PN OB TTT Unit 2 Exam - notes PDF

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PN OB TTT Unit 2 Exam 1. What is Hyperemesis Gravidarum (HG)? Excessive nausea and vomiting that can significantly interfere with her food intake & fluid balance. Fetal growth may be restricted, resulting in a low-birth-weight infant. Dehydration impairs perfusion of the placenta, reducing the delivery of blood oxygen & nutrients to the fetus Treatment: Correct dehydration & electrolyte or acid base imbalance with fluids 2. What impact can HG have on the pregnant woman? Inability to retain food & fluids, significant weight loss, dehydration, electrolyte & acid-base imbalances, ketonuria, stress, emotional immaturity 3. Create a chart comparing Placenta Previa (1) & Placental Abruption (2) Pain: 1. None, other than from normal uterine contractions // 2. Gradual or abrupt onset of pain & uterine tenderness; possibly low back pain Uterine consistency: 1. Uterus soft; no abdominal contractions or irritability // 2. Uterus firm & broadlike; may be irritable, with frequent, brief contractions Fetus: 1. Fetus may be in an abnormal presentation such as breech or transverse lie // 2. Fetus presentation usually normal Blood clotting: 1. Normal // 2. Often accompanied by impaired blood clotting Postpartum complications: Infection: 1. Placental site is near the nonsterile vagina // 2. Bleeding into uterine muscle fibers predisposes to bacterial invasion Hemorrhage: 1. Lower uterine segment does not contract as effectively to compress bleeding vessels // 2. Bleeding into uterine muscle fibers damages them, inhibiting uterine contractions after birth 4. When would a mother need to be concerned about Rh incompatibility? If the maternal & fetal blood factors differ, the mother’s body will produce antibodies to destroy the foreigh fetal RBS. (Rho-GAM) 5. Diabetes impacts fetal health. Describe the potential impact. Congenital abnormalities, complications of large fetal size (macrosomia), intrauterine growth restriction, birth injury, delayed lung maturation, respiratory distress syndrome, neonatal hypoglycemia, neonatal hypocalcemia, neonatal hyperbilirubinemia, neonatal polycythemia (excess erythrocytes), death 6. How does pregnancy affect glucose metabolism? Pregnancy affects a woman’s metabolism to make ample glucose available to the growing fetus 7. Pregnancy induced hypertension manifestation?

Vasospasm impedes blood flow to the mother’s organs & placenta, resulting in hypertension. 8. Treatments for gestational hypertension Mag sulfate (usually anticonvulsant) may slightly reduce hypertension, avoid weight loss programs, discontinue smoking & alcohol, daily blood pressure & weights, urine dipstick for protein, monitor fetal kicks, balanced diet, encourage side lying during rest periods - Meds if needed: hydralazine & labelatolol 9. How is gestational diabetes different from DM type 1 & type 2? Type 1: Usually caused by autoimmune destruction of beta cells of the pancreas resulting in insulin deficiency Type 2: Usually caused by insulin resistance; usually has a strong genetic predisposition & is associated with obesity GDM: Glucose intolerance with onset during pregnancy 10. What does TORCH stand for? T: Toxoplasmosis - Parasitic infection(?) O: Other R: Rubella - Mild viral disease with a low fever & rash. If occurs in early pregnancy, this can disrupt the formation of major body systems, whereas rubella acquired later is more likely to damage organs that are already formed. (Problems: microcephaly (small head size), intellectual impairment, congenital cataracts, deafness, cardiac defects) C: Cytomegalovirus - A herpes infection that is sexually transmitted (Problems: intellectual impairment, seizures, blindness, deafness, dental abnormalities, petechiae rash) H: Herpes - After virus occurs, it will become dormant in the nerves * may reactivate later as a recurrent infection. Initial infection during the first half of pregnancy may cause spontaneous abortopn. 11. Obesity can lead to several complications of pregnancy, what are they? GDM, hypertension, cardiac problems, preeclampsia, & respiratory issues 12. Describe how to time contractions Frequency is the elapsed time from the beginning of one contraction until the beginning of the next contraction. Duration is the elapsed time from the beginning of a contraction until the end of that same contraction. Interval is the amount of time the uterus relaxes between contractions. 13. What parameters of the contractions during labor should alert the nurse to potential complications?

