Test #4 Flashcards

Question

With HIV, since we are trying to prevent transmission between mom and baby, what are we looking at? Why?

Answer 1

Mom's viral load, because the higher her viral load the more likely she is to pass it on

Answer 2

1. Ante: HIV can cross the placenta if we don't do anything to prevent the transmission (without intervention rates can be as high as 25% of babies becoming infected) 2. Intra: transmission into babies bloodstream due to minor tears during birth 3. Post: through breast milk

Answer 3

1. Antiretroviral therapy to help decrease viral load (usually 3 different medications) (usually need to start by 28 weeks to reduce risk at birth) 2. Have a C-section if viral load is not low enough to help prevent transmission 3. Newborns will receive antiretrovirals for 5 weeks after delivery 4. Do not let mom breast feed

Answer 4

It's a universal screening for all pregnant mothers, so this could be the first time that she's ever being tested for and the first time finding out if she is HIV positive, which can be a shock

Answer 5

That HIV is no longer a death sentence, it is a chronic illness that can be managed

Answer 6

- They will be on antivirals, which will help prevent transmission across the placenta, where it is most likely to occur - Safe to deliver vaginally - Can breastfeed

Answer 7

- First thing: bathe baby prior to giving any injections (like the vitamin k and hep B vaccine) - Will receive a hep B vaccine - Will receive hep B immunoglobulin (HBIG) (these injections should be given within the first 12 hours to prevent any transmission that may have occurred)

Answer 8

Yes, it's a potent teratogenic drug

Answer 9

- Heroin, codeine, fentanyl, methadone, oxy, hydrocodone

Answer 10

- Very fussy, sensitive, hyperreactive due to withdrawals after delivery - Increased risk for IUGR (why these babies born from smokers are generally small)

Answer 11

- Intimate partner violence - STIs - Lack of prenatal care

Answer 12

- If she has had no prenatal care - If there is a placental abruption without an obvious reason - If there is IUGR without obvious reasons

Answer 13

Sometimes there will be a mandate from social services telling us that there is a hx of abuse and we need to do a toxicology screen

Answer 14

No, even if there is a court order, she would end up just being in violation of the order

Answer 15

- Meconium - Urine

Answer 16

- They are often SGA (small) - There may be some neurodevelopmental abnormalities - Acute withdrawals

Answer 17

Yes, typically like to use the screening tool within the first 4 hours (looking at things like does baby have a high pitched cry, decreased sleeping, hyperactive reflexes, etc), then this gives us a score and tells us how frequently we should rescore the baby and what our treatments should be. - Good to note that we may not see signs of withdrawal until 12-24 hours after birth, but it's still good to start at hour 4 so we have a baseline before withdrawals kick in

Answer 18

- High-calorie formula (due to all of their extra movements going on and increased metabolism during their withdrawal) - Small frequent meals - Antidiarrheals - Meticulous Is and Os - Wts - Breastfeeding - Morphine or methadone if baby has a high score - Promote comfort like swaddling, sucking (give pacifier), swing - Billy lights - Monitor tox screen - Work with social services

Answer 19

If they take SSRIs during the first trimester, there is conflicting info on whether it can cause fetal malformation, so we would want to work with their doctor to see if they should be taken off the medications (weight the risk vs benefit)

Answer 20

A and B are generally safe. C we don't know either way. D we're going to avoid.

Answer 21

Developing postpartum depression

Answer 22

They're feeling down longer than 14 days (it's normal to have a few days that you may feel like this

Answer 23

Persistent vomiting that is not caused by something like the flu or eating something bad It's just vomiting that goes on and on while pregnant and you can't figure out why

Answer 24

- There will be signs of malnutrition, so we would see ketonuria (+2 ketones with dipstick) - Weight loss (below pregnancy weight by 5%)

Answer 25

Not really clear, but we think it has something to do with high levels of HCG, estrogen or thyroid hormones Might also be a genetic component Increase risk if you're having a girl Can be worse symptoms if you have multiple babies (due to more hormones being released) Hx of motion sickness or migraines may make a woman more susceptible

Answer 26

- Antiemetics - IV fluids for hydration - Can give dextrose for calories - Worst case - have central lines to get TPNs

Answer 27

Where the placenta has attached to the lower uterine wall, and may be covering the cervix. This is bad because it can increase mom's chance of having a hemorrhage, where in the 3rd trimester when she starts having contractions, those contractions around her cervix can put a lot of pressure on her placenta and cause bleeding. Plus a baby can't be born vaginally if the placenta is completely blocking the cervix, because the placenta will be born before the baby, so the baby won't be getting perfusion.

Answer 28

1. Complete: where the placenta is completely blocking the cervix 2. Partial: where part of the placenta is blocking the cervix 3. Marginal: where the placenta is very close to blocking all of the cervix 4. Accreta: placental attaches too deep into the uterine wall 5. Percreta: where the placenta grows through the wall and attaches to nearby organs 6. Increta: attaches even deeper into the uterine muscle

Answer 29

Because the placenta has attached itself so deeply in the uterine wall, or muscle or other organs, which can lead to massage bleeding once baby is born because we can't really do a fundal massage or anything in this area, it will just keep bleeding

Answer 30

In the OR, where we are ready to do a massive transfusion. May even need to do a hysterectomy

Answer 31

- Painless bright red vaginal bleeding (think about the placenta covering the cervix, and any little disruption to that placenta's blood vessels can cause bleeding, but the pt might not feel any pain) (usually occurs in 3rd trimester) - Abdomen will be soft, nontender

Answer 32

Vaginal exams, because we don't want to be poking and prodding the placenta since it's right at the cervix

Answer 33

When they go to the hospital or get checked, make sure they tell whoever that they have a placenta previa and cannot have vaginal checks

Answer 34

Maternal and fetal well being. - Vital signs on mom - Look at mom - Get baby on monitor

Answer 35

Their BP will be higher due to their increase in blood volume, so this can be a poor indicator of volume status, so we want to look at her HR to see how she's coping (tachycardia would show that something is up) We would also see changes in baby's HR first if there is an issue with blood volume (like bleeding), where baby will get tachycardia trying to compensate, then eventually mom's HR will also go into tachycardia

Answer 36

A Kleihaurer-Betke (KB) test to see if mom's blood has mixed with baby's, especially for our RH negative moms (if mom is Rh negative and baby is positive, than mom can create antibodies that kill baby's RBCs) (since mom's with placenta previa are at an increased risk of bleeding, we want to be on the lookout for Rh negative and positive situations)

Answer 37

A premature separation of the placenta from the uterus

Answer 38

- ***Very painful - May or may not Vaginal bleeding (a complete separation may block blood from leaking out, so that blood will just collect where its separated) - With a complete separation and blood blooding in the abdomen, we will get a rigid abdomen

Answer 39

1. Marginal 2. Partial 3. Complete

Answer 40

We would see late decels on FHR

Answer 41

The mom can go into DIC, which can lead to hypoxia of the baby

Answer 42

Some can be minor, where maybe we didn't even know they had one until after delivery or they can be extreme, where we would need to do an emergency c-section

