OB TEST 2

The pain of labor is influenced by many factors. What is one of these factors?

The woman is prepared for labor and birth.

The health care provider approves a labor plan which includes analgesia. The client questions how analgesia will help her pain during labor.

"The analgesia will reduce the sensation of pain for a limited period of time."

Apgar

1 and 5 minutes of life 0-3 severe distress 4-6 moderate difficulty 7-10 minimal or no difficulty with adjusting to extrauterine life Heart Rate RR Muscle tone reflex irritability color

AGA

Appropirate for gestational age (weight it between 10 to 90th percentile)

a nurse is caring for a client who is in preterm labor and is scheduled to undergo an amniocentesis. the nurse should evaluate which of the following tests to assess fetal lung maturity a. alpha fetoprotein (AFP) B. lecithin/sphingomyelin (L/S) c. kleihauer-betke test d. indirect combs

B. lecithin/sphingomyelin (L/S)

Preeclampsia without severe features

BP 140/90 , or systolic pressure elevated 30mmHg or diastolic pressure elevated 15. proteinuria of 1+ to 2+ on a random sample weight gain over 2lb/week in second trimester 1lb/week in third trimester mild edema in upper extremities or face

Gestational Hypertension

BP 140/90, or systolic pressure elevated 30mmHg or diastolic pressure elevated 15. no proteinuria no edema blood pressure returns to normal after birth

Severe preeclampsia

BP 160/100 or greater proteinuria greater than 3+, oliguria, elevated serum creatinine >1.1

Preeclampsia with severe features

BP 160/110 proteinuria 3+ or 4+ on a random sample 5g on a 24 hour sample oliguria cerebral or visual disturbances (HA, Blurred vision) pulmonary or cardia involvement extensive periphearl edema hepatic dysfunction thrombocytopenia epigastric pain

BUBBLE

Breasts Uterus (fundal height, uterine placement) Bowel (and GI) Bladder (Function) Lochia (color, odor, consistency and amount) Episiotomy (edema, ecchymosis, approximation)

A nurse in an obstetrical clinic is teaching a client about using an IUD for contraception. Which of the following statements by the client indicates an understanding of the teaching? A) "An IUD should be replaced annually during a pelvic exam" B) "I cannot get an IUD until after I've had a child" C) "I should expect intermittent abdominal pain while the IUD is in place" D) "A change in the string length of my IUD is expected"

D) "A change in the string length of my IUD is expected"

Eclampsia

HA, severe epigastric pain, hyperreflexia, hemoconcentrations

HELLP

HEMOLYSIS ELEVATED LIVER ENZYMES LOW PLATELETS

most common fatal position

LOA (left occipitoanterior) ROA (right occipitoanterior)

A pregnant client is admitted to a health care facility with a diagnosis of premature rupture of membranes (PROM). Which of the following tests would the nurse expect to be used to predict fetal lung maturity when the client goes into labor?

Lecithin/sphingomyelin ratio

LBW

Low birth weight ( <2500 g or less)

Which maneuver is first attempted to deliver an infant with shoulder dystocia?

McRoberts maneuver

Drugs for preeclampsia

Mg Sulfate (influse over 15-30 minutes), Hydralazine (slowly admin to avoid sudden drop in BP) Diazepam (Valium) Calcium gluconate (ANTIDOTE FOR MG SULFATE)

Gestational HTN

Mild and severe preeclampsia, eclampsia and hemolysis, elevated liver, and low platelets (HELLP) 20 week of pregnancy describers HTN disorders with an elevated bp OF 140/90. OR greater recorded on two different occasions at least 4 hr apart Magnesium sulfate (may feel flushed, hot, and sedated with the MG bolus) fluid restrictions 100 to 125mL/hr side lying position avoid alcohol or tobacco and limit caffeine

A woman in labor suddenly reports sharp fundal pain accompanied by slight dark red vaginal bleeding. The nurse should prepare to assist with which situation?

Premature separation of the placenta

Vital Signs (newborn)

RR 30 - 60 (apnea longer than 15 seconds need evaluated) HR 110-160 (APICAL is assessed for 1 minute) BP 60-80/40-50 Temperature 97.7-99.5

Placenta previa

third trimester placenta abnormally implants in lower segment smoking painless bright red vaginal bleeding uterus soft, relaxed, contender leopold manuever IV FLUIDS, blood, bethamethasone bed rest

SGA

Small for gestation age (weight is less than the 10th percentile)

A nurse is caring for a client who is pregnant nd is to undergo a contraction stress test (CST). which of the following findings are indication fro this procedure? (Select all that apply) a. decrease fetal movement b. intrauterine growth restriction (IUGR) c. post maturity d. placenta previa e. amniotic fluid emboli

a. decrease fetal movement b. intrauterine growth restriction (IUGR) c. post maturity

bleed third trimester

abruptio placentae vase previa

factors are used to determine if the cervix is ripe enough for induction

Station, effacement, cervical consistency, dilatation, and cervical position

The nurse is caring for a client who has an irregular pattern of uterine contraction. As a result, the nurse anticipates a problem with which?

