Glossary of Things to study for pp
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- What is the antidote for Magnesium Sulfate?
- Calicum Gluconate
- What does magnesium sulfate for?
- Controls Seizures in severe pre-clampsia and also prevention of uterine contractions in pre-term labor
- Some things you have to observe for when adminstering Magnesium Sulfate are:
Loss of Reflexes
Over Sedation and Confusion
- What is the last reflex to go when about to have a seizure?
- Knee-Jerk Reflex
- If a person has any of the below symptoms, do not adminster ______________:
impaired renal function
- Magnesium Sulfate
- Some symptoms of Magnesium toxicity are:
Decrease in reflexes
- What are these signs the result of:
depressed deep tendon reflex
- Magnesium Overdose
- What do you assess closely during adminstration of Magnesium Sulfate?
- Blood Pressure Closely
Respiratory Rate of at least 12 breaths per minute
Presence of Deep tendon Reflexes
Urinary Output greater than 30ml/hr
- What should be kept in the magnesium Sulfate?
- Resuscitation Equipment
Syringes and Needles
- Abortion is
- Spontaneous of elective ending of pregnancy before the pregnancy reaches states legal limit
- Antiphospholipid Antibodies:
associated with Recurrent spontaneous abortion, fetal loss and severe pregnancy induced hypertension
- autoimmune antibodies directed against phosphoplipid in cell membranes
- Bicornate Uterus
- Malformed uterus having 2 horns
- Caudal Regression Syndrome
- malformation that results when sacrum, l-spine, and lower extremeties fail to develop
- encircling of the cervix with suture to prevent spontaneous abortion caused by early cervical dilation
- difficult or prolonged labor, often associated with abnormal uterine activity and cephalopelvic disproportion
- Euglycemiaational trophoblastic tumors
- Normal blood glucose level
- Gestational Trophoblastic disease
- disease that include benign hydatidiform mole and gest
- excess amount of amniotic fluid
- Hypovolemic shock
- acute peripheral circulatory failure caused by loss of circulating blood volume
- Staining of brain tissue caused by accummulation of unconjugated bilirubin in the brain.
- Lipogenic Substance
- stimulates the production of fat...ex:insulin
- discoloration and softening of tissues and eventual disintergration of a fetus retained in the uterus after its death
- Marfan Syndrome
- a hereditary condition that involves weakness in connective tissue, bones and muscles.
- change in a blood test result from negative to positive, indicating the development of antibodies in response to infection or immunization
- Vacuum Curettage
- Removal of the uterine contents by application of a vacuum through a hollow curette or canula introduced into the uterus
- Spontaneous Abortion
- Termination of a pregnancy without action taken by the woman or any other person
- Incidence of spontaneous abortion increases with
- Parental Age
- Most spontaneous abortions occur if the first ______ weeks of pregnancy
- 12 weeks
- 6 Types of spontaneous abortion
- First sign of threatened abortion is
- Vaginal Bleeding
- Vaginal Bleeding, uterine cramping, persistent backache, or feelings of pelvic pressure are sign of possible
- loss of pregnancy
- Bleeding in 1st half of pregnancy are considered a
- threatened abortion
- Fever or Uretrine Tenderness suggest
- Woman may be adivised to lay off sex for ___ weeks after vaginal bleeding has ceased
- If the woman has a foul smelling drainage, it suggests
- You should always instruct the patient to keep all ________ pads and count number used. She should also note the ______ and ______ of the blood on the pads
Quantity and Color
- Inevitable abortion is when the
- membranes rupture and the cervix dilates
- If tissue remains or if bleeding is excessive in an inevitable abortion a ______ procedure may be needed
- Incomplete Abortion is when some but not all of the products of __________ are expelled from the uterus
- Major manifestations of Incomplete abortion are ________ bleeding and severe abdominal __________
- Active Uterine Bleeding and cramping
- Products of conception during a incomplete abortion may still remain in the ________ because of their small size
- When treating someone who we think is having a spontaneous abortion we should
- Monitor BP and pulse frequently
Observe for signs of shock including pallor, clammy skin, perspiration, dyspnea or restlessness
Count and weigh pads
Give Rhogam to Rh-cl within 72hrs
- If pregnancy is 12 weeks gestation of beyond, assess fetal heart tones with a
- Collect and organize all data including
- antepartal history
onset of bleeding episode
- Some complications of abortion are
powerlessness/feeling of failure
- About 50% of spontaneous abortions result from chromosomal ___________ in the embryo or fetus
- Some other factors that may result in spontaneous abortion is:
- Infections; herpes, syphillis and Strep B
Auto Immune Factors
Drugs and envirnomental chemicals; chemo, cigarettes, alcohol, cocaine, organic solvents
- In spontaneous abortion the _____ an infection is treated the __________
- What is the classic symptom of spontaneous abortions?
