Term
| At the prenantal visit obtain basic historical information about the woman and family concerning----------? (3) |
|
Definition
| diseases, surgeries, and deaths |
|
|
Term
| Ask if the pt. has been treated for--------?(9) |
|
Definition
| kidney or bladder problems;high BP;heart disease;rheumatic fever; hypo or hyper thyroidism;DM; allergies to any foods, drugs, or environmental substances; or STDs |
|
|
Term
| Ask if the pt. has been exposed to any ___ since b4 becoming pregnant. |
|
Definition
|
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Term
| Also remember to ask if the pt has ever received_____or_____; and if the pt _____. |
|
Definition
| Blood or blood products: smokes |
|
|
Term
| Request the approximate date of the last _____ and results. |
|
Definition
|
|
Term
| Gather data about menstrual pattern such as_____(5) and if any ____ are used. |
|
Definition
age of onset,duration and frequency, date of last full cycle,any bleeding since;
contraceptives |
|
|
Term
| Take an obstetric history including____(6) |
|
Definition
| previous live births,stillbirths,miscarriages orinduced abortions,c-sections, or if Rho(d) immune globulin (RhoGam)was needed for incompatibility. |
|
|
Term
| If any previous deliveries were premature obtain info about___(4) |
|
Definition
| age of gestation, survival of child, suspected cause, or infection. |
|
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Term
| Obtain a nutritional history including___(8) |
|
Definition
| pts usual wt;how much wt gained or lost in th epast 3 months;favorite foods;foods she avoids;how often does she eat;what has she eaten in the last 3 days;does she take a vitamin, mineral or herb products;cultural food practices to be observed during preganacy. |
|
|
Term
| Psychosocial culture history including ___ (6) |
|
Definition
| how does she feel about the pregnancy; cultural practices to follow during pregnancy; what makes up her support group; employment status;level of education, economic status. |
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|
Term
| Take a med. history including___(5) |
|
Definition
| any prescribed, OTC, herbals;alcohol and street drugs, |
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|
Term
| If she is not currently taking any meds. ask whether any have been taken over the past___ |
|
Definition
|
|
Term
| Include _(7)__ in the physical exam |
|
Definition
| ht and wt; BP (hx of hypertension?); heart rate (take for one full min);respirations;temp;urine specimen;cbc |
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|
Term
| Assessment done at routine visits during pregnancy includes: (6) |
|
Definition
| wt; bp;p; resp;abd measurement including fundal height and fetal heart sounds;any problems or concerns |
|
|
Term
| The pregnant woman who does not experience complications is usually examined ___for the first 6 months;every___in the 7th and 8th month; and ____in the 9th month. |
|
Definition
| monthly;every 2 weeks; weekly |
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|
Term
| S&S of potential obstetric complications are: (10) |
|
Definition
| infection;hyperemesis gravidarum;miscarriage;abortion;preterm labor;premature membrane rupture;GDM;hypertension;intrauterine fetal death; and HELLP syndrome (hemolysis elevated liver enzymes and low platelet count) |
|
|
Term
| Assess the status of the fetus by___(5) |
|
Definition
| fetal movement counts, contraction stress testing, biophysical profile, ultrasound, or amniocentesis. |
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Term
| When giving magnesium sulfate for pregnancy-induced hypertension (PIH) be sure to assess____(6) |
|
Definition
| deep tendon reflexes; respiratory status;sedation level;I&O; seizure precauctions and cardiac status |
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Term
| ___ is the antidote for mag sulfate. |
|
Definition
|
|
Term
| After delivery the VS should be checked ____ |
|
Definition
| every 15 mins for the first hour or until stable then every 30 mins for the nest 2 hrs |
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|
Term
| After delivery inspect the ___ and note any abnormal swelling or bruising |
|
Definition
|
|
Term
| Assess the fundal ___ &___ every 15 mins for 1 hr and then every 30 mins for the next 4 hrs. |
|
Definition
|
|
Term
| Describe the amount of ___ and the color and presence of clots every ___ mins for 1 hr; every___ for the next 4 hrs; and ___ for the next 12 hrs. |
|
Definition
|
|
Term
| Assess breasts for ___&___ approx.3-4 hrs postpardum |
|
Definition
| colestrum/breastmilk; engorgement/discomfort |
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Term
| Assessment of the neonate includes___(4) |
|
