OB Exam 2 Galen College of Nursing
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Created by:
andilyn72 on February 24, 2012
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Description:
OB Nursing Exam 2 Galen College of Nursing
Classes:
copd 2013, umich nursing, CSC nurses, sbashoes, UtahPharmacology, My Own Group - OB
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270 terms
Terms | Definitions |
|---|---|
 What is the most common medical complication of pregnancy? | Hypertension |
| What is PIH? | Pregnancy induced hypertension |
| How is PIH diagnosed? | 140/90 two times 6 hours apart |
| What is gestational hypertension? | Onset after 20 weeks of gestation without proteinuria, return of normal B/P in postpartum |
| What is Pre-eclampsia? | onset after 20 weeks of gestation with proteinuria, multisystem vasopastic, reduced organ profusion, classified as mile or severe |
| Risk factors for PIH | women younger than 20 or older than 40, african and native americans, primigravidas, obesity, multiple fetus', family history, comorbitities (diabetes), chronic hypertension, chronic renal disease |
| A concentration of _________ mg/dl or greater in at least ___ random urine specimens is proteinuria. | 30;2 |
| Edema is not used as a marker of what? | preeclampsia |
| What is pathologic edema? | generalized accumulation of fluid in the face, hands or abdomen that is not responsive to 12 hours of bed rest, rapid weight gain of more than 2 kg in 1 week |
| If a womens last menstrual period is 5/21 when is her estimated due date? | February 28th |
| What is Leopolds maneuver? | It is used to determine the baby's position and know where to place the stethescope. |
| Left occiput anterior = | Easy labor |
| Left occiput posterior= | Difficult/painful labor |
| What is considered tachycardia for a fetus? Indicative of what? | >160 bpm, indicative of maternal or fetal infection or fetal hypoxia (an ominous sign). |
| What is considered fetal bradycardia? Indicative of? Intervention? | <120 bpm, indicative of fetal hypoxia or stress and maternal hypotension after epidural initiation (place client on left side, increase fluids, and stop pitocin). |
| WHAT IS AN EARLY DECELERATION? | HR SLOWS BEFORE PEAK OF CONTRACTION AND RECOVERS BY END OF CONTRACTION. (BEING EARLY IS GOOD) |
| WHAT ARE EARLY DECELERATIONS INDICATIVE OF? | HEAD COMPRESSION (NOT OMINOUS=NO INTERVENTION REQUIRED). |
| WHAT ARE LATE DECELERATIONS? | HR DECREASES AFTER PEAK OF CONTRACTION AND RECOVERS AFTER CONTRACTION ENDS. (BEING LATE IS BAD). |
| WHAT ARE LATE DECELERATIONS INDICATIVE OF? INTERVENTIONS? | FETAL STRESS AND HYPOXIA OR DEFICIENT PLACENTAL PERFUSION (CHANGE MATERNAL POSITION AND DISCONTINUE OXYTOCIN (PITOCIN)). |
| WHAT ARE VARIABLE DECELERATIONS? | TRANSIENT DECREASE IN HR ANY TIME DURING CONTRACTION. |
| WHAT ARE VARIABLE DECELERATIONS INDICATIVE OF? INTERVENTIONS? | CORD COMPRESSION (CHANGE MATERNAL POSITION-KNEE CHEST/ASS IN AIR). IF CORD IS PROTRUDING NEVER TOUCH. |
| What is decreased variability? | A smooth baseline. The baseline should vary by 10 to 15 beats every minute. The loss of short term variability can be ominous where as long term loss (20 to 40 mins) is probably not significant and can indicate a sleep cycle. |
| What is decreased variability indicative of? | Fetal sleep cycle, depressant drugs, hypoxia, or CNS anomalies. |
| What is an acme? | A peak of something |
| What are the three different ratings for APGAR CRITERIA? | 0 (POOR), 1, and 2 (BETTER). LOWEST SCORE IS A 0 AND HIGHEST IS 10. |
| What are the different criteria for APGAR SCORING? | COLOR, HR, REFLEX IRRITABILITY, MUSCLE TONE, RESPIRATORY EFFORT. |
| What pregnancy complications are of concern in the 1st trimester? | Ectopic pregnancy, abortion, incompetent cervix, and hyperemesis gravidarum) |
| What pregnancy complications are of concern in the 3rd trimester? | Placenta previa, abruptio placenta, and hypertensive disorders. |
| What treatment should be done for ectopic pregnancy? | Surgical treatment and IV FLUID |
| What is a characteristic sign of placenta previa? | painless bleeding around the 7th month |
| What is characteristic of abruptio placentae? | Tender abdomen c pain/bleeding |
| What classifies as eclampsia? | Pregnancy induced hypertension after a seizure. |
| What preventative measures are taken for hypertensive disorders during pregnancy? | No sodium intake, I&O, and elevate extremities. |
