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OB test 2 Flashcards

1
Q

Spontaneous abortion

A

pregnancy that ends before 20 weeks.

ends by natural causes.

most occur with in the first 12 weeks.

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2
Q

Possible causes of spontaneous abort

A
  • chromos abnormalities
  • endocrine disorder- hypothyrodism
  • infections- syhphillis. G/C
  • implantation disorders
  • structural factors (incompetent uterus)
  • immunologic factors
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3
Q

s/s of abortion

A

Bleeding, uterine cramping/pain/ctx

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4
Q

complications of an abortion

A
  • risk for infection
  • risk for hemorrhage
  • tissue/organ damage with instrumental procedures
  • potential RH sensitization
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5
Q

Threatened abortion

A

typically just bleeding

days or weeks

may have cramping, back and pelvic pressure which indicates increased risk for inevtiable abortion

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6
Q

management for threatend abortion

A

speculum rxam w/ gentle SVE

ultrasound

type and screen, beta hCG and progesterone (maintains preg, develops lining)

pelvic rest

pad count

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7
Q

inevitable abortion s/s

A

SROM

dilation

ctx’s

active bleeding

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8
Q

incomplete abortion s/s

A

partial expulsion of parts of conception (the parts will leave uterus but remain in vagina due to being so small)

severe abd cramping

uterine bleeding

dilation

tissue passed

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9
Q

managment of incomplete

A

stablize mom= Vs O2 and IV

Labs: t&s, antibody screen

once stable: sedation, vaccum curettage or D&C, oxytocin or methergine after, PhoGAM PRN

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10
Q

complete abortion

A

All POC passed, incomplete becomes complete onces all parts pass

cramping and bleeding subside

cervix closes

loss of preg symptoms

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11
Q

management of complete

A

Beta hCG tracked (will go down), pad count, monitor for infection, No intercouse until check, RhoGAM PRN

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12
Q

Missed abortion

A

Dead fetus is retained in uterus

s/s- loss of preg symptoms @

size < date

possible brownish-red vag bleeding

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13
Q

managemen of misses

A

U/S - will be no FHR

beta hCG - decreased

evacuation procedure or labor initiation

RhoGAM PRN

A D&C will be done in 1st trimester

Cytotec or methylitrexate - used to expell fetus

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14
Q

reccurrent abortion

A

2 or morse losses in 1st trimester

causes:

genetic or chromosomal

reproductive tract anomalies

systemic conditions

STDS

DM, Lupus

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15
Q

incompetent cervix

A

reproductive tract abdnormality that cause painless dilation of cervix in 2nd trimester

cannot hold preg to term

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16
Q

possible causes of incompetent cx

A

scarring

lacerations/trauma hx

over-stretching

excessive cx dilation in previous D&C

shorten cx

infections

LEEp or cone procedure - takes part of uterus

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17
Q

Cerclage

A

A small stitch put on the cervix to help it stay closed

done between 13-14 wks, rarely done after 25 wks, took out at 37 wks, and some will go right into labor, some dont .

Risks- Rupture of members, chorioaminoitist (infection), Pre term labor from stimulating the uterus.

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18
Q

nursing care post cerclage

A

montior for contractions, SROM, signs of infection

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19
Q

medical termination of pregnancy < 7 wks

A

RU-486 & cytotec

methotrexate

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20
Q

medical termination of pregnancy >7 wks

A

thru 12th week - vacuum aspiration

after 12th wk- dilation and evacuation.