Definition
| patent airway;umbilical cord is observed till pulsation ceases then clamped;apgar at 1 and 5 mins;rapid gestational age assessment |
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|
Term
| There are four primary clinical indications for the use of uterine stimulants |
|
Definition
| induction or augmentation of labor; control of postpardum atony and hemorrhage;control of post surgical hemorrhage (c-section);induction of therapeutic abortion. |
|
|
Term
| ____ using a uterine stimulant like___ may be used in cases where cont. of the pregnancy is considered to be greater risk to the mother or fetus than the risk assoc. with induced labor. |
|
Definition
| Induction of labor;oxytocin |
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|
Term
| A Hx of___(5)__ may indicate the need to induce labor. |
|
Definition
| precipitous labor and delivary; postterm pregnancy;prolonged preg. with placental insufficency;prolonged rupture of membranes;pregnancy induced hypertension |
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|
Term
| Vaginal inserts,gels and PO forms of _____are being tested as adj. therapy to help ripen the cervix |
|
Definition
|
|
Term
| In general ____ should not be used to hasten labor.The type and force of contraction induced may be harmful to the mother or fetus. |
|
Definition
|
|
Term
| In occasional cases of ___ there is a prolonged latent phase of cervical dilation or arrest of descent through the birth canal. |
|
Definition
|
|
Term
| ___&____ may be useful in cases of dysfunctional labor. |
|
Definition
| low dosages of oxytocin and continuous fetal monitoring |
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|
Term
| After delivery the uterus sometimes remains___&___ |
|
Definition
|
|
Term
| ____or____ may be used in cases of post pardum atony or hemmorrhage |
|
Definition
| continued iv low-dose oxytocin or IM inj. of ergonovine or methylergonovine |
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|
Term
| Occasionally oral doeses of ___or___ are admin. for a few days after delivary to assist in uterine involution. |
|
Definition
| ergonovine oor methylergonovine |
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|
Term
| Various dosage forms of ___ or ____ may be effective in eveacuating uterine contents. |
|
Definition
| prostaglandins or hypertonic(20%)sodium chloride |
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|
Term
| Uterine smooth muscle is not very responsive to ____stimulation until late in the thirs trimester so it isn't indicated in therapeutic abortion. |
|
Definition
|
|
Term
| Regardless of the stage of pregnancy stimulans such as ____or__ may be prescribed after the uterus is emptied to control bleeding and maintain uterine muscle tone. |
|
Definition
| ergonovine or methylergonovine |
|
|
Term
| ____ is a natural chemical in the body that causes uterine and GI smooth muscle stimulation. |
|
Definition
| Dinoprostone (prostaglandin E2) |
|
|
Term
| Dinoprostone also plays an active role in ___and ___unrelated to uterine muscle stimulation. |
|
Definition
| cervical softening and dilation(cervical ripening) |
|
|
Term
| In higher doses dinoprostone increases ____&____ of contractions |
|
Definition
|
|
Term
| Dinoprostone is used to start and continue___. |
|
Definition
|
|
Term
| In large doses dinoprostone is used to expel uterine contents in cases of___(4) |
|
Definition
| intrauterine fetal death;benign hydatidiform mole;spontaneous miscarriage;and 2nd trimester abortion. |
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|
Term
| Occasionally dinoprostone and ___are used together to shorten the duration of time required to expel uterine contents. |
|
Definition
|
|
Term
| The primary therapeutic outcomes assoc. with dinoprostone therapy are:(2) |
|
Definition
| cervical softening and dilation b4 labor and evacuation of uterine contents |
|
|
Term
| What is the premed assessment for dinoprostone(4) |
|
Definition
| baseline VS, every half hour after initiation of therapy;assess state of hydration;assess uterine activity including discharge;chk for antiemetic and anyidiarrheal meds ordered. |
|
|
Term
| Side effects to expect with dinoprostone therapy |
|
Definition
| nausea, vomiting, diarrhea,fever |
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|
Term
| Temp elevations to ____ occur within __to__ and continue for up to 6 hrs. with dinoprostone |
|
Definition
|
|
Term
| ___does not inhibit dinoprostone-induced fever |
|
Definition
|
|
Term
| side effects to report with with dinoprostone therapy are |
|
Definition
|
|
Term
| ______is a synthetic prostaglandin E used to prevent nonsteroidal antiinflammatory drug induced ulcer disease. |
|
Definition
|
|
Term
