Shared Flashcard Set

Details

NARM
Studying for the CPM
1441
Medical
07/12/2011

Additional Medical Flashcards

 


 

Cards

Term
What are reasons for sore nipples other than thrush?
Definition
Poor latch and infrequent nursing.
Term
What suggestions can be made for sore nipples that are not caused by thrush?
Definition
Reasses latch, ice (analgesic), comfrey root ointment(soften nipples >healing), yarrow leaf poultice (relieve pain >healing), vit. E or aloe can be benefical. To prevent nipple soreness allow the nipples to air dry between feedings, apply lanolin and/or breastmilk and try a diffn't position. 
Term
What causes mastitis?
Definition
Breast injury or pathogen that has invaded the tissue.
Term
What are some things that can lead to mastitis?
Definition
Engorgement, blocked duct or cracked nipples.
Term
Mastitis can be prevented by the following.
Definition
Frequent feedings until the breast is empty, good hygiene, and ensuring a proper position and latch.
Term
What are the s/s of mastitis?
Definition
Sudden onset of a high fever, general malaise, chills, painful hard area of the breast, rapid pulse. 
Term
What can be done to resolve mastitis?
Definition
Bed rest, gentle massage while nursing on demand, good nutrition and fluids, warm compresses, poke root, comfrey, propolis, echinacea and elder root.
Term
How do I educate parents on the care of their sons uncircumsized penis?
Definition
Bathe the penis like the rest of the baby. Don't pull the foreskin back until it does on it's own, around the age of two. Once the child is old enough to bathe himself you'll have to teach him how to do so.  
Term
What are non-allopathic treatments for thrush?
Definition
Yogurt or acidophilis rubbed on the nipples or in the baby's mouth. One TBSP of vinegar to one cup of H2O, washing the nipples after nursing. If these efforts don't resolve  then referral to a physician is necessary (nystatin).
Term
Physiological jaundice is most common in the following situations.
Definition
Most newborns, premature, high altitude, bowel obstruction and infection.
Term
Severe jaundice can manifest with the following symptoms (2).
Definition
Lethargy and refusal to nurse.
Term
If the jaundice is observable only on the face and upper chest, what can be suggested?
Definition
Nursing frequently and exposing the baby to sunlight for 30m 2x's a day.
Term
Explain the care of the circumsized penis. 
Definition
Keep the original gauze on for the 1st 24hrs, unless it gets soiled. Then remove and replace with fresh gauze and vaseline after each diaper change for the next week.
Term
What will a normal circumsized penis look like after being circumsized?
Definition
It will appear red and the remaining foreskin will appear edatamous, there may be some drainage for the 1st 2-3 days and will take about a week to heal.
Term
If jaundice is more widespread than the face and upper body what should be done?
Definition
Referral for bili-lights and serum level cks.
Term
How will an infection manifest on a circumcised penis?
Definition
Any reddness, drainage, swelling, refusal to feed, fever 101 and lethargy.
Term
What two things should not be used to clean the glans and why? 
Definition
Alcohol and soap, they cause drying and irritation.
Term
What two things need to occur for a newborn to beable to take a bath?
Definition
Umbilical cord needs to fall off and circumicision needs to be healed.
Term
Postpartum psychosis is characterised by the following. 
Definition
Suicidal tendencies and infantcide along with delusions.
Term
List some p.p. perineal care tehniques.
Definition
Apply aloe vera gel to sutures or tears, use warm water to rinse after using the bathroom and pat dry, apply counterpressure with folded tissue to the perineum when having a B/M, eat fiber rich foods and > water, apply EPO when scarring has developed by 6 weeks
Term
Who tends to be at higher risk for postpartum psychosis?
Definition
Women with a Hx of bipolar.
Term
How does postpartum psychosis present and when?
Definition

The mother may have manic or depressive episodes. She may suffer from confusion or disorientation, agitation, mood swings, and fear. She may refuse to eat. Onset is rapid, typically within the first week postpartum but rarely before the third day although symptoms may not appear for up to three months.

 

Term
What is postpartum psychosis thought to stem from?
Definition
A chemical imbalance.
Term
_____________ and ______ ____________ are required for treating postpartum psychosis.
Definition
Medication and continued observation
Term
What two things can predispose a woman to p.p urinary tract infection?
Definition
Catheritization and vaginal trauma.
Term
S/s of p.p UTI are the following. What needs to be present in order to diagnose a UTI?
Definition

Dysuria, urgency, and frequency. Overabundance of bacteria.

 

*perform a clean catch*

Term
Define delayed p.p. hemorrhage.
Definition

Profuse bleeding from 24hrs.-6 weeks.

*commonly between 1-2 weeks*

Term
S/S of delayed p.p. hemorrhage are the following.
Definition

Bleeding that soaks one sanitary pad in an hour, bleeding is bright red, and blood clots are larger than a golf ball.

 

Term
List some medical reasons why a mom should supplement formula.
Definition

infants whose mothers are extremely ill immediately after birth, infants who are premature or of very low birth weight, infants with hypoglycemia that does not improve with breastfeeding, infants with dehydration or inborn errors of metabolism, infants whose mothers are taking medication that is passed through breastmilk and is harmful to the infant

 

Term
What is  delayed p.p hemorrhage due to?
Definition

retained remnants of the placenta or membranes in the uterus or a uterus that does not contract sufficiently due to infection or other conditions.

 

Term
What is the treatment for delayed p.p. hemorrhage?
Definition

 

Treatment

 

includes oxytocic medications, removal of

 

any placental or membrane fragments,

 

rest, hydration, and a blood transfusion if

 

needed.

 

Term
What is p.p infection due to?
Definition

during prolonged rupture of the  membranes or when many vaginal exams are performed during labor when aseptic technique is not scrupulously followed during or after extensive tissue

 damage during intrauterine manipulation with previous untreated disease

or infection of the reproductive tract with hemorrhage, retention of placental fragments, or poor perineal care

 

 

Term
Contaminated gloves, hands or equipment can possibly cause what?
Definition
P.P infection
Term
24hrs. p.p. swelling should be mostly resolved except in the case of the following. 
Definition

 

Excessive tissue trauma, tearing, or

 

suturing occurred.

 

Term
S/S of p.p. uterine infection are the following.
Definition

 

general malaise, pain, elevated temperature, and lochia with a foul odor. Endometritis, in particular, typically presents with a fever of up to 104 degrees F, chills, tachycardia, pelvic pain during bimanual exam, lateral

 

uterine tenderness, elevation of the white blood count, and subinvolution.

 

Term
What is the position of the uterus and cervix at 24-48hrs p.p., and at 3-6 weeks?
Definition
 Uterus 24-48hrs. at or below U, cervix will still admit a finger, 3-6 weeks the uterus is no longer palpable and the cervix is high and closed. 
Term

What is one reason why the tone and position of the cervix may not have returned to normal at 6 weeks?

 

Definition
The mom is breastfeeding.
Term
What can occur if p.p. uterine infection isn't diagnosed and treated appropriately?
Definition

 

salpingitis, peritonitis, septic thrombophlebitis, and necrotizing fasciitis may result.

 

Term

 

Lochia serosa is more pink than red. It persist for how many days and transitions into what?

 

Definition

 

 It persists for seven to eight days and transitions to lochia alba, which is a light pink, yellow or white color.

 

Term
 Lochia alba begins around the 10th day p.p. and ends when? 
Definition
two to four weeks
Term

Sudden recurrence of bright red vaginal bleeding p.p. is abnormal and must be assessed. It may be caused by the following.

Definition
overwork, uterine atony, or retained placental or membrane products.
Term
What should be suggested if the uterus hasn't involuted and she is still spotting at 3-6 weeks p.p.?
Definition
Rest, good nutrition, on demand breastfeeding, and involuting teas such as black haw and shepards purse.
Term
Is breastfeeding a good form of birth control?
Definition
No
Term
The 6-8 week p.p. visit consist of the following:
Definition

Uterus: for any continuing enlargement Cervix: for firmness and position, perform Pap smear, Internal muscle tone: exercises

must be continued if tone has not returned, Lacerations or episiotomy: for healing, Abdominal muscle tone: check for gaping at the juncture of the abdominal muscles from umbilicus to pubis, Breasts: tenderness or lumps, Hemoglobin and hematocrit: In

case of exhaustion or if hemorrhage occurred during birth, Diet, Adjustment to parenting 
 

Term
1-2 week p.p. visit will consist of the following:
Definition
Assess for postpartum blues/depression, overdoing it (>lochia, fatigue), established breastfeeding, cystocele/rectocele should be better (encourage excercises), sexual activity should not be resumed unless bleeding has ceased especially if stitches were recieved.
Term
The 3-4 day p.p. visit for the baby will consisit of the following:
Definition

Cord stump: cord clamp removal or removal of cord plus placenta in a lotus birth, Skin for jaundice, Dehydration, Behavior, feeding, crying, Mother’s relationship to breastfeeding: make certain

the baby is not being placed on a schedule, Sleeping arrangements: cosleeping or sleeping in separate bed but in the same room

Term
The 3-4 day p.p. visit will consisit of: 
Definition

Breasts: engorgement, cracked nipples, Uterus, perinreum: lochia, color, odor, vol. uterinie: enlargement, tenderness,perineal cystocele or rectocele. Temperature

 

Term
Day 1 p.p. visit, sore cracked nipples are noted, what should be done?
Definition
Assess position and latch and apply vit. E between feedings and start nursing on the least affected side first.
Term
At day 1 p.p. swelling is noted on the perineum, what should be done? If increased swelling is noted what may be the problem? If reddness is also noted what should be done?
Definition
Hot/cold compresses, rinsing w/ warm H2O w/ betadine 2x's a day, sitx bath.  A hematoma. Referral to a physician.
Term
Elevated temp. and pulse may indicate what at day 1 p.p.?
Definition
Infection or dehydration
Term
A p.p.(1-2 wks.) visit should be scheduled immediately to assess when the following presents: 
Definition

mother reports sensations of pressure in her vagina,extreme fatigue, continued bleeding, or exhaustion

Term
An elevated B/P right after or w/in day 1 p.p. may indicate what?
Definition
Preeclampsia
Term
Go over how to manually express breastmilk.
Definition

 

The mother places her thumb on top of the

 

breast to be expressed where the areola

 

and the breast tissue meet. The forefinger

 

is placed on top in the same position. The

 

fingers draw the areola back into the

 

chest wall while gently compressing the

 

nipple between them

 

Term
How acurate is the New Ballard Scale?
Definition
Plus or minus 2 weeks, 20 weeks gestation.
Term
List the characteristics and postures that are scored on the New Ballard Score.
Definition

Characteristics-square window, arm recoil, popliteal, scarf, heel to toe,Observations-lanugo on the bk., cartilage in the pinna of the ear, breast tissue and nipples, creases on the bottom of the feet

 

 

 

 

 

Term

 

The gestational age assessment is applied by using it to

 categorize the newborn, (<38wks), (38-42 wks), (>42 wks.)

 

Definition
Preterm(<38wks.), term (38-42wks.), postterm (>42 wks.) add the weight and they add the terms SGA(small for gest. age), AGA (appropriate for gest. age), LGA (large for gest. age)
Term
The let down reflex is the influence of what hormone and stimulated by what?
Definition
oxytocin and suckling/crying infant
Term
Describe breast engorgement.
Definition

 

The breast may feel warm or hot, it may have a shiny

 

appearance, and it will feel tight and hard to the touch. Engorgement typically occurs when feedings are not given often enough.

 

Term
What is the best relief for engorgement?
Definition

Breastfeeding until the baby is full and the breast is empty, ice, warm compresses, or manual expression so the baby can latch, Arnica, Bryonia, Phytolacca, and Belladonna. Echinacea is thought the help prevent the

 progression of engorgement to mastitis. Comfrey leaf compresses or raw cabbage leaves on the breasts also help relieve engorgement.

 

 

Term
Colostrum contains the folllowing:
Definition
>protein, >calories in a sm. vol., antibodies, immune globulins, and a laxative effect that < jaundice, last for the first 2-3 days p.p.
Term
What describes a proper latch?
Definition

 

the infant begins with a wide open mouth and latches on with an asymmetrical latch. The areola is drawn

 

into the lower portion of the mouth

 

Term
If the latch is poor, what tends to occur?
Definition

pain and discomfort will result. Eventually, the nipples will crack and possibly bleed, leading to the inability

to breastfeed until the nipples heal. If this occurs before breastfeeding is wellestablished, the mother’s intentions to continue to breastfeed may fade especially if she lacks a support and education network to encourage her to continue and to educate and assist her in attaining proper positioning.

 

Term

 

It is a fallacy that dehydration, poor nutrition, and lack of rest in the mother will decrease milk production unless she is profoundly malnourished. T/F?

 

Definition
T
Term

 Is it important for the mother to maintain her health by

 eating properly, drinking as needed, and obtaining sufficient rest as much as possible? T/F?

 

Definition
T
Term

 A sitz bath consisting of comfrey leaf, Yarrow, Rosemary,

Golden Seal, Oak bark, Witch hazel, Sea salt, Grape bark,and Myrrh, are helpful for:

 

Definition
P.P. perineal care for swelling, > healing, itching and pain.
Term
List some other helpful remedies for p.p. perineal care.
Definition

 

Aloe vera, fresh or gel, and vitamin E are both helpful for

 

healing as is Slippery Elm bark.

 

Term
List the positions for nursing.
Definition
Madonna, cross cradle, football and side-lying
Term

If the uterus is fully contracted, there will be no increased lochial flow during massage? T/F?

 

Definition
T
Term

 

If the uterus is relaxed and boggy, the lochial flow will increase, sometimes significantly.T/F?

 

Definition
T
Term

The mother should be taught to perform light uterine massage and to check her lochia regularly for the first 24 to 48 hours after birth. T/F?

 

Definition
T
Term
Breastfeeding/nipple stim. and light uterine massage will encourage the uterus remain contracted. T/F?
Definition
T
Term
What would be a reason to assess the cervix in the immediate p.p.?
Definition

 

When a steady flow or trickle of bright red blood from the vagina is observed, or if there was rapid labor, cervical manipulation during labor, pushing before dilation was

 

complete, or a traumatic or instrument delivery.

 

Term
What are you evaluating when assessing the perineum, vag., and annal area during the immediate p.p.?
Definition

 

The lower vagina, periurethral areas, and the perineum are assessed for lacerations and torn blood vessels, including determination of the need to repair; bruising; and hematoma. Episiotomies are assessed for depth and

 

extensions. The perianal area is assessed for hemorrhoids and skin tears.

 

Term
What are the s/s of shock?
Definition

 

decreasing blood pressure, rapid pulse and respirations, and cold, clammy skin

 

Term
What should be the first attempt to correct uterine atony?
Definition

 

Fundal massage is generally the first response to uterine atony.

 

Term
Describe external uterine compression.
Definition

 

Lifting the uterus through the abdominal wall and squeezing it between both hands.

 

Term
Describe internal bimanual exam, and what it does.
Definition

 

Place one hand inside the vagina, palmar surface up and fisted. The other hand is pushed deeply into the

 

abdomen and behind the uterus. The uterus is then compressed between the external hand and the internal fist. This compresses internal uterine vessels and

 

causes the uterus to contract.

 

Term

What degree of laceration involves the vaginal mucosa, posterior fourchette, and perineal skin?

 

Definition
First degree
Term

What degree of tear involves the following tissue:

vagina, mucosa,posterior fourchette, perineal skin and perineal muscles

 

Definition
2nd degree
Term

What degree of tear involves the following tissue:

 vaginal mucosa, posterior fourchette, perineal skin, perineal muscles, and external anal sphincter?

 

 

Definition
3rd degree
Term
What tissue is involved in a 4th degree tear?
Definition

 

vaginal mucosa, posterior fourchette, perineal skin, perineal muscles, external anal sphincter, and anterior rectal wall

 

Term

  Vaginal abrasions, some perineal lacerations, or minor tears of the bulbocavernosus wall need repair. T/F?

 

 

Definition
F
Term

 

Uterine assessment by abdominal palpation revealS the uterus above and, typically, to the right of the umbilicus, when the following has occurred.

 

Definition
Full bladder
Term

Catheterization should not be the first

choice due to the following reasons.

Definition
discomfort it causes to the mother and the increased potential for infection
Term

 

The mother should be encouraged to urinate. If she is unable to do so after repeated attempts, what should be done?

 

Definition
She should be catheterized to empty the bladder.
Term
What is the reason why some women have a problem urinating after labor?
Definition

 

The bladder may develop hypotonicity which leads to the loss of the urge to urinate.

 

Term
Bladder disention can lead to:
Definition

 

Preventing the uterus from contracting and increased bleeding. It is also a risk for bladder infection.

 

Term
Why is 4th stage intrauterine exploration done?
Definition

 

To ensure no clots, retained placental fragments, or membranes are left in the uterus which may be inhibiting

 

the complete contraction of the uterus or causing bleeding.

 

Term
Describe how to perform an intrauterine exploration
Definition

 

A gauze pad is wrapped around the forefinger of a gloved hand. Betadine is poured over the gloved hand and guaze.This hand is placed entirely inside the uterus. The back of the hand is placed against the uterine wall. The other hand is placed on the abdomen at the same area

 

as the internal hand. The uterus is swept and anything on the gauze pad is identified

 

Term
What things are done immediately after an intrauterine exploration?
Definition

 

Oxytocin and/or Methergine are administered to promote uterine contractions. Herbal remedies such as Shepherd’s Purse and blue Cohosh may also be used. In some cases, the mother can stop the bleeding by focusing on the

 

problem, tightening the uterus and taking control of her body.

 

Term

 

Most immediate postpartum hemorrhages are caused by:

 

Definition

 

incomplete delivery of the placenta or uterine atony which may be due to an overdistended uterus,

 

oxytocin induction or augmentation uterine relaxing medications,

grand multiparity, rapid labor and delivery, history of uterine atony or postpartum hemorrhage,

 

prolonged first or second stage labor

 

 

 

Term
What are some other causes of 4th stage bleeding?
Definition

 

cervical lacerations, extensive vaginal or perineal lacerations, and laceration of the lower uterus/uterine rupture, which is rare.

 

Term

 

If a client has two or more risk factors for uterine atony, the birth should be in a hospital.T/F?

 

Definition
T
Term
The umbilical cord is inspected for the following.
Definition

 

The umbilical cord: There should be three cord vessels, two arteries and a vein. The presence of only two vessels may indicate a non-visible fetal anomaly. It should also

 

be inspected for knots, tumors, cysts, edema and hematomas. The volume of Wharton’s jelly should also be noted along with the location of cord insertion

 

(eccentric, marginal, or central)

 

Term
The membranes are inspected for the following:
Definition

 

The membranes are inspected for completeness and

 

succenturiate lobes, blood vessels, or defects.

 

Term
The placenta is inspected for the following:
Definition

 

The placenta is observed for meconium staining and

 

calcifications. The fetal side is observed for cysts, a determination of extrachorial placenta, and missing or intact succenturiate lobe. The maternal side is observed for infarcts and intactness such as missing colydon.

 

Term

 

The placenta is often weighed and the umbilical cord measured, in the following situation:

 

Definition

 

 especially if they are abnormally small or large.

 

Term
What should be done  to avoid a trickle bleed after the delivery of the placenta?
Definition

 

A quick, firm massage will facilitate the expulsion of any remaining clots.

 

Term

 If the uterus continues to feel soft or asymmetrical, or

 if excess bleeding is occurring, what should be done?

 

Definition

firm massage, nipple stimulation (especially breastfeeding) and/or administration of Shepherd’s Purseand blue Cohosh tinctures can facilitate further

contractions. The mother’s bladder should be checked for distention as this can also keep the uterus from full

contraction.

Term

 

A slow trickle bleed may also be caused by retained placental fragments.T/F?

