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OB Exam 2

OB nursing

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)
Created by: jperrault9941