OB Exam 1; 139 cards; WSU CON N416 Exam 1 material

Labor

cervix is changing

2.

Dilation

opening of cervical os. Occurs more quickly in

multiparous, more quickly if rupture of membranes.
Measured in cm. Approx 10 cm the cervix cannot be
palpated (complete dilation)

3.

Effacement

drawing up of lower uterine segment. measured prior to

labor in primiparous, with labor in multiparous. Measured
in percentages

4.

Passsage

Path fetus takes to get out of uterus. Affected by pelvis

shape, soft tissue and condition of bony parts (has the
pelvis been broken, coccyx position)

5.

Gynecoid pelvis

most common pelvis shape, more round diameter,

favorable for birth

6.

Anthropoid pelvis

Long and narrow, oval shaped inlet, second most

common, favorable for birth

7.

Platypelloid pelvis

flat and wide

8.

Android pelvis

Heart shaped opening

9.

Passsenger effects on
birth

size of fetus, presenting part, size/shape of head and it's

ability to mold

10.

Fetal lie

axis of fetus to axis of mom, longitudinal or transverse

11.

Fetal attitude

Relationship of fetal parts to one another (flexion of head)

12.

Fetal presentation

determined by fetal lie and body paret of fetus that enters

pelvic passage first, presenting part

13.

Vertex presentation

Normal presentation, fetal head is flexed, occiput presents

14.

Military presentation

Fetal head in neutral position, top of head presents

15.

Brow presentation

fetal head partially extended, occiptomental diameter

(largest diameter of fetal head) present to pelvis

1.

16.

Face presentation

Fetal head completely extended, face is presenting part

17.

Complete breech
presentation

legs in "C shape", fetal knees and hips flexed, buttocks

and feet of fetus present to pelvis

18.

Incomplete breech
presentation

fetal hips and legs extended, one or two feet present

19.

Frank breech
presentation

Fetal hips flexed and knees extended, legs straight up.

Buttocks present to pelvis

20.

Compound presentation

when one arm prolapses alongside presenting part

21.

External version

turning baby from outside to better delivery position

22.

Fetal engagement

when the largest diameter of the presenting part reaches or

passes through the pelvic inlet. Baby "dropping", comes
down into pelvis. Occurs earlier in primiparous patient (2
wks before term), occurs in labor with multiparous

23.

Station

relationship of the presenting part to an imaginary line

drawn between the ischial spines of the maternal pelvis.
How far down in the pelvis the fetus is

24.

Measuring fetal station

Narrowest diameter is at the inlet (marked 0). Negative

numbers above ischial spines, positive numbers below
ischial spines.

Fetal position

How fetus enters pelvis. Determined by R or L side of

maternal pelvis, landmark of fetal presenting part
(Occiput--O, mentum--M, sacrum--S, acromion process-A) and anterior--A, posterior--P, or transverse--T

25.

26.

27.

28.

Easiest fetal positions to ROA, then LOA. Posterior is difficult to deliver because
deliver
bony part of head puts pressure on mother's sacrum
Contractions

Intermittent, should not be longer than 90 sec, should not

average more than 5 in 10 minutes

Monitor only measure freqency, not how hard the

contractions are. Count for 30 min, divide by 3 to get
Measuring contractions
number of contractions in 10 minutes (should not exceed
5).

Contraction intensity

Subjective: externally measured (mild/mod/strong).

Objective: internally measured by mmHg
Resting tone (between contractions) also measured

30.

Ferguson's reflex

uncontrollable urge to push that occurs at ~2+ station (2

cm below ischial spines). Occurs because of nerve tissue
in the vagina that feels pressure. Epidural intereferes with
this perception

31.

Open glottis pushing

follows instinct, results in better outcomes, evidence based

32.

Closed glottis pushing

holdng breath and bearing down. Not evidence based, can

cause tearing and bruising of cervix and maternal
exhaustion.

33.

Psychosocial factors of
labor

education, support, fear, anxiety, personality, previous

experiences (childbirth, sexual hx), control issues, life
changes, all affect attachment/parenting

34.

Causes of labor

Progesterone withdrawal, prostaglandin increase causes

contractions, corticotrophin releasing hormone (CHR)
increases prostaglandin production, uterine stretching,
fetal hormone production, pressure of presenting part,
sexual intercourse, impatience

35.

Contractions increased
by..

dehydration, prostaglandins, oxytocin

36.

Real labor

cervical change, membranes rupture, bloody show, felt

lower in abdomen

37.

False labor

everyone has this! Activity changes, comes and goes,

tends to be irregular, felt higher in abdomen, relaxation
decreases

Bloody show

Mucus plug expelled because cervix begins to dilate,

surface capillaries breaking causes blood-tinged
discharge, a sign that labor will occur within 24-48 hrs

How membranes
rupture

can occur without contractions (PROM--premature

rupture of membranes), SROM--spontaneous rupture of
membranes, AROM--artificial rupture of membranes (use
a hook, method of labor induction)

29.

38.

39.

Amniotic fluid

early in pregnancy the placenta produces fluid. later when

fetal kidneys can function (16th week) the fetus produces
urine. Should be clear or a little yellow. Green may
indicate fecal matter

41.

Lightening

fetus begins to descend and settle into the pelvis. Women

may find it easier to breathe, but may cause discomfort
(increased pelvic pressure, urinary frequency, vaginal
secretions)

42.

Braxton Hicks
contractions

irregular, intermittent contractions that occur throughout

pregnancy before the onset of labor.

43.

Signs of impending
labor

Lightening, braxton hicks, mucus plug, bloody show,

ROM, burst of energy, backache, diarrhea because of
catecholamine rush, weight loss

40.

44.

Cardiac output response CO increases, BP rises during uterine contractions, may be

to labor
further increased during pushing.

45.

Decreased output because of dehydration and decreased

blood flow to kidneys. Increase in renin and
Renal response to labor
angiotensinogen. Bladder and urethra may be compresed,
retention issues exacerbated by epidural.

46.

GI response to labor

decreased motility, eat things that are easy to digest prior

to labor, people may throw up around 6 cm dilation if
there is a lot in their stomach

47.

WBC response to labor

WBC increases 25,000-30,000/mm3, body interprets labor

as an inflammatory response

48.

Blood glucose response

to labor

blood glucose levels decrease because NPO and energy is

being used. Lower insulin requirement for diabetic
patients

49.

Respiratory response to
labor

Hyperventilation leads to respiratory alkalosis. Holding

breath to push leads to metabolic acidosis.

50.

Stage one: phase one

Latent, 0-3.9 cm dilation, 5-9 hrs. Contractions are mild,

frequency 3-30 min, duration 20-40 sec. Fear, relief,
talkative, excitement.

Stage one: phase two

Active, 4-7.9 cm dilation. Contractions frequency 2-5 min,

duration 40-60 sec, moderate-strong intensity. Decreased
ability to cope, increased anxiety, partner fearful and
helpless

52.

Stage one: phase three

Transition, 8-10 cm dilation, shortest phase of labor.

Contractions frequency 1.5-2 min, duration 60-90 sec,
strong, slowing near end. Fear, withdrawal from
surroundings, irritable and apprehensive, inability to
focus, tired, crying

53.

Labor stage two

pushing until baby is out. Expulsion 10 cm dilation to

birth. Contractions 60-90 sec, strong.

54.

Stage two phase one

Latent, contractions slow down, regains control, rests.

Short lived

55.

Stage two phase two

active pushing, Ferguson's reflex, urge to push is

overwhelming w/o regional anesthesia

56.

Labor stage three

birth to placenta, completed within 30 min. Sign of

separation=umbilical cord gets longer.

57.

Labor stage four

Recovery. 2-4 hr.

58.

Episiotomy

No evidence supports use, increases tearing, poor healing,

bleeding and infection. Indicated to expedite delivery

59.

1st degree laceration

Fourchette, perineal skin and vaginal mucosa

60.

2nd degree laceration

fourchette, perineal skin, vaginal mucosa, plus underlying

fascia, muscles of perineum

61.

3rd degree laceration

fourchette, perineal skin, vaginal mucosa, underlying

fascia, muscles of perineum, involvement of anal
sphincter

62.

4th degree laceration

fourchette, perineal skin, vaginal mucosa, underlying

fascia, muscles of perineum, involvement of anal
sphincter, tear through rectal mucosa into the lumen of the
rectum

63.

Who is at risk for an

anal laceration?

Older, white, longer gestation, larger baby, OP position,

operative delivery, episiotomy, stretch marks

51.

64.

Cephalohematoma

Collection of blood between the surface of a cranial bone

and the periosteal membrane. Doesn't cross suture, goes
away in 2-3 wks

65.

Subgaleal hematoma

bleeding above periosteum, can extend throughout scalp

and into neck. Baby can die

66.

Caput succedaneum

scalp edema, reabsorbed in 12 hrs, cone head from vaginal

birth

67.

Cardinal movements

Descent, flexion (tuck chin), internal rotation (to fit head

sideways through pelvis), extension (under pubic bone),
restitution, external rotation, expulsion. Damn Fools in
Rotterdam Eat Rotten Egg Rolls Everyday

68.

Fetal assessment

Continuous for high risk, Q 15 min during active labor, Q

5 during stage 2

69.

Cervical assessment

as infrequently as possible. Observe blood/fluid/condition

of perineum. Check for effacement, dilation, presenting
part, station, look at glove.

70.

When is it ok to
induce?

Post term (41+ wks), medical issues with mom or baby,

obstetric issues, elective only after 39 weeks

71.

Risk of induction

Cesarean birth, accidental preterm birth, uterine

hyperstimulation leading to fetal complications, abruption
or uterine rupture. umbilical cord prolapse

72.

Cervical ripening

Method of induction to soften cervix, break down collage.

Use misoprostol (cytotec) insert vaginally, dinoprostone
vaginal inserts

Induction methods

oxytocin (Pitocin) cervical ripening, amniotomy,

membrane stripping (finger through closed cervix),
mechanical methods (urinary catheter to stretch cervix
open)

Cesarean risks

Major abdominal surgery (could nick bowel/bladder),

future childbearing potential (50% more likely to miscarry
next pregnancy), future implantation problems (risk of
placenta previa), risk of hysterectomy & uterine rupture,
maternal mortality rate.

73.

74.

75.

Labor support

Touch, massage, heat (use carefully), birthing balls,

hydrotherapy

76.

Epidural options

continuous by pump, boluses, PCA boluses, spinal

epidural (less motor blockage), epidural narctoic analgesia

77.

Epidural side effects

Hypotension, inability to void (urinary stasis), inability to

move. Less common: high spinal (can stop innervation to
diaphragm, stop breathing), spinal headache, inadequate
block, neurological problems, positional injuries, delayed
gastric emptying, longer labor if before 4 cm dilation,
infection.

78.

Epidural effects on
newborn

delayed breast feeding, bupivicaine & fentanyl in cord

blood (changes upper body tone, depresses primary
reflexes, adaptive responses decreased)

Epidural positives

reduces catecholamine production, improving uterine

efficiency, allows for rest, reduces support needed, allows
for more provider control

80.

Epidural nursing
responsibility

education, prep (assessment of mom and fetus, equipment,

fluid bolus, positioning), support during placement,
monitor for side effects, pain assessment, labor progress
assessments, positioning, bladder maitenance (straight
caths better)

81.

Nulliparous

never given birth to a baby greater than 20 weeks

gestation

82.

Primiparous

been pregnant once beyond 20 weeks

83.

Multiparous

has given birth before to a baby greater than 20 weeks

gestation

84.

Grand multiparous

>6 deliveries

Dystocia

"dificult labor". Prolonged labor can only occur in active

phase. Caised by failure to progress, stress/pain,
dehydration, old uterus, passenger (too many, too big),
passage (doesn't fit, poor presentation, something in the
way), PROM

79.

85.

86.

Labor augmentation

already in labor, going to increase progression. When

inadequate contractions exist (hypotonic labor, less than 3
in 10 min, less than 25 mmHg), Pitocin titrated until 5
contractions in 10 min

87.

Hypertonic
labor/tachysystole

Too many contractions. Most common cause is impatience

with labor induction, often drug induced. Risks are
maternal exhaustion, trauma (mom and baby),
deteriorating fetal status (hypoxia), precipitous delivery

88.

Nurse tachysystole
interventions

hydration, comfort measures, terbutaline (bronchodilator

that relaxes smooth muscles, slows contractions), sedation
in latent phase

Precipitous labor

lasting less than 3 hours, rapid delivery. Injury to mom,

(bruising, risk of 4th degree laceration), injury to baby
(shoulders get stuck, bruising). Keep environment calm,
support

90.

Post term pregnancy

After 42 weeks, caused by errors in dating, primagravida

(first pregnancy), >35 yrs old, anencephaly, male gender
fetus. Risk of placental aging, fetal wasting, perinatal
mortality (increases 6x after 43 wks)

91.

Macrosomia

large baby, >4 kg (8.82 lbs), can only dx after delivery.

92.

Macrosomia causes

post term, male gender, large partents, grand multiparity,

maternal DM

93.

Macrosomia problems

Fetal and maternal trauma, cesarean, shoulder dystocia

94.

Nonreassuring fetal
heart rate

Normal fetal HR 110-160. Abnormal fetal heart rate or

rhythm on electronic monitoring, suggesting fetal
ischemia, fetal distress

95.

Interventions for fetal

airway

POISON! Position change (get pressure off umbilical

cord), Oxygen (8-10 L non rebreather mask), IV bolus (1
L, increase CO, increase bloodflow to fetus), Stop
contractions (terbutaline), Off pitocin, Notify provider

96.

Abruption

separation of placenta from uterus prior to delivery of

fetus, complete or incomplete.

89.

97.

Abruption causes

HTN, drugs (cocaine, meth), rapid uterine decompression,

over distended uterus, short umbilical cord, uterine
fibroids or scarring, smoking, trauma.

98.

Abruption S/S

Hypteronus (too many contractions, uterus doesn't relax),

elevated resting tone, firm abd, with or without pain, dark
bleeding, NR FHR, shock (late)

99.

Abruption interventions

Rapid response! Hydration, cesarean, hemorrhage can be

massive, resulting in DIC

Placenta previa

placenta covers all or part of the cervical os, implanted in

the lower uterine segment. Complete (os totally covered),
partial (partially covered), marginal. After delivery, will
lose more blood because there are fewer muscles to clamp
down in lower uterine segment.

100.

Grand multiparity (scarring from previous pregnancy),

101. Placenta previa causes previous uterine surgery, previous hx, >35 (more fibroids,
drier uterus), smoking

102.

Placenta previa S/S

No pain, bright red bleeding, ultrasounds tell early where

placenta is, NR FHR, first bleed with early dilation, then
second bleed

103.

Prolapsed umbilical
cord

umbilical cord presents in front of fetal presenting part

104. Prolapsed cord causes

Can occur with ROM (cord washes out before baby), most
often iatrogenic (pushing too hard on present part, ROM
too soon), malpresentations

105.

Prolapsed cord
interventions

Keep fingers in vagina pushing hard on presenting part

until baby can be delievered via cesarean. Use gravity to
keep baby in, knee-chest position (butt in air) or
Trendelenburg position.

106.

Polyhydraminos

Too much amniotic fluid, stretches amnoitic sac, increases

likelihood of PROM and preterm labor.

107.

Polyhydraminos
interventions

Ultrasound to determine cause, reductions to remove

excess amniotic fluid.

108.

Oligohydraminos

Too little amniotic fluid. Causes: maternal dehydration,

fetal kidney problesm. Dries out umbilical cord, skin, lung
and joint problems. Do amnioinfusion with intrauterine
catheter

109.

Mutliple gestation

Increases risk of entanglement, prolapsed cord, some may

not descend. Risk of PROM and UTI. Have delivery in
OR, prepared for emergent cesarean.

110.

Cephalo pelvic
disproportion

CPD, fetus size and pelvis shape are not compatible

111.

Shoulder dystocia

difficulty delivering shoulder.

Shoulder dystocia
interventions

McRoberts maneuver (mother brings knees up to

shoulders), suprapubic pressure to dislodge baby shoulder,
reposition to hands and knees, direct rotational maneuvers.
May need to bush baby back into uterus (Zavanelli,
cephalic replacement, high morbidity and mortality) or
break clavicle. Symmphysiotomy (breaking pubic bone) is
rare in the US

112.

113.

Shoulder dystocia fetal Asphyxia, brachial plexus injuries, clavicle and humerus
risks
fractures

114.

Shoulder dystocia
maternal risks

Hemorrhage, lacerations

115.

VBAC benefits

shorter recovery, fewer morbidities/mortalities,

satisfaction, maintain reproducive capacity.

116.

TOLAC

Trial of Labor after Cesarean. Not done often because

staff has to be immediately available during entire labor,
easier to do a repeat cesarean, fear of uterine rupture.

Placenta

exchange of gasses and nutrients through membrane

which covers chorionic villi. Placental blood flow
enhancesd by normal maternal BP and non-compromised
vena cava flow.

117.

118.

119.

120.

121.

122.

Placenta function

Hormone production to maintain pregnancy, placental

membranes control transport of substances (facilitated
diffusion requires carrier molecule, high to low
concentration), active transport against gradients (glucose,
amino acids, Ca, Fe, vitamins), pinocytosis (engulfing),
delivery system of O2 and nutrients to fetus.

Umbilical cord

the weakest link. One vein carries oxygen/nutrient rich

blood from placenta to fetus. Two arteries carry fetal
blood to the placenta to cappillaries of the villi. Wharton's
jelly protects vessels and BP keeps vessels open.

Fetal circulation

umbilical vein (rich O2 and nutrients) shunt around liver

via ductus venosus then into IVC, then R atrium to L
atrium via foramen oval (bypasses lungs), L ventricle,
aorta, fetal body. From SVC to R atrium, R ventricle,
pulmonary artery to aorta via ductus arteriosus back to
placenta

Ductus arteriosus

Shunt between pulmonary artery and arota. Kept open by

prostaglandins from placenta and low O2 saturation.
Increased PO2 stimulates constriction of the ductus
arteriosus. Functional 15 hrs, permanent 3 wks.

Fetal oxygenation

Maternal O2 diffuses from PO2 of 50 to fetal PO2 of 3040. Fetal Hgb carries 20-30% more O2 than adult. Higher
O2 carrying capacity, more RBC, higher CO due to higher
HR

primitive alveoli at 24-28 wks. Cells differentiate into type

1 and type 2 cells. Type 1 cells secrete liquid to keep lungs
moist (helps growth) Cl secreting (later Na absorbing), 5
123. Fetal lung development
cc/kg/hr. Type 2 cells synthesize and store surfactant
(peaking after 35 wks). Full term lungs stop fluid
production, absorb.

124. Initiation of breathing

Cold stimuli at birth=first breath. Negative intrathoracic

pressure at expulsion, transitory asphyxia increases
respiratory center (caused by cord pinching during
descent)

125.

Foramen ovale

126. Delayed cord clamping

Hold between atria, kept open by increase right atrium

pressure, kept open by flow from placenta. Increased
pressure in L atria as pulmonary blood flow begins
(sudden volume from lung pressure), closes foramen
ovale. Functional 1-2 hrs, permanent 6 months.
Wait until cord stops pulsing to clamp, milk cord, hold
neonate below level of uterus. Prevents need for
transfusion.

127.

Ductus venosus

shunt around liver, kept open by placental blood flow, no

flow when cord is clamped (can be opened if necessary in
a few hrs after birth for IV infusions), fibrotic by 2
months.

128.

Newborn respiration

40-60/min, count for 60 seconds. Abd and chest rise

synchronously. <20 seconds without breathing is normal,
no breathing for >20 sec is apnea. Obligate nose breathing

129.

Symptoms of NB
resipiratory distress

Retractions, nasal flaring, central cyanosis, persistent

tachypnea, expiratory grunting.

TTN

Transient tachypnea of the newborn, failure to clear

airway, lung fluid. Early onset of respiratory distress.
Nippling contraindicated when RR>60 at rest. Clears by
72 hrs, occasionally need IV fluids & O2.

130.

131. Fist actions after birth

Stabilize. Dry! Breathing, HR, gross assessment for

anomalies. Apgar scoring

132.

Apgar scoring

At 1 & 5 minutes of life, if score is 7 or below continue

every 5 min. Useful as a measure of response to
resusciation, not predictive of future problems.

133.

HR apgar score

Absent (0), <100 (1), >100 (2)

134.

Respiratory effort apgar

score

Absent (0), irregular (1), regular or crying (2)

135. Muscle tone apgar score

136.

Reflex irritability apgar

score

Flaccid (0), some flexion (1), active or flexed (2)

None (0), grimace (1), vigorous reponse (2)

137.

Color apgar score

Pale blue (0), centrally pink/extremities blue (1), pink (2)

138.

Early assessments

Weight, head, chest circumference, blood glucose if

indicated, length, birth trauma (clavicles)

139.

Early interventions

Brestfeeding if indicated, Vit K injection, eye infection

prophylaxis. Can delay these up to 1 hr.

N416-2
Study online at quizlet.com/_8emnw
What did electronic fetal monitoring have an
1
effect on in pregnancies
2 does fetal monitoring improve fetal outcomes
3 what does fetal monitoring tell us?
4

how much IV fluid bolus do we give if there is a

problem with fetus?

