OB test 2

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OB test 2
2013-10-15 15:58:34

OB test 2
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  1. This medication is used for the promotion of follicle maturation & ovulation. It stimulates LH resulting in maturation of more ovarian follicles than would normally occur?
    Clomid (Clominhpene)
  2. This medication is used when infertility results of disruption at pituitary level, while promoting follicle maturation & ovulation?
    Pergonal (Menotropins)
  3. This medication is used for severe preeclampsia, it is an antihypertensive
    apresoline (hydralazine)
  4. This is a prophylactic treatment of the ophthamia neonatorum caused by neisseri gonorrhea? (This is required by law)
  5. This is used for revention of isoimmunization in RH neg women; RH- mother & RH+ fetus?
  6. This is used to develop the lungs of a fetus when a mother may deliver early; it prevents neonate respiratory distress?
  7. This is given to prolong coagulation time in women who have coagulation problems
  8. Does Heparin cross the placenta?
    No heparin does not cross the placenta
  9. This is used in pregnancy/ labor for chronic hypertension?
  10. This is used for the induction of labor? To increase the force and frequency of uterine contractions?
    Pitocin/ Oxytocin
  11. This medication is contradicted in preeclampsia & eeclampsia patients?
    Pitocin/ Oxytocin
  12. This is used for the PREVENTION of nausea and vomiting?
  13. Used to TREAT nausea & vomiting; and sometimes used with analgesics
    Phenergan (Promethazine)
  14. This is used for preeclampsia & eclampsia patients to reduce the possibility of convulsions?
    Magnesium Sulfate
  15. this is given to reverse magnesium toxicity?
    Calcium Gluconate
  16. What is calcium gluconate used for?
    To reverse magnesium toxicity
  17. What is the first sign of magnesium toxicity?
    diminished or absent reflexes
  18. Diminished or absent reflexes are the first sign of what?
    Magnesium toxicity
  19. This is a short acting opiate that is sometimes used during labor to relieve pain & induce sedation? It does NOT cross the placenta?
  20. Does fentanyl cross the placenta?
    No it does not cross the placenta
  21. This is an antiemetic that helps eliminate gastric contents for a c-sec, and used to treat GERD?
    Reglan (Metachopramide)
  22. This is a tocolytics, to inhibit uterine contractions during premature labor?
    Brethine (terbutaline)
  23. This pain reliever crosses the placenta & if given in the 3rd trimester the baby can be born with narcotic withdrawals?
  24. This is for the treatment of hemorrhage postpartum or postabortion?
    Methergine (methylergonovine)
  25. This should only be used during the 4th stage of labor and not to be used to augment labor?
    Methergine (methylergonovine)
  26. This is used to induce a medical abortion during the first 7 weeks of pregnancy?
    Cytotec (mifeoristone)
  27. This is used to ripen the cervix and induce labor?
    Cytotec (misoprostol)
  28. What is the major risk factor when using cytotec (misoprostol)?
    Uterine rupture
  29. This is vaginally inserted, used to ripen the cervix & stimulate the smooth muscle of the uterus to enhance contractions?
    Prepidil (dinoprostone)
  30. Why are women assessed for 2 hrs after prepidil is placed?
    hyperstimulation & nonreassuring fetal status typically occur in the first hour after administration and peak in 4 hrs.
  31. If hyperstimulation occurs, or contractions sustain, or there is nonreassuring fetal status occurs with prepidil administration, what is the priority nursing action?
    prepare to administer terbutaline
  32. This is used in abortion & ectopic pregnancies, and is a folic acid antagonist that interferes with DNA synthesis & cell multiplication?
  33. If alcoholism, chronic liver disease, immunosuppressed patient, or blood dycrasis is present, it is contradicted to use what medicine?
  34. What is the treatment for overdose of methotrexate?
    Leucovorin (folinic acid)
  35. What is leucovorin (folinic acid) used for?
    macrocytic anemia caused by folic acid deficiency, overdose of methotrxate
  36. To prevent leucorvin overdose, you encourage the patient to?
    increase fluid intake
  37. What is used for hypotension from epidural regional block & nasal stuffiness?
  38. This is used as a nerve block for spinal & epidural anesthesia?
  39. This is used to reverse opioid overdose?
  40. This is used to treat heartburn when accompanied by GERD?
  41. This is an antacid, not be used for more than 2 wks and should not take with milk, as alkali syndrome may occur?
    Sodium Bicarbonate
  42. This increases cardiac output by blocking acetylcholine at parasympathetic neuroeffector sites. Also dries secretions?
