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162 Cards in this Set
- Front
- Back
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what is the first infertility test done?
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semen analysis
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What does an infertility hormone analysis cover?
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prolacitn, FSH, LH, estradiol, progesterone, and thyroid hormones
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What does an endometrial biopsy do?
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evaluates endometrial response, secretory, and luteal phase of cycles
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What is a hysterosalpingography?
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outpatient radiology, dye is used to assess patency of fallopian tubes
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what is an ectopic pregnancy?
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ovum implants into fallopian tubes, needs to be surgically removed
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what are some presumptive signs of pregnancy?
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1. amenorrhea
2. fatigue 3. nausea and vomiting 4. urinary frequency 5. darkened areolae, enlarged breasts 6. quickening (fluttering movements of fetus during 16-20 weeks) |
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What are some probable signs of pregnancy?
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1. abdominal enlargement
2. hegar's sign 3. chadwick's sign 4. goodell's sign 5. ballottement 6. Braxton hicks contractions 7. positive pregnancy test 8. Fetal outline felt by examiner |
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What is hegar's sign?
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softening and compressibility of lower uterus
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What is chadwick's sign?
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deepened violet-bluish color of cervix and vaginal mucosa
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What is goodell's sign?
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softening of cervical tip
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what is ballottement?
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the rebound of an unengaged fetus
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What serum and urine tests can verify pregnancy?
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1. human chorionic gonadotropin (hCG) is produced from implantation to 10 days of growth
2. some meds can cause a false positive |
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What is the best pregnancy urine sample?
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first-voided morning specimens
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What is GTPAL?
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G = # of pregnancies
T = pregnancies to term P = preterm births A = abortions/miscarriages L = living children |
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What are the physiologic changes in pregnancy to the reproductive system?
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uterus increases in size, ovulation/menses cease
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What are the physiologic changes in pregnancy to the cardiovascular system?
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1. CO, HR, and blood volume increase (volume 40-50%)
2. S1 and S2 are more distinguishable, with S3 more easily heard after 20 weeks |
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What are the physiologic changes in pregnancy to the respiratory system?
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oxygen demands increase, size of chest enlarges, RR increases, lung capacity decreases
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What are the physiologic changes in pregnancy to the musculoskeletal system?
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Adjustment in posture to handle bodily changes
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What are the physiologic changes in pregnancy to the GI system?
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1. nausea and vomiting during first trimester
2. constipation can occur |
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What are the physiologic changes in pregnancy to the renal system?
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1. filtration rate increases from blood volume and metabolic demands
2. urinary frequency |
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What are the physiologic changes in pregnancy to the endocrine system?
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1. placenta becomes an endocrine organ
2. large amounts of hCG, progesterone, estrogen, human placental lactogen, and prostaglandins |
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What are some nursing interventions for a pregnant patient?
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1. patient education
2. discuss expected physiologic changes 3. assist client in goals for postpartum period 4. Encourage appointment keeping 5. call provider if there is bleeding, leakage of fluid, or contractions |
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What initial nursing assessment occurs in prenatal care?
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1. Reproductive and OB history
2. PMH, immune status 3. Family history 4. Recurring illness or infections 5. Current medications, substance abuse 6. Psychosocial history 7. lifestyle habits |
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When are prenatal visits scheduled for a normal pregnancy?
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monthly for 7 months, every 2 weeks during eight month, and weekly during last month
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What occurs at the first prenatal visit?
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1. estimate date of birth
2. obtain medical and nursing history 3. baseline vitals 4. pelvic examination 5. assess costovertebral angle tenderness for kidney infection |
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What occurs at all ongoing prenatal visits?
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1. monitor weight, BP, urinalysis for glucose, protein, and leukocytes
2. monitor for edema 3. monitor fetal development |
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When can FHR be heard?
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10-12 weeks
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when is fundal height measured?
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after 12 weeks gestation
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when is fetal movement assessed?
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16-20 weeks gestation
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What are some common discomforts and concerns with pregnancy?
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1. nausea and vomiting
2. fatigue 3. backache 4. varicosities 5. heartburn |
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What are some routine prenatal lab tests?
