OBGYN test 2
Erythema toxicum
"Newborn rash" happens within the first 24-72 hours and can last up to 2-3 weeks. Unknown cause, probably inflammatory response -Macules, papules, vesicles
Nevi skin lesions
"Stork bites" small, red blanchable rashes caused by capillary beds close to the surface of the skin
Miscarriage care
(Depends on the type of miscarriage and s/s) -expectant management -medical management: misoprostol (cytotec) -surgical management: dilation and curettage D&C -follow up care
Chemical induction of labor
(Used for cervical ripening) -Cytotec (oral or vaginal tablet) -Cervidil (vaginal tablet)
Postpartum assessments
- involution -descent of uterine fundus -lochia -every 4 hours after first 24 hours and then 8-12 hours after that
Intrauterine Devices IUDs
-4 IUDs available -99% effective -Long acting, reversible -biamanual exam and cervical inspection needed prior to placement
Abortion pill
-Approved for up to 10 weeks gestation -legal in all 50 states (Most require physician to administer) -19 states require Dr to be present when administering -mifepristone -Misoprostol
How to diagnose infertility
-STI screening -hormone levels -semen analysis -ovulation function analysis -endometrial biopsy -hysterosalpingogram -laparoscopy
Physiological adaptations of integumentary system
-Vernix Caseosa -Milia -Epstein pearls -desquamat -Mongolian spots -acrocyanosis -nevi -erythema toxicum
C section nursing care
-abdominal surgery -circulating nurse is LD nurse -NNP and nursery nurse at delivery -skin to skin contact in OR -fundal massage -breast feeding -early ambulation
Signs and symptoms of cold stress
-axillary temp <96.8 (36.0) -lethargy -tachypnea -grunting -hypoglycemia -hypotonia
Postpartum changes
-cervix: dilated, edematous, and bruised (Rapid healing takes place) -vagina: greatly stretched, edematous -vaginal epithelium will be restored within 6-10 weeks, wall will regain thickness, and gradual muscle tone -perineum: pelvic floor muscles Stretch and thin out, pain, bruising -perineal lacerations/ episiotomy (ICE PACKS)
What constitutes an assisted vaginal delivery?
-concerns about fetal heart rate -prolonged pushing with limited fetal decent -maternal fatigue -cardiac disease ( pushing would increase problems) considerations: -fetal estimated weight -fetal station -pelvis size
Pre-gestational diabetes risks to fetus/ newborn
-congenital defects - 5x the incidence of cardiovascular/ CNS problems -GI, GU, skeletal problems -macrosomia: insulin does not cross placenta and fetus is exposed to hyperglycemia/ produces more insulin -birth injuries -stillbirth -metabolic syndrome -prediabetes -type 2 later in life
Signs of respiratory distress in a newborn
-cyanosis -apnea -tachypnea -retractions of chest wall -grunting -flaring of nostrils -hypotonia
Preeclampsia
-diagnosed by hypertension and proteinuria developing after 20 weeks of gestation in a previously normotensive woman -proteinuria is not required for dx -patient may experience a new onset of: thrombocytopenia, impaired liver function, new renal insufficiency, and new visual disturbances/ photophobia
Cold stress prevention
-dry newborn thoroughly -stocking cap on head -remove wet blankets -skin to skin with mom -warm blankets
Nursing interventions when parents lose a baby
-encourage parents to hold the baby ( facilitates grief) -prepare them for baby having macerated skin, deformities, etc) -bathing baby, diaper, hat, baby powder -angel gown project -special outfit -warm blanket or warmer -unlimited time with baby -photographs and memory boxes -assisting with decisions about funeral and autopsies -paperwork
Preeclampsia assessment
-epigastric pain -liver enzymes -platelet count and bruising -deep tendon reflexes (will be hyper reflexive ) -headaches that wont go away -edema and swelling -double vision/ scotoma
Management of chronic hypertension in pregnancy
-establish mom's baseline with testing (serum creatinine, urine protein, EKG) -if moms BP gets over 160 systolic or 105 diastolic, give antihypertensives -continuously check urine for protein at prenatal visits -renal and liver function testing -have mom do kick counts, NSTs, and BPPs in 3rd trimester
combined hormonal contraceptives
-estrogen and progestin -the pill -patch -ring -prevents ovulation and thickens cervical mucous -91% effective -contraindications: hypertension, clotting disorders, DVT history -risks: MI, ischemic and hemorrhagic stroke, DVT -BP needs to be evaluated prior -precautions in patients with breast cancer, diabetes, migraines, and liver disease
Mechanical induction of labor
-foley bulb -amniotomy -Pitocin
Hypertension risks on fetus
-higher risk of miscarriage -fetal growth restriction -risk for preterm birth -death -2-3 times more likely to have a stillbirth -higher risk of developing preeclampsia
What causes infertility in men?
