Families Exam 1

A nurse is administering magnesium sulfate IV to a client who has severe preeclampsia for seizure prophylaxis. Which of the following indicates magnesium sulfate toxicity? (Select all that apply) A. Respirations < 12/min B. Urinary output <30 mL/hr C. Hyperrefexic deep-tendon reflexes D. Decreased level of consciousness E. Flushing and sweating

A, B, D

A nurse is caring for a client who is at 14 weeks gestation and has hyperemesis gravidarum. The nurse should identify that which of the following are risk factors for the client? Select all that apply A. Obesity B. Multifetal pregnancy C. Maternal age >40 D. Migraine headache E. Oligohydramnios

A, B, D

A nurse is providing care for a client who is in active labor. Her cervix is dilated to 5 cm, and her membranes are intact. Based on the use of EFM, the nurse notes a FHR of 115 to 125/min with an occasional increases up to 150-155/min that last for 25 seconds, and have beat-to-beat variability of 20/min. There is no slowing of FHR from the baseline. The nurse should recognize that this client is exhibiting signs of which of the following? (Select all that apply) A. Moderate variability B. FHR accelerations C. FHR Decelerations D. Normal baseline FHR E. Fetal tachycardia

A, B, D

A nurse is caring for a client who reports indications of preterm labor. Which of the following findings are risk factors of this condition? (Select all that apply) A. UTI B. Multifetal pregnancy C. Olioghydramnios D. DM E. Uterine abnormalities

A, B, D, E

A nurse is called to the birthing room to assist with the assessment of a newborn who was born at 32 weeks of gestation. The newborn's birth weight is 1,100 g. Which of the following are expected findings in this newborn? (Select all that apply) A. Lanugo B. Long nails C. Weak grasp reflex D. Translucent skin E. Plump face

A, C, D

A nurse is caring for a client who has a prescription for magnesium sulfate. The nurse should recognize that which of the following are contraindications for use of this medication? (select all that apply) A. Fetal distress B. Preterm labor C. Vaginal bleeding D. Cervical dilation > 6 cm E. Severe gestational hypertension

A, C, D

A nurse is caring for a client who is at 40 weeks of gestation and experiencing contractions every 3 to 5 min and becoming stronger. A vaginal exam reveals that the client's cervix is 3 cm dilated, 80% effaced, and -1 station. The client asks for pain medication. Which of the following actions should the nurse take? (Select all that apply) A. Encourage use of patterned breathing techniques B. Insert an indwelling catheter C. Administer opioid analgesic medication D. Suggest application of cold E. Provide ice chips

A, C, D

A nurse on the postpartum unit is performing a physical assessment of a client who is being admitted with a suspected DVT. Which of the following clinical findings should the nurse expect? (Select all that apply) A. Calf tenderness to palpation B. Mottling of the affected extremity C. Elevated temperature D. Area of warmth E. Report of nausea

A, C, D

A nurse is teaching a newly licensed nurse about neonatal abstinence syndrome. Which of the following statements by the newly licensed nurse indicate understanding of the teaching? A. The newborn will have decreased muscle tone B. The newborn will have a continuous high-pitched cry C. The newborn will sleep for 2 to 3 hours after a feeding D. The newborn will have mild tremors when disturbed

B

A nurse is caring for a client who is diagnosed with a marginal abruptio placentae. The nurse is aware that which of the following findings are risk factors for developing the condition? A. Fetal position B. Blunt abdominal trauma C. Cocaine use D. Maternal age E. Cigarette smoking

B, C, D

A nurse is reviewing findings of a client's biophysical profile (BPP). The nurse should expect which of the following variables to be included in this test (Select all that apply)? A. Fetal weight B. Fetal breathing movement C. Fetal tone D. Fetal Position E. Amniotic fluid volume

B, D, E

A nurse is teaching a client about the benefits of internal fetal heart monitoring. Which of the following statements should the nurse include in the teaching? (Select all that apply) A. It is considered a noninvasive procedure B. It can detect abnormal fetal heart tones early C. It can determine the amount of amniotic fluid you have D. It allows for accurate readings with maternal movement E. It can measure uterine contraction intensity

B, D, E

A nurse at an antepartum clinic is caring for a client who is at 4 months of gestation. The client reports continued N/V and scant, prune-colored discharge. She has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse suspect? A. Hyperemesis gravidarum B. Threatened abortion C. Hydatidiform mole D. Preterm labor

C

A nurse is caring for a client following the administration of an epidural block and is preparing to administer an IV fluid bolus. The client's partner asks about the purpose of the IV fluids. Which of the following is an appropriate response for the nurse to make? A. It is needed to promote increased urine output B. It is needed to counteract respiratory depression C. It is needed to counteract hypotension D. It is needed to prevent oligohydramnios

C

A nurse is caring for a client who is at 42 weeks of gestation and in active labor. Which of the following findings in the fetus is at risk for developing? A. Intrauterine growth restriction B. Hyperglycemia C. Meconium aspiration D. Polyhydramnios

C

A nurse is caring for an infant who has a high bilirubin level and is receiving phototherapy. Which of the following is the priority finding in the newborn. A. Conjunctivitis B. Bronze skin discoloration C. Sunken fontanels D. Maculopapular skin rash

C

A nurse is reviewing a new prescription for ferrous sulfate with a client who is at 12 weeks gestation. Which of the following statements by the client indicates understanding of the teaching? A. "I will take this pill with my breakfast" B. "I will take this medication with a glass of milk" C. "I plan to drink more orange juice while taking this pill" D. "I plan to add more calcium-rich foods to my diet while taking this medication"

C

A nurse is teaching a client who is pregnant about the amniocentesis procedure. Which of the following statements should the nurse include in the teaching? A. "You will lay on your right side during the procedure" B. "You should not eat anything for 24 hours prior to the procedure" C. "You should empty your bladder prior to the procedure" D. "The test is doen to determine gestational age"

