OB Assessment 2
Terms in this set (73)
What does diabetes put expecting mothers at risk for?
Pre-eclampsia, hemorrhage, and infection
What are signs and symptoms of hypoglycemia? Hyperglycemia?
Hypoglycemia: Cold, clammy, dizzy, chills, irritable, confused.
Hyperglycemia: acetone breath, hungry, thirsty, increased urination, agitation
What substance related to diabetes can pass the placenta? What cannot? What does that put the fetus at risk for?
Glucose passes the placenta but insulin does not. Therefore, macrosomia is a big risk because the fetus does not have mature pancreas to create sufficient insulin.
What is DIC? How is it treated?
Disseminated Intravascular Coagulation
Maternal condition where clotting cascade is activated
Results in uncontrolled bleeding. Bleed from every orface
Usually a result of HELLP because liver enzymes breakdown all clotting factors.
Deliver the baby as soon as possible! Continues 24-48 hours postpartum but usually goes away after birth.
What is an ectopic pregnancy? What are the risk factors? S&S?
Ectopic pregnancy: implantation of fertilized ovum outside of the uterus. Usually in the fallopian tubes although can be anywhere outside the uterus.
Risks: IUD placement, age (<18, >35)
S&S: vaginal bleeding, sharp pelvic pain/abdominal pain, referred shoulder pain
What is a placental abruption? S&S? Interventions?
Placental abruption: premature separation of the placenta
>20 weeks gestation. <20 weeks is considered an abortion
S&S: vaginal bleeding- usually dark red (blood between uterus and placenta is released), severe abdominal pain, board-like abdomen
Interventions: Prepare for cesarean birth, no perfusion without placental attachment
What is placenta previa? S&S? Interventions?
Placenta previa: Abnormal implantation of the placenta in lower uterine segment
S&S: Painless, bright red bleeding
Interventions: Side laying position, prepare for cesarean (cannot birth the child with the placenta in the way)
What is pre-ecalmpsia?
High blood pressure
Usually associated with protein in the urine (glucose is normal, not protein), increase in blood pressure, and increase in uric acid (increases action potential)
Can cause eclampsia- seizures
Interventions: decrease stimulation (low lights, noise, activity)
What is HELLP? S&S? Interventions?
HELLP: hemolytic, elevated liver, low platelets
Variant of preeclampsia involving hepatic function
S&S: headache, RUQ pain, flu-like symptoms
AST, ALT, SGPT, SGOT, and alkaline phosphotase are checked
Liver enzymes break down RBCs at an extremely fast rate, decreasing RBC's and platelets
Interventions: Assess for hyperactive reflexes and protein urea.
What is magnesium sulfate used to treat? What is the antidote? When should you hold the dose?
Preeclampsia: prevents seizures
Prevent premature contractions (tocolytic)
Antidote: calcium carbonate
Hold the dose when deep tendon reflexes are absent and when respirations are less than 12. DTR should be decreased although not absent. Urine output <30mL/hr, respirations <12/min, absent DTRs, and serum levels >8mg/dL are all signs of toxicity
What is effacement? Dilation?
Effacement: thinning of uterus
Dilation: Opening of the cervix
What type of birth are TEDS used for? SCDs?
Teds for vaginal birth
SCDs for cesarean
What is the average blood loss for vaginal birth? Cesarean?
Why does the risk for clotting increase after birth?
Clotting factors increase; fibrinogen
How often should the mother go to the bathroom during labor? Why
Every 1-2 hours
A full bladder can prevent the fetal decent slowing the birthing process.
Same with postpartum, a full bladder can prevent uterine contractions making hemorrhage risk increase
What is the normal FHR?
What is the different between lung maturity during vaginal birth? Cesarean?
In a vaginal birth, fluid is pushed out of the fetal lungs and increases the absorption rate helping the fetus clear lung secretions.
Cesarean birth, the fluid is not pushed out therefore they are at an increased risk for respiratory issues post partum
What type of bony pelvic is preferred? Why
Gynecoid is the preferred pelvic shape because it allows the fetus to pass easier. A more round, rather than narrow, pelvis makes birthing easier.
What are the variations is presentation? What is the presenting part for each?
Cephalic: Occiput. military, brow, face
Breech: Sacrum. frank (feet by head), full (completely flexed), single foot
Transverse: completely horizontal. Cannot give birth. Shoulder is presenting part
What are signs of labor?
Braxton hick's contractions: ineffective contractions
Blood show: looks like snot
happens once the cervix effaces and dilates
Lightening is a good indicator, although usually happens two weeks before labor
What is the difference between true and false labor?
True: Abdominal pain radiates into the back, cervical changes, inability to move
False: without cervical change, annoying cramp pain
What is engagement?
