Tuesday, March 3, 2009

OB NURSING BULLETS

http://nursingpoint.blogspot.com/2009/03/ob-nursing-bullets.html
  • Sexual intercourse OK anytime during pregnancy except for: (+) PROM, pre-term labor, incompetent cervix and (+) vaginal spotting
  • HUMAN CHORIONIC GONADOTROPIN (HCG) – responsible for a positive pregnancy test
  • FLUID RETENTION caused by elevated estrogen and progesterone and also fatigue
  • OXYTOCIN – produced by posterior pituitary gland for uterine contractions
  • FUNDAL PRESSURE – aids in placental delivery if mother is anesthetized
  • GLOBULAR – uterus in 3rd stage of labor
  • CORD TRACTION AND FUNDAL PRESSURE DANGER – inversion of uterus and avulsion of cord
  • AFTERCARE post PLACENTA DELIVERY – comfort, dry clothing, perineal pads and linens
  • CHECK 4TH STAGE OF LABOR q15 – lochia, fundus, hematoma
  • AVOID SEX if cervical mucus is clear and elastic (for contraception)
  • INTRAFALLOPIAN TRANSFER – for low sperm count
  • IN-VITRO – for tubal occlusion
  • ANOVULATION – tx of Clomid or Parlodel
  • CERVICAL CAP – (-) spermicide pre-intercourse, can stay up to 24-48h, durable, contraindicated if with abnormal pap smear
  • IUD doesn’t protect against STDs
  • PROFUSE BLOOD LOSS – saturation of peripad within 15 minutes and with pain sensation
  • DISTENDED BLADDER inhibits uterine contraction with increased risk of blood loss
  • FOR IMPENDING HEMORRHAGIC SHOCK massage fundus if boggy, elevate legs from hips, IV line, oxygen at 8-10 l/min, stay with patient
  • PRE- LM – void
  • FHR – priority post rupture of membranes
  • FHR frequency – beginning to beginning
  • ENDOMETRIOSIS – growth of endometrial tissue outside the uterus; dx: lap and biopsy
  • DANOCRINE – menses stop, edema, weight gain, anovulation
  • BBT – drop 0.2 F pre ovulation, increase 0.4 F post ovulation
  • MOST ACCURATE BBT READING – immediately after awakening and before arising
  • STRIAE GRAVIDARUM – abdominal stretches
  • DIPPING – descending but not at ischial spine
  • IMPENDING DELIVERY – increase in bloody show, rectal pressure, rupture of membranes, regular and long contractions
  • RITGEN’S MANEUVER at crowning
  • FUNDAL HEIGHT AT UMBILICUS at 20 weeks or 5 months gestation
  • HEMORRHAGE AND INFECTION – most important to check 24 postpartum
  • COMPLETE CERVICAL DILATATION – termination of first stage of labor
  • PLACENTAL DELIVERY – end of third stage of labor
  • VITAMIN K – 1.0 mg for full terms, 0.5 mg for pre-terms
  • CLINIC VISITS 12 TO 24 MONTHS – monthly
  • ROOMING IN – for maternal-infant bonding
  • HCG PRIMARY FUNCTION – maintain corpus luteum during 1st trimester
  • DODERLEIN’S BACULLUS – maintains acidic vaginal pH
  • BTL – no lifting activities post surgery
  • BSE SCHED – 5-7 days post menstruation
  • MAMMOGRAPHY – dx of breast CA; yearly for 40s, biannual for 50y above
  • RADICAL MASTECTOMY – removal of breast/s, pectoral muscle, pectoral fascia, nodes
  • VITAL SIGNS – most important 2 h postpartum
  • IUD INSERTION – done during menstrual days 1-4
  • OVULATION PERIOD – 24-48 hours pre-ovulation to 48 hours post ovulation
  • OCPs – prevent ovulation
  • CLOMID – stimulates oogenesis
  • LIGHTENING - decrease in fundal height due to a change in shape of the abdomen a few weeks before onset of labor
  • HOME VISIT – for continuity of care
  • ABORTION – loss of fetus before viability (20 weeks)
  • INEVITABLE ABORTION – with dilated cervix
  • THREATENED ABORTION – closed cervix, spotting and uterine cramping
  • HABITUAL ABORTION – consecutive abortions
  • THREATENED ABORTION – complete bed rest, check vaginal bleeding and observe uterine contractions
  • OVULATION – 14 days before menstruation (for a 28 day cycle); increased pH of cervical secretions, (+) MITTLESCHMERZ; increase in BBT
  • PROLIFERATIVE – LH surge from anterior pituitary gland
  • AGE OF VIABILITY – at 5th month or 20-24 weeks
  • OSSIFICATION OF BONES – at 10th lunar month
  • FHT – Doppler at 3 weeks, fetoscope at 18-20 weeks
  • MC DONALD’S RULE – fundic ht in cm x 8/7 = aog