 

Definition
T
Term
When I suspect retained placental fragments, causing a trickle bleed, what will answer that ques.?
Definition

 

inspection of the placenta for completeness

 

Term

 

Neither massage nor pitocin will help in this case. When dealing with a trickle bleed.

 

Definition
Retained placental fragments/clots.
Term
What is the herbal remedy, Angelica used for?
Definition

 

used to facilitate uterine contractions for placental delivery “like an angel”. A few drops are placed under the mother’s tongue. It may also be used for partial

 

placental separation and to ensure complete delivery

 

Term
What is Shepherd's purse used for?
Definition

 

Shepherd’s Purse is given after placental delivery to facilitate clotting so it is important the placenta be

 

completely delivered prior to administration (along with Blue Cohosh) to cause uterine contractions to expel

 

excess clots and reduce bleeding.

 

Term

 

The administration of raspberry leaf infusion during labor is helpful for ensuring uterine contractual efficiency. T/F?

 

Definition
T
Term
Name another herb that can be used too facilitate placental delivery.
Definition

 

Glechoma hederacea

 

 

 

, or Ground Ivy Herb, administered as a tincture.

Term
Dirty duncan refers to:
Definition

 

 A placenta that delivers with the meaty maternal side presenting.

 

Term
Shiny Shultz refers to:
Definition

 

The placenta that presents the fetal side with shiny membranes upon delivery. This occurs when the placenta begins separation in the center.

 

Term

 _______  _________ separates along the edges and is often found in placentas that implanted low in the uterus. 

 

 

Definition
Dirty duncan
Term
List the s/s of placental delivery.
Definition

 

bleeding, increased visible umbilical cord length,

 

changed uterine shape, and allowing the uterus to rise in the abdomen through uterine displacement. The uterus

 

becomes globular. Mom feels the placenta or the urge to push. 

 

Term
The placenta tend to deliver w/in __m.
Definition
30-60
Term
What can be done to speed up the delivery of the placenta?
Definition
Breastfeeding/nipple stim.
Term
When can cord traction be done?
Definition
S/s of placental delivery, the placenta is sitting at the OS and the uterus is ctx.
Term
Explain the process of cord traction.
Definition

 

The uterus is held in place with the edge of a hand pressing inward and upward just above the pubic bone.

 

Traction is gently applied to the cord first downward then outward as in the birth of the infant. The mother should push while this it performed. The membranes may not follow immediately and may need to be teased out. When the mother delivers in a squat this is rarely an issue. The placenta should be gently delivered a

 

short distance into a container otherwise any adherent membranes may tear and separate.

 

Term
A condition where the posterior parietal bone presents at the cervix, is called what?
Definition
Posterior asynclitism
Term
Posterior asynclitism can be managed in several ways, through position changes, name several.
Definition
Duck walking, Rebozo, walking up the stairs two at a time, hip-twist, lunges
Term
Duck walking and climbing stairs two at a time have the same effect, what does it do to the pelvic cavity?
Definition
It opens up the pelvic.
Term
Define circumoral/central cyanosis.
Definition

 

bluish discoloration of not only the oral mucous membranes, but the lips, tongue, and trunk

 

Term

 Cyanosis is a sign of _______ _______ or compromise.

 

Definition
Respiratory distress
Term

Cyanosis, along with grunting, nasal flaring, and retractions of the intercostal muscles, are all indicators of ___________   ____________.

 

Definition
respiratory compromise
Term

 

Cyanosis, along with _______, ______ _______, and retractions of the intercostal muscles, are all indicators of respiratory compromise.

 

Definition
grunting, nasal flaring
Term

 

What does grunting typically indicate?

 

Definition
air trapped within a lung
Term
What is the most important thing when establishing an airway?
Definition
That it is clear.
Term

 Once an airway has been established, give the newborn a few breaths by way of a _______ _______ or

 ___________  ___________ __________.

 

Definition
Pocket mask or positive pressure ventilation (PPV)
Term

 

Once spontaneous respiration is in evidence, what can be done?

 

Definition
Blow-by O2 (until color returns)
Term

 

If spontaneous respiration does not commence, what needs to be done?

 

Definition

 

PPV using 5 to 10 L/min of oxygen at the rate

 

of 40 to 60 respirations per minute through a rescusitation bag and mask should be performed. PPV should pause every 30 seconds to check for spontaneous respiration.

 

Term
What needs to be done for the newborn in the first minute?
Definition

 

Clear airway by holding the infant so the head is below

 

the body, wipe the face and head, and clean fluid from the nose and mouth. Suction the nasal and oral cavities. Keep the infant warm, preferably on the mother’s abdomen with a cap placed on its head and covered with a blanket.

Assign the 1 minute APGAR score.

 

 

Term
Describe the corkscrew manuever.
Definition

 

Place the hands on the fetal chest and back as in a typical rotation procedure but the fetus is rotated 180 degrees one direction, then 180 degrees the opposite direction until the baby is “screwed out”.The fetus

 

should be rotated so the back is rotated anteriorly.

 

*Three to four complete rotations should be attempted before abandoning this maneuver.*

 

Term
If all maneuvers fail to deliver the baby what procedure can be performed as a last resort?
Definition

 

To fracture the fetal clavicle or use the Zavanelli maneuver.

 

Term
Describe how to deliver the posterior arm. When is it performed?
Definition

 

You place your entire hand into the vagina and follow the fetal arm to the elbow and forearm. Flex the arm by

 

pressing the antecubital space and bringing it across the fetal abdomen and chest in the normal range of motion until the hand can be grasped and the arm delivered. It is performed after McRoberts has failed.

 

Term
What should not be done when delivering the posterior arm?
Definition

 

Do not hook the fingers into the axilla or armpit.

 

Term
What procedure is performed after the delivery of the posterior arm?
Definition

 

Delivery is completed using McRobert’s maneuver, suprapubic pressure, and downward and outward pressure on the fetal head.

 

Term
If delivery has still not happened after McRobert's/ delivery of the post arm, what can be done?
Definition

 

The fetus can be rotated 180 degrees in the corkscrew maneuver and delivery is attempted again.

 

Term

 

If the fetus assumes direct mentum posterior position during rotation (face presentation), describe how to deliver.

 

Definition

 

Notify the consulting physician. To deliver the head, apply pressure to the brow until the chin is born. Once the chin

 

and the rest of the head are born, complete the delivery normally.

 

Term
What should be assessed after delivery of a face/brow delivery?
Definition
Edema of the trachea, nose and mouth.
Term
Why does a brow presentation normally end in a C-section?
Definition

 

Unless transitory prior to face presentation, will cause the

 

largest diametrical portion of the head to present which is nearly always too large for the pelvic outlet.

 

Term
Explain the steps to dealing with a moderate dystocia.
Definition

1.Activate EMS, 2.explain to mom, 3.place mom in McRobert's or Gaskin, 4.fetal shoulders are rotated into the oblique angle (

One hand is placed on one side ofthe fetal chest, the other behind the opposite shoulder blade; as much force as necessary is used to rotate the body), 4. apply suprapubic presssure(

 

press downward and outward on the side of the head)

 

 

 

Term
If the baby is still not delivered after the McRobert's/ Gaskin, suprapubic pressure and attempting to rotate the baby's shoulders to the oblique, what should be considered?
Definition

 

catheteriize, determine the need for an episiotomy, and perform avaginal exam for short cord, enlarged fetal thorax or abdomen. The baby is then delivered on a renewed attempt from McRobert’s maneuver.

 

Term
Describe the steps for dealing with a nuchal cord.
Definition
If it can be slipped over the head do so, if it's too tight then push it past the shoullders and allow the baby to deliver through it, if it's too tight for that then flex the baby;s head toward the mother's thigh and allow the baby to summersault out and then untangle the baby, if the cord it too tight for all these cut and clamp while asking the mother to pant while doing so.
Term

 

When a cord prolapse occurs:

 

Definition

 You place your entire hand into the vagina to hold the presenting part off the cord at the pelvic inlet, The cord MUST NOT be replaced This may cause cord spasm or further compression,

Summon assistance, inform the mother and secure her cooperation, Send STAT notification to the consulting physician, Have other helpers place the mother in Trendelenberg or knee chest to keep the fetus off the pelvic inlet, Wrap any cord protruding through the vagina in gauze soaked with warm saline

 *emergency caesarian section is performed*

 

 

 

 

Term
Cord pulsations are adequate in assessing FHT'S during a cord prolapse. T/F?
Definition
F
Term
List the two types of cord prolapse.
Definition

 

Frank cord prolapse: the cord has protruded through the cervix.

 

Occult cord prolapse: the cord lays aside the presenting part but does not protrude through the cervix.

 

Term

 

Umbilical cord prolapse is at high risk when:

 

Definition
Small fetus, position other than cephalic, unengaged, fetal assessment/ OB intervention, SROM (unengaged), AROM (unengaged)
Term
Whenever membranes rupture what should be done?
Definition
FHT's, vag. exam (make sure there is no cord)
Term

 

Occasionally the midwife will be asked to see a mother who has “something coming out between her legs”. List the possibilities.

 

Definition

 

cord, a mucus plug, or a prolapsed foot or arm

 

Term
When dealing with non-emergency non-reassuring FHT's, what is done?
Definition
Reposition the mom, reasses fluids (consider I.V. non-glucose), fetal sleep cycle, oligohydraminos, fetal stim., intermittent fetal auscultation
Term
After attempting to make changes for non-reassuring FHT's, they are unchanged, what should be done?
Definition

 

If unchanged notify the consulting physician.

 

Term
Explain one way to determine dilation visually.
Definition

 

A crease will develop just above and parallel to the pubic bone, extending completely across the lower abdomen when dilation is complete.

 

Term
Explain another way to visually determine dilation.
Definition

 

A dark red line will be seen to extend up towards and between the buttocks. When it reaches the sacrococcygeal joint, dilation is complete.

 

Term
When I see a crease just above the pubic bone, I can assume what?
Definition

 

The fetus is likely passing through the spines if the head is no longer palpable above the pubic bone or if the shoulders seem to be rotating upon palpation.

 

Term

 

Any nonreassuring fetal heart tone that cannot be attributed to narcotic administration or fails to resolve with inutero rescusitation efforts, needs to be:?

 

Definition
Referred to a physician
Term
Management of abnomal FHT'S in order:
Definition
1.Prolapse cord 2. Rapid descent 3.Determine the length of time t delivery 4.Stimulate the fetal scalp 5.Transport for internal monitor, oxytocin 6. Fluids/I.V. 7.Admin. 8L O2 8. Transport
Term

Stage two labor is usually signaled by an intense

 desire to ____, meaning that the fetal head has descended to the ______  _____.

 

Definition
push, perineal floor
Term

 

Delivery is approaching when rectal bulging, perineal bulging, and progressive visibility of the ____ _____at the _______ _______ are observed. The mother may express the desire to ____ ____ _____.

 

Definition
fetal head, vag. introitous, use the bathroom
Term
When is it a good reason to encourage pushing? What also may need to be done?
Definition

 

In a situation where the fetusis crashing and must be birthed quickly to be resuscitated, you must have the

mother push to help speed delivery. Episiotomy

 

Term
Herbal/ homeopathic remedies for intense early labor are the following:
Definition

 

Cimicifuga 200C reduces intensity and establishes an

 

effective rhythm. Caulophyllum 200C encourages regular contractions. Pulsatilla 200C helps inconsistent early

 

labor and emotional tensions.

 

Term
Definition
Term
Homeopathic support for active labor is:
Definition

 

Sepia 200C reduces the mother’s fears of the intensity of

 

contractions.

 

Term
Homeopathic support when birth appears imminent:
Definition

 

Gelsimium 200C administration facilitates cervical dilation and effacement

 

Term
Homeopathic support when a mom has the urge to push but is not completely dilated are the following:
Definition

 

Arnica 200C will prevent cervical swelling. If there is a strong urge to push at 6 or 7 cm dilation, Sepia and

 

Arnica administered together with repeated administration of Sepia every 10 to 15 minutes reduces swelling and

 

inhibits tension.

 

Term
Homeopathic support for exhaustion in labor are the following:
Definition

 

China, Carbo Veg, or Ustilago plus an

 

enema of warm water and honey, or some royal jelly taken orally. Essence of Chicken may also help.

 

Term

 

What homeopathic can help labor continue and reduce the risk of postpartum hemorrhage?

 

Definition

 

Caulophyllum

 

Term
What homeopathic calms the mother during labor?
Definition
Aconite
Term

 

What homeopathic helps with pain, uneven contractions, and swelling?

 

Definition
Arnica
Term
 If labor seems to have stalled, physical activity, such as ________, can help stimulate labor and give the mother a _________  __ _____. 
Definition
walking, change of scenery
Term
The lunge hip-twist and rebozo all hope to do what to the fetal head?
Definition
Reposition
Term
What is the most common fetal position when starting labor?
Definition
LOT
Term

 

Vaginal examination after the cervix has started to dilate  will confirm definitive diagnoses of the

 

Definition

 

presentation, position, and variety determined during abdominal palpation.

 

Term

 

Breech presentation at the start of labor accounts for about 3 to 3.5 % of mothers. One half percent are

 

face presentations. The majority of the remaining is  typically transverse and oblique lies. They all require ________ _______.

 

Definition
immediate referral
Term
When dealing with posterior asynclitism, manual rotation will consist of the following:
Definition

 

Disengage the head by placing fingers on either side of the sagittal suture and lightly pressing upward on the

 

parietal bones. The mother then fully reclines with an assistant next to her on the side of the fetal back, facing the midwife. Steady, even pressure on the bony edge of the anterior fontanelle is used to rotate it to a transverse position. The fontanelle is pressed toward the vaginal side wall. The posterior fontanelle is then caught and rotated to the anterior while the assistant presses the fetal body to the anterior with mother turning in the direction of fontanelle rotation.

 

Term
What position should a mother assume after an internal manual rotation for a posterior asynclitic fetus?
Definition

 

sit upright and stand with a forward leaning position to  secure the fetal position. Without an assistant the mother assumes knees-chest position.

 

Term
What position changes can be used for an anterior lip?
Definition

 

Place the mother upright if she has been prone, or lying on one side then the other if she has been upright

 

Term
Name two non-allopathic remedies for an anterior lip
Definition

 

Relieve swelling by icing the lip and/or administering

 

homeopathic Sepia 200C and Arnica 200C

 

Term
When dilation is nearly complete, describe how an anterior lip can be manipulated.
Definition

 

placing the fingers on the lip where it touches the

 

fetal head and massaging the lip back over the fetal head above the inferior border of the pubic symphysis. The lip

 

should be held in place until the next contraction when the woman is asked to push down.

 

Term
What position works well when manipulating an anterior lip?
Definition

 

half squatting during this maneuver.

 

Term

 

Effacement and dilation are the result of __________ ___________ and progressive effacement and dilation are the only indications of ______  _____.

 

Definition
uterine ctx's, true labor
Term

 

No effacement is _______ effaced”, complete effacement is _________ effaced”.

 

Definition
0%, 100%
Term

A primagravida often presents 50 to 60% effaced and up to 1 cm dilation prior to labor due to _______ _______.

Definition
Braxton Hick's
Term

A multigravida may present with no effacement and 1-2 cm dilation when entering labor. T/F?

Definition
T
Term

The station of the presenting part is measured in centimeters from above or below the _______ _______.

Definition
Ischial spines
Term

______ is an unengaged floating presenting part whereas _____ is the presenting part at the vaginal orifice.

Definition
-5, +5
Term

The ischial spines represent ____ station.

 

Definition
0
Term

___________ is the point where the widest portion of the

presenting part has passed through the pelvic inlet, not the point where the presenting part is at station __.

Definition
engagement, 0
Term

When there is significant fetal skull molding and caput

succedaneum, the ________ may be difficult to determine.

Definition
station
Term

 

The membranes typically rupture by the ____ of the first stage of labor.

 

Definition
end
Term
Definition
Term

 

80% of PROM cases, labor begins spontaneously within

 

______?

 

Definition

 

24 hours

 

Term

______ contractions are irregular with short duration, every 20 to 30 minutes lasting 15 to 20 seconds with mild

intensity.

Definition
Early
Term

By the end of the first stage of labor, the contractions are regular with longer duration and intensity, every ___ ___minutes and lasting ___ ___ seconds with severe intensity.

Definition
2-3, 30-60
Term
FHT's should be checked whenever the following occurs in labor:
Definition
every 30m in active labor, ROM, anytime there is a change in labor pattern, enema expulsion, maternal meds., O.B. or med. complications beginning 
Term
What is the normal gradient pattern?
Definition

 

develops synchronous activity in which the contraction is longer and harder at the top of the fundus and gradually decreases in duration and intensity through the midportion until it ceases towards the cervix.

 

Term
Homeopathic/herbal support for labor with vomiting and dehyration are the following:
Definition

China, Carbo Veg, or Ustilago 200C

Term

It has been found that ice chips actually intensify the desire for liquids rather than relieving thirst and

dehydration.  T/F? What is another alternative to dealing with dehydration in labor?

Definition
T, Sips of water or other clear liquid with some sugar added for energy are better treatments for dehydration, dry mouth and throat, although unrestricted access to liquids would be best if possible.
Term

 

Herbs that have often been used to alleviate nausea and vomiting are:

 

Definition

 

peppermint, spearmint, or chamomile tea, and ginger capsules or tea. Nausea can also be relieved by pressure on the acupressure point PC-6 on the inner wrist

 

Term
What is the frequency of vitals during the first stage of labor?
Definition
B/P every hour, temp. pulse and res. every 2-4 hrs.unless waters have ruptured then q 1-2 hrs., every time a mom urinates ck ketones for exhaustion and protein for preeclampsia, take note of intake/output and emesis
Term
What suggestions for mternal positions during labor can I make?
Definition

 

supine with any or no incline, knee-chest, all-fours, lateral recumbent, sitting, standing, walking or squatting.

 

Term

 

Rotation of the fetus to an anterior position may be accomplished by the following:

 

Definition

mother leaning forward, supported by a partner, table, birthing ball, or other 

support. The hands-and-knees or kneeschest position may also accomplish this. Lateral recumbent positions can help rotate a fetus from an occipital posterior position.

 

Term
Non-allopathic treatment for pain relief in labor are the following:
Definition
Arnica, motherwort, St. Joan's Wort, skullcap, aromatherapy, accupuncture and reflexology
Term
Abdominal breathing has two modes of action:
Definition

 

performing controlled breathing will serve as a distraction from the pain of contractions and it helps lift the diaphragm off the uterus to relieve pressure and pain.

 

Term
Once transistion has occurred what form of breathing can be helpful?
Definition

 

pant-pant-blow rhythm, if possible, or panting “like a dog”, whichever the mother is capable of.

 

Term
Name two other times during transisition/pushing that panting is helpful?
Definition
Cervix is not complete w/ the urge to push, cord is tight around the neck at delivery (breath w/ her)
Term
Name several benefits to a bathe during the active phase of labor
Definition
Creates bouyancy (hydrotherapeutic relief) which relieves pressure thus < pain, relaxation >cervical dilation, good place for a partner to be involved, *after about 2hrs. ctx's may < so she may have to get out for a change
Term
Communication in the birth enviornment may include the following:
Definition
kind calm encouraging firm words, silence, music
Term
What is the OB back rub?
Definition
This is a back rub that is used to counteract the pressure of the fetal on the lower spine. The mother is in control of the amt. of pressure and normally only during a ctx. A folded towel or a tennis ball can be used.
Term
Risk for the incidence of shoulder dystocia can increase with the following:
Definition

 

Post-term pregnancy

 

• high parity

 

• maternal obesity

 

• maternal age over 35

 

• maternal diabetes

 

• gestational diabetes

 

• fetal macrosomia

 

• oxytocin induction

 

• prolonged labor

 

• operative deliveries• prolonged second stage labor

 

Term
What may be some signs that shoulder dystocia is ensuing?
Definition

 

If the delivery is initially uncomplicated but the head birthed slowly with problems in delivering the chin over the perineum, shoulder dystocia may be implicated. The head may appear to be receding back into the vagina as reverse traction ensues. If normal maneuvers to birth the baby fail, shoulder dystocia is diagnosed. Turtle sign

 

Term
Shoulder dystocia is when the following has occurred?
Definition

 

The anterior shoulder is caught behind or on the pubic

 

symphysis and the posterior shoulder is in the sacral hollow or above the sacralpromontory.

