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OB-Final test review
| Question | Answer |
|---|---|
| an inability to conceive despite engaging in unprotected sexual intercourse for a prolonged period of time or at least 12 months; common factors: decreased sperm production, endometriosis, ovulation disorders, tubal occlusions | infertility |
| Assess: medical/surgical, gynecological and sexual history; Tx: medications, genetic counseling, emotional support, In Vitro fertilization, embryo transfer or surrogate parenting | infertility |
| bladder protrudes through the vaginal wall; Tx: surgical repair | cystocele |
| colon protrudes through the vaginal wall; Tx: surgical repair | rectocele |
| vaginal discharge that occurs after birth from seperation of placenta from uterus; continues for approximately four to eight weeks; results from involution | lochia |
| discharge that is a deep-red mixture of mucus, tissue debris, and blood that occurs for the first 3 to 5 days after birth | lochia rubra |
| pinkish brown discharge; expelled 6 to 10 days postpartum; primarily contains leukocytes, decidual tissue, red blood cells, and serous fluid | lochia serosa |
| creamy white or light brown discharge; consists of leukocytes, decidual tissue, and reduced fluid content; occurs from days 10 to 14 but can last 3 to 6 weeks postpartum in some women and still be considered normal | lochia alba |
| uterine fundus to or through the cervix so that the uterus is turned inside out after birth; multiparaous women are at particular risk for this; Tx: pessary devices, Kegel exercises, hysterectomy | uterine inversion/prolapse |
| normal fundal measurements at birth? Postpartum 12-hrs? 24-hrs? 2nd day? 3rd day? | birth U, 12-hrs U+1, 24-hrs U-1, 2nd day U-2, 3rd day U-3 |
| retrogressive changes that return the reproductive organs to their non-pregnancy state | involution |
| this reflex is paired with the rooting reflex; newborn is searching for food; is elicited by gently stimulating the newborn’s lips by touching them; placing a gloved finger in the newborn’s mouth will also elicit this reflex | sucking reflex |
| reflex that is seen in normal newborn babies, who automatically turn the face toward the stimulus and make sucking motions with the mouth when the cheek or lip is touched; helps to ensure successful breastfeeding. | rooting reflex |
| reflex as a response to a sudden loss of support, when the infant feels as if it is falling; involves three distinct components: spreading out the arms (abduction), pulling the arms in (adduction), crying (usually); fingers spread to form a C | Moro reflex (lost at 4 months) |
| stroking the lateral sole of the newborn’s foot from the heel toward and across the ball of the foot; toes should fan out; a diminished response indicates a neurologic problem and needs follow-up | Babinski reflex |
| place a finger on the newborn’s open palm, baby’s hand will close around the finger, attempting to remove the finger causes the grip to tighten; grasp should be equal bilaterally; lost around 6 months | palmar grasp |
| place a finger just below the newborn’s toes, toes typically curl over the finger; should be equal bilaterally | plantar grasp |
| multiple pearly-white or pale yellow unopened sebaceous glands frequently found on a newborn’s nose, may also appear on chin and forehead; form from oil glands and disappear on their own within 2 to 4 weeks | milia |
| benign blue or purple splotches that appear solitary on lower back and buttocks of newborns, but may occur as multiple over the legs and shoulders; tend to occur in dark skin ethnicities; caused by concentration of pigmented cells | Mongolian spots |
| benign, idiopathic, generalized, transient rash that consists of small papules or pustules on the skin resembling flea bites; often mistaken for staph pustules; common on the face, chest, and back; chief characteristics of rash is its lack of pattern | erythema toxicum |
| most common on face (can be on neck, upper back, chest; rare elsewhere); caused by maternal hormones; often appears as whiteheads; some also develop red pimples and mild skin inflammation; Tx: usually no treatment; severe symptoms-ATBs | baby/neonatal acne |
| permanent neurologic damage from high levels of bilirubin; bilirubin moves from blood stream into brain tissue | kernicterus |
| high risk newborn nursing interventions: monitor what? | temperature, food & fluids, and resp. function |
