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MC OB Exam 3

Collins Spring 2013

Antidote for Magnesium Sulfate calcium gluconate
Side effects of Yutopar hypotension, cardiac arrhythmia, tachycardia, palpitations, MI, pulmonary edema, hyperglycemia
action of Betamethasone induce pulmonary maturation & decrease incidence of RDS
Initial weight loss postpartum 15-18 lbs
temp is increased for 24 hrs AFTER milk comes in 100.4 & below
uterus palpable where midline contracted size of grapfruit
lochia alba days 10-12 white light WBC & D/C
lochia serosa days 3-10 cell component decreases=serosanguous
lochia rubra 1st 2-3 days increased with activity/breastfeeding, no odor or clots
1st period occurs when breastfeeding 36 weeks or 3 months nonbreastfeeding 6-10 weeks
striae take on different colors based on moms skin tone
what can delay elimination? pain d/t episiotomy/laceration/hemorrhoids
after pain help with breastfeeding NSAID prior to breastfeeding
taking in dependent mom expresses need for food & rest
taking hold focus on newborn, independence for self & newborn
letting go end of 1st postpartum phase, realize what REALLY happens
postpartum blues 1st 10 days, spontaneous recovery & self limiting
postpartum depression anytime in the 1st year, affective mood disorder, & requires MEDICAL Interventions
BUBBLEHE breasts uterus bowel bladder lochia episiotomy/laceration homan's/hemorrhoids emotional
prevent UTI front to back wiping & change frequent pads
REEDA redness, edema, ecchymosis, discharge, approximation
ice when 1st 24 hrs
heat when after 1st 24 hrs
rubella vaccine given do not become pregnant for how long? 3 months
threatened abortion pt has slight bleeding, decrease uterine pain, no dilation/effacement
Treatment for threatened abortion bedrest
total placenta previa completely covers cervical opening
why not to do a cervical exam placenta previa
abruptio placentae bleeding dark port wine, no clot, quick shock state or can be conceeled
typical location for ectopic pregnancy falllopian tubes
treatment for ectopic pregnancy methotrexate 1-2 doses to prevent cells from rapidly dividing OR surgical
Pt with gestational trophoblastic disease is told what DO NOT become Pregnant
PUBS under US guide, removes blood form cord for testing
PUBS tests for what hemophilia, hemoglobinopathies, fetal infections, chrom. abnormalities, nonimmune hydrops
CVS early genetic testing
CVS detects what genetic, metabolic & DNA abnormalities
Amniocentesis 15-20 weeks removes fluid for genetic testing
Amniocentesis can detect what enzyme analysis, AFP, NTD, blood typing, cytogenic (metabolic/DNA testing)
LS Ratio determines RDS 2:1 unlikely
PG 2nd most abundant phopholipid in surfactant
PG detects PROM, vascular disease, severe preeclampsia before 35 weeks
Quad Marker Screening AFP, HCG, diameric inhibin A, & estriol
Quad Marker Screening detects NTD, trisomy 21, downs syndrom & trisomy 18
Preterm labor that begins between 20 & 37 weeks
diagnosis of preterm labor uterine contractions every 5 mins ofr 20 mins OR 8 contractions in 60 mins AND documented cervical change or cervical effacement of 80% or more OR dilation greater than 1 cm
weaned from open crib 1500 g, 5 days wt gain, respiratory & cardiac stability, & PO feeds
Mild preeclampsia dx BP 140 systolic or 90 diastolic proteinuria 3 g/L or greater in 24 hr urine +1 or +2 dipstick
epigastric or RUQ pain severe preeclampsia S & S
eclampsia main symptoms seizures
only cure for PIH delivery
during a seizure nothing in mouth, stay with pt, call for help, O2 via facemask 8-10 L/min, protect from harm, side-lying, suction
glucose challenge test 130-140
main complication of gestational diabetes in infant macrosomia (large tissue growth)
newborn caloric need 110-130 kcal/kg/day
blood loss from delivery approximately 5 lbs vaginal 500cc C-section 1000cc
prepregnancy weight by 6-8ths week post delivery
if lochia doesn't follow the one way flow pattern what is suspected & should be done? hemorrhage & call the doctor
NI for constipation & bowel issues walking, drinking H2O, stool softner, dietary fiber (roughage)
afterpains cramping experienced as the uterus contracts down. gives pt contraction sensation
pulmonary thrombi alerts sudden chest pain & + Homan's sign
3+ or 4+ Deep Tendon Reflex indicates PIH
care for breast for breast feeding heat, no restrictive bra or clothing, face water in shower.