 

Term

Women who are allowed to remain ambulatory during labor, experienced:

 

 

 

 

Definition

Fewer caesarian sections and episiotomies, Less need for labor augmentation or induction, Shorter labors, Less need for analgesia, Fewer issues with fetal compromise, More effective uterine action

 

Term

The upright position during labor alleviates problems with the following:

Definition
 supine hypotension, reduced pelvic outlet space, perineal trauma, and less effective uterine contractions. The upright position takes advantage of both gravity to help engage the fetal head and the movement of walking to distribute the pressure of the head across the cervix to allow for coordinate and effective uterine contractions
Term
What assessmnet is done with PROM after labor commences?
Definition

Assess temperature and pulse every 2 hours, Monitor FHR every hour prior to onset of labor. For induction, the FHR is monitored more closely, even constantly with electronic

monitoring, Avoid vaginal exams if possible, If a vaginal exam is performed

observe the temperature of the vaginal walls, and the odor and color of the discharge or fluid, Monitor hydration levels closely

 

Term
If the mom is atleast 36 weeks, PROM has occurred and everything else is normal and mom wants to wait for spontaneous labor, what may be done?
Definition
She is allowed to go home and monitor for signs of infection and baby well being.
Term
If signs of infection is noted with PROM, what is done?
Definition
Client must go to hospital.
Term
What must be done in the case of prolonged PROM and >36 weeks gestation, what is the course of action?
Definition
Call consulting physician
Term
What is the greatest risk after rupture?
Definition
Maternal/fetal infection
Term
What should be done when rupture does take place with no labor?
Definition

avoid tub baths until advanced

labor,

 use increased vigilance in hygiene,when using the bathroom, using,sterilized toilet paper if desired (toilet paper that has been baked at 200 degrees for 1 hour) avoid hand-to-genitalia contact, underwear, and pads unless flowing heavily, then the pad should be changed frequently, remain hydrated, increase vitamin C consumption to 250 mg every 24 hours, eat non-constipating foods, 

monitor her temperature every 3 to 4 hours

Term

After 24 hours have passed since rupture, what should be done?

Definition

A CBC may be necessary, ck FHT's regularly,

supplemental vitamin E along with the vitamin C, ingesting 5 to 10 drops of Echinacea tincture 2 to 3 times a

day to prevent infection, and drinking Nettle, Comfrey, or Violet leaf infusions

for healing.

Term
Identification of PROM includes the following:
Definition
COAT, prolapse cord, nitrazine paper, fern test, differentiate between urine/semen-amniotic fluid, abdominal palpation to determine between a frank rupture or a leak, sterile speculum exam
Term

Management options of PROM include:

 

 

Definition

1. Ensuring birth within 24 hours of rupture 2. Awaiting spontaneous labor while monitoring for signs of chorioamnionitis

 

Term
In the case of PROM a cervical dilation is unecessary unless induction is being performed? T/F?
Definition
T
Term
In the case of PROM a digital exam is warranted when the FHT's are abnormal. T/F?
Definition
T, ck. for prolapsed cord
Term
If the pregnancy is not yet term and rupture has occurred, what is the proper term?
Definition
PPROM
Term

If the membranes rupture more than ____hours prior to the commencement of labor, the condition is called _____ ________ ___ ________.

Definition
24,PROLONGED RUPTURE OF MEMBRANES
Term

 

There is increased risk of PROM with the following:

 

Definition

 

incompetent cervix, fetal malpresentation, vaginal/cervical

 

infection, polyhydramios, and multiple gestation. Nulliparous women due to occupational fatigue.

 

Term
In the case of placental abruption, maternal p.p. complication could involve the following:
Definition

DIC, postpartum hemorrhage, renal failure, and pituitary necrosis.

Term

Placenta previa is more common with:

 

 

Definition

maternal age over 35, multiparity, history of placenta previa, multiple gestation, smoking, previous uterine surgery

 

 

 

 

Term
 Sudden, painless bleeding will desribe this condition.
Definition
placenta previa
Term

 

When painless third trimester bleeding is reported, a vaginal exam should ____ be performed until placental position is confirmed.

Definition
not
Term

 

If the placenta moves away from the os and no other symptoms, such as bleeding, occur, vaginal birth may be attempted with careful observation for ______  _______or other _____  _______.

 

Definition
cord presentation, cord issues
Term
What may be a sign of placental abruption?
Definition

Fetal movement may become excessive then cease due to hypoxia.

Term

If fetal death has occurred, I should never do what?.

Definition
Do not attempt to hide this information from the mother for any reason or length of time.
Term

 

Failure to elicit fetal heart tones with a stethoscope,

fetoscope or dopplar is ______ _______ a sign of fetal demise.

 

Definition
NOT NECESSARILY *Ultrasound and EFM are more accurrate* 
Term
What makes someone more prone to placental abruption?
Definition

There may be maternal history or symptoms of preeclampsia, headaches, nausea, and vomiting. There may be trauma due to accidents or domestic violence. External cephalic version, birth of a first twin, and loss of large volumes of amniotic fluid can cause placental abruption.

Term
Placental abruption may lead to what for the mom/baby?
Definition
Maternal: shock (if B/P was high it may be normal), uterus may be hard/guarded (dont palpate-further damage), Fetal: death
Term

Any unexplained abdominal pain and bleeding early in the pregnancy should alert you to the possibility of an ______ _________. Additional symptoms include gastrointestinal upset, vomiting, and diarrhea.

Definition
ectopic pregnancy
Term

Cervical pregnancy and abdominal pregnancy, both very rare, can cause ________  ________.

Definition
massive hemorrhage
Term

Abdominal pregnancy can also result in infection followed by _______ ___ ______+.

Definition
peritonitis and septicemia
Term

Placental abruption is the separation of a normally implanted placenta after the ____ ____ __ ______

.

Definition
22nd week of gestation
Term
What two things can increase the chances of a placental abruption.
Definition

 

A previous caesarian section can increase the risk of

 

placental abruption by 40%. Cigarette smoking may also be a factor.

 

Term
Placental abruption is classified in two ways and which describes the most severe?
Definition
Revealed, concealed or mixed. Mild, moderate or severe*concealed, severe*
Term
Bimanual exam reveals a luteal mass, what am I diagnosing?
Definition
ectopic tubal preg.
Term
Tubal pregnancy symptoms include:
Definition
pelvic pain, shoulder pain, spot bleeding, high degree of shock (differentiating it from miscarriage)
Term
What is the major cause of tubal pregnancy?
Definition
PID
Term
Other conditions that predispose women to tubal pregnancy.
Definition

STD infections

• trauma from IUDs

• infection after abortion

• progesterone based birth control

• reconstructive surgery from a

prior tube rupture

• DES exposure

• assisted reproduction

Term

Conditions that mimic tubal pregnancy symptoms are:

Definition

 pelvic inflammatory disease, appendicitis, and severe

gastrointestinal illness.

Term

When notified of symptoms indicative of tubal pregnancy or rupture, what should be done?

 

Definition

call the consulting physician immediately and instruct the mother to call an ambulance.

Term
A mom has suffered a tubal pregnancy emergency, what would you refer her for and why?
Definition

Counseling to deal with the impact of nearly dying, losing a baby, and possibly losing her fertility.

Term
List some non-allopathic methods for inducing labor.
Definition

EPO taken orally/internally, blue/black cohosh tincture,

Caulophyllum, 30C or 200x, or Cimicifuga30C.Acupuncture, blue cohosh enemas abdominal massage, and visualizing the uterus contracting

Term

 

Bishop scoring system assigns a point value to the centimeters of _____, the percentage of ________, the ________, the cervical ______, and the cervical  ________.

 

Definition
dilation, effacement, station, consistency, position 
Term
Whats the highest score the Bishop's scale gives? And what is the average score for induction?
Definition
13,6
Term
It is known that hormonal (medical) induction is more stressful, what increases with medical induction?
Definition
anelgesic usage
Term
These are non-hormonal methods of induction.
Definition
Nipple stim., castor oil(60mg w/ juice, 2-6hrs., labor), foley catheter place in the cervix and expanded, sex, stripping the membranes, amniotomy
Term

When a mom reaches 40 weeks I should review the postdate management plan with her and document her

acceptance of the plan.What is that?

Definition

Perform nonstress tests and measurements of amniotic fluidvolume twice weekly starting at the 41

 

st

week and continuing until birth. Perform

a full biophysical profile and contact the

consulting physician if the nonstress test

or amniotic fluid volume is not

reassuring. If labor has not begun by 42

weeks and the dating of the pregnancy is

accurate, notify the consulting physician

and being active management of the

pregnancy.

Term

If labor has not begun by 42 weeks and the dating of the pregnancy is accurate, I should do the following?

Definition
 notify the consulting physician and being active management of the pregnancy
Term
Risk of true postdates pregnancy is what?
Definition
stillbirth
Term
What is postdates stillbirth caused by?
Definition
uteroplacental insufficiency
Term
Uteroplacental insufficiency causes what?
Definition
fetal hypoxia
Term
When dealing with postdates, the fluid levels go down, what are some possible complications?
Definition

Cord compression and meconium aspiration

Term
Postdates can also lead to ________ and ___________ both leading to a stressed newborn.
Definition
IUGR (loss of subcutaneous fat), macrosomia ( dystocia)
Term
In postdates, labor an exacerbate any issues and lead to _____  ______.
Definition
fetal compromise
Term
Labor induction in postdates is indicated in the folllowing situations. 
Definition
A low BPP, preeclampsia, insulin diabetic, IUGR, oliogohydraminos, hx of stillbirth, rapid labor/delivery,
Term
Fundal ht. is used to assess _______ ______ and correlates w/ ______ __ ________.
Definition
gestational age, weeks of gestation
Term
Name the things that can interfere with the accuracy of measuring fundal ht.?
Definition

bladder distension

• position of the fetus

• the length of the cervix

• maternal build

• fibroids

• uterine abnormalities

• placental location

• amniotic fluid volume

• retroflexion or retroversion of the

fetus

• placental location

• examiner experience

• foreknowledge of the last

menstrual period

Term

Fundal assessment is typically most accurate between _____and ____ weeks gestation with a margin of error of up to __ weeks.

Definition
20-30, 3
Term

Quickening and using the time of uterus at the umbilicus as a benchmark for 20 weeks gestation have significantly wide margins of error as do using signs and symptoms of pregnancy or the date on first noting fetal heart tones by

ultrasound or fetoscope. T/F?

Definition
T
Term
Postdates and postmaturity syndrome are different how?
Definition
Postdates-preg. past 294 days (prenatal condition), Postmaturity syndrome- based on a newborn exam
Term
The following are methods of dating a pregnancy.
Definition
Basal body temp., 1st trimester ultrasound, LNMP, serum HCG, 2nd trimester ultrasound, 3rd trimester ultrasound, p.e. @20 weeks
Term
Definition
Term
How accurate is basal body temp. in dating a preg. and what is the possible downfall? 
Definition
+/- 2-5 days and depends on the accuracey of the charting
Term

 

How accurate is first trimester ultrasound in dating a pregnancy and what is the possible inaccuracey?

Definition

 accuracy of +/- 3 to 5 days.

gestational age, sonographer’s

skill, fetal position, and available technology.

Term
How accurate is the BhCG in dating a pregnancy and what values determine a viable pregnancy?
Definition

 

Serum BhCG of less than 10,000,

 

using two values obtained 1 week

 

apart and rising appropriately.

 

o

 

 

Accuracy +/- 3 to 5 days.

 

Term
How accurate is LNMP consistent w/ a 1st trimester exam in dating a preg.?
Definition

Last accurately recorded normal,

regular menstrual period that is

consistent with a first trimester

exam.

o

Accuracy +/- 1 to 2 weeks.

Term

Second trimester ultrasound.is accurate up to how many wks? And it on what?

 

Definition

 

o

Accuracy +/- 1 to 2 weeks, accurate tech. skills.

Term

Third trimester ultrasound is accurate in dating a preg. up to how many wks.?

 

 

Definition

 

o

Accuracy +/- 2 to 3 weeks,

depending on the ultrasound

conditions.

Term

Physical exam after 20 weeks is accurate in dating a pregnancy up to how many weeks?

 

Definition
Accuracy +/- 2 to 3 weeks
Term
Is placing a mom on bedrest for preterm labor benefical?
Definition
no
Term
What are the potential downfalls of placing a mom on bedrest for preterm labor?
Definition
blood clots, decreasing muscle strength required for birth and p.p.
Term
If bedrest is required for preterm labor, what does that look like?
Definition
Place mom in the lt. lateral or side lying position, EFM, vag. cervical exams when intact
Term
The most common method of dating a pregnancy is?
Definition
According to the menstural age, LNMP
Term

 

The menstrual age, the gestational age and the fetal age are all identical. T/F?

 

Definition
T
Term

The average length of pregnancy is:

Definition

280 days (40 weeks or 10 lunar months/9 calendar

months).

Term

Conceptual age and ovulatory age are identical. T/F?

Definition
T
Term

The average length of pregnancy for the conceptual and

ovulatory age is ___ days or ____ weeks.

Definition
266,38 (9 lunar/8 calendar months)
Term

The average gestational age of a pregnancy allows for estimated birth dates within a ___ ____ range, ___ ____ on either side of the estimated birth date.

Definition
4 weeks , 2 weeks
Term

A

post date

pregnancy is considered to be any accurately dated pregnancy that is more than _____  days, more than ____ weeks,or more than ____ lunar months.

Definition
294, 42, 10
Term

If there is a predisposition towards preterm labor, what things can be added to the diet for prevention? 

Definition
consumption of oily fish or fish oil capsules, or supplemental magnesium may help prevent preterm labor.
Term
Mag. supplement can be used up to how many wks. gestation?
Definition
37
Term
Is ctx's start what can be suggested?
Definition
> mag. and epsolm salt bath
Term
Care should be taken when using Mag it can cause what?
Definition
diarrhea
Term
List two more suggestions for stalling/stopping labor.
Definition

Homeopathic Mag

Phos 30C may be effective at a rate of 7

pellets per 4 oz of hot, but not boiling,

water. The solution is sipped until gone

and the contractions should slow or stop

within the hour. Postural tilting several

times daily has occasionally stopped

preterm labor

Term
When dealing w/ preterm labor:If you can't get ctx's to slow or they accelerate what should be done?
Definition
referral
Term
What is the best type of counsel given to parents during a possible preterm birth or miscarriage? 
Definition

An empathetic approach devoid of false reassurances is the best route to take. Trust the mother’s suspicions and her

reports of any important changes; remain available by phone

Term
Name the tocolytic agents:
Definition
Prostaglandin, calcium channel blocker, oxytocin antagonist
Term
Prostaglandin benefits and risk:
Definition

They are more effective than other agents at inhibiting uterine contractions. They also have fewer of the severe side effects of betamimetics.

 

better choices for women with heart disease, hyperthyroidism, or diabetes

Term
What are the benefits and risk of calcium channel blockers?
Definition

There are fewer side effects than betamimetics and

magnesium sulfate, and there is little to no adverse effect on fetal outcome. preferable to betamimetics as tocolytics.

postpone birth longer

Term
Oxytocin antagonist carry what benefits/risk?
Definition

They appear to have fewer maternal side effects and equal effectiveness in tocolysis but carry greater fetal risk. New on the scene and needs more research.

Term
Hydration has been used to stop preterm labor effectively but what can it cause if tocolytics are needed?
Definition
pulmonary edema
Term
What things need to be considered when deciding to use/not use tocolytic therapy?
Definition

uterine environment must be assessed, side effects and risk of complications to the mother, time needed to reach an appropriate tertiary care facility or to begin corticosteroid administration for fetal lung maturity issues

Term

Beta-adrenergic drugs are the most commonly used tocolytics for stopping or stalling labor. T/F?

Definition
T
Term

Beta adrenergic drugs typically have maternal side effects of:

Definition

tachycardia, pulmonary edema, markedly increased cardiac output, blood pressure effects, and increased blood sugar and insulin

secretion.

Term
Fetal side effects of beta-adrenergics are the following:
Definition

fetal side effects are tachycardia, hypoglycemia, and

hyperinsulinism after birth.

Term
Magnesium sulfate is most effective for the use of controlling ___________?
Definition
eclampsia *has alot of serious side effects*
Term
Tocolytic therapy is suggested in the following situation:
Definition

preterm labor, dilated to 4cm and gestation <34 weeks gestation

THESE DRUGS ARE

EXTREMELY TOXIC AND MAY

PRODUCE DANGEROUS SIDE EFFECTS

IN MOTHER AND FETUS.

Term

 

If there is a history of preterm labor,perform the following:

 

 

 

Definition

perform increased monitoring starting at 24 weeks with visits every 2 weeks.

Recommend a reduced workload and the

use of condoms.

Term

 

If the cervix begins to efface, or if preterm labor is

 

halted, what should be suggested?

 

Definition

 sexual contact should cease and

visits become weekly.

Term

 

Dealing w/ preterm: If regular contractions begin or the cervix begins to dilate, immediately do the following:

 

Definition
 contact the consulting physician.
Term

 

Preterm labor is diagnosed when gestation is between ___ and ___ weeks, uterine contractions are __ to __ minutes apart or there are ____ contractions in twenty minutes or____in sixty minutes, and (5 possibilities).

 

 

 

 

Definition

20-37,5-8, 4 or 8 the membranes are ruptured, OR membranes are intact and there is progressive cervical change OR membranes are intact and the cervix is 2 cm dilated OR membranes are intact and there is a positive fFN test

 

 

Term
S/S of preterm labor:
Definition

duration, frequency, physical location, regularity, and progress to stronger, longer or more frequent. You should then palpate the contractions for intensity, duration and frequency.

Term

The followingconditions can result in or contribute to

preterm labor:

Definition
Vag./UTI infection-chorioamnionitis, incompetent cervix, polyhydramnios, malnutrition/dehydration, twins, uterine abnormalities, improper placental implantation, <between birth, fetal death, chronic/extreme stress, substance abuse
Term
What is the primary issue with preterm delivery?
Definition
Fetal lung maturity, RDS
Term
There are two types of uterine rupture, what are they?
Definition
Catastrophic rupture, atraumatic dehiscence
Term

 

 Uterine rupture involves the old incision separating completely, what is it called?

 

Definition
Catastrophic
Term

 

The first sign of catastrophic rupture is ________ _______.

 

Definition
fetal bradycardia
Term
In a catastrophic uterine rupture, the mom will present in the following way:
Definition

 

feels a sharp, shooting abdominal pain at the peak of a contraction. The presenting part is now movable, a loss of station or repositioning is apparent, fetal parts are easily palpated, fetal movements are violent and then cease, the contracted uterus is felt beside the fetus. Maternal shock may occur.

