Flashcards on OB HESI Practice
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What hypothalamic-pituitary hormones rule each phase of the ovarian cycle?
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FSH in the follicular phase and LH in the luteal phase.
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What are the four phases of the endometrial cycle?
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Menstruation, proliferative phase, secretory phase, and ischemic phase.
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How long do eggs live?
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About 24 hours
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How long do sperm live?
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About 48-72 hours
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Describe GTPAL.
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Gravida=number of pregnancies, including the present one; Term=number of term births; P=number of preterm births; Abortions=number of elective or spontaneous births before 20 weeks; Living children=children born live.
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How do you calculate gestational age using Nagele's Rule?
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Take the first day of the LMP, count back three months and add 7 days.
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What are normal hematocrit values at 28-32 weeks gestation?
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32%-42%
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What is the normal fetal heart rate?
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110-160 bpm
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Name three objective signs of ovulation.
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Thin, clear, stretchy, egg-white cervical mucus; drop in BBT and then rise of 0.5-1 degree F; and ferning under the microscope
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Name the three ways of identify the chronological age of a pregnancy.
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10 lunar months, 9 calendar months, or 40 weeks.
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How many calories should be added to the maternal diet?
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300 calories/day
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What would the fundal height be at 20 weeks?
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At the umbilicus
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What should the total weight gain be in a "normal" weight woman during pregnancy?
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25-35 lbs.
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At what point is fetal heart rate able to be auscultated during pregnancy?
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10-12 weeks.
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What is the pattern of check-ups in a low-risk pregnancy?
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Every 4 weeks until week 28. Every two weeks from 28 to 36 weeks. Every week from week 36 to delivery.
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When is chorionic villus sampling done?
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Between 8 and 12 weeks' gestation.
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When is amniocentesis done?
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As early as 14-16 weeks
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What is the peak of a contraction on fetal monitoring called?
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The "acme"
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How do you calculate the frequency of contractions?
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From the beginning of one contraction to the beginning of the next
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What is measured in intraunterine monitoring that cannot be measured externally?
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The intensity of contractions, measured by the increased IUP in mmHg (30-70 mmHg)
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What is the baseline FHR?
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The heart rate between contractions, monitored over a 10-minute period.
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What is variability?
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The normal irregularity of the cardiac rhythm.
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Name the four categories of variability and what they mean.
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Absent-undetectable; minimal- amplitude detectable up to and including 5beats/min; moderate- 6-25 beats/min; and marked=>25 beats/min
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What are FHR accelerations?
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An increase in FHR in response to stimulus (contractions, etc.). Indicates a healthy fetus.
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What are FHR decelerations?
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A decrease in FHR that can be early or late when compared to uterine contractions.
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What are early decelerations?
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Decelerations that begin with the beginning of contractions or with contractions that symbolize a benign pattern caused by head compression. Slowly decelerates and returns to baseline.
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What are variable decelerations?
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Common pattern with rapid decelerations that is variable in duration, depth, and fall, and timing relative to the contraction cycle.
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What are the nursing actions associated with variable decelerations?
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Change position, stimulate fetus if indicated, d/c oxytocin, give O2 at 10L by tight face mask, SVE for cord prolapse, and the report findings to physician and document.
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What are late decelerations?
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An ominous and potentially disastrous non-reassuring sign. Indicates uteroplacental insufficiency. Uniform shape of deceleration that occurs toward the end of contractions and recovery occurs after end of contraction. Decel's don't go past 100 bpm
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What are nursing actions for late decelerations?
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Turn client to left side, d/c oxytocin, give O2 10L by tight face mask, assist with fetal blood sampling if indicated, maintain IV, elevate legs to increase venous return (if possible), correct any hypotension by increasing IV or with meds, assess FHR variability, notify MD, and document pattern and response to each nursing action.
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What are the possible causes of absent or minimal variability?
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Hypoxia, acidosis, maternal drug ingestion, or fetal sleep.
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How is fetal bradycardia defined?
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A FHR below 110 bpm for 10 minutes.
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What are causes of fetal bradycardia?
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fetal hypoxia (late manifestation), medications, maternal hypotension, fetal heart block, prolonged umbilical cord compression.
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How is fetal tachycardia defined?
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Baseline of greater than 160 bpm for 10 minutes.
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What are the causes of fetal tachycardia?
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Early sign of fetal hypoxia, fetal anemia, dehydration, maternal infection/fever, maternal hyperthyroid disease, and medication-induced tachycardia.
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What are the nursing actions for decreased variability?
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Depends on cause.
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What are the nursing actions for FHR bradycardia?
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Depends on cause.
