Essentials Ch 2 High Risk Pregnancy

Front 1

What's the easiest and simplest way to do fetal testing?

Back 1

count the number of fetal movements in 1 hour. If fetal movements are less than three, decreased, or absent over 1 hour, addition testing is warranted.

Front 2

Explain a nonstress test

Back 2

requires the mother to identify when she feels fetal movements while being monitored with an external fetal monitor. Fetal HR should change in response to movement.

Front 3

How will a hypoxic fetus respond to the nonstress test?

Back 3

with late u-shaped heart rate decelerations between contractions.

Front 4

What is the combination of four to six of the following diagnostic tests: ultrasound, FHR, fetal breathing movements, gross body movement, fetal tone, FHR variability, and amniotic fluid volume.

Back 4

biophysical profile

Front 5

What is the most accurate test?

Back 5

biophysical profile

Front 6

_______ is an invasive procedure using sonography to guide placement of a needle into the uterus to obtain amniotic fluid for laboratory testing.

Back 6

Amniocentesis

Front 7

What are possible complications of amniocentesis?

Back 7

contractions, labor, and hemorrhage if the placenta was nicked.

Front 8

What's another name for oxytocin challenge test?

Back 8

contraction stress test

Front 9

What is the oxytocin challenge test?

Back 9

the use of the hormone oxytocin to induce uterine contractions. The FHR is monitored for decelerations during the contraction.

Front 10

What is the risk of the oxytocin challenge test?

Back 10

being unable to stop contractions.

Front 11

How long should a client stay at the facility after a oxytocin challenge test? and why?

Back 11

At least 30 minutes. To ensure that contractions have stopped.

Front 12

What are Sx of an ectopic pregnancy?

Back 12

amenorrhea of abdominal menses, pain, and some bleeding.

Front 13

What are Sx of a ruptured fallopian tube due to an ectopic pregnancy?

Back 13

sharp lower abdominal pain radiating to the shoulders.

Front 14

What's another name for a molar pregnancy?

Back 14

gestational trophoblastic tumor or hydatidiform mole

Front 15

What causes a molar pregnancy?

Back 15

related to abnormal chromosomes, folic acid deficiency, or hormonal imbalance.

Front 16

What are the Sx of a molar pregnancy?

Back 16

high HCG level, bleeding, hyperemesis, no fetal heart tones, palpable ovaries, and abdominal pain.

Front 17

What is the treatment option for a molar pregnancy?

Back 17

D and C. to remove diseased products and involved tissue

Front 18

Frequent monitoring of the client's ___ levels for (how long) following molar pregnancy is necessary?

Back 18

HCG - 1 year

Front 19

Abortion resulting from fetal flaws occurs during _ to _ weeks gestation and usually is related to what?

Back 19

6 - 10 weeks.
Usually related to improper implantation of the fetal sac to the uterine wall, leading to an inability of the fetus to grow and survive.

Front 20

Spontaneous abortion at approx. 14 weeks is thought to be associated with what?

Back 20

defective implantation of the placenta into the uterine wall, separation of the placenta from the uterine wall, or an error of hormone production by the placenta.

Front 21

What is cervical incompetence?

Back 21

when the cervix prematurely dilates, with rupture of the membranes and premature loss of the products of conception.

Front 22

What are Sx of spontaneous abortion?

Back 22

painless contractions, bleeding, cervical dilation, and rupture of membranes prior to expulsion of the fetus.

Front 23

What can be done to prevent cervical incompetence if it is dx before it happens?

Back 23

cerclage procedure - cervical closure with a suture.

Front 24

Many women experience nausea and vomiting in the ____ trimester of pregnancy?

Back 24

First.

Front 25

Explain hyperemesis gravidarum...

Back 25

severe vomiting causing altered nutritional status, dehydration, electrolyte imbalance, weight loss, ketoacidosis, and acetonuria.

Front 26

A ________ ________ is when the fetus is expelled completely; no products of conception remain in the uterus.

Back 26

complete abortion

Front 27

What is an incomplete abortion?

Back 27

it is the partial expulsion of the uterine contents

Front 28

A _________ ________ is when fetal products remain in the uterus and are not expelled.

Back 28

missed abortion

Front 29

What is a threatened abortion?

Back 29

term used when any bloody discharge occurs during the pregnancy, because the fetus may or may not be expelled.

Front 30

An ______ ______ is when amniotic membranes rupture and cervical dilation begins.

Back 30

inevitable abortion

Front 31

What is a septic abortion?

Back 31

associated with an infectious process resulting from a break in the sterile environment during a procedure.

