Maternity Nrsg

Front 1

How to introduce solid foods

Back 1

- start at 4 to 6 months
- introduce 1 food at a time, per 2 week period
- introduce least allergenic foods first

usual order - cereal, fruits, veggies, potatoes, meat, eggs, OJ

Front 2

Menopause (what is it, and age it starts)

Back 2

- cessation of ova release, uterine lining & menstruation

age 45-55

Front 3

S/S of Menopause

Back 3

alterred thermoregulation (night sweats/ hotflashes)
vaginal atrophy
breast atrophy
dyspareunia (d/t decrease vaginal secretions)

Front 4

Dyspareunia

Back 4

Painful intercourse

Front 5

Fetal Anoxia

Back 5

one of the causes of mental retardation

insufficient oxygen during birth or pregnancy

ex. long, strenuous birth, or cord occlusion

Front 6

Mental Retardation NRSG

Back 6

- assist parents with adjustments
- provide sensory stimulation
- encourage socially acceptable behaviors
- provide emotional support
- facilitate optimal functioning

Front 7

Fetal Alcohol Syndrome (FAS)
s/s?

Back 7

- thin upper lip
- smooth philtrim (upper lip)
- short palprebral fissures (small eyes)
- Microcephaly (small head)
- Micrognathia (small jaw)
- short nose
- irritable/hyperactive childhood
- growth retardation
- Hearing disorders

Front 8

Fetal Alcohol Syndrome (FAS)
NRSG
(prevention, secondary)

Back 8

prevention - education - NO ETOH for 3 months before conception;
there is no safe level of ETOH

secondary - monitor infants weight gain;
promote nutritional intake;

Front 9

Fetal Alcohol Syndrome (FAS)
Pathophysiology

Back 9

ETOH consumption -->
Deforms baby's Corpus Collostrum (which connects the left and right hemispheres of the brain; largest white matter of the brain)-->
Difficulty problem solving (hard to connect information, or associate information to things that would normally be connected by our brain.. ex. go put the dirty dishes away.. In the sink. But a FAS wouldnt be able to make the connection)

Front 10

Down Syndrome
(what is it? common manifestations? risk factors?)

Back 10

Trisomy 21 (extra 21st chromosome)
mild to severe mental retardation;
marked Hypotonia;
Fat pads on neck;
80% have hearing loss;

associated with maternal age > 35 years old

Front 11

Down Syndrome
NRSG

Back 11

Provide stimulation (special ed, OT, PT)
Observe for common problems associated with Down Syndrome (Heart Dz, Hearing Loss, Resp. Infections);

Parental education/support

Front 12

Learning Disabilities
(ADD, ADHD, etc)

characteristics

Back 12

Hyperkinesis (hyperactive)
decreased attention span (ADD)
Perceptual deficits
Aggression/depression
CNS malfunctions

Front 13

Learning Disabilities
NRSG + Tx

Back 13

Reduce frustration;
Special ed. considerations (smaller classes, longer test time)
Meds (psychostimulants)
Resources - support group

Front 14

Learning Disability
Medications

Back 14

Ritalin (methylphenidate)
Dexedrine (dextroamphetamine)
ADDeral (dextroamphetamine and amphetamine)

**Psychostimulants**
increase norepinephrine and dopamine by inhibiting reuptake

Front 15

Dexedrine
(dextroamphetamine)

what it does? s/e?

Back 15

Psychostimulant;

ADD medication (learning disability)

s/e: raise in HR and BP
Headache;
Insomnia

Front 16

Ritalin
(methylphenidate)

what it do? s/e?

Back 16

Psychostimulant;

increase dopamine and norepinephrine by inhibiting reuptake;

s/e: sweating
increase HR,
headaches

**used for ADD and ADHD

Front 17

Adderall
(dextroamphetamine & amphetamine)

what is does? s/e? and risks?

Back 17

Psychostimulant;

increases dopamine and norepinephrine by inhibiting reuptake;

s/e: increases HR and BP
decreases appetite;
risk of MI and CVA

Front 18

Frigidity

Back 18

hypoactive sexual drive;
inability to orgasm

Front 19

Naegele's Rule

Back 19

Used to find Estimated Date of Confinement

**-3+7+1**

go back 3 months,
add 7 days,
add 1 year.

Front 20

Finding Estimated Date of Confinement (EDC)

Back 20

Naegele's Rule
Fundal Height
Ultrasound (head measurements)

Front 21

Ultrasound
how it is used to find EDC (estimated date of confinement)

Back 21

estimates fetal age by head measurements

Front 22

Fundal Height for EDC
(estimated date of confinement)

Back 22

measure of fundal height from top of symphysis pubis, using a flexible tape measure;

above level of symphysis pubis = atleast 12-14 weeks

at umbilicus or 20 cm = 20 weeks

above umbillicus = 1 week for each cm (fingerbreadth) above umbillicus until 36 weeks

Front 23

Gravida

Back 23

total # of pregnancies regardless of duration
(includes present pregnancy)

Front 24

Nulligravida

Back 24

woman who has never been pregnant

Front 25

Para

Back 25

# of past pregnancies that have gone beyond period of viability (20wks or >500g)

regardless of the # of fetuses or if the infant was born alive or dead

Front 26

Primipara

Back 26

woman who was completed one pregnancy with fetus that reach viability

Front 27

Term

Back 27

38-42 weeks

Front 28

Abortion

Back 28

any pregnancy that terminates before the period of viability (20 weeks)

Front 29

Trimesters
(at which number of weeks do 1st, 2nd, and 3rd start and end)

Back 29

first trimester: conception-12 weeks

second trimester: 13-26 weeks

Third trimester: 27-42 weeks

Front 30

Fetus is viable if...

Back 30

20 weeks or 500grams

Front 31

Chadwicks sign

Back 31

Bluish discoloration of the cervix;

sign of pregnancy (probably sign)

Front 32

Striae Gravidarum

Back 32

"stretch marks"

pinkish or reddish streaks on breast, abd, buttocks, or thighs;

result of Fat Deposits causing stretching of skin

Front 33

Chloasma

Back 33

Increased pigmentation on face;

blotchy brown areas on the forehead and cheeks;

"mask of pregnancy"

Front 34

Linea Nigra

Back 34

increased pigmentation;

dark line from umbilicus to the symphysis pubis;

Front 35

Gravida vs. Para

Back 35

gravida --> total pregnancies

para --> total pregnancies carried to term

Front 36

Human Chorionic Gonadotropin
(hCG)

Back 36

produced by embryo & later by the placenta-->

prevents destruction of the corpus luteum -->

Maintain progesterone -->

Maintains Pregnancy**

Front 37

Pregnancy on Placental Hormones

Back 37

Increased estrogen
Increased Progesterone
Increased hCG
Increased hPL

Front 38

Pituitary on Pregnancy

Back 38

Increased Estrogen
Increased Progesterone
Decreased LH
Decreased FSH
Decreased Oxytocin

Front 39

Weight Gain during pregnancy

(total, and for each trimester)

Back 39

Total - 24 to 28 pounds

1st trimester - 2 to 4 pounds
2nd trimester - 12-14 pounds
3rd trimester - 8-12 pounds

Front 40

Pregnancy Tests
(urine vs serum, how they work)

Back 40

hCG is measured by radioimmunoassay;

blood is more accurate;
urine is available OTC

Front 41

Presumptive vs Probably vs Positive
signs of pregnancy

Back 41

presumptive - changes felt by the woman
ex. morning sickness, amenorrhea

probably - changes observed by examiner;
ex. Hegar's or Chadwick's sign, urine

Positive - definite signs;
ex. Fetal Heart Beat, X-ray

Front 42

Hegar's Sign

Back 42

softening & compressibility of isthmus of uterus;

Dr palpates for softness through insertion of finger

Front 43

Normal FHR

Back 43

120-160 bpm

Front 44

Fetal Movements (FM)

Back 44

good - a regular pattern of 10 movements in 20 minutes to 2 hours, twice a day

report less than 3 movements per hour

Front 45

Chorion

Back 45

layer of membrane that exist in pregnancy between fetus & mother;

produces hCG

Front 46

Morning Sickness (n/v)
NRSG

Back 46

dry crackers on arising;
small, frequent meals;

**doesnt only occur in the "morning"

Front 47

Pregnancy
Constipation & Hemorrhoids
NRSG

Back 47

Fiber, bulk foods;
increase fluid intake;
Encourage routine, regularity

Front 48

Pregnancy,
Leg Cramps
NRSG

Back 48

increase Calcium
Flex feet
Local Heat

Front 49

Pregnancy,
Breast Soreness
NRSG

Back 49

well-filling bra,
wear bra at night

Front 50

Pregnancy,
back ache
NRSG

Back 50

emphasize Posture;
careful lifting;
Good shoes;

Front 51

Pregnancy,
Heartburn
NRSG

Back 51

small, frequent meals;
decrease fatty & friend foods

antacids, but AVOID the ones with phosphorus;

Front 52

Pregnancy,
lightheadedness, Vertigo
(maternal hypotensive syndrome, vena cava syndrome)
NRSG

Back 52

Turn on Left side, to relieve pressure off of Vena Cava;

Front 53

What is Vena Cava or maternal hypotensive syndrome??

Back 53

baby puts pressure on vena cava -->
Decreased blood return to heart-->
Hypotension

Tx: Turn mother on left side

Front 54

Tay-Sach's Disease
(TSD)

Back 54

common in Ashkenazi Jew descendents (northern european);
Autosomal Recessive Disorder;
Mental & physical deterioration;
Death < 4 years (infantile TSD)

Deficiency in Hexosaminidase A
s/s: blind/deaf, paralysis, atrophy
(symptoms don't arise till after 6 months)

Front 55

Thalassemia
(risk factors, what is it? Treatment?)

Back 55

increased risk to mediterranean ancestry;
autosomal recessive;

Abnormal hemoglobin d/t mutation of globin chains --> ANEMIAS

tx: Transfusions (chronic), Iron Chelation, Hematopoeitic transplantation

Front 56

Down Syndrome
(risk factors, s/s)

Back 56

increased risk to maternal age > 35 years;

s/s: low-set ears, large fat pads at the nape of the neck, protruding tongue, slanted eyes, hypotonic muscles, inward curved little finger

Front 57

Turner's Syndrome

Back 57

Female with only one X

s/s: short stature,
fibrous streaks in ovaries (usually causing infertility)
No intellectual impairments,
webbed necks

tx: Estrogen --> for breast development
GH --> early, to achieve adult height

Front 58

Klinefelter's Syndrome

Back 58

XXY (male with an extra X)

s/s: normal to mild retardation,
small testes (usually infertile),
decreased testosterone,
feminine fat distribution,
decreased facial hair,
gynecomastia

Front 59

Autosomal Dominant

Back 59

If the dominant gene is passed on to the baby, the trait will be expressed.

