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1
Q

What is considered PIH?

A

new development of htn AFTER 20 weeks, w/o protein in urine, BP greater than 140/90

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2
Q

What is considered Preeclampsia?

A

BP over 140/90 after 20 weeks
proteinuria > .3 g in 24 hrs
Maybe Edema

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3
Q

What is considered Severe Preeclampsia?

A

BP 160/110
Proteinuria over 5 mg
Less than 500 mL of urine output
Headache, visual disturbances, epigastric pain, edema

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4
Q

Name the symptoms of preeclampsia from head to toe.

A

Headache, Visual disturbances, periorbital swelling, edema, epigastric pain, clonus, hyerreflexia

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5
Q

Risk factors for PIH

A

1st pregnancy, POC, chronic HTN, older than 35, multi pregnancies, Diabetes, family hx, late prenatal care

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6
Q

How do we manage PIH? What happens if it is severe?

A

bedrest, BP monitoring, daily weight, fetal surveillance, high protein diet
C-section

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7
Q

Manifestations of Magnesium toxicity

A

Respiratory rate less than 12, absences of deep tendon reflexes, sweating and flushing, hypotension, confusion, lethargy

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8
Q

What is the therapeutic level of magnesium?

A

4- 8mg/dL

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9
Q

What are the seizure precautions?

A

provide a quiet environment, pad side rails, bed in low positions, make sure oxygen and suction is available, have mom lay on left side

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10
Q

Risk factors for gestational diabetes.

A

Obesity, chronic HTN, age 30 or older, family hx, prior birth of large infant, stillbirth, hx of GDM

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11
Q

How do we screen for GDM?

A

1 hour glucose challenge test between 24-28 weeks

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12
Q

Effects of Diabetes on pregnancy?

A

PIH, UTIs, hydramnios, ketoacidosis, PROM, preterm labor, difficult labor, injury to birth canal, C/S, postpartum hemorrhage

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13
Q

Effects of diabetes on fetus?

A

death, congenital anomalies, macrosomia, IUGR, birth injury, hypoglycemia, RDS, hyperbilirubinemia

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14
Q

Risk factors for ectopic pregnancy

A

hx of one, failed tubal ligation, IUD, older than 35, STD

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15
Q

Signs and symptoms of ectopic pregnancy

A

missed period, sudden severe lower abdominal pain, spotting

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16
Q

Treatment for ectopic pregnancy if tube is intact

A

Methotexate and salpingostomy

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17
Q

Treatment of ectopic pregnancy if tube ruptures

A

Control bleeding, salpingectomy

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18
Q

Signs and symptoms of placenta previa

A

Painless bleeding in last half of pregnancy

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19
Q

Management of placenta previa

A

No vaginal examinations or pitocin, fetal monitoring, prepare for C/S

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20
Q

What is abruptio placenta?

A

separation of normally implanted placenta before fetus is born

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21
Q

Dangers of abruptio placenta on fetus

A

anoxia, excessive blood loss, preterm labor

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22
Q

Dangers of abruptio placenta on mother

A

hemorrhage and hypovolemic shock

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23
Q

Signs and symptoms of abruptio placenta

A

bleeding (can be concealed), abdominal pain, uterine hyperactivity with poor relaxation, uterine tenderness

