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OB > simulation > Flashcards

simulation Flashcards

1
Q

temp

A

36.5-37.5 C (97.7-99.5 F)

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2
Q

pulse

A

120-160

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3
Q

respiration s

A

30-60

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4
Q

intermittent uterine contractions that happen after birth

A

after pains

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5
Q

If the uterus is contracted but there is excessive lochia, what type of injury is suspected?

A

laceration of the birth canal

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6
Q

6 hazards of cold stress?

A

a. Increase oxygen needs
b. Decrease surfactant production
c. Respiratory distress
d. Hypoglycemia
e. Metabolic acidosis
f. Jaundice

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7
Q

postpartum hemorrhage for vaginal birth

A

loss of 500 ml

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8
Q

postpartum hemorrhage for c section

A

loss of 1000 ml

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9
Q

when does late postpartum hemorrhage occur

A

24 hours and 6-12 weeks after birth.

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10
Q

early postpartum hemorrhage occurs

A

during first hour after birth. Most often caused by uterine atony (a lack of tone)

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11
Q

What is the first intervention in uterine atony?

A

Massage fundus until firm, and express the clots that may have accumulated in uterus

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12
Q

earliest indication of hypovolemic shock?

A

Tachycardia, even the smallest increase in pulse should be noted

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13
Q

Acute peripheral circulation failure resulting from loss of circulating blood volume.

A

hypovolemic shock

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14
Q

Abnormally decreased volume of circulating fluid in the body

A

hypovolemia

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15
Q

Where is the location of the uterus immediately after delivery?

A

Midway between the symphysis pubis and the umbilicus and midline of abdomen

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16
Q

Within 12 hours after birth?

A

Fundus rises to level of umbilicus

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17
Q

Each day thereafter until the 14th day?

A

Descends into abdominal cavity and cannot be palpated abdominally

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18
Q

Why do some women have severe afterpains?

A

Most cases have multipara (multiple children) have more severe because of repeated stretching of uterus, primipara remains contract but may feel some afterpain – due to over distention of uterus or blood clots

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19
Q

8 risk factors for post-partum hemorrhage.

A

a. Trauma to birth canal
b. Hematoma
c. Retention of placental fragment
d. Abnormalities of coagulation
e. DIC
f. Placenta prevera
g. Placenta accreta
h. Inversion of uterus
i. Someone who has multiple babies, LIKE MULTIPLE

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20
Q

When assessing bladder elimination, explain the concern if a woman has frequent voids of less than 150 cc after birth?

A

This is known as urinary retention, mother is not emptying bladder all the way, mother’s fundus should be palpated to know how full bladder is

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21
Q

Explain the procedure and risks of expressing clots from the uterus after birth.

A

Apply firm and gentle pressure on fundus in the direction of the vagina. Very important that the uterus is contracted firmly before attempt to express clots
Risk : pushing on uterus that is not contracted can invert the uterus and cause massive hemorrhage and shock

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22
Q

If the uterus does not remain contracted or is displaced, what is the next step in dealing with uterine atony?

A

Assist the mother to urinate or put in catheter.

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23
Q

Explain the procedure in replacing intravascular fluid volume.

A

Administer hall blood, packed RBC, normal saline and other plasma extenders are used, enough fluid should be given to maintain urinary output of 30 mL per hour, lactated ringers, whole blood

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24
Q

When should lacerations of the birth canal be suspected?

A

If excessive uterine bleeding continued when the fundus is contracted firmly and is at expected location

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25
Q

What is the most common cause of late post-partum hemorrhage?

A

subinvolution – delayed return of uterus to its not pregnant size and consistency

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26
Q

How much blood loss can a pregnant or newly delivered woman tolerate

A

1500 – 2000 mL

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27
Q

How does anemia impact the effect of blood loss in the pregnant or newly delivered woman?

A

Has less of a reserve for blood

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28
Q

How is amount of blood loss estimated?

A

Weigh peri pads, linen savers, weigh linens

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29
Q

Why would a woman who is hemorrhaging be temporarily rolled on her side?

A

Check underneath legs butt and back for lochia drainage

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30
Q

Explain the differences in effacement in the parous woman and the woman who has not previously given birth.

A

Parous woman – thicker at point of time compared to nullipara, nullipara completes most cervical effacement early in the process of dilation

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31
Q

Why are intermittent rather than continuous contractions in the laboring woman important to the fetus?

A

To allow fetal exchange of oxygen, nutrients, and waste products in the placenta during the period between the end of one contraction to the beginning of the next one.

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32
Q

BP FOR prec

A

look up

33
Q

stimulates sustained contraction of the uterus and causes vasoconstriction

A

methylergonovine

34
Q

prevents hemorrhaging after labor

A

meth

35
Q

who do you not want to give the meth drug to

A

mom with hypertension, thrombophlebitis, CAD

36
Q

stimulates contractions of the uterus; used for treatment of postpartum hemorrhage caused by uterine atony

A

carboprost trome

37
Q

dont want to give carboprost trome to what patients

A

asthma, hypertension/hypotension, anemia, jaundice

38
Q

POST PARTUM hemorrhage

A

carboprost trome

39
Q

route for carboprost trome

A

IM ONLY

40
Q

route for Oxytocin/Pitocin

A

IV or IM

41
Q

route for meth

A

IM or PO

42
Q

side effects of carboprost Tromethamine/Hemabate

A

tachycardia, vomiting, diarrhea

43
Q

Occurs when bleeding into loose connective tissue occurs, while over lying tissue remains intact. Development as result of blood vessel injury and spontaneous deliveries, and deliveries where vacuum and forceps were used.