care for breast for bottle feeding cold, tight bra, back to water in shower, cabbage leaves
Nipple care lanolin & vitamin E cream. cleansed off prior to breastfeeding.
hemorrhage signs saturates 1 pad in 15 mins or less
heavy bleeding signs saturates 1 pad in every 2 hrs
when to resume sexual activity once episiotomy healed & lochia has stopped
symptoms to report depression, increased bleeding, fever over 100.4, D/V, dizziness, unrelived HA, swelling, breast tenderness, mastitis, abd pain
Spontaneous Abortion occurs when before 16 weeks
incomplete abortion fetus partially expelled surgery done to scrape uterus
complete abortion everything comes out pain & bleeding STOP
missed abortion fetus dies enutero & all remains in uterus. pregnancy symptoms stop. increased risk for infection. surgery treatment.
placenta previa placenta implants & develops in the low uterine area & covers cervical opening
partial (marginal) partially covers cervical opening
low-lying close to covering cervical opening
S&S for placenta previa & treatment S&S: painless vaginal bleeding after 24 weeks that will stop spontaneously. Tx: 36 week planned c-section until then monitor H&H & Bedrest
Placenta previa is a risk for bleeding
abruptio placentae placenta prematurely separates from the uterine wall after 20 weeks gestation
S&S for abruptio placentae uterus hard, constant contractions, decreased perfusion, board like abd
Placenta previa is a risk for sudden massive bleeding
ectopic pregnancy tubal pregnancy implantation outside the uterus
S&S of ectopic pregnancy doubled over in pain, syncope, referred shoulder pain
intrauterine fetal demise fetus dies enutero after 20 weeks
complete gestational trophoblastic disease sperm meets egg with no neucleus 23+ chromosomes
partial gestational trophoblastic disease normal ovum fertilized by 2 sperms 69 chromosomes
invasive gestational trophoblastic disease same as complete but invades the uterus
carcinoma gestational trophoblastic disease malignant highly treatable if found early
S&S of gestational trophoblastic disease vaginal bleeding @ 4 weeks, dark bleeding, uterine size larger than gestation, increased HcG, N/V, manifest PIH symptoms, cause hyperthyroidism
after removal gestational trophoblastic disease weekly HcG levels until prepregnancy than monthly for 1 yr
transabdominal ultrasound needs what FULL bladder 1-2Quarts
fetal surveillance occurs because PIH, GDM, DM, decreased fetal movements, chronic medical conditions
NST reactive (HR of 15 beats up for 15 secs from baseline) is wanted nonreactive (none in 40 mins)
CST negative is wanted positive is where late decelerations are present in 50% of contractions
BPP checks for FHR acceleration, FHR breathing, fetal movements, fetal tone, amniotic fluid volume
BPP results to induce 6/10 or lower
Quad marker screening is done when around 15-18 weeks
S&S of preterm labor change in DC, vaginal bleeding, ROM, D, fetal engagement prior to 32 weeks, UTI, low back pain that is different, pelvic/thigh pressure, sensation of uterine tightening, lower abd cramping
treatment for Inpatient preterm labor fetal/uterine monitoring, bedrest, side-lying, tocolytics, evaluate fetal lung maturity
treatment for outpatient preterm labor uterine monitoring, modified bedrest, side-lying, tocolytics, non-caffeinated fluids, empty bladder, no heavy lifting, no sexual activity
preterm neonate kidneys immaturity increases risk for metabolic acidosis so avoid & caution meds due to nephrotoxicity
if preterm neonate is stressed due to things like touch, noise, & light reacts by decreasing HR & O2
severe preeclampsia 160 systolic or 110 diastolic proteinuria 5g/L or more in 24 hr urine
S&S of severe preeclampsia cereral/visual disturbances (HA, altered concsiousness, blurred vision), pulmonary edema or cyanosis, epigastric or RUQ pain, thrombocytopenia or impaired liver funciton, oliguria (<500cc/24hrs)
pathophysiology of PIH exaggerated response to angiotensins & thromboxane increases. arteriolar vasospasm, endothelial damage, stimulates platelet & fibrinogen use. systemic vasospasm, vascular damage & fluid shifts.