5 fetal strip interpretations

6 contraction pattern frequency,
7 contraction pattern duration
8 contraction pattern intensity
9 most frequent cause of tachysytole
10 decreased contractions causes
11 fetal heartrate baseline
12 preterm baby heart rate is
13 post term baby heart rate is
14 causes of fetal tachycardia
15 what do we not give as an antipyretic?
16 causes of fetal bradycardia
17
18
19
20

measuring variability
causes of decreased variablility
interventions for decreased variability
abrupt change in FHR

21 gradual change in FHR

22 prolonged change in FHR

23 variable decelerations are not to be confused with
24 early decelerations
25 late decelerations
26 variable decelerations
27 nursing intervention for variable decelerations
28 prolonged deceleration
29 ultimate compression of cord compression
30 VEAL-> CHOP
31
32
33
34
35

1st trimester
2cd trimester
third trimester
definition of survive of preterm baby
full term babies is until

36 new acronym for apgar

37 definition of postpartum hemmorrhage
38 best prevention of postpartum depression
39 tebutaline
40 magnesium sulfate
41 Maternal risks associated with PROM
42 Fetal risks associated with PROM
43 Cervical insufficiency
44 What do we do if there is a PROM
45

Labor that occurs between 20 and 36 weeks of

pregnancy

46 what to look for when patient is on mag sulfate

47 calcium channel blockers that stop contrations

48

Why do we need to teach patients to recognize

preterm labor symptoms

49 Common symptoms of preterm labor

50 never give ___ and __ together
Fibronectin found in high amounts during 22-37
51
weeks means, or positive fFN test
52 Tocolysis is
53 Side effect of tocolysis
54 Symptom of preterm labor

55 Early signs of twins

56 high risk for preterm babies
57 Hyperemesis gravidarum
58 What happens when you have hyperemesis?
59 Therapy for hyperemesis
60 17P is indicated for

61 how does 17P work

62 PPROM
63 cause PPROM
64 risk factors for PPROM
65 treatment of PPROM
66 decision to deliver
67 chronic hypertension
68 gestational hypertension
69 BP in gestational hypertension
70 pre eclampsia
71 mild pre-eclampisa

72 severe pre-eclampsia
73 what you see in sever pre eclampsia
74 eclampsia
75 treatment for pre eclampsia
76 HELLP
77 cause of preeclampsia
78 thromboxane
79 HELLP sign and symptoms
80 labs for HELLP
81 pulmonary edema presentation
82 when should a preterm baby eat
83 how much to feel baby in the first few days?
84 newborn responses
85 in the 1st hour to 1.5hr of life babys will be
86 physical assessment standards
87 NIPS pain scale is based off
88
89
90
91
92
93
94
95

pain management in newborns

absence of murmurs at birth does not
hemoglobin in newborn
hct normal
WBW normal for newborn
what do we give that newborns dont have?
vomiting from newborn is because of
meconium needs to be passed in the first
if meconium hasnt been passed what do we worry
96
about
97 milia
98 MCAD screening
99 cord care
100 where to put baby to sleep
101 how many feedings a day for newborn

102 4 ways baby can lose heat

103
104
105
106
107
108
109
110

most likely way to overheat

how to tell if NB is sick?
s/s of infection
IGG come from
IGA
IGM
biggest concern for nurses postpartum
when do we start worrying for temp postpartum

111 normal postpartum pain

112 involution
113 Most common time for postpartum hemorrhage
114 when to message uterus
115 why does early hemorrhage accur
116
117
118
119
120
121

late hemmorage is usually due to

retained placenta
early identification of hemorrhage
what increases risk of pulmonary edema
what are you looking for in breasts
mastatits

122 what is engorgement caused by

123 uterine assesment includes
124 postpatrum assesment
125 bowel assessment
126 bladder assessment
127 how to help people pee
128 lochia assessment
129 what are you looking at with episotmy
130 hematoma signs
131 how accurate is homans sign in identifying clots
132 early interventions for DVT's
133

can circumcision reduce risk of of heterosexual

men getting HIV

134
135
136
137
138
139
140

Does circumcision reduce the risk of other

infections like STI's
postpartum depression has been linked to
what can a pregnant women do to reduce her risk
for postpartum depression
magnesium sulfate can reduce the risk of what in
preterm babies if given before birth
stomach capacity of newborn day 1
stomach capacity of newborn 3 days
stomach capacity day 10

it increased the amount of C sections because we

got more nervous about problems
no, it only improves bank accounts.
current oxygenation of the fetus. doesn't really give
us an idea if the fetus is healthy
500-1000 ml
contraction pattern, fetal heart rate baseline,
variability of the heart rate, changes in FHR
count by 30 mins divide by 3 then you have how
many per 10 mins
easiest way is to count how many little boxes there
are across the contration, each little box is 10
seconds
objective is with machine, subjective is palpating
outside the body
pictocin, placenta abruption, over distention of
uterus
overstretching of uterus, analgesia, fetal
malposition, CPD, chroioamnionitis
average FHR rounded to nearest 5 BPM, normal is
110-160, if you auscultate have to listen for a full
min
higher end of the range
lower end of the range
most likely maternal fever, early fetal hypoxia, drug
induced (ritodrine, terbutaline,
atropine,meth),prematurity, maternal anexiety
asprin
late fetal hypoxia, drug induced (oxytocin,
epidural), cord compression, maternal hypotension,
maternal hypothermia, prolapsed cord, fetal cardiac
dsyrethmias,
measure between peak and trough
drugs, drinking, sleep, hypoxia, acidosis,
premaurity
rule out benign cause, then do usual POISON stuff
a change within 30 seconds of leaving baseline
reaches its extreme in longer then 30 seconds from
baseline

changes that last longer then 2 mins but less then 10

variability
caused by head compression, took longer than 30
seconds to get to the lowest point
lowest point happens after 30 and after the peak of
the contractions
are abrupt, to the lowest point is less than 30
seconds, most common thing we see. have to last
15 seconds, caused by cord compression
position change first! get them off the damn cord
last longer than 2 min and less then 10 min
cord prolapse
Variable- cord, early-> head, Acceleration-> OK,
Late-> placenta
conception through week 12
week 12- 24
24-delievery
leave the hospital with a heart beat
the beginning of the 28th week
shirt- skin color, heart rate, inspirations, reflexes,
tone
saturated pad in less then 15 min, or 1000 cc of
blood loss.
adequate support from family and friends
causes increased heart rate, pulmonary edema, chest
pain, hypotension, not used for long term use
flushing, lethargy, weakness, pulmonary edema, 46gm bolus over 20 mins
Infection, abruptio placentae, hemorrhage, maternal
sepsis.
fetal sepsis, respiratory distress syndrome,
malpresentation, prolapse cord, compression of
cord, premature birth
Painless dilation of the cervix without contractions
dt functional defect of cervix
deliver the baby either by vaginal birth or c section,
maternal corticosteroid admin for baby lungs,
proflacticly treat infection
Preterm labor
check for respiratory sounds, and also look for
muscle reflexes
procardia, side effects with hypotension

So we can stop it as soon as possible before it

progresses past a time when we can intervene
Cervicovaginal fibronectin, abnormal cervical
length, history of preterm birth, presence of
infection
mag sulfate and procardia
High risk for preterm labor
Use of medication to stop labor
Maternal pulmonary edema, fetal respiratory
depression, fetal hypotonia, fetal lethargy
Uterine contractions every 10 min without pain,
menstrual like cramps low, dull backache, pelvic
pressure
Two gestational sacs 5-6 weeks, fundal height to
high for gestation, heart rates differ more than 10
beats per min
people who have had them before
Excessive vomiting during pregnancy
Patient becomes dehydrated
Control vomiting, restore electrolyte balance, iv
fluids administered antiemetics given
pts with previous PTD, 250mg weekly 16-20 wks,
no side effects
Increasing the threshold for stimulation of a
contraction, decreasing the conduction of
contractions, decreasing the number of oxytocin
receptors, and preventing the formation of gap
junctions
preterm premature rupture of membranes
interuterine infections that digest the mucous plug
STI, prior pre term delivery, vaginal bleeding,
smoking, cervical conization
bed rest, watch for s/s of infections, pelvic rest,
seteroids, antibiotics
gestestional age, infection, presence of contractions
had hypertension before 20 weeks gestation
happens after 20 weeks, and does not have
proteinurea.
Systolic higher then 140
dystolic higher than 90
same as gestational with protein in urine more then
200mg
bp 140/90 to 160/110
proteinurea 3gm to 5gm per day

systolic BP over 160, dystolic over 110

proteinuria more then 5gm
pulmonary edema, epigastric pain, impaired liver
function, low platelets, IUGR (intra urterine growth
restriction)
everything with pre eclampsia with seizure
mag sulfate 4gm load 1-4 per hour after, only lower
BP if super high
hemolysis, elvevated liver enzymes, low platelets
totally unknown, lots of theories...
vasocontrictor, bad, thromocytepenia
epigastric pain, nausea or vomitting, weakness,
jaundice,
hemolysis, low platelets
tachypena, dyspnea, cough, apprehension,
decreased o2 sats
within an hour of birth
5-7ml
know that baby will breastfeed better if he can do it
immediately dont take baby away from mom after
birth
wide awake, very conducive of learning
needs to do assessment within first 2 hours of life
facial ecpression, cry, breathing, arms, legs,
alertness
suckling, cuddling, sweets, Tylenol
correlate with normal hearts
15-20g/dl
43-61%
10000-30000
vitamin K so they can make coagulation factors
to much food
24 hours
not enough moucus in the babies probably have
cystic fibrosis
looks like zits but normal
missing enzyme to break down fatty acids for
energy, vomiting can be deadly
leave open to the air, dont use alcohol, and wash
with water when it needs it
on their back
8-12 feedings

convection (air blow), radiation,

evaperation( moisture on baby), conduction (when
baby skin is on something cold)
the heat lamp
decreased temp
sleeping more, poor eating, temp low
GIVEN by mom
found in breast milk, activly eating
made by baby
BP, pulse and respiratory rate.
around 101
cramping/ contractions, perineum going to hurt,
hemorrhoids
when the uterus goes back to normal size and shape
first 2 hours after birth to the placenta
no flow, or not hard fundus
uterus is in shock, maternal stress, always massage
then drugs
infection
going to cause really bad infection
1 pad in 15 mins
pictocin, mag sulfate, terbutaine, pre eclampsia
hard areas, redness areas, nipples, cracking of skin
starts as a clogged duct, prevention is breast feeding
overproduction of milk, ice helps take swelling
down, breast pump will help
where is the uterus is it firm or boggy
Breasts, uterus, bowel, bladder,
obstruction? sounds? last BM? give them a stool
softerner
is she peeing? is there a problem? infection
run water, try peppermint, hand in warm water.. last
resort you cath
whats the color, how much, are there clots and what
size are they
location, color, bruising, stitches
extreme pain and cant get comfortable sitting
50%
getting up and walking, fluid intake, if you think
they have a DVT you get a dopler, notify provider,
elevate the limb, do not message
yes

NO
fatigue
physical activity
cerebral palsy
5-7ml
22-27ml
60-80 ml

OB Exam 2; 150 cards; WSU College of Nursing N416 Exam 2 material

1.

S/S perinatal mood disorder

Mood volatility, loss of control, feeling trapped,

heightened anxiety about baby's safety, delayed feelings
of lov for baby, depressive mood, sadness, diminished
interest in activities, feeling of worthlessness, recurrent
thoughts of death/suicid, >12 of edinburgh postnatal
depression scal

2.

Biological risk factors of

perinatal mood disorders

Hx depression, depressive symptoms during pregnancy,

family hx of dpression, hx of premenstrual dysphoric
disorder (severe PMS), PP blues

3.

Psychosocial risk factors of

perintatal mood disorders

lack of social support, poor/no relationship with father of

baby, stressful lif evens, primiparitiy, adolescence, certain
ethnicities

4.

PTSD after childbirth

Traumatic childbirth, emergent cesarean, forcep or

vaccum extraction, prolapsd cord. Relive the experience,
recurrent nightmares

5.

PP panic disorder

intense fear of harm/harming baby, palpitations,

hyperventilation, sweating, chest pain, difficulty caring
for or leaving baby

6.

PP OCD

intrusive thoughts/images of severe harm to baby, mother

sometimes imagines herself inflicting harm

7.

Nursing care of PP depression

women

Assess risk factors at admission, administer ediburgh

postnatal depression scale evening before discharge, any
woman with score >13 given list of resources, instructed
to slf readminister EPDS scael at one week after
discharge

8.

PP dpression tx

stress reduction, support/help from family friends,

support groups, psychotherpay, medications (SSRIs for
prophylaxis), estradiol to replace estrogen, light therapy

PP psychosis symptoms

Depression, mania, mixed, cycling, suicidal impulses,

hallucinations, delusions, delusion-based
homicidal/infanticidal impulses, disturbances of
consciousness, attention, cognition, perception,
fluctuation of symptoms

9.

10.

PP psychosis risk factors

Hx schizophrenia, bipolar disorder with psychotic

breaks. risk increases with# of prior episodes

11.

PP psychosis management

Hospitalize, constant close observation, supervised visits

with baby

12.

PP psychosis tx

Mood stabilizers, antipsychotics, antidepresssants,

benzodiazepines, ECT to reset mood

13.

PP vital signs

BP should be be baseline (1st prenatal visit), pulse rate

low (decreased volume & cardiac effort, blood loss),
elevated temp to 100.4 normal (worry at 101), pain

14.

PP pain

Cramping/uterine contractions normal (worse after breast

feeding due to release of oxytocin, worse for multiparous
because uterus is stretched out). Premedicate with
ibuprofen. Perineum/incisional--ice packs

15.

Involution

utuerus returns to normal size/shape, cesarean may go

faster.

16.

Fundal assessment

midway umb/pubis, then relaxes to the umbilicus,

decreases 1 fingerbreadth per day after 1st day.

Lochia

How much? Color & odor. Rubra through day 3, serosa

day 3-10, alba day 10...Shedding of decidua (skin cells,
mucus, blood), primarily blood from implantation site.
Watch for clots (size, tissue?), document Q 15 min

PP breast assessment

Palpate for hard/red areas (mastitis), reddened areas

(inflammed ducts) visualize nipples for poor latching
(creasing, chapping, bleeding, blisters, inverted nipples,
swollen breasts), teaching moment about self breast
exams. Milk comes in 2-3 days

19.

Mastitis

Often starts as clogged cut, prevention is key, fully empty

ducts, avoid milk stasis, don't constrict breast tissue
(underwire bras), position change for baby during
nursing. Antibiotics are safe, can still breastfeed with
mastitis. May become abscess if not treated

20.

Breast engorgement

Overproduction. Ice decreases pressure and milk

production. Breast feeding may be impared (nipple
disapears)

17.

18.

PP uterine assessment

Where in relationship to umbilicus (document as above

or below, midline or to side). Firm=well contracted.
Boggy=filling with blood, 2 hand massage, look for
reason. Shape

PP bowel assessment

Obstruction or ileus a risk for cesarean. Bowel sounds.

Don't expect stool for awhile, give stool softener,
reassure that she won't "rip open". Encourage ambulation
to reduce gas pain

23.

PP bladder assessment

Risk for infection (stasis, dehydration during labor,

frequent caths, indwelling cath). Risk for injury (bladder
full or indwelling cath at delivery). Watch amounts
(diuresis normal, may be postponed with pitocin),
measure first two voids. Can she ambulate? Running
water, hand in warm water, peppermint spirits to help
pee. Last resort is catheterization

24.

PP episiotomy or incision
assessment

Size, tissue type, edges, exudate, periwound skin,

infection, pain (Some Times Elephants Eat Pizza In Pjs)

25.

Cleansing incision

Abd/perineum continuously, shower when possible, linen

change

26.

Incision care

Staples out in 24-48 hrs, steristrips, episiotomy stitches

dissolve, open air to help heal stitches

27.

PP DVT

Assessment: redness in calf, heat, Homan's sign (50%

accurate). Ambulation, fluid intake to prevent. DO NOT
massage when DVT suspected, heparin therapy

28.

PP emotions

Attachment, interaction with others, infant cares. Parents

attach early in pregnancy and bond at birth. Babies attach
at delivery, bonding develops over time

29.

PP rest

Rest when newborn rests. Restless leg syndrome and

anemia contribute to poor sleep

30.

PP activity

Social time, family centered care, encourage movement,

exercise.

31.

PP nutrition

Good time to change bad eating habits.

21.

22.

32.

PP health promotion

Rubella immunization (can't give during pregnancy

because it is a live vaccine)--wait one cycle to get
pregnant again. Flu vaccine any time during pregnancy.
Get pertussis during 3rd semester.

33.

PP follow up phone call

Prevent smoking relapse, increase breastfeeding duration,

dcrease pp depression

34.

BUBBLE HER VAN

Breasts, uterus, bowel, bladder, lochia,

episiotomy/incision, homan's/DVT, emotions, rest, vitals,
activity, nutrition

35.

Laceration hemorrhage

Constant trickle, flow not affected by massage,

36.

Uterine atony

#1 cause of PP hemorrhage. Flow increases with

massage, uterus feels boggy,

37.

Retained placenta hemorrhage

firm but lots of flow with massage

38.

Bladder caused hemorrhage

Filling bladder pushes uterus up out of pelvis, fundus felt

above umbilicus or deviated to right or left. Uterus can't
contract, straight cath

39.

Hemorrhage actions

Empty bladder, massage, drugs, intervention. Pitocin IV

(usually already hanging), misoprostol/cytotec (800 mcg
rectally, bronchoconstricts don't use with asthma),
methergine (can't give to hypertensive pt, given IM,
causes severe cramping), hemabate (makes mom very
sick, N/V, diarrhea, delays milk) Reassess!

40.

CV changes in PP

Cardiac output decreases (less volume). Body tries to get

rid of fluid accumulation with masive diuresis (kidneys,
third spacing/edema, diaphoresis).

41.

PP bladder issues

May not feel urge to pee with epidural (bladder stretches

a lot!), stretching of tissue in lower pelvis further inhibits
sensation. Swelling of tissue around urethra.

Corks

Pieces of tissue or blood clots that block blood escape

from uterus. Uterus fills up and cannot contract (atony).
Aggressive massage to push cork out, expect gush
behind cork.

42.

43.

Early hemorrhage

within 42 hrs. >1 saturated pad in 15 min. Caused by

uterine atony or partial atony. Uterus "in shock" (large
baby, long labor, manipulation, overuse, maternal stress
response to chaotic birth). Massage, drugs, bladder

44.

Hemorrhage surgical
intervention

Dilation and curretage (scrape wall of uterus to remove

placental fragments), hysterectomy (risky due to current
blood flow), uterine artery embolization

45.

Late hemorrhage

After 24 hrs. Increased flow, returns to bright red, odor.

Infection--most likely patient is Cesarean, too many
cervical exams during labor, prolonged ROM without
pelvic rest, treat with antibiotics. Retained placenta-dilation and curettage & antibiotics

46.

Cesarean post partum

Not likely to have retained placenta, more likely to

hemorrhage, increased risk for clots, delayed milk
production, diuersis quickly.

47.

Pulmonary edema risk factors

Pitocin, magnesium sulfate, terbutaline, pre-eclampsia.

Assess lungs

48.

PP hematoma

Extreme pain, can't get comfortable. Visualize area of

concern, could be in perineum or vagina. Can
hemorrhage large amts (1700 cc).

49.

Hematoma tx

Stop bleeding, drain and cauterize. ice, lots of pain meds

50.

Rhogam

turns off the production of antibodies. Coombs test

determines presence of antibodies in baby, how much
Rhogam is needed? Direct test done on newborn to detect
antibodies. Indirect test done on mom to determine if
antibodies exist, at 1st prenatal visit and again at 28 wks

51.

Four steps to interpret EFHR

strips

Contraction pattern, fetal baseline HR, variability,

periodic changes

52.

Contraction frequency

Average contractions in 10 min window over 30

min...count for 30, divide by 10

53.

Contraction duration

measured from the beginning to the end, in seconds

Contraction intensity

relative strength of contractions, expernal monitoring is

subjective, nose=mild, chin=moderate, forehead=strong).
Internal is the only accurate way, pressure range from 50100 mmHg peak.

55.

Tachysystole

>5 contractions in 10 minutes. Most common cause is

Pitocin administration. Other causes: abruption, uterine
overdistension, pregnancy associated BP changs, drugs
(prostaglandins, beta blockers, ilicit drugs)

56.

Terbutaline

tocolytic to relax uterus. Give 0.124-0.25 mg SQ, beta

mimetic. Side effect is tachycardia

57.

Decreased uterine activity

Insufficiently intense or frequent to achieve cervical

dilation or fetal descent. Causes: overstretching of uterus,
analgesia, CPD, malpresentation/malpostiion,
chorioamnionitis (infection inside uterus), anxiety

58.

Decreased uterine activity

interventions

Decrease anxiety, provide comfort measures, notify

provider, last resort is augmentation

59.

Baseline FHR

Average FHR rounded to nearest 5 bpm, excluding

accel/decels. Auscultation count for 1 min. Normal 110160, pre-term wil be higher, post-term will be lower

60.

Fetal tachycardia

Causes: infection, maternal fever, early fetal hypoxia,

drug induced, prematurity, maternal anxiety or
hyperthyroid, fetal infection, movement, stimulatoin,
cardiac arrhythmia, amniocentesis, heart failure.

61.

Fetal tachycardia interventions

Check maternal temp. POISON

62.

Fetal bradycardia

Late fetal hypoxia, drug induced (hypotensive mom,

shunts blood away from uterus, compensatory
mechanisms run out), prolapsed cord, fetal cardiac
dysrhythmias, prolonged maternal hypoglycemia,
cytomegalovirus, abruption, uterine rupture, second stage
bradycardia=vagal response.

63.

Fetal bradycardia interventions

Improve oxygenation, POISON. Correct hypotension if

present, cervical exam for prolapsed cord to pressure on
head.

54.

64.

Variability

fluctuation in FHR above or below, must be looked at

over 10 min. Determines health of CNS function.

65.

Absent FHR variability

Difference is undetectable, straight line

66.

Minimal FHR variability

difference is greater than undetectable but less than or

equal to 5 bpm

67.

Moderate FHR variability

Range of 6-25 bpm, normal.

68.

Marked FHR variability

differences greateter than 25 bpm, can't tell what baseline

is.

69.

Causes of less than moderate

FHR variability

FETAL SLEEP, DRUG INDUCED. Hypoxia or acidosis,

extreme prematurity (CNS not matured), fetal cardiac
arrhythmias, congenital anomalies (CNS or cardiac)

70.

Interventions for decreased FHR

variability

Rule out benign cause (sleep, meds), then POISON

71.

Abrupt

a change in rate that reaches its highest or lowest point

within 30 sec of leaving baseline

72.

Gradual

change in rate that reaches its extreme in longer than 30

sec of leaving baseline

73.

Prolonged

any change in rate that lasts >2 min but <10 min

Acceleration

an abrupt increase in FHR (to peak in <30 sec) above the

baseline. Highest point is >15 bpm above baseline and
lasts >15 sec. Indicates well oxygenated brain and heart.

Early decelerations

Gradual decrease (to lowest point > 30 sec) and return to

baseline FHR associated with a contraction. Lowest point
of decel at same time as peak of contraction. Cause is
head compression. Not concerning

Variable deceleration

An abrupt decrease (lowest point <30 sec) in FHR below

baseline. Has to drop 15 bmp and last 15 sec. Most
common thing we see. Can occur with or without
contractions. Cause is cord compression. Position change
is prioritiy, cervical exam for prolapse, then POISON

74.

75.

76.

Late decelerations

A gradual decrease (to lowest point >30 sec) and return

to baseline FHR associated with uterine contraction.
Lowest point of decel occurs after peak of
contraction. Uteroplacental insufficiency, fetus is
decompensating, not getting enough O2 to cope with
contractions, not fully recovering. POISON

78.

Prolonged deceleration

A visually apparent decrease in FHR below the baseline.

Decrease >15 sec, lasts >2 min, <10 min. Can occur with
or without contractions. Many causes (cord compression,
maternal hypotension, titanic uterine contractions,
maternal hypoxia, rapid fetal descent, pelvic exam,
application of spiral electrode, sustained Valsalva).
Nursing interventions POISON and cervical exam.

79.

Recurrent/repetitive decels

Occur with equal to or greater than 50% of uterine

contractions in any 20 min segment, intermittent

80.

VEAL CHOP

Variable decel---cord, Early decel---Head,

Acceleration----OK, Late----Placenta

81.

1st trimester

conception through week 12

82.

2nd trimester

end of week 12 through week 24

83.

3rd trimester

end of week 24 to delivery. Fetus is viable

84.

Perinatal

20 weeks gestation through 6 days of life

85.

Neonatal

First 28 days of life

86.

Infant

28-365 days of life

87.

Infant survival

discharged alive

88.

Preterm labor

>20 weeks, <37 weeks. Regular contractions and cervical

change. Combination of environment and genetics.

89.

Preterm labor causes

decidual hemorrhage (tiny abruptions behind placenta),

uterine over-distension, cervical insufficiency, hormonal
changes, bacterial infections

90.

Pre-term labor risk factors

Multifetal gestation or hx of preterm labor/delivery.

77.

91.

S/S preterm labor

Cramps, change in vaginal discharge, backache,

contractions every 10 min or more, intestinal cramping,
pelvic pain/pressure

92.

Diagnosis of preterm labor

Contraction & dilation, cervical changes, presence of

fibronectin ("glue" glycoprotein present until 22 weeks,
many false positives).

93.

Preterm labor tx

Steroids to decrease respiratory distress symdrome (helps

fetal lungs mature with surfactant production & tissue
drying). Betamethasone or Dexamethasone. Broad
spectrum antibiotics for infection

94.

Terbutaline

Tocolytic given for management of preterm labor. SQ

0.25 mg Q 20 min. Worry about pulmonary edema

95.

Decreases frequency and intensity of uterine

contractions, used as a tocolytic. Provides
Magnesium sulfate for preterm neuroprotection (protects against cerebral palsy). 4-6 gm
labor
bolus over 20 min. Overdose is respiratory arrest.
Antidote is calcium gluconate. Monitor for toxicity: CNS
function by reflexes.

Calcium channel blockers for

preterm labor

Nifedipine--30 mg followed by 10-20 Q 4-6 hr. Must be

swallowed. Side effects are flushing, HA, nausea, may
result in hypotension. Magnesium & nifedipine drug
interaction=severe hypotension and motor blockade.

Indomethacin

NSAID used to stop labor up to 32 weeks. 50 mg orally,

followed by 25-50 mg Q 6 h. Side effects are nasuea and
heartburn. Premature closure of ductus arteriosus and
decreased renal function.

17P

Progesterone to relax uterine muscles, indicated for pts

with previous preterm labor. 250 mg weekly starting at
16-20 weeks, give IM once a week. $10/week, only side
effects are injection site irritation.

99.

Cervical insufficiency

Painless dilation of cervix without contractions because

of structural or function defect of cervix. Woman is
unaware of contractions, and presents with advanced
effacement, dilation and possible bulging membranes.

100.

Cervical insufficiency causes

Congenital/cervical/uterine anomalies, LEEP, 2nd

trimester terminations.