The powers

TORCH

Toxoplasmosis (hepatitis, rubella, cytomeglaovirus, HSV, cat litter) DX, immunologic survey used to indentify existence of these infections in the mother or newborn

Rho(D) immune gloublin

administer 72 hours to women who are Rh-negative (Baby is Rhpositive)

Fundus

after delivery, should be firmand midline with the umbilicus 12 hr pp palpated at 1 cm about the umbilicus every 24hr descend 1 to 2 cm assess every 8 hrs oxytocin/ misoprostol = hypotension methylergonovine, ergonovie, carboprost = hypertension empty bladder every 2 to 3 hours

A nurse is reviewing findings of c client's biophysical profile (BPP). the nurse should expect which of the following variables to be included in the test a. fetal weight b. fetal breating movmeent c. fetal tone d. fetal position e. amniotic fluid volume

b. fetal breating movmeent c. fetal tonee. e. amniotic fluid volume

A nurse is reviewing the health record of a client who is pregnant. The provider indicated the client exhibits probable signs of pregnancy. Which of the following findings should the nurse expect (select all) a. montgomery's glands b. goodell's sign c. ballottement d. chadwick's sign e. quickening

b. goodell's sign c. ballottement d. chadwick's sign

premonitory stages

backache weight loss ligthening contractions irregular to regular increase vaginal discharge bloody show energy burst GI changes (N/V) cervical ripening rupture of membranes assessment of amniotic fluid

False

begin and remain irregular felt first abdominally and remain confined to the abdomen and groin often disappear with ambulation or sleep do not increase in duration, frequency, or intensity do not achieve cervical dilation

True contractions

begin irregularly but become regular and predictable felt first in lower back and sweep around to the abdomen in a wave continue no matter what the woman's activity is increase in duration frequency, intensity achieve cervical dilatation

mongolian spots

bluish purple spots of pigmentation (shoulders, back,and buttocks) usually on dark skin

Decrease estrogen (postpartum)

breast engorgement, diaphoresis, diuresis, diminished vaginal lubrication

A nurse in a clinic is teaching a client about her new prescription of medroxyprogesterone. Which of the following information should the nurse include in the teaching (Select all that apply) a. weight loss can occur b. you are protected against STIs c. you should increase your intake of calcium d. you should avoid taking antibiotics e. irregular vaginal shooting can occur

c. you should increase your intake of calcium e. irregular vaginal shooting can occur

Cephalophematoma

collection of blood between the periosteum and the skull bone that it covers. DOES NOT CROSS the suture line appears in the first 1 to 2 days after birth and resolver in 2 to 3 weeks

Breast

colostrum (2 to 3 days after birth) milk (3 to 5 days after delivery of NB)

acrocyanosis

cyanotic hands and feet

Breast assessment

engorgement redness tenderness cracked nipples

Gonorrhea

erythromycin to all infants following delivery

Hyperemesis gravidarum

excessive N/V due to high hCG levels (After 12 weeks gestation) results in 5% body weight IV lactated ringers and pyridoxine (vitamin b6) Hgb less than 11mg/dL (first trimester) Hct less than 3% Ferrous Sulfate (iron) empty stomach or with orange juice vitamin c containing foods

postpartum depression

feeling of guilt and inadequacies irritability anxiety fatigue feeling of loss lack of appetite persistent feeling of sadness intense mood swings sleep pattern disturbances **crying weight loss flat affect irritability rejection of the infant severe anxiety and panic atttack

post partum blues

feeling of sadness lack of appetite sleep pattern disturbances feeling of inadequacies crying easily for no reason restlessness, insomnia, fatigue anxiety, anger, sadness

Kleihauer Betke test

fetal blood in maternal circulation if a large fetomaternal transfusion is suspected. (>15mL or more of fetal blood is detected, mother should receive immune globulin dose)

Vasa previa

fetal umbilical vessel implants into the fetal membranes Velamentous (branch at the membranes) Succenturiate (divided into two) Battledore (marginal insertion)

Ectopic pregnancy

first trimester unilateral stabbing pain and tenderness in lower abdominal quad scant, dark red or brown vaginal spotting occurring 6 to 8 weeks after last normal period METHOTREXATE (do not drink alcohol or take vitamins with folic)

