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RN Program OB

RN Program Test 3: OB

QuestionAnswer
what are the three s/s of pregnancy PRESUMPTIVE (subjective) PROBABLE (objective) POSITIVE (diagnostic)
examples of presumptive s/s NAUSEA/VOMITING BREAST TENDER/FULL URINARY FREQUENCY FATIGUE QUICKENING (? PROBABLE) AMENORRHEA
examples of probable s/s of prego Increased uterine size Fetal outline palpated Braxton hicks + pregnancy test Hegars & Goodell’s (soft cervix) Chadwick’s (blue cervix) pigmentation
braxton hicks contractions that are not true contractions of labor
positive s/s of prego Fetal heart tones Fetal movement by examiner Ultrasound Fetal ekg
what causes nausea during prego increase in progesterone & Altered CHO metabolism(Prego hormones are insulin antagonists) Hcg level will show how pregnant a woman is
r/t prego, fatigue is r/t ? > metabolism, and < blood sugar
quickening appears when? 16-20 weeks
what are some skin changes in a prego woman? Greater in brunettes-linea nigra Striae- rupture of connective tissue Spiders- increased vacularity Palmar erythema Increased sweat glands and hair follicles
system changes r/t prego BMR ^ at 4 months By term ^25% Normal 5-6 days postpartum Decreases blood glucose Unless insulin ineffective
circulatory changes r/t prego Increased blood volume by 30-50% ( risk of heart failure ESPECIALLY if hx of heart condition) Increased RBC, WBC, fibrin Decreased HCT Needs 800mg Fe day ( store less than 500)-- supplement
why does blood pressure decrease late in 2nd or early 3rd trimester? decreased venous return, compression of vena cava- tx by turning to left side
what kind of urinary changes happen during prego? ^kidney size, ^GFR, impaired glucose resorption, dialation of ureters, diminished peristalsis, ^nocturnal output, RISK OF UTI
any UTI in a prego woman puts them at risk for what? preterm labor
after prego, is the woman at risk for hypothyroidism or hyperthyroidism? HYPOthyroidism
how do you calculate the due date? 1st day of LMP, count back 3 months, add 7 days
gravida = # of prego
Para = # of pregos > 20 wks
Abortion = # pgs < 20weeks
TPAL stands for what? Term, Preterm(<38wks), A-terminated, L-live children
diagonal conjugate is ? 11.5cm
normal value for specific gravity 1.010 - 1.030
what is a normal schedule for prenatal care? monthly for 28wks, q2wks till 36wks, and weekly until delivery
prenatal visits include what? Weight Blood pressure Fundal ht Edema? UA/labs Problems ? Appetite Problems TEACH
prenatal visits also include what? 12 weeks- FHT by doppler 20 weeks-fetoscope (Leopolds) 20-24 weeks –post-prandial blood glucose testing 32-34 weeks- HCT - maybe high/normal-water in interstitial space Fundal ht in cm = gestation (approximate)
what nutritional considerations r/t prego? Weight gain 25-35 pounds Need more calories (300-500), protein, folic acid, iron Teens need calcium (gynecological age)-figured from when you start your period Pica Ask about herbs, alcohol. Tobacco and drugs
what are some examples of knowledge deficit r/t self care? Nutrition Personal Hygiene Prevent UTI Kegel Exercises Breastfeeding Dental Health Posture
if a woman does not have a Ruebella immunization, when should she get it? AFTER prego. 3 months after delivery. OR prior to pregnancy.
stopped at slide 37-42
the peak of the contraction is also known as the ____ of the contraction. acme of the contraction
what is the normal baseline for FHR? 110/120 - 160
what are some warning FHR patterns? baseline change for 10 min, tachycardia(low oxygen), decrease in variability
ominous FHR patterns(really bad) severe variable decels, late decels, absence of variability, prolonged decels, severe bradycardia(70 or below)
a ph of less than 7.25 will indicate that the baby's APGAR will probably be ____? 7
what is a maternal assessment of activity? count first 10 movements of the day; if it takes longer than 12 hrs=call!, count to 10; > 2hrs=call!, count 3x p/day expect >4 in 30 min-if not=call!
