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Maternal OB > week 3 & 4 > Flashcards

week 3 & 4 Flashcards

1
Q

a nurse is caring for a client who is at 32 weeks gestation and has placenta a previa. the nurse notes that the client is actively bleeding. which of the following medications should the nurse expect the provider to prescribe?

  1. Betamethasone
  2. Indomethacin
  3. Nifeidipine
  4. Methylergonovine
A
  1. Betamethasone
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2
Q

a nurse is caring for a cliet who is suspected of having hyperemesis gravidarum and is reviewing the client’s lab reports. which of the following findings is a manifestation?
1. hgb 12.2
2. urine ketones present
3. alanine aminotransferase 20
4. blood glucose 114

A
  1. urine ketones present
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3
Q

antidotes for magnesium sulfate

A

calcium gluconate
calcium chloride

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4
Q

pyridoxine

A

vitamin B6 supplement prescribed to clients with hyperemesis gravidarum

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5
Q

spontaneous abortion

A

pregnancy ends as a result of natural causes BEFORE 20 WEEKS of gestation

4 types = threatened, inevitable, incomplete, and missed

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6
Q

threatened spontaneous abortion symptoms

A

mild cramps
slight spotting
no tissue passed
closed cervix

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7
Q

inevitable spontaneous abortion symptoms

A

mild/moderate cramps
moderate bleeding
no tissue passed
DILATED CERVIX

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8
Q

Incomplete spontaneous abortion symptoms

A

SEVERE cramps
HEAVY bleeding
YES - tissue passed
DILATED w tissue present

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9
Q

complete spontaneous abortion symptoms

A

mild cramps
minimal bleeding
tissue passed
CLOSED CERVIX

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10
Q

dilation & currettage (D&C)
vs
dilation & evacuation (D&E)

A

D&C = dilate & scrape uterine walls

D&E = dilate & excavate AFTER 16 WEEKS

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11
Q

prostaglandins & oxytocin

A

induce uterine contractions & expulse products

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12
Q

interventions with bleeding during pregnancy

A

count pads
NO VAGINAL EXAMS
bed rest

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13
Q

education about spontaneous abortions

A

small amount of discharge is normal for 1-2 weeks

no bath tubs, or sex for 2 weeks

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14
Q

ectopic pregancies usually occur in

A

fallopian tubes

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15
Q

s/s of ectopic pregnancy

A

referred shoulder pain

unilateral quadrant pain in lower abdomen

dark red/brown spotting after normal menses

hemorrhage /shock

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16
Q

methotrexate

A

chemo drug that inhibits cell division and embryo enlargement

**ectopic pregnancies
avoid folic acid vitamins

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17
Q

lab test w ectopic pregnancies

A

indicate lower than normal HcG levels

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18
Q

salpingostomy
vs
laproscopic salpingectomy

A

salp = salvages fallopian tube

lap = removal of fallopian tube

*ectopic pregnancies

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19
Q

gestational trophoblastic disease

A
  • Hydatidiform Mole*
    fluid filled grapelike clusters formed from the placenta associated w cancer (choriocarcinoma)

2 types = complete mole & partial mole

patient MUST follow up

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20
Q

complete hydatidiform mole

A

all genetic material is derived from father

ovum w/o genetics, fetus, placenta, fluid
higher risk for cancer

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21
Q

partial hydatidiform mole

A

genetic material from both parents

ovum fertilized w abnormal embro/fetal parts

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22
Q

s/s of hydatidiform mole

A

hyperemesis gravidarum
PRUNE JUICE blood
uterus LARGER than gestational age
preeclampsia
anemia

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23
Q

labs of a hydatidiform mole will indicate

A

abnormally high HcG

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24
Q

placenta previa

A

implantation of placenta in lower uterus or cervix instead of fundus
*bleeding risk
**diagnosed by ultrasound

