Maternal Child Test 2

What is PUBS (Percutaneous Umbilical Blood Sampling)?

* insertion of a needle directly into a fetal umbilical vessel, preferably the vein under US guidance * Direct Access to fetal Circulation * most common indication = evaluation of mosaic results found in amniocentesis * can also be used for fetal anemia, infection, and thrombocytopenia * Side effects= bleeding from cord puncture site or transient fetal bradycardia (baby); amnionitis or transplacental hemorrhage (mom) p. 236

What are nursing interventions for all pregnant women?

- Education - Anticipatory guidance - counseling for family adaptation -Assessment - Planning appropriate interventions

What are indications for an amniocentesis?

- Genetic concerns - Fetal lung maturity -Fetal hemolytic disease diagnosis

What is the Contraction Stress Test (CST) ?

- Graded Stress test of the fetus - Purpose is to identify the jeopardized fetus that was stable at rest but Showed evidence of compromise after Stress -Earlier warning of fetal compromise than the NST and produces fewer false-postives - Invasive procedure if oxytocin stimulation is required -Cannot be performed on women who should not give birth vaginally at the time test is done

What are contraindications of a CST?

- Preterm labor - Placenta previa - vasa previa - cervical insufficiency - multiple gestation -Previous classic uterine incision for c-Section p. 240

What is The Coombs Test?

- Screening tool for Rh incompatibility - can also detect other antibodies that may place fetus at risk for incompatibility with material antigens - NIPT (Non invasive prenatal Testing)

What is a nonstress test (NST) for?

-Antepartum evaluation of the fetus - Basis is that the normal fetus produces characteristic heart rate patterns in response to fetal movement, uterine contractions, or stimulation -Most common reason for absence of FHR accelerations is the quiet fetal Sleep State p. 238

What is recommended to prevent hypoglycemia and starvation ketosis during the night?

A large bedtime snack of at least 25 g of complex carbohydrate with some protein or fat P. 250

Describe the second stage of labor?

♣ lasts from the time the cervix is fully dilated to the birth of the fetus. ♣ two phases: the latent (passive fetal descent) phase and the active pushing phase. p.330

What is the recommended caloric intake for women with a BMI of 22 to 27?

For women with a body mass index (BMI) of 22 to 27, dietary counseling includes advice to consume about 35 kcal/kg of ideal body weight per day. P. 250

How many stages of labor are there?

Four stages p. 330

What is Cholecystitis?

Inflammation of the gallbladder P. 312

Where is an epidural injected?

Injection is made between the fourth and fifth lumbar vertebrae for a lumbar epidural block P. 351

What is the drug of choice for eclampsia?

Magnesium sulfate is the drug of choice for treating eclamptic seizures and preventing repeated seizures.

What are the variations of Vasa Previa?

2 Variations • Velamentous insertion of the cord = when the cord vessels begin to branch at the membranes and then course onto the placenta • Succenturiate = the placenta has divided into two or more lobes rather than remaining as a single mass p. 310

What happens if there is maternal blood loss?

Maternal blood loss decreases oxygen-carrying capacity, which places the woman at increased risk for hypovolemia, anemia, infection, and preterm labor and adversely affects oxygen delivery to the fetus. P. 296

What are risks of an amniocentesis?

Maternal complications (hemorrhage, feto/maternal hemorrhage, Infection, labor, abrupto placentae, damage to intestines or bladder or amniotic fluid embolism ) fetal complications ( Death, hemorrhage, Infection ( aminionitis), injury from the needle

What are symptoms of an recurrent (habitual) miscarriage?

♣ Is three or more spontaneous pregnancy losses before 20 weeks of gestation. ♣ The most widely accepted causes of recurrent miscarriage are parental chromosomal abnormalities, antiphospholipid antibody syndrome, and certain uterine abnormalities

What is descent?

The progress of the presenting part through the pelvis. It depends on at least four forces: (1) pressure exerted by the amniotic fluid, (2) direct pressure exerted by the contracting fundus on the fetus, (3) force of the contraction of the maternal diaphragm and abdominal muscles in the second stage of labor, and (4) extension and straightening of the fetal body.

What happens during the latent phase of the first stage of labor?

There is more progress in effacement of the cervix and little increase in descent. p. 330

What happens during the active phase of the first stage of labor?

There is more rapid dilation of the cervix and increased rate of descent of the presenting part. p. 330

What are nutritional recommendations that can be made for a pregnant woman with cholecystitis?

• Assess your diet for foods that cause discomfort and gas, and omit foods that trigger episodes. • Reduce dietary fat intake to 40 to 50 g/day. • Limit protein to 10% to 12% of total calories. • Choose foods so most of the calories come from carbohydrates. • Prepare food without adding fats or oils as much as possible. • Avoid fried foods P. 313

What are symptoms of an incomplete miscarriage?

♣ moderate to heavy amount of bleeding with an open cervical os. ♣ Tissue may be present with the bleeding. ♣ Mild to severe uterine cramping may be present. ♣ Involves the expulsion of the fetus with retention of the placenta.

What are the signs preceding labor?

• Lightening • Return of urinary frequency • Backache • Stronger Braxton Hicks contractions • Weight loss of 0.5 to 1.5 kg (approximately 1 to pounds) • Surge of energy • Increased vaginal discharge; bloody show • Cervical ripening • Possible rupture of membranes P. 329

What are pain meds for Vaginal Birth?

• Local infiltration anesthesia • Pudendal block • Epidural (block) analgesia and anesthesia • Spinal (block) anesthesia • CSE analgesia and anesthesia • Nitrous oxide p. 344

What are the common skin disorders that are induced by pregnancy?

• Melasma (chloasma) • Vascular "spiders", palmar erythema • Striae gravidarum P. 272

What are pain meds for the 2nd stage of labor?