| high risk newborn nursing intervention: temp | minimize cold stress, maintain skin temp, continuously monitor temp, prevent rapid warming or cooling, use a cap to prevent heat loss from head |
| high risk newborn nursing intervention: food & fluids | monitor for hypoglycemia, assess tolerance of oral or tube feedings, monitor hydration closely, assess for gastric residual/ bowel sounds/ change in stool pattern/ abd girth, monitor weight gain/loss |
| high risk newborn nursing intervention: resp function | position for increased O2 (semiprone/side lying), maintain resp tract patency, stimulate-->remind to breathe, monitor O2 therapy, assess resp effort (grunting, nasal flaring, cyanosis, apnea) |
| signs of jaundice in high risk newborn | yellowing of skin and sclera, elevated blood bilirubin level (total serum bilirubin level above 5 mg/dL) |
| signs of correct latch in breastfeeding | nose is free, most of areola is hidden inside baby's mouth, lips are flanged outward (like a fish), baby's chin is immersed in breast at bottom of areola |
| newborn's immature liver often can't remove bilirubin quickly enough, causing an excess of bilirubin; typically appears on the second or third day of life | physiologic jaundice |
| most serious type of jaundice; occurs within 24-48 hours after birth; baby’s bilirubin level usually rises fast; most likely cause is blood incompatibility or liver disease; prompt medical attention is necessary, blood transfusions may be required | pathologic jaundice |
| amenorrhea, N/V, breast sensitivity, fatigue, urinary frequency, sickness in morning; least reliable signs of pregnancy as they may be caused by other conditions | presumptive signs (changes felt by woman) |
| uterine enlargement, positive urinary pregnancy tests, Hagar’s sign, Chadwick’s sign, Goodell's sign | probable signs (changes observed by examiner) |
| fetal heartbeat (8-12 wk.’s by doppler/ 18-20 wk.’s by auscultation), palpation of fetal movement, and visualization of fetus by ultrasound | positive signs (definite signs of pregnancy) |
| detects neural tube defects and Down syndrome; done 15-18 weeks gestation or second trimester; if elevated then an amniocentesis test is performed | maternal serum alpha-fetoprotein (AFP) |
| complications of ____: absent fetal heart rate or movement, premature labor, infection, abruptio placenta, or an amniotic embolism | amniocentesis |
| continuous vomiting in first trimester that depletes fluid and electrolytes; > or = to 5% weight loss during pregnancy due to excessive vomiting.; Sx: dehydration and electrolyte imbalances | hyperemesis gravidarum |
| Tx: IV hydration and electrolyte replacement, monitor I/O and labs, quiet environment, rest, stress reduction, avoid noxious odors, antiemetics | hyperemesis gravidarum |
| evaluate fetal response or fetal heart rate to natural contractile uterine activity, or to increase in fetal activity; reactive response is 2 or more accelerations of FHR lasting >15sec. associated with fetal movement in a 20min. period | non-stress test (NST) |
| measures fetal breathing movement, gross body movement, fetal tone, FHR, and amniotic fluid; non-invasive: uses ultrasound and fetal monitoring; reasons: management of pregnancies at risk d/t HTN, IUGR, DM, multiple fetuses, or preterm labor | biophysical profile (BPP) |
| many women diagnosed with preeclampsia beforehand; usually develops before the 37th week of pregnancy but can occur shortly after delivery; Sx: nausea, headache, abd pain, swelling in extremities, high B/P, malaise, headache | HELLP syndrome |
| HELLP syndrome: what does it stand for? | hemolysis (resulting in anemia and jaundice), elevated liver enzymes (elevated ALT/AST, epigastric pain, N/V), low platelet levels (thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, and possibly DIC) |
| implantation of the fertilized ovum outside of its normal place in the uterus (i.e. ovary, fallopian tube, or abdominal cavity); Tx: methotrexate in early pregnancy, salpingostomy or laparotomy (abdominal in late pregnancy), D&C | ectopic pregnancy |
| BP>140/90 x2, 4-6hr apart in a week, proteinuria>1+,transient H/A’s, irritable, placental perfusion normal | mild preeclampsia |
| BP>160/110 x2, proteinuria >3+, hyperreflexia with possible ankle clonus, pedal/ankle edema 1-4+ pitting or non-pitting, HAs, blurred vision, severe irritability, HELLP syndrome, or decreased placental perfusion | severe preeclampsia |