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21
Q

s/s of ectopic preg

A

missed period, vag bleeding, abd pain, + preg test, shock s/s possible if full on rupture

unrupture - dull/ intermittent to colicky pain

rupture- acute pain

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22
Q

management of ectopic preg

A

check labs- hcG will be down and progeterone will be done, get CBC, type & cross match, RH

Transvaginal U/S done

salpingostomy - open and scrap out tube

methotrexate - folic acid antagonist - stops pregnancy

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23
Q

complete mole

hydatidiform mole

A

results from fertilized egg with no nucleus

looks like a bunch of white grapes on u/s
-no fetus, placenta, membranes or fluid

20% progess to choriocarnioma later on

vag bleeding/hemorrage are common

hcG goes up

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24
Q

incomplete mole

hydatidiform mole

A

often contrains embryonic or fetal parts and amniotic sac

congential anomolies common

rarely develop cancer later

symptoms may mimic an imcomplete or missed AB

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25
s/s of molar pregnancy
absense of F\<3R vag bleeding n/v- casued by increase hcG levels preg induced hypertension before 20 wks
26
management of molar preg
dx by u/s and b-hcG tc for HEG or preeclampsia follow-up care - serial b-hcG for 1 year - delay another preg
27
risk for placenta previa
previous c/s increase risk with multiple gestations- more babies more chance a placenta will implant near OS cocaine use smoking mulitpara
28
Assessment of previa pt.. s/s
sudden onset of Paibless birght red bleeding after 20 wks, scant to profuse amount, may cease, may recur VS-normal,FHT- reassuring abd- soft, relaxed, non-tender, with normal tone, fetus often unengaged due to placental location
29
management of previa pt
get hx- bleeding hx?, amt of bleeding general status and VS - usually no chagne till late external fetal monitoring - fetal status, ctx's labs: CBC, T&S, coags US spec exam, NO SVE if 36 wks and lung maturity documented or is in labor is active significant bleedin - immediate labor !
30
Assessment of abruptio pt
may have vag bleeding (dark red) or it may be concealed abd or low back pain =dull or ache uterine tenderness- localized - slight to ridgid/board-like uterine activity = irritability with hypertoncity common or hyerstimulation elevated uterine resting tone
31
risk factors for abruptio placentae (premature seperation of placenta prior to delivery
maternal HTN advanced maternal age trauma cocaine use PROM
32
managment of abruptio
determine by amount of blood loss, fetal maturity, and maternal/fetal status evaluate bleeding monitor labs - H&H decreases, decrease in clotting factors Kleihauer-betke (fetal blood cells in mothers system) - to see if theres been a bleed- exchange of fetal and maternal blood.
33
S/S of uterine atony (most common cause of Early PPH)
uterine fundus difficult to locate boggy uterus fundus firms w/ massage then becomes soft again elevated fundal height excessive bleeding often more bright red excessive clots
34
meds for atony
oxytocin, methergine, carboprost, hemabate or prostin, cytotec.
35
subinvolution
-most common cause of late hemorrhage uterus will be larger than normal and its often soft or boggy causes- retained placental frags, pelvic infection TX retained placental frags - D&C infections - ABX methergine
36
nursing care for PPH
montior closey assist with care to stablize hemodynamic status emotional support Teaching - fatigue/exhaustion potential, high iron foods, vit C, protein, nutrition, activity guidelines, support systems.
37
mngt hemorrhagic shock
promote tissue oxygenation -lateral postition w/ HOB flat -limit activity reduce anxiety & fear -02 tx Restore circulation/address blood volume - large bore IV access - fluids - PRBCs, fresh frozen plasma - monitor output hemodynamic monitoring monitor for signs of coagulopathy -labs: T&S, CBC, coags
38
DIC (disorcer of clotting)
