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OB Exam 2
OB nursing
| Question | Answer |
|---|---|
| What is an abortion | End of the pregnancy before 20 weeks gestation |
| Spontaneous abortion: Early | "miscarriage" of the pregnancy before 12 weeks gestation |
| Spontaneous abortion: Late | "miscarriage" of the pregnancy between 12-20 weeks gestation |
| Causes of early spontaneous abortions | Infections, genetic problems, autoimmune diseases, endocrine imbalances |
| Causes of late spontaneous abortions | Maternal causes: age, nutrition, drug use, chronic infection, incompetent cervix |
| Threatened abortion | Bleeding with no cervical changes. Can be treated and reversed. |
| Inevitable abortion | Bleeding, cramping, with cervical changes. Cannot be stopped |
| Incomplete abortion | Abortion where some of the products of conception are left behind. |
| Risks and treatment for incomplete abortion | Risk of infection and hemorrhaging; treat with D&C (dilation and certage) |
| Complete abortion | abortion where all of the products of conception are expelled |
| Missed abortion | The fetus passes away, but the body retains the contents. s/s include brownish discharge |
| Recurrent abortions | Three or more consecutive abortions; when this is happening look at WHY it is happening (genetics, incompetent cervix, infections, ect.) |
| Treatments for patients with abortion | Monitor bleeding, vaginal rest (no tampons/sex), vital signs, bed rest, emotional support; biggest risks are infection and Hypovolemic shock |
| What is the treatment for an incompetent cervix | Cerclage: stitch cervix to keep from dilation; make sure to cut the stitches before L&D start |
| What are nursing considerations for reoccurring abortions | refer to genetic counseling |
| What is ectopic pregnancy | When the embryo implants outside the uterus; commonly the fallopian tubes but could be anywhere. |
| A patient presents with one-sided abdominal pain, light vaginal bleeding and referred shoulder pain, what you expect | Ectopic pregnancy |
| s/s of ectopic pregnancy | One-sided abdominal pain, light bleeding, referred shoulder pain, and s/s of Hypovolemic shock (rigid abdomen) |
| How is ectopic pregnancy diagnosed | ultrasound |
| What is the treatment for ectopic pregnancy | Laparoscopy: removal of the products of conception while trying to save the fallopian tube |
| What is PTL (preterm labor) | Start of labor between 20-37 weeks gestation |
| What is the #1 cause of PTL | Infection: UTI |
| s/s of preterm labor | PPROM; contractions, bloody show, lower back pain, flu-like symptoms, pelvic pressure (lightening), cervical changes, engagement |
| A 26 week gestation patient calls her doctor complaining of body aches and flu-like symptoms; what should you do | Have her come in to be seen; these are signs of PTL |
| What is fetal fibronectin (FFN) used for and the considerations | Determining risk of PTL; it is expensive and not very accurate |
| What WBC count signals infection | >18,000 |
| When should fetal lung maturity testing be done for patients with PTL | Only after 34 weeks gestation |
| A 30 week gestation patient comes in with s/s of PTL; should fetal lung maturity testing be done? | No; only after 34 weeks |
| Interventions for patients in PTL | IV fluids, abx to treat any infections, medication to stop contractions or delivery if >34 weeks or ROM |
| What are tocolytic agents used for | Stops contractions in PTL |
| Magnesium Sulfate (for PTL): Nursing considerations | Relaxes smooth muscle; must be administered via IV pump; monitor for magnesium toxicity; monitor VS closely; monitor serum mg levels |
| s/s of magnesium toxicity | Loss of DTR; depressed cardiac and respiratory function (acts on CNS in brain); flushing, sweating, flaccid paralysis |
| What is the therapeutic range for magnesium sulfate serum for PTL | 4-6 mEq/L |
| A patient on magnesium sulfate has loss of DTR; what would you expect the magnesium serum to be | 10 mEq/L |
| A patient on mag sulfate has respiratory depression; what you expect the mag serum level to be | 15 mEq/L |
| A patient on mag sulfate goes into cardiac arrest; what must the mag serum level be | 25 mEq/L |
| What is the antidote for magnesium sulfate | Calcium gluconate |
| Terbutaline (for PTL): nursing considerations | Monitor HR closely; *do not give if HR >100 |
| What are the side effects of Terbutaline (for PTL) | Tachycardia, nervousness, tremors, decreased potassium & cardiac arrhythmia |