If one parent has the trait, and the other does not, there is 50% chance the baby will demonstrate the gene.

If both parents have the gene, then 100% chance their kid will.

Front 60

Autosomal Recessive

Back 60

Both parents need to be carriers of the gene for the trait to be demonstrated.

50% chance if one parent express trait; 25% if one both parents are carriers; 100% if both parents express the gene;

Front 61

Sex-linked Transmission Traits

Back 61

trait carried on either a X or Y sex chromosome;
Women give the X
Man may give an X or Y --> determines sex of the baby

if male, and trait is on the X, it is expressed; but if female, it depends on which X is dominant

Front 62

Phenylketonuria
(PKU)

Back 62

Autosomal Recessive
Deficiency in Liver Enzyme (phenalalanine hydroxylase)-->
inability to metabolize phenylalanine (which is toxic to brain cells)

if untreated leads to retardation, brain damage & seizures;

tx: diet changes, meds (that reduce protein--> reduce amino acid (phenylalanine)

Front 63

Phenylketonuria
(PKU)
Treatment & meds

Back 63

Diet changes:
decrease protein (meats, eggs, nuts, legumes,etc.)
avoid sweeteners containing aspartame (contains phenylalanine)

Meds: Tetrahydrobiopterin (BH4) --> decreases phenylalanine

Front 64

Cystic Fibrosis
(what is it? s/s? diagnosed by?)

Back 64

Autosomal Recessive Disorder

Mucoviscidosis or fibrocystic disease of the pancreas;

increases viscosity of musuc of exocrine glands;

s/s: difficulty breathing, poor growth, diarrhea, infertility (absent vas deferens)

diagnosed via Sweat Test

Front 65

Alpha-fetal Protein Test

Back 65

mother's blood checked for AFP;
used to predict Neural Tube Defects (such as Spina Bifida)

Done between week 16-18;
high incidence of false-positive
usually concurrently done with acetylcholinesterase test

Front 66

Chorionic Villus Sampling
(CVS)

Back 66

study of chromosomes for abnormalities;
done between 8-12 weeks;
give RHogam
Ultrasound Guided (needle into placenta)

**FULL BLADDER required**

Front 67

Amniocentesis

Back 67

amniotic fluid aspirated by needle; done at 16 weeks to detect genetic disorders
done at 30 weeks to check L/S ratio (lung maturity)

US guided
EMPTY BLADDER
give RHogam
monitor maternal/fetal status after amnio

Front 68

Ultrasound

Back 68

soundwaves imaging;
as early as 5 weeks (confirm pregnancy and gestational age)

other uses: position, number of fetuses, and measurements

FULL BLADDER increases clarity of image
NON-invasive
NO harmful effects

Front 69

Non-Stress Test
(NST)

Back 69

tocodynameter (records fetal movements)
doppler US (measures FHR)
to asses fetal well-being after 28 weeks;
Pt should eat snacks;

Good results:
2+ FHR accels of 15x15 over a 20 minute interval, that return to baseline (15minx15secs)

Front 70

Favorable NST
Results

Back 70

atleast 2 FHR Accels (15min x 15secs) over a 20 min interval

with a return to baseline

Front 71

Contraction Stress Test
(CST)

Back 71

by nipple stimulation or oxytocin drip, to evaluate fetal response to stress of labor;

performed after 28 weeks;

Semi-fowlers or side-lying;
Monitor for post-test labor onset;

Front 72

Positive vs Negative Results of a CST (contraction stress test)
and what they mean

Back 72

(+) test result = bad - late decels, with 50% contractions;
Risk to fetus, may need cesarean birth

(-) result = good - No late decels with atleast 3 contractions > 40-60 secs

Front 73

Estriol Levels
(test)

Back 73

serial 24-hr urine samples, or serum;

used to determine fetoplacental status;

**low levels indicate deterioration

Front 74

Urinary Tract Infections
(UTI)
s/s, diagnosed by, tx

Back 74

s/s: frequency, urgency, dysuria, hematuria (rare)

upper UTI s/s: fever, malaise, n/v, flank pain;

Confirmed by clean catch urine sample;

Tx: sulfa-based meds & Ampicillin

Front 75

TORCH test series

Back 75

Toxoplasmosis
Other - varicella, syphilis, GBS, Hep B & A, AIDS
Rubella
Cytomegalovirus (CMV)
Herpes II

Front 76

Toxoplasmosis & Pregnancy

Back 76

a protozoa, can cross transplacentally to fetus

education:
Avoid undercook meats;
Dont handle cat litter;

Front 77

"O" in TORCH
NRSG

Back 77

Syphilis;
Varicella/shingles - avoid exposure, give zoster Ig if exposed
GBS - treat with PCN G
HEP B - screen, give newborn HBIg
HEP A - handwashing
AIDS

Front 78

Rubella in Pregnancy

Back 78

can cross transplacentally;
prenatal testing required by law;

vaccine NOT given during pregnancy

Front 79

Cytomegalovirus (CMV)
in pregnancy

Back 79

transmitted in body fluids;

detected by antibody/serological tests

Front 80

Herpes II
in pregnancy

Back 80

transplacental, or ascending infection within 4-6 hours after ROM or contact during delivery with ACTIVE LESIONS

cesarean if active lesions present;

Front 81

Danger Signs of Pregnancy

Back 81

Gush of fluid or bleeding;
regular uterine contractions;
severe HA, visual disturbance;
Persistent n/v
Fever/chills
swelling in face & fingers that doesnt resolve with rest

Front 82

Lightening

Back 82

Sensation as fetus descends into pelvic inlet;

primipara - happens up to 2 wks before delivery;
multipara - may not occur until labor

Front 83

"show"

Back 83

Expulsion of mucus plug

Front 84

Effacement

Back 84

progressive thinning and shortening of the cervix;

expressed 0-100%

Front 85

Characteristics of Onset of Labor

Back 85

Lightening - descent into pelvic inlet
softening of cervix
expulsion of mucus plug
progressive & regular contractions
Increased effacement and dilation
ROM

Front 86

Prolapse Cord
(s/s, NRSG, expected outcome)

Back 86

s/s: PROM, presenting part not engaged, fetal distress, protruding cord;

NRSG: call for help, push against presenting part, Trendelenberg or knee-chest position;

expected outcome : FHR remain at baseline

Front 87

External Electronic Fetal Monitoring Tools

Back 87

Tocodynameter (contractions)
US doppler (FHR)

non-invasive

Front 88

Internal Electronic Fetal Monitoring tools

Back 88

IUPC (intrauterine pressure catheter) - measures contractions;

must have ROM, cervix dilated enough, and presenting part low

Front 89

Normal FHR

Back 89

120-160bpm

must obtain baseline;

Front 90

FHR
Tachycardia

(HR? what it means? caues?)

Back 90

HR > 160 lasting longer than 10 mins;

early sign of fetal hypoxia;

d/t: fever, anemia, infection, drugs, heart failure, hyperthyroidism

Front 91

FHR
Bradycardia

(HR? what it means? causes)

Back 91

FHR<110-120bpm lasting at least 10 mins;

LATE sign of hypoxia;

d/t: anesthetics, cord compression, hypotensive syndrome;

Front 92

Variability

Back 92

irregular fluctuations in the baseline of FHR of 2 cycles/ minute or greater;

absent -> fetal sleep (if >30mins, indicates fetal distress)
minimal (0-5bpm) --> non-reassuring sign
Moderate (6-25bpm)--> may be significant
Marked (25+bpm)--> significance unknown

Front 93

Accelerations
in FHR

Back 93

>15bpm raise above baseline, followed by a return to baseline;

response to fetal movement;

indicates fetal well-being;

Front 94

Early Decels
in FHR

Back 94

falls below baseline at least 15 seconds followed by return;

occur before the peak of contraction;
often mirror image of contraction tracting;

associated with head compression**

Front 95

Late Decels

Back 95

fall below baseline lasting 15 seconds or more, followed by a slow return to baseline;

indicative of Fetal hypoxia d/t deficient placental perfusion;
ex. PIH, DM, placenta previa, abruptio placentae

NON-reassuring sign;

Front 96

Variable Decels

Back 96

transiet U or V shaped reduction occuring at anytime;

drop more then 15 bpm, at least 15 seconds, with a return to baseline in < 2 minutes;

can indicate cord compression;
can be relieved by maternal position change;

if prolonged, give oxygen or d/c oxytocin

Front 97

Tx for Late Decels

Back 97

Left side-ling, if no change, flip to other side or Trendelenberg;
administer oxygen;
start IV or increase flow rate;
stop oxytocin;
may need cesarean section;

Front 98

Fetal Lie
(and examples)

Back 98

relationship of fetal spine to maternal spine;

longitudinal - parallel
transverse - right angles
Oblique - slight angle off a true transverse lie

Front 99

Fetal Presentation

Back 99

part of the fetus that enters maternal pelvic inlet

Front 100

Vertex presentation

Back 100

Cephalic (or head first)

Front 101

Frank Breech Presentation

Back 101

Most common of breech;

Flexion of hips & extensions of knees;

BUTT first

Front 102

Complete Breech
Presentation

Back 102

Flexion of hips and knees;

Butt and feet first;

Front 103

Footing/ Incomplete Breech
presentation

Back 103

extension of hips & knees;

Front 104

Fetal Attitude

Back 104

relationship of fetal parts to each other;

usually flexion of head & extremities on chest;

Front 105

Fetal Position
definition

Back 105

relationship of fetal reference point to maternal pelvis;

Front 106

Fetal Reference Points

Back 106

O - occiput
B - brow
SC - scapula
S - sacrum
M - mandible (chin)

Front 107

Fetal position LOA

Back 107

Left occiput anterior:

occiput is facing the left side of the maternal pelvis, but slightly angled towards the Front (anterior) side;

Front 108

Fetal position LOT

Back 108

Left Occiput Transverse:

occiput of baby is facing the left side of the maternal pelvis;

Front 109

Station

Back 109

level of presenting part in relation to imaginary line between ischial spines (zero station);

-5 to -1 indicates above zero station (not engaged)
+1 to +5 indicates part below zero station

Front 110

Engagement

Back 110

presenting part is at or below zero station;

0 to +5 station

Front 111

3 phases of contrations

Back 111

increment - slope up
acme/peak - point of max contraction
decrement - slope down to relaxation

Front 112

Frequency

Back 112

start of one contraction to the start of the next contraction;

f< Q2mins should be reported;

