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Antepartal Care
OB Nursing
| Question | Answer |
|---|---|
| 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
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