C

A nurse is caring for a client who is receiving IV magnesium sulfate. Which of the following medications should the nurse anticipate administering if magnesium sulfate toxicity is suspected? A. Nifedipine B. Pyridoxine C. Ferrous sulfate D. Calcium gluconate

D

A nurse is caring for a client who is using patterned breathing during labor. The client reports numbness and tingling of the fingers. Which of the following actions should the nurse take? A. Administer oxygen via nasal cannula at 2 L/min B. Apply a warm blanket C. Assist the client to a side-lying position D. Place a oxygen mask over the client's nose and mouth

D

A nurse is reviewing discharge teaching with a client who has premature rupture of membranes at 26 wks gestation. Which of the following instructions should the nurse include in the teaching? A. Use a condom with sexual intercourse B. Avoid bubble bath solution when taking a tub C. Wipe from back to front when performing perineal hygiene D. Keep a daily record of kick counts

D

A nurse is reviewing the electronic monitor tracing of a client who is in active labor. The nurse should know that a fetus receives more oxygen when which of the following appears on the tracing? A. Peak of the uterine contraction B. Moderate variability C. FHR acceleration D. Relaxation between uterine contractions

D

A nurse on the postpartum unit is planning care for a client who has thrombophlebitis. Which of the following nursing interventions should the nurse include in the plan of care? A. Apply cold compresses to the affected extremity B. Massage the affected extremity C. Allow the client to ambulate D. Measure leg circumferences

D

Decrease

Do maternal insulin needs increase or decrease during labor?

Increase

Do maternal insulin needs increase or decrease during pregnancy?

Decrease

Do maternal insulin requirements decrease or increase after birth?

Newborn Jaundice

Elevated bilirubin due to breakdown of erythrocytes

Expected findings GTD

Excessive vomiting, rapid uterine growth more than expected for the duration of the pregnancy due to the overproliferation of trophoblastic cells, dark brown bleeding or bright red bleeding

Risk factors of PPH

Grand multiparity, history, over distention of the uterus, oxytocin use, chorioamnionitis, prolonged labor, precipitous birth, C/S, prolonged 3rd stage, general anesthesia, preeclampsia, magnesium sulfate use

Risk factors abruptio placentae

HTN, abdominal trauma, ATOD, Cigarette, multifetal pregnancy, PROM, >35 yo and <20 yo, Short umbilical cord, coagulation disorders, infection (Chorioamnionitis), Elevated second trimester maternal serum alpha protein

Hemolytic disease of the newborn (HDoN)

Hemolysis of RBCs in the newborn; a complication of Rh incompatibility

HELLP Syndrome

Hemolysis, Elevated Liver Enzymes, Low Platelets - complication of preeclampsia and eclampsia - only cure is birth

1000 mL

How many mL of blood is considered a PPH in a C/S delivery?

1000 mL

How many mL of blood is considered a PPH in a vagnial birth?

Nursing care Abruptio placentae

IV access, Frequent VS, Continuous EFM, Monitor & measure bleeding, monitor and prepare for coagulation defects (DIC), blood transfusions PRN, preparation for C/S, type and crossmatch. Watch/Wait approach

Preeclampsia w/ severe features

Includes one of the following: - BP 160/110 - Abnormal liver function - Epigastric pain - New onset of headaches or visual changes - Pulmonary edema - Thrombocytopenia (less than 100,000)

Manifestations of Uterine atony

Increased vaginal bleeding, boggy uterus, larger than expected uterus, prolonged lochial discharge, tachycardia, hypotension, skin that is pale, cool, and clammy w/ loss of turgor and pale mucous membranes

Nifedipine

a calcium channel blocker that is used to suppress contractions by inhibiting calcium from entering smooth muscles

Hematoma

a collection of clotted blood within tissues that can appear as a bulging bluish mass

Magnesium sulfate

a commonly used tocolytic that relaxes the smooth muscle of the uterus and thus inhibits uterine activity by suppressing contractions

1st degree laceration

extends through skin and structure superficial to muscle

Occiput posterior

face up; presents a larger diameter of the fetal head

Cephalopelvic Disproportion (CPD)

fetal head is too large to fit through the pelvis due to small pelvis, large fetus or abnormal fetal position

Amnio-infusion

fluid added via IUPC to provide cushion around umbilical cord

Oral glucose tolerance test

following overnight fasting, 100 g glucose load is given and serum glucose levels are determined at 1, 2, and 3 hr

PTL Non-modifiable risk factors

history of PTL, multiple gestation, uterine or cervical injury/anomalies, age, race, poor nutrition, economic status

Risk factors of cervical insufficency

history of cervical insufficency

Neonatal sepsis

infectious organism in the blood

Methotrexate

inhibits cell division and embryo enlargement, dissolving the pregnancy

Elective abortion (EAB)

intentional interruption of a pre-viable pregnancy for personal reasons

chorioamnionitis

intra-amniotic infection resulting from bacterial invasion before birth

HDoN complications

intrauterine fetal demise (IUFD), cardiac abnormalities, hydrops fetalis, newborn jaundice

Preterm labor

labor that begins >20 weeks and <37 weeks completed gestation

Newborn hypoglycemia

less than 30 mg/dL for the first 24 hours

Disseminated intravascular coagulation (DIC)

life-threatening complication of missed abortion, placental abruption, uterine rupture, and preeclampsia, in which pro-coagulation and anticoagulation factors are simultaneously activated; the pt is at risk for both internal and external bleeding

Indirect coombs test

looks for antibodies to RBC proteins (aka Anti D antibodies)

Adverse effects of Magnesium sulfate

loss of deep tendon reflexes, urinary output less than 30 mL/hr, respiratory depression, pulmonary edema, and chest pain

Polyhydramnios s/s

maternal pain, lower extremity edema, SOB

Late onset neonatal sepsis

not always acquired from mother and onset is after 4 days

Postpartum Hemorrhage (PPH)

obstetrical emergency following normal spontaneous vaginal delivery (NSVD) or C/S leading to hypovolemic shock, renal failure, acute respiratory distress and coagulopathy

