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UTA NURS 4441 Exam 3

UTA NURS 4441 OB Exam 3

high-risk pregnancy one in which the life or health of the mother or fetus is jeopardized by a disorder coincidental with or unique to pregnancy.
free noninvasive assessment of fetus after 20 weeks Daily fetal movement (or kick) counts
When vaginal U/S is the preferred method of sonogram In the first trimester. Also useful in obese women whose thick abdominal layers cannot be penetrated adequately with an abdominal approach.
sonogram that requires mother to have a full bladder Abdominal ultrasonography, to displace the uterus upward
five variables studied in a biophysical profile Fetal breathing movements, gross body movements, fetal tone, reactive FHR, qualitative amniotic fluid volume
indications for an amniocentesis when there is a prenatal diagnosis of genetic disorder or congenital anomalies (neural tube defect in particular), assessment of pulmonary maturity, and diagnosis of fetal hemolytic disease.
earliest possible time when an amniocentesis can be done 14 weeks
CVS chorionic villus sampling; Removal of fetal tissue from the placenta for genetic diagnostic studies.
Weeks gestation CVS can be performed First or second trimester, ideally between 10 – 13 weeks
Weeks gestation MSAFP is reliable Between 15-20 weeks
Disorders screened for in the triple or quad screen Chromosomal abnormalities like Down’s syndrome (Trisomy 21) and other types of trisomy (Trisomy 18), and neural tube defects.
weeks gestation triple marker should be done 16-18 weeks
Coombs’ test Indirect: determination of Rh-positive antibodies in maternal blood. Direct: determination of maternal Rh-positive antibodies in fetal cord blood. A positive test result indicates the presence of antibodies or titer.
goal of 3rd trimester testing To determine whether the intrauterine environment continues to be supportive to the fetus
When woman presses button while doing an NST When she feels fetal movement
criteria for a reactive NST tracing Two accelerations in a 20 minute period, each lasting at least 15 seconds and peaking at least 15 beats/min above the baseline.
two sources of oxytocin that may be used for the contraction stress test (CST) IV oxytocin and nipple stimulation
positive result for a CST Repetitive late decelerations occur with 50% or more of contractions (even if fewer than three contractions occur in 10 minutes)
pregnancy-related hypertension trend On the rise
complications that hypertensive women are at risk for Abruptio placenta, ARDS, stroke, cerebral hemorrhage, hepatic or renal failure thrombocytopenia, DIC, pulmonary edema
Maternal death from preeclampsia causes Hepatic rupture and placental abruption (abruptio placenta), or eclampsia
Gestational weeks that Gestational HTN begins 20 weeks
Gestational HTN manifestations HTN not associated with proteinuria
Gestational weeks that preeclampsia develops 20 weeks
Preeclampsia initial manifestations HTN and proteinuria
B/P measurement that defines HTN Systolic >140 and diastolic >90
severe preeclampsia differentiation from mild B/P ≥160/110 and proteinuria ≥5 gm/24 hours (≥3 + on the dipstick).
Severe preeclampsia manifestations Oliguria, headache, visual disturbances (like scotomata) or blurred vision, irritability or changes in affect. Hepatic involvement including epigastic pain, RUQ pain, impaired liver function, thrombocytopenia with platelets < 100,000 mm3; pulmonary edema
When preeclampsia becomes eclampsia the onset of seizure activity or coma in a woman with preeclampsia, with no history of preexisting pathology, which can result in seizure activity
Chronic HTN differentiation from pregnancy-related HTN Chronic hypertension in pregnant woman is present before pregnancy or diagnosed before 20 weeks of gestation and persistent after 6 weeks postpartum.
Pregnancy-related HTN differentiation from chronic HTN New-onset proteinuria or significant increase in hypertension, plus new onset of symptoms, thrombocytopenia, or elevated liver enzymes signifies a pregnancy-related hypertension.
Preeclampsia main pathogenic factor Poor perfusion as a result of vasospasm and decreased plasma volume.