 

Term
Atraumatic dehiscence presents in the following way:
Definition
The scar doesn't tear all the way through. There is no bleeding, fetal parts don't come through and there is little to no bleeding
Term
These s/s may indicate what? Maternal vomitting, >abdominal tenderness, hypotonic ctx's, > suprapubic pain, < labor progress, maternal syncope, later hematuria, slight pain & vag. bleeding, and shock will occur, FHT's are not evident, peritoneal irritation.
Definition
Quiet uterine rupture, it may also mimic placental abruption, and pulmonary embolism
Term
A VBAC may be more successful with the following hx:
Definition

 

 

 Hx of previous c-section, not a repeat for the same reason, spontaneous labor with normal progression 

 

Term

 

A trial of labor may end in a repeat caesarian section if the same reasons for the previous caesarian occur such as:

 

Definition

 

failure to progress or cephalopelvic disproportion,

 

the need to induce or augment labor, no prior vaginal delivery, more than one previous, caesarian section,

a non-reassuring fetal heart tone, early in labor

 

Term
Third stage is caused by what?
Definition
partial placental seperation
Term
What is partial placental seperation caused by?
Definition
uterine massage prior to delivery
Term
If hemorrhage occurs in the third stage, what is the first thing that should be done?
Definition
call consulting physician and EMS (by someone other than the midwife)
Term
After EMS has been called, what is the next phase of events for dealing with 3rd stage p.p.h
Definition
1. massage the uterus to try to get the placenta out 2.set up I.V. lactated ringers 3. manage for shock 4. catheritize 5. manually remove the placenta 6. oxytocin solution (ONLY IF NECESSARY)
Term

 

The greatest risk of uterine rupture during VBAC is when the previous caesarian section was performed via a

 

_______ incision of the _____ contractile uterine segment.

 

Definition
vertical, upper
Term

 

If the caesarian was performed prior to 28 weeks gestation, especially without labor, it indicates the corpus muscular mass was likely incised regardless of type

 

of incision; the risk of rupture in this case may be significant enough to deny a trial of labor. T/F?

 

Definition
T
Term

 

Labor induction increases the

 

risk of uterine rupture, especially if prostaglandins are used. T/F?

 

Definition
T
Term

 

Twin pregnancy is at higher risk than singleton for a number of complications:

 

Definition

 

malpresentation

 

• gestational diabetes

 

• placenta previa

 

• stillbirth

 

• fetal abnormalities

 

• early pregnancy loss

 

• IUGR

 

• premature labor and birth

 

• preeclampsia

 

• dysfunctional labor

 

Term

 

 Define monozygotic  twins:

 

Definition
from the splitting of a single embryo
Term

 

Define dizygotic twins:

 

Definition
from the fertilization and implantation of two ova
Term

 

An amniotic sac is being shared by the

 

fetuses is called what? 

 

Definition
monochorionic
Term
Whether two seperate amniotic sacs are present is called:
Definition
dichorionic
Term

 

 In the event of twins:Quickly clamp

 

and cut the cord to prevent the possibility

 

of the other fetus(es) _____  _____ through the cord.

 

Definition
bleeding out
Term
The Pinard maneuver is:
Definition

 

The hips are deflexed, the legs are brought down one at a time and the frank breech is changed into a footling.

 

Term
When is the Pinard maneuver used?
Definition

 

delivery has stalled due to a splinting effect of the fetal legs.

 

Term

 

What is the Mauriceau-Smellie-Veit maneuver and when is it used?

 

Definition

 

the index finger goes into the mouth and the back of the

 

finger is pressed against the maxilla. This is not to provide traction. The rest of the hand supports the head. Place the other hand at the back of the neck with one finger hooked over each shoulder to provide traction. Breech delivery

 

Term
How would I determine multiples?
Definition
> 1 FHT'S, Hx of ovulatory drugs, severe NSV, lg. for dts. > fundal ht. >20 wks., family Hx, >parts in 3rd trimester
Term

If there is a discrepancy between the estimated gestational age and the uterine size at the first prenatal visit, what should be done?

Definition
refer for ultrasound
Term

This procedure can induce these complications, and they include separation of the placenta, rupture of the membranes, and knotting of the umbilical cord. what is it?

Definition
Complications that can occur with ECV
Term

Absolute contraindications for ECV include:

Definition
hydrocephalic fetus, multiple pregnancy, oligohydramnios, preeclampsia, ruptured membranes, and any condition that requires the fetus to be delivered by caesarian section.
Term
How to manage a breech birth:
Definition
make the room extremely warm, put mom in an uprt. position, tell mom not to push until the body is born, make sure there is no tension on the cord and don't handle it, if frank or complete becomes arrested place legs into the AP position, once the shoulders are born place the head into the OA postion by gently rotating using th hips, baby should hang until the nap/jaw appear, admin. support for res.
Term
Name four ways to turn a breech.
Definition
Moxibustion, homeopathic Pulsitilla 30c, postural tilt, swimming while doing hand stands/summersaults
Term
Definition
Term
Describe briefly how Moxibustion works.
Definition

adrenocortical output is stimulated and increases the release of lactogens. This, in turn, increases myometrial sensitivity and contractility. The fetal heart rate and fetal

movements increase and the fetus turns cephalic on its own. This is done to each ft. 2-3x's a day while in a postural tilt.

Term
ECV should only be performed by a trained physician. T/F?
Definition
T
Term
Breech positionis when the fetus is in a longitudinal but not ______ presentation.
Definition
cephalic
Term
Name the diffn't types of breech.
Definition
Frank,complete, footling, and knee
Term
Define frank breech:
Definition

The fetus is flexed at the hips with the legs against the

abdomen and the feet in front of the face. This includes nearly 70% of breech births and is very common in primagravidas.

Term
Define complete breech:
Definition

The arms and legs are flexed and the fetus is sitting on the cervix

Term
Define footling breech:
Definition

One or both feet are presenting through the cervix

and into the birth canal. This breech position is very rare.

Term
Define knee breech:
Definition

Even more rare, the presenting part is one knee (through the cervix) or both knees, fetus is kneeling on the cervix.

Term

When dealing w/ breech presentation, the fetus can assume six different positions within the uterus: left and right ________, left and right _______, and left and right ___________.

Definition
sacroposterior,sacroanterior, sacrolateral
Term
ECV should not be attempted prior to ___ weeks due to it's risk to the fetus
Definition
37
Term
What is the best method for determining a breech position?
Definition
ultrasound
Term
What would I find upon palpation/ascultation for a breech presentation?
Definition
longitudinal lie, FHT's above U, ballotable head in the fundus unless it' in a frank position (the head wonnt ballott as easy), soft/uneven presenting part
Term
If the birth wt. of an infant is below the 10%, it's considered to be _____.
Definition
SGA
Term

 

Signs of IUGR are:

 

Definition

subcutaneous tissue wasting, prominent eyes and firm skulls. 10% birth wt., polycythemia

Term
There are two types of IUGR, what are they?
Definition
symmetrical, asymmetrical
Term
Define symmetrical IUGR, and what does it stem from?
Definition

 

Includes infants who were affected early in gestation. They will have both reduced cranial circumference and reduced birthweight. Symmetrical IUGR can be caused by chromosomal anomalies, exposure to drugs or other

 

teratogens, or perinatal infections.

 

Term
Define asymmetrical IUGR, and what is the cause?
Definition

 

affected late in gestation, usually the third trimester. The birth weight is below the 10

 

th

percentile but the cranial

circumference is above the 10

 

 

th

percentile. It is usually due decreased placental blood flow or oxygenation of the fetus.

 

Term
A fetus suffering from IUGR is stressed from a chronic hypoxic enviornment. T/F? 
Definition
T
Term
Baby's suffering from IUGR tend to not handle the stres of labor very well. T/F?
Definition
T
Term

After birth of a baby who has potentially suffered IUGR, quickly assess the fetus for the following:

Definition

visible abnormalities or infection and determine the gestational age.Hypoglycemia and hypothermia

Term
I should closely observe the newborn who may have suffered IUGR for the following:
Definition
glucose 35(asymptomatic), 45(symptomatic) temp., save the cord blood for examination
Term

Pyelonephritis is:

Definition
an inflammation of the kidney(s), typically due to a bacterial infection.
Term
Pyelonephritis is the most commonnon-O.B. cause of hospitalization in pregnancy. T/F?
Definition
T
Term
The most common complications of kidney infection in preg.?
Definition

preterm labor and delivery

• acute respiratory distress

syndrome

• septic shock

• hemolysis leading to anemia

Term
The causes of kidney infection are the following:
Definition

ureter compression by the uterus

at the pelvic brim

• decreased bladder tone

• dilation of the renal pelves

• urinary stasis

Term
S/S of a kidney infection are:
Definition

fever

• chills

• suprapubic or lumbar pain

• CVA tenderness

• hematuria

• myalgia

• dysuria

• nausea and vomiting

• a history of asymptomatic

bacteriuria or cystitis

• Urinary frequency and urgency

Term
The lab results for a kidney infection would be the following:
Definition

 

Laboratory results include bacteriuria, hematuria, pyuria, and proteinuria, and an increased white count with a left shift.

 

Term
What would I do in the case of positive lab results for a kidney infection?
Definition
refer
Term
What is the proper action for the treatment for a kidney infection?
Definition

Hospitalization. Pyelonephritis requires IV therapy for dehydration and electrolyte imbalance. Antibiotic suppressive therapy is usually maintained until delivery.

Term

A fetus considered small for dates in the first half of pregnancy is often the result of _________  __________.

Definition
inaccurate dating
Term
Other possible causes or reasons for small for dates in the early part of preg.?
Definition

missed abortion

• ectopic pregnancy

• a small maternal frame

• inaccurate first measurement

• fetal or chromosomal abnormality

• placental pathology

• fetal death

• oligohydramnios

• fetal infection

• insufficient intrauterine growth

due to maternal illness

Term
Causes for small for dates in the later half of preg.
Definition

intrauterine growth retardation

• fetal death

• oligohydramnios

• poor maternal weight gain

• transverse or oblique lie

• genetically small infant that is

normally grown

Term
List the things to be done or addressed for small for dates.
Definition
 ultrasound, assess diet, assess stress < work, assess smoking or substance abuse, if truly small for dts. consult
Term

Urinary tract infections are common during pregnancy because

Definition

urinary stasis occurs due to normal hydronephrosis,

creating a breeding ground for bacteria.

Term

Urinary tract infections during pregnancy are associated with:

Definition

preterm labor, low birth weight, hypertension, preeclampsia, pyelonephritis and maternal anemia

without prompt identification and treatment.

Term
Who tends to be more prone to UIT's?
Definition

Those who have sickle cell trait or anemia, diabetes, or a history of UTI are at higher risk of developing infections.

Term

UTI during pregnancy often lacks symptoms; it is recommended that

Definition

screening of the urine be performed at the first prenatal visit. The presence of more than 100,000 bacteria of the same species per milliliter of urine indicates infection.

Term

Cystitis is:

Definition
is a condition of inflammation of the bladder typically caused by a bacterial infection
Term
Symptoms of cystitis include:
Definition

Symptoms include urinary urgency and frequency, dysuria,

nocturia, suprapubic pain, and hematuria.

Term

Asymptomatic bacteriuria has __ associated symptoms and can progress into __________ with complications of

pregnancy. Since up to ___ of untreated UTIs can become pyelonephritis, identification and treatment are

paramount concerns.

Definition
no,pylonephritis, 40%
Term

Cystitis: Laboratory examination of the urine will show bacteriuria, increased white blood cells, red blood cells, and nitrites. It is necessary to await for identification of the specific pathogen to begin treatment? And what is the normal antibiotic given?

Definition

No.

(Bactrim), (Macrodantin), cephalosporins, and ampicillin or

amoxicillin. Sulfa drugs should not be used past 36 weeks,

 

Term

Fasting blood sugar should be less than __ mg/dl, 1 hour postprandial blood sugars should be less than ___ mg/dl and 2 hour postprandial blood sugar should be less

than ___ mg/dl.

Definition
95,140,120
Term

Complications to the fetus of uncontrolled diabetes include:

Definition

macrosomia, polyhydramnios, and pregnancy induced

hypertension or preeclampsia.

Term

If the fundal height is greater than expected for dates, what may be the blame when dealing w/ gest. diabetes?

Definition
polyhyraminos, macrosomia
Term
What should be done when I suspect possible gest. diabetes and lg. for dates measurements?
Definition
ultrasound,  if confirmed then consult
Term
Definition
Term
When dealing w/ lg. for dts. what should be done at 34-36 weeks gestation?
Definition

At 34 to 36 weeks, fetal movement

 

counting should commence. If the fetus is

 

the appropriate size, the amniotic fluid is

 

at the appropriate levels, there is no

 

hypertension and no history of stillbirth,

 

the pregnancy can proceed until labor

 

begins naturally.

Term
What should be done at 40 weeks when dealing with lg. for dts.?
Definition

At 40 weeks a biophysical profile should be performed

twice a week until birth. If, however, complications occur, or there is a history of stillbirth, labor should be induced at 40 weeks.

Term
How to manage PIH:
Definition
Monitor diet, rest, fluids and wt., B/P q 4hrs. @home, daily abd. exam (abruption, HELLP), BPP, labs (BUN, CBC, coagulation profile, electrolytes, creatinine, albumin, and liver function),* Severe preeclampsia (repeat blood test q 12-24 hrs.), drugs to reduce B/P and possible DIC complications  
Term
Hydrotherapy is meant to deliver what to a laboring mom?
Definition

Water is used to deliver heat or cold to various areas of the body requiring analgesia or other treatment.

warm and cold compresses placed on affected body parts

can increase circulation and analgesia.increases the rate of healing and relaxation of aching muscles or bruising and sore tissues from birth.

Term

Full immersion in a hot bath is not advisable due to possible danger to the fetus.T/F?

Definition
T, Brief tepid baths are appropriate.
Term

 

The best nutritional sources for calcium are in  the following foods/herbs:

 

Definition
fish and dairy products. Salmon, sardines, mackerel, seaweed (kelp), sesame salt, tahini, and dark leafy vegetables such as turnip tops, kale and beet greens are all good sources of calcium in food. Nettle and Raspberry leaf infusions
Term

 

Many wild greens such as Lamb’s Quarters, Mallow, Galinsoga, Shepherd’s Purse, Knotweed, Bidens, Amaranth, and Dandelion leaves are good sources of_______.

 

.

 

Definition

 

calcium

 

Term

 

The role of calcium in controlling hypertension has not been satisfactorily proven or explained. T/F?

 

Definition
T
Term

 

Calcium uptake by the body requires adequate amounts of the following vit./minerals? 

 

Definition
magnesium, phosphorus, and Vitamins A, C, and D.
Term

 

Studies have shown _______ and ______ intake can impact blood pressure.

 

Definition
magnesium and phosphorus
Term

What is the following condition?

 

The primary complaint is generalized itching and burning of the skin and an erythematous rash. The rash begins on the abdomen and spreads to the rest of the trunk and to the extremities. Blisters develop that can subsequently become infected. T

ypically begins

in the second trimester and can extend to the postpartum period.

 

 

 

 

Definition

 

Pemphigoid Gestationis (Herpes Gestationis)

 

Term

How is

 

Pemphigoid Gestationis

 

 

confirmed through diagnosis? And what is the treatment?

Definition

 

diagnosis is confirmed by skin biopsy, topical or oral steroids may be prescribed. Induction occurs at 35-37 wks. due to placental insufficiency and IUGR.

 

Term

 

Pemphigoid gestationis:

 

Definition
A skin condition that is of unknown etiology but may begin with a maternal autoimmune response to paternal antigens that is prolonged by pregnancy hormones.
Term

 

An incompetent cervical os (incompetent cervix) is diagnosed when the following occurs: 

 

Definition
cervix effaces and dilates in the second or early third trimester without pain.
Term

 

The symptoms of cervical incompetence are the following: 

 

Definition

vaginal bleeding,

ruptured membranes, or pelvic pressure.

Term

 

Risk factors for cervical incompetency include:

 

Definition

a history of abortion at 14 or more weeks of gestation or

cervical laceration after a vaginal or caesarian birth, extreme distension of the cervix during a prolonged second stage labor in a previous pregnancy, multiple

elective abortions in the first or second trimester, exposure to DES, or extreme cervical conization.

Term

 

If the membranes are still intact and the cervix is in an

 

appropriate condition, an incompetent cervix is often treated with _____ _____ sometimes called a purse-string.

 

Definition
cervical cerclage
Term
What herbs are helpful in preventing hypertension in preg.?
Definition

 

The regular ingestion of Raspberry leaf or Nettle infusions help prevent hypertension.

 

Term

 

When hypertension occurs,in preg. what herbs can be suggested?

 

Definition

hops, skullcap, passionflower, hawthorn, and chamomile all induce relaxation and reduce systolic pressure. Diastolic pressure can be reduced through the use

of cayenne pepper, which acts as a vasodilator and cardiac stimulant.

Term
This herb is the most potent of the herbs listed for reducing hypertension and is contraindicated in the 1st trimester. What is is?
Definition

hops

Term
Define missed abortion:
Definition

 

 The fetus dies but the products of conception are not expelled for 2 or more weeks.

 

Term

These s/s are present with this condition:

 

vaginal spotting or bleeding or lower abdominal or back pain at fetal death. The fundal height no longer increases and will decrease somewhat. Mammary changes will reverse. The woman will lose weight and no fetal heart

 

tones will be present. Amenorrhea is present.

 

 

Definition
Missed abortion
Term
When dealing with a possible missed abortion, whta is the course of action?
Definition
Ultrasound for confirmation and referral, >DIC
Term

 

Habitual abortion:

 

Definition

three or more consecutive pregnancies have terminated in spontaneous abortion.

Term
A who is dealing with a hx habitual miscarriage should recieve the following care: 
Definition
Counseling: emotional, sexual, contraceptive, genetic
Term

 

Inevitable abortion:

 

Definition

 A spontaneous abortion (SAB) is highly likely to occur

and cannot be stopped.

Term
What are the s/s of in inevital abortion?
Definition

 

Beyond bleeding and lower back or abdominal pain, there

 

is also cervical dilation and/or rupture of the membranes.

 

Term
If a mom decides to miscarry at home she should be informed to look for the following:
Definition
signs of infection, heavy bleeding, clots bigger than 3cm, and inform the midwife once shes miscarried
Term
If a woman has a hx of SAB she should be asked to dave the POC so the following can be done:
Definition

 

saved for genetic studies and confirmation of a complete abortion and intrauterine pregnancy.

 

Term

 

Incomplete abortion:

 

Definition

An SAB occurs without expelling the placenta along with

the fetus.

Term
What are the s/s of an incomplete miscarriage, and what needs to be done?
Definition

 

result in bleeding, possibly heavy, and infection, especially in the second trimester. Referral to the consulting physician is required to

 

manage the infection and evacuate the retained placenta.

 

Term
Cervical bleeding can be caused byt hhe following:
Definition

 

 cervical bleeding, such as gonorrhea, chlamydia, or trichomonas. Cervical dysplasia may also be at fault.

 

Herpes lesions, yeast infections, polyps, and bacterial vaginosis can also cause cervical bleeding as can sexual

 

intercourse due to increased cervical vascularity.

 

Term
Infection is the primary cause of _____ ________.
Definition
cervical bleeding
Term

 

If there is a concern about ectopic pregnancy, a history of repeated miscarriage, or a non-reassuring

 

bimanual exam perform an ______ ______.

 

Definition
ultrasound exam
Term

 

When dealing w/ vag. bleeding, it is important to examine for the source of the bleeding. If the blood is coming from within the uterus, a ________ and ______ ____ ______,________.

 

Definition
sonogram, bloodwork for BhCG and progesterone
Term

 

If the blood is from the cervix itself, it is rarely implicated in pregnancy loss. T/F? 

 

Definition
T, but must still be treated.
Term
Abortion is termination of a preg. pror to __ weeks and weighing less than ___g.
Definition
20,500
Term
SAB is a naturally occurring loss of preg., the most common reason is ________ ________.
Definition
genetic abnormalities
Term
Genetic abnormalities are the most common reason for SAB, what are some other reasons?
Definition

 

 Other causes are abnormal progesterone levels, thyroid conditions, uncontrolled diabetes, autoimmune disease, infection and uterine abnormalities.

 

Term

 

If both bleeding and pain are present, prognosis for the pregnancy is _____.