Pulmonary embolism

occurs when a clot or amniotic fluid moves into circulation and moves into the pulmonary artery or one of its branches and lodges in a lung, occluding the vessel and obstructing blood flow to the lungs

Turtle sign

occurs when the head is born but then retracts against perineum; present at every case of shoulder dystocia

PPROM (prolonged)

occurs when the membranes rupture <37 weeks gestation

PROM

occurs when the membranes rupture >18 hours prior to birth

Placenta previa

occurs when the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus; results in bleeding during the third trimester of pregnancy as the cervix begins to dilate and efface

Cervical insufficiency

painless premature cervical dilation that occurs early 2nd trimester (21-24 weeks)

Abruptio placentae

premature separation of the placenta from the uterus, which can be a partial or complete detachment. Occurs after 20 weeks gestation and in the third trimester

Third trimester Nursing care DM

prenatal visits 1-2 times per week, fetal surveillance (fetal movement count, NST, CST), ultrasound, amniocentesis (fetal lung maturity prn), consider indications for induction of labor, continue home BGL, educate (s/s of PTL, preeclampsia and induction of labor)

Risk factors for GTD

prior molar pregnancy, clients in early teens or older than age 40

Induction

process of stimulating UC before the onset of spontaneous labor for the purpose of accomplishing brith

Augmentation

process of stimulating uterine contraction during labor for the purpose of accomplishing birth

fetal firbronectin

protein in the amniotic fluid that appears between 24 and 34 weeks of gestation; protein can be found in vaginal secretions when the fetal membrane integrity is lost

Progesterone

recommended treatment for women for prevention of PTL if 1) PPROM OR 2) Previous pregnancy resulted in PTL OR 3) Pregnant w/ a short cervix (<15 mm) Give 17p IM weekly from 16-20 weeks to 37 weeks Found to decrease PTL by 33%!

Tocolytic medications

reduce or stop uterine contractions; may prolong pregnancy for 48 hours while mom receives betamethasone

Uterine atony

results form the inability of the uterine muscle to contract adequately after birth; leads to PPH

Risk factors of Uterine atony

retained placental fragments, prolonged labor, oxytocin induction or augmentation of labor, overdistention of the uterine muscle, precipitous labor, mangesium sulfate, trauma during labor and birth from operative delivery

AROM

rupture of membranes that can be done at any time after the latent phase of the 1st stage of labor of 4cm of dilation and above

SROM

rupture of membranes that can occur at any time during pregnancy, labor or birth

Uterine rupture

separation of the uterine muscle; high rate of perinatal morbidity and mortality

Shoulder dystocia

shoulder of the fetus becomes lodged under symphysis following the birth of the head

Clonus

solicited by dorsiflexing the ankles - caused by increased motor nueron excitability - may be classified as absent, 1 beat, 2 beat, 3 beats, 4 beats or sustained - associated w/ increased risk of stroke

Risks of DM in pregnancy

spontaneous abortion, fetal anomalies, preeclampsia, intrauterine fetal demise, macrosomia, neonatal hypoglycemia, neonatal hyperbilirubinemia

Etiology of late PPH

subinvolution from retained placental fragments, infection or failure of placental site to heal

DVT S/S

swelling, redness, tenderness, warmth, unilateral pain: leg, inguinal area, lower abdomen; cool, pale, extremities, pedal edema, decreased pedal pulses, + human's sign

Abortion

termination of a pregnancy of expulsion of a pre-viable pregnancy for medical reasons

Compete placenta previa

the cervical os is completely covered by the placental attachment

Incomplete placenta previa

the cervical os is only partially covered by the placental attachment

Marginal placenta previal

the placenta is attached in the lower uterine segment but does not reach the cervical os

Gestational trophoblastic disease (GTD)

the proliferation and degeneration of trophoblastic villi in the placenta that becomes swollen, fluid-filled, and take on the appearance of grape-like clusters. The embryo fails to develop beyond a primitive state and these structures are associated with choriocarcinoma.

Hypotonic UCs

too little contractions; occurs in the active labor stage of labor (after 6 cm)

Hypertonic UCs

too many and not effective contractions occurs before the active phase of labor

DIC manifestations

unusual spontaneous bleeding from the guns and nose, oozing, trickling, or flow of blood from incision, lacerations, or episiotomy, petechiae and ecchymoses, excessive bleeding from venipuncture, injection sites, or slight traumas, hematuria, tachycardia, oliguria, HTN

Subinvolution

uterus remains enlarged w/ continued lochial discharge can result in PPH

Hydralazine (IV or oral)

vasodilator increases cardiac output and blood flow to the placental

Spontaneous abortion

when a pregnancy is terminated before 20 wks gestation of a fetal weight less than 500 g

Oxytocin Adverse Effects

-uterine hypertonus -hyperstimulation - water intoxication: headache, blurred vision, increased BP and RR, coughing, wheezing, and rales

Treatments of Maternal hypotension

1) Anticipate 2) IV bolus= 500 mL 3) Reposistion= left side-lying 4) O2 maks 8-10 L 5) Vasopressor as ordered 6) Stop oxytocin 7) Notify provider 8) Keep pt informed

Nursing interventions: Lacerations

1) Contact CNM or MD 2) IV access/fluids 3) Anticipate need for repair

When to see a provider: PTL

1) Contractions increase in intensity 2) Contractions are >5 in 1 hr 3) Loss of fluid 4) decreased fetal movement 5) Fever

Nursing care Interventions

1) Notify CNM or MD 2) Local moist heat 3) Elevate the affected extremtiy 4) Elastic support hose 5) Bed rest 6) Pain managment 7) Anticoagulation medication

Nursing care pulmonary embolism

1) Place the client in a semi-fowler's position 2) Administer O2 by mask

Prolapsed cord nursing care

1) call for help 2) remain calm 3) Trendelenberg positioning 3) Push the presenting park off the cord and cervix 4) Do not touch/manipulate the cord 5) Oxygen mask 8-10 L 6) Terbutaline subq 7) C/S

What to do if you experience PTL

1) empty bladder 2) lie down 1 hour (left side) 3) Hydrate 4) Place hand on the abdomen to palpate uterus 5) Note fetal movement Symptoms should stop!