Front 113

Duration

Back 113

from start of contraction to the end of the same contraction;

d>90 seconds should be reported (risk for rupture or fetal distress)

Front 114

Intensity
(of contractions)

Back 114

the strength of contraction on acme;
can be estimated by palpation also;

Front 115

True Labor Signs
(contractions, discomfort, cervix)

Back 115

Contractions: Progressive (increase in intensity, duration, and frequency), Regular, and doesnt not decrease with rest
Discomfort: radiates from back around the abdoment

cervix - progressively effaced & dilated

Front 116

False Labor Signs
(contractions, discomfort, cervix)

Back 116

contractions: irregular, no change in duration, frequency, or duration, lessen with rest

Discomfort: usually abdominal

Cervix: no changes occur

Front 117

Stages of Labor
(4)

Back 117

stage 1: from start to complete dilation of cervix (0-10cm)
Stage 2: birth of baby
Stage 3: Delivery of placenta
Stage 4: First four hours after delivery of the placenta

Front 118

First Stage of Labor

Back 118

Latent, active, and transition phase

- increase dilation
- strength, duration, and frequency of contractions

Front 119

Second stage of Labor

Back 119

- advancing in stations

- increase in dark red bloody show

- urgency to bear down

Front 120

Third stage of Labor

Back 120

- placental delivery

slight gush of blood;
lengthening of the umbilical cord;

**check for remaining fragments**

Front 121

Irregular Fetal
Heartbeat
NRSG (4)

Back 121

Turn on Left side;
Give oxygen
Start IV or increase flow rate
check for prolapse cord

Front 122

Cord Prolapse
NRSG (5)

Back 122

Call for help;
Give oxygen;
apply pressure on presenting part;
Trendelenberg or knee-chest position;
start IV or increase flow rate;

Front 123

How to decrease
discomfort/exhaustion/pain

Back 123

breathing relaxation techniques;
low back pain - massage sacral area;
encourage rest between contractions;

Front 124

Nitrous Oxide & Oxygen
for anesthetic in labor

Back 124

via inhalation;
intermittently with each contraction;
pt is able to cooperate in bearing down;

increase risk of neonatal depression if used >15-20 minutes

Front 125

Methoxyflurane
(penthrane)
for anesthetic in labor

Back 125

self-administered by inhaler;

may cause maternal/fetal narcotic depression;

Front 126

Regional Blocks
(examples, level of cooperation, s/e)

Back 126

examples: Epidural, Caudal, subarachnoid, spinal block, paracervical, intravenous

Allows mother to be awake and participate;

s/e: Maternal hypotension, Prolonged labor (atony), post-spinal headache, and fetal bradycardia

Front 127

Lumbar Epidural Block

Back 127

blocks below T10;
administered continuously, tubing left in place;

minimize hypotension by administering 500-1000mL at a rapid rate before administering anesthetic, and maintaing mother in side-lying position;

monitor maternal/fetal Q1-2mins for first 15 minutes, and Q15min after that

Front 128

How to minimize Maternal Hypotension caused by Epidural Block

Back 128

Administer 500-1000mL of IV fluids at a rapid rate prior to administering anesthetic, and maintain mother in side-lying position;

Front 129

Maternal Hypotension
NRSG

Back 129

Give Oxygen;
IV fluids or increase rate;
Left Lateral position;
Notify Physician;

if severe, Trendelenberg position

Front 130

Caudal Block

Back 130

administered during second stage of labor just before delivery;

Not commonly used;

administered low, into tail (caudal) area;

Front 131

Subarachnoid Block
"saddle block"

Back 131

S1-S4 block;
injection given in sitting position, with mother arching her back;
Must remain upright for 30seconds to 2 minutes;
Mother cannot push as strong;
at risk for maternal hypotension

NRSG: keep hydrated with IV fluids

**this is the procedure i watched**

Front 132

Spinal Block

Back 132

now used primarily just prior to cesarean section;

1 shot lasts 1-2 hours;

May need additional shots;

Front 133

Paracervical Block
analgesics

Back 133

injection of anesthetic solution into region around the cervical area;

used to relieve pain of cervical dilation;
may cause Respiratory Depression in Infant;

**used during first stage of labor (cervical dilation)

Front 134

Intravenous Anesthesia
(pentothal)

Back 134

rarely used;
fetal depression;
vomiting & aspiration risk;
uterine atony

Front 135

VBAC

Back 135

Vaginal birth after cesarean;

at risk for uterine rupture;

higher risk if previous cesarean was classical (vertical);

Front 136

Immediate Newborn Cares
(5)

Back 136

1 - establish airway (bulb suction)
2 - APGAR (1&5mins)
3 - Clamp cord
4 - Maintain warmth
5 - ID band mother and baby

Front 137

fourth stage of labor
NRSG (5)

Back 137

vitals Q15min
fundus Q15min
Lochia Q15min
Urinary - measure first void
Bonding - encourage interaction

Front 138

Fundus Height
Post-labor

Back 138

should be even to 1 cm above umbilicus for first 12 hours;
then descends 1 cm per day;
back to pelvis by day 10;

Front 139

Lochia
(what is it? 3 types? what indicates infection?)

Back 139

Endometrial Sloughing;

Rubra (day 1-3) - bloody red with fleshy odor; may have clots;
Serosa(day4-9) - pink/brown with fleshy odor;
Alba (day 10+) - yellow/white

**foul odor indicates infection

Front 140

RHogam

Back 140

given to Rh- mother with an Rh+ baby;
Promotes lysis of Rh+ RBCs in maternal blood before she develops antibodies to them;

Front 141

Episiotomy

Back 141

surgical incision through the perineum to make the vagina larger;
Use Local anesthetic
Suture after delivery;

Front 142

First Degree Perineal Tear

Back 142

Superficial tears;
involve the skin of perineum and the tissue around the opening of the vagina or the outermost layer of the vagina; NO MUSCLE

Front 143

Second Degree Perineal Tear

Back 143

deeper into muscles; These tears need to be stitched closed, layer by layer; take a few weeks to heal;

Front 144

Third Degree Perineal Tear

Back 144

a tear in vaginal tissue, perineal skin, and perineal muscle that extends into the anal sphincter;

Front 145

Fourth Degree Perineal Tear

Back 145

goes through vaginal tissue, perineal skin, and perineal muscle that goes through the anal sphincter and the tissue underneath it

Front 146

Periurethral laceration

Back 146

Perineal tear to the anterior side of the vagina, near the urethra;
Usually small, and need a few stitches, if any;
Burning on urination;

Front 147

Sulcus tear

Back 147

internal tear along vaginal wall, involving deep internal muscles of the vagina;

Front 148

How to suppress Lactation

Back 148

tight-fitting bra for 72 hours;
ice packs;
minimize breast stimulation;

Front 149

Nipple Cleansing

Back 149

clean with WATER;
NO SOAP;
dry thoroughly;
expose to air;

Front 150

Nipple care
(and signs of infection)

Back 150

infants mouth should cover most of areola;
use finger to break suction, to release baby's mouth;
rotate positions Q5mins, rotate breasts;

**redness and swelling can indicate infection**

Front 151

Engorgement Treatment

Back 151

nurse frequently (Q30min-3Hr)'
empty breast Qfeed;
warm shower/compresses
alternate starting breast;
ice packs between feeds;

Front 152

Plugged Ducts
(s/s, tx)

Back 152

area of tenderness, lumpiness;
often associated with engorgement;

tx: heat & massage before feeding

Front 153

Expression of breast Milk

Back 153

to collect for supplemental feedings; to relieve breast engorgement; or to build milk supply;

Front 154

Storing milk

Back 154

2x2x2 rule

2 days in the fridge
2 weeks in the freezer
2 months in deep freezer

Front 155

"postpartum Blues"

Back 155

days 3-7 is NORMAL;
"let down" feeling;
relieved by emotional support and rest/sleep;

**Report if late onset, or prolonged

Front 156

Kegel Exercises

Back 156

tighten pubococcygeal muscles, hold for 3 seconds, then relax;
Repeat 10 times TID;

helps with urinary incontinence following child birth;

Front 157

Urinary Incontinence
Treatment
(2)

Back 157

Kegel Exercises;
Avoid diuretics (caffeine);

Front 158

Sex after giving Birth

Back 158

abstain untill episiotomy is healed & lochia ceased (about 3-4weeks, 1 month);

assess & discuss couple concerns;

Breastfeeding is NOT reliable as contraception;

NO ORAL contraceptives during breast feeding;

Front 159

Spontaneous Abortion
assessment findings

Back 159

persistent uterine bleeding;
cramplike pain;
negative/weak positive pregnancy test;

Front 160

Threatened abortion

Back 160

vag. bleeding & cramps;
CERVIX still closed;

NRSG:
Ultrasoud
pregnancy test (hCG)
decrease activity (no sex, less walking)
decrease stress

** report clots, tissue, foul odor

Front 161

Inevitable Spontaneous abortion

Back 161

persistent bleeding & cramps;
CERVICAL DILATION & EFFACEMENT;

NRSG:
save & count pads (monitor bleeding),
monitor for infection,
D&C,
Emotional support

Front 162

D and C

Back 162

Dilation and Curettage;
Uterine scraping;
removal of contents of the uterus;

Front 163

Incomplete Spontaneous Abortion

Back 163

persistent bleeds & cramps;
expulsion of part of the produects of conception;

NRSG:
administer IV/blood products,
Oxytocin (help expel what is left),
D&C,
Suction Evacuation

Front 164

Complete Spontaneous Abortion

Back 164

persistent bleeds & cramps;
NO RETAINED TISSUE;

NRSG: Methergine - treatment for uterine bleeds,
no other treatment, unless complications occur

Front 165

Methergine

Back 165

Blood vessel constrictor;
smooth muscle agonist --> uterine contractions

used to prevent and treat uterine bleeding

Front 166

Missed Abortion

Back 166

fetus dies in utero but isnt expelled;
cervix is closed;
if retained >6 weeks --> risk for infection, DIC, and emotional distress
NRSG:
D&C if < 6 weeks
After 12 weeks:
Prostaglandin gel --> induces labor, violent contractions
Laminaria suppositories (dried sterile seaweed) --> dilates cervix

Front 167

Habitual Abortion

Back 167

3 or more fetuses;
may have incompetent cervix

NRSG- cerclage

Front 168

Cerclage

Back 168

encircling cervix with suture;

treatment for spontaneous abortions and incompetent cervix;

Front 169

Basic NRSG for all
Spontaneous Abortions

Back 169

monitor Bleeds & pain; (fluid, e-lyte status)
RHogam (if needed)
save all tissues passed, and take it to doctor;
BEDREST;
Emotional support;

