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446 Cards in this Set
- Front
- Back
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CHAPTER THREE
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(Ignore this card)
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List presumptive pregnancy signs
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amenorrhea, fatigue, N/V, Urinary frequency, breast changes, quickening, uterine enlargement, linea nigra, chloasma, striae gravidarum
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Quickening
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Slight fluttering movements of the fetus felt by a woman, usually between 16 to 20 weeks of gestation
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List probable pregnancy signs
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abdominal enlargement, cervical changes, Hegar's sign, Chadwick's sign, Goodell's sign, Ballottement, Braxton-Hicks contrations, positive pregnancy test, fetal outline felt by examiner
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List positive signs of pregnancy
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Fetal heart sound, visualization of fetus by U/S, fetal movement palpated by an experienced examiner
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McDonald's method
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Method of determining gestational age: measure uterine fundal height in cm from the symphysis pubis to the top of the uterine fundus (between 18-30 weeks gestation). The gestational age is equal to that of the fundal height.
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Parity
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number of pregnancies in which the fetus or fetuses reach viability (approx. 20-24 weeks or fetal wieght of 500g (2 lb))
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Does lung capacity increase or not during pregnancy?
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Decreases
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What happens to the amount of urine produced during pregnancy
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remains the same
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What happens to B/P during 1st trimester
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remains the same
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What happens to B/P during the 2nd trimester
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DBP and SBP decrease by 5-10
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What happens to B/P during the 3rd trimester
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Returns to prepregnancy baseline
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What happens to pulse during pregnancy
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increases 10-15 bpm around 20 weeks gestation
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What happens to respiration during pregnancy
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increase by 1-2 bpm
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When is S3 (heart sound) heard more easily?
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After 20 weeks gestation
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Uterine size changes from weight of 50 to 1000g
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(Please ignore this side of the card)
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The fundus reaches the xiphoid process by
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the 36th week
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CHAPTER FOUR
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(Ignore this card)
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A majority of birth defects occur between
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2 and 8 weeks gestation
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In an uneventful pregnancy, prenatal visits are scheduled
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every month for 7 months, every 2 weeks during the 8th month, and every week during the last month
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FHR can be heard by Doppler at
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10-12 weeks gestation
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FHR can be heard with U/S stethascope at
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16-20 weeks gestation
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Start measuring fundal height after
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12 weeks gestation
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Erythroblastosis fetalis
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Maternal-fetal blood incompatibility
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One-hour glucose tolerance test
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PO ingestion or IV administration of concentrated glucose with venous sample taken 1 hour later (fasting not required)
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When should the 1-hour GTT be performed?
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at initial visit for at-risk clients and at 24-28 weeks for all pregnant women
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Follow-up is required when the 1-hour GTT is above
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140 mg/dL
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Three-hour GTT
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fasting overnight prior to PO or IV intake of concentrated glucose with a venous sample taken 1, 2, and 3 hours later
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A diagnosis of GDM requires
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two elevated blood-glucose readings
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What does a PAP test screen for?
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cervical cancer, herpes simplex type 2, and/or HPV
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With a + PPD (purified protein derivative) test, what is the next step?
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chest screening after 20 weeks gestation
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VDRL or RPR tests for
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Syphilis
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TORCH screening
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tests for toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes virus
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ETOH during pregnancy results in
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birth defects
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tobacco during pregnancy results in
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LBW
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Fetal kick count should be performed
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2 or 3 times a day for 60 minutes each
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There should be how many fetal movements per hour?
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3
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To prevent N/V during pregnancy, what should the woman do?
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eat crackers or dry toast 0.5-1 hour before rising in the AM
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Avoid UTIs by wearing
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cotton underpants
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Avoid heartburn by
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sitting up for 30 minutes after meals
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Hemorrhoids may occur
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during the second and third trimesters
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Hemorrhoids can be treated with
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a warm sitz bath, witch hazel pads, and topical ointments
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Backaches can be treated with pelvic tilt exercises. What are these?
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alternately arching and straightening the back
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What is one method of treating shortness of breath and dyspnea?
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sleeping with extra pillows
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Leg cramps may occur
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During the third trimester
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What are the causes of leg cramps?
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compression of lower extremity nerves and blood vessels by the enlarging uterus, resulting in poor peripheral circulation as well as an imbalance in the calcium/phosphorus ratio
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What can be done to relieve leg cramps?
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massaging and applying heat over the affected muscle or a foot massage while the leg is extended
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Gingivitis, nasal stuffiness, and epistaxis can occur due to
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elevated estrogen levels causing an increased vascularity and proliferation of connective tissue
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Braxton Hicks contractions occur
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from the first trimester onwards
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Edema of the face and hands is a sign of
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PIH
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Epigastric pain is a sign of
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PIH
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Dick-Read Method
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refers to "childbirth without fear;" woman relaxes completely between contractions and keeps all muscles except the uterus relaxed during contractions
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Lamaze Method
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advocates a healthy, natural, and safe approach to pregnancy, childbirth, and early parenting
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Leboyer Method
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"birth without violence", environmental variables are stressed to ease the transition of the fetus from the uterus to the external environment.
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Water births are based on which method?
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Leboyer method
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Bradley Method
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stresses the partner's involvement as the birthing coach; woman deals with the stress of labor by tuning into her own body
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CHAPTER FIVE
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(Ignore this card)
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An increase of how many calories is needed during the second trimester?
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340
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An increase of how many calories is needed during the third trimester?
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452
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If the patient is breastfeeding, how many extra calories are needed in the first 6 mo PP?
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330
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If the patient is breastfeeding, how many extra calories are needed in the second 6 mo PP?
