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90 Cards in this Set

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  • Back
When doing a vaginal exam and the nurse feels pulsating this is a sign of? What must the nurse do next?
This is sign of a prolapsed cord. The nurse must stay there until a cesarean section can be performed.
What is Occiput Posterior and what is management?
the babies head is down and faced towards the mothers stomach instead of towards her back.
Delivery is imminent when?
The mother says "the baby is coming", Pressure, or involuntary pushing or if you can see the babies head coming out of the vagina.
Shoulder dystocia is?
Impaction of anterior fetal shoulder within or above maternal pelvis after delivery of fetal head.
A medical emergency it is most common with with macrosomia, the babies shoulders can be crepatice.
PLACENTA ACCRETA is?
abnormal adherence to myometrium
Cervical Ripening is?
Process of effecting physical softening and distensibility of cervix
Labor Induction is?
Stimulation of uterine contractions before spontaneous onset of labor
Labor augmentation is?
Stimulation of ineffective uterine contractions after spontaneous onset of labor to manage dystocia
When do you hold Methylergonovine
?
BP of 140/90
What does the nurse do if the patients uterus is up and to the left?
Have the patient void or straight cath.
Women more at risk of compromise of a postpartum hemorrhage?
preeclampsia, anemia, dehydration, small suture.
PP Blues is?
Occurs in 50%-85% in women, occurs 3 - 4 days after birth, intervention is often not needed,
PP Depression is?
occurs in 10% - 20% in women, within 1 - 6 months after birth, intervention may be needed with antidepressant therapy and psychotherapy.
PP psychosis is?
1-2/1000 of women, occurs with first couple days, the patient can have hallucinations, delusions and phobias. Is a severe medical emergency that requires hospitalization
Physiologic Jaundice ?
developmental jaundice
Pathological jaundice is?
Occurs in the first 24hrs of life.
TORCH Infections?
Toxoplasmosis
Other (gonorrhea, syphilis, varicella, hepatitis, HIV)
Rubella
CMV
Herpes simplex virus
What is NEC?
Acute inflammatory disease of GI mucosa
Signs and Symptoms of NEC?
Decreased activity
Hypotonia
Recurrent apnea and bradycardia
Metabolic acidosis
Abdominal distention
Vomiting
Grossly bloody stools
Abdominal tenderness
Abdominal wall erythema
Postterm Infant: Meconium Aspiration Syndrome
Meconium stained fluid occurs in approximately 13% of all births
MAS incidence 5% of all infants born in meconium stained fluid
5-12% mortality rate
Postterm Infant: Meconium Aspiration Syndrome sign is?
Overdistended, barrel-shaped chest with increased AP diameter can develop hypoxia.
Infant Pain
Infants experience pain
Infants remember painful experiences
Infants show memory of pain by exhibiting defensive behaviors when painful procedures are repeated
Why do we give prostaglandin gel?
To ripen the cervix, especially at 42 weeks to prep for preop labor induction.
Which assessment is most relative to epidural narcotics?
respiratory rate
What is the advantage of a woman having an epidural during birth instead of general anesthesia?
the airway stays intact
What medication do you give pre-op to a woman having a c-section for her GI tract?
bicitra
What's the normal fetal heart rate?
110-160 bpm
If a pt. comes in at 42 weeks and the fetus has only moved 2 times in the last four hours, is this a concern?
Yes
What are some cues of a baby being overstimulated?
hiccups and bad tensing of body. If the baby is gazing at the caregiver, the baby isn't overstimulated.
If a baby has a heart rate of 80-90 bpm and an overdistended barrel shaped chest, this is a sign of what?
meconium aspiration syndrome
What should be part of the best reason to do a routine pain assessment on newborns?
newborns will remember painful experiences
If you have a baby that has low O2 saturation, what do you want to do?
auscultate the breath sounds. if you have an ET tube, assess patency or increase oxygen. Notify the physician.
If you have a baby that has a respiratory rate of 88 breaths/min, should you start a feed?
No, do not start a feed. Wait until respiratory rate is normal (40-60 breaths/min)
What is the normal blood sugar of a baby?
40-60mg/dL
What are some complications of a baby that was born at 42 weeks gestation?
dry cracked skin, meconium aspiration syndrome, hypoglycemia
what is the normal respiratory rate of the newborn?
40-60 breaths/min
How will labor be different if the baby is in occiput posterior (OP) position?
the patient will experience more back pain
If a pregnant woman has her water broken, what is the priority nursing assessment?
assess the FHR before and after
You are taking care of a patient that has been laboring for several hours and she is not progressing. She is 7cm, 0 station, and 100% effaced. She is having persistent late decels. The doctor says to begin pitocin augmentation, what is the nurses responsibility?
inform the physician you aren't going to start the pitocin and that he/she needs to come to the hospital. A c-section will most likely need to be done.
What does it mean when there is an impending delivery?
the baby is coming the patient says. DO NOT leave the room.
If a pt. is asked to sign a consent regarding the delivery, but doesn't understand, what should the nurse do?