 

Definition

 

poor

 

Term

 

Threatened abortion:

 

Definition
This is a condition of vaginal bleeding during the first half of pregnancy.
Term
To determine a threatened miscarriage the following should be performed:
Definition

 

A physical exam and evaluation of the serum BhCG and progesterone levels as well as ultrasound

 

Term
In an office exam when dealing with first trimester bleeding what should be done first?
Definition
Vitals and repeat urine preg. test
Term
What should be done when dealing with first trimster bleeding after the inital vitals and urine pregnancy test?
Definition
Palpation-tenderness, pain, rebound tenderness, CVA. Speculum exam-vag. infection, cervical condition. Bi-manual exam- masses, fundal ht., cervical dilation or effacement. FHT'S. Ultrasound,BhCG, HCT, HGB, and progesterone
Term
Why is exercise helpful to women w/ PIH?
Definition

 

increases circulation and dilates blood vessels

 

Term

 

If the mother’s blood pressure rises to ______, rest should be recommended over exercise.

 

Definition
140/90
Term
List some foods that are good for reducing blood pressure.
Definition
Watermellon, cucumber, parsley, garlic and onion
Term
Whta spices should be removed when dealing w/ an elevated B/P?
Definition

mustard, ginger, nutmeg and black pepper

Term
What stimulants can be contributing to an elevated B/P, and should be removed?
Definition

caffeine, nicotine, and cocaine can cause vasoconstriction and low birth weight

Term
When evaluating the diet of a client who is dealing with an elevated B/P, what am I looking for?
Definition

High quality protein, whole grains, and mineral-rich vegetables and fruits should be consumed and salt to taste.

Term

If the bleeding is light and there is no attendant low

abdominal or back pain, the woman should observe precautionary instructions: ____ ____, ____ _____, _____ ______, and notify you of any changes.

Definition
bodily rest, pelvic rest, avoid orgasm
Term
Other causes of first trimester bleeding are: 
Definition

ectopic pregnancy

cervical lesions or polyps

post-coital bleeding

implantation spotting

severe cervicitis

subchorionic bleed

Term

Venous return, cramping, varicose veins, and edema can

occur easily in preg. so the following should be suggested?

Definition
Leg/foot exercises
Term
The differential diagnosis for first trimester bleeding is the following:
Definition
Confirmation of LMP, what contraception was used prior to prg. (IUD), results of preg. test, hx of bleeding (when it started, heaviness, color and frquency), pain or cramping (location and intensity), UTI/STD, changes in preg. symptoms, recent intercourse 
Term
The transverse exercise and pelvic rock can both help with what in preg.?
Definition
lower backache
Term
List some things that are benefical in maintaining an intact perineum:
Definition
moether's self control, prenatal perineal stretching, warm compresses, counter pressure when in a dorsal/lithotomy positioncreating fetal flexion, perineal suport w/ thumb and middle finger
Term

_______ and _______ may be decreased or prevented if the mother has vaginal muscle control.

Definition
Tearing , laceration
Term
What exercise should be taught to teach good vag. muscle control? 
Definition
elevator pelvic floor exercise
Term
Describe the elevator exercise:
Definition

The pelvic floor muscles pull up as if they were part of an elevator. The elevator stops at the first, second, third, fourth, and fifth floors. At each point hold the pelvic muscles momentarily. Once the “fifth floor” is reached, hold the muscles 30 seconds and descend the elevator, pausing at each floor and stopping at the “sub-basement”

where birth takes place.

Term

 

Dyspareunia:

 

Definition
is defined as pain during sexual intercourse.
Term

 

The pain of intercourse in preg. may be caused by:

 

Definition

pelvic/vaginal congestion from impaired circulation by uterine pressure. The abdominal enlargement may cause

positional changes that are painful. Psychological  

Term
Name some suggestions for dyspareunia:
Definition
Diff'nt positions, ice to relieve congestion, counseling over misconseptions/ fears
Term

Techniques Ineffective in Preserving an Intact Perineum are:

Definition
ironong out the perineum, perineal massage w/ massage/oil, perineal bracing
Term

An accurate and complete chart will also be helpful in establishing the midwife's _______________.

Definition
professionalism
Term

The chart must contain all records of assessments, procedures, recommendations, discussions with the

patient and other care providers, and all observations during any examination and during the birthing process in case of lawsuit. T/F?

Definition
T
Term

 

For legal defensibility the records must contain:

 

Definition
Written on lined paper, initaled at the end of every note, no empty spaces, never erased crossed out instead and the reason why, mom's initial were appropriate, never obliterate info.
Term

Blank areas can invalidate an entire chart. T/F?

Definition
T
Term

Sometimes the leg or foot can become weak or numb, when dealing w/ sciatic pain? T/F?

Definition
T
Term
In preg. sciatica results for the following reasons?
Definition

 

 The pressure of the uterus on the sciatic nerve or from

 

muscular tension or vertebral compression from the extra weight and posture changes in pregnancy.

 

Term

 

Medications such as nonsteroidal anti-inflammatories are used to relieve inflammation while physical therapy can relieve both inflammation and pressure. What is this treatment for?

 

Definition
sciatica
Term
Describe the Count-to-ten method:
Definition

 One count session is performed at the same time each day. The time taken to reach 10 movements is recorded. At least 10 movements should be felt in 10 hours. If there are fewer than 10 movements, if the time to reach 10

movements is increasing, or if no movement is felt within 10 hours, the woman should contact you.

Term

 

The fetal scalp can be massaged through the dilated cervix with a finger for 15 seconds. If this doesn't create the desired result, what can be done?

 

Definition
Pinch the scalp w/ an Allis clamp, FHR should accelerate for 15sec.
Term
What is another way to stimulate the FHR?
Definition
vibroacoustic, if the baby is sleeping tachycardia may occur, monitor until return to baseline
Term
Definition
Term

Fetal bradycardia with a heart rate >80 bpm with appropriate variability_______ indicates acidemia. DOES/NOT?

Definition
doesn't, rarely
Term

 

What FHR is typically found in hypoxia and metabolic

 

acidosis?

 

Definition

 

No variability with prolonged or late decelerations

Term

 

Severe fetal hypoxia can present with:

 

Definition
bradycardia with no variability and no return to baseline; this condition worsens over time and may be seen immediately before intrauterine fetal death.
Term

 

With bradycardia only, at rates of 100-120 bpm, the following may be present:

 

Definition

 

maternal hypothermia, administration of drugs such as propanolol, prolapsed cord or cord compression, cardiac

 

abnormalities, vagal stimulation, or fetal hypoxemia or asphyxia.

 

Term

 

With rates of less than 110 bpm an immediate assessment should be performed for:

 

Definition

a prolapsed cord, expected time until delivery, duration of

the bradycardia, the presence/absence of variability, and late or prolonged decelerations

Term

 

Sustained bradycardia with positive fetal movement is indicative of a______ _____ ________heart blockage

 

Definition
complete/incomplete heart AV block
Term

 

Fetal heart tones should be audible by __ weeks gestation

 

Definition
20
Term

In a cephalic presentation the fetal heart tones can be heard midway between the ____________ and _________ ____________.

Definition
Umbilicus and superior iliac spine
Term

In a breech presentation with anterior variety, fetal

heart tones are heard level with or above the ________.

Definition
U
Term

With a breech in transverse variety, the heart tone is near the ______ _________.

Definition
ABD. MIDLINE
Term

With a breech in posterior variety, the heart tones are

heard in the flank area or near the midline on the opposite side of the abdomen. T/F?

Definition
T
Term

 

Define an acceleration in FHR:

 

Definition

 

A FHR increase of 15 bpm above the baseline, and last for 15 sec.-2m. from the onset to return to the baseline. * An acceleration of > or = to 10m. is a baseline change*

Term

A reactive test is a positive indicator of fetal well-being. A non-reactive test is considered a nonreassuring

result, especially if a previous test showed reactivity. T/F?

Definition
T
Term

 

Fetal tachycardia in conjunction with ____ decelerations or prolonged ______ decelerations _____ variability

 

indicates fetal hypoxia

 

Definition
late, variable, w/out
Term

 

Tachycardia with no other fetal heart rate

 

changes may indicate:

 

Definition

hyperthyroidism, fetal anemia, maternal dehydration,

congenital anomalies, maternal hyperthermia, fetal hypoxia, administration of drugs such as betasympathomimetics, hypertension or

asthma medications, and prematurity with gestational age less than 28 weeks.

 

Term

 

Proteinuria in conjunction with gestational hypertension is a hallmark of __________.

 

Definition
preeclampsia
Term
What is another reason to see proteinuria and elevated B/P?
Definition

 

It can also occur due to renal damage suffered in acute

 

pyelonephritis.

 

Term
What is happening that glucose is evident on a urine strip?
Definition

 

Glucose is spilled into the urine when lack or ineffectiveness of insulin causes the cells of the body to be unable to up glucose to use for energy. The excess glucose is cleared through the kidneys and excreted

 

in the urine

 

Term

 

What is going on in the body that ketones are evident on the urine strip?

 

Definition

 

Ketones are metabolic breakdown products of fat and protein which the cells use for energy in place of the unavailable glucose. Ketones cause acidosis which, in the extreme stages of diabetes, can cause coma and death.

Term

 

The total blood volume in a singleton pregnancy can increase between___ and ___ with increases above ____ in multiple gestation.

 

Definition
30-50%, 50%
Term
What is the majority of the  vol. increase for hemodilution to occur?
Definition
 plasma
Term

 

The most significant decrease in hematocrit occurs between ____ and ____ weeks of gest.

 

Definition
24-32
Term
The hemodilution effect stabilizes after ____ weeks.
Definition
32
Term

 

Gestational diabetes will cause the serum glucose to

 

remain _______ longer than normal and may cause the levels to become ____ _____than normal when ingesting a standard load of glucose.

 

Definition
elevated, more elevated
Term

 

Biopsy, surgery, or injury to the breast may impact the nerve tissue and/or the ducts and decrease the ability to breastfeed. T/F?

 

Definition
T
Term

 

Classification of inverted nipples:

 

Definition

 Grade 1 - easily pulled out ,Grade 2 - can be pulled out but

will not remain everted

 

 

Grade 3 - may not pull out

 

 

 

Term

 

Brain growth consists of ________ and _________ of cell growth.

 

Definition
HYPERPLASIA HYPERTROPHY
Term

 

Malnutrition decreases both types of_____ and  ______ growth and can result in a smaller brain.

 

Definition
hyperplasia hypertrophy
Term

 

Malnutrition during _______ cellular growth causes irreversible damage because a reduced number of cells will be created.

 

Definition
hyperplastic
Term

 

Improved nutrition during any phase of ________ can increase cell size as needed and reverse any previous damage.

 

Definition
hypertrophy
Term
Malnutrition often results in LBW along w/ the following:
Definition

 

Perinatal mortality, mental retardation, cerebral palsy, visual, hearing and neurological defects, and poor perinatal growth and development all increase

 

Term
Malnutrtion is often linked to the following things:
Definition

 

 tobacco,alcohol, caffeine, marijuana, cocaine or other illicit drugs. Multiple gestation, lactose intolerance, eating disorders, and strict vegetarianism can also cause malnutrition.

 

Term
What predisposes women to varicosities in preg.?
Definition
Family hx, progesterone, wt. of the uterus, and constrictive clothing
Term
What remedies could be used for varicosities/veins?
Definition

 

Remedies include the use of support hose, elasticized sport wraps, or elastic stockings  Rest with the legs elevated

 

throughout the day, decreased standing time, avoidance of crossing the legs and constrictive clothing will help mitigate the problem.

 

Term
Peristalsis is caused by what hormone and can inhibit what?
Definition
progesterone, reg. BM
Term
What suggestions can I make to help w/ peristalsis?
Definition

 

Adequate fluids, rest and fiber, and mild laxative foods such as prunes and warm liquids, with the addition of gentle exercise can keep the bowel moving and regular.

 

Term
Common urinary issues w/ preg. are the following:
Definition
First trimester: increased frequency, 3rd trimester: increased urgency due to engagement, night time diuresis > fluids before bed
Term
What are some remedies to encourage sleep?
Definition

 

Remedies include warm baths, a warm drink such as milk

 

prior to bed, and techniques of relaxation

 

Term

 

The normal hemoglobin level in a pregnant woman is:

 

Definition
11.0 g/dl due to an increase in plasma rather than a decrease in red blood cells.
Term
What will help you differentiate the cause of any anemia?
Definition
CBC
Term
A hemoglobin level below ____ is of concern and the cause should be discovered.
Definition
10.0
Term
Signs of significant anemia are:
Definition

 

pallor

 

• jaundice

 

• tachypnea or dyspnea on exertion

 

• splenomegaly

 

• tachycardia or flow murmur

 

• orthostatic hypotension

 

• peripheral edema

 

• smooth and sore tongue

 

• pale mucus membranes and nail

 

beds

 

Term
Symptoms of anemia are:
Definition

 

poor appetite or changes in food

 

preferences

 

• changes in mood

 

• changes in sleep habits

 

• pica

 

• malaise

 

• headaches

 

• weakness

 

• dizziness

 

• fatigue

 

• drowsiness

 

Term
What is the most common reason for anemia in preg.?
Definition
iron
Term
Infections are caused from pathogenic organisms such as:
Definition

 

 such as bacteria, viruses, fungi, parasites, protozoans, and rickettsia

 

Term

 

Systemic infections can cause the following symptoms: 

 

Definition
chills, sweats, fever, malaise, and sometimes headache, muscle or joint pain, or changes in mental status.
Term

 

Localized infections can cause the following symptoms: 

 

Definition
tissue swelling and redness, tenderness, heat, and loss of function.
Term
The fetus may be indirectly impacted by the mom being sick, how?
Definition

mom is too ill to take in proper nutrition/fluids 

 

Term

 

Biceps reflex:

 

Definition

 

The tendon of the biceps

 

brachii in the bend of the elbow is struck.

 

The patient’s arm is flexed and rested on

 

her lap or the examiner’s arm. The elbow,

 

arm and forearm should flex; the hand

 

should supinate.

 

Term

 

Triceps reflex:

 

Definition

 

The tendon of the triceps

 

brachii on the back of the upper arm

 

above the elbow is struck. The patient’s

 

arm is flexed and the elbow held in the

 

patient’s opposing hand. The elbow and

 

forearm should extend and the arm

 

should adduct.

 

Term

 

Quadriceps (knee-jerk) reflex:

 

Definition

 

The

 

patellar tendon below the patella is

 

struck. The leg is flexed. The knee should

 

extend and the leg should jerk.

 

Term

 

Gastrocnemius-soleus (ankle-jerk) reflex:

 

Definition

 

The Achilles’ tendon above the heel is

 

struck. The leg is flexed at the knee and

 

the foot is dorsiflexed. Plantar flexion of

 

the foot at the ankle should be observed.

 

Term

 

Brachioradialis reflex:

 

Definition

 

The radius is used to elicit this response rather than a

 

tendon directly. The patient’s arm is slightly flexed, the hand slightly bent at the wrist, and the arm rested on lap or abdomen. The elbow and forearm should flex.

 

Term
What is the most common complaint of preg.?
Definition
edema
Term
What is the most common site of edema?
Definition
ankles
Term

 

Edema of the upper shins, breastbone or sacrum is definitive for ___________.

 

Definition
hemoconcentration
Term
When edema of the upper shin, sternum or sacrum is coupled w/ proteinuria and hypertension, what does this indicate?
Definition
preeclamsia
Term

 

The degree of edema is rated by

 

depression size:

 

Definition

 

+1 = 2mm

 

 

 

 

+2 = 4mm

 

 

 

 

+3 = 6mm

 

 

 

 

+4 = 8mm

 

Term

 

Any pitting of +2 or higher is indicative of _________.

 

Definition
preeclampsia
Term

 

Varicosities can cause pain and ________ or ______ areas on the calf, secondary to deep vein thrombosis or phlebitis. What needs to be done in this case?

 

Definition
reddened, white. Referral to a physician is recommended.
Term

 

Examination of the mucus membranes should note:

 

 

 

 

Definition

 

degree of moisture

 

 

 

 

hyperemia

 

 

 

 

pallor

 

 

 

 

cyanosis

 

 

 

 

pigmentation

 

 

 

 

lesions

 

 

 

 

hemorrhage

 

Term
Pallor of the mucus membranes is indicative of:
Definition
anemia, hypovolemic shock, pallor/flushing-heart problem
Term
Hyperemia(reddness) of the mucus membrane:
Definition

 

tooth decay, stomatitis or trauma.

 

Term
Hyperemia of the nose is caused by:
Definition

 

ulceration, inflammation, or rhinitis.

 

Term
Dry membranes indicate:
Definition

 

fever, chronic gastritis, liver disturbances, shock, prostration, fatigue, dehydration, and use of certain drugs.

 

Term

 

Upon vag. exam: starts w/ the mons, and is observed

 

for:

 

Definition
hair growth pattern and pediculosus.
Term

 

The labia majora and perineum are checked for:

 

Definition
swelling, edema, cysts, inflammation, dermatitis, irritation, discoloration, tenderness, lesions, vesicles, ulcerations, crusting, or condylomata
Term

 

I should also take note of the following, upon my examination of the external genitalia:

 

Definition
Varicosities and episiotomy or perineal laceration scars
Term
Upon examining the labia minora I should take note of:
Definition

The labia minora is checked for inflammation, irritation, discoloration, herpetic vesicles, chancre, fistulas or

fissures

Term

If I find any

inflammation, irritation, discoloration,

herpetic vesicles, chancre, fistulas or fissures upon my exam of the labia minora, I should do the following?

Definition
refer
Term

The clitoris is checked for:

 

Definition

adhesions and enlargement; the urethral orifice is checked for irritation or dilation (possible repeated UTIs or insertion of foreign objects), and for growths or

fistulas,

Term

If any adhesions and enlargement; the urethral

orifice is checked for irritation or dilation (possible repeated UTIs or insertion of foreign objects), and for growths or fistulas are found on the clitoris, what should be done?

Definition
referral
Term
What if any infalmmation, cysts,growths, fistulas, fissures, or uterine prolapse is dicovered upon examination of the introitus, what should be done?
Definition

referral

Term
What hormones affect the joints in preg.?
Definition

estrogen, progesterone and relaxin

Term
What things can help w/ the joint and pelvic discomforts:
Definition

Various exercises, such as pelvic rocking and other centering activities, help keep the back muscles strong and improve the spinal alignment. Some joint pain may be alleviated by ensuring proper support when sitting or lying down. The side-lying position is best for pregnancy.

Term
What are some other helpful things to be suggested for the joint/pelvic dicomforts?
Definition

Strengthening muscles such as the gluteals, abdominals, hamstrings, and upper back; and stretching others, such as the psoas, low back, and chest, can keep proper skeletal alignment more easily

Term
What area of the cervix is collected during the PAP smear? 
Definition
endocervical region
Term

The Pap smear is the standard method of detecting ________ _______.

Definition
cervical cancer
Term

The report from a PAP smear may include observations of various organisms such as:

Definition

Trichomonas or Candida and cellular changes due to

inflammation or the presence of an IUD

Term

 

Gonorrheal infection during pregnancy has been linked to:

 

 

 

Definition

spontaneous abortion, very low birthweight, chorioamnionitis

postpartum endometritis, pelvic sepsis,

and premature rupture of the membranes.

 

 

Term

 

Chlamydia in pregnancy has been linked to:

 

Definition

amnionitis and postpartum endometritis. Both infectious agents can infect the newborn as it transits the birth

canal.

Term

 

The gynecological culture is a method of diagnosing:

 

Definition
gonorrhea and Chlamydia
Term
Obtaining a report of anything outside normal on a PAP smear requires the following:
Definition
referral
Term
Explain how a bimanual exam is done of the cervix:
Definition

One hand is placed on the abdomen between the umbilicus and the symphysis pubis. Two vaginal fingers should be placed to either side of the cervix, pressed on top of it and the cervix pushed downwards with the backs of the fingers. The tips of the fingers are pushed upwards to feel the shape, size and contour of the uterus

Term

A multiparous uterus is larger than a nulliparous uterus.T/F?

