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OB chapter 15 and 16
OB chapter 15 and 16 study guide
| Question | Answer |
|---|---|
| preterm labor | gestation less than 36 weeks; contractions every 5 to 10 minutes lasting for at least 30 seconds and persisting for more than 1 hour; dilation more than 2.5 cm and 75% effaced |
| reasons for IV fluids in preterm labor | to increase vascular volume and prevent dehydration; prevents oxytocin from being released |
| ritodrine and corticosteroids cause a risk for? | fluid overload and pulmonary edema |
| betamethasone | used to reduce respiratory distress in newborn; needs to be given to the mother at least 24 to 48 hours before the birth of the newborn who is less than 34 weeks’ gestation |
| nursing implications related to tocolytic therapy | report 120 bpm or greater and BP less than 90/40 mm Hg; monitor oxygen levels |
| complications of PROM | infection; compression of the umbilical cord; prolapsed cord |
| hypertonic uterine dysfunction | a labor with uterine contractions of poor quality that are painful, out of proportion to their intensity, do not cause cervical dilation or effacement, and are usually uncoordinated and frequent |
| management of cephalopelvic disproportion | external cephalic version; cesarean birth |
| complications of breech position | fetal descent is slow; cord prolapsed occurs more often; risk of postpartum hemorrhage is also increased |
| relation to abnormal fetal presentations | associated with preterm birth, multiple gestation, congenital anomalies, placenta previa, and multiparity |
| amniotomy indications | vertex must be engaged; fetal heart rate should be monitored; the character, odor, and color of the amniotic fluid should be documented |
| 1st responsibility after amniotomy | monitor fetal heart rate |
| overstimulation of contractions due to pitocin | contractions longer than 90 seconds, intervals less than 60 seconds, and nonreassuring fetal heart rates |
| what can hyperstimulation with use of pitocin lead to? | uteroplacental insufficiency, fetal compromise, uterine rupture, and a very rapid labor with potential uterine or cervical lacerations |
| When do you turn it off, slow it down | discontinue immediately and contact PHCP if uterine hyperstimulation or nonreassuring fetal heart rate occurs |
| Four degrees of laceration | 1st:extends through skin into mucous membrane; 2nd extends farther, reaching the muscles of the perineal body; 3rd the anal sphincter muscles and muscles of the perineum are torn; 4th reaches into the anal sphincter muscles and anterior wall of the rectum |
| fetal complication from forceps and vacuum | bruising and edema; potential cephalhematoma, intracranial hemorrhage, scalp lacerations, subdural hematoma, and with forceps, possible paralysis of a facial nerve |
| risks of rapid deliveries | fetal hypoxia, fetal intracranial hemorrhage; maternal cervical, vaginal, or perineal lacerations |
| 1st action to take for a prolapsed cord | place woman’s hips higher than her head; knee chest, Trendelenburg, or side-lying with hips elevated on pillows |
| what infections require c-sections | active herpes viral infection |
| why is a foley inserted before a c-section | inserted to keep the bladder empty during surgery, which reduces the risk of injury to the bladder when the incisions are made |
| disadvantage of general anesthesia in a c-section | it crosses the placental barrier, newborn may need vigorous resuscitation |
| c-sections and the future of being able to deliver vaginally with next pregnancy | one previous c-section; adequacy of pelvis; available facilities for a c-section within 30 minutes; provision of EFM; availability of IV access |
| priority nursing diagnosis with giving pitocin | hyperstimulation or nonreassuring fetal heart rates |
| when to review pre/post-op procedures with pt | do even if they’ve had a c-section before |
| Bishop scale and induction | the American College of Obstetricians and Gynecologists has recommended that a Bishop score of 6 or more is necessary to predict a successful outcome of labor induction |
| risk of hemorrhage after delivering twins | the woman is more likely to hemorrhage because of overdistention of the uterus |
| classification of infants is based on? | gestational ages and birth weights |
| small for gestational age (SGA) | below the 10th percentile |
| large for gestational age (LGA) | above the 90th percentile |
| LGA and postterm infants are prone to? | meconium aspiration; appearing thin with loose, dry skin; at risk for hypoxia, hypoglycemia, polycythemia, cold stress, and asphyxia |
| characteristics of preterm infant | skin is wrinkled and delicate and usually covered with lanugo; has few creases on the sole of the foot; is thin, and has prominent fontanelles and suture lines; cry is weak; body appears limp and is in extension |
| scarf sign maneuver | in the term newborn the elbow cannot be drawn past the midline of the body; the elbow easily passes the midline of the body of a preterm newborn |
| inefficient thermogenesis is prone to which type of infant | preterm |
| too high of O2 can damage what on an infant? | vision; retinopathy of prematurity causes vasoconstriction in the vessels of the retina |
| gavage feeding techniques for newborn | connect syringe; verify; connect barrel and pinch; pour 1-3 ml SW for patency; pinch; pour formula or milk into barrel; release pinching of the tube and allow fluid to flow by gravity; stimulate newborn; flush with SW; pinch tube; remove syringe |
| reasons for premie being high risk for respiratory distress | surfactant deficiency |
| necrotizing enterocolitis (NEC) | an acute inflammatory process of the bowel; episodes of asphyxia may reduce the circulation, causing ischemia and necrosis in areas of the bowel; feeding precedes onset of symptoms; occult blood |
| intraventricular hemorrhage | a common type of intracranial hemorrhage; bulging fontanelles and seizure activity is seen |
| parents of NICU patients | encourage parents to still touch and hold infant in NICU if allowed |
| generalized signs of NEC | distention of the abdomen with increased amount residual feeding; diminished or absent bowel sounds, diarrhea, and occult blood |
| why premies are more likely to develop hyperbilirubinemia | poor clearance of bilirubin in the liver and reduced fluid intake can inhibit the removal of bilirubin in the intestine; also cold stress releases free fatty acids which displace bilirubin from albumin-binding sites |
| signs of neonatal pain | facial grimaces; cry; increased respiration and heart rate; increased movement of extremities; increased state of arousal |
| overhydration signs in premies | urinary output greater than 3 ml/kg/hr; urine specific gravity less than 1.001; edema; increased weight gain; rales; intake greater than output |
| kangaroo care | skin-to-skin contact of the newborn onto the parent’s chest; has evidence-based positive effects on newborn oxygenation, thermoregulation, and stabilization of vital signs, in addition to fostering the bonding process |
| symmetric and asymmetric growth | symmetric: interference with growth occurs early in pregnancy, all parts of the body are small; asymmetric: growth interference begins later in pregnancy, newborn weight is below normal, but length and head circumference is normal |
| patent ductus arteriosis | congenital heart disease resulting when the opening between the pulmonary artery and the aorta does not close after birth |
| respiratory distress syndrome | inability of newborn, especially preterm newborn, to maintain adequate respiratory effort, resulting from insufficient surfactant in the lungs |
| retinopathy of prematurity | retinal damage and blindness in the preterm neonate resulting from exposure to high oxygen concentrations; also known as retrolental fibroplasia |
| bronchopulmonary dysplasia | pulmonary condition affecting preterm newborns who have had respiratory failure and have been oxygen dependent for several days |
| intraventricular hemorrhage | bleeding within the ventricles of the brain |
| necrotizing enterocolitis | acute inflammation of the bowel that leads to necrosis |
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laotracuata
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