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OB ati
ATI concepts for OBsetrics
| Question | Answer |
|---|---|
| Indications for initiating Oxytocin | Moderate variability of FHR, cessation of uterine dilation, and prolonged active phase of labor |
| Contraindications of initiating Oxytocin (pitocin) | Fetal decelerations |
| Pregnant and has gonorrhea, this client is at risk for... | Premature rupture of membranes |
| Actions to take for umbilical cord prolapse... | Insert two gloved fingers and push up to relieve the pressure on the cord, apply O2 w/ nonrebreather @ 8 to 10 L/min, place in modified SIMs or extreme Trendelenberg, wrap visible cord loosely with saturated sterile towel in 0.9% NaCl |
| Instructions to include to the client for the non-stress test | Takes 20 -30 min, position in reclining chair in semi-fowlers, press handheld button when fetus moves, they do NOT need to be NPO |
| Leopald maneuver steps... | Start from top of fundus with palms, locate fetal back, determine what part is presenting, cephalic prominence with finger tips |
| Risk factors for developing preeclampsia | BMI over 30, pregestational DM, multifetal pregnancy, maternal age less than 19 and greater than 40 |
| Expected findings of a newborn physical assessment | acrocyanosis, positive Babinski, anterior fontanel larger than posterior, observing 2 arteries and one vein in the umbilical cord |
| Expected adverse effects of magnesium sulfate (this means you do not need to report) | Nausea, flushing/ feeling hot, and oliguria |
| Use of Amniocentesis | Used to determine ling maturity, detect congeniteal anomalies, and diagnose fetal hemolytic disease |
| Use of cordocentesis | ID fetal blood type and RBC when there is a risk of isoimmune hemolytic anemia |
| Use of Kheihaur Betke test | Amount of fetal blood in the maternal circulation when there is a risk of Rh isoimmunization |
| Magnesium sulfate toxicity signs | Loss of deep tendon reflexes, respiratory depression, slurred speech, and cardiac arrest |
| Magnesium sulfate antidote | Calcium gluconate |
| Findings of maternal Hypoglycemia (low BS) | Shallow respirations, diaphorisis / clammy skin, and blurred or double vision |
| Expected findings in a newborn | Temp. at or below 99.5F, pink tinged urine, erythema toxicum, meconium stool passing within 24 and 48 hr |
| Newborn indications of hypoglycemia | Hypotonia, poor feeding behaviors, hypothermia, respiratory distress |
| Use of Maternal Alpha-fetoprotein | Assess for neural tube defects or chromosome disorders |
| Use of Lecithin/sphingomyelin ratio | Part of amniocentesis to evaluate fetal lung maturity |
| If a client has Fifth's Disease what are the risks to the fetus? | Fetal hydrops, miscarriage, fetal anemia, stillbirth, or intrauterine growth restriction |
| Pt Edu and Nursing Interventions for Misoprostol | Oxitocin cannot be given earlier than 4 hours after the last dose of misoprostol, instruct client to void prior administration, client should remain side lying for 30 to 40 min after admin, avoid giving antacids w/ this drug |
| Common adverse effects of oral contraceptives | Urticaria, depression, hypertension, and fluid retention |
| What is a nuchal cord | The umbilical being wrapped around the fetus' neck |
| Findings of a nuchal cord | Petechiae and bruising over face, head, and neck |
| Adverse effects of carboprost | Hypertension, fever, and diarrhea |
| Expected measurements of a new born | Length = 45 to 55 in. Weight = 5.5 -8.8 lb. HR = 110 -160. RR = 30 to 60. Chest circumference = 12 -13 in. |
| 1st trimester reportable signs | Burning on urination, abdominal cramping/vaginal bleeding, fever or chills, and diarrhea, |
| Signs of gestational hypertension | Edema of face and hands, epigastric pain, severe headaches |
| Signs of hypergpycemia | Concurrent occurrence of flushed dry skin, fruity breath, rapid breathing, increased drinking and urination, and head ached |
| Signs of hypoglycemia | Clammy pain skin, weakness, tremors, irritability, and lightheadedness. |
| Leopold Maneuvers can determine what | Number of fetus's, presenting part, fetal lie, fetal attitude, degree of descent, location of fetus's back |
| Location of fetal heart tones when fetus is in vertex presentation. | Below maternal umbilicus, in either right or left lower quandrant |
| Location of fetal heart tones when fetus is in breech presentation. | Above maternal umbilicus, in either right or left upper quadrant |
| Preparation of client before Leopold manuvers | Empty bladder, lay supine with knees slightly flexed, place small rolled towel under left or right hip to prevent supine hypotensive syndrome (displace the uterus off the blood vessels) |
| Patient education on contraception post partum and when it can occur | Pregnancy can occur when breastfeeding even though menses hasn't started. If breast feeding do not take oral contraceptives until milk production is well established (6 weeks). |
| When will menses start again post partum? | If not breastfeeding, menses might not resume until 4 to 10 weeks. For breastfeeding moms, menses might not resume for 6 months or until breastfeeding has stopped. |