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1. Blood type, Rh factor, titers
2. CBC with differential, Hgb, Hct 3. Hgb electrophoresis for sickle cell and thalassemia 4. Rubella titer 5. Hepatitis B screen 6. Group B Streptococcus (GBS) |
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When is GBS screening done?
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35-37 weeks gestation
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what does a prenatal urinalysis screen for?
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pregnancy, diabetes, gestational hypertension, renal disease, infection
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When is a one-hour glucose test performed?
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1. 24-28 weeks for all women
2. initially for high-risk patients |
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what is the highest acceptable glucose value for a one-hour tolerance test?
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>140 mg/dl
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Which glucose tolerance test requires fasting?
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3 hr glucose tolerance
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how does a 3 hr glucose tolerance test work?
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1. fast over night
2. glucose sample taken at 1, 2, and 3rd hour 3. two elevated blood readings indicate diabetes |
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What is a prenatal PAP test for?
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screens for cervical cancer, herpes, and HPV
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what is a TORCH screening?
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1. toxoplasmosis
2. others 3. rubella 4. cytomegalovirus 5. herpes |
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What helps with comfort during vaginal examination?
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patient empties bladder and takes deep breaths
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When is RhO immune globulin administered to an Rh-negative patient?
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around 28 weeks gestation
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When should a patient be counting and recording fetal movements/kicks?
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1. daily
2. two to three times daily for 60 min each time |
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When is a lack of fetal movement a concern?
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less than 3 per hour or movements that cease entirely for 12 hrs
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When does urinary frequency occur and what can be done?
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1. first and third trimester
2. reduce fluids before bed, pee frequently, and use perineal pads 3. kegel exercises |
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How can UTIs be reduced during pregnancy?
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1. wipe front to back, avoid baths, cotton underpants, increase fluid intake
2. urinate before and after intercourse 3. urinate whenever an urge is felt 4. call doctor if urine is foul-smelling or appear cloudy |
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How is heartburn managed in pregnancy?
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1. Occurs in second and third trimester
2. frequent small meals 3. sitting up after meals 4. do not use OTC antacids without doctor permission |
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How can hemorrhoids be managed?
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1. Second and third trimester
2. warm sitz baths 3. witch hazel pads 4. application of topical ointments |
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What can be done to handle gingivitis and epistaxis?
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1. gentle teeth brushing
2. humidifiers 3. normal saline nose drops/spray |
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What are some danger signs during pregnancy?
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1. gush of fluid from vagina
2. vaginal bleeding 3. abdominal pain 4. changes in fetal activity 5. persistent vomiting 6. severe headaches 7. elevated temperature 8. dysuira 9. blurred vision 10. edema of face and hands 11. epigastric pain 12. flushed dry skin, fruity breath, rapid breathing increased thirst 13. clammy pale skin, weakness, termors, irritability |
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What is the recommended weight gain during pregnancy?
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1. 25-35 lbs overall
2. 1-2 kg during first trimester 3. 1 pound per week for last two trimesters |
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what are underweight women suggested to gain?
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28-40 pounds
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What are overweight women suggested to gain?
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15-25 pounds
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How many calories a day should be increased?
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1. +340 calories during second trimester
2. +452 calories during third trimester |
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how much fluids daily for a pregnant women?
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2-3 L a day
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what helps with nausea during pregnancy?
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1. crackers or toast
2. avoid alcohol, caffeine, fats, spices 3. drink fluids after meals 4. DO NOT TAKE MEDICATIONS to control nausea |
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What is maternal phenylketonuria?
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1. maternal genetic disease
2. high levels of phenylalanine 3. PKU diet 3 months prior to pregnancy 4. high protein foods avoided |
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Nursing teachings for ultrasound visit?
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1. drink 1-2 quarts of fluid prior to fill bladder and lift uterus
2. supine position with wedge to prevent supine hypotension |
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What is a biophysical profile?
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1. real-time ultrasound to visualize physical and physiological characteristics of the fetus
2. assesses well-being by following five variables (2 points each) |
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What are the 5 variables for a BPP?
