Labor and Delivery
A 25 yr old woman presents to the ED @ 38 weeks gestation with steady contractions. She informs the nurse that she has had 2 miscarriages and has a 1 year old at home. What is her gravida/para?
G:4 P:1
What special considerations are needed for placenta accreta?
MTP, planned birth w/ multiple surgeons
Define BUBBLEHE
Breast Uterus Bladder Bowel Lochia Episiotomy Hemorrhoids Emotions
What kind of heat loss would cause a baby to lose heat to a nearby cold window?
Radiation
Use Naegele's rule to determine the EDD of a patient who's LMP was July 23
April 30
A 32 year old patient on the L&D floor is suddenly having prolonged variable decels, how should the nurse proceed?
Reposition the mother onto her left lateral side.
VEAL CHOP MINE
Define placental previa and the different types
Placenta implanted low in the uterus, w/o PAIN
Low lying: placenta low, not over cervix
Partial: placenta partially over cervix
Complete: entirely over cervix
What are the types of lochia and how long do they last
Rubra: Red, 2-3 days
Serosa: Pink, 3-10 days
Alba: White, potentially 6 wks
The nurse suspects that baby H has jaundice, how can the nurse confirm her suspicions?
Assessing baby's forehead for blanching, blood draw, or transcutaneous bili
What education would you give a couple post vasectomy?
Adhere to follow up appointment and use other protection methods until sperm count reaches 0
What maternal test is performed at 38 weeks? How do you proceed if it comes back positive?
Group B Strep, if positive baby gets antibiotics during labor
S/S of an Amniotic Fluid Embolus
Rare, dyspnea, chest pain, hypotensive, tachy, change in loc
How do you manage a PPH
Call HCP, massage uterus, administer meds, ensure 2 large bore IVs, replace, apply pulse ox
The nurse is assessing a newborn baby and observes a bluish/black mark on the back of its thigh. What is this spot called?
A patient tells you about her friend who was Rh incompatible with her baby and almost died. She expresses fear that the same will happen to her and asks when she'll get the medicine to stop it. What will you tell her?
Inform the patient that the medication is called Rhogam and will be given at her 28 week appointment, as well as 72 hours postpartum if they are incompatible.
The nurse is monitoring a mom on the L&D unit who starts to experience variable decels. The nurse performs a cervical check and feels the pulsing of the umbilical cord. What is happening?
Cord Prolapse
What is the term for a detached placenta? Split into marginal, central, and complete
Define normal blood loss and parameters for PPH
Vaginal: 200-500 mLs
Cesarean: 700-1000 mLs
PPH: vag loss > 500, C loss > 1000 or 10% decrease in hct
A newborn baby has a heart rate of 130, a pink body and blue hands/feet, a weak cry, flexion in the arms and legs, and movement/crying when stimulated. What is this baby's APGAR?
7
A patient in a family care practice is asking about a vaccine to protect her daughter from cervical cancer. What is she talking about?
Gardasil to protect from certain strains of HPV
A mother comes into the ED 37 weeks pregnant, status post MVA. She is unconscious, contracting, and baby is experiencing prolonged decels. What kind of anesthesia will be used for the EMERGENCY c-section?
General Anesthesia
What is the term for a pregnancy implanted outside of the uterus?
S/S and Treatment?
Ectopic Pregnancy
sharp one sided pain, syncope, referred shoulder pain, lower abd pain/rigidity/tenderness, decreased hgb/hct
IM methotrexate (only without rupture), IM folic acid antagonist, or laparoscopic salpingectomy
Where is the fundus after delivery and how does it descend?
@ or below umbilicus 6-12 hrs post birth, 1 cm per day until in pelvis @ 10 days
The nurse observes baby R exhibiting retractions, grunting, nasal flaring, tachypnea, and progressive cyanosis. What is going on with baby R?
Baby R is in Respiratory Distress
N/V, quickening and amenorrhea are considered what sign of pregnancy?
Goodell, Chadwick, and a home pregnancy test?
fetal movement?
Presumptive, Probable, Positive