96.

97.

98.

101.

Cervical insufficiency tx

Sew uterus shut in early second semester (cerclage).

Frequent vaginal ultrasounds and pelvic rest (nothing
going in vagina)

102.

PROM

Premature rupture of membranes, risk is intrauterine

infection, cord compression.

103.

PPROM

Preterm premature rupture of membranes (before 37

weeks). Caused by intrauterine infection

104.

PPROM management

Modified bed rest, watch for infection, pelvic rest,

steroids less than 34 wks, antibiotics, aggressive
tocolysis x 48 hrs, no cervical exam.

105.

Decision to deliver

Gestational age? Infection? Abruption? Prolapsed cord?

Presence of contractions?

106.

Gestational HTN

w/o proteinuria, after 20 weeks, resolves postpartum.

Systolic >140, diastolic >90

107.

Pre-eclampsia

HTN and proteinuria after 29 wks, systolic >140,

diastolic >90 OR >300 mg protein in 24 hr urine.

108.

MIld pre-eclampsia

140/90 to 160/110, proteinuria 3-5 gm/day, dipstick +2,

+3, output >30 cc/hr or 65 cc/24 hrs. Edema 1+ to 2+,
HA, visual disturbances.

109.

Severe pre-eclampsia

Systolic >160 OR diastolic >110 OR proteinuria >5/24 hr

urine OR 3+ on 2 random urines >4 hrs apart. Oliguria
<500 ml/24 hrs. Cerebral or visual disturbances. Severe
HA. Pulmonary edema, cyanosis, epigastric, RUQ pain,
impaired vision.

110.

Eclampsia

new onset grand mal seizures in woman with preeclampsia

HELLP syndrome

Step beyond severe pre-eclampsia. Hemolysis, Elevated

liver enzymes, low platelet count. 70% in atepartum,
30% postpartum (may develop anytime up to 7 days after
delivery). Causes death (hemorrhage, coagulation
problems, ARDS, acute renal failure, sepsis,
cardiopulmonary arrest. S/S: epigastric/RUQ pain, HA,
weakness, jaundice, hematuria

111.

112.

Magnesium sulfate for preeclampsia

CNS depressant that reduces possiility of convulsion. 4

gm loading dose, 1-4 gm/hr. Will get very lethargic
quickly, toxicity is resp depression, watch kidneys.

113.

Thrombaxane

BAD hormone, vasoconstrictor, stimulant of platelet

aggregation.

114.

Prostacyclin

GOOD hormone, vasodilator, inhibitor of platelet

aggregation.

115.

Placental ischemia

inflammation at time of initial implantation, blood

vessels in placenta dont' grow well, hypoxic placenta
leads to more inflammation and overbroduction of
thrombaxane.

116.

Spasmodic vasospams

increased sensitivity to angiotensin II, blood flow

impeded and blood cells and vessel walls damaged.
Blood flow decreased by 60%, affecting all organs.

Pre-eclampsia S/S

edema, HA, seizure activity, hyperreflexia, blurred

vision, scotomo (temporary blindness), Hgb drops,
swelling liver, RUQ/epigastric pain, elevated liver
enzymes, N/V, platelet aggregations leading to low
platelets and DIC.

117.

118. Hepatic hemorrhage or rupture

Epigastric pain, HTN, N/V, shoulder pain, HA, shock

119.

Pulmonary edema

chronic HTN get this in antepartum, pre-eclampsia get it

in postpartum. Caused by decreased oncotic pressure &
endothelial damage, iatrogenic fluid overload. S/S:
tachypnea, dyspnea, cough, apprehension, decreased O2
sats.

120.

Normal newborn reflexes

Blink, gag, sneeze, grasping, Moro, pain withdrawal

121.

Sleep phase in 1st 24 hrs

No interest in sucking, HR/RR decrease, difficult to

wake, lasts about 4 hrs, will sleep 2-3 hrs normally

122.

Ballard assessment of
gestational age

Done within first 4 hrs, identifieds gestational age related

problems.

Newborn pain management

Pain from heel stick, circumcision, birth injuries. Tx:

suckling, cuddling, sucrose or breastfeeding.

Newborn weight loss

Physiologic weight loss 5-7% due to fluid shifts in first

24 hrs. >7% weight loss indicates need for follow-up.
Back to birth weight by 2 weeks. Double birth weight by
5 months.

125.

Newborn cardiac function

Cardiac workload of LV increased until ductus arteriosus

closes, 90% of murmurs normal transitional events. HR
ranges from 100 (asleep) to 120-160 (awake). BP highest
at birth, lowest at 3 hrs, plateaus 4-6 days. Only check
BP on newborn when O2 sats on arm and leg differ.

126.

Newborn Hgb

15-20 g/dl (higher if chronically hypoxic fetus,

erythropoesis stimulated)

127.

Newborn Hct

43-61 %

128.

Newborn WBC count

10,000-30,000 mm3, elevated from birth stress,

inflammatory response

129.

Newborn blood volume

80-85 mL/kg

130.

Newborn coagulation

Factors II, VII, IX & X are activated by VIt K. Absent

flora in intestine prevents production of Vit k.

Newborn GI adaptation

Term infants have enzymes to digest carbs, fats, protein

(inability to digest stinky poo). Preterm infants have
insufficient pancreatic enzymes and bacteria, don't digest
complx carbs and fats well. Meconium passed by 8-24
hrs, then transition to fecal. If no meconium in 24 hrs
screen for CF> Keep glucose 50-70 mg/dl, worry if
below 40 (affects brain then breathing)

Newborn urinary adaptations

Renal function limited, easily dehydrated. Voiding by 2448 hrs (delayed with pitocin), 2-6 voids per 24 hrs first 2
days, 6+ after. May see rusty color caused by uric acid in
urine.

123.

124.

131.

132.

Acrocyanosis, erythema toxicum (blotchy skin on face,

milia (exposed sebaceous glands), cysts on gums,
133. Common newborn observations obligate nose breathers, face movements symmetrical,
ears at eye level, molding/caput, extra niplles, skin tags,
extra digits.
134.

Brazelton test

Neonatal behavior assessment, consolability, alertness.

135.

Newborn discharge

Oximetry, bilirubin levels, car seat test if <38 wks,

weight.

136.

Newborn safety teaching

Back to sleep prevents SIDS, hand-washing, sick

visitors, car seats, security, bulb syringe available,
prevention of abduction in hospitals, co-sleeping
precautions, holding safety

137.

Newborn meds

Aqua mephyton (Vit K) IM in 1st hr, eye ointment

(erythromycin) in first hr, Hep B vaccine offered, if
mother is Hep B positive, give Hep B immune globin

138.

Breastfeeding

latch check each shift by RN, no schedule (8-12

feedings/day). Support, education. No supplements
unless medically necessary. Post discharge instructions.

139.

Newborn thermoregulation

Cold stress increases O2 consumption and metabolism

which produces heat. Prolonged cold stress results in
depleated glycogen stores, loss of liver function
temporarily and acidosis.

140.

Thermoregulation actions

Immediate drying, skin to skin on mom's sternum, radiant

warmer. Temp maintained btwn 97.7-98.6

141.

Convection

Air current blowing past takes away heat. Think

convection oven (air moving)

142.

Radiation

Heat loss incurred when heat transfers to cooler surfaces

and objects not in direct contact with the body.

143.

Evaporation

Loss of heat incurred when water on the skin surface is

converted to vapor

144.

Conduction

Loss of heat to a cooler surface by direct skin contact

145.

Neonatal heat production

Little or no shivering, skin receptors stimulated by cold

SNS usese brown fat stores to produce heat, increased
metabolism for thermogenesis uses O2.

146.

Newborn immune response

Limited inflammatory response to invasive bacteria. S/S

infection subtle (fluctuating temp, can't maintain temp).

147.

IgA

Found in colostrums (ACTIVELY eating)

148.

IgG

Maternal immunoglobin transferred to baby during 3rd

trimester (GIVEN)

149.

IgM

MADE BY BABY

Newborn shift assessment

More frequent assessments during 1st hours (at least Q30

min till stable, then X2 hrs). Auscultate heart 1 min.
Inspection (rashes, color, behavior). Elimination,
nutrition, pain.

150.

N416-3
1
2
3
4
5
6
7

SGA (smaller than gestational)

percentile
LGA percentile
AGA percentile is
normal glucose for a full term
baby is at least
stress, pain, and surgery do what
to blood sugar?
autonomic regulation for babies
flexed or extended position in
premies

8 skin taking in premies

lungs WOB position
9
oxygenation
10 respiratory distress is the
11

reasons for respiratory distress

in premies

12 new hypothermia therapy

13 kernicterus
14 phototherapy
what is the easiest thing to do to
prevent newborn infection
ductuct artieosis should be
16
closed within
where to place pulse o2 on
17
which foot or hand on babies
18 congenital heart defects
15

19 new sids preventions

20

most drug use in pregnant

women

21 maternal assessment for drugs

22

meth crystals causes what in

preg

less than the 10 percentile

greater than the 90th percentile
between 10-90 percentile
40
increase it
RR and pattern, Heart rate, o2 sat
means that the baby is in motoric stress
sensory, pain, fluid/solutions, eyelids thin unable to
protect
this is where we put babies in frog lay or butt in the air
number one reason we see premies because of lack of
surfactant
alveolar immaturity, lack of surfactant,
ph less then 7, BE-16,and hypoxic insult cool to 34C,
72 hours decrease brain cell death
happens in babies with high billirubin then baby gets
stuck in a body with cerebral palsy or brain damage
done for babies with high bilirubin and need to be
comfortable in the bed and wear eye protection
gel in and gel out
24 hours of age
Right hand or either foot
check upper and lower pulses
back sleep for 32 weeks, no animals in icubators, at
home no bed sharing or sleeping with baby in couch
or chair
cigarets, marijuana,crystal meth
how much did u use before you got preg, how many
doses, how much did you use, how much have you
used.
abruption

23
24
25
26
27

symproms of meth exposed

infants
baby response to mom on
hydrocodone
Goal in premature baby
Hypoglycemia is caused by
what in babies
IDDM

28 Prevention of hypoglycemia

29 Assessing jaundice

30 where do we do heel sticks on?

motor develop low, dont like things touching their

hands or feet, will no look in the eye
curled toes, sleep deprived, GI cramp, increased
movement, sneezing, elevated temp, poor feeding
To mimic their natural environment
Making to much insulin because it is used to doing it
in moms womb and doesn't stop doing it
Insulin dependent diabetic mother
Feed within the first 15 mins of life, and anytime it
gets down to 40 mg/dl always feed with protein not
just sugar
always do it in a bright light, blanch skin over boney
surface do forehead first, look at sclera, describe
where it is seen, will move from head to feet, takin in
number of hours old compared to serum billirubin
the permiter of the foot not in the middle there is a
large nerve
excreated
not excreated we worry about this more

31 conjugated billrubin
32 unconjugated billirubin
anything that effects the amount
33
effects the billirubin
of RBC
if baby doesnt pass stool what
34
their billrubin level
goes up
does oxytocin increase billrubin
35
yes
levels
36
37
38
39
40
41

hypoglycemia, hypoxia, infection, prematurity, cold

stress, hepatitis all cause gluconamal transferase to go
down
more than usual bilirubin reason bruising (more RBC production), polycythemia
physiological jaundice - normal
jaundice three types
pathological jaundice
breastfeeding jaundice- not getting enough milk
normal happens because it isnt being excreted enough,
physiologic jaundice
not until after 24 hours and gone by 5 days usally
who gets higher billirubins
african americans and asians
before 24 hours of age, levels rise very quickly, use
pathologic hyperbillirubin
early photo therapy, sometimes have to do
transfusions, caused by RHI problems
what causes problems with
conjugation r/t birth

42 breastfeeding jaundice

not abnormal, stop breastfeeding for 12 hours and see

if it goes down, onset is after 5 days when the mother
is getting more milk, levels typically dont get to the
point where they are harmful

43 starvation jaundice

not getting enough milk so they need to get more, its

caused by not having enough stools

44 photo therapy lowers what

the bilirubin levels because it causes conjugation to

occur

45 precautions to photo therapy

eye protection, monitor temp, extra fluids every 2

hours breast feeding, rotating skin surfaces, assess
skin after their blood circulates

if high levels arent treated in

bilirubin what happens
do nurses need an order for a
47
blood billirubin
46

48 warning signs of kernicterus

49
50
51
52

good reason for circumcision

things you can do for it
anacephaly
hydrocephalus

53 spinal bifida
all problems that were just
described are prevented by
55 in utero surgeries
54

56
57
58
59

brain damage, the ganglia gets stained and they end up

with cerberal palsy
no
lethargy, poor feeding, high pitch crying, yellow skin
tone, poor muscle tone
cultural religious norm
lidocane, sweeties, suckling
no upper brain
dont shunt their fluid from brain, need to put in shunt
spinal cord is oped to the world when born, can treat
intrauterinly, dont deliver vaginally
folic acid

hypoplastic left heart, obstructed uropathys

intestines outside the abdomen, its a meth thing, and
gastroschisis
they have a 90% success at solving
if mom has diabetes shes at risk polyhydraminos -> PTB, pre eclampsia, increased
for
insulin resistance and ketoacidosis
fetal anomalies, agenesis, macrosomia, polycythemiarisks for diabetes on fetus
hyperbilli, hypoxia, delayed surfactant production
1st trimester issues with type 1 very had to keep insulin and BG requirements met
diabetes
because of throwing up

more glucose is stored so need more insulin, more

2cd trimester issues with type 1
60
fetal growth needs, 24-28 weeks plecenta hormone
diabetes
produced which makes you more resistant
not storing any glucose and they get very low from
activities
62 type 2 and gestational diabetics higher risk at later getting type 2 diabetes
50 g glucose on empty stomach either orange sodish
screening for gestational
63
thing or 28 orange jelly bellys and then wait an hour
diabetes
to see what blood sugar is less then 130-140 is good
61 labor issues with diabetes

64 treatment for type one diabetic

65 treatment for type two diabetic
66 GDM treatment

frequent fetal testing, and they titrate insulin and

glucose during labor, glybulide for baby
use diet, glybulide, testing
same as type two

67

understanding what you need

for diabetes in pregancy

68 infant formula
69 estrogen drops when
70 progesterone
71 prolactin anterior pituitary
72 oxytocin post pituitary
73 WHO recommendations

74 benefits of breast feeding

75 what is in breast milk

76 how long do you breastfeed

77 reasons for no breastfeeding

78

when is breast feeding a

challenge

79 artificial baby milk

important teaching for bottle
feeding
how do I know if im making
81
enough milk
82 when does milk come in
80

high glucose- poor placenta implantation, before 8

weeks birth defects, insulin resistance at 8 weeks,
excess fetal growth, increase in O2 requirements,
more RBC production which gives them hyperbilli,
hypoxia-intolerance of labor, increased risk of HTN,
higer risk of diabetes later in life.
come from different kinds of animals
drops at delivery and becomes stable at 7 days
helps produce colasterum in 3rd trimester and comes
from placenta
increase in breast mass stimulates milk to rise and
delays ovulation
contactions occur because of this, ejects milk- causes
contractions in the alveoli into nipple with suckling
breastfeed for first six months, start complemtary
foods at 6 months, keep going after 2 years
correct nutrition, less waste, not stinking! perfect
volume, evolves with time, antibodies, appropriate
weight gain, lower risk for diabetes, cheaper, always
available
fore milk mostly water for thirst, hind milk is 2X is fat
for calories
until the milk is all gone in that feeding then switch to
the other breast next time
Mother to ill: cancer, birth complications, depression,
metabolic issues, stressors,
cultural bias.
prefer formula, or paternal concerns (jealousy is an
issue)
HIV? motivations, back to work, comfort level, does
baby have cleft palate
have to know how to prepare and know your water is
good, watch out for recalls
still cuddle baby, keep out as much air as possible,
burp every couple ounces, keeping things aseptic
if the baby is making diapers you are making enough
milk
5-6 days prime 3 days mult

83 advantages to breast feeding

insures nutrients, growth and immunological

components, reduction of allergies and infections,
proper serving size all the time, prevention of diabetes
and obesity

84 contrindications to breastfeeding

breast cancer, some metabolic disorders, mother has

HIV

85

effects of maternal anesthesia

and neonates

linked anesthesia with newborn behavior and

breastfeeding relationship between the mother and
their baby.

86 effects of epidural on neonate

initially decrease neonate alertness and apgar scores,

disturbed temp regulation in first two days of life,
healthcare providers spend more time assessing the
newborn initially which can interrupt the process of
breastfeeding first thing.

87 effects of alcohol on a neonate

causes Alcohol related birth defects, mental

retardation, behavioral problems, cranial facial
anomalies

88

interventions for alcohol toxicity screening and education among women who drink,
during pregnancy
also have them sign I will not drink contract

article suggests the baby is at higher risk for drug

findings on general anesthesia
addiction problems later on in life and a large amount
89 during c-sections and effects on
of the general anesthesia goes through the placenta
child
then when using a local anesthesia which is preferred.

90

substance abuse reasoning in

pregancy

91 uterine changes during pregancy

92 bicornuate uterus
93 smoking during first trimester
why is it easier to get UTI in
94
pregnant women
95
96
97
98
99
100
101

changes to skin and hair in

pregnant women
musculoskeletal changes in
pregnant women
normal weight gain for normal
BMI at start
overweight BMI weight gain at
start
obese BMI weight gain at start
unnderweight BMI at start
HPL increases

102 couvade syndrome

women who are pregnant and drinking tend to drink

because they have a history of trauma wither it be
physical abuse, sexual abuse, rape, emotional or
physiolgical abuse or trauma. we have to get to the
root of the problem before we attempt to lecture them
on not drinking
weight, goes from 2oz-2.2lbs, hold 2ml at first to 2
liters later
where the baby grows up in one horn or the other and
not in the middle like normal and run out of room
increased risk of wheezing and asthma in children
because the urethra is straighter so it makes it easier
for things to get up there
increased pigmentation (darker), hyperactive sweat,
striae, hair thinning or loss ,spider nevi (looks like
spider bites around eyes)
pelvic joint changes, curve is accntuated, some people
get numbness in extremities
25-35 ibs
15-25 lbs
less than 15lbs
28-40lbs
insulin resistance
when the father experiences everything that the
mother experiences, weight gain, morning sickness..

103
104
105
106
107
108
109

legal consent for pregnant

woman
gravida
TPAL
as soon as shes pregnant she
gets a
how to calculate due date
after 20 weeks the fundus is
if she is not immune to rubella
for prenatal visit what do we
do?

with HIV during preg what do

we do
is methadone safe to use for
111
breastfeeding women

110

all the consent is on her while pregnant and makes

decisions for baby too
total amount of pregancys
term, preterm, about, living child
G, must be varified by a physician
first day of last period, minus 3, plus 7 days
20 cm up and then goes 1 cm a week up from that
give her the vaccination after birth because it is a live
birth
give antivirals asap
yes, it is safe to use and causes not problems with the
babies
infant 35 gestational or older and two of these: apgar
less then 5, ph less then 7 after an hour of age,
required at least 10 mins of vent, and seizures

112

qualifications for fetal

hypothermia treatment

113

How can text messaging be used Can send messages about the babies health every two
for pregnancy?
weeks and ideas for care

What drugs don't give to opiate

114 addictive mothers for pain
Phenytnl or Nubane
control during labor.
Lab values associated with
elevated, liver enzymes
substance abuse
116 Cerberus cortex and drug abuse Reasoning center, cog function goes down
Survival instincts, and pleasure center. Makes you
117 Mesolimbic region
think you need drugs to survive after you are off them
1st trimester gastro problems in Nausea, vomiting, heartburn, constipation -increased
118
mother
progesterone, and hemorrhoids
What causes physiologic anemia
119
Increased plasma and not able to increase your RBC
in pregnancy?
Decreased vascular resistance, increased cardiac
120 First trimester cardio changes
output, lots of platelets, supine hypotension
Progesterone- produced by corpus labium then 4-8
121 Hormones of pregnancy
weeks then placenta makes it. Causes thicker mucous
Increased respiratory rate in first Moms have to blow off more c02 to lower gradient in
122
trimester
the placenta and gets less co2 left for baby
115

Increased respiratory rate, diaphragm elevated,

increased tidal volume, decreased airway resistance,
nasal congestion no nasal cannula
124 When does colostrum begin
12 weeks
It gets ducts ready for milk, although prolactin starts
125 What does estrogen do in breast
milk production
First trimester respiratory
123
changes

126 Gtd treatment

Should we be giving antibiotics
127 proflacticly for step b to moms
at 35-37 weeks
128 Hcg
Gtd or molar pregnant is
129
diagnosed with
130 Ectopic preg management
131 Bottle feeding to be weary of
132
133
134
135
136
137

Every rh- mom gets rhogram

when
Gdm 1 hour test
Gdm 2 hour
Gdm 3 hours
Gdm is diagnosed
Type 1 gdm treatment

138 Nigiels rule

139 Type 2 gdm treatment
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154

What does formula feeding

increasing?
Goodell sign is
Hagars sign is
McDonald's sign
Chadwick sign
Probable diagnosis of preggers
Presumptive diagnosis of
preggers
Late preterm is
Mary Jane in kids

Hypermolar pregnancy, we treat with D and C and if

older take out uterus
Only if positive culture, cholioamnionitis or other
indications like pyelonephritis or c sections
Increases in molar pregnancies
Rapid growth, large uterus, high hcg, hyperemesis,
increased Bp
Methotrexate, targets fast cell growth, saves her tubes,
or takes tubes out
Check for additives, keep bottles bpa free, clean
bottles well, use distiller or boiled water, check
formulas for additives
28 weeks, any major trauma, any invasive procedure
Higher the 180
155
140
Any 2 abnormal labs
Maintain alc below 7, frequent fetal testing
Minus 3 months plus seven days after the first day of
last period
Use diet, oral antihyperglymecics, give some with
insulin
Obesity, allergies, asthma, in mom and baby
soft cervix
Softening of the isthmus above the cervix
Flexible uterus againts the cervix
Blue cervix
objective
subjective, these are signs and symptoms

34-36 and 6/7

5x risk of SIDS, jittery baby
Gas build up cells, causes further damage blows up
Nec causes
intestinal walls
Breastmilk, resolve on its own, resection of damaged
Nec treatment
bowel, pro biopics long term
Finnagan score
Assess withdrawal symptoms
Cheap, dopamine release, vasoconstrictor, prolonged
Meth
sleep in baby
When is circumcision nessasary Hypospasia
Neural tube defect prevention
Folic acid/ b12

155 Risks of diabetes in preg

156 Progestone
157 Risks of diabetes on neonates

158 COPE program

Polyhydraminos, ghtn, increased insulin resistance,

increased infections
Relaxes vascular smooth muscle
Delayed surfactant production, hypoglycemia on
babies
a program with premature babies in the NICU that
make parents aware of what is going on in their baby
and how they can help to make them better, also helps
after discharge when they take baby home

OB exam 3; 192 cards; WSU College of Nursing Obstetrics N416 exam 3 material
1.

SGA

less than 10th percentile, at risk for heat loss

(decreased brown fat), hypoglycemia

2.

AGA

within 10 and 90th percentile

3.

LGA

Greater than 90th precentile

4.

Hypoglycemia

Blood glucose <40 mg/dl. At risk (SGA, LGA,

labor stress, cold stress, immature liver, premature,
sepsis, insulin dependent diabetic mother (out of
control A1C), late preterm). Prevention is early
feeding

5.

Autonomic regulation

respiratory rate and pattern, HR, O2 saturation

6.

Motoric stress

Extension of extremities or limp extensions

7.

State regulation

transitions between states and stages of alert/sleep.

8.

Attention interaction

Focus and response

9.

Premature lungs

Lack of surfactant, pulmonary hypertension,

increased musculature of pulmonary arteries,
decreases blood flow to alveoli, which collapse.
Will be on ventilator with nitric oxide (relaxes
muscles, opens pulmonary arteries, 5 sec half life).
Will oxygenate best prone position (butt up)

10.

Premature gut

Suck/swallow/breathe not developed. Trophic

feeds, 0.5 ml/hr, prime gut with breast milk.

11.

Hypothermia therapy

Must be >36 wk gestation with blood gas <7.0.

