OB Exam 1

olanjones's version from 2016-11-13 23:25

Section 1

Question Answer
Etiology of heartburn for pregnant clientprogesterone causes LES to relax
Treatment/teaching for heartburnEat 5-6 small meals throughout day; wait 1hr after eating to lie down; avoid spicy, greasy foods
Caution with using antacids for heartburnhigh use increases Na+ → fluid build up
Foods/fluids for temporary heartburn reliefyogurt or milk; hot herbal teas
What causes the increase in urination for a pregnant client?hCG ↑s blood flow to pelvic area and kidneys, kidneys dilate
If woman holds pee or ↓'s fluid intake, what complication could arise?UTI
Steps to good urination habitslean forward to empty bladder; keep hydrated; restrict evening fluids; skip diuretics (coffee, tea); KEGELS!
Symptoms r/t gestational hypertensionBP elevated after 20 weeks NOT accompanied by proteinuria, pounding headache
Symptoms r/t pre-eclampsiaBP > 140/90 after 10 weeks WITH proteinuria, pounding h/a, visual disturbances, edema, hyperreflexia, epigastric pain, pulmonary edema, oliguria
Repositioning clientbest position is side-lying (enhances blood flow to the utero-feto-placental unit and maternal kidneys)

Section 2

Question Answer
First trimester1-12 wks
Second trimester13-27 wks
Third trimester28 wks to birth
Week 3-8 most vulnerable to teratogens & not enough folic acid to prevent neural tube defects
week 4fetal heart beat
Week 8all of body organs are formed
Week 8-12FHT
12 weeksmuscles & nerves work
Week 16baby's sex can be seen on ultrasound
Week 16-22 Quickening, fetal movement
Week 22-25viable fetus (CNS & Lungs) needs to be in NICU for 20 weeks for lung care)
Week 32Lungs matured (surfactant)
Week 37 Full term

Section 3

Question Answer
True laborContractions: consistent pattern & increasing frequency, duration and intensity, increase with walking
True laborcontractions/pain begin lower back and sweep around lower abdomen
False laborcontractions inconsistent in frequency, duration and intensity, do not change with activity
False laborcontractions are felt in abdomen or groin, more annoying than painful
False laborNO sig. change in effacement or dilation
True laborprogressive effacement and dilation
Normal findings in Prodromal Stage of laborbraxton hicks, lightening, release of mucous plug, nesting, wt. loss, diarrhea, nausea, increased backache
1st stagedilation & effacement-relieved, excited.
1st stage-earlyrelieved, excited; maybe some anxiety; (0-3cm)
1st stage-activeconcentrated & dependent, waivering self-confidence, fear loss of control. (4-7cm), contractions 30sec q10-30min
1st stage-transitionirritable, disoriented, dependent no touching or talking to her, self-doubt 8-10cm, 40-60sec contractions q2-5min
2nd stagefull dilation (10cm) and birth of baby. Overwhelming emotions, relief, increased energy or exhaustion
3rd stagebirth of placenta (30 min or less), joyful, relieved, tired
4th stagerecovery 1-4hours (highest r/f hemorrhage)
Normal FHT110-160bpm
Tachy FHT>160
Brady FHT<100 (decreased perfusion => hypoxia, requires intervention ASAP)
Normal findings intrapartum: VSBP <130/85, Pulse 60-90, RR 14-22, Temp 98-99.9F; cervical dilation & effacement, fetal descent
Normal fetal findings intrapartumLOA most common position, and fetal movement
Normal findings intrapartum: contractionsprogressively longer, closer together, increased intensity and duration