Life-threatening liver complication that is a surgical emergency Rupture of a subcapsular hematoma
Preeclampsia neurological manifestations headaches, hyperreflexia, positive ankle clonus, and seizures
impaired placental perfusion affect on the fetus restriction of fetal growth and the increased incidence of placental abruption, premature birth, and early degenerative aging of the placenta
HELLP syndrome A laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction, characterized by hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP); it is not a separate illness.
typical ethnicity of women who develop HELLP syndrome Caucasian
HELLP syndrome adverse outcomes pulmonary edema, acute renal failure, DIC, placental abruption, liver hemorrhage or failure, ARDS, sepsis, and stroke, and preterm birth
Clonus assessment examiner supports the leg with the knee flexed, with one hand sharply dorsiflexes the foot, maintains the position for a moment, and then releases the foot. Normal (negative clonus) response is when no jerks are felt
Evaluation of fetus for mild preeclampsia Daily fetal movement counts, nonstress test or biophysical profile once or twice weekly, and serial ultrasound evaluations of amniotic fluid volume and estimated fetal weight.
Mild preeclampsia Self-monitoring Urine dipstick protein (report if 2+ or more), B/P checking (report increase), and kick counts (report ≤ 4 movements/hr)
Earliest gestational age pregnancy can be induced 34 weeks
drug of choice to prevent seizures in preeclampsia and HELLP syndrome magnesium sulfate
magnesium sulfate IV loading dose and typical hourly dose loading dose of 4 to 6 g of magnesium sulfate is infused over 15 to 30 minutes (2 g/hr)
magnesium target therapeutic serum levels 4 to 7 mEq/L
magnesium toxicity manifestations Mild toxicity: lethargy, muscle weakness, decreased or absent DTRs, double vision and slurred speech. Increasing toxicity: maternal hypotension, bradycardia, bradypnea and cardiac arrest
antidote for magnesium sulfate calcium gluconate or calcium chloride
antihypertensives used for the treatment of HTN in preeclampsia Hydralazine, Labetalol Hydrochloride, Methyldopa, Nifedipine
resolvement of preeclampsia manifestations after birth 48 hours after birth
PPH postpartum hemorrhage
Medications used to increase uterine tone in preeclamptic woman with signs of PPH oxytocin or prostaglandins. (Ergot products (e.g., Ergotrate, Methergine) are contraindicated because they increase BP)
spontaneous abortion/miscarriage A pregnancy that ends as a result of natural causes before 20 weeks of gestation
percentage of confirmed pregnancies in the US that end in miscarriage Approximately 10% to 15%
D & C Dilation and curettage (D&C), a surgical procedure in which the cervix is dilated and a suction curette is inserted to scrape the uterine walls and remove uterine contents
incompetent cervix Premature dilation of the cervi; passive and painless dilation of the cervix during the second trimester.
incompetent cervix management bed rest, pessaries, antibiotics, antiinflammatory drugs, and progesterone supplementation. Surgical management, with placement of a cervical cerclage, may be chosen instead.
pessary treatment for incompetent cervix or prolapse; Device placed inside the vagina to function as a supportive structure for the uterus.
Cerclage Use of nonabsorbable suture to keep a premature dilating cervix closed; released when pregnancy is at term to allow labor to begin.
complete hydatidiform mole cause fertilization of an egg in which the nucleus has been lost or inactivated
partial hydatidiform mole cause two sperm fertilizing an apparently normal ovum.
molar pregnancy manifestations Vaginal bleeding, uterus larger than expected, anemia, excessive nausea and vomiting, cramping, preeclampsia.
blood test used to test for Hydatidiform moles and GTN hCG levels are persistently high or rising beyond 10 to 12 weeks of gestation, the time they would begin to decline in a normal pregnancy
GTN gestational trophoblastic neoplasia; Persistent trophoblastic tissue that is presumed to be malignant.
