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50 Cards in this Set
- Front
- Back
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What is habitual incompetent cervix?
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Women who had > 3 pregnancies lost early
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What is incompetent cervix?
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recurrent premature dilation of cervix
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What are the symptoms of incompetent cervix?
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Passive and painless dilation of the cervix during the second trimester
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What are some s/s of ectopic pregnancy?
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1. Vaginal bleeding (maybe small or large, depends on location & if it has ruptured or not)
2. Pain: maybe unilateral; dull, colicky. Complaint of referred pain (shoulder) 3. Delayed menses |
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What are the risk factors for ectopic pregnancy?
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1. H/o endometriosis
2. PID, gonorrhea, chlamydia 6 3. Infertility treatment 4. Tubal ligation (clipped or stapled tubes) |
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A lady came in with unilateral colicky pain, referred shoulder pain, and small bleeding. After repetitive vaginal exam, the lady is tachycardic. Her umbilicus has an ecchymotic blueness around it. What could be going on here?
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The patient is probably having ectopic pregnancy and because of repetitive vaginal exame, the ectopic probably ruptured. The first sign of hemorrhage is increased pulse. Cullen's sign (edema & bruising) around the umbilicus is due to peritoneum bleeding out.
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What is the criteria for diagnosis of ectopic pregnancy?
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1. Low beta hcg levels
2. Low progesterone level 3. U/S: mass on one side, fluid in pelvis, no pregnancy structures |
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What is methotrexate used for?
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Inhibits pregnancy growth (for pregnancy around no greater than 6-8 weeks)
It is a treatment for unruptured ectopic pregnancy |
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What should the nurse inform the patient before taking methotrexate?
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1. D/c prenatal folic acid
2. No sexual activity 3. No use of tampons for bleeding 4. Return visits to evaluate the decreasing beta hcg levels 5. Grief support |
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Besides methotrexate, what other surgical treatments are out there for ectopic pregnancy? Give options for decisions on wanting to have future pregnancy or not
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1. Removal of fallopian tube (salpingectomy)
2. Remove ecopic pregnancy & repair the tube (salpingostomy)-if she wants to have future pregnancy |
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What is hyperemesis gravidarum & what's one important nursing intervention that we need to keep in mind w/ this type of pt?
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It is severe nausea vomiting during pregnancy. MUST KEEP YOUR PATIENT HYDRATED. First intervention should be to start an IV
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What are the common causes of hyperemesis gravidarum?
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Rapid rising of Hcg & increased estrogen levels
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What are some ways a patient can medically manage hyperemesis gravidarum at home?
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Antiemetics & vitamin B6
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What are s/s of hyperemesis gravidarum?
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1. Severe nausea
2. Persistent excessive vomiting 3. Weight loss 4. Dehydration 5. Possible ketones in urine 6. Elevated Hct |
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What is hydatidiform mole?
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It is when a sperm penetrates an empty ovum. Therefore, only male DNA is in there.
Hydatidiform mole could be benign or malignant, & looks like a bunch of grapes |
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In pt. suspecting of hydatidiform mole, what does her history usually look like?
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1. Bleeding during late first trimester & early second trimester.
2. Dark brown to bright red vaginal blood (could be spotting or profuse bleeding) 3. PASSAGE OF CYSTS (in grape-like clusters) 4. Absence of quickening 5. Exaggerated signs of pregnancy (i.e: excessive n/v) |
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What is seen on physical assessment with a pt. w/ a hydatidiform mole?
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1. Elevated BP
2. Fundal height > expected for dates 3. Uterus larger than expected for dates 4. Mild uterine tenderness d/t over distention 5. Fetal parts not felt/ fetal heart not heard 6. Cysts might be present in blood |
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What is the management care for hydatiform mole?
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1. May deliver spontaneously, but followed by D & C evacuation of the uterus
2. INDUCTION IS NOT RECOMMENDED!!! (d/t risk of bleeding & embolization) |
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How long must the patient stay unpregnant after the evacuation of the uterus in hydatidiform mole?
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6 months
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Hydatidiform mole can be malignant, & hcg level will rise if pt develops malignant dz. What is the hcg f/u care look like to detect cancer risk?
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Draw first level 48 hrs after evacuation
Draw every 2 weeks until levels are within reference ranges (levels should consistently drop) Once reach reference ranges, check each month for a year. If levels rise, should prompt chest radiograph & pelvic examination |
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After evacuation of uterus due to hydatidiform mole, a patient is instructed to be on effective contraception. She chose IUD. What should the nurse inform her about?
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Insertion must wait til involution of uterus & normalization of serum Hcg levels
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What is diabetes type A1? What is the tx?
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1. Abnormal OGTT
2. Normal glucose levels during fasting, Normal 1-2 hrs after meals Tx: diet modification |
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What is diabetes type A2? What is the tx?