A

hematomas

44
Q

symptoms of hematomas

A

deep severe unrelieved pains and feelings of pressure that are not relieved by usual methods, tachycardia, decreased BP.

45
Q

hematoma treatment

A

small hematomas reabsorb naturally, large hematomas may require incision, evacuation of clots, and location/ligation of bleeding vessels

46
Q

pharm therapeutic management when late post-partum hemorrhage occurs

A

oxytocin, methergine, prostaglandins

47
Q

therapeutic management when late post-partum hemorrhage occurs

A

If bleeding continues or reoccurs, dilation and stretching of cervical OS2 permits suctioning or scraping of the walls of the uterus may be necessary to remove fragments.

48
Q

Explain the cause of increased respiratory rate, skin pallor, decreased blood pressure, anxiety and confusion in the hemorrhaging woman.

A

Decrease in BP due to decrease in circulating blood volume, respiratory rate increases as woman becomes more anxious in attempts to take in more oxygen, vasoconstriction in skin which cause pallor

49
Q

nursing care during a hemorrhage

A 
vital signs and pulse 
assessment of fundus and lochia 
uterine massage
oxygen administration 
iv fluids 
blood administration 
meds
urine catheter 
position 
notify Doc
family support
50
Q

explain the benefit and procedure of modified Trendelenburg positioning

A

Legs are elevated 10-30 degerees to increase blood return from the legs, head is elevated, trunk is horizontal

51
Q

most common cause of subinvolution

A

delay ??

52
Q

nullipara advice to these laboring women about coming to the hospital

A

contractions are 5 minutes apart lasting 1 minute for 1 hour

53
Q

multi para advice to these laboring women about coming to the hospital

A

contractions are 10 minutes apart lasting one minute for one hour

54
Q

womans whose bag has possibly broken advice to these laboring women about coming to the hospital

A

come in; could be trickle or gush of fluid

55
Q

what other patient should you suggest to come into the hospital

A

women with bright red bleeding

56
Q

where does the transducer go

A

on the fetal back

57
Q

Continuous headache, drowsiness, mental confusion, blurred/double vision, numbness/tingling in feet, epigastric pain, decreased urine output

A

hypertension and preclampsia

58
Q

Impaired liver function, pulmonary edema, renal insufficiency, and death to baby and mom.

A

complications with preclampsia

59
Q

cure for preclampsia

A

deliver the baby

60
Q

Reduce activity, BP monitoring, go to doctor, monitor weight, urine collection to test for protein, increase kick counts, diet should have proteins and calories.

A

regular interventions for preclampsia

61
Q

severe preclampsia

A

bed rest in lateral position, calm environment, antihypertensive meds.

62
Q

numbers for preclampsia ??

A

dont know

63
Q

treats preeclampsia and hypertension; contraindications include heart block, impaired renal func, respiratory distress, myocardial damage

A

magnesium sulfate

64
Q

treats preeclampsia and hypertension; less maternal tachycardia, contraindicated for patients with asthma, CHF, or heart disease, associated with hypoglycemia and small for gestational aged infants

A

labitol

65
Q

antidote for magnesium sulfate

A

calcium gluconate

66
Q

nursing interventions for patient on magnesium sulfate

A

monitor lungs for pulmonary edema and respiratory rate

67
Q

treats preeclampsia and hypertension; higher doses associated with maternal hypotension, headaches and fetal distress

A

Hydrolizide

68
Q

prevent eclampsia.

A

Early and regular prenatal care, close attention to weight, monitor BP, urinary protein analysis, low does aspirin, calcium and magnesium supplements, and a salt restricted diet

69
Q

BUBBLEHE

A 
breasts
uterus 
bladder
bowel
lochia
EPISITOMY/INCISION
HEMMORHOIDS/HOMAN’S SIGN
EMOTIONAL STATUS
70
Q

preeclampsia blood pressure levels

A

140/90

71
Q

Where is the Doppler ultrasound transducer placed?

A

On the fetal back: monitoring the fetal heart rate.

72
Q

normal is bloody small cloths, earthy odor, fleshly, dark red or red brown
-Abnormal:really large clots, foul odor

A

Lochia Rubra

73
Q

day 3-10 Decreased amount of blood- pink or brown tinged

-Abnormal: excessive amount, foul smell, dark deep red color

A

lochia serosa

74
Q

day 10-14 white creamy light yellow color

Abnormal: red foul odor, discharge is continuous

A

lochia albia

75
Q

What does REEDA mean?

A 
REEDA for someone who has had an episiotomy (cut) or a laceration.
Redness
Edema
Ecchymosis
Discharge
Approximation
76
Q

How do we do a bubblehe assessment on a postpartum mother?

A

Breast - check nipples, wearing supportive bra
Uterus - palpate fundus
Bladder - pain or burning with urination
Bowel - passing gas, bowel movement, listen to bowel sounds
Lochia - how much they have been bleeding, color
Edema - check stitches for REEDA, education on peri bottle
Hommen’s sign/hemorrhoids - hommen’s sign is patient has history of DVT
Education/emotion - overall mood and bonding with infant, signs of baby blues

77
Q

breast fed infants should have how many stools per day

A

4 stools

78
Q

formula fed infants should have how many stools per day

A

1-3 stools

OB (5 decks)

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