-hormonal causes such as pituitary tumor and low testosterone -problems with spermatogenesis ( drugs, infections, prolonged heat exposure, pesticide exposure) -decrease in sperm motility (antibody reaction, testicular trauma, vasectomy reversal) -missing or blocked structures interfering with sperm transport -erectile dysfunction/ ejaculatory dysfunction
Pre-gestational diabetes risks for pregnant woman
-hypertension ( preeclampsia) -preterm labor -miscarriage -polyhydramnios -oligohydramnios -labor complications -complications related to chronic diabetes ( heart, kidney problems ) -higher risk of infection -UTIs, postpartum endometriosis -increased risk of mortality
Prolapse cord nursing care
-increase IV fluid drip rate -place client in extreme trendelenburg -administer oxygen via nonrebreather -notify primary health care provider -glove up examining hand and insert two fingers into the vagina to the cervix
Newborns respond to cold by:
-increasing metabolic rate -increasing muscle activity -peripheral vasoconstriction -metabolism of brown fat ( dense vascular fat) -non-shivering thermogenesis
Post term pregnancy care
-induction at 41 weeks -daily fetal kick counts -BPP, NST
What hypertensives can you give to pregnant women
-labetalol (NOT for asthma patients) -Nifedipine ( calcium channel blocker) -Hydralazine (vasodilator) -Thiazide diuretics (second line of defense med)
Infertility treatment for women
-lifestyle changes -drugs that stimulate ovulation (Clomiphene Citrate) -antibiotics -surgery ( open Fallopian tubes, remove uterine fibroids)
Triple I s/s
-maternal fever of 102.2 or two measurements of 100.4 and 102.2 -fetal tachycardia -WBC > 15,000 -purple to fluid from cervical OS -treatment is started if suspected -dx: placenta/ amniotic fluid culture
Placental abruption risk factors
-maternal hypertension -smoking -Cocaine use -blunt force trauma (MVA, battery)
Gestational hypertension
-occurs after 20 weeks gestation -rule out preeclampsia since patient will be more at risk -SHOULD go away after birth but sometimes lingers -if diagnosed after 37 weeks, delivery is recommended -if less than 37 weeks, medication, amniotic fluid and fetal growth monitoring -plan for an early delivery
Risk factors for infertility in women
-older age (older than 35) -smoking -excessive alcohol use -extreme weight gain or loss -eating disorders -excessive physical or emotional stress that results in amenorrhea -history of STDs -diabetes -autoimmune disorders -history of cancer treatments (gonadotoxic chemicals, radiation)
What causes infertility in women?
-ovulation dysfunction -uterine fibroids -damage from endometriosis -tubal scar tissue -problems with cervical mucous -mucous too thick that is hostile to sperm ( what the pill does)
Which adverse effect would the nurse monitor for after administering vitamin K to a newborn?
