NUR 2005 Comprehensive Final Exam Study Flashcards

Comprehensive practice flashcards covering Antepartum, Intrapartum, Postpartum, Newborn, and various Medical-Surgical conditions based on the lecture notes.

Presumptive Signs of Pregnancy

Subjective signs that the woman feels but cannot confirm pregnancy, such as amenorrhea, excessive fatigue, urinary frequency, nausea/vomiting, breast changes, and quickening.

Probable Signs of Pregnancy

Objective signs detected by an examiner that are still not diagnostic, including Goodell sign, Chadwick sign, Hegar sign, McDonald sign, uterine enlargement, ballottement, and positive pregnancy tests.

Diagnostic/Positive Signs of Pregnancy

Conclusive evidence that confirms pregnancy: fetal heartbeat auscultated, fetal movement felt by a trained examiner, and ultrasound visualization of the fetus.

GTPAL

A system for recording obstetric history: G = Gravida (total pregnancies), T = Term (deliveries $\ge 37\,weeks$), P = Preterm (deliveries $20-36\,weeks$), A = Abortions (losses $< 20\,weeks$), and L = Living children.

Naegele's Rule

The formula for calculating EDD: Take the first day of the LMP, subtract $3\,months$, and add $7\,days$.

Amniocentesis L/S Ratio

A diagnostic test for fetal lung maturity; a ratio $\ge 2:1$ indicates the lungs are mature and it is safe to deliver.

Reactive Non-Stress Test (NST)

A reassuring result characterized by $2+$ accelerations of $15\,bpm$ for $15\,sec$ within a $20\,minute$ period.

Bishop's Score

A scoring system used before induction to determine if the cervix is favorable; a score $\ge 6$ is favorable, while $\ge 8$ is most favorable.

Folic Acid in Pregnancy

A supplement of $0.4-0.8\,mg/day$ must begin before conception to prevent neural tube defects.

Danger Signs in Pregnancy

Signs requiring immediate report: severe headache/blurred vision (preeclampsia), RUQ pain (HELLP), decreased fetal movement, any vaginal bleeding, or a sudden gush of fluid (PROM).

McDonald's Rule

After $20\,weeks$, the fundal height in cm should equal the weeks of gestation $\pm 2\,cm$.

The 5 Ps of Labor

Factors affecting labor progress: Powers (contractions), Passage (pelvis), Passenger (fetus), Position (maternal), and Psyche (psychological response).

True Labor

Characterized by cervical change (dilation and effacement), with regular contractions that get stronger and more frequent, often increasing in intensity with walking.

False Labor (Braxton Hicks)

Irregular contractions that do not cause cervical change and often stop with walking, hydration, or sleep.

Stages of Labor

Stage 1 (Dilation: Latent, Active, Transition phases), Stage 2 (Pushing to Birth), Stage 3 (Placenta Delivery), and Stage 4 (Recovery: 1–4 hours post-delivery).

VEAL CHOP

A mnemonic for FHR patterns: Variable/Cord compression, Early/Head compression, Acceleration/Okay, Late/Placental insufficiency.

Placental Insufficiency Intervention

The emergency treatment for late decelerations: position patient left lateral, administer $O_2$, give IV fluids, stop Pitocin, and notify the MD immediately.

Epidural Hypotension

The most common complication of an epidural; treated with an IV fluid bolus, left lateral positioning, and checking BP every $5\,min$ for $20\,min$ after placement.

BUBBLE-HE

Postpartum assessment acronym: Breasts, Uterus, Bowel, Bladder, Lochia, Episiotomy, Homan's sign, Emotions.

Uterine Atony (Boggy Uterus)

A soft, non-firm fundus that indicates a risk for hemorrhage; the first nursing action is to massage the fundus.

Postpartum Lochia Stages

Rubra (red, $days\,1-3$), Serosa (pink/brown, $days\,4-10$), and Alba (white/yellow, up to $6\,weeks$).

Methergine (methylergonovine)

A uterotonic medication that is contraindicated in patients with hypertension because it causes vasoconstriction.

APGAR Score

Assessed at $1$ and $5\,minutes$ based on Appearance, Pulse, Grimace, Activity, and Respirations; a score of $7-10$ is normal.