| Indocin (for PTL): nursing considerations | NSAID (blocks prostaglandins); only used in less than 32 weeks gestation; hold if patient has signs of pulmonary edema |
| Side effects for Indocin (for PTL) | Pulmonary edema |
| PROM | ROM before start of contractions and after 38 weeks: must delivery baby within 48 hours |
| PPROM | ROM before start of contractions and before 38 weeks |
| Risks associated with PROM/PPROM | Infection; prolapsed cord |
| Uterine irritability | Mild, frequent contractions; can decrease perfusion to the baby |
| What is fetal tachycardia indicative of | infection |
| When performing contraction monitoring you should use electronic monitoring AND palpation; true/false | true |
| What do fetal lung maturity screens look for | Maturity of aveoli and sufficient surfactant production |
| What are nursing considerations for PROM patients | NO routine pelvic exams (risk of infection); start IV abx at 24h |
| cardinal signs of pre-ecclampsia | HTN and proteinuria |
| what is HELLP | destruction of RBC; elevated liver enzymes; decreased platelets (r/t pre-E) |
| ecclampsia | seizures or coma during pregnancy (severe) with s/s of pre-E |
| chronic HTN | HTN the existed before pregnancy; managed with medications |
| chronic HTN with superimposed pre-E | Pt had HTN before pregnancy and develops proteinuria during the pregnancy |
| Transient HTN/PIH (pregnancy induced HTN) | HTN that develops during pregnancy without proteinuria: predisposes pt to chronic HTN later in life |
| s/s of Pre-E | HTN (rise greater than 10% above baseline), proteinuria, increased DTR (+3/4), edema, headaches, blurred vision, epigastric (RUQ) pain, oliguria |
| why do pts with pre-E have proteinuria | tissue damage in liver/kidneys releases protein; damage to kidneys decreases filtering ability = proteinuria |
| why do pts with pre-E have hemolysis | vasospasms damage and increased vascular resistance damage RBC = RBC destruction and decreased organ perfusion |
| why do pts with pre-E have increased liver enzymes | liver damage causes liver swelling and release of liver enzymes |
| Diagnosing Pre-E | monitoring BP 2x/day; 24 hour UA; subjective data analysis |
| s/s of severe pre-E | 4+ DTR, clonus, edema, oliguria (<30mL/h), blurred vision, epigastric pain, thrombocytopenia, pulmonary edema, numbness in hands/feet |
| What are some fetal complications with pre-E | decreased placental perfusion, hypoxia, IUGR, PTL |
| how to obtain BP on a pt with pre-E | left lateral position; left arm (same position every time) |
| what is clonus | # beats after flexion of foot; indicated risk of seizures due to CNS irritability |
| nursing interventions for pre-E | monitor weights, BP, VS, edema, lung sounds (pulmonary edema), DTR, platelets, STRICT I&Os, seizure precautions |
| what is the biggest hepatic risk for a pt with pre-E | hepatic rupture = death |
| what does thrombocytopenia place a pt at risk for | DIC: hemorrhaging |
| what precautions should be in place for pre-E | seizure precautions (padded bedrails, suction & O2 at bedside); fall precautions (altered mental status) |
| Magnesium sulfate (for pre-E) | relaxes smooth muscle in brain to decrease CNS excitability (decrease seizure risk); and in uterus to increase blood flow (increase placental perfusion) |
| Normal side effects of mag sulfate | flushing and sweating |
| s/s of mag sulfate toxicity | N&V, depressed DTR, paralysis, hypocalcemia, depressed cardiac & respiratory function |
| antidote for mag sulfate | calcium gluconate |
| Treatment of ecclampsia (pt in active seizure) | code light, left lateral position, check ABCs, suction & O2 as needed, bolus with mag sulfate |
| normal control of blood sugar in early pregnancy | estrogen causes increase fluid retention; Hcg causes nausea and hypoglycemia |
| normal control of blood sugar during later pregnancy | HPL (human placental lactogen) causes increased insulin resistance to provide extra glucose to developing fetus |
| Macrosomia | LGA baby: >8#13oz |
| potential fetal complications of diabetes | SGA/LGA; placental insufficiency; heart, lung, and neural tube defects; hypoxic environment |
| potential newborn complications of diabetes | SGA/LGA baby; hypoglycemia; cold stress; ruddy appearance (RBC production); jaundice, respiratory distress |
| when is the glucose challenge test done | 28 weeks gestation |