Answer 43

Preterm premature rupture of membranes (PPROM)

Answer 44

- Infection, which is called chorioamnionitis - Uterine distention like from multiple babies or a lot of fluid - STIs - Smoking

Answer 45

- A provider will do a sterile speculum exam to see if they can see fluid in the birth canal - nitrazine test where normal vaginal pH is between 4.5-5.5, but amniotic fluid increases the pH - Amnisure (lab test) - Ferning (amniotic fluid will fern when dried)

Answer 46

- Infection risk (decrease number of invasive procedures) - Fetal wellbeing (we are losing our amniotic fluid cushion, babies may have variables on the monitor, because there can be compression of cord without the cushion)

Answer 47

Deliver the baby right away, because mom and baby are at risk for sepsis

Answer 48

No, we will keep a close eye on them and try and let the baby cook longer

Answer 49

- They are at an increased risk of going into labor spontaneously - They will be on bed rest

Answer 50

- Tenderness - Cramping - Lower back pain - Odor - Increased HR of both mom and baby (infection will usually trigger the body to go into labor, because it knows that we need to get the baby delivered)

Answer 51

Slow down labor for at least 48hrs so we can give 2 doses of betamethasone, which can enhance lung maturity of the baby before they are born

Answer 52

Anywhere from 20 weeks (when we consider the baby viable) to before 37 (because we consider 37 weeks and after full term)

Answer 53

Preterm labor

Answer 54

No, we've shifted from prevention to early detection of preterm labor

Answer 55

To be able to give more babies going into preterm labor between 24-32

Answer 56

To be able to give more babies going into preterm labor between 24-32 betamethasone to help their lungs prior to delivery

Answer 57

At 28 weeks (so we REALLY REALLY want to get our babies to 28 weeks)

Answer 58

- Immature lungs (not producing surfactant yet, not having coordinating breathing yet), which can lead to respiratory distress - Small babies, not much subcutaneous tissue or glycogen stores, which can lead to hypothermia and hypoglycemia (monitor temps, put on warmers, check sugars) - Underdeveloped livers (at risk for jaundice) Can have under billy lights - Intraventricular hemorrhage for really small babies, where there is internal bleeding in the babies head, so we don't want to have small babies deliver vaginally, because trauma during birth can increase the risk of intraventricular hemorrhage - Cerebral palsy longer term - Retinopathy long term

Answer 59

- Periodontal disease - Diabetes, HTN - *Infections - *Uterine distention usually caused by multiples - Hx of preterm labor - Demographics (older and younger, no prental care) - Smoking - Stress - Interpregnancy interval (less than 6 months since last pregnancy)

Answer 60

- Number one thing is prenatal care - Manage chronic conditions that might trigger it (like managing HTN, diabetes, stress) - Screen and treat infections - Give progesterone intravaginally (pro-pregnancy hormone - wants to keep you pregnant)

Answer 61

- Greater than 20 weeks pregnant and less than 37 weeks - Have to have persistent contractions - Dilating more than 1cm or dilation is changing - Effacement of 80% - Get a UA - Fetal fibronectin (FFN) test - Exam cervical length

Answer 62

- Drink water (dehydration can cause contractions) - Go to the bathroom (full bladder can cause issues) - Put their feet up - Take a nice warm bath

Answer 63

- A test used to rule out preterm labor - The fetal fibronectin is a prostaglandin that is released when membranes are disturbed by contractions (so this is how we can tell if they're actually having contractions) - Don't use if there are rupture membranes (PPROM) or if there is vaginal bleeding - Can't use if there has been anything in the vagina in the last 24 hours, like from having sex or having their cervix checked. Negative means that there is a less than 1% chance that the mom is going to deliver that week. (we want negative)

Answer 64

Because the FFN test won't be accurate if anything has been in the vagina in the last 24 hours, like from having an exam. So we always want to do this test first before a cervical exam.

Answer 65

Well it tells us that the mom has a 20-50% chance of delivering this week, but there are also a lot of false positives, so basically a positive result doesn't really tell us much.

Answer 66

- We want to delay delivery! How we accomplish: - Give tocolytics, which are medications used to reduce contractions. - Try to delay delivery enough to get two doses of betamethasone in within 48 hrs - Abx for GBS as needed - Bed rest (remember increase of DVTs on bed rest, maybe more of an activity restriction) - Possibly may need to transport to another facility

Answer 67

- Nifedipine (Ca channel blocker) (don't give nifedipine and magnesium sulfate together because both compete with calcium and cause cardiac issues) - Indomethacin (NSAID) - Terbutaline (beta-adrenergic receptor agonist) (not first line, will stop contractions, but can cause maternal tachycardia) - Magnesium sulfate (CNS depressant - also competes with Ca) (has to be given inpatient)

Answer 68

Give 12mg to mother IM every 24hrs twice Give to mothers if babies are less than 34 weeks Helps babies produce surfactant

Answer 69

Reduces: - Respiratory distress syndrome - Intraventricular hemorrhages - Necrotizing enterocolitis - Neonatal mortality - Neurologic handicap

Answer 70

You can give one "rescue dose" of betamethasone a week later, or even at a later time.

Answer 71

- Diabetic moms (this med will spike their sugar levels) (might need extra insulin coverage)

Answer 72

No, it's a dual RN sign off

Answer 73

It's a CNS depressant so... It provides neuroprotection to the baby to help reduce cerebral palsy risk Reduces contraction and tone (helps baby cook longer) It's a vasodilator, so it can drop BPs (we don't want to drop mom's BP too much, because this can reduce profusion to the baby

Answer 74

- BP and RR frequently (remember, it's a CNS depressant) - Continuous EFM - DTRs (don't want these to become too decreased) - LOC (don't want these to become too decreased) - Lung sounds - Urinary output - Watch for late decels (signs of poor placenta perfusion)

Answer 75

- Groggy - Malaise like when they have the flu - Flushed

Answer 76

We should stop the mag sulfate and consider giving the antidote, calcium gluconate

Answer 77

Mag sulfate does cross the placenta, so these babies will also have mag sulfate in their system, and we may see signs of CNS depression, like decreased RR, muscle tone, they'll likely have low APGAR scores

Answer 78

- Intrauterine distention - ROM - Pre term labor - Hyperemesis

Answer 79

- There may be more bleeding than usual, which may turn into a DIC event - Infections can occur if membranes have been for some time or if the baby has died a while ago and these things are still inside mom - If Rh-, mom should still have RhoGAM

Answer 80

Usually where you have dilation and effacement of the cervix when you're not supposed too, which can lead to loss of the baby (usually occurs in 2nd trimester - basically cervix won't stay closed)

Answer 81

Through a cerclage, where the provider will stitch up the cervix until delivery to help keep baby inside