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1. Reactive FHR
2. Fetal breathing movements at least 1 episode greater than 30 seconds duration in 30 min 3. Gross body movements (at least 3 body or limb extensions in 30 min) 4. Fetal tone (1 episode of extension with quick return to flexion) 5. Qualitative amniotic fluid volume (at least 1 pocket of fluid measuring at least 2 cm in 2 perpendicular planes) |
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How to interpret a BPP's findings?
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1. 8-10 is normal
2. 4-6 abnormal 3. <4 is very abnormal |
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What are some potential diagnoses from a BPP?
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1. nonreactive stress test
2. suspected oligohydramnios or polyhydramnios 3. suspected fetal hypoxemia or hypoxia |
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when is BPP indicated?
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1. PROM
2. maternal infection 3. Decreased fetal movement 4. Intrauterine growth restriction |
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What is a reactive Non-stress test?
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FHR is normal baseline rate with moderate variability accelerating to +15 beats/min for at least 15 seconds two or more times during a 20-min period
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What is a nipple-stimulated CST?
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1. a woman brushes her nipple lightly for 2 min, stimulating the pituitary gland to release oxytocin
2. she stops once she feels a contraction 3. FHR response determines how fetus will tolerate labor 4. three contractions of 40-60 seconds within a 10-minute time |
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What is a pitocin CST?
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1. same as nipple stimulation, used when nipples dont work
2. Can cause preterm labor |
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When is a CST indicated?
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1. non-reactive stress test
2. high risk pregnancies 3. decreased fetal movement 4. intrauterine growth restriction 5. postmaturity 6. diabetes 7. gestational hypertension 8. sickle cell disease |
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what is a negative CST?
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1. normal
2. 3 contractions in 10 minutes with no late decelerations |
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What is an amniocentesis?
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1. aspiration of amniotic fluid for analysis
2. performed after 14 weeks gestation |
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What are some indications for an amniocentesis?
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1. chromosomal anomaly
2. parents are genetic carriers 3. neural tube defects in PMH 4. lung maturity 5. fetal hemolytic disease 6. meconium in amniotic fluid |
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How does an amniocentesis interpret AFP?
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1. alpha-fetoprotein measured in weeks 16-18
2. helps diagnose neural tube defects or chromosomal disorders 3. High AFP = neural tube defects, anencephaly, spina bifida, or omphalocele 4. Low AFP = chromosomal disorders or gestational trophoblastic disease |
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How does an amniocentesis check for lung maturity?
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1. gestation <37 weeks
2. ROM 3. preterm labor 4. upcoming cesarean birth 5. L/S ration of 2:1 and presence of phosphatidylglycerol (PG) are good |
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What is a percutaneous umbilical blood sampling?
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1. most common test for fetal blood sampling and transfusion
2. fetoscope goes into amniotic sac and aspirates blood from umbilical cord |
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When is a PUBS indicated?
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1. Karyotyping malformed fetus
2. Fetal infections 3. altered acid-base balance of fetuses with IUGR |
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What is a chorionic villus sampling?
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1. assessment of a portion of a developing placenta
2. first trimester alternative to amniocentesis 3. 10-12 weeks gestation |
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what is a CVS indicated for?
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1. genetic chromosomal abnormality
2. cannot determine spina bifida or anencephaly |
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What are typical causes of vaginal bleeding during the first trimester?
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1. spontaneous abortion
2. ectopic pregnancy |
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What are some S&S of spontaneous abortion?
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vaginal bleeding, uterine cramping, and partial or complete explusion of products of conception
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what are some S&S of ectopic pregnancy?
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abrupt and unilateral lower quadrant abdominal pain with or without bleeding
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What is a common cause of bleeding during second trimester?
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Gestational trophoblastic disease
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What are some S&S of gestational trophoblastic disease?
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1. uterine size increase abnormally fast
2. high levels of hCG 3. nausea and increased emesis 4. no fetal presence 5. dark brown or red vaginal bleeding |
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What are some common causes of third trimester vaginal bleeding?
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1. Placenta previa
2. Abruptio placenta |
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What are the S&S of placenta previa?
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painless vaginal bleeding during third trimester
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what are some S&S of abruptio placenta?