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What are the nursing actions for FHR tachycardia?
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Depends on cause.
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What are severe variable decelerations?
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FHR below 70 bpm lasing longer than 30 seconds, with a slow return to baseline and decreasing or absent variablity.
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What are the nursing actions for severe variable decelerations?
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Turn client to left side, d/c oxytocin, give O2 10L by tight face mask, assist with fetal blood sampling if indicated, maintain IV, elevate legs to increase venous return (if possible), correct any hypotension by increasing IV or with meds, assess FHR variability, notify MD, and document pattern and response to each nursing action.
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How should cord prolapse be managed?
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Position mother to relieve pressure on the cord (knee-chest) or push presenting part off of cord until delivery is accomplished.
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What conditions might cause uteroplacental insufficiency and late decelerations?
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Preeclampsia, DM, cardiac disease, and placentae abruptio.
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How is IUGR diagnosed?
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With serial ultrasounds
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Name two nursing interventions to be done prior to a first trimester ultrasound.
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Have client fill bladder and lie supine with uterine wedge.
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What is an advantage CVS has over amniocentesis?
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It can be done earlier (8-12 weeks gestation) with results back within a week, allowing for a first trimester termination, if warranted.
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What do high or low AFP levels mean?
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High could mean NTD's and low could be trisomy 21.
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What is the most important indicator of fetal autonomic nervous system integrity and health?
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FHR variability
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What is a reactive fetal nonstress test?
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A normal result indicating good fetal health where the fetus responds to its own movements with an acceleration of 15 bpm lasting for 15 seconds after the movement, twice within a 20 minute period.
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What is the normal range for fetal scalp pH during labor?
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7.25-7.35
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What fetal scalp pH indicates true acidosis?
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7.2 or under
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What is the first stage of labor?
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First stage: From beginning of regular contractions or rupture of membranes to 10 cm dilation with 100% effacement
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What are the three phases of the first stage of labor?
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Latent - from beginning to 3-4 cm; Active - from 4-7 cm cervical dilation; Transition - from 8-10 cm dilation
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What is the second stage of labor?
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10 cm to delivery
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What is the third stage of labor?
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Deliver of the fetus to delivery of the placenta
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What is the fourth stage?
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About two hours after the delivery of the placenta
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What is fetal presentation?
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The part of the fetus that is presenting int the inlet. Usually, the vertex, acromion, or breech.
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What is fetal position?
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The relationship of the point of reference on the fetal presenting part to the mother's pelvis. LOA is left occiput anterior. Left is the mother's left pelvis.
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What is the fetal lie?
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The relationship of the spine of the mother to the spine of the fetus. It can be longitudinal, transverse (perpendicular), or oblique.
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What is the fetal attitude?
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The relationship of the fetal parts to one another. The fetal attitude can be flexion or extension.
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Name three uterine stimulants given for uterine atony.
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Oxytocin, methergine, and hemabate.
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What should be assessed before giving methergine?
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Blood pressure - withhold if over 140/90 and notify physician. Use with caution in pts with preeclampsia
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Who should not get hemabate?
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Patients with asthma
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What is the most common cause of uterine atony?
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Full bladder - if patient has soft fundus displaced to the right of the umbilicus, massage uterus and then have patient empty bladder.
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What tissue to tears extend to?
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1st degree - epidermis 2nd degree - dermis, muscle and fascia 3rd degree - extends into anal sphincter 4th degree - extends into rectal mucosa
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What five things does APGAR assess?
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Appearance, Pulse, Grimace, Activity, Respiration
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How should an IV bolus be administered during labor?
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Slowly, beginning at the start of a contraction, so that less gets to the fetus.
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Name two tests that show the membranes have ruptured.
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Nitrazine paper turns dark blue or black; ferning under microscope
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Name two reasons that anesthesia and analgesia should be given in the midactive phase of stage I labor.
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Given too early can retard labor; given too late can cause fetal distress
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What blood gas issues can be caused by hyperventiliaton?
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Respiratory alkalosis.
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Where is the fetal heart rate best heard?
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Through the fetal back in vertex, OA positions
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What is considered normal maternal pulse during labor?
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<100 bpm
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Name three signs of placental separation.
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Gush of blood, lengthening of cord and globular shape of uterus.
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What is considered a "good" APGAR score?
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7-10
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What immediate intervention should occur if meconium passage occurred in utero?
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Arrange for immediate ET observation.
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What is one of the first signs of hypotension occurring immediately after administration of regional block?
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Nausea
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What occurs to the maternal pulse after delivery?
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Pulse may decrease to 50 bpm; normal puerperal bradycardia
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When does normal cardiac output return?