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25
s/s of placenta previa
PAINLESS vaginal bleeding (2/3 tri) fundal height > gestational age fetus not in position uterus is soft and nontender decreased urine output
26
nursing interventions for placenta previa
no vaginal exams bed rest WEIGH PERI PADS treated with betamethasone (helps w fetal lung maturity)
27
abruptio placentae
separations of placenta before fetus is born AFTER 20 WEEKS **emergency -- prepare for delivery **increased bleeding, DIC, mortality
28
s/s of abruptio placentae
INTENSE uterine pain DARK red vaginal bleeding fetal distress contractions w hypertonicity
29
risk factors for abruptio placentae
maternal HTN cocaine & smoking trauma to abdomen multi-fetal pregnancies
30
cervical insufficiency & s/s
**premature dilation of cervix BEFORE 36-37 wks pelvic urge to push pink vaginal discharge rupture of membranes contractions
31
interventions for cervical insufficiency
increase hydration avoid intercourse prophylactic cerclage =surgical closure of cervix @ 12-14wks removed at 37/38wks
32
hyperemesis gravidarum
excessive nausea / vomiting PAST 16 WEEKS
33
urinalysis for hyperemesis gravidarum will show
ketones/ acetones (ahh-kalosis) increased urine specific gravity (dehydration)
34
meds for hyperemesis gravidarum
metoclopromide (anti-emetic) IV LR corticosteroid pyridoxine (vit b6)
35
a Hgb less than 11mg is an indication of
anemia in 1st & 3rd pregnancy trimester
36
a hgb les than 10.5mg is an indication of
anemia in 2nd trimester
37
s/s of hypoglycemia
blurred vision weakness irritability headache hunger
38
s/s of hyperglycemia
poly's nausea fruity breath abdominal pain
39
glucose tolerance tests occur when
24 to 28 weeks starts w 1 hour test **abnormal if greater than 140 follows w 3 hr test
40
gestational hypertension
occurs AFTER 20 WEEKS gestation w bp of 140/90 on 2 occasions 4 hours apart *NO PROTEINS PRESENT* *normalized after 12 wks post-partum IF NOT = normal chronic HTN
41
preeclampsia
HTN of 140/90 WITH proteinuria greater than or equal to 1-- AFTER 20 WKS GESTATION
42
s/s of preeclampsia
blurred vision transient headaches possible edema
43
severe preeclampsia
bp greater than 160/110 w/ proteinuria greater than or equal to 3+
44
s/s of severe preeclampsia
RUQ pain hyperreflexia epigastric pain visual disturbances blood creatinine > 1.1
45
preeclampsia is treated w
beta methasone magnesim sulfate (anti-convulsant)
46
eclampsia
preeclampsia with ONSET OF SEIZURE / COMA * emergency
47
HELLP Syndrome
HTN w severe preeclampsia & hepatic dysfunction H = hemolysis = anemia & jaundice EL = elevated liver enzymes LP = low platelets < 100k
48
magnesium sulfate toxicity
absence of patellar deep tendon reflex decreased urine, resp, & LOC cardiac dysrhythmias
49
magnesium sulfate in pregnancy is used to
prevent seizures slow contractions
50
IV site w magnesium bolus is normal to experience
flushing heat & burning sedation diaphoresis
51
HTN meds for pregnancy
methyldopa hydralazine nifedipine labetalol *NO ACE or ARB's
52
Internal fetal monitoring methods & downsides
fetal scalp electrodes - fetal heart intrauterine pressure catheter -acurate *BOTH = require ruptured membranes and dilated cervix
53
periodic vs episodic
periodic = assoc w uterine contractions episodic = not associ w uterine contractions
54
nitrazine paper is used for
asessing amniotic fluid blue = amnio fluid is alkaline yellow = acidic urine
55
cervical changes that define labor
effacement & dilation
56
5 P's in childbirth
P = passenger (fetus & placenta) P = passageway P = power (contractions) p = position (mom) P = psychological response
57
toco measures
uterine activity and contraction patterns
58
passenger P consists of
1. Fetal Presentation -- what part is entering pelvis (head, breech, shoulder) 2. Fetal Lie - relationship of spine to mom = transverse (sideways) or parallel* 3. Fetal Attitude - relationship of fetus parts -- flexion* or extension 4. fetal position
59
Fetal Position is descirbed by
1. naming the side the baby is facing--right (R) or left (L) 2. presenting part of fetus = - occiput /head (O) - sacrum (S) - mentum (M) - scapula (Sc)
59
FIRST stage of labor
onset of labor to full dilation w/ - latent phase = 0 to 3cm - active phase = 4 to 7cm - transitional phase = 8 to 10 cm -- expressing need for bowel movement
60
second stage of labor
fully dilated cervix to birth of baby **assess for lacerations -- 4 degrees each indicative of # of areas injured
61
third stage of labor
from the birth of fetus to the birth of the placenta
62
fourth stage of labor
delivery of placenta to the first 2 hours after birth
63

Maternal OB (8 decks)

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