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382 Cards in this Set
- Front
- Back
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What is the antidote for Magnesium Sulfate?
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Calicum Gluconate
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What does magnesium sulfate for?
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Controls Seizures in severe pre-clampsia and also prevention of uterine contractions in pre-term labor
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Some things you have to observe for when adminstering Magnesium Sulfate are:
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Toxicity
Magnesium Levels Respiratory Depression Loss of Reflexes Circulatory Collapse Muscle Weakness Over Sedation and Confusion Extreme Thirst Hypotension |
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What is the last reflex to go when about to have a seizure?
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Knee-Jerk Reflex
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If a person has any of the below symptoms, do not adminster ______________:
myocardial damage heart block myasthenia gravis impaired renal function |
Magnesium Sulfate
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Some symptoms of Magnesium toxicity are:
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Thirst
Mental Confusion Decrease in reflexes |
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What are these signs the result of:
Flushing sweating hypotension depressed deep tendon reflex CNS depression Respiratory Depression |
Magnesium Overdose
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What do you assess closely during adminstration of Magnesium Sulfate?
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Blood Pressure Closely
Respiratory Rate of at least 12 breaths per minute Presence of Deep tendon Reflexes Urinary Output greater than 30ml/hr |
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What should be kept in the magnesium Sulfate?
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Resuscitation Equipment
Calicum Gluconate Syringes and Needles |
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Abortion is
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Spontaneous of elective ending of pregnancy before the pregnancy reaches states legal limit
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Antiphospholipid Antibodies:
associated with Recurrent spontaneous abortion, fetal loss and severe pregnancy induced hypertension |
autoimmune antibodies directed against phosphoplipid in cell membranes
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Bicornate Uterus
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Malformed uterus having 2 horns
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Caudal Regression Syndrome
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malformation that results when sacrum, l-spine, and lower extremeties fail to develop
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Cerclage
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encircling of the cervix with suture to prevent spontaneous abortion caused by early cervical dilation
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Dystocia
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difficult or prolonged labor, often associated with abnormal uterine activity and cephalopelvic disproportion
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Euglycemiaational trophoblastic tumors
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Normal blood glucose level
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Gestational Trophoblastic disease
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disease that include benign hydatidiform mole and gest
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Hydraminos
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excess amount of amniotic fluid
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Hypovolemic shock
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acute peripheral circulatory failure caused by loss of circulating blood volume
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Kernicterus
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Staining of brain tissue caused by accummulation of unconjugated bilirubin in the brain.
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Lipogenic Substance
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stimulates the production of fat...ex:insulin
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Maceration
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discoloration and softening of tissues and eventual disintergration of a fetus retained in the uterus after its death
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Marfan Syndrome
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a hereditary condition that involves weakness in connective tissue, bones and muscles.
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Seroconversion
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change in a blood test result from negative to positive, indicating the development of antibodies in response to infection or immunization
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Vacuum Curettage
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Removal of the uterine contents by application of a vacuum through a hollow curette or canula introduced into the uterus
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Spontaneous Abortion
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Termination of a pregnancy without action taken by the woman or any other person
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Incidence of spontaneous abortion increases with
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Parental Age
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Most spontaneous abortions occur if the first ______ weeks of pregnancy
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12 weeks
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6 Types of spontaneous abortion
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Threatened
Inevitable Incomplete Complete Missed Recurrent |
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First sign of threatened abortion is
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Vaginal Bleeding
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Vaginal Bleeding, uterine cramping, persistent backache, or feelings of pelvic pressure are sign of possible
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loss of pregnancy
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Bleeding in 1st half of pregnancy are considered a
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threatened abortion
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Fever or Uretrine Tenderness suggest
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infection
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Woman may be adivised to lay off sex for ___ weeks after vaginal bleeding has ceased
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2
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If the woman has a foul smelling drainage, it suggests
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Infection
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You should always instruct the patient to keep all ________ pads and count number used. She should also note the ______ and ______ of the blood on the pads
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Peripads
Quantity and Color |
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Inevitable abortion is when the
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membranes rupture and the cervix dilates
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If tissue remains or if bleeding is excessive in an inevitable abortion a ______ procedure may be needed
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D&C
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Incomplete Abortion is when some but not all of the products of __________ are expelled from the uterus
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conception
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Major manifestations of Incomplete abortion are ________ bleeding and severe abdominal __________
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Active Uterine Bleeding and cramping
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Products of conception during a incomplete abortion may still remain in the ________ because of their small size
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Vagina
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When treating someone who we think is having a spontaneous abortion we should
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Monitor BP and pulse frequently
Observe for signs of shock including pallor, clammy skin, perspiration, dyspnea or restlessness Count and weigh pads Give Rhogam to Rh-cl within 72hrs |
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If pregnancy is 12 weeks gestation of beyond, assess fetal heart tones with a
(Spont Ab.) |
Doppler
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Collect and organize all data including
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antepartal history
onset of bleeding episode lab studies |
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Some complications of abortion are
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hemorrhage
infection septic abortion isoimmunization powerlessness/feeling of failure |
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About 50% of spontaneous abortions result from chromosomal ___________ in the embryo or fetus
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Abnormalities
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Some other factors that may result in spontaneous abortion is:
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Infections; herpes, syphillis and Strep B
Progesterone Deficiency Auto Immune Factors Drugs and envirnomental chemicals; chemo, cigarettes, alcohol, cocaine, organic solvents |
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In spontaneous abortion the _____ an infection is treated the __________
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Early
Better |
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What is the classic symptom of spontaneous abortions?
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Vaginal Bleeding
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When a women is bleeding vaginally, the nurse should ask a series of questions including:
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How many weeks pregnant?