| What is done for an incompetent cervix? | Purse string procedure |
| What is the triad of symptoms in hypertensive disorders? | Edema, increased BP, and Proteinuria |
| What should be watched with hydramnios? | "Too much amniotic fluid". There is an increased risk for hemorrhage. |
| When is Rhogam received? | 1st trimester or 72 hours after childbirth |
| What is the treatment for pregnancy induced HTN (PIH)? | Bed Rest, increased protein diet, BP meds, monitor for seizures, and MgS04 if needed. |
| When does preeclampsia usually occur? | Third trimester |
| What are the symptoms of mild preeclampsia? | Hypertension (sys increase of 30 and diastolic of 15), Edema (generalized & periorbital, gain 1lb/wk in 3rd T), and Proteinuria (1gm/24 hrs, 1+ protein). |
| What are the S&S of severe preeclampsia? | Hypertension, Edema, Proteinuria, Midepigastic pain d/t liver edema, increased ICP (cerebral), visual changes, vomiting, and oliguria. |
| What causes preeclampsia to become eclampsia? | The presence of seizures. |
| What is given to prevent or treat PIH seizures? | Magnesium sulfate |
| What will lab tests show with severe preeclampsia? | HELLP= Hemolysis, Elevated Liver function tests, and Low Platelet count. |
| What needs to be available when a patient with preeclampsia delivers and why? | Blood (ABO) bc the patient will lose an increased amount of blood during delivery. |
| Why is MAGNESIUM SULFATE given to pregnant women? | To prevent seizures with the complication of pregnancy induced hypertension (PIH). |
| What will a woman on MgS04 feel like? | Sleepy bc it is a nervous system depressant. |
| What is the antidote for MgS04? | Calcium gluconate |
| What are the S&S of MgS04 toxicity? Treatment? | BURP= Blood pressure decreased, urine output decreased (<30), respirations <12, and patella reflex absent. D/C mag sulfate if see these signs. |
| What should be done if contractions are lasting 1 1/2 mins or if side effects are presenting? | STOP THE PITOCIN. If contractions are lasting that long then the baby isn't getting oxygen during that time. |
| What are the 4 stages of labor? | First (stage of cervical dilation), second (stage of expulsion), third (placental stage), and fourth (maternal homeostatic stabilization). |
| What are the three parts of the first stage of labor? | Latent (<4cm, if give drugs at this time will stop the labor), Active (Give drugs), and Transitional (>8cm) |
| What does the 1st stage of labor (cervical dilation stage) begin and end with? | Begins with onset of regular contractions and ends with complete dilation. |
| What does the 2nd stage of labor (expulsion stage) begin and end with? | Begins with complete cervical dilation and ends with delivery of the fetus. |
| What does the 3rd stage of labor (placental stage) begin and end with? | Begins immediately after fetus is born and ends when the placenta is delivered. |
| What does the 4th stage of labor (maternal homeopathic stabilization stage) begin and end with? | Begins after the delivery of the placenta and continues for one hour after delivery. |
| Who is most likely to die from hemorrhage during labor, a women having an 11 lb. baby or a woman delivering sextuplets? | The woman with the 11 lb. baby. |
| What are the steps of a postpartum assessment? | BUBBLE HE= BREAST (mastitis), UTERUS (fundus should be firm and midline several fingers above umbilicus about the size of a GRAPEFRUIT), BLADDER (distension, diuresis during 1st 2 days post), BOWEL (laxative need 3rd day should be normal), LOCHIA (no odor & appropriate type), EPIOSIOTOMY (infection & healing), HOMANS SIGN (thrombophlebitis), AND EMOTIONAL (Support). |
| What are the 3 types of lochia and when do they occur? | Rubra (dark red, 1st 3 days), Serosa (pinkish, sero-sanguinous, 3-10 days), and alba (creamy or yellowish after the 10th day and may last a week or two). |
| What should be done if a woman is cramping after being given methergine? | Nothing it is an expected outcome and means that the drug is working. |
| How is methergine used after birth? | It is used to control bleeding by promoting increased contractions and stiffening of the uterus muscles. |
| What should be taught to a woman with mastitis? | Continue to breast feed on both breasts. |
| What should a pregnant woman be taught to do to toughen nipples? | Expose to air after a feeding |
| What should a woman who is having trouble producing milk do? | Apply heating pads to the breasts |