| Tx: IV Mg; antihypertensive meds, check weight, strict I/O, IVs/electrolytes, VS, check maternal reflexes (and check if clonus is present), bedrest on left side or activity restrictions, DVT prevention strategies | preeclamsia |
| early signs: nausea, flushing, muscle weakness, decreased reflexes, slurred speech; late signs: loss consciousness, respiratory/cardiac depression, loss of reflexes, and oliguria | Mg toxicity |
| severe preeclampsia manifestations w/onset of seizure activity or coma; usually preceded by HA, severe epigastric pain, hyperreflexia, and hemoconcentrations | eclampsia |
| any degree of glucose intolerance with the onset or first recognition occurring during pregnancy; Tx: insulin | gestational diabetes |
| premature separation of placenta from uterus; Sx: uterus “boardlike” on palpation, severe abd pain, possible contractions, dark red bleeding and non-reassuring FHR pattern; risks: abd trauma (i.e. MVA, maternal battering, cocaine use, or maternal HTN) | abruptio placenta |
| Tx: emergent C-section, monitor fetal/maternal status, exam & US | abruptio placenta |
| placenta abnormally attaches to lower segment of uterus near or over cervical os instead of attaching to fundus; Sx: no uterine tenderness, painless vaginal bleeding (bright red color), normal FHR; confirmed with US | placenta previa |
| Tx: monitor bleeding, weekly fetal monitoring, pelvic rest, avoid douching, intercourse, enema, cervical or rectal exams, plan for a C-section delivery | placenta previa |
| risks: previous C-section, endometrial scarring, multiple gestation, or a prior occurrence | placenta previa |
| curable STI; many asymptomatic but can still infect others through sexual contact; Sx may include: genital pain and discharge from the vagina or penis | chlamydia |
| common STI marked by genital pain and sores; pain, itching, and small sores appear first, they form ulcers and scabs; after initial infection, lies dormant in the body; Sx can recur for years | genital herpes |
| meds can be used to manage outbreaks (acyclovir, valacyclovir, famciclovir) | genital herpes |
| Tx: ATB for affected pt and pt's sexual partner(s) recommended (i.e. azithromycin, amoxicillin) | chlamydia |
| STI that causes warts in various parts of body (depends on strain); many people asymptomatic but can still infect others through sexual contact; Sx may include warts on the genitals or surrounding skin; no cure but warts may go away on their own | HPV |
| Tx: focuses on removing the warts; there is a vaccine recommended for teens for prevention of strains most likely to cause genital warts and cervical cancer | HPV |
| injected every 3 months at a doctor's office; prevents pregnancy by stopping the woman from releasing an egg; does not protect against STIs | Depo-Provera (medroxyprogesterone) |
| small, flexible T-shaped device that is placed in the uterus by a physician; stays in place as long as pregnancy is not desired; depending on the type (hormonal or copper), it will last for 3, 5 or 10 years; causes degeneration of the fertilized egg | intrauterine device (IUD) |
| combined med that is taken daily; contains two hormones (estrogen and progestin); the hormones stop the release of the egg, or ovulation; also makes the lining of the uterus thinner | oral contraceptives |
| fundal measurement | between 12 and 14 weeks’ gestation, above the symphysis pubis; fundus reaches the level of the umbilicus at approx 20 weeks and measures 20 cm; fundal measurement should approximately equal the number of weeks of gestation until week 36 |
| Tx: magnesium IV, terbutaline, betamethasone; treat underlying cause | preterm labor |
| advantages: highly effective if taken correctly, decreased menstrual blood loss, decreased iron-deficiency anemia, regulation of cycles, reduced incidences of dysmenorrhea and PMS, offers protections against certain cancers, improves acne | oral contraception |
| disadvantages: no protection against STIs, increased risk of stroke/ MI/ HTN, exacerbates conditions affected by fluid retention (migraine, epilepsy, heart disease), adverse effects (HA, nausea, breast tenderness) | oral contraception |
| advantages: very effective, only four injections per year, does not impair lactation, possible absence of periods and decrease in bleeding, decreased risk of uterine cancer if used long-term | Depo-Provera (medroxyprogesterone) |