-pain -edema -jaundice -erythema -hemolysis
Placenta previa risks factors
-previous C section -smoking -uterine surgery -high altitudes -short time duration between pregnancies (Patient will need a C section)
Risk factors for ectopic pregnancy
-previous ectopic pregnancy -prior Fallopian tube surgery -previous pelvic or abdominal surgery -history of certain STIs -history of PID
Injectable birth control ( Depo-provera)
-progestin only -injection every 3 months -94% effective -no exam needed before
Birth control implant (Nexplanon)
-single rod with etonogestrel (size of matchstick) -progestin only -99% effective -long acting up to 5 years -no exams or tests needed prior
Risk factors for infertility in men
-smoking -older age -history of STDs -impotence -exposure to environmental pollutants/chemicals -alcohol, marijuana, or cocaine use -history of cancer treatments
GDM management
-strict glucose control -diet and exercise -insulin therapy -oral hypoglycemia medications ( glyburide, metformin)
Signs of abnormal newborn breathing
-stridor -mottling -bradypnea -nasal flaring -expiration grunting
Fallopian tube rupture s/s
-sudden, severe pain in the abdomen or pelvis -shoulder pain -weakness, dizziness, shock
Placental abruption fetal s/s
-tachycardia -bradycardia -category 2 or 3 FHR patterns -late decels
Types of miscarriages
-threatened -inevitable -incomplete -complete -missed -recurrent ( 3 or more before 20 weeks)
Cervical insufficiency diagnosis / tx
-transvaginal US -cervical funneling visualized -tx: cerclage
Causes of preterm labor and birth
-unclear (multiple factors) -uteroplacental vascular insufficiency -inflammatory response -cervical insufficiency -genetic predisposition
Complete abortion
-vaginal bleeding -closed cervical os -products of conception -completely expelled
Molar pregnancy s/s
-vaginal bleeding -excessive nausea and vomiting -abdominal cramps
Placental abruption s/s
-vaginal bleeding -severe abdominal pain/ rigid abdomen -uterine contractions -increased uterine irritability -s/s of shock -KB test identifies fetal blood in the mom's circulation ( will need moms blood drawn)
threatened abortion
-vaginal bleeding and cramping -cervix closed and soft -fetal cardiac activity but still has a a chance of surviving
Inevitable abortion
-vaginal bleeding and cramping -rupture of membranes -dilated cervical os; products of conception may be seen or felt at or above cervical os
Incomplete abortion
-vaginal bleeding and cramping -dilated cervical os -some products of conception expelled
Where would the nurse expect the fundus to be located on the second postpartum day?
1 or 2 fingerbreadths below the umbilicus ( should be 1 finger per day)
Newborns lose heat by
1) evaporation 2)conduction 3)convection 4)radiation
Perineal laceration degrees
1) skin and mucous membranes 2) fascia and muscles 3) external anal sphincter 4) completely tears through rectal mucosa (urethra, cervix, and vaginal wall can also have lacerations)
A woman is labeled as infertile after how many months of unprotected sex with no ability to conceive
12 months ( if woman is older than 35, its 6 months)
The nurse gently performs Leopold maneuvers on a client with a suspected placenta previa. Which would the nurse expect to find during this assessment?
A high, floating fetal presenting part (presenting part may have difficulty entering the pelvis)
Miscarriage ( spontaneous abortion )
A pregnancy that ends as a result of natural causes before 20 weeks of gestation
Postpartum psychosis
A rare psych condition that can cause hallucinations, delusions, delirium, and deficits in judgment -risk for homicide and suicide -inpatient psych care and antipsychotics needed
Cervical cerclage
A stitch is placed in the cervix to keep it from dilating -can have it placed at 12-14 weeks gestation if hx of miscarriage -removed at 36 weeks
Which statements regarding the involution process are correct? Select all that apply. A) involution begins immediately after expulsion of the placenta b) involution is the self destruction of excess hypertrophied tissue. c) involution progresses rapidly during the next few days after birth d)involution is the return of the uterus to a non pregnant state after birth e) involution may be caused by retained placental fragments and infections
A, C, D
Ectopic pregnancy treatment
ALWAYS requires treatment -medication ( methotrexate) -surgery: removal of Fallopian tube or fertilized egg
Misoprostol
Abortion pill that you take immediately or up to 48 hours after mifepristone -causes cramping and bleeding to empty uterus
Mifepristone
Abortion pill, progesterone blocker
A primigravida at term has dark red vaginal bleeding and complains of pain continuing between contractions. The nurse palpates the abdomen, which is firm and shows no sign of relaxation. Which problem is suggested by these assessment findings?