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400
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What foods are high in folic acid?
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leafy veges, dried peas and beans, seends, and OJ; breads, cereals, and other grains are fortified
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Pregnant women need to take how many mcg of folic acid?
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600
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Lactating women need to take how many mcg of folic acid?
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500
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When is iron best absorbed?
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between meals and when given with a good source of vitamin C
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What can interefere with iron absorption?
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milk and caffeine
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What are good food sources of iron?
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beef liver, red meats, fish, poultry, dried peas and beans, fortified cereals and breads
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Pregnant women and nonpregnant woman over age 19 need how much calcium?
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1000 mg/day
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Women under age 19 need how much calcium?
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1300 mg/day
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Caffeine intake should be limited to
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300 mg/day
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The equivalent of 500-750mL/day of coffee can increase the risk of
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spontaneous abortion or fetal IUGR
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Vegetarians are at risk for low
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protein, Ca, Fe, zinc, and vitamin B12
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It is important for women with PKU to resume the PKU diet for at least how many months before and during pregnancy?
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3 months before as well as throughout the entire pregnancy
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Foods high in phenylalanine levels which should be avoided in patients with PKU include
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foods high in protein: fish, poultry, meat, eggs, nuts, and dairy products
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CHAPTER SIX
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(Ignore this card)
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Placental grading
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evaluting the placental maturation
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How is placental grading performed?
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by U/S
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How much fluid should the woman drink before having an U/S
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1-2 quarts
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To prevent supine hypotensive syndrome, a wedge is placed under which hip?
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the right hip
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Describe the criteria for fetal breathing movements in a BPP
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at least 1 episode of 30 seconds in 30 minutes
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A BPP measures
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NST, fetal breathing movements, gross body movements, fetal tone, and AFV
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Describe the criteria for gross body movements in a BPP
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at least 3 body or limb extensions with return to flexion in 30 minutes
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Describe the criteria for fetal tone in a BPP
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at least 1 episode of extension with return to flexion
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Describe the criteria for AFV in a BPP
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at least 1 pocket of fluid that measures at least 1 cm in 2 perpendicular planes
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If an NST remains nonreactive, anticipate…
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a CST and/or BPP
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Disadvantages of an NST include
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high rate of false nonreactive results with the fetal movement response blunted by sleep cycles of the fetus, fetal immaturity, maternal medications, and chronic smoking
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Describe nipple stimulation in a CST
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brushing her palm across her nipple for 2-3 minutes, then stopping the stimulation when a contraction begins. The same process is repeated after a 5 minute period
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Describe the contraction pattern required for a CST
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at least 3 contractions within a 10-minute period with duration of 40-60 seconds each
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Hyperstimulation of the uterus with a CST is described as
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uterine contractions longer than 90 seconds or more frequent than every 2 minutes
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A negative CST is indicated if
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within 10 minutes, with three uterine contractions, there are no late decels
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How long after a CST should the patient to observed to ensure that contractions have ceased and preterm labor has not begun?
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30 minutes
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Amniocentesis may be performed
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after 14 weeks gestation
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AFP can be measured from amniotic fluid between
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16-18 weeks gestation
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High levels of AFP associated with
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NTDs or normal multifetal pregnancies
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Low levels of AFP associated with
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chromosomal disorders (Down syndrome) or gestational trophoblastic disease (hydatidiform mole)
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In most patients, a lecithin/sphingomyelin (L/S) ratio of what indicates fetal lung maturity?
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2:1
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In DM patients, an L/S ratio of what indicates fetal lung maturity?
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2.5:1 or 3:1
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Absence of phosphatidylglycerol is associated with
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respiratory distress (fetal lungs not mature)
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Kleihauer-Betke test is used to
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ensure that blood obtained is from fetus AND/OR to see if fetal blood is in maternal circulation
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Indirect Coombs' test is to determine
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Rh antibodies
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CVS can be performed
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at 10-12 weeks gestation
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Quad marker screening is done at
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15-20 weeks gestation
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Quad marker screening tests for
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hCG, AFP, estriol, and Inhibin-A
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hCG is a hormone produced by
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the placenta
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AFP is a protein produced by
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the fetus
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Estriol is a protein produced by
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the fetus and placenta
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Inhibin-A is a protein produced by
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the ovaries and placenta
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Down syndrome may be indicated if the level of estriol is
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lower than normal
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Down syndrome may be indicated if the levels of hCG and Inhibin-A are
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higher than normal
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CHAPTER SEVEN
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(Ignore this card)
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List risk factors of spontaneous abortion
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chromosomal abnormalities, maternal illness (such as DM type 1), advancing maternal age (AMA), premature cervical dilation, chronic maternal infections, maternal malnutrition, trauma or injury, anomalies in the fetus or placenta, substance abuse
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Backache may be a sign of
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spontaneous abortion
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Dilation and evacuation may be performed on a spontaneous abortion after how many weeks?
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16
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Threatened abortion
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No tissue is passed, spotting or moderate bleeding, possible slight cramps; cervical os is closed
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Inevitable abortion
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No tissue is passed, mild to severe bleeding, moderate cramps; cervix is dilated and membranes or tissues are bulging
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Incomplete abortion
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Some tissue is passed; severe cramps and severe, continuous bleeding; cervix is dilated
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Complete abortion
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Minimal bleeding and mild cramping; cervix is now closed but all tissue is passed
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Missed abortion
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brownish discharge and no tissue passed - prolonged retention of tissue
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Septic abortion
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Malodorous discharge
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Recurrent abortion
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usually dilated; tissue passed
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Nothing should be put into the vagina for how many weeks following spontaneous abortion?