| disadvantages: adverse effects (decreased bone mineral density, weight gain, increase in depression, irreg. vaginal spotting/bleeding), no protection against STIs, return to fertility can be delayed | Depo-Provera (medroxyprogesterone) |
| advantages: effective 1-10 years, can be inserted immediately after abortion/ miscarriage/ childbirth/ while breastfeeding, can be reversed with immediate return to fertility | intrauterine device (IUD) |
| disadvantages: can increase risk of PID/ uterine perforation/ ectopic pregnancy, can be expelled, no STI protection | intrauterine device (IUD) |
| effective for three years with local insertion in arm/removal; subdermal implant | implant (Nexplanon) |
| advantages: effective continuous contraception for 3 years, can be inserted immediately after abortion/ miscarriage/ childbirth/ while breastfeeding, reversible | implant (Nexplanon) |
| disadvantages: can cause irreg. menstrual bleeding, no STI protection, local bruising at insertion site | implant (Nexplanon) |
| longest stage of labor; begins with the first true contraction and ends with full dilation (opening) of the cervix; because this stage lasts so long, it is divided into three phases, each corresponding to the progressive dilation of the cervix | first stage of labor |
| first phase of first labor stage: cervix dilates to from 0-3 cm, 25% or so effaced, 6-8 hrs, 5-30 min apart, last 30 sec each with mild to moderate contractions | early/latent phase |
| second phase of first labor stage: cervix dilates from 4-7 cm, up to 75% or so effaced, 4-6 hrs, 3-5 min apart, last 45-60 sec each with moderate to strong contractions | active phase |
| third phase of first labor state: cervix dilates from 8-10 cm, 100% effaced, up to 2hrs, 1 ½-2 min apart, last 60-90 sec each with intense, strong contractions | transition phase |
| stage of labor? begins with complete cervical dilation (10 cm) and effacement and ends with the birth of the newborn | second stage of labor |
| stage of labor? begins with the birth of the newborn and ends with the separation and birth of the placenta | third stage of labor |
| stage of labor? the first hour after delivery; recovery stage | fourth stage of labor |
| fetal heart monitoring: normal pattern and no treatment needed; causes: uterine contractions/ fundal pressure/ vaginal exams (head compression); normal during stage 2 (pushing); Tx: facilitate delivery | early decelerations |
| causes (umbilical cord compression): maternal position, cord around baby’s body parts, short/knotted or prolapsed cord, prolonged tachycardia, uterine tachysystole | variable decelerations |
| Tx: change position (lateral), D/C oxytocin, O2 (8-10 LPM), notify MD, assess for cord prolapse, assist with birth | variable decelerations |
| causes (uteroplacental insufficiency): anesthesia, placenta previa/abruptio, hypertensive disorders, DM, intra-amniotic infection, post maturity | late decelerations |
| Tx: change position (lateral), correct maternal hypotension, IV fluids, D/C oxytocin, administer oxygen (8-10 LPM), internal monitoring, contact provider, may need C-section delivery | late decelerations |
| no fetus; a gestational trophoblastic disease; risk with fertility drugs, nutritional factors and history of miscarriages; Sx: anemia, N/V, abd cramps | Hydratidiform mole |
| Tx: induce labor or suction curettage, U/S, BHCG titers monthly for up to 1yr., genetic counseling, referral to support resources, and chemotherapy for persistent disease | Hydratidiform mole |
| stage of fetal development: brain differentiates, limb buds grow, stomach/pancreas/liver begin to form | week 4 |
| stage of fetal development: heart developed, facial features continue to develop, and resembles a human | week 8 |
| stage of fetal development: gender forms by __ to __ week, urine begins to be produced and excreted, head/face formed, limbs are long and digits well formed | weeks 9-12 |
| stage of fetal development: rapid brain growth, fetal heart tones heard with Doppler, vernix caseosa covers the fetus, muscles well developed and eyebrows with head hair and nails are present | weeks 17-20 |
| stage of fetal development: fetus has hand grasp & startle reflex, alveoli forming in lungs, lungs begin to produce surfactant, body is lean & skin translucent | weeks 21-24 |
| stage of fetal development: fetus reaches 15 inches, rapid brain growth, nervous system controls some functions, blood formation shifts from spleen to bone marrow | weeks 25-28 |