Management goals of cervical insufficency

1) prevent PTL 2) cerclage to reinforce cervix 3) bed rest

Nursing care Uterine hyperstimulation

1) turn off oxytocin IV infusion/clamp tubing 2) EFM to determine fetal response 3) side-lying position 4) Increased rate of IV fluid 5) O2 mask of 8-10 L 6) Notify provider

Nursing interventions PPH

1) vigorous fundal massage of uterus to firm FIRST (then q 15 x1 hr, q 30 x 1 hr, q 4hr x2) 2) look for free flowing bright red lochia 3) Call for help 4) contact CNM or MD STAT 5) IV access/fluids 6) VS 7) O2 8-10 L 8) Verify standing order of oxytocin and or methergine or prostaglandin 9) verify pt is not hypertensive 10) continue fundal massage; document fundal height and tone 11) empty bladder 12) weight clots and pads

Early PPH

1st 24 hours after birth; causes include uterine atony, lacerations, and hematoma

When do women receive rhogam?

28 weeks & 72 hours after delivery

Recurrent abortion

3 consecutive losses

Post term

42 0/7 wks

glucose challenge test

50 g oral glucose load, followed by plasma glucose analysis 1 hr later performed at 24-28 wks of gestation; fasting not necessary (+ test if glucose is > 130-140 mg/dL)

Early preterm

<32 weeks

Fetal macrosomia

> 4000 g or >4500 g at term

Post-term pregnancy

>42 wks gestation

A nurse is caring for a client who has disseminated intravascular coagulation (DIC). Which of the following antepartum complications should the nurse understand is a risk factor for this complication? A. Preeclampsia B. Thrombophlebitis C. Placenta previa D. Hyperemesis gravidarum

A

A nurse is caring for a client who is in active labor and reports severe back pain. During assessment, the fetus is noted to be in the occiput posterior position. Which of the following maternal positions should the nurse suggest to the client to facilitate normal labor progress? A. Hands and knees B. Lithotomy C. Trendelenburg D. Supine with a rolled towel under one hip

A

A nurse is caring for a client who is in labor and observes late decelerations on the electronic fetal monitor. Which of the following is the first action the nurse should take? A. Assist the client into the left-lateral position B. Apply a fetal scalp electrode C. Insert an IV catheter D. Perform a vaginal exam

A

A nurse is caring for a client who is in the 2nd stage of labor. The client's labor has been progressing, and she is expected to deliver vaginally in 20 min. The provider is preparing to administer lidocaine for pain relief and perform an episiotomy. The nurse should know that which of the following types of regional anesthetic block is to be administered? A. Pudendal B. Epidural C. Spinal D. Paracervical

A

A nurse is caring for a client who is postpartum. The nurse should identify which of the following findings as an early indicator of hypovolemia caused by hemorrhage? A. Increasing pulse and decreasing BP B. Dizziness and increasing RR C. Cool, clammy skin, and pale mucous membranes D. Altered mental status and LOC

A

A nurse is caring for a newborn who is preterm and has respiratory distress syndrome. Which of the following should the nurse monitor to evaluate the newborn's condition following administration of synthetic surfactant? A. Oxygen saturation B. Body temperature C. Serum bilirubin D. Heart rate

A

A nurse is providing care for a client who is at 32 weeks of gestation and who has placenta previa. The nurse notes that the client is actively bleeding. Which of the following types of medications should the nurse anticipate the provider will prescribe? A. Betamethasone B. Indomethacin C. Nifedipine D. Methylergonovine

A

A nurse is caring for a client who is pregnant and is to undergo a contraction stress test (CST). Which of the following findings are indications for this procedure? (Select all that apply) A. Decreased fetal movement B. Intrauterine growth restriction (IUGR) C. Postmaturity D. Placenta previa E. Amniotic fluid emboli

A, B, C

Methylergonovine (Methergine or "Ergotrate")

Action: contracts vascular smooth muscle Dose: 0.2 IM every 2-4 hours x5 Route: IM, PO Contraindications: HTN or cardiac disease

Complete abortion

All POC are expelled

What condition do these s/s suggest? -Pregnancy s/s are present -Light bleeding -ONE-SIDED abdominal pain -Low levels of hCG -Would require surgery -Could be treated with medication -FHR heard or not heard

An ectopic pregnancy

Nursing care assessment of ROM

Ask: 1) when, amount, color, odor 2) bleeding 3) contractions/pain/pressure 4) Presence of fetal movement 5) Gestational age

Nursing care PPROM (Fetal)

Assess FHR; color, amount, odor of amniotic fluid; fetal position and presentation; gestational age; anticipate for a possible prolapsed cord

Nursing care: Intervention PTL

Assess for contractions, cervical E&D, prepare for possible birth, coordinate appropriate personnel to be at beside for newborn resuscitation/care

Prenantal Nursing care GDM

Assess risks for GDM, Glucose challenge test for women of high risk, exercise, home glucose monitoring, insulin or metformin, educate

Educate: SVT

Avoid prolonged sitting/standing; avoid crossing legs; regular exercise; increased fluids; stop smoking

Educate: DVT

Avoid prolonged sitting/standing; avoid crossing legs; regular exercise; increased fluids; stop smoking; don't rub affected area; decrease alcohol; bedrest; avoid pregnancy

A nurse in the ED is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states she missed one menstrual cycle and cannot by pregnant because she has an IUD. The nurse should suspect which of the following? A. Missed abortion B. Ectopic pregnancy C. Severe Preeclampsia D. Hydatidiform mole