• Nerve block analgesia and anesthesia • Local infiltration anesthesia • Pudendal block • Spinal (block) anesthesia • Epidural (block) analgesia • CSE analgesia • Nitrous oxide p. 344

What is a normal result on a nonstress test (NST) ?

A reactive NST is considered normal nonreactive requires further evaluation (Testing period often extended 20 minutes)

What is Multipara?

A woman who has completed two or more pregnancies to 20 weeks of gestation or more P. 150

What is Multigravida?

A woman who has had two or more pregnancies

What is Nullipara?

A woman who has not completed a pregnancy with a fetus or fetuses who have reached at least 20 weeks of gestation P. 150

What is Primigravida?

A woman who is pregnant for the first time

The nurse explains to the pregnant client that the serum alpha-fetoprotein test screens for which condition?

A. Trisomy 21 B. Turner syndrome C. Open neural tube defect D. Chromosomal aberrations (From EAQ quiz)

What is a continuous block?

Achieved by using a pump to infuse the anesthetic solution through an indwelling plastic catheter.

What is expulsion (birth)?

After birth of the shoulders, the head and shoulders are lifted up toward the mother's pubic bone, and the trunk of the baby is born by flexing it laterally in the direction of the symphysis pubis. When the baby has emerged completely, birth is complete, and the second stage of labor ends.

When do maternal insulin requirements increase during pregnancy ?

Approximately 18-24 weeks gestation to approximately 30 weeks Maternal insulin requirements may double or triple by the end of pregnancy p. 246

For which reason would a nurse limit food and oral fluids as a laboring client approaches the second stage of labor? A. The mechanical and chemical digestive processes require energy that is needed for labor B. Undigested food and fluid may cause nausea and vomiting and limit the choice of anesthesia c. The gastric phase of digestion stimulates the release of hydrochloric acid and may cause dyspepsia D. Food and fluid will further aggravate gastric peristalsis, which is already increased because of the stress of labor

B. Undigested food and fluid may cause nausea and vomiting and limit the choice of anesthesia. Abdominal contractions put pressure on the stomach and can cause nausea and vomiting, increasing the risk for aspiration. (from EAQ Quiz)

What is Internal rotation?

Begins at the level of the ischial spines but is not completed until the presenting part reaches the lower pelvis. As the occiput rotates anteriorly, the face rotates posteriorly. With each contraction, the fetal head is guided by the bony pelvis and the muscles of the pelvic floor. Eventually the occiput will be in the midline beneath the pubic arch. The head is almost always rotated by the time it reaches the pelvic floor. Both the levator ani muscles and the bony pelvis are important for achieving anterior rotation. A previous childbirth injury or regional anesthesia may compromise the function of the levator sling.

What are pain meds for the 1st stage of labor?

• Opioid agonist analgesics • Opioid agonist-antagonist analgesics • Epidural (block) analgesia • Combined spinal-epidural (CSE) analgesia • Nitrous oxide p. 344

Which assessment findings correlate with a diagnosis of unruptured tubal pregnancy? A. Rigid abdomen B. Referred Shoulder Pain C. Unilateral abdominal pain D. Hx of a sexually transmitted disease E. Ecchymotic blueness around the umbilicus

C and D Pain usually occurs at the location of the affected tube before it has ruptured STIs are related to pelvic inflammatory disease. Finding pt has had an STI increases likelihood that the tubes will be affected, resulting in tubal pregnancy (From EAQ Quiz)

Which prenatal test provides the earliest diagnosis of fetal defects?

Chorionic Villis Sampling (CVS) - Can be performed between 10-12 weeks gestation (from EAQ Quiz)

What are complications in women who have had a heart transplant?

Complications include hypertension and at least one episode of rejection P. 266

What are signs of false labor?

Contractions ♣ Occur irregularly or become regular only temporarily ♣ Often stop with walking or position change ♣ Can be felt in the back or the abdomen above the umbilicus ♣ Can often be stopped through the use of comfort measures Cervix (by Vaginal Examination) ♣ May be soft but with no significant change in effacement or dilation or evidence of bloody show ♣ Is often in a posterior position Fetus ♣ Presenting part is usually not engaged in pelvis P. 378

What are signs of true Labor?

Contractions ♣ Occur regularly, becoming stronger, lasting longer, and occurring closer together ♣ Become more intense with walking ♣ Are usually felt in the lower back, radiating to the lower portion of abdomen ♣ Continue despite use of comfort measures Cervix (by Vaginal Examination) ♣ Shows progressive change (softening, effacement, and dilation signaled by appearance of bloody show) ♣ Moves to an increasingly anterior position Fetus ♣ Presenting part usually becomes engaged in the pelvis, which results in increased ease of breathing; at the same time, the presenting part presses downward and compresses the bladder, resulting in urinary frequency P. 378

How is Disseminated intravascular coagulation (DIC) cured?

DIC usually is "cured" with the birth and as coagulation abnormalities resolve. P. 310

What is the degree of effacement?

Degree of effacement is expressed in percentages, from 0% to 100%

What is a clotting disorder in pregnancy?

Disseminated intravascular coagulation (DIC) P. 310

What is the preferred anesthesia for obese pregnant patients? A. Epidural anesthesia B. Oral opioid anesthesia C. Pudendal nerve anesthesia D. Intravenous opioid analgesia

Epidural anesthesia because during the first stage of labor, this anesthesia decreases metabolic and respiratory demands Obese women are sensitive to systemic opioids (from EAQ Quiz)

What should be monitored after an epidural?

FHR and pattern, contraction pattern, and progress in labor must be monitored carefully because the woman may not be aware of changes in the strength of the uterine contractions or the descent of the presenting part. P. 351

What can be palpated when effacement is complete?

Only a thin edge of the cervix can be palpated when effacement is complete. P. 327

Maternal Adaptations During Pregnancy and Relation to Trauma

P. 314 table 12.8

What renders a positive CST?