in normal pregnancy patho normal pregnancy blunts response to angiotensin II (increase BP/decreases fluid) thromboxane (increases BP & promotes platelet aggreagation)
Treatment for Mild PIH IP/OP, rest, NST, BPP, fetal movement, assessment of BP, monitor for advancement
treatment for severe PIH IP seizure precautions, continous fetal monitoring, DTR every hr, BP monitoring, rest & quiet, daily wt, proteinuria, end organ changes, amniocentesis, betamethasone & dexamethasone, mag sulfate
treatment for eclampsia mag sulfate, Na amobarbitol, observe for precipitous labor/delivery & placental abruption, seizure safety
S&S for GDM vary none to coma 3 P's glucosuria
Screening criteria for GDM prior GDM, LGA infant, marked obesity, dx of polycystic ovarian syndrome, glycosuria, family hx of diabetes
if at risk random test HbA1c >6.5% or fasting glucose >126
if not high risk GDM is screened at 24-28 weeks
maternal complications from GDM infection, HTN, polyhydramnios, postpartum hemorrhage, premature delviery, over distended uterus
infant complications from GDM macrosomia, IUGR, congenital abnormalities, IUFD, birth asphyxia, birth injury, RDS, hypoglycemia
self glucose monitoring of GDM pre below 95, 1 hr post below 130-140, & 2 hrs post below 120
nutrition GDM 3 meals & 3 snacks. 40-50% complex carbs, 15-20% protein, 20-30% fat
why is oral hypoglycemics rarely used crosses the placenta
Mag sulfate neuromuscular relaxation given IV SE: flushing, warmth, HA, N, nystagmus, dry mouth, dizzy, lethargy, & sluggish NI: monitor BP, resp, mag levels, DTR, urinary output infant SE: hypotonia, lethargy, hypoglycemia, hypocalcemia
ritodrine hcl (Yutopar) beta blocker SE: hypotension, cardiac arrhythmia, tachycardia, palpitations, MI, pumonary edema, hyperglycemia NI: IV, IM, SQ, oral
betamethasone (Celestone Solusapn) induce pulmonary maturation & decrease incidence of RDS SE: increase infection, hyperglycemia, pylmonary edema, Na & fluid retention, N, impaired wound healing infant SE: decrease cortisol levels @ birth, hypoglycemia, increased risk for sepsis
NI for betamethasone (Celestone Solusapn) assess for contraindications, deep in gluteal muscle, monitor BP, HR, wt, & edema, assess lab values for electrolytes & blood glucose
Contraindications for betamethasone (Celestone Solusapn) cant delay birth, adequate L/S ratio, maternal bleeding, maternal infection, DM, more than 34 weeks, Cushing syndrome
Terbutaline same as yutopar beta blocker
Nifedipine reduces flow of extracellular Ca ions into intracellular space=inhibits contractile activity SE: hypotension, tachycardia, facial flushing, HA NI: assess BP, HR, & resp CI: heart disease, cardio compromise, intrauterine infection, multiple pregnancy, H
increases risk for preeclampsia primigravida <20 yrs old, chronic HTN, low SES, >35 yrs old, & multiple gestation
increases risk for GDM prior GDM, LGA infant, marked obesity, polycystic ovarian disease, glycosuria, history of DM type 2
increases risk for preterm OB complications, poor uterine blood flow, maternal employment, stress, history of Preterm labor
increases risk for abruptio placentae increased parity (multiple gestation), low SES, PIH, increased maternal age, cocaine use, smoking alcohol, history of it
increases risk for ectopic pregnancy damaged fallopian tubes or history of surgery on , pelvic inflammatory disease, increased age
increases risk for IUFD DM especially type 1, PIH, Rh incomptabilities, abruption of the placenta, cord compression, illegal drugs, anything that decreases perfusion to the baby
which procedures should you have a full bladder? abdominal ultrasound & CVS. Not amniocentesis.
Created by: midnight1854