therapy, NSAIDS, encourage ambulation,

Question 84

endometritis

Answer 84

infection of lining of uterus cause: mix of bacteria from genital tract. common with emergent csection. RF: chorioamnionitis, prolonged labor, PROM, multiple cervical exams during labor, internal monitoring during labor, preterm, maternal diabetes/anemia prognosis: uterus may become soft and sub involuted- hemorrhage, peritonitis, thromboembolism, pelvic abscesses, sepsis and death s/s: fever, tender uterus, tachy, purulent lochia, flu-like symptoms, Tx: broad spectrum abx

Question 85

lactational mastitis

Answer 85

inflammation of breast tissue, with infection cause: engorgement of one or more milk ducts bc of poor drainage (nipple damage or compression of duct). stagnant milk can cause bacteria growth in milk RF for duct damage/delayed breast emptying: consistent pressure on breast, ill fitting bra, oversupply of milk, nipple trauma, rapid weaning, illness of pt or baby, mom stress or fatigue prognosis: signs should improve within 48-72 hours- if not get US for abscess: usually tender and non fixed, compresses with palpation Assessment: area of breast becomes red, swollen and painful. most common in first 3 months of lactation Tx:cold compress, NSAIDS, regular complete emptying of breast. longer than 12-24 hours =-12 hours infection- give abx- dicloxacillin, clindamycin for 10-14 days

Question 86

PP blues

Answer 86

transent, self-limiting mood disorder- within 2-3 days after delivery and resolves within 2 weeks s/s: insomnia, fatigue, dysphoria, impaired concentration

Question 87

PP depression

Answer 87

onset during pregnancy or in first 4 weeks after birth RF: genetics, hormones, brain changes PP prognosis: less likely to breastfeed, less bonded with baby, less likely to participate in infant safety activity. Child is also more prone to health issues: asthma and diabetes, small/underweight Dx: 5 of 9 diagnostic criteria

Question 88

PP psychosis

Answer 88

disturbance of pt perception of reality PP- hallucinations, thought disorganization, disorganized behavior and delusions RF: previous hx of psychotic disorders Tx: safety for child and mom. hospitalization, antipsychotic meds

Question 89

Bishop Score

Answer 89

parameter include: dilation, effacement, station, cervical consistency and position of cervix cervical consistency: firm, medium, soft cervical positioning: becomes anterior and in line with vaginal introitus Score >6 is favorable- higher chance of successful vag delivery

Question 90

Pharm ripening

Answer 90

prostaglandins (given before oxytocin and may initiate contractions w/o need for oxytocin) ex: misoprostol (vaginal or oral- 25-50 mcg Q3-6H) or dinoprostone (intravaginal)

Question 91

mechanical ripening

Answer 91

insertion and expansion of balloon catheter in cervix or hygroscopic dilators. lower risk for tachysystole but higher risk for infection

Question 92

Pitocin administration

Answer 92

60U/1000mL - dosage increases until contractions are strong, regular, occurring 3-5x in 10 mins -SE: n/v, HA, flushing, tachy, hypotension, arrhythmias, hyponatremia (HA, GI distress, abd pain, mental change, seizure) -tachysystole risk: >5 contractions in 10 min, if it persists give tocolytic (terbutalines)

Question 93

Forceps-assisted birth

Answer 93

outlet, low or mid forceps (highest risk for fetal injury) complications: scalp and facial lacerations, eye trauma, intracranial or subgaleal hemorrhage, skill fracture,

Question 94

vacuum-assisted birth

Answer 94

suction against fetal head and aids in extraction -more likely to use this than forceps -lower rate of patient injury -soft cups-occiput anterior presentations -rigid cups- less likely to detach, for OP and transverse positions

Question 95

Cesarean birth

Answer 95

indications: fetal malpresentation, failure to progress, nonreassuring fetal status. abnormal placentation (previa), uterine rupture, cord prolapse, genital herpes RF: r/t anesthesia, bowel and bladder injury, hemorrhage, air/amniotic fluid embolism. Infection at wound site, UTI, endometritis. atelectasis, bowel dysfunction complications: wound hematoma or dehiscence, necrotizing fasciitis and thromboembolism Nursing: educate pt about risks, benefits and alternatives. consent form!! Minimize distraction, play music for patient, dim lights, meds for aspiration risk minimization. catheter

Question 96

TOLAC

Answer 96

only attempted in setting with access to advanced OB care best candidates: low risk for uterine rupture and high likelihood of successful VBAC contraindications: close together preg, fetal macrosomai, AMA, maternal comorbid conditions, more than 1 previous csection, >40 wks gestational deliveries considerations: prostaglandins contraindicated, OB hx

Question 97

Uterine Rupture

Answer 97

tear in wall of uterus RF: labor induction with prostaglandins or oxytocin with csection hx, vertical uterine incision assessment: first signs include category 2 or 3 fetal HR, bradycardia, decals, mom hemodynamic instability (hypotension, tachy), weakening contractions, loss of fetal stations, abd pain, vag bleeding Tx: triggers csection. give IV fluids and blood, general anesthesia if epidural or spinal isn't inlace, may result in hysterectomy

Question 98

Cord prolapse

Answer 98

umbilical cord precedes fetal head in birth canal- increase risk for hypoxia due to cord compression -overt: cord slips out of vagina ahead of fetus -occult: cord descending next to fetus and entrapped RF: non vertex position, low birth weight, prematurity, uterine malformations, multiple pregs, polyhydramnios interventional RF: AROM,mechanical cervix ripening, labor induction, forceps/vacuum, fetal scalp electrode, IUPC etc s/s: change in FHR tracing, severe brady and cariable decels. maternal hypotension, placental abruption, uterine rupture, and uterine tachysystole. PAINLESS AND NO BLEEDING asses/tx: FHR monitoring, csection

Question 99

Amniotic fluid embolism (anaphylactoid syndrome of pregnancy)

Answer 99

rare- amniotic fluid enters maternal circulation RF: labor induction, operative delivery, AMA, cervical lacerations, eclampsia, fetal distress, placenta previa or abruption, grand multiparity, complications: cariogenic shock, inflammation or anaphylactic reaction. resp failure assess: during labor up to 48H after delivery. resp failure signs and cardiac arrest, hemorrhagic shock w/ DIC if they survive the first signs Tx: no tx, correct hypotension and hypoxemia. intubation, blood products, fluids, vasopressor. Csection

Question 100

meconium stained amniotic fluid

Answer 100

fetal stool in the fluid RF: post-term pregnancy, diabetes, HTN, prolonged labor, decreased o2 to fetus, fetal growth restriction associations: increase risk for chorioamnionitis, non reassuring FHR, fetal hypoxia, meconium aspiration fetal risks: resp distress, acidemia, seizures, cerebral palsy, sepsis

Question 100

shoulder dystocia

Answer 100

obstruction of fetal descent by the shoulders after birth of head associated with maternal diabetes and macrosomia S/s: "turtle sign"- fetal head is born but cheeks rest on the patient introitus as the fetal anterior should is unable to pass beneath pubic bone Tx: McRoberts maneuver- sharply flex patients hips with their knees pulled back to their chest. and suprapubic pressure- push down on abd at level of pubic bone while the provider guides the head down toward patient anus