ATI concepts for OBsetrics
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| Indications for initiating Oxytocin | Moderate variability of FHR, cessation of uterine dilation, and prolonged active phase of labor
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| Contraindications of initiating Oxytocin (pitocin) | Fetal decelerations
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| Pregnant and has gonorrhea, this client is at risk for... | Premature rupture of membranes
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| 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
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| 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
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| Leopald maneuver steps... | Start from top of fundus with palms, locate fetal back, determine what part is presenting, cephalic prominence with finger tips
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| Risk factors for developing preeclampsia | BMI over 30, pregestational DM, multifetal pregnancy, maternal age less than 19 and greater than 40
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| 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
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| Expected adverse effects of magnesium sulfate (this means you do not need to report) | Nausea, flushing/ feeling hot, and oliguria
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| Use of Amniocentesis | Used to determine ling maturity, detect congeniteal anomalies, and diagnose fetal hemolytic disease
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| Use of cordocentesis | ID fetal blood type and RBC when there is a risk of isoimmune hemolytic anemia
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| Use of Kheihaur Betke test | Amount of fetal blood in the maternal circulation when there is a risk of Rh isoimmunization
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| Magnesium sulfate toxicity signs | Loss of deep tendon reflexes, respiratory depression, slurred speech, and cardiac arrest
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| Magnesium sulfate antidote | Calcium gluconate
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| Findings of maternal Hypoglycemia (low BS) | Shallow respirations, diaphorisis / clammy skin, and blurred or double vision
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| Expected findings in a newborn | Temp. at or below 99.5F, pink tinged urine, erythema toxicum, meconium stool passing within 24 and 48 hr
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| Newborn indications of hypoglycemia | Hypotonia, poor feeding behaviors, hypothermia, respiratory distress
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| Use of Maternal Alpha-fetoprotein | Assess for neural tube defects or chromosome disorders
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| Use of Lecithin/sphingomyelin ratio | Part of amniocentesis to evaluate fetal lung maturity
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| If a client has Fifth's Disease what are the risks to the fetus? | Fetal hydrops, miscarriage, fetal anemia, stillbirth, or intrauterine growth restriction
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| 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
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| Common adverse effects of oral contraceptives | Urticaria, depression, hypertension, and fluid retention
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| What is a nuchal cord | The umbilical being wrapped around the fetus' neck
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| Findings of a nuchal cord | Petechiae and bruising over face, head, and neck
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| Adverse effects of carboprost | Hypertension, fever, and diarrhea
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| 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.
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| 1st trimester reportable signs | Burning on urination, abdominal cramping/vaginal bleeding, fever or chills, and diarrhea,
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| Signs of gestational hypertension | Edema of face and hands, epigastric pain, severe headaches
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| Signs of hypergpycemia | Concurrent occurrence of flushed dry skin, fruity breath, rapid breathing, increased drinking and urination, and head ached
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| Signs of hypoglycemia | Clammy pain skin, weakness, tremors, irritability, and lightheadedness.
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| Leopold Maneuvers can determine what | Number of fetus's, presenting part, fetal lie, fetal attitude, degree of descent, location of fetus's back
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| Location of fetal heart tones when fetus is in vertex presentation. | Below maternal umbilicus, in either right or left lower quandrant
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| Location of fetal heart tones when fetus is in breech presentation. | Above maternal umbilicus, in either right or left upper quadrant
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| 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)
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| 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).
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| 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.
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| For Rh negative client, when do we administer Rh O(D) Immune globulin? | Around 28 weeks of gestation
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| 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
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| 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)
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| 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
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| 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
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| 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 - ^^
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| 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
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| 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
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| Nursing actions for back pain at 8 cm dilation | Apply sacral counter pressure
Pattern based breathing
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| Post partum taking hold phase includes | Teaching the parents how to give the new born a bath
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| Post partum taking in phase includes | Reflection of birthing experience
Repeating of information to ensure client understanding
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| Adverse effects of terbutaline | Hyperglycemia
Hypokalemia
Hypotension
Tachycardia
Palpitations
Chest pain
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| 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
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| 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.
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| 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
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| 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
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| 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
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| 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.
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| 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
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| 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)
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| Indications for biophysical profile during labor | Premature rupture of membranes
Maternal infection
Decreased fetal movement
Intrauterine growth restrictions
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| 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%
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| Amniotomy nursing actions (AROM) | Document time of the rupture
Temperature checks every 2 hours
Comfort measure (frequently changing pads, perineal cleansing)
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| Drugs for Postpartum hemorrhage | All are uterine stimulantsintr
Oxytocin
Methylergonovine
Misoprostal
Carboprost tromethamine
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| Intrauterine pressure catheter requirements | Membranes must be ruptured
Cervix must be sufficiently dilated
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| 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
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| 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
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| Uses of oxytocin | Delivery of placenta
Management of postpartum hemorrhage
Stress testing
Enhancement of labor
Induction of labor
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