  43. This should never be administered IM, it also increases cardiac output and dries secretions?
  44. This is no longer used in the US, but was used for premature labor?
  45. This is a synthetic opioid analgesic with agonist properties, used for labor pain?
    Nalbuphine (nubain)
  46. If clients are allergic to _______, then an allergic reaction may occur with nalbuphine (nubain)?
  47. What is stadol used for?
    to reduce pain and intensity in laboring women.
  48. This is a peripartum cardiomyopathy, increases the force of myocardial systolic contractions, slows HR
  49. This is used to treat bacterial anaerobic infections, urethritis, PID and infections such as trichomoniasis?
  50. This is contradicted in the 1st trimester of pregnancy?
  51. maternal hypotension can result in?
  52. The nurse observes a pattern of fall in fetal HR that begins at the peak of each contraction & ends well after the end of the contraction. The FHR baseline is about 165 with variability of 0-2 bpm. What is the most likely explanation for this pattern?
  53. An internal fetal monitor is applied after the amniotic fluid membrane ruptures. The nurse observes the tracing for which of the following indications of severe fetal distress?
  54. A pregnant women at 25 weeks of gestation told the nurse that she dropped a pan last week & her baby jumped at the noise. What is an accurate response by the nurse?
  55. A nurse in the labor room is caring for a client in the active stage of labor. The nurse is assessing the fetal patterns & notes a late deceleration on the monitor strip. What is an appropriate action by the nurse?
  56. The nurse caring for a multigravida who is in labor. During an assessment the nurse notes a change in FHR variability on the internal monitor tracing. Previous variability was 6-15 beats; it is now 2-3 beats over several the last hour. Contractions are mild & no medication has been given. What is the best analysis of this data?
  57. A women in early labor is being monitored intermittently (FHR by Doppler or fetascope) & is allowed to ambulate. When the clients membranes rupture, the nurse notes that the fluid is meconium stained. What is the first priority of the nurse?
  58. What is the rationale for using direct (internal) FHR & contraction monitoring?
  59. The nurse cares for a client in labor. The FHR is 150-160. the nurse notes at the apex of a contraction that the FHR is 125 & returns to baseline at the completion of the contraction. What should the nurse do first?
    Continue to monitor FHR
  60. A 41 wk pregnant multigravida presents in the labor & delivery unit after a non-stress test indicated that her fetus could be experiencing some difficulties in utero. What diagnostic tool would yield more detailed info about the fetus?
    biophysical profile
  61. The nurse caring for a women in labor should recognize that fetal tachycardia is most likely the result of which factor?
    maternal fever
  62. For the client with early decelerations the nurse should perform which intervention?
    Continue to assess the EFM for changes
  63. During the contraction stress test, the nurse notes that the FHR decelerates about 15 beats at the peak of each contraction & doesn't go back up until well after the contraction is over. The nurse realizes these results are interpreted as what?
    Positive test
  64. The nurse is admitting a client to the labor room & attaches an external electronic fetal monitor to a clients abdomen. After the monitor is correctly placed, which attribute on the fetal monitor would the nurse initially assess?
    Assess the baseline FHR
  65. A non-stress test (NST) was just completed for a pregnant woman who is at 42 wks gestation. The results were: 1-FHR acceleration of 10 BPM, lasting 15 seconds & 1-FHR acceleration of 12 BPM, lasting 10 seconds within a 40 minute period. What does the result of the test represent?
  66. 2 excelerations that rise 15 beats above the FHR baseline & last for 15 seconds, within a 20 minute window of time is considered what result?
  67. What is it if late decelerations do NOT occur during a contraction stress test?
    negative test
  68. During a contraction stress test, if three contractions in 10 min cannot be elicited or if lates cannot be determined or ruled out, it is known as?
  69. Early decelerations indicate?
    head compression
  70. This response is reassuring as it is a simple vaginal response to having the head squeezed?
    early decelerations
  71. ____ _____refers to the relation of the fetal parts to one another?