Neonatal Vitamin K (Aquamephyton)

An IM injection given in the vastus lateralis to prevent hemorrhagic disease of the newborn.

Newborn Weight Loss

A normal loss of $5-10\%$ of birth weight in the first week, which should be regained by $10-14\,days$.

PKU (Phenylketonuria) Screen

A blood test done via heel stick after the newborn has had at least $24\,hours$ of protein feeding for accurate results.

Hyperemesis Gravidarum

Severe nausea and vomiting beyond normal morning sickness, characterized by weight loss $> 5\%$, dehydration, and ketonuria.

Ectopic Pregnancy Rupture

An emergency signaled by sudden severe unilateral pelvic pain and referred shoulder pain due to blood irritating the diaphragm.

Magnesium Sulfate Toxicity

Signs include decreased/absent DTRs, respiratory rate $< 12/min$, and urine output $< 30\,mL/hr$; the antidote is calcium gluconate.

Placental Abruption vs. Placenta Previa

Abruption is painful, rigid abdomen with dark red bleeding; Previa is painless with bright red bleeding and requires NO vaginal exams.

Prolapsed Umbilical Cord Intervention

Establish upward pressure on the presenting part with a gloved hand to relieve cord compression and maintain until emergency C-section.

McRoberts Maneuver

Hyperflexing the mother's thighs onto the abdomen to widen the pelvic outlet during shoulder dystocia.

Tachysystole

$5+$ contractions in $10\,min$ or a single contraction $> 2\,min$; the first action is to stop Pitocin.

Early vs. Late Postpartum Hemorrhage (PPH)

Early PPH occurs within the first $24\,hours$ (most commonly due to Tone/atony); Late PPH occurs from $24\,hours$ up to $6\,weeks$.

Mastitis Nursing Care

Continue breastfeeding to prevent milk stasis; use warm compresses before feeding and cold after, and complete a full course of antibiotics.

Neonatal Abstinence Syndrome (NAS)

Symptoms of withdrawal in a newborn appearing $24-48\,hours$ after birth, including a high-pitched cry, tremors, and hyperirritability.

Pathological Jaundice

Jaundice that appears within the first $24\,hours$ of life; always considered serious and requires immediate evaluation.

Kernicterus

A condition where untreated high bilirubin is deposited in the brain, leading to deafness, motor delays, and intellectual disability.

Infant of Diabetic Mother (IDM) Risk

These babies are often macrosomic ($LGA$) and are at high risk for hypoglycemia ($BG < 40\,mg/dL$) immediately after birth.

Retinopathy of Prematurity (ROP)

A risk for preterm infants caused by exposure to excess oxygen therapy.

Anxiety Levels

Mild (heightened alertness), Moderate (narrowed focus), Severe (reduced focus, dread), and Panic (terror, dissociation, needs immediate safety).

Obsessive-Compulsive Disorder (OCD) Intervention

The nurse should not reinforce compulsions and should set limits on the time spent performing rituals.

Benzodiazepines

Short-term medications (e.g., Lorazepam) used for anxiety; they are habit-forming and must not be stopped abruptly to avoid life-threatening seizures.

Child Abuse Indicators

Neglect (malnourished, unwashed); Physical (shaken baby syndrome, glove/stocking burn patterns, bruises in various stages).

Rape Trauma Syndrome Phase 1 (Acute)

Occurs immediately after assault; symptoms include expressed distress, controlled calm, or shocked disbelief.

CAUTION

Mnemonic for 7 cancer warning signs: Change (bowel/bladder), A sore (no heal), Unusual bleeding, Thickening/lump, Indigestion, Obvious change (mole/wart), Nagging cough.

TNM Staging

T = Primary tumor size; N = Regional lymph node involvement; M = Distant metastasis.

Neutropenic Precautions

Initiated when the Absolute Neutrophil Count ($ANC$) is $< 1000$ to prevent fatal infection.

Brachytherapy Safety

Maintain Time (limit visitors to $30\,min/day$), Distance ($6\,feet$), and Shielding (lead container/forceps for dislodged implants).

Post-Mastectomy Precautions

No BP, IVs, or blood draws on the affected arm for life to prevent lymphedema.