Any contractions that occur more frequently than every 2 minutes, last longer than 90 seconds, or have intervals shorter than 60 seconds 14. Differentiate between real & false labor Real: Contractions gradually develop a regular pattern & become more frequent, longer & more intense. Contractions become stronger & more effective with walking. Discomfort is felt in the lower back & lower abdomen, often feels like menstrual cramps at first. Blood show is often present, especially if the woman is having her first child. Preogressive effacement & dilation of the cervix occurs. False: Contractions are irregular or do not increase in frequency, duration, & intensity. Walking tends to relieve or decrease contractions. Discomfort is felt in the abdomen & groin. Blood show is usually not present. There is no change in effacement & dilation. 15. Describe the different breech presentations Frank: the fetal legs are flexed at the hips & extend toward the shoulders; this is the most common type of presentation. The buttocks present at the cervix. Full or complete: A reversal of the cephalic presentation, with flexion of the head & extremities. Both feet & buttons are present at the cervix. Footling: One or both feet are present first at the cervix. 16. What are the phases of labor? What do they serve? First Stage - Dilation & Effacement Latent Phase (4-6 hours): Cervix dilation is 1-4 cm, amniotic membranes may be intact, there may be some “bloody show,” contractions every 20 minutes decreasing to every 5 minutes, duration 15-40 seconds, intensity mild to moderate. Active Phase (2-6 hours): Cervix dilation is 4-7 cm, amniotic membranes may rupture, effacement of cervix occurs, contractions 2-5 minutes apart, duration 40-60 seconds, intensity moderate to firm. Transition Phase (30 minutes-2 hours): Cervix dilation is 7-10 cm, cervix fully effaced, amniotic membranes rupture, contractions every 2-3 minutes, duration 60-90 seconds, intensity firm. Second Stage - Expulsion of fetus (30 minutes to 2 hours) Cervix dilation is 10 cm, contractions every 1-3 minutes, duration 60-80 seconds, intensity firm, episiotomy may be performed by healthcare providers, second stage ends with birth of an infant. Third Stage - Expulsion of placenta Duration 5-30 minutes, contractions intermittent, intensity mild to moderate, umbilical cord is cut, signs of placental separation include the following: lengthening of cord, uterine fundus rises & becomes firm, fresh

blood is expelled from the vagina. Placenta is expelled by Schultze mechanism (shiny fetal side first) or by Duncan mechanism (dull, rough maternal side first), uterus contracts to size of grapefruit, episiotomy is sutured by health care providers. Fourth Stage - Recovery Uterus remains midline, firmly contracted at or below umbilicus level, lochia rubra saturates perineal pad, cramping may occur, women may have shaking chills that may be a thermoregulation response. 17. Explain APGAR scoring This system is for evaluating the infant’s condition & response to resuscitation that may be provided at birth. Five factors are evaluated at the 1 minute mark & 5 minutes after birth. They are ranked in order of importance: Heart rate, respiratory effort, muscle tone, reflex response to suction or gentle stimulation on the soles of the feet & skin color. 18. Warning signs & treatments for postpartum hemorrhage Warning signs: trickle of bright red blood, pulse & respiratory rate changes, shock. Treatment: pitocin & massages of the fundus 19. What is an amniotomy & what risks does the amniotomy pose for the baby? Amniotomy is the artificial rupture of membranes by using a sterile sharp instrument to puncture the amniotic sac & release the amniotic fluids for the purpose of inducing or augmenting labor. Risk factors: umbilical cord compression, prolapse of umbilical cord, infection, abruptio placentae. 20. Signs & symptoms of hyperventilation & nursing interventions S/S: dizziness, tingling of hands & feets, cramps & muscle spasms of hands, numbness around nose & mouth, blurring of vision. Nursing interventions: breathe slowly, especially in exhalation, breathe into cupped hands, place a moist washcloth over the mouth & nose while breathing, hold breath for a few seconds before exhaling. 21. Why are infants, born to moms with diabetes, prone to hypoglycemia? The newborn is at risk for hypoglycemia because it leaves the high insulin environment that was in utero & enters a low insulin environment. 22. What do early decelerations on a labor strip look like? Early decelerations are caused by fetal head compression during uterine contractions, resulting in vagal stimulation & slowing of the heart rate. This type of deceleration has a uniform shape, with a slow onset that coincides with the start of the contraction & a slow return to the baseline that coincides with the end of the contraction. 23. Interventions for late decelerations