  • PRENATAL CHECKUPS – 1-7 mo once a month, 8th mo 2/month, 9th q wk
  • PREGNANCY AS A MATURATIONAL CRISIS – due to hormonal and physiological changes occurring
  • PROM – prone to infections
  • TAKING HOLD PHASE – focus is the infant
  • POST PARTUM BLUES – 4-5 days post partum
  • ZYGOTE – cell that results from the fertilization of the ovum by a sperm
  • MITOSIS – cell division of the fertilized ovum
  • OVULATION – rupture of the ovum from the graafian follicle
  • MORULA – mulberry-like ball of cell that results from cleavage
  • FUNDUS – where zygote normally implants
  • IMPLANTATION – 7-10 days post fertilization
  • EFFACEMENT – cervix becomes thinner
  • GDM – carbohydrate intolerance induced by pregnancy
  • ADVERSE EFFECTS OF GDM – morbidity common in newborn, infant may inherit a predisposing to DM, higher perinatal death
  • GDM NURSING INTERVENTIONS – liberal exercise, acceptable diet at 30-35 kcal/kg of IDBW/day, insulin as ordered, CBG monitoring
  • GLUCOSE – 18.02 mg/dl = 1 mmol
  • BREAST ENGORGEMENT – doesn’t last for greater than 24 hours
  • MEFENAMIC ACID – anti-inflammatory
  • PASSAGEWAY – structure of maternal pelvis
  • NITRAZINE PAPER TEST – urine vs. amniotic fluid; yellow vs blue
  • PROM – check temperature
  • NONPREGNANT UTERUS – lined by endometrium
  • VULVA – externally visible structure of the female reproductive system extending from the symphysis pubis to the perineum
  • AMPULLA – fertilization site
  • ISTHMUS – site of sterilization
  • VAS DEFERENS – conduit for spermatozoa
  • EJACULATORY DUCT – seminal fluid
  • LEYDIG’S CELLS – synthesize testosterone
  • PROGESTERONE – increased activity of endometrial glands during luteal phase; increased basal metabolism, increased placental growth, development of acinar cells in the breast
  • ROUND LIGAMENT – (+) hypertrophy during pregnancy
  • SPERM MOTILITY – best criterion for sperm quality
  • HYSTEROSAPINGOGRAPHY – introduction of radiopaque material into uterus and fallopian tubes to assess for tubal patency
  • TETANIC CONTRACTIONS – brought about by the overstimulation by oxytocin
  • DYSTOCIA – due to mechanical factors
  • POSTPARTUM HEMORRHAGE – greater than 500 ml of blood loss
  • CORTEX OF OVARIES – where developing follicles and the graafian follicles are found
  • LABIA MINORA – forms the frenulum and prepuce of the clitoris
  • FOURCHETTE – formed by the labia minora tapering and extending posteriorly
  • RUGAE – thick folds of membranous stratified epithelium on the internal vaginal wall capable of stretching during the birth process to accommodate delivery of fetus
  • EXTERNAL OS – location where squamocolumnar junction is, pap smear location
  • MYOMETRIUM – largest portion of uterus
  • CORPUS – upper triangular portion of uterus
  • LH – testosterone production
  • ESTROGEN – secreted by graafian follicle associated with spinnbarkeit and ferning
  • AUTOSOMAL RECESSIVE – cystic fibrosis, tay-sach’s disease, sickle-cell anemia
  • CHORIONIC VILLI SAMPLING – detects trisomy 21, cystic fibrosis and tay sach’s
  • MATERNAL AGE – indication for chorionic villi sampling
  • RHOGAM – essential post-CVS or RH (-) mom; refrain from sex 48h post-CVS
  • NEEDLE INSERTION SITE – most important factor affecting amniocentesis
  • MORNING AFTER PILL – prevent implantation of the fertilized ovum; taken within 12h post-intercourse, (+) slight nausea post-2d; not given to those with hx contraindications to OCPs
  • COMBINED OCPs – inhibit FSH and LH production
  • ESTROGEN – causes sodium retention
  • PARITY – indication for IUD use
  • HX OF PRETERM LABOR – contraindication for IUD use
  • HYSTEROSALPINGOGRAM – done 2-6 days after menses
  • COVADE’S SYNDROME – way in which an expectant father can explore his feelings
  • RhOGAM – should be administered within 72h; destroys fetal RBCs to prevent antibody formation
  • LEUPROLIDE – tx for endometriosis
  • AMPICILLIN – safest antibiotic for pyelonephritis
  • HYPOTONIC DYSTOCIA – monitor contractions
  • MAGNESIUM TOXICITY – first sign is disappearance of knee-jerk reflex