| a patient is doing the 3 hour glucose tolerance test and gets a 1 hour result of 175 is this normal | yes: 1 hour should be less than 180 |
| Normal fasting, 1, 2, 3 hour results for GTT | 95; 180; 155; 140 |
| a patient taking the 3 hr GTT has a 2 hour result of 165 is this normal | no; 2 hour should be less than 155 |
| a patient taking the 3 hour GTT has a 3 hour result of 150 is this normal | no; 3 hour should be less than 140 |
| what is the treatment for pre-existing diabetes during pregnancy | insulin injections |
| what is the treatment for gestational diabetes | (1st) diet control and exercise; (if not working) insulin |
| fetal monitoring for diabetic patient | biophysical profile, fetal lung maturity testing, kick counts |
| Placenta previa | placenta implants low in the uterus; close to or covering the cervical oss |
| complete placenta previa | placenta completely covers the cervical oss; must deliver via C-section |
| partial placenta previa | placenta covers part of the cervical oss; must deliver via C-section |
| marginal placenta previa | placenta implants very close to the cervical oss; may be able to deliver vaginally |
| low-lying placenta and complications | placenta implants low in the uterus, not covering the cervical oss; placenta may prevent the fetus from getting into a vertex position and cause transverse lie = C-section |
| complications of placenta previa | placental damage, infection, and hemorrhaging |
| s/s of placenta previa | Bright red, painless bleeding (Frank blood) during 3rd trimester |
| nursing considerations for patients with placenta previa | NO pelvic exams (damages placenta); monitor blood loss; blood typing; insert 2 16/18 gauge IV lines incase blood transfusion is needed |
| Placenta abrupta | placenta begins to detach from the uterine wall causing bleeding and uterine hypoxia to the fetus |
| Placenta abrupta: central | placenta begins to separate in the middle with the edges still attached; may cause pain but with no bleeding |
| Placenta abrupta: marginal | placenta begins to separate along the edge of the placenta: may or may not cause vaginal bleeding |
| Diagnoses of placenta previa | ultrasound |
| placenta abrupta: complete | most dangerous: complete separation from the uterine wall. Causes maternal hemorrhaging and fetal death: Emergency C-section |
| s/s of placenta abrupta | sudden intense uterine pain, uterus becomes rigid, DARK RED vaginal bleeding, contractions that don't relax; fetal distress (late decels) |
| SGA baby | Preterm, full term, or post date baby that falls below the 10th percentile at birth |
| What are the expected findings of an SGA baby at birth | Ruddy appearance (jaundice), low apgar scores, hypoglycemic, poor thermoregulation, respiratory distress |
| Symmetrical SGA baby causes | Problems during early pregnancy such as chromosome abnormalities, exposure to toxins during development, or preexisting maternal conditions (diabetes) |
| What does a symmetrical SGA baby look like | Small body and head; proportional body: head size; likely to remain small throughout life |
| Asymmetrical SGA baby causes | Problems during late pregnancy (after 28 weeks): pre-E, gestational diabetes |
| What does an asymmetrical SGA baby look like | A big head and a small body; likely to catch up to normal size with proper nutrition |
| LGA baby; Macrosomia | Premature, full term, or post-date baby that is greater than the 90th percentile at birth (>8#13oz) |
| Expected findings of an LGA baby at birth | Ruddy appearance, lots of fat development, dystocia of the shoulder/clavicle, hypoglycemia, fat umbilical cord and placenta w/ enlarged organs (except brain) |
| Biggest risks for an SGA baby | Cold stress; respiratory distress; hypoglycemia |
| Biggest risks for an LGA baby | Dystocia; trauma during delivery |
| s/s of hypoglycemia in newborns | Persistent tremors, irritability, poor muscle tone, respiratory distress, poor thermoregulation |
| What does a post-date baby look like | Long and thin due to continued bone growth and loss of subQ fat; flaky/peeling skin due to loss of vernix and lanugo, green tinted skin due to processing meconium |
| What is labetalol used for | Control BP in pts with HTN during pregnancy |
| What is betamethasone used for | Fetal lung development and surfactant production |
| Pre- term babies | Delivery between 20-37 6/7 weeks gestation |
