OB/Peds Exam 4

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TMill
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144790
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OB/Peds Exam 4
Updated:
2012-03-30 18:10:56
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Ob Peds
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Fetal monitoring, sensory and skin
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  1. As the myometrium contracts the flow of oxygenated blood through the uterne artery is __________. Therefore, casuing the fetus to have _______ oxygen available.
    • decrease
    • less
  2. What is low tech monitoring?
    auscultation and palpation
  3. What is high tech monitoring?
    electronic monitoring that monitors contractiosn and fetus
  4. True or False: If a contraction lasts longer than 1 min you should be concenred.
    True a contraction should not last longer than 1 min
  5. Indications for fetal electronic monitoring:
    • previous hx of still birth
    • complications of pregnancy
    • induction of labor
    • preterm labor
    • nonreassuring fetal status (decreased movement)
    • meconium staining of amniotic fluid (sign baby is in distress)
  6. Where is the tocodynamometer or "toco" placed on the womans abdomen?
    placed over uterine fundus because it monitors uterine contractions
  7. Where is the ultrasound monitor device placed?
    over the area of the fetal back becuase it transmits info about FHR
  8. Criteria for internal monitoring?
    • amniotic membranes ruptured
    • cervix dilated 2 cm
    • presenting part down against cervix
  9. Where is the internal monitoring placed?
    the sprial electrode is placed on the fetal occiput which allows for more accurate continous monitoring
  10. With which type of monitoring is the mom limited to staying in bed with little movement?
    External
  11. Which type of electronic monitoring allows free movement by mom and fetus?
    Internal
  12. Baseline fetal HR?
    110-160
  13. Tachycardia fetal heart rate:
    >160 bpm
  14. Causes of fetal tachycardia:
    • maternal fever
    • fetal hypoxia
    • intrauterine infections
    • drugs
  15. Bradycardia fetal HR:
    < 110 bpm
  16. Causes of fetal bradycardia:
    • profound hypoxia
    • anesthesia
    • beta adrenergic blocking drugs
  17. Do you want variability of the fetal heart monitor or not?
    YES abseence of variability (or a smooth flat baseline) indicates a sign of fetal compromise
  18. Causes of decreased variability:
    • hypoxia and acidosis
    • medications
    • sleep cycle
    • preterm status
  19. increase in fetal heart rate with a return to baseline = what?
    accelerations
  20. Acceleration of _______ indicates fetal well-being?
    15 bpm for 15 seconds
  21. Decerlerations can be ________, ______, or _______?
    • early
    • variable
    • late
  22. Early, variable or late?
    related to head compressions intervention not necessary
    early
  23. Early, variable or late?
    realted to cord compression
    interventions vary but focus on position changes or amnioinfusion
    variable
  24. Early, variable or late?
    realated to uteroplacental insufficiency
    most omnious need immediate attention
    late
  25. Early, variable or late?
    The onest and return of the decceleration coincide with the start and end of the contraction.
    early
  26. Early, variable or late?
    decelerations change with duration intensity and timing of contraction
    variable
  27. Early, variable or late?
    the fetal heart tones return to the baseline after end of contraction
    late
  28. What should you do as the RN with FHR decelerations?
    • stop pitocin
    • reposition side lying or knee to chest position
    • adminster oxygen by mask at 10L/min
    • Give Terbutaline sub q
  29. V C
    E H
    A O
    L P
    • variable cord
    • early head
    • acceleration okay
    • late placenta
  30. What are they testing for with fetal scalp blood sampling?
    • acidosis- present if pH <7.20
    • require rupturing of membranes
  31. Cord blood analysis criteria:
    • significant abnoral FHR
    • meconium staining amniotic fluid
    • infant is depressed at birth
  32. How do they perform a cord blood analysis?
    Take a small amount of blood from umbilical cord and test for acidosis. normal pH >7.25 lower level indicates acidosis and hypoxia