Was tissue or amnoitic fluid discharged? What other symptoms are you having? Any cramping? Are they sad or frightenend? |
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Implantation of a fertalizied ovum outside of the uterus
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Ectopic Pregnancy
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When does ectopic pregnancies occur?
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1st trimester
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Where is the most common site for implantation in ectopic pregnancy?
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Fallopean Tubes
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If the fallopian tube has become narrowed by scarring or adhesions, ascending infections, PID, use of IUD's or tubel sx you would have an increased risk for
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Ectopic Pregnancy
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What is the clinical presentation for an ectopic pregnancy?
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Unilateral Lower Abdominal Pain, slowly increasing or sudden and severe abdominal rigidity and referred r shoulder pain
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If the fallopean tube has ruptured, sign of __________ shock and possible __________ bleeding may occur
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Hypovlemic
irregular |
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What lab tests conferm pregnancy?
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B-hCG
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What kind of test confirms an extrauterine pregnancy?
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ultrasound
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What are some therapeutic nursing management for ectopic pregnancy?
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Monitor Vitals
Start IV fluids Provide O2 Medicate for pain as ordered Prepare pt for sx Provide pre-op care and teaching Provide post-op care |
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When starting IV fluids for someone who is experiencing ectopic pregnancy, you should always us a _____ gauge needle
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18
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What kind of labs should be ordered in someone who is suspected in having an ectopic pregnancy?
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hCG, CBC, blood group and type, if hemmorrage is suspected also do type and cross match
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What is the non-surgical method of ectopic pregnancy?
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Methotrexate (Folex)
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Risk factors for ectopic pregnancy is
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Hx of STD's
Hx of PID HX of previous ectopic pregnancies Failed tubal ligitation IUD's Multiple induced abortions Maternal age older than 35 Cigarettes Douching |
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Early Signs and Symptoms of ectopic pregnancy are:
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Missed menstral period
Abdominal and pelvic pain Vaginal spotting or light bleeding |
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If progesterone is very low, the pregnancy is __________ to be viable
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Unlikely
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Methotrexate is a cytotoxic drug that inhibits cell __________ in the embryo
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Division
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Sx management of a tubal pregnancy that is unruptured may involve a linear ________ to salvage the tube for future pregnancies
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Salpingostomy
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After an Ectopic pregnancy, a women must refrain from having sex, drinking alcohol or ingesting vitamins that have folic acid in them until ______ levels are normal
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hCG levels
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As a result of abnormal growth, the placenta, but not the fetus develops
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Hydatidform Mole
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______ ___________ _________ may occur if vesicles of the hydatidform mole enter the womans circulation and embolize to her lungs
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Acute respiratory distress
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Levels of hCG are ______ because of rapidly proliferating abnormal villi in molar pregnancies
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Higher
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Some S&S of molar pregnancy are:
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Vaginal Bleeding
Uterus larger than expected for the duration of the pregnancy Excessive N&V due to excessive hCG Early development of preclampsia |
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________ __________ is usually used to extract a mole
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Vacuum Aspiration
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Pregnancy should be avoid for ___ year after evacuation of mole due to high risk of getting __________ cancer which is hidden if hCG is present in system
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1 year
Choriocarcinoma |
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If someone is Rh- they _____ receive RhD immune globulin
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Can
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Marginal (low-lying) Placenta Previa is when the placenta is implanted in the ________ uterus but its lower border is >____cm from internal cervical os
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Lower Uterus
3 |
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Partial Placenta Previa is when the ______ border of the placenta is within ____ cm of the internal cervical os but does not _________ cover the os
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Lower
3 completely |
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What is Nagael's Rule?
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How to find out date of confinement:
7 days +date of last menes - 3 months |
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What are the Five P's of Labor and Delievery?
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Power
Passenger Passageway/Position Presentation Psyche |
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What are the defense mechanisms of cardinal movements of labor?
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Descent
Flexion Internal Extension Restitution Expulsion (F.I.E.R.E.D) |
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What are the 6 P's of Dystocia?
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Powers
Passenger Position and Size Passageway Placenta Psychological Response |
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What 2 things should you be prepared for with multiple gestations?
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Pre-Mature birth and Post-partum hemorrhageI
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What are the 6 P's of Multi-Fetus?
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Pre-Mature
Pre-Clampsia Pressure Placenta Previa Primary Anemia Postpartum Hemorrhage |
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If a baby is coming out Breech, you should do a _________ on a 1st time mom
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C-section
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If a 1st time mom was going to have the baby breech there is an increased risk for
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Intracranial Hemorrhage
Learning Disabilities |
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What trimester does placenta previa and abruption placenta occur?
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3rd Trimester
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What trimester does spontaneous abortion and ectopic pregnancy occur?
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1st trimester
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What trimester does hydatidiform mole and incompetent cervix occur?
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2nd Trimester
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Is a prolapse cord an emergency?
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Yes
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Is the cord always visible when prolapsed?
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No, not always
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What do you do if the cord has prolapsed?
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Use a serile glove and push up on the baby.
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What is a Prolapse of the cord?