May have eperienced hypoxic insult. Cool to 34 C
for 72 hrs (to stop brain cell death, gradually
increase temp 1.5 C over 6 hr)

12.

Kernicterus

Brain damage, "yellow brain". High levels of

bilirubin cross blood brain barrier and stain
ganglia. Causes cerebral palsy.

Phototherapy

Assess jaundice. Light 6-8 in from baby,

conjugates bilirubin in skin capillaries, measure
blue light, wear eye protection, rotate skin
surfaces, and maintain skin integrity

14.

Neonatal infection

Skin is very thin, poor phagocytosis, IgG and IgM

can't cross placenta. E coli is #1 infection, group B
strep #2. Steroids decrease chance of getting
infection.

15.

Congenital heart defects

At 24 hrs of age (when ductus arteriosus closes),

compare right hand to foot O2 sat. Repeat in one
hour if 94 or less. Assess upper and lower pulses.

16.

Cyanotic lesions

Difficulty with oxygenation, increased work of

breathing, increased BMR, volume vs calories

17.

Necrotizing enterocolitis

Preterm immature porus gut (without flora to help

reak down molecules) or formula fed at risk. High
osmolarity molecules of formula invade (get stuck
in) cells and decompose in bowel wall lining.
Cellular damage and gas production, blows up
intestinal wall.

18.

SIDS prevention

Back to sleep, no stuffed animals, no co bedding

or bed sharing, don't have baby sleep on adult's
chest.

19.

Drug molecular weight

Anything less than 600 crosses the placenta and

the BBB

20.

Crank/ice

Smokable form of methamphetamine. Cheap,

stimulates dopamine release, causes
vasoconstriction.

21.

Dopamine release

Upper. Look at pupil dilation, rapid speech pattern.

Crack/cocaine blocks reuptake, Crank/meth
stimulates release

22.

Gastrochisis

intestines on the outside of the body, not covered

by membranes

23.

Meth exposed
infants/children

Sensory integration problems, tactile defensive,

texture issues (don't like to be touched), easily
distracted, gaze aversion

13.

24.

Sleep deprivation, GI cramp, diarrhea, hypertonia,

increased movement, sneezing, increased temp,
Prenatal exposure to opiates
poor feedings, growth challenges. Give morphine
in a controlled manner to fill Mu receptor sites

25.

Necrotizing entercolitis tx

Breastmilk (bacteriostatic effect, easier to digest),

NPO to rest gut, resection of damaged bowel, probiotics to stimulate production of flora. Use
steriods to mature gut and seal it

26.

Jaundice assessment

Assess in bright light, blanch skin over boney

surface (forehead down), look at slcera. Describe
where jaundice is seen, severity based on hours of
age/serum bilirubin. Non-invasive transcutaneous
screening device that looks at amount of bili in
capillaries.

27.

Normal physiology of
bilirubin

Breakdown of excess RBCs and reabsorption of

birth bruising, bili binds to albumin, gluconoryl
transferase conjugates (enzyme from liver),
excreted in stool

Bili binding with albumin

Can have problems binding because of maternal

ingestion of drugs (sulfas, aspirin, oxytocin),
neonatal ingestion of drugs (sulfas). Albumin
binding also affected by poor caloric intake &
infection.

29.

Problems with bili

conjugation

Decreased gluconoryl transferase production due

to hypoglycemia, prematurity, acidemia, hypoxia,
infection, cold stress, hepatitis, maternal diabetes,
maternal hypothyroid

30.

Problems getting bili out of

the bowel

Lack of stools (poor intake, obstruction, CF),

pyloric stenosis (inability to empty stomach), lack
of bile production (biliary atresia, bile duct
blocked, bile backs up in liver leading to cirrhosis)

31.

Hyperbilirubinemia

Bruising (more RBC production), excess

destruction (hemolytic disease, polycythemia from
chronic hypoxia or delayed cord clamping.

28.

Total serum bilirubin

Both conjugated (direct) and unconjugated

(indirect)

Physiologic jaundice

Destruction of RBCs releases unconjugated bili.

Must be conjugated by gluconoryl transferase,
then is excreted in stool. Usually appears after 24
hrs of age, peaks 2-4 days, goes away within 10
days.

34.

Pathologic jaundice

Appears before 24 hrs of age. Levels rise quickly.

Treat with phototherapy or exchange transfusion.
Can be caused by Rh isoimmunization.

35.

Breastfeeding jaundice

Diagnose by stopping breastfeeding to see if bili

levels drop. Usual onset >5 days, peak 10-15 days.

36.

Kernicterus phase 1

First few days of life, is treatable

37.

Kernicterus phase 2

4-7 days, may be treatable, see seizure activity

38.

Kernicterus phase 3

>1 wk, probably not treatable, hypotonia

39.

Warning signs of kernicterus

Lethargy, poor tone, head lag, poor feeding, high

pitched cry, yellow skin tone

40.

For circumcision: preoperative-- tylenol, sucrose,

Neonate pain control methods local anesthetic, perioperative--sucking, sucrose,
restraint control

32.

33.

41.

Septic newborn

Temperature instability, sleep problems, poor

feeding, hypoglycemia.

42.

Newborn sepsis early onset

Infection in first 24 hrs, usually picked up from

mom, E coli, group B strep, pneumonia common

43.

Newborn sepsis late onset

7-90 days, caused by any organism, meningitis is

common

44.

Newborn sepsis diagnostics

CRP (protein produced by liver in acute

inflammation, normal level is 0), CXR, cultures,
CBC (look for neutrophils "left shift", increased
ratio of immature to mature WBCs. Do serial
CBC)

45.

Anencephaly

Neural tube defect, absence of large part of the

brain and skull, no upper brain activity.

46.

Hydrocephalus

Neural tube defect, brain can't drain CSF. Fixable

with shunts in the brain (drain fluid to abdomen)

47.

Spina bifida

Neural tube defect, neural tube not completely

covered at it's base.

48.

Cleft lip/palate

surgically repairable, difficulty eating

49.

Meningomyelocele

Meninges come out between vertebrae

50.

Folic acid before pregnancy

400 mcg

51.

Folic acid during pregnancy

600 mcg

52.

Folic acid if + family hx of

neural tube defects

4,000 mcg

53.

Folic acid if homocystenemia

(inability to absorb)

40,000 mcg

54.

Oomphalocele

Intestines and/or liver herniated outside of

abdomen with membrane covering it

55.

Risk of diabetes on
pregnancy

Polhydraminos (because baby pees a lot, risk for

preterm birth), GHTN and pre-eclampsia,
increased insulin resistance

Risk of pregnancy on
diabetes

Increased vascular damage, infections can be

passed to baby easily, decreased renal threshold for
glucose (glycosuria), increased risk for
ketoacidosis

56.

57.

58.

Cardiac defects and miscarriage, sacral agenesis

Fetal anomalies from diabetes hypoplasia of sacrum (lower half of body doesn't
form)

Macrosomia

Type 2 diabetes tend to have bigger babies

(deposit fat between jaw and clavicles and
shoulder bones), risk for shoulder/labor
dystocia/hyperbilirubinemia

59.

60.

61.

DMT1 SGA

Cold stress leads to

hyperbilirubinemia/hypoglycemia (baby's
overproduction of insulin due to mom's high level
of blood sugar, cut cord and their blood sugars
drop

Polycythemia from DM

Too many RBCs. Can't carry as much O2 on hgb

because of high blood sugars. Leads to
hyperbilirubinemia

Delayed surfactant production leading to RDS (too

much insulin delays production of enzyme
Risks of diabetes on neonate
precursors to surfactant. Hypoglycemia from
increased insulin production
1st trimester insulin needs

Insulin needs decreases for everyone (don't eat as

much/throw up more, not much fetal growth)

63.

2nd trimester insulin needs

More glucose stored, more insulin needed. More

fetal growth. At 24-28 wks human Placental
Lactogen (hPL) produced by the placenta
(increases insulin resistance). Do NST, amniotic
fluid volumes (to identify polyhydraminos),
ultrasounds

64.

3rd trimester insulin needs

Needs continue to rise, storing energy for labor,

rapid fetal growth.

Labor insulin needs

Using lots of energy (do hourly blood glucose

testing, have two IVs, D50 titrated to blood sugar
levels, pitocin or NaCl). Need for storage
decreases.

Postpartum insulin needs

Sudden loss of hPL when placenta searates,

significant decreased need for insulin. May have
"honeymoon phase"--period of time, 24-36 hrs,
where they don't need insulin. Will return to prepregnancy needs.

62.

65.

66.

67.

Low risk individiuals

Don't need diabetic testing. <25 yrs, not member

of high risk ethnicitiy (hispanic, african, native
american, south or east asian, pacific islander),
BMI <25, no previous hx abnormal glucose
tolerance, no hx adverse pregnancy outcomes
associated with GDM, no 1st degree relatives with
diabetes.

68.

Screening: One hr oral

glucose tolerance test

Non fasting ingestion of 50 g glucose. If blood

sugar is normal in one hour you don't need
diagnostic testing for GDM (<130).

69.

Diagnostic: 3 hr oral glucose

tolerance test

3 days of high carb diet, then fasting level (NPO

since midnight), then 1/2/3 hrs after 100 g oral
glucose. Any 2 abnormal levels=diagnosis GDM

70.

DMT1 tx

Preconceptual stabilization, maintain Hbg A1c

below 7, frequent fetal testing.

71.

DMT1 labor care

IV glucose and IV insulin titrated to hourly levels.

Early delivery vs RSD issues, late delivery vs
placental issues

72.

DMT1 postpartum care

Breastfeeding decreases DM risk for neonate. Oral

antihyperglycemics contraindicated. Insulin sliding
scale.

73.

DMT2 tx

Diet to control diabetes. Glyburide during

pregnancy, or insulin. BG testing depending on
acuity during labor.

74.

GDM tx

Diet and activity, BG tested depending on acuity

during labor.

75.

Breast development

Breast cells in embryo 4-5 wks gestation, develop

in pubery 10-11 yrs, adulthood. Changes in
pregnancy, then lactation

76.

Lactogenesis I

During pregnancy breasts get ready to make milk,

affected by pregnancy hormones, transition to
lactation

77.

Lactogenesis II

Making milk, drop in progesterone when placenta

separates stimulates milk production

78.

Estrogen

Drops at delivery, stable by day 7, remains stable

until first menstrual cycle.

79.

Progesterone

Drop in progesterone when placenta delivers,

stimulates prolactin

80.

Prolactin

From anteriory pituitary, causes increase in breast

mass, stimulates milk production. Delays
ovulation (must breastfeed every 2-3 hrs around
the clock for breastfeeding to be used as birth
control.

81.

Oxytocin

From posterior pituitary, causes contractions of

alveoli, ejects milk

WHO recommendations

Exclusive breastfeeding for 6 months, use of

complementary food starting at 6 months.
Breastfeed for up to 2 yrs and beyond, no cow's
milk before 1 yr.

83.

Benefits of breastfeeding

Correct nutrition for gestational age, can digest

everything in breastmilk, perfect volume, no
mixing/mistakes, laxative effect of colostrum helps
get rid of jaundice, IgA antibodies, fewer allergies,
cheaper, no recalls!

84.

Foremilk

Beginning part of feed, mostly water, satisfies

thirst

Hindmilk

Second part of feed when breast is almost empty.

2x higher in fat, high in calories. Infant will sleep
through the night better if they get more hindmilk

Good latch

Get as much of the areola in mouth, flanged lip,

nipple far into mouth, audible swallow, should see
jaw movement. Feeding cues (rooting, tongue,
smacking lips), break suction with finger in mouth
to detach baby from breast.

82.

85.

86.

87.

Cancer/chemo, complications from birth

(Sheehan's syndrome/pituitary shuts down),
depressed to point of psychosis, unable to produce
Mothers who can't breastfeed
due to metabolic issues, stressors, cultural bias,
previous surgeries (incision around nipple affects
nerve fibers), piercing.

Other reasons not to

breastfeed

Prefer formula, paternal concerns, cleft palate,

diseases (HIV), lack of motivation, return to work,
pathological barriers (hypotrophic breast tissue,
inverted nipple), sore nipples, yeast infections,
fissures/cracks, mastitis

89.

Formula

140-160 mL/kg/day, hold baby close, hold bottle

with no air in nipple, burp every couple ounces,
aseptic technique.

90.

Formula shelf life

Room temp have 1 hr to use, keep in fridge for 48

hrs, open can of powder can be used for 1 month.

91.

Breastmilk shelf life

In bottle finish in 1 hr, thawed breastmilk in fridge

24 hrs, deep freeze for up to 12 months, room
temp acceptable up to 8 hrs, fridge acceptable up
to 8 days

92.

Medications with
breastfeeding

Most are compatible. Avoid aspirin,

pseudoephedrine, stimulants, diet aids, chronice
use of pain meds.

88.

93.

8-12 feeds in 24 hrs. Day one 5-7 ml. Day three ~

1 oz (22-27 mL), day ten 2-2.7 oz (60-81 mL).
Feeding frequency & amount
May not produce stool because there is so little
waste product in breast milk

94.

Newborn to 1 month calories

100-115 kcal/kg/day

95.

6-12 mo calories

85-95 kcal/kg/day

96.

Calories in breast milk

Fat 52%, carbs 42%, proteins 6%

97.

Lactation consultant

With multiples, maternal request, no latch in 12

hrs, weight loss concerns, flat or inverted nipples,
maternal illness, preterm delivery, newborn
infection, teen mother, nipple pain/injury, mastitis,
engorgement

98.

Bicornuate uterus

Uterus has septum down middle, creating two

sides of a uterus. Predisposes to preterm labor (can
usually get to ~28 weeks)

99.

100.

101.

Cervix changes

Firm and 4 cm (2nd knuckle of index finger) long

when nonpregnant. Softens and thins in late
pregnancy. Progesterone causes thickened mucus
"plug"

Trophoblast feedback cycle

Trophoblast (fertizlized egg) makes HCG, which

stimulates corpus luteum to make progesterone
which supports ovum and implantation (until
placenta takes over)

Breast changes in 1st

trimester

Areola pigmentation increases, colostrum by 12th

week. Lactogenesis I occurs (estrogen causes duct
proliferation, and progesterone develops alveoli,
suppresses production)

Increased tidal volume, increased rate

(hyperventilate to blow off CO2, allowing for
lower gradient in placenta), decreased airway
Respiratory system changes
102.
resistance, diaphragm elevated (anatomically short
in 1st trimester
of breath), AP diameter increases to compensate
for decreased volume, nasal congestion (mouth
breathers).

103.

Cardiovascular changes

104. Supine hypotensive syndrome

blood volume increases 45% by 3rd trimester,

decreased vascular resistance, BP lowest in 2nd
trimester, femoral venous pressure rises, cardiac
output increased (slight pulse increase), reduction
of plasma albumin, anemia, hypercoaguable state
(extra clotting factors).
Lying on back puts pressure on vena cava,
decreases blood return

Physiologic anemia in
pregnancy

Plasma increases faster than RBCs

106.

GI changes in pregnancy

Nasuea/vomiting, heartburn later in pregnancy,

constipation (progesterone decreases peristalsis),
hemorrhoids from presure of fetus on rectal
muscles.

107.

Urinary tract changes

Urinary frequency, increased GFR and tubular

reabsorption, glycosuria, increased UTI
susceptbility as urethra straightens.

105.

Skin /hair changes

Increased pigmentation, linea nigra (line from

belly button down to pubic bone), chloasma (age
spots, get around upper cheekbones), hyperactive
sweat and sebaceous glands. Striae (stretch
marks), spider nevi, hair thinning and loss

109.

Musculoskeletal changes

Pelvic joints relax. Lumbodorsal curve

accentuated, Paresthesias of extremities, diastasis
recti (abs split down middle).

110.

Weight gain
recommendations

Normal weight 25-35 lbs, overweight 15-20 lbs,

obese <15 lbs, underweight 28-40 lbs. For
multiple gestation, double these weights.

111.

Metabolism changes

Fluid retention, increased protein and lipid

retention, insulin needs drop in first trimester then
slowly rise until 28 wks, steep increase till labor.
Iron use changes.

112.

Endocrine changes

Thyroid changes, increased thyroxine, increased

BMR, parathyroid parallels fetal calcium
requirements.

113.

Pituitary hormones during

pregnancy

LH prolongs luteal phase allowing for

implantation, keeps corpus luteum going until
HCG takes over. Oxytocin, vasopressin, prolactin.

114.

Adrenal hormones during

pregnancy

Increased levels of aldosterone (holds onto

sodium), increased levels of cortisol due to
estrogen.

Pregnancy hormones

Pregnancy test measure hCG. HPL is an insulin

antagonist after 28 wks. Estrogen helps maintain
uterine environment and changes breasts.
Progestone=pregnancy hormone

108.

115.

116.

117.

Adolescent pregnancy

Father usually older, poverty, high risk behaviors.

Commonly seek care later, denial is common.
Abuse/neglect likely in early adoslescents.
Nutrition is vital, family/friend responses are
unpredictable. Minor can give consent during
pregnancy, consent for newborn from birth on.
May lose right to consent for self at birth (unless
legally emancipated).

Delayed pregnancy

>30. Difficult to get pregnant, have more

education and finances, increased risk for
chromosomal abnormalities, increase risk of twins,
increase risk of medical problems (HTN, DM).

118. Subjective signs of pregnancy

Tingling breasts, amenorrhea, fatigue, N/V,

frequent urination, uterine enlargement

119. Objective signs of pregnancy

Positive serum or urine pregnancy test, signs

Diagnostic signs of
pregnancy

Fetus heard, seen or felt (2nd trimester)

121.

Goals of antepartum care

Monitor progression of pregnancy, provide

education and screening, assess well-being of
mom and baby, reassurance, identify complications
and intervene

122.

Gravida

# of pregnancies

123.

Para

Number of infants after 20 weeks

124.

TPAL

Term, preterm, abortions (includes elective

abortions and miscarriages), living children

125.

Antepartum assessments

BP, weight, urine (protein & glucose), uterine size,

FHR, fetal movements or contractions? Bleeding?
leakage?

126.

EDD "nagele's rule"

First day of last period, minus 3 months + 7 days

Most accurate if menstruation is regular.

120.

127.

McDonald's rule

20 week fundal height is at umbilicus (about 20

cm above pubic bone). 1 cm/week growth after 20
weeks

128.

Antepartum lab tests

H &H, blood type, rubella immunity, STI, pap

smear if indicated, urinalysis

129.

Rhogam

"Turns off" production of antibodies. Coombs test

to determine if fetus is at risk (identifies
antibodies, determines how much Rhogam is
needed)

130.

Direct Coombs

Done on newborn to detect antibodies attached to

RBCs

131.

Indirect Coombs

Done on mom to determine if antibodies exist,

repeat at 28 wks

132.

Risk factors for 1st trimester

nausea

Large placental mass, previous hx, female fetus,

hx of migranes or motion sickness

Hyperemesis gravidarum

Extreme persistent N/V during pregnancy. Most

common 1st trimester admission. Dehydration,
ketosis, electrolyte imbalances, fetal and maternal
morbidity, pathology can progress to liver &
kidney damage.

134.

Nausea tx

Frequent small meals, anti-emetics, avoid iron,

ginger tablets, wrist pressure not supported by
research. Severe: IV fluids, NPO, vitamin B6 plus
antihistamine (benadryl), TPN last resort

135.

1st trimester bleeding

Spotting may be normal (with implantation or

intercourse), assess pain, pulse, BP, signs of shock.

136.

Spontaneous abortion

Often unrecognized, cause is unknown:

chromosomal abnormalities, thrombophilias (clots
in placenta), infection, bad implantation, SLE.

137.

Incomplete abortion

Part of fetus retained, can be a septic response due

to toxins from decaying tissue.

138.

Missed abortion

Fetus dies, no expulsion (septic response

possible).

133.

Typical course of abortion

(miscarriage)

Fetal death, hCG drops, corpus luteum no longer

supported with progesterone, decidua slough and
fetus expelled

Why do miscarriages occur

Clotting disorders, genetically incompatible, poor

implantation, inability of mother to maintain
hormone support, lifestyle. Most frequent cause of
1st trimester mortality

141.

Ectopic pregnancy

Implantation outside of uterus. Increased risk of

tubal anomalies and PID. Trophoblast cells grow
into tissues which bleed, rupture, internal
bleeding, shock, death

142.

Ectopic pregnancy dx

Pain, bleeding occasionally. hCG to confirm

pregnancy, ultrasound to confirm location,
laparoscopy.

143.

Ectopic pregnancy
management

Methotrexate (anti-neoplastic, destroys fast

growing tissue but saves fallopian tubes),
salpingostomy/ectomy (removal of fallopian tubes)

144.

Molar pregnancy

Also called hydatidiform mole, gestational

trophoblastic disease (GTD). Abnormal
proliferation of trophblastic tissue, placenta
develops grapelike clusters, dark brown clusters or
drainage often passed.

145.

Partial GTD

2 sperm enter ovum, wrong number of

chromosomes (69), embryo lives 8-9 weeks

146.

Compete GTD

Only one sperm (23 chromosomes), ovum has no

genetic material, no embryo develops, can become
carcinogen

147.

GTD diagnosis

Rapid fundal growth, bleeding, hydropic vesicles

passed out vagina, unusual enlargement of uterus,
no FHR, high hCG, hyperemesis, increased BP

148.

GTD management

Dx by ultrasound, evacuation of uterus.

139.

140.

149.

150.

Exercise contraindications

Significant heart disease, restrictive lung disease,

cervical insufficiency, multiple gestation,
persistent bleeding, placenta previa after 26 wks,
preterm labor, ruptured membranes, gestational
HTN

AVOID during exercise

Rapid changes in CO because of change in

placenta perfusion, supine positions (pressure on
IVC), motionless standing, contact sports, scuba
diving, exercises with fall risk

151. Avoid UTIs in 2nd trimester

Drink 2 L fluid/day, don't delay urination, no

bubble baths/oils, front to back wiping, urinate
before & after intercourse

152. 2nd trimester visit & teaching

Dipstick urine for glucose & protein, weight,

vitals, fetal movement, leaking, decision about
feeding method, don't use soap on nipples, don't
express colostrum

153.

2nd trimester safety

Avoid cat litter, avoid soft cheess, deli meats, large

fish with high levels of mercury (danger to
developing nervous system) swordfish, albacore
tuna, tilefish, king mackerel, shark, don't eat
farmed fish (have PCBs), limit fish intake to 12
oz. Gloves when handling chemicals, no
prolonged sitting, seat belts, no live-virus
vaccines, check medications/herbal/OTC with
HCP, alcohol/drug free, smoking cessation

154.

Elective abortion

Regulated by states, most limit to < 20 weeks

gestation. Medically, D&C, induction.

Amniocentesis

After 14 weeks with ultrasound only, collect

amniotic fluid that contains fetal cells. For
diagnosis of genetic disorders and anomlaies. Risk
of bleeding, ROM and abruption when done
commonly

Percutaneous umbilical blood

sampling

Needle into base of umbilical cord, draw 1-4 ml

from umbilical vessel. Dx blood disorders.
Complications are bleeding, clot PTL, ROM,
infection.

155.

156.

157.

Maternal serum alphafetoprotein (MSAFP)

158. Idiopathic thrombocytopenia

Screen for neural tube defects, abd wall defects,

trisomies, downs. Offered to all pregnant women
between 15 and 22 weeks (16-18 ideal)
Anti-platelet antibodies, fetal platelet destruction
possible. Give predisone to keep platelets at
50,000

159.

Group B strep

Screen at 36 weeks. If positive, treat during labor

and delivery, 2 doses of IV antibiotics, ampicillin

160.

Third trimester visit

assessment

Fetal movement, leaking, BP, urine, fundal height

161.

Fetal NST

Should see 2 accelerations every 20 minutes

162.

Contraction stress test

how well does the fetus respond to stress?

163.

Kick counts

3x/day, same time every day, look for trends over

time

164.

Biophysical profile

Gives an idea of acute issues (NST, fetal

movement, fetal breathing, extension-flexion), and
chronic issues (amniotic fluid index)

165.

Aneupolidies

Variations in chromosome numer.

166.

Carrier testing

Used to detect recessive alleles; can test DNA,

RNA, proteins or metabolites from parents. Allows
reproductive choices.