Abruptio placentae
For which complication is a client with gestational hypertension at risk? A) placenta previa b) abruptio placentae
Abruptio placentae ( vasospasm of placental vessels occur due to HBP, causing separation of placenta
amniotic fluid embolism
An extremely rare, life-threatening condition that occurs when amniotic fluid and fetal cells enter the pregnant woman's pulmonary and circulatory system through the placenta via the umbilical veins, causing an exaggerated allergic response from the woman's body ( anaphylaxis) -s/s acute hypoxia, hypotension, cardiovascular collapse, and coagulopathy -CPR/ C section needed
Betamethasone and dexamethasone
Antenatal glucocorticoid that accelerates lung maturity of fetus if preterm birth is expected -given at 24-34 weeks -reduces incidence of respiratory distress syndrome and death -2 doses: IM 24 hours apart -causes hyperglycemia in mom
Suprapubic pressure
Applying pressure to anterior shoulder to push it under the pubic bone ( shoulder dystocia)
When assessing a client who gave birth 1 day ago, the nurse finds the fundus is firm at 1 finger breadth below the umbilicus and the peri pad is saturated with lochia rubra. Which is the nurse's next reaction?
Asking the client when she last changed the peri pad ( lochia would be considered excessive if it had only been 15 minutes. It would be heavy bleeding if it had been 2 hours)
Intrauterine inflammation or infection (triple 1)
Bacterial infection involving amniotic fluid, fetus, umbilical cord, placenta, and fetal membranes -old name "chorio" risk factors -prolonged rupture of membranes -multiple cervical exams, internal monitors, meconium stained fluid, STIs, GBS -sepsis, PPH, C section
Mongolian spots
Benign Bluish black areas of pigmentation typically seen on the back or buttocks of newborns (look like bruises) will usually fade in a few months up to year
succenturiate placenta
Bi-lobed placenta with cord laying in between lobes
Cervical mucus method
Birth control method to predictive ovulation -check cervical mucus every morning. Gets slippery ( egg whites) pre ovulation stage
Marquette method
Birth control method to predictive ovulation -urine sample every morning to check for estrogen and luteinizing hormone. 98% effective
Basal body temperature method
Birth control method to predictive ovulation -take temperature in the morning every day before you get out of bed. Slight increase in post ovulation stage
Preterm birth
Birth that occurs before the 36.6 weeks (75% are result of spontaneous preterm labor and premature rupture of membranes)
Which assessment finding indicates that disseminated intravascular coagulation (DIC) is occurring in a postpartum client who has experienced an abruptio placentae?
Bleeding at the venipuncture site
Subgaleal hemorrhage
Bleeding into the subgaleal space -difficult operative vaginal delivery (vacuum extraction) -blood loss can be severe, leading to hypovolemic shock
Acrocyanosis
Blue condition of the extremities
Which finding would the nurse be most concerned about in the client receiving a bolus of magnesium sulfate IV for preeclampsia treatment?
Blurred vision (sign of toxicity)
An infant is admitted to the nursery after a difficult shoulder dystocia vaginal birth. For which condition would the nurse carefully assess this newborn?
Brachial plexus injury
The nurse is caring for a preterm neonate with physiological jaundice who requires phototherapy. Which is the physiological mechanism of this therapy?
Breaks down the bilirubin into a conjugated form
Lactation Amenorrhea Method
Breastfeeding to avoid ovulation -must be EXCLUSIVELY breastfeeding with no bottles or pumping -only works for about 6 months -98% effective if used perfectly
A woman in the third trimester of pregnancy presents with vaginal bleeding and states she snorted cocaine approximately 2 hours ago. Which complication would this profile suggest? a) placenta previa b) tubal pregnancy c) abruptio placentae d) spontaneous abortion
C) abruptio placentae
Methotrexate
Cancer drug that is used for ectopic pregnancy treatment that destroys rapidly dividing cells
Preterm labor
Cervical changes and uterine contractions occurring at 20-36.6 weeks of pregnancy
Women with recurrent miscarriages may have?