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It is when the cord comes before the presenting part of the baby and it causes severe hypoxeia
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Hypertonic contractions have a ___________ phase
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Active
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The contractions in a hypertonic phase are __________ and ______________
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Coordinated, but to weak
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Hypertonic contractions are managed by _________, induction of ___________, CPD and always prep for a _________
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AROM
Oxytocin C-Section |
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Medications used for hypertonic contractions are ________ and ________
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Oxytocin or Pitocin
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Hypotonic Contractions occur during a _________ phase
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Latent
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Hypotonic contractions are usually _____________ and _________ and can be extremely _________ and ____________
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Uncoordinated
Erradic Painful Ineffective |
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Hypotonic contractions cause an __________ resting tone of the ____________
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Increased
Uterus |
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Since there is an increased resting tone of the uterus with hypotonic contractions, this _________ labor, gives prolonged _________ phase, and causes __________ uterine contractions
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Lengthens
Latent Incomplete |
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In precipitate labor, you deliever in less than _________ hours
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3 hours
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Since delievery is so fast in Precipitate labor, the _____ doesn't have a chance to mold to the _________ canal
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Head
Birth |
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Since the head doesn't have the chance to mold in the birth canal in precipate labor, this serious side effect can happen to the babies head
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Cephalic Bleeding
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With the medication Terbutaline, will it augment or induce the labor?
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Augment
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With the medications oxytocin and pitocin, will it induce or augment the labor?
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Induce
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What is the psychological response to pregnancy?
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Grief, because you are not going to be the same women you use to be
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Uterine Ruptures cause
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Excessive Bleeding
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Physiological Pregnancy changes in the cardio system include what possible complications?
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Venous Congestion
Edema |
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What is pitting edema
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When pressure exerted by a finger or thumb leaves a persisitant depression
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Edema of the hands or face may be a sign of what complication?
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Preeclampsia
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Blood Volume increases ____ to ____%
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30-50%
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Because of cardiovascular changes the need for ____ and ____ is increased
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Iron and Folic Acid
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The body compensates by producing more RBC early in the 2nd trimester by ____ to ____%
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18-30%
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Since Blood plasma increases ____ and ____ concentrations decreases causing _________
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Hb and RBC
Pseudoanemia |
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Cardio changes include ________ Blood volume, cardiac output, and HR
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Increased
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Changes in cardio may cause a _________ heart murmur
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Innocent
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BP remains ________ with a slight __________ in the 2nd trimester
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Stable
Decrease |
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_________ clotting factors are called DIC
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Increased
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Most changes in the Ingegumentary System occur due to
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Increased Estrogen Levels
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Because of physiological changes in the respiratory system ___________ pCO2 in the mother allow for the fetal pCO2 to be _______
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Increased
Higher |
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Maternal Kidneys react to increased pCO2 and releases more bicarbonate which causes
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Polyuria
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The physiological pregnancy changes in the endocrine system cause the thyroid to _______ slighty during the 2nd trimester.
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Enlarge
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Because of the endocrine system, _______ and ________ are produced
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Estrogen and Progesterone
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Estrogen and Progesterone cause _________ and _________ enlargement, __________ coagulation, and cause Sodium and H2O __________
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Uterine and Breast
Increase Retention |
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In the endocrine system, _______ is increased causing softening of the cervix and collagen of joints
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Relaxin
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Because of the Human Placental Lactogen, it cause __________ glucose fors and also the avaliability for fetus and also __________ maternal utilization of ________ increasing protein avaliability
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Increased
Protein |
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The Pituitary Gland causes FSH and LH to _________ for anovulation
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Decrease
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Prolactin is ________ in the endocrine system
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Increased
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Because of the endocrine system, the human growth hormone is ____________
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Increased
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The posterior pituartary gland produces _________ and _________
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Oxytocin and Prolactin
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Oxytocin also ________ in labor and helps the _________ plant down and push out. It also helps with bleeding
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Aid
Uterus |
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Prolactin prepares for ______ after birth
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Lacation
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Because the thyroid enlarges it _________ the Basal Metabolic rate which causes Palpations, ___________ HR and emotional Liability
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Increases
Increased |
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When the parathyroid enlarges it causes an _________ metabolism of needed calicum
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Increase
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The pancreas increases production of __________
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Insulin
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Adrenal Gland activity increases causing an ________ levels of cortisteroids and aldosterone.
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Increase
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Increased Aldosterone promotes ______ reabsorbation and maintains the osmalarity in the amount of fluid retained
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Sodium
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Because of the increase in cortisteroids and aldosterone it causes a _________ in inflammatory responses
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Decreased
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The adrenal gland regulates ________ metabolism
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Glucose
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Physiological Changes in the immune response causes ________ responsiveness which makes you more prone to infection
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Decreased
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Physiological changes of pregnancy in the Urinary System causes an ________ in urine output and a ________ in specific gravity.
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Increase
Decrease |
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There is a _________ glomerular filtration rate and a _________ in BUN and Creatine
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Increased
Decreased |
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T
P A L |
Term Births
Pre-Term Births Abortions Living Children |
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Gravdia
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Amount of total pregnancy, including pre-term
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Para
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Births non-pre-term
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Effacement, dilation and cervical changes occur during true or false labor?
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True Labor
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Descent is
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Descent of the fetal presenting part through the true pelvis
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Engagement is
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engagement of the fetal presenting part as its widest diamter reaches the level of the ischial spines of the mothers pelvis
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Flexion is
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flexion of the fetal head so that the smallest diameters pass throught the pelvis
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_______ _________ to allow the largest fetal head diameters to match the largest maternal pelvic diameters
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Internal Rotation
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_________ of fetal head as it passes beneath the mothers symphysis pubis
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Extension
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_______ __________ of the fetal head to allow the shoulders to rotate internally to fir the mother's pelvis
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External Rotation
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_______ of the fetal shoulders and fetal body
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Expulsion
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These are the defense mechanisms of cardinal movements of labor
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Descent
Engagement Flexion Internal Rotation Extension External Rotation Expulsion |
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Inconsistent contractions in frequency, duration, and intensity...