167.

Preimplantation testing

To detect genetic disorders in embryos prior to

implantation.

Prenatal genetic screening

Screening for Downs syndrome and neural tube

defects. False positives are common (sensitivity
>specificity), interpretation relies on accurate
gestational age.

168.

Prenatal genetic diagnosis

To identify fetus with genetic disease/condition.

Involves amniocentesis or chorionic villus
sampling--invasive. Noninvasive=fetal cells in
maternal blood, can be distinguished from
maternal DNA. As early as 7 weeks.

170.

Newborn screening

Offered in all states, currently 29 recommended

conditions, parents can opt out. For every true
positive there are about 50 false positives.

171.

NBS benefits

Improved health outcomes for child, prepare for

child with special needs, informing reproductive
decision making.

172.

NBS risks

Stress, anxiety, disruption of parent-infant

bonding, seek out treatment for children

Refer to genetic specialist

Family hx of developmental delay, child with

congenital anomalies, consanguinity, client
seeking genetic info, advanced maternal age, hx
infertility or recurrent miscarriage, exposure to
teratogen, pos NBS, newly diagnosed genetic
condition.

174.

Healthy preconception
behavior

Smoking cessation/reduction, alcohol/substance

free, achieve ideal weight, moderate exercise
starting before pregnancy, avoid food faddism, tx
and prevention of STIs, immunizations, accurate
menstrual hx for pregnancy planning, achieve
control of pre-existing disease, folic acid,
elimination of teratogens

175.

Preconceptual screening

Abuse screening, immunizations, genetic hx,

physical condition, STI risk

176.

Pre-embryonic stage

0-2 weeks after fertilization, ~4 weeks since LMP.

177.

Zygote

4 cell fertilized ovum, ~30 hrs

178.

Morula

12-16 cells by day 4

169.

173.

179.

Blastocyst

Inner mass of cells, will become baby (anmion &

embryo)

180.

Trophoblast

Outer mass of cells, will end up being the placenta

(chorion, chorionic villi)

181.

Implantation

Occurs 8-9 days after fertilization

182.

Placenta growth

Develops at site of implanted embryo during 3rd

weeks. Trophoblast cells grow into decidua,
forming maternal blood pools, where chorionic
villu grow. Exchange of gasses and nutrients
occurs through membrane which covers chorionic
villi.

183.

Placenta accreta

Placenta grows into uterine wall

184.

Placenta increta

Placenta grows through the uterine muscle wall

185.

Placenta percreta

Placenta grows through entire uterine wall and to

attaches to other organs

186.

Dizogotic twins

"Fraternal", ovulated twice, babies have different

genes (2 ova, 2 sperm). 2 separate placentas may
fuse

187.

Monozygotic twins

"Identical", from same ovum (have same

genotype). Divion time affects placenta &
membranes: within 3 days=dichorionic,
diamniotic, safer. At 5 days=monochorionic,
diamniotic. At 7-13 days=monochorionic &
monoamniotic, most dangerous

188.

Monochorionic

Same placenta, increased risk of common

circulation

189.

Monoamniotic

Increased risk of entanglement, umbilical cord

accidents

190.

Risks with twins

Cord entanglement, PPROM, prematurity, growth

discordance, death of one (leading to septicemia
and loss of second), twin to twin transfusion.

191.

192.

Embryonic stage

2-8 weeks after fertilization, 4-12 weeks after

LMP. All organs have formed, most vulnerable to
teratogens, tissues begin to differentiate.

Amniotic fluid

Cushions fetus, prevents adherence to membranes,

controls temp, promotes symmetrical growth, lung
development, permits movement. Produced by
placenta early, later is fetal urine.

Ch. 20 Postpartum physiology

Study online at quizlet.com/_lcar8

1 afterpains

uncomfortable cramping caused by periodic

relaxation and vigorous contractions that are
more common in subsequent pregnancies,
breastfeeding and oxytocic medication
intensify

2 autolysis

caused by the decrease in the secretion of

hormones after birth, the self destruction of
excess hypertrophied tissue, however the
additional cells laid down during pregnancy
remain and account for slight increase in
uterine size after birth.

3 involution

the return of the uterus to a non pregnant state

after birth the uterus should not be palpable
after 2 weeks and should have returned to its a
non pregnant state.

4 subinvolution

failure of the uterus to return to a nonpregnant state, most common cause is retained
placental fragments and infection.

5 lochia rubra

initially the bright red discharge after birth that

may contain small clots, for the first 2 hours
after briththe amount should be of a heavy
menstrual period

6 lochia serosa

consists of old blood, serum, leukocytes,

tissue debris. duration should be 22 to 27
days, a pink or brown color after 3 to 4 days.

7 lochia alba

yellow to white lochia conitues 10 to 14 days

but may last longer persists 4 to 8 weeks after
birth.

measurements after postpartum

period

at the end of the third stage of labor the uterus

is in the middle, approx. 2 cm below the level
of the umbilicus, within 12 hours the fundus
rises to approx. the level of the umbilicus the
fundus depends 1 to 2 cm every 24 hours, by 1
week after birth the fundus is normally
between the umbilicus and the symphysis
pubis. after 2 weeks should not be palpable.

9 lochial bleeding

usually trickles from the vaginal opening,

steady flow increases as the uterus contracts.
A gush of lochia may result as the uterus is
massaged, if lochia is dark that means it has
pooled in the vagina and should be followed
by a stead flow of bright red lochia

10 puerperium

interval between the birth of the newborn and

the return of the reproductive organs to their
normal non pregnant state, or fourth trimester
of pregnancy

11 pelvic relaxation

the lentheing and weakening of the fascial

supports of the pelvic structures that happens
later in life.

12 change in hormones from placenta

a decrease in estrogen, HcG, cortisol, reverses

the high blood sugar levels of pregnancy
moms with Type 1 diabetes will require much
less insulin that normal

13 decreased estrogen levels

associated with breast engorgement and with

diuresis of excess extracellular fluid
accumulated during pregnancy

14 HcG

can be detected in maternal system 3 to 4

weeks after birth.

15 increased prolactin levels

in lactating women are responsible for

suppressing ovulation, if you breastfeed the
initial ovulation is approx. 6 months after
giving birth

16 decreased prolactin levels

17 renal fxn during pregnancy

18 urine compenents

in women who are not breastfeeding, reach

pre pregnant levels by 3rd postpartum week,
ovulation occurs as early as 27 days after
birth, menstruatin usually resumes by 4 to 6
weeks postpartum some women ovulate
before first period so make sure contraceptive
is used. first menstrual flow is normally
heavier.
increase in renal fxn, 2 to 8 weeks for renal
system to return to normal
renal glycosuria induced by pregnancy
disappears by 1 week postpartum, BUN
increases as autolysis begins, proteinuria
resolves by 6 weeks after birth

19 postpartal diuresis

within 12 hours women begin to lose the

excess tissue fluid accumulated during
pregnancy, especially at night for first 2 to 3
days. caused by decrease in estrogen levels,
removal of increased venous pressure in lower
extremities, and loss of extra blood volume,
adccound of weight loss of approx. 2.25 kg

20 urethra and ladder

a decreased urge to void, decreased voiding

and postpartum diuresis can result in bladder
distention,can cause excessive bleeding
bladder fxn restored 5 to 7 days after birth.

21 avg blood loss for vaginal birth

22 avg blood loss for c-section

300 to 500 mL
500 to 1000 mL

23 cardiac output

in increased during pregnancy remains

elevated for 48 hours b/c of increase in SV
caused by return of blood to maternal systemic
venous circulation and a rapid decrease in
uteirne BF decreases by 30% after 2 weeks
and normal values by 6 to 12 weeks

24 abdomen

6 weeks required for the abdominal wall to

approximate its pre pregnancy state, striae
may persist, return of muscle tone depends on
previous muscle tone

25 diastasis recti abdominis

with or without over distention because of a

large emus or multiple fetuses, the abdominal
wall muslces separate, with time the defect
becomes less apparent.

Ch.21 Nursing Care of family during

postpartum period
Study online at quizlet.com/_lamcy
1 couplet care
2 engorgement

3 homans sign

mother baby care or single room maternity care

swelling of breast tissue caused by increased
blood and lymph supply occurring at 72 to 96
hours after birth can use ice packs, cabbage
leaves
dorsiflexing the foot sharply with the knee flexed
cause pain in the calf due to deep vein thrombosis
notify healthcare provider and elevate leg.

4 uterine atony

failure of uterine muscle to contract firmly, most

common cause of prevention of excessive
bleeding need to maintain good uterine tone and
prevent bladder distention

5 when can mom go home early?

uncomplicated pregnancy, labor etc. no evidence

of premature membranes, ambulating unassisted,
hemoglobin greater than 10, no vaginal bleeding
excessive, term infant, normal findings of
physical assessment, two successful feedings,
urination and stooling have occurred at least
once, no jaundice, no excessive bleeding, hep b
vaccine given or scheduled, no social or family
risks. follow up schedule 1 week after discharged.

6 Health protection act

all health plans are required to allow mother and

baby to maintain in hospital a minimum of 48
hours after a normal vaginal birth and 96 hours
after a c-section

nursing interventions to prevent

infection

maintain a clean environment, bed linens chafed,

disposable pads changed frequently, women
should wear shoes, educate woman to wipe front
to back after voiding or defecating, squeeze bottle
with antiseptic solution, change pad after going to
restroom.

nursing interventions to prevent

excessive bleeding

maintain good uterine tone and prevent bladder

distention MOST IMPORTANT. Must have
accurate visual estimation of blood loss also look
at serum H&H LEVELS to id shock loo at
respirations, pulse, skin condition, urinary output,
level of consciousness.

9 interventions to maintain uterine tone

gently massage the fundus until it is FIRM. tell

woman why you are massaging, tach woman to
massage her own fundus, administer IV fluids
and oxytocic meds if bleeding still occurs.

interventions to prevent bladder

10
distention

assist woman to bathroom or bedroom if unable

to ambulate, focus on spontaneous emptying of
bladder! turn on running water, place hand in
warm water, void in the shower

11 interventions to prevent thrombus

SCDs, exercise, alternating flexion and extension

of feet, rotating ankles, alternating flexion and
extension of legs, walk around

12 fundal massage

use lower hand to support fundus and top hand

cupped over the fundus

13 breastfeeding promotion

baby must get to breast between 1 to 2 hours after

birth, at this times infants are alert and ready to
nurse, breastfeeding aids in contraction of uterus,
assess breasts and breastfeeding at this time as
well.

14 lactation suppression

15 rubella vaccine

16 RhoGam

wear a well-fitted support bra for at least 72 hours

women need to avoid breast stimulation such as
running, sucking, pumping
given in postpartum period to prevent the
possibility of contraction rubella in future
pregnancies, it is not communicable in breast
milk, do not give if mom is
immunocompromised,
suppression of immune response in non sensitized
women with Rh negative blood who receive Rh
positive blood cells, routine antempartum
prevention of 28 weeks, IM injection, baby must
be Rh positive.

Ch. 22 Transition t parenthood

Study online at quizlet.com/_lif17
1 attachment
2 bonding
3 mutuality

the process by which a parent comes to love and

accept a child and a child comes to love and accept
a parent, occurs through the process of bonding
used interchangeably with attachment
the infants behaviors and characteristics elicit a
corresponding set of parental behaviors and
characteristics.

4 acquaintance

an important part of attachment when parents use

eye contact, touching, talking and exploring to
become acquainted with their infant in the
postpartum period

5 claiming process

the identification of the new baby, the baby is first

identified in term of likeness, then differences then
uniqueness and the unique incomer is incorporated
into the family. "he looks like his father but his
toes are shaped like mine"

6 en face position

a position in which the parents and infants faces

are approx. 20 cm apart and on the same plance,
promote eye contact b/w mom and baby, antibiotic
ointment can be delayed

7 early contact

can facilitate the attachment process between

parent and child, early skin-to-skin contact
between the mother and newborn immediately
after birth and ruing the first hour facilitates
maternal affectionate and attachment behaviors,
promotes breastfeeding and increases duration, less
infant crying and thermoregulation, PROCESS
THAT OCCURS OVER TIME don't sweat if can't
see the baby right after birth

8 extended contact

should be available for all parents but especially

those at risk such as adolescents, nurses encourage
dads help in activities and grandparents etc.

9 biorhythmicity

refers to the infant being in tune with mothers

natural rhythms, a recording of heartbeat can sooth
baby, give consisted care and use babys alert state
to develop responsive behavior and increase social
opportunities and learning

10 reciprocity

type of body movement or behavior that provides

the observer with cures and the observes responds
to them. ex: when newborn cries, mother responds
by picking up and cradling the infant and the baby
becomes quiet and alert and the mom coos and
makes noises so the baby pays attention then falls
asleep

11 synchrony

refers to the fit between the infants cues and the

parent's response, ex: the different types of cries

12 postpartum blues

women are emotionally labile and often cry easily

for no apparent reason, peak around 5th day and
subsides by the 10th day.

13 teaching for postpartum blues

remember they are normal, mom or dad can

experience them, get plenty of rest when baby
naps, go to bed early, relaxation techniques, do
something for yourself like a bath, plan a day out
of the house she th baby or without, talk about
your feelings, give baby and you time to learn how
to breastfeed, seek out community resources

14 engrossment

the term used for the fathers absorption,

preoccupation and interest in the infant. eye to eye
contact and the fathers keen awareness of features
both unique and similar to himself that validate his
claim to the infant

15 rhythm

to modulate both parents and child must be alert,

parents must keep baby in alert state by assuming
the en face position and keeping eye to eye contact
during feedings etc.

16 repertoire of behaviors

include gazing, vocialing and facial expressions by

sensitive to the infants capacity for attention and
inattention ex: when babes gaze at moms face or
when mom talks in a baby voice to infant.

17 responsivity

response of infant such as smiling or cooing to

parent behavior

Maintenance of balance between heat loss

and heat production
Heat production
Heat production process unique to the
newborn accomplished primarily by brown
fat and secondarily by increased metabolic
activity in the brain, heart, and liver.

Thermoregulation
Thermogenesis
Nonshivering
thermogenesis

Flow of heat from the body surface to cooler

ambient air. Two measures to reduce heat
convection
loss by this method would be to keep the
ambient air at 24C and wrap the infant.
Loss of heat from the body surface to a
cooler, solid surface no in direct contact but
in relative proximity. To prevent this type of
radiation
heat loss, cribs and examining tables are
placed away from outside windows and care
is taken to avoid direct air drafts
Loss of heat that occurs when a liquid is
converted to vapor; in the newborn heat loss
occurs when moisture from the skin is
vaporized. This heat loss can be intensified evaporation
by failure to dry the newborn directly after
birth or by drying the newborn too slowly
after a bath.
Loss of heat from the body surface to cooler
surfaces in direct contact. When admitted to
the nursery, the newborn is placed in a
warmed crib to minimize heat loss. Placing conduction
a protective cover on the scale when
weighing the newborn will also minimize
heat loss by this method.
High body temperature that develops more
rapidly in newborn than in the adult. The
newborn has a decreased ability to increase
evaporative skin water losses because sweat
hyperthermia
glands do not function sufficiently to allow
the newborn to sweat; serious overheating
can cause cerebral damage from dehydration
or heat stroke and death.
Pinkish, easily blanched areas on the upper
eyelids, nose, upper lip, back of head, and
telangiectatic nevi
nape of neck. They are also known as stork
bites.

Overlapping of cranial bones to facilitate

passage of the fetal head through the
maternal pelvis during the process of labor
and birth.

molding

generalized, easily identifiable edematous

area of the scalp usually over the occiput
area

Caput succedaneum

Collection of blood between skull bone and

its periosteum as a result of pressure during Cephalhematoma
birth
Bluish-black pigmented areas usually found
of back and buttocks.
Bluish discoloration of the hands and feet,
especially when chilled.
White, cheesy substance that coats and
protects the fetus's skin while in utero.
White facial pimples caused by distended
sebaceous glands.
Yellowish skin discoloration caused by
increased level of serum bilirubin.
Thick, tarry, dark green-black stool usually
passed within 24 hours of birth.

mongolian spots
Acrocyanosis
vernix caseosa
Milia
Jaundice
meconium

Sudden, transient newborn rash

characterized by erythematous macules,
papules, and small vesicles.

Erythema toxicum

Transient cross-eyed appearance lasting

until the third or fourth month of life.

Pseudostrabismus

Color variation related to vasoconstriction

on one side of the body and vasodilation on Harlequin sign
the other side of the body
Accumulation of fluid in the scrotum,
around the testes.

Hydrocele

Monilia infection of the oral cavity resulting

in white plaques on buccal mucosa and
Thrush
tongue that bleed when touched.
Membranous area formed where skull bones
Fontanel
join.
soft, downy hair on face, shoulders, and
Lunugo
back.

Bleeding into a potential space in the brain

that contains loosely arranged connective
tissue; it is located beneath the tendinous
sheath that connects the frontal and occipital Subgaleal
muscles and forms the inner surface of the hemorrhage
scalp. The injury occurs as a result of forces
that compress and then drag the head
through the pelvic outlet.
Peeling of the skin that occurs in the term
infant a few days after birth; if present at
birth, it may be an indication of post
maturity.

Desquamation

Flat red to purple birth mark composed of a

plexus of newly formed capillaries in the
papillary layer of corium; it caries in size,
Port wine stain
shape, and location, but it is usually found
on the neck and face. It does not blanch
under pressure or disappear.
Birth mark consisting of dilated, newly
formed capillaries occupying the entire
dermal and subdermal layers with associated
connective tissue hypertrophy; it is typically
Strawberry
a raised, sharply demarcated bright or dark
Hemangioma
red, rough-surfaced swelling that may
proliferated and become more vascular as
the infant grows; usually is found as a single
lesion on the head.
Slightly blood-tinged mucoid vaginal
discharge associated with an estrogen
decrease after birth
Foreskin
White cheesy substance commonly found
under the foreskin
Small, white, firm cysts seen at the tip of the
foreskin.
Extra digits, fingers or toes.
fused fingers or toes
variations in the state of consciousness of
newborn infants
The 2 sleep states.
The newborn sleeps about _______ hours a
day, when periods of wakefulness gradually
__________.
the 4 wake states

Pseudomenstruation
Prepuce
Smegma
Epithelial pearls
Polydactyly
Syndactyly
sleep wake states
deep light
16-18
increasing
1. drowsy
2. quite alert

the 4 wake states

3. active alert
4. crying

The optimum state of arousal in which the

infant can be observed smiling, responding
to voices, watching faces, vocalizing, and
moving in synchrony.

quiet alert

Ability of the newborn to respond to

internal and external environmental factors
by controlling sensory input and regulating
the sleep-wake states thereby making
smooth transitions between states.

State modulation

Protective mechanism that allows the infant

to become accustomed to environmental
stimuli. it is a psychologic and physiologic habituation
phenomenon in which the response to a
constant or repetitive stimulus is decreased.
quality of alert states and ability to attend to
Orientation
visual and auditory stimuli while alert
Individual variations in a newborn's primary
Temperament; easy,
reaction pattern. The three major types are
slow to warm up,
the _______ child, _______ child, and
difficult
________ child.
Child that demonstrates regularity in bodily
functions, readily adapts to change, has a
predominantly, positive mood and moderate
easy child
sensory threshold, and approaches new
situations or objects with a moderate
response.
Child that has a low activity level,
withdraws with first exposure to new
stimuli, is slow to adapt and low in intensity slow to warm up
of response, and is somewhat negative
mood.
Child that is irregular in bodily function,
intense in reactions, generally negative in
mood, and resistant to change or new
difficult
stimuli and often cries loudly for long
periods.
Apply pressure to feet with fingers, when
the lower limbs are semi-flexed-legs
Magnet
extended against examiner's pressure.

Place infant supine on flat surface and make

a loud abrupt noise- symmertic abduction
and extension of arms, fingers fan out,
Moro
thumb and forefinger form a C; arms are
then adducted into an embracing motion and
return to relaxed flexion and movement.
Place finger in palm of hand or at base of
toes-infant's fingers curl around examiners
finger, toes curl downward.

Grasp

Place infant prone on flat surface, run finger

down side of back forst on one side then
Truncal incuration
down the other 4 to 5 cm lateral to supine(Galant)
body flexes and pelvis swings toward
stimulated side.
Tap over forehead, bridge of nose, or
maxilla when eyes are open-blinks for first 4 Glabellar (Myerson)
or 5 taps.
use finger to stroke sole of foot beginning at
heel, upward along lateral aspect of sole,
Babinski
then across ball of foot-all toes
hyperextended, with dorsiflexion of big toe.
Anal sphincter responds to touch by opening
Wink reflex
and closing
Testes retract when infant is chilled
Cremasteric
touch infant's lip, cheek, or corner of mouth
with nipple-turns head toward stimulus,
Rooting
opens mouth, takes hold, and sucks.
Place infant in a supine position, turn head
to side-arm and leg extend on side to which
Tonic neck
head is turned while opposite arm and leg
flex.
Hold infant vertically, allowing one foot to
touch table surface-infant alternates flexion Stepping (walking)
and extension of its feet.
Touch or depress tip of tongue-tongue is
forced outward.

Extrusion

Place infant in supine then extend one leg,

press knee downward, and stimulate bottom
Crossed extension
of foot-opposite leg flexes, adducts, and
then extends.

Tool used to rapidly assess the

newborn's transition to extrauterine
Apgar Score
existence at 1 and 5 minutes after birth.
1. heart rate
2. respiratory rate
The Apgar score is based on 5 signs
that indicate his or her physiologic
3. muscle tone
state namely:
4. reflex irritability
5. color
Device used to suction mucus and
secretions from the newborn's mouth
and nose immediately after birth and
when needed.

Bulb syringe

Automatic sensor usually placed on the

upper quadrant of the abdomen
immediately below the right or left
Thermistor probe
costal margin; it is attached to the
radiant warmer and monitors the
newborn's skin temperature.
Inflammation of the newborn's eyes
from gonorrheal or chlamydial
infection contracted by the newborn
during passage through the mother's
birth canal.

Ophthalmia Neonatorum

Ointment is usually instilled into the

Erythromycin or
newborn's eye's within 1-2 hours after
Tetracycline
birth to prevent infection.
Medication administered
intramuscularly to the newborn to
prevent hemorrhagic disease of the
newborn; it is administered in a dose
of 0.5 to 1mg using a 25-gauge, 5/8
-7/8-inch needle.

Vitamin K

Scale currently used to assess and

estimate a newborn's gestational age at
birth; the initial assessment should be
Simplified Ballard Scale
preformed within the first 48 hours of
life to ensure accuracy and assess
physical and neurologic maturity
Term that describes an infant whose
birth weight falls between the 10th and
Appropriate for
90th % as a result of growing at a
gestational age (AGA)
normal rate during fetal life regardless
of length of gestation.

Term that describes an infant whose

birthweight falls above the 90th % as a
Large for gestational age
result of growing at an accelerated rate
(LGA)
during fetal life regardless of length of
gestation.
Term that describes an infant whose
birthweight falls below the 10th % as a
Small for gestational age
result of growing at a restricted rate
(SGA)
during fetal life regardless of length of
gestation.
Infant born at 34-36 weeks of
gestation; this infant has risk factors
because of his or her physiologic
late preterm
immaturity that require close attention
by nurses working with them.
Pinpoint hemorrhagic areas acquired
during birth that may extend over the
upper trunk and face; they are benign
if they disappear within 2-3 days of
birth and no new lesions appear.

Petechiae

One of the products derived from the

hemoglobin released with the
breakdown of RBC and the myoglobin
in muscle cells; its accumulation in the Bilirubin
blood results in a yellowish
discoloration of skin, sclera, and oral
mucous membranes.
Yellowish discoloration of the
integument and sclera that first appears
after the first 24 hours of life and
Physiologic jaundice
disappears by the end of the 7th day of
life.
Test performed to distinguish
cutaneous jaundice of the skin from
normal skin color. It is performed by
applying pressure with a finger over a
bony area, usually the nose, forehead
Blanch test
or sternum, for several seconds to
empty all capillaries in the spot. The
area will appear yellow when the
finger is removed if jaundice is
present.