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vaginal bleeding, sharp abdominal pain, tender rigid uterus during third trimester
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What are some signs of a spontaneous abortion?
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1. backache and abdominal tenderness
2. ROM, dilation of cervix 3. Fever 4. hemorrhage S&S such as hypotension and tachycardia |
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What are the types of spontaneous abortions?
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1. threatened
2. inevitable 3. incomplete 4. complete 5. missed 6. septic 7. recurrent |
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What are some S&S of ectopic pregnancy?
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1. stabbing pain and tenderness in lower-abdominal quadrant
2. delayed, lighter, or irregular menses 3. scant, red, or brown vaginal spotting 6-8 weeks after menses 4. faintness or dizziness 5. hemorrhage and shock signs |
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What can rule out an ectopic pregnancy?
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1. serum levels of progesterone
2. elevated hCG |
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Treatment of ectopic pregnancy?
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1. salpingosotmy to salvage fallopian tube
2. laparoscopic salpingectomy if tube has ruptured 3. medical management if tube has not ruptured, but needs to be salvaged |
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What medication is used for an ectopic pregnancy?
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Methotrexate; inhibits cell division and embryo enlargment
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Client education for methotrexate?
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no alcohol or vitamins with folic acid
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What is gestational trophoblastic disease (GTD)?
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poliferation and degeneration of trophoblastic villi in the placenta becoming swollen, fluid-filled, and makes a grape-like cluster
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What is a complete mole (GTD)?
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1. ovum has no genetic matieral
2. all genetic material is paternal 3. no placenta, hemorrhage in uterine cavity occurs |
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How many complete moles (GTD) progress to a choriocarcinoma?
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20%
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What is a partial mole?
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1. normal ovum fertilized by two sperm or one sperm with improper chromosome material
2. abnormal embryonic parts, amniotic sac, fetal blood, and congenital anomalies |
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What are the S&S of GTD?
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1. excessive vomiting
2. rapid uterine growth 3. bleeding is dark brown resembling prune juice or bright red 4. preeclampsia symptoms before 24 weeks 5. persistently high hCG instead of expected decline after weeks 10-12 |
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Diagnosis and treatment of GTD?
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1. dense growth with characteristic vessels on ultrasound
2. suction curettage aspirates the mole 3. serum hCG analysis weekly for 3 weeks, monthly up to a year |
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What is placenta previa?
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1. placenta abnormally implants in the lower segment of the uterus over the cervix instead of the fundus
2. causes bleeding during third trimester |
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What are the three types of placenta previa?
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1. complete/total = cerical opening completely covered
2. incompelte/partial = when the cervical os is only partially covered by placental attachment 3. Marginal/low-lying = palcenta is attached in lower uterine but does not reach opening |
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What are some S&S of placenta previa?
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1. painless, bright red vaginal bleeding in second or third trimester
2. uterus soft, relaxed 3. fundal height greater than expected 4. reassuring FHR 5. fetus in breech, oblique, or transverse position 6. Vital signs WNL |
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What is abruptio placenta?
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1. premature separation of placenta from wall of uterus
2. occurs after 20 weeks gestation 3. significant maternal and fetal morbidity 4. leading cause of maternal death |
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What is often associated with a moderate or severe abruption of placenta?
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a coagulation defect
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What are the S&S of abruptio placenta?
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1. sudden onset of intense localized uterine pain
2. dark red vaginal bleeding 3. contractions with hypertonicity 4. fetal distress 5. signs of hypovolemic shock 6. decreased Hct, Hgb, and coagulation factors |
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Nursing actions for abruptio placenta?
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1. assess FHR
2. administer fluids, blood products, medications 3. corticosteroids promote fetal lung maturity 4. oxygen 8-10L |
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What are some nursing care considerations for a patient with AIDS?
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1. encourage vaccinations
2. cesarean birth at 38 weeks if maternal viral load more than 1,000copies/ml 3. bath infant before mother contact |
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What medication used for prenatal AIDS patients?
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retrovir
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When is retrovir provided in OB?
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1. 14 weeks gestation
2. throughout pregnancy 3. before onset of birth |
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When is retrovir provided to the infant?
