Chapter 31 Obstetrics and Neonatal Care

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Chapter 31 Obstetrics and Neonatal Care
2014-05-07 15:27:13
Chapter 31 Obstetrics Neonatal Care

Chapter 31 Obstetrics and Neonatal Care
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  1. Each ovary contains thousands of ____, and each ____ contains an egg.
  2. Ovulation occurs approximately __ weeks prior to menstruation.
  3. If fertilized, the egg implants in the ____, or the lining, of the inside of the uterus.
  4. If the egg is not fertilized within __ to __ hours after it has been released, the lining is shed as menstrual flow.
    36 to 48
  5. The uterus, or womb, is a muscular organ, and it is here that the fetus grows for approximately 9 months (__ weeks).
  6. The birth canal is made up of the vagina and the lower third, or neck, of the uterus, called the ____.
  7. When the cervix begins to dilate, this plug is discharged into the vagina as pink-tinged mucus, or:
    bloody show.
  8. The ____ ____ consists of two layers of cells, keeping the circulation of the woman and fetus separated but allowing substances to pass between them.
    placental barrier
  9. The umbilical ____ carries oxygenated blood from the woman to the heart of the fetus.
  10. The umbilical ____ carry deoxygenated blood from the heart of the fetus to the woman.
  11. The amniotic sac contains about ____ to ____ mL of amniotic fluid, which helps insulate and protect the floating fetus.
    500 to 1,000
  12. Rapid uterine growth occurs in the ____ trimester of pregnancy.
  13. As the uterus grows, it pushes up on the ____ and displaces it from its normal position resulting in respiratory changes.
  14. As the pregnancy continues, respiratory capacity changes, with ____ respiratory rates and ____ minute volumes.
    • increased
    • decreasing
  15. Overall blood volume gradually ____ throughout the pregnancy.
  16. Blood volume may eventually increase as much as __% by the end of the pregnancy.
  17. By the end of pregnancy, the pregnant patient’s heart rate increases up to __% to accommodate the increase in blood volume.
  18. In the ____ trimester, there is an increased risk of vomiting and potential aspiration following trauma because of changes that occur in the gastrointestinal tract.
  19. Changes in gastrointestinal motility and the displacement of the ____ upward significantly increase the chance that a pregnant trauma patient will vomit and aspirate if you are unable to clear her airway.
  20. Increased hormones affect the musculoskeletal system by making the joints more:
    “loose” or less stable.
  21. In the ____ trimester, changes in the body’s center of gravity increase the risk of slips and falls.
  22. There are three stages of labor:
    • dilation of the cervix
    • delivery of the infant
    • delivery of the placenta
  23. The ____ stage of labor is usually the longest, lasting an average of __ hours for a first delivery.
    • first
    • 16
  24. The onset of labor starts with:
    contractions of the uterus.
  25. During the onset of labor, the uterine contractions become more regular and last about __ to __ seconds each.
    30 to 60
  26. A ____ is a woman experiencing her first pregnancy.
  27. A ____ is a woman who has experienced previous pregnancies.
  28. A woman may experience preterm or false labor, or ____-____ contractions.
  29. Toward the end of the third trimester, the head of the fetus normally descends into the woman’s pelvis as the fetus positions for delivery.  This movement down into the pelvis and the sensation that may accompany the descent is called:
  30. The ____ stage of labor begins when the fetus begins to encounter the birth canal and ends when the infant is born (spontaneous birth).
  31. Under no circumstances should you let the mother sit on the:
  32. The perineum will begin to bulge significantly, and the top of the infant’s head should begin to appear at the vaginal opening.  This is called:
  33. The ____ stage of labor begins with the birth of the infant and ends with the delivery of the placenta.
  34. One complication that occurs most commonly in patients who are pregnant for the first time is ____, or pregnancy-induced hypertension.
  35. This condition can develop after the 30th week of gestation.  Characterized by the following signs and symptoms:
    -Seeing of spots
    -Swelling in the hands and feet (edema)
    -High blood pressure
  36. Another condition, ____, is characterized by seizures that occur as a result of hypertension.
  37. Transporting the patient on her left side can also prevent ____ ____ ____.  This condition is caused by compression of the descending aorta and the inferior vena cava by the pregnant uterus when the patient lies supine.
    supine hypotensive syndrome
  38. Internal bleeding may be the sign of an ____ pregnancy, a pregnancy that develops outside the uterus, most often in a fallopian tube.  This occurs about once in every ____ pregnancies.