Repetitive late decelerations Positive result usually leads to hospitalization for further observation

What is the desired result of a CST ?

The desired result is negative

What are common side effects of an appendicitis in a pregnant woman?

The most common symptom of appendicitis in pregnant women is right lower quadrant abdominal pain, regardless of gestational age. Nausea and vomiting are often present, but loss of appetite is not a reliable indicator of appendicitis. P. 312

What is placenta previa?

The placenta is implanted in the lower uterine segment such that it completely or partially covers the cervical os or is close enough to the cervix to cause bleeding when the cervix dilates or the lower uterine segment effaces P. 305

What is Alpa-feto protein (AFP) lab for?

• Screening for NTDs (Neural tube defects) in pregnancy • Produced in the fetal gastrointestinal tract and liver • Recommended for all pregnant women • detectable from 14 to 34 weeks gestation p. 237

What happens during the active phase of the 2nd stage of labor?

Woman has strong urges to bear down as the presenting part of the fetus descends and presses on the stretch receptors of the pelvic floor.

What is the recommended caloric intake for obese women with a BMI of 30 or greater?

obese women with a BMI of 30 or greater may be managed with a caloric intake as low as 15 kcal/kg of actual weight per day P. 250

What are pain meds for c-section Birth?

• Spinal (block) anesthesia • Epidural (block) anesthesia • General anesthesia p. 344

What is effacement?

the shortening and thinning of the cervix during the first stage of labor. P. 327

What happens after an eclamptic seizure?

usually preceded by premonitory signs and symptoms, including persistent headache, blurred vision, photophobia, severe epigastric or right upper quadrant abdominal pain, and altered mental status. p. 294

What are some nutritional counseling's you can provide as a nurse to a patient with Cholecystitis?

• Assess your diet for foods that cause discomfort and gas, and omit foods that trigger episodes. • Reduce dietary fat intake to 40 to 50 g/day. • Limit protein to 10% to 12% of total calories. • Choose foods so most of the calories come from carbohydrates. • Prepare food without adding fats or oils as much as possible. • Avoid fried foods. P. 313, Patient Teaching box

What is Vasa Previa?

• When fetal vessels lie over the cervical os. • the vessels are implanted into the fetal membranes rather than into the placenta • These vessels are protected only by the membranes (not Wharton's jelly) increase risk for rupture or compression • Diagnosed during pregnancy by ultrasound using color and pulsed Doppler imaging p. 309-310

What are signs and symptoms of cholecystitis?

• epigastric or right upper-quadrant pain is present, but the pain is usually more severe and prolonged. • Nausea, vomiting, and fever may also be present. P. 312-313

What is Pruritus Gravidarum?

• generalized itching without the presence of a rash • Often limited to the abdomen • usually caused by skin distention and development of striae. • associated with twin gestation, fertility treatment, diabetes, and nulliparity. • treated symptomatically with skin lubrication, topical antipruritics, and oral antihistamines. • Ultraviolet light and careful exposure to sunlight decrease itching P. 312

What are the 7 Seven cardinal movements of mechanism of labor that occur in vertex presentation?

•Engagement •Descent •Flexion •Internal rotation •Extension •Restitution and external rotation •Expulsion (birth)

What is CVS (chorionic villus sampling)?

☆ Can be performed in first or Second trimester, ideally 10-13 weeks ☆ When done in first trimester, known as late CVS or placental biopsy ☆ Removal of a small tissue sample from fetal portion of placenta (transcervical or transabdominal) ☆ Rhogam following each procedure if needed ☆ Small risk for pregnancy loss and infection p. 236

What is a normal score on a BPP?

♣ 8 or 10 with a normal AFV is considered normal. ♣ Advantages of the test include excellent sensitivity and a low false-negative rate. One limitation of the test is that, if the fetus is in a quiet sleep state, the BPP can require a long period of observation.

What are signs and symptoms of an ectopic pregnancy?

♣ Abdominal pain occurs in almost every case. It usually begins as a dull, lower-quadrant pain on one side. The discomfort can progress from a dull to a colicky pain when the tube stretches, to sharp, stabbing, pain. It progresses to a diffuse, constant, severe pain that is generalized throughout the lower abdomen. ♣ a period that is delayed 1 to 2 weeks or lighter than usual or an irregular period. ♣ Mild-to-moderate dark red or brown intermittent vaginal bleeding occurs in many of these women. ♣ If the ectopic pregnancy is not diagnosed until after rupture has occurred, referred shoulder pain may be present in addition to generalized, one-sided, or deep lower quadrant acute abdominal pain.

What is a spinal headache?

♣ After birth, the incidence of bladder and uterine atony, as well as postdural puncture headache (PDPH), is higher. ♣ Leakage of CSF from the site of puncture of the dura mater (membranous covering of the spinal cord) is thought to be the major causative factor in PDPH, commonly referred to as a spinal headache. P. 350

What is restitution and external rotation?

♣ After the head is born, it rotates briefly to the position it occupied when it was engaged in the inlet. ♣ The 45-degree turn realigns the infant's head with her or his back and shoulders. The head can then be seen to rotate further. ♣ This external rotation occurs as the shoulders engage and descend in maneuvers similar to those of the head

What are ways to treat a spinal headache?

♣ An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for PDPH. The woman's blood (i.e., 20 mL) is injected slowly into the lumbar epidural space, creating a clot that patches the tear or hole in the dura mater. Treatment with a blood patch is considered if the headache is severe or debilitating or does not resolve after conservative management. ♣ Methylxanthines cause constriction of cerebral blood vessels and may provide symptomatic relief P. 351

What are common findings of a hydatidiform mole?

♣ Anemia from blood loss, excessive nausea and vomiting (hyperemesis gravidarum), and abdominal cramps caused by uterine distention are relatively common findings.

What are 2 common nonobstetric abdominal conditions requiring surgery during pregnancy?