Answer 82

Usually things that have caused scarring to the fallopian tube, which is where we see a lot of ectopic pregnancies occur So...: - STIs - PID - Prior ectopic - Hx of abd surgeries - Endometriosis - Hormone therapy - Assisted reproduction - Use of an IUD

Answer 83

- Bleeding - Missed period - Abd pain/tenderness (usually unilateral on the side where the ectopic is in the fallopian tube) - Referred shoulder pain - Pain that worsens with rupture (pretty severe)

Answer 84

- Hx (previous ectopic - especially in the same fallopian tube as the previous ectopic, due to the scar tissue, if they still have that tube) - Palpable mass - Ultrasound to see if pregnancy is actually in the utererus - hCG will be low - Going to have hypotension s/s if ruptured

Answer 85

- We can give methotrexate to terminate pregnancy if unruptured and less than 4cm in size - Salpingectomy via laparotomy

Answer 86

YES! There can be massive internal bleeding going on. It definitely becomes an emergency

Answer 87

Basically a woman has a positive pregnancy test, but instead of a baby growing, the placenta develops abnormally and grows fluid filled grape like clusters instead of a baby (basically abnormal tissue growth instead of a baby, even though there was a positive pregnancy test)

Answer 88

- There would be a discrepancy in the size of mom's tummy and how far along she is (these fluid filled sacs are going to grow a lot larger, and much faster than a baby would) - Bleeding, possibly passing some of these little fluid filled clusters - Markedly elevated hCG - No fetal HR

Answer 89

These women are at an increased risk of developing cancer So we will measure their hCGs for at least one year, where a rise in hCG may indicate malignancy We advise our moms to not become pregnant for at least one year, because their pregnancy could mask a rise in hCG, which is helping us determine if she may have cancer

Answer 90

We don't need insulin as much in the first half of pregnancy, things like our hormones may be decreasing our need for insulin, as well as maybe we have morning sickness so we're not eating as much, and baby isn't needing very much. An increase in insulin needs can lead to insulin resistance (pancreas is excreting more insulin in second half of pregnancy, but can't keep up with the demand) Think of pregnancy as a stressor, and your pancreas isn't able to keep up with the high demand in the second half of pregnancy

Answer 91

The previous picture still holds true for type 1 and type 2 diabetics, where both may need to actually decrease their insulin in the first half of pregnancy, or may not even need it at all, however, they may need to increase their insulin injections in the second half of pregnancy

Answer 92

She can develop: - High BPs - Preeclampsia - Eclampsia - 2 times as likely to experience miscarriage - Poly(hydramnios (excess amount of amniotic fluid, over 2000mLs) (remember that high blood sugars can cause polyuria, where there is excess peeing, so since mom has high blood sugars, so will the baby, so the baby will be urinating a lot in their sac creating more and more amniotic fluid) - this can lead to uterine distention, which can cause problems later on - Ketoacidosis - Retinopathy - Increased risk of infections like UTIs (UTIs can quickly progress to phylo) - Increased risk for developing future diabetes after birth

Answer 93

- Macrosomia (excessive birth weight due to high maternal levels of glucose) - The baby can develop hyperinsulinemia, because only mom's glucose crosses the placenta, they don't get mom's insulin (this is why we like to give pregnant diabetic mom's insulin, because the insulin doesn't impact the baby), so babies will actually produce their own insulin, but since they are getting an excessive amount of glucose from mom, they will be producing excessive amount of insulin, which can cause the baby to store glucose in fatty deposits around their chest and shoulder areas. (this increase in babies shoulder and chest can make for challenges during delivery). - Increased risk for respiratory distress syndrome, because hyperinsulinemia can lead to a decrease in surfactant production - Neural tube defects (diabetic moms will need to take an increased amount of folic acid compared to nondiabetic moms to prevent neural tube defects) - After birth, babies will most likely have low blood sugars (this is due to baby's pancreas being use to produce high levels of insulin due to mom's high sugars, so it may take a while for baby's pancreas to stop making so much insulin, so baby's sugar may be low in the meantime) and possible jaundice (so be prepared for this) - Increased risk for developing type 2 diabetes later in life

Answer 94

Usually at 24-28 weeks, only sooner if high risk. From the previous slides, insulin needs are usually low in the first half of pregnancy, but increase in the second half, so there's not really a point in testing in the first half

Answer 95

Mom drinks a sugary drink, she comes and checks her blood glucose after an hour, if that number is really high, then she has to come back in 3 hours later and if that number is high, then this can confirm gestational diabetes

Answer 96

- Obesity - Family hx of type 2 - Hx of previous gestational diabetes - Hx of LGA infant (large infant, greater than 90th percentile for weight) - Polycystic ovary disease

Answer 97

No! It is likely that her insulin needs will decrease after delivery, so we will adjust accordingly

Answer 98

- Many can manage through lifestyle and diet changes - Increase folic acid intake to prevent neural defects - Maintain euglycemia (tight glycemic control) - Fasting less than 95 (check fasting in the morning) - 120-135 post-prandial (after eating) - A1C goal is 6 (8 or above shows poorly controlled diabetes) - Insulin is drug of choice (bc it doesn't cross to the baby) - More frequent prenatal visits, especially towards the end of pregnancy were we do nst (non-stress tests) to look at the fetal HR - Mom will have biophysical profiles done, where we do stress tests but also look at HR and ultrasound - Might have an early delivery (especially if baby is getting large, etc)

Answer 99

Only sometimes, it does cross the placenta, even though it is a category B, many providers will switch mom to insulin to error on the side of caution

Answer 100

- Kick counts (at home) - Biophysical profile (BPP) - Femur length - Abdominal/head circumference - Nonstress test - Contraction stress test - Amnio for fetal lung maturity - L/S ratio of 2:1 (tells us if baby has adequate surfactant)

Answer 101

We give point values to each item so: - Fetal HR can score up to 2 - Amniotic fluid can score up to 2 - Respiratory movements can score up to 2 - Muscle tone can score up to 2 - Movement of extremities can score up to 2 So there can be a total of 10 points. (a score of 8-10 is normal) (4 below mean deliver asap)

Answer 102

Between 80-110

Answer 103

Dextrose in case mom goes hypoglycemic

Answer 104

- All infants born from diabetic mothers, all LGAs and SGAs will be on glucose protocols Glucose protocols: - Monitor sugars (protocol will tell you what to do depending on where baby's sugar is at) - Use heel stick - Get babies to breast asap - Check baby's sugar 30 minutes after feeding - Want babies eating every 2-3hrs - Can't let babies sleep for long periods of time, because they do need to feet regularly - Protocol usually lasts 24-48hrs

Answer 105

She will likely come off her diabetic diet and be placed on a regular diet

Answer 106

Usually 6-12 weeks and then annually, just because gestational diabetes increases their risk of developing type 2 later on

Answer 107

Yes, it is the second leading cause of mortality for pregnant women

Answer 108

Systolic at or greater than 140 and/or Diastolic at or greater than 90 Pt has to have a BP at or greater than 140/90 at least twice taken 4 hours apart