    Fetal attitude
  72. What is the normal attitude of the fetus? Moderate flexion of the ___, flexion of the ___ onto _, & flexion of the ____ onto the abdomen.
    head/arms-chest/ legs
  73. _____ ______ refers to the relationship of the cephalocaudal axis (spinal column) of the fetus to the cephalocaudal axis of the woman
    Fetal lie
  74. _______ lie occurs when the cephalocaudal axis of the fetus is parallel to the woman's spine
  75. ______ lie occurs when the cephalocaudal axis of the fetus is at a RIGHT angle to the woman's spine
  76. _____ ______ is determined by fetal lie and by the body part of the fetus that enters the pelvic passage first
    Fetal presentation
  77. The portion of the fetus showing is referred to as the _______ __________
    presenting part
  78. fetal presentation maybe ________ ,_________, or _________
    Cephalic, breech, shoulder
  79. _______ presentation, in which the fetal head presents itself to the passage, occurs in approximately 97% of term births
  80. which 2 presentations are called malpresentations
    breech & shoulder
  81. the cephalic presentation can be further classified according to degree of flexion or extension of the fetal head (attitude) in 4 categories
  82. ______ presentation, is the MOST common, the head is completely flexed onto the chest, and the smallest diameter of the fetal head (suboccipitobregmatic) presents to the maternal pelvis. OCCIPUT is the presenting part.
  83. _________ presentation, the fetal head is neither flexed nor extended. the occipitofrontal diameter presents to the maternal pelvis. the TOP OF HEAD is the presenting part
  84. _________ presentation,the fetal head is partially extended. the occipitomental diameter, the largest anteroposterior diameter, is presented to the maternal pelvis. the SINCIPUT is the presenting part
  85. ______-- presentation, the fetal head is hyperextended (completely extended). the submentobregmatic diameter presents to the maternal pelvis. the FACE is the presenting part
  86. _________presentation is when the buttocks and feet are the presenting part rather than the head. In this presentation the _________ is the landmark to be noted
    Breech/ Sacrum
  87. ______ breech the fetal knees and hips are both flexed; thighs are at the abdomen/ and calves are on the posterior aspect of the thighs. the BUTTOCKS and FEET of the fetus present to the maternal pelvis
    Complete Breech
  88. ________ breech the fetal hips and legs are extended, and the feet of the fetus present to the maternal pelvis. there is single ___ and double ___
  89. A shoulder presentations is also called a _________ lie
  90. ________ of the presenting part occurs when the largest diameter of the presenting part reaches or passes through the pelvic inlet
  91. engagements can be determined by _________
    Vaginal examiniation
  92. when does engagement start for a primigravida?
    2 weeks before term
  93. when does engagement start for a multipara?
    several weeks before onset of labor or during labor
  94. Engagement _______ __ indicate whether the midpelvis and outlet are also adequate
    does NOT
  95. ______ refers to the relationship of the presenting part of an IMAGINARY line drawn between the ischial spines of the maternal pelvis
  96. the _______ spines as a landmark at _____ station
    Ischial /Zero
  97. presenting part is higher than the ischial spines a ______ number is assigned
  98. ________ numbers indicate that the presenting part has passed the ischial spines
  99. station ___ is at the pelvic inlet?
    station ___ is at the pelvic outlet?
    • pelvic inlet = -5
    • pelvic outlet = +4
  100. there may be disproportion between the maternal pelvis and fetal presenting part if  what happens?
    if presenting part fails to descend in the presence of strong contractions
  101. ________ refers to the relationship of a designated landmark on the presenting fetal part to the front, sides or back of the maternal pelvis
    Fetal position
  102. the land mark chosen for vertex presentation is _________
  103. the land mark chosen for the breech presentation is the ________
  104. the _____ on the scapula is the landmark in the shoulder presentation
  105. when does the first stage of labor begin and end?