Definition
T
Term

An enlarged uterus can indicate_____ or ______.

Definition
preg., tumors
Term

Normal ovaries during childbearing years are ___ to___cm

long, __ to __ cm wide, and__ to __ cm thick.

Definition
2.5 to 5cm, 1.5 to 3cm, 0.5 to 1.5cm
Term
List the several types of speculums:
Definition
virginal, Gaves (reg.,lg.) Pederson (nulliparas,scarred tissue)
Term

Chadwick’s sign in pregnancy is indicated by a _____ _______of the cervix caused by increased vascularity.

Definition
bluish color
Term

Cervical growths, lesions, nodules, ulcerations, masses, polyps, erosions, and infected nabothian cysts are considered abnormal and she should be __________.

Definition
referred
Term

Cervicitis presents with:

Definition
hypertrophy, edema, discharge, and friability.
Term

Deviation of the uterus to one side can indicate:

Definition

 pelvic masses or uterine

adhesions.

Term

If lacerations of the os are extensive the cervix may be ___________.

Definition
incompetent
Term

The nulligravid cervix is ________.

Definition
closed
Term

A multiparous cervix is ______ to a ______ degree with each birth.

Definition
open, larger
Term

Palpation for CVAT should be performed when assessing first trimester ________.

Definition
bleeding
Term

Where do I elicit the CVAT?

Definition

The costovertebral angle is formed at the junction of the twelfth rib and the paravertebral muscles.

Term

Any report of pain while eliciting CVAT is reason to?

Definition
investigate further
Term
What is the first thing done in pelvimetry?
Definition
measure the sacral curve
Term
How do I measure the sacral curve?
Definition

 

It is found by locating the coccyx and tracing the sacral curve up toward the sacral promontory.

 

Term
Pelvimetry in order of steps:
Definition
1.Measure the sacral curve 2.Pelvic inlet is assessed 3.Diagonal conjugate is measured 4.Obstetric measurement is extracted from the diagonal conjugate(10.5 or>) 5.measure the ischial spines (interspinous dia. 10.5>) 6.pubic arch is measured next 7.Outlet dia.(intertuberous dia. 8.5>) is measured next  
Term
Intertuberous diameter should be ___ or ____.
Definition
8.5, greater
Term
Interspinous diameter is noted for the following:
Definition
Protrusion, sharpness and 10.5>
Term
How much do you subtract from the diagonal conjugate to come up with the obstetrical measurement?
Definition
diagonal conjugate - 1.5 = obstetric conjugate (should equal 10.5 or >)
Term

 

Obstetric conjugate is the inlet dimension the _______

 

must move through.

 

Definition
fetus (10.5 or >)
Term
Definition
Term
How do I measure the sacral curve?
Definition

It is found by locating the coccyx and tracing the sacral curve up toward the sacral promontory.

Term
What could it mean if reflexes are hypo/hyper reactive?
Definition

If the reflexes are hyperactive, there may be a disease of the upper motor neuron or pyramidal tract.

Some diseases can cause hypoactive reflexes.

Term
How are reflexes scored?
Definition

Reflexes are evaluated according to a scale from zero to 4+ with zero meaning the reflex was absent and 4+

indicating hyperactivity.

Term

Reflexes at either extreme, zero or 4+ are abnormal and the patient should be ________ .

Definition
referred
Term
Define clonus:
Definition

Clonus is rapid, repetitive, rhythmical, involuntary contraction and relaxation of a muscle when it is sharply stretched and the stretch is maintained in either flexion or extension.

Term
When is clonus present?
Definition

It is only present when there is central nervous system disease.

It is typical of upper motor neuron disease.

Term

Check for clonus If ___________ is found.

Definition
hyperreflexia
Term

________ is a highpitched sound occurring on inspirations

indicating an upper airway obstruction.

Definition
stridor
Term

__________ is the expulsion or expectoration of blood from the larynx, trachea, bronchi or lungs. Small amounts

may occur in several illnesses that may irritate these areas.

Definition
Hemoptysis
Term

_________ is the inflammation of the pleura and can be primary or secondary; unilateral, bilateral or local; acute or chronic, fibrinous, serofibrinous, or purulent.

Definition
Pleurisy
Term

________ is labored breathing while supine. Tachypnea is abnormally rapid respiration.

Definition
Orthopnea
Term

 

_________ is a lack of air resulting in labored or difficult breathing. Breathing may be audible with retracted intercostal spaces, and cyanosis.

 

Definition
Dyspnea
Term

ROS for the cardiorespiratory system

includes:

Definition

dyspnea, orthopnea, tachypnea, wheezing, cough, pleurisy, sputum production, cyanosis, dependent edema,night sweats, palpitations, hemoptysis, chest pain, stridor, history of respiratory infections, contact with tuberculosis, results and date of latest chest x-ray,

known abnormalities of the heart rate or rhythm, history of rheumatic heart disease, anemia, hypertension, and

coronary artery disease (CAD)

Term

ROS for the mouth includes :

Definition

toothaches, bleeding, lesions, pain, or edema of the

gums, lips, mouth, or tongue, extractions and dentures, and difficulty with swallowing or chewing. Other observations include breath odor, color and symmetry of lips and tongue, whether the palate is intact, the color of

the mucus membrane and gum, and any signs of infection

Term

Significant periodontal disease can cause premature

labor and birth? T/F?

Definition
T
Term

Bleeding is increased due to the increased vascularity caused by the pregnancy.T/F?

Definition
T
Term

Any palpable node is cause for concern and should be

_________ __ _ _______ for investigation.

Definition
referred to a physician
Term

If palpable nodes are found in the axilla area, what should be examined next? And what would be done if the exam is positve?

Definition
the fingers and hand of that side should be examined for abrasions and cuts around the cuticles and fingernails. Refer for confirmation.
Term

 

Scotomata:

 

Definition

 an island like blind spot in the

visual field. There are many different

types of scotomata: annular, absolute,

arcuate, central, centrocecal, color,

eclipse, flittering, negative, peripheral,

physiological, positive, relative, ring, and

scintillating.

Term
Diplopia:
Definition

 

 double vision, or, more formally,

 

two images of an object seen at the same

 

time. There are several types of diplopia:

 

binocular, crossed, homonymous,

 

monocular, uncrossed, and vertical.

 

Photophobia: also called photodysphoria,

 

this is an intolerance, or sensitivity, to

 

light.

 

Term

 

Lacrimation:

 

Definition
the secretion of tears. It may become excessive.
Term
Strabismus:
Definition

 

 an optical disorder where the

 

optic axes cannot be directed to the same

 

object. It is commonly called crossed eyes.

 

There are several types: unilateral,

 

alternating, constant, and periodic.

 

Term

When examinig the thyroid, abnormal symptoms would include:

 

Definition

enlargement, excessive sweating, dry skin or hair, fatigue or excessive energy

Term
What test would I perform when testing the thyroid?
Definition

Common laboratory tests for diagnosis of thyroid disease are TSH, Free T4 and Serum T3.

Term

 

Hyperthyroidism means (lab findings):  Another less common cause of hyperthyroidism is high hCG in hydatidiform moles.

 

Definition
TSH is low or absent and T3 and Free T4 are increased.
Term
Grave’s Disease:
Definition
an autoimmune disease, is the most common type. The thyroid is enlarged and tender with optical symptoms.
Term
Definition
Term
I might find hyperthyroidism and a unusally high hCG level w/ this situation:
Definition

 

hydatidiform moles.

 

Term
Chronic headaches can be debilitating and have found positve reesults w/ the following:
Definition

Medications such as acetaminophen or NSAIDs may be

ineffective. A combination of 400 mg ibuprofen and 200 mg caffeine has proven more effective than either alone. A combination of behavioral therapy for stress management and tricyclic antidepressants also proved more effective than either alone.

Term

ROS for the eyes should include a discussion of:

Definition

any blurring of vision, scotomata, diplopia, spots before the eyes, flashing lights, pressure or pain, injuries,

diseases or conditions, photophobia, discharge, redness, burning, lacrimation, the presence of corrective lenses, and the patient’s own evaluation of her visual

health.

Term

Other observations when examining the eyes include:

Definition

 eyelids are abnormally closed, edematous, have signs of infection, masses, lesions, ptosis, matting in or

absence of eyelashes, involuntary eye movements, observation of the lacrimal ducts for infection or tenderness, the color of the sclera and lower conjunctival sac, any abrasions or opacities of the lens

or cornea, strabismus, parallel movement, papillary reaction to light, protrusion of the eyeball, the size, shape and equal appearance of the eyes.

Term

The most common headaches are:

Definition
migraines and tension headaches.
Term

Less common are headaches caused by:

 

 

Definition

infections 

cerebrovascular events 

meningitis 

tumors 

glaucoma 

dental issues 

overuse of medication,

arteriovenous abnormalities

 

 

 

 

 

 

 

Term

Immediately ______ any sudden, severheadache that persists despite remedies to a neurologist.

Definition
refer
Term

Well women hx:A thorough history to investigate headache issues should include:

Definition

 a full description of the headache, frequency and onset, location, precipitating factors if known, family

trends, menstrual history, and any other conditions such as neck stiffness, visual complaints, and head trauma.

Term

Migraines tend to be seen in waht age group? 

Definition
adolescents, early adulthood, through middle age.
Term
Migraines tend to present in the following way?
Definition

They are often unilateral, severe and cause throbbing pain, nausea and vomiting, and sensitivity to light or noise. Prior to the migraine striking, there are often recognizable symptoms of its approach which can last for days prior to the migraine (prodromes)

Term
The most common symptoms of a migraine are the following:
Definition

light and noise

sensitivity, irritability, mood changes,

drowsiness, and increased thirst and

hunger. Some may experience aura an

hour prior to the migraine.

Term
List some relief methods for migraine sufferers:
Definition
Life-style changes, avoiding causes, NSAIDS, acetamenophen, meds. perscribed by a physician, OCT's for menstural induced,
Term

Increased temperature indicates infection although it may also be a symptom of _________.

Definition
dehydration
Term

Increased pulse rate may be due to anxiety or exertion, or

it may be a sign of infection,_______ or ________.

Definition
dehydration or shock
Term

 

An increased respiratory rate can also be due to ________, _________ or __________.

 

Definition
anxiety, infection or shock
Term

 

Increased or decreased blood pressure can indicate a

 

__________ disorder of pregnancy or ______, in that order

 

Definition
hypertensive, shock
Term

 

If increased respirations are accompanied by coughing or

 

wheezing, what may be to blame?

 

Definition
Asthma or respiratory infection
Term
What questions need to be asked when dealing with headaches?
Definition

 

location, duration, time of day of occurrence, type of pain, frequency any known causes, any medications or other remedies

taken and the effectiveness, other symptoms associated with them

 

includes dizziness, syncope, and sinusitis

 

 

 

Term
Definition
Term
What other obsevations am I making when examining the head for IPNV?
Definition

 

the size, shape, contour and

 

symmetry of the head

 

 

 

the facial symmetry

 

 

 

 

the location of the facial

structures

 

 

 

 

 

facial tenderness over the sinuses

 

 

 

 

involuntary movements

 

Term

 

Syncope can be from the folowing: 

 

Definition

vasovagal, cardiogenic (often from arrhythmias), orthostatic, and neurogenic. It may also be due to certain

medications.

Term

 

Exam of the skin for:

 

Definition

pruritis, rashes, moles, lesions, tendency towards bruising, hirsutism and the type of skin: oily or dry. It includes and exam of the hair for hair loss, reasons for

wearing a wig, whether there is a scalp infection, dandruff or lice, and the type: oily or dry.

Term

 

Document and investigate any abnormal findings of the skin such  as:

 

Definition

abnormal temperature, color (pallor, cyanosis, pigmentation, and jaundice), moles, scars, turgor, rashes, lesions, bruises, tumors, and patterns of injury on the skin. Examine the hair and scalp for bald spots, lumps, hair pattern, and infections.

Term

 

The skin and hair can indicate variety of conditions:

 

Definition

 

hypothyroidism causes dry skin

and hair

 

 

 

 

 

a pattern of injury may indicate

domestic violence, abuse, a

 

balance problem, or selfmutilation

 

 

 

 

 

changes in moles over time in the

size, shape, or color of the mole

 

can indicate melanoma

 

 

 

 

 

cyanosis indicates a respiratory or

cardiac problem

 

 

 

 

 

jaundice may indicate a liver

condition.

 

 

Term

 

The nipple and primary areola darken in the_____ month of gestation.

 

Definition
third
Term

 

Pigment changes may be caused by_____ or ________ stimulating the melanocytes of the skin.

 

Definition
 estrogen or progesterone
Term

 

Chloasma is:

 

Definition
 mask of pregnancy
Term

 

Pigmentation Changes of the Skin include:

 

Definition

 

nipple and primary areola darken, linea nigra, chloasma

 

Term
Pigment changes always occur w/ preg.? T/F?
Definition
F. Some women may not have changes in preg. and it can be related to hormone usage and tumors.
Term

 

Observe the breasts in several diffn't positions, list them:

 

Definition

Observe the breasts with arms by sides, arms raised overhead, and with hands pressed against hips or palms pressed together under the chin. 

Observe the breasts while the client is bent forward from the hips with arms extended toward

the examiner.

 

 

Term
Definition
Term
What is the next step after observing the breasts in several positions in a breast exam?
Definition

 

Next palpate the supraclavicular and

 

infraclavicular regions for the subclavian

 

nodes; palpate the axilla; inspect the

 

nipple epithelium. Lastly, palpate the

 

breasts on a supine client.

 

Term
What are considered abnormal findings in a breast exam?
Definition

 

asymmetry in breast contour, retraction signs, nipple deviation or retraction, shrunken breasts, edema, dilated subcutaneous veins, reddness or heat in a nonpostpartal woman, ulcerations, excessive breast elevation and asymmetry w/ contracted pectoral muscle, palpable nodes, erosion, ulceration, thickening, roughness, crusting, nipples (non-nursing), course nodularity in a localized area, loss of elasticity of the tissue or nipple w/ increased firmness/thickening of the skin, any mass.

 

Term
What should be done upon finding abnormalities in a breast exam?
Definition
Document well and refer
Term

 

Normal breast variations in a pregnant woman include:

 

Definition

              increase in size, possible tingling, tenderness, increased general coarse, nodularity and lobularity,colostrum discharge as early

as 6 weeks gestation, Montgomery’s follicles, enlargement and increased erection of the nipples broadening and increased

pigmentation of the areola, dilated subcutaneous veins vascular spiders on upper chest

 

 

 

 

 

striae of the breasts

 

Term

 

Colostrum expression is another ________ sign of pregnancy.

 

Definition
presumptive
Term

 

The least accurate method  of measuring fundal ht is measuring w/ the _______ ________.

 

Definition
examiners fingersbreadths
Term

 

Leopold’s Maneuvers indicate ________ ______ ,________, _______ or ________.

 

Definition
fetal lie, presentation, position or variety
Term
In Leopold's maneuver how many maneuvers are there and where do you begin palpating, and how many weeks gestation?
Definition

 

There are four maneuvers starting from the top of the fundus.36

 

Term
What part of the hand am I using to palpate when using Leopold's maneuver?
Definition
palmar side /flat of fingers
Term

 

The first three maneuvers are performed while ________ to one side of the mother and ____ ___ ______.

 

Definition
standing, facing her head
Term
What is Leopold's third maneuver?
Definition

 

The third maneuver consists of grasping the lower abdomen immediately above the symphysis pubis between the thumb and middle finger of one hand

 

Term

 

The fourth maneuver is done facing the ______ _____. The bottom of the fundus is palpated with both hands. This will determine, what?

 

Definition
mother's ft., presentation and engagement
Term

 

Fundal height is determined starting about ___ to ____weeks of gestation.

 

Definition
22-24
Term

 

If the fundal height does not increase over a period of time, what may be some possibilities?

 

Definition
IUGR, inaccurate dates, fetal death
Term
What is the least used and most accurate way of determining fundal ht.?
Definition
calipers
Term
What is the second most accurate and most popular way of measuring fundal ht.?
Definition
tape measure( 0 on the top of symphysis pubis and top of fundus)
Term

 

The number of _________ should approximately equal the number of _________  weeks.

 

Definition
centimeters, gestational
Term
Leopold's first maneuver consist of:
Definition

 

the top of the fundus is palpated with one hand on either side of the fundus. This maneuver identifies whether the lie is longitudinal or transverse and whether the fetus is in breech

 

Term
Leopold's second maneuver consist of:
Definition

 

midway between the fundus and symphysis pubis. The area from the abdominal midline to the lateral side and from the symphysis pubis to the fundus is palpated by holding the fetus to one side and palpating with the other, then reversing. This will indicate the variety and the position: anterior, posterior, or lateral.

 

Term

 

 ROS:

 

Definition

review of systems

 

which is a structured investigation of past or current symptoms or complaints

 

Term

 

The palpation of fetal movement and the presence of fetal heart tones are _______________

 

 

 

signs of pregnancy.

 

 

Definition
confirmatory
Term

 

The typical fetal heart rate is _________beats per minute.

 

Definition
120-160
Term

 

The linea nigra and the abdominal striae are ___________

 

 

physical signs of pregnancy.

 

Definition
presumptive
Term
Possible information gathered from examining the woman's abd. may include:
Definition
scars (VBAC,appendectomy, surgeries), bruises (explained by mom, vit. C, abuse), linea nigra, abd. striae
Term
What can I do in the case of PTSD?
Definition

 

At this time, there is no standard treatment for this issue. You can assist by encouraging the mother to talk about her experiences and fears and by reassuring the mother that nightmares can simply be a way to express fear and anxiety.

 

Term
What are some of the symptoms of PTSD?
Definition

 

Others may not be able to overcome these experiences and suffer flashbacks and nightmares along with other issues related to PTSD.

 

Term

 

The American Academy of Family Physicians released recommendations in 2005 stating women with a single

 

previous caesarian delivery with a low transverse incision should be offered a trial of labor and not restricted to

 

facilities with surgical teams present due to lack of evidence of improved outcomes.

 

Definition
Term
Counseling a sexual abuse victim:
Definition

 

The mother’s perceptions should be validated even if inaccurate or exaggerated. This diffuses anger and

 

increases the chances of gaining and establishing trust.

 

Term

 

The midwife must also educate these mothers (abuse victims) about their legal situation:

 

Definition

 

may be obligated by law to report evidence of violence to the authorities, which can have an emotional impact on the mom.

 

Term
What are the risk when a mom gets preg. w/ an IUD in place?
Definition

 

intrauterine infection, placenta previa, premature labor, spontaneous abortion, and spontaneous septic abortion, and

 

 

ectopic pregnancy.

 

Term
If a women gets preg. w/an IUD, and the IUD string is not visible at OS or on ultrasound, what is done?
Definition
It may have been expelled, make plans for prenatal care or theraputic abortion
Term

 

 A women gets preg. w/ an IUD in place and the IUD is found but inaccessible for removal, what needs to be done?

 

Definition

 

therapeutic abortion should be discussed since the risk of septic abortion in the second trimester is significant and lifethreatening to the mother. The IUD should be removed in any case. Even if therapeutic abortion has been chosen,

 

removal of the IUD decreases the risk of a spontaneous septic abortion prior to therapeutic abortion.

 

Term

 

A sexual abuse survivor may have a history of chronic conditions of:

 

Definition

the reproductive organs and menstrual cycle

such as severe PMS, vaginal infections, eating disorders, and/or painful intercourse.

Term
If a sexual abuse survivor has been preg. before you may see a hx of:
Definition

 

hyperemesis gravidarium, premature labor, or repeated abortion

 

Term
A sexual abuse survivor may react in one of two ways during a vag. exam:
Definition
intense emotions, completely free access
Term
The labor process can be very difficulat when a women is a sexual abuse survivor due to the loss of __________.
Definition
control *breastfeeding issues*
Term

 

Both hyperthyroidism and hypothyroidism are associated with ________ _______ _________.