| What is the #1 cause of premature birth | Infection: UTI |
| What does a pre-term baby look like | Bigger heads with tiny bodies; frail, little fat stores; prominent eyes; unfinished development |
| What is an environmental concern for pre-term babies | Over stimulation: stress leads to hypoglycemia; cold stress; and respiratory distress |
| What is periodic breathing | Normal fluctuations in breathing patterns of newborns |
| What is apnea of the newborn (especially preemies) | Lack of breathing for >20-30 seconds |
| Positioning of the pre-term baby | Keep lateral or prone; NOT on back |
| Interventions for pre-term babies | Incubator, oxygen hood, warm blankets, tube feeding until suck reflex is developed, calm environment, monitor VS, I&Os, BS closely |
| Describe proper newborn suction technique | Suction the mouth first (angle the tip toward the cheeks not directly back) and then the nose; be careful not to damage the larynx |
| What is normal temperature range for preemie babies | 36.3-36.9 |
| Expected output for a preemies baby | 1-3 mL/kg/hr |
| Risks for preemies babies | Dehydration (insensible fluid loss), cold stress (underdeveloped thermoregulation), hypoglycemia (poor feeding & stress), respiratory distress (hypoglycemia) |
| s/s of dehydration in a newborn | Decreased output, poor skin turgor, sunken fontanels, dry mucous membranes |
| s/s of cold stress in a newborn | Poor feeding, low temp, fatigue, irritability, cool skin with mottling |
| Nursing considerations for preemies babies | No tape, alcohol, or betadine used on these babies due to skin and endocrine sensitivity |
| Comfort measures (pain control) for pre-term babies | "squish" the baby, sucking, pain meds |
| What is DIC | The body uses up all available platelets and clotting factors and is no longer able to control bleeding; Life Threatening |
| s/s of DIC | Bleeding gums or nose, petechiae, excessive bleeding from IV sites/wounds, increased HR, decreased BP, decreased T, increased R |
| What will the labs of a pt with DIC look like | Decreased platelets and clotting factors, increased PT time, increased clotting time |
| Treatment of DIC | tx the cause of the DIC (infection, placental abruption, incomplete abortion); manage with packed RBC and plasma infusion |
| Fibrocystic breast condition | Begin, fluid-filled cysts in the breast tissue that are mobile and change with menstruation (painful); affects middle aged women |
| How do you diagnose fibrocystic breast condition | Biopsy of fluid to rule out cancer |
| Treatment of fibrocystic breast condition | Supportive bra, NSAIDs during menstruation, Vit. E supplement, diet changes; (severe) fluid aspiration |
| Fibroadenoma | Benign, solid masses in the upper-outer part of the breast; occurs in young people; does not change with menstruation |
| Endometriosis | Uterine cells located outside of the uterus inflame and slough with each menstrual cycle causing pain and tissue scarring |
| Complications of endometriosis | Tissue scarring, pain, infertility, increased risk of ectopic pregnancy |
| s/s of endometriosis | Heavy throbbing pain in abdomen and pelvis radiating down legs, painful intercourse (dyspareunia) and BMs, infertility |
| Treatment of endometriosis | Oral contraceptives and NSAIDs; hysterectomy (if done having children) |
| Follicular ovarian cyst | Failure of functional follicle to rupture; usually painless |
| Luteal ovarian cyst | Failure of corpus luteum to regress; painful, large, may inhibit menses |
| Diagnoses of ovarian cysts | Ultrasound; biopsy to rule out cancer |
| Treatment of luteal cysts | laparotomy to remove cyst |
| Uterine fibroid | Benign uterine tumor; can be very large and cause pregnancy complications |
| s/s of uterine fibroids | Enlarged uterine size, anemia, increased menstrual bleeding, pelvic pressure, bloating, urinary frequency |
| Treatment of uterine fibroids | Dependent of size and symptoms: myomectomy (fibroid removal); hysterectomy (sends pt into menopause), medications to reduce fibroid size (unpleasant side effects), embolization (destroy fibroid blood supply), Depo Vera injection (mimics pregnancy) |
| PMDD | Severe menstrual symptoms which provide only 7 days of no symptoms which eat cycle |
| s/s of PMDD | Bloating, breast tenderness, hot flashes, fatigue, depression, mood swings, anxiety |
| Treatment for PMDD | Vitamin B6 & E; Tums (Mg&Ca), Aldactone (tx fluid retention), NSAIDs (pain & inflammation), SSRI (tx depression), oral contraceptives (hormone balance) |