    onset of true labor/ends when cervix is completely dilated to 10cm
  106. When does the second stage of labor begin and end?
    begins w complete dilation/ ends w the birth of baby
  107. When does the third stage of labor begin and end?
    begins w birth of baby/ ends w delivery of placenta
  108. Some Drs identify a fourth stage which lasts __ to __hrs after the expulsion of the placenta, the ____contracts to control the bleeding at placental site
  109. contractions that occur at regular intervals. Intervals between contractions gradually shorten is ____ labor
  110. contractions that increase in duration and intensity. Intensity usually INCREASES w walking is ___ labor
  111. contractions are irregular. Usually have no change in intervals. Usually have no change in duration and intensity are ___ labor
  112. Discomfort is usually in the abdomen. ___ labor
  113. discomfort begins in the back and radiates around the abdomen. ____ labor
  114. cervical dilation and effacement are progressive. ___ labor
  115. walking has no effect on or lessens contractions. _______ labor
  116. The __ phase of the 1st stage. this is starts with beginning of regular contractions, usually mild. she is relieved that labor has started.  She may be ___, _________, and eager to talk about herself.
    Latent/anxious/ talkative
  117. During latent phase (in 1st stage)  contractions are established and increase in frequency.  They may start as mild lasting __ secs w/ a frequency of __ to __ minutes and progress to moderate ones lasting ___to __secs with a frequency of __ to __min
    • 30 seconds,
    • 10-30 minutes,
    • 30-40 seconds,
    • 5-7 minutes
  118. A nullipara labor (latent phase)  averages 8.6hrs and should not exceed ___hrs
    20 hrs
  119. The latent phase in the multipara labor averages 5.3hrs but not more than ____hrs
    14 hrs
  120. which phase does the amniotic membranes bulge through the cervix in the shape of a cone and a gush of fluid from vagina appears?
    latent phase
  121. During this phase(of 1st stage) the cervix dilates from about a 4cm to _cm. Fetal descent is progressive. Cervical dia. average ___cm/hr in nulls/ ___cm/hr in multi
    • Active,
    • 7cm,
    • 1.2cm,
    • 1.5cm
  122. when a mom enters early ______ phase (of 1st stage) her ANXIETY tends to increase as she senses the contractions intensifying and pain. She begins to ____ loss of control and may have decrease in coping skills
    • Active,
    • Fear
  123. this is the last part of the first stage. this is when mom shows significant _____. she becomes acutely aware of increasing force and intensity of contrac. she may become ______, frequently changing positions
  124. During this phase (1st stage) mom is often tired. she may ___ being left alone at same time the support person may be feeling the need for a break. RN reassures she will not be ___ _____!
    transition/fear/left alone
  125. During transition phase the contractions have a frequency of __to__mins, duration ___to___seconds and strong intensity
    1.5 to 2 mins/ 60-90sec
  126. cervical dilation slows in _____ phase as it progresses from 8cm-10cm and the rate of fetal distention increases. average descent is 1.6cm/hr- at least 1 cm/hr in null. and 5.4cm/hr - at least 2.1cm/hr  in multi.
  127. transition phase does NOT usually last longer than 3hrs for null and or 1 hr for _____
  128. transition phase does NOT usually last longer than 3hrs for null and or 1 hr for _____
  129. during this phase mom feels like she is going to split apart. she may doubt her ability to cope w labor and may become apprehensive, irritable and withdrawn. may be terrified of being left alone, yet she doesn't want anyone to talk or touch her.
  130. during ____phase there is increased bloody ______, __________ as mom increases her breathing, generalized discomfort including low _____, shaking and cramping in ____, increased sensitivity to _____
  131. during _____ phase there is an INCREASE need for partner or nurse support. mom is ________ and increased apprehension and _________, difficult understanding __________. a sense of bewilderment, frustration, and _______ at the contractions.
    transition/restless, irritability, directions, anger
  132. during ____ phase mom request for meds,has hiccuping, belching, N/V. increased rectal pressure and urge to bear down
  133. anxious to "get it over with " phase. mom nay fee amnesic and sleep between frequent contractions. support person may feel helpless
  134. 2nd stage is usually completed in __hrs (null) and __mins (multi) after the cervix becomes fully dilated
    • 3
    • 15
  135. crowning occurs during this stage. mom may feel some relief that the acute pain is over.
  136. fetus BEGINS to descend into pelvis at this phase
  137. woman pushes due to pressure of fetal head on sacral and obturator nerves, and uses intra abdominal pressure. Perineum begins to bulge, flatten and move anteriorly as fetus descends at this stage.