| The ____also induce uterine contractions in the pregnant uterus. |
|
Definition
|
|
Term
| misoprostol is not approved by the ___ as a cervical ripening agent, induction of labor,or Tx of serious postpardum hemorrhage with uterine atony. |
|
Definition
|
|
Term
| Misoprostol is used in combo with____ as an abortifacient. |
|
Definition
|
|
Term
| Misoprostol should not be used to induce labor in women with a Hx of ___ |
|
Definition
|
|
Term
| therapeutic outcomes of misorostol therapy are: |
|
Definition
| cervical softening and dilation;induction of active labor;reduction of postpardum hemorrhage in th presence of uterine atony;evacuation of uterine contents |
|
|
Term
| Premed assessment of Misoprostol (4) |
|
Definition
| baseline VS monitored every half hr;state of hydration;uterine activity& discharge;antemetic & antidiarrheal meds |
|
|
Term
| Rare adverse effects of misoprostol may include__ |
|
Definition
| uterine hyperstimulation with subsequent fetal hypoxia,uterine rupture,amniotic fluid embolism |
|
|
Term
| ____&__produce more sustained contractions than oxytocin and are used in small doses in postpardum pts.to control bleeding and maintain uterine firmness. |
|
Definition
| ergonovine & methylergonovine |
|
|
Term
| the primary therapeutic outcome assoc with ergonovine and methylergonovine therapy is |
|
Definition
| reduced postpardum blood loss |
|
|
Term
| premed assessment for ergonovine and methylergonovine is |
|
Definition
| base VS and amount and characteristics of discharge,fundal height and contractility |
|
|
Term
| side effects to expect with ergonovine and methylergonovine are |
|
Definition
| nausea,vomiting,abd cramping, |
|
|
Term
| SE to report with methylgonovine and ergonovine are |
|
Definition
|
|
Term
|
Definition
|
|
Term
| hypertension and headaches may develop in pts.who have received ___followed by a dosage of ergonovine or methylergonovine |
|
Definition
| caudal or spinal anesthesia |
|
|
Term
| oxytocin is a hormone produced in the __ and stored in the ___ |
|
Definition
| hypothalamus;pituitary gland |
|
|
Term
| when oxytocin is released it stimulates the smooth muscles of____ |
|
Definition
| uterus;mammory glands and blood vessels |
|
|
Term
| oxytocin is the drug of choice for ___and ___ |
|
Definition
| inducing labor and for augmentation of uterine contractions |
|
|
Term
| oxytocin is routinely admin. immediately postpardum to control___&__ |
|
Definition
|
|
Term
| Therapeutic outcomes assoc with oxytocin therapy are |
|
Definition
| initiation of labor;support of uterine contractions and control of potpardum bleeding |
|
|
Term
| SE to expect with oxytocin therapy are |
|
Definition
| uterine contractions nausea and vomiting |
|
|
Term
| Contractions longer than ___ require the flow rate of the oxytocin to be slowed or discontinued |
|
Definition
|
|
Term
| SE to report with oxytocin therapy are |
|
Definition
| fetal distress,hypertension,hypotension,water intoxicaton, dehydration,postpardum hemorrhage. |
|
|
Term
| ___aka ___ are used primarily to delay or prevent preterm L&D in selected pts. |
|
Definition
| uterine relaxants aka tocolytic agents |
|
|
Term
| Tocolytic agents act by inhibiting ___ |
|
Definition
| uterine muscle contractions |
|
|
Term
| Tocolytic agents are most commonly used to inhibit labor for __ to __ |
|
Definition
|
|
Term
| Mag sulfate is used primarily to inhibit___or control____ |
|
Definition
| premature labor;seizures assoc with preeclampsia |
|
|
Term
| when mag sulfate is used as an anticonvulsant or to inhibit labor blood levels shoild be maintained at __to__ |
|
Definition
|
|
Term
| at levels aprrox 5-8 to mEq/L pts begin to show signs of __ |
|
Definition
|
|
Term
| Therapeutic outcomes expected with mag sulfate are; |
|
Definition
| arrest of preterm labor;elimination of seizure activity |
|
|
Term
| premed assessment for mag sulfate is |
|
Definition
| base Vs;mental status;deep tendon reflexes;I&O; have calcium gluconate or calcium gluconate with Iv admin equip available; base serum mag level; fetal heart rate ,uterine activity monitoring |
|
|
Term
| Se to report with mag sulfate |
|
Definition
| deep tendon reflexes,I&O,VS,confusion,overdose |
|
|
Term
| Infants born to mothers who receive magnesium sulfate must be monitored for |
|
Definition
| hypotension,hyporeflexia and resp. depression |
|
|
Term
| The primary therapeutic outcome assoc. with terbutaline therapy is___ |
|
Definition
|
|
Term
| Se to report with terbutaline sulfate |
|
Definition
| tachycardia,palpitations hypertension,hypotension,tremors,nervousness,anxiety,restlessness,headache, nausea, vomiting dizziness, hyperglycemia,electrolyte imbalance. |
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