Cervical insufficiency (passive and painless dilation and funneling of the cervix during the second trimester)
The nurse admits a client with preeclampsia to the high risk prenatal unit. Which is the next nursing action after the vital signs have been obtained?
Checking the client's reflexes ( presence of hyperreflexia indicates CNS irritability meaning condition is getting worse)
vernix caseosa
Cheesy white substance on newborn's skin that is a protective covering of sebaceous gland secretions -emollient -anti microbial -antioxidant -hydrating
Induction of labor
Chemical or mechanical initiation of uterine contractions -cervical ripening/ Pitocin -amniotomy and Pitocin -should never be before 39 weeks
Cephalhematoma
Collection of blood between the skull and periosteum -resolves in 2-8 weeks -does NOT cross suture line, firm
One hour after a birth the nurse palpates a client's fundus to determine whether involution is taking place. The fundus is firm, in the midline, and 2 fingerbreadths below the umbilicus. Which would the nurse do next?
Continue periodic assessments and record the findings (these are normal findings )
Imminent birth
Contractions closer than 2 mins apart are intense and last from 30-90 secs
Normal newborn stools
Day 1/2: meconium: sticky, thick, black day 3: transitional: looser, greenish, black/brown day 4:yellow, soft, watery day 5-1 month: if baby is breastfed stool will be yellow. If baby is formula fed stool will be yellow or brown with unpleasant odor
Care and management of preterm births
Delay delivery 48-72 hours for steroids to facilitate fetal lung maturity -suppress uterine activity -fetal neuro protection
Molding
Distorted Shaping of the fetal head during movement through the birth canal
Ectopic pregnancy manifestations
Early s/s are the same as a normal pregnancy ( nausea, breast tenderness) -delayed menses -abnormal vaginal bleeding -abdominal pain (6-8 weeks)
The nurse is differentiating between cephalhematoma and caput succedaneum. Which finding is unique to caput succedaneum?
Edema that crosses the suture line ( ceph does not extend beyond suture line)
Plan B pill
Emergency contraception that delays ovulation -OTC -must take within 72 hours after unprotected sex -effectiveness depends on where a woman is in her period cycle
Although the newborn was just cleaned and examined, the mother notes a red rash consisting of small papules on the face, chest, and back of the newborn. Which condition would the nurse recognize?
Erythema toxicum
Bishop's score
Evaluating induction success -score of 8 or more means induction will most likely be successful
Immediately after birth, a newborn is dried before being placed in skin-to skin contact with the mother. Which type of heat loss would this intervention prevent?
Evaporation
Reproductive system of newborns
Female - Vaginal mucous discharge - Vaginal bleeding - Edematous labia Male - Foreskin - Swollen scrotum - Descent of testes Breast tissue swollen - Could be male or female -caused by estrogen from pregnancy
Shoulder dystocia
Fetal head is delivered, but anterior shoulder cannot pass under pubic arch -increased risk with larger babies -specific maneuvers needed to deliver baby -risks: PPH, rectal injuries, birth injuries, brachial plexus Damage and fracture to newborn
Caput succedaneum
Generalized edema of the scalp, crosses suture lines ( resolves in 4 days)
Which prenatal condition would the nurse expect to dins in the history of a client with an abruptio placentae?
Gestational hypertension
Post term pregnancy
Greater than 42 weeks
HELLP syndrome
H- hemolysis EL- elevated liver enzymes LP- low platelets (severe preeclampsia)
Newborn transition of thermoregulatory system
Higher risk for thermoregulatory problems -limited ability to respond to changes in extrauterine temperature -higher body surface area to body mass ratio -higher metabolic rate
Why does gestational diabetes happen?
Hormonal changes occur that desensitizes insulin and lowers glucose tolerance, allowing for glucose to be available for the developing fetus -insulin needs increase, and when there is not an increase in insulin production and continues to have elevated glucose levels, mom develops disease
Which factor in pregnant client's History would the nurse recognize as a risk factor for abruptio placentae?