  33. What is the procedure when the MD "breaks the water"?
    amniotomy
  34. Risks of an Amniotomy?
    • umbilical cord prolapse
    • infection
    • abruption
  35. Why would a MD perform an amniotomy?
    • induction/augmentation
    • allows for internal monitoring
  36. Indication or contraindication for induction:
    pregnancy inducted hypertension
    indication
  37. Indication or contraindication for induction:
    placenta previa
    contracindication
  38. Indication or contraindication for induction:
    premature rupture of membranes
    indication
  39. Indication or contraindication for induction:
    post term pregnancy
    indication
  40. Indication or contraindication for induction:
    chorioamnionitis
    indication
  41. Indication or contraindication for induction:
    maternal medical conditions
    indication
  42. Indication or contraindication for induction:
    hostile intraauterine conditons
    indication
  43. Indication or contraindication for induction:
    fetal demise
    indication
  44. Indication or contraindication for induction:
    abnormal fetal presentation
    contraindication
  45. Indication or contraindication for induction:
    active genital herpes
    contraindication
  46. Indication or contraindication for induction:
    previous classical uterone incision
    contraindication
  47. Indication or contraindication for induction:
    overdistended uterus
    contradindication
  48. Indication or contraindication for induction:
    severe maternal conditions
    contraindication
  49. Indication or contraindication for induction:
    non reassuring fetal heart rate patterns
    contraindication
  50. What presentations are the greatest risk for cord prolapse?
    -2, -3 presentation
  51. What all does the bishop score evaluate?
    • dilation
    • effacement
    • fetal station
    • cervical consistency
    • cervical position
  52. The higher the bishop score the ______ likely for a successful induction.
    MORE
  53. Risks associated with induction:
    • hyperstimulation
    • uterine rupture
    • maternal water intoxication
    • increaed risk for need for c-section
    • increased risk for operative vag delivery
  54. What is the bishop score that indicates cervial rediness or cervical ripening?
    >8
  55. What type of drug causes cervical ripening?
    • prostaglandins
    • prepidil cervidil cytotec or
    • hydrophilic inserts (laminaria)
  56. Most common drug given for induction/augmentation?
    oxytocin (pitocin)
  57. What is the doseage for pitocin?
    • 30 U pitocin/ 500 ml of LR
    • always give as piggyback to closest prot to main iv bag... never mainline always use infusion pump and titration per hospital policy
  58. Types of operative vaginal deliveries:
    • vacuum extraction
    • forceps extraction
  59. Indication/Contraindication for use of forceps/vacuum:
    maternal exhaustion fetal non reassuring FHR
    indication
  60. Indication/Contraindication for use of forceps/vacuum:
    maternal ineffective pushing fetal failure of presenting part to rotate and descend
    indication
  61. Indication/Contraindication for use of forceps/vacuum:
    maternal cardiac or pulmonary disease
    indication
  62. Indication/Contraindication for use of forceps/vacuum:
    severe fetal compomise
    contraindication
  63. Indication/Contraindication for use of forceps/vacuum:
    acute maternal conditions
    contraindication
  64. Indication/Contraindication for use of forceps/vacuum:
    high fetal station
    contraindication
  65. Indication/Contraindication for use of forceps/vacuum:
    cephalopelvic disproportion
    contraindication
  66. Risks of vacuume and foreps:
    • trauma to maternal and fetal tissues
    • vaginal lacerations and hematoma
    • fetal bruising facial laterations and cephalhematoma and intracranial hemorrhage
  67. Two types of episiotomy incisions:
    • midline (more common)
    • mediolateral
  68. Disadvantages of episiotomy:
    • infection risk
    • perineal pain may last longer
    • impairs resumption of sexual intercourse
  69. Nursing intervention for episiotomy:
    promote gradual stretching by perineal massage and warm compresses to perineum
  70. C-section indications
    • dystocia
    • CPD
    • PIH
    • maternal diseases
    • active herpes
    • previous classical incision
    • presistent non reassurng FHR
    • prolapsed cord
    • fetal malpresentation
    • placental abnormalities
  71. C-section prep:
    • shave prep
    • NPO or meds given to reduce acidity (reglan or bicitra)
    • insert foley catheter
    • routine labs CBC and HC
    • regional anesthesia preferred
    • informed consent
  72. C-section maternal risks:
    • infection
    • hemorrhage
    • UTI or trauma
    • DVT or emboli
    • paralytic ileus
    • ateletasis
    • anesthesia complications
  73. C-section fetal risks:
    • inadvertent premature birth
    • TTN due to delayed absorption of lung fluid
    • PPHN pulmonary vasoconstriction
    • injury
    • lung immaturity

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