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2 weeks
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The woman should avoid pregnancy for how many months following spontaneous abortion?
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2 months
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What is the second most frequent cause of bleeding in early pregnancy?
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Ectopic pregnancy
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Risk factors for ectopic pregnancy
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any factor that compromises tubal patency: PID, IUD
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What is a common symptom of ectopic pregnancy?
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referred shoulder pain from blood irritation of the diaphragm or phrenic nerve
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What happens to progesterone and hCG in an ectopic pregnancy?
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elevated levels
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Which drug causes evacuation of the uterine contents?
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methotrexate (MTX)
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The client who is prescribed methotrexate should avoid what to prevent a toxic response to the medication?
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ETOH and vitamins containing folic acid
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In the complete mole, all genetic material is
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paternally derived
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The complete mole contains no
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fetus, placenta, amniotic membranes, or fluid
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Describe genetic material in a partial mole
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ovum fertilized by two sperm OR one sperm in which meiosis or chromosome reduction and division did not occur
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A risk factor for hydatidiform mole is
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low protein intake
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elevated hCG levels in hydatidiform mole may cause
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hyperemesis gravidarum
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Molar pregnancy may cause vaginal bleeding when?
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16 weeks gestation
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PIH may occur after 20 weeks gestation. Symptoms of PIH before 20 weeks may indicate
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molar pregnancy
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What is the normal value of hCG in a molar pregnancy? What should it be?
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Molar: 1-2 million IU; Normal: 400,000 IU
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Analysis of serum hCG following molar pregnancy should occur…
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every 1-2 weeks until levels are normal, every 2-4 weeks for 6 months, and every 2 months for 1 year
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Complete or total placenta previa
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when the cervical os is completely covered by the placental attachment
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Incomplete or partial placenta previa
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when the cervical os is only partially covered by the placental attachment
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Marginal or low-lying placenta previa
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when the placenta is attached near but does not reach the cervical os
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Is placenta previa painful?
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No
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What occurs with the fundal height in placenta previa
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fundal height is greater than expected for gestational age
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List sesveral risk factors of abruptio placentae
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cocaine abuse resulting in vasoconstriction; cigarette smoking; PROM; short umbilical cord
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A board-like abdomen that is tender may indicate
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abruptio placentae
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A firm, rigid uterus with contractions (uterine hypertonicity) may indicate
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abruptio placentae
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Vasa previa
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presence of fetal blood vessels crossing the amniotic membranes over the cervical os
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Painless heavy bleeding following ROM may indicatae
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vasa previa
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Vasa previa is associated with fetal bradycardia
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(Please ignore this side of the card)
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CHAPTER EIGHT
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(Ignore this card)
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Procedures such as amniocentesis or episiotomy should be avoided with what infection?
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HIV
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Use of internal fetal monitors, vacuum extraction, and forceps should be avoided with what infection?
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HIV
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List some S/S of HIV/AIDS
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fatigue, diarrhea, weight losss, anemia
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Describe the medication used for HIV/AIDS
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Retrovir (Zidovudine) - an antiretrovial that is a nucleoside reverse transcriptase inhibitor
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Toxoplasmosis is caused by
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consumption of raw or undercooked meat or handling cat feces
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The S/S of toxoplasmosis are
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similar to influenza or lymphadenopathy; fever and tender lymph nodes
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Rubella is contracted when?
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through children who have rashes or neonates who are born to mothers who had rubella during pregnancy
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CMV is transmitted when?
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by droplet infection from person to person in body fluids. Viruses may be latent and may be reactivated
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HSV is spread by what?
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direct contact with oral or genital lesions
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Rubella causes what S/S?
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joint and muscle pain, rash, mild lymphedema, fever, miscarriage, congenital anomalies, fetal death
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CMV has what S/S?
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asymptomatic or mononucleosis-like symptoms
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Toxoplasmosis Tx is
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sulfonamides or a combination of pyrimethamine and sulfadiazine (potentially harmful to fetus, but parasite treatment is essential)
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Rubella vaccine is teratogenic!!!
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(Please ignore this side of the card)
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Effects of +GBBS include
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PROM, preterm labor and birth, chorioamnionitis, UTIs, and maternal sepsis
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Vaginal and rectal cultures for GBBS are done when?
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35-37 weeks
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What two meds are used for GBBS?
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penicillin G or ampicillin (Principen)
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Describe penicillin G administration for GBBS
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5 million U initially IV bolus, then 2.5 million U intermittent IV bolus every 4 hours
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Describe ampicillin administration for GBBS
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2g IV initially, followed by 1 g every 4 hours
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Most common STD
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Chlamydia
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Symptoms of chlamydia
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Commonly asymptomatic; vaginal spotting and vulvar itching; white, watery vaginal discharge
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Which women should be screened for STDs?
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All women and adolescents ages 20-25 who are sexually active
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After taking the prescribed regimen for chlamydia, women who are pregnant should be retested when?
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3 weeks after completing regimen
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What medications are used for chlamydia?
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Broad spectrum antibiotics: azithromycin (zithromax), amoxicillin (Amoxil), erythromycin (Ery-tab)
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Why is erythromycin (Romycin) given to neonates?
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for ophthalmia neonatorum, prophylactic against neisseria gonorrhoeae and chlamydia trachomatis
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Male S/S of gonorrhea
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urethral discharge, painful urination, frequency, PID, heart disease, arthritis
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Female S/S of gonorrhea
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lower abdominal pain; dysmenorrhea; urethral discharge; yellowish-greenish vaginal discharge; reddened vulva and vaginal walls; PID, heart disease, arthritis
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Which medications are given for gonorrhea
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ceftriaxone (Rocephin) IM or azithromycin (Zithromax) PO; broad-spectrum antibiotics; given for 7 days
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Risk factors for Candida albicans include
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DM or oral contraceptives
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What preps are used to identify candida albicans?
