OB-Maternity (Exam 1) Questions and Answers Graded A

OB-Maternity (Exam 1) Questions and Answers Graded A Presumptive Signs of Pregnancy Amenorrhea, Nausea and Vomiting, Fatigue, Urinary Frequency, Breast and Skin Changes, Vaginal and cervical color changes, and Fetal Movement. Probable Signs of Pregnancy Abdominal Enlargement, Cervical Softening, Uterine Changes, and Pregnancy Tests Positive Signs of Pregnancy Auscultation of Fetal Heart Sounds, Fetal Movements felt by examiner, Visualization of Fetus. Leukocytes (WBC) during pregnancy... 12,000 cells/mm3 to 15,000 cells/mm3 Leukocytes (WBC) during labor and early postpartum... 25,000 cells/mm3 to 30,000 cells/mm3 Magnesium Sulfate This depresses the CNS acting as an anticonvulsant by decreasing acetylcholine released by motor nerve impulses blocking neuromuscular transmission. This medication is used to prevent and control seizures in severe preeclampsia and helps to prevent uterine contractions during preterm labor. Also can cause respiratory depression. (4 to 6 grams) External Version This is more common and promotes vaginal birth by changing the fetal presentation from a breech or transverse lie (shoulder) to a cephalic lie (head). This helps to avoid a cesarian birth. Internal Version This is used to change the presentation of the second twin after birth of the first twin in hopes for a vaginal birth of second twin rather than a cesarian. Pitocin Used for the induction of labor and control of postpartum bleeding. Stimulates the uterine smooth muscle producing uterine contractions and has vasoactive and antidiuretic effects. Also known as Oxytocin. Precautions for Pitocin administration... Give this as a piggyback infusion so it may be stopped if complications occur, insert into primary line as close to the venipuncture site as possible, monitor FHR and patterns before administration to determine baseline and after, start medication slowly and increase gradually as regulated by an infusion pump. Actual Nursing Diagnoses... Imbalanced Nutrition: Less than Body Requirements or Ineffective Breastfeeding Risk Nursing Diagnoses... Risk for Imbalanced Nutrition: Less than Body Requirements or Risk for Ineffective Breastfeeding Wellness Nursing Diagnoses... Readiness for Enhanced Self-Health Management or Readiness for Enhanced Nutrition Calcium Gluconate This acts as an antidote for Magnesium Sulfate. Folic Acid This can help decrease the amount of neural tube deficits such as spina bifida and is especially important to take before conception and during the first trimester. Products containing enriched flour, breads or cereals can help adequate intake. (G) GTPAL Pregnancies or Gravida (How many times pregnant) (T) GTPAL Term Pregnancies delivered (How many delivered to full term 37+ weeks) (P) GTPAL Pre-Term delivered (How many delivered pre-term 20 to 36 6/7 weeks) (A) GTPAL Abortions (How many abortions, under 20 weeks, etopic?) (L) GTPAL Living Children (How many kids do you have?) Nagele's Rule Used to establish estimated delivery date (EDD) by subtracting 3 months since the last normal menstrual period (LNMP) then adding 7 days, then correcting year if needed. Polyhydramnios Excessive volume of amniotic fluid usually associated with fetal abnormalities. Can be caused by gestational diabetes. Usually in excess of 2000 ml. Oligohydramnios Abnormally small quantity of amniotic fluid usually associated with placental insufficiency or fetal urinary tract abnormalities. Usually less than 700-800 ml Cytotec Used for gastric ulcers but also used forcervical ripening and induction of labor and is not to be given to a woman with a previous cesarian birth. Also known as Misoprostol. Usual dose 25 mcg vaginally. Amniotomy Artifical rupture of the amniotic sac usually performed in conjunction with an augmentation of labor and to allow fetal monitoring. Performed by a physician or nurse-midwife. Chorioamnionitis Inflammation of the amniotic sac caused by bacterial or viral infections Risk associated with Amniotomy and Spontaneous rupture of membranes... Prolapse of umbilical cord, Infection, compression of the umbilical cord and Aburptio Placentae. Primary risk for a prolapsed cord... Umbilical cord slips down in the gush of fluid during membrane rupture and compression against the fetal presenting part and woman's pelvis. Pitocin should be stopped when... Hypertonic Uterine Activity, contractions less than 2 minutes apart, rest interval shorter than 30 seconds, or contraction duration longer than 90 to 120 seconds. Amniocentesis Aspiration of amniotic fluid from the amniotic sac for examination and is best performed at 15 to 20 weeks gestation. Mid-trimester amniocentesis purpose... Examination of fetal cells present in amniotic fluid to identify chromosome abnormalities, evaluation of fetal condition with woman sensitized to Rh-positive blood, and diagnosis of intrauterine infections. Third trimester amniocentesis purpose... Glucose testing, H&H, Syphilis screen, fetal lung maturity, fetal condition when the woman has Rh isoimmunization (Rh Factor), Group B Strep Cultures. Alpha-Fetoprotien Screening Performed on maternal serum or amniotic fluid to identify open body wall defects and chromosomal anomalies. Markers assessed with this are human chorionic gonadotropin, estriol and Inhibin A. NST (Non-Stress test) Identifies whether an increase in the FHR occurs when fetus moves indicating adequate oxygenation, healthy neural pathway from the fetal CNS to the fetal heart, and ability of fetal heart to respond to stimuli. CST (Contraction Stress Test) This is done if NST findings are non-reactive Vibroacoustic