Answer 109

1. Chronic HTN 2. Gestational HTN 3. Preeclampsia/eclampsia 4. Chronic HTN with superimposed preeclampsia

Answer 110

Before 20 weeks (so basically in her 1st trimester)

Answer 111

It is actually normal to have our BP decrease, which is why HTN during pregnancy is weird

Answer 112

- Have to have an increase in BP after 20 weeks - Need to either have protein in urine or other s/s of preeclampsia like vision problems, liver problems and/or kidney problems

Answer 113

Where we have an increase in BP after 20 weeks, but we don't have proteinuria

Answer 114

- Headache - Visual disturbances - Right upper quadrant pain due to hepatic ischemia - Reduced urine output - Low abd pain (which can be a sign of placenta abruption which is more common in women with preeclampsia) - Pulmonary edema - Peripheral edema - Hyperreflexia

Answer 115

1. Vasoconstriction leading to HTN 2. Platelet activation with intravascular coagulation 3. Endothelial dysfunction, where fluid shifts out of the vascular system and into the interstitial space 4. Maternal plasma volume contraction

Answer 116

Mom: - Eclampsia, which is essentially a seizure - Pulmonary edema - Renal failure - Stroke Baby: - Intrauterine growth resistance - Placental abruption - Still birth

Answer 117

- Hx of preeclampsia - First pregnancy or first pregnancy with a new paternal partner (something to do with dad's antigens) - Family hx of preeclampsia - Pre-existing HTN - Diabetes! (4x risk) - Renal disease - Obesity - Connective tissue disease like lupus and RA - Under 17 or over 35 - Multiples

Answer 118

- Look at CBC to see if we see any hemolysis (platelets less than 100,000) - CMP to check for kidney and liver function - Look for protein in urine, gold standard is to measure urine over 24hrs, where anything above 300mg for protein can be a sign of preeclampsia - Checking fetus for any signs of growth restriction

Answer 119

Deliver the baby

Answer 120

We want to determine what kind of HTN it is (gestational HTN or preeclampsia) So we'll do a 24hr urine collection to look for protein, if protein is over 300mg, then we know it's preeclampsia and not just gestational HTN

Answer 121

Yes, it can range from mild to severe

Answer 122

Aspirin to prevent preeclampsia from developing

Answer 123

1. We have endothelia damage, where little holes are made in blood vessels and leaking fluid into the surrounding tissue 2. Body tries to respond by activating intravascular coagulation to form little clots, but this also uses up our clotting factors (increases risk of DIC) 3. The damage to the endothelia also causes vasospasms 4. Intrauterine growth restriction because blood vessels are working like they should for perfusion 5. Pulmonary edema in lungs due to fluid leaking into this area (remember to listen to lungs) 6. Pulmonary edema is very common especially in face, hands and abd (can be pretty significant) 7. Vasospasms in liver (causes upper right quadrant pain, might also feel like epigastric pain - this is also why we watch liver enzymes) 8. Liver involvement is very serious and it is very very serious pain 9. Vasospasms can also cause headaches (think of downtown abbey) 10. Hyperreflexia can happen so make sure you're checking reflexes 11. Spasms can happen in eyes and cause blurry vision so ask if they have blurred vision.

Answer 124

- Have a BP at or greater than 140/90 after 20 weeks with 2 readings taken 4 hours apart - Have proteinuria (>300mg in 24 hours) or have involvement of end organs

Answer 125

- Can possibly be managed at home - Pt needs to know what to report to their provider (because we want them to tell us if they have any signs that the preeclampsia is progressing) - Will need to know how to take their BPs - Will need to have frequent trips to provider

Answer 126

- BP at or above 160/110 or any of the below: - Platelets <100 - AST/ALT 2x above normal - Severe, persistent RUQ/epigastric pain (like as severe as you can get for pain, worst pain of your life from the microhemorrhages in the liver that are occurring) - Elevated creatinine and protein - Oliguria (<500mL/24hrs) - Pulmonary edema - CNS disturbances (visual, DTRs and/or clonus)

Answer 127

We need assess DTRs on the pt with the off/oncoming nurses so that we can confirm what, if anything has changed

Answer 128

That the CNS is increasing in excitability, which can increase the risk of seizures developing

Answer 129

- Changes in HR - Poor variability - Late decels

Answer 130

- Severe HTN - Severe pulmonary edema - MI - ARDS - *Hepatic rupture - Eclampsia (grand mal seizure - can happen post partem as well, remember downtown abbey) - Cerebral edema - Hemorrhage - Acute renal failure - Coagulopathy > HELLP > DIC - Retinal injury

Answer 131

- Checking BPs - Checking DTRs/clonus - Ask about RUQ pain - Ask about headaches - Ask about visual changes - Listen to lungs to assess for pulmonary edema - Look for edema in hands/face - Assess urinary output - Run labs - AST/ALT, platelets, creatinine, protein in urine - Assess fetus using NST or BPP

Answer 132

Hemolysis (hemolytic anemia), elevated liver enzymes (AST/ALT 2x normal) and low platelets (<100)

Answer 133

Upper right quadrant pain

Answer 134

Where arteriolar vasoconstriction occurs and leads to grand mal seizures

Answer 135

Delivery but eclampsia can still occur post partem

Answer 136

No, we can generally let the baby cook for longer and watch mom for signs that the preeclampsia is progressing

Answer 137

- Home BP monitoring - Daily protein testing - Kick counts - NST every 3-4 days for baby - Checking baby's growth using the ultrasound

Answer 138

- Labs - Fetal monitoring

Answer 139

37-38 weeks

Answer 140

- We're going to try and deliver baby it is older than 34 weeks - If less than 34 weeks, we want to try and hold off on delivery for 48 hours to get betamethasone onboard

Answer 141

We're worried if her BP can handle the induction (like can she handle the labor pains, and everything that comes with a vaginal birth)

Answer 142

- Have them on bedrest with bathroom privileges - Minimize stimulation (lights dim, nice, and calm) - Have NICU provider/nurse come in and educate mom on what will be happening - Have them on magnesium sulfate to prevent clonus/seizures - May have on antihypertensives like labetalol or hydralazine - Strict Is and Os - Daily weights - Check DTRs - Check vital signs

Answer 143

If we see one of the following: - Uncontrollable severe HTN - Eclampsia - Liver rupture - Pulmonary edema - Placenta abruption - DIC - Evidence of category III fetal status - Fetal demise

Answer 144

Remember that mag sulfate completes with calcium, where calcium is trying to excite things and cause contraction, versus mag, which is trying to relax things

Answer 145

You can give too much and cause respiratory depression

Answer 146

4-6g bolus, followed by 2g/hr IV (remember this is high risk - so it's a dual RN sign off)