| For Rh negative client, when do we administer Rh O(D) Immune globulin? | Around 28 weeks of gestation |
| Sibling adaption: Encourage parents to do the following | Let sibling be the 1st to see the infant Provide gift from infant to sibling Allow older sibling to help care for infant Provide preschoolers a doll to care for When caring for infant have the other parent spend time with the sibling |
| Normal vitals for a new born | RR =30 - 60 HR = 110 -160 BP = systolic 60 - 80 diastolic 4- 50 Temp. = 97.7 to 99.5 (note. this is also the order you want to take the vitals) |
| IV Flow Rate Equation | (Volume/Time in min) X gtt/mL round to nearest whole number The drop factor of manual IV tubing is 155 gtt/mL |
| How and When to give Betamethasone | IM in 2 injections 24 hr apart For enhancing fetal lung maturity and surfactant production between 24 to 34 weeks |
| Weight gain during the trimesters of pregnancy | 1st - 1 - 2 kg (2.2 -4.4 lb) 2nd - 0.5 kg (1 lb) per week for last 2 trimesters 3rd - ^^ |
| Conditions that are indications for fetal assessment via electronic fetal monitoring are? (besides hypertension and diabetes) | Oliogohydraminos Hypertension Diabetes Intrauterine growth restriction Renal disease Previous fetal death Decreased fetal movement Post term pregnancy Systemic lupis erythematosus Intrahepatic choletasis |
| Nursing actions for phototherapy for hyperbilirubilemia | Cover baby's eyes Remove all outer clothing except diaper Do Not apply cream or moisture Turn and reposition baby every 2 to 3 hours |
| Nursing actions for back pain at 8 cm dilation | Apply sacral counter pressure Pattern based breathing |
| Post partum taking hold phase includes | Teaching the parents how to give the new born a bath |
| Post partum taking in phase includes | Reflection of birthing experience Repeating of information to ensure client understanding |
| Adverse effects of terbutaline | Hyperglycemia Hypokalemia Hypotension Tachycardia Palpitations Chest pain |
| Conditions that are contraindications of oral contraceptives | Cholecyctisis (gall bladder) Hypertension Migraine headaches Thromboembolic disorders Diabetes with vascular problems Breast or Estrogen related cancers Cirrhosis or liver tumor |
| What is Transcervical sterilization? | Small flexible agents are insert into the vagina past the cervix and into the Fallopian tubes. This causes scar tissue in the tubes and prevents conception. 3 month post exam is done to make sure the fallopian tubes are blocked. |
| Complications of transcervical sterilization | Perforation can occur Delay in effectiveness up to 3 months, unwanted pregnancy can occur during this time. Increased risk of ectopic pregnancy if pregnancy occurs |
| What does an epidural block treat? | Eliminates pain from the level of the umbilicus to the thighs, relieving discomfort from uterine contractions, fetal descent, and stretching of the perineum |
| Where and when is the epidural block injected? | The epidural space at the fourth or fifth vertebrae. This is in active labor and dilation is at minimum 4 cm |
| What are insulin changes in pregnancy | Insulin decreased during 1st trimester and level of exercise Insulin increase during 2nd and 3rd trimesters and with increased caloric intake, infection, stress, and growth spurts. |
| Nursing Actions for NonStress test | Sit patient in reclining chair, semi-fowlers, or left lateral position Conduction gel to abdomen FHR is two belts Patient should push hand held button every time fetus moves |
| If there is no fetal movement during the nonstress test, what can you do? | Have the mother drink something (orange juice, cold water) or Vibroacoustic stimulation (for 3 seconds over the fetal head so to wake the kiddo up) |
| Indications for biophysical profile during labor | Premature rupture of membranes Maternal infection Decreased fetal movement Intrauterine growth restrictions |
| Expected labs for iron deficiency anemia in pregnancy | Blood ferritin - less than 12 mcg/L Hgb - less than 11 mg/dL Hct - less than 33% |
| Amniotomy nursing actions (AROM) | Document time of the rupture Temperature checks every 2 hours Comfort measure (frequently changing pads, perineal cleansing) |
| Drugs for Postpartum hemorrhage | All are uterine stimulantsintr Oxytocin Methylergonovine Misoprostal Carboprost tromethamine |
| Intrauterine pressure catheter requirements | Membranes must be ruptured Cervix must be sufficiently dilated |
| Mastitis S/S and expected findings | Painful or tender localized mass and reddened area on one breast Flu like symptoms (chills fever headache) Fatigue Enlarged tender axillary lymph nodes on affected side |
| Family education on bulb syringe techniques | Compress bulb before insertion Avoid center of the mouth to prevent stimulating gag reflux Aspirate mouth first then nostrils |
| Uses of oxytocin | Delivery of placenta Management of postpartum hemorrhage Stress testing Enhancement of labor Induction of labor |
Created by:
glang
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