    • ectopic
    • 300
  39. The leading cause of maternal death in the first trimester is internal hemorrhage into the abdomen following rupture of an ____ pregnancy.
  40. You should consider the possibility of an ____ pregnancy in women who have missed a menstrual cycle and complain of sudden stabbing and usually unilateral pain in the lower abdomen.
  41. In ____ placenta, the placenta separates prematurely from the wall of the uterus, most commonly from hypertension in the mother and as a result of trauma.
  42. In placenta ____, the placenta develops over and covers the cervix.
  43. Diabetes develops during pregnancy in many women who have not had diabetes previously.  This condition, called ____ diabetes, will clear up after delivery.
  44. If spinal immobilization is indicated, secure the mother to the backboard and elevate the ____ side of the board with rolled towels or blankets.
  45. If her water is broken, ask whether the fluid was green.  Green fluid is due to ____ (fetal stool).
  46. The presence of ____ can indicate newborn distress, and it is possible for the fetus to aspirate ____ during delivery.
  47. It is typical for a woman’s blood pressure to ____ slightly during the first two trimesters of pregnancy but return to normal during the third trimester.
  48. ____ ____ can be used to slow vaginal bleeding after delivery.
    Uterine massage
  49. On the rare occasion that delivery does not occur within __ minutes or you determine that a complication is occurring that cannot be treated in the field, notify the hospital and provide rapid transport.
  50. As soon as the head is delivered, use one finger to feel whether the umbilical cord is wrapped around the infant’s neck.  This commonly is called a ____ cord.
  51. The infant will be slippery and covered with a white, cheesy substance, called:
    vernix caseosa.
  52. Tie the end of the umbilical cord coming from the infant with special “____ ____.”
    umbilical tape
  53. The placenta delivers itself, usually within a few minutes of the birth, although it may take as long as __ minutes.
  54. You can help to slow bleeding by gently massaging the mother’s abdomen with a firm, circular, “kneading” motion.  You should be able to feel a firm, grapefruit-sized mass in the lower abdomen, called the ____.
  55. Some bleeding, usually less than ____ mL, occurs before the placenta delivers and is normal and expected.
  56. A newborn infant will usually begin breathing spontaneously within __ to __ seconds after birth, and the heart rate will be ____ beats/min or higher.
    • 15 to 30
    • 120
  57. Aim blow-by ____ at the infant’s mouth and nose during resuscitation.
  58. Evaluate the heart rate by palpating the pulse at the base of the umbilical cord or at the ____ artery.
  59. If chest compressions are required, give them at a rate of ____ beats/min using either the hand-encircling technique or the two-finger technique.  Coordinate chest compressions with ventilations at a ratio of:
    • 120
    • 3:1.
  60. Any newborn who requires more than routine resuscitation requires transport to a hospital with a Level ___ neonatal intensive care unit.
  61. About __% of deliveries are complicated by the presence of meconium.
  62. The ____ score is the standard scoring system used to assess the status of a newborn.
  63. It Apgar score assigns a number value (0, 1, or 2) to five areas of activity:
    • Appearance
    • Pulse
    • Grimace or irritability
    • Activity or muscle tone
    • Respirations
  64. A perfect Apgar score is:
  65. Calculate the Apgar score at __ minute and __ minutes after birth.
    • 1
    • 5
  66. The pulse rate of a neonate should be at least  ____ beats/min.
  67. The ____ is the position in which an infant is born or the body part that is delivered first.
  68. Most infants are born headfirst, called a ____ presentation.
  69. Occasionally, the buttocks are delivered first, called a ____ presentation.
  70. Prolapsed cords are more common in a ____ delivery.
  71. If the mother does not deliver within __ minutes of the buttocks presentation, provide prompt transport.
  72. During a ____ birth, make a “V” with your gloved fingers and position them in the vagina to keep the walls of the vagina from compressing the infant’s airway.
  73. On rare occasions, the presenting part of the infant is neither the head nor the buttocks, but a single arm, leg, or foot.  This is called a ____ presentation.