Telangiectatic nevi (Stork bites)

flat pink or red marks that easily blanch and are found on the back of the neck, nose, upper eyelids and middle of the forehead

bleed second trimester

gestational trophoblastic disease ( high hCG, no fetus present, cluster of grape like fluid filled sacs, prune color)

Decreased progesterone (postpartum)

increase in muscle tone

Phases

increment (intensity of the contract increases) acme (at its strongest) decrement (intensity decreases) 10 minutes early in labor to only 2 to 3 minutes increasing from 20 to 30 seconds at the beginning to range of 60 to 70 second by the end of the first stage

IUGR

intrauterine growth restriction growth rate does not meet expected norms

LGA

large for gestational age (weight is greater than the 90th percentile)

Caput succedaneum

localized sweeping of the soft tissues of the scalp caused by pressure on the head during labor soft edematous mass and CAN CROSS over the suture line resolves in 3 to 4 days does not require treatment

pace maker

located in the uterine myometrium near one of the uterotubla jnctions

Trichomoniasis

low birth weight perform delivery <5.5lbs

The nurse is assessing a client in labor for pain and notes she is currently not doing well handling the increased pain. Which opioid can the nurse offer to the client to assist with pain control?

meperidine

New Ballard Scale

newborn maturity rating scale that assess neuromuscular and physical maturity -1 to 5 scale (a score of 35 indicates 38 weeks of gestation)

molding

overlapping of the skull bones along the suture lines (only lasts a day or two. babies born c section do not have this)

Non lactating women ovulation and menses

ovulation 27 to 75 days after birth menses 4 to 6 weeks postpartum

five p's

passenger (fetus and placenta) passageway (birth canal) powers (contractions) position (of the woman) psychological response

Abruptio placentae

premature separation of the placenta from the uterus >20 weeks HTN, Cocaine, smoking PAIN dark red vaginal bleeding uterus boardlike, tender IV fluids, blood, oxygen 8-10L

Lepold

presenting, lie, attitude, descent, FHT,

Preterm newborn

preterm 20-37 weeks late preterm 34 to 37 weeks early term 37 to 38 6/7

A 24-year-old client presents in labor. The nurse notes there is an order to administer RhoGAM after the birth of her infant. When asked by the client the reason for this injection, which reason should the nurse point out?

prevent maternal D antibody formation.

Mild preeclampsia

proteinuria > +1

Station

relationship of the presenting part of the fetus to the level of the spines 0 = at level -1 to -4 above + 1 to + 4 below (+ 3 to +4 = crowning )

Gestational trophoblastic disease

second trimester embryo fails to develop past primitive stage grape like clusters prune juice discharge (dark brown) or bright red (lasting for several days) elevated hCG suction curettage to remove

Eclampsia

seizure or coma S/S of preeclampsia are present

engagement

settling of the presenting part of the fetus far enough into the pelvis that it rests at the level of ischial spines, the midpoint of the pelvis. not not engaged = floating descending but not yet reach = dipping

Cervix, vagina, perineum (post partum)

soft, edematous, bruised, small lacerations bright red trickle of blood from the episiotomy site in early postpartum is normal apply ice packs for the first 24-48 hours

Bleed first trimester

spontaneous abortion, ectopic pregnancy

Spontaneous abortion

terminated before 20 weeks of gestation (or weight of 500g) types: threatened, inevitable, incomplete, complete, missed

HIV

through placenta and breastmilk (DO NOT breastfeed) no episiotomy or amnio Western blot test Retrovir 14 week gestational until birth Retrovir to infant until 6 weeks

Cervical insufficiency

ultrasound shows short cervix (less than 24 mm), cervical funneling (breaking) or effacement **cervical cerclage is done at 12-14 weeks of gestation. It is removed at 37 weeks of gestation or when spontaneous labor occurs activity restriction and bed rest *NO sex, tampons, douching

Lochia

uterine discharge that contains blood, mucus, and uterine tissue Rubra, bright red, small clots, fleshy odor (1 to 3 days after delivery) Serosa, pinkish brown (4 to 10 days after deliver) Alba, yellowish white creamy color fleshy odor (11 up to 4 to 8weeks

Physiological maternal changes (Postpartum)

uterine involution lochia flow cervical involution decrease in vaginal distention alteration in ovarian function ***hemorrhage, shock and infection ** greatest risk

Postpartum assessment

vital signs uterine firmness uterine position vaginal bleeding every 15 min for the first 2 hr after birth. temperature should be assessed every 4 hr for the first 8 hr after birth and then at least every 8 hr

expected reference ranges weight length

weight 2500 to 400 (5.5 to 8.8lbs) length 45 to 55 (18 to 22 in)