B

A nurse is caring for a client who has suspected hyperemesis gravidarum and is reviewing the client's laboratory reports. Which of the following findings is a manifestation of this condition? A. Hgb 12.2 B. Urine ketones present C. Alanine amniotransferase 20 IU/L D. Serum glucose 114 mg/dL

B

A nurse is caring for a client who is in active labor. The client reports lower-back pain. The nurse suspects that this pain is related to a persistent occiput posterior fetal position. Which of the following nonpharmacological nursing interventions should the nurse recommend to the client> A. Abdominal effleurage B. Sacral counter pressure C. Showering if not contraindicated D. Back rub and message

B

A nurse is caring for a client who is in labor and experiencing incomplete uterine relaxation between hypertonic contractions. The nurse should identify that this contraction pattern increases the risk for which of the following complications? A. Prolonged labor B. Reduced fetal oxygen supply C. Delayed cervical dilation D. Increased maternal stress

B

Causes of neonatal sepsis

- Group B strep - E coli - Coagulase-negative staph - Haemophilius influenzae - Listeria monocytogenes

S/S of Late PPH

- Heavy bleeding and lochia rubra > 2 wks - Lochia has foul odor -Fever

Pain in the 2nd stage

- Hypoxia of the uterine muscle cells during contraction - distention fo the vagina and perineum - pressure on adjacent structures (lower back, buttocks, and thighs) - Physiology (vagina, vulva, perineum)

Respiratory Distress Syndrome causes

- Immature lungs - Amniotic fluid aspiration - Pneumothroax - Meconium Aspiration - Drug use - Occasionally cardiac related - C/S

Nursing care of Hypotonic UC

- Interventions r/t amniotomy and augmentation - position changes - ambulation if not contraindicated - emotional support

S/S of chorioamnionitis

- Maternal temp >100.4 - WBC > 15,000 - Maternal HR > 100 - FHR >160 - Tender uterus - Foul smelling amniotic fluid

Contraindications of Magnesium sulfate

- Myocardial damage - Impaired renal function

Fetal complications of HTN

- Oliogohydramnios - IUGR - Uteroplacental insufficiency - Prematurity - IUFD

Causes of preterm birth

- PPROM - Infection - "Incompetent cervix" - Uterine structural abnormalities - High-risk pregnancy - Abruption - IUGR - Fetal indications

Incomplete Abortion

- Part of the POC is retained - Fetus passes - Placenta remains partially attached - Bleeding continues

Nursing care hypertonic contractions

- Position= left side-lying - promote rest, comfort, relaxation and pain relief - emotional support

Risk factors of cervical laceration

- Precipitous delivery - Vacuum extraction/forceps -Macrosomia

Side effects of Magnesium sulfate

- RSD - Fetal intolerance - Generalized weakness - flushing/sweating - lack of energy

Nursing care of OP

- Sacral pressure - Positions= side-lying, hands and knees, lunge, squatting (for 2nd stage of labor)

Phenergan and Vistaril

- Sedative - Decrease N/V - Decreases anxiety and apprhension - Induces sleep - Potentiate opiod alagesic effects - Opioid dose can be reduced

Puerperal infection

- Temp of 100.4F or above taken by mouth 4 times/day - Occurring on any 2 of the first 10 postpartum days - Exclusive of the first 24 hours

S/S of Newborn hypoglycemia

- Temperature instability - Jitteriness - Low tone - Poor feeding - Apnea - Central cyanosis

Nursing Interventions Neonatal sepsis

- Treat mothers with known + GBS status - Identify s/s of chorioamnionitis - identify neonates w/ risk factors - administer neonatal antibiotics

Advantages of regional analgesia

- awake and can participate in birth experience - retain airway reflex

Threatend abortion

- bleeding, cramping and/or backache -cervix close - placenta is attached except for small area where uterine bleeding occurs - Can develop into normal pregnancies when the bleeding site heals

Cervical laceration S/S

- bright red bleeding - Fundus firm, midline - No lacerations apparent in perineum

Pain in the 3rd Stage

- cervical dilation as the placenta is expelled - uterine contractions - perineal pain

Morphine and Fentynl

- decreases pain - Give too early--> slows labor - Given too late--> no relief and neonatal respiratory depression

Pain in the 1st stage

- dilation of cervix (primary source) - Hypoxia of the uterine muscle cells during contraction - stretching of the lower uterine segment - pressure on adjacent structures (lower back, buttocks, and thighs) - physiology (cervix and uterus)

Intrathecal

- fentanyl, morphine and "caine" drug injected into the subarachnoid space - pain relief for 2-6 hr - usually give in active labor - Minimal pain relief for pushing--> effective b/c sensation can be felt

Nursing interventions for newborn hypoglycemia

- initiate breastfeeding - Check BG within 1 hr of birth - Help w/ breastfeeding, provide donor breast milk, or obtain consent for formula - Recheck BG within half hour

Spinal

- local anesthetic injected into the subarachnoid space at L3 and 4 -Anesthesia for c/s - Immediate effect - Hypotension profound

Limitations of regional analgesia

- maternal hypotension - FHR changes associated w/ impaired placental perfusion - Delayed RSD - N/V - Pruritius - Urinary retention

Nursing care chorioamnionitis

- monitor VS and FHR - administer antibiotics in labor - educate to reduce anxiety - monitor endometritis, UTI, sepsis - educate s/s of infection at discharge

Fetal complications associated w/ Post-term pregnancy

- oligohydramnios= cord compression - shoulder dystocia - meconium stained fluid - Postmaturity syndrome - Morbidity and mortality slightly increase

S/S of RDS

- poor tone - central cyanosis - weak cry - grunting - retractions - RR <40 or >60 - HR < 100

FTD nursing care

- position= squatting, side-lying - promote rest - emotional support

RDS risk factors

- prematurity - Substance use/abuse during pregnancy - IUGR - Cat III tracing - C/S - Structural abnormalities - Precipitous delivery