  74. ____ of the umbilical cord, where the umbilical cord comes out of the vagina before the infant, must be treated in the hospital.  The infant’s head will compress the cord during birth and cut off circulation to the infant, depriving it of oxygenated blood.
  75. ____ ____ is a developmental defect in which a portion of the spinal cord or meninges may protrude outside of the vertebrae and possibly outside of the body.
    Spina bifida
  76. Passage of the fetus and placenta before __ weeks is called abortion.
  77. Twins occur about once in every __ births.
  78. If twins are present, the second one will usually be born within __ minutes of the first.
  79. A normal, single infant will weigh approximately __ lb at birth.
  80. Any infant who delivers before __ months (__ weeks) or weighs less than __ lb at birth is considered premature.
    • 8
    • 36
    • 5
  81. Postterm pregnancy refers to pregnancies lasting longer than __ weeks.
  82. Postpartum patients are also at an increased risk of an embolism—most commonly a:
    pulmonary embolism.
  83. A ____ ____ results from a clot that travels through the bloodstream and becomes lodged in the pulmonary circulation.
    pulmonary embolism
  84. If you deliver a newborn in the field and the mother begins to report sudden difficulty breathing or shortness of breath, consider ____ ____ as a possibility.  Also suspect a ____ ____ in patients of childbearing age with respiratory complaints who have recently delivered, especially with the sudden onset of difficulty breathing or altered mental status.
    pulmonary embolism
  85. When assisting ventilations in a newborn with a bag-mask device, the rate is:
    40 to 60 breaths/min
  86. When suctioning the baby's airway after deliver of the head, suction the ____ first and then the ____.
    • mouth
    • nostrils
  87. Excessive bleeding after birth is usually caused by the muscles of the ____ not fully contracting.
  88. APGAR:
    • Appearance
    • Pulse
    • Grimace
    • Activity
    • Respiration
  89. APGAR scoring for appearance:
    • 0 - blue or pale all over
    • 1 - blue at extremities, body pink
    • 2 - pink all over
  90. APGAR scoring for pulse:
    • 0 - absent
    • 1 - <100
    • 2 - >100
  91. APGAR scoring for grimace:
    • 0 - no response to stimulation
    • 1 - grimace/feeble cry when stimulated
    • 2 - cry or pull away when stimulated
  92. APGAR scoring for activity:
    • 0 - none
    • 1 - some flexion
    • 2 - flexed arms and legs that resist extension
  93. APGAR scoring for respiration:
    • 0 - absent
    • 1 - weak, irregular, gasping
    • 2 - strong, lusty cry
  94. You have just delivered a full-term infant. His respirations are rapid and irregular, and he has a strong cry. What should you do next?
    A. Allow the mother to hold her baby.
    B. Clamp and cut the umbilical cord.
    C. Assess the brachial or umbilical pulse.
    D. Begin assisting the newborn's breathing.
    C. Assess the brachial or umbilical pulse.
    (this multiple choice question has been scrambled)
  95. Your 22-year-old patient is in active labor. Upon visual inspection, you note that the infant's leg is protruding from the vagina. Appropriate management of this situation includes:
    A. carefully attempting to push the infant's leg off of the umbilical cord.
    B. placing the mother in a recumbent position and rapidly transporting.
    C. gently pulling on the infant's leg in an attempt to facilitate delivery.
    D. placing the mother supine with her head down and pelvis elevated.
    D. placing the mother supine with her head down and pelvis elevated.
    (this multiple choice question has been scrambled)
  96. You have just delivered a baby boy. His body is pink, but his hands and feet are blue. His heart rate is approximately 110 beats/min and his respirations are rapid and irregular. He has a weak cry when stimulated and resists attempts to straighten his legs. His Apgar score is:
  97. The fetus develops inside a fluid-filled, bag-like membrane called the amniotic sac, and contains ____ to ____ mL of fluid.
    500 to 1,000
  98. As the time for delivery nears, certain complications can occur.  Preeclampsia, or pregnancy-induced hypertension, is a condition that can develop after the __th week of gestation.
  99. Which of the following does not occur during the second stage of labor?
    A. The perineum will begin to bulge.
    B. The mother may feel pressure on her rectum.
    C. The fetus enters the birth canal.
    D. Lightening occurs.
    D. Lightening occurs.
    (this multiple choice question has been scrambled)