exam 4

Nursing 3024 with O'neal at Oklahoma Christian University of Science & Arts

About this deck

By: Melissa Etheridge
Textbook:

Maternal Child Nursing Care (Wong, Maternal Child Nursing Care)

Maternity & Women's Healthcare: Irm

Study Guide for Maternity Nursing
Created: 2012-02-20
Size: 46 flashcards
Views: 18

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produced by the fetal liver

alpha-fetoprotein

detectable in serum 14-34wks

amniotic fluid index

normal = 10+

oligo = <5

poly = >25

normal score on BPP

8-10

elevated S/D ratios using doppler blood flow indicates what

poor perfusion of placenta

MSAFP

used for screening NTDs, screening tool only, may identify a need for amniocentesis

best time for testing is 16-18 wks

categories of high risk

biophysical

psychosocial

sociodemographic

environmental

how to perform DFMC

count once a day for 60 mins or

count 2-3 times a day for 60 mins

abdominal ultrasound

more useful after first semester

full bladder

pillow under head and knees

transvaginal ultrasound

probe inserted into vagina

no need for full bladder

useful in obese women

lithotomy position with raised pelvis

1st trimester to detect ectopic, development, abnormal, age

uses of ultrasound in 1st trimester

confirm pregnancy and viability

age

rule out ectopic

twins

use of US in 2nd trimester

establish/confirm dates

IUGR

oligo or poly

use of US in 3rd trimester

confirm age and viability

macrosomia

position

BPP

AFV

doppler flow studies

placental maturity

fetal heart activity can be seen early as...

6-7 wks

fetal heart activity can be heard early as...

10-12 wks

methods of determining age

8 wks - gestation sac dimensions

7-12 wks - crown to rump length

12+ - biparitetal diameter and femur length

ultrasound is more accurate then menstrual dates

macrosomic

>4000g

by ?-? wks placenta is clearly define

14-16

placenta previa cannot be confirmed until ? wks

oligohydramnios is associated with.

renal trouble

growth restriction

fetal distress during labor

polyhydramnios is associated with...

GI obstruction

NTDs

multiple fetuses

fetal hydrops

How to use scoring on BPP

breathing: 30sec or longer in 30 min period

gross body movement: 3 moves in 30 mins

fetal tone: @ least one active extension with return to flexion

reactive fetal heart rate: 2 accels with fetal movement

AFV: @ last least one pocket measuring 2cm

how is an amniocentesis performed

needle inserted transabdominally into uterus and fluid is withdrawn

when can you have an amniocentesis

after 14 weeks

complications of amniocentesis

hemorrhage, possible Rh isoimmunization, infection, labor, abruption, damage to moms bladder or intestines

Who is RhoGAM given to?

Rh (-) women with Rh (+) babies

What does an amniocentesis test for?

IEM, downs, karyotyping, twins, fetal lung maturity, hemolytic disease

Two ways of obtaining CVS

transcervical: in cervix, aspirated into syringe, contraindicated if infection is present

transabdominally: 18 gauge spinal needle, aspirated into sponge

RhoGAM if necessary

when can we perform a CVS

10-13 wks

1st trimester (earlier dx, rapid results)

from fetal portion of placenta

PUBS

2nd and 3rd trimester

insert directly into umb cord

identifies fetal blood type, RBC count, presence of maternal antibodies

continue FHR monitoring 1-2 hrs after

indications for NST and CST

DM, chronic HTN, IUGR, sick cell, postterm, previous stillbirth, decreased fetal movement, isoimmunization, hyperthyroidism, collagen disease, chronic renal disease

NST

monitors babies HR in response to fetal movement

want to see accelerations

recline with slight left tilt

20-30 mins

orange juice helps increase fetal movement

reactive = good, 2+ accels of 15x15 over 20 min

CST

identifies if fetus is stressed

recline mom with left tilt

10-20 mins

considered invasive if oxytocin used

negative = good, 3 contrtactions in 10 min with no late decels

gestational diabetes

after 20 wks

w/o proteinuria

over 140/90

preeclampsia

htn and proteinuria

after 20 wks

most common in very young or very old moms

more weight gain then is normal, hyperreflexia, maybe HA

eclampsia

convulsions

chronic HTN

before 20 wks

superimposed preeclampsia

HTN before 20 wks

new onset of proteinuria >0.5g in 24 hrs

superimposed eclampsia

both HTN and proteinuria before 20 wks

large increase in HTN plus one of the following:

new onset of symptoms, thrombocytopenia, elevated enzymes

difference between mild and severe preecelampsia

mild: BP>140/90, >1+ on dipstick

severe: BP> 160/110, >3+ on dipstick, RUQ pain, impaired liver function, pulmonary edema

risk factors for preeclampsia

age, history, multifetal, molar pregnancy, chronic HTN, DM, renal disease, poor outcome in previous pregnancy, first pregnancy

diet for preeclampsia

proteins (meat, beans, nuts)

calcium

folic acid, zinc and sodium, roughage, water, salt foods to taste

severe toxicity symptoms of mag

hypotension, serum level over 8, bradypnea, bradycardia, cardiac arrest

misoprostol

cytotec, stimulates contractions, used to induce labor or if remnants of miscarriage are present

methrotrexate

given to dissolve tubal pregancy, given for unruptured mass, <3.5 cm, no fetal heartbreat, and hCG <5000mLU/L