Answer 147

- Oxygen via a simple mask - Suction available - Eclampsia kit nearby - Still assess for preeclampsia progression - Check BP to make sure we're not dropping it too low - Check DTRs to make sure we're not losing DTRs (if we see a decrease or absent DTRs we need to stop the mag) - Continuous fetal monitoring - Can cause issues when trying to induce mom because it's fighting against induction (might need additional doses of prostaglandins or Pitocin - can be very difficult to get a mom on mag to go into labor) - Mag does cross the placenta, so the same things it can do to mom it can do to baby like decrease tone, decrease respiratory drive, we would see lower APGARs - Mag sulfate can cause issues with having uterus clamp down after delivery (might need to give extra fundal massage and extra Pitocin, have hemorrhage medications ready to use)

Answer 148

No, generally we want to keep mom on it for 24 hours because she is still at risk for eclampsia after delivery

Answer 149

Normal = +2 +3 or +4 = hyper +1 or 0 = sluggish or no response

Answer 150

- Pt reports metallic taste in mouth - Feel very fatigued - Sweating - Hypotension - Depressed/absent reflexes - Depressed respiratory

Answer 151

Calcium gluconate

Answer 152

6 weeks (so make sure we're teaching the warning signs)

Answer 153

Want them to have elective if baby is beyond 39 weeks (even though they're considered full term technically at 37 weeks, we want them to be beyond 39 weeks)

Answer 154

- Mom is in the supine position (laying flat - why we don't want mom laying flat) - Mom could have hypotension - Mom could be on an adrenergic-receptor blocking drug like Propranolol - Mom could be on anesthetics

Answer 155

- *Maternal fever and infection - Increase in fluid volume - Mom could have hyperthyroidism - Mom could have anxiety - After mom has smoked since nicotine is a stimulant

Answer 156

- *Maternal fever and infection - Increase in fluid volume - Mom could have hyperthyroidism - Mom could have anxiety - After mom has smoked since nicotine is a stimulant

Answer 157

We see moderate variability changes in their HR, usually changes from 5-25 BMP.

Answer 158

- Could be that baby is in their sleep cycle, which usually lasts for about 20 minutes. but.... - If it's been over 20 minutes and the baby's HR is still unchanged, then it could be a sign of hypoxia or acidosis

Answer 159

- Mom could be on fentanyl for pain - Mom could be on mag sulfate

Answer 160

Yes, they can tell us that the baby is well oxygenated

Answer 161

No - usually means something is wrong (remember veal chop)

Answer 162

1. Category 1: everything is good. We have moderate variability and some accels. (no decels happening) 2. Category 2: Everything in between. We're continuously monitoring, we're trying different interventions to see if we can improve things. Remember POISON. 3. Category 3: Very concerning - indicate a need for immediate delivery. Example - absent variability, flat line HR, with recurrent decelerations (these are all signs of acidosis). Could have bradycardia, huge decel, even down to 60 and it stays down there for 10 minutes (indicates an immediate delivery).

Answer 163

Yes, they happen right when mom has a contraction, and indicate that the head is being compressed, which is usually because the baby is advancing down the canal

Answer 164

No, late are the worst type of decels. It means that the placenta is unable to perfuse baby (not enough reserves etc)

Answer 165

Not good, but not as bad as late. Only really bad if they keep occurring, ok from time to time. Means that there is some cord compression. These look "V" shaped on the monitor.

Answer 166

POISON P - position change O - oxygen I - IV fluids S - sterile vaginal exam O - oxytocin OFF N - notify

Answer 167

- Power of contractions - Passenger (size of baby) - Passageway (positioning of baby coming out) - Psyche

Answer 168

Normal: 4-5 contractions in 10 minutes Hypotonic: less than 2-3 contractions in 10 minutes

Answer 169

- Overdistended uterus (like with multiples, polyhydramnios) - Presenting part is not being well applied (like if baby's head is not being applied to mom's cervix, then it's not going to help stimulate good contractions)

Answer 170

- Have mom try to walk/change positions - AROM (artificial rupture of membranes) (helps augment labor to get contractions going) - Start oxytocin to help augment labor

Answer 171

We can cause tachysystolic labor, where we're having more than 5 contractions in 10 minutes averaged over 30 minutes

Answer 172

- It's a dual RN sign off because it is a very high risk med - Start very low with 2 miliunits every hour - Then increase every 30 minutes until we get to a desired labor pattern, where we're having contractions every 2-3 minutes

Answer 173

We don't want contractions too close together, because we want time for that placenta to perfuse and establish reserves, because remember when mom is having a contraction, the placenta is using reserves to perfuse the baby, but if her contractions are happening too close together, than she doesn't have enough time to build up these reserves in-between contractions

Answer 174

- Stop oxytocin - Want to promote relaxation - Treat mom's pain due to having so many contractions (which can also help relax the uterus) - Terbutaline giving SQ helps relax the uterus (remember that it does increase maternal HR)

Answer 175

We do when we want to help labor progress because when we rupture the membranes it will remove the fluid that may be separating the baby's head from the cervix, so now if that fluid is gone baby's head will make contact and apply pressure to the cervix which can help the cervix start to have meaningful contractions

Answer 176

- Have to have fetal HR monitoring going on before, during and 20 minutes after the procedure so we can see how baby is tolerating the change in environment (aka loss of fluid) - Let mom know that there shouldn't be any pain, it will just be discomfort like with any cervical exam - "start the clock" when the rupture occurs, because we want to deliver baby within 24hrs from this time - Document amount and color of fluid, may have meconium in it

Answer 177

Yes, it's very rare

Answer 178

When the baby's head is not applied correctly in the cervix, which leaves room for the baby's cord to fall out before delivery - High station of baby - Small fetus - Breech presentation - Transverse lie - Polyhydramnios

Answer 179

Artificial

Answer 180

- Occult: hidden, we can't really see that it is occurring - Complete: where we can see that cord

Answer 181

Because if the cord is coming first in front of the baby's head, then when the baby's head makes contact with the cervix, it's going to be a tight fit, so this can cut off the cord blood supply to the baby

Answer 182

We see a major, prolonged decels and bradycardia

Answer 183

Make sure baby's head is well applied before rupturing any membranes

Answer 184

Stat C-section

Answer 185

- Want to relieve pressure off the cord - Provider will use two fingers to try and push baby's head up and off that cord without touching the cord, because touching it can cause vasospasms

Answer 186

- Position of mom - Decreased amniotic fluid, like from ROM

Answer 187

We have variable decels with every contraction

Answer 188

- Have mom change positions - Amnioinfusion

Answer 189

We insert sterile saline or LR into the uterine cavity via an IUPC (intrauterine pressure catheter) May be done to treat repetitive variables due to low amniotic fluid volume

Answer 190

- Fluid should be warmed before instilling - Watch our intrauterine pressure so we don't put too much fluid in - Make sure uterine tone stays consistent - Changing pad and chucks frequently, continuous fluid will be leaking - Watch for improvement in baby's FHR and wanting variables to stop - Have infection on your mind (frequent temp checks, very 2hrs first and then moving to every 1hr)