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delivery and 6 weeks following birth
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Should HIV mother breastfeed?
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No
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What are the TORCH infections?
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1. Toxoplasmosis
2. Other infections 3. Rubella 4. Cytomegalovirus 5. Herpes |
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What are the signs and symptoms of toxoplasmosis?
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flu symptoms, fever, tender lymph nodes
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What are the signs and symptoms of rubella?
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joint and muscle pain with flu symptoms, rash, fetal consequences
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What are the S&S of cytomegalovirus
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asymptomatic or mononucleosis-like
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What are the S&S of HSV?
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1. lesions and tender lymph nodes
2. fetal consequences like miscarriage, preterm labor, and intrauterine growth |
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What is a recurrent premature dilation of the cervix?
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1. variable condition
2. expulsion of products of conception occurs |
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what are some risk factors for premature dilation of cervix?
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1. cervical trauma, short labors, pregnancy loss
2. exposure to diethylstilbestrol 3. congenital suture defects of uterus or cervix |
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what are the S&S of premature dilation of cervix?
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1. increase in pelvic pressure or urge to push
2. pink-stained vaginal discharge 3. ROM 4. uterine contractions with expulsion of fetus |
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What are the risk factors of abruptio placenta?
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1. maternal hypertension
2. abdominal trauma from blunt force 3. cocaine use 4. cigarette smoking 5. premature rupture of membranes |
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What are the risk factors of placenta previa?
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1. uterine scaring
2. maternal age greater than 35 3. multiple gestations or closely spaced pregnancies 4. smoking |
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What are the risk factors for GTB?
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1. low carotene or animal fat intake
2. age (<18 or >40) 3. ovulation stimulation with clomid |
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What are the risk factors for ectopic pregnancy?
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anything that compromises tubal patency
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What is hyperemesis gravidarum?
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1. excessive nausea and vomiting during pregnancy past 12 weeks gestation
2. causes 5% loss of weight |
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What are some risk factors for hyperemesis gravidarum?
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1. younger than 20 years old
2. PMH of migraines 3. obesity 4. primigrava 5. GTB or chromosomal anomaly 6. transient hyperthyroidism |
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What are some S&S of hyperemesis gravidarum?
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1. excessive vomiting and diarrhea
2. dehydration and weight loss 3. high HR 4. decreased BP |
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What is the most important initial lab test for hyperemesis gravidarum?
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urinalysis for ketones and acetones (breakdown of proteins and fat)
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What are the nursing interventions for hyperemesis gravidarum?
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1. NPO for 24-48 hrs
2. IV fluids Ringer's 3. Vitamin B and other vitamins 4. Zofran and Raglan cautiously |
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What are some S&S of anemia?
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1. fatigue
2. sob on exertion 3. unusual food craving 4. pallor 5. low Hgb and Hct |
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What are the nursing interventions for anemia?
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1. prenatal supplements with iron
2. Ferrous sulfate twice daily 3. Supplements on an empty stomach 4. Vitamin C increases absorption |
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What are some dangers of gestational diabetes?
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1. spontaneous abortion
2. infections 3. hydramnios (PROM, overdistention, hemorrhage) 4. Ketoacidosis 5. hypoglycemia |
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What are some risk factors for gestational diabetes?
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1. obesity
2. family history of diabetes 3. Previous LGA birth |
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What are some S&S of gestational diabetes?
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1. hypoglycemia (nervousness, weakness, irritability, hunger, tingling)
2. hyperglycemia (thirst, nausea, abdominal pain, frequent peeing, fruity breath) 3. shaking |
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What medications can be used for hypoglycemia?
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1. most are contradindicated for gestational diabetes
2. some limited use of DiaBeta |
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What are some nursing education tips for gestational diabetes?
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1. daily kick counts
2. diet and exercise 3. self-administration of insulin |
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What is gestational hypertension?
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1. starts after 20th week of pregnancy
2. elevated blood pressure at least 140/90 twice, 4-6 hrs apart, in a 1 week period 3. no proteinuria |
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What is mild preeclampsia?
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GH with proteinuria greater than +1
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What is severe preeclampsia?