Change in activity such as walking does not alter contractions or activity may decrease them... Contractions felt in abdomen and groin... Contractions more annoying than painful... no significant change in effacement or dilation of the cervix... |
False LAbor Contractions
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Consistent pattern of increasing frequency, duration, and intensity usually develops with contractions...
Contractions begin in the lower back and gradually sweeps around to the lower abdomen like a girdle... Back pain may persist in some women (feels like menstrual cramps)... Effacement or dilation of cervix occurs |
True Labor Contractions
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What are the 4 stages of Labor?
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Stage of dilation
Expulsion Stadge Placental Stadge Stadge of Ph |
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_______ of the fetal shoulders and fetal body
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Expulsion
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These are the defense mechanisms of cardinal movements of labor
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Descent
Engagement Flexion Internal Rotation Extension External Rotation Expulsion |
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Inconsistent contractions in frequency, duration, and intensity...
Change in activity such as walking does not alter contractions or activity may decrease them... Contractions felt in abdomen and groin... Contractions more annoying than painful... no significant change in effacement or dilation of the cervix... |
False LAbor Contractions
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Consistent pattern of increasing frequency, duration, and intensity usually develops with contractions...
Contractions begin in the lower back and gradually sweeps around to the lower abdomen like a girdle... Back pain may persist in some women (feels like menstrual cramps)... Effacement or dilation of cervix occurs |
True Labor Contractions
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What are the 4 stages of Labor?
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Stage of dilation
Expulsion Stadge Placental Stadge Stadge of Ph |
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What are the 4 stadges of labor
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Stadge of dilation
Stadge of Expulsion Stadge of Plancenta Stadge of Physical Recovery for mother and baby |
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In the first stadge of labor, it begins with the onset of _______ ______ _______ and ends with _______ _________ and _________
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True Labor Contractions
Complete Dilation and Effacement |
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Friedmans Curve is
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Labor progression plotted on a graph
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What are the 3 phases of the 1st stage of labor?
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Latent
Active Transition |
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The latent phase last from the beginning of ________ until about __cm of cervical dilation.
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Labor
3cm |
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Cervical Effacement and subtle feal position change occur during what phase of the 1st stage?
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Latent
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The woman is usually socialable and excited during this phase
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Latent
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In the active phase, the cervix dilates from ____ to ____cm and dilates more rapidly than in the latent phase
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4-7cm
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Effacement of the cervix is completed in what phase?
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Active
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The fetus descends in the pelvis and ________ rotation begins during the active phase
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Internal
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The woman becomes more anxious and may feel helpless as the contractions intensify during what phase?
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Active
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In the transition phase the cervix dilates from ___ to ____cm, and the fetus descends further into the pelvis
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8-10 cm
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_____ ____ often increases with completion of cervical dilation during the Transition Phase
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Bloody Show
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Transition phase is a _____ phase, but intense with very strong _________
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Short
Contractions |
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The woman may have the urge to push down during __________ in the transitional phase as the fetal presenting part reaches her pelvic floor
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Contractions
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Leg tremors, nausea and vomiting are common during the ________ phase
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Transitional Phase
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The woman will be _______ and lose control during the transitional phase
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Irritable
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Contractions come infrequently and progess to moderate strength every ____ minutes with a regular pattern and the duration increases to ____ to ____ seconds during the Latent Phase
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5 minutes
30-40 seconds |
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Contractions iincrease in frequency, duration and intensity until every ___ to ____ minutes for ____ to ____ seconds and moderate to strong intensity during the active phase
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2-5 minutes
40-60 seconds |
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In the transitional phase, contractions are strong and occur every ____ to ____ minutes, for ____ seconds
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1 1/2 to 2 minutes
60 seconds |
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The 2nd stage of labor (Expulsion) begins with complete dilation of _____ cm and full effacement of the cervix and ends with the ______ of the baby
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10cm
Birth |
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_____ describes the 2nd stage well
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Labor
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Between contractions in the expulsion stage, the woman may appear ______ or oblivous to her surrondings
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Asleep
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The third stage (placental) begins with the birth of the baby and ends with the expulsion of the ___________
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Placenta
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What are these the signs of?
-Uterus has a spherical Shape -Uterus rises upward in the abdomen as the placenta descends into the vagina and pushes the fundas upward -The cord descends further from the vagina -A gush of blood appears trapped behind the placenta is released |
Placenta Separtion
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The 2nd stage of labor (Expulsion) begins with complete dilation of _____ cm and full effacement of the cervix and ends with the ______ of the baby
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10cm
Birth |
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_____ describes the 2nd stage well
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Labor
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Between contractions in the expulsion stage, the woman may appear ______ or oblivous to her surrondings
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Asleep
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The third stage (placental) begins with the birth of the baby and ends with the expulsion of the ___________
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Placenta
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What are these the signs of?