| What should a woman do if not breast feeding their baby to prevent engorgement? | Apply ice pack to breasts and wear a tight bra |
| What sign will the baby show that they are correctly latched to the breast? | Their lips will flange |
| What is the proper way to help the baby release suction on the breast? | Put finger in the corner of the mouth to break suction. DON'T pull or can cause trauma to breast. |
| What are the 4 types of heat loss in an infant? | Evaporation (moisture on skin), CONDUCTION (CONTACT WITH COLD OBJECTS-SCALE OR COLD HANDS), Convection (drafts from open doors or air conditioning), and Radiation (by cold surfaces, so from baby to crib and out window). |
| What will a woman with abruptio placentae present with? | Sharp abdominal pains and vaginal spotting (or large amounts of vaginal bleeding), tender and rigid abdomen, pale, anxiousness, diaphoretic, tachycardia, increased respirations, and increased temperature. |
| What should be done 1st for abruptio placentae? | Place in left side lying position and administer 4 L nasal cannula. |
| What are the risks of abruptio placentae? | Fetal anoxia or death, and maternal shock, hemorrhage, or death. (an emergency c-section is usually indicated). |
| What should be done in preparation for an emergency c-section as a result of an abruptio placentae? | Keep her NPO for surgery, administer supplemental oxygen, and start a large bore IV line. |
| What are causes of abruptio placentae? | HTN, trauma, diabetes, cocaine use, alcohol abuse, cigarette smoking, PROM, or an abnormally short umbilical cord. |
| What are the S&S of a ruptured ectopic pregnancy? | Sick to stomach, cramps, pallor, slight fever, bright red vaginal bleeding, excruciating shooting pain in right shoulder which worsens with inhaling, tachycardia, and hypotension. (if states last menstrual period 8 weeks ago with spotting can suspect) |
| What should be done immediately for a women with a ruptured ectopic pregnancy? | Notify MD, insert a large bore IV, infuse NaCl at 150/hr, ask about food incase surgery, blood and urine tests, vital signs, morphine, and surgery prep. |
| What needs to be taught to new parents about preterm bonding? | Encourage parents to hold/sing to their infant, promote skin to skin contact, feedings promote bonding, and make sure focused when bonding (ex: NO TV while breast feeding. |
| Normal Fetal Heart Rate | 110 - 160 bpm |
| Fetal Tachycardia | above 160 bpm |
| Fetal Bradycardia | below 110 bpm |
| Severe fetal tachycardia | above 180 bpm |
| Severe fetal bradycardia | below 80 bpm |
| Periodic changes in fetal heart rate | accels or decels that occur with a contraction |
| Episodic changes in fetal heart rate | accels or decels not correlated with a contraction |
| Acceleration of fetal heart rate | an increase of 15 bpm over baseline for 15 seconds |
| What device measures contractions? | the external monitor with a button |
| What are 3 indicators of fetal health? | variability, accelerations, normal heart rate |
| What is the best indicator of fetal health? | variability |
| Early decels are caused by what? | head compression, mimics a contraction, not worrisome |
| Late decels are caused by what? | uteroplacental insufficiency, these are worrisome |
| Variable decels are cuased by what? | cord compression or obstruction |
| What is the first thing to do when there is fetal stress? | Reposition the mother |
| What are other actions that can be taken when there is fetal stress? | Reposition the mother, give oxygen (8L via face mask), administer tocolytics (brethine, procardia, utapar, mag. sulfate, indocin) to slow or stop contractions |
| What is the biggest cause of FHR tachycardia? | maternal fever |
| What should be given to the mother if there is FHR tachcardia? | tylenol and IV fluids to bring fever down |
| What should be done for FHR bradycardia? | Scalp stimulation |
| Dystocia | difficult, long, abnormal labor, which may be produced by the large size of the fetus or the small size of the pelvic outlet |
| Hypertonic uterine dysfunction | to many contractions, administer demerol and phenergan to start "therapeutic rest" |
| Hypotonic uterine dysfunction | too few contractions (usually due to big baby), admin pitocin or prepare for c/s |
| What is the number 1 reason for cesarean section? | fetal cephalopelvic disproportion |