♣ Appendicitis ♣ Symptomatic cholelithiasis P. 312

What are forms of non-pharmacologic pain control methods?

♣ Aromatherapy ♣ Breathing techniques ♣ Hypnosis ♣ Counterpressure ♣ Effleurage (light massage) ♣ Therapeutic touch and massage ♣ Walking ♣ Rocking ♣ Music ♣ Meditation P. 338, box 14.2

What is flexion?

♣ As soon as the descending head meets resistance from the cervix, pelvic wall, or pelvic floor, it normally flexes so the chin is brought into closer contact with the fetal chest ♣ This movement permits the smaller suboccipitobregmatic diameter (9.5 cm) rather than the larger diameters to present to the outlet.

Describe the 4th stage of labor

♣ Begins with the delivery of the placenta and includes at least the first 2 hours after birth. ♣ During this stage, the woman begins to recover physically from birth, so it is an important time to observe for complications, such as abnormal bleeding p. 330

What is a hydatidiform mole?

♣ Benign proliferative growth of the placental trophoblast in which the chorionic villi develop into edematous, cystic, avascular transparent vesicles that hang in a grapelike cluster. Is a type of Gestational trophoblastic disease (GTD) ♣ Women at increased risk for hydatidiform mole formation are those who have had a prior molar pregnancy and those who are at the extremes of age for reproduction ♣ cause is unknown, although it may be related to an ovular defect or a nutritional deficiency. ♣ Two distinct types of hydatidiform moles are: •Complete (or classic): mole results from fertilization of egg with lost or inactivated nucleus •Partial mole: result of two sperm fertilizing a normal ovum

What are the categories of high risk factors?

♣ Biophysical ♣ Psychosocial ♣ Sociodemographic P. 226, box 10.1

What are uses for US in the 4th Trimester?

♣ Confirm gestational age ♣ Confirm viability ♣ Detect macrosomia ♣ Detect congenital anomalies ♣ Detect IUGR ♣ Determine fetal position ♣ Detect placenta previa or placental abruption ♣ Visualization during amniocentesis, external version ♣ Biophysical profile ♣ Amniotic fluid volume assessment ♣ Doppler flow studies ♣ Detect placental maturity ♣ Evaluate for preterm labor

What are uses for US in the 1st Trimester?

♣ Confirm pregnancy ♣ Confirm viability ♣ Determine gestational age ♣ Rule out ectopic pregnancy ♣ Detect multiple gestation ♣ Determine cause of vaginal bleeding ♣ Visualization during chorionic villus sampling ♣ Detect maternal abnormalities such as bicornuate uterus, ovarian cysts, fibroids

What are factors that influence the way a woman deals with pain?

♣ Culture ♣ Age ♣ Previous personal experience with pain ♣ Parity ♣ Anxiety ♣ Gait-Control Theory of Pain ♣ Comfort ♣ Environment ♣ Physical, psychologic, and emotional support ♣ Unique circumstances of every labor (previous surgical or diagnostic procedures that affect the responsiveness of the cervix to uterine contractions, medical and nursing procedures performed during labor, and length of labor) P. 334

What are maternal and fetal side effects of opioids?

♣ Decrease maternal heart and respiratory rate and blood pressure, which affects fetal oxygenation. ♣ Therefore maternal vital signs and FHR and pattern must be assessed and documented before and after administration of opioids for pain relief ♣ Opioids readily cross the placenta. Effects on the fetus and newborn can be profound, including absent or minimal FHR variability during labor and significant neonatal respiratory depression requiring treatment after birth P. 345

What is a D&C?

♣ Dilation and curettage ♣ a surgical procedure in which the cervix is dilated if necessary and a curette is inserted to scrape the uterine walls and remove uterine contents. P. 299

What is a pregnant woman at increased risk for with asthma?

♣ During the postpartum period women are at increased risk for hemorrhage. ♣ Effect of pregnancies on asthma is unpredictable P. 271

What can happen if drugs are used in early pregnancy?

♣ Early in gestation, drugs can cause significant teratogenic effects. ♣ Abnormal growth and maturation, alterations in neurotransmitters and their receptors and brain organization. These are considered to be the direct effects of drugs ♣Drugs that exert a pharmacologic effect on the mother can indirectly affect the fetus. ♣ Indirect effects include altered delivery of nutrition to the fetus, either because of placental insufficiency or altered maternal health behaviors attributable to the mother's addiction. ♣ Maternal factors can indirectly place the fetus at risk. Examples include decreased access/compliance with health care, increased exposure to violence, and increased risk for mental illness and infection P. 276

What are uses for US in the 3rd Trimester?

♣ Establish or confirm dates ♣ Confirm viability ♣ Detect polyhydramnios, oligohydramnios ♣ Detect congenital anomalies ♣ Detect intrauterine growth restriction (IUGR) ♣ Assess placental location ♣ Visualization during amniocentesis ♣ Evaluate for preterm labor

What are common side effects of magnesium sulfate?

♣ Feeling of warmth, flushing, diaphoresis, and burning at the IV site. ♣ Symptoms of magnesium toxicity include absent deep tendon reflexes, respiratory depression, blurred vision, slurred speech, severe muscle weakness, and cardiac arrest P. 291

What happens during the latent phase of the 2nd stage of labor?

♣ Fetus continues to descend passively through the birth canal and rotate to an anterior position as a result of ongoing uterine contractions. ♣ The urge to bear down during this phase is not strong, and some women do not experience it at all. p. 330

What should be discussed during preconception counseling?

