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