Front 32

Hyperemesis gravidarum is more prevalent in caucasians or african americans?

Back 32

caucasians

Front 33

What are Sx of hyperemesis gravidarum?

Back 33

severe nausea and vomiting, coffee-ground emesis of undigested food.

Front 34

Pregnancy enduced hypertension is elevation of maternal blood pressure after the __th week of gestation.

Back 34

20th

Front 35

What is the leading cause of maternal death?

Back 35

PIH - pregnancy induced hypertension

Front 36

If PIH is left untreated, what can it lead to?

Back 36

stroked, cardiac decompensation, renal failure, and possibly maternal death.

Front 37

Incidence of PIH is increased with who?

Back 37

adolescent pregnancy, pregnancy after age 35, nulliparity, multiple gestation, history of vascular disease, low socioeconomic status, increased body mass index, abnormal placenta, and molar gestation.

Front 38

What is preeclampsia?

Back 38

PIH with proteinuria, characterized by a sudden increase in BP.

Front 39

What is an aftermath of preeclampsia that involved seizures of the central nervous system?

Back 39

eclampsia

Front 40

What are complications of both preeclampsia and eclampsia?

Back 40

abnormal liver enzymes
thrombocytopenia
HELLP (hemolysis, elevated liver function, low platelets)
fetal and maternal death

Front 41

How is PIH diagnosed?

Back 41

Solely on raise in BP only.

Front 42

What is classified as mild PIH?

Back 42

140/90

Front 43

What is classified as severe PIH?

Back 43

160/110

Front 44

Sx of PIH - beyond high bp

Back 44

headaches, oliguria, blurred vision (due to possible IICP), heartburn, increased irritability, and emotional tension. Edema of the face and hands, pitting edema of the legs and feet, and hyperreflexia of the deep tendons.

Front 45

Tx for PIH?

Back 45

bed rest, antihypertensive meds, hospitalization for IV magnesium sulfate to gain control of the BP.

Front 46

If PIH is not controlled, what can it lead to?

Back 46

multiorgan system failure and convulsions.

Front 47

What is needed in the room with someone who has PIH?

Back 47

toxemia tray with preparations for a cesarean section and emergency resuscitation.

Front 48

What can diabetes mellitus lead to if untreated?

Back 48

infertility and polycystic ovarian syndrome.

Front 49

Why are women with diabetes type 1 at an increased risk during pregnancy?

Back 49

because of the lack of endogenous insulin production

Front 50

What is gestational diabetes?

Back 50

diabetes occurring in a woman for the first time during pregnancy. Usually develops during the 2nd trimester as a result of metabolic changed associated with the growing fetus and placental production of hormones, which increase insulin resistance.

Front 51

What is OGTT?

Back 51

Oral glucose tolerance test

Front 52

Explain what oral glucose tolerance test is.

Back 52

used to identify gestational diabetes in any woman older than 25 years between 24 and 28 weeks gestation.

Front 53

What pain relief procedure is recommended for a pregnant woman with a cardiac condition?

Back 53

epidural - to conserve energy and decrease the workload on the heart.

Front 54

What classification? - Patients have cardiac disease but without the resulting limitations of physical activity. ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain.

Back 54

1

Front 55

What classification? Patients have cardiac disease resulting in slight limitation of physical activity. they are comfortable at rest. ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.

Back 55

2

Front 56

What classification? Patients have cardiac disease resulting in marked limitation of physical activity. they are comfortable at rest. less than ordinary physical activity causes fatigue, palpitation, dispnea, or anginal pain.

Back 56

3

Front 57

What classification? Patients have cardiac disease resulting in inability to carry on any physical activity without discomfort. Sx of cardiac insufficiency or of the anginal syndrome may be present even at rest. if any physical activity is undertaken, discomfort is increased.

Back 57

4

Front 58

Drugs, alcohol, and tobacco can lead to what with pregnancy?

Back 58

low birth weight, growth and mental retardation, or malformations.

Front 59

What are the signs of substance abuse in pregnant woman?

Back 59

fatigue, erratic appetite, missed appointments or starting prenatal care late in pregnancy, a history of frequent miscarriages or stillbirths, previous abruptio placenta, and sign and symptoms of intoxication.

Front 60

What maternal complications are there from substance abuse?

Back 60

anemia, hypertension, premature rupture of membranes, placental problems, hemorrhage, STI's, nutritional deficits, and low self esteem.

Front 61

_______ ________ is a potentially life threatening condition occuring in the third trimester. The placenta is implanted and covers the cervix totally, partially, or marginally.