Front 170

Ectopic Pregnancy
Assessment findings

Back 170

Unilateral lower quadrant pain after 4-6 weeks;
rigid, tender abdomen;
referred shoulder pain;
low Hct
low hCG
Bleeding - oozing to frank bleeding
MAY NOT HAVE POSITIVE PREGNANCY TEST d/t low hCG, because lack of chorion

Front 171

Causes of ectopic pregnancies
(risk factors)

Back 171

Tubal surgery;
Pelvic Inflammatory Disease (PID);
Abnormalities of fallopian tubes

Front 172

Ectopic Pregnancy
NRSG

Back 172

prepare for surgery;
monitor for shock (bleeding)
emotional support (loss of baby);
RHogam if needed;

Front 173

Gestational HTN

Back 173

HTN without proteinuria or edema after 20 weeks of pregnancy

Front 174

Pre-eclampsia

Back 174

BP 140-160/110-90
Proteinuria +2 to +4
Generalized EDEMA
Hyperreflexia
Headache, irritability;
HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets)

Front 175

Severe Pre-eclampsia

Back 175

Hyperreflexia
Proteinuria +4
HELLP

Front 176

Eclampsia

Back 176

HTN
Proteinuria
Convulsions (seizures)
Coma

Front 177

Post-delivery Eclampsia
NRSG

Back 177

if DIC --> anticoagulant therapy

Monitor BP for 48 hours;

Front 178

Risk factors of PIH, Eclampsia

Back 178

Large fetus
Old or young maternal age (+35 or -17);
primigravida
hydatiform mole
multiple gestations
poor nutrition
obesity
DM
family Hx
Other vascular disease

Front 179

Pre-eclampsia
NRSG

Back 179

Bedrest;
Weight Daily (edema)
I&Os (edema)
Seizure precautions;
Meds (apresoline, mg sulfate, diazepam, procardia)

Front 180

Pre-eclampsia
Meds

Back 180

Mg Sulfate (anticonvulsant) -->prevent and treat seizures
Apresoline (vasodilator) --> decrease BP
Diazepam (valium) - anticonvulsant
Procardia (CCB) - vasodilator - decreases BP

Front 181

Placenta Previa
Assessment Findings

Back 181

1st and 2nd trimister SPOTTING;

3rd trimester - bright-red, PAINLESS bleeding

Ultrasound shows evidence

Front 182

Placenta Previa
Treatment

Back 182

Bedrest
Side-lying/trendelenberg (relieve pressure on cord)
daily Hct/Hgb (bleeding)
Amniocentesis (check lung maturity)
NO SEX!!

NST Q2wks

Cesarean Birth Recommended

Front 183

Abruptio Placentae
Assessment findings

Back 183

PAINFUL, dark-red bleeding;
tender, RIGID, painful Abdomen;

contractions;

risk for maternal shock;

Front 184

Risk Factors of
Abruptio Placentae

Back 184

Maternal HTN;

Cocaine abuse;

Front 185

Abruptio Placentae
NRSG

Back 185

monitor blood loss;

prepare for immediate delivery;

Blood Transfusions (type and cross)

Front 186

Postpartal Complications of
Abruptio Placentae

Back 186

DIC
Pulmonary Emboli
Infection
Renal failure (d/t hypovolemia, decreased renal perfusion)
Transfusion hepatitis

Front 187

Glycosylated Hgb

Back 187

HbA1c;

indicates past glucose levels over previous 3 months;

>8% elevations --> anomalies, miscarriage (if during 1st trimester), Macrosomia (if during 3rd trimester)

Front 188

Glucose Tolerance Test

Back 188

1 hr test at 24-28 weeks, start of 3rd trimester (for women at risk);
Screen BG 1 hour after taking 50g of glucose solution;

<140 not considered GDM
>140 needs further testing

Front 189

Diabetes Risk/effects
on Pregnancy

Back 189

risk of infections;
PIH
Hydramnios
macrosomia
Congenital anomalies
prematurity
RDS (comes with prematurity)

Front 190

Hydramnios
(same as polyhydramnios)
(what it is? and treatment)

Back 190

>2,000mL of amniotic fluid

can lead to preterm labor;
can be caused by over active fetal urine production;

tx: amniocentesis; meds that decrease fetal urine, close monitoring

Front 191

Macrosomia
(LGA)

Back 191

Large for Gestational Age;
But may have immature organ systems;

GDM increases risk for LGA(macrosomia)

Front 192

Gestational DM
(GDM)

Back 192

hyperglycemia after 20 weeks, when insulin need accelerates;

usually controlled by diet;

NO ORAL HYPOGLYCEMICS - teratogenic & increase neonatal hypoglycemia

Front 193

Gestational Diabetes
(GDM)
Treatment

Back 193

Healthy diet;
exercise;
insulin;
careful BG monitoring;

PRO/CARB snack before bed

Front 194

Diabetes Risk/effects
on Pregnancy

Back 194

risk of infections;
PIH
Hydramnios
macrosomia
Congenital anomalies
prematurity
RDS (comes with prematurity)

Front 195

Hydramnios
(same as polyhydramnios)
(what it is? and treatment)

Back 195

>2,000mL of amniotic fluid

can lead to preterm labor;
can be caused by over active fetal urine production;

tx: amniocentesis; meds that decrease fetal urine, close monitoring

Front 196

Macrosomia
(LGA)

Back 196

Large for Gestational Age;
But may have immature organ systems;

GDM increases risk for LGA(macrosomia)

Front 197

Gestational DM
(GDM)

Back 197

hyperglycemia after 20 weeks, when insulin need accelerates;

usually controlled by diet;

NO ORAL HYPOGLYCEMICS - teratogenic & increase neonatal hypoglycemia

Front 198

Gestational Diabetes
(GDM)
Treatment

Back 198

Healthy diet;
exercise;
insulin;
careful BG monitoring;

PRO/CARB snack before bed

Front 199

Cardiac Disease in
Pregnancy

Back 199

may be aggravated by pregnancy;

NRSG:
encourage rest,
moderate physical activity,
teach importance of avoiding respiratory infections,
be alert to s/s of heart failure (dyspnea, tachycardia)

Front 200

Syphilis
in pregnancy
(s/s, tests, tx)

Back 200

s/s: Lesion (chancre) on internal or external genitalia

tests: VDRL (blood tests)

Tx: PCN --> crosses placenta & treats fetus also;

** danger to brain, heart, and bones if not treated early

Front 201

Gonorrhea
in pregnancy
(s/s, complications, Tx)

Back 201

s/s: purulent discharge, may be asymptomatic;

diagnosis - by culture of vaginal secretions;

Complications: spread to infant, can cause sterility;

Tx: Antibiotics, Prophylactic eye medications (after delivery)

Front 202

Hydatiform Mole

Back 202

nucleus-less egg fertilized by sperm;

risk of choriocarcinoma;

D&C ASAP

a gestational trophoblastic disease (GTD)

Front 203

Hydatiform Mole
Assessment findings

Back 203

elevated hCG (like pregnancy)
larger size than expected for gestational age;
NO FHR!!!
dark red/brown vaginal bleeding;
Passage of grape-like clusters;

increased N/V & PIH;

Front 204

Hydatiform Mole
plan and Tx

Back 204

D&C all molar tissue (it can become malignant);
Rhogam (if needed);
Discourage pregnancy for a year;
Monitor hCG levels for 1 year;

NO IUDs !!

Front 205

Preterm Labor
Risk Factors

Back 205

African-american;
old/young maternal age (-17 or +35)
low socioeconomic status
drugs/smoking
medical conditions

Front 206

Preterm Labor vs Spontaneous Abortion

Back 206

preterm Labor occurs after 20 wks, when fetus is VIABLE;
Spontaneous abortion, occurs before 20 weeks, before viability;

Front 207

Preterm Labor
Tx/NRSG/Plan

Back 207

Bedrest, Side-lying;
Uterine monitoring (contractions, FHR);
Relaxation techniques;
Meds

Front 208

Preterm Labor
Medications

Back 208

Ritodrine(yutopar) - Tocolytic (beta2 adrenergic agonist) -- smooth muscle relaxer
Terbutaline(brethine) - tocolytic (B2adrenergic agonist) --smooth muscle relaxer;
Magnesium Sulfate - tocolytic - decreases Ca+ in uterine muscle
Indomethacin (NSAID) - inhibits prostaglandins (tocolytic)
Nefidipine (CCB) - blocks Ca+ (blocking contractions)

Front 209

Ritodrine (Yutopar)

Back 209

Beta2 adrenergic agonist (smooth muscle relaxer)

TOCOLYTIC to treat preterm labor

Front 210

Terbutaline (brethine)

Back 210

beta2 adrenergic agonist (smooth muscle relaxer)

TOCOLYTIC to treat preterm labor

Front 211

Magnesium Sulfate

Back 211

Decreases Ca+ in uterine muscle walls
TOCOLYTIC to treat preterm labor;

ANTICONVULSANT used to prevent and treat seizures associated with Eclampsia

Front 212

Indomethacin (Indocin)

Back 212

Non-Steroidal Anti-Inflammatory Drug (NSAID)

used as a TOCOLYTIC in preterm labor d/t the Prostaglandin inhibiting effect

Prostaglandin lead to muscle contraction, therefore, blocking them blocks contractions;

Front 213

Nefidipine (procardia)

Back 213

Calcium Channel Blocker (CCB)

used in to treat Preterm Labor by blocking Ca+ which blocks contractions (in this case, uterine contractions)

Front 214

"Pre-requisites" of Labor Induction (4)

Back 214

Engaged;
cervix ripened or induced ripening must occur first;
Cephalic presentation;
Cannot have CPD (cephalopelvic disproportion)

Front 215

Induced Labor
NRSG

Back 215

continuous Fetal/Maternal Monitoring
Prepare for AROM (amniotomy)
Piggy back Oxytocin via infusion pump;
stop oxytocin if indicated (fetal distress, or hypertonic contractions)

Front 216

Oxytocin (pitocin)
in labor induction
(dosages, administration, when to stop)

Back 216

Begin at 0.5-1 mU/min
increase 1-2 mU/min at intervals of 30-60 mins until desired contractions (Q2-3mins, <90 seconds)
**max of 20mU/min

Piggyback to principle IV line
administer through infusion pump (which can give mU/min)

STOP if fetal distress, or hypertonic contractions

Front 217

Amniotomy

Back 217

AROM (artificial rupture of membranes)

Usually done during labor induction or labor;

Front 218

Dystocia
(definition & tx)

Back 218

abnormal or difficult labor;

tx: Cesarean, Ventouse (vacuum), forceps, pitocin drip

Front 219

Ventouse

Back 219

Vacuum, used for child birth;
Usually used for dystocia (difficult/prolonged childbirth)

