NCLEX MARK K > OB > Flashcards

OB Flashcards

(66 cards)

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1
Q

Determining the estimated date of delivery

A

• Use the Naegele rule—take first day of last menstrual period (LMP), add 7 days and subtract 3 months from it

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2
Q

if the last menstrual period of a pt was between June 10 and 15…

A

The estimated date of delivery = March 17

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3
Q

Weight gained during pregnancy

• 1st trimester (12 weeks)

A

o 1 lb per month = Total of 3 lbs

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4
Q

Weight gained during pregnancy

• 2nd and 3rd trimesters

A

o Add 1 lb every week

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5
Q

• The ideal weight gained during pregnancy

A

o 28 lbs, plus or minus 3

o Between 25 to 31 lbs

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6
Q

If weight gained is within +/–3 lbs …

A

Assess her

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7
Q

If weight gained is within +/–4 lbs or more…

A

There is trouble.. perform a BPP on the fetus

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8
Q

Alternative method

A quick and dirty way to come up with the ideal weight gained during pregnancy is to..

A

• Take the number of weeks gestation minus 9

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9
Q

Fundal height cannot be palpated until

A

week 12 - That when the fundus is midway between the umbilicus and the pubic symphysis

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10
Q

• The fundus can be palpated at the umbilicus between..

A

20 and 22 weeks

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11
Q

Positive Signs of Pregnancy (4)

A
  1. Fetal skeleton on x-ray
  2. Presence of fetus on ultrasound
  3. Auscultation of fetal heart (Doppler)
  4. Examiner palpates fetal movement (outline)
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12
Q

fetal HR can be heard first between…

A

8 to 12 weeks gestation

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13
Q

Quickening (baby Qicks) may be first felt between…

A

16 to 20 weeks gestation

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14
Q

Maybe Signs of Pregnancy

A
  1. Positive urine/blood hCG tests

2. Chadwick sign, Goodell sign, Hegar sign

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15
Q

Chadwick sign

A

cervical color change to cyanosis (Cs)

• Bluish discoloration of the vulva, vagina and cervix

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16
Q

Goodell sign

A

good and soft

• Softening of the cervix

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17
Q

Hegar sign

A

uterine softening

• Softening of lower uterine segment

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18
Q

During pregnancy, pt is advised to go for prenatal visits as follows…

A
  • Once a Month until week 28
  • Every other week between 28 and 36
  • Once a week after week 36 until delivery or week 42, whichever comes first
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19
Q

Hemoglobin (Hb) level will fall during pregnancy

A

Hemoglobin (Hb) level will fall during pregnancy

  • First Trimester: Hb can fall to 11 and be perfectly normal
  • Second Trimester: Hb can fall to 10.5 and be perfectly normal
  • Third Trimester: Hb can fall to 10 and be perfectly normal
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20
Q

How do you treat morning sickness?

A
  • Morning sickness is usually seen during the 1st trimester

* Treatment: Dry carbohydrates—not before breakfast but—before pt gets out of bed

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21
Q

How do you deal with urinary incontinence?

A
  • Urinary incontinence is seen in the 1st and 3rd trimesters

* Pt needs to void every 2 hours from the day she gets pregnant until 6 weeks postpartum

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22
Q

A pregnant pt complains of difficulty breathing. What should you advise her to do?

A

• Advise pt to assume to tripod position

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23
Q

A pregnant pt complains of back pain. What should you advise her to do?

