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Unit 2 Flashcards

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1
Q

What is labor dystopia

A

Long difficult or abnormal labor
Most common indication for c section
Can be attributed to any of the 5 Ps

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2
Q

What are some factors to the 5 Ps for dysfunctional labor pattern

A

Passenger—to big, breech, placental detrachment,
Passageway—narrow pelvis, bifurcated uterus
Powers—epidural not able to feel, tachystystole, fatigue
Position—not progressing related to moms position, prolapse, cord compression
Psychological- high anxiety, social dynamics

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3
Q

What are hypertonic uterine contractions

A

Frequent painful contractions
Ineffective in dilating cervix
May be treated with therapeutic rest

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4
Q

Hypotonic uterine contractions

A

Usually start with normal pattern and then contractions become weak and ineffective
Rule out CPD (cephalon pelvis disproportion)
Labor may be augmented

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5
Q

What is precipitate labor

A

Less than 3 hours
Can lead to both maternal and fetal complications

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6
Q

What are complications for obesity in pregnancy

A

More likely to develop hypertension disorders, gestational diabetes, VTE, post term pregnancy, c csections
Maternal body surface area can affect the response to oxytocin

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7
Q

What is the difference between induction of labor and augmentation of labor

A

Induction is stimulation of uterine contractions
Augmentation is stimulation of ineffective contractions

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8
Q

What is a bishop score that will be good to induce

A

6 or above

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9
Q

What are drugs to cervical ripen

A

Prepidil —oxytocin should be delayed 6-12hrs
—gel
Cervidil—oxytocin should be delayed 30-60 min
—vaginal insert should be removed 12 hrs
Cytotec (misoprostol) —oxytocin delay 4 hours
—contraindicated w uterine surgery

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10
Q

How much should we adjust oxytocin

A

Start slow-go slow
1 mu/min
Increase by 1 to 2 every 30-60

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11
Q

T/F 90% of pregnant women at term have successful inductions with 6mu/min or less

A

T

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12
Q

T/F maintain dose if contraction 2-3 min frequency, 80-90 seconds duration, strong intensity, resting tone of 5-15 mm

A

T

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13
Q

How often should u monitor FHR

A

15 minutes during 1st stage
5 minutes in 2nd stage
Assess BP, HR, and RR every 30-60 min

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14
Q

What factors put a mother and fetus at risk for chorioamnionitis in labor

A

Premature/prolonged rupture membrane
Multiple vaginal exams/internal monitoring
Pre-existing maternal infection
Meconium stool in utero

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15
Q

What do you need to do for external cephalic version

A

Ultrasound to locate umbilical cord, placenta, and adequate amniotic fluid
Metal monitoring to assure fetal well being
Pain mediation and tocolytic (to relax uterus)
Rhogam if indicated

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16
Q

What do you asses after forceps

A

After delivery, asses mother for vaginal and cervical lacerations, urine retention, and hematoma
Assess newborn for bruising and abrasions, facial palsy, and subdural hematoma

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17
Q

What do you need to document after vacuum

A

Number of pop offs

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18
Q

What are indicatations for cesarean birth

A

CPD
Malpresentations
Placental abnormalities
Fetal distress
Multiple fetuses
Active genital herpes
Other maternal medical conditions

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19
Q

Other than c sections, what indicates a possible uterine rupture

A

Uterine hyperstimulation or tachysystole
LGA, multiples, polyhydramnios
Birth trauma
Uterine abnormalities

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20
Q

What are signs and symptoms of uterine rupture

A

Fetal distress
Hypotonic or loss of contractions
Change in uterine shape
Pain present in complete rupture but may be absent in incomplete rupture
Hypovolemic shock

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21
Q

What are interventions for shoulder dystocia

A

Help is called
Episiotomy
Lift legs— McRoberts Maneuver (legs off of bed)
Pressure—suprapubic pressure

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22
Q

What is umbilical cord prolapse

A

Umbilical cord lies below presenting part

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23
Q

What are risk factors of umbilical cord prolapse

A

Multiples, olighyrdamnios, nucas cord (around neck), low placenta,

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24
Q

What are interventions for prolapse cord

A

Call for assistance
Knee/chest or Trendelenberg position (hips higher than head)
Lift presenting part off of cord