fetal diagnostics-go back to 1-48
what is the acceptable O2 saturation for baby? 40-70% - less than 30%=hypoxia; Must have vertex presentation and ROM (rupture of membranes)
advantages of NST Quick Inexpensive Easily interpreted Can be repeated Non-invasive Low risk
what is a "reactive" NST? (positive) 2 INCREASES OF 15BPM LASTING 15 SECONDS IN A 10-20 MINUTES
what is a suspicious NST? LESS THAN 2 INCREASES IN FHR OF 15 SECONDS IN A 10-20 MINUTE PERIOD
what is proper position for an NST? No smoking prior to test Semi-fowlers/reclining chair Empty bladder
what is an OCT/CST? oxytocin stress test/contraction stress test
what happens during an OCT/CST? STIMULATE CTX TO MEASURE PLACENTAL/ FETAL RESPONSE TO CTX- TRIAL OF LABOR
what are some examples of stimulating contractions? nipple stimulation, admin oxytocin(piggyback!), Stimulate 3 contractions lasting 40-60 seconds each in 10 minutes
contraindication for CST? Preterm labor risk or history Premature rupture of the membranes Hx of extensive uterine surgery or classical c-section incision Placenta previa
describe "negative" results for a CST NO LATE DECELS SUGGESTS FETAL WELLBEING Negative is GOOD
describe "positive" results for CST PERSISTENT LATE DECELS WITH 3 OR MORE CTX
what is fetal fibronectin test? found in vaginal secretions until 20 weeks gestation the reappear 2 week prior to onset of labor. Increased risk in patients with bacterial vaginosus
what are the instructions r/t a fetal fibronectin test? No sex 24 hours prior to test Report any episode of vaginal bleeding Collect specimen with q-tip (pre-packaged) prior to vaginal exam
what does AFP stand for? Alpha-FetoProtein
describe the AFP Initial screening 15-18 weeks Screen for neural tube defects Elevated with neural tube defects Blood sample-venipuncture Repeat if elevated ( later gestation, multiple pg If still elevated –ultrasound
multiple marker tests will include what? AFP, hCG, estriol levels, Inhibin A: abnormal results indicate increased risk of trisomy 21 and trisomy 18.
what does folic acid prevent? neural tube defects (spina bifida)
what are the 5 factors of labor? 1. Pelvic structure 2. Fetal size, position, presentation 3. Contractions 4. Psyche 5. position
name for the normal female pelvis gynecoid
what are 4 ways to find fetal position 1. Palpate (Leopolds) 2. Vaginal exam 3. Auscultate- FHT 4. Ultrasound
what are the three Relationship of the long axis of fetus to the long axis of the mother Longitudinal Oblique Transverse
what is the most common fetal position? ROA - right occiput anterior
r/t baby position: station RELATIONSHIP OF PRESENTING PART TO AN IMAGINARY LINE BETWEEN THE ISCHILA SPINES
what are some signs on impending labor? 1. LIGHTENING- 36 WEEKS –LABOR- SUDDEN OR GRADUAL 2. SHOW- DILATION DISLODGES PLUG AND RUPTURE CERVICAL CAPILLARIES –24-48H 3. RUPTURE OF MEMBRANES-LABOR IN 24 HOURS –RISK OF INFECTION-- IMMEDIATE CONCERN CORD PROLAPSE
what are the 3 increments of a contraction? increment, acme, decrement
what is the frequency of constractions? start of 1 contraction to the start of the next. Beginning of one to the beginning of another
what is the duration of a contraction? start of 1 to the end of it. How long is 1 contraction?
what is the correct position for mother during labor? UPRIGHT. STRENGTHEN CTX COMFORT HASTENS DESCENT CENTERS FETUS QUICKER LABOR RELIEVES VENA CAVAL SYNDROME
what are other birthing positions? Recumbent -lithotomy Side-lying Birthing Stools Birthing Bar Squatting –more effective, less instrumentation
what are the stages of labor? dialation, expulsion, placental stage, recovery
describe the dialation stage of labor 1st ctx to 10cm
describe the expulsion stage of labor 10cm to birth
describe the placental stage of labor birth to delivery of placental delivery
describe the recovery stage of labor PLACENTAL DELIVERY TO PHYSIOLOGICAL RECOVERY
what are the 3 phrases of the 1st stage of labor? latent, active, transition
describe the latent phase of labor EFFACEMENT IS GOAL SHORT& MILD CONTRACTIONS 5 MINUTES APART AMBULATORY ENDS WITH 100% EFFACEMENT IN PRIMIGRAVIDA
describe the active phase of labor DILATION – CONTRACTIONS 2-5 MIN APART 1.2 CM /HR PRIMIGRAVIDA 1.5CM/HR MULTIPARAS INTENSE PREFER TO STAY IN BED ENDA AT 7CM
what is the transitional phase of labor DILATION – CONTRACTIONS 2-5 MIN APART 1.2 CM /HR PRIMIGRAVIDA 1.5CM/HR MULTIPARAS INTENSE PREFER TO STAY IN BED ENDA AT 7CM "i'm outta here!!"