DIC triggers Abruptio placenta, retained dead fetus, amniotic fluid emboli, severe preeclampsia, HELLP Syndrome and gram negative sepsis
key to optimal pregnancy outcomes in patients with diabetes strict maternal glucose control
gestational diabetes mellitus any degree of glucose intolerance with the onset or first recognition occurring during pregnancy
fetal glucose level relationship to the maternal glucose levels directly proportional
Where the fetus get its insulin It manufactures its own insulin, since insulin does not cross the maternal fetal barrier.
susceptibility to hyper or hypoglycemia during the first trimester Hypoglycemia
When insulin resistance usually begins in pregnancy As early as 14 – 16 weeks
disorders diabetics are at risk for that end up making the uterine size larger Polyhydramnios (or hydramnios), and fetal macrosomia.
Hydramnios Amniotic fluid in excess of 1.5 L; often indicative of fetal anomaly and frequently seen in poorly controlled, insulin-dependent diabetic pregnant women even if there is no coexisting fetal anomaly.
Fetal macrosomia Large body size as seen in neonates of mothers with diabetes or prediabetes defined in several different ways, including: a birth weight more than 4000 to 4500 g; birth weight greater than the 90th percentile; and estimates of neonatal adipose tissue.
diabetic risk for preeclampsia more likely than non-diabetics
DKA blood glucose levels in pregnancy DKA may occur with blood glucose levels barely exceeding 200 mg/dl
DKA effect on the fetus Fetal death
Frequency glucose levels checked in a laboring diabetic Hourly
1-hour screening glucose level requiring a more extensive glucose test to determine if the woman is diabetic or not 130 – 140 mg/dl
weeks of pregnancy 1 hour glucose tolerance is typically done 24- 28 weeks
3-hour OGTT number of values that must be elevated to diagnose GDM ≥ 2
usual number of calories per day allowed in the GDM diet 1500-2000 kcal/day
percentage of patients with GDM that will need to take insulin Up to 20%
medications often prescribed for hyperemesis gravidarum Pyridoxine, doxylamine, Phenergan and metoclopramide
Antenatal corticosteroids medication given to accelerate fetal lung maturity
IUGR intrauterine growth restriction; Fetal undergrowth of any cause, such as deficient nutrient supply or intrauterine infection, or associated with congenital malformation; birth weight below population 10th percentile corrected for gestational age.
PTL preterm labor; Gestational age between 20 – 37 weeks, uterine activity (contractions) and progressive cervical change.
deleterious effects of bedrest Decreased muscle tone, weight loss, calcium loss, glucose intolerance, bone demineralization, constipation, fatigue, isolation, loneliness, anxiety and depression.
Tocolytic contraindications When dilation reaches 6 cm
adverse effects of beta-adrenergic agonists as tocolytics SOB, coughing, nasal stuffiness, tachypnea, pulmonary edema. Tachycardia, palpitations, myocardial ischemia, hypotension, muscle cramps, hyperinsulinemia nausea and vomiting.
antenatal corticosteroids use accelerate fetal lung maturity
PROM premature rupture of membranes; the spontaneous rupture of the amniotic sac and leakage of amniotic fluid beginning before the onset of labor at any gestational age
What is PPROM preterm premature rupture of membranes; occurs when membranes rupture before the completion of 37 weeks of gestation
Chorioamnionitis potentially life-threatening bacterial infection of the amniotic cavity; occurs most often occurs after membranes rupture or labor begins, as organisms that are part of the normal vaginal flora ascend into the amniotic cavity
precipitous labor Labor that lasts less than 3 hours from the onset of contractions to the time of birth
CPD Cephalopelvic disproportion; fetus cannot fit through the maternal pelvis. Either the baby is too big or the pelvis is too small, and the baby cannot be born though the birth canal—meaning it will have to be born via C/S
most common malpositions Right occipitoposterior (ROP) or left occipitoposterior (LOP)
most common malpresentation Breech
frank breech hips flexed, knees extended
complete breech hips and knees flexed
footling breech when one foot or both feet present before the buttocks
long-term problems such as cerebral palsy is higher among what sort of births multiple births
position that the mother may assume during labor that promotes fetal descent and shortens the second stage of labor Upright positions such as sitting or squating
ECV external cephalic version; Turning the fetus to a vertex position by exertion of pressure on the fetus externally through the maternal abdomen.