Vitamin B12 Deficiency (Pernicious Anemia)

Megaloblastic anemia characterized by neurological symptoms like paresthesias and balance issues, which are absent in folic acid deficiency.

Tumor Lysis Syndrome (TLS)

An oncologic emergency from rapid cell destruction causing hyperkalemia, hyperuricemia, and hyperphosphatemia; treated with aggressive hydration and allopurinol.

Finasteride (Proscar)

A 5-alpha reductase inhibitor for BPH that is a teratogen; pregnant women/nurses should never handle crushed or broken tablets.

TURP Syndrome

Medical emergency caused by dilutional hyponatremia from irrigation fluid absorption during surgery; signs include confusion and hypertension.

Urolithiasis Gold Standard

A CT scan is the gold standard for diagnosing kidney stones; nursing care focuses on straining all urine and force fluids.

Wernicke's Encephalopathy

Acute thiamine depletion in chronic alcohol use; requires IV thiamine administration before glucose to prevent worsening.

Delirium Tremens (DTs)

Life-threatening alcohol withdrawal starting $day\,2-3$, featuring confusion, hallucinations, and cardiovascular collapse; high risk if CIWA-Ar is $> 20$.

Disulfiram (Antabuse)

Aversion therapy for alcohol use disorder that causes severe vomiting and flushing if even small amounts of alcohol are consumed.

Naloxone (Narcan)

An opioid antagonist used for life-threatening overdose to reverse respiratory depression and coma.

Disenfranchised Grief

A loss that is not publicly acknowledged or socially validated, such as a miscarriage, suicide, or non-traditional relationship loss.

Kübler-Ross Stages of Grief

A non-linear process involving Denial, Anger, Bargaining, Depression, and Acceptance.

Hospice Care

Comfort-focused care for terminal patients with a life expectancy $\le 6\,months$ who forgo curative treatment.

Suicide Risk: Sudden Improvement

A sudden improvement in a previously depressed patient can signal they have decided to attempt suicide and feel relief.

McBurney's Point

The RLQ location where pain migrates and rebound tenderness (Blumberg's sign) occurs in appendicitis.

Murphy's Sign

Inspiratory arrest when the RUQ is palpated during a deep breath; a positive sign indicates cholecystitis.

Peptic Ulcer Disease (PUD) Perforation

An emergency characterized by a rigid board-like abdomen, absent bowel sounds, and severe pain.

Sucralfate (Carafate)

A mucosal protectant used for PUD that must be taken on an empty stomach $1\,hour$ before meals.

Crohn's Disease vs. Ulcerative Colitis

Crohn's has skip lesions and non-bloody diarrhea; UC has continuous lesions limited to the colon and bloody diarrhea.

PDE5 Inhibitor Contraindication

Medications like sildenafil (Viagra) are strictly contraindicated with nitrates as they can cause fatal hypotension.

STEMI

A ST-elevation myocardial infarction indicating complete occlusion; requires the cath lab within $90\,minutes$.

PAD vs. CVI Positioning

For Peripheral Arterial Disease (PAD), keep legs dependent; for Chronic Venous Insufficiency (CVI), elevate the legs.

tPA Window

The timeframe for administering tPA for ischemic stroke is within $3-4.5\,hours$ of symptom onset, but only after a CT scan rules out hemorrhage.

Beck's Triad

Signs of cardiac tamponade: hypotension, muffled heart sounds, and JVD; requires emergency pericardiocentesis.

Malignant Hyperthermia (MH)

A fatal reaction to inhaled anesthetics featuring muscle rigidity and high temperature; the antidote is dantrolene sodium.

Atelectasis vs. Pneumonia POD

Atelectasis peaks as an early fever on Post-Op Day ($POD$) $1-2$; Pneumonia usually appears on $POD\,3-5$.

Acute Hemolytic Reaction

The most serious blood transfusion reaction (ABO incompatibility) presenting with sudden fever, chills, and severe back/flank pain; stop the transfusion immediately.

Sentinel Event

An unexpected occurrence resulting in serious harm or death (e.g., wrong-site surgery) that requires a Root Cause Analysis (RCA).

SBAR

A standardized communication tool for handoffs and provider notification: Situation, Background, Assessment, Recommendation.