Stimulation (VAS) Sound stimulation to elicit fetal movement. Can be given up to 3 seconds and repeated at 1 minute intervals up to 3 times. Increased AFP Levels... High Risk of Neural Tube Deficit (Spina Bifida, anencephaly, fetal demise, abdominal wall defects, esophageal obstruction. Decreased AFP Levels... Down Syndrome or Trisomy 21 Amenorrhea Absence of menstruation Supine Hypotension Occurs when women is in supine position and the weight of uterus and baby partially occlude the vena cava and aorta reducing cardiac output 25% to 30%. Turning to a lateral recumbent (side lying) position will correct this. Lightening Decent of fetal head that reduces pressure on the diaphragm at 36 weeks so the last 4 weeks the baby sits lower. Chadwick's Sign A bluish purple color of the vagina and labia caused by the congestion of blood in the area and is considered an early sign of pregnancy. Goodell's Sign A sign of cervical softening in which the cervix feels like lips or an ear lobe rather than it's normal consistency like the tip of a nose. "Bloody Show" This consists of the mucous plug and a small amount of bleeding as can be considered one of the earliest signs of labor. Braxton Hicks Contractions These are irregular and infrequent contractions that occur in the first two trimesters and are not normally felt by the mother. They can occur during the third trimester and cause discomfort. Also known as 'false labor". Phenylketonuria (PKU) Genetic condition in which the infant cannot metabolize the amino acid phenylalanine which is common in protein foods like milk. Latent Phase of Labor... 1st phase of the first stage of labor. Lasts through the first 3 cm of cervical dilation. (0 cm to 3 cm) Active phase of Labor... 2nd phase of the first stage of labor.Increase in pace of natural labor. (4 cm to 7 cm) Transition phase of Labor... 3rd phase of the first stage of labor.The fetus descends further into the pelvis. (8 cm to 10 cm) Second stage of Labor... This begins when 10cm and 100% effacement of the cervix ends with the birth and delivery of the baby. Third stage of Labor... This is the delivery of the placenta and is always consistent no matter how many births a woman may have. Fourth stage of Labor... This is the physical recovery of the mother and infant and lasts from the delivery of the placenta through the first 1 to 4 hours after birth. Positions for pushing in 2nd stage of Labor... Hands and Knees, Squatting, Semi-Sitting Pushing, Side-Lying pushing, Positions for 1st stage of Labor... Sitting upright, Standing, Sitting leaning forward with support, semi-sitting, side-lying, kneeling and leaning forward with support. Early Decelerations Fetal head briefly increases intracranial pressure causing vagus nerve to slow the heart rate. Occur during contractions as the fetal head presses against the woman's pelvis or soft tissue such as the cervix. Late Decelerations The slowing of the fetal heart rate after the onset of a uterine contraction and persisting after the contraction ends. Variable Decelerations This results from conditions that reduce flow through the umbilical cord and they can rise and fall abruptly with the onset and relief of cord compression. RhoGAM Administered to unsensitized Rh-negative woman at 28 weeks gestation to prevent sensitization. Effectively prevents formation of active antibodies against Rh-Positive erythrocytes if small amount of fetal Rh-positive blood enters the mother's circulation if she is Rh-negative. Administration repeated after birth if woman delivers an Rh-Positive infant. Ambivalence (First Trimester) Conflicting feelings about pregnancy once pregnancy is confirmed. Woman's primary focus is on herself and not the fetus. Betamethasone Used to accelerate fetal lung maturity in order to reduce incidence and severity of respiratory distress syndrome. Given 12mg IM for two does 24 hours apart. Active infections such as chorioamnionitis and be cautious in patients that have diabetes complications. Dizygotic Twins 2 separate eggs (Fraternal Twins) Monozygotic Twins 1 egg fertilized then split (Identical Twins) 12 weeks fundal height in pregnancy Peak above symphysis pubis 20 weeks fundal height in pregnancy Umbilicus Area 36 week fundal height in pregnancy Highest point at xiphoid process and can cause some pressure on diaphragm. 40 week fundal height in pregnancy Lightning and lower than xiphoid process and head at pelvic area. This could be necessary for a diagnosis of iron deficiency anemia in the first trimester of pregnancy... Hemoglobin below 11 g/dL Physiologic Anemia of Pregnancy Reflects dilution of RBCs in expanded plasma volume rather than an actual decline in the number of RBCs and does not indicate true anemia. Uses for Iron in pregnancy... Dairy decreases the effects, take this right before bed, can cause constipation son increase fruits and greens for fiber, can cause green stools. Ambivalence (Second Trimester) Focus is on the baby, there is physical evidence of baby present inside mom, body image begins to change, and changes in sexuality occur. Ambivalence (Third Trimester) Mom feels vulnerable, focus on the baby increases and preparation for birth begins. Prenatal visits to doctor from conception to 28 weeks... Every 4 weeks Prenatal visits to doctor from 29 to 36 weeks... Every 2 weeks Prenatal visits to doctor from 36 weeks until delivery... Every week Functions of Progesterone during pregnancy... Relaxes smooth muscles, maintains uterine lining for implantation, develops breasts for lactation, increases carbon dioxide sensitivity, retains sodium, facilitates the deposit of maternal fat stores.