Front 220

Classical Incision Cesarean

Back 220

vertical;
more blood loss;
Rapid delivery;

VBAC is risky **

Front 221

Low-segment Transverse Cesarean

Back 221

horizontal;
less blood loss;
VBAC is possible **

Front 222

VBAC

Back 222

Vaginal Birth After Cesarean

risky if had classical cesarean before;

Front 223

Cesarean Section
NRSG
(pre,post,during)

Back 223

Pre- type & cross, CBC, emotional support (not being able to have natural birth), preop analgesics, EMPTY BLADDER

Monitor for hemorrhage

Post- deep breathing exercises (splint site), encourage ambulation (decrease clot risk)

Front 224

Precipitous Labor

Back 224

labor lasting < 3 hours from start of contractions

Front 225

Nuchal Cord

Back 225

Cord wrapped around neck

Front 226

Delivery Outside Hospital Setting
NRSG

Back 226

Dont Leave Mother;
Prepare sterile/clean environment;
support infant's head (control delivery)(apply slight pressure);
slip nuchal cord over head;
rotate infant externally as head emerges;
dry baby, place on mothers abdomen;
hold placenta as delivered;
baby to breasts;
Check for bleeding and fundal tone;

Front 227

Postpartum Hemorrhage
assessment findings

Back 227

boggy uterus (flaccid/reduced tone);
excessive bleeding;
lochia regresses to previous stage;

Front 228

Postpartum Hemorrhage
Tx/plan/NRSG

Back 228

massage uterus (fundus);
monitor involution;
monitor for signs of shock
give Oxytocin or Methergine --> contracts uterus & vasoconstricts

Front 229

Meds for Postpartum Hemorrhage

Back 229

Methergine
Oxytocin

contraction uterus, and vasoconstricts

Front 230

Postpartum Infection
assessment findings

Back 230

temp >100.4F on any 2 consecutive days;
chills, tachycardia;
server afterpains, perineal discomfort;
Foul-smelling lochia;
cultures (lochia, urine, blood)
WBC elevated;

Front 231

Postpartum Infection
plan/tx/NRSG

Back 231

early ambulation;
change peripads frequently;
monitor for signs of infection;

tx: antibiotics

Front 232

Postpartum Depression
Assessment Findings

Back 232

Low estrogen & progesterone;
occurs about 3-7 days postpartum is NORMAL;
"rollercoaster" emotions;
"let-down feeling"
Fatigue;
Appetite and sleep disturbances

Front 233

Postpartum Blues
NRSG

Back 233

encourage Verbilization of feelings;
Assess suicide risk;
Support groups;
consult with medical and psych staff;

Front 234

Newborn
Respiratory/perfusion
Assessment

Back 234

APGAR;
Color - Cyanosis?
HR - tachycardia?
Breathing pattern - retractions? grunts?
RR - tachypnea?

Front 235

Assessing Newborn
Nutritional Status

Back 235

Measurements: Weight, Length, head & chest circumference;
Feeding success?
Increased nutritional demand ?? (ex. sepsis, distress)
Diaper counts;

Front 236

Assessing Newborn
Heat Regulation

Back 236

Acidosis and hypoglycemia may occur if poor regulation;

acidosis d/t increased uric and lactic acid because increased calorie consumption when body tries to control body temperature;

Front 237

Newborn
CNS assessment

Back 237

Reflexes: (moro, tonic neck, babinski)
Autonomics: (suck, rooting, swallowing)
Fontanelles (ICP)
Activity/cry
Paralysis/Paresis/palsy - cranial nerves, brachial plexus

Front 238

Hydrocephalus
(definition, s/s)

Back 238

"water in head"
Increased CSF causing increased ICP;

s/s: bulging fontanelles, Separated sutures,
high-pitched cry,
seizures,
irritability, n/v,
eyes roll downward

Front 239

Erb's Palsy

Back 239

Brachial Palsy (damage to brachial plexus nerves)
weakened/loss of arm movement;
absent moro on affected side;
weak grip on affected side;
FULL RECOVERY expected;

Front 240

Bell's Palsy

Back 240

damage to Facial Nerve (cranial VII nerve)
facial paralysis to affected side;

r/t Herpes (zoster/epstein barr) virus

Front 241

Newborn Parenting
Assessment

Back 241

Touching?
Reciprocity of interaction?
ability to interact?
age/developmental level of parent;

Front 242

Bulb Suctioning

Back 242

Mouth then nose;

d/t the fact that suction the nose might cause the baby to inhale (so make sure fluids are out of mouth or it might be inhaled into lungs)

**think clean then dirty, even though it isnt the rationale

Front 243

APGAR stands for?

Back 243

Appearance - color
Pulse - HR
Grimace - cry, reflex
Activity - muscle tone
Respiration - cry, respiratory effort

Front 244

APGAR score interpretation
(what do the scores mean)

Back 244

0-3: poor
4-6: fair
7-10: excellent

Front 245

APGAR scoring

Back 245

Appearance - color: Pale/Bluish all over (0), pink body, bluish extremities (1), Pink all over (2);
Pulse - HR: absent (0), <100 (1), >100 (2);
Grimace - reflex irritability: no response (0), grimace, weak cry (1), vigorous cry (2);
Activity - Muscle tone: Flaccid (0), some flexion (1), Active motion, flexion of all extremities (2);
Respiratory effort: Absent (0), Slow, irregular (1), Good cry (2);

Front 246

Normal Weight at term

Back 246

6-9 pounds;

normal 5-10% loss in the first few days, but will be regained by 2 weeks;

Front 247

Normal Length at term

Back 247

19-21 inches

Front 248

Normal Head Circumference
at term

Back 248

13-14 inches

Front 249

Normal Chest Circumference
at term

Back 249

12-13 inches;
1 inch less than the head circumference;

Front 250

Normal Newborn Temperature
(norm, do's and dont's)

Back 250

Axillary: 97.7 - 99.7F

NO RECTAL temp - risk for perforation;
Hold axillary in place for 3 minutes, unless using electric thermometer

Front 251

Normal Newborn Heart Rate

Back 251

120-160 awake;

100 at sleep;

180 if crying;

Front 252

Normal Newborn
Respiratory Rate
and characteristics of breathing patterns

Back 252

30-60 breaths/min;

periods of apnea;

diaphragmatic breathers (abdominal breathers, "belly breathers")

Front 253

Normal Newborn
Blood Pressure

Back 253

65/41 mmHg in arm & calf

Front 254

Normal Newborn Posture

Back 254

Fetal Position for several DAYS;

with resistance to extension;

Front 255

Acrocyanosis

Back 255

bluish discoloration of extremities (hands and feet);

Normal for first 24 hours;

Front 256

Central Cyanosis

Back 256

Bluish discoloration of skin and mucous membranes;
indicates lack of oxygen in blood;

treatment necessary;

Front 257

potere (imperf)

Back 257

potevo,-i
potevamo potevate potevano

Front 258

Lanugo

Back 258

downy, fine hair;

extensive amount in preterm babies;

Front 259

Milia

Back 259

distended sebaceous glands;

tiny, white, pinpoint papules on face;

Disappear in a few days to weeks;

Front 260

Mongolian Spots

Back 260

Bluish gray or dark non-elevated pigmentation area over the lower back and buttocks;

primarily on NON-caucasians;

Front 261

Telangiectatic Nevi

Back 261

"stork bites"

cluster of small, flat, red localized areas of CAPILLARY DILATATION;
usually on the eyes, nose, and nape of the neck;
Can be blanched by applying pressure;

**Fade during infancy

Front 262

Nevus Vasculosus

Back 262

"strawberry mark"
Raised, demarcated, dark red, rough-surfaced capillary HEMANGIOMA;
Rapidly GROWS for several months, then begins to FADE;

disappears by age 7

Front 263

Nevus Flammeus

Back 263

Port wine stain;
Reddish, usually flat, discoloration commonly on the face or neck;

doesnt grow;
doesnt fade;

Front 264

Posterior Fontanel

Back 264

Triangular; 0.5 - 1cm
Not easily Palpated;

Closes by 8-12 weeks (2-3 months);

Front 265

Bulging vs depressed vs moderately bulging
Fontanelles

Back 265

bulging - increased ICP
depressed - Dehydration
Moderately bulging - crying, stooling

Front 266

Cephalohematoma

Back 266

Collection of blood under the periostenum of a cranial bone;
DOES NOT CROSS SUTURE LINE;
appears on the 1st or 2nd day
disappears in weeks to months
** appears & disappears late**

Front 267

Caput Succedaneum

Back 267

Localized soft swelling of the scalp;
CROSSES SUTURE LINES ("cap is worn over whole head")
present after birth
fluid reabsorbed within hrs to days
**appears and disappears early**

Front 268

Umbilical Cord
(contents of arteries and veins, when it falls off, and indications of infection)

Back 268

2 arteries (deoxygenated blood to placenta)
1 vein (oxygenated blood from mother to fetus)

Falls off within 1-2 weeks

**foul smelling discharge indicates infection
** treat infection immediately to avoid septicemia

Front 269

Brick-red spots on diaper

Back 269

Uric acid crystals;

From FIRST VOID;

after 1st void, normal to pale urine is expected;

Front 270

Newborn Genitalia

Back 270

Male - testes can be palpated in scrotum
Female - relatively large labia; may have a normal thick white, a white cheese-like (smegma), or blood tinged (pseudomenstruation) discharge

Front 271

Rooting Reflex
(definition, disappears?)

Back 271

Baby turns towards any object touching its cheek or mouth;

Disappears by 4-7 months;

Front 272

Tonic Neck Reflex
(definition, disappears?)

Back 272

"fencing position"
Head turned to one side causes arm and leg on the same side to extend, while arm and leg on the opposite side are flexed;

Disappears at 3-4 months;

Front 273

Moro Reflex
(definition, disappears?)

Back 273

"startle reflex"
body will stiffen, arms in tense extension followed by embrace gesture & index finger in "c" formation;

Disappears at 3-4 months

Front 274

Babinski Sign
(definition, disappears?)