  138. at this stage mom may feel a sense of purpose. may feel out of control, frightened, and irritable
  139. at this stage placenta separates, mom bears down and expels it. dr. may put slight traction on cord to assist expulsion
  140. at this stage mom may feel relief at completion of birth. mom is usually focused on welfare of of infant and my not recognize the placenta expulsion
  141. this stage mom experiences increased pulse and decreased blood pressure d/t redistribution of _____  from uterus and blood loss.
    fourth/ blood
  142. this stage uterus remains contracted  and is located  between _______ and _________ pubis. mom may experience a shaking chill. ___ may be retained due to ______ bladder tone and possible trauma to bladder
    fourth/umbilicus and symphysis/urine/ decreased
  143. during this stage mom may experience euphoria and be energized at birth of child. may be thirsty and hungry
  144. ___ can occur with intracranial pressure of 40-55mmHg, as the head pushes against the cervix. It is believed to be due to ____ depression on CNS. This is a NORMAL & harmless finding
    Early fetal heart rate decelerations
  145. The FHR monitor is used to indicate ___ on the baby. It is also monitored in relationship to the contractions that are known to ___ the available oxygen?
    Distress/ Decrease
  146. _____ starts before or during a contraction & usually requires NO intervention, it mirrors the contractions on FHM
    early decelerations
  147. ____ occurs during & after a contraction. (begins after the acme of the contraction & doesn't return to baseline until after contraction is over)  indicates insufficient blood flow to the fetus. This is a non-reassuring sign on FHM?
    Late decelerations
  148. ____ occurs due to umbilical cord compression & requires further assessment?
    variable decelerations
  149. Tachycardia is caused by maternal or fetal infection or ____ is present?
  150. If hypoxia or infection is present, the fetal heart rate may be ______?
    Tachycardia >160
  151. Maternal hypotension after epidural initiation can cause the FHR to ______
    bradycardia <120
  152. list 3 interventions for Bradycardia of FHR?
    • place mom on left side,
    • if hypotension is present increase fluids,
    • Stop oxytocin (Pitocin) if in use
  153. What is the cause of early decelerations?
    Head compression
  154. interventions for early decelerations:

    Continue to monitor. As this may indicate the beginning of fetal ____ & _____ stage of labor. IF EARLY IN LABOR, IT COULD POSSIBLY INDICATE _____ _____
    • Decent
    • Second
    • Fetopelvic Disproportion
  155. Fetal stress, deficient PLACENTAL PERFUSION, & maternal hypotension can cause ____ ____ on FHR monitor
    Late Decelerations
  156. If late decels are present, and hyperstimulation is present, _____ may be administered?
  157. ____ ____ are a transient decrease in FHR any time during or between contractions?
    Variable decelerations
  158. Causes of variable 2 CH?
    Cord Compression
  159. What is a decrease in FHR of 15 beats or more below the baseline & lasting2-10 minutes?
    prolonged decelerations
  160. _____ is determined by measuring the time between the start of one contraction until the start of another contraction?
  161. The ____ is when a contraction is measured by counting the number of boxes between the start of  contraction to the end of the contraction & multiplying this number by 10?