A
  • Back Pain is seen during the 2nd and 3rd trimester

* Advise pelvic tilt exercises to pt

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24
Q

Dilation

A

is opening cervix from 0 to 10 cm

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25
Effacement
thinning of the cervix. It goes from thick to 100% efface (thin like paper)
26
Station
the relation between fetal presenting part and the mother’s ischial spines (know this)—the narrowest part of the pelvis o Positive numbers mean the baby has made it through this tight squeeze—good to go o Positive numbers = Positive news o If a baby stays at a –3, –2, –1, it can’t get through vaginally. It needs C-section for delivery
27
Engagement
is station zero—this means the presenting part is at the ischial spines
28
Lie
is relationship between the spine of the mother and spine of the baby • You want a vertical lie—compatible with vaginal birth o If the mother’s spine and the baby’s spine is parallel—we got a baby • If lie is perpendicular—tranverse lie = Trouble ... C-section o If we got them perpendicular, we’ve got trouble—T
29
Most common presentation is..
ROA or LOA—that’s the guess—don’t bother memorizing • ROA (right occiput anterior) • LOA (left occiput anterior) • Pick ROA before LOA
30
Stage 1 Onset of Labor—It has 3 phases
Latent, Active, Transition
31
Latent
cervical dilation from 0 to 4 cm o Phase 1 o Contractions are 5 to 30 minutes apart, lasting 15 to 30 seconds o Mild intensity
32
Active
cervical dilation from 5 to 7 cm o Phase 2 o Contractions are 3 to 5 minutes apart, lasting 30 to 60 seconds o Moderate intensity
33
Transition
cervical dilation from 8 to 10 cm o Phase 3 o Contractions are 2 to 3 minutes apart, lasting 60 to 90 seconds o Strong intensity
34
What is purpose of uterine contraction in first stage?
• Dilation and effacement of the cervix
35
What is the purpose in 2nd stage?
• Delivery of baby
36
What is the purpose 3rd stage?
• Delivery of placenta
37
What is the purpose of 4th stage?
• Stop bleeding
38
When does postpartum technically begin?
• 2 hours after delivery of placenta
39
Uterine contraction should be no longer than
90 seconds and no closer than 2 minutes
40
Painful Back pain—“OP” = Oh Pain. What do you do?
• Position—Push • What position? o KNEE-CHEST position then o PUSH with fist into sacrum to use counter pressure
41
Prolapsed Cord
• Push head in off cord and position knee-chest or Trendelenburg • Prep for C-section • Think PUSH/POSITION o Push head off the cord of fetus and position mother to knee-chest
42
Interventions for all other complications
• All treated the same—with “LION” o Left side (place mother on the left side) o IV o Oxygen o Notify HCP • Stop Pitocin (pit) if it was running—the first thing to do
43
Low Fetal HR (heart rate)—
HR <110 • This is BAD • You do “LION” o Left side (place mother on the left side) oIV o Oxygen o Notify HCP • Stop Pitocin (pit) if it was running o Implement before “LION”
44
High Fetal HR—
HR >160 • Document acceleration of fetal HR • Take the mother’s temp • Not a high priority ... Baby is WNL
45
Low Baseline Variability
``` • This is BAD • Fetal HR stays the same—it doesn’t change • You do “LION” o Left side oIV o Oxygen o Notify HCP • Stop pit if it is running (first) ```
46
High Baseline Variability
* Fetal heart rate is always changing—This is GOOD | * Document finding
47
Early Deceleration
* This is normal ... No big deal | * Document finding
48
Variable (VERY) Decelerations
• This is very BAD • This indicates prolapsed cord • What is the nursing intervention? o PUSH and POSITION
49
Late Decelerations
``` • This is BAD • You do “LION” o Left side oIV o Oxygen o Notify HCP • Stop pit if it is running ```
50
Second stage of L&D (labor and delivery)
Delivery of the fetus ... This is about order. 1. Deliver head ... The mother needs to stop pushing 2. Suction the mouth then the nose ... ABC order 3. Check for nuchal (around the neck) cord 4. Deliver the shoulders, next, the body 5. Make sure baby has ID band on before it leaves the delivery area
51
Third stage of L&D
• Delivery of the placenta • What do you check for with the delivery of the placenta? o Make sure the placenta is complete and intact o Check for 3-vessel cord—2 arteries and 1 vein, AVA
52
Fourth Stage of L&D
* Recovery | * There are 4 things you do in the 4th stage, 4 times an hour (every 15 minutes)
53
There are 4 things you do in the 4th stage, 4 times an hour (every 15 minutes)
1. Vital signs: Assessing for shock ... Blood pressure goes down, HR goes up ... Pt looks pale, cold, and clammy 2. Fundus: If it is boggy, massage it ... If displaced, catheterize it 3. Check perineal pads ... If there is excessive bleeding, the pad will saturate in 15 minutes or less 4. Roll pt over and check for bleeding underneath her
54
Uterine fundus should be...
firm o Massage if fundus is boggy and midline o Catheterize pt if fundus is boggy and not midline
55
• The tone of the fundus should be...
firm, not boggy
56
• The height of the fundus after delivery should be at the..
umbilicus (or navel) o Fundus involutes about 2 cm every day PP (postpartum)
57
• The location of the uterus should be...
midline | o If not midline, the bladder is distended
58
• Lochia is vaginal drainage postpartum (Know the order) ... Important
o Rubra—red o Serosa (if your cheeks are rosy)—pink o Alba (albino)—white o Moderate amount: 4 to 6 inches on pad in an hour o Excessive: saturate a pad in 15 minutes
59
Extremities—
Looking for thrombophlebitis ... Important
60
o What is the best way to determine if a pt has thrombophlebitis?
The best way is to measure Bilateral calf circumference (Best answer) Homan sign is not the best answer
61
Cephalohematoma vs. Caput succedaneum
Caput Succedaneum (CS)—Crosses Suture line, and Caput Symmetrical
62
Tocolytics
(Stop contractions, stop labor) | • Tocolytics are given to women in premature labor that must be stopped
63
examples of tocolytics
• Terbutaline (Brethine) o S/E: maternal tachycardia (don’t give with cardiac disease) • Mag sulfate o Treatment with Mag sulfate will induce hypermagnesemia - which will cause everything to go down (HR will go down, BP go down, Reflexes go down, RR go down, LOC go down)
64
Oxytocics
(Stimulate and strengthen labor)
65
Examples of oxytocics
• Pitocin (Oxytocin) o S/Es: Uterine hyperstimulation (defined as longer than 90 seconds, closer than 2 minutes) The nursing intervention is to lower the dose of pitocin in case of uterine hyperstimulation • Methergine o Causes HTN—if it contracts blood vessels it makes sense that this increases BP
66
Fetal/Neonatal Lung Meds
• Betamethasone (steroid) o Given to mother IM o Can repeat as long baby is in utero o S/E: increase glucose (steroid) • Surfactant (Survanta) o Given to baby via transtracheal route o Given After birth
NCLEX MARK K
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