- Vaginal Bleeding
- When a women is bleeding vaginally, the nurse should ask a series of questions including:
- How many weeks pregnant?
Was tissue or amnoitic fluid discharged?
What other symptoms are you having?
Are they sad or frightenend?
- Implantation of a fertalizied ovum outside of the uterus
- Ectopic Pregnancy
- When does ectopic pregnancies occur?
- 1st trimester
- Where is the most common site for implantation in ectopic pregnancy?
- Fallopean Tubes
- If the fallopian tube has become narrowed by scarring or adhesions, ascending infections, PID, use of IUD's or tubel sx you would have an increased risk for
- Ectopic Pregnancy
- What is the clinical presentation for an ectopic pregnancy?
- Unilateral Lower Abdominal Pain, slowly increasing or sudden and severe abdominal rigidity and referred r shoulder pain
- If the fallopean tube has ruptured, sign of __________ shock and possible __________ bleeding may occur
- What lab tests conferm pregnancy?
- What kind of test confirms an extrauterine pregnancy?
- What are some therapeutic nursing management for ectopic pregnancy?
- Monitor Vitals
Start IV fluids
Medicate for pain as ordered
Prepare pt for sx
Provide pre-op care and teaching
Provide post-op care
- When starting IV fluids for someone who is experiencing ectopic pregnancy, you should always us a _____ gauge needle
- What kind of labs should be ordered in someone who is suspected in having an ectopic pregnancy?
- hCG, CBC, blood group and type, if hemmorrage is suspected also do type and cross match
- What is the non-surgical method of ectopic pregnancy?
- Methotrexate (Folex)
- Risk factors for ectopic pregnancy is
- Hx of STD's
Hx of PID
HX of previous ectopic pregnancies
Failed tubal ligitation
Multiple induced abortions
Maternal age older than 35
- Early Signs and Symptoms of ectopic pregnancy are:
- Missed menstral period
Abdominal and pelvic pain
Vaginal spotting or light bleeding
- If progesterone is very low, the pregnancy is __________ to be viable
- Methotrexate is a cytotoxic drug that inhibits cell __________ in the embryo
- Sx management of a tubal pregnancy that is unruptured may involve a linear ________ to salvage the tube for future pregnancies
- After an Ectopic pregnancy, a women must refrain from having sex, drinking alcohol or ingesting vitamins that have folic acid in them until ______ levels are normal
- hCG levels
- As a result of abnormal growth, the placenta, but not the fetus develops
- Hydatidform Mole
- ______ ___________ _________ may occur if vesicles of the hydatidform mole enter the womans circulation and embolize to her lungs
- Acute respiratory distress
- Levels of hCG are ______ because of rapidly proliferating abnormal villi in molar pregnancies
- Some S&S of molar pregnancy are:
- Vaginal Bleeding
Uterus larger than expected for the duration of the pregnancy
Excessive N&V due to excessive hCG
Early development of preclampsia
- ________ __________ is usually used to extract a mole
- Vacuum Aspiration
- Pregnancy should be avoid for ___ year after evacuation of mole due to high risk of getting __________ cancer which is hidden if hCG is present in system
- 1 year
- If someone is Rh- they _____ receive RhD immune globulin
- Marginal (low-lying) Placenta Previa is when the placenta is implanted in the ________ uterus but its lower border is >____cm from internal cervical os
- Lower Uterus
- Partial Placenta Previa is when the ______ border of the placenta is within ____ cm of the internal cervical os but does not _________ cover the os
- What is Nagael's Rule?
- How to find out date of confinement:
7 days +date of last menes - 3 months
- What are the Five P's of Labor and Delievery?
- What are the defense mechanisms of cardinal movements of labor?
- What are the 6 P's of Dystocia?
Position and Size
- What 2 things should you be prepared for with multiple gestations?
- Pre-Mature birth and Post-partum hemorrhageI
- What are the 6 P's of Multi-Fetus?
- If a baby is coming out Breech, you should do a _________ on a 1st time mom
- If a 1st time mom was going to have the baby breech there is an increased risk for
- Intracranial Hemorrhage
- What trimester does placenta previa and abruption placenta occur?
- 3rd Trimester
- What trimester does spontaneous abortion and ectopic pregnancy occur?
- 1st trimester
- What trimester does hydatidiform mole and incompetent cervix occur?