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25
What is pre term labor
Between 20 and 36 6/7 uterine contractions that cause progressive cervical change
26
What are risk factors of preterm labor
Previous preterm birth Ethnic group Genital tract infections Multifetal gestations Increased fetal fibronectin
27
What is fetal fibronectin
Glycoprotein produced in early and late pregnancy Usually not present between 24 and 36 weeks Generally post predictable of who will not go into preterm labor
28
What are the three diagnostic criteria of preterm labor
Gestational age 20-36 weeks Uterine activity occurring every 10 min or less Progressive cervical change or 2 cm dilation and or 80% effaced
29
What are contraindications for tocolytic therapy
Cardiac issues, diabetes, high BP
30
What are requirements for corticosteroids
Used between 24 and 34 weeks Estimated fetal weight of at least 1000grams
31
What are complications of PPROM
Increased risk for placental abruption Increase risk for malpresentation Pulmonary hypoplasia and skeletal deformities
32
What are nursing cares for PPROM
NST—stress test for baby Anticipatory tocolysis Avoid vaginal exams Temp q4
33
What are clinical manifestations
Before 6 weeks—heavy menstrual flow 6-12 weeks moderate discomfort After 12 weeks —severe pain
34
What are the different types of abortion
Spontaneous—natural causes before 20 weeks Threatened-spotting w closed cervix Inevitable—cervical dilation Incomplete—explosion of fetus wo placenta Complete—cervic is closed after expulsion Missed—fetus died but not miscarried yet Recurrent—3 or more spontaneous losses before 20 weeks
35
What are nursing care management for miscarriage
Pelvic rest Save tissues Report signs of infection, hemorrhage Medical management—prostaglandin medication Uterine evacuation Rhogam Emotional care
36
What is cervical incompetence
Passive and painless dilation of cervix
37
What is care management of an imcompetent cervix
Bedresk Hydration Medications Cerclage— suture is placed to constrict cervix
38
What are emergent signs that need to return to the hospital after cerclage
Contractions <5 minutes Vaginal bleeding Perineal pressure, urge to push Preterm premature rupture of membranes
39
Contractions <5 minutes Vaginal bleeding Perineal pressure, urge to push Preterm premature rupture of membranes
40
What are the surgical management for an ectopic pregnancy
Salpingostomy Preserve tubal function Removal of entire tube
41
What is the medical management for an ectopic pregnancy
Methotrexate Used for unruptured ectopic pregnancy IM injection Dissolve rapid dividing cells. May be infertile due to chemo drug High risk for infection
42
What is a molar pregnancy
Benign prolerative growth of the placental throb last. Develops into edematous, cystic, a vascular transparent vesicles. Grape like cluster
43
What is the difference between partial mole and complete most
Partial—chromosomes from both parents, embryonic or fetal parts on the aminiotic sac Complete—no fetus, just throphblasic tumor
44
What is the manifestations of molar pregnancy
Vaginal bleeding, elevated Hcg Anemia Excessive NV Abdominal cramping Early onset of pre
45
What is follow up after molar pregnancy
Weekly HCG levels and exams to rule out metastasis Don’t get pregnant for a year
46
What is placenta prevails
Low lying placenta that causes bleeding
47
What are manifestations of placenta previa
Painless, bright red vaginal bleeding DO NOT STIMULATE UTERUS
48
What is active management of placenta previa
Delivery should be accomplished as soon as fetal lungs are mature or if bleeding is excessive or continuous
49
What is placental abruption
Premature separation of the placenta Accounts for significant maternal and fetal morbidly
50
What are causes of placenta abruption
Maternal hypertension Cocaine use Trauma Cigarette smoking History of abruption PPROM
51
What are signs of placental abruption
Vaginal bleeding Abdominal pain Uterine tenderness
52
What are the uterine activity difference between placenta previa and placenta abruption
Previa—usually soft and non tender. Not associated with contractions Abruption—high or increasing resting tone, less relaxation between contractions. Some have board like abdomen
53
What are insulin considerations with pre gestational diabetes