Implement position changes to relieve the pressure on the fetal umbilical cord. Administer oxygen. Administer IV fluids. Correct hypotension. Implement measures to reduce uterine activity. Implement amnioinfusion. Use altered pushing & breathing techniques during the second stage.Changing from Valsalva (holding the breath & pushing) to open glottis pushing. Fewer pushing efforts during contractions. Pushing with every other contraction. Pushing only with the urge to push. 24. Compare/Contrast the 3 main natural pain control methods Dick-Read Method: An english physician who introduced the concept of a fear-tension-pain cycle during labor. He believed that fear of childbirth contributes to tension, which resulted in pain. His methods include education & relaxation techniques to interrupt the cycle. Bradley Method: This method was originally called “husband-coached childbirth” & was the first to include the father as an integral part of labor. It emphasizes slow abdominal breathing & relaxation techniques. Lamaze Method (The Psychoprophylactic Method): This is the basis of most childbirth preparation classes in the US. It uses mental techniques that condition the woman to respond to contractions with relaxation rather than tension. Other mental & breathing techniques occupy her mind & limit the brains’ ability to interpret labor sensations as painful. 25. Epidural Anesthesia that penetrates the epidural space with a large needle. A catheter is threaded into the epidural space through a bore needle. The anesthetic drug is constantly infused into the catheter. Most important assessment following administration: fetal heart rate & blood pressure should be monitored & documented every 5 minutes for 15 minutes & then every 30 minutes for 1 hour. Side effects: maternal hypotension & urinary retention 26. ROP, LOP, ROA, LOA; which causes back labor? Which is the most favorable for vaginal delivery? Right occiput posterior & left occiput posterior cause back labor. (Occipital bone posterior = towards mothers sacrum). Right occiput anterior & left occiput anterior are most favorable. 27. Nonpharmacological pain control methods Progressive relaxation: Helps distinguish tense muscles from relaxed ones, release muscle tension Neuromuscular dissociation: Contraction of one group of muscles strongly & consciously relaxes all other

Touch relaxation: Contraction of a muscle group & then relaxes it when her partner strokes or massages it Relaxation against pain: The woman’s partner exerts pressure against a tendon or large muscle of the arm or leg, gradually increasing pressure & then gradually decreasing pressure to stimulate the gradual increase, peak, & decrease in contraction strength Effleurage: The abdomen or other areas are massaged during contractions Sacral pressure: Techniques help to reduce the pain of back labor Thermal stimulation: Technique is used to stimulate temperature receptors that interfere with pain transmission Positioning: Any position except the supine position is acceptable if there is no other indication for supine position, upright position favors fetal descent. Diversion & distraction: Technique increases mental contraction on something besides pain Hydrotherapy: Water delivered by shower or whirlpool relieves tired muscles & relaxes the woman. 28. Normal amniotic fluid appearance The fluid should be clear, possibly with flecks of vernix (newborn skin coating) & should not have a bad odor. Usually around 1000 mL. 29. Amniotic fluids that indicates fetal distress Cloudly, yellow fluid suggests infection. Green fluid means the fetus passed the fist stool (meconium) into the fluid before birth. Meconium-stained amniotic fluids are associated with fetal compromise during labor & infant respiratory distress after birth. 30. Define hypotonic labor; hypertonic labor; false labor & true labor Hypotonic: Contractions are weak & ineffective. Uterine resting tone is not elevated. It is more common than hypertonic labor dysfunction. It occurs during the active phase, after 4 cm of cervical dilation. It is more likely if the uterus is overly distended or if the woman has had many births. Medical management includes amniotomy, oxytocin augmentation, & adequate hydration. Hypertonic: Contracts are poorly coordinated, frequent & painful. Uterine resting tone between contractions is tense. It is less common than hypotonic labor dysfunction. It is more likely to occur during latent labor, before 4 cm of cervical dilation. Medical management includes mild sedation & tocolytic drugs. Real: Contractions gradually develop a regular pattern & become more frequent, longer & more intense. Contractions become stronger & more effective with walking. Discomfort is felt in the lower back & lower abdomen, often feels like menstrual cramps at first. Blood show is often present, especially if the woman is having her first child. Preogressive effacement & dilation of the cervix occurs.