what are the cardinal movements r/t birth Engagement Descent Flexion Internal rotation Extension Restitution
what are the s/s of the 2nd stage of labor? Involuntary bearing down Bloody show increases Rupture of membranes Urge to defecate Bulging of perineum and anal orifice Change in mood
what are some characteristics of a vaginal birth? Increase uterine size-firmer and more globular Sudden spurt of blood Cord lengthens Push-inspect “ MY that is a pretty placenta” Administer oxytocin IV
what does the nurse do during a post-partum assessment? Fundus Vital signs Lochia Bladder Perineal status IVF/meds Anasthesia Bonding pain
things you document after a birth Date& time of birth Cord status Fetal position Episiotomy Sex Apgar 1&5 min Time placenta delivers Placental intactness & appearance # cord vessels Meds given to mother General condition of mom & baby Meds given to baby
involution of the uterus includes what? 1. Placenta site walls off 2. Uterine walls thicken and contract ** Uterus never returns to pre-pregnant size
about how many days after delivery will the uterus not be palpable? 9-10 days
what is the #1 cause of postpartum hemorrhage? uterine atony
factors that inhibit uterine involution 1. Overly stretched uterus – (twins, hydramnios) 2. Exhaustion 3. Multiparity 4. Full bladder 5. Incomplete placental expulsion
Factors that enhance uterine involution 1. Normal L&D 2. Complete placental expulsion 3. Breast feeding 4. Early ambulation 5. Nutrition
what do you tx after pains with? NSAIDS
what does lochia look like 1-3 days? Rubra(Red)
what does lochia look like from 4-9 days? – Serosa( brown –less blood-more wbc)
what does lochia look like after 10 days? Alba (white-colorless)
what physical changes will a mother expect PP? Cervix- soft & flabby - retains slit opening Vagina –smooth walls without rugae- may be thin and bleed with nursing Perineum – assess for bruising, hematomas – episiotomy Abd wall- diastasis recti abdominus Diaphoresis
GI changes r/t Postpartum hunger, thirst, decrease bowel muscle tone, must stool in 2-3 days
normal blood loss for vaginal birth 500ml
normal blood loss for C-Section 1000ml
r/t PP, if Hgb is <10 we think about what? iron
r/t PP, what is taking in? preoccupied with self
r/t PP, what is taking hold? taking charge
r/t PP, what is "letting go" delivery and prego
r/t epidural, we watch for hypertension or hypotentsion? HYPOtension
UTERINE LITHOPEDION some kind of stone in the uterus
INTERVENTIONS FOR THREATENED ABORTIONS RESTRICT ACTIVITY/COITUS SEDATION PRN CORTICOSTEROIDS ASA FOR ANTIPROSTAGLANDIN IVF/TRANSFUSE/D&C/ RHOGAM PRN EMOTIONAL SUPPORT
what is a habitual abortion? three or more spontaneous and consective abortions.
PREDISPOSING FACTORS FOR ECTOPIC ADHESIONS FROM STD PREVIOUS SURGERY USE OF IUD>2YRS IN VIVO DES EXPOSURE ANOMALIES / FIBROIDS ALTERED HORMONES
S/S OF ECTOPIC PG AMENORRHEA MASS ON 1 SIDE OF ABD PELVIC PAIN - DULL TO SHARP NAUSEA AND BREAST TENDERNESS LESS THAN NORMAL PG LOWER HCG LEVELS REFERRED SHOULDER PAIN
CHRONIC ECTOPIC DARK VAGINAL BLEEDING ABD TENDERNESS FLATULENCE/ MASSES FEVER , INCREASED WBC DECREASED HCT AND HGB CULLEN’S SIGN: BLUENESS OF UMBILICUS
TREATMENT OF ECTOPIC CULDOSCOPY LAPARASCOPY TO INCISE, EVACUATE AND RESECT TUBE SALPINGECTOMY METHOTREXATE
True/False: Bleeding r/t a placenta previa is painless. TRUE: PAINLESS
what is the importance of the prenatal chart? offers current and past hx pt & prego, predicts needs for tx.