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Within 2 to 3 weeks postpartum
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What is considered normal WBC level after labor?
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12,000 to 25,000
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What is the normal leukocytosis of pregnancy?
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12,000 to 15,000
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What is the most common cause of uterine atony after the first postpartum day?
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Retained placental fragments
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How soon after delivery should the client void?
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Within four hours of delivery.
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What should the fundal height be three days after a vaginal delivery?
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3 finger-breadths below the umbilicus
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What is the normal range for newborn respirations?
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30-60 breaths/min
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What is the normal newborn heart rate?
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110-160; 100-180 if sleeping or crying
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What is the normal newborn temperature?
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97.7-99.4
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What is the normal newborn blood pressure?
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80/50, but not usually measured.
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How should suctioning be done in the newborn?
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Mouth first and then nose (to prevent aspiration in the mouth)
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What is caput succedaneum?
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Edema under the scalp that crosses suture lines and is usually present at birth.
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What is cephalhematoma?
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Bruising under the periosteum that does not cross suture lines and usually manifests a few hours after birth. Can cause hyperbilirubinemia.
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What vessels should be found in the umbilical cord?
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One vein (that takes oxygen to the fetus) and two arteries (which carry unoxygenated blood back to the mother).
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What complications can occur from hypothermia?
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Depletion of glucose and the use of brown fat, leading to ketoacidosis.
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What precautions should be done when performing heel stick?
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Avoid the plantar artery in the middle of the heel and wipe away the first drop with sterile gauze.
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What muscle should be used in newborn injections?
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The vastus lateralis muscle of the thigh.
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How is pathologic jaundice different from physiologic jaundice?
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It occurs before 24 hours of age or persists for longer than 7 days.
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What causes physiologic jaundice of the newborn?
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It begins 2-3 days after birth because the newborn liver can't keep up with the RBC destruction and to bind bilirubin. Unconjugated bilirubin is the culprit.
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How do you calculate 1 mL of urine when weighting diaper?
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Each gram of weight of the urine is calculated as 1 mL of urine.
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What respiratory rate in the newborn indicates that the newborn should not be fed?
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60 breaths/min or more
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How many calories/day does an infant need for the first six months?
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About 50 calories/lb or 108 calories/kg of body weight.
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What is considered the newborn transitional period of life?
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The first 6-8 hours.
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What three risk factors can lead to respiratory depression (depression) in the newborn?
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Cesarean delivery, mag given to mother in labor, and/or ashyxia or fetal distress during labor
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Is the newborn's head smaller than its chest?
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No, it should be 2cm larger unless severe molding has occurred.
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Should a newborn have a positive or negative Babinski?
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A positive unti 12-18 months of age
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How are SGA and LGA defined?
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Below the 10th percentile or above the 90th percentile.
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What is normal blood glucose in the term neonate?
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40-80
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When is PKU testing done usually?
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At 2-3 days of life
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What should patients be taught are signs that the doctor should be called after discharge?
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Lethargy, temp > 100, vomiting, green stools, or refusal of two feeds in a row.
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When do most miscarriages occur?
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Between 8 and 13 weeks.
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What interventions should be done in patient having miscarriage?
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Start IV of at least 18 gauge, give RhoGAM if indicated, and teach client to notify nurse with temp > 100.4, foul-smelling discharge, or bright-red bleeding with tissue larger than a dime.
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Why is hCG taken for a year after hydatidiform mole?
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Because hCG levels that do not diminish can lead to choriocarcinoma. Pregnancy must also be avoided for a year.
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How is placentae abruptio different from previa?
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Dark red vaginal bleeding, rigid uterus, and severe pain.
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What interventions should be started with placentae abruptio?
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Notify MD! Do not manipulate abdomen or vagina, give O2 by facemask, monitor for DIC signs, type and cross-match, side-lying position, and prepare for emergency C-section.
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How is previa different from abruption?
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Painless, bright red bleeding, soft uterus, with FHR usually normal.
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What interventions should be started with previa?
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Side-lying position, bed rest, bp and pulse every 15 minutes, start IV, type and screen, monitor blood loss, prepare for u/s and possible c/s.
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How is anemia defined through the pregnancy?
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First trimester: Hgb < 11; Hct < 37% Second: Hgb < 10.5; Hct < 35% Third: Hgb < 10 ; Hct < 32%
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How is chlamydia treated in pregnancy?
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Erythromycin and treat for gonorrhea, too (penicillin and/or erythromycin and ceftriaxone)
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How is gonorrhea treated in pregnancy?
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Penicillin and/or erythromycin and ceftriaxone and treat for chlamydia (erythromycin)
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What HPV drug is contraindicated in pregnancy and what drug is recommended?