| stage of fetal development: rapid increase in body fat, rhythmic breathing movements occur and lungs still developing | weeks 29-32 |
| stage of fetal development: fetus fills uterus and increase in body fat, lanugo begins to disappear, testes are in scrotum of male, small breast buds appear and antibodies are supplied to fetus | weeks 33-38 |
| Tx includes: avoid odors, eat dry crackers or toast before arising, small frequent meals, avoid greasy/spicy foods, drink fluids between meals | treatment for N/V |
| Tx: sit up after meals, avoid greasy/fried food, eat small frequent meals, antacids (Tums) | heartburn (from increased progesterone) |
| Tx: wear well-fitted, supportive bra | breast tenderness (from increase of estrogen/progesterone) |
| Tx: take naps, reduce work hours | fatigue (from metabolic demands for fetus growing, tiring schedule, or interrupted sleep) |
| Tx: cool air vaporizer, normal saline drops/spray | nasal stuffiness (from high estrogen levels) |
| Tx: void as urge is felt, increase fluid in day and reduce in evening, Kegel exercises | urinary frequency (from pressure of uterus on bladder) |
| Tx: drink plenty of fluids, eat a diet high in fiber, exercise regularly | constipation-increased levels of progesterone, pressure of enlarged uterus on intestine, diet, lack of exercise |
| Tx: warm sitz bath, witch hazel pads, apply topical ointments that help relieve discomfort | hemorrhoids (from increased pressure on veins and constipation) |
| Tx: exercise regularly, perform pelvic tilt exercises, use proper body mechanics when lifting, side-lying position | backaches (from increased curvature of spine, fatigue, poor body mechanics & softening of cartilage in body joints) |
| Tx: maintain good posture, sleep with extra pillows, contact provider if Sx worsen | shortness of breath/dyspnea (from decreased vital capacity from pressure of enlarging uterus on the diaphragm) |
| Tx: stretching affecting limb (dorsiflexion), heat on affected muscle or foot massage | leg cramps (from imbalance of calcium/phosphorus ratio, increased pressure of uterus on nerves, fatigue, poor circulation to low extremities) |
| Tx: rest with legs elevated, avoid constricting clothing, wear TED hose, avoid sitting or standing for extended periods, don't cross legs when sitting, sleep in left-lateral position, exercise | varicose veins and lower-extremity edema |
| change of position and walking should cause this to stop | Braxton Hicks contractions (false labor pains) |
| non-invasive test using high frequency sound waves and external signal source for fetal surveillance | ultrasound |
| invasive test: needle into abdomen/uterine walls; 16 weeks gestation to detect genetic disorder; >30 weeks gestation to assess L/S ratio or check lung maturity | amniocentesis |
| test to stimulate uterine contractions for the purpose of assessing fetal response (healthy fetus does not react to contractions); tested with IV pitocin or nipple stimulation and external monitoring | contraction stress test (CST) |
| test for gestational diabetes (diagnosis requires two elevated readings) | glucose tolerance test (GTT) |
| decreased amount of amniotic fluid (less than 500 mL); may result from any condition that prevents the fetus from making urine or blocks it from going into the amniotic sac; puts the fetus at an increased risk of perinatal morbidity and mortality | oligohydramnios |
| too much amniotic fluid (more than 2,000 mL) surrounding fetus; associated with fetal anomalies of development i.e. upper GI obstruction, neural tube defects, and anterior abd wall defects | polyhydramnios |
| med to delay premature delivery or to slow/reduce contractions | terbutaline sulfate |
| med for eclampsia/seizures during pregnancy | magnesium sulfate |
| med for iron deficiency and anemia | ferrous sulfate |
| med to induce labor; also used for postpartum hemorrhage | misoprostol (Cytotec), oxytocin (Pitocin) |
| med to prevent newborn eye infection | erythromycin ophthalmic ointment |
| med to prevent newborn bleeding | phytonadione (Vitamin K) |
| clear and odorless fluid; nitrazine test PH-alkaline; nurse’s action: first check fetal HR for distress or prolapsed cord | rupture of membranes |
| a bag of clear, odorless fluid that maintains temperature and protects the fetus | amniotic sac |
| organ that develops in uterus during pregnancy; provides oxygen and nutrients to growing baby and removes waste products from baby's blood; attaches to wall of uterus, and baby's umbilical cord arises from it | placenta |
