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Maternity/Newborn

QuestionAnswer
GPTAL(Gravida)# of pregnancies of the woman G= # of pregnancies,T= # of full term deliveries,P= # of pre-term pregnancies, A= # of "abortions" (spontaneous or elective), L= # of living children
Nagle's Rule Determining a woman's due date. (LMP -3 months + 7 days= EDC)
Infertility
Basal Body Temperature Upsurge of LH that occurs before ovulation and stays in conception occurs.
Sperm/Semen Analysis # of sperm, Appearance of sperm, Motility of sperm, Sperm penetration
PID (Pelvic Inflammatory Disease) Infection caused by untreated STD. Risk of infertility due to scar tissue.
Presumptive Signs of Labor(Subjective) Amenorrhea, breast chanfes, Nausea/vomiting, Frequent urination, Fatigue
Probable Signs of Labor(Objective) Laboratory Tests(Beta HCG), Home pregnancy test, Chadwick's sign(bluish hue cervix), Goodell's sign(softening of uterus), Hegar's sign(softening of cervix), Sonographic evidence of gestational sac
Positive Signs of Labor Fetal heart seperate from mother's, Fetal movement felt by examiner, Visualization of fteus via ultrasound
(1)Hegar Sign (2)Chadwicks Sign (3)Goodells Sign Softening of the uterine cervix, Bluish hue of the cervix, Softening of the vaginal cervix.
HPV (Human Papilloma Virus) Most prevalent viral STI, Previously called genital or venereal warts, Over 40 serotypes, Types 6 and 11 are visible, Types 16, 18, 31, 33, and 35 has highest oncogenic potential, More common in pregnant women, Enlarge greatly during pregnancy
Group B Streptococcus(Treated with Ampilcillin 2gms IVPB bolus, then 1 gm every 4 hours during labor (at least 2 doses) until delivery, if allergic to PNC, use clindamycin 900 mg IVPB q8h until patient delivers) Tested with GBH, Usually no symptoms, Infects neonates causing sepsis, pneumonia, respiratory distress, meningitis and can lead to neonatal death by sepsis. Screen at 35-37 weeks, Studies show 40-70% of infants become infected, Womans normal flora 9-23%.
Aminocentesis Performed to obtain amniotic fluid which contains fetal cells, needle inserted transdermally, done after 14 weeks, indicated for prenatal diagnosis of congenital or genetic disorders (neural tube defects), pulmonary maturity and fetal hemolytic disease.
What Causes Labor?
Signs of Impending Labor and True Labor. Lightening, Braxton-Hicks contractions, Bloody show, ROM, Sudden burst of energy, Slight weight loss. True: Contractions at regular intervals that shorten and increase, Pain in back radiates to stomach, Cervix dilates, Intensity increases with walking.
Dilatation, Effacement, Station Openeing of cervix, Thinning of cervix, Position of fetus relative to ischial spine with "0" being at the level of the ischisl spine "-1 to -5" being above the ischial spine and "+1 to +5 being below the ischial spine.
Amniotic Fluid
Accelerations Basis for the NST test and occur with fetal movement, indication of fetal well being, irregularities should be seen. Accelerations should be seen with every contraction.
Early Decelerations Occur in response to compression of felal head (head compression) - OK to have during labor.
Late Decelerations Caused by uteroplacental insufficiency. Deceleration begins after the contraction is well established and persists after contraction ends. Position on left side, administer fluids, elevate HOB, if continues C-Section.
Variable Decelerations Often at midpoint, Usually caused by cord compression. Do not mirror contractions no pattern. Reposition.
Nursing Care of Laboring Woman Respect contraction time, Change positions, Encourage fluids/ice chips, voiding and bladder care, support, pain management.
Lithotomy Woman's legs are simutaneously and carefully lowered from stirrups to prevent back injury.
Positions for Delivery and Increasing Pelvic Outlet. Squatting(optimal), kneeling, walking, sitting, "all fours position".
Nursing Care of Rupture of Membranes Patient should be put on bedrest, check for hypotension, treat with antibiotics for possible infection (chorioamninitis) and administer IV fluids.
Nursing Care of Patient with Epidural IV fluids, Change position
Side Effects of Epidurals and What to Do.
Betamethasonen (Fetal Lung Glucocorticoid)12mg IM x2 doses 24 hours apart Given as IM injections to the mother to accelerate fetal lung maturity, this class of meds also decrease rates of intraventricular hemorrhage, greater risk for pulmonary edema when given with b-adrenergic meds, may worsen maternal conditions( HTN, diabete
indomethacin(Indocin) - Tocolytic Promotes relaxation of smooth muscle(suppress uterine activity).NSAID, suppress preterm labor by blocking production of prostglandins, risk for premature closure of ductus arteriosus increases if treatment > 48 hours or fetus is 32 or more weeks gestation
pitocin(Oxytocin)- Hormone Used to induce or augment labor by stimulating uterine contractions. Risk for hyperstimulation. side effects is abruptio placenta, ruptured uterus. Contraction>90sec, uterune resting tone>20mmHg, nonreassuring FHR pattern.
Narcan (Opiod) walking epidural
Magnesium Sulfate - Tocolytic Most commonly used tocolytic with few adverse reactions.Promotes relaxation of smooth muscle. Don't use if >6 cm, active bleeding, chorioamnionitis, pregnancy induced hypertension. Administered IV infusion. Calcium Gluconate is antedote.
Bacterial Vaginosis Gram-, High concentration of Gardnerella and Mobiliuncus. Causes preterm labor, treated with antibiotics
Fetal Tachycardia Greater than 160
Fetal Bradycardia lower than 110
Newborn Care Immediately After Delivery ABC's,
Apgar Score Done @1 and 5 minutes. Score should be at least 9. Heart rate, Respirations, Muscle Tone, Color
Erythromycin Administered to newborns born to mothers who are +chlamydia
Vitamin K Promotes coagulation, synthesized in GI tract
Care of Circumcision Check for bleeding, Petroleum gel (large amount) with gauze, Clean with warm water, Don't wash off exudate.
Created by: Honeynut718