Level II Process Unit 2

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saraherin
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232625
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Level II Process Unit 2
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2013-09-19 19:07:53
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SCF Unit level II nursing
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maternal/ newborn
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  1. What are the leading causes of maternal death in the USA?
    • Gestational Hypertension 
    • Pulmonary Embolism
    • Hemorrhage
  2. Contributing related to maternal death include:
    • age under 20 / over 35
    • lack of prenatal care
    • low educational attainment 
    • unmarried status 
    • non-white race
  3. Leading cause of death in neonates is _____.
    • congenital anomalies  
    • ch.9 page 190
  4. What are daily fetal movement counts?
    • "KICK COUNTS" 
    • counting fetal movement for 1-2 hours daily - should be 10 or more
  5. If no fetal movement is felt by the woman for a period of _____ hours, she should be evaluated ASAP.
    12 hours
  6. Ultrasonography is more useful after what trimester?
    after the first trimester, when the pregnant uterus becomes an abdominal organ
  7. What technique/testing equipment is used for the BPP test?
    (Biophysical profile)
    Ultrasonography
  8. What are some of the items measured by the BPP?
    • Fetal breathing movements
    • Gross body movements
    • Fetal tone
    • Reactive fetal heartbeat
    • Amniotic fluid volume
  9. What are the normal measurements for Fetal breathing movements?
    > or equal to 1 episode in a 30 minute period, lasting more than 30 seconds
  10. What is the normal range of fetal body movements for the BPP profile?
    3 or more body/limb movements in 30 minutes
  11. What indicates normal fetal tone for the BPP profile?
    >1 active extension with return to flexion of fetal limbs or trunk (hand flexion counts as well)
  12. What is a normal reactive fetal heart rate for a BPP test?
    greater than 2 accelerations(>15 beats/min) in 20 minutes - each lasting > 15 seconds & associated with fetal movement
  13. A non-stress test is also an indication of what?
    Fetal well being
  14. What is a normal level of  qualitative amniotic fluid volume n the BPP test?
    > 1 pocket of fluid measuring >1cm in perpendicular planes
  15. What test can indicate impending fetal death?
    • BPP Profile 
    • (Biophysical profile)
  16. An amniocentesis may be done at ____ weeks gestation.
    16 weeks
  17. Increased levels of AFP can indicate what?
    neural tube defects (spina bifida)
  18. Decreased levels of AFP may indicate what?
    Downs syndrome
  19. The PUB test is done to look for what? and is done when?
    • Anemia
    • Infection

    in the second & third trimesters
  20. The CVS test is done at ___ weeks.
    10-12 weeks
  21. The MSAFP test is done when and for what?
    • 15-22 weeks 
    • can detect abdominal wall defects and/or neural tube defects 
    • (maternal serum AFP)
  22. A glucose test is done at _____ weeks to screen for gestational diabetes.
    24-28 weeks
  23. How often should pre-natal visits be scheduled?
    • monthly until 28 weeks 
    • then every 2 weeks until 36 week 
    • then weekly till delivery
  24. How is Hepatitis C contracted?
    Needle sharing
  25. What complication may occur from Hepatitis C?
    pre-term labor
  26. If an infant is born to a mother who tests positive for Hep C, what actions should be taken?
    Child should be vaccinated at 12-18 months of age
  27. At 18-30 weeks - where should the fundus be when measured in centimeters ?
    Should be the same number of weeks gestation as height. Variations may indicated IURG or other issues.
  28. What agent is used to reverse sedatives?
    Narcan
  29. When is the use of Narcan contraindicated?
    when a baby is born to mother who is addicted to drugs and has been using during pregnancy - Narcan can cause these neonates to have seizures
  30. What must be administered before an Epidural?
    • IV bolus of fluids 
    • 500-1000 mL for a single fetus
    • 2000ml for twins
  31. What are some contraindications for an epidural?
    • Tattoo at injection site
    • Coagulation/bleeding disorders 
    • Low platelet count 
    • Cardiac issues 
    • Scolliousis
  32. What is Duramorph?
    are there any side effects?
    • synthetic morphine used in epidurals
    • side effect is itching - give Beneadryl
  33. Why is hypothermia a side effect of child birth?
    the combination of vasodilation combined with the effects of analgesia and anesthesia
  34. High blood pressure is the main factor of what outcome?
    death
  35. Chronic HTN is classified as what?
    BP exceeding 140/90 (at least on 2 occasions) 