Answer 191

Intrauterine infection of membranes and/or fluid

Answer 192

Usually an ascending microbe from the GU system that climbs up in there

Answer 193

No, you can still get chorioamnionitis even if your membranes aren't ruptured, but it is more common in women who have ruptured membranes

Answer 194

At 12, 18 and 24hrs

Answer 195

- Increased vaginal exams - GBS that is untreated - Internal monitors (like with amnioinfusion)

Answer 196

- Increased maternal HR and temp - Increased fetal HR is often the first thing we see - Fundal tenderness - Foul odor of fluid is usually a later sign

Answer 197

Abx for mom

Answer 198

When the head gets delivered but the shoulders are stuck

Answer 199

Yes, because if the baby is trapped in the birth canal it can cause irreversible brain and organ damage after 6 minutes

Answer 200

Mark the time, because we want to make sure that the rest of the baby is delivered pretty quickly and is not stuck like with shoulder dystocia. If a baby's heads delivered but not the baby within 1 minute or more, then it is considered a shoulder dystocia.

Answer 201

- Increased birth weight - Gestational diabetes (chest is the largest part) - Obesity - Size discrepancy between the parents (small mom and big dad) - Use of vacuum or forceps (since you had such trouble delivering the head, are we going to have enough space to deliver the shoulders?) - Prolonged second stage (pushing, like for 2 hours for a primi or 1 hour for a multi, might cause us to think that since it is taking so long to push that maybe this baby isn't the right size to come out) - Previous hx of shoulder dystocia

Answer 202

That most occur in average size babys

Answer 203

- Make sure mom has an empty bladder (sometimes foley is removed if they have an epidural to create more space) (we can straight cath a pt if needed) - Providing firm pressure under mom's buttocks - NICU should be present and resuscitation equipment must be present and ready - Position mom (lower the HOB down, pull legs) - Have 10L of oxygen on - Make a change in approach to delivery every 30 seconds (try different maneuvers)

Answer 204

Mc Roberts maneurver 1. Lower HOB 2. Bring knees apart and to her shoulders (moving her legs back really opens the pelvis) 3. Perform suprapubic pressure as directed

Answer 205

Where the provider tries to rotate the baby around and deliver the other shoulder

Answer 206

Have mom on her hands and knees to help change position of baby

Answer 207

The ligaments of the symphysis are cut, which can add an extra 2-3 inches to the maternal pelvis

Answer 208

Baby's head is pushed back in and the baby is delivered via c-section

Answer 209

Brachial plexus or fractured clavicle injury

Answer 210

When you assess the clavicle you're going to feel crepitus (snap/crackle of air)

Answer 211

There is either bruising, stretching, avulsion (forcible detachment) of the nerve networks C5 to T1

Answer 212

Yes, it could just be temporary palsy to flaccid, or it could lead to serious damage, where the newborn is unable to move the shoulder

Answer 213

The moro reflex, where you startle the baby to see if they pull their arms out and up to their chest (if there is a brachial plexus injury, they won't be able to move the affected arm because of the shoulder injury)

Answer 214

Erb's palsy, which is where the newborn doesn't have any movement in their affected arm

Answer 215

- Membranes need to be ruptured - Mom needs to be fully dilated

Answer 216

- To help with the "power", which is one of our 4 P's, where mom is getting tired and her pushes aren't as strong anymore, a vacuum or forceps can help her to get the baby out - And baby is starting to go into distress

Answer 217

- May increase the risk for shoulder dystocia - Lacerations/nerve damage to the baby - Vacuum can cause cephala hematomas - Going to be more swelling/trauma to head - Does swelling cross the sutures? (if it doesn't cross sutures, we worry about blood loss) - Monitor VS - Monitor head circumference of baby (should be getting smaller, not bigger) - Do our neuro assessments on baby's (sucking reflex, apply pressure to rough of baby's mouth) (If baby isn't sucking, this could be a sign of neuro damage) - Forceps can cause more tissue damage on mom, which can lead to hematomas - Mom would usually have an episiotomy so we can make space

Answer 218

Where amniotic fluid enters the mom's blood stream and gets carried into the lungs, basically it becomes a blood clot

Answer 219

- Circulatory failure - Respiratory failure - DIC can occur due to the amniotic fluid interferring with clotting

Answer 220

- Acute drop in BP - Cardiac arrest - Cough - Chest pain - Think about PE symptoms

Answer 221

We treat it like a code - CPR - Oxygen with ventilation - Fluid volume expansion - Vasopressors - Packed cells - FFP - Fibrinogen

Answer 222

Uterine tilt, so she's not completely on her back

Answer 223

When we let a woman who had a previous c-section try to have a vaginal birth with her next child, because the reason she had a c-section may not necessarily happen again, like say her previous baby was a breach, so that's why they had a do a c-section, well that doesn't mean her next baby is going to be breach, so try and do a vaginal birth (her body was still able to physically have a baby, it's just that the baby was upside, or maybe she had a cord prolapse)

Answer 224

- Needing a c-section anyways - Uterine rupture due to the previous incision site

Answer 225

- Hx of only one previous low-transverse c-section - Adequate pelvis in relation to fetal size - No other uterine scars, anomalies or previous ruptures - Physician is always available throughout active labor

Answer 226

- Have them on high-risk - Continuous fetal monitoring - Plan as if they're going to have a c-section (have consents signed, have hair clipped and removed from area)

Answer 227

An actual rupture of the uterine muscle

Answer 228

- Concerned about BLEEDING - Hypovolemic shock for mom - Poor fetal perfusion for baby

Answer 229

- Sudden, sharp abdominal pain with a contraction (may stop when contraction stops) - When you palpate mom's abdomen you might be able to feel fetal parts - Sudden drop in fetal HR (bradycardia) - Might have loss of strong contractions - Might have loss of station (think about it - if you have that rupture of the uterine muscle, the baby might just float back up to the abdominal cavity)

Answer 230

- EMERGENCY - STAT C-section - Might have a hysterectomy if completely rupture (difficult to repair)

Answer 231

When twins are sharing a placenta, but one twin isn't getting as much perfusion/fluid as the other twin, and the other twin is getting too much perfusion/fluid

Answer 232

The baby that is getting too much fluid can be at an increased risk of HF

Answer 233

Use a doppler to see if the perfusion/fluid is being evenly distributed between the twins

Answer 234

- Pre-term labor (due to the increase in pressure) - Preeclampsia - Gestational diabetes - Placental masks - Hyperemesis - Placenta previa (if more than one placenta) - Abnormal presentation - Cord prolapse

Answer 235

We want to be checking for all of the baby's HRs at the same time (don't do one at a time, because you wouldn't be able to determine which HR belongs to which baby)

Answer 236

C-section (too difficult to deliver all of the baby's vaginally without complications)

Answer 237

We want to encourage them to get an epidural, just to help with the pain in case we need to have extra assistance (like forceps or a vacuum, etc) during the delivery, since they will be doing double the work, or if we need to end up having a c-section