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Podophyllin is contraindicated; The one with the initials is still used (TCC/BCA, idk, lol)
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How is toxoplasmosis treated during pregnancy?
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Sulfa drugs; maybe therapeutic abortion if discovered before 20 weeks.
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How is Flagyl used during pregnancy?
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Its use is contraindicated in the first trimester and its use in the second trimester is contraversial.
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What are nursing implications with Yutopar (Ritodrine) and terbutaline?
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Maternal pulse should not exceed 140 bpm, fetal heart rate should not exceed 180 bpm, and keep antidote (beta-blocking agent) available.
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What are nursing implications with Mag sulfate?
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Hold if respirations are < 12/min or urine output is < 100 mL/4hrs; keep calcium gluconate handy
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What are nursing implications with Procardia (nifedipine)?
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Check bp for hypotension immediately before given, do not use with Mag, and dangle before rising.
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What are nursing implications with indomethacin?
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Only give for 48 hours or less, do not use for women with bleeding potential, and give with food.
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What are signs of mag toxicity and what should be done?
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Respirations < 12/min, urine output 8mg/dL; Hold dose and notify provider.
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What are symptoms of uterine rupture?
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Sharp pains accompanied by abrupt cessation of contractions.
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What is the main drug given for preeclampsia in the hospital?
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Mag sulfate
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When are antihypertensives given to the preeclamptic patient?
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If the diastolic is greater than 110 mm Hg, and then hydralazine is given.
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When is the risk of seizures usually gone in the preeclamptic patient?
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48 hours after birth
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What drugs should cardiac patients NOT get for preterm labor?
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Terbutaline or Yutopar (ritodrine HCl) because of the risk of myocardial ischemia.
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What can cause problems postpartum in the cardiac patient?
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Normal postpartum diuresis can increase CO.
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What anticoagulant can be used in pregnancy?
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Heparin
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Can oral hypoglycemics be taken during pregnancy?
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Nope.
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What insulin should be used during labor?
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Regular insulin
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What is TTN?
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Transient tachypnea of the newborn; commonly seen in c/s babies
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What instructions should be given to the woman with a threatened abortion?
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Bedrest for 24-48 hours, no sex for 2 weeks.
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When can preterm labor be arrested?
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When cervix is < 4cm dilated, <50% effacement, and membranes are intact and not bulging out of the cervical os.
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What is considered a prolonged latent phase in a multipara?
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> 14 hours
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What is considered a prolonged latent phase in a nullipara?
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> 20 hours
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Name three conditions that DM patients are likely to develop in pregnancy.
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Preeclampsia, hydramnios, and infection
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Can insulin be used in breastfeeding?
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Yes
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What is the euglycemia goal for the diabetic patient in labor?
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70-90 mg/dL
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What type of contraceptive should diabetics use?
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They should avoid estrogen. They should also avoid IUDs due to the increased risk for infection.
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What interventions are used during the labor of a cardiac patient?
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Semi- or high- Fowler position, prevent valsalva, side-lying position for regional anesthesia, and avoid stirrups.
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What immediate nursing interventions should be taken when a postpartum hemorrhage is detected?
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Massage fundus, notify HCP if fundus doesn't get firm with massage, count pads, assess vital signs, increase IV fluids, and administer oxytocin as prescribed.
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What are signs of endometritis?
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Subinvolution, lochia returning to rubra with possible foul smell, temper of 100.4 or higher, and unusual fundal tenderness.
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When should breastfeeding be discontinued in the patient with mastitis?
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Only if pus present or antibiotics are contraindicated for neonate. However, the mother may throw away expressed milk to help condition and resume breastfeeding after the infection has cleared.
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What two diseases can cause jitteriness in the newborn?
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Hypoglycemia and hypocalcemia
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What is the Silverman-Anderson Index?
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A measure of respiratory distress where 10 is severe and 1 is okay.
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What complications can result from O2 toxicity?
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Retinopathy of prematurity and bronchopulmonary dysplasia.
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What are complications with neonatal hypoxia?
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NEC, PDA, or intraventricular hemorrhage.
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What are the PO2 goals in the neonate?
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Between 50 and 90 mm Hg.
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How do you assess for jaundice in the infant?
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Blanche forehead with thumb. If jaundiced, skin will turn yellow before normal skin color reappears. In dark-skinned infants, observe conjunctival sac and oral mucosa.
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What is the dangerous bilirubin type?
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The unconjugated, indirect type.
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When should compressions be done in a newborn?
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HR < 60 bpm; do 90 compressions and 30 breaths.