-Uterus has a spherical Shape -Uterus rises upward in the abdomen as the placenta descends into the vagina and pushes the fundas upward -The cord descends further from the vagina -A gush of blood appears trapped behind the placenta is released |
Placenta Separtion
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The Schultze mechanism of placneta expulsion is when the placenta is expelled with the shiny, _____ side first
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Fetal
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Duncan Mechanism of placenta expulsion is less common and it is when the rough maternal side is ________
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Presenting
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Inadequate uterine contraction after birth may result in
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Hemmorahge
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The fourth stage of labor (physical recovery) lasts from the delievery of placenta through the first ___ to ____ hours after birth
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1-4
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Lochia Rubia
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Vaginal Drainage during fourth stage of labor
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For comfort of mother after complete birth, cover mother with _____ blanket or hot drinks or soup. Also an ____ pack on the perineum limits discomfort and hematoma formation
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Warm
Ice |
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The fourth stage of labor is an ideal time for the ________ of the new family because the interest of both parents and newborn is high
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Bonding
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Nulliparious mother
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Never had deliever 1st time mother
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Parous mother
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Already experienced a full labor
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|
These are _________ Signs of Labor:
Braxton Hicks Contractions, Lightening, Increased Vaginal Secretions, Bloody Show, An energy spurt (nesting) or a small weight loss of up to 3lbs |
Premonitory
|
|
|
5 P's of Labor and Delievery are:
|
Powers
Passage Passenger Presentation Psyche |
|
|
Uterine Contractions and Maternal Pushing Efforts are components of the _______ in the 5 p's
|
Power
|
|
|
The ________ (2nd p) for birth of the fetus consisits of the maternal pelvis and its soft tissues
|
Passage
|
|
|
Softening of the cartilage linking pelvic bones is because of ________
|
Relaxin
|
|
|
Female pelvic structure and configuration consists of the ____ pelvis and the _____ pelvis
|
True Pelvis
False Pelvis |
|
|
The true pelvis is a ________ portion above the pelvic brim
|
Shallow
|
|
|
The true pelvis consists of the ______ inlet, midpelvis, and the ______ outlet
|
Pelvic
Pelvic |
|
|
The false pelvis has a __________ portion above the pelvic rim and it also ________ the abdominal visera
|
Shallow
Supports |
|
|
Diagonal Conjugate is the distance from the ______margin of the symphysis pubis to the sacral promontory and is at least ____
|
Lower
12.5 |
|
|
True Conjugate is the distance from the ______margin of the symphysis pubis to the sacral promontory and is at least 11.5cm
|
Upper
11.5 |
|
|
Obstetric Conjugate is the smallest front-to-back distance through which the fetal head must pass in moving through the pelvic inlet, and it is usually about ____cm
|
11cm
|
|
|
Transverse is the ________ of all the pelvic inlet diameters and it is located at right angles to the true conjugate and is about ____cm
|
Largest
13.5cm |
|
|
Bi-ischial diameter is ___cm
|
10
|
|
|
What are the 5 bones on the babies head?
|
2 frontal
2 parietals 1 occipital |
|
|
Sutures are the line of junction or closure between the bones and they permit ______ to accommodate head to birth canal
|
Molding
|
|
|
Sagittal
Coronal Lambdoidal are what? |
Suture Lines
|
|
|
Sagittal
Coronal Lambdoidal are what? |
Suture Lines
|
|
|
What is the passenger in the 5 p's of labor?
|
The fetus plus the membranes and placenta
|
|
|
The Bi-Parietal Diameter of the babies head is usually ____ cm
|
9.5cm
|
|
|
What is the passenger in the 5 p's of labor?
|
The fetus plus the membranes and placenta
|
|
|
Supine Hypotension
|
when the mother lays on her back and the fetus is placing pressure on the vena cava causing dizziness, lightheadness, and possible agitation
|
|
|
Nursing intervention for supine hypertension is
|
Side-lying position
|
|
|
The Bi-Parietal Diameter of the babies head is usually ____ cm
|
9.5cm
|
|
|
Supine Hypotension
|
when the mother lays on her back and the fetus is placing pressure on the vena cava causing dizziness, lightheadness, and possible agitation
|
|
|
Nursing intervention for supine hypertension is
|
Side-lying position
|
|
|
Fetal lie is the orientation of the ______ axis of the fetus to the _____ axis of woman
|
Long
Long |
|
|
A longituditional lie the ________ way of delievery, while the ___________ lie makes it prone to c-section
|
Best
Transverse |
|
|
Fetal ________ is the relation of fetal body parts to each other
|
Attitude
|
|
|
The fetal part that enters the pelvis first is the __________ part
|
Presenting
|
|
|
3 types of presentation are
|
Cephalic, Breech and Shoulder
|
|
|
Fetal ________ describes the location of a fixed reference point on the presenting part in relation to the four quadrants of the maternal pelvis
|
Position
|
|
|
________ is a crucial part of childbirth because anxiety, fear or fatigue decreases a womans ability to cope with pain in labor
|
Psyche
|
|
|
Station is the
|
descent of the fetal presenting part in relation to the level of the ischial spines
-3 -2 -1 _________ +1 +2 +3 |
|
|
Engagement is
|
when the largest diameter of the fetal presenting part has passed the pelvic inlet and entered the pelvic cavity
|
|
|
Leopolds Manever is when how you determine the
|
presentation and position of fetus by placing hands on and around baby
|
|
|
Chief Complaint of Placenta Previa is
|
Painless Uterine Bleeding
|
|
|
Chief complaint of Abruptia Previa is
|
Sudden onset of intense uterine bleeding
|
|
|
Incompetent Cervix
|
inability for the cervix to remain closed long enough during pregnancy for the fetus to survive
|
|
|
S&S suggestng Hemorrhage in abruptio placentae:
|
Increase in fundal height
Hard board-like abdomen High uterine baseline tone Persistant abdominal pain Systemic signs of early hemorrhage Persisitent late deceleration in fetal heart rate or decreasing baseline variablity Vaginal Bleeding that may be slight or absent |
|
|
Excessive bleeding and fetal hypoxeia are major concerns with
|
Abrupto Placentae
|
|
|
Hypovelmic shock has signs of
(Early Signs) |
Fetal Tachycardia
Maternal Tachycardia Weak peripheral pulses Decreased BP Increased Respiratory Rate Cool, pale skin and mucous membranes |
|
|
Later signs of hypovolemic shock include:
|
falling BP
Pallor of skin and mucous membranes Urine output less thanb 30ml/hr Restlessness, agitation, decreased mentation |
|
|
Possible causes of ineffective contractions include:
|
maternal fatigue
maternal inactivity Fluid and Electrolyte imbalance Hypoglycemia Excessive analgesia or anesthesia Disportportion of maternal pelvis and the fetal presenting part Uterine overdistension |
|
|
FETAL HYPOXEIA IS NOT USUALLY SEE IN HYP______TONIC DYSFUNCTION
|
HYPO
|
|
|
aMINOTOMY OR OXYTOCIN AUGMENTATION MA BE USED TO STIMULATE ________ THAT SLOWS AFTER ITS ESTABLISHED
|
LABOR
|
|
|
Oxytocin is not given in someone who is experiencing Hyp____tonic contractions
|
Hyper
|
|
|
Hypotonic in the _______ phase while Hypertonic in the ______ phase
|
Active
Latent |
|
|
During hypertonic contractions, _______ drugs may be ordered to reduce uterine resting tone and improve placental blood flow.