| Precipitous labor | labor that last less than 3 hours from onset of contractions to deliver |
| Version | manual turning of a fetus in the uterus (usually to aid delivery) |
| Nurses job when version is imminent | Have and IV in, monitor V/S and fetal monitoring |
| Complications of version | placental abruption, uterine rupture, fetal distress |
| When does the placenta start getting "old"? | at 36 weeks gestation |
| shoulder dystocia | Head is delivered but shoulders become impacted above mother's symphysis pubis. |
| What should be done for shoulder dystocia? | act fast, only have 1-2 minutes before the baby dies, apply suprapubic pressure (NOT fundal) and put Mom in McRobert's Maneuver |
| McRobert's Maneuver | thighs flexed into the abdomen which changes the angle of the pelvis, increases pelvic diameters & facilitates delivery of the shoulders. |
| If a Mom is having contractions ONLY before the due date what is she experiencing? | Braxton Hicks contractions |
| If a Mom is having only a cervical change before the due date what does she have? | An incompetent cervix |
| If a Mom is having both contractions and cervical change before the due date she is in? | Preterm labor |
| If a baby is delivered before 20 weeks it is called ____________. | spontaneous abortion/miscarraige |
| If a baby is delivered between weeks 20 and 37 it is called ____________. | preterm |
| If a baby is delivered between 38 and 42 weeks it is called __________. | Term |
| If a baby is delivered after 42 weeks it is called ___________. | post term |
| What is common after rupture of membranes? | A prolapsed cord |
| What is the best position for Mom to be placed in with a prolapsed cord? | Reverse Trendelenburg |
| A nurse should do what if a prolapsed cord has occurred? | hold the presenting part up and off the cord and change the mom's position |
| What is a uterine rupture usually due to? | A previous c/s |
| What are the signs and symptoms of a uterine rupture? | pain, bleeding, fetal distress, maternal nausea, hypotension, shock |
| What needs to happen with a uterine rupture? | An emergency c/s and advise against subsequent pregnancies |
| amniotic fluid embolism | some fluid enters woman's circulation and obstructs small blood vessels in lungs. Characterized by abrupt onset of hypotension, resp distress, and coagulation abnormalities |
| What must be in place for a cesarean section? | a foley and the uterus needs to be displaced to the side with a wedge under the hip |
| Risk factors for preterm labor | african american, maternal extremes of age (less than 16 or greater than 40), lose SES, no GED or HS diploma, alcohol or other drug use, poor nutrition, maternal periodontal disease, smoking, uterine abnormalities, low pregnancy weight, diabetes or HTN, multiple gestation, PROM, late or no prenatal care, short cervical length, STDs, bacterial vaginosis, polyhydramnios, rapid pregancies, placental problems, maternal anemia, UTI, domestic violence, maternal stress |
| Signs and symptoms of preterm labor | increased vaginal dischange, pelvic pressure, backache, menstrual like cramping, obvious uterine contractions, fluid leaking from vagina, vaginal bleeding, diarrhea, intestinal cramping |
| What should a woman do if she suspects she is in preterm labor? | Stop and rest for an hour, empty bladder, side-lying, drink 2-3 glasses of water, then call provider if these don't work |
| What medications can be given for preterm labor? | Celestone to tone the fetal lungs (take 28 hours to work) given to mom 24 to 24 weeks who is at risk for preterm labor. Or tocolytics such as procardia, brethine, mag sulfate, indocin |
| PROM | Premature Rupture of Membranes (after 37 weeks) |
| PPROM | Preterm Premature Rupture of Membranes (before 37 weeks) |
| Biggest risk of PROM and PPROM | infection |
| If PROM or PPROM occurs what needs to happen? | Keep Mom in the hospital, give Celestone and prophylactic antibiotics and wait until you can't wait anymore |
| Nitrazine test | this is a test of vaginal secretions if the client is uncertain whether the membranes have ruptured. Color will indicate whether amniotic fluid is present. Yellow = urine. Blue = Amniotic fluid. |
| Involution | reduction in size of an organ or part (as in the return of the uterus to normal size after childbirth) |
| What is the normal flow of the involution? | When placenta is expelled uterus is 2 cm below umbilicus, w/in 12 hours it rises above the umbilicus then descends 1-2 cm q24h and is not palpable after 2 weeks |