Level of serum bilirubin, which if left

untreated, can result in sensorineural
hearing loss, mild cognitive delays,
Pathologic jaundice
and deposition of bilirubin in the brain;
it typically appears during the first 24
hours following birth.
Yellow staining of brain cells that may
Kernicterus
result in bilirubin encephalopathy.
Device used for noninvasive
monitoring of bilirubin via cutaneous
reflectance measurements; it allows for Transcutaneous
repetitive estimation of bilirubin and bilirubinometry (TcB)
works well on both dark and light
skinned newborns.
Breast feeding associated jaundice that
begins at 2-4 days of age; typically it
results from decreased caloric and
fluid intake by breast fed infants before
Early-onset jaundice
the milk supply is well established,
because fasting is associated with
decreased hepatic clearance of
bilirubin.
Breast feeding associated jaundice that
may begin at age 4-6 days or sooner
with the rising levels of bilirubin
peaking during the second week and
gradually diminishing; it may be
Breast milk jaundice
associated with factors in breast milk (late-onset jaundice)
that inhibit bilirubin clearance or with
less frequent stooling by breast fed
infants that extends the time bilirubin
can be absorbed from stools.
Blood glucose concentration less than
adequate to support neurologic. organ,
and tissue function during the early
newborn period; the precise level at
Hypoglycemia
which this occurs in every neonate is
not known although intervention is
usually required if the blood glucose
level falls below 45mg/dl
Serum calcium levels less that 7.8 to 8
mg/dl in the term infant and less that Hypocalcemia
7mg/dl in the preterm infant

Newborn respiratory rate of 30 breaths

per minute or lower
Newborn respiratory rate of 60 breaths
per minute or higher
The most important single measure in
the prevention of neonatal infection

Bradypnea
Tachypnea
Hand washing (hand
hygiene)

An alternative device for phototherapy

in the treatment of hyperbilirubinemia;
Fiberoptic blanket
it involves a fiberoptic panel attached
to an illuminator.
Surgical procedure that involves
removing the prepuce (foreskin) of the circumcision
flans penis.
1. Thinning of lanugo
A newborn male is estimated to be at with some bald areas
40 weeks of gestation following an
2. testes descended into
assessment using the New Ballard sale. the scrotum
Which of the following would be a
Ballard scale finding consistent with 3. Elbow does not pass
midline when arm is
this newborn's full term status.
pulled across the chest
The nurse evaluates the laboratory test 1. Glucose 34 mg/dl
2. Total serum bilirubin
results of a newborn who is 4 hours
3.1 mg/dl
old. Which of the following results
would require notification of the
or
pediatrician.
A newborn male has been designated 3. Hematocrit 54%
as large for gestational age. His mother 1. unstable body
was diagnosed with gestational
temperature
diabetes late in her pregnancy. The
2. jitteriness
nurse should be alert for signs of
hypoglycemia. Which of the following 3. loose, watery stools
or
assessment findings would be
4. laryngospasm
consistent with a diagnosis of
hypoglycemia?
1. undress and dry the
infant before placing her
under the warmer
2. set the control panel
A radiant warmer will be used to help a between 35-38C
3. Place the thermistor
newborn girl to stabilize her
probe on her abdomen
temperature. The nurse implementing
just below her umbilical
this care measure should do which of
cord
the following
or
4. assess her rectal
temperature every hour
until her temperature
stabilizes.

A newborn male has been scheduled

for a circumcision. Essential nursing
care measures following this surgical
procedure would include

apply petroleum jelly or

A&D ointment to the site
with every diaper change
until site is healed

Ch. 27 hypertensive disorders in

pregnancy
Study online at quizlet.com/_o996l
1 gestational hypertension

2 preeclampsia
3 eclampsia
4 chronic hypertension

5 preeclamsia physiology

6 140/90
7 160/110

8 HELLP, hepatic

9 physical exam for preeclampsia includes

10 30, 1
11 s/s of severe preeclampsia

12 150/100, 500

13

14 FHR
15 seizure
16 diminished DTRs, clonus

17 calcium gluconate, antidote

18 magnesium sulfate

19 mag nursing alert

20 renal
21 expected side effects of mag
22 s/s of mild toxicity of mag
23 increasing toxicity of mag

24 160, 110
25 seizure
26 diuresis, edema

34

27 headache, mental
28 alone
29 not

development of mild hypertension after 20 weeks of

pregnancy in previously normotensive woman without
proteinuria
development of hypertension and proteinuria in
previously normooensive woman after 20 weeks or in
early postpartum period
development of convulsions or coma not attributable to
other causes
hypertension in pregnant women present before
pregnancy diagnosed before 20 weeks and persistant 6
weeks postpartum
in preeclampsia, the thick walled vessels that supply
the placenta and uterus do not become thin vessels like
they are supposed to so this increases the BP in these
arteries and causes placental ischemia that causes a
release of toxins that effect all organ systems and cause
a generalized increase in BP and increased endothelial
cell permeability. the main pathogenic factor is not an
increase in BP but poor perfusion as a result of
vasospasm and reduced plasma volume
mild preeclampsia will have a BP reading over or
equal to ____________
severe preeclamsia will have a bP of ___________
_____ syndrome is a laboratory diagnosis for a variant
of severe preeclampsia that involves _____
dysfunction, characterized by hemolysis, elevated liver
enzymes and low platelet count, most women do not
convey any signs or symptoms
TAKE BP, note any edema, deep tendon reflexes with
a grade of 2+ which is normal check for clonus (foot
beats when moved from dorsiflexed to plantar flexed)
look for presence of preteinuria
proteinuria is defined as a concentration at or greater
than __ mg/dl or > or equal to _ on a dipstick
measurement
severe headaches, epigastric pain, RUQ pain, visual
disturbances or double vision

a BP less than _______ ; proteinuria less than

________ mg per day, normal platelet count, live
enzymes and creatinine levels ALL indicate that the
mom can do home care
for sever preeclampsia if the pregnancy is __ weeks of
gestation or greater, birth might be accomplished
promptly either by cesarean or after labor induction
intrapartum care for severe preeclampsia is directed at
the early identification of _____ abnormalities and
prevention of maternal complications
for moms giving birth with sever preeclampsia, _____
precautions should always be in effect
______ and _____are a good indicator of when a
seizure could be present that is why you give
magnesium sulfate to reduce hyperactivity
with severe preeclampsia always have ___ ____ or
calcium chloride on the unit to e available as an ____
for magnesium sulfate toxicity
______ _______ is the drug of choice in the
prevention and treatment of seizure activity caused by
severe preeclampsia or eclampsia almost always
administered as a piggy back
high serum levels of magnesium sulfate can cause
relaxation of smooth muscle such as the uterus, but
when therapeutic levels are kept between 4 and 7
mEq/l it should not happen
if ______ function declines, all of the magnesium
sulfate will not be adequately excreted resulting in
magnesium toxicity
warmth, flushing, diaphoresis and burning at the IV
site
lethargy, muscle weakness, decreased or absent DTRs,
double vision, slurred speech
bradycardia, maternal hyotension, bradypnea, cardiac
arrest. stop mag immediately and give calcium
gluconate or calcium chloride!!!
use antihypertensive meds if systolic BP exceeds
_____ or diastolic exceeds ____ hydrazine, labetalol
and nifedipine are effective drugs.
the mag sulfate is continued after birth for _____
precautions for 12 to 24 hours
clinical signs that demonstrate resolution of
preeclampsia include ____ and decreased _____

eclampsia is normally precede by s/s including

persistent ________, blurred vision, severe epigastric
or RUQ pain, and altered ____ status
after ecalmpsia, it may take the woman several hours
to return to self so do NOT leave the woman _____
eclampsia alone is ____ an indication for immediate
cesearan birth

Ch. 28 lower respiratory

problems

1 atelectasis
2 community acquired pneumonia
3 hospital acquired pneumonia

colapsed, airless alveoli of one or part of one lobe.

these areas usually clear with coughing and deep
breathing
is a lower respiratory tract infection with onset in the
community or during the first 2 days of
hospitalization.
is pneumonia occurring 48 hours or longer after
hospital admission and not incubating at the time of
hospitalization

4 cor pulmonale

enlargement of the right ventricle secondary to

diseases of the lung, thorax or pulmonary circulation,
pulmonary hypertension most common cause is
COPD treatment is at underlying cause, low oxygen
therapy and low sodium diet to decrease plasma
volume and workload of the heart treatment of
pulmonary hypertension

5 hemothorax

an _______ is an accumulation of blood in the pleural

space from an intercostal blood vessel, the lung, the
heart or great vessels

6 lung abscess

a cavity in the lung parenchyma containing purulent

material, formed by necrosis of lung tissue most
common symptoms is a cough-producing purulent
sputum that is foul smelling and foul tasting,
hemoptysis occurs if abscess bursts. dullness to
percussion use broad spectrum antibiotics given IV
and the oral teach patient how to cough effectively

7 pleural effusion

an abnormal collection of fluid in the pleural space,

normal is 5 to 15 mL that acts as a lubricant between
the chest wall and the lung. can be caused by
increased production of fluid due to increased
capillary permeability, bleeding into the space,
decreased lymphatic clearance of pleural fluid or
infection

8 pleurisy

inflammation of the pleura, most common cause is

pneumonia. pain is abrupt and sharp in onset and is
aggravated by inspiration treat underlying cause and
give analgesics, lye on affected side, splint rib cage
when coughing

9 pneumothorax

10 tension pneumothorax

11

medical emergency,
decompression, chest tube

12 chest tube, chest drainage system

13

fluid, alveoli, interstitial spaces,

left sided heart failure

14 pulmonary embolism
15

risk factors for pulmonary

embolism

air in the pleural space that is not normally present, as

a result there is partial or complete collapse of the
lung due to there not being a negative pressure there
any longer.
a pneumothorax with rapid accumulation of air in the
pleural space can cause high intrapleural pressures
that results in compression of the lung on the affected
side and pressure on the heart and great vessels
pushing home away from the affected side which
compresses that other long as well.
tension pneumothorax is a ______ _______
immediate needle ______ followed by _____ _____
insertion with chest draiainge system is needed
pneumothorax insert a _____ _____ with ______
______ ______
pulmonary edema is an abnormal accumulation of
______ in the _____ and ______ ______ of the lungs
most common cause is ____ _____ _____ ____
the blockage of pulmonary arteries by a thrombus
immobility, surgery within the last 3 months, stroke,
paresis, paralysis, history of DVT, malignancy,
obesity in women, heavy cigarette smoking and
hypertension

16 s/s of pulmonary embolism

varies and nonspecific, dyspnea, chest pain and

hemoptysis, hypoxemia with a low paCO2 is
common. cough, pleuritc chest pain, hemoptysis,
cracked, fever, pumonic heart sound, sudden change
in mental status as a result of hypoxemia, pallor,
hypotension, chest pain, tachycardia and rgith
ventricular strain small emboli are undetected or
produce vaguer symptoms right ventricular
hypertrophy

17 thoracentesis, intercostal

____ is the aspiration of intrapleural fluid for

diagnostic and therapeutic purposes. needle inserted
into the _____ space.

18 1000, 1200, hypotension

19 thoracotomy, majoy

usually only _____ to ______ mL of pleural fluid is

removed at one time to prevent _______.
______ surgical opening into the thoracic cavity is a
_____ surgery.

20 patient after thoracotomy

assist with frequent position changed to promote

drainage of pockets of fluid, encourage slow deep
breathing, turning and coughing to control respiratory
pattern, assist with incentive spirometer to provide
visual feedback to the patient on effectivenes of
respirations, auscultate breath sounds, pain meds,
elevate head of bed and provide overbid table for
patient to lean on, ambulate 3 to 4 times to promote
deep breathing and lung reexpansion

21 bubbling, tidaling

monitor chest tube for ______ of the suction chamber

and _____ in water-seal chamber to ensure adequate
ventilation

22 below chest level

23 color, volume, shade, consistency
24 28, 72

keep the drainage container ____ _____ ____ to

prevent pneumothorax
observe ____, _____, _____ and _____ of drainage
from lung and record to detect infection
change dressing around chest tube every ___ to ____
hours as need to monitor site and provide protection

25 chest level, straight, compressed

keep all tubing loosely coiled below ___ ____, tubing

should drop _____ from bed or chair to drainage unit.
do not let it be ____

26 rise, fall

tidaling observed should _____ with inspiration and

____ with expiration

27 blocked, suction

if no tidaling is observed the drainage system is

_____, the lungs are reexpanded or the system is
attached to ____

28 call, NOT
29 >100

if drainage system is full ______ the physician and

anticipated changing the system. do _____ empty it!
report any change in quantity or characteristic of
draining to physician and if _____ ml/he drainage.

30 TB

is an infectious disease caused by mycobacterium

tuberculosis spread by airborne droplets from person
to person by speaking or coughing, transmission
requires multiple encounters that are very long you
can't get it that easily

no, spread, positive, normal,

31
negative

person with latent TB infection usually has ___

symptoms, does not feel sick, cannot ____ TB to
others, usually has a ____ TB skin test or blood test,
has a _____ chest x-ray or a ______ sputum

32

3, sick, can, positive, abnormal,

positive

33 outpatient, compliance

34 drug therapy for TB

35 INH drug alert

a person with active TB has many s/s such a a bad

cough that last for ___ weeks or longer, pain in the
chest, coughing up blood, weight loss, no appetite,
chills, fever, sweating at night, feels
_____,____spread TB to others has a _____ skin or
blood test for TB, has an _____ chest x-ray or ___
sputum
most TB patients are treated on an _______ basis,
many people can continue to work, drug therapy
promoting and monitoring ____ is critical for
treatment to be successful
2-month initial phase with four drug therapy of
Rifadin, PZA, INH and ethambutol continuation
phase of INH, rifampin daily for 126 doses OR 5
days/wk
alcohol may increase hepatotoxity of drug, instruct pt
to avoid drinking alcohol during treatment, monitor
for signs of liver damage

36 directly observed therapy

involved providing the antituberculous drugs directly

to patients and watching as they swallow the
medications preferred strategies for all patients with
TB

37 drug therapy for latent TB

involves only one antibiotic because there are much

fewer bacteria, INH is normally used. administered
once daily for 6 to 9 months, 9 is more effective but
compliance issues make the 6 month regimen
preferable

Ch. 33 Labor and Birth

Complications
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1 preterm labor
2 preterm birth
3 late preterm
4 very preterm birth
5 low birth weight

defined as cervical changes and uterine contractions

occurring between 20 and 37 weeks
any birth that occurs before the completion of 37 weeks
of pregnancy
occur between 34 and 36 weeks of gestation
infants born before 32 weeks
describes only the weight at birth, preterm birth is more
serious than low- birth weight, not necessarily preterm
they can be full term.

6 IUGR

intrauterine growth restriction, a condition of

inadequate fetal growth not necessarily correlated with
initiation of labor. sometimes the cause of low birth
weight. happens with mom has gestational diabetes or
poor nutrition that causes the baby to get little
uteroplacental perfusion

7 s/s of preterm labor

uterine contractions occurring more frequently than

every 10 minutes for 1 or more hours, uterine
contractions may be painful or pain less, lower
abdominal cramping (gas pains), low dull back pain,
painful menstrual like cramps, pelvic pressure or
heaviness, suprapubic pain, ticker than normal vaginal
discharge thinker or thinner, rupture of amniotic
membranes

8 tocolytics

medications given to arrest labor after uterine

contractions and cervical change have occurred.

9 magnesium sulfate

beta adrenergic ageists, most common for preeclampsia

but tocolytic effectiveness is weak. use if woman
cannot use other tocolytics.CNS depressant; relaxes
smooth muscle including uterus so frequently assess
respiratory status, deep tendon reflexes and level of
consciousness to id signs that serum level of meds is
too high. do not continue maintenance dose for more
than 24-48 hours. therapeutic range is between 4 and
7.5 mEq/ L or 5-8 mg/dl, ensure that calcium gluconate
is available for emergencies, IV intake limited to 125
ml/hr

10 Brethine

relaxes smooth muscles, inhibiting uterine activity and

causing bronchodilation, discontinue after 24 hours ,
do not use in women with history of any high blood
pressure or diabetes, must be greater than 20 weeks
and less than 35 weeks, look for hyperglycemia nd
hypokalemia, make sure inderal is available. not used
commonly b/c of risk of tacycardia and hyperglycemia
do not use in women with migraine headache either
yoooo

11 Brethine

most commonly used for tocolysis, administer to see if

woman really is in preterm labor, if contractions persist
then she probably is.

12 Nifedipine

calcium channel blocker, used more commonly.

generally mild maternal reactions, hypotension and
reflex tachycardia, decrease in blood pressure may be
helpful, INSTRUCT WOMEN TO CHANGE
POSITION SLOWLY AND SIT BEFORE
STANDING, MAINTAIN ADEQUATE FLUID
BALANCE TO REDUCE DROP IN BLOOD
PRESSURE.

13 antenatal glucocorticoids

given IM injections to accelerate fetal lung maturity by

stimulating fetal surfactant production, all women
should be given between 24 and 34 weeks when
preterm labor may happen, TEACH MOM SIGNS OF
PULMONARY EDEMA, ASSESS GLUCOSE
LEVELS AND LUNG SOUNDS. optimal benefit
begins 24 hours after the first injection.

14 dystocia

long, difficult, or abnormal labor caused by various

conditions associated with the 5 factors affecting labor.
most common indication of a c-section.

15 hypertonic

primary dysfunctional labor, often is an anxious first

time mother who is having painful and frequent
contractions that are ineffective. Contractions occur
during latent phase of first stage of labor are are
uncoordinated, the force of contractions may be in the
midsection of the uterus instead of the funds so it
doesn't move baby down.

16 therapeutic rest

rest given to hypertonic moms who are frustrated and

in a lot of pain from not makin progress, achieved with
a warm blanked or shower and administration of pain
meds. give ambient, after 4 to 6 hours of labor women
normally will wake up in active labor with normal
contractions.

17 hypotonic

18

more common, secondary uterine dysfunction, woman

initially makes progress until active phase of 1st stage
of labor when contractions slow or stop all together,
CPD and malposition are common causes of this,

measures to reduce back pain during a counterpressure, heat or cold applications, double hip
contraction
squeeze, knee press

measures to facilitate the rotation of

19
the fetal head

lateral abdominal stroking, all fours position, pelvic

rocking, stair climbing, lateral position, lunges,
squatting

20 external cephalic version

used in an attempt to turn the fetus from a breech or

should presentation to a vertex presentation for birth.
gentle, constant pressure on the abdomen, tocolytic
agent given, continuously monitor the FHR and pattern
and maternal VS

21 Bishop score

can evaluate indelibility, a score of 8 or more indicates

that it is okay. document this prior to induction

Ch. 34 Postpartum Complications

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1 PPH

2 early PPH
3 dark red blood
4 bright red blood
5 spurts of blood with blood clots
6 incomplete placental separation

continues to be a leading cause of maternal

morbidity and mortality in the US and
worldwide. life-threatening even that can occur
with little warning and is often unrecognized
until the mother has profound symptoms. defined
as the loss of more than 500 ml of blood after
vaginal delivery and more than 1000 after csection
occurs within 24 hours of birth,
of venous origin prob. from varicose or
superficial lacerations of the birth canal
arterial and can indicate deep lacerations of the
cervix
indidates partial placental seperations
excessive bleeding may occur during the prior of
separation of placenta to its expulsion due to this

7 uterine atony

marked hypotonia of the uterus. if the uterus is

flaccid after detachment of all or part of the
placenta, brisk venous bleeding occurs and ormal
coagulation of the open vasculature is impaired
and continues until the uterine muscle is
contracted. leading cause of PPH

8 lacerations

bleeding should be suspected due to this reason if

uterus remains hard and contracted after birth,
from prolonged pressure of fetal head on vaginal
mucosa, abnormal presentation of fetus, or
position, vaginal hematomas occur from use of
forceps, an episiotomy, or primigravidity

9 nonadherent retained placenta

may result from partial separation of a normal

placenta, entrapment of the partially or
completely separated placenta by an hourglass
constriction ring of the uterus or mismanagement
of the third stage of labor. common in very
preterm births 20 to 24 weeks, must be manually
taken out by healthcare provider

10 adherent retained placenta

caused by possible zygotic implantation in a bad

area of endomentrium cells,

11 inversion of the uterus

12
13
14
15
16
17
18

rare, complete inversion is obvious a large, red,

rounded mass protrudes 20 to 30 cm outside the
introits, incomplete cannot be seen by must be
felt; a smooth mass will be palpated through the
dilated cervix,

primary presenting signs of inversion of

uterus

hemorrhage, shock and pain in the absence of a

palpable fundus abdominally
caused by retained placental fragments and pelvic
sub involution of the uterus
infection
prolonged lochial discharge, irregular or
s/s of sub involution of the uterus
excessive bleeding and sometimes hemorrhage
can be given for contraction of uterus to decrease
oxytocin
bleeding, continue to monitor vaginal bleeding.
can be given for contraction of uterus, do not
methergine
give if BP is greater than 140/90
misoporstol
contraction of uterus
check arterial pulse, auscultate, inspect skin
noninvasive assessments of cardiac output
color, capillary refill etc. observe for anxiety,
in postpartum bleeding
measure BP, pulse ox and urinary output

19 intervention for PPH

assess uterine tone, empty bladder, massage

fundus, monitor vital signs, administer oxytocin,
give oxygen, lab studies, fluid/blood
replacement, surgical intervention,

20 nursing alert PPH

to prevent injury to the suture line a woman with

third or fourth degree lacerations is not given
rectal suppositories or enemas or digital rectal
exams.

21 hypovolemic shock

hemorrhage may result in this, adrenal glands

release catecholamines causing constrictio not
arterioles and venues leaving less BF to liver,
kidneys, uterus etc. blood diverted to brain and
heart results in acidosis

22 treatment hypovolemic shock

vigorous treatment of restoring circulating BV

and treating cause of hemorrhage first IV fluids
then blood given

23 IV infusion for hypovolemic shock

IV crystalloid solution infused at a rate of 3 ml

for every 1 ml of estimated blood loss

24 emergency box hemorrhagic shock

25 urinary output
26 nursing interventions hypovolemic shock

27

idiopathic or immune thromboycytopenic

purpura

assess respirations, pulse, blood pressure, skin,

UO, level of consciousness, mental status, central
venous pressure characteristics: rapid and
shallow, rapid, weak, irregular, decreasing BP,
cool pale and clammy skin, lethargy to coma or
anxiety to coma CVP decreased. Nurse must
summon assistance and equipment, start IV per
standing orders, ensure patent airway and
administer oxygen, continue to monitor status.
want at east 30ml/hour it is the most objective
and least invasive assessment of tissue perfusion
want to ensure a patent large bore IV catheter, 2
IV lines facilities fluid resuscitation
autoimmune disorder in which anti platelet
antibodies decrease the lifespan of the platelets,
increased bleeding, thrombocytopenic and
capillary fragility are diagnostic findings, control
platelet stability

28 von willebrand disease

a type of hemophilia, most common of al

hereditary bleeding disorders symptoms include
recurrent nose bleeds, bruising easily, prolonged
bleeding time administer desmopressin which
promotes the release of vWF

29 thrombophlebitis

partial obstruction of the vessel caused by

inflammation from the formation of a blood clot
inside the blood vessel

30 superficial venous thrombosis

involvement of the superficial saphenous venous

system, most common in postpartum, s/s pain in
the lower extremities, warmth, redness and an
enlarged, hardened vein over the site treated with
analgesia, rest with elevation of leg and elastic
stockings

31 deep venous thrombosis

involvement varies but can extend from the foot

to the iliofemoral region more common during
pregnancy not after birth, unilateral leg pain, calf
tenderness and swelling, redness and warmth
positive humans sign treated with anticoagulant
bed rest and analgesia. put on elastic stockings
before getting out of bed

32 pulmonary embolisim

complication of deep venous thrombosis

occurring when part of a blood clot dislodges and
is carried to the pulmonary artery whiere it
occludes the vessel and obstructs BF to the lungs
s/s dyspnea and tachypneacough, elevated temp,
syncope treatment with continuous IV heparin

33 DO NOT GIVE ASPIRIN

TO PATIENTS THAT HAVE A

THROMBOEMBOLIC DISEASE, oral
contraceptives are contraindicated

34 postpartum infection

any clinical infection of the genital tract that

occurs within 28 day safer birth. a fever of 38
degrees or more on 2 successive days of the first
10 postpartum days. endometritis is most
common cause.