 

Definition
congenital fetal anamolies
Term

 

Positive titers for Toxoplasmosis and CMV show that there

 

is _______ pregnancy risk while a ________ titer shows non-immunity and education about avoidance can be offered.

 

Definition
minimal, negative
Term

 

Negative results for STD'S and HIV, _____ months prior to preconception generally negate the need to repeat them after pregnancy begins.

 

Definition
three
Term
Recommendations to delay preg. after discontinuing OCT's is what?
Definition
wait for the first period to resume
Term
What is the recommended time to wait to get preg. after discontinuing Depro Provera or implants?
Definition
It may take several months for her cycle to resume, so use a barrier method until that occurs.
Term
A woman w/ cardiac disease who is planning a preg.,  should be urged to do the following?
Definition
Refer to her cardiologist and obstetrician
Term

 

A woman w/ cardiac disease is assessed for risk based on:

 

Definition
the cardiac lesion, the baseline functional compromise, and the possibilities of complications during pregnancy. Genetic counseling may also be indicated if a condition is the result of inherited heart disease
Term

 

The following cardiac diseases are examples of those carrying a serious risk of maternal mortality during

 

pregnancy:

 

Definition

 

 Pulmonary hypertension, Dilated cardiomyopathy, Marfan’s syndrome,

Any uncorrectable cardiac lesion in classes III or IV refractory to medical management.

 

Term

 

Chronic hypertension rarely impacts pregnancy as long as blood pressure is under control? T/F?

 

Definition
T
Term
When dealing w/ preexisting hypertension the mom should be counselled not to be on the following meds.?
Definition

 

ACE inhibitors (FDA Pregnancy Category C) and angiotensin II receptor agonists (FDA Pregnancy Category D)

 

Term
Counselling a mom on IUGR and preeclampsia is necessary when she has preexisting __________?
Definition
hypertension
Term

 

 Women who have Phenylketonurics should be counseled to:

 

Definition
return to there strict diet prior to conception
Term
What are the possible side effects to the fetus if a mom w/ PKU doesn't follow a strict diet? 
Definition
the fetus will be severely mentally retarded or have microcephally due to high levels of PKU
Term

 

Advanced maternal age is defined as delaying conception past the age of ___.

 

Definition
35
Term
What are the increased risk associated w/ conception past the age of 35 yrs.?
Definition

 

genetic disorders, gestational diabetes, hypertension and other chronic conditions. Another issue is decreased

 

fertility.

 

Term

 

What category does the FDA list this? Failure to demonstrate a risk to the fetus in the first trimester through human studies, risk of fetal harm remote

 

Definition
A
Term
Category B drugs are described in the following:
Definition

 

Animal studies show no risk to the fetus or do show risk but studies in pregnant women show no risk.

 

Term

 

Animal studies show no risk to the fetus or do show risk but studies in pregnant women show no risk. What category of drug is this?

 

Definition
B
Term

 

Animal studies show no risk to the fetus or do show risk but studies in pregnant women show no risk.

 

Definition
B
Term

 

Definite serious teratogen as demonstrated by fetal abnormalities found during studies or fetal risk demonstrated based on human experience, or both. Risk outweighs any benefit. What category of drug iis this?

 

Definition
X
Term
How are desicions made about the use of certain drug use in preg.?
Definition
made by the mom in conjunction w/ the midwife and physician
Term

 

Persistent high B/B in the first 6 weeks of pregnancy can increase the risk of major _______ _________and/or ____ ____________.

 

Definition
congenital anomalies, low birthweight.
Term
Definition
Term

 

If the woman is diet controlled or on oral medication, she may be required to use insulin during the pregnancy. She should be _________ to either an obstetrician who

 

specializes in high risk pregnancies or an endocrinologist to help manage the diabetes during her pregnancy.

 

Definition
referred
Term

 

A history of gestational diabetes in previous pregnancies can _______the risk for developing it in future pregnancies.

 

Definition
increase
Term
When working w/ someone who has a hx of gestational diabetes in previoous preg., what is the best management plan?
Definition

 

A management plan that includes a good diet and exercise may reduce the risk of gestational diabetes and/or its complications.

 

Term

 

Cephalopelvic disproportion is:

 

Definition
a disparity between the size of the mother’s pelvis and the size of the fetal head.
Term

 

Cerclage is:

 

 

 

Definition

non-absorbable suture

inserted into the cervix to keep it closed

in the case of incompetent cervix

Term
When is a cerclage used?
Definition
incompetent cervix
Term

 

Incompetent cervix may be caused by:

 

Definition

cone biopsy, trauma during a D&C or induced abortion. It can also be a congenital weakness of the cervix.

Term

 

Disseminated Intravascular Coagulation (DIC):

 

Definition

 If abnormal blood clotting occurs in the blood vessels, the coagulation cascade is disrupted, clotting factors are used up and the blood loses the ability to clot,

thereby causing severe hemorrhage.

Term
What is the severe complication of DIC?
Definition
severe hemorrhage/death
Term
Why does DIC occur in preg.?
Definition

 

miscarriage or stillbirth occurs and all products of conception are not expelled from the uterus within 3 to 4 weeks of the fetal death.

 

Term

 

No client should discontinue any prescribed treatment for such disorders without a physician’s guidance.T/F?

 

Definition
T
Term

 

Women who have epilepsy, chronic hypertension, psychoses, malaria and some other conditions are usually

 

managing the illness using a medication that is __________to a fetus.

 

Definition
teratogenic
Term

 

You must work with the client’s ________ who is treating the illness to try to find ________for the medications and to determine the risk to the fetus in the event the client has already conceived.

 

Definition
physician, alternatives
Term

 

Single/multi dose ampules of medication may be _____ or ______ dried.

 

Definition
liquid, freeze
Term

 

If reconstitution is  for a single/multi dose vial is needed, how is this done?

 

Definition
 draw up the required amount of liquid with a sterile syringe needle. After reconstitution use a new sterile needle to draw up the medication for injection.
Term
Reconstituted medication vials need to be discarded w/in what time frame?
Definition
A few hrs. of being reconstituted
Term

 

Each time the multidose vial is used

 

Definition
wipe the diaphragm on the bottle with 70% alcohol and use a sterile syringe each time
Term

 

All of these herbs are said to keep the emotions calm during pregnancy:

 

Definition

 

Motherwort Tincture, Skullcap Tincture, and Blessed Thistle Tonic

 

Term
What tincture calms w/out causing sleepiness?
Definition

 

Motherwort tincture

 

Term
What is the dosage/amt. of motherwort tincture:
Definition

 

Five drops in a small glass of water helps the emotions balance about 15 minutes after ingestion. This can be taken as often as every 2 hours.

 

Term
Motherwort can become psychologically habit forming. T/F?
Definition
T
Term

 

Skullcap tincture:

 

Definition
 helps provide sleep
Term
What is the appropriate amt. of skullcap to give?
Definition
 Up to 30 drops of a commercial tincture or 5 to 15 drops of fresh plant tincture 30 minutes before bed helps create a refreshing sleep. An infusion can help calm emotions. Two cups daily can be taken for several months.
Term

 

Blessed Thistle tonic, along with Burdock and Sarsaparilla tonics, can be used occasionally for:

 

Definition

as an emotion calming agent.

 

Term
What can be substituted for red rasberry leaf infusion?
Definition
Blessed Thistle tonic, along with Burdock and Sarsaparilla tonics,
Term

 

Homeopathy is considered an ______ medicine.

 

Definition
energy
Term

 

Homeopathic remedies work by stimulating ____ _______ rather than _________ a symptom.

 

Definition
self-healing, suppressing
Term

 

Arnica Montana is used to treat _______, _______ and _________.

 

Definition
bruising, shock and trauma
Term
List appropriate administration of Arnica and how not to apply it.
Definition
tablet or cream and never to an open wound
Term
List reasons to use Pulsitilla:
Definition

 

treat hemorrhoids, varicose veins, and heartburn. It has also been used for apprehension and slow labor progress

 

with ineffective contractions, emotional distress, and fainting.

 

Term

Both of these practices do the following:

rebalance the neuromusculoskeletal system to align the body.

 

Definition
osteopathy, chiropractic
Term
Both osteopathy and chiropractic are diffn't in the following way:
Definition

 

osteopathy looks at mobility in joints where chiropractic treats the relative position of joints.

 

Term

 

Some osteopaths specialize in ________ therapy which treats infants with excessive head molding after

 

instrument deliveries.

 

Definition
craniosacral
Term

 

While both practices, osteopathy and chiropractic have been used to treat symptoms of heartburn, nausea and constipation, they more often deal with structural symptoms such as _____ and _______.

 

Definition
bkache, sciatica
Term
Visualization and ________ techniques are oftne taught together to reach a positive birth experience.
Definition
relaxation
Term
Hydrotherapy relieves muscle spasms and gravity on the pelvis and aching joints, it also decreases the need for _________ and the need for ________.
Definition
analgesics, augmentation
Term
When using hydrotherapy the water temp should not exceed:
Definition
normal body temp. eliminates increasing fetal temp.
Term
Continuous hydrotherapy can also do the following, so monitoring is necessary.
Definition
>fetal temp, slow progress
Term

 

Acupuncture is based on the principle of ______, or energy lines, running through organs in the body. Stress causes _________ on a meridian.

 

Definition
meridians, obstuctions
Term
Name four methods an accupuncturist can stimulate an obstruction allowing a rebalancing of energies?
Definition
accupuncture,accupressure, suction cups,moxa stick
Term
Accupuncture has been useful for treating ______ prenatally and the following for labor?
Definition

nausea, 

pain relief, labor induction an acceleration of labor, as well as treatment for a retained placenta

 

Term

 

When using accupuncture: Pain relief can take effect as quickly as ___ minutes and last as much as __ hours with no drugs.

 

Definition
40,6
Term

 

Advocacy is defined as:

 

 

 

Definition

speaking for someone; in other words, ensuring that person’s wishes are executed

Term
As a midwife how do I advocate for my moms?
Definition

 

educate the mother of her options and ensure they are clearly understood, the mother is then empowered to control her own pregnancy.

 

Term

 

The pituitary releases what hormone in women? 

 

Definition
GnRH
Term

The 

anterior pituitary releases:

 

Definition
FSH and LH.
Term

 

FSH influences ______ within the ovaries to ______ and ________ levels increase.

 

Definition

 

 follicles, enlarge, estrogen

 

Term

 

LH is produced a few days after FSH’ when both levels peak, then what occurs?

 

Definition
the follicle ruptures and ovulation occurs.
Term
What happens after ovulation occurs?
Definition

 

Estrogen levels increase causing FSH production to

 

stop.

 

Term

 

What happens after the estrogen levels increase causing FSH production to stop?

 

Definition

 

Progesterone levels rise and cause FSH and LH levels to fall.

 

Term

 

If the released ovum is not fertilized, what happens? 

 

Definition
it degenerates in 14 days and the cycle begins again.
Term
Once the ovum moves throught the fallopian tube and becomes fertilized, what occurs?
Definition

 

it is fertilized by only a single sperm. The gametes merge to convert the ovum into a zygote. Once the zygote reaches the uterus in the form of a blastocyst, the outer layer becomes the placenta and chorion, and the inner portion becomes the fetus, amnion and umbilical cord. The blastocyst adheres to the uterine wall and is embedded into the endometrium (implantation). The zygote becomes an embryo until 8 weeks post conception when it becomes a fetus.

 

Term
Order of fertilization:
Definition
Gamette-zygote-blastocyst (outer layer-placenta/chorion, inner layer-baby,amnion and cord)-implants into the endometrium-zygote becomes an embryo until 8 wks. postconception then its a fetus
Term

 

Tandem nursing appears to ______ the relationship between the children and ______ the older child’s feelings of isolation from his or her parents when the new baby arrives.

 

Definition
deepen, lessen
Term
What are some keys to giving upsetting news?
Definition
allot enough time, make it clear/simple, allow for any support people they want to be there, give references to specialist and support services, be honest, never w/hold info., have the report in hand, be willing to be available anytime 
Term

 

The uterus can be malformed due to:

 

Definition
the failure of the Müllerian ducts to fuse correctly.
Term

 

When the Mulleran ducts fail to fuse correctly this can result in several abnormalities:

Definition

a double uterus with a double vagina, a double uterus with a single vagina, a bicornate uterus,

 

Term
When a double uterus is diagnosed, what are some of the complications:
Definition

 

premature labor, abnormal lie of the fetus, and abortion may result. In the case of a double uterus, the fetus takes up one horn while the other remains empty.

 

The empty horn enlarges under hormonal influence and can obstruct the birth canal. In this case, a caesarian section will be required.

 

Term

 

The Lactation Amenorrhea Method (LAM) combines, what two things to ensure a good form of birth control?

 

Definition
no menstruation, strickly breastfeeding for the first 6 months p.p.
Term
What are the chances of her conceiving if she abides by the LAM method?
Definition
2%, after 6 months >
Term
The four pelvic types are:
Definition
android, gynecoid,platypelloid, anthropoid
Term

This describes what type of pelvis:

The brim is rounded and the forepelvis is roomy. The ischial spines are blunt, sciatic notch rounded, and subpubic angle 90 degrees.

 

Definition
gynecoid
Term

This discribes what type of pelvis:

 

The brim is heart-shaped; the forepelvis is narrow. The ischial spines are prominent and sub-pubic angle less than 90 degrees.

 

 

Definition
android
Term

This describes what type of pelvis:

 

The brim is long and oval, with the anteroposterior diameter longer than the transverse. The ischial spines are not prominent, a very wide sciatic notch and sub-pubic angle.

 

 

Definition
anthropoid (typically no issues)
Term

What type of pelvis is this:

 

The brim is kidney shaped; the pelvis flat. The anteroposterior diameter is decreased; the transverse increased. The ischial spines are blunt with a wide sub-pubic angle and sciatic notch.

 

 

Definition
platypelloid (typically no problems)
Term

 

Whta type of pelvis would this woman tend to have? The woman’s build and height is average.

 

Definition
gynecoid
Term

 

What type of pelvis could this woman have? The woman’s build and height is short and heavy.

 

Definition
android (not suitable for a vag. delivery)
Term

 

What type of pelvis would this woman have? The woman’s build is tall with narrow shoulders.

 

Definition
anthropoid(suitable)
Term

 

The female reproductive system consists of:

 

Definition

the pelvic floor, vulva, vagina, uterus,

Fallopian tubes, and ovaries.

Term

 

The vulva includes all external genital organs:

 

Definition

the mons pubis, labia majora, labia minora, clitoris, vestibule, urethral orifice, vaginal orifice, and Bartholin’s glands.

Term
What is the vaginas purpose?
Definition

 

The vagina excretes menstrual flow, encloses the penis, receives sperm, and forms an opening for the fetus.

 

Term

 

Posterior to the vagina lays the pouch of Douglas,it contains what?

 

 

 

Definition

rectum and perineal body

Term

 

The Fallopian tubes provide what function? 

 

Definition
push the ovum toward the uterus, receive the sperm, and allow fertilization.
Term

 

The ovaries produce:

 

Definition
ova,estrogen and progesterone.
Term

 

The pelvic floor provides what function:

 

Definition
supports the abdominal and pelvic organs.
Term
Definition
Term

 

The muscles  of the pelvis control:

 

 

 

Definition

urination and defecation and gives slight control to the

passage of the fetus.

Term

The muscles that control

urination and defecation and gives slight control to the

passage of the fetus, consist of:

Definition

 

It includes the perineal body: the muscle and tissue between the vagina and the rectum.

 

Term
Posterior, superior and inferior portions of the pelvis contain what organs?
Definition

Posterior:

 

pouch of Douglas, rectum and perineal body, Superior: uterus, inferiorly: external genitalia

 

 

Term

 

The true pelvis is the:

 

 

Definition

bony opening through which the fetus passes during

birth.

Term
The true pelvis consist of what bony structures?
Definition

It is formed by a brim, a cavity and

an

 

outlet

.

 

Term

 

Three diameters of the brim are measured.What are they?

 

Definition
Obstetrical conjugate, obstetrical outlet, anterioposterior diameter
Term
The obstetrical conjugate consist of:
Definition

 

11 cm from the sacral promontory to the posterior border of the upper surface of the symphysis pubis.

 

Term
The obstetrical outlet is formed by:
Definition

 

formed by the narrow pelvic strait and the anatomical outlet.

 

Term
The anteriorposterior diameter consist of:
Definition

 

a line from the lower border of the symphysis pubis to the sacrococcygeal joint measuring 13 cm, indicates the available space during delivery.

 

Term

 

Fixed points on the pelvic brim are landmarks. Beginning from the posterior the landmarks are as follows:

 

Definition
sacral promontory, sacral wing, sacroiliac joint, iliopectineal joint, iliopectineal eminence, superior ramus of the pubic bone, upper inner border of the body of the pubic bone, the upper inner border of the symphysis pubis
Term

 

The line between the sacral promontory and the top of the symphysis pubis forms a ___ degree angle

 

with the floor.

 

Definition
60
Term

 

A line from the center of the sacrum and the center of the

 

symphysis pubis forms a ___ degree angle with the floor.

 

Definition
30
Term

 

At the outlet, the angle of inclination is ___ degrees.

 

Definition
15
Term

The ___ of _____is formed when a curved line is imagined exactly half-way between the anterior pelvic wall and the posterior pelvic canal.

Definition
curve of Carsus
Term

 

When a mom is using/abusing drugs, what is the highest likelihood to occur?

 

Definition
there is a high likelihood that the infant will go through withdrawal either during labor or after birth
Term

 

When a mom is using/abusing drugs, additional fetal problems include:

 

Definition

placental abruption, fetal distress during labor, intrauterine growth restriction and stillbirth.

Term
When a mom is abusing/using drugs, she is unlikely to do the folowing?
Definition
to attend regular pnv, disclose her drug use
Term
Due to the typical lifestyle of a drugs user there is a greater risk for the following:
Definition
STD'S infections, HIV, Hep. B/C, poor housing and not conducive to raising a child
Term

There are three pelvic bones:

Definition

the innominate (hip) bones (2), the sacrum (1) and the coccyx (1). The innominate bones are composed of the ilium, the ischium, and the pubic bone. The ischium

contains an inward projection called the ischial spine

Term
Definition
Term
The innominate bones consist of:
Definition
The innominate bones are composed of the ilium, the ischium, and the pubic bone.
Term

 

The ischium contains an inward projection called the

 

______ ______.

 

Definition
ischial spines
Term

 

There are four pelvic joints:

 

Definition
the symphysis pubis (1), the sacroiliac joints (2) and the sacrococcygeal joint (1).
Term

 

During pregnancy, the ligaments soften due to _________ activity and move to make room for the fetal head during birth.

 

Definition
estrogenic
Term

 

The pelvic joints are held together by the __________ ligaments at the symphysis pubis, the _________ ligaments and the ____________ ligaments

 

Definition

 

interpubic , sacroiliac, sacrococcygeal

 

Term
Besides the  interpubic , sacroiliac, sacrococcygeal ligaments, What are the other two important ligaments of the pelvis and what is there function?
Definition

 

sacrotuberous ligament and the sacrospinous ligament which cross the sciatic notch and form the posterior wall

 

of the pelvic outlet.

 

Term
What are some tips for instructing a mom on self breast exam?
Definition
Do it in a mirror, shower while soaped up, collar bone to nipple, cleavage to armpit, perform it laying down, leaning and facing a mirror, take note of any dimpling, puckering or bulging, inverted nipple or repositioned, reddness, rash, swelling or soreness
Term
Smoking during preg. can increase the chances of the following:
Definition
prematurity, LBW, stillbirth
Term
Definition
Term

 

the infant has a higher risk of having:

 

Definition

respiratory problems, asthma, and

otitis media, SIDS

Term
What are some complications w/ smoking during preg.?
Definition

 

Other complications are spontaneous abortion, placental

 

abruption, and placenta previa.