| Subinvolution | failure of the myometrium to contract after delivery of the baby |
| If subinvolution occurs what should be done? | Give oxytocin, it coordinates the uterus to contract |
| After pains | Cramp like pains due to contractions of uterus after childbirth. More common with Multiparas and most severe during breastfeeding. Lasts 2-3 days. |
| Rubra | ruby red color of lochia, delivery thru day 5 |
| Serosa | brownish or pink color of lochia, up to 3 weeks |
| Alba | Mostly mucous lochia, for the last 2 weeks |
| Lochia | substance discharged from the vagina (cellular debris and mucus and blood) that gradually decreases in amount during the weeks following childbirth, less with cesarean section |
| Pospartal diuresis | begins 12 hours after delivery, the Mom has to pee alot and experiences diaphoresis |
| How long does it take for a new Mom's milk to come in? | 48-72 hours |
| When the new mother's milk is coming in it is normal for the breasts to feel __________. | lumpy |
| Treatment for Mom's who don't want to breast feed and want their milk to dry up | breast binders, mild analgesics, cabbage leaves, ice packs, milk should not be expelled and nipple stimulation should be avoided |
| WBC count of 20000 - 25000 is normal when? | during the first couple of weeks post partum |
| Postpartum pain control | ice first 24 hours, heat after first 24 hours, nsaids are #1 med for uterine pain |
| Postpartum tremors | normal, comfort mom and give warm blankets |
| Postpartum hemorhage | greater than 500 mL vaginal or greater than 1000mL cesarean |
| Primary cause of postpartum hemorhage | uterine atony |
| uterine atony | marked hypotonia of the uterus |
| Early vs. late post partum hemorhage | in first 24 hours vs after 24 hours |
| What can the nurse do for postpartum hemorhage | provide a fundal massage - external uterine massage |
| What can the doctor do for postpartum hemorhage | bimanual massage - interal uterine massage |
| Hematoma | a localized swelling filled with blood |
| signs and symptoms of hematoma | unrelieved pain and pressure |
| treatment for hematoma | ice or if over 5 cm surgical removal |
| Inverted uterus | medical emergency, uterus turns inside out |
| treatment for inverted uterus | punch it back in there |
| Postpartum infection | occurs within 28 days of delivery (or abortion/miscarriage) |
| Signs and symptoms of endometritis | fever, pain/;tenderness, foul smelling lochia, possibly lethargy, decreased appetite, n&v |
| There is an increased risk of what postpartum infection with cesarean section? | endometritis |
| Mastitis signs and symptoms | redness, swelling, pain, tenderness, flu like symptoms |
| Risks fo mastitis | miss feeding, wait too long in between feedings, have cracked nipples, abrupt weaning |
| What are post partum blues | emotional (self limiting) |
| What is post partum depression? | lack of interest, depressed mood |
| Postpartum psychosis | hallucinations, delusions out of touch with reality |
| nfp stands for ... | natural family planning |
| NFP as contraception | ovum is viable up to 24 hours post ovulation, sperm can fertilize an egg up to 48 hours post coitus |
| Calendar method of contraception | subtract 18 from shortest cycle and subtract 11 from longest cycle and these indicate the period you can't have sex. |
| bbt | basal body temperature |
| Basal body temperature method of contraception | slight drop before ovulation, slight rise after. should be taken right after waking and before getting out of bed |
| Diaphragm method of contraception | can be inserted up to 6 hours before sex, must be left in at least 6 hours after sex |
| problems of using a diaphragm for contraception | increased risk of cystitis, contraindicated in pelvic relaxation and latex allergy |
| What is the main reason for taking progesterone only oral contraception is _________. | breastfeeding |
| IUD is contraindicated for women with a history of __________. | PID (pelvic inflammatory disease, undiagnosed bleeding, malignancy or a distorted uterus |
| Problems using IUD for contraception | increased risk of PID in first 20 days, risk of bacterial vaginosis and uterine perforation |
| What must be checked for expulsion after menstruation when using an IU? | the thread |