Back 61

placenta previa

Front 62

What are the risk factors of placenta previa?

Back 62

previous history, uterine scars or anomalies, short time intervals between pregnancies, smoking, and multiple gestations.

Front 63

What are the symptoms of placenta previa?

Back 63

painless vaginal bleeding at least once
shock
coagulopathy
uterine rupture

Front 64

What trimester(s) is placenta previa usually diagnosed?

Back 64

2nd or 3rd.
most common in 3rd

Front 65

What should the client diagnosed with placenta previa refrain from doing?

Back 65

fucking
limit activity

Front 66

What procedure is usually always done with a pregnant woman with placenta previa?

Back 66

C section at around the 37th week gestation

Front 67

T/F - A doctor can do a vaginal examination on a woman diagnosed with placenta previa.

Back 67

false - that shit will cause a hemorrhage

Front 68

What is placenta accreta?

Back 68

when the decidual formation (lining of the uterus during pregnancy) is defective, with the placenta attached firmly to the wall over a uterine scar or the lower segment.

Front 69

What are the treatments for someone with placenta accreta?

Back 69

maintenance of maternal blood volume
provision of oxygen to the fetus until an emergency Csection can be performed.

Front 70

What is abruptio placenta?

Back 70

it is premature separation of the placenta prior to delivery, causing hemorrhage into the deciduas basalis (the part of the decidua that helps to form the placenta) and forming a hematoma.

Front 71

What are the risk factors of abruptio placenta?

Back 71

PIH, smoking, multigravida, illicit drug use, chronic renal disease, and abdominal trauma.

Front 72

What are the Sx of abruptio placenta?

Back 72

blood loss, an enlarging uterus, and a firm, painful abdomen with or without contractions.

Front 73

What is considered a marginal abruptio placenta?

Back 73

slow gradual bleed

Front 74

What is considered a moderate abruptio placenta?

Back 74

approximately 50% separated.

Front 75

What is considered severe abruptio placenta?

Back 75

70% separation or more, which causes severe pain and rapid progression to maternal shock and fetal death.

Front 76

_________ is abnormal amniotic fluid (2L between 32 and 36 wee and weeks gestation)

Back 76

Polyhydraminos

Front 77

Polyhydraminos causes a risk for ________ delivery and prolapsed cord is increased.

Back 77

preterm

Front 78

Who is polyhydramnios more common with?

Back 78

Rh sensitized pregnancies
IDDM
defective fluid transfer mechanism
fetal gastrointestinal obstructions

Front 79

Fungal infections such as candidiasis are more common when and why?

Back 79

3rd trimester because hormone production increases.

Front 80

Can the mother get an immunization during pregnancy?

Back 80

not recommended.

Front 81

What is a situation when a mother should get an immunization while pregnant?

Back 81

When the fetus or herself is exposed to a preventable disease, because the disease will cause more harm than the immunization.

Front 82

_________ twins result when one egg is fertilized by one sperm and the initial cells divide into two separate beings.

Back 82

monozygotic

Front 83

________ twins result when two separate ova are fertilized by two separate sperm.

Back 83

dizygotic

Front 84

What is it called when one twin grows larger while the other is lacking in size?

Back 84

twin-to-twin transfusion syndrome.

Front 85

What does PROM stand for?

Back 85

premature rupture of membranes

Front 86

What is premature rupture of membranes?

Back 86

the spontaneous rupture of the membranes before labor begins in pregnancies over 20 weeks gestation.

Front 87

When does labor usually begin after PROM?

Back 87

within 24 hours

Front 88

What is thought to be associated with malpresentation?

Back 88

PROM

Front 89

What should you monitor for after PROM, and how often?

Back 89

S/Sx of infection at least every 4 hours

Front 90

What are some causes for preterm labor?

Back 90

PROM, uterine anomalies, PIH, multiple gestation, polyhydramnios, maternal age younger than 16 or older than 40, smoking, substance abuse, trauma, previous history, low socioeconomic status, placenta abruptio and previa, incompetent cervix, abdominal surgery, infectious process, and fetal death.

Front 91

What drugs are effective in stopping labor for 48-72 hours, allowing delivery of _________ in an effort to enhance fetal lung maturity.

Back 91

Tocolytics
glucocorticoids

Front 92

What is a complete uterine rupture?

Back 92

a laceration directly into the peritoneal cavity

Front 93

what is a incomplete uterine rupture?

Back 93

a laceration separated by the visceral peritoneum.

Front 94

What is a uterine scar dehiscence uterine rupture?

Back 94

when a previous scar begins to separate

Front 95

What are possible causes of a uterine rupture?