  162. If using an external monitor (tocodynameter), the actual strength of the contraction is _____?
  163. – begins with onset of regular contractions, with contrac q15-20 min, lasting 20-30 secs, gradually increase to  q5-7 min, 30-40 secs duration. Little/no cervical dil. Women stay home. Phase ends when cervix is 3 cm. Lasts 8.6 hrs for primi, < 6 for multi
    latent phase (1st stage)
  164. phase-begins 4 cm, ends when dilated to 7cm; contractions 2 – 3 mins, 40 – 60 secs; cervix should dilate about 1 to 1.5 cm /hr.  Primi – avg 4.6 hrs, multi 2.4 hrs
    Active phase (1st stage)
  165. phase – shortest,most intense. Dila from 8 to 10 cm; contrac q1.5 – 2 mins, lasting 60 –90secs (pain & rest about same). Lasts avg 3.6 hrs for Primi;varies with multi
  166. . Woman becomes restless, angry,wants to go home, wants a C-sec,N&V,etc. Withdraws from support (spouse, coach, etc), leaving partner feeling useless.. NURSE IS VITAL at this point to both. NURSE must prepare for ____stage
    • Transition
    • 2nd stage
  167. ___stage:cervix is compl. dilated & effaced;aka pushing stage; up to 3hrs for primi,< 30mins in multi.mom bears down, abdominal muscles contract, & help fetal head descend. When fetal head is visible at vulvar opening,____ has occurred & birth is imminent
    • 2nd stage
    • crowning
  168. usually happy, talkative and eager to be in labor, exhibits need for independence by taking care of own bodily needs and seeking info. ____phase
  169. may experience feelings of helplessness. Exhibits increased fatigue and may begin to feel restless and anxious as contractions become stronger. Fear of abandoment. becomes more dependent b/c she is less able to meet her needs. ____phase
    active phase
  170. tires and may exhibit increased restlessness and irritability. feels she cannot keep up w labor process and out of control. physical discomforts. fear of being left alone. fear TEARING open/splitting apart w contractions ___phase
    transition phase
  171. may feel out of control, helpless, panicky _____stage
  172. This stage-begins as a baby delivers & lasts until placenta delivery. Combo of contrac & involution.Placenta detaches from wall within 10 – 15 mins,increased bleeding/“gush of blood”; delivery of placenta follows.signs:uterus “rounds up” into ball,moves upward,cord le
    stage 3
  173. stage ___ “recovery stage” or 1st 4 hours of placenta delivery. Average blood loss is __-____; blood is redistributed in venous bed, with a moderate ___ in BP, increase pulse pressure, and moderate tachycardia. Fundus is midline
    • stage 4
    • 250-500 cc
    • drop
  174. While waiting for signs of the placental delivery, palpate the uterus for signs of uterine relaxation & possible bleeding into uterine cavity. Pitocin may be given to promote ____, involution & decrease bleeding. Sometimes __ or Hemabate is given.
    What stage is this in?
    • contractions
    • methergine
    • 4th stage
  175. Effacement causes ______ dilatation and as the cervix begins to efface it moves the fetus into different ________.
    • cervical
    • stations
  176. Positive (+) 4 is at the_________.
  177. Minus (-5) is at the pelvic _____
  178. _______numbers = presenting part has passed the ischial spines
  179. ____ refers to the drawing up of the internal os and the cervical canal into the side walls of the uterus.  The cervix changes progressively from a long, thick structure to one that is tissue-paper thin
  180. _______breathing decreases the pressure of the diaphragm and abdominal muscles against the uterus
  181. _________breathing is an effective tool in helping the laboring woman feel relaxed and in  Control
  182. regardless of the level of breathing used, a _______ breath begins and ends each pattern
  183. ________ involves ONLY the chest. it consists of inhaling through the _____ and exhaling through ______ _____
    • Cleansing
    • nose
    • pursed lips
  184. the pant pant blow  or abdominal breathing can be taught when a woman has not learned a particular method and is in _______ labor
  185. 4 complications of general anesthesia:
    • Fetal depression
    • uterine relaxation
    • vomiting
    • aspiration
  186. first level (___ paced or slow deep breathing) starts w cleansing breath followed by breathing of 6-9/min or 2 breaths/15 seconds. only chest. in threw nose out threw mouth
  187. second level (________ or modified- paced breathing. begins w cleansing and at end of cleansing breath pushes out a short breath. then inhales and exhales through _______. 4/5 sec. do not exceed to 2/second
    • shallow
    • mouth
  188. pattern can be counted as "one and two and, with woman exhaling on the numbers and inhaling on the "and"
    Second level- modified pace
  189. pattern can be counted by "one one thousand, two one thousand, three one thousand..." exhalation begins and continues through the same count
    First level-slow paced
  190. ___ level (pant-blow or _____ paced)-all breaths are rhythmic, in and out threw mouth. Exhalations are accompanied by a "hee" or "hoo" in varying pattern 2:1 or 3:1 (hee hee hee hoo)counted as one and two and.
    • Third level
    • pattern pace
  191. ________ breathing the woman moves the abdominal wall upward s she inhales and downward as she exhales. this method lifts abd wall off the contracting uterus and may provide pain relief.
  192. S/s of _________ tingling or numbness in tip of nose, lips, fingers, or toes; dizziness; spots before eyes; or spasms of hands or feet.
  193. __________ labor: Diagnostic- produce progressive dilatation and effacement of cervix. ASSESS for DILATATION
  194. spontaneous rupture of the membranes before onset of labor?
