Ati Ob Study

Front 1

Mild preeclampsia is gestational hypertension with the addition of what 3 things?

Back 1

1. Proteinuria of 1 to 2+
2. Weight gain of more than 2 kg (4.4lbs) per week in the second and third trimesters
3. Mild edema begins to appear in the upper extremities or face

Front 2

What 6 things make up gestational hypertension?

Back 2

1. Begins 20th weeks of pregnancy
2. Elevated bp at 140/90 or greater
3. Systolic increase of 30 or diastolic increase of 15 from prepregancy baseline
4. No proteinuria
5. No edema
6. Patient's bp returns to baseline by 12 weeks postpartum

Front 3

What is the underlying mechanism for the signs and symptoms of pregnancy hypertensive disorders?

Back 3

Vasospasm contributing to poor tissue perfusion

Front 4

What 11 things make up severe preeclampsia?

Back 4

1. BP that is 160/100 or greater
2. Proteinuria 3 to 4+
3. Elevated serum cretinine greater than 1.2 mg/dL (normal for female is 0.6-1.1)
4. cerebral or visual disturbances (headache blurred vision)
5. hyperreflexia with possible ankle clonus (an involuntary tendon reflex that causes repeated flexion and extension of the foot. It may be caused by pressure on the foot or corticospinal disease. More than four beats of clonus is pathologic)
6. Pulmonary or cardiac involvement
7. extensive peripheral edema
8. hepatic dysfunction
9. epigastric and right upper quadrant pain
10. thrombocytopenia
11. Oliguria (too little urine)

Front 5

What 6 things make up Eclampsia?

Back 5

Eclampsia is severe preeclamspia along with these onsets
1. Seizure activity or coma
2. preceded by headache
3. peceded by severe epigastric pain
4. preceded by hyperreflexia with possible ankle clonus
5. preceded by hemoconcentrations (an increase in the number of red blood cells resulting from either a decrease in plasma volume or increased production of erythrocytes)
6. All of the above is probable warning signs of convulsions

Front 6

What does HELLP syndrome stand for and is it diagnosed clinically or by lab tests and what is it a variant(a form or version of) of ?

Back 6

H=hemolysis resulting in anemia and jaundice
EL=Elevated liver enzymes resulting in elevated alanine aminotranferase (ALT) (ALT is measured to see if the liver is damaged or diseased. Low levels of ALT are normally found in the blood. But when the liver is damaged or diseased, it releases ALT into the bloodstream, which makes ALT levels go up. Most increases in ALT levels are caused by liver damage)or aspartate transaminase (AST) (Low levels of AST are normally found in the blood. When body tissue or an organ such as the heart or liver is diseased or damaged, additional AST is released into the bloodstream) , epigastric pain, and nausea and vomiting
LP=low platelets (<100,000/mm3), resulting in thrombocytopenia (low platelet count), abnormal bleeding and clotting time, bleeding gums, petechia, and possibly DIC (In DIC, the body's natural ability to regulate blood clotting does not function properly. This causes the blood's clotting cells (platelets) to clump together and clog small blood vessels throughout the body)

Lab tests

GH

Front 7

Variant of GH in which hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction

Back 7

HELLP syndrome

Front 8

What medication should be given to treat gestational hypertension?

Back 8

Magnesium sulfate

Front 9

What is magnesium sulfate and what does it do, how should it be administered and what will client feel?

Back 9

Anticonvulsant

lowers blood pressure and despress the CNS

Client may initially feel flushed, hot, and sedated with the mag sulfate bolus, use an infusion control device to maintain a regular flow rate

Front 10

When a client has gestational hypertension what should their fluid restriction be what does clients urine output be?

Back 10

100 to 125 ml/hr, client also needs to maintation a urinary output of 30 ml/hr or greater

Front 11

What are 5 things that are a sign of mag toxcity?

Back 11

1. Absence of patellar deep tendon reflexes
2. Urine output less than 30 ml/hr
3. Respirations less than 12/min
4. Decreased level of consciousness
5. Cardiac dysrhythmias

Front 12

What 3 things should you do if mag toxicity is suspected?

Back 12

1. Immediately discontinue infusion
2. Administer antidote calcium cluconate
3. Prepare for actions to prevent respiratory or cardiac arrest

Front 13

True or False a reactive nonstress test is good

Back 13

True

Front 14

When is an NST considered reactive?

Back 14

1. FHR is a normal baseline rate with moderate variability
2. Accelerates to 15 beats/min for at least 15 seconds
3. Occurs 2 or more times during a 20 min. period

Front 15

When is an NST considered nonreactive?