♣ Financial implications of diabetic pregnancy and other demands related to frequent maternal and fetal surveillance should be discussed. ♣ Medications the woman is currently taking must be assessed for safety during pregnancy. ♣ Medications that carry risk for adverse maternal or fetal outcomes should be changed to ones that are safer but equally effective. ♣ Discussion of microvascular and macrovascular complications that carry significant risk for maternal morbidity and mortality during pregnancy such as coronary artery disease and renal insufficiency. ♣ Renal transplantation may be necessary prior to conception. ♣ Contraception is another important aspect of preconception counseling to assist the couple in planning effectively for pregnancy. They should be encouraged to use reliable contraception until glycemic control is optimal. P. 246

Assessment of Sickle Cell pregnant patient

♣ Folic acid supplementation of at least 1 mg/day should begin as soon as pregnancy is diagnosed. ♣ monitored carefully during pregnancy for the development of UTI or preeclampsia. ♣ serial ultrasound examinations to monitor fetal growth and will likely have antepartum fetal testing performed regularly during the third trimester because of her increased risk for stillbirth. ♣ Infections are treated aggressively with antibiotics. ♣ If crises occur, managed with analgesia, oxygen, and hydration. P. 270

What are biophysical risk factors?

♣ Genetic considerations. Genetic factors may interfere with normal fetal or neonatal development, result in congenital anomalies, or create difficulties for the mother. These factors include defective genes, transmissible inherited disorders and chromosomal anomalies, multiple gestation, large fetal size, and ABO incompatibility. ♣ Nutritional status ♣ Medical and obstetric disorders. Complications of current and past pregnancies, obstetric-related illnesses, and pregnancy losses put the woman at risk P. 226, box 10.1

Thyroid issues in pregnancy

♣ Hyperthyroidism in pregnancy is rare ♣ A serious but uncommon complication of undiagnosed or partially treated hyperthyroidism is thyroid storm, which can occur in response to stress such as labor and vaginal birth, infection, preeclampsia, or surgery ♣ hypothyroidism is often associated with infertility and an increased risk for miscarriage, it is not often seen during pregnancy ♣ Hypothyroidism, If untreated, at risk for infertility and miscarriage. Risk for congenital hypothyroidism in baby ♣ fetus depends on maternal thyroid hormones until approximately 18 weeks of gestation P. 261

What are expected findings during labor?

♣ Increased respiratory rate ♣ Decreased blood sugar (due to exertion and glucose consumption for energy ♣ Increased systolic blood pressure ♣ Elevated white blood cell count (due to stress response) ♣ Slightly elevated temp (up to 100.4)

What are the methods used for an epidural block?

♣ Intermittent block ♣ Continuous block ♣ Patient-controlled epidural analgesia

When can a woman after a heart transplant begin to start getting pregnant?

♣ It is recommended that pregnancy be avoided for at least 1 year after the transplant because by that time the risk for acute rejection and the intensity of immunosuppression are considerably less ♣ Before conception, the woman should be assessed for quality of ventricular function and potential rejection of the transplant. Additionally, she should be stabilized on her immunosuppressant regimen. P. 266

What are Sociodemographic risk factors?

♣ Low income ♣ Lack of prenatal care ♣ Age ♣ Adolescents ♣ Mature Mothers ♣ Parity ♣ Marital Status ♣ Residence ♣ Ethnicity ♣ Environmental factors P. 226, box 10.1

What are most maternal injuries the result of?

♣ MVA (motor vehicle accident) ♣ Serious injuries are more likely to occur in an MVA if the woman is not wearing a seat belt with a shoulder harness and is ejected from the vehicle. ♣ However, approximately one-third of pregnant women do not wear seat belts because of discomfort, inconvenience, or fears of hurting the baby. P. 313

What are the uses for Magnesium sulfate with pregnancy?

♣ Medication of choice for preventing and treating seizure activity (eclampsia) ♣ rarely given intramuscularly because the absorption rate cannot be controlled, injections are painful, and tissue necrosis may occur. ♣ Because magnesium is excreted in the urine, accurate measurements of maternal urine output must be obtained.

What medication is given for an ectopic pregnancy?

♣ Methotrexate to dissolve the tubal pregnancy by destroying rapidly dividing cells ♣ Methotrexate is an antimetabolite and folic acid antagonist. It is classified as a hazardous drug and can cause serious toxic side effects even when given in low doses. ♣ The woman must be hemodynamically stable and have normal liver and kidney function to be eligible P. 303

What are the common bleeding disorders of early pregnancy?

♣ Miscarriage (spontaneous abortion) ♣ Cervical insufficiency ♣ Ectopic pregnancy ♣ Hydatidiform mole (molar pregnancy) P. 296

Assessment for Cardiac decompensation

♣ Monitoring for cardiac decompensation in the postpartum period is essential. ♣ Monitoring for cardiac decompensation continues after birth. During the first 2 postpartum weeks, extravascular fluid is mobilized, diuresis begins, and vascular resistance increases, as the woman returns to a nonpregnant state

How are ectopic pregnancies diagnosed?

♣ Most are diagnosed before rupture based on the three most classic symptoms: (1) abdominal pain, (2) delayed menses, and (3) abnormal vaginal bleeding (spotting). ♣ The most important screening tools for ectopic pregnancy are quantitative β-hCG levels and transvaginal ultrasound examination ♣ A transvaginal ultrasound may also be repeated to determine if the pregnancy is inside the uterus. ♣ A progesterone level greater than 25 ng/mL almost always rules out the presence of an ectopic pregnancy. P. 302

What are symptoms of HELLP syndrome?

♣ Most women with the disorder report a history of malaise, influenza-like symptoms, and epigastric or right upper quadrant abdominal pain. ♣ Symptoms tend to worsen at night and improve during the daytime. HELLP syndrome can progress rapidly P. 284

What should you do as the nurse if you patient has an eclamptic seizure?

♣ Nursing actions during a seizure are directed toward ensuring a patent airway and patient safety ♣ turn head to one side, place pillow under one shoulder or back if possible. ♣ It is important to note the time of onset and duration of the seizure. ♣ The nurse should call for help but remain at the bedside. ♣ After the woman is stabilized, uterine activity, cervical status, and fetal status must be assessed.