Hypertension
Which finding is indicative of hypothermia in a newborn
Hypoglycemia
For which complication would the nurse closely monitor a client with a diagnosis of abruptio placentae?
Hypovolemic shock (from massive internal hemorrhage)
Pathophysiology of preeclampsia (placental)
In a normal pregnancy, uterine vasculature results in a spiral artery formation. In preeclampsia, spiral artery formation is incomplete, causing the placenta to have poor perfusion -acute plaque develops in placenta causing hypoperfusion and placental infarcts -IGUR ( impaired fetal growth) -decelerations ( late) -
IVF
In vitro fertilization -woman takes hormones to stimulate ovulation -egg retrieval -sperm preparation -co-incubation -embryo transfer to uterus
Pathophysiology of preeclampsia (maternal systemic)
Inflammatory response -liver: ischemia, URQ pain, elevated enzymes -renal: glomerular damage, decreased blood flow and GFR, proteinuria, oliguria -hematologic system: thrombocytopenia, hemolysis of RBCs, increased platelet adherence and clotting factors -CNS: fibrin deposits, edema, severe headaches, hyperreflexia -Retina: arterial spasms, scotoma, blurry vision, photophobia -Tissue: damaged cap walls, tissue edema, cap leakage ( hand and face swelling)
The nurse is admitting a client to the unit after fetal death was confirmed by ultrasound. While initiating IV therapy, the nurse notes blood continually oozing from the puncture site. Which is the nurse's next action?
Informing the primary health care provider ( oozing from a venipuncture site is a sign that disseminated intravascular coagulopathy DIC is developing)
Postpartum depression
Intense and pervasive sadness with severe and labeled mood swings ( 10-15% of women ) -risk factors: history of mental disorders -poor nutrition ( folate and vitamin b12 are needed for synthesis of neurotransmitters
Neonatal neuroprophylaxis
Intervention of magnesium sulfate for the mother before preterm delivery -CNS depressant, decreases neural excitability, reduces inflammatory response -decreases risk of cerebral palsy in newborn -continuous infusion up to 24 hours before delivery
A client who had tocolytic therapy for preterm labor is being discharged. Which instruction would the nurse include in the teaching plan?
Limit daily activities (bed rest can limit preterm labor)
Epstein pearls/ milia
Little white sebaceous cysts -face: milia -mouth: Epstein pearls
Descent of uterine fundus
Location of the uterine fundus helps determine whether involution is progressing normally -involution should happen rapidly after birth and return to true pelvis within 2 weeks -after first 24 hours, uterus should descend about 1cm every day -fundus should be firm and midline (not boggy) -uterine massage allows removal of any blood and clots present
Which lochia stage involves white/yellowish discharge that is generated during the healing process and the initial reconstruction of the endometrium?
Lochia alba
Which lochia is the first and heaviest stage of lochia?
Lochia rubra ( bright red blood and clots, lasts for about 7 days)
Which stage of lochia involves postpartum bleeding and is thinner in consistency and brownish or pink in color?
Lochia serosa
dysfunctional labor (dystocia)
Long, difficult, or abnormal labor -most common reason for C SECTION -abnormal uterine activity (hypertonic or hypotonic) -secondary powers: problems with bearing down -malposition/ presentation of fetus ( anything not vertex) -multifetal pregnancy
Which is the priority nursing intervention for the postpartum client whose fundus is 3 fingrrbreadths above the umbilicus, boggy, and midline?