Back 15

If the FHR does not accelerate adequately with fetal movement and does not meet the criteria within 40 min.

Front 16

What are high levels of AFP (alpha-fetoprotein) associated with and what are low levels of AFP associated with?

Back 16

High=neural tube defects such as ancephaly, spina bifida, or omphalocele (abdominal wall defect). High AFP levels may also be present with normal multifetal pregnancies

Low=chromosomal disorders (down syndrome) or gestational trophoblastic disease (hydatidiform mole) A hydatidiform mole is a relatively rare condition in which tissue around a fertilized egg that normally would have developed into the placenta instead develops as an abnormal cluster of cells. (This is also called a molar pregnancy.) This grapelike mass forms inside of the uterus after fertilization instead of a normal embryo. A hydatidiform mole triggers a positive pregnancy test and in some cases can become cancerous.

Front 17

When should bonding and integration of an infant into the family structure start?

Back 17

1. During pregnancy
2. continue into the fourth stage of labor
3. Throughout hospitalization

Front 18

In what weeks after birth do clients go through a period of acquaintance with her newborn, as well as physical restoration?

Back 18

2 to 6 weeks after birth

During this time she also focuses on competently caring for her newborn

Front 19

When is the final act of achieving maternal identity accomplished?

Back 19

Around 4 months following birth

These stages may overlap, and are variable based on maternal, infant, and the enviornmental factors

Front 20

What are the 3 stages of paternal transition to fatherhood?

Back 20

1. Expectations: father has preconceived ideas about what it will be like to be a father

2. Reality: the father discovers that his expectations may not be met. Commonly expressed emotions include feeling sad, frustrated, and jealous. He embraces the need to be actively involved in parenting

3. Transition to mastery: the father decides to become actively involved in the care of the infant

Front 21

What are the 3 stages of development of the father infant bond?

Back 21

1. Making a commitment: father takes the responsibility of parenting

2. Becoming connected: experiences feelings of attachment to the infacnt

3. Making room for the infant: the father modifies his life to include the care of the infant

Front 22

Labor usually occurs with how many hours of the rupture of membranes?

Back 22

24 hours

Front 23

Prolonged rupture of membranes greater than ___ hr before delivery of fetus may lead to an _____.

Back 23

24

infection

Front 24

What 4 things do you assess of amniotic fluid (completed once membranes rupture)?

Back 24

1. Color (should be pale to straw yellow)
2. Odor (should not be foul)
3. Clarity (should appear watery and clear)
4. Volume (between 500-1200 ml)

Front 25

How often should you check maternal temperature if membranes are ruptured?

Back 25

Q 1-2 hr

Front 26

What are the 3 parts of the first stage of labor?

Back 26

1. Latent
2. Active
3. Transition

Front 27

What 6 things makes up the latent phase of labor?

Back 27

Cervix 0-3 cm
irregular, mild to moderate contractions
Frequency 5-30 min.
Duration: 30-45 sec
Some dilation and effacement
Mother is talkative and eager

Front 28

What 6 hings make up the active phase of labor?

Back 28

Cervix is 4-7 cm
Contractions: More regular moderate to strong
Frequency 3-5 min.
Duration 40-70 seconds
Rapid dilation and effacement
Some fetal descent
Feelings of helplessness
Anxiety and restessness increase as contracions become stronger

Front 29

What 11 things make up the transition phase of labor?

Back 29

Cervix is 8-10 (Ends with complete dilations at 10 cm)
Strong to very strong contractions
Frequency 2 to 3 min.
Duration 45 to 90 sec
Tired, retless, and irritable
Feels out of control, "I can't continue"
May have nausea and vomiting
Urge to push
Increased rectal pressure and feeling of needing to have a bowel movement
Increased bloody show
Most difficult part of labor

Front 30

What makes up the second stage of labor?

Back 30

Birth
Full dilation
Intense contractions 1-2 min.
Pushing results in birth of the fetus

Front 31

What makes up the third stage of labor?

Back 31

delivery of placenta, placental seperations and expulsion
Schultze presentations: shiny fetal surface of placenta emerges first
Duncan presentation: dull maternal surface of placenta emerges first

Front 32

How often should you assess maternal vital signs during the 4th stage?

How often should the fundus and lochia be assessed?

Back 32

q 15 min. for the 1st h and then according to facility protocol

q 15 min. for the first hour and than according to hospital protocol