Back 95

prolonged labor, multiple gestation, malpresentation, oxytocin induction, obstruction, previous cesarean section, uterine abnormalities, or traumatic use of forceps or traction could cause a rupture.

Front 96

You should be alert for what sx of a uterine rupture?

Back 96

presence of retraction rings

Front 97

what is Bandl's ring? And what condition does it have to do with?

Back 97

a visible line between the upper and lower uterine segments
ruptured uterus symptom

Front 98

What should you prepare for as soon as you realize a ruptured uterus is occurring?

Back 98

emergency c section fo sho!

Front 99

What does Dystocia mean?

Back 99

dysfunctional (long, difficult, and abnormal) labor resulting from maternal or fetal factors.

Front 100

What is maternal dystocia?

Back 100

results from ineffective uterine contractions, alterations in the pelvic structure or maternal position during labor, or psychologic responses during labor based on past experiences, culture, preparation, or support person.

Front 101

what is fetal dystocia?

Back 101

based on abnormal presentation or position, multiple fetuses, or fetus size.

Front 102

What are some other causes of dystocia, besides maternal and fetal.

Back 102

small maternal pelvis, fatigue, dehydration, fear of a long labor, too early or too much analgesic administration, and uterine abnormalities.

Front 103

With someone who has dystocia, how often should you perform assessments? What should you monitor?

Back 103

at least every 30 minutes, monitor I&O

Front 104

A prolapsed cord is more common in what circumstances...?

Back 104

premature fetus, hydramnios, multiple gestation, placenta previa, malpresentation, PROM, and conditions that prevent the fetal head from engaging into the pelvis.

Front 105

When the FHR decelerates, what is typically suspected?

Back 105

prolapsed cord, because cord compression causes hypoxia.

Front 106

What position do you put the client in when a prolapsed cord is present, to relieve pressure until you cut that shit open and take the baby out?

Back 106

knee chest or trendelenburg position. and administer oxygen.

Front 107

How often do you do vitals on the fetus when a prolapsed cord is fucking shit up?

Back 107

continuous monitoring until csection.

Front 108

What is a nuchal cord?

Back 108

when the cord is looped around the newborn's neck.

Front 109

When are post term pregnancies induced?

Back 109

beyond 42 weeks.

Front 110

What is the treatment for a hematoma?

Back 110

ice for the first 24 hours followed by warm, moist heat.

Front 111

During the birthing process what is the maximum blood loss to be considered normal for vaginal birth?

Back 111

500ml

Front 112

during a csection what is the maximum blood loss that is considered normal?

Back 112

1200ml freak a bitch out!

Front 113

What time holds the greatest period of hemorrhage?

Back 113

first hour post plop

Front 114

Where are the most common sites of puerperal infection?

Back 114

reproductive system
urinary tract
bewbies

Front 115

what's the first sx of a puerperal infection, when does it happen, and how long does it last?

Back 115

first is increased temperature within 10 days of delivery lasting 24 hours, with chills and headache.

Front 116

What Dx tests are used to identify a puerperal infection?

Back 116

culture and sensitivity of lochia, cesarean incision, and vaginal tissue; WBC cound, and sedimentation rate.

Front 117

What is thrombophlebitis?

Back 117

an infection in a vessel lining with a clot attached

Front 118

Where is the most common site for thrombophlebitis?

Back 118

veins in the legs or pelvis

Front 119

When does thrombophlebitis occur in regards to pregnancy?

Back 119

usually between 10 and 20 days postpartum

Front 120

Clients with thrombophlebitis are at risk for what?

Back 120

pulmonary embolism

Front 121

Superficial thrombophlebitis is thought to be a result from what?

Back 121

lithotomy position

Front 122

What can a patient do to help prevent thrombophlebitis after giving birth?

Back 122

ambulate mother fucker! Ambulate!

Front 123

What is the treatment for thrombophebitis after you already have it?

Back 123

strict bed rest, anti-coagulation therapy, and antibiotics if ordered.

Front 124

What should you monitor for in someone with thrombophlebitis?

Back 124

edema of the leg or groin, stiffness, chills, and pain (a positive homan's sign) - and vitals every 4 hours - check coagulation studies and measurements of the leg, assess the lungs and mental status.

Front 125

If a woman feels overwhelmed, and is crying, complaining of headache, insomnia, fatigue, depression, and anger, she may be experiencing what?

Back 125

postpartum blues aka postpartum depression

Front 126

If someone has postpartum blues, when does it happen, and how long does it usually last?

Back 126

begins immediately after birth and goes away within a few days.