what are the different labs taken in the prenatal assessment? blood type; Rubella status, RPR(syphilis) HepB; HIV, GBS
what type of questions will you ask an antepartum pt during assessment? specifics about chief complaint, labor- when did s/s start, describe pain(OPQRST), Onset,Provocation, Quality, Radiate?, Severity, Time) is the baby moving?, SROM, Bleeding?
variability is not the same as a variable decel. True or False? TRUE: Variability=how much if any is the FHR moving? Min - 0-5 beats, Mod - 6-25 beats of variability, Marked - > 25 beats of variability
define acceleration r/t FHR HR goes 15 beats above base line for 15 seconds or more.
early deceleration early deceleration in FHR that begins to decelerate when a contraction begins, it comes to it's lowest point at peak of contraction and returns to base as contraction resolves.
what does an early deceleration look like? the mirror image of the contraction wave
Early deceleraton = _____ _____ head compression
variable deceleration is or is not in relation to a contraction? NOT necessarily r/t to a contraction, can be, but not always.
define variable deceleration FHR rapidly falls below baseline and rapidly comes back to baseline.
99% of the time, variable deceleration is caused by what? cord compression
what 4 things does a nurse do for interuterine resucitation? Re-position mom, Give O2, IV Bolus, Stop Pitocin.
does a late deceleration have to be r/t a contraction? YES!
define late deceleration deceleration in FHR that begins to decel at or just after peak of contraction, comes to lowest point as contraction is ending and resolves back to baseline well after contraction is over.
almost 100% of the time, what does a late deceleration mean? placental insufficiency - possible placental abrution
what is resting tone, r/t fetal monitoring? plapate the abd and assess if soft, firm
what is a molar prego? PLACENTAL ABNORMALITY WITH PROLIFERATION OF TROPHOBLASTS
S/S HYDATIDIFORM MOLE BLEEDING UNUSUAL UTERINE ENARGEMENT EARLY PREECLAMPSI GREATLY INCREASED HCG EXCESSIVE N & V VESICULAR VAGINAL DISCHARGE NO FHT OR FETAL OUTLINE ANEMIA, LOW ESTRIOL LEVEL
TREATMENT OF MOLAR PG IMMEDIATE EMPTYING OF UTERUS PATHOLOGY EXAM FOR CHORIOCARCINOMA CLOSE MONITOR OF HCG LEVELS AVOID PG FOR ONE YEAR AFTER HCG LEVELS RETURN TO NORMAL
HYDRAMNIOS GREATER THAN 2000 ML FLUID UNKNOWN CAUSE ASSOCIATED WITH FETAL ABNORMALITIES, MATERNAL DIABETES AND MULTIFETAL PG
CONSEQUENCES OF HYDRAMNIOS UTERINE PAIN PROM CORD PROLAPSE PREMATURE PLACENTA SEPARATION DYSTOCIA PP HEMORRHAGE BREECH BIRTH
s/s of hydramnios hard to palpate fetus, faint FHT, large uterus, dyspnea, perineal edema, vena cava
tx for hydramnios if preterm=amniocentesis, if term=assess for amniotomy. Assess for cord prolapse!
what is a CVS?
