Maternal-Newborn Nursing Exam IV Review Flashcards

Practice flashcards covering high-risk pregnancy, hypertension, labor complications, and obstetric emergencies based on lecture notes.

Four High-Risk Hemorrhagic Conditions

Ectopic pregnancy, placenta previa, placental abruption, and gestational trophoblastic disease.

Ectopic Pregnancy

Implantation of a fertilized ovum outside the uterine cavity, classically presenting with unilateral pelvic pain, shoulder pain, vaginal bleeding, and a missed period.

Risk Factors for Ectopic Pregnancy

Previous ectopic pregnancy, previous tubal surgery, endometriosis, pelvic inflammatory disease (PID), infertility treatment, and smoking.

Gestational Trophoblastic Disease (GTD) Care

Avoid pregnancy for at least 1 year, monitor hCG levels closely, continue follow-up until released by provider, and use contraception during recovery.

Gestational Trophoblastic Disease (GTD) Presentation

Characterized by grape-like clusters that may expel from the vagina.

Placenta Previa

Painless, bright red vaginal bleeding with a soft abdomen; vaginal exams are contraindicated.

Placental Abruption

Severe abdominal pain with dark red bleeding (or concealed bleeding), resulting in a board-like abdomen; considered an obstetric emergency.

Concealed Hemorrhage in Abruption

Visible bleeding does not determine severity because blood may remain trapped behind the placenta.

DIC (Disseminated Intravascular Coagulation)

A life-threatening maternal complication associated with severe placental abruption and amniotic fluid embolism.

Hypertension Progression in Pregnancy

Gestational Hypertension → Preeclampsia → Severe Features → HELLP and/or Eclamsia.

Gestational Hypertension Criteria

BP $140/90$ or higher recorded twice, 4 hours apart, after 20 weeks gestation, without proteinuria or other systemic features.

Preeclampsia Clinical Picture

Hypertension with 2+ proteinuria on a dipstick, edema of the hands and face, and hyperreflexia ($3+$ DTRs).

Severe Preeclampsia Indicators

BP $\text{160/110}$ or higher, 3+ proteinuria, severe headache, blurred vision, right upper quadrant pain, and clonus.

Common Medications for Pregnancy Hypertension

Hydralazine, Labetalol, and Procardia.

Magnesium Sulfate Indication

Administered to prevent seizures (seizure prophylaxis), not primarily to treat high blood pressure.

Magnesium Sulfate Loading Dose (Standard)

$4\text{ g}$ IV administered over $20\text{ minutes}$.

Magnesium Sulfate Maintenance Dose

Commonly $1\text{ to }2\text{ g/hour}$ via IV infusion.

Magnesium Sulfate Diluent

Lactated Ringers.

Hourly Magnesium Assessments

Urine output, deep tendon reflexes (DTRs), clonus, respiratory assessment/lung sounds, level of consciousness, and fetal status.

Action for Low Urine Output on Magnesium

Notify the healthcare provider immediately.

Calcium Gluconate

The specific antidote for magnesium toxicity that must be kept at the bedside.

Magnesium Toxicity Priority Action

Stop the infusion immediately.

Signs of Magnesium Toxicity

Respirations $< 12$ (specifically $8$ in the notes), absent DTRs, urine output $< 30\text{ mL/hr}$ (specifically $20\text{ mL/hr}$), and extreme lethargy.

Therapeutic Serum Magnesium Level

$4.8 - 8.4\text{ mg/dL}$.

H (HELLP Syndrome)

Hemolysis: The destruction of red blood cells.

EL (HELLP Syndrome)

Elevated Liver Enzymes: Liver injury leading to right upper quadrant or epigastric pain.

LP (HELLP Syndrome)

Low Platelets: Platelet count $< 100,000$, increasing the risk for bleeding and DIC.

NCLEX Red Flags for HELLP

Severe persistent headache, right upper quadrant pain, nausea/vomiting, hypertension, and elevated AST/ALT.

Maternal Risks of Diabetes

Spontaneous abortion, UTIs, polyhydramnios, hypertension/preeclampsia, cesarean birth, and postpartum hemorrhage.

