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382 Cards in this Set

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What is the antidote for Magnesium Sulfate?
Calicum Gluconate
What does magnesium sulfate for?
Controls Seizures in severe pre-clampsia and also prevention of uterine contractions in pre-term labor
Some things you have to observe for when adminstering Magnesium Sulfate are:
Toxicity
Magnesium Levels
Respiratory Depression
Loss of Reflexes
Circulatory Collapse
Muscle Weakness
Over Sedation and Confusion
Extreme Thirst
Hypotension
What is the last reflex to go when about to have a seizure?
Knee-Jerk Reflex
If a person has any of the below symptoms, do not adminster ______________:
myocardial damage
heart block
myasthenia gravis
impaired renal function
Magnesium Sulfate
Some symptoms of Magnesium toxicity are:
Thirst
Mental Confusion
Decrease in reflexes
What are these signs the result of:
Flushing
sweating
hypotension
depressed deep tendon reflex
CNS depression
Respiratory Depression
Magnesium Overdose
What do you assess closely during adminstration of Magnesium Sulfate?
Blood Pressure Closely
Respiratory Rate of at least 12 breaths per minute
Presence of Deep tendon Reflexes
Urinary Output greater than 30ml/hr
What should be kept in the magnesium Sulfate?
Resuscitation Equipment
Calicum Gluconate
Syringes and Needles
Abortion is
Spontaneous of elective ending of pregnancy before the pregnancy reaches states legal limit
Antiphospholipid Antibodies:
associated with Recurrent spontaneous abortion, fetal loss and severe pregnancy induced hypertension
autoimmune antibodies directed against phosphoplipid in cell membranes
Bicornate Uterus
Malformed uterus having 2 horns
Caudal Regression Syndrome
malformation that results when sacrum, l-spine, and lower extremeties fail to develop
Cerclage
encircling of the cervix with suture to prevent spontaneous abortion caused by early cervical dilation
Dystocia
difficult or prolonged labor, often associated with abnormal uterine activity and cephalopelvic disproportion
Euglycemiaational trophoblastic tumors
Normal blood glucose level
Gestational Trophoblastic disease
disease that include benign hydatidiform mole and gest
Hydraminos
excess amount of amniotic fluid
Hypovolemic shock
acute peripheral circulatory failure caused by loss of circulating blood volume
Kernicterus
Staining of brain tissue caused by accummulation of unconjugated bilirubin in the brain.
Lipogenic Substance
stimulates the production of fat...ex:insulin
Maceration
discoloration and softening of tissues and eventual disintergration of a fetus retained in the uterus after its death
Marfan Syndrome
a hereditary condition that involves weakness in connective tissue, bones and muscles.
Seroconversion
change in a blood test result from negative to positive, indicating the development of antibodies in response to infection or immunization
Vacuum Curettage
Removal of the uterine contents by application of a vacuum through a hollow curette or canula introduced into the uterus
Spontaneous Abortion
Termination of a pregnancy without action taken by the woman or any other person
Incidence of spontaneous abortion increases with
Parental Age
Most spontaneous abortions occur if the first ______ weeks of pregnancy
12 weeks
6 Types of spontaneous abortion
Threatened
Inevitable
Incomplete
Complete
Missed
Recurrent
First sign of threatened abortion is
Vaginal Bleeding
Vaginal Bleeding, uterine cramping, persistent backache, or feelings of pelvic pressure are sign of possible
loss of pregnancy
Bleeding in 1st half of pregnancy are considered a
threatened abortion
Fever or Uretrine Tenderness suggest
infection
Woman may be adivised to lay off sex for ___ weeks after vaginal bleeding has ceased
2
If the woman has a foul smelling drainage, it suggests
Infection
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
Peripads
Quantity and Color
Inevitable abortion is when the
membranes rupture and the cervix dilates
If tissue remains or if bleeding is excessive in an inevitable abortion a ______ procedure may be needed
D&C
Incomplete Abortion is when some but not all of the products of __________ are expelled from the uterus
conception
Major manifestations of Incomplete abortion are ________ bleeding and severe abdominal __________
Active Uterine Bleeding and cramping
Products of conception during a incomplete abortion may still remain in the ________ because of their small size
Vagina
When treating someone who we think is having a spontaneous abortion we should
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
If pregnancy is 12 weeks gestation of beyond, assess fetal heart tones with a
(Spont Ab.)