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1. Abnormal OGTT
2. Abnormal glucose levels during fasting. Abnormal 1-2 hrs after meals Tx: additional therapy with insulin or other meds |
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When should a pregnant woman go for diabetes check up?
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Between 24th & 28th week
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What's the recommended A1C range for nondiabetic pregnant women? For diabetic women?
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1. 4-6%
2. < 7% for diabetic women |
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How does the management of GDM usually look like?
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Begin with diet & exercise --> metformin --> (if fails or severe) subq insulin therapy
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A woman was taught about daily fetal movement count (DFMC) aka kick counts. A count of how many is going to warrant further evaluation by a nonstress test
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A count of fewer than 3 kicks
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What are some complications of amniocentesis?
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1. excessive loss of blood
2. infection 3. harm to baby, placenta, or cord from needle 4. premature rupture of amniotic sac 5. premature contractions or labor |
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1. What is considered macrosomia?
2. What weight & height are considered average for a full term baby? |
1. 4000-4500 g (8.8 - 9.9 lbs)
2. 20", weigh 6-9 lbs |
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If fetal heart deceleration occur during labor of a diabetic woman, fluid bolus needs to be
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non sugar base because of hyper/hypoglycemia problems with newborn
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What are some medical risks that put a woman at risk for preterm labor?
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1. Renal dz/ frequent UTI
2. HTN problems 3. Previous 2nd trimester abortion 4. Abnormal maternal uterine structure |
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What are some demographics that put a woman at risk for preterm labor?
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1. Teen, AMA
2. Low SES 3. Women of color 4. Smoker 5. Subabuse 6. <100 lbs prenatally |
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Low birth weight is defined as
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</ 2500 g
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What's the difference between PROM & PPROM?
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PPROM is ruptured of membranes </ 37 weeks, making the baby preterm...whereas PROM is ROM prior to onset of labor
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What is fFN (Fetal fibronectin) & how reliable is it?
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If fFN is present in the cervico-vaginal secretions of symptomatic women during wk 24-34, that's an indication of increased risk of preterm delivery. However, absent of fFNN is more of a reliable predictor (pregnancy is likely to continue for at least another 2 wks)
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What are some basic care when a patient is admitted to antepartum?
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1. May have fluid bolus 500ml
2. May have abx therapy if infxn 3. May give pain meds (stadol) 4. May give betamethasone (if lungs haven't matured 5. Fetal monitoring |
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What is the MgS therapeutic range for preeclamptic pt?
For normal pt? |
Preeclamptic: 4-7
Normal: 6-9 |
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What should we watch for when giving a patient terbutaline?
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S/S of Pulmonary Edema
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When giving nifedipine, a calcium channel blocker (tocolytic) to decrease the # & frequency of contractions, what are the side effects of this drug?
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1. Headache
2. Flushing 3. N/V 4. Tachycardia |
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When giving indomethacin, a prostaglandin (tocolytic) to decrease uterine activity, what are the side effects of this drug?
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1. Epigastric pain
2. N/V 3. Heartburn |
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What does biophysical profile consist of?
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1. Assess fetal tone, movement, breathing movements
2. Amniotic fluid index 3. NST |
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What does a score between 0-4 on a NST mean?
Do you want the test result to be reactive or nonreactive? Remember, you give 0 for abnormal & 2 for normal |
1. 0-4 = severe fetal compromise, delivery indicated
2. REACTIVE! |
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What is the classic sign for placenta previa?
What is the mother at high risk for after delivery? |
PAINLESS VAGINAL BLEEDING at 2nd or 3rd trimester, or at term. Usually following intercourse. She may have preterm contractions.
Mother is high risk for hemorrhage |
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What is placenta accreta?
Can you pick up placental accreta w/ U/S? |
When placenta grows into the myometrium muscle & you're at high risk for severe hemorrhage & possibility of hysterectomy
NO |
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What is the treatment plan for a patient diagnosed w/ placenta previa, but with no active bleeding?
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Expectant management
No intercourse. No digital exams |
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What is the treatment plan for a patient diagnosed w/ placenta previa, but with active bleeding?
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Assess overall status, circulatory stability.
Full dose of Rhogam if Rh- Consider maternal transfer if premature May need corticosteroids, tocolysis, amniocentesis |
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What are the 4 stages of grief
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1. shock/numbness
2. searching/yearning 3. disorientation 4. reorganization/resolution |
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Usually how long is the shock/numbness stage & what are the characteristics seen?
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24hrs to 2 weeks
Denial, difficulty making decisions, emotional labile |
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Usually how long is the searching & yearning stage & what are the characteristics seen?
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2 weeks - 4 months
sensitive to stimuli, ANGER/GUILT, restless/impatient, testing what is real, weight loss or gain |
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What are the medical or surgical interventions for inevitable abortion?
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Prostaglandins to terminate pregnancy
Surgical interventions: D&C to scrape products out |
