Maternity

Question 1

What are s/s of Respiratory Distress Syndrome?

Answer 1

RR 60 breaths per min or greater

Grunting, nasal flaring, cyanosis, intercostal and sternal retractions

Question 2

Describe the 3 causes of postpartum hemorrhage

Answer 2

> Uterine atony – Atony describes a lack of normal muscle tone.
Lacerations - Uncontrolled tearing of perineal tissue
Hematomas - Collection of blood within tissue

Question 3

Define Acrocyanosis of newborn

Answer 3

Peripheral blueness in the hand and feet result from poor circulation. Is normal and will resolve.
When assessing signs of adequate oxygenation, no not use the limbs

Question 4

What is the quality of respirations of the newborn?

Answer 4

Shallow and irregular

Question 5

When do the 3 phases of newborn care occur?

Answer 5

• Phase 1 - From birth to 1 hour (usually in delivery room)
• Phase 2 - From 1 to 3 hours (usually in transition nursery or postpartum unit)
• Phase 3 - From 2 to 12 hours (usually in postpartum unit if rooming-in with the mother)

Question 6

First stage of labour— from onset of regular uterine contractions to the full effacement and dilatation of the cervix (can last 4 to 6 hours). describe 3 phases (latent, active, transitional)

Answer 6

 Latent phase: up to 3 cm dilatation, regular contractions, mostly progress in effacement
 Active phase: 4-7 cm dilatation, contractions every 2-5 minutes, descent of fetus begins
 Transitional phase: 7 cm to full dilatation; contractions every 2 minutes and very intensely felt by mother

Question 7

Second stage of labor—

Answer 7

expulsion of fetus (30 minutes to 2 hours) – from complete dilatation and effacement to the birth of the infant
o Pushing is stopped to allow for controlled delivery of the head

Question 8

Third stage includes—expulsion of placenta (5 to 30 minutes); uterus maintains a contracted state, constricting blood vessels and controlling bleeding

Answer 8

expulsion of placenta (5 to 30 minutes); uterus maintains a contracted state, constricting blood vessels and controlling bleeding

Question 9

Fourth stage of labour —recovery; delivery of the placenta to 2-4 hours after birth

Answer 9

—recovery; delivery of the placenta to 2-4 hours after birth

Question 10

how do you Calculate length of pregnancy

Answer 10

• Identify first day of LNMP.
• Count backward 3 months.
• Add 7 days.

Question 11

Define: - Gravida

Answer 11

any pregnancy, regardless of duration, also the number of pregnancies.

Question 12

Define: - Primigravida

Answer 12

woman who is pregnant for the first time.

Question 13

Define: - Cervical Dilation

Answer 13

Full effacement and dilation of the cervix to 10cm.

Question 14

Define: - False Labor

Answer 14

Contractions without effacement or dilation of the cervix.

Question 15

Define: - Braxton Hicks

Answer 15

Irregular contractions which begin in early stages of labor

Question 16

• Diagnosis of preterm labor is based on

Answer 16

cervical effacement and dilation of more than 2 cm.

Question 17

pre-eclampsia vs severe pre eclampsia signs and symp

Answer 17

Pre-eclampsia
oPregnancy-specific syndrome
oNew-onset proteinuria
ohypertension
	Urine protein values

Severe pre-eclampsia
oProteinuria
oSystolic BP >160 mm hg
oDiastolic BP >110 mm hg
o Cerebral disturbances
oEpigastric pain

Question 18

what is placenta previa

Answer 18

PAINLESS

• Placenta implants in lower uterus instead of top one-third of uterine fundus
• classified by placenta position

Question 19

Clinical manifestations of placenta previa

Answer 19

Painless, bright red vaginal bleeding with a uterus that is soft and relaxed or relaxes between contractions

Question 20

what is Placental abruption

Answer 20

premature separation of placenta in second half of pregnancy or during labour
- High risk of maternal and fetal morbidity

Question 21

manifestations of Placental abruption

Answer 21

o Sudden, intense pain with or without bright red vaginal bleeding
o Concealed bleeding
o Hard uterus that does not relax between contractions
o Signs of maternal shock with tachycardia, hypotension, cold clammy skin, pallor, LOC

Question 22

Nursing Care Immediately After Birth for mother

Answer 22

• Observing for hemorrhage
  o Vital signs
  o Skin color
  o Location and firmness of uterine fundus
  o Lochia – drainage and discharge following delivery
  o Pain
• Promoting comfort
  o Keep warm and dry
  o Ice to perineum to help reduce swelling and bruising

Question 23

it normal for flow to be absent? Explain.

Answer 23

• Immediately after delivery there should be some lochia flow for at least 21 days, otherwise if none or large/excessive amounts (soaking pad less than 2 hours must be notified) = ABNORMAL
• Could indicate subinvolution of the uterus

Question 24

normal amount of blood loss during labour and delivery for Vaginal delivery

Answer 24

500 ml

Csec=1000ml

Question 25

is bradycardia or tachycardia normal after delivery?

Answer 25

Bradycardia = normal: may experience postpartum bradycardia up to 48 hours after delivery. Abnormal – Tachycardia. Look for possible hemorrhage, infection

Question 26

what are the three types of lochia in order?

Answer 26

Lochia Rubra -> Lochia Serosa -> Lochia Alba

Question 27

Describe the color, consistency and time seen of lochia

Answer 27

Lochia Rubra: Red, Mostly blood, About 3 days Lochia Serosa: pinkish, Blood and mucus, 3rd to 10th day Lochia Alba: Clear/colorless or white, Mostly mucus, 10th to 21st day

Question 28

what position and height is the uterus fundus immediately after placenta expelled? Descent rate?

Answer 28

can be felt midline, at or below umbilicus as a firm mass. After 24 hrs fundus begins to descend about 1 cm each day

Question 29

Signs of true labor

Answer 29

* Contractions gradually develop a regular pattern * Contractions become stronger and more effective with walking * Discomfort in lower back or abdomen * Bloody show often present * Progressive effacement and dilation of cervix

Question 30

Reassuring FHR patterns are: Baseline FHR in a normal range of____. Are accelerations of FHR normal or abnormal?

Answer 30

110 to 160 beats/min, with no periodic changes and a moderate baseline variability - Accelerations of FHR with fetal movement are normal patterns

Question 31

Nonreassuring FHR patterns

Answer 31

Baseline FHR <110 or >160 beats/min • Decreased or absent variability; little fluctuation in rate • Late decelerations • Variable decelerations

Question 32

What is a doppler test

Answer 32

Used to determine adequacy of blood flow through fetal vessels, placenta and the umbilical cord - For women in whom it is likely to be impaired (such as women with pregnancy-induced hypertension or diabetes mellitus)

Question 33

What is a ferning test?

Answer 33

determine whether amniotic fluid or urine came out if pt comes in stating they had leakage - If your water is broken, the fluid mixed together with estrogen will create a “fern-like” pattern under a microscope due to salt crystallization

Question 34

Diagnosis of preterm labor is based on? | How is it determined?

Answer 34

- cervical effacement and dilation of more than 2 cm - shortened cervix on ultrasound at 20 weeks may determine - A fibronectin test: a protein produced by the fetal membranes and leaks into vaginal secretions if uterine activity, infection, or cervical effacement occurs. (presence of fibronectin in vaginal secretions between 22 and 24 weeks)