Answer 238

Vaginally - usually 15 minutes apart C-section - usually 1 minute apart

Answer 239

We like them to deliver in the OR, just in case

Answer 240

Post-partem hemorrhage, they are at an increased risk as their uterine muscle was stretched larger, so we may have difficulty getting it to clamp down

Answer 241

Quantitative blood loss (QBL) is 1000 mL

Answer 242

Within the first 24hrs after delivery

Answer 243

after that 24hrs and up to 12 weeks

Answer 244

1. Tone (most common issue) 2. Trauma 3. Tissue 4. Thrombin (very rare) (see the table on pg 420)

Answer 245

- Drills - PPH Kit - Admission record - showing religious or cultural considerations (want to know if they will accept blood products if needed) - If they have a hx of PPH it gives them a 10% risk of having it happen again (so make sure everything is ready to go) - Everyone gets a CBC and type and screen on admission

Answer 246

If she had a previous PPH with her other pregnancies

Answer 247

- Address the cause (ie tone - give fundal massage) - Make sure you do frequent fundal massages after delivery (midline at the umbilicus, or a finger or two above or below) - Assess lochia every time we do a fundal massage (how much blood is coming out) - Maternal VS (not going to show us early changes, because women have things that buffer signs and symptoms of blood loss initially due to the pregnancy) (fyi - baby's HR, then mom's HR, then mom's BP will be signs of hemorrhage in this order) - Quantitative blood loss - make sure we measure everything (1gram = 1 mL)

Answer 248

- Overdistended or exhausted uterus (LGA babies, polyhydramnios, multiples, multify (+5 babies) (uterus is soo stretched it has difficult getting back to original size) - Infection (infected uterus isn't going to contract effectively) - Anatomical/functional issues (full bladder - fundus will be off to the side if bladder is full, Pitocin over a long period of time, if we give more Pitocin it isn't going to do anything)

Answer 249

- #1 start vigorous fundal massage - Bi-manual exam (provider does this) - Empty bladder if we need to

Answer 250

- #1 Pitocin (usually already hanging and ready to go as it is standard to give to everyone after delivery, if PPH starts, will probably need to titrate up) - Then give Misprostol (Ctyotec) (Can we given rectally) - Methylergonovine maleate (Methergine) (Give IM) - Prostaglandins (Hemabate) (Give IM)

Answer 251

If they have hypertension (because it causes hypertension)

Answer 252

Awful diarrhea (makes it difficult to measure blood loss)

Answer 253

Tranexamic acid - helps prevent breakdown of clots

Answer 254

Balloon that is inserted into the uterus, and is filled with 500-1,0000 MLs of saline, this helps put manual pressure where the placenta was attached to help clots form

Answer 255

It was be hard, above the umbilicus (don't want to disturb it, because we don't want it to rupture)

Answer 256

- Lacerations (we will see a red trickle stream of blood) - Hematomas - Uterine inversion

Answer 257

Very, very painful where the hematoma is forming

Answer 258

We might drain it or we might let is reabsorb overtime

Answer 259

- Providers may put too much pressure on the cord when trying to get the placenta out - this can cause the uterus to go inside down and invert - If we don't put our hand below the uterus when doing a fundal massage we could invert it

Answer 260

- Manually reducing the uterus (putting it back in the right spot - might need anesthesia for this) - Tocolytics - Terbutaline - Fluid bolus if issue with volume - Possible transfusion

Answer 261

Infection because you have the uterus coming out of the body

Answer 262

- Retained products (like little membranes, pieces of placenta (this is why we check the placenta after birth to see it it's still in tack) - Abnormal placentation

Answer 263

placenta accreta (where the placenta has grown into the uterine wall)

Answer 264

Anaphylactoid Syndrome (amniotic fluid embolism)

Answer 265

- Assess vital signs, uterine position and uterine bleeding every 5min x for the first 15min, then every 15 minutes for the first hour, then Q30min x 2, then Q1 x4 - Promote breastfeeding (helps stimulate contractions to prevent hemorrhage)

Answer 266

Late - a change in mom's VS are late signs of PPHs

Answer 267

- #1 cause is retained products - Uterine infection (causes an increase risk of bleeding - want to teach mom to be clean down there and good peri care so we can reduce risk of infection) - Coag defects like Von Willebrand

Answer 268

If hemoglobin is less an 7 or they're symptomatic of blood loss

Answer 269

Infection of the uterus (it's like chorioamnionitis, but now the membranes are gone because the baby has been delivered)

Answer 270

- *Pelvic pain - Increase in lochia - Foul smelling lochia - Fever - Increased HR

Answer 271

- *Unilateral symptoms and more localized - Going to be a red, hard wedge shape towards the armpits - Breast tenderness - Pain/burning with or without breastfeeding - Malaise - Temp

Answer 272

- Oral abx - Continue to breastfeed - Apply hot packs if needed

Answer 273

A woman may think that they have mastitis when their milk comes in because when your milk comes in it can cause tenderness and warmth, but this occurs in both breasts (bilaterally), whereas mastitis symptoms happen in only one breast (unilateral)

Answer 274

Primagravida History of depression Medical complications Immaturity and/or low self-esteem Dysfunctional personal relationship Financial concerns Chronic stress Infant with illness or anomalies Isolation/lack of support Uncertainty about the pregnancy that lasts beyond the first trimester

Answer 275

With the baby blues, symptoms will disappear without medication tx, they usually occur within the first 2 weeks of postpartum, and mom is still able to safely handle the baby. With PPD, symptoms require medical tx, they usually occur within the first 12 months, and they are unable to safely care for the baby.

Answer 276

- Fatigue - Anxiety - Tearfulness - Mood swings (a lot has to do with changes in hormones) (mom is still able to care for themselves and baby)

Answer 277

No, that's not normal

Answer 278

- Depression - Apathy (not caring) (big red flag - not caring about the baby) - Anxiety - Panic attacks - Fatigue - Significant weight loss or gain - Insomnia or hypersomnia - Feelings of worthless or guilt - Decreased ability to concentrate - Inability to make decisions (fyi - these s/s need to last longer than 2 weeks)

Answer 279

We want to teach the SO, because usually pts with PPD do not identify themselves, so we want the SO to watch for signs and symptoms

Answer 280

- SSRIs (Paroxetine, Fluoxetin, Setraline) - Complimentary therapies - Lots of support

Answer 281

Yes - she has a 50-90% chance of having PPD again with any future pregnancies Provider might preemptively start her on SSRIs

Answer 282

It can lead to PP Psychosis (this is where women try to kill the baby and go crazy)

Answer 283

- Paranoia - Gradiose, bizarre delusions (usually about the baby) - Mood swings - Confused thinking - Anxiety - Panic (very dramatic changes from normal)

Answer 284

- First peak in first 10 days - Second peak in 6-8

Answer 285

As a true emergency, because these are usually the moms that kill their babies - They'll go on long-term psychotherapy and medication