external version precautions U/S, NST, possible tocolytic agents and informed consent
external version contraindications Uterine anomalies, previous C/S, CPD, placenta previa or any third trimester bleeding, multiple gestation, oligohydramnios, evidence of uteroplacental insufficiency, evidence of a nuchal cord (cord around the neck)
most common methods of induction used in the US Intravenous oxytocin (Pitocin) and amniotomy, with prostaglandins increasingly being used
“score” designation used to determine inducibility of a pregnancy Bishop score: 13 point scale that considers the dilation, effacement, station, cervical consistency and cervical position
cervical ripening methods Prostaglandin E1 & E2, laminaria tents and lamicel, amniotomy and membrane stripping
frequency temperature should be checked after amniotomy Every 2 hours after rupture of membranes, more frequently if signs of symptoms of infection are noted
common adverse reactions of oxytocin infusions Water intoxication, uterine hyperstimulation leading to excessive contractions or rupture with fetal effects being decreased FHR and hypoxia
non-invasive methods of augmenting the process of labor Emptying the bladder, ambulation, position changes, relaxation measure, nourishment and hydration, hydrotherapy (only before invasive interventions)
hours after admission delivery is desired in active management of labor 12 hours
mechanical (operative) methods of assisting vaginal birth and expediting second stage Forceps and vacuum extractor
labor management approach that results in a lower risk for C/S Early continuous one-on-one support throughout labor
C/S incision where VBAC is permitted low transverse
postterm pregnancy A pregnancy extending past the 42nd week
indications for amnioinfusion Oligohydramnios (or meconium, sometimes)
oligohydramnios Abnormally small amount or absence of amniotic fluid; often indicative of fetal urinary tract defect.
“turtle sign” Retraction of the fetal head against the perineum immediately following its emergence
maneuvers for dealing with shoulder dystocia Suprapubic pressure, McRoberts and Gaskin maneuvers, and other position changes like squatting or lateral recumbent positions
McRoberts maneuver used to deal with shoulder dystocia; woman's legs flexed apart, with knees on her abdomen causing the sacrum to straighten, and the symphysis pubis to rotate toward the mother's head. The angle of pelvic inclination is decreased, which frees the shoulder.
Gaskin maneuver hand-and-knees position
Positioning to deal with a prolapsed cord Knee-chest position or any that uses gravity to help keep the head of the fetus off the pelvis to prevent cord compression
causes of uterine rupture Past classic-type C/S, Intense contractions possibly from augmentation, over-distended uterus, malpresentation, version forceps
uterine rupture manifestations Possibly decels or other non-reassuring FHR patterns, bleeding, sharp, shooting or tearing abdominal pain, cessation of contractions and possibly shock.
complete or large rupture of the uterus treatment Hysterectomy and blood replacement
amniotic fluid embolism manifestations Acute dyspnea, restlessness, cyanosis, pulmonary edema respiratory arrest
proportion of women who have first occurrence depression during pregnancy 1/3
three critical cues in identifying depression in pregnant women Psychological symptoms, a suicide plan, major disruptions in sleep patterns
medication for coughing that if taken with an SSRI can cause serotonin syndrome to develop Dextromorphan
physical birth defects caused by benzodiazepines Cleft lip and palate
greatest single preventable cause of mental retardation Prenatal alcohol exposure
illicit drugs that may cause placental abruption Methamphetamine, cocaine
postpartum depression manifestations Fear, anxiety, despondency, irritability, jealousy, and difficulty falling asleep and returning to sleep when awakened
medication considerations clinicians and pharmacists should consider for women with PP psychosis Medications with the greatest documentation of prior use, lower FDA risk category, few or no metabolites, and fewer side effects
medication category of choice for the treatment of PP onset of anxiety disorders SSRIs
maternal factors that predispose an infant to birth injuries maternal age (younger than 16 years old or older than 35); primigravida, uterine dysfunction leading to prolonged or precipitate labor, preterm or postterm labor, and cephalopelvic disproportion.