35 endometritis

the most common postpartum infection begins as

a localized infection at the placental site but can
spread to entire endometrium, incidence higher
after c -section PREVENTION: GOOD
MATERNAL PERINEAL HYGIENE IV
BROAD SPECTRUM ANTIBIOTICS AND
SUPPORTIVE CARE INCLUDING
HYDRATION

Ch. 35 Acquired problems of the

newborn
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1 environmental
2 forceps, vacuum
3

acquired problems refers to those conditions

resulting from ________ factors rather than
genetic circumstances
major trauma is often the result of instrumentation
during birth or the use of ______ or _______
petechiae are benign if they disappear within ____
2
days of birth and no new lesions appear

4 2, serious

ecchymoses and petechiae can be signs of a more

______ disorder such as thrombocytopenic
purport, if the hemorrhage areas do not disappear
spontaneously in ___ days

5 fingers, not

to differentiate hemorrhagic areas from skin

rashes such as mongolian spots, the nurse
blanches the skin with two ______ petechiae and
ecchymoses do ______ blanch

6 forceps, linear

______ injury typically has a _____ configuration

across both sides of the face, outlining the
placement of the forceps and these injuries
normally resolve within several days with no
specific therapy

7 hemorrhages, capillaries, ICP

8 clavicle, dystocia

9 linear, depressed

two of the most commonly occurring birth injuries

are subconjuctival and retinal _______, they result
from rupture of ______ due to increased ______
during birth they normally clear within 5 days
the _______ is the bone most often fractured
during birth and ______ is a risk factor for it,
limited movement of the arm, crepitus over the
bone and absence of the moro reflex are
diagnostic for this
two types of skull fractures, _____ and _____
fractures

10 treatment

for depressed and linear fractures there is normally

no significant treatment needed unless increased
ICP or bone fragments occur

11 glucose, insulin

the combination of increased supply of maternal

____ and other nutrients and increased fetal
______ results one excessive fetal growth called
macrosomia

12 8th
13 insulin, growth hormone

14 macrosomia

in most defects associated with diabetic

pregnancies, the structural abnormality, occurs
before the ______ week after conception
_______ has been proposed as the primary
_________ ________ for intrauterine
development
in macrocosmic babies there is an increase in
insulin production due to the increased glucose
supply from mom this causes hypoglycemia as
they insulin takes the glucose out of the fetal
blood supply

15 normal

early onset infection is usually caused by

microorganisms from the ______ flora of the
maternal vaginal tract such as B streptococci,
haemophilus influenza, listeria monocytogenes,
escherichia coli and streptococcus pneumonia

16 hospital acquired

late-onset sepsis, occurring at approximately 7 to

30 days of age can include maternally rived
infection or _____ _____ associated infection like
staphylococci, enterococci, E.coli and
psudoomonas or candida species

17 BP

the most common sign of septic shock is a

decrease in ______ the infant will often appear
gray or mottled and can be noted to have cool
extremities, rapid irregular respirations and pulse

18 lethargy

the nonspecific signs include ______, poor

feeding, poor weight gain and irritability, they are
the earliest clinical signs

19 IgA

colostrum contains _______ which offers

protection against infection in the GI tract

20 TORCH

stands for toxoplasmosis, other (gonorrhea,

hepatitis B, syphilis, varicella-zoster virus,
parvovirus, B19, HIV) rubella, cytomegalovirus
and herpes simplex virus

21 cat liter

changing ____ ______ is a known risk for

toxoplasmosis treated with pyrimethamine
combined with oral sulfadizine; folic acid
supplement to prevent anemia

22 eye prophylaxis

_____ _______ is administerd within the first

hour after birth to prevent an eye infection if baby
has infection one dose of ceftriaxone should be
received

23

infants born to women treated within _____ weeks

4 of birth should be investigated for congenital
syphilis

24 early
25 birth, first few

some babies exposed to HBV will be born ______

most babies are infected with HBV during _____
or in the ______ ______ days of life

26 HBV nursing alert

infants whose mothers have antibodies for HBsAg

or in whom hepatitis developed during pregnancy
or the postpartum period should receive hepatitis
B immunoglobulin 0.5 ml IM as soon as possible
after birth preferably within the first 12 hours

27 universal

______ HIV testing for all pregnant women

allows for early identification and treatment of
HIV positive women

28 avoided completely
29 hearing loss

in the US _____ _______ is avoided completely if

the mom is HIV positive
_____ ______ Is the most common side effect of a
rubella infection

30 rubella nursing alert

the rubella virus can been cultured in infants for

up to 18 months, they are a serious source of
infection to susceptible individuals particularly
women of childbearing age

31 Group B streptococci

_______ _______ ________ is a leading cause of

neonatal morbidity and mortality in the US

Ch.37 Nursing Care of the high risk

newborn
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1 acrocyanosis, central

_______ is a normal finding in the neonate but

_______ cyanosis indicated an underlying problem
that requires further evaluation

2 flaring, grunt

early signs of respiratory distress include ___ of the

nares and expiratory ______

3 kangaroo

skin-to-skin contact ______ care between the stable

preterm infant and parent is a viable option for
interaction because of the maintenance of
appropriate body temperature by the infant

4 large, weight

because of their ______ body surface in relation to

their ______ preterm infants are at high risk for heat
loss

Ch 20, 21, 22, 23, 24, 27, 28, 32, 33, 34, 35, 37
Multiple Choice

A nurse has assessed a woman who gave birth

vaginally 12 hours ago. Which finding would
require further assessment?

A. Bright to dark red uterine discharge

1 (Ch20)

B. Midline episiotomy-approximated, moderate

edema, slight erythema, absence of ecchymosis
C. Protrusion of abdomen with sight separation of
abdominal wall muscles
D. Fundus firm at 1 cm above the umbilicus and to
the right of midline
A woman, 24 hours after giving birth, complains to
the nurse that her sleep was interrupted the night
before because of sweating and the need to have her
gown and bed linen changed. The nurse's first action
is to:

2 (Ch20)

A. assess this woman for signs of infection

B. explain to the woman that the sweating

represents her body's attempt to eliminate the fluid
that was accumulated during pregnancy
C. notify her physician of the finding
D. document the finding as postpartum diaphoresis

Which woman at 24 hours following birth is least

likely to experience afterpains?

A. Primipara who is breastfeeding her twins that

were born at 38 weeks of gestation
3 (Ch20)
B. Multipara who is breastfeeding her 10-pound
full-term baby girl
C. Multipara who is bottle feeding her 8-pound baby
boy
D. Primipara who is bottle feeding her 7-pound
baby girl
A nurse is prepared to assess a postpartum
woman's fundus. To facilitate the accuracy and
comfort of the examination, the nurse should tell the
woman to:
4 (Ch21)

A. Elevate the head of her bed

B. Place her hands under her head
C. Flex her knees
D. Lie flat with legs extended and toes pointed
The expected outcome for care when
methylergonovine (Methergine), an oxytocic, is
administered to a postpartum woman is that the
woman will:

5 (Ch21)

A. Demonstrate expected lochial characteristics

B. Achieve relief of pain associated with uterine

cramping
C. Remain free from infection
D. Void spontaneously within 4 hours of birth
A nurse is preparing to administer RhoGAM to a
postpartum woman. Before implementing this care
measure the nurse should:

6 (Ch21)

A. Ensure that medication is given at least 24 hours

6 (Ch21) after the birth

B. Verify that the indirect and direct Coombs' test

results are negative
C. Make sure that the newborn is Rh negative
D. Cancel the administration of the RhoGAM if it
was given to the woman during her pregnancy
When teaching a postpartum woman with an
episiotomy about using a sitz bath, the nurse should
emphasize:

7 (Ch21)

A. Using sterile equipment

B. Filling the sitz bath basin with hot water (at least
42 C)
C. Taking a sitz bath once a day for 10 minutes
D. Squeezing her buttocks together before sitting
down, then relaxing them
Before discharge at 2 days postpartum, the nurse
evaluates a woman's level of knowledge regarding
the care of her episiotomy. Which statements made
by the woman indicate the need for further
instruction before she goes home? (Circle all that
apply.)

A. "I will wash my stitches at least once a day with

mild soap and warm water."
8 (Ch21)

B. "I will change my pad every time I go to the

bathroom-at least four times each day."
C. "I will continue to apply ice packs to my
perineum to reduce swelling."
D. "I will use my squeeze bottle filled with warm
water to cleanse my stitches after I urinate."

E. "I will wear a pair of clean, disposable gloves

when I wash my stitches and change my pad just
like the nurses did."
F. "I will apply the anesthetic cream to my stitches
at least six times per day."
When assessing postpartum women during the first
24 hours after birth the nurse must be alert for signs
which could indicate the development of postpartum
physiologic complications. Which signs are of
concern to the nurse? (Circle all that apply.)

9 (Ch21) A. Temperature-38 C

B. Fundus-midline, boggy
C. Lochia-three quarters of pad saturated in 3 hours
D. Positive Homans sign in right leg
E. Anorexia
F. Voids approximately 150 to 200 ml of urine for
each of the first 3 voidings after birth
During the final phase of the claiming process of a
newborn, a mother might say:

A. "She has her grandfather's nose."

10 (Ch22)

B. "His ears lie nice and flat against his head, not
like mine and his sister's, which stick out."
C. "She gave me nothing but trouble during
pregnancy, and now she is so stubborn she won't
wake up to breastfeed."
D. "He has such a sweet disposition and pleasant
expression. I have never seen a baby quite like him
before."
Which nursing action is least effective in facilitating
parent attachment to their new infant?

11 (Ch22)

A. Referring the couple to a lactation consultant to

ensure continuing success with breastfeeding
11 (Ch22) B. Keeping the baby in the nursery as much as
possible for the first 24 hours after birth so the
mother can rest
C. Extending visiting hours for the woman's partner
or significant other as they desire
D. Providing guidance and support as the parents
care for their baby's nutrition and hygiene needs
Which behavior illustrates engrossment?

A. A father is sitting in a rocking chair, holding his

new baby boy, touching his toes, and making eye
contact.
12 (Ch22)

B. A mother tells her friends that her baby's eyes and

nose are just like hers.
C. A mother picks up and cuddles her baby girl
when she begins to cry.
D. A grandmother gazes into her new grandson's
face, which she holds about 8 inches away from her
own; she and the baby make eye-to-eye contact.
A woman expresses a need to review her labor and
birth experience with the nurse who cared for her
while in labor. This behavior is most characteristic
of which phase of maternal postpartum adjustment?

13 (Ch22)
A. Taking-hold (dependent-independent phase)
B. Taking-in (dependent phase)
C. Letting-go (interdependent)
D. Postpartum blues (baby blues)
Before discharge, a postpartum woman and her
partner ask the nurse about the baby blues. "Our
friend said she felt so let down after she had her
baby, and we have heard that some women actually
become very depressed. Is there anything we can do
to prevent this from happening to us or at least to
cope with the blues if they occur?" The nurse could
tell this couple:

14 (Ch22)

14 (Ch22) A. "Postpartum blues usually happen in pregnancies

that are high risk or unplanned, so there is no need
for you to worry."

B. "Try to become skillful in breastfeeding and

caring for your baby as quickly as you can."
C. "Get as much rest as you can and sleep when the
baby sleeps, because fatigue can precipitate the
blues or make them worse."
D. "I will call your doctor before you leave to get
you a prescription for an antidepressant to prevent
the blues from happening."

Ch23

66. A newborn, at 5 hours old, wakes from a sound

sleep and becomes very active and begins to cry.
Which signs if exhibited by this newborn indicate
expected adaptation to extrauterine life? (Circle all
that apply.)
A. Increased mucus production
B. Passage of meconium
C. Heart rate of 160 beats/min
D. Respiratory rate of 24 breaths/min and irregular
E. Fine crackles on auscultation
F. Expiratory grunting with nasal flaring

Ch23

67. When assessing a newborn boy at 12 hours of

age, the nurse notes a rash on his abdomen and
thighs. The rash appears as irregular reddish
blotches with scattered papules. The nurse:
A. Documents the finding as erythema toxicum
B. Isolates the newborn and his mother until
infection is ruled out
C. Applies an antiseptic ointment to each lesion
D. Requests nonallergenic linen from the laundry

Ch23

68. A breastfed fullterm newborn girl is 12 hours old

and is being prepared for early discharge. If present,
which assessment findings could delay discharge?
(Circle all that apply.)
A. Dark greenblack stool, thick consistency
B. Yellowish tinge in sclera and on face
C. Swollen breasts with a scant amount of thin
discharge
D. Bloodtinged mucoid vaginal discharge
E. Blood glucose level of 35 mg/dl
F. Acrocyanosis

Ch23

69. As part of a thorough assessment of a newborn

the pediatric nurse practitioner (PNP) should check
for hip
dislocation and dysplasia. Which technique does the
PNP use?
A. Check for syndactyly bilaterally
B. Stepping or walking reflex
C. Magnet reflex
D. Ortolani maneuver

Ch23

70. When assessing a newborn after birth, the nurse

notes flat, irregular, pinkish marks on the bridge of
the nose, nape of neck, and over the eyelids. The
areas blanch when pressed with a finger. The nurse
documents this finding as:
A. Milia
B. Nevus vasculosus
C. Telangiectatic nevi
D. Nevus flammeus

Ch24

60. A newborn male is estimated to be at 40 weeks

of gestation following an assessment using the New
Ballard Scale. Ballard Scale findings consistent with
this newborns full-term status are: (Circle all that
apply.)
A. Apical pulse rate of 120 beats/min, regular, and
strong
B. Popliteal angle of 160
C. Weight of 3200 g, placing him at the 50th
percentile
D. Thinning of lanugo with some bald areas
E. Testes descended into the scrotum
F. Elbow does not pass midline when arm is pulled
across the chest

Ch24

61. The nurse evaluates the laboratory test results of

a newborn who is 4 hours old. Which results require
notifying
the pediatrician? (Circle all that apply.)
A. Hemoglobin 20 g/dl
B. Hematocrit 54%
C. Glucose 34 mg/dl
D. Total serum bilirubin in peripheral blood 9 mg/dl
E. White blood cell count 24,000/mm3
F. Calcium 8 mg/dl

Ch24

62. A newborn male has been designated as large for

gestational age. His mother was diagnosed with
gestational diabetes late in her pregnancy. The nurse
should be alert for signs of hypoglycemia. Which
assessment findings
are consistent with a diagnosis of hypoglycemia?
A. High-pitched cry
B. Jitteriness
C. Hyperthermia
D. Laryngospasm

Ch24

63. A radiant warmer will be used to help a newborn

girl to stabilize her temperature. The nurse
implementing this care measure should:
A. Undress and dry the infant before placing her
under the warmer.
B. Set the control panel between 35 and 38 C
C. Place the thermistor probe on her abdomen just
below her umbilical cord
D. Assess her rectal temperature every hour until her
temperature stabilizes

Ch24

64. A newborn male has been scheduled for a

circumcision. Essential nursing care measures
following this surgical procedure include:
A. Administering oral acetaminophen every 6 hours
for a maximum of 20 mg/kg in 24 hours
B. Applying petroleum jelly or A&D ointment to the
site with every diaper change until the site is healed
C. Checking the penis for bleeding every 15 minutes
for the first 4 hours
D. Teaching the parents to remove the yellowish
exudate that forms over the glans using a diaper
wipe

Ch24

65. A physician has ordered that a newborn receive a

hepatitis B vaccination prior to discharge. In
fulfilling this order
the nurse should: (Circle all that apply.)
A. Confirm that the mother is hepatitis B positive
before the injection is given
B. Obtain parental consent prior to administering
the vaccination
C. Inform the parents that the next vaccine in the
series needs to be given at 1 month
D. Administer the injection into the vastus lateralis
muscle
E. Use a 1-inch 23-gauge needle
F. Insert the needle at a 45-degree angle

Ch24

66. A nurse is preparing to administer erythromycin

ophthalmic ointment 0.5% to a newborn after birth.
Which nursing actions are appropriate? (Circle all
that apply.)
A. Administer the ointment within 30 minutes of the
birth.
B. Wear gloves.
C. Cleanse the eyes if secretions are present.
D. Squeeze an ointment ribbon of 3 cm into the
lower conjunctival sac.
E. Wipe away excess ointment after 1 minute.
F. Apply the ointment from the inner to outer
canthus.

7 Ch27

When measuring the blood pressure to ensure

consistency and to facilitate early detection of B/P
changes consistent with preeclampsia, the nurse
should-

8 Ch27

When caring for a women with mild preeclampsia,

it is critical that during assessment the nurse be alert
for signs of progress to severe preeclampsia.
Progress to severe preeclampsia is indicated by the
assessment finding-

9 Ch27

A women's preeclampsia has advanced to the severe

stage. She is admitted to the hospital and her
primary health care provider has ordered an infusion
of magnesium sulfate be started. In implementing
this order, the nurse should- (select all that apply)

10 Ch27

The primary expected outcome for nursing care

associated with the administration of magnesium
sulfate would be met if which assessment findings is
present? The women-

10 Ch27

The primary expected outcome for nursing care

associated with the administration of magnesium
sulfate would be met if which assessment findings is
present? The women-

11 Ch27

A women has been diagnosed with mild

preeclampsia and will be treated at home. In
teaching this women about her treatment regimen
for mild preeclampsia, the nurse should tell her to(select all that apply)

12 Ch27

The women with severe preeclampsia is receiving

Nifedipine (Procardia). She asks the nurse what this
medication is for. The nurse should tell her that
nifedipine is used to.-

13 Ch27

14 Ch27

15 Ch27

A women with preeclampsia gave birth by c-section

1 hr ago. She is still receiving a magnesium sulfate
infusion at 1g/hr. A major concern regarding the
administration of magnesium sulfate at this time isFollowing vaginal birth 2 hrs ago a women with
preeclampsia is experiencing a heavy flow as a
result of a boggy uterus. It is determined that she
will require medication to reduce the amount of
blood loss. Which medication would the nurse
anticipate administering?

A women, at 35 weeks of gestation with

preeclampsia, has a seizure. Immediately after the
seizure, the nurse's priority action is to:

Ch 28

16 Ch28

A primigravida at 10 weeks of gestation reports

mild uterine cramping and slight vaginal spotting
without passage of tissue. When she is examined, no
cervical dilation is noted. The nurse caring for this
women should?

17 Ch28

A women is admitted through the emergency dept.

with a medical diagnosis of ruptured ectopic
pregnancy. The primary nursing diagnosis at this
time is:

17 Ch28

A women is admitted through the emergency dept.

with a medical diagnosis of ruptured ectopic
pregnancy. The primary nursing diagnosis at this
time is:

18 Ch28

A women diagnosised with an ectopic pregnancy is

to receive methotrexate. The nurse should explain
that - (select all that apply)

19 Ch28

20 Ch28

A pregnant women at 32 weeks of gestation comes

to the emergency dept because she has begun to
experience bright red vaginal bleeding. She reports
that she has no pain. The admission nurse suspects
that the women is experiencingA pregnant women at 38 weeks gestation diagnosed
with marginal placenta previa has just given birth to
a healthy newborn boy. The nurse recognizes that
the immediate focus for the care of this women is-

37 Ch32

Nurses caring for postpartum women experiencing

depression need to be aware of the safety of
administering antidepressants. Which antidepressant
should be avoided by women who wish to continue
breastfeeding?

38 Ch32

Which measure is least effective in helping a

women prevent postpartum depression?

39 Ch32

A pregnant women being treated for major

depression arrives for her first prenatal visit. During
the health HX interview she shows the nurse the
cough medication that she just bought for a cold.
The nurse notes that the cough medicine contains
dextromethorphan. The nurse is concerned if the
women reports taking which medication for her
depression?

39 Ch32

A pregnant women being treated for major

depression arrives for her first prenatal visit. During
the health HX interview she shows the nurse the
cough medication that she just bought for a cold.
The nurse notes that the cough medicine contains
dextromethorphan. The nurse is concerned if the
women reports taking which medication for her
depression?

40 Ch32

A priority question to ask a women experiencing

postpartum depression is:

41 Ch32

The nurse should recognize that a complication of

pregnancy associated with the intravenous use of
cocaine is-

42 Ch32

When conducting a health HX interview during a

pregnant women's first prenatal visit, the nurse must
determine if the women is substance dependent. The
nurses first question should relate to the women's
use of:
Ch 33
When assessing a pregnant women, the nurse is
alert to for factors associated with preterm labor.
Which factors if exhibited by this women increases
her risk for spontaneous preterm labor and birth?(select all that apply)
a) caucasion race
B) obstetric HX - 3-0-2-0-1
C) HX of bleeding at 20 weeks
D) currently being treated for second bladder
infection in 2 months
E) employed as a nurse in a trauma ICU
f) BMI of 22 and height of 158 cm
Bed rest for prevention of preterm birth can result
in:
A) bone demineralization with Ca+ loss
b) weight gain
C) fatigue
D) dysphoria and guilt
e) increased cardias output
F) emotional lability

A women's labor is being suppressed using IV

magnesium sulfate . Which measure should be
implemented during the infusion.
A) limit intravenous fluid intake to 125ml/hr
b) D/C infusion if maternal respirations are less than
14 breaths/min
c) ensure that indomethacin is available should
toxicity occur
d) assist women to maintain a comfortable semi
recumbent position
A DR. has ordered that dinoprostone (cervidil) be
administered to ripen a pregnant womens cervix in
preparation for a induced labor. In fulfilling this
order the nurse should
a) insert the cervidil into the cervical canal jus
below the internal os
b) tell the women to remain in bed for at least 15
mins.
C) observe the women for signs of uterine
tachysystole
d) remove the cervidil as soon as the women begins
to experience uterine contractions
A nulliparous women experiencing a post term
pregnancy is admitted for labor induction.
Assessment reveals a Bishop score of 9. the nurse
shoulda) call the women's primary health care provider to
order cervidil ripening agent
b) mix 20 units for oxytocin (pitocin) in 500 ml of
5% glucose in H2O
c) Piggy back the oxytocin solution into the port
nearest the drip chamber of the primary IV tubing
D) Begin the infusion at a rate between 1
miliunits/min as determined by the induction
protocol

A nulliparous women experiencing a post term

pregnancy is admitted for labor induction.
47
Assessment reveals a Bishop score of 9. the nurse
should-

A women's labor is being induced. The nurse

assesses the women's status and that of her fetus and
the labor process just before an infusion increment
of 2 mu/min. The nurse D/C's the infusion and
notifies the women's primary health care provider if
during this assessment she notes:
A) frequency of uterine contractions- q 1.5 mins
b) variability of FHR - present
c) deceleration patterns- early decelerations noted
with several contractions
d) intensity of uterine contractions at their peaks80-85 mm/Hg
A laboring women's vaginal exam reveals the
following - 3cm, 50%, LSA, 0. The nurse caring for
this women should
a) place the ultrasound transducer in the left lower
quadrant for the women's abdomen
b) recognize that passage of the meconium would be
a definitive sign of fetal distress
C) expect the progress of fetal descent to be slower
than usual
d) assist the women into a knee-chest position for
each contraction
A nurse is caring for a pregnant women at 30 weeks
gestation in preterm labor. The women's physician
orders betamethasone 12mg IM for 2 doses with the
first dose to begin at 11am. In implementing this
order the nurse shoulda) consult the physician because the dose is too high
b) explain to the women that this medication will
reduce her HR and help her breath easier
c) assess the women for tachycardia and
hypotension
D) schedule the second dose for 11am the next day
A nurse caring for a pregnant women suspects of
being in preterm labor recognizes this sign as
diagnostic of preterm labor.
A) cervical dilation of at least 2 cm
b) uterine contractions occuring q 15 mins
c) spontaneous rupture of the membranes
d) presence of fetal fibronectin in cervical secretions