    • PROM
    • Premature Rupture Of Membrane
  195. rupture of membranes occurring before 37 weeks?
    • PPROM
    • Preterm Premature Rupture of Membraine
  196. CAUSES of PROM/PPROM: unknown but associated with  1. _____ 2 ._______ ________. 3. Bleeding during preg. 4. Trauma
    • Infection
    • Multi Births
  197. CARE for PROM: Observe for s/s of ___/review WBC  Temp (fever?? Check hydration status)/pulse, &  _____fluid character.
    • infections
    • Amniotic
  198. CARE for PROM: Prevention of infection A. limit ___ exams B. change ___ _____ frequently. Monitor____ carefully 4. Evaluate childbirth preparation/coping Of woman/partner 5. Encourage rest on LEFT side/ use COMFORT MEASURE!6. Ensure _____ IS MAINTAINED
    • Vaginal exams
    • Bed Pads
    • Fetus
    • Hydration
  199. labor that occurs between 20-36 wks is
    Preterm Labor (PTL)
  200. MEDS/CARE PTL: 1. Administration of ________(meds to stop labor): a. adrenergic agonists aka B mimetics- terbutaline sulfate (____) & Mag Sulfate b.Cycloxygenase (Prostaglandin) c.Calcium channel blockers- nifedipine (Procardia) MONITOR LABOR PROCESS
    • Tocolytics (Med to stop labor)
    • Brethine
    Magnesium Sulfate
  202. PAINFUL/DARK RED BLOOD! Placenta prematurely separates from uterine wall CAUSES:1.Severe _____ 2. Pain 3. Clotting disorder in mother 4._____of mother/fetus /both  CARE:1.frequent assessment of ____tone 2. Measurement of abdominal girth
    • Abruption
    • Bleeding
    • Death
    • Uterine
  203. _____ is NO PAIN/ BRIGHT RED BLOOD!DEF: placenta implants in the lower segment of the uterus 1. Partially 2. Completely CAUSES: 1. Bleeding occurs with _____ 2. Bleeding ranges from mild to severe (SCANTY TO PROFUSE) 3. Possible fetus ____/anemia or both
    • Previa
    • Dilation
    • Hypoxia
  204. CARE for Previa: 1. Assessing blood loss, pain and uterine contractions 2. NEVER perform___ ____ if previa is suspected
    Vaginal exam
  205. LESS THAN 37 WEEKS expectant management is used to delay birth PREVIA: a. Bed rest w/ BRP if not _____. b.NO ___ ____ c. Evaluate FHR w/ _____ monitor d. Monitor maternal VS every _minutes W/O BLEED every_Minutes W/ BLEED e. Lab eval. f. IV FLUIDS- __ ___g.2 units of cross-matched avail
    • Bleeding
    • Vaginal exams
    • external
    • 15 minutes
    • 5 minutes
    • Lactade Ringers Solution
  206. POLY/HYDRAdramnios- MORE THAN _____ ML AMNIOTIC FLUID. procedure for it?
    • 2000 ml
    • Amniocentesis (removal of excess fluid)
  207. What is the procedure called to remove excess fluid?
  208. OLIGOdramnios- LESS than ___ ml of amniotic fluid. procedure for it?
    • 500 ml
    • Amnioinfusion (administration of fluid to cushion the fetus & umbilical cord)
  209. What is it called when you add fluids to the amniotic fluid?
  210. This is when you have too much amniotic fluid?
  211. this is when you don't have enough amniotic fluid?
  212. How do you diagnose PPROM?
    • Speculum vaginal Exam
    • Ferning (fluid under microscope)
    • Nitrazine paper (most common at bedside)
  213. What procedure is most commonly used at the bedside to diagnose PPROM?
    Nitrazine Paper
  214. Delivery should be within ____ hrs if mom is at term and diagnosed with PROM, as there is an increase risk for infection?
  215. Early Diagnosis of Preterm Labor: Fetal ________(protein normally found in the fetal membranes), the cervical vaginal fluid in early pregnancy. If the test is positive then they are in preterm labor).check Cervical ____- short is no good, there is less to thin out.