Maternal complications of HTN in pregnancy

- seizures - stroke - DIC - Hepatic failure - Acute renal injury - Pulmonary edema - Placental abruption

Nursing interventions RDS

- stimulate for first 30 sec of life - assess infant for tone, color, flexion, and cry - bring infant to warmer and initiate resuscitation measures including PPV, chest compressions, suction, or CPAP - Draw cord gases is needed

S/S of Neonatal sepsis

- temperature instability - RDS - Pathological jaundice - Poor feeding - Lethargy - Bradycardia - Seizures - Diarrhea

Sources of pain in childbirth

- tissue ischemia - cerivcal dilation - pressure and pulling on pelvic structures - distention of the vagina and perineum

Hypertonic UCs s/s

- uncoordinated, irregular contractions - short and poor intensity contractions - Cramp-like contractions - higher than normal uterine resting tone

Pain in the 4th stage

- uterine contractions - After pains - perineal pain - incisional pain

Nursing interventions Hematoma

-Assess vulva, perineum, rectal area - Notify CNM or MD - Ice packs - Narcotic analgesia - Antibiotics to prevent infection or abscess - Educate (good hand washing & perineal hygiene)

Signs of CPD at >40 wks

-Ballotable= fetus rebounds when pushed by examining finger through the vagina - Floating= fetus floating free in amniotic fluid indicating fetus has not entered the birth canal

Fetal indications for induction

-IUGR/macrosomia - Non-reassuring FHR

Maternal indications for Induction

-Post-term pregnancy >42 wks - Placental abruption -Uterine infection -Severe preeclampsia -DM or GDM - Rh disease

Post-term pregnancy surveillance

-b/t 41-42 wks - daily fetal movement count - cervical check= dilation, effacement and station - NST -BPP - Measure doppler blood flow in umbilical cord

Ambien

-induces sleep

Narcan

-opiod antagonist - reverses RSD, sedation, and hypotension - Contraindicated in women with narcotic drug abuse treatment

A nurse is caring for a client who is 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) ration C. Kleihauer-Betke test D. Indirect Coombs' test

B

Hematoma risk factors

-prolonged/precipitous labor -prolonged 2nd stage of labor -pudendal anesthesia -episiotomy -Large baby - vacuum extraction/forceps - Large baby

Maternal complications associated with induction

- "cascade effect of interventions" - Water intoxication - Uterine hyperstimulation -Uterine rupture - precipitous labor - c/s - PPH

Risk factors for preeclampsia

- 1st pregnancy - Younger than 18 or older than 35 - Women who are black - Obesity - Close pregnancy spacing - Chronic HTN - Type 1 or II DM - Use of SSRI during 2nd and 3rd trimester - Multiple gestation - GTD

Puerperal infection interventions

- Administer antibiotics -Pain management - Warm compress - Sitz bath - Tucks and sprays

Side effects narcotics

- All cross placenta - Maternal side effects: N/V, sedation, tachycardia, hypotension - fetal side effects: decreased variability - Newborn side effects: RSD at birth

Hypotonic UC Therapeutic managment

- Amniotomy - O2 augmentation - C/S for failure to progress

Inevitable abortion

- Bleeding and cramping increases - Cervix open - Placenta has seperated

Nursing care of shoulder dystocia

- Call for help - Resuscitation team present at birth - McRoberts Maneuver (thighs to abdomen) - Directional suprapubic pressure as directed by CNM/MD

Epidural

- Continuous infusion via catheter of anesthetic and opiate injected into the epidural space b/t L4 and L5 - Usually given in active labor - Allowed to wear off for pushing--> pushing effective bc sensation can be felt - Hypotension profound

Hypotonic UCs S/s

- Coordinated but weak contractions that become less frequent and short in duration - Easily indented fundus in peak - Minimal maternal discomfort

Causes of Newborn hypoglycemia

- Deficient glycogen stores - Hyperinsulinism - Congenital metabolic deficiencies

Risk factors for newborn hypoglycemia

- Diabetic mother - Preterm - Birth trauma - LGA - SGA - Terbutaline - Bethamethasone

Risk factors for newborn jaundice

- Early/late preterm gestational age - Birth trauma - Poor feeding - Rh incompatibility - ABO incompatibility - Exclusive breastfeeding

Missed abortion

- Fetus dies - POC not expelled - Blighted ovum and embryo/fetal mortality - No s/s of bleeding or cramping - s/s of pregnancy disappear - Uterus stops growing or decreases in size r/t absorption of POC

Risk factors for Neonatal sepsis

- GBS staus - Chorioamnionitis

A nurse educator on the postpartum unit is reviewing risk factors for postpartum hemorrhage with a group of nurses. Which of the following factors should the nurse include in the teaching? (Select all that apply) A. Precipitous delivery B. Obesity C. Inversion of the uterus D. Oligohydramnios E. Retained placental fragments

A, C, E

A nurse is caring for a client who is receiving nifedipine for prevention of preterm labor. The nurse should monitor the client for which of the following manifestations? A. Blood-tinged sputum B. Dizziness C. Pallor D. Somnolence

B

A nurse is performing Leopold maneuvers on a client who is in labor. Which of the following techniques should the nurse use to identify the fetal lie? A. Apply palms of both hands to sides of uterus B. Palpate the fundus of the uterus C. Grasp lower uterine segment between thumb and fingers D. Stand facing the client's feet with fingertips outlining cephalic prominence

B

Preconception Nursing care DM

Achieve glucose control before conception; educate about early and regular prenatal care

Misoprostol (Cytotec)

Action: contraction of uterus Dose: 400-800 mcg Route: Buccal, PR Onset of action: 15-20 min

Oxytocin

Action: contracts the uterus Dose: 10-20 units IM or 10-40 units/L (IV) LR or NS Route: IM, IV, dilution, IU

Chronic HTN

BP equal to or higher than 140/90 in pregnancy before 20 weeks gestation

Gestational HTN

BP of 140/90 at 20 weeks gestation w/ no associated proteinuria

Preeclampsia

BP of 140/90 on two occasions at least 4 hrs apart OR 160/110 once. Must also have a protein/creatinine ratio of .3 or higher or 24 hour urine protein of 300 mg+

Manifestations of Spontaneous abortion

Backache, abdominal tenderness, ROM, fever, s/s of hemorrhage, painless vaginal bleeding, uterine cramping, partial or complete expulsion of POC

Why do you need more insulin during pregnancy?