Doppler
Collect and organize all data including
antepartal history
onset of bleeding episode
lab studies
Some complications of abortion are
hemorrhage
infection
septic abortion
isoimmunization
powerlessness/feeling of failure
About 50% of spontaneous abortions result from chromosomal ___________ in the embryo or fetus
Abnormalities
Some other factors that may result in spontaneous abortion is:
Infections; herpes, syphillis and Strep B
Progesterone Deficiency
Auto Immune Factors
Drugs and envirnomental chemicals; chemo, cigarettes, alcohol, cocaine, organic solvents
In spontaneous abortion the _____ an infection is treated the __________
Early
Better
What is the classic symptom of spontaneous abortions?
Vaginal Bleeding
When a women is bleeding vaginally, the nurse should ask a series of questions including:
How many weeks pregnant?
Was tissue or amnoitic fluid discharged?
What other symptoms are you having?
Any cramping?
Are they sad or frightenend?
Implantation of a fertalizied ovum outside of the uterus
Ectopic Pregnancy
When does ectopic pregnancies occur?
1st trimester
Where is the most common site for implantation in ectopic pregnancy?
Fallopean Tubes
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
Ectopic Pregnancy
What is the clinical presentation for an ectopic pregnancy?
Unilateral Lower Abdominal Pain, slowly increasing or sudden and severe abdominal rigidity and referred r shoulder pain
If the fallopean tube has ruptured, sign of __________ shock and possible __________ bleeding may occur
Hypovlemic
irregular
What lab tests conferm pregnancy?
B-hCG
What kind of test confirms an extrauterine pregnancy?
ultrasound
What are some therapeutic nursing management for ectopic pregnancy?
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
When starting IV fluids for someone who is experiencing ectopic pregnancy, you should always us a _____ gauge needle
18
What kind of labs should be ordered in someone who is suspected in having an ectopic pregnancy?
hCG, CBC, blood group and type, if hemmorrage is suspected also do type and cross match
What is the non-surgical method of ectopic pregnancy?
Methotrexate (Folex)
Risk factors for ectopic pregnancy is
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
Early Signs and Symptoms of ectopic pregnancy are:
Missed menstral period
Abdominal and pelvic pain
Vaginal spotting or light bleeding
If progesterone is very low, the pregnancy is __________ to be viable
Unlikely
Methotrexate is a cytotoxic drug that inhibits cell __________ in the embryo
Division
Sx management of a tubal pregnancy that is unruptured may involve a linear ________ to salvage the tube for future pregnancies
Salpingostomy
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
hCG levels
As a result of abnormal growth, the placenta, but not the fetus develops
Hydatidform Mole
______ ___________ _________ may occur if vesicles of the hydatidform mole enter the womans circulation and embolize to her lungs
Acute respiratory distress
Levels of hCG are ______ because of rapidly proliferating abnormal villi in molar pregnancies
Higher
Some S&S of molar pregnancy are:
Vaginal Bleeding
Uterus larger than expected for the duration of the pregnancy
Excessive N&V due to excessive hCG
Early development of preclampsia
________ __________ is usually used to extract a mole
Vacuum Aspiration
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
1 year
Choriocarcinoma
If someone is Rh- they _____ receive RhD immune globulin
Can
Marginal (low-lying) Placenta Previa is when the placenta is implanted in the ________ uterus but its lower border is >____cm from internal cervical os
Lower Uterus
3
Partial Placenta Previa is when the ______ border of the placenta is within ____ cm of the internal cervical os but does not _________ cover the os
Lower
3
completely
What is Nagael's Rule?
How to find out date of confinement:
7 days +date of last menes - 3 months
What are the Five P's of Labor and Delievery?
Power
Passenger
Passageway/Position
Presentation
Psyche
What are the defense mechanisms of cardinal movements of labor?
Descent
Flexion
Internal
Extension
Restitution
Expulsion
(F.I.E.R.E.D)
What are the 6 P's of Dystocia?
Powers
Passenger
Position and Size
Passageway
Placenta
Psychological Response
What 2 things should you be prepared for with multiple gestations?
Pre-Mature birth and Post-partum hemorrhageI
What are the 6 P's of Multi-Fetus?
Pre-Mature
Pre-Clampsia
Pressure
Placenta Previa
Primary Anemia
Postpartum Hemorrhage
If a baby is coming out Breech, you should do a _________ on a 1st time mom
C-section
If a 1st time mom was going to have the baby breech there is an increased risk for
Intracranial Hemorrhage
Learning Disabilities
What trimester does placenta previa and abruption placenta occur?
3rd Trimester
What trimester does spontaneous abortion and ectopic pregnancy occur?
1st trimester
What trimester does hydatidiform mole and incompetent cervix occur?
2nd Trimester
Is a prolapse cord an emergency?
Yes
Is the cord always visible when prolapsed?
No, not always
What do you do if the cord has prolapsed?