Fetal/Newborn Risks of Diabetes

Congenital malformations, macrosomia, birth trauma, neonatal hypoglycemia, hyperbilirubinemia, polycythemia, and stillbirth.

Rh Incompatibility Management (Pregnancy)

Rh-negative mothers receive RhoGAM at approximately $26\text{ weeks}$ gestation.

Rh Incompatibility Management (Postpartum)

Rh-negative mothers with Rh-positive babies receive a second RhoGAM injection within $72\text{ hours}$ of delivery.

Indirect Coombs Test

Performed on maternal blood to detect free Rh antibodies and determine if the mother is sensitized.

Direct Coombs Test

Performed on neonatal blood to detect antibodies attached to RBCs and determine if the baby is affected.

Toxoplasmosis

An infection that causes congenital defects; sources include cat litter and gardening soil.

GBS (Group Beta Strep)

An infection present in approximately 25\text{%} of pregnancies that requires IV antibiotics during labor to prevent neonatal sepsis.

Adequate GBS Treatment

The patient must receive at least $2$ doses of IV penicillin, with the second dose occurring at least $4\text{ hours}$ before delivery.

Labor Induction

The process of creating labor when labor is not already in progress.

Labor Augmentation

Helping speed labor along or making labor more progressive once it has already started.

Bishop Score

A calculation used to determine if labor induction should be considered.

Nurse's Highest Priority in Labor

To ensure adequate maternal and fetal oxygenation throughout the process.

Contraindications for Labor Induction

Placenta previa, previous classical cesarean incision, genital herpes, and unknown presenting part.

Oxytocin (Pitocin)

A high-risk drug given via pump for specific titration, usually between $1 - 20\text{ mu/min}$.

Cytotec (Misoprostol)

A labor induction agent given in small doses ($25\text{ }\text{mcg}$ every $2 - 4\text{ hours}$); contraindicated for TOLAC.

Cervidil (Dinoprostone)

A vaginal insert left in for $12\text{ hours}$ to ripen the cervix; the patient must lie flat after insertion.

Tachysystole

More than $5$ contractions in $10\text{ minutes}$ (specifically $6$ contractions in $10\text{ minutes}$ in clinical scenario) or recurrent late decelerations.

Priority Action for Tachysystole

Stop or decrease the Pitocin infusion.

Hypotonic Labor

Contractions that are too weak or infrequent to produce cervical change or fetal descent.

Interventions for Hypotonic Labor

Oxytocin infusion, amniotomy, position changes, ambulation, and hydration.

Hypotonic Labor Complication

Increased risk for postpartum hemorrhage due to uterine atony.

Amniotomy Documentation

Time of rupture, color, odor, and amount of fluid (scant, small, moderate, or copious).

Priority Nurse Assessments after ROM

Assessing fetal heart rate (FHR) for cord compression/prolapse and monitoring maternal temperature every $2\text{ hours}$.

Fetal Risks of Operative Vaginal Delivery

Cephalohematoma, jaundice, facial bruising/nerve injury, cerebral hemorrhage, and fractured clavicle.

Circulating Nurse Responsibilities

Ensure correct patient/procedure, position patient safely, count instruments/sponges, and record times/procedures.

Circulating Nurse Priority

Watch the sterile field to maintain sterility.

Strongest Predictor of Preterm Birth

A previous history of preterm birth.

Preterm Labor Risk Factors

Previous preterm birth, infection (UTI/chorioamnionitis), multiple gestation, polyhydramnios, diabetes, IVF, and dehydration.

Betamethasone

A corticosteroid administered to accelerate fetal lung maturity in preterm labor.

Terbutaline

A medication used to relax the uterus and slow contractions; cannot be given if maternal heart rate is above $120\text{ bpm}$.

Nifedipine (Procardia)

A calcium channel blocker used to decrease uterine contractions in preterm labor.

Magnesium Sulfate for Neuroprotection

Administered to mothers before anticipated early preterm birth (usually before $32\text{ weeks}$) to protect the fetal brain.

Chorioamnionitis Triad

Maternal fever, maternal tachycardia, and fetal tachycardia.

Physical Signs of Chorioamnionitis

Tender uterus on palpation and foul-smelling amniotic fluid.