Where the fetus is in relation to the ischial spine
+ below the spine
- above the spine
"engaged" is at 0
What are the stages of labor?
Stage 1: latent, active, transition. Full dilation of the cervix
Stage 2: delivery of the baby
Stage 3: expulsion of the placenta
Stage 4: 1-4 hours after delivery- hemorrhage is a concern
What are accelerations? Decelerations? Variable? Which are normal and/or abnormal? How are late decelerations treated?
Accelerations: accelerations in FHR. Normal during contractions. Means the fetus is responding appropriately. Increase of 15 bpm/15 seconds
Early decelerations: Suggests the head is compressing on the cervix. Normal
Late decelerations: utero/placental insufficiency. Bad.
Treated by decreasing oxytocin administration, increasing oxygen flow, and placing in side laying position.
Variable: suggests compression of the umbilical cord. Look like a "u" "v" or "w"
Where is the best place to hear the FHR?
Around the shoulder
Occiput: lower abdomen
Breech: upper abdomen
What is the fetal spiral electrode used for? The intrauterine pressure catheter (IUPC)?
FSE: Placed on the fetus's head to measure FHR
IUPC: placed within the cervix to help measure contractions
What is a sinusoidal FHR pattern? What does it suggest?
a curvy pattern on FHR monitor
Suggests severe hypoxia. No reserve
Never a good thing
What impact does fear and anxiety have on labor?
Reduce blood flow to and from the placenta and reduce the efficiency of contractions; prolonging labor
What is the difference between an epidural, intrathecal injection, and subarachnoid block?
Epidural: injection/pump into epidural space. Used with vaginal birth primarily although can be given at an increased dosage for cesarean. Takes 10-20 minutes to be effective therefore is usually administered early in labor. Can cause hypotension (narcotic analgesia)
Intrathecal: Used when other forms of pain relief are ineffective. Not common. One injection and then needle is removed, although lower body movement is possible.
Subarachnoid block: needle is removed immediately after one injection like an intrathecal. Although it differs such that movement is not possible. Usually when cesarean is necessary
When is a blood patch used?
It is used when CSF continues to leak after spinal injection resulting in a spinal headache (relieved when laying). The patients own blood is injected in the same injection site to promote clotting.
What is AROM?
Artificial Rupture of Membranes: amniotomy
Used to induce or augment labor
Risks: prolapsed cord, infections, placental abruption
What is gestational thromboplastic disease?
Looks like grapes: increased hcG
can be with or without fetal parts
Cannot become pregnant <6 months after diagnosis
What is hyperemesis gravidarum?
Vomiting not related to morning sickness
Usually results in weight loss, electrolyte imbalance, nutritional deficiencies, and ketonuria.
What is chronic hypertension?
Hypertension that exists before conception or before 20 weeks.
Gestational HTN: >20 weeks gestation associated with proteinuria
Increase risk of preeclampsia, eclampsia
What is PROM?
Premature Rupture of Membranes
<37 0/7 weeks
Increases risk of infections: chorioamniocentesis (treated with antibiotics)
What position should a woman be in with a fetus with shoulder dystocia?
Knee to chest
How would a nurse intervene with a prolapse umbilical cord?
Cord is beneath the presenting part of the fetus
If it is suspected, the nurse will hold the umbilical cord between two fingers and will not let go until the fetus is born.
What are normal cardiovascular changes post-partum?
Blood volume decreases: increased urination (weight loss)
Hgb and Hct return to normal in 6 weeks
Milk production: suckling stimulates
What is BUBBLECE?
B: bowel and Gi function
B: bladder function
E: emotional status
Used to assess the new mother post-partum
What is uterine atony? How is it treated?
When the uterus is not contraction effectively, increasing risk for hemorrhage post-partum. Treated first by emptying the bladder, then a firm uterine massage to promote contraction. May also be given pitocin.
What medications are usually given postpartum? why?
Ibuprofen and stool softener
Constipation is an issue and inflammation is common, decrease discomfort.
What are the three phases of maternal role attainment?
Taking in: eating and taking as much help as possible
Taking hold: taking maternal role, helping care for infant
Letting go: changing old role
When can sexual intercourse be resumed postpartum?
6 weeks, the mother needs time to heal.
When is a fever in a woman postpartum significant?
>100.4°F on two consecutive days
Does not count the first 24 hours postpartum. Temperature naturally increases
What is the difference between lochia? Rubra, serosa, alba?
Rubra: bright red. <3 days
Serosa: brown/red, 3-7 days
Alba: clear, white, 7+ days. WBC dense
What is the difference between postpartum blues, depression, and psychosis?