Section 4

Question Answer
Cord prolapse: nursing intervention?after ROM, take FHT and monitor through several contractions. If brady: vaginal exam & pressure on fetal presenting part until delivery-Get help!; knee chest; hips higher than head, o2, IV bolus
If cord is visible during cord prolapse, NI?cover with sterile saline soaked dressing (prevent drying and vasoconstriction) PREP for ER CS
Placental premature seperationabruptio placentae; hemorrhage, decreased O2 to fetus SX: tense/painful uterus, possible fetal distress, bleeding, acute abd pain, rigid abd, uteroplacental insufficiency
uterine rupture s/spain in chest or abd, feel 'ripped', hypovolemia, fetal distress
uterine rupture NIER CS & uterine repair
Uterine inversion is rare, but what would you do?pull on cord, rigorous massage, ER CS
Amniotic fluid embolismsudden onset, resp. distress, heart failure, circulatory collapse, DIC
amniotic fluid embolism NICPR, O2, correct hypoTN, blood therapy, ER CS
Trauma: accidents, assault, suicide, NI?focus on maternal injury 1st, then fetal mgmt
After epidural (vasodilation)check BP Q2min initially for hypotension
If hypoTN develops after epidural, NI?L side trendelenberg, monitor maternal VS & FHT, increase IV, O2 & vasosuppressor, call anesthesia for mgmt
Drug for hypoTNEPHEDRINE
Nursing Diagnosis and interventions for HEGsevere n/v related to ketosis & wt. loss-give antiemetics, smaller, more frequent meals/fluids; sleep/manage stress; ginger 1-1.5mg/day; thiamine 1.5 mg/day
Presumptive signs of pregnancySUBJECTIVE-n/v, breast changes, skin changes
Probable signs of pregnancy OBJECTIVE- mom feeling movements, hCG
Positive signs of pregnancyultrasounds, second person feels movement, FHT
Cervical ripening agentsChemical: prostaglandin gel; Hypertonic Uterine Activite; Rupture of membranes
Labor induction & augmentation agentsLabor induction: pitocin via IV infusion; Nursing: informed consent, baseline + bishop score, monitor FHR/Uterine Activity (Contractions q2-3min; lasting 40-60seconds, mod. intensity, good resting tone) STOP infusion and give O2 if adverse effects occur

Section 5

Question Answer
Etiology of complications of pregnancy in preterm clientUTI, cocaine, GBS (or other vaginal infx), DEHYDRATION
S/S preterm complications: uterine contractions, cramps, constant low backache, sensation of pelvic pressure, pain, vaginal drainage, abd cramps, sense of something out of vagina
Interventions for preterm complicationstreat underlying cause; hydrate; side-lying; no lifting; avoid caffeine; empty bladder q2h + prn; no breast stimulation; pelvic rest (no sexy time)
If you can't stop preterm labor from happening: give glucocorticoids to mature fetus; prep NICU; provide information, emotional support, listen
Complications r/t tobacco use and fetal developmentaffects normal growth & development of fetus (teratogens), ↑RF placenta abruption, ↓ O2
preterm delivery morbidity mortality rate, why?75-80% d/t the immaturity of lungs
Agents for treatment of preeclampsiadiet, bed rest (lateral); close observation; antihypertensive; Mg. Sulfate (CNS depressant blocks NM transmission, smooth muscle relaxant)
S/S Mg Sulfate Toxicitydepressed DTRs, oliguria, confusion, resp. depression **delivery of fetus is only cure for preeclampsia ANTIDOTE: Calcium gluconate

Section 6

Question Answer
abnormal findings r/t newborn, r/t GDM after birthHigh blood glucose levels in mother → extra glucose goes to baby → baby gets extra weight (macrosomia), may be hypoglycemic (from hyperinsulinemia)
Decreased maternal arterial oxygen tesnsionrespiratory, hypoventilation, smoking
decreased maternal oxygen carrying capacitysignificant anemia, carboxyhemoglobin
Decreased uterine blood flowhypoTN, regional anaesthesia, maternal positioning
Chronic maternal conditionsvasculopathies, anti-phospholipid syndrome
Uteroplacental factorsexcessive uterine activity (too many prostagandins, placental abruption); uteroplacental dysfunction (placental dysruption, placental infarction/dysfunction)
Fetal factors concerning oxygenation<30% = hypoxia = immediate birth; cord compression (oligohydraminos, cord prolapse or entanglement); decreased fetal oxygen carrying capacity
Rh compatibility agentsRhoGAM given at 28 weeks to Rh negative mothers; also given when there is RF fetal blood mixing; blood agent from blood bank
Variations HCT & HGBdecrease (33.8-39% & 10-11 mg/dl)
WBC variations during pregnancyincreases 5-15000
RBC variations during pregancydecreases d/t hemodilution (3.8-4.4)
hcG, estrogen, progesterone variations during pregnancyincreased levels

Section 7

Question Answer
Signs of domestic violenceoverbearing partner, flat affect, unexplained injuries
Triage assessment priorities determine if birth is imminent and maternal fetal health is in danger
Educate client on unhealthy cravingsPICA-craving for non-nutritive substances; nutritional deficiency or unsafe
Birth Plan educationmore positive attitude about child birth; reduced use of meds; reduced report of pain; shorter labors; fewer interventions
Preventable complications r/t ETOH useAbnormal facial features; smaller head size; short height; low wt.; poor coordination; hyperactive; attn difficulty; poor memory; learning disability; speech delay; sleep & sucking problems; vision hearing problems
Ruptured membranes amount during intrapartum process800-1000mL
COAT for ruptured membranesColor Odor Amount Time (crucial inc. r/t infection >18hrs)
Ruptured membranes risk factorscord prolapse; infection
STD manifestationsPROM; preterm birth; systemic fetal infection; lab and diagnostic findings during prenatal visits to diagnose
highest risk for hemorrhage time1-4 hours in recovery
hemorrhage antepartum d/t placenta praevia or abruption =>severe continuous abd pain => signs of shock (pulse >100, hypotensive, cool, sweaty)
Loss of how much blood after birth, CS or any time puts mother at risk?500ml after birth and 1000ml after CS
Severe Hemorrhage Tx?Focus on underlying cause; uterine massage; remove retained placental fragments; Abs for infx; repair of laceration; fluid admin.; monitor for s/s of shock; output measurement