Back 274

Stroking the sole of the foot from heel upwards elicits all toes to fan;

Disappears by 1 year;

Front 275

NRSG for Newborn
(13)

Back 275

Airway;
APGAR (1&5min)
Clamp cord
maintain WARMTH
decrease environmental stimuli
ID band mother/baby
Prophylactic meds (eye and vitamin K)
Record first stool/void
weight/measure
Observe/support bonding
Begin/monitor feeding
Umbilical cord care
circumcision care

Front 276

Newborn Prophylactic Meds

Back 276

Vitamin K (cannot synthesize it for the first 3-4 days, but needs it for clotting and coagulation)
Eye Prophylactic - 0.5%Erythromycin, 1% tetracycline, 1% silver nitrate

Front 277

How to check for readiness to start feeding/breastfeeding (4)

Back 277

active Bowel Sounds;
absent Distended Abdomen;
Lusty Cry;
Absent Gagging/chocking (indicates possible tracheoesophageal fistula or Esophageal Atresia)

** should be ready to start immediately after birth**

Front 278

Esophageal Atresia
(what it is? Med Tx)

Back 278

Birth Defect of Alimentary Tract;
Esophagus ends in a pouch (rather than being connected to the stomach);

Tx: surgery to connect the esophagus

Front 279

Umbilical Cord Care
(NRSG, what to report)

Back 279

clean cord and surrounding tissue
use Alcohol, Erythromycin solution, or Triple Blue Dye;

No Bath tubs until cord falls off;
Fold diaper below cord - to keep it dry and clean;

** report redness, drainage, or foul odor

Front 280

Care of Uncircumcised Penis

Back 280

Do NOT force retraction of foreskin (it may take up to 5 years);
Gently test during warm bath for retraction;

clean glans with SOAP & WATER;

Front 281

Care of Circumcised Penis

Back 281

monitor for bleeding & first void;
apply A&D ointment or Petroleum Jelly (unless Plastibell was used);

Clean with WARM WATER and dry gently;
White/yellow exudate is normal and shouldnt be removed;

Report if foreskin doesnt fall off by 8 days if by plastibell;

Front 282

conoscere (imperf)

Back 282

conoscevo,-i,-a
conoscevamo conoscevate conoscevano

Front 283

Respiratory Distress Syndrome
(RDS or IRDS)
assessment findings

Back 283

labored respiration after several hours;
Cyanosis;
grunting/retractions;
Nasal flare;
tachypnea>60
Amniocentesis - Lipid level, Creatine level, L/S ratio

Front 284

Lecithin-Sphingomyelin Ratio

Back 284

High L/S ratio = more surfactant

L/S ratio > 2 = low risk for RDS
L/S ratio < 1.5 = high risk for RDS

Front 285

Causes/Risk Factors for
Respiratory Distress Syndrome
(RDS)

Back 285

Prematurity
Surfactant Deficiency Disease

Front 286

Respiratory Distress Syndrome
medical Treatment

Back 286

CPAP, PEEP - alveolar recruitment;

give surfactant (through tube)

ECMO (extracorpeal membranous oxygen) - provides oxygen to blood

Front 287

Extracorpeal Membrane Oxygenation
(ECMO)

Back 287

Continuous pumping of oxygenated blood into a large vessel;

Removes carbon dioxide;

use Heparin to prevent clots;

used when lung cannot do the work;

Front 288

Respiratory Distress Syndrome
(RDS)
NRSG

Back 288

control temperature
TPN (d/t NPO - hard to breath if eating)
IV fluids (d/t NPO) for hydration
Maintain AIRWAY (SUCTION prn)
side-lying or on back with neck slightly extended;

Oxygen hood/ventilator;

Front 289

Respiratory Distress Syndrome
Medications

Back 289

Surfactant (through tube)
Antibiotics (prophylactic)
Vitamin E (premature babies are deficient in vitamin E)
Diuretics (excess fluid in lungs)

Front 290

Perinatal Asphyxia

Back 290

Condition as result of Oxygen Deprivation during pregnancy during labor;
Depending on damage to brain, can cause developmental delays;

Front 291

Perinatal Asphyxia
Assessment Findings

Back 291

Low APGAR (cyanosis, tachycardia(or bradycardia), week response, Respiratory distress)
Meconium staining
signs of intracranial damage (increased ICP, seizures, bradycardia)
Abnormal respirations (decreased RR)
Cyanosis

Front 292

Meconium Staining

Back 292

Passing of first stool in utero;
Indicates Fetal Distress;

Front 293

Causes/risk factors of
Perinatal Asphyxia

Back 293

SGA (small for gestational age) (more likely to have meconium staining)
SMOKING
pre/eclampsia
multiple gestations

Front 294

Perinatal Asphyxia
NRSG

Back 294

Aggressive VENTILATOR Support
Keep AIRWAY patent

Front 295

Physiologic Hyperbilirubinemia (physiologic jaundice)
(cause, onset, duration, Tx)

Back 295

Cause - Immature hepatic ability to clear bilirubin
Onset - 24hours
Duration - 1 week
treatment - None needed

Front 296

Early Breastmilk Jaundice
(cause, onset, duration, tx)

Back 296

"lack of breastmilk jaundice"
cause - poor milk/caloric intake --> decreased stools --> bilirubin isnt excreted

onset (early) - 2-3 days
Duration - 3+weeks
Tx- frequent breastfeeds, caloric supplements

Front 297

Late Breastmilk Jaundice
(cause, onset, duration, tx)

Back 297

Cause - d/t factor in breastmilk
onset (late) - 4-5 days
duration - 10+days
Tx- d/c feeds for 24 hours - resume feed after serum bilirubin level drops;

Front 298

Hyperbilirubinemia d/t Hemolytic Disease
(cause, onset, treatment)

Back 298

cause - blood antigen incompatability (Rh or ABO)
onset - FIRST DAY
tx - phototherapy, Exchange transfusions (remove antigen RBC's and replace them)

Front 299

Jaundice
Tx & NRSG

Back 299

monitor Bilirubin levels;
monitor behavior;

PHOTOTHERAPY (bili lights)(biliblanket)
Exchange Therapy
(remove antigen RBC's and excess bilirubin)

Front 300

Hemolytic Disease of the Newborn

Back 300

Destruction of RBCs d/t antigen-antibody reaction;
Baby's Rh antigens enter the mother, mother produces antibodies, antibodies re-enter baby -->Hemolysis
Rh- mother & Rh+ baby;
**rare in first pregnancy

Front 301

Hemolytic Disease of Newborn
Assessment Findings

Back 301

Jaundice on FIRST DAY
Rapidly Elevating bilirubin level
Anemia, decreased Hct & Hgb
Coombs Test (+)

Front 302

Hemolytic Disease of Newborn
Tx & NRSG

Back 302

assist in early detection (Rh- mother & Rh+ baby, prevention)
Phototherapy (cover eyes and genitals, expose as much skin, allow time for bonding)
Exchange transfusions (removes bilirubin and antibodies)

Front 303

Necrotizing Enterocolitis
(NEC)
assessment findings

Back 303

feeding intolerance - Bile EMESIS (vomiting)
Blood in stool - hematest (+)
distended Abdomen
onset 4-10 days after feeding starts
Abdomen radiograph shows air in bowel walls

Front 304

Necrotizing Enterocolitis
(NEC)
Tx, NRSG

Back 304

NPO - rest bowel
NGT - relieve gas in stomach
antibiotics - most likely bacterial cause, and prophylactic for weakened immune
IV fluids & TPN - d/t NPO
Loose Diapering
Careful Handwashing - compromised immune system

Tx: bowel resection, Colostomy (temporary or permanent)

Front 305

Necrotizign Enterocolitis
(NEC)
Medical Treatment

Back 305

Bowel Resection (remove dead bowel)
Colostomy (permanent, or temporary)

Front 306

Necroticing Enterocolitis
(NEC)

Back 306

seen in preterm infants;

Weakened immune system -->
Bacterial infection -->
Necrosis of bowel

Usually leads to Short bowel syndrome;

Front 307

Hypoglycemia in Newborns
Assessment Findings

Back 307

BG<45mg/dL
jitteriness, twitching
irregular respirations
cyanosis
ALOC, lethargy
eye-rolling
seizures

Front 308

Hypoglycemia in Newborn
NRSG, Tx

Back 308

accucheck Q4hr
give GLUCOSE
start FEEDINGS

Front 309

Narcotic-Addicted Newborns
Assessment Findings

Back 309

High-pitched cry
Hyperreflexivity
Diaphoresis
tachypnea>60
Tremors
** withdrawal symptoms occur as early as 12-24 hours after birth
** may last as long as 10 days

Front 310

Narcotic-Addicted Newborns
NRSG, Tx

Back 310

Meds
Decrease Stimuli
Adequate fluid/nutrition (d/t increased activity)
monitor child/mother interation
vitals, monitor for respiratory distress (usually tachypnea)

Front 311

Narcotic-Addicted Newborn
Medications

Back 311

Phenobarbital (sedative)
Chlorpromazine (sedative)
Diazepam (valium) - (antianxiety)
Paregoric - decrease seizures, increasing sucking coordination, decreased explosive stools

Front 312

Phenobarbital (Luminal)

Back 312

barbiturate;
anticonvulsant;
sedative (antianxiety)

can be used to treat Narcotic-addicted newborns

Front 313

Chlorpormazine (thorazine)

Back 313

sedative (anticholinergic, antidopaminergic, antihistamine)

can be used to treat narcotic-addicted newborns

Front 314

Diazepam (valium)

Back 314

antianxiety, anticonvulsant, antispasmodic

Can be used to be treat withdrawal symptoms of narcotic-addicted infants

Front 315

Paregoric

Back 315

Antidiarrheal;

Use in narcotic-addicted newborns:
decreases seizures
increases sucking coordination
decreases explosive stools

Front 316

Naloxone (narcan)

Back 316

Counter opioids;

Treatment for respiratory depression d/t analgesics given to mother;

Front 317

Cold Stress
assessment findings, what is body trying to do?

Back 317

Cyanosis
mottling of skin
metabolic ACIDOSIS
HYPOXIA
HYPOGLYCEMIA

**no shivering, lack reflex as infants

body tries to increase temperature by using more calories and oxygen to produce heat (increases metabolism)--> uric/lactic acid (ACIDOSIS)

Front 318

Cold Stress
NRSG, Tx

Back 318

place baby in warm environment immediately after birth;
thermal environments (incubator, warming panel, cotton blankets)
Monitor temperature - 97.7-99.7F
Cap on head!!