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1. blood pressure 160/100, proteinuria greater than +3
2. oliguria 3. elevated creatinine >1.2 4. cerebral disturbances 5. hyperreflexia 6. edema 7. epigastric and right upper-quadrant pain |
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What is exlampsia?
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1. severe preexclampsia with seizures or coma
2. predicated by headache, severe pain, hyperreflexia |
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What is HELLP syndrome?
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1. variant of GH
2. hematologic conditions coeexist with severe preeclampsia 3. hepatic dysfunction 4. diagnosed with tests, not clinically |
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What does HELLP stand for?
|
H = hemolysis causing anemia and jaundice
EL = elevated liver enzymes LP = low platelets |
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What does gestational hypertension put pregnancy at risk for?
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1. placental abruption
2. kidney failure 3. hepatic rupture 4. premature birth 5. fetal/maternal death |
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What meds should be avoided with gesational hypertensions?
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1. ACE inhibitors
2. angiotensin II blockers |
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What antihypertensive meds are used for gestational hypertension?
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1. aldomet
2. adalat, procardia 3. hydralazine 4. labetalol hydrochloride |
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What is magnesium sulfate used for gestational hypertension?
|
anticonvulsant medication
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What nursing considerations occur for gestational hypertension?
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1. magnesium may initially cause feelings of flush, heat, and sedation
2. fluid restrictions of 100-125ml.hr 3. urinary output 30ml/hr or greater 4. Monitor for magnesium toxicity |
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What are the signs of magnesium toxicity?
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1. absence of patellar deep tendon reflex
2. urine output <30ml/hr 3. RR less than 12 4. decreased LOC 5. cardiac dysrhythmias |
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What are the nursing interventions for magnesium toxicity?
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1. stop infusion
2. administer calcium gluconate 3. prepare for possible respiratory or cardiac arrest |
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What is preterm labor?
|
uterine contractions and cervical changes between 20-37 weeks of gestation
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What are some subjective signs of preterm labor?
|
1. persistent lower backache
2. pressure in pelvis and cramping 3. GI cramping, diarrhea 4. urinary frequency 5. vaginal discharge |
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What are some objective finding for preterm labor?
|
1. increase or change in vaginal discharge
2. cervical dilation 3. Regular uterine contractions every 10 min or greater 4. PROM |
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What helps diagnose preterm labor?
|
1. vaginal secretions for fetal fibronectin 24-34 weeks
2. Endocervical length (shortened can precede preterm) 3. cervical cultures for infection 4. BPP and/or nonstress test |
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What medications can be used for preterm labor?
|
1. Nifedipine
2. Mangesium sulfate 3. Indocin 4. Celestone |
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What is nifedipine used for?
|
1. calcium channel blocker
2. suppresses contractions 3. DO NOT GIVE WITH MAGNESIUM SULFATE |
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What is magnesium sulfate used for in preterm labor?
|
1. commonly used tocolytic that relaxes smooth muscle of uterus
2. risk for pulmonary edema |
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What are some contraindications for tocolytics?
|
1. vaginal bleeding
2. cervix dilation >6cm 3. chorioamnionitis 4. > 34 weeks gestation 5. fetal distress |
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What is indocin used for?
|
1. NSAID that suppressed preterm labor
2. blocks production of prostaglandins 3. suppressed uterine contractions |
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What is longest indomethacin treatment can run for?
|
48 hrs
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What is the gestational age limit for indomethacin?
|
32 weeks
|
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What is celestone?
|
1. glucocorticoid givin IM twice, 24 hrs apart
2. enhances fetal lung maturity and surfactant production |
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Nursing guidelines for celestone?
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1. IM 24-48 hrs before birth of neonate
2. monitor for pulmonary edema |
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What is PROM?
|
rupture of membranes 1 hr or more before onset of true labor
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What is PPROM?
|
PROM that occurs between 20-37 weeks
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What is the major risk for PROM and PPROM?
|
infection
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What are some S&S of PROM?
|
1. large gush or leakage of clear fluid
2. elevated temperature 3. foul-smelling fluid or vaginal discharge 4. abdominal tenderness |