| Menopause | End of menstruation around age 51 years |
| Physical changes that occur with menopause | Atrophy of reproductive organs, dry skin, decreased lubrication, high cholesterol, hot flashes, fatigue |
| Side effects of estrogen replacement therapy | Increased risk of breast cancer and stroke |
| Treatment for menopause symptoms | Hormone replacement to decrease symptoms and decrease risk of osteoporosis |
| Pelvic Inflammatory Diseases | Infection of the upper genital tract (most commonly STDs) |
| Complications of pelvic inflammatory disease | Infertility, ectopic pregnancy, pain, tubal scarring |
| s/s of pelvic inflammatory disease | May be asymptomatic; pelvic pain, fever, purulent discharge, N&V (indicates sepsis); EXTREME pain with cervical/pelvic exam |
| Treatment for pelvic inflammatory disease | Antibiotics, and sex education |
| Toxic Shock Syndrome (TSS) | Serious staph infection in the vagina from poor feminine hygiene |
| s/s of TSS | Sudden high fever (104/105), N&V, sunburn-like rash, hypotension, coma, organ failure, peeling hands and feet |
| Treatment for TSS | Antibiotics, fluids, cardiac meds, education on PREVENTION |
| Bacterial Vaginosis (BV) | Overgrowth of normal flora in the vagina |
| s/s of BV | Intense itching, watery gray discharge with a fishy odor |
| Diagnoses of BV | Whiff test; microscope "clue" cells |
| Complication of Bacterial vaginosis | Increased risk of developing other STDs |
| Treatment of BV | Antibiotics; education of feminine hygiene |
| Yeast infection | Suppression of normal flora with overgrowth of yeast |
| s/s of yeast infection | Intense vaginal itching, cottage cheese odorless discharge, painful intercourse and urination |
| Treatment for yeast infection | Antifungal; Lotrimin |
| Cervical cancer | cancer of the superficial cells of the cervix |
| s/s of cervical cancer | Bleeding, referred leg/back pain, hematuria, bloody stools, anemia, and weight loss |
| Diagnoses of cervical cancer | Pap smear every 1-3 years |
| Treatment for cervical cancer | Radiation therapy; hysterectomy |
| Nursing care post-cervical biopsy | Vaginal rest (no sex/tampons), minor bleeding and cramping is normal |
| Prognosis of uterine cancer | Very slow growing; good outcomes usually; spreads through lymph system; difficult to treat once it spreads |
| Endometrial cancer | Cancer of the endometrial cells of the uterus |
| s/s of endometrial cancer | Abnormal uterine bleeding; lymph node enlargement; pleural effusion (fluid in lungs); abdominal masses; ascites (fluid in the abdomen); enlarged boggy uterus |
| Diagnoses of endometrial cancer | Assessment of uterus; ultrasound; biopsy; D |
| Treatment for endometrial cancer | Total hysterectomy; progesterone therapy for prevention |
| Ovarian Cancer | Small cell cancer of the ovary |
| s/s of ovarian cancer | (no symptoms until it is advanced) pain; increased abdominal size; bloating; poor appetite |
| Screening for ovarian cancer | No screening procedures; Silent killer |
| Treatment for ovarian cancer | radical hysterectomy followed with chemo and radiation |
| Prognosis for ovarian cancer | 40% survival rate; this is not a good cancer to have |
| Infertility | Inability to conceive after 1 year of unprotected sex |
| Primary infertility | The couple has never been able to conceive |
| Secondary infertility | The couple has been able to conceive before but cannot conceive again |
| Factors affecting infertility: Female | fallopian tube defects; lack of mature ovum; irregular menstruation; incompetent cervix; maternal endocrine problems (diabetes); immune response (lupus); chronic infection |
| Factors affecting infertility: Male | Inability to produce or ejaculate mature sperm, chromosome abnormalities; seminal fluid abnormalities |
| Interventions for infertility | Genetic counseling; thorough assessment; provide emotional support |
| Treatment for infertility | Clomide therapy; IVF; genetic counseling; surrogacy |
| Use & side effects of Clomide | Stimulates the ovaries to release more ovum; side effects: decreased cervical mucus, hot flashes, breast & pelvic pain, nausea |
| s/s of severe ovarian hyperstimulation syndrome | Clomide: acute fluid shift into the third space (life threatening) |
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jperrault9941
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