what issues will you see with an Rh baby? megaly, bili in amniotic fluid, at birth see yellow cord, anemia, jaundice
what med to we give to prevent isoimmunization? Rhogam - only to Rh (-) mother, given at 28 wks prego after amnio, cvs, ab
what is PROM? premature rupture of membranes. ROM 1 hr or more before onset of ctxs. >risk of infection
what is premature labor/preterm birth GESTATION 20-37 WEEKS WITH DOCUMENTED UTERINE CTX AND ROM OR CERVICAL CHANGES
tocolysis to stop or end ctx
what are contraindications of tocolysis? SEVERE PIH FETAL DISTRESS/ FETAL DEMISE ROM HEMORRHAGE SEVERE RENAL DISEASE
RELATIVE CONTRAINDICATION TO TOCOLYSIS ( THE GREY AREA) DILATION OF 5CM OR MORE CHRONIC HTN (MILD) STABLE PLACENTA PREVIA UNCONTROLLED DIABETES MATERNAL CARDIAC DISEASE
MANAGEMENT OF PRETERM LABOR BEDREST (SIDE LYING) AVOID SITTING MINIMAL VAG EXAMS HYDRATION IM STEROIDS
what med is used to increase secretion and storage of surfactant in the baby? betamethasone
how long does labor need to be delayed for after being given betamethasone? 24 hours
Review L:S Ratio if it's 2:1, baby doesn't need betamethasone because lungs are good to go.
three contraindications r/t betamethasone maternal infection, DM, HTN
use for Mag Sulfate TREATS PIH BUT IS SMOOTH MUSCLE RELAXANT SO STOPS UTERINE CTX
other tocolytics nifidipine, indomethacine, ritodrine
contraindications r/t Pitocin FETOPLEVIC DISPROPORTION (CPD) ABNORMAL PRESENTATION UNRIPE CERVIX (<3CM AND THICK) RISK FOR UTERINE RUPTURE ACTIVE GENITAL HERPES OR + CX ECLAMPSIA- PREVIA- FETAL DISTRESS
stop Pitocin if ctx are q ___mins or less in order for uterus to relax 2
s/e of pitocin HYPERSTIMULATION OF UTERUS abruptio uterine rupture rapid L & D fetal hypoxia OXYTOCIN HAS A POTENT ANTIDEURETIC EFFECT SO WATER INTOXICATION(water retention!)
Newborn and Mother Health Protection Act- guarantees ___ hours after vaginal birth and ___ after c-section 48 - 96
normal blood loss during vaginal delivery 500mls
normal blood loss during C-section 1000mls
what is an accurate way to define hemorrhage in delivery? Decrease in HCT by 10 from admission to pp period
s/s of hemorrhage Tachycardia Decreased blood pressure Decreased urinary output Decreasing level of consciousness Pale, poor capillary refill (change in VS=late sign)
when are the two periods for normal pp hemorrhage? first 24hrs & later: 24hr-6wks
factors for pp hemorrhage Over distention of uterus Multiparity Tocolytics Precipitous delivery Long labor C-section Manual removal of placenta Asian or Hispanic heritage
more factors for pp hemorrhage Previous pp hemorrhage General anesthesia Placenta previa Magnesium sulfate Clotting disorders Previous uterine surgery DIC REDHEADED women
ways to prevent pp hemorrhage (nursing care) Prenatal care Good nutrition Avoid traumatic procedures Risk assessment Early recognition
relaxation of uterine muscles uterine atony
tx for uterine atony Palpate for fundal tone Massage to keep firm May perform bimanual uterine massage Administer IV oxytocin, (methergine, ergotrate and Hemabate), May require ligation of uterine vessels Hysterectomy
what are some reasons for lacerations of genital tract? Nulliparous mother Epidural Precipitous births Macrosomia (large baby) Forceps-vacuum birth
what is the most common cause of late PP hemorrhage? retained placental fragments
risk factors r/t hematomas Preeclampsia Pudendal anesthesia First birth Precipitous labor Prolonged 2nd stage of labor Large baby – macrosomia- IDDM Operative procedures
Site of infection is placental attachment enometritis
teaching r/t UTI's Teach – fluids, frequent bladder emptying, empty before and after intercourse, Wash from front to back, Cotton underwear, no bubble baths Avoid carbonation Encourage cranberry, plum, apricot and prune juice and take Vitamin C to increase acidity
s/s of mastitis Onset 10 days after delivery Usually unilateral Localized red, hot and swollen Intense local pain Fever Flu-like symptoms
antidote for Heparin protamine sulfate
what foods are high in Vit K? green leafy veges
adjustment reaction with depressed mood after birth postpartum blues
risk factors for postpartum psychosis Previous postpartum psychosis Bipolar Prenatal stressors- lack of support Obsessive personality Family history of mood disorders
Created by: jrstrader