- 2nd Trimester
- Is a prolapse cord an emergency?
- Is the cord always visible when prolapsed?
- No, not always
- What do you do if the cord has prolapsed?
- Use a serile glove and push up on the baby.
- What is a Prolapse of the cord?
- It is when the cord comes before the presenting part of the baby and it causes severe hypoxeia
- Hypertonic contractions have a ___________ phase
- The contractions in a hypertonic phase are __________ and ______________
- Coordinated, but to weak
- Hypertonic contractions are managed by _________, induction of ___________, CPD and always prep for a _________
- Medications used for hypertonic contractions are ________ and ________
- Oxytocin or Pitocin
- Hypotonic Contractions occur during a _________ phase
- Hypotonic contractions are usually _____________ and _________ and can be extremely _________ and ____________
- Hypotonic contractions cause an __________ resting tone of the ____________
- Since there is an increased resting tone of the uterus with hypotonic contractions, this _________ labor, gives prolonged _________ phase, and causes __________ uterine contractions
- In precipitate labor, you deliever in less than _________ hours
- 3 hours
- Since delievery is so fast in Precipitate labor, the _____ doesn't have a chance to mold to the _________ canal
- Since the head doesn't have the chance to mold in the birth canal in precipate labor, this serious side effect can happen to the babies head
- Cephalic Bleeding
- With the medication Terbutaline, will it augment or induce the labor?
- With the medications oxytocin and pitocin, will it induce or augment the labor?
- What is the psychological response to pregnancy?
- Grief, because you are not going to be the same women you use to be
- Uterine Ruptures cause
- Excessive Bleeding
- Physiological Pregnancy changes in the cardio system include what possible complications?
- Venous Congestion
- What is pitting edema
- When pressure exerted by a finger or thumb leaves a persisitant depression
- Edema of the hands or face may be a sign of what complication?
- Blood Volume increases ____ to ____%
- Because of cardiovascular changes the need for ____ and ____ is increased
- Iron and Folic Acid
- The body compensates by producing more RBC early in the 2nd trimester by ____ to ____%
- Since Blood plasma increases ____ and ____ concentrations decreases causing _________
- Hb and RBC
- Cardio changes include ________ Blood volume, cardiac output, and HR
- Changes in cardio may cause a _________ heart murmur
- BP remains ________ with a slight __________ in the 2nd trimester
- _________ clotting factors are called DIC
- Most changes in the Ingegumentary System occur due to
- Increased Estrogen Levels
- Because of physiological changes in the respiratory system ___________ pCO2 in the mother allow for the fetal pCO2 to be _______
- Maternal Kidneys react to increased pCO2 and releases more bicarbonate which causes
- The physiological pregnancy changes in the endocrine system cause the thyroid to _______ slighty during the 2nd trimester.
- Because of the endocrine system, _______ and ________ are produced
- Estrogen and Progesterone
- Estrogen and Progesterone cause _________ and _________ enlargement, __________ coagulation, and cause Sodium and H2O __________
- Uterine and Breast
- In the endocrine system, _______ is increased causing softening of the cervix and collagen of joints
- Because of the Human Placental Lactogen, it cause __________ glucose fors and also the avaliability for fetus and also __________ maternal utilization of ________ increasing protein avaliability
- The Pituitary Gland causes FSH and LH to _________ for anovulation
- Prolactin is ________ in the endocrine system
- Because of the endocrine system, the human growth hormone is ____________
- The posterior pituartary gland produces _________ and _________
- Oxytocin and Prolactin
- Oxytocin also ________ in labor and helps the _________ plant down and push out. It also helps with bleeding
- Prolactin prepares for ______ after birth
- Because the thyroid enlarges it _________ the Basal Metabolic rate which causes Palpations, ___________ HR and emotional Liability
- When the parathyroid enlarges it causes an _________ metabolism of needed calicum
- The pancreas increases production of __________
- Adrenal Gland activity increases causing an ________ levels of cortisteroids and aldosterone.
- Increased Aldosterone promotes ______ reabsorbation and maintains the osmalarity in the amount of fluid retained
- Because of the increase in cortisteroids and aldosterone it causes a _________ in inflammatory responses
- The adrenal gland regulates ________ metabolism
- Physiological Changes in the immune response causes ________ responsiveness which makes you more prone to infection
- Physiological changes of pregnancy in the Urinary System causes an ________ in urine output and a ________ in specific gravity.
- There is a _________ glomerular filtration rate and a _________ in BUN and Creatine
- Term Births
- Amount of total pregnancy, including pre-term
- Births non-pre-term
- Effacement, dilation and cervical changes occur during true or false labor?
