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What are the leading causes of maternal death in the USA?
- Gestational Hypertension
- Pulmonary Embolism
- Hemorrhage
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Contributing related to maternal death include:
- age under 20 / over 35
- lack of prenatal care
- low educational attainment
- unmarried status
- non-white race
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Leading cause of death in neonates is _____.
- congenital anomalies
- ch.9 page 190
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What are daily fetal movement counts?
- "KICK COUNTS"
- counting fetal movement for 1-2 hours daily - should be 10 or more
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If no fetal movement is felt by the woman for a period of _____ hours, she should be evaluated ASAP.
12 hours
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Ultrasonography is more useful after what trimester?
after the first trimester, when the pregnant uterus becomes an abdominal organ
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What technique/testing equipment is used for the BPP test?
(Biophysical profile)
Ultrasonography
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What are some of the items measured by the BPP?
- Fetal breathing movements
- Gross body movements
- Fetal tone
- Reactive fetal heartbeat
- Amniotic fluid volume
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What are the normal measurements for Fetal breathing movements?
> or equal to 1 episode in a 30 minute period, lasting more than 30 seconds
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What is the normal range of fetal body movements for the BPP profile?
3 or more body/limb movements in 30 minutes
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What indicates normal fetal tone for the BPP profile?
>1 active extension with return to flexion of fetal limbs or trunk (hand flexion counts as well)
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What is a normal reactive fetal heart rate for a BPP test?
greater than 2 accelerations(>15 beats/min) in 20 minutes - each lasting > 15 seconds & associated with fetal movement
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A non-stress test is also an indication of what?
Fetal well being
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What is a normal level of qualitative amniotic fluid volume n the BPP test?
> 1 pocket of fluid measuring >1cm in perpendicular planes
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What test can indicate impending fetal death?
- BPP Profile
- (Biophysical profile)
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An amniocentesis may be done at ____ weeks gestation.
16 weeks
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Increased levels of AFP can indicate what?
neural tube defects (spina bifida)
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Decreased levels of AFP may indicate what?
Downs syndrome
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The PUB test is done to look for what? and is done when?
in the second & third trimesters
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The CVS test is done at ___ weeks.
10-12 weeks
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The MSAFP test is done when and for what?
- 15-22 weeks
- can detect abdominal wall defects and/or neural tube defects
- (maternal serum AFP)
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A glucose test is done at _____ weeks to screen for gestational diabetes.
24-28 weeks
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How often should pre-natal visits be scheduled?
- monthly until 28 weeks
- then every 2 weeks until 36 week
- then weekly till delivery
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How is Hepatitis C contracted?
Needle sharing
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What complication may occur from Hepatitis C?
pre-term labor
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If an infant is born to a mother who tests positive for Hep C, what actions should be taken?
Child should be vaccinated at 12-18 months of age
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At 18-30 weeks - where should the fundus be when measured in centimeters ?
Should be the same number of weeks gestation as height. Variations may indicated IURG or other issues.
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What agent is used to reverse sedatives?
Narcan
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When is the use of Narcan contraindicated?
when a baby is born to mother who is addicted to drugs and has been using during pregnancy - Narcan can cause these neonates to have seizures
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What must be administered before an Epidural?
- IV bolus of fluids
- 500-1000 mL for a single fetus
- 2000ml for twins
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What are some contraindications for an epidural?
- Tattoo at injection site
- Coagulation/bleeding disorders
- Low platelet count
- Cardiac issues
- Scolliousis
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What is Duramorph?
are there any side effects?
- synthetic morphine used in epidurals
- side effect is itching - give Beneadryl
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Why is hypothermia a side effect of child birth?
the combination of vasodilation combined with the effects of analgesia and anesthesia
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High blood pressure is the main factor of what outcome?
death
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Chronic HTN is classified as what?
BP exceeding 140/90 (at least on 2 occasions)
Before 20 weeks gestation
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Medication is indicated to treat a BP reading of what ?
160/110 or higher
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A woman with a BP of 140/90 requires what nursing intervention?
Education
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HTN will damage what organs?
brain, liver, kidneys, placenta - usually from hemorrhage
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What are some HTN disorders ?
- Chronic HTN
- Gestational HTN
- Pre-eclampsia
- Eclampsia
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A BP of 140/90 after 20 weeks gestation is defined as what?
- Gestational HTN
- No proteins found in urine
- will return to normal approx. 12 weeks after birth
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Complaints of right upper quadrant pain coupled with high blood pressure could indicate what?