Blues: normal. First day or two postpartum. Cry easily. Usually subsides by 10th day
Depression: depression resulting in the inability to care for themselves and the infant. Usually up to one year after birth
Psychosis: Depression that can result in hallucinations, delirium, or disorientation. Usually results in hospitalization and separation from infant. Often cause harm to themselves or infant.
What size clots need to be notified to the health care provider?
>1 cm. There are normally tiny clots present, although when they get larger they are a concern.
When does the first fetal stool occur?
First 12-24 hours
Meconium: black and tarry. High in bilirubin
What are signs of infant respiratory distress?
Nasal flaring, retractions, grunting (singing)
Cyanosis is normal the first 24 hours of life
How do you promote thermoregulation in the infant?
Dry them off
Put them on a warm surface
Keep the room temperature neutral
Keep them away from drafts
What are the effects of cold stress?
Increased metabolism: brown fat used
Acidosis: brown fat metabolism
Compensatory respiratory alkalosis
Jaundice: bilirubin cannot be passed in GI
Why is jaundice normal in infants?
RBC's breakdown at an increased level, therefore there are a lot of free bilirubin. Usually the bilirubin is passed through meconium.
What is the difference between pathologic, physiologic, and breast-feeding jaundice? How is it treated?
Pathologic: first 24 hours
Physiologic: >24 hours
Breastmilk: lack of breast feeding but usually is given formula to promote GI motility
Treatment: bili-lights. Eye protection is important
When do infants void for the first time?
Usually void within the first 24 hours. If not, renal impairment is suspected
What is the APGAR score?
Fetal well being
Scored right after birth, usually not given if respiratory issues occur.
Performed 1 minutes and 5 minutes after birth
Should not be completely pink after birth: some cyanosis is normal
4-6: needs moderate resuscitation efforts
0-3: severe need for resuscitation
What is the difference between term, preterm, and post-term infants?
Term: flexed, flex fingers to wrist, cannot completely scarf arm around neck, ear recoil, covered labia and developed scrotum
Preterm: flacid, cannot flex fingers to wrist, can scarf arm around neck, lack of ear recoil, feet can extend towards head
Post-term: Like term infant but usually amniotic fluid contains meconium
How long does a mother normally breast feed? When is solid food introduced?
6-12 months breast feeding
Solid foods are usually introduced between 4 and 6 months or when developmentally ready
What are nutritional needs of infants?
Breastmilk provides all nutrients needed
What is the impact of maternal diabetes on the newborn?
Macrosomia; a lot of fat
Hypoglycemia: glucose is being used
What are common maternal infections?
O: other, hep. b, HIV, parvovirus, west nile
Herpes simplex virus
What is the most optimal position for the fetus to be in to be born?
Direct occiput anterior: allows the head to come out and then rotate
LOA: on the left side of the mothers hips
When is RhoGAM administered? Why?
RhoGAM is administered 28 weeks gestation and right after birth
Prevent mother sensitization to Rh+ blood
How would you obtain blood for a glucose meter on an infant?
Through their feet: heelstick blood because it is the most vascular area on the infant
Who most often experiences afterpains?
Breastfeeding women, multipara, and women who experience over-distention of the uterus
What are normal vitals for the mother postpartum?
Temperature: may rise to 100.4°F but may suggest dehydration. promote fluids
Pulse: may decrease to 50 bpm. >100 suggests blood loss or infection
Blood Pressure: should be normal
Respirations: rarely change
What is the rate of involution of the uterus?
1 finger space (cm) below the umbilicus/day
Usually cannot palpate at day 14
What are normal vitals during pregnancy?
Pulse: <100 bpm
Blood pressure: <140/90
Which drug is given during pregnancy to prevent blood clots?
Heparin is used during pregnancy because it does not pass the placenta. Coumadin does.
When during pregnancy does ankle edema usually occur?
During the second or third trimester when the weight of the uterus impacts venous return from the legs resulting in edema.
What maternal position promotes the fetal position to change from occiput posterior to occiput anterior (more favorable)?
When the mother is on all fours, it promote the fetus to rotate. Otherwise, the Leopold maneuver can also be used but the less invasive measure is performed first.
How do you measure the fundal height? Why is it measured?
Symphysis pubis to top of fundus
Helps determine gestational age. After week 18, each cm represents 1 week gestation.
For example, at week 36 the fundal height would be 36 cm.
What are interventions when late decelerations occur?
Maternal left laying position
*Late decelerations suggests uterine/placental insufficiency therefore left laying position helps promote blood flow. Continue to monitor
During pregnancy, when are UTIs most common? Why?
Usually most common in the third trimester because insulin insensitivity occurs to promote glucose movement to the fetus. Glucose in the urine is also normal in this time for that reason.
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