| Signs and symptoms of potential complications with an IUD | PAINS -P period late, abnormal spotting or bleeding, A abd pain, paind with intercourse, I infection, exposure, abnormal vaginal discharge, N not feeling well fever or chills, S string missing, shorter or longer |
| The normal newborn has respirations of | 30-60 per minute, shallow, abdominal, no use of accessory muscles, brief periods of apnea lasting 10 sec or less |
| The normal newborn has a heart rate of | 80-120 bpm |
| The normal newborn has urine output of | 15-60 mL/Kg/day |
| What is the optimal state for bonding and learning for a newborn? | quiet and alert |
| What is cold stress? | heat loss through convection, conduction, evaporation and radiation |
| What happens when a baby is in cold stress? | increased need for oxygen and may deplete glucose stores |
| The normal newborn axillary temperature is | 36.5-37.2 degress Celsius |
| The normal newborn blood pressure is | 60-80 mmHg/40-50 mmHg |
| What is the nurses role in circumcision? | hold feedings 2-3 hours, pertrolatum gauze after prodedure, check hourly 4-6 hours, wash w/ warm water (no baby wipes) |
| What indicates infection in a circumcision? | redness, swelling or discharge |
| What does eye prophylaxis protect against? | chlamydia and gonorrhea |
| Why is Vit K given? | to prevent hemorrhagic disease |
| The normal newborn weight is | 2500-4000g |
| The normal newborn length is | 45-55 cm |
| The normal newborn head circumference is | 33-35 cm |
| What is jaundice? | bilirubin is byproduct of RBC breakdown, jaudice appears at 5 mg/dL of bilirubin |
| Normal bilirubin level | less than 1 mg/dl |
| What helps jaundice? | feeding, it creates peristalsis and defecation |
| What is kernicterus? | rare type of brain damage that occurs in a newborn with severe jaundice. It happens when bilirubin builds up to very high levels and spreads into the brain tissues |
| Signs and symptoms of kernicterus | lethargy, irratibility, hyperactivity, floppy muscles |
| Treatment for kernicterus | lights if leves are greater than 12 mg/dl |
| Chlamidia (bacteria) signs and symptoms | increased vaginal discharge, burning, dysuria, dyspareuria |
| Chlamydia can lead to | infertility and PID |
| Gonorrhea (bacterial) signs and symptoms | increased discharge, dyspareumia, dysuria, dysmenorrhea |
| What can gonorrhea lead to? | amniotic infection syndrome |
| Syphilis (bacterial) primary signs and symptoms | single painless ulcer |
| syphilis (bacterial) secondary signs and symptoms | widespread symmetrical rash on palms and feet, generalized lymphadenopathy, fever and headache, condylomata, onset 6 wk - 6 mo after primary ulcer |
| Syphilis (bacterial) tertiary signs and symptoms | widespread affecting multi organ systems |
| How is syphilis detected? | VDRL/RPR - might take 2 months to serum convert after infection |
| Syphilis is a _________disease. | reportable |
| HPV (viral) leads to what? | genital warts and cervical neoplasia |
| During an outbreak of warts can a baby be born vaginally? | Yes. |
| Herpes (viral) signs and symptoms | painful lesions |
| how to relieve pain from herpes | drying the lesions |
| What is the only environmental factor affecting menopause? | cigarette smoking |
| Menapause leades to | atrophic vaginitis |
| atrophic vaginitis | thinning of the vagina and loss of moisture because of depletion of estrogen, which causes inflammation of tissue |
| What is dysmenorrhea and what is the treatment? | pain during menstration, NSAIDS |
| When do PMS symptoms occur? | luteal phase |
| When do PMS symptoms resolve? | within a few days of menses onset |
| Screening for cervical cancer | pap smears every 1=3 years |
| What should women ages 20-39 do for breast cancer awareness | monthly self breast exams and clinical breast exam every 3 years |
| What should women ages 40 plus do for breast cancer awareness | monthly self breast exams, yearly clincal breast exams, yearly mammograms |
| What should men to do for testicular cancer awareness? | monthly self testicular exams after puberty |
| Metrorrhagia | bleeding from the uterus at any time other than normal menstruation |
| Menorrhagia | abnormally heavy or prolonged menstruation |
| What women are at risk of maternal death? | older, white, multiparous women |
| Signs and symptoms of magnesium toxicity | hypotension, nonexistent reflexes, respiratory depression |
| antidote for mag sulfate | calcium gluconate |