Answer 286

All women are screened between 35-37 weeks

Answer 287

Ampicillin/Clindamycin Give within 4 hours of delivery Doesn't cure it - only working during labor and then the GBS will eventually grow back

Answer 288

Typically caused by ascending polymicrobial infection after membranes have been ruptured Prolonged ROM Prolonged labor Nulliparity Internal monitoring Multiple VE (vaginal exams) Meconium-stained amniotic fluid Smoking Drug or alcohol abuse Immune compromised Bacterial vaginosis Group Beta Strep colonization STDs

Answer 289

Can cause the uterus to not function correctly, leading to dysfunctional contractions during delivery and after - which increases risk for PPH

Answer 290

- Preterm delivery - Prolonged labor - ROM greater than 18 hours - Maternal fever - *Chorioamnionitis (infection of the uterus and amniotic sac) - *Maternal GBS

Answer 291

They may be asymptomatic at first

Answer 292

We see behavioral changes in the baby

Answer 293

First s/s can be very subtle (why we like to have the same nurses assigned to them so we can notice the changes) - May be hyper or hypothermic - Lethargic - Hypoglycemic - Poor feeding

Answer 294

- High pitched cry - Low temp - Decreased tone - Poor feeding

Answer 295

- CBC - C-reactive protein (CRP) - Platelets - Blood culture

Answer 296

- Start on ampicillin and Gentamycin until cultures come back after 48hrs (broad spectrum and to narrow once cultures come back)

Answer 297

If mom is Rh- and if baby is Rh+

Answer 298

RhoGAM at 28 weeks even though we don't know if baby is Rh+, and not she may receive it again within 72hrs after delivery and after we test baby, if baby is actually Rh+

Answer 299

If an Rh- mom is exposed to an Rh+ baby, then antigens are created by baby and transferred into mom's bloodstream, where the first child is usually not affected, but the antigens can destroy fetal RBCs and cause anemia in the second child

Answer 300

If mom has type O blood, but has a fetus with A or B = mom's antibodies (anti A and anti B) will attack baby's RBCs

Answer 301

Tells us that there was a mixing of mom and baby's blood, because it detects antibodies that may not have been compatible and baby is at risk for hyperbilirubinemia (aka jaundice)

Answer 302

- Frequent feedings, because bilirubin is excreted in the stool, so we want frequent feedings to keep things moving through their digestive tract. - Might need bilirubin lights (helps breakup bilirubin)

Answer 303

Infant of diabetic mothers

Answer 304

- Hypothermia (don't have reserve adipose tissue and brown fat) - Hypoglycemia - Infection - Hyperbilirubinemia

Answer 305

- Hypoglycemia - Nutritional deficits (low mag and calcium levels and low glucose) - Hyperbilirubinemia - Transient tachypneic (respiratory distress) of newborn due to surfactant production (too much insulin when in utero can decrease surfactant production)

Answer 306

- Infection - Previous preterm labor hx - Multiples - Polyhydramnios - Preeclampsia - Gestational diabetes

Answer 307

- FFN (the diva test) - Cervical length - UA

Answer 308

- Tocolytics (these stop contractions) (mag sulfate, Nifendine, another one, and Tubutaline (remember HR)) - Give betamethasone

Answer 309

- CNS depression - Relaxes uterus - Causes vasodilation (lowers BP)

Answer 310

- Decrease in RR - Decrease in Tone - Minimal variability on FHR monitor

Answer 311

- Hypoglycemia - Hypothermia - RDS (due to decrease surfactant) - Jaundice - IVH (intraventricular hemorrhage - trauma to head from vaginal birth)

Answer 312

- Increase RR >60 - Retractions - Cyanosis - Decreased breath sounds

Answer 313

- CPAP - Surfactant via ET

Answer 314

- Meconium aspiration - Dry, flaky skin (decrease in vernum) - Oligohydramnios with risk of cord compression - Still birth (due to placenta issues) - Dystocia's - Assisted births

Answer 315

- Try to induce at 41 weeks - Manage baby with frequent nonstress tests and biophysical profiles

Answer 316

- Post-term baby's - Baby is under stress or something traumatic

Answer 317

Yes MAS is pretty common, but it is very uncommon for it to actually cause any complications

Answer 318

If the baby has some kind of stress, like a moment of poor perfusion that causes them to poop and then they have a "shock moment" where they take a breath and then breathe in that meconium

Answer 319

- Suctioning if baby is not vigorous - Possible ventilation - Monitor for infection - Might need some surfactant - Might need prophylactic abxs - Have a team in the room ready in case something happens

Answer 320

Diffuse swelling is normal after delivery (cone head babys) - Cephlahematoma (collection of blood that doesn't cross the sutures - monitor head circumferance to make sure it doesn't grow, make sure there isn't a subdural hematoma, blood should just absorb back)

Answer 321

- Heroin - Methadone - Pain meds

Answer 322

- No neonatal visitis

Answer 323

Modified Finnegan Neonatal abstinence Score Sheet

Answer 324

- Excessive high pitch cry - Decreased sleep - Hyperactive moro reflex - Tremors - Sweating - INcreased temp - Elevated RR (everything is upwhen they're withdrawaing)

Answer 325

- Do a tox screen after they're born

Answer 326

- High-calorie formula - Small frequent feedings - Antidiarrhea - Meticulous I/Os - Wts - Skin care with barrier ointments - Breastfeeding if not CI - Morphine/methadone as needed - Collaborate with SS - Promote comfort - Tox screen

Answer 327

Risk factors: - Obesity - Family hx of diabetes - A lot of time no risk factors for pts Maternal risks for mom with diabetes: - DKA - Infections - Preeclampsia - C-section - Difficult delivery if baby is big - Increased risk of developing type 2 later on Neontal risk - Hypoglycemia - Macrosomia - IUGR when blood vessels on the placenta are damaged - Respiratory distress due to decrease in surfactant production - SHoulder dystocia (these baby's can have broader chests)

Answer 328

- Euglycemia

Answer 329

Folic acid

Answer 330

1st half: less insulin 2nd half: more insulin PP: less insulin

Answer 331

Widespread vasospasm and endothelial damage

Answer 332

- IUGR - Late decels once contractions start (not good placenta reserve)

Answer 333

- Headaches - Spots in vision - Upper right quadrant pain - Edema - Urinary output (kidney function) - Reflexes

Answer 334

- Delivery - Give mag for seizures - Calm, mellow, dark room - Bed rest, but can still use the bathroom

Answer 335

- Delivery - Give mag for seizures - Calm, mellow, dark room - Bed rest, but can still use the bathroom

Answer 336

With the baby blues, symptoms will disappear without medication tx, they usually occur within the first 2 weeks of postpartum, and mom is still able to safely handle the baby. With PPD, symptoms require medical tx, they usually occur within the first 12 months, and they are unable to safely care for the baby.

Test #4 Flashcards

(374 cards)