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25 Cards in this Set
- Front
- Back
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7 Steps in the nurse midwifery management process
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- Investigate- obtain data for complete evaluation
- Identify- problems/diagnoses/health care concerns based on data - Anticipate- other problems/diagnoses you expect based on primary diagnosis - Evaluate- need for intervention/consultation/collaboration with other HCPs - Develop- a plan of care (based on data) in collaboration with woman - Assume responsibility- for safe, effective implementation of plan - Evaluate effectiveness- of care; recycle through mgmnt process as appropriate |
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Types of speculums and what size should be used for what type of pt.
- Virginil - Pederson - Graves - Large Graves - Extra Large Graves |
- Virginal- young girls, women not sexually active
- Pederson- nullip, good tone, contracted vagina - Graves- multip, obese - Large graves- obese, poor tone, grand multip - Extra large graves- morbidly obese Insertion- warm, lubricate, place at angel, advance to hilt, turn and open slowly |
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Types of pelvis'
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- Gynecoid- optimal
- Android- small- may have difficulty progressing - Anthropoid- heart shape - deep- may have OP baby - Platypelloid- wide- may have delay at inlet |
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Explain procedure of pelvimetry, touching bone
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o Pubic arch (2-3 fingerbreadths)
o Curve of sidewalls (straight) o Shape of ischial spines (blunt/ flat) o Interspinous diameter (10cm) o Sacrospinous ligament and arch (2-3 fb; rounded arch) o Diagonal conjugate (>12cm) o Shape of sacrum (concave, parallel to symph pubis) o Coccyx (mobile) o Assess opposite sidewall o Ischial tuberosities- biischial diameter (>= 8cm) |
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Indications for microscopy
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nex sex partner or multiple partners
new OB Annual GYN excessive discharge friable cervix blood in urine sample |
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Diaphragm
3 advantages and disadvantages of contraindications reasons for method failure |
Barrier; use w/ spermacide
- positive- no systemic side effects; no hormone alteration; partner involvement not required; immediate action; some protection from STIs and cervical neoplasia - negative- may l/t irritation/discomfort, odor; latex allergy; vaginal/urinary infection; TSS (rare); perceived messiness; necessitates touching genitals; taste of spermicide; interruption of sex - contraindications- allergy to spermicide/latex; abnormal vaginal anatomy; active lesions; hx of TSS; repeated UTIs; need STI protection; lack of personnel to provide fit and teaching; inability of pt to master insertion - method failure- dislodged, improper position; no spermicide; inconsistent use |
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IUD
3 advantages and disadvantages |
Advantages
o IUDs do not interfere with lactation o Cost is less after 1yr o Ease of use o Immediately effective (if put in on menses) o Decreased risk of endometrial cancer o No systemic side effects Disadvantages o Increased risk of PID for 1st 20 days o Expulsions- 2-10% in 1st year; inc with prior expulsion o Perforation- d/t insertion; 1/1000 or less o Pregnancy complications- inc risk of early spont abortion if implantation while in place; remove if you see strings, but can remain in place throughout pregnancy |
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What is the primary mechanism of action for IUD
- Paragard - Mirena |
Paragard: spermicidal- decapitates sperm, induces phagocytic activity; does not work after fertilization
Mirena: progestin- slows egg and sperm, thickens cervical mucous, inhibits capacitation of sperm; thins endometrium, relaxation of uterus and tubes, inhibits ovulation |
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10 Contraindications for IUDs
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- Pregnancy
- Current PID - Cervical or uterine cancer - Uterine distortion - History of dysmenorrhea - History of menorrhagia/metrorrhagia (bleeding between periods)- paragard - Nulliparity - Previous problems with IUDs - History of severe vasovagal response - Copper allergy - At risk for STIs - Severe anemia (not Mirena) - Uterine size- mirena 6-10cm; paragard 6-9cm - Undiagnosed vaginal bleeding |
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Instructions for IUD follow up and care
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- Post procedure
o Information card with date of removal, teach to feel strings, tell her not to remove herself o Learn IUD warning signs • P regnancy- discuss changes in menses • A bdominal pain- pain with intercourse • I nfection exposure- STDs; s/s of infection • N ot feeling well, fever, chills • S trings missing, shorter or longer o Return visit in 2-8wks, check string o Understand STI risks, include partner if possible |
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7 things included in abdominal assessment of pregnant women
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35-42 wks- fundal ht, fetal lie, presentation, FHTs, position, EFW, growth, fetal movement awareness
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Approximate fundal height expected at various weeks of gestation
12 wks 16 wks 20 wks 24 wks 28 wks 36 wks |
- 12 wks- 1-2 cm above symph pubis
- 16 wks- midway between symph pubis and umbilicus - 20 wks- at umbilicus - 24 wks- 1-2 fingerbreadths above umbilicus - 28 wks- midway between umbilicus and xyphoid - 36 wks- 1 fingerbreadth below xyphoid |
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5 purposes for conducting abdominal palpation (Leopold's maneuvers)
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- Leopold’s maneuvers- lie, presentation, attitude, heart tones
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4 steps of Leopolds maneuvers
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1) What is in the fundus?
2) Where is the back? 3) What is in the pelvis? 4) What is fetal attitude? |
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Calculate EDD using Naegele's Rule
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LMP + 1 year, - 3 months, + 7 days =
Example: LMP = 8 May 2007 +1 year = 8 May 2008 -3 months = 8 February 2008 +7 days = 15 February 2008 |
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Instruments to detect fetal heart tones and at what weeks you can hear w/ them
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stethoscope (17-19wks);
fetoscope (18-20wks); Doppler (10-12wks); US (6wks) |
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Sinusoidal:
Reassuring? Assoc w/? |
variant pattern- smooth, sine wave; no beat to beat variability; assoc. with fetal anemia; nonreassuring; follow closely; may transfuse through umbilical cord
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Variability indicates the baby's abilty to respond to?
Moderate variability means that |
SNS/PNS signals
• Moderate- 6-25 bpm- excellent sign, means no acidosis |
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What might cause a decrease in variability?
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• Variability may be dec d/t hypoxia/acidosis; sleep cycles, drugs (esp stadol); congenital neuro anomalies
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What is the cause of an early decel?
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uterine contraction
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What is the cause of a late decel?
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hypoxia - sign of stress
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Interventions for late decels
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Interventions- consider cause of hypoxia to choose intervention
• Lateral positioning maximizes venous return and cardiac output • Oxygen 10L per face mask • Decrease, turn off pitocin • NS bolus if hypotensive |
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Variable Decelerations
Cause: Interventions: |
abrupt decrease taking <30sec
cause may be cord compression Interventions- position change- may try knee/chest position (inc venous return); amnioinfusion (rarely used, goal is to cushion the cord) |
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Prolonged Deceleration:
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decrease in FHR at least 15 bpm lasting 2-10min (>10min baseline change)
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Recurrent Deceleration:
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occurring with >50% of contractions in a 20 min period
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