Major Risk Factor for Chorioamnionitis

Prolonged rupture of membranes (PROM).

Post-Term Pregnancy Definition

A pregnancy extending to $42\text{ weeks}$ or beyond.

Post-Term Pregnancy Concern

Placental insufficiency resulting in fetal hypoxia.

Post-Term Complications

Oligohydramnios, meconium-stained fluid, and fetal distress.

Shoulder Dystocia

An emergency where the fetal head delivers but the shoulders do not.

Turtle Sign

A clinical indicator of shoulder dystocia where the head retracts against the perineum.

First Priority in Shoulder Dystocia

Call for help.

McRoberts Maneuver

Flexing the mother's thighs toward her abdomen to widen the pelvic outlet during shoulder dystocia.

Suprapubic Pressure

Pressure applied above the pubic bone to dislodge the anterior shoulder; never use fundal pressure.

Maternal Concerns in Shoulder Dystocia

Third-to-fourth degree lacerations and postpartum hemorrhage.

Neonatal Concerns in Shoulder Dystocia

Brachial plexus injury (Erb's Palsy), fractured clavicle, fractured humerus, and hypoxia.

Umbilical Cord Prolapse

The cord slips below the presenting part, leading to compression and decreased oxygen to the fetus.

Sign of Cord Prolapse

Sudden fetal bradycardia, often following rupture of membranes.

Priority Action for Cord Prolapse

Elevate the presenting part off the cord with a gloved hand and leave the hand in place until delivery.

Patient Positioning for Cord Prolapse

Trendelenburg or knee-chest position.

Umbilical Cord Prolapse Risk Factors

Polyhydramnios, high unengaged presenting part, breech presentation, transverse lie, and multiple gestation.

Uterine Rupture Signs

Sudden loss of fetal station, sudden fetal bradycardia, severe abdominal pain, and cessation of contractions.

Action for Uterine Rupture

Stop oxytocin, notify provider, prepare for emergency cesarean, and administer oxygen.

Amniotic Fluid Embolism (AFE) Hallmarks

Sudden respiratory distress, hypotension, cardiovascular collapse, and hypoxia occurring after ROM.

AFE Pathophysiology

Amniotic fluid triggers a massive inflammatory response and DIC.

AFE Nursing Actions

High-flow oxygen, call rapid response, support airway/circulation, prepare for CPR and blood products.

Prolonged Labor Path (NCLEX Pearl)

Weak Labor → Weak Uterus → Hypotonic Labor → Prolonged Labor → Uterine Fatigue → Uterine Atony → Postpartum Hemorrhage.

TOLAC

Trial of Labor After Cesarean; Cytotec is specifically contraindicated for these patients.

Priority Assessment after Amniotomy

Assessing the Fetal Heart Rate (FHR).

Frequency of Temperature Checks after ROM

Every $2\text{ hours}$ to monitor for infection.

Common Post-Term Fetal Tracing Signs

Variable or late decelerations due to reduced amniotic fluid or placental failure.

Shoulder Dystocia Contradiction

Fundal pressure must never be applied.

Splash and Dash

Slang for a rapid, emergency cesarean birth often required for cord prolapse or uterine rupture.

Induction for TOLAC

Cervidil and Cytotec use is avoided or high-risk; specific protocols apply to avoid uterine rupture.

Uterine Atony

Failure of the uterus to contract after birth, leading to postpartum hemorrhage; often follows hypotonic labor.

Fetal Neuroprotection

Short-term magnesium sulfate used before $32\text{ weeks}$ to reduce the risk of cerebral palsy.

Meconium-stained Amniotic Fluid

A risk in post-term pregnancies indicating potential fetal distress.

Vaginal Exams in Hemorrhage

Strictly avoid vaginal exams in patients with known or suspected placenta previa.

Clonus

A sign of neuromuscular irritability measured by 'beats' during a DTR assessment; indicative of severe preeclampsia.

Loading Dose for Preeclampsia (Alternative)

$6\text{ g}$ IV over $30\text{ minutes}$.

Amniotic Fluid Volume Term: Scant

A very small amount of fluid documented after rupture of membranes.

Fetal Malformations in Diabetes

An increased risk specifically associated with poor glycemic control during the first trimester.