fetal factors that predispose the fetus to birth injuries Macrosomia, multifetal gestation, abnormal or difficult presentation, congenital anomalies
bone most commonly fractured during birth clavicle
most common type of paralysis associated with a difficult birth Erb-Duchenne palsy, or brachial plexus injury
Erb-Duchenne palsy Paralysis caused by physical injury to the upper brachial plexus, occurring most often in childbirth from forcible traction during birth. Also called Erb's palsy and brachial plexus injury.
Erb-Duchenne palsy manifestations loss of sensation in the arm and paralysis and atrophy of the deltoid, the biceps, and the brachialis muscles.
percentage of infants born to mothers with diabetes at risk for complications All infants of mothers with diabetes are at some risk for complications.
mortality rate of unborn babies resulting from one episode of maternal ketoacidosis 50% or more
Excessive shoulder size in macrosomic infants may lead to which birth problem Shoulder dystocia.
hypoglycemic blood glucose levels in term infants Less than 40 mg/dl
infant hypoglycemia is most common The macrosomic or LGA baby, also preterm
percentage of infants of diabetic mothers with hypocalcemia and hypomagnesaemia 50%
infants of diabetic mothers risk of developing hyperbilirubinemia and polycythemia Increased risk
Possible cause of elevated bilirubin levels in neonates amount of hemoglobin in the tissue from bruising (and even in cephalhematomas)
most common form of neonatal infection Pneumonia
common animals toxoplasmosis is found cats, dogs, pigs, sheep, and cattle
Risk of HIV transmission to baby if no precautions or treatment is given approximately 12% to 40%.
Risk of HIV transmission to baby from breastfeeding 1/3 to 1/2
Vaccinations for HIV exposed infants All HIV-1–exposed infants should receive routine immunizations; however, HIV-1-infected infants can receive only inactivated vaccines and, in the absence of severe immunosuppression, the varicella vaccine.
infection that is the leading cause of neonatal morbidity and mortality in the US Group B Streptococci (GBS)
source of neonatal exposure to E.Coli maternal birth canal or rectum during birth, although it also can be hospital acquired through person-to-person transmission or from the hospital environment
major source of colonization by S. aureus in the hospital hands of medical and nursing personnel (p. 854)
jaundice or icterus yellow discoloration of the sclera and mucus membranes of the head and face
Pathologic jaundice or hyperbilirubinemia the level of serum bilirubin that left untreated can result in acute acute bilirubin encephalopathy or kernicterus.
Acute bilirubin encephalopathy Acute manifestations of bilirubin toxicity that occur during the first weeks after birth.
kernicterus Bilirubin encephalopathy involving the deposit of unconjugated bilirubin in brain cells, resulting in death or impaired intellectual, perceptive, or motor function and adaptive behavior.
RhoGAM mechanism of action destroys any fetal RBCs in the maternal circulation and blocks the maternal antibody production
When RhoGAM should be given to the Rh negative pregnant/perinatal woman At 28 weeks of pregnancy, within 72 hours after delivery, after an invasive procedure or any time there is risk of fetal blood entering mom’s circulation—like after an auto accident.
major cause of deaths in the US among infants younger than 1 year of age major congenital defects
most common congenital heart defect and acyanotic lesion VSD
most common congenital heart defect and cyanotic disorder Tetralogy of Fallot
critical time period for cardiovascular development 3-8 weeks
cardiac anomaly manifestations seen in a neonate Cyanosis, paleness, mottling on exertion, restlessness, lethargy, brady or tachycardia, abnormal heart rhythms, murmurs. Tachypnea, sternal or costal retractions, nasal flaring, grunting, dyspnea. Pg.875 and my study guide.
neural tube defects (NTDs) causes Ingestions of valproic acid, methotrexate, excessive maternal heat (febrile or hot tub), maternal folic acid deficit and low s/e class
positions infant with a myelomeningocele is placed a prone-kneeling position and the knees protected from skin breakdown (878)
dressing a myelomeningocele will be covered with a sterile, moist, nonadherent dressing, and cared for using sterile technique
choanal atresia A bony or membranous septum located between the nose and pharynx originating as a laryngeal web.
