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Antepartal Care

OB Nursing

What is the painless effacement and dilation of the cervix? Incompetent cervix
Is incompetent cervix associated with contractions? No
How is incompetent cervix treated if interventions aren't successful?
What is the reinforcing the closing of the cervix with sutures? Cervical cerclage
What are the first interventions for cervical cerclage? Bedrest and limitation of activity
When is the best time to determine cervical length? 16-24 weeks
What is the implantation of the placenta in the lower uterus, close to the cervical os? Placenta previa
What are the three types of placenta previa? Total, partial, or marginal
What is the classic symptom of placenta previa? Painless uterine bleeding
True or False: You should perform a cervical exam to detect placenta previa? False
How can you verify placenta previa? Ultrasound
What should you do before performing an ultrasound when placenta previa is suspected? Check fetal heart tones
Should a woman avoid intercourse if she has placenta previa? Yes
What are nursing interventions appropriate for placenta previa? Bedrest, pad count, kick counts, monitor for uterine contractions
What drug is often used for placenta previa to spur fetal lung maturity? Betamethasone
If a peri pad weighs 1 g, how much blood is lost? 1 mL
What is the separation of the normally implanted placenta before the fetus is delivered? Abruptio placentae
Is abruptio placentae considered an OB emergency? Yes
What are major complications of abruptio placentae for the mother? Hemorrhage, DIC, hypovolemic shock
What are major complications of abruptio placentae for the fetus? Asphyxia, excessive blood loss, premature delivery
What is a major risk factor for abruptio placentae? Maternal cocaine use
What are S/S of abruptio placentae? Red, painful bleeding; uterine tenderness, knife-like abdominal pain; FHR tracing deteriorates, increased fundal height
If the mother and fetus are stable, what is the treatment for abruptio placentae? Fluids, tocolytic meds, steroids
If mother and fetus are unstable, what is the treatment for abruptio placentae? Immediate delivery
How much blood can the mother lose and remain asymptomatic? 40%
What is DIC? Disseminated intravascular coagulation
What is a loss of balance between the clot-forming activity of thrombin and the clotting activity of plasmin? Disseminated intravascular coagulation
What lab test is specific for DIC? D-Dimer; a positive D-Dimer confirms DIC
True or False: PT and PTT are prolonged with DIC. True
What is the attachment of the placenta too deeply into the wall of the uterus, without detaching after delivery? Placenta accreta
What indicates hyperemesis gravidarum? Loss of 5% of pregnancy body weight
How is hyperemesis gravidarum initially treated? IV fluid replacement, NPO, antiemetics
Describe patient education for hyperemesis gravidarum. Eat small meals of dry, bland foods and remain upright after meals
How is gestational hypertension defined? Blood pressure elevation occurring after 20 weeks gestation with NO proteinuria
How long after delivery does gestational hypertension resolve? Within 12 weeks
How is preeclampsia classified? A systolic blood pressure above 140 and diastolic above 90, occurring after 20 weeks gestation, and accompanied by proteinuria
What is eclampsia? The progression of preeclampsia to seizures
What is the only cure for preeclampsia? Delivery of the fetus
Does preeclampsia effect DTRs? Yes, they become more brisk
How is preeclampsia managed conservatively? Restriction of activity, monitor BP, daily weights, 24 hours urines, Kick counts
What is the use of magnesium sulfate? It prevents seizures; used in aggressive preeclampsia
What is the therapeutic range of magnesium? 4-8 mg/dL
Will a patient on magnesium sulfate for preeclampsia have a Foley catheter? Yes
How does magnesium toxicity affect the DTRs? Decreases or absent
How long is magnesium sulfate continued post C-section in preeclamptic mothers? 24-48 hours
What is the antidote to magnesium sulfate? Calcium gluconate
What are the S/S of magnesium toxicity? Decreased or absent DTRs, respirations less than 12, decreased urine output less than 30 mL/hr, and magnesium levels above 8
What is HELLP syndrome? Hemolysis, elevated liver enzymes, low platelets
How is HELLP syndrome treated? Antihypertensives, magnesium sulfate, deilvery
Does ABO incompatibility require treatment? Not usually
How does Rh incompatibility occur? If the mom is Rh negative and the fetus is Rh positive
Is the first baby usually affected by Rh incompatibility? No
When does fetal and maternal blood usually mix? Delivery
How much fetal and maternal blood need to mix to cause sensitization? 1 mL
What happens to future fetuses after Rh incompatibility? Anemia, specifically eryhtoblastosis fetalis
What determines if an Rh negative woman is exposed to Rh positive blood? Coombs' test
When should a negative Coombs' test be repeated? 28 weeks gestation
What is given to the unsensitized Rh negative woman to prevent sensitization? RhoGAM
When is RhoGAM given to prevent sensitization? 28-32 weeks
What are the cardinal S/S of diabetes? Polydipsia, polyuria, and polyphagia
Does preexisting diabetes increase the risk for preeclampsia? Yes
Is gestational diabetes associated with increased abortion or maternal ketoacidosis? No
When is a glucose challenge test done? 24-28 weeks
How much weight gain is recommended in a woman with multiple gestation? 35-45 pounds
What is the rupture of the bag of waters before the onset of labor, 37 weeks of after? Premature rupture of the membranes
Should you conduct a vaginal exam after PROM happens? Only if sterile
How many theories explain labor initiation? 4: Progesterone withdrawal theory, oxytocin stimuli theory, cortisol/estrogen response theory, and uterine stretch theory
What is the action of progesterone? Maintains pregnancy
What is the action of oxytocin? Acts on uterine muscle to produce labor contractions