A women 27 weeks gestation experiences some

mild uterine cramping. Which action should we
take?
A) empty bladder
b) call her nurse midwife immediately
c) relax in a chair
D) drink 2-3 glasses of H2O or juice
E) palpate her uterus for 1 hr.
f) resume the activity she was doing if the cramping
subsides
A women is in active labor. On spontaneous rupture
of her membranes, the nurse caring for this women
notices variable deceleration patterns during
evaluation of the monitor tracing. When preparing
to perform a vaginal exam, the nurse observes a
small section of the umbilical cord protruding from
the vagina. What should the nurse do next?
a) increase IV drip rate
b) admin. O2 to the women via mask at 8-10 L/min
C) place sterile gloved hand into the vagina and
hold the presenting part off the cord while calling
for assistance
d) wrap the cord loosely with sterile towel saturated
with warm normal saline
Ch 34
25. Methylergonovine (Methergine) 0.2 mg is
ordered for a woman who gave birth vaginally 1
hour ago; it is to be administered intramuscularly to
treat a profuse lochial flow with clots. Her fundus is
boggy and does not respond well to massage. She is
still being treated for preeclampsia with IV
magnesium sulfate at 1 g/hr. Her blood pressure,
measured 5 minutes ago, was 155/98 mm Hg. In
fulfilling this order, the nurse should:
A. Measure the womans blood pressure again 5
minutes after administering the medication
B. Question the order, based on the womans
hypertensive status
C. Administer the methylergonovine because it is
the best choice to counteract the possible uterine
relaxation effects of the magnesium sulfate infusion
the woman is receiving.
D. Tell the woman that the medication will lead to
uterine cramping

A postpartum woman in the fourth stage of labor

received 15-methylprostaglandin F2a
(Hemabate) 0.25 mg intramuscularly. The expected
outcome of care for the administration of this
medication is:
A. Relief from the pain of uterine cramping
B. Prevention of intrauterine infection
C. Reduction in the bloods ability to clot
D. Limitation of excessive blood loss that is
occurring after birth
The nurse responsible for the care of postpartum
women recognizes that the first sign of puerperal
infection most likely is:
A. Temperature elevation of 38 C or higher after
the first 24 hours following birth
B. Increased white blood cell count
C. Foul-smelling profuse lochia
D. Bradycardia
A breast feeding women's c-section birth occurs 2
days ago. Investigation of the pain, tenderness, and
swelling in her left leg led to a medical diagnosis of
DVT. Care management for this women during the
acute stage of DVT involves- (select all that apply)
a) explaining that she will need to stop
breastfeeding until anticoagulation therapy is
completed
57
b) administering warfarin (coumadin) orally
C) placing the women on bed rest with her let leg
elevated
d) fitting the women with an elastic stocking so that
she can exercise her leg.
e) telling her to avoid changing her position for the
first 24 hours
F) administering heparin IV for 3-5 days
Ch 35
31. When assessing a newborn after birth, the nurse
notes the following: limited movement of left arm
with crepitus at the shoulder and absence of Moro
reflex on left side. The nurse suspects:
A. Brachial plexus injury
B. Fracture of the clavicle
C. Phrenic nerve injury
D. Intracranial hemorrhage on the right side of the
brain

32. A nurse is caring for a male newborn whose

mother had gestational diabetes during pregnancy.
His estimated gestational age is 41 weeks, and his
weight indicates that he is macrosomic. When
assessing this newborn, the nurse should be alert for
which findings associated with macrosomia? (Circle
all that apply.)
A. Fracture of the femur
B. Hypocalcemia
C. Blood glucose level of 38 mg/dl
D. Signs of a congenital heart defect
E. Pale complexion
F. Round cherubic face

33. A woman who developed hepatitis B during

pregnancy gives birth vaginally to a healthy baby
boy. Her baby is receiving hepatitis B
immunoglobulin (HBIg) 0.5 mg IM 2 hours after
birth. When should he receive his first dose
of the hepatitis B vaccine?
A. At the same time as the HBIg but in a different
site
B. One month after birth
C. Six months after birth
D. One year after birth

34. A woman was discovered to be HIV positive as

part of routine screening during pregnancy. She was
immediately treated with HAART. She just gave
birth to a baby girl. Care management of this
newborn includes:
A. Encouraging the mother to breastfeed to protect
her infant from infection
B. Teaching the mother about the importance of
taking her infant for routine immunizations
C. Isolating the newborn in a special nursery
D. Initiating HAART treatment as soon as the
newborn is diagnosed as HIV positive

35. A woman in labor admits that she used heroin

during her pregnancy. After the birth of her baby
boy, the nurse caring for him must be alert for which
signs that indicate neonatal abstinence syndrome?
(Circle all that apply.)
A. Sleepiness
B. Poor feeding
C. Bradypnea
D. Hyperthermia or hypothermia
E. Diarrhea
F. Frequent yawning
Ch 37
38. Preterm infants are at increased risk for
developing respiratory distress. The nurse should
assess for signs that would indicate that the newborn
is having difficulty breathing. Signs of respiratory
distress are: (Circle all that apply.)
A. use of abdominal muscles to breathe
B. Expiratory grunting
C. Periodic breathing pattern
D. Suprasternal retraction
E. Nasal flaring
F. Acrocyanosis

39. When caring for a preterm infant at 30 weeks of

gestation, the nurse should recognize that the
newborns primary nursing diagnosis is:
A. Risk for infection related to decreased immune
response
B. Ineffective breathing pattern related to surfactant
deficiency and weak respiratory muscle effort
C. Ineffective thermoregulation related to immature
thermoregulation center
D. Imbalanced nutrition: less than body
requirements related to ineffective suck and swallow

40. A nurse is preparing to insert a gavage tube and

feed a preterm newborn. As part of the protocol for
this procedure the nurse should: (Circle all that
apply.)
A. Determine the length of tubing to be inserted by
measuring from tip of nose to lobe of ear to
midpoint between xiphoid process and umbilicus
B. Coat the tube with sterile water to ease passage
C. Insert the tube through the nose as the preferred
route for most infants
D. Check placement of the tube by injecting 2 to 3
ml of sterile water into the tube and listening for
gurgling with a stethoscope
E. Assess residual gastric aspirate every 4 hours
F. Provide nonnutritive sucking during gavage
feedings

41. Evaluating blood gas values provides essential

information about the effectiveness of the preterm
newborns respiratory effort and oxygen
administration measures. Which arterial blood gas
values indicate adequate gas
exchange? (Circle all that apply.)
A. pH 7.40
B. Pao2 75 mm Hg
C. Paco2 48 mm Hg
D. HCo3 14 mEq/l
E. Base excess 6
F. oxygen saturation 93%

42. Preterm newborns are at increased risk for

infection. The most important measure to prevent
iatrogenic infections in the preterm newborn is to:
A. Monitor vital signs for instability
B. Teach parents infection control measures
C. Cleanse the newborns skin with plain warm
water
D. Perform hand hygiene

43. Preterm infants are at risk for cold stress. Which

signs should alert the nurse that the preterm infant
he or she is caring for may be hypothermic? (Circle
all that apply.)
A. Acrocyanosis
B. Emesis (vomiting)
C. Irritability
D. Periodic breathing pattern
E. Bradycardia
F. Abdominal distention

Normal NB: 10 questions; Normal Postpartum: 6

questions; Complicated PP: 8 questions; 3rd
trimester complications: 7 questions; NB transition
5 questions; Care through the trimesters: 12
2 sets of matching
3 CHOOSE ALL THAT APPLY
D

Fundus should be at midline; deviation from

midline could indicate a full bladder; bright to dark
red uterine discharge refers to lochia rubra; edema
and erythema are common shortly after repair of a
wound; decreased abdominal muscle tone and
enlarged uterus result in abdominal protrusion;
separation of the abdominal muscle walls, diastasis
recti abdominis, is common during pregnancy and
the postpartum period.

The woman is describing the normal finding of

postpartum diaphoresis, which is the body's
attempt to excrete fluid retrained during the
pregnancy; documentation is important but not the
first nursing action; infection assessment and
physician notification are not needed at this time.

Afterpains are most likely to occur in the following

circumstances: multiparty, over distention of the
uterus (macrosomia, multifetal pregnancy),
breastfeeding (endogenous oxytocin secretion),
and administration of an oxytocic.

The woman should be assisted into a supine

position with head and shoulders on a pillow, arms
at sides, and knees flexed; this facilitates
relaxation of abdominal muscles and allows deep
palpation.

Methergine as an oxytocic contracts the uterus,

thereby preventing excessive blood loss; lochia
will therefore reflect expected characteristics; this
medication can cause uterine contractions that are
severe enough to require an analgesic.

A direct and indirect Coombs' must be negative,

indicating that antibodies have not been formed,
before RhoGAM can be given; it must be given
within 72 hours of birth; the newborn needs to be
Rh positive; it is often given in the third trimester
and then again after birth.

Squeezing the buttocks together before sitting

down will reduce pulling on any perineal repairs;
this is a medical aseptic procedure; therefore, clean
not sterile equipment is used; the water should be
warm at 38 to 40.6 C; it is used at least twice a day
for 20 minutes each time.

C, E, F

Ice packs are used during the first 2 hours after

birth to decrease edema; topical medications
should be used sparingly only three or four times
per day; gloves are not needed but she should wash
her hands before and after perineal care.

B, D, E

Temperature of 38 C during the first 24 hours may

be related to deficient fluid and is therefore not a
concern; fundus should be midline but firm not
boggy; saturation of the pad in 15 minutes or less
would be a concern; a positive Homans sign could
indicate DVT; usually women have a good appetite
and eat well after birth; each voiding should be at
least 100 to 150 ml.

D
A reflects the first phase of identifying likeness; B
reflects the second phase of identifying
differences; C reflects a negative reaction of
claiming the infant in terms of pain and
discomfort; D reflects the third or final stage of
identifying uniqueness.

Early close contact is recommended to initiate and

enhance the attachment process.

A
Engrossment refers to a father's absorption,
preoccupation, and interest in his infant; B
represents the claiming process phase I identifying
likeness; C represents reciprocity; D represents en
face or face-to-face position with mutual gazing.

Taking-in is the first 1 to 2 days of recovery

following birth; other behaviors exhibited include
reliance on others to help her meet needs, being
excited, and talkative.

Approximately 50% to 80% of women experience

postpartum blues; new parents should be reassured
that theirs kills as parents develop gradually and
they should seek help to develop these skills;
postpartum blues that are self-limiting and short
lived do not require psychotropic medications;
support and care of the postpartum woman and her
newborn by her partner and family is the most
effective prevention and coping strategy; feelings
of fatigue from childbirth and meeting demands of
newborn can accentuate feelings of depression.

66. Choices A, B, and C are correct; the newborn

at 5 hours old is in the second period of reactivity,
during which tachycardia, tachypnea, increased
muscle tone, skin color changes, increased mucus
production, and passage of meconium are normal
findings; respiratory rate should range between 30
and 60 breaths/min; expiratory grunting and nasal
flaring are signs of respiratory distress; crackles
commonly present in the first period of reactivity
immediately following birth should be absent
during the second period representing the
absorption of lung fluid into the circulatory
system.

67. Choice A is correct; the rash described is

erythema toxicum; it is an inflammatory response
that has no clinical significance and requires no
treatment because it will disappear spontaneously.

68. Choices B and E are correct; physiologic

jaundice does not appear until 24 hours after birth;
further investigation would be needed if it appears
during the first 24 hours, because this is consistent
with pathologic jaundice; glucose levels should
range between 50 to 60 mg/dl and should not be
lower than 40 mg/dl; acrocyanosis is normal for 7
to 10 days after birth.

69. Choice D is correct; choices B and C are

common newborn reflexes used to assess integrity
of neuromuscular system; syndactyly refers to
webbing of the fingers.

70. Choice C is correct; telangiectatic nevi are

known as stork bite marks and can appear on the
eyelids; milia are plugged sebaceous glands and
appear like white pimples; nevus vasculosus or a
strawberry mark is a raised, sharply demarcated,
bright or dark red swelling; nevus flammeus is a
port-wine, flat red to purple lesion that does not
blanch with Pressure.

60. Choices D, E, and F are correct; thinning of

lanugo with bald spots, absence of scarf sign, and
descended testes are assessed and the New Ballard
Scale and are consistent with full-term status;
pulse and weight are not part of the Ballard scale;
the popliteal angle for a full-term newborn is 100
degrees or less.

61. Choices C and D are correct; glucose should be

45 to 65 mg/dl; total serum bilirubin in peripheral
blood should be 6 mg/dl or less in the first 24
hours after birth; A, B, E, and F all fall within the
expected range (see Box 24-6).

62. Choice B is correct; signs of hypoglycemia

include
apnea, jitteriness, respiratory distress, poor
feeding,
lethargy, hypotonia, hypothermia, and seizures;
laryngospasm and a high-pitched cry are signs of
hypocalcemia.

63. Choice A is correct; the control panel should

be set between 36 and 37 C; the probe should
be placed in one of the upper quadrants of the
abdomen below the intercostal margin, never over
a rib; axillary, not rectal, temperatures should be
taken.

64. Choice B is correct; acetaminophen should be

given
every 4 hours for a maximum of 5 doses in 24
hours at 75 mg/kg/day; the site should be checked
every 15 to 30 minutes for the first hour then every
hour for 4 to 6 hours; diaper wipes should not be
used on the site because they contain alcohol,
which
delays healing and causes discomfort; the yellow
exudate is a protective film that forms in 24 hours
and should not be removed.

65. Choices B, C, and D are correct; mother does

not
have to be hepatitis B positive for the vaccine to
be given to her newborn; use a 5/8-inch 25-gauge
needle and insert it at a 90-degree angle.

66. Choices B, C, E, and F are correct; administer

within 1 to 2 hours and squeeze a 1- to 2-cm
ribbon
of ointment into the lower conjunctival sac.

A) place the women in a sitting position with feet

flat on the floor
b) allow the women to rest for 10 mins after
positioning before measuring her B/P
c) record Korotkoff phase IV (muffled sound) as
the diastolic pressure
d) use a proper sized cuff that covers at least 50%
of he upper arm.
a) proteinuria greater than 2+, in two specimens
collected 6 hours apart
b) platelet count of 180,000/mm3
C) positive ankle clonus response
d) B/P of 154/94 and 156/100, 6 hours apart
a) prepare a solution of 20g of magnesium sulfate
in 100ml of 5% glucose in water
b) monitor maternal VS, FHR patterns and uterine
contractions q hr.
C) expect the maintenance dose to be
approximately 2g/hr
D) administer loading dose of 4-6g over 15-30
minutes
e) prepare to administer Hydralazine (Apresoline)
if signs of magnesium toxicity occur
F) report resp. rate of 12 breathes or less per min
to the primary care provider immediately
a) exhibits a decrease in both systolic and diastolic
B/P
B) experiences no seizures
c) states that he feels more relaxed and calm

d) urinates more frequently resulting in a decrease

in pathologic edema
a) follow a low salt diet
B) use a dipstick to check urine for protein
C) maintain fluid intake to 6-8, 8 oz glasses of
H20 each day
D) increase the roughage in her diet
E) perform gentle range of motion exercises for
her upper and lower extremities
f) ask her friends to avoid visiting for calling her
because she needs to rest.
a) prevent seizures
b) relieve the head aches she is starting to have
C) decrease her B/P
d) reduce the edema in her hands and legs
a) increased risk for seizures
B) central nervous system depression
c) hypotension
d) diuresis
a) methyergonovine (methergine)
b) calcium gluconate
C) oxytocin (pitocin)
d) labetolol (normodyne)
a) evaluate FHR and pattern for signs of
decreasing variability, later decelerations, or
bradycardia.
B) assess status of the maternal airway, resp effort,
and pulse
c) determine if membranes have ruptured and if the
amniotic fluid contains meconium
d) prepare to increase the amount of magnesium
sulfate being infused from 1g/hr to 2g/hr
A) anticipate that the women will be sent home
with instructions to limit her activity and to avoid
stress or orgasm.
b) prepare the women for dilation and curettage
c) notify a grief counselor to assist the women with
the imminent loss of her fetus
d) tell the women that the doctor will most likely
perform a cerclage to help her maintain her
pregnancy
a) acute pain related to irritation of the peritoneum
with blood
b) risk for infection related to tissue trauma

C) deficient fluid volume related to blood loss

associated with rupture of the uterine tube
d) anticipatory grieving related to unexpected
pregnancy outcome
a) methotrexate is an analgesic that will relieve the
dull abdominal pain she is experiencing
B) she should avoid alcohol until her primary care
provider tells her the treatment is complete
C) she will receive the medication intramuscularly
D) She must stop taking folic acid supplements as
long as she is on methotrexate.
e) her partner should use a condom during
intercourse
f) she must return for a measurement of her
progesterone level to determine if a second dose of
methotrexate is required.
a) abruptio placentae
b) disseminated intravascular coagulation
C) placenta previa
d) preterm labor
A) preventing hemorrhage
b) relieving acute pain
c) preventing infection
d) fostering attachment of the women with her son
a) Desipramine (Norpramin)
b) Sertraline (Zoloft)
C) Doxepin (Sinequan)
d) Paroxetine (Paxil)
a) share feelings and emotions with family
members and her partner.
b) recognize that emotional problems after having
a baby are not unusual
C) care for the baby by herself to increase her level
of self confidence and self-esteem.
d) ask friends and family members to take care of
the baby while she sleeps or has a date with he
partner.
A) citalopram (Celexa)
b) desipramine (Norpamin)
c) doxepine (sinequan)

d) Amoxapine (asendin)
A) have you thought of hurting yourself?
b) does it seem like your mind is filled with
cobwebs?
c) have you been feeling insecure, fragile, or
vulnerable?
d) does the responsibility of motherhood seem
overwhelming?
a) prolonged, difficult labor
B) premature separation of the placenta
c) increased risk for vaginal and urinary tract
infections
d) PROM
a) alcohol
b) caffeine
c) cocaine
D) OTC and prescription medications

Choices B, C, D, and E are correct; women who

are
underweight or overweight/obese, have high stress
jobs, are members of the non-Hispanic black race,
or
have a history of preterm birth, multiple abortions,
infections of the genitourinary tract, including
UTIs
and reproductive tract such as bacterial vaginosis,
and bleeding in the second trimester are at
increased
risk for preterm labor and birth

Choices A, C, D, and F are correct; weight loss,

not
gain, occurs and cardiac output is decreased.

Choice A is correct; magnesium sulfate is a CNS

depressant; woman should alternate lateral
positions
to decrease pressure on cervix, which could
stimulate uterine contractions; calcium gluconate
would be used if toxicity occurs; infusion should
be
discontinued if respiratory rate is less than 12.

Choice C is correct; it is inserted into the posterior

vaginal fornix; the woman should remain in bed
for
2 hours; caution should be used if the woman has
asthma; therefore, ensure that physician is aware;
the insert is removed for severe side effects such as
uterine tachysystole; dinoprostone (Cervidil) often
stimulates contractions and may even induce the
onset of labor, eliminating or reducing the need for
oxytocin (Pitocin); it should be removed after 12
hours or with onset of active labor.

69. Choice D is correct; a Bishop score of 9

indicates
that the cervix is already sufficiently ripe for
successful induction; it is currently recommended
that 30 units of oxytocin (Pitocin) be mixed in
500 ml of an electrolyte solution such as Ringers
lactate; the oxytocin solution is piggybacked at the
proximal port (port nearest the insertion site)

a) call the women's primary health care provider to

order cervidil ripening agent
b) mix 20 units for oxytocin (pitocin) in 500 ml of
5% glucose in H2O
c) Piggy back the oxytocin solution into the port
nearest the drip chamber of the primary IV tubing
D) Begin the infusion at a rate between 1
miliunits/min as determined by the induction
protocol

70. Choice A is correct; uterine contractions should

not occur more frequently than 5 uterine
contractions
in 10 minutes to allow for an adequate rest period
between contractions; choices B, C, and D are all
expected findings within the normal range.

71. Choice C is correct; the presentation of this

fetus is breech; the soft buttocks are a less efficient
dilating
wedge than the fetal head; therefore, labor may be
slower; the ultrasound transducer should be placed
to the left of the umbilicus at a level at or above it;
passage of meconium is an expected finding as a
result
of pressure on the abdomen during descent; kneechest position would be used for occipitoposterior
positions

72. Choice D is correct; the dosage is correct at 12

mg 2 doses; this medication will stimulate her
babys lungs to produce surfactant and help him or
her to breathe more easily should birth occur;
dosages should be spaced 24 hours apart;
therefore, the next dose should be given at 11
amthe next day; tachycardia and hypotension are
not effects of this medication
73. Choice A is correct; the definitive sign of
preterm
labor is significant change in the cervix; while
uterine contractions do occur they must occur at a
frequency of more than six uterine contractions per
hour and cause significant changes in the cervix;
the
pregnancy must be at 20 to 37 weeks of gestation.

74. Choices A, D, and E are correct; See Teaching

for Self-Management boxWhat to Do if
Symptoms
of Preterm Labor Occur.

75. Choice C is correct; although A, B, and D are

appropriate actions along with changes in her
position, removing pressure from the cord to
preserve perfusion is the priority. (see Emergency
boxProlapsed Umbilical Cord).

Choice B is correct; although BP should be taken

before and after administration of
Methylergonovine
(Methergine), the womans hypertensive status
would be a contraindicating factor for its use,
especially if administered parenterallytherefore,
the order should be questioned; a more appropriate
choice would be oxytocin (Pitocin); Methergine
should not be given if the BP is greater than
140/90.

Choice D is correct; 15-methylprostaglandin F2a

(Hemabate) is a powerful prostaglandin that is
given
to treat excessive uterine blood loss or hemorrhage
related to uterine atony; it has no action related to
pain, infection, or clotting.

Choice A is correct; puerperal infections are

infections of the genital tract after birth; pulse will
increase, not decrease, in response to fever; B and
C
will also occur but are not the first signs exhibited.

Choices C and F are correct; heparin and warfarin

are safe for use by breastfeeding women; heparin,
usually administered intravenously for the first 3
to 5 days, is the anticoagulant of choice during the
acute stage of DVT; after acute phase, warfarin
(Coumadin) is begun orally; woman should be
fitted for elastic stockings after the acute stage is
past when edema subsides; the woman should be
encouraged to change her position when on bed
rest.

Choice B is correct; findings are consistent with a

bone fracture, in this case the clavicle.

Choices B, C, and F are correct; macrosomic

(birth weight of more than 4000 g (8 lb, 13 oz))
infants are at increased risk for hypoglycemia (e.g.,
a blood glucose level of 38 mg/dl would be
considered
hypoglycemia); hypocalcemia is also common;
fracture and trauma are more common in the upper
body such as the humerus and clavicle; the
newborn
of a pregestational diabetic mother is more likely
to experience congenital anomalies such as heart
defects; there is no increased risk over the general
population with gestational diabetes; the
complexion
is characteristically plethoric or flushed.

Choice A is correct; the second dose is given at

one
month and the third at 6 months.

Choice B is correct; isolation is not required and

breastfeeding is contraindicated because of the
potential for viral transmission; the nurse should
be
using Standard Precautions as would be used with
all clients; HAART is used to prevent transmission
of HIVthe chance of this newborn becoming
HIV
positive is very low because the mother was
treated
during pregnancy.

Choices B, D, E, and F are correct; signs of

abstinence syndrome also include little sleep,
tachypnea, jitteriness, hyperactivity, shrill cry,
vomiting.

Choices B, D, and E are correct; retractions, nasal

flaring, and expiratory grunting reflect increased
effort and work to breathe; choices A, C, and F
are all expected findings consistent with efficient
respiratory effort in the preterm newborn.

Choice B is correct; although choices A, C, and

D are appropriate and important, respiration with
adequate gas exchange takes precedence,
especially
because adequate surfactant is not produced before
32 weeks of gestation.

Choices A, B, E, and F are correct; air, not sterile

water, is used to check placement before feeding;
because newborns are nose breathers, the mouth is
the preferred route for insertion unless the infant is
unable to tolerate. (see Procedure boxInserting a
Gavage Feeding Tube and Fig. 37-6).

Choices A, B, and F are correct; see Table 37-2 for

normal arterial gas values for neonates.

Choice D is correct; monitoring vital signs is an

assessment measure; cleansing the skin and
teaching
parents are important but not the single most
important action; hand hygiene practiced by
everyone
in contact with the preternm newborn is critical

Choices B, C, E, and F are correct; acrocyanosis

and periodic breathing patterns are expected
findings but central cyanosis and apnea reflect
hypothermia.