What are the methods for DFMC?

♣ Once a day for 60 minutes ♣ 2 to 3 times daily for 2 hrs or until 10 movements are felt ♣ 10 movements in a 12-hour period ♣ There are approximately 30 gross fetal movements/hr in the third trimester. Only 70-80% of these are felt. ♣ Count of fewer than 3 fetal movements within 1 hour warrants further evaluation by a nonstress test or a contraction stress test and a complete or modified biophysical profile ♣ "Fetal alarm signal" - no fetal movement for 12 hours

What is Somatic Pain?

♣ Pain described as intense, sharp, burning, and localized ♣ During the 2nd stage of labor ♣ Results from Stretching and distention of perineal tissues and pelvic floor to allow passage of fetus from distention and traction on peritoneum and uterocervical supports during contractions and lacerations of soft tissue P. 334

What is Disseminated intravascular coagulation (DIC)?

♣ Pathologic form of clotting that is diffuse and consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both, and clotting ♣ an overactivation of the clotting cascade and the fibrinolytic system, resulting in depletion of platelets and clotting factors, which causes the formation of multiple fibrin clots throughout the vasculature of the body, even in the microcirculation. ♣ DIC is never a primary diagnosis. ♣ Instead it results from some problem that triggered the clotting cascade, either extrinsically by the release of large amounts of tissue thromboplastin or intrinsically by widespread damage to vascular integrity. P. 310

What are complications of diabetes in pregnancy?

♣ Pregnancy complicated by diabetes is considered high risk ♣ fetal macrosomia ♣ Infants born to women with diabetes tend to have a disproportionate increase in shoulder, trunk, and chest size. Because of this tendency, the risk for shoulder dystocia is greater in these babies than in other macrosomic infants. ♣ increased likelihood of cesarean birth because of failure of fetal descent or labor progress or of operative vaginal birth ♣ preeclampsia ♣ Hydramnios (polyhydramnios) frequently develops during the third trimester of pregnancy in women with diabetes. ♣ Vaginal infections, particularly monilial vaginitis, are more common. Urinary tract infections (UTIs) are also more prevalent. ♣ Ketoacidosis ♣ Hyperglycemia and hypoglycemia

What is preeclampsia (PIH)?

♣ Pregnancy-specific syndrome ♣ Hypertension develops after 20 weeks of gestation in previously normotensive women with proteinuria ♣ A vasospastic systemic disorder categorized as mild or severe ♣ Gestational usually resolves within first week postpartum, no longer than 12 weeks p. 281-282

What are warning signs if a pregnant woman abuses drugs?

♣ Pregnant women who abuse drugs can display warning signs such as receiving no prenatal care, late entry into care, or sporadic care, with multiple missed appointments. ♣ They may keep prenatal appointments but leave without being seen. ♣ Another warning sign in pregnant substance abusers is noncompliance with recommended treatment ♣ These women may also show evidence of poor nutrition, have frequent encounters with law enforcement officials, or be involved in marital and family disputes. P. 276

Preconception counseling is recommended for who?

♣ Recommended for all women of reproductive age who have diabetes because it is associated with less perinatal mortality and fewer congenital anomalies ♣ women with pregestational diabetes are counseled before the time of conception to plan the optimal time for pregnancy, establish glycemic control before conception, and diagnose any vascular complications of diabetes. P. 246

What have the highest incidence of maternal mortality?

♣ Ruptured ectopic pregnancy ♣ Abruptio placentae (placental abruption)

What are psychosocial risk factors?

♣ Smoking ♣ Caffeine ♣ Alcohol ♣ Drugs ♣ Psychologic status: Childbearing triggers profound and complex physiologic, psychologic, and social changes, with evidence to suggest a relationship between emotional distress and birth complications. This risk factor includes conditions such as specific intrapsychic disturbances and addictive lifestyles; a history of child abuse or intimate partner violence; inadequate support systems; family disruption or dissolution; maternal role changes or conflicts; noncompliance with cultural norms; unsafe cultural, ethnic, or religious practices; and situational crises. P. 226, box 10.1

How many calories does the average diet during pregnancy include?

♣ The average diet includes 2200 calories (first trimester) to 2500 calories (second and third trimesters). ♣ Total calories may be distributed among three meals and one evening snack or, more commonly, three meals and two or three snacks. P. 250

What are symptoms of an complete miscarriage?

♣ The cervix has already closed after all products of conception were expelled. ♣ Slight bleeding may occur, and mild uterine cramping may also be present, as well.

What is a daily fetal movement count (DFMC)?

♣ The daily fetal movement count (DFMC) (also called kick count) frequently used to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation ♣ During the third trimester, the fetus makes about 30 gross body movements each hour. The mother is able to recognize 70% to 80% of these movements

What is Parity?

♣ The number of pregnancies in which the fetus or fetuses have reached 20 weeks of gestation, not the number of fetuses (e.g., twins) born. ♣ Parity is not affected by whether the fetus is born alive or is stillborn (i.e., showing no signs of life at birth).

What are signs and symptoms of a miscarriage?

♣ The presence of uterine bleeding, uterine contractions, or abdominal pain is an ominous sign during early pregnancy and must be considered a threatened miscarriage until proven otherwise. ♣ If miscarriage occurs before the sixth week of pregnancy, the woman may report what she believes is a heavy menstrual flow. ♣ Miscarriage that occurs between weeks 6 and 12 of pregnancy causes moderate discomfort and blood loss. ♣ After week 12 miscarriage is typified by severe pain similar to that of labor because the fetus must be expelled. ♣ Diagnosis of the type of miscarriage is based on the signs and symptoms present

What is Disseminated intravascular coagulation (DIC) triggered by?