|
Tocolytic
|
|
|
Macrosomia is when the infant weighs more than _________lbs at birth
|
8.8lbs or 4000g
|
|
|
Shoulder dystocia is the delayed or difficult birth of the ________ that may occur as they become impacted abover the maternal symphasis pubis.
|
Shoulders
|
|
|
Transabdominal punture of the amnoitic fluid that contains fetal cells and biochemical substances for lab examination
|
Aminocentesis
|
|
|
Method for evaluating fetal status during the antepartum period by observing the response of the fetal heart to intermittent stress by uterine contractions
|
Contraction Stress Test
|
|
|
A method for evaluating fetal status during the antepartum period by observing for accelerations of the fetal heart rate
|
Non Stress Test
|
|
|
Ratio of 2 phospolipids in amnotic fluid that is used to estimate fetal lung maturity
|
L/S Ratio
2:1 |
|
|
Technique for visualizing deep structures of the body by recording the reflections of sound waves directed into the tissue
|
Ultrasonography
|
|
|
3 reasons for performing fetal diagnostic and surveillance procedures
|
1. To detect congential anomalies
2. To evaluate the condition of the fetus if the pregnancy is high-risk and allow apprioriate intervention 3. To provide baseline information such as a more accurate gestational age. |
|
|
Fetal viability is confirmed by observation of the fetal heartbeat which is visible as early as ____ days after the last menstrual cycle
|
38 days
|
|
|
Transvaginal probe is used during the ____ trimester
|
1st
|
|
|
Transabdominal ultrasonography is used during the ____ and ____ trimesters
|
2nd and 3rd
|
|
|
During the 2nd trimester a _____ bladder is needed to displace the intestines and evaluate the uterus for better visibility during a transabdominal ultrasonography
|
Full
|
|
|
Estimating age by ultrasonography is unreliabele for testing for gestational age after _____ weeks
|
32
|
|
|
Hydraminos
|
excessive amnoitic flud
|
|
|
You use the L:S ratio in the doppler ultrasound _____ _____ assessment
|
Blood Flow
|
|
|
Low levels of AFP are associated with _____ ______
|
Down Syndrome
|
|
|
Elevated AFP is a _____ of the embryonic neural tube or anterior body wall to close properly
|
Failure
|
|
|
AFP testing is done between weeks ____ and _____
|
16-18
|
|
|
If AFP are abnormal, next test will be ____________ to determine whether the abnormal concentration is due to multifetal gestation, inaccurate age, or fetal death
|
Ultrasonography
|
|
|
If ultrasonography does not explain the abnormal levels of HFP, ___________ is the next step
|
aMINOCENTESIS
|
|
|
2nd Trimester Aminocentesis is best performed during weeks ____ to _____ because amnoitic fluid volume is adequate and there are many viable fetal cells in the fluid
|
15-20
|
|
|
Early aminocentesis between weeks ____ and ____ are possible but has higher risk for fetal loss and fetal foot deformations are more likely
|
11-14
|
|
|
Primary purpose for midtrimester __________ is to examine fetal cells present in amnotic fluid to identify chromosomal or biochemical abnormalities and detect high levels of AFP
|
Aminocentesis
|
|
|
During the ________ trimester, aminocnetesis is performed to determine fetal lung maturity or to diagnose fetal hemolytic disease
|
3rd
|
|
|
Reduction aminocentesis is when _____ amnotic fluid is removed and discarded when hydramnios occurs
|
Excess
|
|
|
L:S Ratio is the best test to accurately evaluate _____ _____ maturity
|
Fetal Lung Maturity
|
|
|
L:S ratio is a good test for someone with ________
|
Diabetes
|
|
|
Aminocentesis also is used to obtain fluid for determining of fetal _______ concentration if the mother s RH-abs us sensitized
|
Bilirubin
|
|
|
Electronic fetal monitoring is done for ____ to ____ minutes to identify continuing uterine contractions or non-reassuring fetal heart activity
|
30-60
|
|
|
Non stress test is termed non-stress because it consisits of __________ only
|
Monitoring
|
|
|
During the non stress test, the woman is given a remote event marker to press each time she senses __________
|
Movement
|
|
|
If a non-stress test findings are non-reactive, than the next test would be a _______ ________ _________
|
Contraction Stress Test
|
|
|
10 point Systems includes 2 points or 0 points for different things done and a perfect score is ____ out of ____
|
8 out of 10
|
|
|
NonStress Test Results, fetal breathing movements, gross body movemnents, fetal tone, and amnoitic fluid volume are in the _________ ________
|
Biphysical Profile Scoring System
|
|
|
A reactive sign worth 2 points in the non-stress test would be more than _____ fetal heart rate accelerations peaking at least _____ beats per minutes within 20 minutes
|
2
15 |
|
|
For fetal breathing movements a score of 2 would mean that there would be more than ____ episode of rythmatic FBM of ____ seconds or more within 30 minutes
|
1
30 |
|
|
For a score of 2 in the gross body movements category, you would have to have more than _____ trunk movements in _____ minutes
|
3
30 |
|
|
For a score of 2 in fetal tone category you would have to have more than ______ episode of fetal extermity extension with return to flexion
|
1
|
|
|
For a score of 2 in the amnoitic fluid volume, there would have to be at least _____ pocket if fluid that measures at least _____ cm in 2 planes perpendicular to each other
|
1
2cm |
|
|
Nutritional requirements is an additional ________ calories a day are required during the 2nd and 3rd trimester
|
300
|
|
|
Additional requirement of ____g of protein per day is recommended over the non-pregnant intake
|
10 grams
|
|
|
Carbs should supply ____ to ___ % of calories in the diet
|
55-60%
|
|
|
Intake of carbs should be in the form of complex carbs including:
|
whole grain cereal products
starchy veggies Legumes |
|
|
Fat intake should not exceed ____% of the diet and saturated fats should not exceed ______% of the total calories
|
30%
10% |
|
|
Since RBC increase about 40-50% during pregnancy, iron requirements are increased ____ to _____mg a day
|
20-40
|
|
|
During the last half of the pregnancy, _____ is transferred to the fetus and stored in the fetal liver
|
Iron
|
|
|
Beta-Mathasone is for ____ maturity of a neonate
|
Lung
|
|
|
What are the three phases of contractions?