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wet preps; KOH (potassium hydroxide) preps
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S/S of candida albicans
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vulvar itching; thick, creamy, white vaginal discharge; vulvar redness; white patches on vaginal walls; tray-white patches on the tongue and gums (neonate)
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What medications are used to treat candida albicans?
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Antifungal agents: Fluconazole (Diflucan); OTC med is clotrimazole (Monistat)
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What should women not wear to avoid candida albicans?
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Tight-fitting clothing
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CHAPTER NINE
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(Ignore this card)
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Is incompetent cervix painful?
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NO - painless dilation
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Are uterine ctxs responsible for incompetent cervix?
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No - dilation without contractions
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When does incompetent cervix occur
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around 20 weeks
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What medication is a risk factor for incompetent cervix?
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DES
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A short cervix is defined as
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Less than 20 mm in length
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A cerclage is removed at
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37 weeks gestation
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What effect does dehydration have on uterine contractions?
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stimulates uterine contractions
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Hyperemesis gravidarum is related to
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elevated hCG
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N/V is prolonged past when in hyperemesis gravidarum?
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12 weeks gestation
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What does hyperemesis gravidarum do to weight?
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results in 5% weight loss from prepregnancy levels
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Hyperemesis gravidarum may result in
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IUGR or preterm birth
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Hyperemesis gravidarum is more likely if maternal age is
|
less than 20 y/o
|
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Is hyperemesis gravidarum related to gestational trophoblastic disease?
|
Yes
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What happens to Na, K, and Cl during hyperemesis gravidarum?
|
Decreased
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What happens to liver enzymes during hyperemesis gravidarum?
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increasaed
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During hyperemesis gravidarum, what does a thyroid test indicate?
|
hyperthyroidism
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What IV solution is given to the patient with hyperemesis gravidarum?/
|
Lactated Ringers
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Which vitamin is given to the patient with hyperemesis gravidarum?
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Vitamin B6 - pyridoxine
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Which antiemetics may be given to the patient with hyperemesis gravidarum?
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Promethazine (phenergan) and metoclopramide (Reglan)
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What is given to the patient with refractory hyperemesis gravidarum?
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Corticosteroids
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In severe cases or if N/V returns, what is done for the patient with hyperemesis gravidarum?
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tube feeding or TPN may be considered
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There is a risk for anemia if there were how many years between pregnancies?
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less than 2 years
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What physical assessment findings would be found in the patient with anemia?
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pallor, brittle nails, shortness of breath
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How is anemia treated prophylactically?
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60 mg of iron supplement
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What is used in the treatment of iron-deficiency anemia when PO supplements cannot be tolerated?
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iron dextran (imferon)
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Ideal blood glucose levels during pregnancy are
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70-110 mg/dL
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Are abortions related to GDM?
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Yes, spontaneous abortions are r/t poor glycemic control
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How are infections related to GDM?
|
related to increased glucose in the urine and decreased resistance because of altered carbohydrate metabolism
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GDM is more common in what age group
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Those over 25 y/o
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S/S of hypoglycemia
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nervousness, HA, weakness, irritability, hunger, blurred vision, tinging of mouth or extremities
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S/S of hyperglycemia
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thirst, nausea, abd pain, frequency, flushed dry skin, fruity breath
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Describe a Glucola Screening Test / 1-hour GTT
|
50 g oral glucose load followed by plasma glucose analysis 1 hour later performed at 24-28 weeks of gestation; 140 or greater indicates positive
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How much glucose is given with a three-hour GTT
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100 g
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Most PO hypoglycemic agents are contraindicated for GDM, but there is limited use of …
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glyburide (DiaBeta)
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GH
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gestational hypertension
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Describe GH
|
begins after 20th week, B/P is 140/90 or greater OR an SBP increase of 30 or DBP increase of 15 from prepregnancy baseline; returns to baseline by 12 wks PP
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Describe mild preeclampsia
|
GH with 1 or 2+ proteinuria and weight gain of more than 2 kg (4.4 lb) per week plus mild edema in upper extremities or face
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Describe severe preeclampsia
|
B/P that is 160/100 or greater; proteinuria of 3 or 4+, elevated serum creatinine greater than 1.2 mg/dL, HA and blurred vision, hyperreflexia with ankle clonus, pulmonary or cardiac involvement, extensive peripheral edema, RUQ pain, thrombocytopenia
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|
|
Is eclampsia usually preceded by hyperreflexia and hemoconcentration?
|
Yes
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|
|
In HELLP, 'low platelets' refers to how low?
|
< 100,000
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|
|
GH (PIH) may result in what
|
placental abruption, acute renal failure, hepatic rupture, preterm birth, and fetal and maternal death
|
|
|
DM is a risk factor for PIH
|
(Please ignore this side of the card)
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|
Rh incompatibility is a risk factor for PIH
|
(Please ignore this side of the card)
|
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|
Molar pregnancy is a risk factor for PIH
|
(Please ignore this side of the card)
|
|
|
Name some S/S of PIH
|
oliguria, scotoma, dyspnea, diminished breath sounds, jaundice, rapid weight gain of 2 kg(4.4 lb) per week in the second and third trimesters
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|
What happens to Hgb during PIH?
|
decreases
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|
What happens to bilirubin during PIH?
|
hyperbilirubinemia
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|
According to ATI, the client on MgSO4 should be on fluid restriction of what?