Choanal atresia treatment Perforating the web by emergency surgery.
Age repair of cleft lip usually done 6 – 12 weeks or when the infant reaches 3600 – 4000 gms
Age repair of Cleft palate usually done 1 – 2 years of age
common maternal finding in a pregnant woman whose fetus has esophageal atresia or tracheoesophageal fistula history of polyhydramnios because the fetus is unable to swallow the amniotic fluid
esophageal atresia or tracheoesophageal fistula manifestations Excessive oral secretions, drooling, feeding intolerance, coughing and gagging when taking anything orally, leading to choking and respiratory distress in some cases.
chronic illness in which meconium ileus is a manifestation Cystic Fibrosis
device used to treat congenital hip dysplasia Pavlik Harness
medical intervention for clubfoot serial casting
Polydactyly treatment if there is no bone present in the digit Tied with suture and allowed to fall off
most common anomaly of the penis Hypopspadias
reason infants with hypospadias are not circumcised The foreskin may be needed for surgical repair
periodic breathing Respiratory pattern commonly seen in preterm infants where they exhibit 5- to 10-second respiratory pauses followed by 10 to 15 seconds of compensatory rapid respirations
factors that cause increased risk for neonates to be susceptible to RDS Perinatal asphyxia, hypovolemia, male gender, Caucasian race, maternal diabetes (types 1 and 2), second-born twin, familial predisposition, maternal hypotension, cesarean birth without labor, hydrops fetalis, and third-trimester bleeding
cause of RDS lack of pulmonary surfactant, which leads to progressive atelectasis, loss of functional residual capacity, and a ventilation-perfusion imbalance with an uneven distribution of ventilation
cause of having insufficient amounts of surfactant not making enough, Abnormal composition and function, and disruption of production or a combination of factors
RDS cascade affect on the fetal structures of the heart It could reopen the foramen ovale and ductus arteriosis
Reason RDS is self-limiting and decreases after 72 hours Because of production of surfactant in the type 2 cells of the alveoli
RDS management Positive pressure ventilation, bubble CPAP, oxygen therapy, exogenous surfactant
Intraventricular hemorrhage nursing care interventions decrease risk of bleeding and supportive care; Head in midline position, HOB elevated slightly, avoid rapid IV infusions, monitor B/P and avoiding or minimizing activities that increase cerebral blood flow. Swaddle or comfort for painful procedures
necrotizing enterocolitis (NEC) Acute inflammatory bowel disorder that occurs primarily in preterm or low-birth-weight neonates.
NEC causes Perinatal asphyxia, colonization with harmful bacteria, and enteral feeding
Substance with protective effect from NEC Breast milk
Age NEC usually manifest in term and preterm infants Typically 1 – 3 days after birth for term; within 7 days for
GI Manifestations of NEC are Abdominal distension, bile-stained gastric aspirate, vomiting bile or blood, grossly bloody stools, abdominal tenderness and erythema of the abdominal wall
cause of the air in the bowels and abdomen that is seen on X-rays of the abdomen Gases produced by bacteria invading the intestinal walls
NEC management NPO, O/G tube to suction, parenteral nutrition, control infection with handwashing, antibiotics, and surgical resection if needed
Grief A cluster of painful emotional and related behavioral and physical responses experienced following a major loss or death; also called bereavement
three phases of grief Acute distress, intense grief and reorganization
handling of a dead baby When bringing the baby to the parents, it is important to treat the baby as one would a live baby.
physical needs of a postpartum bereaved mother vs. non-bereaved mother The mother is still postpartum so has the same physical needs; yet will have no baby to nurse and will still have afterpains and the typical PP changes
When grieving parents should be referred to counseling When they show signs of complicated grief or posttraumatic stress
Created by: camellia