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24
Q

Signs of concealed hemorrhage

A

Increase in fundal height, hard abdomen, signs of hemorrhage, late decels,

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25
What is preterm labor?
labor between 20 and 37.6 weeks
26
S/S of preterm labor
Contractions, sensation of baby balling up and or pushing down, cramps, vaginal discharge
27
When is mother cultured for GBS?
at 35-37 weeks
28
Frequency of contractions
beginning of one contraction to beginning of the next
29
Duration of contractions
beginning of one contraction to end of same contraction
30
Acme
period where contraction is the most intense
31
Decrement
Period where contraction relaxes
32
Effacement
thinning and shortening
33
Dilation
opening
34
What is the normal blood loss for a vaginal delivery and c-section?
500 mL for vaginal, 1000 mL for C/S
35
Normal range of heart rate and respirations for baby
110-160 bpm; 30-60
36
What are the 4Ps?
powers, passage, passenger, and psyche
37
Powers involve
contractions and pushing
38
Fetal lie
orientation of long axis of fetus to long axis of mother
39
Attitude
relationship of fetal body parts to one another
40
What is normal attitude?
flexion
41
Types of fetal presentation
cephalic, breech, or shoulder
42
Labor onset theories
increase prostaglandins, oxytocin, increased stretching and pressure of uterus and cervix
43
Normal signs of labor
bloody show, dilations, increased vaginal mucus, softening, energy spurt, lightening
44
What is considered true labor?
increased contractions and discomfort, effacement and dilation
45
What is considered false labor?
inconsistent contractions, nonchanging cervix
46
What are the stages of labor?
first = effacement and dilation second = delivery of fetus third = delivery of placenta fourth = postpartum
47
stages of first stage of labor
latent, active, and transition
48
Cervical dilation of the 3 phases of the first stage of labor
latent = 0-3 cm active = 4-7 cm transition = 8-10 cm
49
Effleurage
gentle massage during or between contractions
50
Nursing care for epidural
bolus 500-1000 mL of LR before, frequent vital signs, catheter insertion, monitor leg movement
51
Epidural side effects
hypotension, bladder distention, fever, prolonged 2nd stage, catheter migration
52
Side effects of duramorph
Nausea and vomiting, pruritis, respiratory depression
53
Where is the toco placed?
on top of uterus
54
Limitations of external monitors
mobility, repositioning of transducers, can't assess strength of contraction, obese women
55
Fetal scalp electrode requirements and where is it placed.
requires dilation ROM, placed on fetal presenting part
56
Intrauterine pressure catheter (IUPC
sterile catheter inserted directly into uterus and measures uterine pressure
57
Limitations of IUPC
requires ROM and dilation, can cause trauma, risk for infection, maternal position can give inaccurate readings
58
Classifications of variability
absent, minimal, moderate, and marked
59
Early decelerations
head compression which are okay
60
Late decelerations
uteroplacental insufficiency
61
Variables
cord compression
62
What is the purpose of variability?
determines oxygenation
63
What is considered minimal variability?
less than 5 bpm
64
What is considered moderate variability?
6-25 bpm
65
What is considered marked variability?
greater than 25 bpm
66
Reasons for decreased variability
fetal sleep, drugs, tachycardia, prematurity, hypoxia, CNS abnormalities, hypoxemia
67
What is considered an acceleration?
>32 weeks must be 15 bpm above baseline for 15 seconds but less than 2 minutes <32 weeks must be 10 bpm above baseline for 10 seconds or more but less than 2 minutes
68
What is considered a prolonged acceleration?
increase in FHR for 2 minutes but less than 10 minutes
69
What happens if accelerations are longer than 10 minutes?
a change in FHR baseline
70
What is a prolonged deceleration?
a decrease in FHR of 15 bpm or more for 2 minutes but less than 10 minutes
71
What can cause prolonged decelerations?
maternal hypotension, fetal hypoxia, hemorrhage, cord prolapse, cord compression, uterine rupture
72
Interventions for variables or late decels
reposition, bolus, oxygen, stop pitocin,
73
Dystocia
describes any difficult labor or birth
74
What is considered a dysfunctional labor?
ineffective pushing, no fetal descent, effacement, or dilation