|
100-125 mL/hour
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|
|
The client on MgSO4 should have a urine output of
|
30 mL or greater per hour
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|
The client on MgSO4 should avoid what three foods?
|
high in Na, high in caffeine, ETOH
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|
Describe Class I heart disease
|
client exhibits no S/S with activity
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|
Describe Class II heart disease
|
client has S/S with ordinary exertion
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Describe Class III heart disease
|
client has S/S with minimal exertion
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|
|
Describe Class IV heart disease
|
client has S/S with rest
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|
|
What does the healthcare provider determine the client's classification of heart disease/.
|
At 3 and 7 months gestatoin
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|
|
The risk factors for heart disease includ3
|
preterm labor, miscarriage, and IUGR
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|
|
List three physical assessment findings for the patient with heart disease?
|
hemoptysis, IUGR, decreased amniotic fluid
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|
|
Holter monitoring is used…
|
on the patient with heart disease
|
|
|
Which vaccines should always be administered to clients with heart disease?
|
influenxa and pneumococcus vaccines
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|
|
List five medications used for heart disease
|
Propranolol (Inderal), gentamicin (Garamycin), Ampicillin (Polycillin), Heparin sodium, Digoxin (Lanoxin)
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|
Describe propranolol as a heart medicine
|
(Inderal) - a beta-blocker that is used to treat tachyarrhythmias and to lower maternal B/P
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|
Describe Gentamicin as a heart medicine
|
(Garamycin) - an aminoglycoside antibiotic that is used prophylactically to prevent endocarditis
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|
Describe Ampicillin as a heart medicine
|
(Polycillin) an antibiotic that is used prophylacticallly to prevent endocarditis
|
|
|
Describe heparin Na as a heart medicine
|
an anticoagulant for PE, DVT, cyanotic heart defects, and rheumatic heart disease
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|
|
Describe Digoxin as a heart medicine
|
(Lanoxin) - a cardiac glycoside that is used to increase CO during pregnancy, and may be prescribed if fetal tachycardia is present
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CHAPTER TEN
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(Ignore this card)
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|
|
Preterm labor is more likely in what age group?
|
below 17 or over 35
|
|
|
DM is a risk factor for Preterm labor
|
(Please ignore this side of the card)
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|
|
HTN is a risk factor for preterm labor
|
(Please ignore this side of the card)
|
|
|
What medication is a risk factor for preterm labor?
|
DES
|
|
|
DES exposure is now known to cause increased incidents of what in women who were exposed in utero?
|
vaginal clear cell carcinoma
|
|
|
Describe the uterine contractions that occur with preterm labor
|
regular, frequency of every 10 minutes or greater, lasting 1 hour or longer
|
|
|
HUAM
|
home uterine activity monitoring
|
|
|
Is HUAM considered to be effective in preventing preterm labor?
|
No
|
|
|
What does dehydration stimulate?
|
the pituitary gland to secrete an ADH and oxytocin
|
|
|
What is terbutaline (Brethine)
|
a beta-adrenergic agonist that relaxes uterine smooth muscle by stimulating beta-2 receptors in the smooth muscle fibers to inhibit uterine activity
|
|
|
Tocolytic therapy should be d/c-ed STAT if what occurs?
|
S/S of pulmonary edema, chest pain, SOB, respiratory distress, audible wheexing and crackles, productive cough containing blood-tinged sputum
|
|
|
The client on terbutaline (Brethine) should have her fluid restricted to what and why?
|
to 1,500-2,400 mL/24 hours to reduce the risk of pulmonary edema
|
|
|
When should you withhold terbutaline (Brethine)
|
maternal heart rate is 120-140/min OR if there is chest pain or cardiac arrhythmias
|
|
|
List S/S of MgSO4 toxicity
|
loss of DTR, urinary output less than 30 mL/hour, respiratory depression less than 12/minute, Pulmonary edema, and/or chest pain
|
|
|
List the contraindications for tocolytic therapy
|
active vaginal bleeding, dilation of the cervix greater than 6 cm, chorioamnionitis, greater than 34 weeks gestation, acute fetal distress, and severe PIH or eclampsia
|
|
|
Describe Indomethacin (Indocin)
|
an NSAID that suppresses preterm labor by blocking the production of prostaglandins, suppressing uterine contractions
|
|
|
Indomethacin Tx should not exceed how long?
|
48 hours
|
|
|
Indomethacin should only be used if gestational age is what
|
less than 32 weeks
|
|
|
Indomethacin may result in what
|
PP hemorrhage r/t reduced platelet aggregation
|
|
|
How should Indomethacin be administered?
|
with food or rectally to decrease GI distress
|
|
|
Describe the two tests which verify ROM?
|
(1) positive Nitrazine paper test - blue, pH 6.5-7.5, (2) positive ferning test
|
|
|
VS should be assessed when for the client with PROM or PPROM?
|
every 4 hours
|
|
|
The healthcare provider should be notified if maternal temperature is what?
|
38C/100F
|
|
|
Describe Ampicillin
|
(Omnipen), an antibiotic that treats infections
|
|
|
How should betamethasone be administered?
|
IM deep into the maternal gluteal muscle
|
|
|
CHAPTER ELEVEN
|
(Ignore this card)
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|
|
"nesting response"
|
the energy burst occurring before labor
|
|
|
describe the backache which may precede labor
|
a constat low, dull backache, caused by pelvic muscle relaxation
|
|
|
How much weight may be lost before labor
|
0.5-1 kg (1-3 lb)
|
|
|
Premonitory signs
|
signs preceding labor
|
|
|
Amniotic fluid volume should be
|
500-1200 mL
|
|
|
Nitrazine paper is used to test
|
the pH of amniotic fluid
|
|
|
When using nitrazine paper, what color indicates alkaline?