False: Contractions are irregular or do not increase in frequency, duration, & intensity. Walking tends to relieve or decrease contractions. Discomfort is felt in the abdomen & groin. Blood show is usually not present. There is no change in effacement & dilation. 31. List nursing interventions for hypotonic & hypertonic labor Hypotonic: Non Pharmacological stimulation methods include walking, assuming other upright positions, & stimulating the nipples. Other nursing interventions include position changes & encouragement. Hypertonic: Nursing interventions include acceptance of a woman's discomfort & frustration & the provision of comfort measures. 32. Vaginal delivery assisted by forceps Forceps are instruments with curved blades that fit around the fetal head without unduly compressing it. They may be used to end the second stage of labor if it is in the best interest of the mother or fetus. The mother may be exhausted, or she may be unable to push effectively. The cervix must be fully dilated, the membranes ruptured, the bladder empty & the fetal head engaged. Risk factors: Trauma to maternal or fetal tissues is the main risk when forceps or vacuum extraction is used. The mother may have a laceration or hematoma in her vagina. The infant may have bruising, facial or scalp lacerations or abrasion, cephalhematoma, or intracranial hemorrhage. Maternal assessment: Ice applied to the perimeun to reduce bruising & edema. The health care provider is notified if the woman has signs of vaginal hematoma, which included several & poorly relieved pelvic or rectal pain. Infant assessment: The infant's head is examined for lacerations, abrasions, or bruising. Mild facial reddening & molding of the head are common. Pressure from the forceps may injure the infant's facial nerve. This is evidenced by facial asymmetry (different appearance of right & left sides), which is most obvious when the infant cries. Facial nerve injury usually relieves without treatment. 33. Vaginal delivery assisted by vacuum extractor A vacuum extractor uses suction applied to the fetal head so that the health care provider can assist the mother’s expulsion efforts. The vacuum extractor is used only with an occiput presentation. They may be used to end the second stage of labor if it is in the best interest of the mother or fetus. The mother may be exhausted, or she may be unable to push effectively. The cervix must be fully dilated, the membranes ruptured, the bladder empty & the fetal head engaged. Risk factors: Trauma to maternal or fetal tissues is the main risk when forceps or vacuum extraction is used. The mother may have a laceration or hematoma in her vagina. The infant may have bruising, facial or scalp lacerations or abrasion, cephalhematoma, or intracranial hemorrhage. The vacuum extractor causes a harmless area of circular edema on the infant's scalp (chignon) where it is applied.

Maternal assessment: Ice applied to the perimeun to reduce bruising & edema. The health care provider is notified if the woman has signs of vaginal hematoma, which included several & poorly relieved pelvic or rectal pain. Infant assessment: The infant's head is examined for lacerations, abrasions, or bruising. Mild facial reddening & molding of the head are common. Pressure from the forceps may injure the infant's facial nerve. This is evidenced by facial asymmetry (different appearance of right & left sides), which is most obvious when the infant cries. Facial nerve injury usually relieves without treatment. The scalp chignon from the vacuum extractor does not necessitate interventions & resolves quickly. 34. What is terbutaline used for? This is administered subcutaneously to stop uterine contractions within minutes. Side effects: Increased pulse rate & blood pressure, nasal stuffiness & hyperglycemia Contraindications: Should not be used in women with preeclampsia, placenta previa, abruptio placentae, gestation age greater than 37 weeks, chorioamniotisia or fetal demise. Nursing implications: Positioning the women on her side for better placental blood flow, assessing vital signs frequently, & notifying the healthcare provider if tachycardia occurs. Signs of pulmonary edema (chest pains, cough, crackles, or rhonchi) & intake & output should be closely monitored. 35. Premature rupture of membranes: PROM Is spontaneous rupture of membranes at term (38 weeks or more) more than 1 hour before labor contractions begin. Risk factors: Risks of early delivery of the fetus against the risks of infection & sepsis in the newborn. Patient education: Report a temperature above 100.4 F. Avoid sexual intercourse or insertion of anything in the vagina, which can increase the risk of infection. Avoid orgasm, which can stimulate contractions. Avoid breast stimulation, which can stimulate contractions because of natural oxytocin release. Maintain any activity restrictions prescribed. Note any uterine contractions, reduced fetal activity or other signs of infection. Record fetal kick counts daily, & report fewer than 10 kicks in a 12-hour period. When should they see their doctor: Contractions that may be either uncomfortable or painless, feelings that the fetus is “balling up” more frequently, menstrual-like cramps, constant low backache, pelvic pressure of a feeling that the fetus is pushing down, a change in vaginal discharge, abdominal cramps with or without diarrhea, pain or discomfort in the vulva or thighs, & “just feeling bad” or “coming down with something” 36. Magnesium sulfate

Drug of choice: It is not a very effective tocolytic, but it is used to protect the fetus from developing cerebral palsy. Overdose can affect the cardiorespiratory system. Common immediate side effect: Flushing or hot flashes, feeling tired & lethargic, N/A, dizziness, blurred vision, & muscle weakness. Baby: decreased muscle tone & low APGAR scoring Counter agent, if mag levels are too high? Calcium gluconate Purpose for using mag sulfate? Stop uterine ...