Call the doctor and have them give more detailed information to the patient
What is considered full dilation?
10cc
What is the difference between true labor and false labor?
true labor brings about cervical dilation with progressive cervical change. False labor will show consistent contractions without cervical change.
What would be a good reason to discontinue pitocin?
uterine hyperstimulation
what would be considered another sign of true labor?
when the cervix is effacing and dilating
What do you want to assess before giving terbutaline to a 32 week pregnant woman?
assess maternal HR
What do you want to assess with the administration of methargen?
confirm BP
MgSO4 toxicity shows signs of:
absence of deep tendon reflexes, decreased respiratory rate
If a pregnant mom was involved in a motor vehicle accident, what will be done?
K-B assay Kleihauer test to rule out abruption, blood transfusion, Rh-, administer Rhogam, assess uterus for contractions
What is one important thing you want to do for a patient that is having a c-section?
give the proper teaching regarding c/s even if it is a repeat procedure. Ensure they understand pre and post op care and procedures.
What are important things to know about breech presentation?
more likely to have meconium stained fluid, preterm labor and birth, usually early rather than late
What is the purpose of giving bicitra?
to prevent chemical pneumonitis, which causes aspiration
What are the five P's?
Psyche- psychological response of mom to labor
Power- hyper/hypotonic uterine dysfunction and inadequate bearing down efforts
Passage- alterations in pelvic structure
Position- changes in position facilitate labor in a positive manner
Passenger- the baby and its presentation, size, anomalies, and multiples
What is a velamentous insertion?
complications of labor (variable decels, IUGR, fetal exsanguination)
cervical ripening is:
physical softening and distensibility of cervix
bishop's scoring system is used for:
to indicate the relative likelihood of an induction attempt being succesful
what are some cervical ripening mechanical methods?
laminaria tents, synthetic hygroscopic dilators, and balloon catheters
laminaria tents:
absorb cervical fluids and swell, causing mechanical dilation and prostaglandin release
How do laminaria tents and synthetic hygroscopic dilators (SHD) differ?
Both absorb cervical fluids causing the cervix to dilate and the release of prostaglandins. laminaria tents swell 2-3 times their original size, where SHDs swell 3-4 times their original size.
what are two types of synthetic hygroscopic dilators?
lamicel and dilapan
what are some pharmacologic agents used for cervical ripening?
cervidil PGE2, prostaglandin gel, and cytotec PGE1
what needs to be monitored with the use of prostaglandin gels?
FHR and uterine activity should be monitored for 30mins to 2 hrs
misoprostol should not be used:
patients who have had prior c/s or major uterine surgery
what are the two types of induction of labor?
stripping of membranes and amniotomy
Can a nurse perform an amniotomy?
no, not in scope of practice. Can apply FSE per AZ Nurse Practice Act
The only agent approved by the FDA for induction of labor with a living fetus?
oxytocin
oxytocin must be administered:
IV piggyback via infusion pump
During the active phase of labor, what would be considered adequate progress?
cervical dilation of 1cm/hr
what do you want to assess before any increase or decrease in oxytocin?
FHR; contraction frequency, duration, and intensity; uterine resting tone
oxytocin has what kind of effect when given in large doses?
antidiuretic; kidneys rebsorb water and urinary output is decreased
If uterine hyperstimulation occurs, what intervention should the nurse do?
remove prostaglandin or stop oxytocin, administer tocolytic, in-utero resuscitation prn
Regional anethetics can cause what kind of effect?
hypotension
general anesthesia is only used for:
emergency delivery or contraindication to regional anesthesia
what are the two types of operative vaginal delivery (OVD)?
vacuum and forceps
what is the most common complication with cesarean deliveries?
infection
what are the three types of incisions for c-sections?
classical, low classical, and low transverse
What should be assessed during post-op care of c-section?
pain; VS q10-15 mins for 1-2hrs; assess airway; assess fundus and incision
what is the normal cord length in-utero?
50-60cm
if a cord is too short, what is a possible complication?
placental abruption or uterine inversion
if the cord is too long, what is a possible complication?
true knots, prolapse of cord, or wrapping around baby
what are some pharmacologic agents used for cervical ripening?
cervidil PGE2, prostaglandin gel, and cytotec PGE1
what needs to be monitored with the use of prostaglandin gels?
FHR and uterine activity should be monitored for 30mins to 2 hrs
misoprostol should not be used:
patients who have had prior c/s or major uterine surgery
what are the two types of induction of labor?
stripping of membranes and amniotomy
Can a nurse perform an amniotomy?
no, not in scope of practice. Can apply FSE per AZ Nurse Practice Act
The only agent approved by the FDA for induction of labor with a living fetus?
oxytocin
oxytocin must be administered:
IV piggyback via infusion pump
During the active phase of labor, what would be considered adequate progress?
cervical dilation of 1cm/hr
what do you want to assess before any increase or decrease in oxytocin?
FHR; contraction frequency, duration, and intensity; uterine resting tone
oxytocin has what kind of effect when given in large doses?
antidiuretic; kidneys rebsorb water and urinary output is decreased