Because your body becomes resistant due to placental hormones, insulinase, and cortisol

What condition do these s/s suggest? -Pregnancy s/s are diminished or gone -No bleeding -Low levels of hCG -Would require evacuation of the uterus -Could be treated with medication -FHR not heard

Blighted Ovum

Manifestations of abruptio placentae

Bright red vaginal bleeding, continuous abdominal/ low back and uterine pain, rigid uterus, frequent uterine contractions w/ no resting time b/t contractions, hemorrhage/shock/DIC, non-reassuring FHR

A nurse is caring for a client who is pregnant and undergoing a non-stress test (NST). The client asks why the nurse is using a acoustic vibration device. Which of the following responses should the nurse make? A. "It is used to stimulate uterine contractions" B. "It will decrease the incidence of uterine contractions" C. "It lulls the fetus to sleep" D. "It awakens a sleeping fetus"

D

Risk factors for placenta previa

C/S, uterine scarring, maternal age > 35, multifetal gestation or closely spaced pregnancies, smoking, male fetus, ATOD, African or Asian American previous placenta previa

Etiology of cervical insufficency

Cervical trauma (STIs, sexual assault at a young age

A nurse in L&D is providing care for a client who is in preterm labor at 32 wks gestation. Which of the following medications should the nurse anticipate the provider will prescribe to hasten fetal lung maturity? A. Calcium gluconate B. Indomethacin C. Nifedipine D. Betamethasone

D

A nurse is caring for a client in labor. When last examined 2 hr ago, the client's cervix was 3 cm dilated , 100% effaced, membranes intact, and the fetus was at -2 station. The client suddenly states "My water broke." The monitor reveals a FHR of 80 to 85/min, and the nurse performs a vaginal examination, noticing clear fluid and a pulsing loop of umbilical cord in the client's vagina. Which of the following actions should the nurse perform first? A. Place the client in the Trendelenburg position B. Apply pressure to the presenting part with her fingers. C. Administer Oxygen at 10 L/min via a face mask D. Call for assistance

D

A nurse is caring for a client who has a diagnosis of ruptured ectopic pregnancy. Which of the following findings is seen with this condition? A. No alteration in menses B. Transvaginal ultrasound indicating a fetus in the uterus C. Serum progesterone greater than expected reference range D. Report of severe shoulder pain

D

A nurse is caring for a client who is admitted to the labor and delivery unit. With the use of Leopold maneuvers, it is noted that the fetus is in a breech presentation. For which of the following possible complications should the nurse observe? A. Precipitous labor B. Premature rupture of membranes C. Postmaturity syndrome D. Prolapsed umbilical cord

D

A nurse is caring for a client who is at 42 weeks gestation and in labor. The client asks the nurse what she should expect bc her baby is postmature. Which of the following statements should the nurse make? A. "Your baby will have excess body fat" B. "Your baby will have flat areola without breast buds" C. "Your baby's hells will easily move to his ears" D. "Your baby's skin will have a leathery appearance"

D

Birth

What is the treatment for preeclampsia?

Hematoma etiology

Injury of blood vessel during birth

Insulin needs _________ until term, then they ________ after they are born drop? rise?

Insulin needs RISE until term, then they DROP after they are born

Precipitous labor

Labor that is lasts < 3 hrs Maternal risks: vaginal/ perineal lacerations or hematoma and PPH Fetal risk: non-reassuring FHR, hypoxia, cerebra trauma and/or pneumothorax due to rapid descent

Oligohydramnios

Lower than normal amount of amniotic fluid; <500 mL - Associated with: postmaturity, pulmonary hypoplasia, preterm birth - Risks: meconium stained fluid, cord compression, fetal hypoxia, and death

Why doesn't Rh incompatibility affect the first Rh + baby born to an Rh - mom?

Maternal antibodies formed to "attack" Rh antigen in first pregnancy cannot cross the placenta at that time; primary immune response

Treatment of Late PPH

Methergine, antibiotics, D&C to remove fragments

Excess amniotic fluid, preterm labor, preeclampsia, LGA, and shoulder dystocia are all common for what type of mom?

Moms with DM or GDM

Indomethacin

NSAID that suppresses preterm labor by blocking the production of prostaglandins which suppresses uterine contractions

Nursing Care Placenta previa

No vaginal exams, assess for amount of bleeding

Risk factors of GDM

Obesity, hypertension, glycosuria, maternal age >25, family history of DM, previous delivery of an infant that was large or stillborn

Physiologic newborn jaundice

Occurs after 24 hours; Breakdown of fetal erythrocytes

pathologic newborn jaundice

Occurs within first 24 hours and occurs due to blood incompatibilities

Manifestations of placenta previa

Painless bright red vaginal bleeding during the second or third trimester, fundal height > than expected for gestational age, relaxed uterus

What condition do these s/s suggest? -Hemorrhaging risk -Light bleeding which stops spontaneously -NO pain with bleeding -Would require surgery -FHR heard with distress

Placenta Previa

What condition do these s/s suggest? -Hemorrhaging risk -Uterine PAIN with or without bleeding -Would require surgery -FHR not heard or heard with distress

Placental Abruption

Second trimester nursing care DM

Prenatal visits every 1-2 weeks, ultrasound, continue home blood glucose monitoring and urine ketone testing, educate (fetal movement count, nutrition, physical activity)

PTL management goals

Reduce frequency and strength of contractions; optimize fetal status prior to brith; determine level of care needed;

Why does Rh incompatibility matter?