    • Fibronectin
    • Length
  216. Nifedipine or Procardia- is a calcium channel blocker and blocks the calcium that causes ____ and is used in ____
    • Muscles to contract
    • preterm labor
  217. Dexamethasone or Betamethasone- is always used for what
    Help lung development in preterm labor
  218. ___________•Could cause shortness of breath and edema in the mother
    •If amniotic fluid is removed rapidly before birth ________placenta can result!
    •Chronic- fluid gradually increases
    •Acute- rapid increase of fluid
    • Polyhydramnios/Hydramnios
    • abruptio
  219. cause of Oligohydramnios?
    • defect in fetal urine output
    • kidney problems
  220. Any deviation from the normal progressive labor. (irregular contractions) is?
  221. ______ labor: ineffective uterine contractions of poor quality occur in the _______ phase of labor and the resting tone of the myometrium increases. Contractions might be MORE frequent but decrease in intensity
    • Hypertonic
    • Latent
  222. Mom Risk for _______ labor: Early phase hurts but the patient doesn't _____/More common in 1st babies/Very uncomfortable, lots of contractions, fatigue No progression of labor Fetal Risk: Fetal distress Prolonged _______on fetal head
    • hypertonic
    • progress
    • pressure
  223. HYPOtonic labor: usually develops in the _____ phase of labor, after labor has been well established. Fewer than __ or ___ contractions in a 10 minute period.
    • Active
    • 2-3
  224. Mom Risk for_____ labor: Maternal exhaustion/ Stress/PP ______/Intrauterine infection Fetal Risk: Non reassuring fetal status d/t prolonged labor pattern/Fetal _____ *bed rest and possible sedation
    hypotonic/ hemorrhage
  225. ____ labor that last less than 3 hours and results in rapid birth. *Contributing factors:Multiparity, large ____, previous precipitous labor, small fetus, recent maternal cocaine use
  226. IF UNRESOLVED- LEADS TO FETAL DEATH!!!! Prep woman for C/S
    shoulder dystocia
  227. ____________lie- shoulder presentation- woman’s abdomen appears widest from side to side
  228. Maternal Risk ______ labor: Loss of coping abilities Laceration of cervix, vagina, and perineum PP hemorrhage Fetal Risk: Non-reassuring fetal status Cerebral trauma Brachial plexus injuries
  229. Fetal occiput: Back of head faces mothers back: To the left _ _ _,To the right, _ _ _  Leads to long intense labor, very painful, increased back pain. *frequent position changes, ____ _____!, knee- chest position, hands and knees position
    persistent occipitoposterior position/ side lying
  230. _____ _____=Fetopelvis disproportion with wide shoulder usually is the cause (often seen in big babies).Babies head will deliver but shoulders won't
    Shoulder dystocia
  231. this is an Obstetric emergency
    prolapsed cord
  232. umbilical cord precedes the fetal presenting part. Pressure is placed on the umbilical cord as it is trapped between the presenting part and the maternal pelvis.*the job of the nurse is to get get pressure off the cord ASAP, resulting in c-section
    prolapsed cord
  233. apply counter-pressure on ___ area to decrease discomfort for occipitoposterior position
  234. Discontinue ________admin if labor becomes accelerated then turn to LEFT SIDE
  235. CORD PROLAPSE CARE:Instruct woman to assume ______- _______position/T_________.Sterile vaginal exam- gloved fingers MUST stay in vag  until DR arrives/give ___ face mask/monitor for FHR transport woman to DR in position
    knee chest/trendelenburg/o2
  237. _____ placenta=retention of placenta for 30m+ after birth a.DR attempt to ______ remove b.If fail- surgical removal by curettage
  238. degree of laceration- fourchette, perineal skin, vaginal mucous
  239. degree of laceration- perineal skin, vaginal mucous, fascia/muscles on 1 or both sides of vagina
  240. degree of laceration- perineal skin, vaginal mucous, perineal body/sphincter front of rectum
  241. degree of laceration- aka 3rd degree w/ rectal all extension--- mucosa to lumen
  242. a sign of fetal stress, it is not normally present unless the neonate is in the breech position. Color of fluid can indicate how long its been there gold/brown is old, _____ is recent.._________ is often used to dilute thick meconium .
    meconium stained amniotic fluid/green/anmioinfusion
  243. agents are used to ripen the cervix of a woman who is at term or late term when there is a medical or ob indication for induction of labor