    Before 20 weeks gestation
  36. Medication is indicated to treat a BP reading of what ?
    160/110 or higher
  37. A woman with a BP of 140/90 requires what nursing intervention?
    Education
  38. HTN will damage what organs?
    brain, liver, kidneys, placenta - usually from hemorrhage
  39. What are some HTN disorders ?
    • Chronic HTN 
    • Gestational HTN 
    • Pre-eclampsia 
    • Eclampsia
  40. A BP of 140/90 after 20 weeks gestation is defined as what?
    • Gestational HTN
    • No proteins found in urine 
    • will return to normal approx. 12 weeks after birth
  41. Complaints of right upper quadrant pain coupled with high blood pressure could indicate what?
    Liver hemorrhage
  42. Define preeclampsia :
    • occurs after 20 weeks gestation
    • includes gestational HTN & proteins in the urine
  43. S/S of severe Preeclampsia:
    • BP > 160/110
    • + 500mg of proteinurea 
    • Headache 
    • Oliguria 
    • Blurred vision
    • Pulmonary edema 
    • Low platelets (<100,000 mm2)
    • Epigastritis or RUQ pain 
    • HELLP
  44. Eclampsia includes what symptom:
    • Onset of seizures
    • Edema in hands & feet
  45. What treatment is given to treat seizures associated with eclampsia?
    • Magnesium Sulfate
    • Oxygen 
    • Oxitocyn
  46. What is the antidote for Magnesium Sulfate?
    Calcium Gluconate
  47. What is an AE of magnesium sulfate toxicity?
    • Nausea, warmth, flushing, slurred speech 
    • Decreased breathing <12/ minute 
    • Urine <30 mL/hour 
    • Absence of deep tendon reflexes
  48. What is HELLP syndrome?
    • found in sever preeclampsia patients (22-36 weeks)
    • Hemolysis = low hematocrit 
    • Elevated 
    • Liver enzymes = NV, RUQ pain, LDH, AST
    • Low 
    • Platelets = <100,000cell/mm3
  49. What is used to treat HELLP syndrome?
    Magnesium Sulfate -
  50. What is a complication of eclampsia?
    Abruptio Placenta
  51. What is placenta previa?
    placental implanted in lower uterus
  52. Hypothyroid can out a mother at risk for what complications?
    • Preterm birth
    • Low birth weight
    • Neonatal mortality
  53. Untreated hypothyroidism untreated can lead to?
    • Preeclampsia
    • Placenta abruption
    • Still birth
    • Fetal neurological disorders if hormones are too low
  54. Mothers with diabetes mellitus are at risk for what?
    • Preterm birth 
    • Macrosomia (large baby)
    • Congenital anomalies with high glycemnia
  55. Nursing care for diabetic mothers:
    • Diet & exercise
    • Insulin therapy 
    • Monitor glucose levels
    • Fetal surveillance
  56. What is he only PO med approved for diabetics?
    Metformin used with diet & exercise to control Type II diabetes
  57. What is a side effect for baby when born to a mom on metformin?
    Hypoglycemia
  58. What may change about insulin doses in the pregnant woman?
    May be doubled or tripled in the 2nd & 3rd  trimesters.
  59. What are side effects of a mother with cardiovascular disease?
    • Miscarriage 
    • Preterm labor/ birth is more prevalent 
    • IUGR 
    • Incidences of congenital heart lesions increased if mothers has a congenital heart disease
  60. Iron deficiency is also know as ____.
    anemia
  61. How would you treat sickle cell hemoglobinopathy?
    • Hydration 
    • Pain medication 

    very painful disorder
  62. What common ailment is experienced in the first trimester of pregnancy?
    Common Cold
  63. Mothers with epilepsy are at risk for what?
    • not taking medication 
    • increase risk of bleeding & abruptio placenta
  64. How are mothers with Multiple Sclerosis treated?
    bed rest & steroids for acute exacerbations
  65. Bell's Palsey
    may develop during pregnancy and resolve after birth
  66. What is uterine atony?
    • marked hypotonia of uterus
    • #1 reason for postpartum hemorrhage
  67. What would a slow trickle of blood with a firm uterus indicate?
    possible lacerations of the genital tract
  68. What is an inversion of the uterus?
    • turns inside out 
    • potentially life threatening
  69. What is a pelvic hematoma? what are the s/s?
    collection of blood in the connective tissue - may be vulvar, vaginal, or retroperitoneal.

    Pain is the most common s/s
  70. What types of birth are associated with pelvic hematomas?
    • Forceps-assisted 
    • Episiotomy 
    • Primigravidity
  71. What is a s/s of a subinvoluted uterus?
    • Late postpartum bleeding
    • Prolonged lochia discharge
    • Irregular or excessive bleeding
  72. How long does it take the fundus to drop?
    About ten days - one finger per day
  73. What is one of the first signs of postpartum hemorrhage?
    Tachycardia while trying to compensate for blood volume loss
  74. What fluids are given to help increase blood volume?
    • Lactaded Ringer's 
    • Normal Saline 
    • Packed Red Blood cells
  75. Medication for managing bleeding?
    • Pitocin 
    • Methergine
  76. urinary output of less then 30mL/ hour could be a sign of what?
    blood loss in postpartum bleeding
  77. What is disseminated intravascular coagulation?
    DIC pathogenic form of clotting - consumes large amounts of clotting factors, including platelets, fibrinogen, prothrombin, and factor V & VII
  78. What is endometritis ?
    infection of the lining of the uterus
  79. What are s/s of DIC?
    spontaneous bleeding from gums or nose, petechiae from the BP cuff, excessive bleeding following a venipuncture
  80. What is the antidote for Heprin?
    Protamine Sulfate
  81. What is a puerpal infection?
    any infection of the genital canal within 28 days after abortion or birth

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