Liver hemorrhage
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Define preeclampsia :
- occurs after 20 weeks gestation
- includes gestational HTN & proteins in the urine
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S/S of severe Preeclampsia:
- BP > 160/110
- + 500mg of proteinurea
- Headache
- Oliguria
- Blurred vision
- Pulmonary edema
- Low platelets (<100,000 mm2)
- Epigastritis or RUQ pain
- HELLP
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Eclampsia includes what symptom:
- Onset of seizures
- Edema in hands & feet
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What treatment is given to treat seizures associated with eclampsia?
- Magnesium Sulfate
- Oxygen
- Oxitocyn
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What is the antidote for Magnesium Sulfate?
Calcium Gluconate
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What is an AE of magnesium sulfate toxicity?
- Nausea, warmth, flushing, slurred speech
- Decreased breathing <12/ minute
- Urine <30 mL/hour
- Absence of deep tendon reflexes
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What is HELLP syndrome?
- found in sever preeclampsia patients (22-36 weeks)
- Hemolysis = low hematocrit
- Elevated
- Liver enzymes = NV, RUQ pain, LDH, AST
- Low
- Platelets = <100,000cell/mm3
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What is used to treat HELLP syndrome?
Magnesium Sulfate -
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What is a complication of eclampsia?
Abruptio Placenta
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What is placenta previa?
placental implanted in lower uterus
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Hypothyroid can out a mother at risk for what complications?
- Preterm birth
- Low birth weight
- Neonatal mortality
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Untreated hypothyroidism untreated can lead to?
- Preeclampsia
- Placenta abruption
- Still birth
- Fetal neurological disorders if hormones are too low
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Mothers with diabetes mellitus are at risk for what?
- Preterm birth
- Macrosomia (large baby)
- Congenital anomalies with high glycemnia
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Nursing care for diabetic mothers:
- Diet & exercise
- Insulin therapy
- Monitor glucose levels
- Fetal surveillance
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What is he only PO med approved for diabetics?
Metformin used with diet & exercise to control Type II diabetes
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What is a side effect for baby when born to a mom on metformin?
Hypoglycemia
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What may change about insulin doses in the pregnant woman?
May be doubled or tripled in the 2nd & 3rd trimesters.
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What are side effects of a mother with cardiovascular disease?
- Miscarriage
- Preterm labor/ birth is more prevalent
- IUGR
- Incidences of congenital heart lesions increased if mothers has a congenital heart disease
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Iron deficiency is also know as ____.
anemia
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How would you treat sickle cell hemoglobinopathy?
- Hydration
- Pain medication
very painful disorder
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What common ailment is experienced in the first trimester of pregnancy?
Common Cold
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Mothers with epilepsy are at risk for what?
- not taking medication
- increase risk of bleeding & abruptio placenta
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How are mothers with Multiple Sclerosis treated?
bed rest & steroids for acute exacerbations
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Bell's Palsey
may develop during pregnancy and resolve after birth
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What is uterine atony?
- marked hypotonia of uterus
- #1 reason for postpartum hemorrhage
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What would a slow trickle of blood with a firm uterus indicate?
possible lacerations of the genital tract
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What is an inversion of the uterus?
- turns inside out
- potentially life threatening
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What is a pelvic hematoma? what are the s/s?
collection of blood in the connective tissue - may be vulvar, vaginal, or retroperitoneal.
Pain is the most common s/s
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What types of birth are associated with pelvic hematomas?
- Forceps-assisted
- Episiotomy
- Primigravidity
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What is a s/s of a subinvoluted uterus?
- Late postpartum bleeding
- Prolonged lochia discharge
- Irregular or excessive bleeding
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How long does it take the fundus to drop?
About ten days - one finger per day
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What is one of the first signs of postpartum hemorrhage?
Tachycardia while trying to compensate for blood volume loss
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What fluids are given to help increase blood volume?
- Lactaded Ringer's
- Normal Saline
- Packed Red Blood cells
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Medication for managing bleeding?
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urinary output of less then 30mL/ hour could be a sign of what?
blood loss in postpartum bleeding
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What is disseminated intravascular coagulation?
DIC pathogenic form of clotting - consumes large amounts of clotting factors, including platelets, fibrinogen, prothrombin, and factor V & VII
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What is endometritis ?
infection of the lining of the uterus
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What are s/s of DIC?
spontaneous bleeding from gums or nose, petechiae from the BP cuff, excessive bleeding following a venipuncture
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What is the antidote for Heprin?
Protamine Sulfate
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What is a puerpal infection?
any infection of the genital canal within 28 days after abortion or birth
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