Massaging the uterine fundus
Triple I treatment
Maternal: ampicillin and gentamicin if no allergic -control of fever -hydration newborn: antibiotics (possible NICU admission)
Risks of bleeding in pregnancy
Maternal: hypovolemia/ hypovolemic shock, anemia, preterm delivery, impaired oxygenation of the fetus fetal: hypoxia, preterm birth, demise
Pre gestational diabetes management
Medical: insulin, frequent testing, NST, BPP, hourly blood sugar mom: BG control, exercise, nutrition, fetal kick counts
Which type of lochia would the visiting nurse expect to observe on a client's pad on the fourth day after vaginal delivery? a) scant alba B) scant rubra c) moderate rubra d) moderate serosa
Moderate rubra
Post term pregnancy risks
Mom: increase risk for C section, prolonged inductions, forceps or vacuum fetal risk: abnormal fetal growth (macrosomia) -birth trauma, shoulder dystocia -aging placenta (intolerance to labor) -decreased amniotic fluid and Wharton's jelly ( increased cord compression) -post maturity syndrome -meconium aspiration syndrome -increased risk of fetal demise
Newborn change in respiratory system
Most critical physiological change -newborn Thorax is compressed in vaginal delivery -amniotic fluid is forced from the lungs -once delivered, negative pressure in lungs causes passive inspiration of air -entry of air in the alveoli replaces amniotic fluid -O2 decreases, CO2 increases -medulla stimulates respirations -cessation of blood flow from umbilical cord
Indomethacin (Indocin)
NSAID that suppresses uterine activity by inhibiting prostaglandins and relaxing smooth muscle -32 weeks or less -given PO for 2 days -side effects: GI distress, heartburn -careful with patients sensitive to aspirin
Which condition would the nurse document when a newborn infant is noted to have small, flat pink spots on the nape of the neck?
Nevi
Eclampsia
Onset of seizure activity or coma in a woman with preeclampsia (normally occurs while pregnant but can occur postpartum )
Which would the nurse expect to find when assessing the head of a healthy newborn after a C section?
Open anterior and posterior fontanels
Placenta previa s/s
Painless bright red vaginal bleeding during second or third trimester (major complications is hemorrhage and preterm birth/ death)
Newborn immunity
Passive immunity is acquired from maternal immunoglobulins -IgG: crosses over placenta and enters fetal system -IgA: present in breast milk
Which clinical finding would the nurse evaluate before continuing the administration of IV magnesium sulfate?
Patellar reflexes and urinary output ( signs of toxicity are hyporeflexia and urinary output indicates renal function)
Desquamation
Peeling of the skin a few days after delivery. Completely normal, and skin isn't "dry" doesn't need any lotion
McRoberts maneuver
Pelvic tilt to make symphysis more horizontal ( opens birth canal) used for shoulder dystocia, patient will lye flat on back
Why is multiple gestation pregnancy considered a high risk?
Perinatal mortality is 2-3 times more likely in multiple than single births
placenta previa
Placenta implanted in lower uterine segment near or over internal cervical OS -classified into 3 types based on degree of coverage of OS (complete, marginal, low lying)
Lochia
Postpartum uterine bleeding and discharge that contains uterine cells, mucous and blood -assessment: type, amount, odor -rubra: first 3 days, red bloody and mucousy -Serosa: 4-10 days, pink with mucous -Alba: next 1-2 weeks, white in color, thick
Ectopic pregnancy
Pregnancy implanted outside of the uterus ("tubal pregnancy") More than 90% are in the Fallopian tube
Placental abruption
Premature separation of the placenta -part of or all of placenta detaches from the implantation site after 20 weeks -high risk for mom and baby -may need ER C section
Which action would be the highest priority for the nurse to initiate for a client with eclampsia? a) prevent injury b)assess fetal heart tones c)maintain an open airway d)increase infusion rate
Prevent injury
Involution
Return of the uterus to a nonpregnant state after birth -begins immediately after expulsion of the placenta and release of oxytocin -uterine muscle contracts/ decreases in size -provides homeostasis at site of placental attachment -autolysis of uterine blood vessels ( byproducts are excreted in urine) -regeneration of epithelium
Marijuana in pregnancy
Risk for low birth weight -social services need to be notified if THC positive newborn tests
Hyperemesis gravidarum
Severe vomiting in pregnancy from rapid increase in hormone levels -dehydration -electrolyte and acid base balance -starvation ketosis -weight loss -muscle wasting -emotional debilitating -risk for SGA and preterm delivery -mom: encephalopathy/ esophageal rupture
NuvaRing
Small flexible ring you insert inside your vagina. take out after 3 weeks and reinsert a new one one week layer
Newborn Transition of circulatory system
Strongly influenced by the changes in the respiratory system -decrease in pulmonary vascular resistance causes increase in pulmonary blood flow -systemic vascular resistance increases -closure of ductus venosus, foremen ovale, and ductus arteriosus -may hear fetal heart murmur until foramen ovale closes
How would the nurse explain the cause of caput succedaneum in a newborn to the mother?