consumes large amounts of clotting factors causes: abruptio, amniotic fluid emboli, dead fetus syndrome, PIH, infection, cardiopulmonary arrest, and hemorrhage managment-correct underlying cause, volume replacement, blood component therapy, increase oxygenation, and montior labs and pt status nursing care: ongoing assess of bleeding, admin fluids and blood products, strict I&O montoring.
39
Classifications of Gest HTN
\>140 systolic or \>90 diastolic afer 20 eks, in previously normotensive women, neg or trace protenruia, BP to normal within 6 weeks PP
40
Classifications or preeclampsia
\>140 S or \>90 D and \> 1+ proteinuria seen after 20 wks
41
Classifcations of chronic HTN
\>140 S or \>90 D dx prior to preg or before 20 neg or trace protenuria puts pt at greater risk of becoming preeclamptic
42
Risk factors or developing preeclampsia
primipara (first baby), age \>35, anemia, family hx of it, obesity, multifetal pregnancy, DM, renal disease, HTN, antiphospholipid syndrome, angiotensin gene T 235
43
Patho of preeclampsia
vasospasm and hypoperfusion -Arteriolar vasospasm injures endothelial cells so platelets aggregate, fibrin deposits are laid down, and blood vessels decrease in diameter which lyses RBCs and decrease blood flow to all organs and increases BP sensitive to angiotensin II (vasoconstrictor)
44
s/s of mild preeclampsia of mom
\>140/90 BP, 1+ 2+ proteinuria, dependent edema-eyes, face, fingeres, no pulmonary
45
s/s of severe preeclampsia in mom
\>160/110 BP \> or = 3+ proteinuria generalized edema with possible pulmonary \<30 ml/hr urine output headache usually visual problems
46
Fetal symptoms of mild preeclampsia
placental perfusion reduced
47
fetal symptoms of severe preeclampsia
Placental perfusion = IUGR, abruptio placenta, FHT late decels premature placental aging = small size, signs of aging (white and red infants)
48
preeclampsia managment
early detection is key mild- home mangement - assessed every 2-3 wks - NST, BPP, freq U/S
49
Lacerations
1st degree- no repair needed 2nd degree- muscle, repair needed 3rd degree - muscle and anal sphincter, repair 4th degree- muscle, anal sphincter, and anus, repair
50
Hematomas (early PPH)
location: vulvar, vag, retroperitoneal appearance: discolored, bulging mass common with SVD or assister deliveries
51
hematomas s/s
cause deep unrelived pain and pressure; sensative to touch firm fundus, may not be visible, systemic signs of concealed blood loss
52
care for hematomas
O2, IV fluid, stabilize if s/s of shock, anesthesia, OR - incisie and drain, incise and cauterize vessel
53
HELLP syndrome
H- hemodylasis (burr cells, increase bilirubin) EL-elevated liver enzymes (AST, ALT) LP= low plateletes (\<100,000 mm3 ) prominent symptom = epigastric pain -n/v, generalized edema sign that preeclampsia is getting worse
54
Care for HELLP
cont close monitoring cont mgSo4 -24 hrs after delievery minimally monitor lochia - increase PPH risl, oxytocin or prostaglandins for increase bldg ,not ERGOT preps they increase BP if dia BP remains above 105 then put on antihypertensive
55
Iron deficiency anemia
hgb 10.5 -11 maternal - causes decrease O2 carrying capacity of blodd, pallor, fatigue, pica (non-food craving), increase risk of infection fetal - iron supp-325 mg - 1-3/day, take with vit C (OJ)
56
hyperemesis s/s
**severe n/v, dehydration, decrease BP, increase P, poor skin tugor weight loss \<5% of pre-preg weight acidosis from starvation ketosis (elevated blood and urine ketones)** liver dysfunction alkalosis from loss of hydrocholoride acid in gastric fluids hypokalemia
57
hyperemesis managment
NPO - 24-36 hts IV fluids Monitor: wt, I&O, VS's, fetal status, U/S, labs-liver, electrolytes, H&H dark, quiet enviornment meds- zofran, phenergan, benadryl diet-progress slowly
58
Insulin needs with DM in preg
first half- decrease in maternal glucose levels second half - increase in insulin resistance by term - insulin needs double or triple after deliver- need goes down, baby stops taking sugar
59
DM mom complications