Rh isoimmunization (an antibody produced from interaction w/ cells from sampe species) can cause serious fetal complications

Pulmonary embolism S/S

SOB, chest pain, tachypnea, CV collapse, elevated temperature, hypotension, hypoxia

Risk factors Ectopic pregnancy

STIs, tubal surgery, IUD, assisted reproductive technologies

Hematoma S/S

Severe vaginal or perineal pain, not relived by analgesics

SVT S/S

Swelling, redness, tenderness, warmth, unilateral pain: leg, inguinal area, lower abdomen

False, it is lower than baseline

T/F BP is elevated in the second trimester

False, it is normal

T/F BP is lower in the third trimester

True

T/F BP is normal in the first trimester

What kind of spontaneous abortion would these s/s suggest? (Threatened, incomplete, inevitable, complete, missed or septic) -Pregnancy s/s are present -Painful bleeding -High or low levels of hCG -FHR heard

Threatened spontaneous abortion

Manifestation of Ectopic Pregnancy

Unilateral stabbing pain and tenderness in the lower-abdominal quadrant, delayed (1-2 weeks), lighter than usual or irregular menses, scant dark red or brown vaginal spotting; red vaginal bleeding if rupture has occurred, referred shoulder pain

PPH S/S

Uterine atony, blood clots larger than a quarter, perineal pad saturation 15 min or less, constant oozing, trickling, or flow of bright red blood from the vagina, tachycardia, hypotension, skin pale, cool and clammy w/ loss of turgor and pale mucous membranes, oliguria

First trimester Nursing care DM

Visits every 1-2 weeks, routine prenatal + additional tests (A1c, 24 hr urine collection, maternal serum alpha-fetoprotein and triple screen/Quadruple screen, ultrasound, daily home glucose monitoring, educate (diet/exercise, s/s of infection)

Calcium gluconate

What is the reversal agent of magnesium sulfate?

Risk factors of Rh incompatibility in pregnancy

abdominal trauma, Abortion, placental abruption, antepartum bleed, normal birth, C/S AKA: anytime fetal blood and maternal blood mix!!

Ectopic pregnancy

abnormal implantation of a fertilized ovum outside of the uterine cavity usually in the fallopian tube, which can result in a tubal rupture causing a fatal hemorrhage.

Early onset Neonatal sepsis

acquired from mother and onset is within 72 hours

Carboprost (Hemabate)

action: contraction of uterus Dose: 250 mcg Route: IM Contraindications: asthma, renal, liver or cardiovascular disease Side effect: diarrhea Can repeat every 15 min as provider order

Nursing care PPROM (Maternal)

address anxiety, promote comfort, limit activity, positioning, promote hydration, identify and treat existing infections, prevent exposure to infection, instruct the women and family about s/s of infection

Late PPH

after 24 hours to 6 weeks

Risk factors of DVT/SVT

age (older), multiparity, history of thromboembolic disease, inherited coagulation disorder, varicose veins, trauma to extremity, anemia, inactivity, C/S, obesity, diabetes, smoking

Gestational diabetes mellitus

an impaired tolerance to glucose w/ the first onset or recognition during pregnancy; symptoms usually disappear a few weeks following delivery; however, 50% of women will develop type II within 5 yrs

Rh Factor

antigen found on blood cells

Therapeutic abortion (TAB)

deliberate interruption of pre-viable pregnancy for medical reasons- maternal physical disorder

Measure endocervical length with an ultrasound

diagnostic procedure to predict PTL; a shortened cervix is suggested to precede preterm labor

Vaginal swab for Fetal fibronectin

diagnostic test to predict PTL

Postpartum nursing care DM

encourage breastfeeding; screen 6-12 weeks after labor, continue healthy diet and exercise

polyhydramnios

excessive amniotic fluid; >1000 mL Associated with: fetal anomalies, Rh sensitization, and DM Risks: PPROM, IUGR, fetal malpresentation, cord prolapse, placental abruption, IUFD, and preterm birth, PPH

2nd degree laceration

extends through muscle up to the rectal sphincter

Late preterm

b/t 32 0/7 and 36 6/7

Early term

b/t 37 0/7 and 38 6/7

Term

b/t 39 0/7 and 41 6/7 Optimal time to be born

Pathophysiology of Rh incompatibility

begins w/ mixing of maternal fetal blood, body only makes antibodies when exposed to an Rh + baby; first baby is unaffected, but second baby is affected

Labetalol (IV or oral)

beta-adrenergic blocker First choice in hypertensive crisis

Risk factors of Rh incompatibility prior to pregnancy

blood transfusion; history of needle stick or shared needles

Laceration S/S

bright red bleeding, firm uterus/midline

Nifedipine (oral)

calcium channel blocker

PTL modifiable risk factors

chronic condition, substance use, prenatal care, pregnancy intervals, infections, stress

Manifestations of PTL

complaints are often vague... but may include menstrual-like cramping, persistent low backache, gastrointestinal cramping, urinary frequency, vaginal discharge

Vasa previa

condition when the fetal umbilical vessels implant into the fetal membranes rather than the placenta

3rd degree laceration

continues through anal sphincter muscle

4th degree laceration

continues through anal sphincter muscle and also involves the anterior rectal wall

Labor nursing care DM

continuous EFM, maintain maternal BGL (80-110), administer insulin before active labor, monitor blood glucose

Betamethasone

corticosteroid used to help speed up fetal lung maturity; recommended for women with PPROM at <34 wk gestation or PTL b/t 24-34 wks gestation; contraindicated in diabetic pts

Magnesium sulfate (IV)

decreases ACh released by motor nerve impulses, thereby blocking neruomuscular transmission - depresses the CNS to act as an anticonvulsant

Eclampsia

defined as new onset of grand mal seizure activity in pregnancy or postpartum w/ s/s of preeclampsia