  • IUD SIDE EFFECT – excessive menstrual flow
  • IUD COMMON PROBLEM – spontaneous expulsion of device
  • IUD – provides contraception by setting up a non-specific inflammatory cell reaction in the endometrium
  • OVULATION – occurs when LH is high
  • OCPs – causes breakthrough bleeding
  • POST COITAL TEST – best timed within 1-2 days of presumed ovulation
  • TUBAL DEFECTS – are most often related to past infections
  • INFERTILITY – inability to become pregnant after a year of trying
  • SIMS HUHNER (POST COITAL TEST) – determine the number, motility and activity of sperm
  • HYATIDIFORM MOLE – be alert for unusual uterine enlargement
  • ECTOPIC PREGNANCIES – sudden lower right or left abdominal pain radiating to the shoulders
  • TUBAL RUPTURE – sudden knifelike, lower quadrant pain
  • GERM PLASMA DEFECTS – causes most spontaneous abortions
  • INCOMPLETE ABORTION – fetus is expelled but part of the placenta and membranes are not
  • FUNIS – umbilical cord
  • AMNION – inner membrane that encloses the fluid medium for the embryo
  • FETUS – 8th week to birth
  • 12th WEEK – uterus becomes an abdominal organ
  • QUICKENING – first fetal movement felt by the mother
  • GREATEST WEIGHT GAIN – in third trimester; 2nd trimester: height and length
  • PLACENTA – chief source of estrogen and progesterone after the first 3 months
  • DUCTUS VENOSUS – has the highest oxygen content
  • DIAGONAL CONJUGATE – A-P diameter of pelvic inlet
  • BLOOD VOLUME INCREASE – 30-50% is normal
  • CHADWICK’S SX – purplish discoloration of vaginal mucosa
  • PHYSIOLOGIC ANEMIA – result of increased plasma volume of the mother
  • CHORIONIC GONADOTROPIN – causes nausea and vomiting
  • PITUITARY GLAND – increase in melanotropin hormone causing dark nipples and linea nigra
  • RH DETERMINATION - routinely performed on expectant mothers to predict whether the fetus is at risk for acute hemolytic anemia
  • LEUKORRHEA – caused by elevated estrogen
  • TX FOR FLUID RETENTION - adequate fluids and elevation of lower extremities
  • FULL BLADDER – pre UTZ
  • NORMAL AMNIOTIC FLUID – clear, almost colorless, containing little white specks
  • RESTRICT MOVEMENT – when an external fetal monitor is being used
  • EARLY DECELERATION – FHT decreases just before acme due to head compression
  • LATE DECELERATION – FHT decreases just after acme caused by uteroplacental insufficiency; may lead to distress
  • VARIABLE DECELARATION – due to cord compression
  • LOCATION OF FUNDUS AFTER PLACENTAL DELIVERY – halfway between the symphysis pubis and the umbilicus
  • SLOW DEEP BREATHING – alleviates discomfort during contractions
  • PANTING – during crowning
  • OCCIPUT POSTERIOR – causes low back pain
  • APPLICATION OF BACK PRESSURE – during contractions to increase comfort
  • NPO – during second stage of labor because undigested food and fluid may cause nausea and vomiting, limiting the choice of anesthesia
  • TRANSITIONAL PHASE – help client retain/remain in control
  • POSITIONING DURING DELIVERY – legs elevated simultaneously to prevent trauma to the uterine ligaments
  • UTERINE TETANY – observe carefully for this during the induction of labor
  • PUSH WITH GLOTTIS OPEN – when fully dilated but (-) crowning
  • EPISIOTOMY is done to prevent lacerations
  • PUERPERAL INFECTIONS – 2 most important predisposing factors to its development is hemorrhage and trauma during birth
  • PROLACTIN - stimulates secretion of milk from the mammary glands
  • SITZ BATH – promotes vasodilation, relieves hemorrhoids
  • INFANT FEEDING – on demand; baby will soon develop a feeding schedule
  • CLOSURE OF FORAMEN OVALE – after birth is caused by an increase in the pulmonary blood flow
  • DUCTUS ARTERIOSUS – becomes the ligamentum arteriosum
  • HEART RATE – primary critical observation in apgar scoring
  • MECONIUM CHECK Q SHIFT – to keep limit development of hyperbilirubinemia
  • ASSYMETRICAL MORO REFLEX – associated with brachial plexus, cervical or humerus injuries
  • STERILE INFANT INTESTINES – lack bacteria necessary for the synthesis of prothrombin