Use a serile glove and push up on the baby.
What is a Prolapse of the cord?
It is when the cord comes before the presenting part of the baby and it causes severe hypoxeia
Hypertonic contractions have a ___________ phase
Active
The contractions in a hypertonic phase are __________ and ______________
Coordinated, but to weak
Hypertonic contractions are managed by _________, induction of ___________, CPD and always prep for a _________
AROM
Oxytocin
C-Section
Medications used for hypertonic contractions are ________ and ________
Oxytocin or Pitocin
Hypotonic Contractions occur during a _________ phase
Latent
Hypotonic contractions are usually _____________ and _________ and can be extremely _________ and ____________
Uncoordinated
Erradic
Painful
Ineffective
Hypotonic contractions cause an __________ resting tone of the ____________
Increased
Uterus
Since there is an increased resting tone of the uterus with hypotonic contractions, this _________ labor, gives prolonged _________ phase, and causes __________ uterine contractions
Lengthens
Latent
Incomplete
In precipitate labor, you deliever in less than _________ hours
3 hours
Since delievery is so fast in Precipitate labor, the _____ doesn't have a chance to mold to the _________ canal
Head
Birth
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
Cephalic Bleeding
With the medication Terbutaline, will it augment or induce the labor?
Augment
With the medications oxytocin and pitocin, will it induce or augment the labor?
Induce
What is the psychological response to pregnancy?
Grief, because you are not going to be the same women you use to be
Uterine Ruptures cause
Excessive Bleeding
Physiological Pregnancy changes in the cardio system include what possible complications?
Venous Congestion
Edema
What is pitting edema
When pressure exerted by a finger or thumb leaves a persisitant depression
Edema of the hands or face may be a sign of what complication?
Preeclampsia
Blood Volume increases ____ to ____%
30-50%
Because of cardiovascular changes the need for ____ and ____ is increased
Iron and Folic Acid
The body compensates by producing more RBC early in the 2nd trimester by ____ to ____%
18-30%
Since Blood plasma increases ____ and ____ concentrations decreases causing _________
Hb and RBC
Pseudoanemia
Cardio changes include ________ Blood volume, cardiac output, and HR
Increased
Changes in cardio may cause a _________ heart murmur
Innocent
BP remains ________ with a slight __________ in the 2nd trimester
Stable
Decrease
_________ clotting factors are called DIC
Increased
Most changes in the Ingegumentary System occur due to
Increased Estrogen Levels
Because of physiological changes in the respiratory system ___________ pCO2 in the mother allow for the fetal pCO2 to be _______
Increased
Higher
Maternal Kidneys react to increased pCO2 and releases more bicarbonate which causes
Polyuria
The physiological pregnancy changes in the endocrine system cause the thyroid to _______ slighty during the 2nd trimester.
Enlarge
Because of the endocrine system, _______ and ________ are produced
Estrogen and Progesterone
Estrogen and Progesterone cause _________ and _________ enlargement, __________ coagulation, and cause Sodium and H2O __________
Uterine and Breast
Increase
Retention
In the endocrine system, _______ is increased causing softening of the cervix and collagen of joints
Relaxin
Because of the Human Placental Lactogen, it cause __________ glucose fors and also the avaliability for fetus and also __________ maternal utilization of ________ increasing protein avaliability
Increased
Protein
The Pituitary Gland causes FSH and LH to _________ for anovulation
Decrease
Prolactin is ________ in the endocrine system
Increased
Because of the endocrine system, the human growth hormone is ____________
Increased
The posterior pituartary gland produces _________ and _________
Oxytocin and Prolactin
Oxytocin also ________ in labor and helps the _________ plant down and push out. It also helps with bleeding
Aid
Uterus
Prolactin prepares for ______ after birth
Lacation
Because the thyroid enlarges it _________ the Basal Metabolic rate which causes Palpations, ___________ HR and emotional Liability
Increases
Increased
When the parathyroid enlarges it causes an _________ metabolism of needed calicum
Increase
The pancreas increases production of __________
Insulin
Adrenal Gland activity increases causing an ________ levels of cortisteroids and aldosterone.
Increase
Increased Aldosterone promotes ______ reabsorbation and maintains the osmalarity in the amount of fluid retained
Sodium
Because of the increase in cortisteroids and aldosterone it causes a _________ in inflammatory responses
Decreased
The adrenal gland regulates ________ metabolism
Glucose
Physiological Changes in the immune response causes ________ responsiveness which makes you more prone to infection
Decreased
Physiological changes of pregnancy in the Urinary System causes an ________ in urine output and a ________ in specific gravity.