- True Labor
- Descent is
- Descent of the fetal presenting part through the true pelvis
- Engagement is
- when the largest diameter of the fetal presenting part has passed the pelvic inlet and entered the pelvic cavity
- Flexion is
- flexion of the fetal head so that the smallest diameters pass throught the pelvis
- _______ _________ to allow the largest fetal head diameters to match the largest maternal pelvic diameters
- Internal Rotation
- _________ of fetal head as it passes beneath the mothers symphysis pubis
- _______ __________ of the fetal head to allow the shoulders to rotate internally to fir the mother's pelvis
- External Rotation
- _______ of the fetal shoulders and fetal body
- These are the defense mechanisms of cardinal movements of labor
- Inconsistent contractions in frequency, duration, and intensity...
Change in activity such as walking does not alter contractions or activity may decrease them...
Contractions felt in abdomen and groin...
Contractions more annoying than pa
- False LAbor Contractions
- Consistent pattern of increasing frequency, duration, and intensity usually develops with contractions...
Contractions begin in the lower back and gradually sweeps around to the lower abdomen like a girdle...
Back pain may persist in some women
- True Labor Contractions
- What are the 4 stages of Labor?
- Stage of dilation
Stadge of Ph
- What are the 4 stadges of labor
- Stadge of dilation
Stadge of Expulsion
Stadge of Plancenta
Stadge of Physical Recovery for mother and baby
- In the first stadge of labor, it begins with the onset of _______ ______ _______ and ends with _______ _________ and _________
- True Labor Contractions
Complete Dilation and Effacement
- Friedmans Curve is
- Labor progression plotted on a graph
- What are the 3 phases of the 1st stage of labor?
- The latent phase last from the beginning of ________ until about __cm of cervical dilation.
- Cervical Effacement and subtle feal position change occur during what phase of the 1st stage?
- The woman is usually socialable and excited during this phase
- In the active phase, the cervix dilates from ____ to ____cm and dilates more rapidly than in the latent phase
- Effacement of the cervix is completed in what phase?
- The fetus descends in the pelvis and ________ rotation begins during the active phase
- The woman becomes more anxious and may feel helpless as the contractions intensify during what phase?
- In the transition phase the cervix dilates from ___ to ____cm, and the fetus descends further into the pelvis
- 8-10 cm
- _____ ____ often increases with completion of cervical dilation during the Transition Phase
- Bloody Show
- Transition phase is a _____ phase, but intense with very strong _________
- The woman may have the urge to push down during __________ in the transitional phase as the fetal presenting part reaches her pelvic floor
- Leg tremors, nausea and vomiting are common during the ________ phase
- Transitional Phase
- The woman will be _______ and lose control during the transitional phase
- Contractions come infrequently and progess to moderate strength every ____ minutes with a regular pattern and the duration increases to ____ to ____ seconds during the Latent Phase
- 5 minutes
- Contractions iincrease in frequency, duration and intensity until every ___ to ____ minutes for ____ to ____ seconds and moderate to strong intensity during the active phase
- 2-5 minutes
- In the transitional phase, contractions are strong and occur every ____ to ____ minutes, for ____ seconds
- 1 1/2 to 2 minutes
- The 2nd stage of labor (Expulsion) begins with complete dilation of _____ cm and full effacement of the cervix and ends with the ______ of the baby
- _____ describes the 2nd stage well
- Between contractions in the expulsion stage, the woman may appear ______ or oblivous to her surrondings
- The third stage (placental) begins with the birth of the baby and ends with the expulsion of the ___________
- What are these the signs of?