1st trimester=insulin may need to be reduced in order to prevent hypoglycemia 2nd and 3rd trimesters- insulin need to be titrated upward to prevent hyperglycemia
54
What is positive result of one hour glucose test
130-140
55
What are some neonatal hypoglycemic symptoms
Jittery Apnea Tachypnea Cyanosis
56
What are complications of diabetes in pregnancy after birth
Respiratory distress syndrome Cardiomyopathy Hypothermia —if hypoglycemic, they are using energy to compensate
57
What is hyperemesis gravidarum
Excessive nausea and vomiting
58
What is maternal phenylketouria
Autosomal recessive Inborn error of metabolism that creates deficiency in enzyme phenylalanine hydroplane Connote metabolize amino acids found in all dietary protein Toxicity =inferfers with brain development and function
59
What are complications of PKU
Hypopigmentation Microcephaly Cognitive impairment Congenital heart defects Breastfeeding controversial
60
What are treatments of PKU
No high protein foods Monitor levels 1 to 2 times per week
61
What is convection
Flow of body heat from body surface to cooler ambient air
62
What is conduction
Loss of body heat to cooler surfaces in direct contact
63
What is radiation
Loss of body heat form non direct surface like concrete wall
64
What is evaporation
Heat loss when liquids evaporate
65
What is a regular temp for a baby
36.5 to 37.5
66
What is cephalhematoma
Does not cross the suture lines No decoration of overlying skin Resolves 2-8 weeks
67
What is caput succedaneum
Scalp edema Disappears 3-4 days after Vacuum extraction Increase bilirubin
68
What is ortolani’s maneuver
Hip pops
69
What is an example of brachial plexus injury
Era-duchenne palsy Facial paralysis
70
What is subarachnoid hemorrhage
Occurs in term infant as a result of trauma and in preterm infants as a result of hypoxia
71
Why is TORCH infections
Maternal infections using early pregnant known to cause congestive malformation and disorders Toxoplasmosis—hydrocephalus Other(syphilis, varicella, parvovirus, Hep B virus, and HIV) Rubella Cytomegalovirus Herpes
72
What are interventions if a mother has HIV
Avoid breastfeeding Start antiretroviral Plan a c section
73
What if a mother has bacterial infections
Penicillin 4 hours before brith prophylactically prophylactic protect after
74
What is pathologic jaundice
Juandice in first 24 hours Think hemolysis Requires immediate intervention
75
What are the three trimesters
1-12 13-26 27 to end
76
What is naegeles rule
- 3 months +7days
77
What are the maternal adaptions to pregnancy phase 1, 2, 3
1: accepts the biological fact of pregnancy 2: she accepts the growing fetus as distinct from herself 3: she prepares realiscally for birth and parenting
78
What is couvade syndrome
Paternal sympathetic symptoms
79
When should a pregnant women go to appointments
Every 4 weeks until 28th week Every 2 weeks until 36th week Every 1 week from 36th until delivery
80
What are you screening for during 11-14 weeks ultrasound
Down syndrome Edward’s Cardiac problems
81
When do you screen for GTT
24-28 week s
82
When do you screen for strep beta
24-28 week s 25-37 weeks
83
What do you give Rhogam
26-28 weeks
84
Wen should assessment happen PP
Every 15 minutes 1 hour PP Every 30 minutes 2 hours PP Every 4 hours 12-24 hours PP
85
What does BUBBLE HER VANE stand for
Breasts Uterus bladder Bowel Lochia Eposiotomy Humans —DVT Emotions Rest Vital sign Attachment Nutrition Eduction
86
T.F at risk for hypoglycemic PP
T
87
Total weight loss occurs 6-8 weeks PP
T
88
What are immunological considerations PP
Immune suppression from pregnancy gradually resolves Postpartum rebound may trigger flare ups of autoimmune disorders
89
What are some PP infection prevention
Hand.peritoneal hygiene Breast hygiene Facilitate complete bladder emptying Adherent aspectic techniques
90
T/F cardiovascular changes return pre pregnant state 6-12 weeks PP
T
91
What do educate for PP cardiac
Heart palpitations or racing heart Sudden or worsening swelling Chest pain or pressure Difficulty breathing 911
92
When does engorgement happen
72-96 hours PP
93
When does postpartum blues resolve
10-14 days due to hormone shifts
94
What is considerations of MMR
Do not get pregnant 1-3 months
95

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