♣ The release of large amounts of tissue thromboplastin, which occurs in placental abruption Preeclampsia, HELLP syndrome, and gram-negative or gram-positive sepsis are examples of conditions that can trigger DIC because of widespread damage to vascular integrity P. 310

What are the types of miscarriages?

♣ Threatened ♣ Inevitable ♣ Incomplete ♣ Complete ♣ Missed ♣ All types can recur in subsequent pregnancies. ♣ All types except the threatened can lead to infection P. 297

How is hydatidiform mole diagnosed?

♣ Transvaginal ultrasound and serum hCG levels are used for diagnosis. ♣ Transvaginal ultrasound is the most accurate tool for diagnosing a hydatidiform mole. p. 305

What is a Patient-controlled epidural analgesia

♣ Uses an indwelling catheter and a programmed pump that allows the woman to control the dosing. ♣ Has been found to provide optimal analgesia with higher maternal satisfaction and enhanced sense of control during labor while decreasing the total amount of medication, including local anesthetic

What are neurologic origins of pain?

♣ Visceral ♣ Referred ♣ Somatic Pain p. 334

When Magnesium Sulfate is administered, what are maternal and fetal assessments that need to be conducted?

♣ Vital signs and assessments are performed as ordered by the health care provider and per hospital protocol. ♣ Monitor blood pressure, pulse, respiratory rate every 15 to 30 minutes, depending on woman's condition. ♣ Monitor FHR and contractions continuously. ♣ Monitor level of consciousness, intake and output, proteinuria, DTRs, headache, visual disturbances, and epigastric pain at least hourly. ♣ Restrict hourly fluid intake to a total of no more than 125 mL/hour; urinary output should be at least 25 to 30 mL/hour. p. 292, box 12.3

What is engagement?

♣ When the biparietal diameter of the head passes the pelvic inlet, the head is said to be engaged in the pelvic inlet ♣ In most nulliparous pregnancies, this occurs before the onset of active labor because the firmer abdominal muscles direct the presenting part into the pelvis. ♣ In multiparous pregnancies in which the abdominal musculature is more relaxed, the head often remains freely movable above the pelvic brim until labor is established. P. 330

What is extension?

♣ When the fetal head reaches the perineum for birth, it is deflected anteriorly by the perineum. ♣ The occiput passes under the lower border of the symphysis pubis first, and the head emerges by extension: first the occiput, then the face, and finally the chin

Describe the 3rd stage of labor

♣ lasts from the birth of the fetus until the placenta is delivered. ♣ The placenta normally separates with the third or fourth strong uterine contraction after the infant has been born. After it has separated, the placenta can be delivered with the next uterine contraction.

What position should a woman be in for an epidural?

♣ Woman is positioned as for a spinal block. ♣ She may sit with her back curved or assume a modified Sims' position with her shoulders parallel, legs slightly flexed, and back arched ♣ It is important to avoid severe spinal flexion because it could compress the epidural space, increasing the risk for dural puncture ♣ After the epidural has been initiated, the woman is positioned preferably on her side so that the uterus does not compress the ascending vena cava and descending aorta, which can impair venous return, reduce cardiac output and blood pressure, and decrease placental perfusion ♣ Her position should be alternated from side to side every hour. P. 351

Who should be involved in the preconception counseling?

♣ Woman's partner should be included in the counseling to assess the couple's level of understanding related to the effects of pregnancy on the diabetic condition and the potential complications of pregnancy as a result of diabetes. ♣ The couple should also be informed of the anticipated alterations in management of diabetes during pregnancy and the need for an interprofessional team approach to health care. P. 246

What a possible side effects of an epidural?

♣ Women who receive an epidural have a higher rate of fever ♣ Hypotension ♣ Dizziness ♣ Urinary retention ♣ limited movement ♣ Pruritus (itching) P. 352 Side Effects of Neuraxial Anesthesia

What can iron do to a pregnant patient with sickle cell?

♣ Women with sickle cell anemia are not iron deficient. ♣ Therefore routine iron supplementation, even that found in prenatal vitamins, should be avoided because these women can develop iron overload P. 270

If a pregnant woman has Sickle Cell hemoglobinopathy, what is she at risk for?

♣ Women with sickle cell trait usually do well in pregnancy. ♣ Increased risk for preeclampsia, intrauterine fetal death, preterm birth and low-birth-weight infants, and postpartum endometritis. ♣ They are also at increased risk for UTIs and may be deficient in iron ♣ at risk for poor pregnancy outcomes, including miscarriage, preterm birth, IUGR, and stillbirth. ♣ The frequency of painful crises also appears to be increased during pregnancy P. 270

What is HELLP syndrome?

♣ a laboratory diagnosis for a variant of preeclampsia that involves hepatic dysfunction, characterized by hemolysis (H), elevated liver enzymes (EL), and low platelet (LP) count. ♣ usually develops during the antepartum period ♣ increased risk for maternal death and adverse perinatal outcomes, including pulmonary edema, acute renal failure, disseminated intravascular coagulation (DIC), placental abruption, liver hemorrhage or failure, acute respiratory distress syndrome (ARDS), sepsis, and stroke P. 284

What is a biophysical profile (BPP)?

♣ a noninvasive dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease. ♣ includes AFV, FBMs, fetal movements, and fetal tone determined by ultrasound and fetal heart rate (FHR) reactivity determined by means of the nonstress test. ♣ can be considered a physical examination of the fetus, including determination of vital signs. ♣ used frequently in the late second and the third trimester for antepartum fetal testing because it is a reliable predictor of fetal well-being. P. 233

What is an Intermittent block

♣ achieved by using repeated injections of anesthetic solution ♣ it is the least common method.

What are nursing interventions for a patient with Disseminated intravascular coagulation (DIC)?