|
deep blue indicates 6.5-7.5
|
|
|
Describe transverse lie
|
fetal long axies (spine) is horizontal and forms a right angel to maternal axis; shoulder is the presenting part
|
|
|
Describe longitudinal lie
|
fetal long axis is parallel to maternal long axis; cephalic or breech presentation
|
|
|
M
|
Mentum
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|
|
Sc
|
scapula
|
|
|
true labor contractions are felt in
|
the lower back, radiating to the abdomen
|
|
|
false labor contractions are felt in
|
the lower back or abdomen above the umbilicus
|
|
|
In true labor, the cervix moves to what position?
|
Anterior
|
|
|
List the mechanisms of labor
|
engagement, descent, flexion, internal rotatoin, extension, external rotation/restitution, expulsion
|
|
|
REMEMBER TO REVIEW EACH OF THE MECHANISMS OF LABOR!!!
|
Important!
|
|
|
the first stage of labor lasts an average of
|
12 and 1/2 hours
|
|
|
The primigravid client should experience cervical dilation at an average rate of
|
1 cm/hour
|
|
|
The multigravid client should experience cervical dilation at an average rate of
|
1.5 cm/hour
|
|
|
The cervix goes from __ to __ in the latent phase, first stage
|
0-3 cm
|
|
|
The primigravid latent phase (first stage) lasts
|
6 hours
|
|
|
The multigravid latent phase (first stage) lasts
|
4 hours
|
|
|
first stage latent phase contraction frequency is
|
5-30 minutes
|
|
|
first stage latent phase contraction duration is
|
30-45 seconds
|
|
|
The cervix goes from __ to __ in the active phase, first stage
|
4-7 cm
|
|
|
The primigravid active phase (first stage) lasts
|
3 hours
|
|
|
The multigravid active phase (first stage) lasts
|
2 hours
|
|
|
first stage active phase contraction frequency is
|
3-5 minutes
|
|
|
first stage active phase contraction duration is
|
40-70 seconds
|
|
|
The cervix goes from __ to __ in the transition phase, first stage
|
8-10 cm
|
|
|
The primigravid transition phase (first stage) lasts
|
20-40 minutes
|
|
|
The multigravid active phase (first stage) lasts
|
20-40 minutes
|
|
|
first stage transition phase contraction frequency is
|
2-3 minutes
|
|
|
first stage transition phase contraction duration is
|
45-90 seconds
|
|
|
primigravid second stage duration
|
30-120 minutes
|
|
|
multigravid second stage duration
|
5-30 minutes
|
|
|
second stage contraction frequency
|
every 1-2 minutes
|
|
|
N/V may occur in which phase?
|
first stage transition phase
|
|
|
third stage duration
|
5-30 minutes
|
|
|
schultze mechanism
|
shiny fetal surface of the placenta emerges first
|
|
|
Duncan mechanism
|
dull maternal surface of the placenta emerges first
|
|
|
fourth stage duration
|
1-4 hours
|
|
|
the fourth stage ends with
|
maternal VSS
|
|
|
Assess maternal VS, fundus, and lochia how often in the first hour following birth
|
every 15 minutes
|
|
|
CHAPTER TWELVE
|
(Ignore this card)
|
|
|
First stage pain is
|
internal visceral pain
|
|
|
Second stage pain is
|
somatic pain
|
|
|
Third stage pain is
|
similar to the pain experienced during the first stage
|
|
|
When are sedatives effective
|
first stage latent phase
|
|
|
When is spinal block effective
|
second and third stages
|
|
|
When are opioids effective
|
first stage active phase
|
|
|
When is epidural effective
|
first stage active phase through third stage
|
|
|
When is pudendal nerve block effective
|
second and third stages
|
|
|
When is local infiltration pain relief effective
|
second and third stages
|
|
|
Before administering analgesics, the nurse needs to ensure that labor is progressing; this is done by performing a vaginal examination that reveals a cervical dilation of ___ cm with a fetus that is
|
4 cm; fetus engaged
|
|
|
Adverse effects of sedatives (3)
|
neonatal respiratory depression, unsteady maternal ambulation, inhibition of maternal ability to cope with pain
|
|
|
Examples of sedatives
|
secobarbital (Seconal), Pentobarbital (Nembutal), phenobarbital (Luminal)
|
|
|
Examples of opioid analgesics
|
meperidine hydrochloride (Demerol), fentanyl (Sublimaze), butorphanol (Stadol), and nalbuphine (Nubain)
|
|
|
Whenich route is recommended when giving opioid analgesics
|
IV route
|
|
|
which opioid analgesics provide pain relief without causing significant respiratory dpression - i.e., are agonist-antagonists?
|
Butorphanol (Stadol) and Nalbuphine (Nubain) - remember the ancient Roman stadium
|
|
|
opioid analgesic A. E.