75
Main sign of shoulder dystocia
Turtle sign
76
Macrosomia is any infant that weighs over..
4000g (8 lbs 13 oz)
77
What is shoulder dystocia?
delayed or difficult birth of shoulders
78
Is shoulder dystocia an emergency? Why?
Yes; cord can be compressed
79
How is shoulder dystocia solved?
McRoberts Maneuver and suprapubic pressure
80
What is done if PROM occurs before 36 weeks? Past 36 weeks?
given tocolytics to slow delivery process; delivery of fetus
81
Precipitous labor
birth that occurs within 3 hours of the onset of labor
82
What is an important management of a precipitous labor?
fetal oxygenation
83
Purpose of bishop score
used to estimate how easily a woman's labor can be induced
84
What is being scored for bishop scoring?
dilation, effacement, fetal station, cervical consistency, cervical position
85
What is cord prolapse?
It slips down after ROM and can be compressed between fetus and pelvis
86
What factors increase risk for cord prolapse?
ROM and fetus is at a high station, fits poorly in pelvis inlet, hydramnios
87
What can cause uterine rupture?
Previous uterine surgery, high parity with thin uterine wall, abdominal trauma, intense contractions, medications
88
Signs and symptoms of uterine rupture
abdominal pain or feeling that something ripped, chest or shoulder pain, hypovolemic shock, hemorrhage, impaired fetal oxygenation,
89
How is uterine rupture treated?
stabilize mom, delivery via c-section
90
Order of meds for postpartum hemorrhage
Pitocin Methergine Cytotec Hemabate
91
What would be some indications for a C-Section?
dystocia, cephalopelvic disproportion (CPD), PIH, active herpes, fetal distress, prolapsed cord, breech, hemorrhage
92
What are some C-section complications?
Infection, atelectasis, paralytic ileus, UTI, hemorrhage
93
What are factors that increase risk for postpartum hemorrhage?
Overdistention of uterus, prolonged labor, precipitous labor, c-section, use of forceps or vacuum
94
What are 2 major causes of early hemorrhage?
uterine atony and trauma to birth canal
95
What is pueperal infection?
bacterial infection after childbirth; fever of 38 C (100.4 F) after the first 24 hours
96
How can you differentiate postpartum blues from postpartum depression?
postpartum blues lasts for 2 weeks and mother will still be capable of caring for baby, past 2 weeks and not able to care for baby indicates postpartum depression
97
Signs and symptoms of postpartum blues
fatigue, irritability, weeping, anxiety
98
Signs and symptoms of postpartum depression
less interest in environment, unable to feel pleasure or love, feelings of unworthiness, guilt, shame
99
What is surfactant and what is its purpose?
it is produced as lungs mature and reduces surface tension within alveoli
100
What does APGAR stand for?
Appearance, pulse, grimace, activity, respiratory effort
101
What are the signs and symptoms of TTN?
high respirations of 120, retractions, nasal flaring, grunting, and mild cyanosis
102
Interventions for TTN
Supplemental oxygen, IV or gavage feeding to prevent aspirations
103
What causes respiratory distress syndrome?
Insufficient production of surfactant
104
Signs and symptoms of RDS
begin within 4 hours of birth, tachypnea, retractions, nasal flaring, grunting, wet breath sounds
105
What is retinopathy of prematurity? When does it occur?
damage from immature blood vessels in retina of eye; less than 36 weeks of gestation or if they weigh under 1500 g
106
What can be done for ROP?
cryotherapy, laser surgery, give vitamin E
107
What is the range for blood glucose for infant?
40-45
108
What are some interventions for hypoglycemia?
early feedings, D5, IV bolus w/ D10
109
Signs and symptoms of hypoglycemia of baby
tremors, cyanosis, convulsions, tachypnea, cardiac arrest
110
What is the management for SGA?
check for hypoglycemia, frequent feedings, regulate temperature, respiratory support
111
What is the management for LGA?
check for injuries from birth and respiratory complications, hypoglycemia
112
What do you check/monitor when Duramorph is given?
respiratory depression, no narcotic use during that 24 hours, check for itching
113
What is Terabutaline used for and what is the dosage?
slows contractions; 0.25 mg
114
When would you withhold Methergine?
if BP is 136/90
115
What is the normal dosage for Vitamin K?
1mg/0.5 mL

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