| the relationship of the presenting part of fetus to the level of the maternal pelvic ischial spines; measured in cms and is referred to as a minus or plus, depending on its location above or below the ischial spines | fetal/pelvic station |
| fetal/pelvic station? baby is high in pelvic cavity within the iliac crest | negative numbers |
| fetal/pelvic station? head of baby equal, or "engaged", with ischial spines | zero station |
| fetal/pelvic station? baby’s head is engaging through the pelvis past the ischial spines | positive numbers |
| fetal/pelvic station? +4 pelvic station | crowning of head |
| the body part of the fetus that enters the pelvic inlet first (the “presenting part”); this is the fetal part that lies over the inlet of the pelvis or the cervical os | fetal presentation |
| occurs when the fetal buttocks or feet enter the maternal pelvis first and the fetal skull enters last; this abnormal presentation poses several challenges at birth | breech presentation |
| the presenting part is usually the occipital portion of the fetal head | cephalic presentation |
| the fetal shoulders present first, with head tucked inside; clinically, signs of this appear while woman is pushing as neonate's head slowly extends and emerges over perineum, but then retracts back into vagina (commonly referred to as the “turtle sign") | shoulder presentation (or shoulder dystocia) |
| relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother | fetal lie |
| occurs when the long axis of the fetus is parallel to that of the mother (fetal spine to maternal spine side-by-side) | longitudinal lie |
| occurs when the long axis of the fetus is perpendicular to the long axis of the mother (fetal spine lies across the maternal abdomen and crosses her spine); cannot be delivered vaginally | transverse lie |
| fetal long axis is at an angle to the bony inlet, and no palpable fetal part is presenting; is usually transitory and occurs during fetal conversion between other lies; cannot be delivered vaginally | oblique lie |
| artificial rupture of the fetal membranes; may be performed to augment or induce labor when the membranes have not ruptured spontaneously | amniotomy |
| fetal head is too large to fit through the pelvic inlet for birth | cephalopelvic disproportion |
| Leopold maneuver steps | palpate fundus; palpate for which maternal side the fetal back is located (fetal heart tones are best auscultated through the back of the fetus); find out what is the presenting part; is fetal head flexed and engaged in the pelvis? |
| normal newborn axillary temp | 36.5-37.2C (97.7-98.8 degrees F) |
| normal newborn apical heart rate | 120-160 beats/min. (crying increases, sleep decreases rate); during 1st period of reactivity (6-8 hr.) heart rate can be up to 180 beats/min |
| normal newborn respiration rate | 30-60 breaths/min. (crying increases rate, sleep decreases rate); during 1st period of reactivity (6-8 hr.) rate goes up to 80 breaths/min |
| normal newborn B/P | 50-75/30-45 mmHg in arm/leg |
| inflammation of the mammary gland; a common problem that may occur within the first 2 days to 2 weeks postpartum; breast abscess may develop if not treated adequately | mastitis |
| treat with antibiotics & continue to feed/pump; non-breastfeeding---tight fitting bra, ice packs, cabbage leaves, no stimulation, analgesics | mastitis |
| flu-like symptoms (including malaise, fever, and chills); tender, hot, red, painful area on one breast; inflammation of breast area; breast tenderness; cracking of skin around nipple or areola; breast distention with milk | mastitis |
| an infection of the bladder; risk for pyelonephritis | cystitis |
| risks-foley catheter, overdistended bladder, operative vaginal procedures; Diagnose-UA/C&S; Treat-ATBs, increase fluids, voiding every 2 hours, frequent pad changes and perineal hygiene | cystitis |
| med that helps control postpartum hemorrhage; stimulates the uterus; prevent and treat postpartum hemorrhage due to atony or subinvolution | methylergonovine (Methergine) |
| med to promote uterine contractions; stimulates the uterus to contract to control bleeding from the placental site | oxytocin (Pitocin) |
| high levels of estrogen during pregnancy place women at higher risk for? | DVT |
| DVT prevention | SCDs, ambulation, ROM exercises, Lovenox (hemorrhage???) |
Created by:
nurse savage
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