ketoacidosis (can lead to death) increase preeclampsia incidence - type 1 greater risk then GDM polyhydramnios- baby has increase sugar, pees a lot more infections- uti, vaginitis PTL birth trauma - big babies C/S delivery PPH
60
intrapartum pre-existing DM care
IV therapy - two lines - reg insulin and glucose solution BS q 1-2 hr goal is 80-110
61
antepartum pre-existing DM care
goal = euglycemia hosp prn for glucose sontrol delievery time - \>39wks
62
Preterm Labor (PTL)
before end of the 37th leading cause of infant death w/in 1 mo common- RDS, infections, congential heart defects, IVH, acidosis
63
PTL risk factors
UTI, drug use, mulitples, smoking, anemia, violence, STDs, hydramnios, infections, short cervix
64
PTL drugs
tocolytics therapy - goal to delay delivery - gen gain 2-7 days, allows fro steriod admin fro fetal lung maturity mag sulfate - decreases uterine contractility beta-adrengergic agonists (ritrodrine and terbutaline) - not used often - serious M//F s.e - tachycardia Calcium channel blocker - Nifedipine - inhibits calcium from enter smooth muscle and decrease ctx given PO Indomethacin (NSAID) blocks prostaglandins - short term use only (not after 32 wks) has potential to close ductus arteriosus
65
hypotonic uterine dysfunction
ctx weaken, shorten and less frquent 1st assess fetal size and pelvis, if ok then,, ambulate, IV hydrate, position change, AROM, nip atim, pain manage, decrease anxiety, OXYTOCIN if abnormal - c/s
66
hypertonic uterine dysfunction
frequent, painful ctxs that do not dialte the cx, encourage decent or effacement ctx is uncoordinated,may not completely relax between ctx, usually in latent and nulliparous TX= rest-warm bath/shower and analgesics - morphine goal- sedation, usually after 4-6 hrs of rest they wake up in active labor
67
shoulder dystocia TX
mcroberts maneuver ( mom flat, knees to chest) suprapubic pressure- abd pressure over pubic area episiostomy gives more room
68
prolapse cord variations
occult - hidden so it isnt seen and cannot be felt by SVE complete - visible protruding from vag
69
prolapse cord risk facotrs
fetus remains in high station, SGA, breech, transverse, hydramnios, AROM/ROM
70
TX for prolapse cord
carefully assess during and after ROM PRIORITY- relieve pressure on cord mom in knee chest, trendelenburg or modified sims SVE till delivery - to lift presenting part off cord - do not touch cord -nurse doing SVE stays in bed with mom, to hold baby in until c/s
71
vaginal birth after having had c/s (VBAC)
Trial of Labor attemp lab when: mothers pelvis right size fetus right position if had classic incision for a previous c/s cant have trial of labor
72
Induction
labor started artificially needs to be present before induction: - benefit of delivery outweighs continuing preg - fetus is longitudinal lie - cervix is ripe - no CPD - fetus is mature dont do if: previa, prolapse, abnormla presentation, scarred upper uterus
73
augmentation
assisting labor that started spontaneiously that has slowed or stopped nip stim, cervix softening
74
bishop score
Predicts inducibility of cervix Score includes - dilation, effacement, fetal station, cervix consistency, cervix position a score over 8 means a successful induction is likely 5-6 prostaglandin gel used 8-10 pitocin can be used
75
Infertility
inability to conceive after ONE YER of unprotected, regular intercourse. primary - never had a baby secondary- had a child, now cant have another
76
fetal implications of adolescent pregnancy
higher risk for: prematurity low birth weight IUGR
77
delayed pregnancy
women \>35 yrs these are good moms to teach - suport
78
fetal px with tobacco use
decrease O2, LBW
79
fetal px with alcohol use
IUGR, CNS dysfunction
80
fetal px with marijuana use
increased moro reflex and tremors
81
px with cocaine use
abruption, LBW
82
px with amphetamines use
vasoconstriction
83
cycle of violence
1st phase: Tension building - anger, blaming, arguing occur 2nd phase: Acute battering= battering incident occurs 3rd phase: honeymoon stage - batterer asks for forgiveness, promises never will happen again. then repeats itself

Nursing 250- OB/Peds (3 decks)

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