When does the uterine sensitivity to oxytocin increase? At the 37th week
Is the uterus a voluntary or involuntary muscle? Involuntary
What is the size of a nonpregnant uterus? Roughly equal to a pear
When is the fetus completely formed with all systems working? By the end of the 3rd month
What is the major goal in the preparation for childbirth? Safe and sensitive care
What factors influence labor (5 Ps)? Passenger, passageway, powers, position, psychological
How much folic acid should a pregnant woman take in daily? 600 mcg
How much folic acid should a woman of child-bearing age take in daily? 400 mcg
What is Naegele's rule? Subtract 3 months from date of last menstrual period, add 7 days, then correct the year
How often are prenatal visits? Every 4 weeks until 28 weeks, then every 2 weeks until 36 weeks, and then weekly until delivery
What are Leopold's maneuvers? Palpating the fetus through the abdominal wall to assess location and presentation of the fetus
What are TORCH infections? Toxoplasmosis, other infections (e.g., hep A), rubella, cytomegalovirus, herpes
How is fundal height measured? From the top of the pubic bone to the top of the uterus while patient is on her back
Where is the fundal height at 20 weeks' gestation? At the umbilicus
Should the fundal height correspond with number of weeks' gestation? Yes
What is the first fetal movements described as? A flutter between 16-20 weeks gestation
What is the normal fetal heart rate? 110-160
What type of ultrasound is done in early pregnancy? Transvaginal
What type of ultrasound is done in late pregnancy? Transabdominal
Is a full bladder usually required for an ultrasound? Yes
What is the main protein in fetal plasma? AFPFetal
What do low levels of AFP indicate? Chromosomal abnormalities
What do high levels of AFP indicate? Open neural tube or body wall defects
What is AFP? Alpha-fetoprotein
What blood test is done to detect risks for Down syndrome a nd open neural tube defects? Marker Screening tests
What is the aspiration of amniotic fluid for examination? Amniocentesis
When is an amniocentesis usually done? Between 15-20 weeks gestation
How much amniotic fluid is usually removed during an amniocentesis? 20 mL
When is chorionic villus sampling done? Between 10-13 weeks gestation
What does chorionic villus sampling test for? Fetal chromosomal, metabolic, or DNA defects
What is the aspiration of fetal blood from the umbilical cord for analysis? Percutaneous umbilical blood sampling
Which blood vessel is usually used to draw blood from the umbilical cord for PUBS? Umbilical vein
What is the most common complication of PUBS? Fetal bradycardia
What does a nonstress test measure? Whether an increase in fetal heart rate occurs with fetal movement
How often is a nonstress test recommended after 28 weeks for high-risk patients? Weekly
What results indicate a reactive nonstress test? At least 2 accelerations of 15 bpm for at least 15 seconds, with or without fetal movement, within a 20 minute period
What results indicate a nonreactive nonstress test? No accelerations with 40 minutes
What does a contraction stress test measure? The response of fetal heart rate to the stress of a contraction
When is contraction stress test contraindicated? If mother has had preterm labor, PROM, extensive uterine surgery, or placenta previa
What does biophysical profile assess? Fetal heart rate, fetal breathing movement, gross fetal movement, fetal muscle tone, and amniotic fluid volume
What is the total points possible for a biophysical profile? 10
What is considered a good score for a biophysical profile? 8-10
How many kick counts should occur within 1 hour? 10
What should your first intervention be if no kicks are counted within an hour? Have the mother eat a meal and try again
What is round ligament pain? Sharp pain the side or inguinal area
What side does round ligament pain usually affect? Right
What can help with urinary frequency associated with pregnancy? Kegel exercises
What is a pregnancy that ends prior to 20 weeks' gestation? Abortion
What is a malformed uterus having two sections? Bicornuate uterus
What is the implantation of a fertilized ovum in any area other than the uterus? Ectopic pregnancy
Where are ectopic pregnancies most common? Fallopian tube
What is kernicterus? Staining of brain tissue caused by accumulation of unconjugated bilirubin in the brain
What is a linear salpinogostomy? An incision along the length of a fallopian tube to remove an ectopic pregnancy and preserve the tube
What is a perinatologist? A physician specializing in high risk pregnancies
What is a salpingectomy? Surgical removal of a fallopian tube
What questions should you ask regarding a spontaneous abortion? Color and amount of bleeding and associated symptoms
What is a threatened abortion?
What should you do for a threatened abortion? Pad count, wait and see
What is an inevitable abortion? Membranes rupture and cervical opening is present. May require D & C
What is an incomplete abortion? Some but not all products of conception are passed
What drug may be necessary after an incomplete abortion? Pitocin
What is a complete abortion? All products of conception are passed, bleeding stops, and cervix closes. No intervention required
What is a missed abortion? A fetus dies but remains in the uterus
Is a D&C needed for a missed abortion? Yes
Is RhoGAM given to a woman who has had any abortion? Yes
What are S/S of an ectopic pregnancy? Sudden severe pain in one quad, radiating pain into scapula, hypovolemic shock
True or False: A woman can have a uterine and ectopic pregnancy at the same time. True
What is choriocarcinoma? A hydatidiform mole that becomes malignant
What is an indication of hydatidiform mole? Fundal height does not correspond with gestational age
How long must pregnancy be avoided after a hydatidiform mole? At least 1 year
Are hCG levels high with a molar pregnancy? Yes
Created by: shrewsburysd