 

Term

 

At this time, nicotine replacement therapy during pregnancy is controversial. T/F?

 

Definition
T
Term
Breastfeeding outweighs the benefits the smoking. T/F? 
Definition
T
Term
Backache is common in all trimesters of preg. due to:
Definition
the growing fetus/uterus, relaxin
Term
What are some basic suggestions for back pain in preg.?
Definition

 

Using proper posture and lifting techniques and avoiding standing for long periods can decrease the discomfort.

 

Pelvic tilts, walking, swimming and a supportive maternity girdle can also ease backache pain.

 

Term
Ligament pain feels like what?
Definition
sharp spasm
Term
What can help relieve ligament pain?
Definition

 

Warm baths, massage, and avoiding stretching can relieve the symptoms.

 

Term

 

Leg cramping may be caused by:

 

Definition
 lowered serum ionized calcium and increased phosphates.
Term
What suggestions can be made for leg cramps?
Definition

 

Leg stretches before bed and a decrease in the intake of

 

milk, carbonated soft drinks and processed foods may decrease the frequency of cramps. When a cramp occurs, the mother should flex the foot in the opposite direction of the cramp.

 

Term
Definition
Term

 

Animal studies show the drug to be teratogenic to animal fetus, but no human studies or no animal or human studies performed.

 

Definition
C
Term

 

Positive evidence of teratogenicity but beneficial for certain reasons that may make drug use acceptable.

 

Definition
D
Term

 

Constipation can be avoided by maintaining:

 

Definition
proper hydration and eating a diet rich in fiber
Term
Definition
Term
Constipation in preg. is caused by:
Definition

 

Intestinal motility is reduced in pregnancy allowing for greater water reabsorption from the gut, as well as intestinal compression and ingestion of iron supplements can be causes of constipation.

 

Term

 

Every state in the United States requires newborn metabolic screening for congenital ____________ and ______________.

 

Definition
hypothyroidism, phenylketonuria
Term

 

If the sample is taken before the infant has been feeding for at least ___ hours, the test will be invalid

 

Definition
48
Term
Definition
Term

 

The PKU sample should be collected from the _______ underside of the infant’s heel.

 

Definition
lateral
Term
All of these issues are contributed to the hormone changes of preg.
Definition
nausea, hyperemesis, nipples enlarge become sensitive and have pigment changes, fautigue, headache, sinusitis,
Term
Contraindications to home birth can be:
Definition
extreme obesity, not compliant, smoking, drinking or drug use that isn't adjusted to the preg., if other behaviors make you ques. a homebirth, contracted or abnormal pelvis, essential hypertension or psychological reasons
Term
Kegel exercises strengthens the pelvic floor which maintains: 
Definition

 

maintain urethral and anal sphincter function before and after birth. It also builds awareness of the muscles and the ability to manipulate them to ease some aspects of giving birth.

 

Term
Kegel exercises are performed how often? And what is one suggestion of how to teach kegel exercises?
Definition

 

The pelvic floor muscles are tightened and held for about 10 seconds, then released for 10 seconds. The exercise is repeated up to 10 times. The exercises are performed three times a day. Kegels is to have the woman sit on the toilet, begin to urinate, and then stop the flow

 

Term

 

Any spotting or bleeding is cause for concern. If there is non-rhythmic pain, a _______ pregnancy may be suspected.

 

Definition
tubal
Term

 

Persistent bleeding implicates a ______ abortion or (rarely) _______ pregnancy.

 

Definition
missed,molar
Term
Other than missed abortion, molar or tubal preg. what are some other causes of bleeding in preg.?
Definition
cervicitis, cervical lesions, polyps, subchorionic bleeding, post-coital bleeding, implantation bleeding, fetal twin death w/out expulsion of tissue
Term
What is a reason for chronic last trimester bleeding?
Definition
placental problems
Term
Cervical bleeding can be caused by the following:
Definition

 

Cervical bleeding is caused by infections, such as gonorrhea, chlamydia, Trichomonas, or cervical dysplasia. A herpes lesion or a vaginal yeast infection can cause the cervix to be friable

 

Term
When dealing w/ cervical bleeding what is the treatment?
Definition

 

Treatment consists of rest. Sexual intercourse, insertion of anything into the vagina, or engaging in behavior that

 

causes orgasm should not be attempted.

 

Term

 

If the bleeding in preg. worsens or is accompanied by pain, ______ the mother to a physician.

 

Definition
refer
Term
This is a common public health issue along w/ an enviornmental hazard and cause miscarriage, LBW, and developmental issues.
Definition
lead paint
Term

 

Other environmental hazards include exposure to drugs such as ________ ________, ________ __________ __________.

 

Definition

 

cancer treatments, ethylene glycol ethers,

 

Term
Jobs that require heavy physical labor can endanger a preg. T/F?
Definition
T
Term

 

Health care workers or animal workers are at particular risk of exposure to any number of infectious agents in the

 

workplace. What can be done for prevention?

 

Definition
Universal precaution, hand washing, vaccination prior to preg.
Term

 

Hazards are:

 

Definition
chemicals, heavy metals, temperature issues, radiation, infectious agents, and stress.
Term

 

A ___________ substance is one that causes congenital defects in the unborn fetus.

 

Definition
teratogenic
Term

 

The type and severity of deformity may depend upon the _________ of the exposure during gestation.

 

Definition
timing
Term

 

A thorough history that includes any medications the woman is taking or handles is important during the _______, so it can be addressed for ______  ______.

 

Definition
IPNV, teratogenic effect
Term

 

Cytomegalovirus (CMV) is part of the _________ group.

 

Definition
herpesvirus
Term

 

With CMV, if the primary infection occurs during pregnancy, the fetus may be at ____.

 

Definition
risk
Term
What are the potential complications of CMV in preg.?
Definition

 

jaundice and moderate enlargement of the liver and spleen to fatality. Most will survive but many will develop such abnormalities as hearing loss, mental retardation, and some blindness. Those who are asymptomatic may still develop some degree of these complications

 

Term
Can CMV be passed along through vag. secretions or breastmilk?
Definition
yes, no complications occur
Term

Parvovirus is transmitted by ___________ secretion and ___________ exposure to infected blood or blood products.

Definition
respiratory, percutaneous
Term
Definition
Term

 

If parvovirus infection occurs during pregnancy, ____-___% of fetuses will become infected. Of those fetuses, some will develop____ ______ or _____ ______. In rare cases, the infection is fatal.

 

Definition
aplastic anemia, nonimmune hydrops
Term
Parvovirus infection in the first half of pregnancy results in:
Definition
the most serious infections.
Term
If a mom has been exposed to parvovirus what testing should occur? 
Definition

 

serum IgM and IgG should be tested for immunity.

 

Term
When testing a mom for parvovirus, her test comes back neg., what should be done?
Definition
Negative results should trigger a repeat test three to four weeks later.
Term
With seroconversion for parvovirus in preg., what should be done? 
Definition

the fetus must be monitored on a weekly basis for fetal hydrops, placentomegaly,

and fetal growth restriction. Referral to a physician is advised.

 

Term
What should be done when you suspect an abuse situation?
Definition

 

It is essential to keep excellent records of any suspected

 

abusive behavior or signs of abuse and any attempted intervention and communication to other professionals or

 

services regarding the family.

 

Term

 

Abuse includes:

 

Definition
physical abuse, sexual abuse, emotional abuse, and neglect. You must be fully cognizant of the child protection laws and services in your area.
Term
The maternal psychological changes of the first trimester consist of:
Definition

 

She can be very sensitive, introspective, vulnerable and dependent. The first trimester is known as the “period of adjustment”; the mother must accept that she is pregnant. Most will be disappointed, anxious, depressed and/or unhappy about the pregnancy, no matter how prepared they were to become pregnant. Libido will decrease

 

Term
The maternal psychological changes of the second trimester include:
Definition

 

“the period of radiant health”, the mother feels good but is at her most introspective.

 

Her primary adjustment is to discover her

 

own mothering identity.

 

After quickening, the social circle

 

of the mother changes to include more

 

new mothers or others who are pregnant. Libido will increase

 

Term
The maternal psychological changes that occur in the last trimester are:
Definition

 

“time of watchful waiting”. The mother becomes anxious both for the baby’s arrival and worried about premature labor. Now is the time of fear about death and abnormalities, and pain during childbirth. The mother may grieve the loss of attention and closeness of the baby once born.

 

Term
What is general recipe fo infusion?
Definition

 

one ounce of herb to one quart of boiling water

 

Term

 

Nettle leaf supports the______, helps prevent leg cramps, and contains vitamins __ __ ___ and ____. It is also a source of:

 

Definition
kidneys, A,C,D and K, calcium, phosphorus, iron and sulfur.
Term

 

Dandelion leaf supports both the _____ and the ______. It helps prevent _________ and acts as a digestive aid.

 

It is a source of vitamins:

 

Definition
liver, kidneys, preeclampsia,A, B complex, C, and D
Term

 

Red raspberry leaf is a ___ _____, a digestive aid and a remedy for ____ ________.

 

Definition
uterine toner, morning sickness
Term

 

Red clover leaves and blossoms are a source of ______, __________ and trace minerals. It supports the ___________and endocrine system.

 

Definition
calcium, magnesium, reproductive
Term
Describe the perscribed amt. of prophylactic eye ointment to be admin. to the newborn, and how?
Definition

 

prophylactic treatment with 0.5% erythromycin ointment, within a few hours of birth

 

The mother may decline the prophylactic treatment in which case a waiver must be signed. The ointment is typically instilled from the inner to the outer canthus of each eye. delayed until after the first hour of birth

 

Term
What are the signs of early labor?
Definition

 

The most obvious signs of impending labor are the “show”, pink tinged vaginal mucus; spontaneous rupture of the membranes, commonly called the breaking of the water; or regular contractions, no more than 20

 

minutes apart.

 

Term

 

Counseling about membrane rupture should include

 

monitoring for ______ _______, ________ passage, and the need to get rest while she is still able

 

Definition
bacterial infection, meconium
Term

 

Once active labor has begun, you can ensure the mother has the setting needed to labor effectively. This may mean:

 

Definition
complete privacy, even from the birth attendant
Term

 

The birth environment must be conducive to a ________ labor.

 

Definition
relaxed
Term
When the parnter is planning on catching the baby, what is my responsibility?
Definition

 

You are responsible for ensuring the partner’s education with appropriate reading materials, discussing the birth process, and depicting the sensual side of it.

 

Term
When preparing siblings for attending the birth, what should I include?
Definition

 

Give siblings age appropriate books and show videos of the birthing process to give them a sense of what to expect. An adult companion for the sibling(s) should

 

be present at the time of birth

 

Term
Besides preexisting medical issues what topics need to be discussed when planning a home birth?
Definition

 

the reasons and perceived benefits for having the baby at home,

 

 the perception of your duties,  the possible reactions to a hospital birth if one is required due to complications,  an enumeration of the risks and complications of birth that are known to the parents,  

how any permanent disability or death of mother or baby will affect the parents

 

Term

 

Prenatal counseling and communication should involve these methods.

 

Definition

 

Techniques such as mirroring, pacing, active listening, and

positive reinforcement are all excellent ways to connect with the mother and work with her to resolve any issues.

 

You should be aware of the boundaries of client privacy and pacing to prevent a codependent relationship and loss of objectivity.

 

 

Term
Define gestational hypertension:
Definition

 

Gestational hypertension, also known as pregnancy induced hypertension, is defined by blood pressure readings of 140/90 or above in repeated readings at least 6 hours apart

 

Term
What is the most accurate way to take a B/P?
Definition

 

Readings done with the mother on her left side are thought to be most accurate

 

Term
Treatment to reduce this preg. induced hypertension includes:
Definition

 

aerobic exercise, deep relaxation practice, elimination of

 

stimulating foods and drinks and strong spices, a proper diet and herbal supplements, and counseling by a therapist

 

Term

 

If readings of 160/100 or more occur, what is needed?

 

Definition
medical intervention is needed.
Term

 

If the blood pressure readings steadily rise during labor, what should be done?

 

Definition

preeclampsia or vascular damage may be beginning. Transport the mother to the hospital.

Term

 

If blood pressure suddenly increases near term with no other symptoms, it will likely ________ when labor begins. If all else shows readiness for labor, attempt _______ _______.

 

Definition
reduce, inducing labor
Term

 

40-42 weeks gestation, the mother may decrease her fluid and food intake in an effort to keep the fetal size down and risk, putting her baby at risk for ____________.

 

Definition
postmaturity syndrome
Term
Postmaturity syndrome
Definition
fetal weight loss, cord compression from oligohydramnios, fetal distress or stillbirth (all included in fetal postmaturity syndrome).
Term

 

If there are no mitigating factors other than postdatism,

 

practice _____ ________.

 

Definition
watchful waiting
Term
When a mom is postdates how do you monitor her/baby?
Definition

 

Assessments to monitor fetal health include fetal kickcounts, a non-stress test, and serial ultrasounds to check amniotic fluid volume

 

Term
When fetal assessment is found to be normal, when dealing w/ postdatism, what can be done?
Definition

 

If no abnormality is found, homebased induction can be attempted, especially if the fetus is becoming large or

 

if the head is well into the pelvis. Or waiting can be continued.

 

Term
Contraindications to home birth are:
Definition
one /both of the couple or midwife have reservations, contracted or abnormal pelvis, essential hypertension, extreme obesity, smoking, drinking, drugs, irresponsibility, hostile reactions to suggestions
Term

 

By ___ weeks approximately 10 pounds should be gained with ____ pound a week after that.

 

Definition
20, one
Term
When someone has a hx of eating disorders, what should I watch for in preg. and what may need to be done?
Definition
preg. can cause a recurrence of eating disorders, if it does occur I need to refer to a specialists
Term

 

The most common glucose disorder is:

 

Definition
hypoglycemia of the newborn,
Term
Hypoglycemia in the newborn is when the blood/glucose levels are:
Definition

 

It is defined as a blood glucose level of 45 mg/dl or

 

lower.

 

Term
Symptoms of hypoglycemia in the newborn are:
Definition
lethargy, jitteriness, poor feeding, seizures, hypothermia, high pitched cry, irregular respirations, decreased LOC
Term
Infants with these conditions should be watched for hypoglycemia:
Definition

 

Premature infants, infants of diabetic mothers, sick infants (i.e. septic), and infants with inborn errors of metabolism are at higher risk of neurological damage.

 

Term
Treatment for hypoglycemia should consist of the following:
Definition

 

encourage the mother to breastfeed as often as possible and afterwards give the infant water with molasses at a rate of 1 teaspoon of molasses per cup of water. If the glucose level does not rise, medical intervention is required.

 

Term
Is treatment usually necessary with hyperglycemia and it when does it usually present?
Definition
no (unless there is a loss of glucose in the urine), premature and IUGR
Term
How does Trisomy 18 present in the newborn?
Definition

 

small head, a flattened

 

 

forehead, receding chin, low-set and malformed ears, and often a cleft palate. The sternum is generally short, the fingers may overlap and the feet have the rocker bottom appearance typical of the

syndrome. Cardiovascular and gastrointestinal defects are common. These infants rarely live out the first year.

 

Term
How does Trisomy 13 present in the newborn?
Definition

 

small stature with microcephaly

 

 

 

limb defects

 

 

 

 

midline facial defects such as cleft

lip and cleft palate

 

 

brain, renal, and cardiac defects

 

Term

 

Klinefelter syndrome:

 

Definition

 

It only affects males and is also not typically diagnosed until the absence of puberty.

 

Term

 

Turner syndrome:

 

Definition

 

female with a short, webbed neck, edematous feet, and widely spaced nipples, underdeveloped genitalia, and

 

reproductive organs that do not mature. Puberty will not occur.

 

Mental development is typically normal but congenital cardiac defects may be present

 

Term

 

Potter syndrome is a fatal condition generally resulting in stillbirth or death soon after birth. How does it present?

 

Definition

 

The face is flattened, with low set ears, antimongoloid slant to the eyes with heavy epicanthic folds and a beaked nose.

 

Term

 

Congenital adrenal hyperplasia is one cause of:

 

Definition
ambiguous genitalia.
Term
Why does congenital hyperplasia
Definition

 

The adrenal gland overproduces androgens due to an

 

enzyme deficiency.

 

Term

 

Congenital hyperplasia also causes loss of ______ from the body and concomitant imbalances in _________ and ________ as well as other blood chemistries.

 

Definition
sodium, electrolytes, glucose
Term

 

When internal reproductive organs do not match the appearance of the external reproductive organs it is called _________.

 

Definition
intersex
Term
What features may be present in a Trisomy 21 baby:
Definition

 

widely set, obliquely slanted eyes, a small nose, a rough thick tongue, a small head with flat occiput, broad, squat hands with stubby fingers and incurving small finger, simian crease and generalized hypotonia.

 

Term

 

Down’s infants also have higher incidence of:

 

Definition

cardiac abnormalities, leukemia, and hypothyroidism. Mental retardation is also present with typical

IQs of 40-80.

Term

 

Posterior urethral valve(s) defects affect _____ infants.

 

Definition
male
Term

 

Posterior urethral valve(s) defect:

 

Definition

 

Urine is prevented from flowing normally out of the body due to valves occurring in the posterior urethra. This in turn causes bladder distension, back pressure on the ureters and the kidneys, and concluding in hydronephrosis.

 

Term
What is the appropriate treatment for posteror urethral valve defect?
Definition
Immediate diagnosis, surgery and other treatment are available
Term

 

Polycystic kidneys can cause birthing problems, why? 

 

Definition
because the infant’s abdomen is larger in circumference than a normal infant.
Term
How is diagnosis confirmed in polycystic kidneys?
Definition
palpable kidneys and confirmation is done via ultrasound *most common outcome is renal failure*
Term

 

Hypospadias is also a defect of the ______ genitourinary system.

 

Definition
male
Term
Hypospadias:
Definition

 

It results in the urethral opening being placed elsewhere

 

on the penis than the tip, as far back as the perineum.

 

Term
Hypospadias is also associated with what syndrome?
Definition
chordee
Term
What is appropriate treatment for hypospadias?
Definition

 

Surgical intervention may be necessary to allow normal urination and sexual function.

 

Term

 

Cryptorchidism is defined:

 

Definition
as undescended testes.
Term

 

Is it true that you can bring down the testes out of the inguinal canal when dealing with Cryptorchidism. T/F? 

 

Definition

If the undescended testes are in the inguinal pouch it is possible to manipulate them into the scrotal pouch where it is likely they will continue to develop normally.

Term

 

If the testis has not descended by __ years of age, surgery may be needed.

 

Definition
2
Term

 

appearance of ambiguous genitalia can be:

 

Definition

 

enlarged clitoris or undescended testes, incompletely separated or poorly differentiated labia, a small hypoplastic penis, bifid scrotum or chordee

 

Term

 

An example of capillary malformations affecting the dermal capillaries?

 

Definition
stork bite, port wine stain
Term
Definition
Term

 

Capillary hemangiomata are both ______ _______and are defects in _______ _________.

 

Definition
vascular nevi, skin development
Term

 

What skin abnormality is this? It will arise after a few weeks and are typically red, raised lesions. They are most often seen in premature infants, more likely females. The lesions will increase for a time then regress until they disappear a age 5-6 years.

 

Definition
Capillary hemangiomata
Term

 

Melanocytic (pigmented) nevi are:

Definition

brown, possibly hairy marks that may be raised or flat and vary in size. Because some of these result in malignancies, they are often surgically removed.

 

Term
What is often the treatment for Melanocytic (pigmented) nevi?
Definition
 Because some of these result in malignancies, they are often surgically removed.