♣ assessing for signs of bleeding and complications from the administration of blood and blood products, ♣ Administering fluid or blood replacement as ordered ♣ Protecting the woman from injury. ♣ Because renal failure is one consequence of DIC, urinary output is monitored closely by using an indwelling catheter ♣ Vital signs are assessed frequently. ♣ Woman should be maintained in a side-lying tilt to maximize blood flow to the uterus

What are fetal risks from maternal hemorrhage?

♣ blood loss or anemia ♣ hypoxemia ♣ hypoxia ♣ anoxia ♣ preterm birth P. 296

How is an ultrasound performed?

♣ can be performed either abdominally or transvaginally during pregnancy. ♣ Abdominal is more useful after the first trimester when the pregnant uterus becomes an abdominal organ. ♣ Transvaginal allows pelvic anatomic features to be evaluated in greater detail and intrauterine pregnancy to be diagnosed earlier. ♣ A transvaginal ultrasound may be performed with the woman in a lithotomy position or with her pelvis elevated by towels, cushions, or a folded pillow.

What does Disseminated intravascular coagulation (DIC) result in?

♣ clinical picture of clotting ♣ bleeding ♣ ischemia

Describe the first stage of labor?

♣ considered to last from the onset of regular uterine contractions to full dilation of the cervix. ♣ much longer than the second and third combined ♣ divided into only two phases, latent (early) and active p. 330

What is Sickle cell hemoglobinopathy?

♣ disease caused by the presence of abnormal hemoglobin in the blood. ♣ Sickling of the RBCs but with a normal RBC life span. Most people with sickle cell trait are asymptomatic. P. 270

What are increased risks of maternal trauma?

♣ fetal death ♣ Miscarriage ♣ preterm birth ♣ preterm premature rupture of membranes ♣ uterine rupture ♣ cesarean birth ♣ Placental abruption ♣ Stillbirth

What are the insulin requirements?

♣ first trimester, from weeks 3 to 7 of gestation, insulin requirements are increased, followed by a decrease between weeks 7 and 15 of gestation. ♣ second and third trimesters, because of insulin resistance, the dose must be increased significantly to maintain target glucose levels. ♣ Insulin requirements normally peak at 36 weeks of gestation and drop significantly after that P. 250

What is visceral pain?

♣ from cervical changes, distention of lower uterine segment, and uterine ischemia ♣ 1st stage of labor. Usually only during contractions (some women have continued back pain-especially if fetus posterior position) ♣ Located over lower portion of abdomen

What is cardiac decompensation?

♣ inability of the heart to maintain a sufficient cardiac output) may occur. ♣ Fever is the major cause of cardiac decompensation during pregnancy ♣ Infections are a major cause of cardiac decompensation during pregnancy. P. 262, 266

What are symptoms of an inevitable miscarriage?

♣ moderate to heavy amount of bleeding with an open cervical os. ♣ Tissue may be present with the bleeding. ♣ Mild to severe uterine cramping may be present. ♣ often accompanied by rupture of membranes (ROM) and cervical dilation. ♣Passage of the products of conception occurs.

What is referred pain?

♣ originates in uterus, radiates to abdominal wall, lumbosacral area of back, iliac crests, gluteal area, and down thighs

What are symptoms of an missed miscarriage?

♣ pregnancy in which the fetus has died but the products of conception are retained in utero for days, weeks, or even months. ♣ It may be diagnosed after the uterus stops increasing in size or even decreases in size. ♣ There may be no bleeding or cramping, and the cervical os remains closed. ♣ A missed miscarriage is often simply referred to as an early pregnancy loss.

What is symmetric IUGR?

♣ reflects a chronic or long-standing insult and may be caused by low genetic growth potential, intrauterine infection, chromosomal anomaly, maternal undernutrition, or heavy smoking. ♣ the fetus is small in all parameters P. 231

What is asymmetric IUGR?

♣ suggests an acute or late-occurring deprivation such as placental insufficiency resulting from hypertension, renal disease, or cardiovascular disease. ♣ head and body growth do not match P. 231

What is intrauterine growth restriction (IUGR)?

♣ term used to describe a condition in which the fetus is smaller than expected for the number weeks of pregnancy. ♣ may be symmetric (the fetus is small in all parameters) or asymmetric (head and body growth do not match). ♣ Reduced fetal growth is still one of the most frequent conditions associated with stillbirth.

What is an ectopic pregnancy?

♣ the fertilized ovum is implanted outside the uterine cavity ♣ a leading cause of infertility ♣ often called tubal pregnancies because at least 90% are located in the uterine (fallopian) tube ♣ can also occur in the abdominal cavity, on an ovary, or on the cervix P. 302

What a pregnant woman is placed on a stretcher after a trauma, what position should be avoided?

♣ the supine position must be avoided, even in women with cervical spine injuries. It is a primary priority that lateral uterine displacement be accomplished without any head movement. As soon as the neck is immobilized, the stretcher should be tilted laterally ♣ This is because Cardiac output increases 30% to 50% over pre-pregnancy values and is position dependent in the third trimester. Because of compression of the inferior vena cava and descending aorta by the pregnant uterus, cardiac output decreases dramatically if the woman is placed in the supine position. P. 314

What is lightening?

♣ the uterus sinks downward and forward about 2 weeks before term, when the presenting part of the fetus (usually fetal head) descends into the true pelvis ♣ Also called dropping P. 329

What are signs and symptoms of placental abruption

♣ uterine tenderness or pain ♣ uterine irritability ♣ uterine contractions ♣ vaginal bleeding ♣ leaking of amniotic fluid ♣ change in FHR characteristics.

When is a spinal headache most likely to occur?

♣ when the dura is accidentally punctured during the process of administering an epidural block. ♣ The likelihood of headache after dural puncture can be reduced if the anesthesia care provider uses a small-gauge pencil-point spinal needle.

What are symptoms of a threatened miscarriage?

♣spotting of blood but with the cervical os closed. ♣Mild uterine cramping may be present.