-Uterus has a spherical Shape
-Uterus rises upward in the abdomen as the placenta descends into the vagina and pushes the fundas upward
-The cord descends further from the vagina
-A gush of blood appears t
- Placenta Separtion
- The Schultze mechanism of placneta expulsion is when the placenta is expelled with the shiny, _____ side first
- Duncan Mechanism of placenta expulsion is less common and it is when the rough maternal side is ________
- Inadequate uterine contraction after birth may result in
- The fourth stage of labor (physical recovery) lasts from the delievery of placenta through the first ___ to ____ hours after birth
- Lochia Rubia
- Vaginal Drainage during fourth stage of labor
- For comfort of mother after complete birth, cover mother with _____ blanket or hot drinks or soup. Also an ____ pack on the perineum limits discomfort and hematoma formation
- The fourth stage of labor is an ideal time for the ________ of the new family because the interest of both parents and newborn is high
- Nulliparious mother
- Never had deliever 1st time mother
- Parous mother
- Already experienced a full labor
- These are _________ Signs of Labor:
Braxton Hicks Contractions, Lightening, Increased Vaginal Secretions, Bloody Show, An energy spurt (nesting) or a small weight loss of up to 3lbs
- 5 P's of Labor and Delievery are:
- Uterine Contractions and Maternal Pushing Efforts are components of the _______ in the 5 p's
- The ________ (2nd p) for birth of the fetus consisits of the maternal pelvis and its soft tissues
- Softening of the cartilage linking pelvic bones is because of ________
- Female pelvic structure and configuration consists of the ____ pelvis and the _____ pelvis
- True Pelvis
- The true pelvis is a ________ portion above the pelvic brim
- The true pelvis consists of the ______ inlet, midpelvis, and the ______ outlet
- The false pelvis has a __________ portion above the pelvic rim and it also ________ the abdominal visera
- Diagonal Conjugate is the distance from the ______margin of the symphysis pubis to the sacral promontory and is at least ____
- True Conjugate is the distance from the ______margin of the symphysis pubis to the sacral promontory and is at least 11.5cm
- Obstetric Conjugate is the smallest front-to-back distance through which the fetal head must pass in moving through the pelvic inlet, and it is usually about ____cm
- Transverse is the ________ of all the pelvic inlet diameters and it is located at right angles to the true conjugate and is about ____cm
- Bi-ischial diameter is ___cm
- What are the 5 bones on the babies head?
- 2 frontal
- Sutures are the line of junction or closure between the bones and they permit ______ to accommodate head to birth canal
Lambdoidal are what?
- Suture Lines
- What is the passenger in the 5 p's of labor?
- The fetus plus the membranes and placenta
- The Bi-Parietal Diameter of the babies head is usually ____ cm
- Supine Hypotension
- when the mother lays on her back and the fetus is placing pressure on the vena cava causing dizziness, lightheadness, and possible agitation
- Nursing intervention for supine hypertension is
- Side-lying position
- Fetal lie is the orientation of the ______ axis of the fetus to the _____ axis of woman
- A longituditional lie the ________ way of delievery, while the ___________ lie makes it prone to c-section
- Fetal ________ is the relation of fetal body parts to each other
- The fetal part that enters the pelvis first is the __________ part
- 3 types of presentation are
- Cephalic, Breech and Shoulder
- Fetal ________ describes the location of a fixed reference point on the presenting part in relation to the four quadrants of the maternal pelvis
- ________ is a crucial part of childbirth because anxiety, fear or fatigue decreases a womans ability to cope with pain in labor
- Station is the
- descent of the fetal presenting part in relation to the level of the ischial spines
- Leopolds Manever is when how you determine the
- presentation and position of fetus by placing hands on and around baby
- Chief Complaint of Placenta Previa is
- Painless Uterine Bleeding
- Chief complaint of Abruptia Previa is
- Sudden onset of intense uterine bleeding
- Incompetent Cervix
- inability for the cervix to remain closed long enough during pregnancy for the fetus to survive
- S&S suggestng Hemorrhage in abruptio placentae:
- Increase in fundal height
Hard board-like abdomen
High uterine baseline tone
Persistant abdominal pain
Systemic signs of early hemorrhage
Persisitent late deceleration in fetal heart rate or decreasing baseline variablity
Vaginal Bleeding that may be slight or absent
- Excessive bleeding and fetal hypoxeia are major concerns with
- Abrupto Placentae
- Hypovelmic shock has signs of
- Fetal Tachycardia
Weak peripheral pulses
Increased Respiratory Rate
Cool, pale skin and mucous membranes
- Later signs of hypovolemic shock include:
- falling BP
Pallor of skin and mucous membranes
Urine output less thanb 30ml/hr
Restlessness, agitation, decreased mentation
- Possible causes of ineffective contractions include:
- maternal fatigue
Fluid and Electrolyte imbalance
Excessive analgesia or anesthesia
Disportportion of maternal pelvis and the fetal presenting part
- FETAL HYPOXEIA IS NOT USUALLY SEE IN HYP______TONIC DYSFUNCTION
- aMINOTOMY OR OXYTOCIN AUGMENTATION MA BE USED TO STIMULATE ________ THAT SLOWS AFTER ITS ESTABLISHED
- Oxytocin is not given in someone who is experiencing Hyp____tonic contractions
- Hypotonic in the _______ phase while Hypertonic in the ______ phase
- During hypertonic contractions, _______ drugs may be ordered to reduce uterine resting tone and improve placental blood flow.
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