Increase
Decrease
There is a _________ glomerular filtration rate and a _________ in BUN and Creatine
Increased
Decreased
T
P
A
L
Term Births
Pre-Term Births
Abortions
Living Children
Gravdia
Amount of total pregnancy, including pre-term
Para
Births non-pre-term
Effacement, dilation and cervical changes occur during true or false labor?
True Labor
Descent is
Descent of the fetal presenting part through the true pelvis
Engagement is
engagement of the fetal presenting part as its widest diamter reaches the level of the ischial spines of the mothers pelvis
Flexion is
flexion of the fetal head so that the smallest diameters pass throught the pelvis
_______ _________ to allow the largest fetal head diameters to match the largest maternal pelvic diameters
Internal Rotation
_________ of fetal head as it passes beneath the mothers symphysis pubis
Extension
_______ __________ of the fetal head to allow the shoulders to rotate internally to fir the mother's pelvis
External Rotation
_______ of the fetal shoulders and fetal body
Expulsion
These are the defense mechanisms of cardinal movements of labor
Descent
Engagement
Flexion
Internal Rotation
Extension
External Rotation
Expulsion
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
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
What are the 4 stages of Labor?
Stage of dilation
Expulsion Stadge
Placental Stadge
Stadge of Ph
_______ of the fetal shoulders and fetal body
Expulsion
These are the defense mechanisms of cardinal movements of labor
Descent
Engagement
Flexion
Internal Rotation
Extension
External Rotation
Expulsion
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
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
What are the 4 stages of Labor?
Stage of dilation
Expulsion Stadge
Placental Stadge
Stadge of Ph
What are the 4 stadges of labor
Stadge of dilation
Stadge of Expulsion
Stadge of Plancenta
Stadge of Physical Recovery for mother and baby
In the first stadge of labor, it begins with the onset of _______ ______ _______ and ends with _______ _________ and _________
True Labor Contractions
Complete Dilation and Effacement
Friedmans Curve is
Labor progression plotted on a graph
What are the 3 phases of the 1st stage of labor?
Latent
Active
Transition
The latent phase last from the beginning of ________ until about __cm of cervical dilation.
Labor
3cm
Cervical Effacement and subtle feal position change occur during what phase of the 1st stage?
Latent
The woman is usually socialable and excited during this phase
Latent
In the active phase, the cervix dilates from ____ to ____cm and dilates more rapidly than in the latent phase
4-7cm
Effacement of the cervix is completed in what phase?
Active
The fetus descends in the pelvis and ________ rotation begins during the active phase
Internal
The woman becomes more anxious and may feel helpless as the contractions intensify during what phase?
Active
In the transition phase the cervix dilates from ___ to ____cm, and the fetus descends further into the pelvis
8-10 cm
_____ ____ often increases with completion of cervical dilation during the Transition Phase
Bloody Show
Transition phase is a _____ phase, but intense with very strong _________
Short
Contractions
The woman may have the urge to push down during __________ in the transitional phase as the fetal presenting part reaches her pelvic floor
Contractions
Leg tremors, nausea and vomiting are common during the ________ phase
Transitional Phase
The woman will be _______ and lose control during the transitional phase
Irritable
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
5 minutes
30-40 seconds
Contractions iincrease in frequency, duration and intensity until every ___ to ____ minutes for ____ to ____ seconds and moderate to strong intensity during the active phase
2-5 minutes
40-60 seconds
In the transitional phase, contractions are strong and occur every ____ to ____ minutes, for ____ seconds
1 1/2 to 2 minutes
60 seconds
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
10cm
Birth
_____ describes the 2nd stage well
Labor
Between contractions in the expulsion stage, the woman may appear ______ or oblivous to her surrondings
Asleep
The third stage (placental) begins with the birth of the baby and ends with the expulsion of the ___________
Placenta
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
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
10cm
Birth
_____ describes the 2nd stage well
Labor
Between contractions in the expulsion stage, the woman may appear ______ or oblivous to her surrondings
Asleep
The third stage (placental) begins with the birth of the baby and ends with the expulsion of the ___________
Placenta
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
The Schultze mechanism of placneta expulsion is when the placenta is expelled with the shiny, _____ side first
Fetal
Duncan Mechanism of placenta expulsion is less common and it is when the rough maternal side is ________
Presenting
Inadequate uterine contraction after birth may result in
Hemmorahge
The fourth stage of labor (physical recovery) lasts from the delievery of placenta through the first ___ to ____ hours after birth
1-4
Lochia Rubia
Vaginal Drainage during fourth stage of labor
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
Warm
Ice
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
Bonding
Nulliparious mother
Never had deliever 1st time mother
Parous mother
Already experienced a full labor
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