Front 319

Neonatal Sepsis
Assessment Findings

Back 319

hypothermia
poor suck
ALOC, lethargy
Seizures
Episodes of Apnea
lack of weight gain, Dehydration

Front 320

Risk Factors/Causes of
Neonatal Sepsis

Back 320

Prematurity
maternal infection
PROM
prolonged birth
LBW

Front 321

Neonatal Sepsis
NRSG, Tx

Back 321

Prophylactic ANTIBIOTICS
Oxygen - increase need during infection
temporary d/c oral feeds
WBC's (granulocytes, leukocytes)
IV gamaglobulin (preventative only, doesnt work on existing infection)

Front 322

IV Gammaglobulin

Back 322

given to prevent Nosocomial Infection;
Given to LBW and high risk infacts;
Temporary BOOSTS IMMUNE system
** doesnt work on existing infections

Front 323

Usual time for repairing
Cleft Lip vs Cleft Palate

Back 323

cleft lip - within first week of life
cleft palate - before child develops altered speech patterns

Front 324

Pre-op cleft lip/palate
NRSG

Back 324

assess ability to suck
feed with: soft nipple, lambs nipple, brechet feeder, or cup;

maintain adequate nutrition

Front 325

Post-op
Cleft lip/palate
NRSG

Back 325

Airway (SUCTION prn)
Endotrach at bedside
watch for respiratory distress;

Gaurd Suture line:
Logan's Bow, side-lying, clean suture line, elbow restraints, avoid crying, NO sucking
Burp frequently - avoid emesis

REFERRALS to: speech therapists & orthodontics

Front 326

Logan's Bow

Back 326

heavy stainless steel wire bent in an arc and taped to both cheeks to protect a freshly repaired cleft lip.

Front 327

Brecht Feeder

Back 327

Used to feed clept lip/palate feeder;

a syringe with tubing that is inserted into the mouth
(thus avoiding sucking)

Front 328

Tetrahydrobiopterin
(BH4)

Back 328

treatment for Phenylketonuria;
reduces Phenylalanine levels;

Front 329

Goodell's Sign

Back 329

significant softening of the vaginal portion of the cervix;

probable sign of pregnancy;

Front 330

Ladin's Sign

Back 330

softening in the midline of the uterus anteriorly at the junction of the uterus and cervix;

Occurs at 6 weeks of gestation;

Front 331

Braxton Hicks Contractions

Back 331

Irregular;
felt in the abdomen and remain confined to area (pain doesnt radiate);
They disappear with ambulation;
No cervical dilation occurs;

Front 332

Sterile Speculum Examination
(use?)

Back 332

If patient is leaking a clear fluid from vagina;
confirmation of ROM by using nitrazine paper and a positive ferning test.
vaginal exam is contraindicated after 37 weeks, to prevent infection;

Front 333

Short-term Variability (STV)
(how it is monitored)

Back 333

can be assessed only by using INTERNAL fetal monitoring and a pressure-sensing catheter that's placed inside the uterine cavity;

Front 334

Long-term Variability (LTV)
(how it is monitored)

Back 334

is obvserved with external and internal monitoring and shows the fluctuations in FHR of 6-10beats occuring 3-10 times per minute;

Front 335

Cause of Edema in
PIH

Back 335

d/t protein loss, sodium retention, and lower glomerular fitration rate (GFR);
causing fluid to move from intravascular space to extravascular spaces;

Front 336

Magnesium Sulfate
(proper administration when used to treat PIH)

Back 336

Loading dose of 4g bolus, followed by a continuous infusion of 1-2g/hour in D5W for maintenance;

Mg sulfate should NOT be given in NS (normal saline);

Front 337

D5W

Back 337

5g of Dextrose per 100mL of solution;

ISOTONIC;

Dextrose 5%

spares protein by providing carbohydrates for metabolism;

Front 338

If patient feels like they need to have a bowel movement in labor..

Back 338

Most likely d/t rectal pressure and indicates a low presenting fetal part, signaling imminent delivery;

perform a pelvic examination to assess station and cervical dilation;

Front 339

What does Magnesium Sulfate do in treating PIH?

Back 339

It is the drug of choice for PIH because:
1. it reduces edema by causing a shift from extracellular spaces into the intestines.
2. It depresses the CNS, which decreases the incidence of seizures;

Front 340

Terbutaline (brethine)

Back 340

Smooth-muscle relaxant;

relaxes the uterus, used to treat preterm labor

Front 341

Calcium Gluconate

Back 341

an antogonist for magnesium toxicity;

Front 342

Variable Decels

Back 342

common in labor when the membranes are ruptured, which decrease to protect the cord, as the fetus descends into the birth canal;

decels are d/t decreased protection of the cord (pressure on the cord);

Front 343

Calcium Gluconate

Back 343

an antogonist for magnesium toxicity;

Front 344

Dinoprostone
(prostin E2)

Back 344

vaginal suppository or gel;

used for cervical ripening;

Pt should be instructed to stay lying down for up to 2 hours;

can be used prior to induction of labor;

s/e: HA, n/v, fever (chills), diarrhea, and HTN

Front 345

Variable Decels

Back 345

common in labor when the membranes are ruptured, which decrease to protect the cord, as the fetus descends into the birth canal;

decels are d/t decreased protection of the cord (pressure on the cord);

Front 346

Characteristics of the First Stage of Labor
which is divided into latent and active states

Back 346

Progressive Cervical dilation and effacement, along with and Fetal Descent;

Front 347

Dinoprostone
(prostin E2)

Back 347

vaginal suppository or gel;

used for cervical ripening;

Pt should be instructed to stay lying down for up to 2 hours;

can be used prior to induction of labor;

s/e: HA, n/v, fever (chills), diarrhea, and HTN

Front 348

what to remember about lochia and the morning after childbirth

Back 348

Perineal pad may be saturated for many reasons, including that her pad may have not been changed all night, or that her lochia may have pooled during the night, resulting in a heavy flow in the morning;

vigorous massage of the fundus isn't recommended for heavy bleeding/hemorrhage;

Front 349

Characteristics of the First Stage of Labor
which is divided into latent and active states

Back 349

Progressive Cervical dilation and effacement, along with and Fetal Descent;

Front 350

what to remember about lochia and the morning after childbirth

Back 350

Perineal pad may be saturated for many reasons, including that her pad may have not been changed all night, or that her lochia may have pooled during the night, resulting in a heavy flow in the morning;

vigorous massage of the fundus isn't recommended for heavy bleeding/hemorrhage;

Front 351

Supplemental Feedings with Formula and its effect with on breast milk production

Back 351

supplementation may interfere with establishing an adequate milk volume because decreased stimulation of the mother's nipples affects hormonal levels and milk production;

Front 352

Conditions that could increase the severity of afterpains

Back 352

Multiple gestations
Breast feeding
multiparity
conditions that cause overdistention of the uterus (ex. Macrosomia)

Front 353

Heavy vs Excessive vs Moderate
bleeding (postpartum)

Back 353

Excessive - saturated pad in 15 minutes
Heavy - saturated pad in 1 hour
Moderate - saturated pad of area of 6 inches during 1 hour

Front 354

Lochia Serosa
(contents and onset/duration)

Back 354

old blood, serum, leukocytes, and tissue debris;

expected to last from day 3-10 postpartum

Front 355

Lochia Alba
(contents and onset/duration)

Back 355

leukocytes, decidua, epithelial cells, mucus, and bacteria;

from day 10 to 2-6 weeks postpartum;

Front 356

Lochia rubra
(contents, onset/duration)

Back 356

blood, decidua, and trophoblastic debris;

from day 1-4 post partum;

Front 357

Decidua

Back 357

endometrium;

uterine lining;

Front 358

Breastfeeding post-cesarean birth

Back 358

encourage the use of football hold position to avoid incisional discomfort;

initiate breast feeding ASAP;


Q2-4hr day and night to promote milk production (for any type of delivery)

Front 359

Transitional Milk

Back 359

comes after colostrum, and last usually for 2 weeks before changes into mature milk;

Front 360

Colostrum

Back 360

thin yellow fluid released by the breasts before and up to 2 weeks postpartum;

Front 361

Hind milk

Back 361

satisfies the infant's hunger and promotes weight gain;

arrives approximately 10 minutes after each feeding starts;

Front 362

Mature milk

Back 362

white and thinner than transitional milk;

is present after 2 weeks postpartum;

Front 363

Mastitis and its effect on breastfeeding

Back 363

client should be encouraged to continue breast-feeding while taking antibiotics for the infection;

Analgesics are safe and can be given when breastfeeding;

breastfeeding actually encourages resolution of the infection;

Front 364

Postpartum DEPRESSION

Back 364

occurs in about 10-15% of all women;

disabling feelings of inadequacy;
in ability to cope that can last up to 3 years;
client is often tearful and despondent;

Front 365

Postpartum Neurosis

Back 365

includes neurotic behavior during the initial 6 weeks after birth;

Front 366

Postpartum Psychosis

Back 366

hallucinations
delusions
phobias

Front 367

Late postpartum Hemorrhages (delayed, secondary)

Back 367

occur more than 24hrs but lesss than 6 weeks after delivery;

caused by retained products of conception or infection;


result of subinvolution of the uterus;

Front 368

Primary Postpartal Hemmorhage (early)

Back 368

occur less than 24 hours after delivery;

Front 369

Postpartum Rubella Vaccine
education

Back 369

client must not become pregnant for 2 to 3 months after the vaccination because of its potential teratogenic effects;

The virus doesnt enter the breastmilk, so breast-feeding is fine;

Transient arthralgia and rash are common adverse effects;

Front 370

Magnesium sulfates effect on
postpartum hemorrhage

Back 370

smooth muscle relaxant that can lead to uterine atony, which would INCREASE the risk for postpartum hemorrhage;

Front 371

For a patient with DM type 1,
is insulin increase or decrease needed immediately following birth? and why?

Back 371

DECREASE;

because the placenta produces hPL which acts as an insulin antagonist; After birth, the placenta, the major source of insulin resistance is gone.

Insulin need may be down to 1/2 or 2/3 the prenatal insulin dose;

Montior BG and adjust insulin as needed;

Front 372

"Taking-hold" Phase

Back 372

in which the new mother strives for independence and is eager for her neonate;

she appears interested in learning more about neonatal care;

Front 373

Urine Retention's effect on postpartum hemorrhage

Back 373

uterine retention causes a distended bladder which displaces the uterus above the umbilicus and to the side;

prevents the uterus from contracting --> uterine atony --> postpartum hemorrhages

Front 374

Urine Retention's effect on postpartum hemorrhage

Back 374

uterine retention causes a distended bladder which displaces the uterus above the umbilicus and to the side;

prevents the uterus from contracting --> uterine atony --> postpartum hemorrhages

Front 375

what percentage of postpartum clients experience "postpartum blues" ???

Back 375

50-80%

Front 376

what percentage of postpartum clients experience "postpartum blues" ???

Back 376

50-80%

Front 377

Normal expected findings in breast feeding mother's nipples/breast

Back 377

Tender, intact nipples (not cracked)
firm, nontender breasts (not engorged)

Front 378

Normal expected findings in breast feeding mother's nipples/breast

Back 378

Tender, intact nipples (not cracked)
firm, nontender breasts (not engorged)

Front 379

How many additional calories should a breast-feeding client consume to ensure high-quality breast milk??