  • PKU SCREENING – measures protein metabolism
  • NORMAL REGURGITATION – in infants is caused by an underdeveloped cardiac sphincter
  • AMNIOCENTESIS – done to detect presence of neural tube defects
  • PREMATURITY – contraindication for oxytocin challenge test
  • UTEROPLACENTAL INSUFFICIENCY – (+) CST
  • PREGNANT ADOLESCENT – emphasize importance of consistent care
  • PERINATAL MORTALITY – is 2-3 times greater in multiple gestation than in single gestation
  • HYPOTONIC UTERINE DYSTOCIA – is oftentimes caused by multiple gestation
  • PYELONEPHRITIS – observe for signs of PTL; antibiotic tx should be administered until urine is sterile—2 (-) C/S
  • CONCEALED HEMORRHAGE – causes abdominal pain associated with abruption placenta
  • DIC/HYPOFIBRINOGENEMIA – causes bleeding following sever abruptio placenta
  • ABRUPTIO PLACENTA – is most likely to occur in women with pregnancy induced hypertension
  • PLACENTA PREVIA – painless vaginal bleeding
  • PAIN MEDS – are kept at minimum during PTL to prevent respiratory depression
  • ATONY OF THE UTERUS – due to overstretching is commonly caused by multiple gestation
  • OVERDISTENED BLADDER/HYDRAMNIOS – may cause uterine atony
  • POSTPARTAL HEMORRHAGE – rarely occurs as a complication of uncomplicated gestational hypertension
  • PIH – BP elevation of 30/15 mmHg from baseline on 2 occasions 6 hours apart
  • EPIGASTRIC PAIN – subjective symptom of an impending seizure
  • ROLLING OF EYES TO ONE SIDE WITH A FIXED STATE – objective sign of an impending seizure
  • DANGER OF SEIZURE – ends in 48h postpartum in a woman with eclampsia
  • CORD COMPRESSION - birth hazard associated with breech delivery
  • GRAVIDOCARDIAC PT - cardiac acceleration in the last half of pregnancy; most compromised during the first 48 hours after delivery; forceps delivery
  • GDM DIET – balanced, to meet the increased dietary needs with insulin adjusted as necessary
  • RENAL AGENESIS - funis with only two vessels
  • DRUG WITHDRAWAL IN INFANT - irritability and nasal congestion
  • NEONATAL MORBIDITY - with low apgar score at 5 minutes post delivery
  • HIV/AIDS INFANT – microcephalic, craniofacial features, persistent diarrhea
  • CHLAMYDIA INFECTIONS – purulent conjunctivitis and pneumonia in infant
  • RETROLENTAL FIBROPLASIA – caused by high oxygen concentration administered in premature infants
  • SYPHILIS – asymptomatic newborn, VDRL test
  • HIP DYSPLASIA – asymmetric gluteal folds
  • ERB’S PALSY – complication of breech delivery; flaccid arm with elbows extended; ROM exercises
  • PRECIPITATE DELIVERY – increased risk for intracranial hemorrhage and elevated ICP
  • PATHOLOGIC JAUNDICE – appearance of jaundice during the first 24 hours
  • DECREASED INFANT GFR – inability of the infant to concentrate urine and conserve water
  • RESPIRATORY DISTRESS – most common preterm complication
  • INFANT HYPOGLYCEMIA SX - tremors, periods of apnea, cyanosis and poor sucking
  • LARGER DM NEWBORNS – due to increased somatotropin and increased glucose utilization
  • UTERINE AND OVARIAN ARTERIES – main blood supply of the uterus
  • ENDOMETRIOSIS – is characterized by painful menstruation and backache
  • RETROCOELE – is brought about by overstretching of perineal supporting tissues as a result of childbirth
  • COLUMNOSQUAMOUS JUNCTION OF THE INTERNALAND EXTERNAL OS – common site of cervical CA growth
  • DIETHYLSTILBESTROL – management for infertility
  • RADIUM REACTION – pain and elevated temperature
  • DOXORUBICIN – inhibits RNA synthesis by binding DNA
  • ESTROGEN RECEPTOR PROTEIN (ERP) – evaluates potential response to hormone therapy
  • BILATERAL OOPHORECTOMY – surgical menopause
  • CESSATION OF MENSES – is due to the inability of the ovary to respond to gonadotropic hormone
  • BARTHOLOMEW’S RULE – via location of fundus
  • HAASE’S RUELE – first 5 months: month2 = aog; second half: month x 5 = aog
  • NAGELE’S RULE – LMP minus 3m +7d + 1y = EDC
  • DECIDUA BASALIS – placenta
  • DECIDUA CAPSULARIS – fetus
  • DECIDUA VERA – others
  • UTERUS – 1 x 2 x 3 cm, pear shaped, ovoid during pregnancy