|
Increment
Peak or acme Decrement |
|
|
The increment is defined as
|
Occurs as the contractions begins in the fundas and spreads throughout the uterus
|
|
|
The peak is defined as the
|
period in which contraction is most intense
|
|
|
The decrement is defined as the
|
Period of decreasing intensity as the uterus relaxes
|
|
|
The frequency of contractions is defined as
|
The time from the begining of one contraction to the begining of the next contraction
|
|
|
Frequency is usually defined in _______ and fractions of minutes
|
Minutes
|
|
|
Duration is defined as
|
the length of each contraction from beginning to end
|
|
|
Duration is expessed in ________
|
Seconds
|
|
|
Intensity is defined as
|
the strength of contractions
|
|
|
The terms mild, moderate and strong are used to describe contraction __________ as palpated by the nurse
|
Intensisty
|
|
|
Interval is defined as
|
the period between the end of one contraction and the beginning of the next
|
|
|
Occipito posterior-toward sacral part takes _____ to turn and _____ labor.
|
Longer
Induce |
|
|
When he baby is in the occiptal posterior sacrum position, the baby needs to be turned to the _____ position
|
Anterior
|
|
|
A baby that was located in the right posterior sacrum would be written
|
RSP
|
|
|
Transverse lie is when the ____ axis of the baby is at right angles to the ____ axis of mother
|
Long
Long |
|
|
In _____ presentation, the fetal head id partly extended and the longest supraoccipitomental diameter is presenting
|
Brow
|
|
|
In _____ presentation, the head is fully extended and the fetal occiput is near the fetal spine
|
Face
|
|
|
A fetal heart rate normal range is _____ to _____ bpm
|
110-160
|
|
|
Meconium stained amnoitic fluid is a condition assoicated with fetal
|
comprimise
|
|
|
Cloudy, yellowish or foul odor to the amnoitic fluid suggests ________
|
Infection
|
|
|
Maternal fever over 38degrees celisus (100.4) or higher may be a condition associated with fetal ________
|
comprimise
|
|
|
Nursing Interventions for woman having contractions
|
-Dim lights
-Cool damp wash cloths -Change sheets and gown to keep her dry and comfy -Provide ice chps or popiscles, AVOID EXCESS SUGAR -Remind woman to empty bladde every 2 hours Provide water for mipple stimulation |
|
|
Nursing priority for an emergency birth is to
|
Prevent or reduce injury to the mother and infant
Maintain in the infants airway and temp after birth |
|
|
Bradycardia is less than ____ bpms persisiting for at least 10 minutes
|
110
|
|
|
Tachycardia is more than _____ bpm persisiting for at least 10 minutes
|
160
|
|
|
Oxytocin can cause __________ and ___________ of the uterus
|
Hyperstimulation
Rupture |
|
|
Oxytocin must be adminstered by ________ pump, never by gravity
|
Infusion
|
|
|
If contractions are less than 2 minutes apart, last longer than 90 seconds or the uterus does not relax completely between contractions, you:
|
1. Stop the Oxytocin
2. Adminster Oxygen 3. Place woman in side lying postion 4. Notify PCP |
|
|
If the cervix is not favorable for induction, a _________ prostaglain gel may be used to soften the cervix prior to induction
|
Intravaginal
|
|
|
Augmentation of labor us the stimulation of ______ contractions after labor has started but is not progressing satisfactorly
|
Uterine
|
|
|
Oxytocin initiates or intensifies _______ ___________
|
uterine contractions
|
|
|
Bishops score assesses that the cervix is soft, anterior, ____% effaced and dilated ___cm or more
|
50%
2 |
|
|
Oxytocin is given in _______ doses until an effective contraction pattern is achieved
|
Incremental
|
|
|
When adminstration of oxytocin is about to start, always monitor for ____ _____ ____ for 20 minutes before induction to establish a fetal baseline status
|
Fetal Heart Rate
|
|
|
When giving oxytocin, always give in __________bag so that in case of emergency, it can be cut off
|
secondary
|
|
|
Always monitor ____ and _____ frequently when adminstering oxytocin
|
BP and pulse
|
|
|
Monitor I&O to asses for fluid _______
|
retention
|
|
|
Headache, blurred vision, increased BP and respirations, rales, wheezing and coughing are signs of water ___________
|
intoxication
|
|
|
Continously monitor for _____ for signs of fetal distress
|
Fetal Heart Rate
|
|
|
If emergency measures for hyperstimulation or non-reassuring FHR pattern always:
|
-turn off oxytocin and increase rate of maintance iv fluids
-adminster oxygen -put in side-lying position -notify pcp |
|
|
The most important hormone during pregnancy is __________ because it maintains the endometrium and prevents abortion by relaxing uterine muscles.