|
potential neonatal respiratory depression, N/V, sedation, tachycardia, hypotension, decreased FHR variability, allergic reaction
|
|
|
Which drug counteracts the effects of respiratory depression in the newborn resulting from opioids
|
Naloxone (Narcan)
|
|
|
Which drugs can control anusea and anxiety but do not relieve pain and are used as an adjunct with opioids
|
phenothiazine medications
|
|
|
Examples of phenothiazine medications
|
promethazine (Phenergan) and hydroxyzine (Vistaril)
|
|
|
A. E. of phenothiazine medications
|
dry mouth, sedation - provide ice chips or mouth swabs
|
|
|
What analgesics are used for epidural or spinal regional analgesia
|
fentanyl (Sublimaze) and sufentanil (Sufenta)
|
|
|
A. E. of epidural and spinal anesthesia
|
N/V, inhibited bowel and bladder sensations, bradycardia or tachycardia, hypotension, respiratory depression, allergic reaction and pruritus
|
|
|
Examples of regional blocks
|
pudendal block, epidural block, spinal block, and paracervical nerve block
|
|
|
When is a pudendal block administered
|
second stage, 10-20 minutes before delivery
|
|
|
What medications may be used for a pudendal block
|
lidocaine (Xylocaine) or bupivacaine (Marcaine)
|
|
|
A. E. of pudendal block
|
broad ligament hematoma, compromise of maternal bearing down reflex
|
|
|
An epidural block consists of what medicationss
|
bupivacaine (Marcaine) along with an analgesic morphine (Duramorph) or fentanyl (Sublimaze)
|
|
|
an epidural block is injected at what level
|
4th or 5th vertebrae
|
|
|
When is an epidural block administed
|
active labor, first stage
|
|
|
A. E. of epidural block
|
maternal hypotension, fetal bradycardia, inability to feel the urge to void, loss of the bearing down reflex
|
|
|
spinal block is injected into what space
|
subarachnoid space at 3rd, 4th, or 5th lumbar interspace
|
|
|
the spinal block eliminates all sensations from the level of
|
nipples to toes
|
|
|
low spinal block may be used for
|
vaginal birth but not labor
|
|
|
spinal block is administered in the
|
late second stage or before C-section
|
|
|
When administering general anesthesia, which medications should also be administered
|
H2 receptor blocker such as ranitidine (Zantac) to decrease gastric acid production; metoclopramide (Reglan) to increase gastric emptying; short-acting barbiturate such as thiopental sodium (Pentothal) to render the client unconscious; succinylcholine chloride (Anectine), a muscle relaxant to facilitate passage of endotracheal tube
|
|
|
CHAPTER THIRTEEN
|
(Ignore this card)
|
|
|
What should the patient do before Leopold's maneuvers?
|
empty the bladder
|
|
|
How often should IA be performed on low-risk women during latent phase
|
every 60 minutes
|
|
|
How often should IA be performed on low-risk women during active phase
|
every 30 minutes
|
|
|
How often should IA be performed on low-risk women during second stage
|
every 15 minutes
|
|
|
How often should IA be performed on high-risk women during latent phase
|
every 30 minutes
|
|
|
How often should IA be performed on high-risk women during active phase
|
every 15 minutes
|
|
|
How often should IA be performed on high-risk women during second stage
|
every 5 minutes
|
|
|
IA should be performed following expulsion of an enema, if IA is used
|
(Please ignore this side of the card)
|
|
|
When using IA, how long should you count the FHR and how long should you listen after a ctx?
|
FHR for 30-60 seconds; auscultate ctx and followinng 30 seconds
|
|
|
Normal FHR accels should return to baselin in less than
|
2 minutes
|
|
|
Fetal bradycardia may be caused by
|
uteroplacental insufficiency, umbilical cord prolapse, maternal hypotension
|
|
|
Fetal tachycardia may be caused by
|
maternal infection, fetal anemia, fetal heart failure, fetal cardiac dysrhythmias, use of cocaine or meth, maternal dehydration
|
|
|
Decrease or loss of FHR variability may be caused by
|
meds that depress the CNS, fetal hypoxemia with resulting acidosis, fetal sleep cycle, congenital abnormality
|
|
|
How do you resond to decreased FHR variability
|
stimulate fetal scalp, position in left-lateral position.
|
|
|
Average IUPC pressure is
|
50-85 mm Hg
|
|
|
What will happen to pH in fetal hypoxia
|
will decrease
|
|
|
normal fetal scalp pH is
|
7.25
|
|
|
fetal scalp blood pH of < 7.20 indicates
|
fetal distress
|
|
|
FSpO2
|
fetal oxygen saturation
|
|
|
The infant must be how old to use FSpO2
|
36 weeks gestation
|
|
|
The cervix must be dilated to at least what to use FSpO2
|
2 cm
|
|
|
The fetal station must be at least what to use FSpO2
|
-2
|
|
|
Normal FSpO2 is
|
30-70%
|
|
|
CHAPTER FOURTEEN
|
(Ignore this card)
|
|
|
How often should VS be taken in the latent phase
|
every 30-60 minutes
|
|
|
How often should VS be taken in the active phase
|
every 30 minutes
|
|
|
How often should VS be taken in the transition phase
|
every 15-30 minutes
|
|
|
Assess temperature how often during labor
|
every 4 hours
|
|
|
How often should contractions be monitored in the latent phase
|
every 30-60 minutes
|
|
|
How often should contractions be monitored in the active phase
|
every 15-30 minutes
|
|
|
How often should contractions be monitored in the transition phase
|
every 10-15 minutes
|
|
|
How often should FHR be monitored in the latent phase
|
every 30-60 minutes
|
|
|
How often should FHR be monitored in the active phase
|
every 15-30 minutes
|
|
|
How often should FHR be monitored in the transition phase
|
every 15-30 minutes
|
|
|
Encourage voiding every ___ during labor
|
2 hours
|
|
|
How often should VS be taken in the second stage
|
every 5-30 minutes
|
|
|
How often should FHR be monitroed in the second stage
|
every 15 minutes and STAT after birth
|
|
|
first degree laceratoin
|
extends through skin of perineum and does not involve the muscles
|
|
|
second degree laceration
|
extends through skin and muscles of perineum
|
|
|
third degree laceration
|
extends through skin, muscles, perineum, and anal sphincter
|
|
|
fourth degree laceration
|
extends through skin, muscles, perineum, anal sphincter, and anterior rectal wall
|
|
|
During the third stage, gently cleanse the vulvar area with what
|
warm water or 0.9% sodium chloride, then apply perineal pad or ice pack
|
|
|
CHAPTER FIFTEEN
|
(Ignore this card)
|
|
|
What is ECV
|
External Cephalic Version - attempt to manipulate the abdominal wall to direct a malpositioned fetus into a normal vertex cephalic presentation
|
|
|
When should ECV be performed?