| threatened miscarraige | spotting, mild uterine cramping, cervical os or closed |
| What to do for a patient experiencing a threatened miscarraige | bedrest, avoid stress & intercourse, watch and wait |
| Inevitable miscarraige | moderate to heavy bleeding, moderate uterine cramping cervical os open |
| What types of miscarriage end with termination and D&C | Inevitable and incomplete |
| Incomplete miscarriage | same as inevitable, fetus expelled, placenta retained |
| Complete miscarriage | all fetal tissue passed, cervix closed, mild cramping, small amount of bleeding |
| Nursing interventions for complete miscarriage | refer to social services motrin for cramping |
| Missed miscarriage | fetus dead, but everything is still in utero |
| What needs to happen with a missed miscarriage? | terminated if spontaneous evacuation does not happen in 1 month |
| incompetent cervix | painless, no uterine contractions, happens 2nd trimester |
| signs and symptoms of ectopic pregnancy | pain and spotting 6-8 weeks after missed period, adnexal fullness and tenderness, n&v, breast tenderness, lower back pain |
| signs and symptoms of rupture from ectopic pregnancy | fainting, hypotension, shoulder pain, hypovolemic shock, cullen's sign |
| cullen's sign | blue hue (cyanotic ring) around umbillicus |
| Placenta previa | painless uterine bleeding, normal V/S, normal fetal monitor, abd exam shows soft, relaxed, nontender uterus, fundal height higher than expected |
| placental abruption | severe abd pain, vaginal bleeding, uterus hard and tender, s/s of shock, non reassuring FHR |
| In true labor ... | cervix dilates, contractions increase and become regular, can not be stopped |
| 1st phase of 1st stage of labor (labor) | Latent (labor) |
| What happens in the 1st phase of the 1st stage of labor, the latent phase: | mild contractions, 10-15 minutes apart, bloody show or ROM, cervix dilates to about 4 cm |
| 2nd phase of 1st stage of labor (labor) | Active (labor) |
| What happens in the 2nd phase of the 1st stage of labor, the active phase: | painful contractions, 3-5 min apart, may try breathing techniques, request pain meds, cervix dilates to about 8 cm |
| 3rd phase of 1st stage of labor (labor) | Transitional (labor) |
| What happens in the 3rd phase of the 1st stage of labor, the transitional phase: | very intense, contractions 2-3 minutes apart, nausea, chills, shaking, diaphoresis, urge to push, cervix dilates to 10 cm |
| 1st phase of 2nd stage of labor (delivery of baby) | Latent (delivery) |
| What happens in the 1st phase of the 2nd stage of labor, the latent phase: | brief period of rest and calm |
| 2nd phase of 2nd stage of labor (delivery of baby) | Descent (delivery) |
| What happens in the 2nd phase of the 2nd stage of labor, the descent phase: | Ferguson reflex (uncontrollable urge to bear down) |
| 3rd phase of 2nd stage of labor (deliver of baby) | Transitional (delivery) |
| What happens in the 3rd phase of the 2nd stage of labor, the transitional phase: | crowning |
| 3rd stage of labor | Delivery of placenta |
| Signs of placental separation | firm contracted uterus, uterus changes to globular shape, sudden gush of dark blood, umbilical cord lengthens, vaginal fullness |
| 4th stage of labor | First 2 hours post partum |
| What should a nurse do during the 4th stage of labor? | Vital signs q15min for 1st hour, q30 min for 2nd hour |
| For station, a negative is | above the ischial spines |
| For station, a positive is | below the ischial spines |
| Engagement movement | widest part of head in pelvis |
| Descent movement | measured by station of presenting part |
| Flexion movement | chin brought toward chest |
| Internal rotation movement | begins at level of ischial spines |
| Extension movement | head deflected anteriorly when it reaches perineum |
| External rotation movement | realigns head with back and shoulders |
| Expulsion movement | after birth of shoulders |
| nonreassuring FHR patterns | progressive increase or decrease in baseline, tachycardia, progressive decrease in variability, absence of variability, severe decelerations, late decelerations, severe bradycardia, prolonged deceleration |
| Hazards of pitocin | tetanic contractions which can lead to premature separation of the placenta, rupture of the uterus, cervical lacerations, or post delivery henorrhage; uterine hyperstimulation decreased blood flow through placenta |
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