Back 379

additional 500 calories/day

Front 380

How many additional calories should a breast-feeding client consume to ensure high-quality breast milk??

Back 380

additional 500 calories/day

Front 381

tissue debris and lochia

Back 381

normal lochia has no tissue debris or placental fragments;

Front 382

tissue debris and lochia

Back 382

normal lochia has no tissue debris or placental fragments;

Front 383

Ways to Reduce Risk of
SIDS
(education to parents)

Back 383

Back to sleep;
Never allow smoking around baby;
Firm, flat surface to sleep;
Remove all soft things such as: loose bedding, pillows, and stuffed toys from the sleep area;
Make sure baby doesnt get too hot;
keep baby's face and head uncovered during sleep;

Front 384

Wharton's Jelly

Back 384

A gelatinous substance within the umbilical cord, largely made up of mucopolysaccharides.

it insulates and protects the umbilical blood vessels;

when exposed to temperature changes, it collapses structures within the umbilical cord, thus providing a physiological clamping of the cord (about 5 mins after birth);

also is a major source of stem cell's which could be used as a source for adult stem cells;

Front 385

Gonorrhea Conjunctivitis
Treatment

Back 385

PCN G;

ceftriaxone(Rocephin) or Cefotaxime (Claforan) - cephalosporins if Resistant to PCN G;

Front 386

HSV (herpes II) Conjunctivitis
Treatment

Back 386

Topical and systemic antivirals;
Acyclovir (zovirax)
topical trifluridine (Viroptic) or Vidarabine (Vira-A)

Front 387

GTPAL

Back 387

Gravida=number of total pregnancies
Term= term deliveries
Preterm=preterm deliveries
Abortions= abortions (both surgical abortions and miscarriages)
Living= living children

Front 388

Balottement

Back 388

The use of a finger to push sharply against the uterus and detect the presence or position of a fetus by its return impact;

Front 389

Fetus vs Embryo
(when is it a fetus, when is it an embryo)

Back 389

2-8 weeks - Embryo;

child in utero after 8 weeks till birth;

Front 390

Quickening

Back 390

The initial motion of the fetus in the uterus as it is perceived or felt by the pregnant woman;

may feel like tapping or fluttering of a butterfly;

when the mother reaches the stage of pregnancy at which the child shows signs of life;

Front 391

Trophoblast

Back 391

the outer layer of the mass of cells of the fertilized ovum;

it establishes the nutrient relationship with the uterine endometrium (helps to form the placenta);

Front 392

Hyperemesis Gravidarum
(definition, mother/fetus effects)

Back 392

Severe form of morning sickness;
more common in multiple pregnancies and gestational trophoblastic disease (d/t increased hCG levels);

dehydration (ketosis,constipation)
Loss of 5% or more of pre-pregnancy weight;
LBW or SGA;
risk for preterm labor;

Front 393

Hyperemesis Gravidarum
Treatment

Back 393

Antiemetic medications (ondansetron(zofran), Promethazine(phenergan);
IV fluids (hydration)
enteral feeds (NGT) or Parenteral feeds (nutrition)
Bland diet (if antiemetics arent effective);
Ginger (CAM);
monitor E-lytes;

Front 394

AGA

Back 394

preterm appropriate for Gestational age

Front 395

Fertility Awareness Method
(what it is, and methods used)

Back 395

a collection of practices that help a woman know when she is most likely to get pregnant by learning when ovulation is coming by observing her own body and charting physical changes;

Used to avoid or encourage pregnancy;

this period is 2-3 days before and after expected ovulation day (either avoid or have intercourse depending if avoiding/encouraging pregnancy);

examples:
Calendar charting;
Cervical Mucus Monitoring;
Basal Body Temperature (BBT);
Cervical Observation;
Cycle beads;

Front 396

Calendar Charting for FAM

Back 396

for of Fertility Awareness Method (FAM);

calculates the average number of days in her cycle and estimates future fertile times;

keep track of menstrual cycle for 8-12 months. Pick the longest and shortest cycles, and subtract 18 from the length of the shortest cycle and note this as the first fertile day. Subtract 11 from the length of your longest cycle and this is the last fertile day;

Front 397

Cervical Mucus Monitoring
for FAM

Back 397

a method for Fertility Awareness Method of contraception/family planning;

"dry" days, wetness begins with sticky, cloudy, whitish, or yellow secretions;
"wettest" days, mucus is abundant, clear, very slippery and very stretchy (like egg whites);
ovulation occurs about 2 days before or after the peak day of stretchy fertile mucus;

pregnancy is more likely to occur day 10 to 20 in which are the Wet to wettest days;

days 1-9 and 21-30 are considered dry, unfertile days;

Front 398

Basal Body Temperature
(BBT) for FAM

Back 398

a method of Fertility Awareness Method of contraception/family planning;

take your temperature every morning immediately upon waking and before any activity;
use graph paper so you can see the rise and fall of temperature;

immediately before ovulation, temperature drops briefly;
Within 12 hours of ovulation the BBT rises and remains up until the next menstrual period;

When your temperature stays high for 3 days in a row, the fertile period is over and the safe infertile begins;

Front 399

Cervical Observation for FAM

Back 399

can be used as Fertility Awareness Method to avoid or encourage pregnancy;

during ovulation, the cervix is at its highest and most open;
after ovulation, the cervix returns to firm, low, and closed position;

insert your middle finger, and feel your cervix for softness, height, opening, and wetness;
check your cervix about the same time of the day, and in the same position (squatting, sitting on the toilet, or with one leg raised);

Front 400

Spinnbarkeit

Back 400

fibrosity;
a term which refers to the stringy and/or stretchy property to cervical mucus;

when cervical mucus is stretchy, and stringy, JUST PRIOR TO or DURING OVULATION;

Cervical mucus is somewhat like egg white;

This is the type at which sperm can penetrate the mucus (a fertile time);

Front 401

Nidation

Back 401

Implantation;

implantation of the early embryo in the uterine mucosa;

Front 402

ballotment

Back 402

opposite of engagement;

Baby is still floating around;

Front 403

Occiput Posterior Position
(good or bad?)

Back 403

malposition;

creates pressure on sacrum (back pain & pelvic pressure);

prolongs second stage of labor (delivery of baby);
may cause mother to beardown & push earlier than needed;

Front 404

Precocious Teeth

Back 404

teeth that are present at birth;

should be removed if loose (d/t aspiration risk);

Front 405

Ortolani Test
(ortolani's sign)

Back 405

physical examination for developmental hip dysplasia;

flexing the hips and knees of a supine infant to 90 degrees, then with your fingers placing anterior pressure on the greater trochanters, gently abducting the legs using your thumbs.

a "clunk" sound should be heard and felt as femoral heads relocates

Front 406

Barlow manuever

Back 406

ADDUCTING leg, to test for hip dysplasia;

Front 407

Normal BG for newborn

Back 407

40-60 (blood glucose)

Front 408

Puerperal Diuresis

Back 408

increase in urinary output (2000-3000mL of extracellular fluid) in early postpartum;

accounts for 5 lbs weight loss during early postpartum period;

Front 409

Homan's Sign

Back 409

check mother for DVT (deep vein thrombosis);

pain when dorsiflexion of patients foot, while knee is flexed 90 degrees - positive sign of DVT (not good);

Front 410

Menstruation Postpartally

Back 410

starts usually 6-8 weeks postpartum in NOT breast feeding;

will be heavier than normal, before returning to normal;

Front 411

Breast feeding Hormones

Back 411

Prolactin (anterior Pituatary): milk making hormone;

Oxytocin (posterior Pituatary): "let-down" or milk ejection reflex
stimulated by nipple stimulation, thoughts of baby, and orgasm;

Front 412

Bishop Score
(definition, what is assessed)

Back 412

pre-labor scoring system to assist in whether induction of labor will be required;

Cervical Dilation;
Cervical Effacement;
Cervical Consistency;
Cervical Position;
Fetal Station;

Front 413

External Cephalic Version

Back 413

a procedure used to turn a fetus into cephalic presentation;

used if in transverse lie or in breech presentation;

Front 414

Amnioinfusion

Back 414

volume of warmed, sterile, NS or RL is introduced into the uterus through the use of an IUPC;

to increased the volume of fluid during oligohydramnios;

relieves pressure on the umbilical cord and promoting increased perfusion to the fetus;

treatment for:
oligohydramnios
decels
meconium staining (dilution)

Front 415

Dependent Edema
in Pregnancy

Back 415

lower leg edema during 3rd trimester;

increase in femoral venous pressure as uterus puts pressure on return blood flow;

may have varicose veins;

Front 416

cause of N/V
in pregnancy

Back 416

elevated hCG levels;

Front 417

Human Placento Lactogen
(hPL)
in pregnancy

Back 417

produced by the placenta;

an antagonist to insulin, increasing the amount of circulating free fatty acids for maternal metabolic needs;

decreases maternal metabolism of glucose to favor fetal growth;

LESS glucose to mother, MORE for infant;

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Relaxin

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inhibits smooth muscle contractions of the uterus;

aids in softening the cervix;

produced by Corpus Luteum and Placenta;

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Couvade Syndrome

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describes the unintentional development of physical symptoms, such as fatigue, increased appetite, difficulty sleeping, headache, or back ache by the partner of the pregnant mother;

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Category A, B, C, D, and X
Medications in Pregnancy

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Category A - controlled studies in women show NO RISK to fetus;
Category B - controlled studies in animals show NO RISK to fetus, but have no women studies;
Category C - studies in animals show RISK, but no studies in women are available;
Category D - human studies show RISK TO FETUS;

Category X - demonstrated fetal risk does exist, but the benefits of the drug are thought outweigh any possible benifit;

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Biophysical Profile
(BPP)
and components (& scoring)

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5 component test: 4 US assessments and 1 NST;

1) NST (at least 2 accels in 30 mins)
2) Fetal breathing movements (at least one episode of > 30s or 20s in 30 minutes)
3) Fetal activity/gross body movements (atleast two movements of torso or limbs)
4) Fetal muscle tone (atleast one episode of active flexion and extension of the limb or trunk)
5) Qualitative AFV/AFI (at least one vertical pocket > 2 cm) (Amniotic Fluid Index);

Each Assessment is given a score of either 2 (normal) or 0 (abnormal);

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What do the Biophysical Profile scores mean?

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8-10 are normal, unless a decrease in amniotic fluid is noted;
Repeat testing is normally done weekly, but twice a week for diabetics;

4-6: suspicious for chronic asphyxia - Repeat testing done in 24 hours;

If repeated test is < 6, delivery is recommended;

0-2: strongly suspicious of chronic asphyxia - test time should be extended to 120 minutes.

A persistent score of < 4 indicates delivery