|
after 37 weeks gestation
|
|
|
ECV caries a high risk of
|
prolapsed cord
|
|
|
Contraindications to ECV include
|
uterine anomalies, previous C-section, cephalopelvic disproportion, placenta previa, multifetal gestatoin, and/or oligohydramnios
|
|
|
What mother needs to take RhoGAM at 28 weeks?
|
the Rh-negative mother
|
|
|
Bishop Score
|
used to determine the maternal readiness for labor by evaluating if the cervix is favorable
|
|
|
What is rated on the Bishop score?
|
cervical dilation, effacement, consistency, position, and presenting part station
|
|
|
How does the Bishop Score work
|
the five factors are assigned a numerical value of 0 to 3, the total score is calculated, and a score is assigned
|
|
|
ON the bishop score, what number do nulliparas need to indicate readiness for labor?
|
9
|
|
|
ON the bishop score, what number do multiparas need to indicate readiness for labor?
|
5 or more
|
|
|
What does cervical ripening do to the dosage of oxytocin needed for induction
|
lowers the dosage needed
|
|
|
Give three examples of prostaglandin gel used to ripen the cervix
|
Cytotec, Cervidil, Prepidil
|
|
|
What are prostaglandin gels used for
|
Ripen the cervix
|
|
|
Can balloon catheters be used to ripen the cervix
|
Yes - inserted into the intracervical canal
|
|
|
How do hydroscopic dilators and sponges ripen the cervix
|
absorb fluid from the surroudning tissues and then enlarge
|
|
|
What cervical ripening method is made from dessicated seaweed
|
laminaria tents
|
|
|
Synthetic dilators and sponges which ripen the cervix contain what
|
Magnesium sulfate (lamicel)
|
|
|
When are synthetic dilators and sponges used, and what do they do
|
They ripen the cervix, used before ROM
|
|
|
How do synthetic dilators and sponges ripen the cervix
|
absorb fluid and expand causing cervical dilation
|
|
|
When cervical ripening is performed, hyperstimulation of the uterus may occur. What is the Tx?
|
administer terbutaline (Brethine) sub-Q
|
|
|
If there is fetal distress and the mother is placed laterally, which side should she be on?
|
left side
|
|
|
Labor should be induced with what maternal medication complications?
|
Rh-isoimmunization; DM; pulmonary disease; PIH
|
|
|
Should labor be induced with fetal demise or with chorioamnionitis?
|
With both
|
|
|
When inducing labor, the nurse may initiate oxytocin how long after the administration of prostaglandin
|
6-12 hours
|
|
|
What must the nurse ensure has happened before the administration of oxytocin
|
ensure that the fetus is engaged at a minimum station of 0
|
|
|
When administering oxytocin via piggyback, which infusion port should be used
|
the one closest to the client
|
|
|
What should uterine resting tone be
|
10-15 mm Hg
|
|
|
there is a problem if uterine contraction frequency is more often than every
|
2 minutes
|
|
|
There is a problem if uterine contraction duration is longer than
|
90 seconds
|
|
|
There is a problem if uterine contraction intensity is greater than
|
90 mm Hg
|
|
|
If a nonreassuring FHR is noted, the IV fluid rate may be increased up to
|
200 mL/hour
|
|
|
When inducing labor and noting a nonreassuring FHR, describe the medicataion to be administeed
|
tocolytic terbutaline (Brethine) 0.25 mg Sub-Q to diminish uterine activity
|
|
|
Augmentation of labor
|
the stimulation of hypotonic contractions once labor has spontaneously begun, but progress is inadequate
|
|
|
What instrument is used to perform an Amniotomy
|
Amnihook
|
|
|
Labor typically begins within how many hours of ROM?
|
12 hours
|
|
|
There is an increased risk of what with ROM?
|
cord prolapse
|
|
|
In order to reduce the risk of infection or malposition of fetus following AROM, what should be limited?
|
maternal activity
|
|
|
When an amnioinfusion is performed, what is instilled and how?
|
0.9% sodium chloride or LR solution thorugh a transcervical catheter
|
|
|
In a vacuum-assisted delivery, when is the vacuum released and removed?
|
preceding delivery of the fetal body but after the delivery of the head
|
|
|
What position is the mother in during a vacuum-assisted delivery
|
lithotomy
|
|
|
What neonatal S/S is a normal occurrence with a vacuum-assisted delivery?
|
caput succedaneum
|
|
|
How long does it take for caput to resolve?
|
24 hours
|
|
|
Is an episiotomy used to prevent cerebral hemorrhage?
|
Yes, in a fragile preterm infant
|
|
|
Which type of episiotomy is easier to repair?
|
midline (Median)
|
|
|
Which type of episiotomy is associated with lower blood loss
|
midline (Median)
|
|
|
Which type of episiotomy is associated with a higher incidence of 3rd and 4th degree lacerations
|
midline (Median)
|
|
|
Which type of episitiomy is sometimes associted with 3rd degree lacerations
|
mediolateral
|
|
|
A tender uterus and foul-smelling lochia may indicate
|
endometritis
|