Section 8

Question Answer
R/T end of pregnancy characteristics:RR increases; wt gain; linea negra; cholasma (facial mask); increased UO; episodes of SOB; sinus congestion; edema; varicose veins; pyrosis; constipations; hemorrhoids; low back pain & leg cramps; fatigue
Infection control measuresantibiotic prophylaxis prior to surgery; sterile procedure; OB + Med + current hx; lifestyle and demographics
Safety measures in pre-op surgical siteconsent; rx to reduce gastric activity; OB hx; foley cath; position to prevent vena cava compression; OB +Med + current hx; lifestyle and demographics
Risk reduction measures after surgeryassess for return of sensation; VS; O2 sat; fundus, lochia; IV fluids; urine op; abd dressing; analgesia; TCDB; assist with bonding and feeding; control shivers
Most common complaints r/t early pregnancy progesterone effects:slows GI tract & digestion, relaxes cardiac sphincter => pyrosis (heartburn)
Most common complaints r/t early pregnancy estrogen effects:increases vascularity & uterine muscle mass;
human placental lactogen effects during early pregnancyinsulin antagonist
Relaxin hormone effectsinhibits contraction, relaxes joints
Frustration r/t early pregnancy complicationsfreq. urination, wt. gain, cholasma (facial mask), leukorrhea, nasal stuffiness, fatigue, increased heart rate, N/V

5 P's of labor

Question Answer
1) Powercontractions + push
2) Passagecervix, vagina, pelvis
3) Passengerfetus, amniotic fluid, placenta
4) Positionmother labor position, fetal position
5) Psycheemotions
How to calculate due dateNagele's Rule-Subtract 3 months from 1st day of LMP; add 7 days; adjust for year
TPALTerm deliveries >37 weeks; Preterm deliveries 20-36wks; Abortions; Living
TPAL 1112=?One term delivery, 1 preterm delivery, 1 abortion and 2 living babies
Gravida# of pregnancies
Para # of deliveries > 20 weeks , Ptpal (T=term,preterm,abortion, live child)

Acronyms / FHT

Question Answer
HOPPHydrate, Oxygen, Position, Pitocin (STOP Admin) - [Interventions for FHT decelations]
VEAL CHOPV: Variable C: Cord Compression
E: Early Deceleration H: Head Compression
A: Accelerations O: Ok, Maybe O2
L: Late Deceleration P: Placental Insufficiency
Accelerations (often occurs with fetal movement)Abrupt, temporary increase in the FHR, peaks at least 15 bpm above the baseline and lasts at least 15 seconds
Early Decelerations (Fetal Head Compression)mirror images of the contraction (lowest point of FHR occurs with peak of contraction); Return to baseline FHR by the end of contraction - No intervention needed
Later Decelerations (Uteroplacental insufficiency)FHR slowing and lowest rate (30 to 40 bpm), shifted to the right in relation to contraction (begins after peak); FHR returns to baseline after contraction ends - Deficient exchange of oxygen and waste products in placenta
Variable Decelerations (Umbilical cord compression)Do not have uniform appearance of early and late deceleration, fall and rise abruptly (within 30 seconds) with onset and relief of cord compression
NSTNon-stress test - observing the fetal heart rate response to fetal movement; Results are reactive or non-reactive
CSTContraction stress test - observing the fetal heart rate response to contractions; Variability and accelerations of the FHR are expected
BPP(1st choice for fetal evals)Biophysical profile - evaluating fetal status with the five variables: fetal heart rate, breathing movements, gross body movements, muscle tone, and amniotic fluid volume; A modified BPP consisting of the NST and amniotic fluid volume likely evaluate the most critical elements to judge fetal well-being.
Scoring BPPs/s present = 2 points, absent = 0; Normal = 8-10 point, Equivocal = 6 points, Abnormal = 4 points or less and delivery may be considered
ALONEAmniocentesis, L/S ratio (2:1), Oxytocin test, Non-stress Test, Estriol level - Assessment tests for fetal well-being
EMTALAEmergency Medical Treatment and Active Labor Act: act that prevents hospitals from turning away laboring woman (woman considered to be in true labor until health care provider certifies she is not)



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