Swelling of the soft tissue of the scalp as a result of pressure during labor
When palpating a client's fundus on the second postpartum day, the nurse determines that it is above the umbilicus and displaced to the right. Which conclusion is supported by this finding?
The bladder has become distended
gestational diabetes mellitus
The onset of glucose intolerance DURING pregnancy
A client has delivered her infant by C section. The nurse monitors the newborn's respiration closely, because infants born via cesarean method are prone to atelectasis. Why does this occur?
The ribcage is not compressed and released during birth (lung expansion is incomplete)
Respiratory newborn transition in C section babies
The squeeze of the lungs doesn't occur, and increased work by infant is needed t get rid of the extra fluid -risk of transient tachypnea of newborn -baby may need oxygen for a few days
Exams and testing for preterm birth and labor
There's no real screening methods or prevention measures -if cervical length >30mm , patient is unlikely to give birth prematurely -fetal fibronectin test: tests for possibility of preterm labor if there are s/s
Why would you take a baby's blood sugar?
To test for cold stress which causes hypoglycemia
The nurse notes that a healthy newborn is lying in the supine position with the head turned to the side with the legs and arms extended on the same side and flexed on the opposite side. Which reflex is this?
Tonic neck
After her baby's birth a client wishes to begin breast-feeding as soon as possible. How can the nurse best assist the client at this time?
Touching the infant's cheek adjacent to the nipple to elicit the rooting reflex
The patch
Transdermal contraceptive patch, wear on skin of belly, upper arm, butt, or back -put a new patch on every week for 3 weeks then apply a week
The primary health care provider plans to perform a vaginal examination of a client with partial placenta previa. Which would the nurse have available when this examination is performed?
Two units of typed and cross-matched blood ( examination in a client with this can cause severe hemorrhage because of location of the placenta near the OS, blood should be ready for shock prevention)
Which test is used to confirm cephalopelvic disproportion?
Ultrasound
Tocolytic medications
Used to suppress uterine activity for preterm birth -24 hours after steroid dose -not recommended if there are contractions but no cervical change -<34 weeks okay
Why is it important for the nurse to encourage a client with preeclampsia to lie in the left-lateral recumbent position?
Uterine and kidney perfusion are maximized, and compression of the major vessels is relieved
Pregestational Diabetes Mellitus
Women who have type 1 or 2 that existed PRIOR to pregnancy
Apgar scale
a standard measurement system that looks for a variety of indications of good health in newborns ( transition to extrauterine life)
Boggy uterus
a uterus that feels soft and spongy, rather than firm and well contracted.
Precipitous birth
birth that occurs in less than two hours ( increased risk of hemorrhage)
Nifedipine
calcium channel blocker/ smooth muscle relaxer to suppress uterine activity -PO -side effects: hypotension, headache, dizziness
hydatidiform mole (molar pregnancy)
gestational trophoblastic neoplasm usually resulting from fertilization of an egg that has no nucleus or an inactivated nucleus (benign) -diagnosed by transv US -tx: suction curettage
Vasa previa
occurs when the umbilical cord vessels cross the internal os of the cervix -no Wharton's jelly to cushion and protect the cord -risk of fetal hemorrhage if vaginal delivery -c section needed and close monitoring
Cervical os
opening of the cervix
Preeclampsia nursing care
primary goal is to control blood pressure, prevent seizures, and prevent hemorrhage -give magnesium sulfate infusion (prevents seizures) -antihypertensives -fetal monitoring -I&Os -seizure precautions -bed rest -education
Moro reflex
startle reflex
non-shivering thermogenesis
the use of brown fat to increase heat production
0 station
tip of head is right at the level of the ischial spine
dilation and curettage (D&C)
widening the cervix and scraping off the endometrial lining of the uterus after a spontaneous abortion that is incomplete