|
Progesterone
|
|
|
Gravida
|
woman who is or has been pregnant
|
|
|
Para
|
indicates # of pregnancies that reached at least 20weeks
|
|
|
Primi
|
First
|
|
|
Multi
|
more than one
|
|
|
Nulli
|
never
|
|
|
G
T P A L M |
Gravida
Term Pregnancies Pre-Mature Births Abortions Number of living children Multiple gestations and births |
|
|
Goodells sign is the
|
Softening of the normally firm cervix
|
|
|
Chadwicks Sign
|
Purphlish tinge of the vulva and vagina
|
|
|
Ballottement
|
detection of fetus floating in amnoitic fluid
|
|
|
Hypertension is defined as anything greater than
|
140/90
|
|
|
The way to treat PIH is by:
|
Ending the pregnancy and delievering the infant
|
|
|
PIH is characterized by:
|
Hypertebsuib
Edema Proteinuria |
|
|
Preclampsia is characterizied by hypertension with proteinuria or edema developing after ____ weeks of gestation
|
20 weeks
|
|
|
Eclampsia is a progession of preclampsia characterizied by
|
Epigastric Pain
Grand Mal Seizres Coma |
|
|
Signs of preclampsia are
|
BP 140/90
Edema Sudden excessive Weight Gain Proteinuria |
|
|
Signs of severe preclampsia are:
|
BP 160/110
Extensive Edema Cyanosis Decreased Urine output N&V Headache Increased Hemocrit |
|
|
Nursing interventions for pre-clampsia
|
-Take vitals
Assess edema Record daily weight Encourage high protein diet Position client on l side Test urine every 8 hours I&O Deep tendon reflexes every 2-4hrs Seizure precautions |
|
|
Treatment for gestational diabetes includes
|
Diet
Exercise Glucose monitoring Evaluation of fetal status |
|
|
Polydipsa, polyphagia, polyuria and glycosuria are all classic signs of ________
|
Diabetes
|
|
|
Nursing interventions for gestational diabetes is
|
Diet instruction
Teach self-care Monitor Blood glucose and urine for ketones Encourage exercise Teach symptoms of hypoglycemia and ketoacidosis Maintain fetal surveillance |
|
|
Vaginal exams are prohibeted in the prescence of vaginal bleeding because of the risk fof perforating the placenta and causing ________
|
Hemorahage
|
|
|
RN interventions for placenta previa are
|
Assess amount and character of bleeding
Monitor Vitals Monitor Urinary Output Monitor FHR and fetal activity Instruct clients to avoid enemas, douching, and sex |
|
|
For pre-term labor prior to 34 weeks gestation, adminster ___________ as prescribed to promote fetal lung maturity if deliever is unavoidable
|
Betamethasone
|
|
|
The narcotic antagonist is _______ and is used to reverse neonatal narcosis
|
NARCAN
|
|
|
The primary nursing responiblity when adminstering pain relief medications is to monitor maternal and fetal _____-_____
|
Well being
|
|
|
Nrcotic analgesics may cause ________ depression in the neonate
|
Repsiratory
|
|
|
Epidural Anesthesia is injected into the ________ space
|
Epidural
|
|
|
________ are used by a flexible catheter when the cervix is dilated 4-6cm
|
Epidural
|
|
|
Epidural provides ___________ pain relief throughtout the labor and delievery
|
Continous
|
|
|
Epidural blocks carry a high risk of maternal ___________, fetal bradycardia and fetal distress
|
Hypotension
|
|
|
Nursing interventions for epidural are:
|
-insstruct patient when to bear down during birth
-Monitor every 5 minutes fir hypotension -Adminsgtering oxygen - |
|
|
________ act by depressing smooth muscle.
|
Tocolytics
|
|
|
_______ therapy may be used to delay the birth long enough for antenatal glucocorticoids to be given to accelerate fetal lung maturity
|
Tocolytics
|
|
|
Notify provider if maternal pulse reached ______ while giving tocolytic medications
|
120
|
|
|
Assess for ________ edema if giving tocoyltic therapy
|
Pulmonary
|
|
|
Limit _______ intake if on tocolytic therapy
|
Fluid
|
|
|
Terbutaline is a _____-_______ Antagonist
|
Beta-Adrenergic
|
|
|
Terbutaline ______ uterine muscles
|
Relaxes
|
|
|
Tachycardia, Dysrhythmias, pulmonary edema, altered blood glucose metabolism, tremors, hypotension, CNS depression are all side effects of
|
Terbutaline
|
|
|
Assess for ________ edema if giving tocoyltic therapy
|
Pulmonary
|
|
|
Limit _______ intake if on tocolytic therapy
|
Fluid
|
|
|
Terbutaline is a _____-_______ Antagonist
|
Beta-Adrenergic
|
|
|
Terbutaline ______ uterine muscles
|
Relaxes
|
|
|
Tachycardia, Dysrhythmias, pulmonary edema, altered blood glucose metabolism, tremors, hypotension, CNS depression are all side effects of
|
Terbutaline
|
